• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/228

Click to flip

228 Cards in this Set

  • Front
  • Back
What characterizes Alzheimer's Disease?
Atrophy of the cerebral cortex
In Alzheimer's disease, what does a CT show?
widening of the sulci, shrinking of the cerebral cortex, enlargement of the ventricles, and degeneration of the hypocampus
Is consciousness preserved in dementia?
Yes
What is the tau hypothesis?
the idea that tau protein abnormalities initiate the Alzheimer's disease cascade.
Eventually they form neurofibrially tangles inside nerve cell bodies.
This results first in malfunctions in biochemical communication between neurons and later in the death of cells.
What is the number one cause of dementia?
Alzheimer's Disease
What are the strongest two risk factors for developing Alzheimer's Disease?
1. Age
2. Having a close relative that has been affected.
Pick's Disease, Parkinson's Disease, Chronic alcohol abuse, depression, and infection are examples of a differential diagnosis for what disease?
Alzheimer's Disease
What are some signs and symptoms of Alzheimer's Disease?
1. Recent memory loss
2. Forgetting how to do simple tasks
3. Problems with language
4. Becoming confused in familiar surroundings or losing a sense of time.
5. Difficulty calculating numbers.
6. Becoming passive or reluctant in getting involved in activites.
7. Rapid, unexplained mood swings.
8. Agitation, Accusations, Delusions, and Unpredictability
What is the definitive diagnosis for Alzheimer's Disease?
Brain Biopsy
What are the labs/tests you would do if you suspected Alzheimer's Disease?
CBC, BMP, TSH, B-12/Folate level, RPR, UA
CT without contrast, MRI
CSF for amyloid beta or tau proteins
Neuropsychological testing, SLUMS, MMSE clock test
True of False: Alzheimer's can be cured.
False: treatment is palliative.
What is the standard of treatment for Alzheimer's patients?
Cholinesterase (ChE) inhibitors:
Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) -- for mild to moderate AD
Which cholinesterase inhibitor can be used in moderate to severe Alzheimer's Disease?
Donepezil (Aricept)
True of False: NMDA antagonists can be combined with cholinesterase inhibitors for the treatment of Alzheimer's.
True: the two work very differently and can be prescribed in combination.
How does memantine (Namenda) work?
regulates glutamate, which in excess can lead to brain cell death
Other than cholinesterase inhibitors and Namenda, what else can be used to treat Alzheimer's Disease?
Anti-inflammatories, Statins, natural Vitamin E, and antidepressants for associated depression.
What can be used to treat the agitation associated with Alzheimer's Disease?
Valproic Acid (Depakote)
What is "sundowning?"
an increasingly agitated, confused and restlessness that occurs toward the end of the day.
What is the etiology of a cerebral aneurysm?
a weakness in the wall of an artery or vein of the brain, causing weakness and dilation of that locale.
What is the most common area for a cerebral aneurysm to develop?
the anterior part of the Circle of Willis, (and involve the internal carotid arteries and their major branches that supply the anterior and middle sections of the brain).
Other than cholinesterase inhibitors and Namenda, what else can be used to treat Alzheimer's Disease?
Anti-inflammatories, Statins, natural Vitamin E, and antidepressants for associated depression.
What can be used to treat the agitation associated with Alzheimer's Disease?
Valproic Acid (Depakote)
What is "sundowning?"
an increasingly agitated, confused and restlessness that occurs toward the end of the day.
What is the etiology of a cerebral aneurysm?
a weakness in the wall of an artery or vein of the brain, causing weakness and dilation of that locale.
What is the most common area for a cerebral aneurysm to develop?
the anterior part of the Circle of Willis, (and involve the internal carotid arteries and their major branches that supply the anterior and middle sections of the brain).
What are some causes of cerebral aneurysms?
congenital defects, hypertension and atherosclerosis, or head trauma
Are cerebral aneurysms more common in men or women?
Women, by a ratio of 2:1
What are the classifications of cerebral aneurysms?
Small: diameter < 15mm
Large: diameter 15 - 25mm
Giant: 25 - 50mm

Saccular: saccular outpouching
Berry: have necks or stems resembling a berry
Fusiform: without stems
What is the most common form of cerebral aneurysm?
