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Royal College: Emergency Medicine > Neurology > Flashcards

Neurology Flashcards

This deck covers Chapters 91-99 in Rosens, compromising all of neurology.

1
Q

What are the NINDS-recommended stroke evaluation time targets in potential tPA candidates?

A
  • Door to MD = 10 minutes
  • Door to CT = 25 minutes
  • Door to CT read = 50 minutes
  • Door to tPA = 60 minutes
  • Access to NSx = 120 minutes
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2
Q

List 6 indications for CT scan of first time seizure

A
  1. Focal deficit
  2. Persistently altered LOC
  3. Fever
  4. Trauma
  5. Persistent H/A
  6. Cancer history
  7. OAC
  8. HIV
  9. Age >40
  10. Partial complex seizure

I scan all first-time seizures…

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3
Q

Differentiate dementia and pseudodementia

A

Pseudodementia

  • Usually rapid onset
  • Previous psychiatric history
  • Social skills intact
  • Attention preserved
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4
Q

What does the CSF look like in GBS?

A
  • High protein
  • Mild pleocytosis
  • Normal CSF does NOT rule out GBS
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5
Q

Describe the clinical syndrome of PCA stroke

A
  • Homonymous hemianopsia
  • Memory impairment (hippocampus)
  • Visual agnosia
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6
Q

Define a myasthenic crisis.

List 5 drugs that may exacerbate MG. List 4 other triggers.

A
  • Respiratory failure

Drugs

  1. Prednisone
  2. BB
  3. CCB
  4. Lidocaine
  5. Procainamide
  6. Clindamycin
  7. Phenytoin

Other

  1. Medication changes
  2. Infection
  3. Aspiration
  4. Surgery
  5. Pregnancy
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7
Q

List 8 contraindications for tPA in STROKE

A

Brain

  1. Hemorrhagic transformation
  2. Previous ICH
  3. AVM
  4. Brain cancer
  5. Stroke within 3 mo
  6. Closed head injury within 3 mo
  7. CNS surgery within 3 mo

Hematologic

  1. OAC
  2. Plt <100
  3. INR >1.7
  4. Heparin use

Other

  1. Arterial puncture non-compressible
  2. Severe uncontrollable HTN
  3. Glucose <2.8
  4. Active bleeding
  5. Bleeding diathesis
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8
Q

Differentiate the following diseases based one (a) strength, (b) DTRs, (c) sensation, and (d) wasting:

  • Myelopathy
  • Motor neuron disease (ALS)
  • Neuropathy
  • Neuromuscular junction disease
  • Myopathy
A
  • Myelopathy
  • Strength - / DTR + / Sens N / No wasting
  • Motor neuron disease (ALS)
  • Strength - / DTR + / Sens N / Wasting
  • Neuropathy
  • Strength - / DTR - / Sens - / Wasting
  • Neuromuscular junction disease
  • Strength fatigued / DTR N / Sens N / No wasting
  • Myopathy
  • Strength - / DTR N / Sens N / Wasting
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9
Q

Name and describe a scale to grade the severity of Bell’s palsy

A

House Brackman Scale

  1. Normal
  2. Mild. Eye closes. Symmetrical at rest.
  3. Moderate. Eye closes. Asymmetrical at rest.
  4. Mod-Severe. Eye can’t close. Asymmetrical at rest.
  5. Severe. Eye can’t close. Only twitches.
  6. Complete paralysis
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10
Q

List 6 signs/symptoms associated with Bell’s palsy

A
  1. Dry eye
  2. Overflow of tears on the cheek
  3. Taste change
  4. Ear pain
  5. Hyperacusis
  6. Perception of ipsilateral sensory change
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11
Q

Define status epilepticus

A

Seizure activity >5 min

2 seizures without recovery between

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12
Q

What is the triad of carotid dissection? How do you treat it?

