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Step2: Neuro2
Neuro 2
| Question | Answer |
|---|---|
| What is the MCC of headaches in adults? | Tension headaches |
| How do you investigate sudden, severe headache or neurological deficit? | CT (WITHOUT contrast)to r/o hemorrhage |
| What causes electric-like pain in face, extremely sensitive to triggering (even by wind)? | Trigeminal headache |
| What's the DOC for a Trigeminal headache? | Carbamezapine. (other anti-convulsants can be given too) |
| Migraines are more comming in [males/females] due to __________. | Females; estrogen fluctuations |
| Alcohol is a precipitating factor for _________ headaches. | Cluster |
| Stress/fatigue causes ___________ headaches. | Tension |
| [Migraine, Cluster, Tension] is usually bilateral. | Tension |
| OCPs, menstruation, and foods containing tyramine/nitrates are precipitating factors of __________ headaches. | Migraine |
| Periorbital pain, unilateral, recurrent: these are KKs of _________ headaches. | Cluster |
| Aura, photophobia are Sx of _________ headaches. | Migraines |
| Never put a females with migraines + aura on _______. | OCPs (DVT risk) |
| Rx of Tension headache? | NSAIDs |
| Rx of Cluster headache? | 100% O2 (impt!) + sumatriptan/ergots |
| Rx of Migraine? | Sumaptriptan + ergots +/- antiemetics |
| What 5 agents can be used as Migraine prophylactics? | CCBs (verapamil), B-blockers (esp if comorbid HTN), TCAs (if comorbid depression), NSAIDs (menstrual cause or arthritis comorbidity), anticonvulsants (valproate, topiramate, gabapentin) |
| What is the likely cause of headache: Obese female with papilledema? | Pseudotumor cerebri |
| What is the likely cause of headache: Jaw muscle pain while chewing? | Temporal arteritis |
| What is the likely cause of headache: Periorbital pain w/ Horner syndrome? | Cluster headache |
| What is the likely cause of headache: Lacrimation and/or rhinorrhea? | Cluster headache |
| What is the likely cause of headache: "Worst headache of my life"? | Subarachnoid hemmorrhage (berry aneurysm) |
| What is the likely cause of headache: raised ESR? | Temporal arteritis |
| What is the likely cause of headache: headache + extraocular muscle palsy? | cavernous sinus thrombosis |
| What is the likely cause of headache: scotomatas prior to h/a? | Migraine |
| What is the likely cause of headache: occurs days after a trauma to the head, persists? | Subdural hematoma |
| Acute focal neuro deficits lasting <24h are ________. | TIA (transient ischemic attacks) |
| What does carotid bruit in a TIA patient suggest? | ATH of carotids. Do USG to quantify. |
| The first line of radiology in TIA patients is __________. | CT to r/o bleeding (MRI is for ischemia!) |
| What is the purpose of ECHO in a TIA patient? | To determine septic emboli, AS, or mural thrombus as a cause |
| Most dangerous outcome of peudotumor cerebri is___________. | Blindness |
| If vomitting PRECEDES headache, and headache worsens over days-weeks, you should suspect ___________. | Brain tumor |
| What is the first line Rx for pseudotumor cerebri? | Acetozolamide |
| Anticoagulant of choice in pt with TIA/Stroke: First TIA? | ASA (prophylactic) |
| Anticoagulant of choice in pt with TIA/Stroke: due to Afib? | warfarin |
| Anticoagulant of choice in pt with TIA/Stroke: w/ coronary artery dz? | clopidogrel |
| Anticoagulant of choice in pt with TIA/Stroke: Repeat TIA/stroke while taking ASA? | agronox/clopidogrel |
| 3 scenarios where you do carotid endarterectomy for TIA/stroke patients? | 1. symptoms + 70-99% occlusion (strong benefit) 2. symptoms + 50-69% occlusion (moderate benefit) 3. asymptomatic + 80-99% occlusion, and expected to live longer than 5y by a surgeon w/ <3% complication rate |
| SSx (5) of carotid artery stenosis? | Bruit, TIAs, reversible neuro defecits, transient u/l blindness (amaurosis fugax), CVAs |
| Nonsurgical Rx of carotid stenosis? | HTN control, Lipid control, DM control, aspirin |
