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234 Cards in this Set
- Front
- Back
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what is akathisia
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sensation of restlessness
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what is myoclonus
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involuntary jerk
-could be in rhythm or pattern |
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what is dystonia
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sustained muscle contraction
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Rx for myoclonus
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valproate
clonazepam |
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what is suggested by vertigo and gait imbalance
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vestibularcochlear problem
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what is the strongest risk factor for stroke
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HTN
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what are some risk factors for stroke
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HTN
DM hyperlipidemia smoking |
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what should be done in a stroke a/w carotid stenosis
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follow up with a duplex every 6-12 months
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what is the best initial test after a stroke
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CT
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what is the most accurate test after a stroke
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MRI
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when is HTN following a stroke Rx
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if BP is >220/120
patient has CAD |
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Rx for ischemic (nonhemorrhagic) stroke
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<3 hours = thrombolytics
>3 hour = aspirin |
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Rx for hemorrhagic stroke
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therapy and recovery
control BP between 140-160 reverse anticoagulant |
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what should be done in a px 5 hours after ischemic stroke who is already on aspirin
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add dipyridamole
or switch to clopidogrel |
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when is a CT needed before an LP
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seizures
focal neuro defects papilledema pupil asymmetry mass effect |
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how should the cause of a stroke be evaluated
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echocardiogram
EKG -if normal do a holter monitor or telemtry carotid duplex US |
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when should carotid stenosis be treated
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>70% stenosis
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Rx for carotid stenosis
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endarterectomy
if not perform carotid angioplasty |
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what should the LDL be in a px with carotid stenosis
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<100
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MCC of headaches
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tension
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what should be done in a px with severe headache and focal neurologic defects and why
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CT w/o contrast or MRI
to rule out hemorrhage |
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what is a/w pseudotumor cerebri
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obesity
OCP Vit A toxicity |
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head ache a/w red tearing eye with rhinorrhea
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cluster head ache
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headache a/w partial horner syndrome
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cluster
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headache a/w abducens nerve palsy
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pseudotumor cerebri
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what should a px with headache and a red eye be evaulated for
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glaucoma
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headache a/w circadian rhythm defect
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cluster headache
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what should be done in a px with pseudotumor cerebri that medical therapy doesnt work or eye vision becomes worse
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perform shunt
or optic nerve sheath fenestrations |
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what can be seen on CT or MRI of pseudotumor cerebri
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empty sella
slit like ventricles downward herniation of arachnocele |
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head ache a/w increased pressure on LP
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pseudotumor cerebri
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Rx for tension headaches
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NSAIDS and acetomenophen
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Rx for migraines
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triptans or ergotamines
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Rx for cluster headaches
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triptans or ergotamines or 100% O2
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when should prophylactic therapy for migraines be started
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3 or more episodes a month
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preventative Rx for migraines
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propanolol or valproate
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how can cluster headaches be prevented
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verapemil
lithium ergotamine indomethacin cyproheptadine |
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what can rapidly lower the pressure in pseudotumor cerebri
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repeated LP
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Dx
px feels pain along the carotid area of the neck |
carotidynia
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what is carotidynia
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inflammation of the carotid and vagus nerve
