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224 Cards in this Set
- Front
- Back
Onset of delerium
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acute and dramatic
|
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Onset of dementia
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chronic and insidious
|
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Common causes of delerium
|
illness, toxic, withdrawl
|
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Common causes of dementia
|
Alzheimer disease, multi-infarct dementia, HIV/AIDS
|
|
Is delerium reversible?
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usually
|
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Is dementia reversible
|
usually not
|
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Describe attention in delerium
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poor
|
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Describe attention in dementia
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usually unaffected
|
|
Describe arousal level in delerium
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fluctuates
|
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Describe arousal level in dementia
|
normal
|
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Memory impairment in dementia
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in early dementia remote memory is usually spared
|
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Memory impairment in delerium
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globally impaired
|
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What is pseudodementia
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depression, usually in elderly, usually treatable
|
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Which is associated with hallucinations, illusions, delusion, orientation difficulties and sundowning...delerium or dementia?
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both
|
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More common treatable causes of dementia
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- Vit B12 deficiency
- endocrine disorders (esp. thyroid and parathyroid) - uremia - syphilis - brain tumors - normal pressure hydrocephalus - Parkinson's (tx may improve) |
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Wernicke's encephalopathy is from what deficiency?
|
thiamine
|
|
Ataxia, ophthalmoplegia, nystagmus and confusion =
|
Wernicke's encephalopathy
|
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An alcoholic with confabulation and anterograde amnesia likely has
|
Korsakoff syndrome
|
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2 key features of Korsakoff syndrome
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- anterograde amnesia
- confabulation |
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How do you avoid ppt Wernicke's encephalopathy in an alcoholic when they show up in your ER?
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give glucose before thiamine
|
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Most common cause of headaches
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tension
|
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Recurrent frontal/occipital bilateral headache with stiffness is likely what type?
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tension
|
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General treatment of stress headaches
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- stress relief
- NSAIDs/acetaminophen |
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Headache that is unilateral, severe, tender, with watery eyes
|
cluster
|
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Treatment of cluster headaches
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oxygen
|
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True or false: migraines often have a family history?
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true
|
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Headaches with aura, photophobia, nausea and vomiting are likely
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migrain
|
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Typical age of onset for migraine
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10-30 years
|
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Morning headaches with projectile vomiting are concerning for
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tumor
|
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What do you order for headache with papilledema?
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CT or MRI with contrast
|
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Likely diagnosis of morning headache in obese young woman with nausea and negative CT scan
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pseudotumor cerebri
|
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LP in pseudotumor cerebri
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elevated opening pressure, otherwise normal
|
|
Possible causes of pseudotumor cerebri
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- megadoses of vitamin A
- tetracyclines - withdrawl from corticosteroids |
|
Pseudotumor cerebri without treatment may lead to
|
permanent vision loss
|
|
Treatment of pseudotumor cerebri
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- supportive
- weight loss - shunt/repeated LPs |
|
Worst headache of your life -
|
subarachnoid hemorrhage
|
|
Diagnostic test for subarachnoid hemorrhage
|
- noncontrast CT
- LP |
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2 major causes of subarachnoid hemorrhage
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- ruptures berry aneurysm
- trauma |
|
Give 4 eye causes of headache
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- optic neuritis
- eyestrain from refractive error - iritis - glaucoma |
|
Give 2 ear causes of headache
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- otitis media
- mastoiditis |
|
List 8 general causes/types of headache
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- tension
- cluster - tumor - migraine - pseudotumor cerebri - meningitis - subarachnoid hemorrhage - extracranial causes |
|
What is Kallman syndrome?
|
- anosmia with hypogonadisms due to gonadotropin-releasing hormone
|
|
anosmnia + hypogonadism =
|
Kallman syndrome
|
|
tic douloureux =
|
trigenimal neuralgia
|
|
CNI =
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olfactory
|
|
CNII=
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optic
|
|
CNIII =
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oculomotor
|
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CN IV =
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trochlear
|
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CN V =
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trigeminal
|
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CN VI =
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abducens
|
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CN 5 innervates
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- muscles of mastication
- facial sensation - afferent corneal relex |
|
unilateral shooting facial pain in older adults =
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trigeminal neuralgia
|
|
Treatment of trigeminal neuralgia
|
antiseizure meds like gabapentin and carbamezepine are most effective
|
|
CN VII =
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Facial
|
|
CN VII innervates
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- muscle of facial expression
- taste of ant 2/3 tongue - dkin external ear - lacrimal gland - salivary (not parotid) gland - stapedius muscle |
|
Flat forehead means CNVII is injured where?
