Flashcards in Neurology Deck (40):
How long does a migraine usually last?
What is the treatment of choice for cluster headache
100% oxygen or triptan therapy. Oxygen is unique to cluster headaches.
What is the most common etiology in encephalitis?
What are the four main organisms responsible for meningitis?
2. Neisseria Meningitidis
30 year old patient is admitted due to fever and headache. On physical exam you notice the patient is alert and oriented x2. The patient has a positive Kernig and Brudzinski sign. The neurological exam is normal. What is the next best step?
This patient has meningitis. The fact that he has an altered level of consciousness requires that a CT be ordered as the first step. Other indications for CT as the first step include: immunosuppression, focal neurological deficit, and papilledema.
What is the treatment of choice for essential tremor?
Propranolol is first line.
How does chorea present when seen in Huntingtons Disease?
Chorea is a rapid arrhythmic involuntary movement disorder that makes the patient appear as if they are dancing or restless.
What is the pathophysiology in parkinsons disease?
There is a decrease in dopamine in the substantia nigra. Also, lewy bodies will be present in the nuclei of neurons.
A 70 year old patient is brought in by his daughter due to progressive cognitive decline. The daughter also states that he has had a couple instances of hallucination. On physical exam you notice tremor at rest, rigidity of the upper extremities on passive flexion, and a shuffling gait. What is the most likely diagnosis?
This patient is presenting with signs and symptoms consistent with lewy body dementia.
Lewy body dementia: Parkinsons + Hallucinations + Dementia
Where do most subarachnoid hemorrhages arise from?
Most are from ruptured berry aneurisms from the anterior circle of willis
If subarachnoid hemorrhage is suspected, what is the next best test? When is LP done in the workup for subarachnoid hemorrhage?
The first test that should be ordered is a non contrast CT. If the CT is negative, but the suspicion remains, an LP should be ordered. A negative LP and a negative CT is enough to reliably exclude the diagnosis.
How can you differentiate a traumatic tap from what is seen in subarachnoid hemorrhage?
A traumatic tap will have have less RBCs with each tube collected. Subarachnoid hemorrhage will have the same amount of RBCs in each tube.
What are the three arteries involved in ischemic stroke?
1. Middle cerebral artery
2. Anterior cerebral artery
3. Posterior cerebral artery
What is the first diagnostic test ordered in the workup of a stroke?
Everyone should have a non contrast CT of the head to rule out hemorrhage.
How long do you have to give TPA?
You have 4.5 hours from the time symptoms began. If that time frame has passed, give aspirin.
What are first line medications for the management of hypertension during a stroke?
Why is an EKG done as part of the workup for stroke?
An ekg is done to rule out arrythmias such as AFIB.
When is endarterectomy indicated?
This is indicated when carotid artery duplex demonstrates >70% stenosis.
A patient is diagnosed with TIA. He has an aspirin allergy. What medication is an acceptable substitute for stroke prophylaxis?
Clopidogrel is given to those patients with aspirin allergy.
If a patient is on aspirin and suffers a TIA, what is the next step in treatment?
The next step is to either:
1. Switch to clopidogrel
2. Add dipyridamole
What are the three indications for hospitalization after suffering a concussion?
What is the most common precipitating infection for GBS?
Campylobacter infection. Infection usually precedes GBS symptoms by two weeks.
What three diagnostic tests that should be ordered in anyone suspected of having GBS?
1. Nerve conduction studies
What is the most dangerous complication of GBS?
Paralysis of the respiratory muscles. About 1/3 of patients will require ventilatory assistance.
What is the most common form of dementia?
Alzheimer’s is by far the most common type of dementia.
What is the difference between dementia and delerium?
Dementia is gradual in onset and permanent. Delerium is rapid in onset and usually has a reversible cause. Delerium will also present with fluctuations in consciousness.
What two labs should be ordered in the workup for dementia?
The two tests which should always be ordered include:
1. B12 level
What are two most common presentations in multiple sclerosis?
1. Sensory symptoms
2. Optic neuritis
Describe Lhermitte sign.
Electric shocks that run down the spine and limbs with flexion of the neck. Seen in multiple sclerosis.
What will lumbar demonstrate in multiple sclerosis?
Look for oligoclonal bands.
How are acute exacerbations in multiple sclerosis treated?
Acute exacerbations are treated with glucocorticoids. If the patient is unresponsive, give plasma exchange.
What is the most serious complication of myasthenia gravis?
Weakness of the respiratory muscles. This can progress to respiratory failure: myasthenia crisis.
What will EMG show in myasthenia gravis?
Progressive weakness is seen with repetitive stimulation.
Thymectomy is contraindicated if what antibodies are present?
Do not perform thymectomy if MuSK antibodies are present.
What type of seizure classification does absence seizure fall into?
This is considered to be a generalized seizure.
Describe Todds paralysis?
Paresis that occurs following a seizure.
What physical exam findings can help differentiate a seizure from syncope?
Patients who have had a seizure will present with postictal confusion. Those with seizures will also have tongue biting, foaming of the mouth, and/or urination.
What is the definition for status epilepticus?
This is defined as a seizure that lasts >5 minutes.
What is the first line treatment in the management of status epilepticus?
First line treatment includes benzodiazepines.