A
  1. Unilateral headache
  2. Horner’s
  3. Contralateral hemispheric signs

Treatment

  • tPA if associated with stroke
  • Heparin if thrombus with dissection
  • Anti-platelets otherwise
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13
Q

List 6 risk factors for SAH

A
  1. PCKD
  2. FHx
  3. Cocaine
  4. HTN
  5. Smoking
  6. Connective tissue disorder
  7. Alcoholism
  8. Coarctation
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14
Q

List the 4 diagnostic criteria for dementia (major neurocognitive disorder)

A

From DSM-5:

  1. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains:
    * Learning and memory
    * Language
    * Executive function
    * Complex attention
    * Perceptual-motor
    * Social cognition
  2. Cognitive deficits interfere with independence in ADLs/IADLs
  3. Do not occur exclusively in the context of delirium
  4. Not better explained by another mental disorder (eg, major depressive disorder, schizophrenia).
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15
Q

What is the ABC/2 technique in ICH?

A

Take measurements widest area of bleed (A x B)

Count the number of slices (10 mm) that blood is present (C)

(A * B * C) / 2 = volume of blood

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16
Q

What is your BP target is SAH?

A

AHA says sBP <160 mmHg or MAP <110 mmHg

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17
Q

Describe the clinical syndrome of MCA stroke

A
  • Contralateral weakness: Face/Arm > Leg
  • Contralateral sensory loss: Face/Arm > Leg
  • Contralateral hemianopsia
  • Gaze preference toward the lesion
  • Aphasia
  • Neglect
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18
Q

What are the CSF findings in a patient with MS?

A
  • Pleocytosis
  • Elevated gamma globulin levels
  • Oligoclonal bands of IgG
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19
Q

What are the three major ‘columns’ of the spinal column and what is their function?

A
  1. Spinothalamic - pain/temp
  2. Corticospinal - motor
  3. Posterior column - proprioception/vibration/touch
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20
Q

List 4 seizures that require ‘specialized therapy’ (not just benzos)

A
  1. Hyponatremia
  2. Hypoglycemia
  3. Hypocalcemia
  4. Eclamptic
  5. Isoniazid
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21
Q

What are your BP targets in ICH? What trial provided evidence on this?

A

ICH

  • BP should be lowered to 140-160 mmHg

​Interact-2: 2013

  • 2800 patients –> Drop BP to 140 in first 6 hours
  • Negative outcome but at p= 0.06 (mortality)
  • Positive for a reduction in disability

ATACH 2

  • Stopped early because of futility
  • Supposed to be 180 vs 140, but was ~140-120
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22
Q

What is an abnormal CSF lactate?

What is an abnormal CSF glucose:serum glucose?

A
  • CSF lactate >3.5
  • Glucose CSF:Serum <0.33
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23
Q

Provide the Hunt and Hess classification scale for SAH

A
  • 0 = Intact
  • 1 = Mild H/A
  • 2 = Severe H/A, nuchal rigidity
  • 3 = Confused
  • 4 = Hemiparesis
  • 5 = Posturing
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24
Q

List 8 causes of delirium

A

I WATCH DEATH

  1. Infection
  2. Withdrawal
  3. Acute metabolic (acidosis, lytes, organ failure)
  4. Trauma
  5. CNS disease (bleed, tumour, seizure, CVA)
  6. Hypoxia
  7. Deficiencies (B12, Thiamine)
  8. Environmental (hypo/hyperthermia)
  9. Acute vascular (HTN, MI, CVA)
  10. Toxins
  11. Heavy metals
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25
Q

What nerve roots does the sciatic nerve arise from?

What are the 2 main branches?

What are the symptoms of sciatic mononeuropathy?

A
  • L4-S3
  • Tibial/Common peroneal
  • Flail foot, can’t flex knee, can’t feel below knee
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26
Q

List 3 treatments for a myasthenic crisis

A
  1. Prednisone
  2. IVIG
  3. PLEX
  4. Airway management
    * FVC <20
    * MIP <30
    * MEP <40
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27
Q

What is the most common cause of bilateral CN7 paralysis?

A

Lyme

Borrelia burgdorferi

Ixodes tick

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28
Q

Differentiate Tick paralysis from GBS and Botulism

A

Tick Paralysis

  • Toxin injected by tick decreases ACh release
  • Ascending paralysis
  • Ocular findings

Botulism

  • C. botulinum toxin prevents ACh release
  • Descending paralysis

GBS

  • Demyelinating
  • Ascending paralysis
  • Ocular muscles spared
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29
Q

What are the diagnostic criteria for migraine with aura?

