Neurology Flashcards
1
Q
occlusive stroke path
A
thrombotic = plaque -> rupture embolic = stroke from somewhere else (AFib, carotids fat, air)
2
Q
occlusive stroke pt
A
focal neurologic deficit, acute
HTN, DM, obese, smoker, vascular disease (thrombotic)
young female with neck pain (dissection)
AFib with valvular disease (embolic)
Think FAST (face droop, arm drift, slurred speech, time and transport)
3
Q
occlusive stroke dx
A
1st: CT scan (r/o bleed)
best: MRI (tPa before MRI if acute)
4
Q
occlusive stroke tx
A
tPA
- < 3hrs if diabetic
- < 4.5hrs if not diabetic
- NEVER brain bleed before
- no recent GI bleed
- no surgery within 21d
- no trauma
5
Q
occlusive stroke tx2:
A
secondary prevention aspirin first line aspirin + dipyridamole if fails aspirin clopidogrel if aspirin not tolerated warfarin INR 2-3 if CHADS2 > 2 and AFib
6
Q
occlusive stroke risk
A
statins, LDL <70, high-potency
insulin, HgbA1c < 7
ACE-I, BP <135/85
7
Q
occlusive stroke f/u
A
Echo (TTE -> TEE), if clot, heparin -> warfarin
U/S carotid; >70% stenosis or symptomatic -> carotid endarterectomy….must wait weeks
8
Q
hemorrhagic stroke path
A
hypertension
intraparenchymnal, subarachnoid
9
Q
hemorrhagic stroke pt
A
focal neurologic deficit
worst headache of their life
10
Q
hemorrhagic stroke dx
A
non-contrast CT = blood
11
Q
hemorrhagic stroke tx
A
neurosurgery
MAP < 110
12
Q
BP goals in stroke (24hrs)
A
stroke, tPA <180/110
stroke, no tPA < 220/120
hemorrhagic MAP < 110
13
Q
posterior fossa tumor path
A
tumor
demyelinating diseases
14
Q
posterior fossa tumor pt
A
NO ear symptoms
YES focal neurologic deficit (dizziness)
15
Q
posterior fossa tumor dx
A
MRI MRA
16
Q
posterior fossa tumor tx
A
control blood flow
resect tumor
17
Q
benign paroxysmal positional vertigo path
A
otolith in semicircular canal
18
Q
BPPV pt
A
recurrent and reproducible vertigo
< 1 min with head movement
19
Q
BPPV dx
A
Dix-Hallpike = rotary nystagmus
20
Q
BPPV tx
A
Epley maneuver (otolith repositioning)
21
Q
Labyrinthitis/vestibular neuritis path
A
post-viral syndrome, usually URI
22
Q
labyrinthitis/vestibular neuritis pt
A
weeks after URI presenting with vertigo, nausea/vomiting, tinnitus/hearing loss (loss specifically labyrinthitis)
23
Q
labyrinthitis/vestibular neuritis dx
A
clinical, diagnosis of exclusion
24
Q
labyrinthitis/vestibular neuritis tx
A
steroids, but only with 72hrs of onset, otherwise wait it out
25
meniere's path
?
