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52 Cards in this Set

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Bacterial Meningitis S/S, CSF & DDx
Must have fever, headache and stiff neck

CSF shows:
High:PMN,Protein(Approx 100)
Low: Glucose

-Pneumococcal:Gram +ve diplo

-Gonococcal(Gram -ve diplo):Give Rifampin or ciprofloxacin to all contacts
Viral Meningitis S/S, CSF, DDX
Will have fever, headache and stiff neck

High: Protein & Lymphocytes
Normal Glucose

-HSV has seizure or AURA from temporal lobe involvement.
Dx: PCR of CSF
Tx: Acyclovir
Pseudotumor cerebri
SS
Dx
Tx
Fat female or on OCP/Steroids w/ photophobia and morning headaches. See Papilledema on fundoscopy and may have CN 6 palsy(Medial deviation)

Dx: Get MRI/CT first to r/o a mass and should see empty sella.

If no mass get LP and CSF will show High Pressure only.

Tx: Vitamin A, lose weight and quit steroids/OCP's
Gullian Barre CSF
Only very high protein>100
MS CSF
Must electrophorese and see kappa light chains, oligoclonal bands, Myelin Basic Protein and IgG
Fungal meningitis
CSF
High lymphocyte w/ low glucose but only in HIV or Immunocompromised.

Must get India Ink of CSF to see cryptococcus
Describe feature of an UMN lesion & a LMN lesion.

Which condition has both?
UMN: Hyperfreflexia, Babinski

LMN: Fasciculations, fibrillations & Hyporeflexia & wasting(EMG shows decreased amplitude w/ contraction)
Conditions where NCV decreased
Slowed by demyelination(EBV or Guillian Barre)
When do you use repetitive NCV stimulation
To test for fatiguability
MG: Worse w/ repetitive stim
Eaton lambert: Better w/ repetitive stimulation
Normal pressure hydrocephalus
SS
Dx
Abnormal gait, forgetfulness,Urinary incontinence
-MRI shows enlarged lateral ventricles
Pick Diesease
Frontal and temporal lobe atrophy leading to dementia and behavioral/personality changes in a female
Myasthenia Gravis
SS
Dx
Tx
Female w/ diplopia and ptosis who is weak w/ effort(or constant NCV stimulation) and better w/ rest

Dx: Anti ACH AB
Tx: Neostigmine,pyridostigmine and thymectomy(get thymomas)
SAH
Causes
SS
Associations
Dx
Tx
Worst headache and stiff neck.
-Assoc= PCKD(berry) & Trauma
-Get SIADH & Hyponatremia

Dx: NC CT HEAD & if -ve do LP(bloody CSF)
Differentiate Infarct vs bleed vs TIA on NC CT Head
Infarct=Black
Blood=White
TIA=May have normal CT but treat based on clinical symptoms
RF for stroke
HTN>A-fib>Coumadin therapy
Central facial palsy vs Bells vs Acoustic Neuroma/Schwannoma
Bells=No forehead wrinkle
Central=Wrinkled
AN/Schwann: Deaf + vertigo+tinnitus w/ bells
Closed Angle Glaucoma
SS
Dx
Tx
Headache and eye is red and painful. Lights have a halo around them. Pupil is mid-dilaed and fixed.

Dx: IOP>>20 on tonometry

Tx: Close the "GAP"
Glycerin
Acetazolamide
Pilocorpine
Open Angle Glaucoma
SS
Dx
Tx
Painless w/ elevated IOP.

Dx w/ Tonometry(measures IOP)

B-Blocker
Acetazolamide
Pilocorpine
Pons hemmhorrhage
SS
Deep Coma
Decerbrate posture
Pinpoint pupil
Cerebellar Hemmhorrhage
Ataxia & facial weakness
Putamen Hemmhorrhage
Eyes deviate to lesion and contra-lateral hemiparesis
Describe the 4 seizure types their treatments and workup
Generalized(All over brain)
1) Absence: Ethosuxamide & Valproic
-3sec spike and wave on EEG

2) Tonic clonic:Phen/Carb

Partial(Part of brain)
-Phenytoin/Carb
1) Simple: Focal neurological deficit(march or hallucination) w/o LOC

2) Complex: Simple then +LOC

Febrile(6mo-5year)
-Tonic clonic in fever>102
-R/O meningitis & give tylenol

Status Epilepticus
-Airway
-diazepam
-phenytoin
-CT head to R/ bleed(NC) & tumor(C)
TIA workup
Tx
What if ASA allergy
1)Get CT head to R/O Bleed
2) EKG to R/O A-fib
-Have A-fib then anticoagulate
-No A-fib give ASA and check carotids
-Carotid>60% get CEA then ASA for life

-Carotid<60% get ASA for life

ASA allergy get clopidigrel
Neurofibromatosis
I
II
Both predispose patient to Tumors!!

