Term
| A headache that is worse in the morning and with performing Valsalva maneuver is consistent with . . . |
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Definition
| ELEVATED INTRACRANIAL PRESSURE |
|
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Term
What should be suspected in a pt who SMOKES, is on ORAL CONTRACEPTIVES, and has a HA that is worse in the morning and with Valsalva, and she also has PAPILLEDEMA on exam?
What are other differentials to include? |
|
Definition
DURAL VENOUS THROMBOSIS
(pseudotumor cerebri, viral and bacterial meningitis) |
|
|
Term
| What is the DIAGNOSTIC TEST OF CHOICE for diagnosing DURAL VENOUS THROMBOSIS? |
|
Definition
| MAGNETIC RESONANCE VENOGRAPHY |
|
|
Term
| What is CRITICAL ILLNESS MYOPATHY? |
|
Definition
| myopathy, which is seen in severely ill pts after a prolonged stay (>7 days) in the ICU. |
|
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Term
| What are the classic findings in CRITICAL ILLNESS MYOPATHY? |
|
Definition
1. inability to EXTUBATE
2. predominantly PROXIMAL FLACCID limb weakness
2. ELEVATED CK level |
|
|
Term
| What are predispoing factors to CRITICAL ILLNESS MYOPATHY? |
|
Definition
Prolonged ICU stay
use of corticosteroids
neuromuscular junction-blocking agents
hyperglycemia |
|
|
Term
| How will CORTICOSTEROID Myopathy present? |
|
Definition
PROXIMAL muscle weakness
PRESERVED reflexes
NORMAL Creatinine kinase
only mildly myopathic findings on EMG |
|
|
Term
| What is most suggestive of ATYPICAL PARKINSONISM SYNDROME? |
|
Definition
absence of response to levodopa
(indicates loss of neurons extends well beyond the substania nigra) |
|
|
Term
| What is the most common PRIMARY BRAIN TUMOR in ADULTS? |
|
Definition
| MENINGIOMAS - these are EXTRAparenchymal and EXTRADURAL |
|
|
Term
| Which brain tumor will appear on MRI as RING-ENHANCING lesion with areas of CENTRAL NECROSIS and HEMORRHAGE? |
|
Definition
|
|
Term
| What is the most common INTRAparenchymal brain tumor in ADULTS? |
|
Definition
|
|
Term
| How will ESR and CRP look in someone with suspected Polymyalgia Rheumatica? |
|
Definition
|
|
Term
| What is the next step in someone suspected of having Temporal Artereitis? |
|
Definition
| high-dose steroids (could save vision) |
|
|
Term
| After giving high-dose steroids for Temporal Artereitis, when do you perform biopsy? |
|
Definition
| Within four weeks of initiating steroid therapy. . . within this timeframe the results are not affected |
|
|
Term
| What do SUBHYALOID HEMORRHAGES suggest? |
|
Definition
| aneurysmal subarachnoid hemorrhage |
|
|
Term
| What are SUBHYALOID HEMORRHAGES? |
|
Definition
| bleeding seen in the eye on fundoscopic exam |
|
|
Term
| In somone with acute neurologic changes, what can NCCT rule out? |
|
Definition
intracerebral hemorrhage
subarachnoid bleeding
hydrocephalus |
|
|
Term
| What is the only confirmatory test required in a pt with examination findings consistent with brain death? |
|
Definition
|
|
Term
| What exam findings are evaluated in a pt with brain death? |
|
Definition
coma
absence of motor responses
pupillary responses
corneal reflexes
oculovestibular reflexes
jaw jerk
gag reflex
reaction to craniofacial pain
cough with tracheal suctioning
sucking or rooting reflexes |
|
|
Term
|
Definition
| Test used to confirm brain death. |
|
|
Term
| How is the Apnea Test performed? |
|
Definition
Test is iniated when PaO2 40 - 60
Pt, who is already intubated and shows signs of brain death, and the pt is NORMOTHERMIC, and has NOT received sedative medications, the pt is DISCONNECTED FROM the VENTILATOR to obtain a baseline PCO2.
ABG is measured at 1, 5, and 8 minutes.
Test is considered positive if PCO2 is elevated by 20 withouth respirations |
|
|
Term
| When can the Apnea Test not be used to assess brain death? |
|
Definition
1. If the pt is HEMODYNAMICALLY UNSTABLE and cannot have ventilator turned off
2. The pt is currently on BENZOS |
|
|
Term
| What is used if the Apnea Test cannot be used? |
|
Definition
EEG
Transcranial Doppler US |
|
|
Term
| What is the initial treatment for transverse myelitis? |
|
Definition
|
|
Term
| What is done next is high dose steroids are ineffective for transverse myelitis? |
|
Definition
cyclophosphamide
Plasmapheresis - this removes the viral antibodies |
|
|
Term
| What is the definition of a concussion? |
|
Definition
| trauma-induced alteration of mental status that may be associated with transient loss of consciousness |
|
|
Term
| How are concussions graded? |
|
Definition
| distinguished by the duration of amnesia and mental status alteration |
|
|
Term
| What defines a GRADE 1 concussion? |
|
Definition
| resolving within 15 minutes |
|
|
Term
| When can an athlete with a GRADE 1 concussion RETURN TO COMPETITION? |
|
Definition
|
|
Term
| What defines a GRADE 2 concussion? |
|
Definition
| symptoms last longer than 15 minutes |
|
|
Term
| When can an athlete with a GRADE 2 concussion return to competition? |
|
Definition
|
|
Term
| What defines a GRADE 3 CONCUSSION? |
|
Definition
|
|
Term
| When can an athlete return to competition with a Grade 3 concussion? |
|
Definition
| after one week of being asymptomatic |
|
|
Term
| When antiepileptic drug is used in pregnant women? |
|
Definition
|
|
Term
| What is NEURALGIC AMYOTROPHY? |
|
Definition
inflammation of the brachial plexus (thought to be autoimmune in origin).
