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75 Cards in this Set

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