Saccular aneurysm
What are the signs and symptoms of a cerebral aneurysm?
A small aneurysm will produce no to little symptoms.
Before a large aneurysm ruptures, patient may have sudden or unusually severe headache, nausea, vomiting, vision impairment, vomiting, and loss of consciousness.
True or False: Patients with large aneurysms will always experience symptoms.
False: An individual may be asymptomatic.
What does a ruptured cerebral aneurysm cause?
a subarachnoid hemorrhage or intracranial hematoma (both which constitute a stroke).
How do you diagnose a cerebral aneurysm?
A CT scan or MRI is usually the first step.
Cerebral angiogram (Gold Standard)
How do you treat a cerebral aneurysm (not including surgery)?
ABC's
Minimize External Stimulation
Control blood pressure
Nimodepine (CCB) to prevent vasospasm
Monitor for hypertension, hypervolemia, hemodilution
What types of surgery are offered for treatment of cerebral aneurysm?
Microvascular Clipping: cutting off the flow of blood to the aneurysm by clipping the aneurysm's neck.
Occlusion: clamping off the entire artery that lead to the aneurysm.
What is the prognosis for a patient with a ruptured cerebral aneurysm?
45% mortality rate: 10% die before reaching the hospital
What is a serious complication of a cerebral aneurysm?
Secondary vasospasm: occurs in 30% of cases. Presents 4 - 14 days after SAH.
Results in increased ICP, HA, brain ischemia.
10% mortality rate
What is the most common type of stroke?
ischemic stroke
What causes an ischemic stroke?
Thrombosis of an atherosclerotic vessel
Embolism secondary to A-Fib
Small vessel lacunar infarct (HTN, DM)
What are two types of hemorrhagic strokes?
Intracranial hemorrhage
Subarachnoid hemorrhage
What are some risk factors for stroke?
Increasing age
A-fib
Hypercoagulable states
HTN
DM
Smoking
Atherosclerosis
TIA
Prior stroke
Inactivity
Recent MI
A patient presents with unilateral paralysis with language and visual disturbances. What do you do first? What do you suspect?
A stroke.
An emergent CT to rule out hemorrhage.
Then cardiac workup, carotid US, MRA, CBC, BMP, lipids, Uric acid, Thyroid panel, EEG.
What symptoms would a vertebro-basilar stroke most likely present with?
Visual, CN deficits, EOMS, coordination, altered consciousness
When would you use rTPA?
within 3 hours hours of the onset of symptoms and hemorrhagic stroke has been ruled out.
What is a TIA?
a temporary disturbance of blood supply to an area of the brain, which results in a sudden, brief decrease in brain function.
How does a TIA differ from a small stroke?
symptoms of a TIA resolve before 24 hours, usually less than 1 hour.
TIA's do no show lasting changes on CT or MRI
What can cause the loss of blood flow in a TIA?
Narrowing of a blood vessel, blood clot, or injury to the blood vessel.
True or False: Patients who experience TIA's rarely progress to a full stroke.
False: TIA's are warning that a true stroke may happen. Approximately 80-90% of people who have a stroke due to atherosclerosis had a previous TIA.
What are the signs and symptoms of a TIA?
Numbness, tingling
Weakness
Speech difficulty
Vision changes
Loss of balance
Lack of coordination
You suspect a patient suffered from a TIA. What do you do next?
PE: listen for bruits, murmurs, arrhythymias
Labs: CBC, Lipids, Glucose, ESR, CXR, RPR
Radiology: Cerebral angiogram, head CT or MRI, carotid doppler, CXR
Cardiac: EKG
How do you treat a TIA?
Control underlying disorder:
Control blood pressure
Use blood thinners: aspirin MC
True or False: A TIA needs to be treated as aggressively as a stroke would.
True: any given TIA could develop into a stroke.
What is cerebral palsy?
an umbrella term encompassing a group of non-progressive, non-contagious conditions that cause physical disability in human development.
True or False: Cerebral Palsy is primarily a behavioral problem.
False: It is predominantly a motor deficit, but it can also encompass learning difficulties, behavioral problems, and epilepsy.