A

2+ attacks with 3+ of:

  • 1+ reversible aura symptom
  • 1+ aura symptom over 4 minutes
  • No aura >60 min
  • Headache during or after aura
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30
Q

What is the agent involved in botulism?

What is the mechanism? List 3 causes. Treatment?

A

Clostridium botulinum

  • Presynaptic inhibition of ACh release

Causes

  1. Food
  2. Wound
  3. Infantile
  4. Iatrogenic

Treatment

  • Airway management
  • Equine antitoxin
  • BabyBIg if infantile
  • PenG 3M units IV q4h if wound
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31
Q

List 8 causes of toxin-induced seizure

A

OTIS CAMPBELL

  • Oral hypoglycemics, Oleander, Organophosphates
  • Theophylline, TCAs
  • Insulin, Isoniazid
  • Sympathomimetics
  • Camphor, CN, CO, Cocaine
  • ASA, Anticholinergics
  • Methanol
  • PCP, Pesticides
  • Barbiturate/Benzo W/D, Bupropion, Botanicals
  • Ethanol W/D
  • Lead, Lithium
  • Lidocaine
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32
Q

What is the ABCD2 score?

A

ABCD2

  • Age >60
  • BP (HTN hx)
  • Clinical (Sens/Speech/Motor)
  • Duration (<10m/10m-60m/>60m)
  • Diabetes

Used to predict CVA at 48h following TIA

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33
Q

List the 4 types of GBS

A
  1. Acute inflammatory demyelinating polyradiculopathy
  2. Acute motor axonal neuropathy
  3. Acute motor and sensory axonal neuropathy
  4. Miller Fisher syndrome
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34
Q

List 5 ischemic changes on CT following stroke

A
  1. Hyperdense artery sign
  2. Loss of grey-white differentiate
  3. Effacement of sulci
  4. Loss of insular ribbon
  5. Mass effect
  6. Hypodensity

Subtle findings as early as 3h post

Usually, 6h before more obvious

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35
Q

List 7 reversible causes of dementia

A
  1. Hydrocephalus
  2. CNS lesion
  3. Heavy metal poisoning
  4. Depression
  5. Hypothyroidism
  6. B12 deficiency
  7. Medication-induced
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36
Q

Describe 7 steps in the management of a SAH

A
  1. HOB
  2. ICP management
  3. BP <140-160
  4. NSx
  5. CCB prophylaxis (Nimodipine)
  6. Seizure prophylaxis
  7. Normothermia
  8. Antiemetics
  9. Neuroprotective intubation, if necessary
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37
Q

What is the clinical triad of Wernicke’s encephalopathy?

A
  1. Encephalopathy
  2. Eye findings (nystagmus, ophthalmoplegia)
  3. Ataxia
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38
Q

What are BP targets in stroke if you want to give tPA and if you don’t want to give tPA?

Name 3 agents that can be used to lower BP in this setting.

A
  • No tPA = <220/120
  • tPA = <185/110
  • During tPA = <180/105

Drugs

  1. Labetolol
  2. Hydralazine
  3. Enaliprilat
  4. Nicardipine
  5. Nitroglycerin
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39
Q

Draw the Circle of Willis

A
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40
Q

What nerve roots does the median nerve arise from?

A
  • C5-T1
  • AIN (Galeazzi injury)
  • Just proximal to wrist, palmar sensory branch comes off
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41
Q

Explain the DAWN Trial:

  • Study Design
  • Population (4)
  • Intervention
  • Outcome Measure (2)
  • Results
A
  • Study Design
  • Multicenter, prospective RCT
  • Population
  • Seen well 6-24h previous
  • Age ≥18
  • Ischemic stroke
  • Failed tPA therapy
  • NIHSS ≥10
  • Pre-stroke mRS <2
  • Anticipated life expectancy ≥6 months
  • Intervention
  • Randomized 1:1 to EVT or not
  • Outcome Measure
  • Modified Rankin Score
  • Functional independence
  • Results
  • EVT group did better
42
Q

List 5 medications and doses used to stop a seizure

A

First-Line

  • Lorazepam 0.1 mg IV
  • Diazepam 0.2 mg IV
  • Midazolam 0.2 mg IV

Second-Line (note all 20 mg/kg)

  • Phenytoin 20 mg/kg
  • Posphenytoin 20 mg/kg
  • Phenobarbital 20 mg/kg
  • Valproate 20 mg/kg

Third-Line

  • Propofol 1-2 mg/kg
  • Midazolam infusion 0.05-2 mg/kg/hr
43
Q

List 2 treatments for GBS

44
Q

Name 10 non-infectious causes of meningitis.

