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105 Cards in this Set
- Front
- Back
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What does peripheral vertigo affect?
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The vestibular apparatus or the 8th CN.
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What does central vertigo affect?
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The brainstem or cerebellum
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What are the characteristics of peripheral vertigo?
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*Intense, sudden
*intermittent, positional *+/- hearing changes *horiz/vert/rotat nystagmus |
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What are the characteristics of central vertigo?
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*Less intense, insidious
*Constant, not positional *Focal neuro findings *VERTICAL nystagmus |
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In the ED, what is the first approach to vertigo? Next?
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1- distinguish btw TRUE vertigo and syncope, presyncope or weakness.
2- If TRUE vertigo, determine whether peripheral or central. |
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_______ is the rhythmic movement of eyes with two components (fast & slow).
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Nystagmus
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______ is the perception of movement when there is no movement.
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Vertigo
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What are some causes of SAH?
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*AVM
*Rupture of aneurysm *Idiopathic *Trauma |
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What are the S&S of a SAH?
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*"worst HA of my life"
*sudden, severe occip. HA *N/V |
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What is the dx of SAH?
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1- First do CT... if neg,
2- LP to check for blood or xanthochromia |
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If left untreated, temporal arteritis can lead to _______.
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vision loss
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What is the tx of temporal arteritis?
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prednisone
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What is the definitive dx of temporal arteritis?
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temporal artery bx showing giant cells-- do NOT await bx results before starting tx
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Who are some high-risk pts for a subdural hematoma?
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*alcoholics
*elderly *pts on anticoagulants |
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Describe the HA due to a brain tumor.
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*insidious
*positional *worse in the morning |
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Who do pseudotumor cerebri (idiopathic intracranial hypertension) typically occur in?
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*young, obese females w/hx of headaches in the past
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What are some S&S of pseudotumor cerebri?
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*papilledema
*absent venous pulsations *headache, nausea, vomiting *visual loss |
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What is used to dx benign paroxysmal positional vertigo?
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Dix-Hallpike maneuver
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What is the Meniere's triad of symptoms? (DVT)
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*Deafness
*Vertigo *Tinnitus |
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What is the tx of Meniere's disease?
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Symptomatic w/antihistamines, antivertigo and antiemetic agents, HCTZ
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What is the pathophys and S&S of vestibular neuronitis?
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*viral etiology
*sudden onset, lasts days *URI |
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What are some causes of peripheral vertigo?
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*BPPV
*Meniere's disease *Vestibular neuronitis *Labyrinthitis *Ototoxicity (drugs) *8th CN lesion *Middle ear disease *Cerebellopontine angle tumors |
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What are some causes of Central vertigo?
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*anything affecting the brainstem or cerebellum
*cerebellar hemorrhage or infarct *Wallenberg syndrome *verebrobasilar insufficienc *MS, neoplasm |
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List some drugs that can cause ototoxicity.
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*aminoglycosides
*furosemide (lasix) *PCP |
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What is Wallenberg syndrome?
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*occulsion of the posterior inferior cerebellar artery
*acute onset, N/V, nystagmus *ipsilateral facial pain or numbness, Horner's *contralateral pain & temp loss |
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What are some S&S of meningitis?
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*Altered mental status
*photophobia *headache *fever *meningeal signs (nuchal rigidity, Kernig & Brudzinski's signs) |
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______ sign is pain or resistance w/passive extension of the knee w/hip flexed at 90 degrees.
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Kernig's
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What is Brudzinski's sign?
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Passive flexion of neck causes flexion of the hips.
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Which organisms cause meningitis in a baby <2 months?
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*GBS
*Listeria *E. coli *Klebsiella *Enterobacter *Staph aureus *H. flu |
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Treatment?
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*IV Ampiciliin AND cefotaxime
*Also generally good to tx early w/steroids |
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What organisms cause meningitis in a person 2 months - 50 y/o?
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*Strep pneumoniae
*N. meningitidis *H. influenzae |
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Treatment?
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*Cefotaxime OR Ceftriaxone
*Vancomycin |
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What are the CSF findings suggestive of bacterial meningitis?
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Increased white blood cells w/a high % of PMNs, low glucose, & high protein
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What is the mainstay of tx in adults with bacterial meningitis? Why?
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Ceftriaxone-- has good CSF penetration
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What are some causes of encephalitis? (HEAR)
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*Herpes
*Epstein-Barr virus *Arboviruses *Rabies |
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The cause of CNS encephalitis is usually ______ in origin.
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viral
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What are some S&S of CNS encephalitis?
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*Abn behaviors, personality changes
*seizures, HA, photophobia *focal neuro findings *signs of peripheral dz: herpes, rabies, arboviruses (bug bite) |
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T or F: If you suspect a pt has meningitis, delay ABX until a CT and LP is performed.
