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Test 7 Neuro Flashcards

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1
Q

Risk factors Migraines

A
  1. FH
  2. Obesity
  3. Sleep apnea
  4. Head injury
  5. Femlae
  6. Analgesic overuse
  7. Caffiene
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2
Q

Common migraine S/S

A
  1. Pulsatile, throbbing
  2. Unilateral
  3. Last hours to days
  4. N&V
  5. Photo & phonophobia
  6. Cutaneous allodynia
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3
Q

Aura

A

10-30 min before HA

  1. Scintillating scotomas
    - peripheral flashing lights in periphery
    - pale blind spot that enlarges
  2. Fortification spectrum
    - zig zagging lines
    - teichopsia
  3. Prodrome of inc. excitability/irritability, fatigue, depression, appetite inc./cravings
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4
Q

Basilar migraine

A
  1. Affects basilar artery
  2. HA
  3. Vertigo
  4. Slurred speech
  5. Impaired coordination
  6. NO MOTOR defecits
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5
Q

Hemiplegic migraine

A
  1. Familial
  2. Paralysis on one side of body
  3. May persist for 24h w/o HA
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6
Q

Ophthalmoplegic migraine

A
  1. HA
  2. Eye pain
  3. Vomiting
  4. Ptosis
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7
Q

Mirgainous carotidynia

A
  1. Face, jaw & neck tenderness & swelling over carotid artery
  2. Older Pts
  3. Normal carotid on US
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8
Q

Abdominal migraine

A
  1. No HA
  2. Vomiting
  3. GI pain
  4. Younger Pts
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9
Q

Catamenial migraine

A
  1. ONLY occur at menses
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10
Q

When to get CT w/ migraines

A
  1. 1st or worse migraine
  2. New >50
  3. Thunderclap HA
  4. Abnormal neuro exam
  5. Rapid onset w/ strenuous activity
  6. HA awakens from sleep
  7. Meningeal signs - vomiting, AMS, personality changes, stiff neck
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11
Q

Tx migraine

A
  1. Excedrin migraine & NSAIDS
  2. Triptans
    Dihydroergotamine
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12
Q

Antinausea for migraines

A
  1. Reglan
  2. Compazine
  3. Atarax
  4. Phenergan
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13
Q

When do you get rebound HAs & what causes them?

A

Overuse of meds >10days/mo

  1. Acetaminophen
  2. Narcotics
  3. ASA
  4. NSAIDS
  5. Ergot alkaloids
  6. Triptans

If overusing triptans, stop & use steroids

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14
Q

When do you start prophylactic migraine meds & what do you give?

A
  1. > 2 HAs/wk
  2. Severe
  3. Duration >2 days
    Continue for 2-3 mo then taper/DC
  4. Beta blockers
  5. Tricyclic antidepressants
  6. Anti-seizure meds (Depakote, Topamax)
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15
Q

Risk factors Cluster HAs

A
  1. Men
  2. 20-40 yo
  3. FH
  4. Tobacco
  5. Head injury
  6. Shift work
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16
Q

S/S cluster HA

A 
Excruciating, stabbing pain, unilateral, behind eye, jaw, teeth, 15min-3h 
Must have 1 of:
1. Lacrimation
2. Ipsilateral nasal discharge
3. Ipsilateral flushing/sweating
4. Conjunctival redness 
5. Horner's syndrome - ptosis, miosis
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17
Q

Tx Cluster HAs

A
  1. Triptans
  2. Oxygen

Prophylaxis:

  1. Verapamil
  2. Maybe steroids
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18
Q

S/S tension HAs

A

Myofascial origin

  1. Vice-like, gripping band HA
  2. Forehead-occiput bilat
  3. Radiates to posterior neck & trapezius
  4. Lasts 30mins-7days
  5. No N/V, photo/phonophobia, pulsatile, not worse w/ activity
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19
Q

Risk factors Tension HAs

A
  1. Stress/anxiety
  2. Depression
  3. Overwork
  4. Lack of sleep
  5. Posture
  6. Marital/family dysfunction
  7. Conversion
  8. Malingering
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20
Q

Tx Tension HAs

A
  1. Exercise
  2. Relaxation/Counseling/Yoga
  3. PT/acupuncture
  4. NSAIDS, tylenol
  5. Myofascial trigger point injections
  6. TCAs/SSRI
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21
Q

