Clinical Neurology (test 1) (part 3)

Part 3 Notecards Pick Up After 'chronic Headaches' And Cover Material Through Dementia And ACS. Enjoy

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Side ASide B
Who are more likely to develop (a) migranes, (b) cluster HA's and (c) tension HA's? Men, Women or equal?
Migrane = women (3:1)Cluster = menTension = equal
Swelling around the optic nerve is a red flag symptom for a severe headache.... what is this the definition of?
Berry Aneurysms are most commonly associated with hemorrhage of what area?
Subarachnoid hemorrhage
T/F:Meningitis patients find a flexed cervical position most comfortable while pts presenting with mechanical neck pain usually find cervical extension brings relief
False; visa versa
T/F:Migraine HA's typically onset in teenage years
Patient complaining of a "daily HA..." what should the doctor suspect?
Rebound HA (due to overdose of pain meds)
Which type of HA is strongly associated with menstruation in women?
Approximately 35% of Migraines are accompanied by what?
In order to diagnose a Classic Migraine the patient must present with at least 3 of 4 possible symptoms.... what are the 4 qualifying characteristics of a Classic Migraine HA?
(1) 1 or more reversible aura symptoms(2) At least 1 aura sx. develops gradually over 5 min.(3) Sx. last between 5 - 60 minutes(4) Migraines follow aura within 60 minutes
HA's that last 4-72hrs and cause nausea, photophobia and phonophobia are classified as what?
Common Migraine
T/F:Common Migraines are aggravated by routine physical activity
What are 3 examples of classic "auras" associated with migraines?
Flashing lights, Dysphasia and Numbness/parasthesia
T/F:Pulsatile pain associated with migraines is mediated by excitability of the peripheral trigeminovascular neurons of CN V
T/F:Migranes are not a progressive disease
T/F:90% of Serotonin is within the brain and platelets
False; 90% in the GI tracts
What type of migraine is associated with stroke-like symptoms?
Hemiplegic migraine
What dose of Aspirin is considered very effective for migraines?
What is the only triptan drug used prophylactically for women who have a predicatable monthly HA?
What is an indication for the use of prophylactic drugs in the treatment of migraine HA's?
HA frequency of 2 or more times a month & when the HA's effect the pt's ADLs
What is the mean age of onset for Cluster HA's?
28 yrs old
Nocturnal occurrence is common which arises pt. from sleep.  Pain is extremely severe around or behind the eye.  These presentations are indicative of what type of HA?
Cluster HA
How long to Cluster HA's generally last?
20-60 min.
T/F:Migraines generally respond well to oxygen inhalation while Cluster HA do not 
False; visa versa
When the pt. describes the HA sensation as "their head feeling like it is in a vise" the doctor should consider what type of HA?
Tension HA
A temporal, band-like pain around the head is indicative of what type of HA
Tension HA
Where may the pain associated with a Tension HA radiate towards on the head?
Frontal region
What is an AKA for Tension HA?
"muscle contraction" HA
What are the 2 types of Tension HA's?
Episodic & Chronic
What type of Tension HA is indicated by a duration of 30 min. to 7 days..... no nausea, may include anxiety and either photophobia or phonophobia (but not both)?
What type of Tension HA usually lasts from 15 days to 6 months and is frequently associated with analgesic overuse?
T/F:Analgesic rebound is usually associated with overuse of OTC drugs.
What type of HA usually onsets after and orgasm?
Coital HA
T/F:Coital HA's are self-limiting
How is a diagnosis of Pseudotumor cerebri confirmed?
elevated pressure during spinal tap
What demographic is most likely to develop Temporal Arteritis?
Females over 60 yoa
Temporal Arteritis produces pain in what areas besides over the temple?
Occipital area, face and side of neck
T/F:Visual pathways are unaffected with Temporal Arteritis
False; vision loss is a severe complication of TA
Severe scalp tenderness is a sx. associated with what condition?
Temporal Arteritis
When examining for Dementia, what is meant by the 'Flat affect?'
Pt. gives up easily when mental status is examined; say they cannot perform tasks
An acute confusional state with a sudden onset, fragmented speech and marked hallucination and problems with concentration is indicative of what?
What is the m/c cause of dementia?
Alzheimer's disease
T/F:Pseudodementia is associated with depression
What condition produces a state of confusion due to encephalopathy and opthalmoplegia, and is commonly associated with chronic alcohol abuse?
If a patient has organic problems with the brain what type of hallucinations will they have?
What is the cause of audio hallucinations?
Psychiatric problem (psychosis)
T/F:Dementia is a diagnosis
False; just a category
T/F:If dementia improves with cessation of drinking then AD is unlikely
When is a lumbar puncture performed for the possible dx. of AD?
When symptoms have a quick onset and rapid progression
T/F:Rigidity, bradykinesia and parkinsonian gait may be associated w/ more rapid progression of AD
T/F:The presence of ApoE4 is a risk factor for AD
Senile plaques and neurofibrillary tangles are highly associated with what condition?
What is the main difference (with respect to onset) between Dementia and Acute Confusional State (ACS)?
ACS has an acute or subacute onset of hours to days while Dementia has a chronic onset of months to years
T/F:Visual hallucinations are common in psychiatric disorders
False; auditory (visual hallucinations are associated with confusional states)
T/F:The ability to store and recall information is impaired by diffuse cortical disease and focal bilateral dysfunction.
What area of the brain is responsible for memory?
Limbic system
T/F:Attention is usually normal in ACS but impaired in pt's with dementia
False; visa versa
Unilateral neglect is when the brain manifests inattention to sensory stimulus on one side of the body.  This is characteristic of dysfunction of what lobe of the brain?
Parietal lobe
What are some examples (4) of integrative sensory functions of the brain associated with Parietal lesions?
Astereognosis, Agraphesthesia, Disorder of spatial thought and Allesthesia (misplaced localization)
T/F:Dialated pupils may indicate parasympathetic hyperactivity
False; sympathetic
Dysarthria, dysphagia, hyperactive jaw and gag reflex as well as uncontrollable laughing or crying are all symptoms associated with what type of palsy?
Pseudobulbar Palsy
What 2 tracts are disrupted in Pseudobulbar Palsy?
Corticobulbar and CS tracts
T/F:Myoclonus is a major motor finding associated with ACS
T/F:Broad based, ataxic gait is one of the cerebellar signs of dementia
What dementia associated diseases have Chorea as a primary clinical presentation?
Huntington and WIlson disease
What dementia associated diseases present with tremor, rigidity and bradykinesia?
Wilson disease
What dementia associated disease present with Myoclonus?
CJD and HIV dementia (ACS is not in the dementia category)
Dementia caused by Vit. B12 deficiency, Neurosyphilis and HIV dementia is associated with an (increase/decrease) in DTR's.....
Decreased DTR
What disease or category of disease is associated with the presence of primitive reflexes later in life?
ACS & Dementia

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