26
meniere's pt
tinnitus, hearing loss, episodic vertigo
| lasts > 30min
27
meniere's dx
clinical
28
meniere's tx
diuretic and low salt diet
29
grand mal seizure path
seizure, generalized, complex
30
grand mal seizure pt
convulsions = tonic clonic jerking
| loss of consciousness
31
grand mal seizure dx
EEG
32
grand mal seizure tx
abort seizure = benzo
33
myoclonic seizure path
seizure, simple, partial
34
myoclonic seizure pt
spastic contractions
| NO loss of consciousness
35
myoclonic seizure dx
EEG
36
myoclonic seizure tx
valproate
37
absence seizure path
seizure, partial, complex
38
absence seizuRe pt
maintains tone
loses consciousness - 100s of times per day
children
you think they are ADHD
39
absence seizure dx
EEG
40
absence seizure tx
ethosuximide or valproate
41
atonic seizure path
seizure, partial, siimple
42
atonic seizure pt
loses tone
| maintains consciousness
43
atonic seizure dx
EEG
44
atonic seizure tx
valproate, helmets
45
trigeminal neuralgia path
seizure of trigeminal nerve
46
trigeminal neuralgia pt
lightning pain across the face, especially while chewing or drinking cold liquids
47
trigeminal neuralgia dx
EEG
48
trigeminal neuralgia tx
carbamazepine
49
status epilepticus path
sustained seizure
50
status epilepticus pt
continued seizure or failure or resolution or failure of post-octal state for 20mins
51
status epilepticus dx
EEG
52
status epilepticus tx
abort the seizure
53
status epilepticus path
VITAMINS vs epilepsy
| non-compliance
54
status epilepticus pt
if after 20mins
- uninterrupted seizure OR
- failure to resolve post-ictal state
55
status epilepticus dx
if seizing, abort seizure first
EEG for seizure
check seizure medication levels
VITAMINS
56
status epilepticus tx
```
for seizures
- lamotrigine
- valproate
- levitiracetam
for status
- IV Benzes, IV Benzos, IV benzos
- IV fosphenytoin
- IV phenobarbital
- IV midazolam and propofol
```
57
VITAMINS for seizures
```
vascular - stroke, bleed
infection - encephalitis, meningitis
trauma - MVA, TBI
autoimmune - lupus, vasculitis
metabolic - Na, Ca, Mg, O2, glucose
idiopathic - 'everybody gets one'
neoplasm - mets vs. primary
(p)sychiatric - faking it, iatrogenic
```
58
Parkinson's path
loss of dopaminergic neurons in substantia nigra, loss of excitatory signal
59
parkinson's pt
bradykinesia
cog-wheel rigidity
resting tremor
gait/postural instability
60
Parkinson's dx
clinical
| best: autopsy = Lewy bodies
61
parkinson's tx
if > 70 or non-functional = levodopa-carbidopa
if < 70 and functional = ropinirole, pramipexole
add others as levodopa-carbidopa fails
-selegiline (MAO-B)
-Entacapone (COMT)
DBS
62
essential tremor path
familial
63
essential tremor pt
no tremor at rest, worsens with movement
| males 40-60y/o
64
essential tremor dx
clinical
65
essential tremor tx
propranolol
66
cerebellar dysfunction path
cerebellar lesion = EtOH, CVA
67
cerebellar dysfunction pt
no tremor at rest
| worsens with movement, gets worse with intention (closer you get, worse it gets)
68
cerebellar dysfunction dx
clinical
69
cerebellar dysfunciton tx
none
70
delirium tremens path
withdrawal from EtOH, benzos
71
delirium tremens pt
tremor at rest
| anxiety, hallucinating, HTN, tachycardia
72
delirium tremens dx
clinical
73
delirium tremens tx
```
oxazepam or chloridazepoxide (ppx)
lorazepam prn (tx)
```
74
huntington's path
genetics, trinucleotide repeat, anticipation
75
huntington's pt
chorea and dementia
76
huntington's dx
clinical
77
huntington's tx
none
78
tension headache path
muscular
79
tension headache pt
bilateral vice-like pain
temples that radiates to neck
worsens with exercise
80
tension ha dx
clinical
81
tension ha tx
OTC (acetaminophen)
82
cluster ha path
vascular ha
83
cluster ha pt