|
lower motor neuron lesion
|
|
CN VIII =
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vestibulocochlear
|
|
CN VIII lesions usually manifest as
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- deafness
- tinnitus - vertigo |
|
CN IX =
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glossopharyngeal
|
|
CNIX innervates
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- pharyngeal muscles
- mucous membranes - afferent gag - parotid gland - taster post 1/3 tongue - skin external ear - carotid body/sinus |
|
CN X =
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vaugs
|
|
CN X innervates
|
- muscles of palate
- muscles of pharynx - muscles of larynx - efferent gag - taste at base of tonge - abdominal viscera - skin external ear |
|
Major things to think of in CNX lesions
|
- aortic aneurysms
- tumors (such as pancoast) |
|
Common things with CNX lesions
|
- hoarseness
- dysphagia - loss of gag - loss of cough |
|
CN XI =
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spinal accessory
|
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CN XI innervates
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- sternocleidomastoid
- trapezius |
|
Muscle findings in CN XI lesions
|
- trouble with contralateral head turn
- ipsilateral shoulder drop |
|
CN XII =
|
Hypoglossal
|
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CN XII innervates
|
muscle of the tongue
|
|
Lesion of CN XII causes
|
deviation of tongue to affected side
|
|
6 Main types of seizures
|
- simple partial
- complex partial - absence - tonic clonic - febrile - secondary |
|
key feature of simple partial seziures
|
conciousness is not impaired
|
|
Seizure where consciousness not impaired =
|
simple partial
|
|
Treatment of simple partial seizures
|
- phenytoin
- valproate - carbamazepine |
|
3 examples of simple partial seizures
|
- motor (Jacksonia march)
- hallucinations - cognitive/affective |
|
Simple partial seizure followed by altered consciousness =
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complex partial seizure
|
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Seizure where people perform purposeless movements and may become aggressive if restrained
|
complex partial seizure
|
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First line agents for treatment of complex partial seziures
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- phenytoin
- volproate - carbamazepine |
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Typical age of onset of absense seizures
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before age 20
|
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absence seizures are a type of _________ seizure
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generalized
|
|
Duration of absence seizures
|
10-30 seconds
|
|
Seizure with a loss of consciousnes with eye flutterings =
|
absence seizure
|
|
Is there a post-ictal state in absence seizures?
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No. This is why people will stare and then pick up a sentence where they left off
|
|
First line agents for treatment of absence seizures
|
- ethosuximide
- valproate |
|
Type of seizure that classically has an aura
|
tonic clonic
|
|
Typical duration of tonic clonic seizures
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2-5 minutes
|
|
4 common features of the post-ictal state of tonic clonic seizures
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- drowsiness
- confusion - headache - muscle soreness |
|
First line agents for treatment of tonic-clonic seizures
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- phenytoin
- valproate - carbamazepine |
|
Age for febrile seizure
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6 months - 5 years
|
|
Type of seizure that usually happens with febrile seizure
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tonic-clonic
|
|
Treatment of febrile seizure
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nonspecific
- treat underlying cause if possible - acetaminophen |
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Mass causes of seizure
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- tumor
- bleed |
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Classic metabolic causes of seizure
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- hypoglycemia
- hypoxia - phenylketonuria |
|
Classic toxic causes of seizure
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- lead
- cocaine - carbon monoxide |
|
Classic drug withdrawl causes of seizure
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- alcohol
- barbituates - benzos - too rapid off anticonvulsants |
|
Classic cerebral edema causes of seizure
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- severe hypertension
- eclampsia |
|
Classic CNS infections causing seizure
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- meningitis
- encephalitis - toxoplasmosis |
|
2 important "positioning" things to remember for seizures
|
- secure the airway
- roll onto side to prevent aspiration |
|
Most common cause of seizures in South America
|
cysticercosis
|
|
Cysticercosis is caused by
|
Taenia solium (larval form of pork tape worm)
|
|
Cysticercosis is most commonly seen in
|
- people with AIDS
- immigrants (S America) |
|
Treatment of cysticercosis
|
- niclosamide
- praziquantel |
|
What test should you do before starting any anticonvulsant?