Causes & Risk factors Pseudotumor cerebri

A

aka idiopathic intracranial HTN

  1. Women 15-44
  2. Obese women
  3. Accutane
  4. Tetracyclines
  5. OCs
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22
Q

S/S pseudotumor cerebri

A
  1. Retro-orbital pain
  2. Worse w/ eye mvmt
  3. Throbbing
  4. Worse in am
  5. N&V
  6. Monocular/binocular vision loss
  7. Pulsatile tinnitus
  8. Neck pain
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23
Q

Dx pseudotumor cerebri

A
  1. Papilledema

2. LP - high opening pressure

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24
Q

Tx pseudotumor cerebri

A
  1. Wt loss
  2. Low Na diet
  3. Avoid sulfa meds
  4. Diuretics
  5. Steroids maybe
  6. NSAIDS/TCAs
  7. LP
  8. Surgery - optic nerve decompression, CSF shunt
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25
Risk factors & Triggers Trigeminal neuralgia
1. Women >40 2. MS 1. Washing face 2. Brushing teeth 3. Chewing 4. Cold air
26
S/S trigeminal neuralgia
1. R side more common 2. Stabbing/electric shock 3. Assoc w/ facial spasm 4. Attacks last <2 mins, dailry/monthly
27
Tx trigeminal neuralgia
1. Tegretol 2. Maybe other anti-seizure meds 3. Maybe baclofen, capsaicin, gamma knife, microvascular decompression
28
S/S concussion
1. Disorientation 2. Amnesia 3. Confusion - vacant state, delayed answers to questions, poor concentration
29
Grading concussions
1. Ding - confusion, no LOC, sxs 15 min | 3. LOC
30
Glasgow coma scale
1. Eye opening 2. Motor response 3. Verbal response Minor: 13-15 Moderate 9-12 Severe <8
31
Red flags of concussion
1. Mental status changes 2. LOC >60s 3. Pupillary asymmetry 4. Vision changes 5. Muscle/sensory deficits 6. Cerebellar dysfunction - gait/ataxia, finger to nose testing
32
When do you need a CT w/ concussion?
Seizure, neuro deficit, anticoagulants 1. Glasgow 60yo 5. Basilar skull Fx 6. Moderate pretrauma amnseia >15m 7. Drug/alcohol intox 8. High risk injury
33
S/S basilar skull Fx
1. Battles sign - mastoid process, ecchymosis 2. Raccoon eyes 3. Hemotympanum 4. CSF leakage via nose/ears
34
Steps to return to sports w/ concussions?
1. Asymptomatic & med free x24h 2. Nonimpact aerobic exercise to inc. HR x24h 3. Sport-specific light drills x24h 4. Non-contact training drills x24h 5. Full contact practice x24h 6. Return to play
35
S/S subdural hematoma
``` Bleeding btwn dura & arachnoid Tearing of the Bridging veins* 1. Confusion 2. Slurred speech 3. HA 4. Lethargy 5. LOC 6. N&V 7. Weakness ```
36
Tx subdural hematoma
Small - burr holes Large - craniotomy to evacuate clots
37
S/S & Tx epidural hematoma
``` Bleeding btwn dura mater & skull From trauma tearing of Middle meningeal artery* Biconcave lens on CT 1. Initial LOC 2. Then lucid Talk & die ``` Tx - surgical evacuation, ligate bleed
38
S/S subarachnoid hemorrhage
Bleeding into subarachnoid space - usually due to rupture of cerebral aneurysm 1. Thunderclap HA 2. N&V 3. Stiff neck 4. Confusion 5. Seizure 6. Xanthochromia
39
What is the most common type of stroke?
Ischemic
40
Risk factors of aneurysm
Usually develop at branching points of arteries 1. Old Black women 2. HTN 3. Straining 4. Cocaine/amphetamines 5. Blood thinners 6. Alochol
41
What is the most common site of aneurysm?
Anterior communicating artery
42
Management goals of hemorrhagic stroke
1. Lower BP 2. Monitor cardiac dysrhythmias 3. ICP monitoring 4. Normothermia
43
Causes of hemorrhagic stroke