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Dx
px has a redenned mucosa and lots of pain especially when their mouth is dry |
burning mouth syndrome
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Rx for trigeminal neuralgia
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oxcarbazepine
or carbamazepine |
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SE of carbamazepine
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aplastic anemia
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how can trigeminal neuralgia be cured
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surgical decompression
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what can reduce the incidence of postherpetic neuralgia
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acyclovir
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Rx for pain of postherpetic neuralgia
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TCA
gabapentin pregabalin carbamazepine phenytoin topical capsaicin |
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when is the zoster vaccine indicated
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all persons above the age of 60
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Dx
px has a seizure and then develops hemiplegia |
todds palsy
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Rx for febrile seizure
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acetomenophen
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Dx
5 yo px with epilepsy a/w mental retardation, cognitive disfunction |
lennox gastaut syndrome
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what is seen on EEG of lennox gastaut syndrome
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slow spike and wave activity
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what do px develop after a seizure
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met acid
because of increased lactic acidosis |
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what should be done in a px with an unprovoked seizure
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CT to exclude hemorrhage
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what is epilepsy
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seizure caused by an unclear etiology
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what is sundowning
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deterioration of px in the evening hours
not a/w dementia |
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what should be done in a px with confusion that has a vague or unknown history
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Rx with thiamine, O2, or Naloxone
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Dx
young px who develops seizures in the mornings especially when sleep deprived |
juvenile myoclonic epilepsy
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Rx for status epilepticus
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check ABC
benzo fosphenytoin phenobarb neuromuscular blocking agents intubate and give general anesthetic -midazolam or propafol |
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initial Rx for partial seizure
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phenytoin
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initial Rx for tonic clonic seizure
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phenytoin and carbamazepine
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Rx for absent seizure
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ethosuxamide or valproic acid
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what is seen on EEG of absent seizures
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symmetric 3 Hz spike and wave activity
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what is considered status epilepticus
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more than 30 minutes of seizure
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what can provoke an absent seizure
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hyperventilation
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Rx for pregnant woman with seizure
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Mg Sulfate
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when should antiepileptics be started after a single seizure
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status epilepticus
abnormal EEG family history head scan shows mass or something uncorrectable |
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when can antiepileptics be discontinued
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seizure free for 2 years
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how can a px on anti epileptics be screen for the possibility of the recurrence of a seizure
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sleep deprivation EEG
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MCC of communicating hydocephalus
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SAH
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where is the bleeding in a SAH
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pia and arachnoid
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why does SAH cause hydrocephalus
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destroys arachnoid villi and cisterns
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what causes a SAH in a premature baby
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intraventricular hemorrhage
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MCC of SAH
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saccular (berry) aneurysm
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Dx
px presents with sudden onset of severe headache with stiff neck, photophobia and fever |
subarachnoid hemorrhage
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what is cerebral salt wasting syndrome
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occurs in px with SAH
increased secretion of ADH and ANP -results in hyponatremia that resolves in 1-2 weeks |
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MC site of hypertensive hemorrhage
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putamen
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initial test for SAH
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CT w/o contrast
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most accurate test for SAH
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LP
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normal ratio of WBC to RBC on LP
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1:500-1000
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how is the WBC:RBC ratio on LP in SAH
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normal, although WBC count is increased