Presents with severe pain, sometimes awakening the pt at night, weakness in the distribution of the scapula |
|
|
Term
| After giving a pt tPA for an ischemic stroke, their blood pressure should less than. . . |
|
Definition
|
|
Term
| What is given if the blood pressure is greater than 180/105 in a pt who received tPA for ischemic stroke? |
|
Definition
|
|
Term
| How long is aspirin held in someone who received tPA? |
|
Definition
|
|
Term
| Are benzos ever given in the setting of an ACUTE stroke? |
|
Definition
| NO!!! they impair recovery from neuronal injury and thus should be avoided!!! |
|
|
Term
| Is NITROPRUSSIDE ever given control BP in a pt with acute stroke? |
|
Definition
| NO!!! it increases intracranial pressure and should be avoided in acute stroke! |
|
|
Term
| What medications should be discontinued and avoided in a pt with dementia? |
|
Definition
anticholinergics
sedatives |
|
|
Term
| What is the minimum dosage of aspirin to treat stroke? |
|
Definition
|
|
Term
| What is the tx for ACUTE cluster HA? |
|
Definition
|
|
Term
| What is the tx for prophylaxis for cluster HA? |
|
Definition
Verapamil
oral corticosteroids |
|
|
Term
| What hormone is typically elevated after a seizure? |
|
Definition
|
|
Term
| What is CHOREA GRAVIDARUM |
|
Definition
| self-limited chorea that occurs during pregnancy (likley 2/2 to elevated estrogen levels) |
|
|
Term
| What is REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROME? |
|
Definition
| comprises a group of disorders characterized by recurrentthunderclap headache of the THUNERCLAP variety occurring over a few days or weeks, often without abnormalities on clinical exam |
|
|
Term
| What is the tx for acute onset Bell Palsy? |
|
Definition
PREDNISONE preferably within 72 hrs of onset
(Antivirals have not been shown to be useful in the tx of Bell Palsy) |
|
|
Term
| What are the presenting symptoms of Bell Palsy? |
|
Definition
Ipsilateral upper and lower facial paralysis
Dry mouth
HYPERACUSIS
Impaired Taste
Pain and numbness near the ear |
|
|
Term
| In a pt with suspected subarrachnoid hemorrhage, what is the order of operations for evaluation? |
|
Definition
|
|
Term
| What are the signs of spinal cord compression |
|
Definition
be suspicious for this in a pt who could previously ambulate, and acutely cannot as well as . . .
increased tone with ankle clonus
hypERreflexia
extensor plantar responses
profound leg WEAKNESS
and NORMAL UPPER EXTREMITY stength and reflexes |
|
|
Term
| What is CORPUS CALLOSTOMY? |
|
Definition
| palliative surgery performed in CHILDREN with SYMPTOMATIC GENERALIZED EPILEPSY with tonic or atonic seizures |
|
|
Term
| What is Acute Disseminated Encephalomyelitis? |
|
Definition
| subacute inflammatory dymelinating disorder in children and young adults characterized by simultaneous demyelination in multiple regions of the central nervous system (typically occurs POST-INFECTIOUSLY) |
|
|
Term
| What are other associated symptoms of Acute Disseminated Encephalomyelitis? |
|
Definition
headache
fever
encephalopathy |
|
|
Term
| What will CSF show in Acute Disseminated Encephalomyelitis? |
|
Definition
|
|
Term
| What agent is used for long-term treatment of MS? |
|
Definition
glatiramer acetate
interferon-B |
|
|
Term
| What is glatiramer acetate? |
|
Definition
| immune modulator which is made up of several amino acids and may act as a decoy in MS |
|
|
Term
| How do oral contraceptive pills affect antiepileptic drugs, specificially LAMOTRIGINE? |
|
Definition
OCPs decrease the serum concentration of lamotrigine by 40 - 60%
Lamotrigine is cleared via glucoronidation. Glucoronidation is increased via ESTROGENs. Therefore when OCPs are being used Lamotrigine dose must be increased |
|
|
Term
| Which antipsychotic agent is never given to a pt with PARKINSON's? |
|
Definition
| HALOPERIDOL - causes paralysis and severe worsening of parkinsons, sometimes not reversible |
|
|
Term
| Is ASA or clopidogrel superior at preventing SECONDARY strokes? |
|
Definition
|
|
Term
| What trial showed Clopidogrel to be superior to ASA at preventing secondary stroke? |
|
Definition
|
|
Term
| What did the MATCH trial show? |
|
Definition
| Showed that combining clopidogrel and ASA for ischemic stroke prevention was associated with slight reduction in risk of ischemic stroke, BUT was offset by hemorrhagic complications |
|
|
Term
| What is Chronic Paroxysmal Hemicrania? |
|
Definition
| a syndrome related to cluster headache that differs in frequency and duration. Both HA types are related to TRIGEMINAL AUTONOMIC NEURALGIAS |
|
|
Term
| What is the treatment for Chronic Paroxysmal Hemicrania? |
|
Definition
| responds dramatically and specifically to INDOMETHACIN |
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