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Neurology Flashcards

1
Q

Vertigo that is episodic with no hearing loss is known as _____.

A

Benign Paroxysmal Positional Vertigo

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2
Q

Vertigo that is episodic with hearing loss is known as _____.

A

Meniere’s Disease

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3
Q

Vertigo that is continuous with no hearing loss is known as _____.

A

Vestibular Neuritis

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4
Q

Vertigo that is continuous with hearing loss is known as _____.

A

Labyrinthitis

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5
Q

Peripheral vertigo is assoc. w/ ____ (horizontal/vertical) nystagmus while central causes of vertigo are associated with ____ (horizontal/vertical) nystagmus.

A

Peripheral- Horizontal–> fatigable

Central- Vertical–> NONfatigable

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6
Q

_____ is caused by displaced otoliths and is the MC cause of vertigo.

A

BPPV

  • Attacks last 10-60 seconds
  • *Dx: Dix-Hallpike Test
  • **Treatment: Epley maneuver, antihistamines
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7
Q

Vestibular neuritis is most likely to occur after a ____ infection.

A

Viral

*Inflammation of vestibular portion of CN8

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8
Q

1st line treatment for Vestibular Neuritis and Labyrinthitis is:

A

CORTICOSTEROIDS, if symptomatic then Meclizine

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9
Q

Episodic vertigo that lasts 1-8 hours w/ horizontal nystagmus, N/V, tinnitus, and fluctuating hearing loss is known as _______.

A

Meniere’s Disease

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10
Q

Diagnosis of Meniere’s is done with:

A

Transtympanic electrocochleography- most accurate test during an active episode

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11
Q

Treatment of Meniere’s:

A

Symptomatic

  • Decompression if refractory to meds or severe
  • Preventative: HCTZ, AVOID salt/caffeine/chocolate/ETOH

(Meniere SYNDROME is due to identifiable cause; Meniere DISEASE is idiopathic)

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12
Q

What are some nonvertiginous causes of dizziness?

A
  1. Disequilibrium: visual or MSK d/o, neuropathies, anxiety/depression
  2. Presyncope: sensation that LOC is imminent; caused by dec. cerebral perfusion- usually orthostatic hypotension or vagally mediated cardiac events
  3. Light-headedness: vague sensation and often psych in origin; tx- trial of antidepressants
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13
Q

What are some common causes of syncope?

A

Arrhythmias, aortic stenosis, carotid sinus hypersensitivity, MI, hypoglycemia, orthostatic hypotension, postprandial hypotension, psychogenic disorders, PE, vagal faint

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14
Q

How is syncope worked-up?

A

EKG, Holter, echo, tilt-table test, electrophysiologic studies, CT or MRI of brain

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15
Q

Partial seizures are confined to 1 hemisphere. _____ is a type in which consciousness if fully maintained. There may be a transient neuro deficit (Todd’s paralysis) lasting up to 24 hours.

A

Simple partial

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16
Q

_____ is a type of partial seizure in which consciousness is impaired. There are auras and automatisms.

A

Complex partial

*Automatisms: lip smacking, manual picking, patting, coordinated motor movement

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17
Q

_____ is a type of seizure that is associated with a brief lapse in consciousness, staring episodes, and eyelid twitching. MC in childhood and usually stops by 20y.

A

Absence (Petit Mal)

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18
Q

______ is associated with LOC and rigidity followed by repetitive, rhythmic jerking for <2-3 min.

A

Tonic-Clonic (Grand Mal)

  • Post-ictal phase= flaccid coma/sleep of variable duration
  • *May have incontinence, tongue biting, or aspiration
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19
Q

_____ is associated w/ sudden, brief, sporadic involuntary twitching. No LOC.

A

May be 1 muscle or groups of muscles

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20
Q

Otherwise known as “drop attacks”:

A

Atonic

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21
Q

______ are repeated, generalized seizures without recovery for >30min.

A

Status epilepticus

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22
Q

______ is a 1st line treatment for Absence seizures.

A

Ethosuximide

*Caution- renal/hepatic failure

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23
Q

Treatment for Grand Mal includes what options (name 4)?

