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100 Cards in this Set
- Front
- Back
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What is a Polyneuropathy?
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neuropathy involving many nerves symmetrically and beginning in the long axons (ex like in diabetes)
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What is a radiculopathy?
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neuropathy liimted to a single spinal nerve (ex L5)
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What is a mononeuropathy?
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neuropathy limited to a single speriperhal nerve
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A 36 yo pt is complaining of numbness in the first four digits that awake her during the night. She has thenar atrophy and is unable to pinch a piece of paper
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Carpal Tunnel Syndromehttp://www.flashcardexchange.com/mycards/add/834865
-pain in hand or forearm -increased pain at NIGHT and DRIVING -weakness of pinch -Thenar atrophy |
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What are the associated conditions with carpal tunnel syndrome?
What is it confirmed? What are the tx? |
conditions:
Hypothyroidism Pregnancy repetitive motions confirm with EMG: prolonged latency Rx: splint, IV steroids, surgical decompression |
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Pt comes in with difficulty spreading his fingers and has atrophy of the intrinsic hand muscles and has numbness in his fingers with increased flexion of the elbows
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Cubital tunnel syndrome
-numbness 4th and 5th digits -medial elbow pain -weakness and atrophy of intrinsic hand muscles -clawing of 4th/5th digits -problems with fine movements |
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What do you need to r/o and how do you confirm cubital tunnel syndrome?
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DDX; is C8 or T1 radiculopathy
lowe plexopathy Confirm with EMG: slowing across the elbow |
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Pt has weakness of the ankle and toes on extension. Has parasthesias on the dorsum of the foot and lateral shin and has problems with foot eversion
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Peroneal Neuropathy
caused my compression at the fibular head due to compression **if problems with inversion then this is NOT peroneal neuropathy..might be a L5 radiculopathy , sciatic neuropathy, |
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What is the tx of peroneal neuropathy?
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-observe 6-8 wks
- ankle foot orthotic -decompress never |
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How can you tell the difference bt bells palsy and bulbar neuropathy?
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Bells Palsy has unilateral facial weakness and bulbar neuropathy is just the lower face
-can also have pain in the ear or vesicles in ear canal (herpes) tx: seriods and antivirals |
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What is a plexopathy?
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lesion of single limb not fitting a single radicular or peripheral nerve territory
Spinal MRI shows no significant disc hernation or osteophyte formation |
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Acute Plexitis
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Spontaneous pain that builds over days
-weakness of 2-3 weeks -sensory loss -Atrophy 1-2 months Etiology: Post infectious, inheritable |
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Diabetic Amyotrophy
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-spontaneous pain in lower back, hip or proximal legs
-sensory loss ant thigh and medical lower legs -weakness for 2-4 weeks ***pt have a painful muscle weakness*** |
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Is Polyneuropathy effect what types of nerves
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-starts with the longest axons first and sensory before motor
Sensory symptoms: burning, aching, pickling, numbness, allodynia Motor: intrinsic muscle weakness, foot drop, muscle stretch reflex loss Automonic: hair loss, decrease sweating |
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What is the workup of polyneuropathies?
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Blood work: glucose, CBC, B12, creatinine, ANA, ANCA, protein electophoriesis
CSF for guillain barre Electro testing: nerve conduction axon vs myelin disease Nerve antibodies, genetic testing, HIV |
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What are the polyneuropathies that show symotoms days to a few weeks?
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- Guilain Barre syndrome
-Toxins: arsenic, chemotherapy - Vasculitis: polyarteritis, Wegeners - critical illness neuropathy - |
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What are the polyneuropathies that show symotoms months, years?
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- Diabetes
- alcoholism -vit def -chronic inflammatory neuropathy -HIV - inherited neuropathy -idiopathic |
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What are the most common causative organisms of community acquired bacterial menigitis
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Strep pneumoniae
Neisseria meningitidis |
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What is the first step when a pt present with HA, febrile and meningismus and lethargic
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start therapy
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What is the therapy that needs to be initiated in this pt?
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-Third or fourth gen cephalosporins (ceftriaxone, cefotaxime, cefepime)
-Vacomyacin 30-45 mg -Acyclovir 10 mg (herpes) - Doxycycline 100mg (ticks) |
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When is it important to add ampicillin + gentamicin
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-Pt over age 60
-Organ transplantation -Pregnancy -malignancy -immunosuppressive therapy or state |
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When must you give a pt dexamethasone?