|
Pregnancy
|
|
Most common cause of neurologic disability in US
|
CVA
|
|
Third leading cause of death in US
|
CVA
|
|
3 classic causes of CVA
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- ischemia from atherosclerosis
- a fib with emboli - endocarditis with septic emboli |
|
First imaging performed in suspected CVA is _____
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noncontrast CT (rule out bleed)
|
|
CT in CVA is often negative for the first _____ hours
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24-36
|
|
Focal neuro deficit lasting seconds to hours =
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TIA
|
|
Define transient ischemic attack (TIA)
|
focal neuro deficit lasting seconds to hours that resolves spontaneously
|
|
TIAs typically last
|
2-3 minutes
|
|
This % of right-handed people are left hemisphere dominant
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99%
|
|
This % of left-handed people are left hemisphere dominat
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60-70%
|
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Apathy is concerning for lesion in what part of the brain?
|
frontal lobe
|
|
Inattention is concerning for lesion in what part of the brain?
|
frontal lobe
|
|
Uninhibited behavior is concerning for lesion in what part of the brain?
|
frontal lobe
|
|
Labile affect is concerning for lesion in what part of the brain?
|
frontal lobe
|
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Broca (motor) aphasia is concerning for lesion in what part of the brain?
|
dominant frontal lobe
|
|
Dominant frontal lobe damage causes which type of aphasia?
|
Broca
|
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Wernicke (sensory) aphasia is concerning for lesion in what part of the brain?
|
Dominant temporal lobe
|
|
Dominant temporal lobe damage causes which type of aphasia?
|
Wernicke
|
|
memory impairment is concerning for lesion in what lobe of the brain?
|
temporal
|
|
aggression is concerning for lesion in what part of the brain?
|
temporal lobe
|
|
hypersexuality is concerning for lesion in what part of the brain?
|
temporal lobe
|
|
Inability to read, write or name is concerning for lesion in what part of the brain?
|
Dominant parietal lobe
|
|
Unilateral neglect is concerning for lesion in what part of the brain?
|
Nondominant parietal lobe
|
|
Nuclei of CN III and IV are in the
|
Midbrain
|
|
Nuclei of CN V, VI, VII and VIII are in the
|
Pons
|
|
Nuclei of CN IX, X, XI and XII are in the
|
Medulla
|
|
Cerebellar CVAs/lesions classically cause these 6 problems
|
- ataxia
- dysarthria - nystagmus - intention tremor - dysmetria - scanning speech |
|
resting tremor is usually from a lesion in the
|
basal ganglia
|
|
chorea is usually from a lesion in the
|
basal ganglia
|
|
2 classic findings in basal ganglia lesions
|
- resting tremor
- chorea |
|
Classic finding in lesion to subthalamic nuclei
|
hemiballismus
|
|
Hemiballismus may be caused by a lesion here:
|
subthalamic nuclei
|
|
Heritability of Huntington disease
|
autosomal dominant
|
|
Age of onset of Huntington disease
|
35-50
|
|
Irregular, spasmodic, involuntary movements of limb/face are called _____ and are found in _____
|
- choreiform movements
- Huntington disease |
|
Cognitive deficits in Huntington disease
|
- progressive intellectual deterioration
- dementia - psychiatric disturbances |
|
CT/MRI finding in Huntington disease
|
atrophy of caudate nucleus
|
|
Treatment of Huntington disease
|
- supportive
- antipsychotics may help |
|
Bradykinesia, rigidity, resting tremor and postural instability =
|
Parkinson's disease
|
|
Classic tetrad in Parkinson's disease
|
- bradykinesia
- rigidity - resting tremor - postural instability |
|
Characteristics of the "pill rolling tremor"
|
- goes away with movement
- goes away when asleep |
|
Mean age of onset of Parkinson's
|
60`
|
|
Drug treatments of Parkinson's
|
- levodopa/carbidopa
- bromocriptine - pergoline - MAOB inhibitors (selegiline) - amantadine - anticholinergics (trihexyphenidyl, benztropine) - antihistamines |
|
Treatment of Parkinsonian side effects from antipsychotics...
|
- anticholinergics (benztropine, trihexyphenidyl)
- antihistamines (diphendydramine) |
|
Heredity of benign tremor?
|
autosomal dominant
|
|
Treatment of benign essential tremor?
|
b-blockers
|
|
4 "other" important causes of resting tremor
|
(other than Parkinsons)
- hyperthyroidism - anxiety - drug withdrawl/intoxication - benign essential tremor |
|
What is hepatolenticular degeneration?