1. HTN 2. Aneurysm 3. AV malformation
44
Causes of ischemic stroke
1. Thrombotic - atherosclerosis 2. Embolic - carotids & heart 3. Lacular infarct
45
Risk factors of ischemic stroke
1. HTN 2. Old Fat lazy blacks 3. FH 4. CAD 5. Smoking 6. Hypercholesterolemia/triglycerides 7. Aortic arch plaque 8. Migraine w/ aura in women >35 that smoke &/or use OCs
46
S/S TIA
Sudden onset of neuro deficit 1. Speech 2. Monocular blindness 3. Hemiparesis 4. Amaurosis fugax Sx resolve w/in 24h
47
How much of the carotid is occluded if you can hear a bruit?
50% Dx w/ ultrasoud or MRA Angiography Gold std but invasive
48
What are lacunar infarcts?
Occlusion commonly affecting caudate, thalamus & putamen
49
S/S Anterior cerebral artery occlusion
1. Confusion 2. Amnesia 3. Personality change 4. Cognitive changes 5. Contralateral hemiparesis 6. Contralateral sensory impairment 7. If left = expressive aphasia 8. Eyes deviate toward affected side
50
S/S Middle cerebral artery occlusion
MC embolus 1. Contralateral sensory/motor deficits 2. Head & eyes deviate towards infarct 3. Neglect to affected side 4. Dysphagia 5. Initially dec. muscle tone then spasticity develops 6. Homonymous hemianopsia 7. If L - global aphasia then Broca's aphasia
51
S/S posterior circulation infarct
1. Nystagmus 2. Ataxia 3. Vertigo 4. Dysphagia 5. Dysarthria 6. Sensory aphasia 7. Alexia
52
NIH stroke scale
``` 0: No stroke 1-4: Minor stroke 5-15: Moderate stroke 16-20: Mod-severe stroke 21-42: Severe stroke ```
53
When do you use TPA?
1. >18 2. NIH stroke scale 5 or + 3. <3h since onset of Sxs
54
Post CVA mgmt
1. Control BP, glucose, fever 2. Cerebal edema - mannitol, hyperventilation high risk of depression
55
Where is the most common site for bacterial meningitis?
Subarachnoid space
56
Where does bacterial meningitis usually come from?
1. Otitis media 2. Sinusitis 3. PNA 4. Immunocompromised
57
Organisms of bacterial meningitis
Infants - Group B beta-hemolytic strep & enteric gram - bacilli Kids - H. flu, N. meningitidis, S. PNA Adults 1. Strep pneumo 2. N. Meningitidis 3. Staph Old people - S. pneumo, E. coli, Klebsiella, listeria
58
S/S Bacterial meningitis
1. HA 2. Stiff neck 3. Fever 4. Photophobia 5. Kernig's sign 6. Brudzinski's sign 7. Skin rash w/ N. meningococcal (petechial)
59
Tx bacterial meningitis
1. Vanco + Ceftriaxone 2. Dexamethasone (steroid) If >50 Add ampicillin
60
Complications of bacterial menigitis
1. Cerebral edema 2. Vasculitis 3. Inc. ICP 4. Hydrocephalus 5. Seizures 6. DIC
61
Post exposure prophylaxis of bacterial menigitis
1. Rifampin 2. Cipro 3. Ceftriaxone
62
Causes of viral menigitis
Much more common but less deadly than bacterial Kids - Enterovirus, arbovirus, HSV, borrelia burgdoferi, coxsackie Adults 1. Enterovirus 2. HSV 3. Varicella-zoster
63
S/S viral meningitis
1. Flu-like Sx 2. HA 3. Fever 4. Malaise 5. Photophobia 6. Meningeal irritation
64
Who gets TB meningitis & Tx?
``` Immunocompromised Spreads from lungs Tx 1. INH 2. Streptomycin 3. Rifampin 4. Pyrazinamide ```
65
Who gets crytococcal meningitis & Tx?
``` Immunocompromised, DM Cranial nerve palsies LP - fungal Tx 1. Intrathecal amphotericin B ```
66
What is the MCC of encephalitis?
Herpes simplex 1. HA 2. Fever 3. Mental status changes
67
Dx & Tx HSV encephalitis
LP - PCR GOLD Std MRI - diffuse edema Tx - acyclovir, steroids maybe High risk of neuro defecits 1. Personality disorders/changes 2. Dementia 3. Aphasia 4. Memory problems
