Term
| What are some pathognomonic brain lesions of a patient with Alzheimer disease |
|
Definition
neurofibrillary tangles (NFTs)
beta amyloid plaques (senile plaques; SPs) |
|
|
Term
| Name some lab tests to run on a patient who is demented to rule out non-Alzheimer causes |
|
Definition
CBC
heavy metal screens
serum lytes
Glucose
TSH
B12 and folate
renal/liver fxn
drug and alcohol levels |
|
|
Term
| What is Dr. Olivera's treatment plan for a patient with Alzheimer disease? (the cholinergic drugs, not side meds). what is his timeline for tx (when do you stop?) |
|
Definition
-Aricept first (works on the Ach NT)
-Namenda added to Arciept after one year (sensitizes receptor to Ach)
-Exelon- works like Aricept, usually used alone, comes in patch form, has many GI side effects
*after 4 years stop tx, brain has less neurons and you will flood the brain with Ach |
|
|
Term
| Lumbar puncture is currently a research technique for Alzheimer disease, what is found in the CSF of an AD patient? |
|
Definition
| high levels of tau and phosphorylated tau and low levels of amyloid |
|
|
Term
| what is the MC type of dementia |
|
Definition
|
|
Term
| what are the three most common mechanisms of vascular dementia |
|
Definition
-multiple cortical infarcts
-strategic single lesion
-small vessel disease |
|
|
Term
| the absence of what on CT scan or MRI is evidence AGAINST vascular pathology? |
|
Definition
|
|
Term
| how does vascular dementia progress? pathognomonic... |
|
Definition
|
|
Term
| what is the mainstay of treatment for vascular dementia? name two classes of meds used |
|
Definition
-prevent new strokes
-Antiplatelets: aspirin, ticlopidine (ticlid), clopidogrel (plavix)
-Hemorheologic agents (improve cerebral blood flow): pentoxifylline (trental) |
|
|
Term
| what is the term for when demented patients start telling untrue stories? |
|
Definition
|
|
Term
| what are some meds used for agitation dementia? short term and long term? |
|
Definition
-short term: zyprexa
-long term: buspar or depakote |
|
|
Term
| what does the acronym P.DIMM WIT stand for in regards to causes of delerium |
|
Definition
Post operative state
Dehydration and malnutrition
Infection (sepsis, meningitis, encephalitis, UTI, etc)
Meds and drug tox (TCA, corticosteroids, anticholinergics, hallucinogens, cocaine)
metals
Withdrawal states (ETOH and benzos)
Inflammation, fever
Trauma, burns |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of level of consciousness |
|
Definition
demented: preserved
delirious: altered and fluctuating |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of hallucinations |
|
Definition
dement: rarely present
delir: frequent (visual) |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of tremor |
|
Definition
dement: rarely present unless due to parkinson dz
delir: sometimes (asterixis) |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of tremor |
|
Definition
dement: rarely present unless due to parkinson dz
delir: sometimes (asterixis) |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of course. what is sundowning? |
|
Definition
dement: insidious and progressive
delir: rapid onset, then waxing and waning. SUNDOWNING: worsening at night |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of reversibility |
|
Definition
dement: typically irreversible
delir: almost always reversible |
|
|
Term
| what is the treatment of deliriuM? |
|
Definition
treat cause
reduce meds if theyre the cause
symptomatic: neuroleptics (haloperidol, seroquel, risperdal), benzo's (lorazepam), olanzapine (zyprexa) |
|
|
Term
| what is the leading cause of childhood disability affecting function and development |
