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Flashcards in Neurology Deck (52)
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1

who is at high risk of delirium during hospitalization?

elderly pts with dementia

2

medical indications for catheter

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

3

which sedatives should be avoided in elderly?

benzodiazepines and diphenhydramine
- can precipite delirium

4

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

think of delirium

5

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

delirium

6

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

antipsychotic agents - haloperidol

7

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

Wernicke encephalopathy - due to thiamine deficiency

8

conditions assoc with Wernicke encephalopathy

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

9

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

toxic encephalopathy - ie. medication induced delirium

10

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

anticholinergic drugs (ex. nortriptyline)

11

migraine with aura consists of..

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

12

aura associated with partial seizures is characterized by..

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

13

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

tension headache

14

chronic daily headache

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

15

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

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

16

what is a cluster headache classically assoc with?

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

17

common visual symptoms associated with migraine

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

18

work-up order for "thunderclap headache" as in subarachnoid hemorrhage

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

19

prophylactic tx. of migraine headaches

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

20

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

Alzheimer's dementia

21

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

Creutzfeld Jakob disease

22

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

Dementia with Lewy Bodies

23

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

frontotemporal dementia

24

stages of dementia based on MMSE

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