A

Valproic acid, Phenytoin, Carbamazepine, Lamotrigine

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24
Q

The treatment of Status Epilepticus is Lorazepam/Diazepam –> Pheytoin –> _______

A

Phenobarbital

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25
_____ is DOC for febrile seizures in kids.
Phenobarbital
26
____ levels are increased in seizures (helps to differentiate between pseudoseizures).
Prolactin
27
Pancreatitis, hepatotoxicity, and thrombocytopenia are associated with what seizure medication?
Valproic acid *Caution- hepatic disorders
28
SJS is associated with what seizure med?
Lamotrigine
29
____ can be given for seizure prophylaxis. It is also the second drug given (after BZD) in episodes of status epilepticus.
Phenytoin *ADRs- gingival hyperplasia, hirsutism, hypotension, arrhythmias
30
Seizures, bipolar disorders, and TRIGEMINAL NEURALGIA can be treated with ____.
Carbamazepine *ADRs- HYPOnatremia, SJS
31
Topiramate can be associated with what unique ADRs?
Wt loss, Nephrolithiasis
32
TIA often last < ___ (time frame). Most resolve in __ to __ (time frames).
Last < 24hr and most resolve in 30-60min
33
___% of patients with TIA will have a CVA in 1st 24-48h afterwards.
50%
34
Probs w/ gait, proprioception, dizziness, and vertigo are associated with what TIA etiology?
Vertebrobasilar
35
How are TIAs worked up?
1. CT scan of head to r/o bleed 2. Carotid doppler 3. CTA, MRA, Transcranial doppler 4. Glucose to r/o HYPOglycemia, also r/o: electrolyte abnormalities, coag probs, and get CBC 5. Echo: TTE or TEE to look for cardioembolic sources 6. ECG: to look for A. fib
36
How are TIAs treated?
ASA +/- Dipyridamole or Clopidogrel (Plavix) *Thrombolytics are contraindicated!!
37
MC type of ischemic CVA occurs in what area of the brain?
Middle cerebral artery- Anterior circulation
38
____ is the inability to sensibly put words together and ____ is the inability to understand speech.
Broca's aphasia- can't put words together Wernicke's aphasia- can't understand speech
39
How are CVAs diagnosed?
CT scan (may be normal in first 6-24h)
40
How are ischemic strokes treated?
Lacunar- ASA--> good prognosis 1. Thrombolytics- w/in 3 hours. CI if BP >185/110, recent bleed/trauma, bleeding d/o 2. Antiplatelet therapy- ASA, Plavix, Dypyridamole 3. Anticoag if cardioembolic
41
Strokes with facial involvement can still raise BOTH eyebrows!!!
fyi
42
Hemorrhagic strokes account for __% of strokes. They include spontaneous ICH and SAH.
20% *Spontaneous ICH- MC from HTN. Treatment is supportive v. hematoma evacuation. Elevate head and mannitol! **SAH- MC secondary to ruptured Berry aneurysm
43
How is a Berry Aneurysm diagnosed?
Angiography
44
____ is a transient confused state due to an identifiable cause. Usually associated with full recovery within 1 week in most cases.
Delirium
45
______ is associated with MEMORY LOSS and loss of impulse control, motor and cognitive functions.
Dementia *RF: age >60y and vascular dz
46
____ is the MC type of dementia. Associated with tau protein deposition.
Alzheimers
47
How is Alzheimers diagnosed?
CT scan of brain usually reveals cerebral cortex atrophy
48
How is Alzheimers treated?
- Ach-esterase inhibitors- Donepezil (Aricept)= doesn't slow progression - NMDA antagonist: Memantine= reduces glutamate excitotoxicity
49
_____ dementia is 2nd MC type and is associated with chronic ischemia and multiple infarctions (lacunar).
Vascular dementia *HTN control may slow progression
50
____ dementia is associated with marked personality changes and new behavioral symptoms such as apathy and disinhibition. Usually NO AMNESIA is present.
Frontotemporal dementia *(+) Pick bodies
51
______ is associated with abnormal neuronal protein deposits in the brain. Symptoms include visual hallucinations, delusions, episodic delirium, and Parkinsonism.
Diffuse Lewy Body Disease
52
RESTING tremor is MC sign of _____ disease. Onset of symptoms is usually between 45y-65y.
Parkinson's *Loss of pigment cells seen in substantia nigra
53
Other S&S of Parkinson's include:
Bradykinesia w/ lack of swinging arms and shuffling gait, Rigidity- increased resistance to passive movement, Fixed facial expressions, Instability
54
Treatment options for Parkinson's include:
1. Levodopa + Carbidopa--> Levodopa is converted to dopamine. Carbidopa reduces the amount of Levodopa needed (reducing ADRs of Levodopa) 2. Dopamine agonists= Bromocriptine, Pramipexole, Ropinirole 3. Anticholinergics= Benztropine (Cogentin) 4. Amantadine
55
______ is an INTENTIONAL TREMOR, with an age of onset typically around 60.
Essential Familial Tremor * MC in UE and head * *Worsened w/ emotional stress
56
What are treatment options for intentional tremor?
- Propranolol may help if severe or situational - Primidone (barbiturate) if no relief from Propranolol - Alprazolam- 3rd line
57
____ is idiopathic, unilateral CN VII/facial nerve palsy. ONLY affects the face, not extremities.
Bell's Palsy *Strong association with HSV reactivation
58
RF for Bell's Palsy include:
DM, pregnancy (esp 3rd trimester), post URI, and dental nerve block
59
Remember...if able to lift BOTH eyebrows it is NOT Bell's Palsy
to distinguish from CVA
60
Treatment for Bell's Palsy includes:
No treatment required, silly! Most cases resolve in 1 month. However... 1. Prednisone can help decrease nerve inflammation (esp in 1st 72 hours) 2. Artificial tears to replace lacrimation and help with vision probs 3. Acyclovir has been shown to improve symptoms/timing of recovery
61
Be suspicious of HA that are abrupt or quickly progress in severity.
Meningitis, SAH, intracranial HTN, HTN crisis, acute glaucoma
62
_____ HAs are MC overall type and are NOT worsened by activity.
Tension
63
____ is MC cause of morning headache. It is LATERALIZED, pulsatile, assoc. with N/V, photophobia and phonophobia. Usually 4-72h in duration.
Migraine *Worse with physical activity
64
How are migraines managed?
1. Triptans or Ergotamines 2. Dopamine blockers- Reglan, Phenergan. If giving these antiemetics for N/V you want to give with Benadryl to prevent EPS, dystonic rxns, and parkinsonism symptoms due to decreased dopamine.
65
Prophylactic treatment for migraines=
- Anti-HTN meds: BB, CCB - TCAs - Valproate, Topiramate - NSAIDs
66
____ HA are seen mostly in young & middle-aged men. They are described as severe UNILATERAL periorbital/temporal pain that is sharp and lasts <2h. They occur several times a day over 6-8 weeks.
Cluster *Triggers: worse at night, ETOH, stress, certain foods
67
What is Horner's syndrome? (can be seen w/ cluster HA)
Ptosis + Miosis + Anhidrosis * SEEN IPSILATERALLY * *Also- nasal congestion/rhinorrhea, conjunctivit, lacrimation
68
How are cluster HA treated?
100% O2 *Prophylaxis- Verapamil 1st line!

Primary Care (12 decks)

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