|
Definition
|
|
Term
| the brain lesions of cerebral palsy occur from the fetal or neonatal period up to age ___ years |
|
Definition
|
|
Term
| what is a common comorbidity (also of neuro origin) of patients with CP |
|
Definition
|
|
Term
| what is the most common type of Cerebral palsy that accounts for up to 80% of cases |
|
Definition
| spastic CP, due to cortex/pyramidal tract lesions |
|
|
Term
| what is a treatment for spasticity in CP |
|
Definition
|
|
Term
| What are two anticonvulsant meds used in CP? what are some symptomatic tx's? |
|
Definition
-dilantin and phenobarbitol
-stool softeners, glasses, hearing aids, walking aides |
|
|
Term
| what is the MCC of unilateral facial paralysis? |
|
Definition
|
|
Term
| what is another name for Bell Palsy |
|
Definition
| idiopathic facial paralysis (IFP) |
|
|
Term
| acute, unilateral, peripheral, lower motor neuron, facial nerve paralysis that gradually resolves over time in 80-90% of cases describes what DO |
|
Definition
|
|
Term
| How do you differentiate between Bell palsy and a lesion involving the central motor neurons above the level of the facial nucleus in the pons? |
|
Definition
| central motor neuron lesion described would cause weakness of the lower face alone |
|
|
Term
| What is the minimum diagnostic criteria for bell palsy |
|
Definition
| paralysis or paresis of all muscle groups on one side of the face, sudden onset, and absence of CNS disease |
|
|
Term
| what is the mainstay of tx for bell palsy |
|
Definition
|
|
Term
| glove and sock distribution of feeling is characteristic of what? |
|
Definition
|
|
Term
| Nerve injuries in peripheral neuropathies effect one of four components: neuronal or axonal, demyelinating, infiltrative, or ischemic. Give an example of a disease state for each type |
|
Definition
-Neuronal axonal: DM, charcot marie tooth
-Demyelinating: MS, Guillan Barre
-Infiltrative: sarcoidosis, amyloidosis
-Ischemic: DM, collagen vascular disease |
|
|
Term
| What is the MC complication of DM |
|
Definition
|
|
Term
| Name some major DDX for diabetic neuropathy |
|
Definition
-Vit B12 def
-Hypothyroidism
-Alcohol related neuropathy
-Other nutritional neuropathy |
|
|
Term
| what is the absolute best treatment for diabetic neuropathy |
|
Definition
|
|
Term
| Name some meds used for the tx of pain in diabetic peripheral neuropathy |
|
Definition
| FIRST NSAIDs, then...Amitriptyline (elavil), Gabapentin (neurontin), pregabalin (lyrica), and others |
|
|
Term
| what is the most common cause of acute flaccid paralysis in the US? |
|
Definition
|
|
Term
| what is another name for guillain barre syndrome |
|
Definition
| acute inflammatory demyelinating polyradiculoneuropathy |
|
|
Term
| describe how the symptoms of guillain barre present |
|
Definition
| symmetrical extremity weakness that begins distally and ascends |
|
|
Term
| describe the DTRs of a patient with Guillain barre |
|
Definition
|
|
Term
| what would be found on in the CSF of a patient with guillain barre in terms of WBC and protein |
|
Definition
protein is usually elevated >0.55 g/dL
WBC will be NL (<10 cells/mm3), if increased consider a different diagnosis |
|
|
Term
| What is the mainstay of tx for guillain barre? what are some other options? |
|
Definition
-hospitalization and symptomatic care- making sure to watch for signs of respiratory failure
-plasmapheresis and IV immunoglobulin tx have been shown to be effective |
|
|
Term
| guillain barre usually comes about after a preceding infection.... what two bugs are very commonly associated with it? |
|
Definition
campylobacter jejuni!!!!!