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FALSE! DO NOT delay ABXs for LP or head CT when meningitis is suspected.
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How is a brain abscess dx?
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CT scan of head w/contrast.
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What disease is an ascending peripheral neuropathy that has a hx of a viral infection?
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Guillain-Barre syndrome
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Which of the following conditions HAS reflexes: GB or MG?
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MG
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What are the S&S of GB?
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*Loss of DTRs
*distal weakness > proximal (i.e. legs > arms) *weakness is symmetrical *numbness/tingling of the extremities *Risk of resp failure |
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How is GB dx and what does it reveal?
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LP --> increased CSF protein w/a nml glucose & cell count
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How is GB treated?
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*Plasmapheresis
*IV immunoglobulin (IVIG) *Intubate if there is resp compromise |
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_____ is an autoimmune disease of the neuromuscular junction.
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Myasthenia Gravis (MG)
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Who does MG typically affect?
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Older males & young females
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What does MG have an association with?
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thymoma
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A 37 y/o female presents w/severe weakness of resp muscles, diplopia, ptosis, & proximal muscle weakness. What is the dx?
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Myasthenic crisis
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What are the S&S of MG?
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*Generalized weakness
*Proximal weakness > distal *Weakness relieved w/rest *Ptosis & diplopia *Usually worsens w/the day |
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How is MG dx?
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*Edrophonium test
*Detection of acetylcholine receptor antibodies in serum *Repetitive stimulation on nerve conduction studies |
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What is the tx of MG?
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*Anticholinesterase
*Plasma exchange *Immunoglobulins *Resp support (intubate prn) *Thymectomy if needed |
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All generalized seizures involve _______.
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LOC
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T or F: Consciousness remains intact during a simple partial seizure.
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True
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In a complex partial seizure, which area is frequently of origin? What happens to consciousness? Is there a post-ictal period?
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*Temporal lobe origin
*Consciousness altered *Yes, there is a post-ictal period |
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What factors lower the seizure threshold?
HINT--> I AM H(4)IP. |
*Infection
*Alcohol w/drawal, drugs *Medication *Head injury, hypoxia *Hypoglycemia *Hypertension *Hyponatremia (& others) *Intracranial lesions *Pregnancy (eclampsia) |
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What is "Todd's paralysis?"
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Focal neuro deficit persisting from seizure, which usually resolves w/in 48 hrs
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What is the mainstay of tx in the seizing pt? What if they fail?
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*Benzodiazepines
*IV fosphenytoid, depakote, or phenobarbital |
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What are some causes of secondary seizures?
HINT --> MITTEN |
*Metabolic
*Infection *Trauma *Toxins *Eclampsia *Neurologic lesions |
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What is the definition of status epilepticus?
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Seizures occurring continuously for at least 30 minutes, or two or more seizures occurring w/o full recovery of consciousness between attacks.
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What can continuous seizures cause?
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Significant CNS injury
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What is the tx for status epilepticus? What are last-line agents?
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*IV benzos, fosphenytoin, depakote, or phenobarbital
*General anesthetics are last-line |
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When does eclampsia typically occur? How do pts present? Tx?
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*>20 weeks gestation
*HTN, edema, proteinuria, HA, vision changes, confusion, & seizure *Mg sulfate |
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What is Primary Hemostasis?
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The initial superficial clotting performed by platelets.
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Give an example of a defect of primary hemostasis.
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Thrombocytopenia-- usually have oozing from IV sites & bleeding from mucous membranes, nose, etc.
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What is Secondary Hemostasis?
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Fxn of the coagulation cascade & clotting factors.
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Give an example of a defect of secondary hemostasis.
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Hemophilia -- result in lg, deep bleeds, such as hemarthrosis, bleeding into a jt.
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Which pathway does Heparin affect? What factors does it primarily affect? What does it increase?
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*Affects intrinsic pathway
*VIII, IX, X, XI, XII *Increases aPTT |
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T or F: Heparin is contraindicated in pregnancy.
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FALSE-- it is SAFE in pregnancy.
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What are some adverse effects of Heparin?
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*bleeding
*thrombocytopenia *osteoporosis |
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What does PTT measure? What does PT measure?
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PTT --> intrinsic pathway
PT --> extrinsic pathway |
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What are the vitamin K dependent factors?
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II, VII, IX, X
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Which pathway does Warfarin affect? What does it increase? Which factors does it primarily affect?
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*extrinsic
*increases PT *II, V, VII |
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What does Warfarin do to vitamin K?
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decreases vit K
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Is warfarin safe in pregnancy?