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what should you suspect if the WBC:RBC ratio on LP shows increased WBC but not normal ratio
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meningitis
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what is seen on CT of SAH
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blood between the sulci and cisternae
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what is seen on EKG in a px with intracranial bleeding
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large or inverted T waves
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Rx for SAH to prevent subsequent ischemic stroke
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nimodipine
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Rx for SAH to prevent repeated hemorrhage
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embolization (coiling)
if not surgical clipping |
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Rx for SAH if hydrocephalus develops
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ventriculoperitoneal shunt
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Rx for SAH seizure prophylaxis
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phenytoin
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what is the best initial Rx fro bacterial meningitis
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ceftriaxone and vancomycin
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triad of normal pressure hydrocephaly
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urinary incontinence
cognitive impairment gait |
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how is the gait in normal pressure hydrocephaly
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feet are attached to the floor like magnets
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what is effected in arterior spinal artery infarction
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everything except dorsal column
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Dx
px presents with loss of all function except position and vibration |
anterior spinal artery infarction
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how is anterior spinal artery infarction Dx
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MRI
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Rx for anterior spinal artery infarction
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supportive
lumbar drains to decrease pressure |
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what can cause subacte combined degeneration of the cord
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B12 def and neurosyphilis
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Dx
px presents with loss of position and vibration |
subacte combined degeneration of the cord
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what is affected in subacte combined degeneration of the cord
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dorsal column
corticospinal tract |
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Dx
px presents with burning pain and paralysis in the upper extremity and sparing of the lower |
central cord syndrome
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what is affected in syringomyelia
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ventral white commissure
-spinothalamic -corticospinal |
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Dx
px presents with asymmetric focal weakness with numbness and parasthesia |
lumbar plexopathy
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what can cause syringomyelia
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MVA a/w whiplash
-disrupted drainage of central canal -post traumatic cystic degeneration |
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most accurate test for syringomyelia
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MRI
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Rx for syringomyelia
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removal of tumor or drainage of fluid
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where does a brain abscess occur
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parenchyma
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how do brain abscess spread
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contiguous infection
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best initial test for brain abscess
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CT or MRI
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most accurate test for brain abscess
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biopsy
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what is seen on a scan of brain abscess
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ring or contrast enhancing lesion
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what is the empiric Rx for brain abscess
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penicillin (vanco)
metro ceftriaxone (cefepime) |
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what are some findings in tuberous sclerosis
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neuro abnormalities
adenoma sebaceum shagreen patches/ash leaf spots retinal lesions cardiac rhabdomyomas |
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what are some findings in NF
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cafe au lait spots
meningiomas and gliomas acoustic neuromas |
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how are acoustic neuromas Dx
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MRI with gadolium enhancement
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what is the most severe form of NF
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wishart
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mutation in NF (wishart)
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nonsense or frameshift mutation
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mutation in NF (gardner)
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missense or splice mutation
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what is hemiparesis
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weakness
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what is hemiplegia
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cant move
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what are some findings in sturge weber syndrome
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MR
port wine stain (unilateral cavernous hemangioma) seizures |
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what is seen on x ray of sturge weber syndrome
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gyriform intracranial calcifications and angiomas
resemble tram track |