|
Wilson disease (this is why there's a tremor)
|
|
Childhood causes of intention tremor
|
- cerebelar astrocytoma
- medulloblastoma - hydrocephalus (prior menigitis, Arnold-Chiari, Dandy-Walker) - Friedreich ataxia - ataxia-telangiectasia |
|
Heritability of Friedreich ataxia
|
autosomal recessive
|
|
Age of onset of Friedreich ataxia
|
5-15 years
|
|
Adult causes of intention tremor
|
* cerebellar disorders
- alcoholism - tumor - ischemia/hemorrhage - MS |
|
Cause of amyotrophic lateral sclerosis
|
idiopathic
|
|
ALS =
|
Amyoptrophic lateral sclerosis
|
|
Lesions of ALS are located here
|
Both upper and lower motor neurons
|
|
Is ALS more common in men or women?
|
men
|
|
Mean age of onset of ALS?
|
55 years
|
|
List 3 UMN lesion signs
|
- spasticity
- hyperreflexia - Babinski |
|
List 3 LMN lesion signs
|
- fasciculations
- atrophy - flaccidity |
|
(Very) general prognosis of ALS
|
50% of patients die within 3 years of onset
|
|
Do not perform an LP acutely in these situations
|
- acute head trauma
- signs of high ICP (risk of uncal herniation) |
|
Give normal profile of CSF for cells, glucose, protein and pressure
|
- cells: <3
- glucose: 50-100 - protein:20-45 - pressure (mmHg):100-200 |
|
Give typical profile of CSF in bacterial meningitis for cells, glucose, protein and pressure
|
- cells: >1000 (PMNs)
- glucose: <50 - protein:100 - pressure: >200 |
|
Give typical profile of CSF in viral/aspeptic meningitis for cells, glucose, protein and pressure
|
- cells: >100 lymphs
- glucose:40-100 - protein: 20-45+ - pressure: 100-200+ |
|
Give typical profile of CSF in pseudotumor cerebri for cells, glucose, protein, pressure
|
- cells: 3
- glucose: 50-100 - protein: 20-45 - pressure: >200 |
|
Give typical profile of CSF in Guillain-Barre syndrome for cells, glucose, protein, pressure
|
- cells: 0-100 lymphs
- glucose: 50-100 - protein: >100 - pressure: 100-200 |
|
Give typical profile of CSF in subarachnoid hemorrhage for cells, glucose, protein, pressure
|
- cells: RBCs
- glucose: 50-100 - protein: >45 - pressure: >200 |
|
Give typical profile of CSF in multiple sclerosis for cells, glucose, protein, pressure
|
- cells: 0-3+
- glucose: 50-100 - protein: 20-45+ - pressure: 100-200 |
|
Normal opening pressure in LP
|
100-200 mmHg
|
|
These LP results indicate:
- cells: 3 - glucose: 75 - protein: 30 - pressure: 150 |
normal LP
|
|
These LP results indicate:
- cells: 1,000 PMNs - glucose: 40 - protein: 100 - pressure: 250 |
Bacterial meningitis
|
|
These LP results indicate:
- cells: 100 lymphs - glucose: 75 - protein: 50 - pressure:210 |
Viral meningitis
|
|
The LP results indicate:
- cells: 3 - glucose: 75 - protein: 40 - pressure: 300 |
Pseudotumor cerebri
|
|
These LP results indicate:
- cells: 100 lymphs - glucose: 75 - protein: 150 - pressure: 150 |
Guillain-Barre
|
|
These LP results indicate:
- cells: RBCs - glucose: 75 - protein: 60 - pressure: 250 |
subarachnoid hemorrhage
|
|
These LP results indicate:
- cells: 5 - glucose: 75 - protein: 50 - pressure: 150 |
MS (generally normal but sometimes slightly elevated cells and protein)
|
|
Abnormal lab results in CSF with MS
|
- oligoclonal bands
- myeline basic protein (during active demyelination) |
|
Classic stain for crypotcoccal meningitis
|
India Ink
|
|
LP in AIDS with high lymphocytes, worry about...
|
- TB meningitis
- Fungal meningitis |
|
Is MS more common in men or women?