A
  1. Vaccine
  2. NSAID
  3. TMP-SMX
  4. INH
  5. IVIG
  6. SLE
  7. Radiation
  8. Cancer
  9. Autoimmune
  10. Sarcoid
45
Q

List 6 causes of dementia

A
  1. Alzheimer’s
  2. Parkinson’s
  3. Huntington’s
  4. CVA
  5. Infectious
  6. Repeated head trauma
  7. Prions
  8. Hydrocephalus
  9. Mass effect (tumour, blood, pus)
46
Q

List 8 host factors that predispose someone to meningitis

A
  1. Age <5y
  2. Age >60y
  3. Male
  4. Low SES
  5. Military
  6. Dorms
  7. Splenectomy
  8. Diabetes
  9. IVDU
  10. Alcohol
47
Q

Describe a typical cluster headache. List 4 treatments.

A

Symptoms

  • Unilateral flushing/sweating
  • Red, tearing eye
  • Rhinorrhea/Nasal congestion
  • Clusters of brief severe pain, often retroorbital
  • Worse in men

Treatment

  1. High-flow oxygen
  2. Triptans
  3. Maxeran
  4. Octreotide
48
Q

Explain why a patient with DM has ptosis and a normal pupillary response.

A

Parasympathetic fibers on the outside of CN3

  • If compression (by P.comm aneurysm), only this down

Motor fibers on the inside of CN3

  • If vascular disease, ischemia happens at the central part of the nerve.
49
Q

What are the diagnostic criteria for migraine?

A

POUND

  • Pulsatile
  • Onset 4-72h
  • Unilateral
  • Nausea and/or Vomiting or Photo- AND Phonophobia
  • Disabling

Need 5 episodes lasting 4-72h with 2 of the above

50
Q

List 5 causes of CN3 palsy

A
  1. DM
  2. Aneurysm
  3. Herniation
  4. Tumour
  5. CVST
  6. Trauma
  7. GBS (Miller Fisher)
51
Q

Describe a typical tension headache.

A
  • Band-like squeezing
  • Temples/Neck
  • 30min - 7hr
  • Triggered by stress/poor sleep
52
Q

What is the triad of Miller-Fisher GBS?

A
  1. Ophthalmoplegia
  2. Ataxia
  3. Areflexia
53
Q

List 4 inclusion criteria for the Ottawa SAH rule

A
  1. Age >16
  2. Non-traumatic
  3. Peak intensity within 1 hour
  4. GCS 15
54
Q

List 6 DDx for seizure

A
  1. Syncope
  2. Hypoglycemia
  3. Hyponatremia
  4. TIA
  5. Narcolepsy
  6. Motor Tics
  7. Hyperventilate/Breath holding
  8. GERD in babies
  9. Conversion D/O
55
Q

Describe 2 ways to diagnose myasthenia gravis in the ED

A
  1. Tensilon
    * AChEi (max 10 mg)
  2. Ice pack
    * 2 min on one eye

Positive if 2mm difference in lid opening

56
Q

Which GBS patients need intubation?

A

Usual reasons to intubate, plus:

  • FVC <20 cc/kg
  • MIP <30 cmH2O
  • MEP <40 cmH2O
57
Q

Describe the epidemiology, pathophysiology, and symptoms of GCA

A

Epidemiology

  • Older women
  • PMR

Pathophysiology

  • Large-vessel vasculitis

Symptoms

  • Headache
  • Jaw/Tongue claudication
  • Constitutional symptoms
  • Visual symptoms
58
Q

Describe and differentiate cauda equina and conus medullaris

A

Conus Medullaris

  • Sudden
  • Bilateral
  • UMN
  • More back pain
  • Less radicular symptoms
  • More impotence

