Clin Med Neuro Cmdt

Front 1

Tension headache sx

Back 1

- poor concentration
- vague nonspecific symptoms
- often vise-like or tight
- stress, fatigue, noise, glare exacerbate
- usually generalized, sometimes intense in neck, back of head
- maybe from chronic anxiety

Front 2

Tension headache tx

Back 2

- analgesics
- antimigrainous agents
- relaxation techniques
- maybe local botulinum toxin type A injx

Front 3

Depression headache sx

Back 3

- worse in AM
- maybe w/other depression sx
- sometime focus of somatic delusional system

Front 4

Depression headach tx

Back 4

- antidepressants
- psychiatric consult

Front 5

Migraine Essentials of Dx

Back 5

- headache, usually pulsatile
- n/v, photophobia, phonophobia
- maybe transient visual neuro sx, e.g., stars, flashes, scintillating scotomas preceding headache
- maybe no preceding aura

Front 6

Migraine pathyphys

Back 6

- related to serotonin
- release of neuropeptides acting as neurotransmitters at trigeminal nerve branches, leading to inflammation
- maybe activation of dorsal raphe nucleus

Front 7

Migraine - basilar artery

Back 7

- uncommon variant
- blindness or vis disturb accompanied or followed by dysarthria, disequilibrium, tinnitus, perioral and distal paresthesias
- sometimes loss of consciousness or confused state
- throbbing, occipital headache, n/v follow

Front 8

Migraine - ophthalmoplegic

Back 8

- lateralized pain around eye
- n/v, diplopia due to transient ext ophthalmoplegia due to CNIII palsy

Front 9

myasthenia gravis

Back 9

- insidious onset
- autoimmune
- fluctuating muscle weakness

Front 10

grand mal seizure
(tonic-clonic)

Back 10

- loss of consciousness
- rigidity (tonic)
- resp depression
- jerking of all 4 limbs (clonic)
- urinary incont, tongue bite

Front 11

carpel tunnel 1st line tx

Back 11

- splinting
- NSAIDs
- ergonomic eval

Front 12

common signs of Parkinson's

Back 12

-resting tremor
- often unilateral
- "pill-rolling"
- also cogwheel rigidity
- bradykinesia
- diminished postural reflexes, i.e., diff keeping balance

Front 13

types of seizures

Back 13

- tonic-clonic
- myoclonic
- absence
- tonic
- atonic

Front 14

myoclonic seizure feature

Back 14

- brief jerking of part or all of the body

Front 15

TIA manifestations

Back 15

- focal deficits of 5-15 min, w/return to baseline
- heaviness of extremities
- paresthesias
- numbness
- monocular loss of vision

Front 16

How is viral meningitis treated?

Back 16

- observation at home
- analgesics
- antiemetics

Front 17

Meniere's syndrome

Back 17

a peripheral lesion causing vertigo

Front 18

What class of drugs are approved for palliative treatment of Alzheimer's?

Back 18

anticholinesterases, e.g., donepezil, selegiline, tacrine (Cognex), psychotropics

Front 19

modifiable risk factors for stroke include:

Back 19

- hypercholesterolemia
- a-fib
- HTN
- DM

Front 20

anti-parkinsonian agent that directly stimulates post-synaptic receptors

Back 20

pergolide

Front 21

sx of peripheral vertigo

Back 21

- marked vertigo
- tinnitus

Front 22

what type of vertigo is shows vertical nystagmus?

Back 22

central vertigo

Front 23

sx of petit mal (absence) seizures

Back 23

- sudden onset of brief episodes of consciousness of which pt is unaware
- often described as daydreaming
- eyelid twitching

Front 24

what agent is used in managing acute coma?

a. mannitol
b. Cogentin
c. ipratropium bromide

Back 24

a. mannitol

The other two are anticholinergics.

Front 25

CVA

Back 25

cerebrovascular accident or stroke syndrome: a condition with sudden onset caused by acute vascular lesions of the brain, such as infarction from hemorrhage, embolism, or thrombosis, or rupturing aneurysm. It may be marked by any of a variety of symptoms reflecting the focus of infarction or hemorrhage, including hemiparesis, vertigo, numbness, aphasia, and dysarthria; it is often followed by permanent neurologic damage.

Front 26

T/F? Multifocal epilepsy is caused by a brain injury.