CMV |
|
|
Term
| What is the pathophys of myasthenia gravis |
|
Definition
| antibodies from against the nictotinic acetylcholine receptors, leading to an increase in the rate of receptor destruction |
|
|
Term
| describe the weakness exhibited in myasthenia gravis |
|
Definition
| exacerbated by continuous use of muscle and relieved with rest |
|
|
Term
| what are the two subtypes of myasthenia gravis |
|
Definition
|
|
Term
| what are the DTRs like in myasthenia gravis? compare to guillain barre? |
|
Definition
-preserved
-in GB they are diminished or absent |
|
|
Term
| What is the workup of a suspected Myasthenia gravis patient |
|
Definition
-anti-ach receptor antibody test
-EMG: shows decremental response to repetitive stimulation of motor nerves
-CT of thorax to rule out thymoma
-Edrophonium (tensilon) or neostigmine test to see if anti cholinesterase meds result in improved strength |
|
|
Term
| What are the 5 options of tx for a myasthenia gravis patient |
|
Definition
-Anticholinesterase inhibitors: pyridostigmine (mestinon) first choice
-Thymectomy is appropriate
-Corticosteroids: short term benefit
-IVIG (for elderly or mod-severe MG worsening to crisis)
-Plasmapheresis: reserved for crisis and refractory cases |
|
|
Term
| A pt with myasthenia gravis will usually not show worsening of sx after what time period? |
|
Definition
| 3 years- usually either plateaus or improves after three years |
|
|
Term
| What is the most common etiology of encephalitis? |
|
Definition
|
|
Term
| What are some s/sx that are more likely to be of encephalitis than of meningitis |
|
Definition
| confusion/disorientation, sleepiness, clumsiness/unsteady, behavior/personality changes, decreased level of consciousness |
|
|
Term
| What is the mainstay of treatment in an acutely ill patient presenting with encephalitis |
|
Definition
|
|
Term
| What is the most sensitive and specific test for dx of viral causes in encephalitis |
|
Definition
|
|
Term
| What imaging would be ordered in a pt with acute encephalitis |
|
Definition
MRI of the brain to rule out focal neurological causes (ie abscess)
-also, increased areas of T2 signal in frontotemporal localization is consistent with HSV encephalitis |
|
|
Term
| what would the glucose levels be in a pt's CSF who has viral meningitis/encephalitis? bacterial meningitis? |
|
Definition
|
|
Term
| What are three characteristic signs of meningeal irritation |
|
Definition
| headache, nuchal rigidity, and photophobia |
|
|
Term
| describe kernig's sign and brudzinskis sign |
|
Definition
Kernigs: with patient supine flex their hip and knee, if pt feels pain in the back this is positive sing
-brudzinskis: with patient supine, flex their neck toward their chest, if the pt flexes the hip and the knee in response then its a positive sign |
|
|
Term
| What is the prophylaxis for close contacts of a pt dx with meningitis |
|
Definition
| rifampin or ceftriaxone 1 dose IM |
|
|
Term
| What are the first and second most common causes of meningitis in patients greater than 18 yoa |
|
Definition
s pneumoniae
n meningitidis |
|
|
Term
| Describe the CSF of a patient with bacterial meningitis in terms of WBC, glucose, protein, and gram stain |
|
Definition
-increased WBC with PMN predominate and a left shift
-decreased glucose
-increased protein
-positive gram stain |
|
|
Term
| Describe the CSF of a patient with aseptic meningitis in terms of cells, protein, glucose... |
|
Definition
-increased in mononuclear cells- lymphocytic pleocytosis
-normal PRO or slightly elevated
-glucose WNL
-CSF can be completely NL |
|
|
Term
| Antibiotic tx should be started immediately in a pt with possible meningitis whose CSF is neither ______ or ______ |
|
Definition
|
|
Term
| What is the most common movement disorder? |
|
Definition
| essential tremor (aka benign essential familial tremor) |
|
|
Term
| What is a non-rx treatment that often provides dramatic, temporary relief for pts with essential tremor |
|
Definition
|
|
Term
| essential tremor usually effects the upper limbs, but what else can it effect that is often embarrassing for the pt |
|
Definition
| chin and speech if laryngeal muscles are involved |
|
|
Term
| Will an essential tremor go away when a pt goes to do a task> |
|
Definition
|
|
Term
| An essential tremor is postural or kinetic. what does this mean> |
|
Definition
postural (occurs with voluntary maintenance of a position against gravity)
kinetic (occurs with voluntary movement) |
