• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

Card Range To Study



Play button


Play button




Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

44 Cards in this Set

  • Front
  • Back

Headaches (Migraine, Cluster, Tension Type)

Primary - no systemic disease or structural abnormalities

Secondary - associated with AMS (subarachnoid, epidural/subdural hemorrhages, tumor abscess

Life threatening - associated with subdural hematoma (severe AMS, severe pain, death)

Migraines (Primary)

Typically occur with increased serotonin levels that cause increased vasoconstriction following by vasodilation of the vessels of the brain.

W/WO aura; typically unilateral throbbing sensation made worse with noise/light. Last 4-5 hrs w/wo meds.

Maybe associated with nausea (aura). Menstrual migraines (around cycle). Migraines in young children <5 (tx w periactin)

Triggers: out of time with regular schedule (sleep/wake, etc); alcohol (red wine)

Cluster (Primary)

Occur suddenly; explosive in nature; nighttime onset; cyclic (reports HA for several days and won't reappear for years); typically short lasting; rare in children

Ipsilateral conjunctival tearing/injection; ptosis (drooping eyelid) & eyelid edema

May be tx w anticonvulsant meds depending on how often they occur

Tension Type (Primary)

Unknown MOA but r/t sustained muscle contraction

Most common in adults/women; r/t stress, depression and hunger; frontotemporal band like distribution

Described as mild/mod, non throbbing pain, tightness or pressure with gradual onset

Tx w analgesics (tyl/ibuprofen) but relieved by stress

Mixed (Primary)

Throbbing, constant pain during waking hours

Mix of findings r/t migraines and tension HA pain

Rebound HA: taking analgesics regularly for extended amount of time and then STOP; avoid taking meds around the clock

Trigeminal Neuralgia

Pain associated w malfunction of trigeminal nerve (CN V has 3 pathways);

>55 yo female; bursts of sharp pain over face innervated by affected nerve; triggered by stimulus to affected nerve (CN V); cyclic (short/quick) stabbing pain

Younger patients, episodes may indicate multiple sclerosis

Temporal Arteritis

Vasculitis of ophthalmic and posterior ciliary branches of internal carotid artery

>50 yo; sharp localized temporal pain; malaise, anorexia; hx of polymyalgia rheumatica

Palpation temporal artery: tender, warm and nodular

May lead to BLINDNESS, which is often permanent

SS: fever, weight loss

D: elevated ESR (>50); immediate referral for tx


Sensation of either their body moving (subjective) or environment moving around them (objective); usually described as spinning/rotary motion

Disruption of the visual, vestibular or sensory system

Can be central (brainstem), peripheral (inner ear/vestibular apparatus) or result from systemic causes

Vertigo: Central causes

Neoplastic or vascular in origin:

---vascular causes: vascular insuff., TIA/stroke, migraines

Brainstem and cerebellar dysfunction, multiple sclerosis and migraine headaches

Brainstem/Cerebellar Dysfunction (Central Vertigo)

Brainstem/cerebellum associated with

--NEOPLASMS: gradual onset; manifest as issue w equilibrium;

--VASCULAR: acute onset; long-lasting; recurrent transient vertigo

Brainstem: reports diplopia, dysarthria, dysphagia and paresthesia; sensory/motor deficits

Cerebellar: reports gait disturbances, fine motor coordination diff including rapid alternating movements (RAM) and finger-finger testing

Multiple Sclerosis (Central Vertigo)

Onset in 3rd/4th decade of life; no findings or may have neuro symptoms

MS can produce a range of neuro symptoms; 50% patient's have vertigo

MRI shows demyelinating plaques

Migraine (Central Vertigo)

30% of patient's w migraines have vertigo; which can be present before/during HA or independent of the HA

Vestibular-type migraines: photophobia and visual aura during vertigo

Basilar-type migraines: visual changes, tinnitus, decreased hearing, ataxia or paresthesia (vertebrobasilar vascular abnormalities)

Diagnosis made based on history

Vertigo: Peripheral causes

Disruptions of inner ear or vestibular apparatus

---common causes idiopathic, canalithiasis (tiny calcium crystals), vestibular nerve inflammation, inner ear inflammation or infection or tumor

Vestibular neuronitis, Meniere's and Labyrinthitis

Vestibular Neuronitis (Peripheral Vertigo)

Precedes acute viral infection; presents w severe vertigo and N/V; lasts days-weeks; auditory function not affected; lying motionless helps

Nystagmus intensifies in amplitude when gaze is directed away from the affected ear; visual ocular reflex will lateralize to symptomatic ear

Meniere's Disease (Peripheral Vertigo)

Classic triad symptoms of vertigo, hearing loss and tinnitus; sensation of ear fullness