68
What is the leading cause of epidemic encephalitis?
Arbovirus Incubation - 2-18 days after mosquito bite, simmer-early autumn West Nile - severe in elderly
69
S/S Arbovirus encephalitis
1. Fever 2. Malaise 3. Fatigue 4. Weakness 5. HA, eye pain, N&V 6. Occipital LAN 7. Maculopapular rash 8. Conjunctivitis 9. Flushing
70
Dx & Tx arbovirus encephalitis
CBC - leukopenia LP - lymphocytosis, IgM ELISA (+8-21 days after onset) Tx - supportive
71
CMV encephalitis in HIV Pts
Retinitis Dx - LP - PCR Imaging - ring enhancing lesions Tx - ganciclovir & foscarnet
72
Other causes of encephatlitis
1. Rabies 2. Varicella zoster 3. EBV 4. Influenza 5. Lyme 6. Cat scratch disease 7. Rocky mountain spotted fever
73
S/S Stages of syphilis
1. Chancre - 21-90 days 2. Macular rash, 2-8wks 3. 1-20 years, CV, neuro
74
What is Tabes-dorsalis
Peripheral neuropathy from syphilis Inflammatory process involving dorsal root ganglion S/S 1. Lightning pains in abdomen & legs 2. Dec. proprioception 3. Dec. vibratory sense 4. Dec. DTRs 5. Argyll-Robinson pupil (accomodate but don't react)
75
What is Syphilic paresis
Frontal lobe dementia Emotional lability & memory issues Psychosis
76
Dx & Tx syphilis
LP - Fluorescent treponemal Ab test FTA-ABS Tx - PCN
77
Stages of brain abscesses
Cerebritis - abx/fungals 2 - walled off/organized abscess that begins to expand - need surgery
78
How to Tx fungal abscesses
Cryptococcus, coccidioides, Histoplaslma, Aspergillosis All Amphotericin B
79
What is the MCC of cerebral mass lesions in HIV Pts?
Toxoplasmosis CT - ring enhancing lesions Dx - IgG & IgM Long term Tx
80
Progressive Multifocal leukencephalopathy
Caused by JCV common in immunocompromised Demyelinating disorder Dx - LP PCR MRI - demyelinated white matter Tx - dec. immunosuppression SIGNIFICANT neuro dysfunction
81
What is the only proven cause of brain CA?
High dose ionizing radiation
82
S/S Brain CA
1. HA 2. Seizures 3. Cognitive/personality changes 4. Focal weakness 5. N&V 6. Speech difficulty 7. Visual changes 8. Papilledema 9. CN6 palsy 10. Gait disturbance
83
Types of benign tumors
1. Meningioma 2. Pituitary adenoma 3. Schwannoma 4. Craniopharyngioma
84
Types of malignant tumors
1. Gliomas 2. Astrocytoma 3. Glioblastoma 4. Oligodendroglioma 5. Pineal tumor 6. Medulloblastoma
85
What is the most common kid brain tumor?
Medulloblastoma
86
What is the most common type of brain tumor?
Meningioma More common in women Arise from the meninges in the arachnoid space CT - dura tail & indentation of brain
87
Grading of meningioma
I - Benign II - atypical, neither cancerous nor benign, grow faster & recur III - anaplastic - malignant & invasive
88
Tx meningioma
Watchful waiting Craniotomy Radiation - gamma knf=ife
89
Pituitary adenoma
MEN1 gene 1. Prolactinoma 2. Growth hormone 3. ACTH 4. Nonfunctioning (compress optic nerve) 5. LS/FSH 6. TSH
90
Craniopharyngioma
Pituitary tumor Compress optic nerve Inc. ICP
91
Craniopharyngioma vs. pituitary adenoma
C - arrise from cells in Rathke's duct P - arise from cells in anterior lobe
92
Acoustic neuroma & S/S
``` Tumor CN VIII, from Schwann cells Benign but can cause serious complications S/S usually unilateral 1. Hearing loss 2. Tinnitus 3. Vertigo Dx - CT Tx - Keyhole surgery ```
93
What is the most common type of glioma & grading?
``` Astrocytoma I - Pilocytic - benign II - Low grade - benign III - Anaplastic IV - Glioblastoma multiforme ```