|
|
Term
| What are the two cornerstone drugs of tx for essential tremor, which is started in the elderly and which is started in the young population |
|
Definition
-propanolol: young
- primidone: elderly |
|
|
Term
| Is an essential tremor usually bilateral? |
|
Definition
|
|
Term
| which tremor usually moves at a faster rate, essential or parkinsonian? |
|
Definition
|
|
Term
| Describe the inheritance pattern of Huntington disease. does it have any predilection for sex? |
|
Definition
|
|
Term
| What are the three parts to huntington disease? |
|
Definition
movement DO: chorea
cognitive DO: dementia
behavioral DO: irritable, moody, antisocial, depressed |
|
|
Term
| When are pts with Huntington dz usually dx? How long do they usually live after this? |
|
Definition
after the age of 30
10-25 years |
|
|
Term
| What is seen on a CT scan of a pt with Huntington dz |
|
Definition
| cerebral atrophy and atrophy of the caudate nucleus |
|
|
Term
| What is the first drug approved to specifically tx chorea associated with Huntington disease |
|
Definition
tetrabenazine (xenazine)
class: MOA inhibitor |
|
|
Term
| Name some drugs used in the tx of Huntington disease |
|
Definition
-risperdal or haldol for behavior and choreic movements
-paxil for depression
-depakote or klonopin for spasms and chorea |
|
|
Term
| what is the pathophysiology of parkinson disease |
|
Definition
| dopamine depletion in the brain leads to an imbalance of dopamine and acetylcholine |
|
|
Term
| Parkinson disease is a disorder of the ______/_______ |
|
Definition
|
|
Term
| what are the 2 characteristic neuropathologic findings in a pt with parkinson disease |
|
Definition
-loss of pigmented dopaminergic neurons in the substantia nigra pars compacta
-presence of Lewy Bodies |
|
|
Term
| What are the 4 cardinal signs of parkinson disease, 2 of the first 3 of which must be present for diagnosis |
|
Definition
-resting tremor
-rigidity
-bradykinesia
-postural instability (dystonia) |
|
|
Term
| describe the tremor in parkinson disease |
|
Definition
| resting tremor, sometimes pill rolling, that goes away with movement |
|
|
Term
| How is parkinson disease diagnosed? |
|
Definition
its clinical, no imaging scans are helpful
sometimes giving levodopa and seeing improvement can help with dx |
|
|
Term
| What is the cornerstone of tx of parkinson disease, explain how it works |
|
Definition
Carbidopa/levodopa (sinemet)
-Levodopa is the precursor of dopamine and carbidopa inhibits the decarboxylation of levodopa to dopamine in the peripheral circulation so that it goes to the brain
-levodopa alone can cause N/V due to buildup of dopamine in the peripheral circulation |
|
|
Term
| what is the basic pathophys of MS |
|
Definition
| inflammatory, demyelinating disease of the CNS |
|
|
Term
| What type of cycle does MS follow? |
|
Definition
|
|
Term
| Sx of an acute attack of MS last for how long? how often do attacks occur |
|
Definition
days to weeks
occur at about 1 per year |
|
|
Term
| Definitie diagnosis of MS requires what? what is a diagnosis criteria to follow (name)? |
|
Definition
-2 episodes of sx and 2 white matter lesions
-McDonald criteria |
|
|
Term
| what imaging study is good for dx MS? |
|
Definition
| MRI- identifies white matter lesions and plaques |
|
|
Term
| what is seen in the CSF after LP of a pt with MS |
|
Definition
| oligoclonal bands of immunoglobulin G and increased myelin protein |
|
|
Term
| what are the two tx aspects of MS |
|
Definition
-immunomodulatory tx for underlying immune DO
-therapies to relieve/modify sx |
|
|
Term
| what are two tx options for acute attack of MS |
|
Definition
-IV steroids
-plasmapheresis (for those who do not respond to steroids) |
|
|
Term
| What eye problem often goes along with MS |
|
Definition
|
|
Term
| What eye problem often goes along with MS |
|
Definition
|
|
Term
| what is the MC type of traumatic intracranial lesion? |
|
Definition
|
|
Term
| what is a subdural hematoma? |
|
Definition
| a collection of blood below the inner layer of the dura, but external to brain and arachnoid membrane |
|
|
Term
| What type of patients get subdural hematomas? |
|
Definition
| pts with severe high speed impact head injuries and pts on anticoags with minor head injuries |
|
|
Term
| what will a subdural hematoma look like on CT? |
|
Definition
| white and crescent shaped |
|
|
Term
| what is the consistency of an acute subdural hematoma? can they be evacuated with burr holes? |
|