| Acute focal neuro defecit lastin >24h is ________. | Stroke |
| What are the 2 types of stroke? | Ischemic and hemorrhagic |
| Most common artery involved in embolism->ischemic stroke is _______________. | Middle Cerebral Artery |
| What is the radiology of choice for stroke? | MRI if pt seen w/i 24h of onset, CT w/o contrast after 24h |
| What is the purpose of ECG in a stroke patient? | To determine if Afib or other arrhythmia is a cause of an embolus |
| Rx of ISCHEMIC stroke? 4 steps | 1. Thrombolytic Tx w/i 3h (6h if given IV @ site of thrombus) 2. Antiplatelet Tx w/i 48h 3.+/- LMWH 4. Lipid lowering drugs w/i 3d |
| You shouldn't treat ______ in a stroke patient unless it is very extreme. | HTN (only Rx >220/120). Risk of decreasing cerebral perfusion if you treat moderate HTN |
| Rx of HEMORRHAGIC stroke? 3 steps | 1. Reversal of any anticoagulant + control BP and ICP 2. +/- surgical decompression 3. Antiplatelet drugs restarted 2w later |
| Never give _______tonic fluid in suspected brain injury. | Hypo-tonic |
| Stroke of what artery causes: c/l lower extremity and trunk weakness? | ACA |
| Stroke of what artery causes: c/l face and arm weakness, aphasia, inability to recall learned actions? | MCA |
| Stroke of what artery causes: c/l visual loss? | PCA |
| What are the 5 lacunar stroke syndromes? Which has cortical signs? | Pure motor hemiparesis (Most common), pure sensory, ataxic hemiparesis, sensory + motor, dysarthria (clumsy hand). NONE of these have cortical signs like aphasia, neglect, visual loss. |
| What radiology is used to determine EXTENT of bleeding in a parenchymal bleed? | CT w/o contrast |
| What radiology is used to determine SITE of bleeding in a parenchymal bleed? | MRA or CTA |
| What Rx do you use in parenchymal bleed that you wouldn't use in stroke? | Anticonvulsants |
| Berry aneurysm is associated with ____________ and ______________. | Marfan's, ADPKD |
| Subarachnoid hemorrhage is bleeding into the space between the arachnoid and __________. | Pia |
| First step in suspected SAH? | CT w/o contrast. If clear, do LP for blood. |
| What systolic BP should you try to target in SAH? What drug would you use? | <150 systolic (only treat if cognitive fxns are intact) use LABETALOL |
| Declining RBCs in serial LPs most likely implies ___________. | traumatic LP, rather than SAH (which is usually the case with blood in LP) |
| MCC of Subarachnoid Hemorrhage vs Epidural Hematoma? | SAH: berry aneurysm. Epidural hematoma: middle meningeal artery damage from TRAUMA |
| Epidural hematoma is blood between the dura and __________. | Skull |
| [Subdural hematoma/Epidural hematoma] can cross the midline in the brain. | Epidural hematoma |
| Which brain bleed has a "lucid interval"? | Epidural hematoma |
| Which brain bleed has a "blown pupil" i.e. fixed and dilated? | Epidural hematoma (or very large subdural hemm) |
| Subdural/Epidural hematoma = concave/convex on CT | Epidural = convex (lens shaped). Subdural = concave (crescent moon). |
| Rx of epidural hematoma? | drainage by radio-guidance or burr hole. |
| Subdural hematoma is collection of blood between the dura and ___________. | Arachnoid |
| Subdural hematoma is caused by damage to which vessels? How are they damaged? | Bridging veins, due to trauma |
| What is the onset/presentation of Subdural hematoma headache? | Slowly progressing, like headache of a tumor |
| Mental status change seen in elderly pt with Hx of falls. You should suspect a possibility of __________ hematoma. | Subdural. Do CT w/o contrast to confirm |
| Why would hydrocephalus occur following SAH? | SAH causes fibrosis of arachnoid granulations (impaired CSF absorption) |
| 3 W's of normal pressure hydrocephalus are? | wacky (cognitive impairment), wet (incontinence), wobbly (gait disturbance; feet stuck to floor) |
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jsad
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