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75 Cards in this Set
- Front
- Back
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Describe a DD that would be appropriate for a pt presenting with a Headache
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subarachnoid hemorrhage, subdural hemmorrhage, migraine, cluster, tension, post coital migraine, meningitis, temporal arteritis, post herpetic neuralgia, TMJ
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Describe a DD that would be appropriate for a pt presenting with a seizure
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syncope, alcohol abuse/withdrawl, TIA, hemiparetic migraine, hypoglycemia, vasovagal rxn, brain tumor, tetanus
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Describe a DD that would be appropriate for a pt presenting with Sensory distrubances
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tumor, mirgraine, conversion disorder, seizure
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Describe a DD that would be appropriate for a pt presenting with weakness and paralysis
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stroke, TIA, migraine, hypoglycemia, conversion disorder, myasthenia gravis, guiallan-Barre
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Identify the most common causes of acute bacterial meningitis in adults
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strep pneumoniae, neisseria meningitis
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What do you see on gram stain with neisseria meningitits
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gram negative diplococci
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What do you see on gram stain with strep pneumoniae
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gram positive cocci in pairs or diplococi
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Who is more at risk for neisseria meningitis
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children nad young adults
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Who is more at risk for strep pneumoniae menengitis
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adults, alcoholics, immune deficiency or contigous infection
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Describe classic clinical picture seen in a pt with acute bacterial meningitis
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nuchal rigidity, positive kernig/brudzinski, altered LOC, petechiae, *HA, *fever, *stiff neck
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Describe the CSF, WBC differential you would expect to see for a pt with acute bacterial meningitis
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purulent, high protein, low glucose, bacteria on gram stain, blood cultures often correlate with CSF cultures
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Describe the importance of obtaining CT scan when possible, prior to LP if there is any suspicion of a space-occupying lesion
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herniation may occur; check for papilledema 1st or if neurologic findings then suspect and CT prior to LP
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If you had to make an empiric antibiotic choice based on pt's age, clincial circumstances, etc. before a definitive bacterial pathogen can be identified, what bug would you suspect in the following:
1. Newborns 2. Children 3. Adults |
1. Group B (H.flu if not vaccinated)
2. Neisseria and Haemophilus 3. Neisseria and streptococcus |
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Do close contacts of pt with neisseria meningitis and hemophilus influenzae type B need to be prophelaxed?
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Yes, highly contagious, very lethal.
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What are symptom differences between viral and bacterial meningitis
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bacterial more severe, petichia and fever with bacterial
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Define aseptic meningitis
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more benign and self-limiting syndrom than purrlent meningitis, is caused by viruses
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Name 2 common causes of subacute and chronic infectious meningitis
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TB and fungi
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What type of meningitis is a common cause of CNS infection in AIDS pts and what test would you use to confirm
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cryptococcus, India Ink
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Describe the typical clinical syndrome of acute viral encephalitis
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malaise, skin rash, myalgia, fever, stiff neck, *focal neural deficits, HA, photophobia, lethargy, seizures, coma
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Note that acute viral encephalitis is an important cause of substantial mortality and serious neurological morbidity in survivors
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Note that acute viral encephalitis is an important cause of substantial mortality and serious neurological morbidity in survivors
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What important Sx of herpes simplex encephalitis requires differences in diagnosing and treatment
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focal neurological signs (anosmio, aphasia) Order MRI, CT or possible brain biopsy; Tx IV acyclovir
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What is the treatment for herpes simplex encephalitis
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IV acyclovir
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Describe typical CSF in a pt with community acquired bacterial meningitis
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high protein, low glucose, pneumo, minigo, coccobacillus on gram stain, high WBC, neutrophils (PMNs) 200-20,000, markedly elevated opening pressure
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Describe typical CSF in a pt with mycobacterial or fungal meningitis
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must perform AFB stain for mycobacterium, low glucose, high protein, moderately elevated opening pressure, 100-1000 WBC, lymphocytes predominating