Definition
-jelly like
-NO they cannot |
|
|
Term
| what is the consistency of chronic subdural hematoma? (>2 weeks). can it be evacuated with burr holes? what color is it on CT |
|
Definition
liquid and can be evacuated with burr holes
will be darker on CT, no longer white! |
|
|
Term
| what blood vessel is usually disturbed in a subdural hematoma? what makes the elderly at greater risk? |
|
Definition
-bridging veins
-atrophy of the brain puts stress on the bridging veins and they tear more easily |
|
|
Term
| What can be used to decrease ICP in a subdural hematoma? |
|
Definition
| mannitol (osmitrol) 1g/kg IV push |
|
|
Term
| what is a subarachnoid hemorrhage? |
|
Definition
| extravasation of blood into the subarachnoid space, between the pial and arachnoid membranes |
|
|
Term
| what is the most common cause of subarachnoid hemorrhages? what is the name most often associated with? |
|
Definition
-trauma
-nontraumatic hemorrhage that usually occurs in the setting of a ruptured cerebral aneurysm or arteriovenous malformation (AVM) |
|
|
Term
| what is the #1 sx in a pt with a totally classic presentation of subarachnoid hemorrhage |
|
Definition
| sudden onset of the worst headache of their life with N/V |
|
|
Term
| What is a complication with subarachnoid hemorrhages that is often seen around day 14? what is the tx for this |
|
Definition
| vasospasm! tx is triple H: hemodilution, hypervolemia, and hypertension |
|
|
Term
| What is a cardiac drug that should be avoided in patients with an already elevated ICP |
|
Definition
|
|
Term
| What is the most common type of aneurysm? Name the other two types. |
|
Definition
-Saccular (berry) 90%
-Fusiform: the entire vessel is diseased
-Mycotic: due to infectious etiology |
|
|
Term
| What is the size threshold for surgical repair of an aneurysm |
|
Definition
<7 mm are not typically operated on
>7 mm are usually considered for surgery |
|
|
Term
| What is an inherited disease that predisposes patients for aneurysms? |
|
Definition
| polycystic kidney disease |
|
|
Term
| Where does the spinal cord end? What is the name of the most distal bulbous part of the spinal cord? |
|
Definition
|
|
Term
| Where does the cauda equina end? |
|
Definition
|
|
Term
| What is cauda equina syndrome? |
|
Definition
| characteristic pattern of neuromuscular and urogenital sx resulting from simultaneous compression of multiple lumbosacral nerve roots below the level of the conus medullaris |
|
|
Term
| What are some common symptoms of cauda equina syndrome? |
|
Definition
| low back pain, sciatica (uni or BL), saddle sensory disturbances, bowel and bladder dysfunction, variable LE sensory and motor extremity loss |
|
|
Term
| Is cauda equina syndrome considered a lower motor neuron or upper motor neuron lesion? |
|
Definition
| LMN because the nerve roots are part of the peripheral nervous system |
|
|
Term
| What is the tx in the ED or primary care office for cauda equina syndrome? |
|
Definition
admit to the appropriate service (neurosurg, neuro, or ortho)
frequent neuro checks
*DO NOT let these patients go home without being evaluated by the consulting physician and without appropriate imaging |
|
|
Term
| What are the typical characteristic features of complex regional pain syndrome |
|
Definition
| dramatic changes in skin color and temperature over the affected body part, accompanied by intense burning pain, skin sensitivity, sweating and swelling |
|
|
Term
| what are some other names for complex regional pain syndrome? |
|
Definition
reflex sympathetic dystrophy
causalgia |
|
|
Term
| what may show on X-rays in patients with complex regional pain syndrome |
|
Definition
|
|
Term
| General characteristics and tx of cluster HAs |
|
Definition
unilateral stabbing pain, around eye, tearing and nasal congestion on same side. may happen many times in a month. peak in 10-15 min. not releived with rest, so these pt's want to pace around
tx with O2 via face mask, triptans, lidocaine in the nostrils, capsaicin intranasally |
|
|
Term
|
Definition
triptans (if no heart disease)
phenergan or compazine for nausea |
|
|
Term
| triptans should not be used in pts with underlying _____ disease |
|
Definition
|
|
Term
| What is an APAP combo med that is often used in the tx of tension and migraine headaches? |
|
Definition
|
|
Term
| what pain medication is contraindicated in a patient with a history of seizures |
|
Definition
|
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