Osce Review: Neurology

Front 1

Stroke
1. Other names
2. Describe
3. MC in who
4. MC in what vessel

Back 1

1. CVA, CVI (infarct), AIS (acute ischemic stroke)
2. sudden onset of focal neuro deficits dt ischemia/hemorrhage
3. MC in AA (and Asians)
4. MCA --> Broca's expressive aphasia & Wernike's receptive aphasia

Front 2

1. What are 4 different types of strokes?
2. What is the MC type

Back 2

1. Ischemic (thrombus or embolic), hemorrhagic, lacunar (HTN vessels leak), watershe (iatrogenic, HoTN related)
2. MCC = ischemic

Front 3

Stroke
1. Non-modifiable risk factors
2. modifiable risk factors

Back 3

1. age, sex, race, FHx, prior CVA/TIA
2. HTN, smoke, DM, hyperlipidemia, cardiac dz, A. fib, hypercoaguability, obesity

Front 4

Labs done with a CVA

Back 4

*glucose, CBC, INR, lytes, Neuro exam, MRI, CT w/o contrast

Front 5

Treatment of CVA
1. Goals
2. Acute phase = inpatient
3. F/U care

Back 5

1. save ischemic penumbra
2. IV tPA (tissue plasminogen activator) w/in 3hrs of sx, ASA (if no bleed), warfarin, Oxygen
3. F/U q3mo x1yr

Front 6

Sx of CVA

Back 6

*FAST (Face = smile nl, A = arms raise equally, S = speech w/o slur, T = time to call 911)
*change in speech, weak/paralysis, visual loss, diplopia, numb/tingling, dizzy

Front 7

What is the difference between a TIA and CVA?

Back 7

*TIA = sudden onset & TRANSIENT (<24hrs) neuro deficit dt ischemia

Front 8

TIA
1. What is it?
2. why important?
3. Sx?
4. Tx

Back 8

1. transient ischemic attack (<24hrs)
2. increases risk for CVA
3. similar to stroke
4. ASA or Clopidogrel (Plavix) and F/U q3mo x1yr

Front 9

TIA
1. What is the ABCD2 scale
2. When can someone be treated at home

Back 9

1. A = age >60 (1), B = BP >140/90 (1), C = clinical signs...unilateral weak (2) or speech change (1), D = DM (1), Duration >60 min (2) or 10-59min (1)
2. score <4 = go home w/ ASA & F/U

Front 10

Migraines
1. MC in men or women?
2. Sx

Back 10

1. MC in women
2. HA sx 4-72hrs, neuro exam= nl

Front 11

Migraine HA precipitants

Back 11

menstruation, sleep pattern changes, caffeine w/d or excess, tyramine food (red wine, cheese, herring), chocolate, nitrites (processed meat), estrogen, stress, activity

Front 12

1. What are the 2 types of Migraines
2. Describe each
3. MC form

Back 12

1. Common (withOut aura)
2. Classic = with aura
2. MC = common

Front 13

Common Migraine

Back 13

*without aura, MC form, unilateral/throbbing pain, pain worse with movement, N/V, photophobia/phonophobia

Front 14

Classic Migraine

Back 14

*with aura
*Aura = gradual, usu lasts <60min --> HA
*flashing lights (MC), unilateral parethesis/weak/numb, odor

Front 15

Migraine Tx
1. Nonpharm
2. Pharm

Back 15

1. regular habits/avoid triggers
2. Abortive tx: analgesics + caffeine, NSAIDS, sumatriptan (supervise 1st dose if postmenopausal, men >40, CAD RFs), cafergot (ergotamine)

Front 16

Migraine Prophylaxis
1. When to start
2. Types

Back 16

1. migraines >2/mo, abortive tx >2x/wk, sx meds not working
2. predictable pattern = NSAIDS, HTN/angina/anxiety = BB, depression/insomnia = TCA, Sz/BPAD = AED, ineffective = methysergide

Front 17

Cluster HA
1. MC in what gender
2. Describe

Back 17

1. MC in men
2. HA x2-3 months, occur q1-2yrs (at least 5 = dx)

Front 18

Sx of Cluster HA

Back 18

*unilateral/excruiating penetraing pain
*max pain = behind pain (trigeminal N distribution)
*lacrimation, rhinorrhea, conjunctival injection

Front 19

Tx of Cluster HA

Back 19

*O2 = 1st line
*Prophylaxis = start early in cluster, take qday until HA free >2wks, use verapamil or prednisone

Front 20

What is the MC form of HA?

