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Flashcards in Neurology Deck (280)
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241

Difficulty standing on toes, reflexes dec'd

Sciatica

242

Wrist drop -

Radial neuropathy

243

Foot drop

Peroneal nerve comopression

244

Antibody induced acute polyneuropathy - occurs in

Guillain-barre syndrome

245

Yound pt with ankle sprain - takes NSAIDs - extreemm tenderness when bed sheet touchs - exam bluish discoloration - dx?

Complex regional pain syndrome - reflex sympathetic dystrophy
If pt with patchy deminralization - bisphosphonates are effective - treatment even in absense of osteoporosis

246

19yo playing football has a sudden imopact and falls to ground - appears confused upon immediate exam - no LOC, 15 minute later normal cognition and vision and finger -nose test - wtd?

Can go back and play (no LOC)

247

20yo playing football - concussive injury - no LOC - in daze on immediate exam - 20 min later alert and oriente but with some amnesia which resooles 15 min later

Monitor closely, if no sx for week then can play again

248

24yo had a concussioni playing ice hockey - lost conciousness x 30 sec - upon waking alert, oreient, figner to nose normal - vision fnorma - WTD (less than 1 min LOC with normal physical exam)

Send hoem with family observation withold from competition - if remains asx can back to play in 1 week

249

24yo had concussion playing contact sports, lost consiounes x 20 sec and waking up was in daze which cleared up on wya to ER (less than one min LOC, abn physical exam upon awakening

ER eval with CT/MRI - withdraw from competition - if asx can go back to play in 2 weeks

250

Concussion with LOC > 1 min with nromal phsyical

ER eval with CT/MRI - withold from competition - if still asyxmt back to play in 2 weeks

251

Seizures

Generalized
1. Tonic Clonic - valproate, lamotrigine, levetiracetam, topriamate
2. Absense/Petit mal:
without aura or post ictal sx, 3 sec spike and wave patternon EEG
tx: ethosuximide, valproate, lamotrigine

Partial
1. Simple - focal seizure affects small volume of cortex, no LOC (psychic sensation, deja vu
2. Complex - involves large enough cortex to cause loss of conciousness
tx: Carbamazepine, phenytoin, valproate, levetiracetam, lamotrigine, gabapentin(adjunctive)

252

Medications that cause seizures

Imipenum, tramadol, bupropion, haldol, meperiridine, PRBC
Partial: Carbamazepine, phenytoin, valproate, levetiracetam, lamotrigine, gabapentin

253

Best Anti-sz med for elderly

Lamotrigene

254

Best anti-Sz med for with liver dz

Keppra (Levetrcetam)

255

Best anti Sz medication in pregnancy

Carbamapezine

256

What antiseizure medication causes kidney stones

Topiramate

257

After the first seizure - best dx imaging is...

CT if neg -> MRI
Then do EEG (epileptiform spike +- slow waves
NORMAL EEG does NOT r/o seizure d/o

258

Pt makign presentation to supervisor slumps over in chair, diaphretic, has jerks of arms nad legs several times - completely recovers in 30 sec and has pallor, BP normal, cardiac/neuro exam normal dx?

Syncopal convulsions

259

Pt in dental chair passes out andhas jerky movement o arms and legs, completely recovers in 30 sec - diaphoretic - similar episode once before

neurocardiogenic syncope

260

22yo h/a, smells of burnign rubber, feels strange, no convulsions seen dx?

partial seizure/psychomotor epilepsy

261

Pt has generalized seuzures not better with dilantin - serum Ca low, ca cl injections don't help wtd?

Iv Mg SO4

262

22yo with weird sensation in stomach followed by sudden freezing, swallowing chewing, lip smacking - minute later she starts talking and doesn't recall eepsode

Partial seizure

263

30yo F brought to office - say having recurrent spells of starting for several seconds the haveing intense familiarity with surrounding sand strangers most likely affected lobe is?

Temporal lobe

264

Young woman with epigastric rising sensation - most likely dz?

simple partial seizure
temporal lobe (deja vu)

265

22yo F with husband and narrating complaint then her leg starts jerking which gets wors and on /off x several minutes - then SOB, then holds head tight afte r3 min jerking stops and feels dizzy and has headache dx?

Pseudoseizure
dec'd Ca+

266

55yo brought in by family - having episodes when staring blankly for several seconds then shakes hand repeately fo rfew minutes then feels tired - no focal neuro deficits, MRI normal wtd?

Sleep deprived EEG
dx: Complex partial

267

Pt with onset of seziure of left arm and then spreads to left leg - after episode wk of left arm and leg dx?

Jacksonian seizure
frontal lobe
starts at arm and marches toward leg in terms of sx (begin with fingers - end with legs) - NO LOC

268

Treatment of status epilepticus (sz >30min or LOC between 2 mor more seizures

1. IV glucose + thiamine
2. Lorazepam
3. Loading dose Phenytoin or Fosphenytoin
4. Maximize Phenytoin
5. Phenobarb/Midazolam
6. General anaestheia/neruomuscular blockade

269

Pt with new monset seizure - post ictal state recommendation?

No driveing
No swimming

270

Pupils

Mid dilated - glaucoma
Mid constricted - uveitis (iridocylitis)
b/l dilated - anti-cholinergics, botulism, cocaine
unilateral dilated - CN III compression
b/l constriction - Opiates, pontine infarct, organophosphate poisoning