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81 Cards in this Set

  • Front
  • Back
What are important labs to do in a patient with a seizure?
• Chem-7
• Tox Screen
What is the most common cause of seizures?
withdrawal from anti-seizure medications
What is the most common site of origin for emboli causing ischemic stroke?
common carotid bifurcation
What is the most common site of occlusion due to emboli for an ischemic stroke?
middle cerebral artery
What are clinical findings associated with cluster headaches?
• conjunctival injection
• facial swelling
• lacrimation
• miosis
• nasal congestion
• ptosis
What patients are high-risk for subdural hematoma?
• alcoholics
• patients taking anticoagulants
• elderly
What drug should be given to patients with subarachnoid hemorrhage to reduce the incidence and severity of vasospasm?
What are treatment options for migraine headaches?
• ergotamines
• opiates
• phenothiazines
• serotonin agonists
What are side effects of phenothiazines (ex. thorazine, compazine)?
may cause extrapyramidal effects
What are contraindications for ergotamine and sumitriptan?
contraindicated in:
• coronary artery disease
• hypertension
• pregnancy
What are signs and symptoms of temporal arteritis?
• anorexia
• blurred vision
• diplopia
• fever
• malaise
• polymyalgia
• weight loss
Name a physical exam finding of temporal arteritis
tenderness to palpation of a pulseless temporal artery
Temporal arteritis is more common in what gender?
The diagnosis of temporal arteritis is established with at least 3 of 5 criteria. What are the 5 criteria?
• at least 50 y/o
• abnormal temporal artery biopsy
• ESR > 50 mm/h
• new onset headache
• temporal artery tenderness (or diminished pulse of temporal artery)
What is the treatment for termporal arteritis?
What is the initial treatment for trigeminal neuralgia (Tic Douloureux)?
An ischemic stroke involving which artery typically causes leg weakness greater arm weakness?
anterior cerebral artery
How does a stroke of the middle cerebral artery typically present?
• contralateral weakness and numbness
• typically with the arm affected more than the leg
• the face is variably affected
How can a patient with occlusion of the basilar artery present?
• coma
• "locked-in" syndrome
• severe quadriplegia
What is the hallmark of brainstem strokes?
crossed neurological deficits (ex. ipsilateral cranial nerve deficits with contralateral motor weakness)
What type of infract leads to pure motor or sensory deficitys and are caused by infarction of small penetrating arteries?
Lacunar infarcts
Patient presents with acute onset of attention deficits and cognitive abnormalities iwth fluctuating severity through the day and worsening at night. What is the most likely dianosis?
Generally, what are causes of delirium in elderly patients?
• cardiopulmonary
• drug related
• infection
• metabolic/toxic
• neurologic
What are drugs that can be used to relieve severe agitation seen with delirium?
• Droperidol (Inapsine)
• Haloperidol (Haldol)
• Lorazepam (Ativan)
• Olanzapine (Zyprexa)
• Ziprazidone (Geodon)
How can you differentiate vascular dementia from Alzheimer disease on physical exam?
vascular dementia may have:
• exaggerated or asymmetric reflexes
• focal extremity weakness
• gait abnormalities
Generally, what are causes of dementia?
• degenerative (ex. Alzheimers, Huntington disease)
• hydrocephalus
• infectious (ex. meningitis, neurosyphillis)
• inflammatory
• metabolic
• neoplastic
• psychiatric (ex. depression)
• traumatic
• toxic
• vascular (ex. mulitple infarcts, hypoperfusion)
What is the definition of a coma?
an eyes-closed state with inappropriate responses to environmental stimuli
What are the 2 general causes of comas?
• diffuse CNS dysfunction (toxic/metabolic etiologies)
• structural coma
What are the 2 types of structural comas?
• hemispheric (supratentorial)
• posterior fossa
Generally, what are physical exam findings of toxic/metabolic comas?
• symmetric findinggs without focal deficits
• pupils small but reactive
How do comas resulting from supratentorial masses often present?
• progressive hemiparesis
• asymmetric of muscle tone & reflexes
• eyes may be conjugately deviated toward the side of the lesion
How can posterior fossa (infratentorial) lesions present?
• abrupt coma
• abnormal extensor posturing
• impaired extraocular movements
• loss of pupillary reflexes
Generally, what are causes of ataxia and gait disturbance?
• systemic illnesses (ex. intoxication, metabolic disorders)
• conditions affecting the nervous system (ex. CNS & PNS pathology)
What are the 2 types of ataxia?
• motor ataxia: usually due to cerebellar processes
• sensory ataxia: from failure of transmission of proprioceptive information to the CNS
What are causes of sensory ataxia?
disorders of:
• peripheral nerves
• spinal cord
• cerebellar input tracts
What is dyssnergia?
the breakdown of movements into parts as assessed by finger-to-nose testing
What are the 4 categories of dizziness?
• vertigo
• near syncope
• disequilibrium
• psychogenic dizziness
What are the 2 types of vertigo?
• central: gradual onset, less intense, and constant
• peripheral: sudden onset, intense, and paroxysmal
What is the most common cause of vertigo?
benign paroxysmal positional vertigo (BPPV)
What causes near syncope?
global hypoperfusion of the brain
What is the most common etiology of disequilibrium?
cervical spondylosis (which leads to myelopathy and poor proprioception in the legs)
How does the Hallpike test determine which ear is affected in patients with BPPV?
the patient will exhibit a latent and short-lived nystagmus with the rapid component toward the affected ear
What are characteristics of vestibular neuritis?
• sudden onset of severe, often incapacitating vertigo
• episodes may last for days to weeks
• hearing is not affected
What differentiates larbyrinthitis from vestibular neuritis?
hearing loss differentiates labyrinthitis from vestibular neuritis
What are medical trement options for peripheral vertigo?
• 1st Line:
- Meclizine (Antivert)
- Ondansetron (Zofran)
- Promethazine (Phenergan)