Cauda is opposite

59
Q

Explain the components FAST-ED scale

A

Field Assessment Stroke Triage for Emergency Destination

  • Facial Palsy (normal/noticable) - 0/1
  • Arm weakness (normal/drift/paralysis) - 0/1/2
  • Speech (normal/slurred/severe) - 0/1/2
  • Eye deviation (normal/partial/forced) - 0/1/2
  • Neglect (normal/1 sens mod/complete) - 0/1/2

If >=4 pts, likely to have IC/M1 clot

60
Q

List 8 causes of status epilepticus

A
  1. Isoniazid
  2. Hyponatremia
  3. Hypoglycemia
  4. Hypocalcemia
  5. Eclampsia
  6. CNS infection
  7. CNS trauma
  8. Cancer
  9. AVM
  10. Stroke
  11. Hydrocephalus
  12. Epilepsy
  13. Toxic (OTIS CAMPBELL)
  14. Alcohol withdrawal
61
Q

What is the cut-off time for tPA in ischemic stroke? What are the 2 other inclusion criteria?

A
  • tPA < 4.5 hours
  • NIHSS >3
  • Age >18
62
Q

What are the 5 diagnostic criteria for GCA

A
  1. Age >50
  2. New-onset localized headache
  3. Temporal artery pain
  4. ESR >50
  5. Positive biopsy

Diagnosed if 3+ (90%+ sensitive and specificity)

Treat with Prednisone 1 mg/kg (max 60 mg)

63
Q

List 3 mechanisms by which NMJ can diminish strength on repeated stimulation. Give an example of each.

A
  1. Decreased ACh release
    * Botulism
  2. Blocked receptors
    * Myasthenia gravis
  3. AChEi
    * Organophosphates
64
Q

How do you treat a hyponatremic seizure (dose)?

A

3% saline 2 cc/kg over 10-60 minutes

65
Q

List 3 causes of meningitis in each of:

  • Bacterial
  • Viral
  • Fungal
  • Parasitic
  • Non-infectious
A

Many…

  • Bacterial
  • S. pneumoniae
  • N. meningitidis
  • H. influenzae
  • L. monocytogenes
  • Viral
  • HSV
  • West Nile
  • HIV
  • Fungal
  • Cryptococcus
  • Histoplasma
  • Blastomyces
  • Candida
  • Parasitic
  • Toxoplasma
  • Neurocysticercosis
  • Bartonella
  • Non-infectious
  • NSAIDs
  • Vaccine-related
  • IVIG
  • Cancer
  • SLE
66
Q

What nerve root does the ulnar nerve arise from?

A
  • C5-T1
  • Mainly C7-T1
67
Q

List 5 indications for endovascular therapy in stroke

A
  1. Age >18
  2. NIHSS >6
  3. ASPECTS >6
  4. IC/M1 clot
  5. mRS 0 or 1
  6. Groin puncture possible within 6h
68
Q

List 4 causes of complete sciatic mononeuropathy

A
  1. Buttock hematoma
  2. Penetrating trauma
  3. Posterior hip dislocation
  4. Deep IM injection
69
Q

Differentiate UMN vs LMN findings

A

UMN

  • Spastic paralyis
  • Increased tone
  • Increased reflexes
  • Babinski +
  • Rigid
  • Bulk preserved

LMN

  • Flaccid paralysis
  • Decreased tone
  • Decreased reflexes
  • Babinski -
  • Fasculations
  • Atrophy
70
Q

List 5 reasons to do a CT scan before an LP in suspected bacterial meningitis

A
  1. Papilledema
  2. Altered
  3. Focal deficits
  4. Seizure
  5. Immunocompromised
71
Q

List 5 causes of mononeuropathy multiplex (2+ named nerves in separate body parts)

A
  1. Vasculitis
  2. Diabetes
  3. Cancer
  4. HIV
  5. Lyme
  6. Sarcoid
  7. Lead
72
Q

What is the dose of tPA in stroke? How is it given?

A

0.9 mg/kg (max 90 mg)

10% bolus, 90% over 1hr

73
Q

How do you diagnose IIH (4)? List 3 treatment options.

