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52 Cards in this Set
- Front
- Back
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Bacterial Meningitis S/S, CSF & DDx
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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 |
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Viral Meningitis S/S, CSF, DDX
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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 |
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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 |
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Gullian Barre CSF
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Only very high protein>100
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MS CSF
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Must electrophorese and see kappa light chains, oligoclonal bands, Myelin Basic Protein and IgG
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Fungal meningitis
CSF |
High lymphocyte w/ low glucose but only in HIV or Immunocompromised.
Must get India Ink of CSF to see cryptococcus |
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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) |
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Conditions where NCV decreased
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Slowed by demyelination(EBV or Guillian Barre)
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When do you use repetitive NCV stimulation
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To test for fatiguability
MG: Worse w/ repetitive stim Eaton lambert: Better w/ repetitive stimulation |
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Normal pressure hydrocephalus
SS Dx |
Abnormal gait, forgetfulness,Urinary incontinence
-MRI shows enlarged lateral ventricles |
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Pick Diesease
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Frontal and temporal lobe atrophy leading to dementia and behavioral/personality changes in a female
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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) |
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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) |
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Differentiate Infarct vs bleed vs TIA on NC CT Head
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Infarct=Black
Blood=White TIA=May have normal CT but treat based on clinical symptoms |
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RF for stroke
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HTN>A-fib>Coumadin therapy
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Central facial palsy vs Bells vs Acoustic Neuroma/Schwannoma
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Bells=No forehead wrinkle
Central=Wrinkled AN/Schwann: Deaf + vertigo+tinnitus w/ bells |
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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 |
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Open Angle Glaucoma
SS Dx Tx |
Painless w/ elevated IOP.
Dx w/ Tonometry(measures IOP) B-Blocker Acetazolamide Pilocorpine |
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Pons hemmhorrhage
SS |
Deep Coma
Decerbrate posture Pinpoint pupil |
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Cerebellar Hemmhorrhage
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Ataxia & facial weakness
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Putamen Hemmhorrhage
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Eyes deviate to lesion and contra-lateral hemiparesis
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Describe the 4 seizure types their treatments and workup
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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) |
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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 |
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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 |
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Creutzfield Jakob
Cause SS EEG |
Prion
Rapidly progressive dementia Myoclonus Sharp triphasic on EEG |
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Huntington Disease
-Inheritance -SS -MRI changes -Tx |
AD chromosome 4
-Chorea, personality changes,Grimace. Dementia later -Caudate Nucleus Atrophies Tx: Haloperidol |
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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 |
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Alzheimer
MRI Changes Drugs |
Symmetrical and diffuse cortical atrophy w/ Amyloid plaques and neurofibrillary tangles
Donepezil |
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Craniopharyngioma
SS Dx Tx |
Causes hypopituiarism(low libido or absent menses) and Bitemporal hemianopsia
Dx: MRI Tx: Surgery |
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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) |
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Anterior cerebral artery stroke
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LE>UE and incontinent
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Posterior cerebral Artery Stroke
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Homonomous hemianopsia
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Middle cerebral/IC stroke
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UE>LE, Homonomous hemianopsia, Amarous Fugaux
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Workup of diabetic polyneuropathy
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NCV and EMG
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Vertebrobasilar stroke
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IPSI face and contra hemiplegia
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Metoclopromide
USE AE |
Pro Kinetic for N-V and gastroparesis.
Can cause EPS(ie dystonia)so watch out for stiff neck. |
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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) |
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Lambert Eaton
SS Pathophys |
Hyporeflexive at rest but gets better w/ repetitive moements or NCV stimulation
Decreased ACH release at pre-synaptic cleft. |
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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. |
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Types of Dementia
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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. |
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Benign Essential Tremor
SS Tx |
Tremor at rest and most pronounced when completing an action
Tx: Propranolol |
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ALS
SS Dx Tx |
UMN & LMN symptoms so limbs waste and fasciculate but also have hyper-reflexia.
Dx: EMG shows denervation-renervation Tx: Riluzole |
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Kallman Syndrome
SS Pathophys |
Deficiency in GNRH
-Anosmia(Defective CN I) -Hypogonadism |
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Trigeminal Neuralgia
SS Association Tx |
Shooting pain in face
-If b/l may be MS Tx: Carbamazapine |
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Dementia vs delirium
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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 |
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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 |
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What to give unconscious person
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DON'T
Dextrose(thiamine first) O2 Naloxone Thimine |
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Headache Type & Tx
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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 |
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Duchenne MD
-Inheritance -SS -Dx |
XLR defective dystrophin
Large calves,Gower sign,High CK and Aldolase Dx: Biopsy Muscle |
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Myotonic dystrophy
-Inheritance -SS |
AD
-CAN'T LET GO OF HANDSHAKE -TESTES ATROPHY |
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McArdles Disease
Pathophys SS |
Deficient Glycogen phosphorylase
Weakness and cramping after exercise |
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Cysticerosis
-Org & spread -Dx -Tx |
Tania Solium after raw pork
Ring enhancing lesions on CT Niclosamide & Praziquntel |
