Neurology II Highlights

Question 1

TBI typically refers to moderate to severe head trauma leading to what?

Answer 1

Functional and structural dysfunction

Question 2

Functional disturbance with preserved structure characterizes what?

Answer 2

Concussion

Question 3

1) What type of injury is concussion?
2) What is it?

Answer 3

1) Mild TBI
2) Functional disturbance with preserved structure

Question 4

Concussion is a head injury resulting in altered consciousness < ___________ hrs

Answer 4

< 6 hrs

Question 5

Repeat neuro checks and rest are mainstays of treating what?

Answer 5

Concussion

Question 6

What meds do you need to avoid post-concussion?

Answer 6

Avoid NSAIDs for 2-3 days (can worsen symptoms)
Avoid sedatives

Question 7

Most adults fully recover from concussion by ____ weeks and kids within ___ weeks

Answer 7

2; 4

Question 8

40 % of patients with concussion (but not necessarily LOC) will have lingering symptoms for how long?

Answer 8

Few weeks to years

Question 9

True or false: a head CT would probably be normal with post concussion syndrome

Answer 9

True

Question 10

How do you stratify the risks of pts with TBIs?

Answer 10

1) Low/Moderate: GCS = >15 (alert, fully oriented and following commands) and CT neg; may d/c home with close observation
2) Mod: GCS 9-14, CT findings do not require surgery; admit to ICU for close observation/neuro checks and repeat CT in 24 hrs
3) High: GCS <=8 serious head injury admit to ICU for neurosurgical consultation; stabilize patient, intubate; do not delay surgery as time is brain cells

Question 11

When should you admit a pt with a TBI?

Answer 11

Intracranial bleed or skull fracture on CT, or:
1) Confusion, AMS
2) GSC <= 14
3) Focal neurologic deficits
4) Post traumatic seizure
5) Alcohol or drug intoxication
6) Significant comorbidities
-AFIB, etc
7) Unreliable living environment

Question 12

Define apraxia

Answer 12

Disordered speech/fine motor skills typically; can’t button shirt, pick up pencil

Question 13

True or false: ataxia is a Sx, not a disease

Answer 13

True

Question 14

What typically involves the bilat hands and is brought about by intentional movements?

Answer 14

Essential tremor

Question 15

Alcohol may alleviate what?

Answer 15

Essential tremor

Question 16

Dopamine depletion is the pathophys of what?

(very emphasized in class)

Answer 16

Parkinson’s disease

Question 17

What are some hallmark features of Parkinson’s?

Answer 17

1) Pill rolling tremor at rest –often unilateral, resolves with intentional movement
2) Cogwheel rigidity

Question 18

Dopaminergic agents is the Tx for what?

Answer 18

Parkinson’s

Question 19

List 2 medications that can Tx Parkinson’s, and what group of meds each is in

Answer 19

1) Levodopa-Carbidopa (Sinemet; dopamine agonist)
2) Benztropine Mesylate (anticholinergic (indirectly increases dopamine))

Question 20

Chorea + dementia are characteristic of what?

Answer 20

Huntington’s disease

Question 21

What condition usually begins prior to age 21 (usually <11) is more common in men, and is often assoc with ADHD and OCD?

Answer 21

Tourette’s

Question 22

Dopamine hypersensitivity is likely the pathophys of what?

Answer 22

Tourette’s

Question 23

What group of meds is contraindicated in Tourette’s?

Answer 23

Stimulants

Question 24

Is restless leg syndrome (RLS) usually unilateral or bilateral?

Answer 24

Bilateral

Question 25

True or false: RLS may be related to circadian rhythm

Answer 25

True

Question 26

The Tx for Tardive Dyskinesia is immediate _____________ removal of offensive agent

Answer 26

gradual

Question 27

15-50% of patients on antipsychotics may develop what?

Answer 27

Tardive Dyskinesia

Question 28

True or false: Tardive Dyskinesia often causes permanent disability

Answer 28

True

Question 29

Most common type of dementia in the elderly is what?

Answer 29

Alzheimer's disease

Question 30

Describe the pathophys of Alzheimer's disease

Answer 30

1) Amyloid plaques, tau protein deposits, neuron tangles 2) APOE E3 gene

Question 31

+Kernig and Brudzinski signs and G– diplococci are characteristic of what?

Answer 31

Neisseria meningitidis (Meningitis- meningococcal)

Question 32

Lung, melanoma, breast are typically examples of what kind of tumors?

Answer 32

Metastatic

Question 33

What is the most common benign tumor?

Answer 33

Meningiomas

Question 34

Name a common cancer of the cerebral hemispheres

Answer 34

Gliomas; particularly glioblastoma

Question 35

Most glial cell tumors are malignant; list 3

Answer 35

1) Astrocytoma 2) Ependymoma 3) Oligodendroglioma

Question 36

What is the most common primary malignant brain tumor? (hint: has poor prognosis)

Answer 36

Astrocytoma grade four: Glioblastoma

Question 37

True or false: most neoplasms are sporadic

Answer 37

True

Question 38

Headache, nausea and vomiting, and seizures are the most common signs of what?

Answer 38

Increased IOP (secondary to brain tumor)

Question 39

New onset seizure is a major Sx of what?

Answer 39

Brain tumor

Question 40

Most common primary malignant brain tumor is what?

Answer 40

Astrocytoma/ tumors coming out of the glial/supportive cell tissue

Question 41

MRI with gadolinium is preferred for what?

Answer 41

Intracranial and spinal neoplasms; neuroimaging

Question 42

Characteristic appearance of _____________ on MRI is virtually diagnostic (typical site = coming from meninges)

Answer 42

meningiomas

Question 43

 What tumor is usually benign, grows very slowly on CN8, and can be diagnosed with MRI?

Answer 43

Schwannoma

Question 44

Metastatic intracranial tumors: 1) What is the most common source? 2) What are some other sources?

Answer 44

1) Lung 2) Melanoma, breast, etc (LaMB)

Question 45

The most common sources of _____________ metastasis in adults are carcinomas from LaMB (Lung, Melanoma, Breast)

Answer 45

intracranial

Question 46

List 5 brain tumor treatments

Answer 46

1) Shunting (for hydrocephalus) 2) Radiation and/or chemotherapy 3) Corticosteroids (for cerebral edema) 4) Anticonvulsants  5) Intramedullary cord lesions