Back 26

F. Mulitfocal epilepsy is of unknown etiology, but brain injury is NOT the suspected cause.

Front 27

Which of the following is chronic and genetic?

a. Bell's palsy
b. myasthenia gravis
c. Parkinson's disease
d. muscular dystrophy

Back 27

d. muscular dystrophy

Front 28

antibiotic therapy for bacterial meningitis

Back 28

ampicillin, chloramphenicol, ceftriaxone

Front 29

most common type of ischemic event in a pt w/ a prior CVA is:

a. thrombotic
b. embolic
c. hemorrhagic
d. edema
e. subarachnoid hemorrhage

Back 29

a. thrombotic

Front 30

trigeminal neuralgia hallmark

Back 30

trigger zone
- naso-labial fold
- upper, lower lips

Front 31

glossopharyngeal CN9 neuralgia

Back 31

pain in tonsil area, base of tongue, lateral pharyngeal wall; pain triggered by eating

Front 32

CRPS - complex regional pain syndrome

Back 32

continuous regional dist of pain, in all or part of extremity. Usually follows trauma, tho no direct correlation between severity of injury and intensity of pain

Front 33

TENS - trancutaneous electrical nerve stimulation

Back 33

elec impulse goes thru skin and desensitizes area to pain

Front 34

4 types of vascular headaches

Back 34

1. migraine
2. cluster
3. toxic
4. hypertensive

Front 35

Brudzinski's sign

Back 35

sign of meningitis -- pt. supine; head passively elevated from table; if positive (pain), pt will flex arm, hip, knee

Front 36

Kernig's sign

Back 36

sign of meningitis -- pain in lower back and resistance to straightening the leg constitute positive sign

Front 37

epidural hematoma

Back 37

between dura and skull

Front 38

intracerebral hematoma sx

Back 38

sudden onset, incapacitating h/a, decreased level of consciousness, maybe n/v

Front 39

tentorium cerebelli

Back 39

separates occipital lobes of cerebral hemispheres from cerebellum

Front 40

superior salvitory nucleus

Back 40

area of pons that produces parasympathetic fibers that go to the SPG sphenopalatine ganglia

Front 41

dyskinesia

Back 41

abnormal involuntary movement

Front 42

dystonia

Back 42

involuntary sustained muscle contraction; painful; fixed postures

Front 43

kinetic tremor; goal-oriented tremor

Back 43

tremor upon movement, not at rest

Front 44

choreoform

Back 44

piano-playing movements

Front 45

essential tremor

Back 45

involuntary fine shaking of the hand, head, face, esp during routine body movement; autosomal dominant

Front 46

ictal

Back 46

pertaining to a sudden acute onset, e.g., seizure

Front 47

reactive seizure

Back 47

single seizure caused by fever, etoh, drug, infxn, etc.

Front 48

secondary generalized seizure

Back 48

starts focal/local; spreads to both hemispheres, becomes generalized

Front 49

status epilepticus

Back 49

generalized seizure that doesn't stop; by def, > 30 min; can be fatal (from hypoxia?)

Front 50

absence seizure

Back 50

epileptic seizure characterized by a sudden, momentary loss of consciousness. Usually occurs many times a day w/o warning aura; most frequent in children, esp. at puberty

Front 51

clonus

Back 51

abnl pattern of neuromuscular activity, rapidly alternating involuntary contraction and relaxation of skeletal muscle

Front 52

Todd's paralysis

Back 52

postepileptic hemiplegia or monoplegia lasting a few min, hrs, days

Front 53

complex partial seizure

Back 53

- focal seizure
- aura
- malaise, nausea
- slow, rep. limb movements w/head, eye and postural rigidity
-autonomic disability
- impaired ability to comprehend, register, or process info during seizure

Front 54

post-traumatic seizure

Back 54

secondary generalized or partial/focal seizure after head trauma

Front 55

BEAM, aka quantitative EEG

Back 55

brain electrical activity mapping; detects very sudden wave/form changes eye can't pick up

Front 56

multiple sclerosis

Back 56

immune mediated demyelinating disease w/periods of relapsing or progressive and remitting neurologic symptoms

Front 57

amyotropy

Back 57

wasting of muscles

Front 58

intention tremor

Back 58

when moving towards something, tremor starts

Front 59

scanning speech

Back 59

abnl speech; singing; staccato-like; person pauses between syllables

Front 60

Charcot's triad

Back 60

3 hallmark sx of MS multiple sclerosis
1. nystagmus
2. scanning speech
3. intention tremor