94
Ependymoma
Block CSF flow - hydrocephalus More common in kids Cut it out, XRT
95
Oligodendroglioma
Graded 2-3 Slower growing than astrocytoma Watchful waiting, surgery & CRT High rate of recurrence
96
What is optic nerve glioma assoc w/?
Neurofibromatosis | May compress pituitary gland
97
Pineal tumor
``` Production of melatonin Hydrocephalus Grades Pineocytoma - benign Peneoblastoma - malignant ```
98
Medulloblastoma
Most common kids tumor Fast growing, high grade Tx - surgery, XRT, chemo
99
What CA most commonly metastasize to the brain?
Lung & breast
100
Neurofibromatosis
Type I - von Recklinghausen disease 1. 6 or + light brown spots (cafe au lait) 2. Freckles in unsual places (freckles & groin) 3. Colored bumps on iris (Lisch nodules) 4. Bony malformations 5. Aneurysm, HTN 6. Many develop gliomas Type II - usually don't have skin manifestations autosomal dominant
101
Risk factors for delirium
1. >60 2. Prior brain injury 3. Insomnia, sleep deprivation 4. Dec. visual/auditory function 5. Hospitalization 6. Polypharmacy 7. Poor nutritional status 8. Renal/hepatic failure 9. Alcoholism 10. Infection 11. Hypoxia, CHF, dehydration, MI 12. Metabolic imbalances 13. CVA, seizures
102
Presentation of dementia
1. New info difficult to learn & retain 2. Complex tasks hard to perform 3. Unable to solve simple problems 4. Get lost in familiar places 5. Difficulty expressing oneself 6. Irritable or aggressive behavior
103
Types of dementia
1. Cortical - alzheimers, metabolic 2. Subcortical - vascular dementia 3. Mixed - Parkinson's, Lewy body
104
Risk factors of Alzheimers
1. >65 2. Female 3. FH 4. Low edu level 5. Head trauma 6. Long standing HTN/MI 7. ApoE
105
Dx Alzheimers
1. Short term emory loss 2. Aphasia 3. Apraxia Dx of exclusion CT - cortical atrophy, volume loss medial temporal lobe PET - hypometabolism
106
Tx Alzheimers
1. Cholinesterase inhibitors - Aricept, Exelon, Razadyne | 2. NMDA receptor antagonist - Namenda
107
Risk factors multi infarct dementia
1. DM 2. CAD 3. HTN 4. CVA 5. Smoking 6. Men Alzheimer's meds not effective
108
S/S & Tx dementia w/ lewy bodies
1. Visual hallucinations - auditory, olfactory 2. Fluctuations in alertness & attention 3. Periods of staring into space 4. Men 1. Alzheimers meds 2. Parkinson meds 3. Maybe anti-psychotics
109
S/S Frontotemporal lobar degeneration
Picks disease - 40-70 yo, FH 1. Inappropriate behaviors & actions 2. Dec. empathy 3. Lack of judgement/inhibitions 4. Apathy 5. Repetitive compulsive behaviors 6. Lack of hygiene 7. Speech & language disorders 8. Mvmt disorders 9. Lack of awareness of behavioral changes
110
Tx Frontotemporal lobar degeneration
1. SSRIs 2. Antipsychotics 3. Alzheimers meds
111
Normal pressure hydrocephalus
Dec. CSF absorption due to scarring/fibrosis of arachnoid villus Ventricles become distended & compress the periventricular tissues/vessels Causes - Idiopathic, head injury, SAH, meningitis
112
S/S & Dx Normal Pressure Hydrocephalus
Can't think, can't walk, can't pee MRI - ventriculomegaly LP - Pressure at upper limits of normal Tx - shunt
113
S/S Vitamin B12 deficiency
1. Weakness 2. Sore tongue 3. Easy bruising, bleeding gums 4. Pallor 5. Paresthesias 6. Mood changes 7. Dementia/memory loss
114
S/S & Tx Wernickes-Korsakoff's disease
1. Ataxia 2. Confusion 3. Opthalmoplegia 4. Vertical & horizontal nystagmus 5. Short term memory loss 6. Confabulation Tx - Thiamine
115