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Describe typical CSF in a pt with spirochetal miningitis
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normal glucose, protein moderately high, normal/slightly elevated opening pressure, 100-1000 WBC, lymphs predominating
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Describe typical CSF in a pt with aseptic or viral meningitis and meningoencephalitis
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normal-low glucose, high protein, slightly elevated opening pressure, 25-2000 cells mostly lymphs
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Describe typical CSF in a pt with neighborhood reaction (brain abcess, vertebral osteomyelitis, epidural abcess, subdural empyema, bacterial sinusitis or mastoiditis)
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normal glucose, normal-high protein, variable opening pressure, cells variably increased
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Identify the 3 major categories of seizures
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1. Generalized seizures
2. Symptomatic 3. partial |
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What part of the body does simple partial seizures involve
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only 1 part
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What might a pt with complex partial seizures experience different from other seizure disorders
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light flashes, buzzing, auditory, gustatory, olfactory sensorium
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Name 3 types of generalized seizures
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1. Absence (petit-mal)
2. Tonic Clonic (grand-mal) 3. Status Epilepticus |
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Describe symptoms for an absence seizure
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impaired consciousness with abrupt onset and ending , pt often unaware of seizure
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Desscribe symptoms of a tonic-clonic seizure
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bilateral muscle involvement, incontinence
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Describe status epilepticus
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True medical emergency. Any seizure longer the 5 minutes is treated as status though true definition is 30+ min.
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Identify the main elements of the history, PE and diagnostic tests that are obtained in working up a pt with seizure disorder
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Hx: onset, duration, witness account, incontinence, hx of mood changes, HA. PE: neurologic deficit, pupils, 2nd* injury to seizure (tongue etc). Dx tests: EEG, CT
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Identify common causes of acute or recurrent seizure disorders
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idiopathic, metabolic and toxic encephalopathies, post traumatic, CNS neoplasms, cerebrovascular disease, intracranial infection
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What is the most common chronic neurologic disease of young adults
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multiple sclerosis (MS)
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What is the most popular current theory of the cause of MS
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dymelination disorder: pathological, focal, often perivenular, areas of demyelination w/reactive gliosis found scattered in white matter of brain, spinal cord, optic nerve
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Describe various clinical manifestations of MS
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gait disturbances, weakness, vision problems, fatigue, symptoms wax and wane
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Identify factors that may precipitate symptoms or attacks of MS
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infection, trauma, pregnancy, increased stressors
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What diagnostic test helps confirm diagnosis of MS
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MRI: shouldn't be dx unless evidence of 2+ regions of central white matter affected at different times.
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List the triad of dysfunctions that characterize parkinsonism and when in life they typicall occur
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akinesia, tremor (worse at rest) cogwheel rigidity. Onset 45-65
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What is the most characteristic pathophysiologic features of parkinson's disease
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dopamine depletion and degeneration of substantia nigra
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Identify the characteristic features of Huntington's disease and describe the typical age of onset, usual progressive nature and ultimate prognosis
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autosomal dominant, mid adulthood onset (30-50). Sxs: choreoform mocements, dementia, fatal in 15-20 yrs
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What kind of inherited disorder is Huntington's disease
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autosomal dominant. Offspring should be offered gentic counseling. Genetic testing permits presymptomatic detection and definitive dx of disease
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Describe history questions, PE and possible labs you would obtain in any of the common headache disorders
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Onset, progression, precipitating factors, recurrent, chronic or new, new meds, change of sxs duration. PE: neuro, HEENT. Labs: CT, ESR, CBC
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Recognize signs and symptoms of potential organic or serious disease in a headache patient
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pupillary changes, nuchal rigidity, altered LOC
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Discribe the major features of the history, PE, diagnosis and basic principles of treatment for tension headaches
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exacerbated by noise, light, fatigue or glare, HA generalized, most intense at back of head, neck, doesn't have focal neuro sxs, common in teens!