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what makes essential tremor worse
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caffeine
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bets treatment for essential tremor
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propanolol or primidone
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SE of primidone
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acute intermittent porphyria
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what can px with essential tremor self medicate with
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alcohol
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what is damaged in parkinsons
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substantia nigra
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what skin abnormality is a/w parkinsons
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seborrheic keratosis
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what are lewy bodies
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eosinophilic cytoplasmic inclusions on neurons
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what accumulates in parkinsons
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a-synuclein protein
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Dx
px with parkinsons presents with severe orthostasis |
shy drager syndrome
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Rx for shy drager syndrome
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anything that increases intravascular volume
-fludracortisone -salt supplementation -a+ -constrictive garments in lower extremities |
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what can cause parkinsons
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boxing
encephalitis MPTP (miperidine ->opioid) |
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Dx
Jew with autonomic disfunction and severe orthostasis |
riley day syndrome
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Dx
waddling gait |
muscular dystrophy
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Dx
en bloc gait |
vestibular ataxia
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Dx
wide gait with high lifted feet that slap when land |
tabes dorsalis (loss of propioception)
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Dx
gait with leg that swings in semicircle |
hemiparesis
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how is the tremor in parkinsons
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resting
5-7 hertz begins in one hand |
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Rx for mild parkinsons < 60 yo
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anticholinergics
-benztropine -trihexyphenidyl |
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Rx for mild parkinsons >60 yo
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amantidine
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SE of amantidine
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livedo reticularis
(mottled vascular pattern in lower extremity) |
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what makes parkinsons severe
|
inability to care for themselves
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best initial Rx for severe parkinsons
|
DA agonist
-pramipexole -ripinirole |
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most effective Rx for severe parkinsons
|
levodopa/carbidopa
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SE of levodopa/carbidopa
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hallucination, confusion and somnolence
on off phenomenon |
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what is the next step in a parkinson px that is on levodopa/carbidopa and develops on off phenomenon
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COMT inhibitors
-talcapone -entacapone |
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what is the next step in a parkinson px that is on levodopa/carbidopa but is inadequate
|
COMT inhibitors
-talcapone -entacapone |
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SE of COMT inhibitors
|
chorieform dyskinesia
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which parkinson Rx slows its progression
|
MAO inhibitors
-rasagiline -selegiline |
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what is done in a parkinson px that begins to develop psychosis because of Rx
|
antipsychotics
-clozapine -quetiapine |
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Rx for spasticity
|
baclofen
dantrolene tizanadine |
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what score of mini mental exam indicates dementia
|
<24
|
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Rx for restless leg syndrome
|
DA agonist
-pramipexole -ropinerole -levodopa |
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what is restless leg syndrome a/w
|
chronic kidney disease
iron deficiency anemia |
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what worsens restless leg syndrome
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caffeine
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what can slow the progression of alzheimers
|
vit E
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what can be seen on CT or MRI in alzheimer px
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cortical atrophy
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what are some histological findings in alzheimers
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neurofibrillary tangles
neuritic plaques amyloid deposition |
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what test can differentiate dementia from pseudodementia
|
dexamethasone suppression test
-abnormal in pseudodementia |
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triad in huntingtons
|
choreaform movements
dementia behavioral changes (irritable,antisocial, moody) |
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most accurate test for huntingtons
|
genetic testing
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Rx for psychosis in huntingtons
|
haloperidole or quetiapine
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Rx for dyskinesia in huntingtons
|
tetrbenazine
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Rx for tourettes
|
haloperidole, clonazepam and pimozide
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Rx for dyskinesia in tourettes
|
tetrabenazine
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Dx
px who becomes weaker after a hot shower |
MS
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most common presentation of MS
|
blurry vision or visual disturbance from optic neuritis
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triad of MS
|
scanning speech
intention tremor nystagmus |
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Dx
young female presents with blurry vision and bilateral trigeminal neuralgia |