unilateral, lacrimation, ptosis, conjunctival injection
84
cluster ha dx
clinical
85
cluster ha tx
oxygen
86
cluster ha ppx
verapamil, diltiazem
87
cluster ha f/u
one-time brain imaging MRI (MRI > CT) scan after attacks end
88
migraines path
vascular, vasodilation
89
migraines pt
photophobia, phonophobia
unilateral pounding headache
aborts with sleep, hangover the next day
90
migraines dx
clinical
91
migraines tx
```
mild = NSAIDs
severe = ergots/triptans (caution CAD)
```
92
migraines ppx
propranolol best
| verapamil/diltiazem ok
93
benign intracranial hypertension path
increased ICP
94
benign intracranial hypertension pt
female on OCPs
HA worse in the morning
sounds like tumor
95
benign intracranial HTN dx
CT r/o tumor
LP has elevated opening pressure
- relief of pressure = relief of symptoms
96
benign intracranial HTN tx
stop OCPs
| acetazolamide
97
benign intracranial hypertension f/u
serial LP or VP shunt
98
analgesic rebound headache path
withdrawal
99
analgesic rebound ha pt
person who takes a bunch of pain meds and then stops
100
analgesic rebound ha dx
clinical
101
analgesic rebound ha tx
just get through it
102
cord compression path
compression of spinal cord by any means - fx, mets, abscess
103
cord compression pt
```
neurologic compromise, back pain, and
hx of cancer
fever
urinary symptoms
sexual dysfunction
sensory deficit in dermatome
bilateral LE weakness
```
104
cord compression dx
1st: xray spine
best: MRI spine
105
cord compression tx
IV steroids, then dz specific
- drain hematoma
- I&D, abx for abscess
- surgery/radiation for tumor
- surgery for fx
106
musculoskeletal back pain path
muscular strain
107
msk back pain pt
patient has belt-like pain
no tenderness, no step-offs, no neuro signs
<40yo lifting heavy weights
108
msk back pain dx
clinical
109
msk back pain tx
NSAIDs and exercise
110
herniation of disk path
nucleus pulposes
111
herniation of disk pt
MSK +
- lightning pain that shoots down the leg with cough nd hip flexion
- straight leg raise elicits pain
- check for plantar flexion (L5, S1) or dorsiflexion (L4, L5)
unilateral
112
herniation of disk dx
1st: xray
best: MRI
113
herniation of disk tx
neurosurgery > conservative management at 6mo
| the same at 1 yr
114
osteophytes path
bone spurs pinch nerve at exit
115
osteophytes pt
old guy, NO heavy lifting, but sounds like herniation
116
osteophytes dx
1st: xray
best: MRI
117
osteophytes tx
surgical removal
118
compression fracture path
osteoporosis
119
compression fx pt
old lady with a fall, falls on her butt
pinpoint tenderness
vertebral step-offs
120
compression fx dx
1st: xray
best: MRI
121
compression fx tx
surgery (laminectomy)
122
compression fx f/u
DEXA scan
123
spinal stenosis path
canal is narrowed (idiopathic)
124
spinal stenosis pt
buerning or lightning pain of thighs and buttocks that is worse when upright, better with leaning forward or climbing stairs
125
spinal stenosis dx
1st: xray
best: MRI
126
spinal stenosis tx
surgery
127
spinal stenosis f/u
mimics claudication but has normal ABIs (pseudoclaudication)
128
NPH path
normal ICP, but hydrocephalus
129
NPH pt
wet, wobbly, and weird
130
NPH dx
CT scan = hydrocephalus
| LP = no increase ICP, but improvement of sxs
131
NPH tx
serial LPs or VP shunt
132
alzheimer's path
plaques, tangles, chromosome 21
133
alzheimer's pt
insidious onset of progressive memory loss
short term first, then long term
sparing of social graces
134
alzheimer's dx
clinical
| CT scan = cerebral atrophy
135
alzheimer's tx
supportive care, family education
| anticholinesterase-I = donepezil, tacrine
136
Alzheimer's f/u
dies from something else
137
Pick's disease path
frontotemporal degeneration
138
Pick's disease pt
insidious onset of loss of personality and social graces