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Discribe the major features of the history, PE, diagnosis and basic principles of treatment for migraine
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pulsatile HA, NV, photophobia, phonophobia, visual neurologic sxs preceding, aura or not, avoid precipitating factors. Tx: prophalactic may include; TCAs, SSRIs, clonidine, CCB, BB
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Discribe the major features of the history, PE, diagnosis and basic principles of treatment for cluster headaches
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predominate in middle age men, unclear cause, may be triggered by alcohol, stress, food, severe, unilateral px, ipsilateral nasal congestion, lacrimation, red eye, Horner's (1 pupil+) Tx: O2, steroids
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Describe the presentation, typical signs and symptoms of intracranial hemorrhage as another cause of headache
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worst HA of life, sudden onset, decreasing LOC
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Describe the presentation, typical signs and symptoms of sinusitis headache as another cause of headache
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Px exacerbated by bending over, tender sinuses areas
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Describe the presentation, typical signs and symptoms of ocular headache as another cause of headache
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lateralized pain around eye, diplopia, NV (refraction error/glaucoma)
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Describe the presentation, typical signs and symptoms of temporal arteritis (Giant Cell) as another cause of headache
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ESR elevated, pain over temperal arteries, biopsy to confirm, tx high dose steroids
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Describe the presentation, typical signs and symptoms of meningitis as another cause of headache
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HA, stiff neck, fever
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Describe the presentation, typical signs and symptoms of post-traumatic headache as another cause of headache
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may follow CHI, be careful for secondary impact syndrome (SIS), analgesics to treat
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Describe the presentation, typical signs and symptoms of LP headache as another cause of headache
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more common in small women, blood patch may relieve sxs, 1/3 pt develop 24-48h post procedure
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Describe the presentation, typical signs and symptoms of intracranial neoplasm headache as another cause of headache
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continuous onset w/increasing severity, may be worse w/postural change, NV
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Describe the presentation, typical signs and symptoms of TMJ/bruxism as another cause of headache
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cervical radiculopathy, due to grinding, clentching, inflammation and tenderness of joint with radiating px down neck and up head, NSAIDS, resting joint. (FYI: Botox works REALLY GOOD!)
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Define coma
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no arousal to stimuli
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Describe briefly the assessment needed to determine the anatomic level of dysfunction in a comatose patient
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glasgow coma scale:
1. eye opening 1-4 2. verbal 1-5 3. motor fxn 1-6 |
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Describe the 2 major categories considered in teh diagnosis of coma
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1. structural lesions
2. metabolic disturbances |
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Describe the physical and laboratory exams that may be helpful in the differntial diagnosis of the cause of coma
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glucose, electrolytes, painful stimuli, pupil response, GCS scores
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Define brain death
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absence of brainstem reflex responses for at least 6hrs, apnea tests, absence of cerebral circulation by angiography is confirmatory
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Define delirium
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acute confusional state, transient global disorder of attention with clouding consciousness usually resulting of systemic problems or too much studying
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Describe the common presenting clinical features of delirium
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inability to concentrate or maintain normal behavior, anxiety, loss of short term memory, visual hallucinations
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Describe the initial laboratory work-up for a patient suffering from delirium
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BMP, TFTs, CBC, EEG, PET scan, LFT, UA, ABG, RPR pretty much the entire ABC soup...
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There are many causes of delirium. The main goal is to recognize the major catagories of etiologies:
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injury by physical agents, infections, intoxications, etc.
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Define dementia
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chronic slow onset of deteriorating mental function
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Describe the most common causes of dementia
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alzheimers, athersclerotic disease/infarct, mixed
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Formulate a work-up for a patient presenting with dementia
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MMSE: draw clock, who's president. CT for all young people: old w/focal neuro deficit or gait disturbances. Vitamin deficiency, metabolic workup, thyroids, HIV, CBC
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compare and contrast the common presentations of deliurium and dementia
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Delirium: fast onset. Dementia: slow onset
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Define Seizure
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sudden, excessive, rapid and local discharge of gray matter
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Can you obtain a culture for meningitis once emperic treatments have begun
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yes, up to 4 hours. After 24hrs glucose and protein won't change and gram stain only reduced by 20%
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NEURO: ADULT MED
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NEURO: ADULT MED
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