When does cerebral palsy most commonly occur?
during pregnancy (75%)
With premature or low-weight babies, does the incidence of cerebral palsy increase or decrease?
Increases, regardless of quality of care.
What are the risk factors for cerebral palsy?
Prematurity
Fetal hypoxia or infection
Twins
Maternal and Paternal age
Traumatic delivery
Preterm: hypoxia, hypoglycemia, cerebral hemorrhage or ischemia
Full Term: infection, trauma, kernicterus
What is the most common form of cerebral palsy?
Spastic
What are the signs and symptoms of spastic cerebral palsy?
congenital spastic paraparesis, sometimes with shortening and deformity of the legs, contributing to walking difficulty.
Upper limbs mostly spared.
May have hand clumsiness.
What causes ataxic cerebral palsy?
damage to the cerebellum
What are the signs and symptoms of ataxic cerebral palsy?
Hypotonia and tremors
Motor skills, balance, and walking can be affected
Visual and/or auditory processing of objects.
What are the signs and symptoms of athetoid/dyskinetic cerebral palsy?
Features mixed muscle tone (hypo/hypertonia)
Hypotonia usually occurs before 1 year old; the muscle tone with be increased with age and progress to hypertonia.
Have trouble holding themselves in an upright, steady position for sitting or walking
Often show involuntary movement.
What treatment is used for cerebral palsy?
physical therapy
occupational therapy
speech therapy
orthopedic intervention
drugs to control seizures, alleviate pain, or relax muscle spasms.
What is Bell's palsy?
idiopathic unilateral lower motor neuron facial paralysis ( CN-VII)
What is associated with Bell's palsy?
with viral or post-viral illness.
some evidence for involvement with Herpes Simplex Virus.
What are the signs and symptoms of Bell's palsy?
Smoothing out of the forehead
Eyebrow droop
Drooping of the corner of the mouth
How do you treat Bell's palsy?
corticosteroids and anti-viral drugs
must be within 48 hours
Can Bell's palsy resolve on its own?
Yes. Most people spontaneously recover. Many show signs of improvement as early as ten days after the onset.
What is the definition of peripheral neuropathy?
diabetes after exclusion of other causes
What are the signs and symptoms of peripheral neuropathy?
Negative sensory symptoms: numbness or deadness (akin to wearing gloves), loss of balance, especially when eyes are closed, and painless injuries.
Positive symptoms: burning, prickling pain, tingling, electric shock-like feelings, aching, tightness, or hypersensitivity to touch
Motor: impaired fine hand coordination, foot slapping, toe scuffing, frequent tripping.
Autonomic: sudomotor, pupillary, cardiovascular, urinary, GI, and sexual.
How do you diagnose peripheral neuropathy?
Diagnosis of exclusion (thyroid problems, anemia, B12 deficiency, alcoholism, nutritional deficits, lupus...)
PE: assess patient's reflexes, ability to feel light touch, and ability to feel vibration.
How do you treat peripheral neuropathy?
Tight glucose control
Tricyclics
Antiepileptic drugs (gabapentin, Valproic acid, Topiramate)
SSRI (Effexor and Symbalta)
Opoids (with extreme caution)
True or False: Smoking seems to contribute to peripheral neuropathy.
True: 62% of patients with diabetic peripheral neuropathy smoked cigarettes compared with 33% of patients who didn't smoke.
What is Guillain-Barre Syndrome?
a rare disorder in which the body's immune system attacks part of the peripheral nervous system.
When does Guillain-Barre syndrome occur?
a few days or weeks after the patient has had symptoms of a respiratory or GI viral infections.
Occasionally surgery or vaccinations will trigger the syndrome.
What are the signs and symptoms of Guillain-Barre syndrome?
weakness and tingling sensations of the legs
abnormal sensations spread to arms and upper body and have cranial nerve involvement
labile blood pressure and cardiac dysrhythmias
When does Guillain-Barre syndrome become an emergency?
when it spreads to the respiratory muscles
How do you diagnose Guillain-Barre syndrome?
PE: flaccid paralysis of the limbs, lost tendon reflexes, minor sensory losses.