Attacks abrupt and recurrent, lasts minutes-hours and interval b/t attacks weeks-months

Sensorineural hearing loss to affected ear or bilateral; nystagmus is lateral or rotary; visual ocular reflex will lateralize to symptomatic ear

Labyrinthitis (Peripheral Vertigo)

Associated w concurrent viral/bacterial illness; produces severe vertigo lasting several days

Can be complication of otitis media or meningitis

Distinguished from Meniere's: no tinnitus with labyrinthitis

Vertigo Diagnostics

Orthostatic BP (volume issue); carotid doppler (esp if auscultate bruit); holter monitor (arrhythmia); CBC, BMP (anemia, electrolyte imbalance)


Transient loss of consciousness and postural tone that results from a sudden decrease in cerebral perfusion

Near Syncope

Lightheadedness: think presyncope and near syncope about to "about to faint;" orthostatic hypotension common cause; risk factors: anemia, dehydrated, hypoglycemia, hyperventilate

Disequilibrium: unsteadiness when ambulating; decreased cerebral perfusion

Medications causes: steroids, ethocrin, streptomycin, gentamicin, aspirin, lasix


Risk factors: manage smoking, obesity, sedentary lifestyle, ETOH abuse, Afib, carotid artery diseaseHTN, HLP,

Blood thinner (INR): afib (prevent stroke=high risk); risk for fall concerns

manage HTN, HLP, and BS


Varied symptoms; may not be noticeable; symptoms resolve within 24 hours


Absence (petit mal):

---CM: sudden brief lapse of consciousness w momentary blinking, starting or movements of the lips and hands but no falling. Typical <10 sec; Atypical >10 sec.

---Postictal: No aura; typical - prompt return to normal; atypical - some confusion


---fever not actual cause but rate of change; not underlying neurological disorder - should be no neurological deficit


Bacterial & aseptic (enteroviruses or mumps virus)

Associated: severe HA, photophobia, stiff neck, fever, ICP, chills, myalgia; toxic child or adult; petechial skin rash

PE: Meningeal signs

+ Neck Mobility/Nuchal Rigidity - neck stiffness with resistance to flexion

+ Kerning's sign (sciatic nerve) - pain and increased resistance to extending the knee

+ Brudzinski signs (femoral nerve) - flexion of both the hips and knees while flexing neck

Normal fundoscopic exam

Bacterial Meningitis causes

Bacteria colonize nasopharynx and enter CNS through the dural venous sinuses or choroid plexus in the subarachnoid space

Adults: staph pneumoniae and meningitis

Children: staph pneumonia and Haemophilus influenzae

Neonates: group B strep and E. coli

Accompanied by severe systemic toxicity and AMS (encephalitis)

Meningococcal Vaccination

Types: MCV4 (9 months - 55 yo); MPSV4 (>55 yo)

Recommendation: 2 doses of MCV4 b/t 11-18 yo; first dose @ 11-12 yo, with booster @ 16 yo. *If first dose given after 16 yo, no booster is required

Adolescents with HIV should get 3 doses (2 doses 2 months apart @ 11-12 plus a booster @ 16)

High risk: college freshmen dorms; lab staff; military; travel africa; damaged spleen/ectomy;


Progressive neurodegenerative disorder caused by degeneration of dopaminergic neurons (substantia nigra pars compacta); pathologic hallmark selective loss of dopamine

CM: resting tremor, rigidity, bradykinesia and gait dysfunction

Diagnosis: history and neuropathologic exam (gold standard); must have 2 of the 3 - tremor, bradykinesia and rigidity

Multiple Sclerosis

Autoimmune destruction of myelin sheath; more common young women

PE: Loss of sense of vibration; trigeminal neuralgia; optic neuritis (blurred vision); painful EOM

Cranial Nerves

Bell's Palsy: cranial nerve VII (facial)

Vertigo: cranial nerve VIII (vestibulocochlear)

Infant Reflexes (Primitive)

Palmer grasp (flex fingers): birth to 3-4 months

Plantar grasp (toes curl): birth to 6-8months

Rooting reflex (turns mouth open): birth to 3-4 months

Moro reflex (lower/startled): birth to 4 months

Tonic neck (head turn opposite extension): birth to 2 months


Grading: 4+ = very brisk, 2+ normal, 0 = no response

Biceps reflex: C5, C6

Brachioradialis: C5, C6

Triceps reflex: C6, C7

Patellar (knee) reflex: L2, L3, L4

Achilles (ankle) reflex: S1


Inflammation of the Bursa

Elbow, hip, knee; often r/t trauma; seen w gouty arthritis or RA

PE: edematous, warm to touch, painless

Will resolve on own


Often seen with repetitive motions, young athletes

PE: tenderness over tendon; redness; warmth

Immobilize tendon (REST), ice, NSAIDS

de Quervains's tenosynovitis

--pain with thumb movement maneuver

Carpal Tunnel Syndrome

Typical numbness/tingling (2,3,4 finger) esp at night


Nerve Conduction Velocity or EMG = definitive

--Thumb abduction: raise thumb w resistance; + test = weakness

--Tinel's sign: tap over median nerve; + test = aching and numbness

--Phalen's sign: wrists flexion for 60 secs; + test = numbness/tingling <60 sec

Osgood Schlatters (Knee)