S/S Progresive supranuclear palsy
Related to Parkinsons & FTLD 1. Blurred vision 2. Loss of balance 3. Stiffness & bradykinesia 4. Dysphagia 5. Dysarthria 6. Emotional labile 7. Apathy/depression Paralysis of vertical gaze*** Startled appearance
116
Tx progressive supranuclear palsy
1. Parkinson's meds for mvmt disorders 2. SSRIs 3. Alzheimers meds
117
What is a cryptogenic seizure?
Don't know what caused it
118
Causes of seizures
1. Brain tumor, CVA, trauma 2. Electrolyte abnormalities 3. Medication overdoses 4. Drug withdrawals 5. Drugs 6. Infection/fever
119
Risk factors for febrile seizure
1. Fever >38 2. Day care attendance 3. Developmental delay 4. Neonatal nursery >30days 5. FH 6. Viral infections 7. Vaccines 8. 6mo-5yrs
120
Risk factors for recurrent febrile seizures
1. Age <104F) | 4. 1st degree relative
121
Absence seizures
``` 5-18 yrs NO aura 1. Vacant, dazed expression 2. Pallor 3. Last 10 sec max, several times/day ``` Usually stop by age 20 Tx - Zarontin, Depakote
122
Generalized tonic clonic seizure S/S & Tx
aka Grand Mal 1. Aura 2. Tonic - muscular rigidity 3. Clonic - jerking 4. Incontinence 5. Tongue biting 6. Sudden LOC Tx - Depakote, Dilantin, Tegretol
123
What seizures have "drop attacks?"
Atonic | LOC, head drops, loss of posture
124
Simple partial seizures
1. Sensory weirdness 2. GI Sxs, flushing 3. Jerking limbs, paresthesias 4. Hallucinations, deja vu, jamais vu
125
Complex partial seizures
Most common 1. LOC 2. Temporal lobe - may travel to frontal 3. Aura - GI Sxs, sense of fear 4. Stare, automatisms 5. Lasts 30s-2 min 6. May progress to generalized tonic-clonic Tx - Tegretol, Dilantin Temporal lobe resection if no improvement w/ therapy
126
Rolandic epilsepy
``` Type of partial seizure that only occurs in kids S/S 1. Face/cheek twitching 2. Drooling 3. Difficulty speaking 4. Centrotemporal spikes on EEG 5. Often occur only during sleep ```
127
Gelastic/Dacrystic seizure
kids G - laughing D - crying
128
Status epilepticus
Life threatening!! Seizure that lasts >30min 2 or + seizures w/o recovery period Risk factors 1. Medication 2. Alcohol withdrawal 3. Drug OD 4. Intracranial infections 5. Cancer
129
Tx status epilepticus
1. Lorazepam/diazepam | 2. Check glucose
130
Can you use valproate or carbamazepine in pregnant ladies?
No mammary glands
131
What are pseudoseizsures?
``` aka psychogenic nonepileptic seizure Common in females, anxiety attacks, PTSD, conversion disorder 1. Nonfocal - opposite arm/leg 2. Pelvic thrusting 3. Head turning side to side 4. Eyes closed tight 5. Tongue biting limiting top 6. Postictal crying 7. Memory of the event 8. May be triggered by emotional/stressful situations ```
132
When do you stop/taper seizure meds?
1. Seizure free for 2 years 2. Normal EEG No driving w/in 6 mo from last seizure
133
Drugs that can cause Parkinsonism
1. Antipsychotics (Halidol) | 2. Metoclopramide
134
S/S Parkinsons
1. Rest tremor - Pill rolling 2. Rigidity - cogwheeling & lead pipe resistance 3. Bradykinesia - micrographia, slow, shuffling gait
135
Tx Parkinsons
1. Levodopa/carbidopa side effects - dyskinesias/choreiform mvmts
136
Benign essential tremor
Onset 20-60 yo Autosomal dominant 1. Action tremor - affects hands & head Exacerbated by stress/fatigue/stimulants Alleviated by alcohol & rest
137
Tx Benign essential tremor
1. Beta-blockers | 2. Anticonvulsant (Mysoline)
138
Huntington's chorea