• 2nd Line: Benzodiazepines
• Scopolamine (takes 4-8 hrs to start working; not used acutely in the ER)
Complex partial seizures are often due to focal discharges in which lobe?
temporal lobe
What is eclampsia?
• combination of seizures, hypertension, edema, & proteinuria in pregnant women
• beyond 20 weeks gestation or up to 8 weeks postpartum
What medication should eclamptic patients be given in addition to the normal anti-seizure regimen?
magnesium sulfate
What is polymyositis?
• an inflammatory myopathy characterizied by chronic of sub-acute proximal, symmetric weakness
• pts may have dysphagia and muscular pain
• can progress to respiratory failure
What labs may be elevated in patients with polymyositis?
• creatine kinase level
• WBCs
What is the clinical presentation of dermatomyositis?
similiar laboratory findings and clinical manifestations of polymyositis with the addition of a violaceous rash, usually on the face or hands
What are clinical features of botulism?
• appear 1-2 days after ingestion
• may be preceded by N/V/D
• progress to descending weakness and respiratory insufficiency
• may have absent light reflex
What are characteristics of Guillain-Barré syndrome?
• usually follows a viral illness (esp. gastroenteritis)
• presents with extremitiy weakness; more pronounced initially in the legs (ascending weakness)
• absent DTRs
What is acute intermittent porphyria?
• a rare autosomal dominant disorder
• triad: weakness, psychosis, abdominal pain
What are characteristics of brachial neuritis?
• causes severe shoulder, back, or arm pain
• followed by weakness in the arm of shoulder girdle
• sensory deficits are less profound
• reflexes in the involved arm are diminished
Which condition is caused by a vasculitis and involves multiple deficits in a stepwise fashion, usually involving both sides of the body?
mononeuritis multiplex
What are treatment options for Bell's palsy?
• Prednisone
• Acyclovir
• Lacrilube (to prevent corneal drying)
What is Amyotrophic lateral sclerosios (ALS)?
• caused by upper and lower motor neuron degeneration
• leads to rapidly progressive muscle wasting and weakness
• symptoms usually are asymmetric and more prominent in the upper extremities
What are signs and symptoms of upper motor neuron dysfunction? lower motor neuron dysfunction?
• Upper motor neuron dysfunction:
- limb spasticity
- hyperreflexia

• Lower motor neuron dysfunction:
- atrophy
- dysarthria
- dysphagia
- fasciculations
- muscle weakness
What is the most useful test in diagnosing ALS?
This condition is due to multifocal areas of CNS demyelination that causes motor, sensory, visual, and cerebellar dysfunctions.
Multiple sclerosis
What are the 3 clinical courses of multiple sclerosis?
• relapsing & remitting (80%)
• relapsing and progressive
• chronically progressive
What are deficits associated with MS?
• extremity numbness
• heaviness
• stiffness
• weakness
What is Lhermitte's sign?
• an electric shock sensation, vibration, or dysthetic pain going dow the back into the arms or legs from neck flexion
• seen in multiple sclerosis
What are factors that can worsen symptoms of MS?
increases in body temperature (ex. exercise, hot baths, fever)
This condition is an autoimmune disease caused by antibody destruction of the acetylcholine receptors at the neuromuscular junction, which results in variable muscle weakness.
Myasthenia gravis
What are the most common symptoms of Myasthenia gravis?
• ptosis
• diplopia
What are tests used to diagnose myasthenia gravis?
• administration of edrophnium (an acetylcholinesterase inhibtor)
• electromyogram
• serum tests for AcH receptor antibodies
What is the treatment for myasthenic crisis?
• supplemental oxygen and airway management
• neostigmine
What are drugs that can exacerbate Myasthenia Gravis?
• aminoglycosides
• fluoroquinolones
• macrolides
• sulfonamides
• tetracyclines
This condition is a myasthenic-like syndrome that causes fluctuating proximal limb weakness and fatigue and is seen mainly in older men with lung cancer.
Lambert-Eaton syndrome
How can you differentiate between Myasthenia Gravis and Lambert-Eaton syndrome by the effect of activity on muscle strength?
• Myasthenia gravis: muscle strength worsens with sustained activity
• Lambert-Eaton: muscle strength improves with sustained actvity
What are the 4 classic signs of Parkinson Disease?
• bradykinesia/akinesia
• cogwell rigidity
• impaired posture and equilibrium
• resting tremors
What is the recommended empiric treatment for bacterial meningitis for the patient severely allergic to penicillin?
• chloramphenicol
• rifampin
• vancomycin
What are examples of viruses that can cause encephalitis?
• arbovirus (ex. West Nile Virus)
• herpes zoster
• rabies
What are the 2 most common primary CNS tumors?
1. Gliomas
2. Meningiomas
What is the most common cause of new-onset seizure in a patient > 50 y/o?
cerebrovascular disease
What is the most common cause of bacterial meningitis in neonates?
gram-negative bacilli
What is the most common cause of bacterial meningitis in preschoolers?
H. Flu
What is the most common cause of bacterial meningitis in diabetics?
Staph aureus
What is the most common type of ischemic event in a patient with a prior CVA?