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NO-- it is teratogenic
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What happens if a pt on warfarin eats too many leafy green vegetables?
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Leafy green veggies have high vit K & can make the INR become subtherapeutic for these pts.
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What is important to note about warfarin's anticoagulation coverage?
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It is initially a PROcoagulant, taking 48-72 hrs to become anticoagulant. Concurrent coverage w/heparin is needed during this time.
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What pathway does aPTT test. What conditions are isolated elevations seen in (with nml PT)?
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*extrinsic & common
*heparin therapy, def of factors VIII (hem A), factor IX (hem B), & factor XII (asymptomatic) |
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What pathway does PT test? Isolated elevations (w/nml PTT) are seen in...?
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*intrinsic & common
*vit K def, warfarin therapy, liver dz (dec factor prod), and congenital (rare) |
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What does thrombin time measure? What conditions is it elevated in?
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*the time it takes to convert fibrinogen into a fibrin clot
*DIC -consumes fibrinogen, *liver dz- dec prod of fibrin *heparin- inhibits fibrin form *hypofibrinogenemia |
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What does bleeding time measure? What conditions is it elevated in?
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*time from start of skin incision to formation of clot
*thrombocytopenia, qualitative platelet disorders, vWD |
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What is the nml bleeding time?
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3-8 minutes
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What is the sex-linked recessive disease causing a def of factor VIII?
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Hemophilia A
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What are the S&S of hemophilia A?
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*severity depends on amt of factor VIII activity
*deep tissue bleeding, hemarthrosis |
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What is the dx of hemophilia A?
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*prolonged aPTT
*clinical picture, family hx, factor VIII coagulant activity |
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What happens to bleeding time in hemophilia?
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It is nml b/c bleeding time is unaffected b/c no abnormality with platelets is present.
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What is the tx of hemophilia A?
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*recombinant factor VIII
*cryoprecipitate |
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Hemophilia B, also known as _______ disease, causes a def in factor ____.
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*Christmas disease
*IX |
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What is the tx of hemophilia B?
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*FFP
*recombinant factor IX |
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What is the most common inherited bleeding disorder?
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vWD
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What is vWF?
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*glycoprotein that is synthesized, stored, & secreted by vascular endothelial cells.
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What are the two functions of vWF?
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1- allow platelets to adhere to the damaged endothelium
2- carry factor VIII in the plasma |
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What type of hemostasis problem is vWD?
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Primary-- epistaxis, GI bleeding, easy bruising, menorrhagia, prolonged bleeding after dental extraction
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How is vWD dx?
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*prolonged bleeding time
*prolonged aPTT *normal PT *nml platelet count *def: abn assay of vWF, vWF:antigen or factor VIII:C |
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How is vWD tx?
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Type I- desmopressin
Type II & III- factor VIII concentrates w/lg amts of vWF |
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How does antiphospholipid antibody syndrome most commonly manifests as?
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recurrent fetal losses in women of child-bearing age
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Thrombocytopenia is defined as a platelet count < ______.
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140,000
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What are some causes of thrombocytopenia?
HINT --> PLATELETS |
*Platelet disorders: TTP, HUS, ITP, DIC
*Leukemia *Anemia *Trauma *Enlarged spleen *Liver disease *EtOH *Toxins (benzene, heparins, ASA, chemo) *Sepsis |
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What are some risk factors of thrombocytopenia?
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*drugs- chemo, thiazides
*prior episode(s) *underlying immuno dz *massive blood transfusion *significant EtOH consump *term pregnancy |
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Typically, platelets only need to be given if < ______ or active bleed.
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10,000/uL
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Platelets are contraindicated in ____.
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TTP
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List some antiplatelet drugs.
HINT --> CAFE PORN |
C- cardio, cholesterol-lowering, cough suppressants, chemotherapy
A- antimicrobials, antihistamines, anticoags, anesthetics F- food E- ethanol P- psychotropics O- opiates R- radiocontrast agents N- NSAIDs |
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Name 3 drugs used in anti-platelet therapy.
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*ASA
*Ticlopidine (Ticlid) *Clopidogrel (Plavix) |
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A 42 y/o woman w/ no PMH presents due to petechiae that have erupted over her arms & legs in the past 2 days. She also reports gingival bleeding. PE reveals petechiae w/in the oral cavity as well. Labs demonstrate a platelet count of 7,000, nml PT/PTT, & a prolonged BT. What is the likely dx?
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ITP
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What is the tx for adults w/ITP?
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*Prednisone 1mg/kg/day x a couple weeks
*Splenectomy |
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What is the tx of pts with ITP & life-threatening bleeding?
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*High-dose steroids
*IVIG *Platelet transfusion |