| sparing of short term memory
139
pick's disease dx
clinical
| CT scan = frontotemporal degeneration
140
pick's disease tx
none, palliative, institutionalized
141
vascular dementia path
strokes
142
vascular dementia pt
acute loss of memory or cognition in a step-wise fashion temporarily associated with stroke
143
vascular dementia dx
CT/MRI = strokes
144
vascular dementia tx
control risk factors for stroke
145
Creutzfeldt-Jakob path
prions, spontaneous mutation >> meat
146
creutzfeldt-jakob pt
young, rapid dementia, myoclonus
147
creutzfeldt-jakob dx
autopsy
148
creutzfeldt-jakob tx
none, palliative
149
reversible causes of dementia
B12 deficiency
syphilis
hypothyroid
CKD
150
tests to r/o reversible causes of dementia
```
B12 level
RPR
TSH and T4
BUN/Cr
CT/MRI head
```
151
coma path
decrease cerebral function (can come back)
| toxic, metabolic
152
coma pt
brain stem reflexes intact
| depressed level of consciousness
153
coma dx
EEG (decrease), reflexes intact, EKG normal
154
coma tx
'cocktail' = naloxone, D50, thiamine
155
persistent vegetative state path
no cerebral function (never coming back)
156
persistent vegetative state pt
swallow, eat food, breathe on their own
157
persistent vegetative state dx
EEG (decreased), reflexes intact, EKG normal
158
persistent vegetative state tx
institutionalized care ,... peg and trache
159
brain death path
brainstem and cerebrum are lost
160
brain death pt
absent brainstem reflexes
161
brain death dx
two separate physicians assess brainstem reflexes and show absence
trial of breathing without ventilator
162
brain death tx
this person is dead, withdraw care
163
locked in path
pontine stroke, intact cerebrum, intact heart, intact brainstem
164
locked in pt
inability to move any part of their body
| disconnect between brain and body
165
locked in dx
MRI/CTA
166
locked in tx
institutionalized care
167
Lambert-Eaton path
paraneoplastic autoimmune disorder
| antibodies against presynaptic calcium channels
168
Lambert-Eaton pt
proximal muscle weakness
- difficulty rising from chair
- difficulty combing hair
169
Lambert-Eaton dx
1st: antibodies
best: EMG
then: CT chest
170
Lambert-eaton tx
chemo/surgery
| azathioprine
171
amyotrophic lateral sclerosis path
unknown, superoxide dismutase?
172
ALS pt
both UMN lesion and LMN lesions
upper = hyperreflexia, positive babinski
lower = atrophy, fasciculation
173
ALS dx
r/o spinal lesions = XR/CT/MRI
| best = EMG
174
ALS tx
none
| 'riluzole' (if you see this word, it's ALS)
175
MS path
autoimmune
| demyelinating
176
MS pt
neuro symptoms separated in both time and space
| optic neuritis = ***blurry vision*** (painful)
177
MS dx
1st and best = MRI with periventricular white lesions, demyelinating plaques
178
MS tx
acute: methylprednisolone x5d
chronic: IFN + glatiramer, fingolimod
symptom control
- urinary retention = bethanechol
- urinary incontinence = amitryptiline
- spasms = baclofen
- neuropathic = gabapentin
179
myasthenia gravis path
autoimmune
| antibodies against ACh-R
180
myasthenia pt
fatiguability of small muscles
| blurry vision, dysphagia worse at end of day
181
myasthenia dx
1st: antibodies
best: EMG
then: CT chest = thymic mass
182
myasthenia tx
increase ACh with stigmine (neostigmine)
decrease autoimmune
- steroids >60, thymectomy < 60
- IVIG = plasmapheresis in acute crisis
183
myasthenia f/u
edrophonium not used anymore
184
Guillain-barre path
autoimmune
| demyelinating
185
Guillain-barre pt
ascending paralysis following diarrhea or vaccination
| hyporeflexia, diaphragmatic paralysis
186
Guillain-barre dx
1st: do they need intubation? ... PFTs
then: LP = lots of protein, few cells
best: nerve conduction
187
guillain-barre tx
IVIG = plasmapheresis
| NEVER steroids