``` Mid-life onset, autosomal dominant 1. Failing memory 2. Restlessness 3. Lack of initiative 4. Choreiform mvmts 5. Mental decline/dementia No Tx ```
139
Restless legs causes
1. Women 2. Idiopathic 3. Iron deficiency anemia 4. Pregnancy 5. Hypothyroidism 6. DM 7. Meds - SSRIs 8. Caffeine 9. Smoking
140
Tx Restless legs
1. Dopamine agonists | Mirapex, Requip
141
Upper motor neuron diseases & S/S
1. MS 2. CVA 3. Traumatic brain injury 4. Cerebral palsy 5. ALS 1. Muscle weakness 2. Dec. motor control 3. Spasticity 4. Hyperreflexia 5. Babinskis
142
Lower motor neuron diseases & S/S
1. Progressive bulbar palsy 2. Bell's palsy 3. ALS 1. Paralysis 2. Atrophy 3. Fasciculations 4. Loss of reflexes
143
Progressive bulbar palsy
1. Lower motor neurons, CN 2. Progressive paralysis - V, VII, IX, X, XII 3. Drooling, chewing, dysphagia, dysarthria 4. Progresses to aspiration PNA 1-3yrs
144
Pseudobulbar palsy
Uncontrollable crying or laughing outbursts
145
Amyotrophic lateral sclerosis
aka Lou Gehrigs disease 30-60 yo 1. Muscle aches/cramps 2. Weakness, distal upper limbs & progresses inferiorly 3. Dysarthria, dysphagia, spasticity, hyperreflexia 4. Muscle fasciculations*
146
Dx & Tx ALS
EMG Riluzole
147
Risk factors Multiple sclerosis
1. White females 2. Richer people 3. Northern latitude 4. 15-60yo
148
Types of MS
1. Relapsing remitting 2. Secondary progressive 3. Primary progressive 4. Progressive relapsing
149
Optic neuritis
``` Usually unilateral Acuity 20/100 Onset hours to days 1. Optic nerve pallor 2. Pain w/ EOM ``` Have 50% chance of developing MS w/in 5 years
150
S/S MS
1. Sensory loss 2. Optic neuritis 3. Weakness 4. Paresthesias 5. Dysarthria 6. Dec. pain, vibration & position sense 7. Ataxia 8. Horizontal nystagmus 9. Inc. DTRs, spasticity, Babinski, ankle clonus
151
Dx MS
1. MRI - spotty, irregular demyelination 2. LP - Oligoclonal bands* 3. anti-MOG 4. anti-MBP
152
Tx MS
1. Steroids 2. Betaseron, Avonex, Rebif, Copaxone 3. Symptomatic Tx
153
Guillan Barre S/S
Progressive symmetrical weakness Usually from antigen mimicry Acute inflammatory demyelinating polyradiculoneuropathy mostcommon 1. Proximal muscle weakness 2. Legs then arms 3. Myalgias - shoulder,back, thighs 4. Paresthesias 5. Dec. DTRs
154
Common causes of Guillan Barre
1. C. Jejuni 2. EBV 3. Mycoplasma 4. H flu 5. CMV 6. VZV Vaccinations - H1N1, tetanus, hepatitis
155
Dx & Tx Guillan Barre
LP - Inc. protein, EMG Supportive Tx
156
Chronic idiopathic demyelinating polyneuropathy
Chronic form of Guillan Barre Symptoms >8wks Dx - LP, EMG, nerve Bx Tx - steroids, IVIg
157
Myasthenia gravis
Neurmuscular autoimmune disease 1. Proximally asymmetric limb weakness 2. CN weakness 3. Lid lag, ptosis, diplopia 4. Facial weakness, slurred speech 5. Easy fatigueability Often get thymoma
158
Dx Myasthenia Gravis
1. ACh receptor Abs 2. Anti-MuSK 3. EMG 4. Tensilon blocks
159
Myasthenia Gravis Tx
1. Mestinon 2. Immunosuppression 3. IVIg 4. Thymectomy
160
Complication of myasthenia gravis
Myasthenia crisis 1. Paralysis of respiratory muscles 2. Aspiration
161
Risk factors of postherpetic neuralgia
Persistent pain in dermatomal distribution 1. Age 2. Female 3. Severe rash, pain at outbreak 4. Zoster ophthalmicus Tx pain
162
S/S RSD
Relfex Sympathetic Dystrophy 1. Skin color changes 2. Temp 3. Swelling 4. Tremor/mvmt disorder 5. Pain 6. Changes in nail/hair growth Tx - symptomatic & rehab

Clinical Medicine (11 decks)

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