Lumbar puncture: increased CSF proteins
EMG can confirm a demyelinating neuropathy
How do you treat Guillain-Barre syndrome?
ICU with ventilation
NG feeding
Cardiac support
Renal support

Plasmapheresis- reduces the severity and duration
High-dose Ig Therapy
What is the prognosis for Guillain-Barre syndrome?
90% of patients are at their weakest by the third week.
Recovery period may be weeks to years.
True or False: All Guillain-Barre patients will make a full recovery with no lasting effects.
False: 30% of patients still have residual weakness after three years. And about 3% will suffer a relapse of muscle weakness.
What is myasthenia gravis?
an autoimmune disorder caused by circulating antibodies that block acetylcholine receptors at the post-synaptic neuromuscular junction.
What is myasthenia gravis associated with?
Thyrotoxicosis, D-penicillamine use, RA, and SLE
What are the signs and symptoms of myasthenia gravis?
Weakness: especially following activity, weakness of the respiratory muscles, diplopia and ptosis, difficulty swallowing and chewing, limb weakness.
Fatigability: Better in the morning, worse at the end of the day. Improves with rest
How do you diagnose myasthenia gravis?
clinically, based on history, physical, and anticholinergic challenge test.
EMG, CT (rule out thymoma), TSH
What syndrome do you want to rule out with myasthenia gravis?
Eaton-Lambert Syndrome (antibodies to calcium channel receptors)
A thorough PE for myasthenia gravis includes what?
Looking upward and sidewards for 30 sec: ptosis and diplopia
looking at feet while lying on back for 60 sec
10 deep knee bends
walking 30 steps on both toes and heels
5 situps
How do you treat myasthenia gravis?
Anticholinergic drugs (pyridostigmine)
Immunosuppression
IVIG and/or plasmapheresis
Thymectomy - may be curative
Avoid beta-blockers, sedatives, aminoglycoside
True or False: Myasthenia Gravis is a progressive disease with worsening symptoms over time.
False: it is usually not progressive and for some, the symptoms decrease after 3-5 years.
True or False: Multiple Sclerosis usually presents in older adults.
False: It is a disease of young adults.
What is the most common form of Multiple Sclerosis?
Relapsing-Remitting MS
Which type of MS is a continuous, gradual decline in a patient's physical ability from the onset?
Primary-Progressive MS
What is usually the first symptom in MS?
visual disturbances (blurred vision, red-green distortion, or sudden monocular blindness), but they usually subside.
What are some common signs and symptoms of Multiple Sclerosis?
muscle weakness, muscle spasms, fatigue, numbness, and prickling pain.
There may be a loss of sensation, speech impediment, tremors, or dizziness.
What are some mental changes that occur in MS?
Decreased concentration
Attention Deficits
Degrees of Memory Loss
Inability to perform sequential tasks
Impairment of Judgement
Do MS patients experience decreased or increased reflexes?
Increased.
What is Lhermitte Sign and what disease is it present in?
Sensation of electricity down the back upon neck flexion; Multiple sclerosis
What test is the most sensitive in diagnosing Multiple Sclerosis?
MRI with IV gadolinium
How do you treat MS?
Interferon B and Glatiramer reduce relapse, frequency and intensity.
Corticosteroids are useful in some relapses.
Natalizumab (Tysabri)
Mitoxantrone (Novantrone) - chemotherapy drug usually reserved for more advanced cases of MS due to the side effects
Natalizumab (Tysabri), a drug for MS, can cause what potentially fatal disease?
Progressive multifocal leukoencephalopathy (PML)
What is the prognosis for MS?
It waxes and wanes.
It is relapsing and remitting.
Symptoms always vary greatly from patient to patient.
True or False: Essential Tremor is most often caused by an underlying condition.
False: By definition, essential tremor isn't caused by other diseases or conditions.
A 70 year old women presents with tremor in her hands, worsened with movement. It has gotten progressively worse over the last year. Is this more characteristic of Parkinson's Disease or Essential Tremor?
Essential Tremor
What are the signs and symptoms of essential tremor?
Begins gradually
Worsens with movement
Occur in the hands first, affecting one or both.