A

Diagnosis

  • Normal neuro exam +/- papilledema/field cut/CN6p
  • CT to rule out mass/CVST
  • LP with normal CSF
  • LP with opening pressure:
  • >20 cmH2O (normal weight)
  • >25 cmH2O (obese)

Treatment

  • Stop offending agent (OCP)
  • Lower ICP (drain, lasix, acetazolamide)
  • Steroids
  • VP shunt if visual symptoms
74
Q

List 6 conditions associated with carpal tunnel syndrome

A
  1. Pregnancy
  2. Diabetes
  3. Acromegaly
  4. Scleroderma
  5. RA
  6. Amyloidosis
  7. Obesity
  8. Hypothyroidism
75
Q

List the 5 types of lacunar strokes

A
  1. Pure motor
  2. Pure sensory
  3. Sensorimotor
  4. Ataxic-Hemiparesis
  5. Dysarthria-Clumsy Hand
76
Q

Who should receive chemoprophylaxis for meningitis? What medication(s) and dose?

A
  • Household contacts
  • Intimate contacts
  • HCWs with mucosal contact with secretions

N. meningitidis

  • Ciprofloxacin 500 mg PO x1
  • Rifampin 600 mg PO q12h x4

H. influenzae

  • Rifampin 600 mg PO daily x4
77
Q

Should you give steroids in meningitis?

A

Yes!

  • Lower mortality in S. pneumoniae
  • Lower hearing loss in H. influenzae

Dex 0.6 mg/kg IV

78
Q

List 6 DDx for a ring-enhancing lesion on CT head

A
  1. Bacteria
    * TB/Listeria/Syphilis
  2. Parasitic
    * Toxo/Amoeba
  3. Fungi
    * Crypto/Coccidiomycosis
  4. Malignancy
    * Lymphoma/Primary/Met
  5. Inflammatory
    * SLE/MS/Sarcoid
79
Q

What are the 5 diagnostic criteria for delirium?

A

From DSM-5:

  1. Disturbance in attention and awareness
  2. Develops acutely, is a change from baseline, and fluctuates over the day
  3. Disturbance in cognition
  4. Not explained by another preexisting, established, or evolving neurocognitive disorder
  5. Due to medical condition, substance intoxication or withdrawal, or exposure to a toxin, or multiple etiologies
80
Q

What are the 4 most common sites for ICH?

A
  1. Putamen (44%)
  2. Thalamus (13%)
  3. Cerebellum (9%)
  4. Pons (9%)
  5. Other cortical areas (25%)
81
Q

List 6 causes of CVST

A
  1. AOM
  2. Sinusitis
  3. Orbital cellulitis
  4. Meningitis
  5. Trauma
  6. NSx procedures
82
Q

What is the Ottawa SAH rule?

A

ANT LEaF

  • Age >40
  • Neck pain/stiff
  • Thunderclap
  • LOC
  • Exertional
  • Flexion limited

Investigate for SAH if any positive

83
Q

List 10 stroke mimics

A
  1. Migraine
  2. Hypoglycemia
  3. Hyponatremia
  4. Bell’s palsy
  5. SDH/EDH/SAH/ICH
  6. CVST
  7. HTN encephalopathy
  8. CNS tumour
  9. CNS abscess
  10. Encephalitis/Meningitis
  11. Seizure (Todd’s paralysis)
  12. Conversion disorder
84
Q

List 5 demyelinating polyneuropathies

A
  1. GBS
  2. AIDP
  3. CIDP
  4. Cancer
  5. HIV
  6. Hepatitis B
  7. Diphtheria
  8. Buckthorn
85
Q

What is Ramsay Hunt Syndrome? How do you treat it?

A

Herpes zoster re-activation causing:

Facial paralysis with ear pain and/or vesicular involvement

  • Valacyclovir 1g TID x10d
  • Prednisone 1 mg/kg x10d
  • Artificial tears
86
Q

What is the pathophysiology of myasthenia gravis?

A

Auto-Ab targeting nicotinic ACh receptors

87
Q

List 8 complications of meningitis

A
  1. Seizure
  2. Coma
  3. Death
  4. Hearing loss
  5. Focal neuro deficits
  6. DIC
  7. Adrenal hemorrhage
  8. CVST
  9. Stroke
  10. SIADH
88
Q

What are the two branches of the common peroneal nerve? What are the motor/sensory findings?

