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Primary care II > Neurology > Flashcards

Neurology Flashcards

1
Q

Cranial nerves

A

On Old Olympuses Towering TOp a Fin and German Viewed Some Hops

  1. Olfactory 2.Optic 3. Oculomotor 4.Trochlear 5. Trigeminal 6. Abducens 7. Facial 8. Auditory 9. Glossopharyngeal 10. Vagus 11. Spinal 12. Hypoglossal

Some say marry money but my brother says big brains matter more

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2
Q

Primary headache

A

headache is the disease no secondary cause (HTN, head injury, tumor, menstrual cycle, sleep, TMJ, infection, sinusitis, dehydration)

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3
Q

Migraine characteristics

A 
Recurrent 
4-72 hours 
unilateral 
pulsating 
mod-severe
*aggravated by activity 
n/v
photophobia, phonophobia
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4
Q

Diagnostic criteria for migraine

A

5 or more headaches

2: unilateral, pulsating, mod-severe, agg. by activity
1: n/v, photo/phono

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5
Q

Migraine with or without aura more common

A

without

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6
Q

Migraine with aura criteria

A

One or more aura: visual sensory speech motor brainstem retinal

Two of four: 
One symptom unilateral 
One spreads gradually >5 minutes 
Each symptom lasts 5-40 mins 
Within 60 minutes of migraine
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7
Q

Chronic migraine definition

A

> 15 days per month for 3 months

meeting migraine char. at least 8 days

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8
Q

Tension HA char.

A 
bilateral* 
pressing/tightening 
mild-mod
*not aggravated by activity
*no n/v 
photophobia/phonophobia maybe
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9
Q

Tension HA diagnostic

A

10 episodes occuring on less than 1 day a month (

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10
Q

Cluster HA char.

A 
severe unilateral 
15 minutes - 3 hours 
Ipsilateral conj. injection or lacrimation
Nasal congestion 
Ipsilateral eye edema 
Forehead facial sweating 
Miosis or ptosis 
restlessness agitation**
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11
Q

Temporal arteritis char.

dx
tx

A 
>50 piercing, throbbing, unilateral 
scalp tenderness
low grade fever 
anorexia, malaise 
swollen hands/feet 
Dx: ESR, biopsy gold standard
Tx: high dose oral steroids
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12
Q

HA red flags

A 
worst HA of life 
thunder clap 
change in char. 
abnormal neuro exam 
altered vision 
head trauma 
>50 
altered LOC 
hx cancer 
stiff neck fever
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13
Q

HA comfort signs

A 
\+ fh 
menses 
preceded by typical aura 
periodic and stable 
normal physical and neuro
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14
Q

Primary migraine tx
prophylactic
abortive

A

proph- topamax, propanolol, timolol, CCB
abort- nsaid, excedrin migraine, ergotamine, triptan (1 then 2 hrs after, no more than 2 in 24 hours, no heart disease or pregnancy, SSRI-caution, dec. bp, flushing, throat tightness)

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15
Q

Tension tx
abortive:
other:
prophylactic

A

abortive: NSAIDS, aspirin
muscle relaxant
prophylactic- amitriptylline, nonspecific bb (propanolol, timolol)

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16
Q

Cluster tx
abortive:
other:
prophylaxis:

A

abortive triptan ergotamine intranasal lidocaine
prednisone
prophylactic- ccb

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17
Q 
Parkinsons 
Progressive \_\_\_\_ d.o
Degeneration of \_\_\_\_\_\_ 
Development of \_\_\_\_\_\_\_ 
Decline in \_\_\_\_ and \_\_\_\_\_ fx
A

progresive neurodegenerative
degeneration of dopaminergic neurons
development of lewy bodies
decline in motor and cognitive fx

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18
Q

Cause parkinsons

A

unknown

environmental genetic combination

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19
Q 
Staging of parkinsons 
1. 
2. 
3. 
4. 
5.
A
  1. one side, inconvenient, tremor limb
  2. bilateral, gait affected
  3. slowing, impaired equilibrium
  4. severe, rigidity, bradykinesia, cant live alone, can kind of walk
  5. cannot stand or walk, constant nursing
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20
Q

Ergotamines
cant be used within ___ of triptans
contraindicated in______ may cause _____
dont use with _______