Can include a "yes-yes" or "no-no" motion of the head
Are aggravated by emotional stress, fatigue, caffeine, or extremes of temperature
In what ways do essential tremor and Parkinson's Disease differ?
Essential tremor - worsen with movement; doesn't cause other health problems; involves hands, head, and voice.
Parkinson's - worse when at rest; is associated with a stooped posture, slow movement, and shuffling gait; affect hands, but not head or voice
What causes essential tremor?
appear to occur because of a genetic mutation
What are complications of essential tremor?
difficulty:
holding a cup or glass without spilling
eat normally
put on make-up or shave
talk
write
How do you diagnose essential tremor?
Diagnosis of exclusion:
Neurological exam - tendon reflexes, muscle strength and tone, sensations, posture, and coordination
Labs - Blood and urine for thyroid disease and drug side effects
How do you treat essential tremor?
Beta-blockers: propanolol (Inderal), atenolol, metoprolol, and nadolol.
Antiseizure: primidone (Mysoline), gabapentin (Neurotin), and topiramate (Topamax)
Transquilizers: diazepam (Valium) and alprazolam (Xanax)
Botox Injections
Deep Brain Stimulation
What is Huntington's Disease?
a progressive, degenerative disease that causes certain nerve cells in the brain to waste away.
Is Huntington's autosomal dominant or autosomal recessive?
Autosomal dominant: only one copy of the defective gene is necessary to produce the disease
How does the Huntington's gene affect the brain?
It interacts with another protein to disturb the way that cholesterol accumulates in the brain.
What are early signs and symptoms expressed in patients with Huntington's Disease?
Personality changes, decreased cognitive ability, depression, irritability, and memory problems.
Mild balance problems, clumsiness and involuntary facial movements.
As Huntington's Disease progresses, what signs and symptoms might they experience?
Chorea throughout the body
Severe problems with balance and coordination
Difficulty shifting gaze without moving your head
Hesitant, halting, or slurred speech
Swallowing problems
Dementia
How do you diagnose Huntington's Disease?
Physical Exam
CT/MRI
Blood Test for defective gene
What is the definitive test for Huntington's?
A blood test for the defective gene.
How do you treat Huntington's?
No treatment can stop or reverse Huntington's.
Tranquilizers: Clonazepam (Klonopin)
Antipsychotics
Speech and physical therapy
When does death usually occur with Huntington's patients?
10-30 years after signs and symptoms first appear
What causes the symptoms of Parkinson's Disease?
the loss of pigmented dopamine-secreting cells in the substantia nigra
In regards to Parkinson's Disease, what does the direct pathway facilitate? The indirect?
the direct facilitates movement while the indirect inhibits movement. Thus the loss of these cells leads to a hypokinetic movement disorder.
How is the diagnosis of Parkinson's disease made?
On history and physical exam.
What is the diagnostic criteria for Parkinson's Disease?
at least two of the three cardinal symptoms:
Tremor, slowing of motion, and muscle rigidity.
What are the signs and symptoms of Parkinson's Disease?
Shuffling of the feet and lack of swing in the arms.
Tremor, slowing of motion, and muscle rigidity.
Onset of symptoms unilateral.
Tremor more pronounced at rest.
What is the most effective drug in treating Parkinson's?
Levodopa
How do you treat Parkinson's Disease?
Levodopa
Levodopa with Carbidopa (Sinemet)
Dopamine Agonists: pramipexole (Mirapex) and ropinirole (Requip) and bromocriptine
MAO B Inhibitors: selegiline (Eldepryl) and rasagiline (Azilect)
Catechol O-Methyltransferase (COMT) Inhibitors: tolcapone (Tasmar) and Entacapone (Comtan)
Anticholinergics: trihexyphenidyl and benztropine (Congentin)
Antivirals: amantadine (Symmetrel)
Physical Therapy
Surgery
How does Carbidopa work in Parkinson's?
It prevents the premature conversion of levadopa to dopamine outside the brain.
How do MAO B Inhibitors work in Parkinson's patients?
help prevent the breakdown of both naturally occurring dopamine and dopamine formed from levodopa.
Many side effects and drug interactions
How do the COMT inhibitors work in Parkinson's patients? What are the agents and side effects?