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15-20 min before first dose of antibiotics or with dose of antibiotics
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What are the indications for CT prior to a lumbar puncture
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- Altered level of consciousness
-Papilledema -New onset seizures -focal neurological deficit - immunocompromised state |
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What must be imaged on a CT or MRI
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4th ventricle and quadrigeminal cistern
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What are the Normal values in CSF
- opening pressure -WBC -glucose -protein |
Opening pressure: 10-180 mmH2o
WBC: 0-5 (NO PMN's) glucose: 45-80 mg protein: > 45mg |
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What to look for in spinal fluid in a pt with bacterial menigitis
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-Increase opening pressure
-Pleocytosis of polymorphonuclear leukocytes -decrease glucose concentration -gram stain and bacterial culture -broad range PCR **want to get LB within 4hrs of starting antibiotics** |
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What is the classic CSF in viral meningitis
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-lympocytic pleocytosis
-normal glucose and protein |
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What are the test that need to be sent for viral meningitis
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CSF RT-PCR for enterovirus
CSF PCR for HIV RNA CSF PCR for HSV-2 DNA CSF viral cultures **Acute and convalescent serology for enterovirus and arborviruses during mosquito season |
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A pt present with malaise, HA, muscle pain and diarrhea. She then becomes confused and has flaccid weakness
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West Nile Virus encephalitis
Diagnosis: West Nile virus IgM antibody in CSF and WN virus RNA in CSF |
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What are the symptoms associated with HSV encephalitis?
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Fever
Hemicarnial HA word finding difficulty behavior abnormalities confusion *seizures* |
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Describe the CSF of HSV encephalitis...
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-increased opening pressure
-lymphocytic pleocytosis 5-500 -normal or increased glucose -mild to moderate elevation in protein -RBC and xamthochromia |
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What test need to be sent in HSV encephalitis?
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PCR for HSV DNA
Serum CSF antibody ration <20:1 **Antibodies do not appear in CSF until 8-12 days after onset of disease and persist for 30 days |
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What is the characteristic of EEG of HSV encephalitis?
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Sharp and slow waves complexes that occur at regular intervals of 2-3 seconds over the TEMPORAL LOBE
-seen bt 2nd-15th day of illness |
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What is the tx for HSV encephalitis
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Acyclovir 10 mg/kg
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What is the the organism that causes neurocyticercosis
-what is the most common symptoms -what does the neuroimaging look like.. |
-Taenia solium
- symptoms = seizures and increased intracranial pressure - neuroimaging: --cystic lesions --brain calcification --ring enhancing lesions --hydrocephalus |
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neurocyticercosis
What is the recommended test and how is it treated? |
- immunoblot
*CSF is usually normal tx: albendazole or praziquantel |
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What are some of the symptoms of HIV associated dementia?
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-Memory loss with selective impaired retrieval
-personality changes -motor dysfunction and dyscoordination |
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What are the best drugs for HIV that can pass though the blood brain barrier?
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nonnucleoside reverse transcriptase inhibitors
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What is ddx in a HIV infected individual with a focal enhancing mass lesion on CT?
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Toxo
tx with pyrimethamine or sulfadiazine CNS lymphoma obtain CSF for Epstein barr virus nucleic acid |
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What are the symptoms of sporadic creutzfeldt-Jakob disease
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progressive dementia
ataxia myoclonus |
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What is the deletion in Prader Willi and what are some of the classical features?
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-Paternal deletion of 15
Features: obesity MR Neonatal hypotonia |
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What is the deletion in Angelman syndrome and what are some of the classical features?
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Maternal deletion of 15
features: Seizures MR autistic features "Happy puppet" Acquired microcephaly |
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What is the inheritance of Rett syndrome and what are some of the classical features
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inheritance: X linked
-only seen in girls -Signs: -sterotypies of hand wringing -seizure -MR -Apnea |
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What is the ddx for childhood epilepsy
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Syncope
breath holding cardiac dysrhythmias -parasomnias -tics -migrains |
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What places kids at increased risk of recurrant seizures?