I(AD):
-Cafe Au Lait(6>1.5cm)
-Axillary & inguinal freckles
-Neurofibromas(late)

II: B/l acoustic neuroma and cataract
Creutzfield Jakob
Cause
SS
EEG
Prion
Rapidly progressive dementia
Myoclonus
Sharp triphasic on EEG
Huntington Disease
-Inheritance
-SS
-MRI changes
-Tx
AD chromosome 4
-Chorea, personality changes,Grimace. Dementia later
-Caudate Nucleus Atrophies

Tx: Haloperidol
Parkinson Disease
SS
MRI changes
How to Tx each age and drug AE
Other causes and how to treat
Shuffle,Pill rolling resting tremor, cogwheel rigidity, masklike facies

MRI shows loss of dopaminergic neurons in Substantia Nigra

Give to old first
-Levo(converts to dopamine)
-Carbidopa(Inhbits peri conv)

AE: Extrapyramydal symptoms

Give to young first
-Bromocryptine
-Pergolide
AE: Hypotention

Use later
-Amantadine
-Trihex/Benzo(Anti-Ch)
-Diphenylhydramine(Anti-hist)

May also be caused by anti-psychotics so must give anti-ch or anti-hist
Alzheimer
MRI Changes
Drugs
Symmetrical and diffuse cortical atrophy w/ Amyloid plaques and neurofibrillary tangles

Donepezil
Craniopharyngioma
SS
Dx
Tx
Causes hypopituiarism(low libido or absent menses) and Bitemporal hemianopsia

Dx: MRI
Tx: Surgery
MS
SS
Dx
Tx
EPISODIC!!!
-Diplopia
-Clumsiness of the hand
-Incontinence or urgency.
-B/l Trigeminal neuralgia(Severe burn or shock like pain from ear to mouth multiple times a day)
-Intranuclear opthalmyoplegia (look R get R eye Nyastigmus and same w/ L eye b/c MLF demyelinatiing)

Dx: USE MRI(periventricular demyelination of white matter). CSF can help but not diagnostic. CSF electrophoresis (OC bands,MBP,KLC, High IgG)

Tx: Acutely give steroids but for long term give IFN-B(prevents relapses)
Anterior cerebral artery stroke
LE>UE and incontinent
Posterior cerebral Artery Stroke
Homonomous hemianopsia
Middle cerebral/IC stroke
UE>LE, Homonomous hemianopsia, Amarous Fugaux
Workup of diabetic polyneuropathy
NCV and EMG
Vertebrobasilar stroke
IPSI face and contra hemiplegia
Metoclopromide
USE
AE
Pro Kinetic for N-V and gastroparesis.

Can cause EPS(ie dystonia)so watch out for stiff neck.
Young patient w/ TIA
DDX
Workup
Probably embolic in nature from the heart so Get TEE.

In kids think homocystinuria(stroke,osteoporosis, posterior lens dislocation)
Lambert Eaton
SS
Pathophys
Hyporeflexive at rest but gets better w/ repetitive moements or NCV stimulation

Decreased ACH release at pre-synaptic cleft.
Lacunar stroke
-RF
-Types
All have HTN as main RF
Can be:

1) Thalamic: Only sensory

2)Basis Pontis: Clumsy hand & slurred speech

3)IC:
-Pure Motor or
-UE>LE and contralateral lega and arm incoordination.
Types of Dementia
1)Multi infarct: Bruit,CAD Hx and episodic

2)Lewy Body: Visual hallucinations

3)Depressive: Worried about their memory loss. Give SSRI

4) Alzheimers: Don't care about their memory loss.
Benign Essential Tremor
SS
Tx
Tremor at rest and most pronounced when completing an action

Tx: Propranolol
ALS
SS
Dx
Tx
UMN & LMN symptoms so limbs waste and fasciculate but also have hyper-reflexia.

Dx: EMG shows denervation-renervation

Tx: Riluzole
Kallman Syndrome
SS
Pathophys
Deficiency in GNRH
-Anosmia(Defective CN I)
-Hypogonadism
Trigeminal Neuralgia
SS
Association
Tx
Shooting pain in face
-If b/l may be MS
Tx: Carbamazapine
Dementia vs delirium
Both may hallucinate and not be oriented to person,place,time

Dementia is chronic w/ good attention level

Delirium is acute w/ poor attention level
Wernicky-Korsakoff
#1 Cause
SS
Tx
Thiamine deficiency in an alcoholic. So give it

Wernicky(Reversible): Nyastigmus, ataxia, confusion

Korsakoff(Irreversible):Anteriograde amnesia w/ confabulation
What to give unconscious person
DON'T
Dextrose(thiamine first)
O2
Naloxone
Thimine
Headache Type & Tx
1) Tension: NSAID

2) Cluster: O2

3) Migraine: Sumitriptam /Ergotamine

4)Pseudotumor cerebri: Vit A & lose weight/stop meds(Steroid/OCP)

5) Meningitis: Fever + stiff neck

6) SAH: Get Angiogram after stable looking for AV malformation
Duchenne MD
-Inheritance
-SS
-Dx
XLR defective dystrophin

Large calves,Gower sign,High CK and Aldolase

Dx: Biopsy Muscle
Myotonic dystrophy
-Inheritance
-SS
AD
-CAN'T LET GO OF HANDSHAKE
-TESTES ATROPHY
McArdles Disease
Pathophys
SS
Deficient Glycogen phosphorylase

Weakness and cramping after exercise
Cysticerosis
-Org & spread
-Dx
-Tx
Tania Solium after raw pork

Ring enhancing lesions on CT

Niclosamide & Praziquntel