They prolong the effect of carbidopa-levodopa therapy by blocking an enzyme that breaks down levodopa.
Tolcapone (Tasmar) is linked to liver failure.
Entacapone (Comtan) doesn't cause liver problems; can be combined with carbidopa and levodopa in a med called Stalevo.
What is the role of anticholinergics in Parkinson's Disease?
help to control the tremor.
Many side effects. Dangers in elderly.
What is the role of antivirals in Parkinson's?
may provide short-term relief in mild, early stage Parkinson's Disease.
Can provide relief from dyskinesia from the levodopa.
The progression of symptoms in Parkinson's Disease may take how long to be fatal?
20 years or more
What are some risk factors for seizures?
family history of epilepsy, head injury, or other condition that causes damage to the brain.
What causes partial seizures?
results from discharge within a particular brain region and manifests with focal symptoms.
Where do generalized seizures begin?
in the thalamus and other subcortical structures.
What do generalized seizures look like on an EEG?
appear to start simultaneously in both hemispheres.
may manifest symptoms bilaterally in the body and are ALWAYS associated with loss of consciousness.
How do simple partial symptoms present while awake?
Preserved consciousness
Sudden unexplained feelings of fear, anger, sadness, joy or nausea.
Unusual feelings or sensations.
Altered senses
Depersonalization
Spatial Disorientation
Labored or difficult speech.
Feelings of Deja vu
How do simple partial seizures present while asleep?
Onset usually in REM sleep
Dream-like state
Appear conscious
Hallucination and/or delusions
Complete amnesia
How are simple partial seizures classified?
based on the type of symptoms:
1. Motor
2. Sensory (smells, clickings, ringing, voices, pins and needles, illusions)
3. Autonomic (changes in pulse, RR, sweating)
What part of the brain do complex partial seizures usually begin?
in the temporal or frontal lobe.
What do temporal lobe seizures usually start with?
Auras
Moving their mouth, picking at the air or clothing, or performing other purposeless actions during a complex partial seizure is called what?
automatisms
How long do simple partial seizures typically last? complex partial seizures?
less than 2 minutes; usually between 30 seconds and 2 minutes.
What type of partial seizure involves a loss of consciousness?
complex partial seizure
What are the three main types of generalized seizures?
1. Tonic/Clonic
2. Absent seizures
3. Moclonic seizures
What are some prodromal symptoms of a Tonic/Clonic seizure?
mood changes, sleep disturbances, lightheadedness, anxiety, irritability, difficulty concentrating
Which phase of the Tonic/Clonic seizure is usually the shortest?
the tonic phase
Which stage of the tonic/clonic seizure has convulsions?
the clonic phase
What age do absence seizures usually begin?
between 4-14
True or False: Children with absence seizures have a higher rate of behavioral, educational, and social problems.
True.
By what age to absence seizures usually stop?
18 years
True or False: Children who begin having absence seizures before the age of 9 are less likely to outgrow them.
False: Children who develop absence seizures before the age of 9 are much more likely to outgrow them than children whose Absence Seizures start after age 10.
Absence Seizures are also known as what?
generalized non-convulsive seizures
What are the signs and symptoms of Absence Seizures?
brief episodes of staring
awareness and responsiveness are impaired
there is no warning before the seizure
eye blinks, fast tasting movements, rubbing the fingers together
True or False: Myoclonic seizures affect only one side of the body.
False: Myoclonic Seizures usually cause abnormal movements on both sides of the body at the same time.
What parts of the body do Juvenile Myoclonic Seizures usually involve?
the neck, shoulders, and upper arms.
When does Lennox-Gastaut Syndrome usually begin? What parts of the body does it involve?
begins in early childhood.
involves the neck, shoulders, upper arms, and often the face.
What is progressive myoclonic epilepsy?
This rare syndrome is caused be a variety of genetic disorders and features a combination of myoclonic seizures and tonic/clonic seizures.
What is the prognosis for Juvenile Myoclonic Seizures? Lennox-Gastaut Syndrome? Progressive Myoclonic Epilepsy?
these seizures can be well controlled with lifelong medications
can be strong and difficult to control
treatment is not successful for very long, as the patient deteriorates over time.
