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46 Cards in this Set
- Front
- Back
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A stroke pt presents with apraxia, aphasia, hemiparesis, hemisensory defects and visual field defects. Which circulation system is affected? Which arteries may be involved?
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Anterior Circulation:
Middle & Anterior Cerebral Arteries Anterior Choroidal |
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What are the s/s associated with strokes affecting the posterior circulation?
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coma
drop attacks vertigo n/v ataxia |
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Which arteries make up the posterior circulation of the brain?
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vertebral & basilar arteries
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What is the best diagnostic test for differentiating between ischemic and hemorrhagic stroke?
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CT (during acute phase)
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What type of therapy is used to treat an acute ischemic stroke or TIA?
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Antiplatelet
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What type of therapy is used to treat a stoke associated with a cardiac embolus?
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Anticoagulants
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Endarterectomy is indicated if ___________if the common or internal carotid artery is present
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70-90% stenosis
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If a pt is having a TIA related to a disturbance in the carotid circulation what s/s do you expect to see?
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contralateral hand-arm weakness with sensory loss
ipsilateral visual sx aphagia amaurosis fugax |
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What is the most definitive diagnostic test for TIAs?
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Arteriography
(MRI also used & is less invasive) |
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Which drugs are commonly used as prophylaxis against stokes in pts with a hx of TIAs?
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ASA
Clopidogrel Ticlopidine Aulfinpyrazone Dipyridamole |
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What is the initial dx modality for suspected SAH?
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CT
(Cerebral angiography should be done later to eval entire vasculature) |
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Sz assoc with postictal obtundation & confusion lasting minutes to hours
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Generalized Convulsive
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Sz assoc with minor motor activity (ie: blinking)
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Generalized nonconvulsive
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Are simple partial sz accompanied by impairment of consciousness?
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NO
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Sz characterized by aura, followed by impaired consciousness lasting seconds to minutes. May also have n/v, focal tonic or clonic activity or focal sensory perceptions.
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Complex Partial Sz
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What will you see on the EEG of a pt experiencing generalized absence sz?
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Generalized spikes and assoc slow waves
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What will you see on the EEG of a pt with simple partial sz?
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focal rhythmic discharge at onset of sz
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What will you see on the EEG of a pt with complex partial sz?
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interictal spikes or spikes assoc with slow waves in the temporal or frontotemporal areas
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What is the typical tx for generalized convulsive, simple partial, and complex partial sz?
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Carbamazepine
Phenytion Valproic Acid |
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Distinction between Federal and CA pleadings?
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Federal = NOTICE pleading
CA = FACT pleading If damages sought, MUST state amount unless seeking punitives. FRCP notice pleading requires that the complaint state 1) grounds for federal j/, 2) a short statement showing the pleader is entitled to relief, and 3) a demand for judgment for relief. In contrast in CA, fact pleading requires 1) a statement of fact constituting a cause of action, 2) a demand for relief, and 3) if applicable, a statement of the amount of damages sought. |
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What is the tx for status eplilepticus?
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Position pt to prevent aspiration
Manage Hyperthermia (cooling blanket or neuromuscular blockade) Diazepam or Lorazepam IV until sz stops Loading dose of Phenytoin or Fosphenytoin |
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Which test is used to visualize white matter lesions of the CNS in MS pts?
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MRI with gandolinium
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A lumbar puncture reveals CSF with lymphocytosis, slight protein elevation, elevated IgG, oligoclonal bands, and increased myelin basic protein. What is the probable dx?
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MS
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What is the drug of choice to decrease the frequency of relapses in pts with moderate to severe MS?
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Interferon-b
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What is the drug of choice to decrease the frequency of relapses in pts with mild MS?
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SubQ glatiramer acetat
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What are the drugs of choice to arrest the course of secondary progressive MS?
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Immunosuppressive agents:
cyclophosphamide azathioprine |
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Intracellular neurofibrillary tangles & extracellular neuritic plaques are characteristic of __________
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Alzheimers
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What are the treatment options for Alzheimer's?
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Acetylcholinesterase inhibitors:
tacrine donepezil galantamine rivastigmine |
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What are the early clinical s/s of vascular dementia?
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-forgetfulness in the absence of depression & inattentiveness
-sx occur in a stepwise fashion -social graces maintained |
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What s/s are seen as vascular dementia progresses?
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loss of computational capacity
problems with word finding & concentration difficulty with AODL complete dissorientation & social withdrawal |
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What are the clinical features of frontotemporal dementia (Picks dz, ALS etc)
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Behavioral Sx (euphoria, apathy, disinhibition)
Compulsiveness Primitive reflexes (palmomental, palmar grasp, rooting reflexes) |
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What is seen on the PET scan of a pt with Pick's dz or ALS?
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frontal and/or anterior temporal hypometabolism
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What are the abortive tx for migraines?
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ASA
Acetominophen NSAIDS Isometheptene |
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What are the longer-term medical treatments for mild-moderate migraines?
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triptans
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What are the prophylactic medications for frequent migraines?
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b-blockers
tricyclics ccb NSAIDS valproic acid topiramate |
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What are the abortive tx for cluster headaches?
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100% O2
injectable ergotamines or sumatriptan analgesics (intranasal butorphanol) |
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What are the prophylactic medications for cluster headaches?
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valproate
cyproheptadine lithium ccb oral corticosteroids |
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What is the drug of choice for pts with mild parkinsons and no disability?
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amantadine (mild anticholinergic)
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Which drugs are useful in treating the tremor of parkinson's?
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Benztropine
Trihexyphenidyl (less helpful for bradykinesia though) |
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Which drug improves all the sx of parkinson's?
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Levadopa
-Carbidopa can be added to decrease the needed dose of Levadopa |
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What are the drugs of choice for restless leg syndrome?
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Dopamine agonists or Ropinirole
(opiate agonists & benzos may also be effective) |
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What are the s/s of Bell's Palsy?
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-forehead & lower face paralysis
-cannot close eye, raise brow or smile on affected side -may have pain about ipsilateral ear -possible impairment of taste, lacrimation, or hyperacusis |
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What is the tx for Bell's Palsy?
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Oral prednisone +/- acyclovir if begun soon after onset of sx may increase the likelihood of complete recovery
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Which medications are used to control the shooting/stabbing pain assoc with DM neuropathy?
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Phenytion
Mexiletine Carbamazepine |
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Which medications may be used to decrease the deep, constant, aching pain assoc with DM neuropathy?
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Amytriptyline
Nortriptyline Desipramine Gabapentin Fluphenazine |
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________ is a serotonin & norepinephrine reuptake inhibitor that has been approved to tx painful DM neuropathy
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duloxetine
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