Painful swelling of the anterior aspect of the tibial tubercle; caused by strenuous activity esp quadricep muscles; Most common in adolescent males, young athletes, accelerated growth pattern

CM: limp and pain that worsens w activity (stair climbing and kneeling)

PE: warm, swollen, tender tibial tubercle; flexion and extension will increase pain; normal knee joint exam

Legg Perthe Calve disease (Femoral head)

Osetochondritis of the femoral head epiphysis; avascular necrosis if femoral head then revascularization and bone healing

Groin & medial thigh pain and LIMP; loss of medial hip motion early sign

Most common in boys 3-11 yo

High incidence of hernia, undescended testicles and kidney abnormalities

Hip Xray (AP/frog lateral) : ossific nucleus of the femoral head combined w widened articular carriage space compared to other hip

Musculoskeletal maneuvers to determine injury, joint health, abnormalities

Inspection: for joint symmetry, alignment, bony deformities, and swelling

Inspection and palpation: of surrounding tissues for skin changes, nodules, muscle atrophy, tenderness

Range of motion and maneuvers to test joint function and stability, and integrity of ligaments, tendons, bursae, especially if pain or trauma

Assessment of inflammation, especially swelling, warmth, redness

Test muscle strength: joint function


Diagnosis of exclusion; chronic fatigue, generalized symmetrical MS (above/below waist) pain and multiple trigger points on exam.

Most common in women 20-50; symptoms worse in morning

Associated with stage IV sleep disturbance, anxiety or depression, OCD and IBS; symptoms exacerbated by stress

PE: focal tenderness without signs of synovitis

Diagnostic criteria include diffuse pain present for 3 months and tenderness at 11 or more of 18 trigger points

Lifestyle change is needed; no narcotics!

Gouty Arthritis

Joint inflammation caused by deposits of urate crystals and associated with inborn error of uric acid secretion or metabolic disorders; males >30 yo & family hx most common

CM: recurrent, sudden onset of pain early in the morning subsides over several days

PE: warm, tender and red first metatarsophalangeal (MTP) joint;

Tophi (chalky urate deposits) on extensor surfaces; differentiated by presents of calcium crystals, involved large joints and secondary OA

D: elevated serum uric acid, ESR and WBC count during acute attack

Educate: dietary issue (etoh, red meats); stay hydrated (risk for stones);Allopurinol, Uloric are preventative no help for acute

Osteoarthritis versus Rheumatoid Arthritis

OA: degenerative; asymmetrical, involves a joint; pain when rising, disappears after moving

RA: autoimmune disease; symmetrical joint involvement; takes hour or more to work through discomfort in AM; weakness and fatigue



Most common in postmenopausal women; >50 yo with family hx; associated w smoking/ETOH; high risk also thyroid disease (replacement/supplement); celiac sprue (absorption issues); CKD


>65 yo women or high risk; Check males too not limited to women

Low Back Pain

85% population; worry about chronic and acutely uncomfortable and have limited ROM; trauma/injury needs XR if not, treat symptoms

Risks: osteoporosis (compression fx lumbar/thoracic)

Goes away with rest/ICE


Acute back pain with radiculopathy; associated with degenerative disc dz; unilateral or bilateral; described as burning/tingling radiate to groin, knee, etc

Bell's Palsy

Facial paralysis resulting from dysfunction of CN VII (facial) causing inability to control facial muscles on the affected side; eye on affected side cannot be closed

Affects both upper and lower face; loss of taste, hyperacusis and increase/decrease tearing

Upper vs Lower Motor Neuron Disease

Upper motor neuron: nerve cell bodies in the motor strip above anterior horn i.e. cerebral cortex/brainstem

--Symptoms: ++DTR, hyperreflexive/spasticity, babinski reflex

--Disorders: tumors, blunt trauma & CVA - contralateral area of infarct

Lower motor neuron: nerve cell bodies located in spinal cord (in/distal anterior horn)

--Symptoms: paralysis, atrophy, fasciculations

--Disorders: polio, Guillian-Barre & cauda-equina

Mixed motor neuron dz (both upper/lower)

--ALS plus syndrome (asymmetric arm weakness is most common sign)

--Progressive bulbar palsy