What is status epilepticus?
When seizures occur one after another with no recovery period between.
When is status epilepticus a medical emergency?
when it occurs with tonic/clonic seizures
When is surgery indicated for seizures?
for early treatment of Lennox-Gastaut
When is diet modification used for treatment of seizures and how does it work?
It's used for patients who cannot tolerate AED's or when seizures are not completely responsive to medications.

Ketogenic Diet: low carb/high fat
Results in persistant ketosis
True or False: Ketogenic Diet is used most often in children and is most beneficial to children.
True
When do you use Vagal Nerve Stimulation for treatment of seizures?
for the treatment of intractable partial seizures
(attaches to the left branch of the Vagus nerve)
What drugs can be used for treatment of Simple or Complex Partial Seizures?
Carbamazepine
Oxcarbazepine
Phenytoin
Valproate
Lamotrigine
What drugs can be used for treatment of Tonic/Clonic Seizures?
Carbamazepine
Oxycarbazepine
Phenytoin
Valproate
What drugs can be used for treatment of Absence seizures?
Ethosuximide
Valproate
What drugs can be used for treatment of Myoclonic seizures?
Clonazepam
Valproate
In MS, is cognitive function harmed or spared?
Spared
Which of the following is not a med to treat alzheimers?
a. Galantamine
b. Donepezl
c. Propoxephrene
d. Memantine
c. Propoxephrene
True or False: The MC type of stroke is ischemic.
True
Myasthenia gravis is an autoimmune disease caused by development of antibodies to acetylcholine receptors on PRE or POST synaptic intramuscular junction?
Post-synaptic
The mc type of cerebral palsy is the ___Type
Spastic
True or False: AB are the treatment of choice for Bell’s palsy.
False: Antivirals and corticosteroids.
On PE , you found flaccid paralysis with nearly absent tendon reflexes such as knee jerks…what is it?
Guillain-Barre
Who is more affected by MS?
Females
True or False: Approximately 85% of cerebral aneurysms develop in posterior circle of willis
False: Anterior Circle of Willis
True or False: Peripheral neuropathy affects sensory and autonomic but spares the motor nerves.
False: It affects all three.
True or False: Huntington's disease will terminate in dementia?
True
True or False: Parkinson’s Disease is result of DOPAMINE depletions in substantia nigra?
True
True or False: Parkinson’s disease will terminate in dementia.
True
True or False: A complex absent seizure is one in which the patient loses consciousness.
False: Although a patient may briefly lose consciousness in absence, it means a change in muscle activity
Alcoholic are at greatest risk from a seizure how many hours after the last drink? 6-12 - 24 - 48
48 hours
What is the combo of myoclonic seizures AND tonic/clonic seizures called?
Progressive Myoclonic Epilepsy
A myoclonic seizure that affects the Head/shoulders/neck and face is called….
Lennox-Gastaut Syndrome
True or False: Anticholinergic drugs should be avoided in Parkinson’s pts bc they worsen the disease?
False: they are benefitial but used with caution in elderly
Name 2 classes of meds that could successfully treat essential (familial) tremor.
Anticonvulsants, Benzodiazepam, Botox
True or False: Huntington’s disease is caused by a gene that affects how acetylcholine is produced in the brain.
False: It affects how cholesterol is deposited in the brain.
What causes a secondary headache disorder? How do you treat it?
an identifiable cause, structural or inflammatory; treatment of the cause often results in the resolution of the headache.
What are the two theories on the cause of primary headaches?
Vasogenic: intracranial vasoconstriction is responsible and the headache pain results from rebound dilation and distention of cranial vessels

Neurogenic: the brain itself is the generator of the migraine. The vascular chages that occur are the result of, rather than the cause, of the pain.
On what three observations is the vasogenic theory of headaches based?
1. Extracranial vessels distend and pulsate during an attack.
2. Stimulation of the intracranial vessels in awake patients results in ipsilateral headache.
3. Vasoconstrictiors, like ergots, abort headaches, whereas vasodilators (nitrates), can provoke attacks.
What supports the neurogenic theory of headaches?
on the basis that migraine attacks are often accompanied by a range of neurologic symptoms in the brain that cannot be explained by vasoconstriction/dilation alone.