A

can’t be used within 24hrs of triptans,

contraindicated in pregnancy, pvd, heart disease, may case vasospastic events

don’t use with ketoconazole, macrolids (life threatening peripheral ischemia)

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21
Q

Triptans
response
do not use with _____
se:

A

80% response, various forms,

DO NOT use with known CAD, angina, pregnancy

side effects: flushing, throat tightness, serotonin syndrome with SSRIs

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22
Q

Parkinsons presentation

dx

A

rigidity
tremor
bradykinesia
postural instability

dx: 2 symptoms, progression, response with levodopa

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23
Q

PARKINSONS

Bradykinesia def./example

A

slowing of movement
reduced walking speed (reduced arm swing, shuffling gait)
diff. from one motor to another

masked faces, statue like, stooped, drooling, monotonous speech

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24
Q

PARKINSONS

Rigidity def. /example

A

cogwheeling (more pron. on limb with tremor)

noted during passive ROM

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25
Q 
PARKINSONS
Tremor 
first symptom usually: 
resting: 
postural tremor worse with:
A

first symptom: pill rolling
resting: asymmetric
postural worse with anxiety

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26
Q

PARKINSONS

Postural instability

A 
poor balance 
loss of postural reflexes 
retropulsion test 
gait freezing 
FALL RISK***
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27
Q

Risk factors migraine

A

family hx
FEMALE birth control
food/ETOH
1st HA in early childhood

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28
Q

Risk factors tension

A

stress

TMJ/jaw clench

29
Q

Risk factors cluster HA

A

MALE
caffeine/nicotine
age>30
suicide HA

30
Q

Nonmotor symptoms in parkinsons

A 
Neuropsychiatric (mood, dep, anxiety, hallucinations)
Sleep disturbance (daytime sleepiness, fragmentation)
Autonomic (ortho hypo, ED, incont., const., drooling, dysphagia)
31
Q 
Parkinsons 
fatigue tx:
sleep: 
ED: 
Constipation: 
Drooling: 
Dysphagia: 
Depression:
A

fatigue: provigil ritalin
sleep: meds, dep., motor problems
ED: viagra
constipation: miralax
drooling: botox
dysphagia: thickened liq., soft diet
depression: TCA

32
Q

Parkinsons Medication

A

selective MAOI: amantadine
dopamine agonist: pramiprexole, ropinorole, bromocriptine
carbidopa-levodopa

33
Q 
Parkinsons 
Amantadine 
early: 
late treatment: 
renal: 
SE:
A

early monotherapy
late tx: dyskinesia
renal adjustment
SE: confusion, nausea, blurred vision, hallucinations, NMS

34
Q

Parkinsons
Dopamine agonist:
early _____ or added to _____ for tx of _____
SE:

A

dopamine agonists: pramiprexole, ropinorole, bromocriptine

early monotherapy or added to levodopa for treatment of motor complications

SE: n/v, ortho hypotension, neuropsych: hallucinations, psychosis, impulse control, excessive daytime sleepiness

35
Q 
Parkinsons 
carbidopa-levodopa 
early: 
late: 
SE: 
How to take:
A

early: smooth sustained
late: dyskinesia “on off”
SE: dyskinesia, dystonia, confusion, psychosis, sedation, n/v, postural hypotension
how to take: empty stomach, 30-60 before meal, if nausea nonprotein like fruit

36
Q

most effective parkinsons tx

A

carb-levo

37
Q

non pharm parkinsons tx

A

coq10 vitamin c and e

creatinine

38
Q

deep brain stimulation
good for:
candidates:

A

good for: poor controlled symptoms desp. tx

candidates: good response to carb-levo, few morbidities, NO cognitive impairment or depression

39
Q

ALS risk factors

death from:

A

age, family hx

death from: neuromuscular respiratory failure, dysphagia

40
Q

ALS progressive ____ d/o causing ____, _____, and ______. No ______

A

prog. neurogenerative d/o causing muscle weakness, disability and death. no remission

3-5 years dx to death

41
Q

dx als

A

upper and lower motor neuron signs
progression
no alt. explanation
no test to rule in or out

42
Q

ALS history

A

progressive symptoms over segment
spreads to other segments months to years
involuntary weight loss and muscle wasting