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Risk increases with:
-seizure is focal -current CNS dysfunction -EEG or MRI abnormal * |
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Just a lil something you should know
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** 50% of children with epilepsy will out grow them***
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What is the cause of Tay Sachs Disease
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-AR
-build up of ganglioside GM2 due to insufficient hexo A -Normal for a months then deaf, blind, dementia, seizures -Death by 4 yrs |
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What is the cause of Krabbe Disease and what aer some of the symptoms?
-What is the tx |
-AR
-leudodystrophy -Deficiency of galactosylceramindase -Symptoms: irritability, limb stiffness, seizures, regression, loss of vision -Tx: bone marrow transplant |
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What is the cause of Adrenoleukodystrophy?
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-X-linked
- most common in boys - Onset 4-10 yrs w/ behavioral changes, regression, blindness, deafness -Adrenal dysfunction after presents later |
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What are the causeds of Niemann Pick Disease
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leukodystrophy
-Type A infintile most common -insufficient sphingomyelinase -Symptoms: jaundice, large liver, death by 18 mos -Tx: bone marrow curative |
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What are the primary criteria for Tuberous Sclerosis
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-Adenoma sebaceum
-Ungual fibromas -cortical tubers -subependymal nodules -renal astrocytomas |
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What are some ofhte secondary criteria of Tuberous Sclerosis
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-infintile spasms
-Ash leaf spots -cardiac rhabdomyoma -renal angiolipoma -subependymal giant cell astrocytomas |
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What are some important think to consider when looking at Tuberous Sclerosis
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-50% will have cardiac rhabdomyomas
-kidney lesion: flank pain and hematuria -subependymal giant cell astrocytoma -hydrocephalus |
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What is the pathophysiology of multiple sclerosis
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immune mediated illness that attacks myeline antigens in the CNS
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What is MS defined clinically
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-symptoms arise over hours to day
-abate in 2-6 weeks -new attacks involve new and other parts of the brain |
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What are some of the most common areas of the brain effects in MS
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-Optic nerve
-periventricular white matter -cerebellum -Brainstem (INO) -Spinal Cord |
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What are some of the more common symptoms of MS
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- fatiuge (most common)
-impaired cortical functions -depression -optic neuritits -Motor -sensory -coordination problems (axatia) -autonomic problems (bladder |
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What are some features that are more suggestive of MS?
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-relapses and remission
-onset b/t ages 15-50 -Optic neuritis -Lhermitte sign INO -fatiuge |
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At what age does is usually present?
Is it more common in men or women? |
- 20-40 years
-more common in women |
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What is the most common form of MS?
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Relapsing remitting (80%)
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What form of MS does not respond to treatment?
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Primary progressive
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What form of MS is primary involves that optic nerves?
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Neuromyelitis Optica
-antibody mediated -demyelination of spinal cord and optic nerve -more severe form -dx with NMO-IgG antibody titers |
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How is MS diagnosed?
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MRI: T2 signal with abnormalities in the periventricaular white water
Spinal Tap: oligoclonal bands and increased CSF/serum IgG ratio Evoked pot: slowing of conduction along different pathways |
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what is used in the Acute treatment attack for MS?
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methylprednisolone
-1 gram only shortens the duration of that attack does NOT alter the course of the disease |
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What are the first line agents in treatment of MS?
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-Interferon beta 1a
-Interferon beta 1b -Glatiramer acetate |
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What do the first line drug therapy do for the disease (MS)
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-reduce the number of relapses by 30%
-decrease disablity to some degrree -decrease the number of lesions that accumulate on MRI |
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What are some side effect of interferon beta 1b?
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depression
flu like symptoms neutralizing antibodies |
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What are the second-line tx of MS
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Mitoxantrone: chemotherapy agents
Natalizumab: reduction of relapses |
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What are some side effects of:
- Mitoxantrone? -Natalizumab? |
Mit: cardiotoxic need to get an EKG
Nat: progressive multifocal leukoencephalopathy (PML) |
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What is the characteristics of Sturge Weber Syndrome
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-port wine stain
-leptomeningeal angiomas -Seizure -focal deficits (hemiparesis) -glaucoma |
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What are the common characteristics of Neurofibromatosis Type 1?
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-AD
-chromosome 17 -2 of the following: -6 or more cafe au lait spots -2 neurofibromas -axillary freckling -sphenoid wing dysplasia -bilateral optic nerve gliomas -> 2 lisch nodules -first degree relative with NF |
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What are the common characteristics of Neurofibromatosis Type 2?