What is the most common cause of primary headache?
Tension headaches
Who are tension headaches more common in?
Women
What are some causes of tension headaches?
Stress, hunger, sleep deprivation, eyestrain, or caffeine withdrawal.
What are the symptoms of tension headaches?
consists of recurrent attacks of tight, band-like or vise-like bilateral pain.
How do you treat tension headaches?
Episodic: APAP, NSAIDS, ASA
Chronic: TCA's
True or False: Frequent use of analgesics can actually increase incidence of tension headaches.
True
What is the drug of choice for chronic tension headaches?
TCA's
True or False: Most cases of Encephalitis are bacterial.
False: Most cases are viral in nature.
What organisms cause the most cases of encephalitis in the United States?
Enteroviruses
Herpes Simplex 1 & 2
Rabies Virus
Arboviruses
Lyme Disease
What is the difference between primary and secondary encephalitis?
Primary: caused by a direct viral infection of the spinal cord and brain.
Secondary: can result from complications of a current viral infection
What is acute disseminated encephalitis?
secondary encephalitis that results from an immunization or earlier viral infection.
What is the prognosis for an untreated case of Herpes Simplex Encephalitis?
more than half are fatal.
What are the four common forms of mosquito-transmitted viral encephalitis?
1. Equine
2. LaCrosse
3. St. Louis
4. West Nile
Who is more susceptible to Western equine encephalitis?
children under 12 months of age
In what age group are most cases of LaCrosse encephalitis reported?
under the age of 16
True or False: St. Louis encephalitis is generally milder in adults than it is in children.
False: It is generally milder in children than in adults, with elderly adults at highest risk of severe disease or death.
How do you treat encephalitis?
Antivirals: acyclovir and ganciclovir
Supportive: fluids, bed rest, OTC analgesics
Anticonvulsants: prevent seizures
Corticosteroids: reduce brain swelling
How do you go about preventing encephalitis?
Good personal hygiene.
Avoid sharing stuff with infected people.
Wash hands
Avoid outdoor activities at night.
Wear long sleeves at night.
Insect repellents.
What is the most common form of meningitis? What is the most serious form of meningitis?
Pneumococcal is the most common and the most serious form of meningitis.
Who are at risk for pneumococcal meningitis?
Children < 2 years old and adults with weakened and depressed immune systems
What type of meningitis is common with college students and travelers to other countries?
Meningococcal meningitis
What kind of meningitis was once the most common form, but due to vaccines, has been greatly reduced?
Haemophilus meningitis
Who is most at risk for Haemophilus meningitis?
children in child-care settings
and unvaccinated
What is the most common meningitis in the United States? What is it caused by?
Viral, or aseptic, meningitis; enteroviruses
AIDS patients are most at risk for what form of meningitis?
Cryptococcal meningitis
What are the hallmark symptoms of meningitis?
sudden fever, severe headache, and a stiff neck; rash may be present
What characterizes encephalitis?
seizures, stupor, coma, and related neurological signs
What signs of encephalitis do you watch for in an infant?
vomiting, body stiffness, constant crying, and a full or bulging fontanel
What is the treatment for cluster headaches?
Oxygen: 12-15 liters per minutes
Alternative Treatment: triptan drugs, like sumatriptan and zolmitriptan; caffiene, beta-blockers, and calcium channel blockers
What are the categories of migraines? What is the most common?
with an aura - MC
without an aura
What is contraindicated in basilar artery type migraine?
Triptans and vasoconstrictors
What kind of weather triggers migraines.
High humidity plus high or low temperature.
Significant changes in weather.
Changes in barometric pressure.
When is daily prophylactic treatment for migraines considered?
if migraines cause disability more than 3 days per month
The use of analgesics can cause in increase the frequency of what two headaches?
tension and migraines
What is the first line of abortive therapy for migraines?
OTC NSAIDS
What treatments can be used prophylactically for migraines?
SSRI's
TCA's
Steroids
Fiorect (barbituate)
Beta blockers
Calcium channel blockers
Anticonvulsants
Botox
Namenda