A
  • Superficial nerve
  • Everters
  • Lateral foot
  • Deep peroneal nerve
  • Ankle dorsiflexion
  • 1st dorsal webspace
89
Q

List 6 risk factors for Alzheimer’s dementia

A

Classic cardiac risk factors

  1. HTN
  2. DLD
  3. DM
  4. Smoking
  5. FHx
  6. Age
  7. Gender
  8. Alcohol
  9. Obesity
  10. CVA
  11. Depression
  12. Sedentary
  13. Low education
  14. Traumatic brain injury
90
Q

List 5 infectious organisms associated with GBS

A
  1. Campylobacter
  2. Mycoplasma
  3. EBV
  4. CMV
  5. Enterovirus
91
Q

List 8 acute, emergent causes of weakness with possible airway compromise

A
  1. MG
  2. LES
  3. Tick paralysis
  4. GBS
  5. Botulism
  6. Tetanus
  7. Coral snake
  8. Heavy metal poisoning
  9. Polio
  10. HyperMg
  11. Hypophos
  12. ALS
  13. Organophosphate
  14. Pufferfish
92
Q

Name 5 types of generalized seizure

A
  1. Tonic-Clonic
  2. Absence
  3. Myoclonic
  4. Clonic
  5. Tonic
  6. Atonic
93
Q

Differentiate generalized and partial seizures

A

Generalized

  • Both cerebral hemispheres
  • Unconscious

Partial

  • One cerebral hemisphere
  • Simple vs Complex based on cognition
94
Q

Differentiate Wernicke’s and Broca’s aphasia

A
  • Broca’s = expressive (motor cortex)
  • Wernicke’s = receptive (temporal lobe)
95
Q

How would you treat meningitis in:

  • Neonate (<1m)
  • Infant (1-23m)
  • Adult (2-50y)
  • Older Adult (>50y)
A
  • Neonate (<1 mo)
  • Ampicillin + Cefotaxime
  • Ampicillin + Gentamycin
  • Infant (1-23 mo)
  • Ceftriaxone + Vanco
  • Adult (2-50 yr)
  • Ceftriaxone + Vanco
  • Older Adult (>50 yr)
  • Ceftriaxone + Vanco + Ampicillin

*Consider dexamethasone and acyclovir

96
Q

List 5 physical exam features of GBS

A
  1. Ascending paralysis
  2. Loss of DTRs
  3. Variable sensory findings
  4. Sparing of anal sphincter
  5. Urinary retention
  6. Autonomic dysfunction (50%)
  7. Sparing of ocular muscles (unless Miller Fisher)
97
Q

Describe the clinical syndrome of ACA stroke

A
  • Contralateral weakness: Leg > Arm
  • Contralateral sensory loss: Leg > Arm
  • Apraxia (poor motor planning)
  • Bowel/Bladder incontinence
  • Primitive reflexes (suckle, grasp)
  • Impaired judgment
98
Q

List 4 treatment options for post-LP headache

A
  1. Tylenol
  2. IVF
  3. Caffeine
  4. Blood patch
99
Q

List 8 treatments for migraine

A
  1. Tylenol
  2. NSAIDs
  3. Prochlorperazine
  4. Metoclopramide
  5. Triptans
  6. Ergot
  7. Opiates
  8. Haldol
  9. Magnesium
  10. Propofol
100
Q

What nerve root does the radial nerve arise from? How do you splint an acute radial nerve palsy?

A
  • C5-T1 brachial plexus
  • C5-C7 mainly
  • The radial nerve innervates brachioradialis
  • Then bifurcates to PIN and sensory at the elbow
  • Volar splint in 60-degree extension
101
Q

Provide a scoring system for predicting mortality with ICH

A

LAGII

  • Location (Supra/Infratent)
  • Age (>80/<80)
  • GCS (3-4/5-12/13-15)
  • ICH Volume (>30 mL/<30 mL)
  • IVH (Yes/No)

  • 2 pts = 26% mortality
  • 3 pts = 72% mortality
  • 4 pts = 97% mortality

Royal College: Emergency Medicine (25 decks)

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