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-AD
-chromosome 22 -cafe au laits (fewer than type 1) -90 % have bilateral acoustic neuromas -schwannomas, meningiomas, ependymomas -cateracts |
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What disease is associated with oculomotor apraxia, growth failure, recurrent infections, dysarthria, truncal ataxia, telengectasia
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Ataxia Telangiectasia
-AR -chromosome 11 -2/3 die by 20 yrs of age -most in wheelchair by 10-15 yrs |
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What are the criteria for Tourette syndrome
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-multiple motor tics
-verbal tics -tics present for at least one year -onset before age 21 |
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What are the comorbidities of tourette syndrome
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OCD
ADHD depression anxiety disorders |
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What are the tx for Tourette syndrome?
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centrally acting alpha 2 agonist
antipsychotics |
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what is a transient tic disorder?
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tic disorder that last less than one year
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What are the values of the platelet and INR must be before you do a LB?
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platelets: > 50,000
INR: < 1.5 |
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What type of HA is a post lumbar puncture HA? how long after procedure?
And what type of symptoms do you see? |
low pressure HA (know this)
-48-72 hrs -HA, back pain, dizziness, nausea, vomiting. orthostatic hyptension |
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What are the TX of post lumbar puncture HA?
How long do they last |
most will resolve in 5 days
Tx: Remain supine drink caffine Caffeine sodium benzoate 500mg IV Epidural blood patch (helps 95& of the time) |
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When you ask for a 14.33 protein from the CSF what disease are you testing for?
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-creutzfeld Jacob
-no rene I dont think they are going to get this specific but if they do we'll know it!! |
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What are some contraindications to LP?
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-brain tumor or abscess
-subarachnoid bleed -obstructive hydrocephalus -post. fossa mass -clinical clues of increased ICP |
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More contraindications to LP?
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-spinal subarachnoid block
-infection in lumbar area -platelet count < 50,000 -on warfarin therapy -INR > 1.5 |
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What is one thing you must always order when doing LB
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SERUM GLUCOSE
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What will cause a low csf/serum glucose ration?
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bacterial and fungal meningitis
carcinomatous meningitis TB has CSF glucose of 40mg |
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There should be __ wbc present for every ____rbc
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1 wbc for 700 rbc
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IS IT OK TO HAVE 3 WBC IN CSF?
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YES NO MORE THAN 5
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When doing a LP what direction should the bevel be in regards to the dura fibers
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should be PARALLEL with the flat portion of the bevel pointing towards the pt side
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How long should the pt be in the recumbent position after LB before they can be discharged home?
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at least 1 hour
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Epidural blood patch should not be done earlier than ___ hrs after LP
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24 hrs
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What are some of the complications of LP?
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epidural or subdural hematoma
infection herniation |
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What is the normal CSF:serum glucose ration
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.6 or 2/3
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What is the definition of brain death?
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irreversible loss of function of the brain including the brainstem
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What are the three cardinal findings in brain death?
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coma or unresponsiveness
absence of brainstem reflexes apnea |
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Coma or unresponsivness
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no cerebral motor response to pain in all extremities
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How do you test absent reflexes?
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Pupils
-no response to light -size: midposition to dilated Ocular movements -no oculocephalic reflex -no deviation of the eyes (Dolls eyes) Facial sensation -no corneal reflex, jaw reflex, no grimacing to deep pressure Pharyngeal and tracheal reflexes -no gag reflex -no cough with bronchial suction |
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What are the prerequisites to the apnea test?
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Core Temp > 36.5 (97 F)
Systolic blood pressure > 90 mm hg Euvolemia Normal PCO2 Normal PO2 |
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How is the Apnea test preformed?
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-connect pulse oximeter disconnect ventilator
-give 100% O2 -look for respiratory movements -measure arterial PO2, PCO2 and pH after 8 min (reconnect vent) - |
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What is considered a positive apnea test?
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if respiratory movements are absent
arterial PCO2 > 60mm or while the ventilator is connect: if the BP < 90mm Hg or desat and arrhythmias are present get arterial blood sample if PCO2> 60 or PCO2 is > 20 over baseline its a positive test -if respiratory movements are observed apnea test is negative and the test should be repeated |
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What conditions can interfere with the dx of brain death?
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severe facial trauma
preexistiong pupillary abnormalities toxic levels of sedative drugs sleep apnea |