MS
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Dx
MRI shows periventricular white matter lesions |
MS
|
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best initial test for MS
|
MRI
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most accurate test for MS
|
MRI
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what is done in a px suspected of having MS and has equivical MRI
|
LP looking for oligoclonal bands
|
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Rx for acute exacerbation of MS
|
high dose steroids
|
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Rx that slows progression of MS
|
beta interferon
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MS Rx that prevent relapse
|
glatiramer (copolymer 1)
beta interferon |
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what is the only oral Rx for MS px
|
fingolimod
|
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which MS Rx is a/w the development of PML
|
natalizumab
|
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what can enhance the effects of immunosuppresives in MS
|
plasmaphoresis
|
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MC initial presentation of ALS
|
difficulty chewing and swallowing
deccreased gag reflex (pooling of saliva) weak cough |
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what is affected in ALS
|
corticospinal tract
|
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what is spared in ALS
|
sensation
sphincters sexual cognitive |
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MCC of death in ALS
|
respiratory failure
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what is a pronator drift and what is it used for
|
px has palms up, when asked to close eyes they will pronate
used to Dx an UMN lesion |
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what is seen on electromyography in ALS
|
loss of neural innervation
|
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what lab abnormality is found in ALS
|
increased CPK
|
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Rx that prevents the progression of ALS
|
riluzole
|
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Rx for spasticity in ALS
|
baclofen
|
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what helps the respiratory difficulties in ALS
|
CPAP and BiPAP
|
|
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what is needed in advanced ALS with respiratory failure
|
tracheostomy and a ventilator
|
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SE of riluzole
|
dizzy/nausea
weight loss increased LFTs |
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what is required to Dx ALS
|
2 extremities with LMN lesions
UMN in one region |
|
|
most accurate test for charcot marie tooth disease
|
electromyography
|
|
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Dx
px presents with high arch of feet and legs that look like champagne bottles |
charcot marie tooth disease
|
|
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MCC of peripheral neuropathy
|
DM
|
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best initial Rx for peripheral neuropathy
|
pregabalin or gabapentin
|
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peripheral nerve damaged:
wasting of hypothenar eminence and pain in the 4 and 5 finger |
ulnar
|
|
|
peripheral nerve damaged:
pain and numbness in outer aspect of the thigh |
lateral cutaneous nerve
|
|
|
peripheral nerve damaged:
pain and numbness in ankle and sole of foot |
tarsal tunnel (tibial nerve)
|
|
|
what are some causes of bells palsy
|
lymes
sarcoidosis herpes zoster tumors |
|
|
findings a/w bells palsy
|
hyperacusis (stapedius muscle)
taste disturbance (anterior 2/3 of tongue) |
|
|
what nerve senses sweet taste and where
|
7
anterior 1/3 |
|
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what nerve senses bitter taste and where
|
9/10
posterior 2/3 |
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Dx
px says that their face feels pulled or stiff on one side |
bells palsy
|
|
|
most accurate test for bells palsy
|
electromyography and nerve conduction
|
|
|
best initial therapy for bells palsy
|
prednisone
|
|
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what is a common complication of bells palsy
|
corneal ulceration
|
|
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how can corneal ulceration be prevented in bells palsy
|
taping eyes
lubricating eye |
|
|
Dx
px develops ascending paralysis within hours to days |
tick born paralysis
|
|
|
Rx for tick born paralysis
|
meticulous search for tick
|
|
|
how can ALS and guillaine barret be differentiated
|
GB - ascends and loses sensation
|
|
|
most accurate test for Guillain barre
|
electromyography and nerve conduction studies
|
|
|
Dx
electromyography shows decrease in propagation of impulse along the nerve |
guillain barre
|
|
|
a/w CSF showing increased protein and normal cell count
|
guillain barre
|
|
|
a/w albumino cytologic dissociation
|
guillain barre
|
|
|
what is seen on PFT on guillain barre that has involved the diaphragm
|
decreased FVC and peak inspiratory pressure
|
|
|
Rx for guillain barre
|
IVIG or plasmaphoresis
|
|
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what is the most urgent step in a px with suspected guillain barre
|
PFTs
|
|
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Dx
px has double vision and difficulty that is worse at the end of the day |
MG
|
|
|
best initial test for MG
|
ACh receptor Ab
|
|
|
most accurate test for MG
|
electromyography
|
|
|
what is seen on electromyography of myasthenia gravis
|
decreased strength with repetitive stimulation
|
|
|
what is seen on histology of MG
|
simplification of post synaptic cleft
widening of the synaptic space |
|
|
what imaging should in MG
|
chest imaging looking for thymoma or thymic hyperplasia
|
|
|
best initial Rx for MG
|
neostogmine or pyridostigmine
|
|
|
Rx for MG when refractory to neostigmine and pyridostigmine
|
IVIG
|
|
|
Rx for MG if refractory to meds and IVIG
|
<60 = thmectomy
>60 = prednisone |
|
|
Rx for acute myasthenia crisis
|
intubate
then give IVIG and plasmaphoresis px should be withdrawn from anticholinergics |
|
|
what is damaged in parinaud syndrome
|
superior calliculus and CN 3
|
|
|
Dx
px with paralysis on vertical gaze |
parinaud syndrome
|
|
|
what is the most common site of entrapment of ulnar nerve
|
elbow
|
|
|
what is seen in the eye of px with amaurosis fugax
|
cholesterol particles (hollenhorst bodies)
|
|
|
what can recurrent amaurosis fugax indicate
|
impending stroke
|
|
|
Dx
px who rapidly develops dementia, myoclonus |
creutzfelt jakob
|
|
|
Dx
EEG shows synchronous bi or triphasic sharp waves |
creutzfelt jakob
|
|
|
what non neurological symptoms are seen in friedrichs ataxia
|
hypertrophic cardiomyopathy
DM skeletal deformity |
|
|
what can cause parinaud syndrome
|
germinoma
pinealoma |