|
women
|
|
Typical age of onset of MS
|
20-40
|
|
List 6 common presenting features of MS
|
- paresthesias
- weakness/clumsiness - visual disturbances - gait disturbances - incontinence/urgency - vertigo |
|
2 classic symptoms of MS
|
- internuclear ophthalmoplegia
- scanning speech |
|
Reflex related finding in MS
|
often + babinski
|
|
Most sensitive tool to show demylinating plaques in MS
|
MRI with and without contrast
|
|
Symmetrical LE weakness distally, lost reflexes and viral illness =
|
Guillain-Barre'
|
|
Sensory changes in Guillain-Barre'
|
Mild or absent
|
|
You may make a Guillain-Barre' patient worse if you give them...
|
steroids
|
|
Treatment of Guillain-Barre'
|
- plasmapharesis
- time |
|
Watch Gauillain-Barre' patients carefully for
|
ascending weakness that involves respiratory muscles
|
|
Lower motor neuron disease is associated with this finding on EMG
|
fasciculations/fibrillations at rest
|
|
Most common cause of syncope
|
vasovagal
|
|
If a person passes out when they have a stroke, where is the likely lesion (vessel)
|
posterior circulation; syncope is generally uncommon in stroke
|
|
Important common causes of altered mental status in the ER
|
- hypoglycemia
- opiod overdose - thiamine defeciency - alcohol - drugs - DKA - CVA - seizure |
|
Treatment of opiod overdose
|
naloxone
|
|
6 important general causes of peripheral neuropathy
|
- metabolic
- nutritional - toxic/meds - immune related - trauma - infection |
|
3 metabolic causes of peripheral neuropathy
|
- diabetes
- uremia - hypothyroidism |
|
4 vitamin defeciencies that cause peripheral neuropathy
|
- B12
- B6 -Thiamine (dry beriberi) - Vitamin E |
|
Patient with B6 defeciency presents with neuropathy. What med were they likely on?
|
Isoniazid
|
|
Peripheral neuropathy with wrist drop and foot drop is classically caused by
|
lead poisoning
|
|
4 drugs that classically cause peripheral neuropathy
|
- lead/heavy metals
- isoniazid - vincristine - ethambutol (optic) |
|
6 autoimmune disorders that are associated with peripheral neuropathy
|
- Guillain-Barre'
- Lupus - Polyarteritis nodosa - Scleroderma - Sarcoidosis - Amyloidosis |
|
3 common causes of peripheral neuropathy associated with trauma
|
- carpal tunnel
- pressure paralysis (radial nerve in alcoholics) - fractures |
|
5 infections that cause peripheral neuropathy
|
- lyme disease
- diphtheria - HIV - tick bite - leprosy |
|
Pathology of myasthenia gravis
|
autoimmune disease attacks acetylcholine receptors
|
|
Typical age and gender for myasthenia gravis
|
women age 20-40
|
|
3 classic features of presenation of myasthenia gravis
|
- ptosis
- diplopia - generalized muscle fatiguability |
|
What is Tensilon?
|
edrophonium (a short acting anticholinesterase)
|
|
Edrophonius is also known as
|
Tensilon
|
|
What is Tensilon used for
|
diagnosis of myasthenia gravis
|
|
Describe the Tensilon test for myasthenia gravis
|
- symptoms improve with injection Tensilon (short active anticholinesterase)
|
|
Most patients with myasthenia gravis also have this removed
|
the thymus
|
|
Treatment of myasthenia gravis
|
- plasmapheresis in acute attack
- Long acting anticholinesterase (pyridostigmine, neostigmine) |
|
How can you differentiate myasthenia gravis from Eaton Lambert syndrome?
|
Eaton Lambert spares the extraoccular muscles
|
|
Eaton Lambert syndrome is associated with what?
|
small cell lung cancer (paraneoplastic syndrome)
|
|
Mechanism of disease of Eaton Lambert syndrome
|
impaires release of acetylcholine from the nerves
|
|
What effect does repetitive activity have on Eaton Lamber?
|
Weakness improves
|
|
Poisoning with miosis, excessive bronchial secretions, urinary urgency, diarrhea
|
Organophosphate poisoning (parasympathetic effects)
|
|
Treatment of orhanophosphate poisoning
|
- atropine
- pralidoxime |
|
Describe the myasthenic type effects of aminoglycosides
|
- in high doses causes weakness similar to myasthnia gravis
- prolong the effects of musculr blackage in anesthsia |
|
Findings in Sturge-Weber syndrome
|
- Port wine stain over divisions of V2 and V3
- glaucoma - seizures |