Back 20

Tension HA

Front 21

Tension HA
1. Sx
2. Dx
3. Tx

Back 21

1. bilateral, tightening band like pressure, non-pulsating
2. HA = 30min-7day w/ sx (no N/V, may have photo or phono - phobia)
3. mild analgesics, relax, prophylaxis w/ TCAs if HAs >2wks

Front 22

Bacterial Meningitis
1. Describe
2. Most fatal cause
3. Most communicable cause

Back 22

1. inflammation of pia-arachnoid & fluid --> cerebral edema
2. S. pneumo
3. N. meningiditis

Front 23

Causes of Meningitis in following age groups:
1. neonates
2. infants, 2-50 yo
3. >50

Back 23

1. Group B strep
2. S. pneumo, N. meningiditis
3. S. pneumo, L. monocytogenes

Front 24

Meningitis
1. Triad of sx
2. other sx

Back 24

1. fever, nuchal rigidity, altered mental status
2. HA, sz, confusion, N/V, irritable

Front 25

Signs for Meningitis

Back 25

1. Brudzinski: you passively flex pt neck --> pt flex LE
2. Kernig: you flex hip --> pt cannot extend knee

Front 26

Meningitis
1. LP where?
2. CSF info

Back 26

1. LP @ L4/5
2. WBC >1000 (nl <5), neutrophils present, Protein 100-500 (nl 20-45), glucose <40 (40-70), Gm stain +, open pressure >200 (nl = 100-200)

Front 27

Meningitis Tx
1. for 1-50 yo
2. Prophylaxis
3. Dexamethasone

Back 27

1. Ceftriaxone/cefotaxime + vancomycin
2. Rifampin (H. flu or N. meningiditis)
3. start before tx (H. flu in kids, S. pnuemo kids/adults)...catch 22 dt decreased inflamm (Abx may need inflamm)

Front 28

Subarachnoid Hemorrhage (SAH)
1. Can lead to?
2. Describe

Back 28

1. MCC of hemorrhagic stroke
2. blood b/t arachnoid and pia mater

Front 29

SAH
1. S/S
2. Dx
3. Tx

Back 29

1. WORST HA OF LIFE, +/- N/V, photophobia, stiff neck, LOC
2. CT, if neg --> LP, cerebral angiography (gold std)
3. stabolize, surgery (1st 72hrs)

Front 30

Epidural Hematoma
1. Describe
2. S/S
3. Dx
4. tx

Back 30

1. arterial bleed b/t skull & dura, MC = middle meningeal artery, usu dt skull fx, may rapidly expand --> herniation & death
2. talk & deteriorate
3. lEnticular shape on HCT
4. surgery

Front 31

Subdural Hematoma
1. Describe
2. MC in who
3. Dx

Back 31

1. venous blood bt dura & arachnoid
2. MC in elderly & alcoholics dt brain atrophy
3. Sickle shape on HCT

Front 32

Head CT:
1. white
2. black

Back 32

1. acute blood
2. chronic blood

Front 33

Transtentorial (uncal) herniation
1. S/S

Back 33

1. Ipsilateral, dilated fixed-pupil, contralateral weakness of arm or leg, deteriorating LOC

Front 34

Seizures
1. describe
2. MC type

Back 34

1. sudden change in electrical activity --> motor/sensory/behavior changes
2. MC = tonic clonic

Front 35

List the types of the following seizures
1. Generalized
2. Partial

Back 35

1. Grand mal, petit mal (absence), myoclonic
2. simple, complex

Front 36

What is the key difference between generalized sz and parital sz?

Back 36

Generalized = LOC

Front 37

Describe Generalized Grand Mal Sz

Back 37

*MC type
*tonic-clonic
*post-ictal phase
*Todd's paralysis (transient paresis)

Front 38

Describe Generalized Petit Mal (Absence)

Back 38

*space out
*Abrupt LOC
*no fall

Front 39

Describe Generalized Myoclonic sz

Back 39

*isolated extremity jerking
*LOC

Front 40

Describe Simple partial sz

Back 40

*no LOC
*motor = unilateral tonic-clonic
*sensory = numb, flashing lights

Front 41

Describe Complex Partial Sz

Back 41

*altered consciousness ("bit off")
*bizarre sx = N, deja vu, hallucinations

Front 42

Sz:
1. labs
2. tx during sz

Back 42

1. glucose, CT/MRI, EEG, lytes, toxicology
2. protect from fall, assure airway, place on side when done to prevent aspiration

Front 43

Seizures:
1. Chronic sz tx
2. Other restrictions
3. Drive?