Front 61

decerebrate posture

Back 61

position of comatose patient in which arms are extended and internally rotated; legs extended w/feet in forced plantar flexion; usually in pt w/ compress of brainstem at low level (midbrain and pons)

Front 62

decorticate posture

Back 62

position of comatose patient in which up extremities are rigidly flexed at elbows and wrists; legs may also be flexed; indicates lesion in higher, corticotract mesencephalic region of brain

Front 63

internuclear ophtalmoplegia

Back 63

lesion in medial longitudinal fasciculus of brainstem causing nystagmus; eyes aBduct; bilateral abducting nystagmus

Front 64

trigeminal neuralgia

Back 64

hearing loss and vertigo

Front 65

neurogenic pain

Back 65

usually band-like pain around body or b ack

Front 66

light coma

Back 66

subgroup of coma; there may be a reflex, primitive response to light

Front 67

deep coma

Back 67

no response to any painful stimuli

Front 68

caloric testing

Back 68

cold water in ears, wakeful pt's eyes will develop rotatory nystagmus away from irrigated side

Front 69

locked-in syndrome

Back 69

looks like coma, but higher mental functions intact; related to infarction of basilar pons region; pt is quadriplegic w/ paralysis of lower cranial nerves -- can't breathe, talk

Front 70

ascending reticular activation system

Back 70

the part of the brain that controls wakefulness/ arousability

Front 71

central herniation

Back 71

cerebral hemisphere is caudally displaced in midline fashion

Front 72

unilateral uncus herniation

Back 72

lesions laterally displaced in temporal lobe, and brain herniates downward (uncus = hooklike anterior end of the hippocampal gyrus on the temporal lobe of the brain)

Front 73

Doll's eyes

Back 73

transient eye movement opposite the direction of head movement; if eyes move in same direction as head, indicative of severe brainstem damage

Front 74

Wernicke's encephalopathy or syndrome

Back 74

inflam, hemorrhagic, degenerative condition of the brain; char by lesions in several parts of the brain; caused by thiamine B12 deficiency and seen in chronic alcoholism
ophthalmoplegia
nystagmus
vomiting
ataxia
mental deterioration

Front 75

post-hyperventilation apnea

Back 75

3 min hyperventillation followed by >30 sec apnea; indicates diffuse metabolic disease or damage to forebrain

Front 76

Cheyne Stokes respiration

Back 76

alternating periods of apnea and deep, rapid breathing; cyclical; slow waxing and waning of repiration, then 30 sec apnea; dysfunction of diencephalon or by bilateral hemispheric lesions or early brain stem compression

Front 77

central neurogenic hyperventilation

Back 77

- regular, rapid breathing; like on ventilator; indicates lesion in midbrain/pons

Front 78

apneustic breathing

Back 78

pattern char by prolonged inspiratory phase followed by expiration apnea; associated w/pontine lesion

Front 79

ataxic breathing

Back 79

associated w/lesion in medullary respiratory center and char by series of irregular inspir, expir

Front 80

dementia

Back 80

adult acquired intellectual deterioration

Front 81

memory impairment

Back 81

impaired ability to learn something new or to recall previously learned info

Front 82

isolated memory impairment (mild cognitive impairment)

Back 82

memory prob with NO other cogntiive disturbances

Front 83

apolipoprotein B

Back 83

lipid transport protein in the brain

Front 84

glutamate

Back 84

neurotransmitter released during thinking; a major excitatory amino acid of the CNS

Front 85

executive function

Back 85

ability to plan and sequence events

Front 86

aphasia

Back 86

absence or impairment of ability to communicate thru speech, writing, or signs because of dysfunction in dominant hemisphere

Front 87

apraxia

Back 87

inability to perform tasks or activities even tho motor, sensory, and cerebellar functions are preserved; problem is in cortex

Front 88

agnosia

Back 88

inability to recognize familiar or common environmental stimulie even tho sensory, motor, and cerebellar functions are preserved; can't recognize color, body parts, etc.

Front 89

anopsia

Back 89

visual field defects

Front 90

Wernicke's aphasia; fluent aphasia

Back 90

-affects dominant temporal lobe
-pt cannot follow commands; cannot repeat sentences
-pure aphasia; no associated weakness
-visual field problems: nystagmus, trouble moving eyes