43
Q

S/S ALS

A

upper lower motor signs

    upper: weak, slow, hyperreflexia, spasticity 
   lower: weak, atrophy, amyotrophy, fasciculation

other: strained voice, weakness of tongue, lips, swallowing problems, inappropriate crying, laughing, yawning, paresthesia, cognitive impariment, delayed eye closure

44
Q

most common presentation ALS

A

asymmetric limb weakness (hand, foot dorsiflexion)

45
Q

pseudobulbar ALS

A

inappropriate crying, laughing, yawning

46
Q

tx ALS

A

interdisciplinary

rilutek- slows progression tracheostomy feeding tube

47
Q

MS dx

A

H&P
Mcdonald criteria
MRI
CSF

48
Q

MS mcdonald criteria

A

review on slide

49
Q

MS vision

A

most common eye problem optic neuritis
acute, unilateral eye pain worse with movement
diplopia decreased acuity

tx: steroids

50
Q

MS sensory

A

paresthesia
coldness
radicular pain
intense itching cervical dermatomes

51
Q

MS neuro

A

ataxia/gait
tremor
speech
cognitive impairment

52
Q

MS PE
Eyes:
Sensory:

A

Eyes: decreased pupillary reaction (marcus gunn); fundoscopic normal or edema, nystagmus
Sensory: impaired vib., position sense, light/touch perceptions, pinprick increase

53
Q

MS symptoms

A 
gait weakness 
vision changes
neuro (numbness, tingling)
bowel bladder dysfunction 
heat sensitivity (uhthoff) 
fatigue
depression
54
Q

MS tx

Acute:

A

steroids

otherwise supportive pain incont. fatigue

55
Q

Stroke def.

A

interruption of blood circulating to brain—> neurologic deficit

56
Q

87% of strokes are

A

ischemic

57
Q

TIA def.

risk of stroke?

A

neuro deficit resolves in a few hours-24 hours

9x more likely

58
Q

Types of stroke

A

Ischemic: blockage of blood vessels lack of blood to area
Hemorrhagic: rupture of blood vessels, leakage of blood to area

59
Q

Risk factors ischemic

A

Both: HTN, family hx, smoking, drug use

male, race, previous stroke, carotid stenosis, afib, chf, mitral stenosis, prosthetic valve, MI

60
Q

Risk factors hemorrhagic

A

Both: HTN, family hx, smoking, drug use
polycystic kidney dx, ehlers-danlos, lupus, neurofibromatosis, tuberous sclerosis, pregnancy, atherosclerosis, alcohol intoxication

61
Q

Ischemic stroke causes

A

Atherosclerotic: dislodges
Afib: clot
Lacunar infarct: elderly, diabetic, smaller areas of brain- arterioles

62
Q

Hemorrhagic stroke are more
typically occurs in
causes

A

deadly
occurs in adults age 40-60
causes: subarachnoid, AV malformation, trauma

63
Q 
Presentation of stroke 
diff. b/w TIA and stroke 
neuro: 
ischemic and ha: 
subarachnoid:
A 
diff b/w TIA and stroke: time frame 
neuro: varies dep. on area 
ischemic and HA: usually not 
        single attack evolves hours to days 
subarachnoid: severe HA, n/v
64
Q

Dx stroke
Ischemic
Hemorrhagic

A

non-contrast head CT

ischemic: may be normal up to 24 hours
hemorrhagic: may need arteriogram

65
Q

Tx strokes

A

TPA; ischemic within 3 hours, not if bleeding risk
surgery
antiplatelet: ASA (TIA ischemic prevention) coumadin (afib, artificial valves, LVD with CHF), plavix, xarelto/pradaxa/eliquis
acute: hospitalize

66
Q

Risk factor modification for strokes

A

simple 7: active, control cholesterol, eat better, manage bp, lose weight, reduce sugar, stop smoking

67
Q

Seizures

Generalized types

A 
absence (petit mal) 
atypical absense 
myoclonic (jerk) 
tonic clonic (stiff) 
tonic, clonic, or stonic
68
Q

seizures highest incidence

risk factors

A

children

risk: family hx, previous seizure, brain tumor, hx neuro insult, withdrawal anticonvulsants

Primary care II (13 decks)

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