Neurology Flashcards

1
Q

who is at high risk of delirium during hospitalization?

A

elderly pts with dementia

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2
Q

medical indications for catheter

A

relieve urinary retention
monitor fluid status in acutely ill pts
pts with stage 3/4 pressure ulcers on butt
- aside of these indications, remove urinary catheter to prevent things like infection and delirium

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3
Q

which sedatives should be avoided in elderly?

A

benzodiazepines and diphenhydramine

- can precipite delirium

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4
Q

pt post-op presents with acute, fluctuating mental status changes with difficulty focusing or maintaining attention and disorganized thinking

A

think of delirium

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5
Q

patients with chronic dementia are at great risk of what after surgery with general anesthesia?

A

delirium

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6
Q

recommended therapy for delirium in the ICU when supportive care is insufficient?

A

antipsychotic agents - haloperidol

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7
Q

pt presents with mental status changes, nystagmus, opthalmoplegia and unsteady gait - what should you consider?

A

Wernicke encephalopathy - due to thiamine deficiency

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8
Q

conditions assoc with Wernicke encephalopathy

A
AIDS, alcohol abuse
cancer
hyperemesis gravidarum
prolonged TPN
post-surgical status
glucose loading
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9
Q

cognitive impairment with fluctuating lethargy/inattention, hallucinations and asterixis implies..

A

toxic encephalopathy - ie. medication induced delirium

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10
Q

what types of drugs can provoke delirium in a elderly pts with mild cognitive impairment, early dementia of Parkinson’s disease?

A

anticholinergic drugs (ex. nortriptyline)

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11
Q

migraine with aura consists of..

A

neurologic abnormalities including visual loss, hallucinations, numbness, tingling, weakness or confusion (diffuse symptoms)

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12
Q

aura associated with partial seizures is characterized by..

A

feeling of deja vu, rising epigastric sensation or autonomic disturbances; automatisms (lip smacking) can also be suggestive of partial seizure

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13
Q

pt presents with a headache that is dull, bilateral or diffuse described as a pressure or squeezing sensation; the pain is usually not disabling

A

tension headache

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14
Q

chronic daily headache

A

headache is present on > 15 days/month for at least 3 months

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15
Q

disabling headache assoc with tearing or rhinorrhea; typically unilateral and periorbital/temporal

A

cluster headache

- cluster episodes usually last 6-8 weeks with remission lasting 2-6 months

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16
Q

what is a cluster headache classically assoc with?

A
lacrimation
rhinorrhea/nasal congestion
eyelid edema
facial/forehead sweating
miosis/ptosis
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17
Q

common visual symptoms associated with migraine

A

perceptions of flashes of light
arcs of flashing light that forms zig-zag pattern
area of loss of vision surrounded by normal visual field

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18
Q

work-up order for “thunderclap headache” as in subarachnoid hemorrhage

A
  1. CT scan without contrast - if neg,
  2. do lumbar puncture, - if neg,
  3. CT or MR angiography
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19
Q

prophylactic tx. of migraine headaches

A

pt should have 2+ headaches per week
first line - propranolol
- can also use: amitriptyline, valproic acid, topiramate, other BB, petasites hybridus

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20
Q

dementia characterized by prominent memory loss, anomia, constructional apraxia, anosognosia (impaired recognition of illness) and personality change

A

Alzheimer’s dementia

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21
Q

dementia the progresses over months and startle myoclonus; also: visual/cerebellar disturbance, pyramidal/extrapyramidal dysfunction and akinetic mutism

A

Creutzfeld Jakob disease

22
Q

dementia accompanied by Parkinsonism, visual hallucinations and fluctuating symptoms; MC includes impaired learning and attention, psychomotor slowing and visuospatial impairment (vs. memory)

A

Dementia with Lewy Bodies

23
Q

pt presents with behavioral and personality changes ranging from apathy to social disinhibition and emotional lability - dementia?

A

frontotemporal dementia

24
Q

stages of dementia based on MMSE

A

MMSE 21-25 = mild dementia
MMSE 11-20 = moderate dementia
MMSE 0-10 = severe dementia

25
first line initial therapy for mild-moderate Alzheimer's dementia
Ach-esterase inhibitors: donepezil, rivastigmine or galantamine
26
first line tx of moderate to advanced Alzheimer dementia
memantine | - better effects when added to donepezil
27
what types of drugs are implicated in acute dystonic reactions?
neuroleptic, antiemetic and serotonergic agents - dystonic reactions typically occur w/in 5 days of initiating therapy
28
pt presents with resting tremor, bradykinesia, rigidity and postural instability
Parkxtinson's disease
29
upper extremity, high frequency tremor present with both limb movement and sustained posture of the involved extremities and is absent at rest; usually bilateral
essential tremor | - usually improved with alcohol and worsens with stress
30
first line therapy of essential tremor
propranolol | - others include: primidone, gabapentin, topiramate
31
CSF findings in viral meningitis
lymphocytic pleocytosis glucose > 45 protein < 200 negative gram stain
32
which serogroup of meningococcus does the vaccine not protect against?
serogroup B
33
clues to diagnosis of RMSF?
headache, fever, myalgia, abdominal pain rash begins on wrists and ankles thrombocytopenia, leukopenia and elevated transaminases infection in spring/early summer
34
CSF and blood cultures with gram positive diplococci
strep. pneumo meningitis
35
empiric tx. for bacterial meningitis
vancomycin ampicillin ceftriaxone - adjunctive tx. with dexamethasone
36
what is the recommended strategy for reducing complications after acute stroke?
early mobilization with physical and occupational therapy
37
tx. of ischemic stroke w/in 3 hours of presentation
thrombolysis with tPA | - if not eligible for tPA, give aspirin or clopidogrel
38
threshold for acute BP lowering in pts with acute stroke who are eligible for thrombolysis
185/110 mmHg | - use IV labetalol or nicardipine
39
threshold for BP lowering in pts with acute stroke
IV labetalol or nicardipine if SBP > 220 mmHg or diastolic < 120 mmHg (or manifestations of end organ damage)
40
Tx. of subarachnoid hemorrhage
surgical clipping of aneurysm with cerebral angiography w/in 72 hours of onset
41
in whom are sumitriptan and other triptan drugs C/I in?
pts with stroke and uncontrolled HTN
42
findings in Bell's palsy
complete facial neuropathy impairing the entire hemiface, including foreheard corrugators which are spared by cerebral lesions
43
Bell phenomenon
reflexive rolling upwards of the globe during eye closure
44
sensory loss and limb weakness beginning in LE and moving up with absent deep tendon reflexes
Guillain-Barre
45
electromyography result in Guillain-Barre
demyelinating polyradiculoneuropathy
46
CSF findings in Guillain-Barre
albuminocytologic dissociation - spinal fluid cell count is normal but spinal fluid protein level is elevated
47
Tx. of Guillain Barre
IVIG and plasma exchange
48
aching wrist pain, numbness and tingling in median nerve sensory distribution of fingers and weakness of thenar muscles; usually worse at night
Carpal tunnel syndrome
49
pain elicited by flexing the thumb into the palm, closing fingers over thumb and bending wrist in ulnar direction (Finkelstein test)
painful in de Quervain tenosynovitis | - tenderness in anatomic snuffbox
50
synovia filled cysts arising from joints or tendon sheaths that typically appear on dorsal hand or ventral wrist
Ganglion cyst | - usually compress other structures and cause pain
51
Guyon tunnel syndrome
ulnar nerve compression
52
loss of sensation in a stocking glove distribution that is associated with paresthesias or painful dysesthesias
diabetic neuropathy