Back 43

1. AEDs (depend on age, goals, other meds)
2. no driving, heavy equipment, heights, unsupervised swimming
3. drive if sz free 3mo up to 1yr
*encourage use of helmets

Front 44

Define Status Epilepticus

Back 44

*Sz that last >30minutes or >2 sz in a row without return to consciousness in between

Front 45

Tx of Status Epilepticus
1. 0-10min (early status)
2. 10-30 min
3. 30-60min (established)
4. >60min (refractory)

Back 45

1. Lorazepam
2 .IV PHT/FPHT
3. add'l PHT/FPHT or PB
4. PB or Valproate or general anesthesia

Front 46

Dementia
1. Types
2. MC type
3. #1 risk factor

Back 46

1. AD, multi-infarct
2. MC = AD
3. age = #1 RF

Front 47

Differences b/t dementia & delirium
1. duration/onset
2. consciousness
3. cause

Back 47

*Dementia: duration = mo-yrs, conciousness = alert, cause = chronic brain dz
*Delirium: duration = abrupt onset (days-wks), consciousness = fluctating, cause = drugs/infxn

Front 48

What are 2 causes of AD

Back 48

1. Plaques (beta amyloid protein) --> blocks signals
2. Tangles (altered tau protein) --> death of nerves

Front 49

Sx of Dementia

Back 49

*word finding ability affected 1st
*memory loss
*decreased executive fx, decreased reason, orientation impairment

Front 50

MMSE Scores for Dementia
1. total points
2. dementia
3. boderline
4. nl

Back 50

1. 30 total
2. dementia <20
3. 21-23 boderline
4. >24 = nl

Front 51

Dementia Tx
1. Non-pharm
2. Pharm

Back 51

1. increase solization, activity, healthy diet, mentally active
2. Donepezil (Aricept) = cholinesterase inhibitor to decrease sx, Memantine (Namenda) for mod-severe sx, tx behavior sx (atypical SGA = increase mortality)

Front 52

What is an inflammatory dz --> demyelinatino of PNS --> progressive weakness in ascending paralysis

Back 52

Guillain Barre

Front 53

Lyme Dz
1. Cause
2. early stage
3. sx of later
4. tx

Back 53

1. Borrelia burgdorferi
2. erythema migrans, flu-like sx
3. early disseminated (nerve/cards), late dz (joint)
4. Doxycycline

Front 54

1. What causes unilateral facial paralysis/weakness?
2. MC in who?
3. Tx

Back 54

1. Bell's palsy (CN 7 (facial))
2. Pg, DM
3. CS

Front 55

What causes electric shock pain, unilateral face involved, triggered by shaving/eating/touch

Back 55

*Trigeminal Neuralgia (CN 5) = 3 areas (supraorbital, maxillary, mandibular)

Front 56

What is an autoimmune dz that causes weakness and fatigue that worsens with exertion & activity?

Back 56

*Myasthenia Gravis
*MC young women, older men

Front 57

Parkinson's Dz
1. Cause
2. S/S

Back 57

1. lose nigrostriatal DA neurons (dec DA, inc cholinergic)
2. bradykinesia + 2 of:
-limb rigid (lead pipe), resting tremor, postural instability, micrographia, shuffling gait

Front 58

Parkinson's Dz
1. Dx

Back 58

*Gold std = 2 of 3 cardinal manifestations: tremor, bradykinesia, rigidity
*good response to L-dopa
*MRI to r/o other causes

Front 59

Parkinson's Dz Tx
1. Nonpharm
2. Pharm

Back 59

1. exercise/movement to preserve fx
2. 1st = MAOB (Selegiline or Rasagiline (prevent breakdown of DA))
*>65 add amantidine
*L-Dopa (Sinemet) or DA agonist (Pramipexole (MIrapex) or Ropinirole (Requip))

Front 60

What are things to consider b/t L-dopa vs DA agonist

Back 60

*L-dopa good w/ motor sx, has more motor complications

Front 61

What inherited dz causes dementia & chorea that has gradual onset and slow progression?

Back 61

Huntington's Dz

Front 62

Multiple Sclerosis
1. Describe
2. MCC of neuro disorder in who

Back 62

1. demyelination/inflammation
--> plaques/sclerosis of CNS
2. MCC of neuro disability in young adults

Front 63

Multiple Scleorsis Signs/Sx

Back 63

*varies
*MC = sensory loss
*visual changes, pain, ataxia, psych changes, fatigue, bladder dysfx, sexual dysfx

Front 64

Types of MS

Back 64

1. Relapse/Remit: attack + recovery
2. Secondary Progressive: always begins as RRMS, over time = steady decline
3. Primary Progressive: steady decline, dz = later in life (onset)
4. Progressive Relapsing: steady decline PLUS attacks

Front 65

MC type of MS

Back 65

*Relapse Remit

Front 66

Dx of MS

Back 66

*>2 episodes of neuro disturbance to different parts of CNS: >24hrs, separated by 1mo, 1 sign on neuro exam, other signs on labs
*MRI shows plaques

Front 67

Tx of MS
1. goal
2. acute sx

Back 67

*minimize dz activity/progression
*Acute sx: CS, plasma exchange

Front 68

Tx of MS
1. Pharm tx

Back 68

*Immunomodulators: avonex, betaseron, copaxone, rebif
*+/- mitoxantrone (suppresses immune cells that attack)
*Natalizumab for monotherapy (relapsing forms)

Front 69

MS tx
1. generic name
2. trade name
3. category

Back 69

1. Interferon Beta-1a
2. Rebif
3. interferon