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44 Cards in this Set
- Front
- Back
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Headaches (Migraine, Cluster, Tension Type) |
Primary - no systemic disease or structural abnormalities Secondary - associated with AMS (subarachnoid, epidural/subdural hemorrhages, tumor abscess Life threatening - associated with subdural hematoma (severe AMS, severe pain, death) |
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Migraines (Primary) |
Typically occur with increased serotonin levels that cause increased vasoconstriction following by vasodilation of the vessels of the brain. W/WO aura; typically unilateral throbbing sensation made worse with noise/light. Last 4-5 hrs w/wo meds. Maybe associated with nausea (aura). Menstrual migraines (around cycle). Migraines in young children <5 (tx w periactin) Triggers: out of time with regular schedule (sleep/wake, etc); alcohol (red wine) |
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Cluster (Primary) |
Occur suddenly; explosive in nature; nighttime onset; cyclic (reports HA for several days and won't reappear for years); typically short lasting; rare in children Ipsilateral conjunctival tearing/injection; ptosis (drooping eyelid) & eyelid edema May be tx w anticonvulsant meds depending on how often they occur |
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Tension Type (Primary) |
Unknown MOA but r/t sustained muscle contraction Most common in adults/women; r/t stress, depression and hunger; frontotemporal band like distribution Described as mild/mod, non throbbing pain, tightness or pressure with gradual onset Tx w analgesics (tyl/ibuprofen) but relieved by stress |
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Mixed (Primary) |
Throbbing, constant pain during waking hours Mix of findings r/t migraines and tension HA pain Rebound HA: taking analgesics regularly for extended amount of time and then STOP; avoid taking meds around the clock |
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Trigeminal Neuralgia |
Pain associated w malfunction of trigeminal nerve (CN V has 3 pathways); >55 yo female; bursts of sharp pain over face innervated by affected nerve; triggered by stimulus to affected nerve (CN V); cyclic (short/quick) stabbing pain Younger patients, episodes may indicate multiple sclerosis |
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Temporal Arteritis |
Vasculitis of ophthalmic and posterior ciliary branches of internal carotid artery >50 yo; sharp localized temporal pain; malaise, anorexia; hx of polymyalgia rheumatica Palpation temporal artery: tender, warm and nodular May lead to BLINDNESS, which is often permanent SS: fever, weight loss D: elevated ESR (>50); immediate referral for tx |
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Vertigo |
Sensation of either their body moving (subjective) or environment moving around them (objective); usually described as spinning/rotary motion Disruption of the visual, vestibular or sensory system Can be central (brainstem), peripheral (inner ear/vestibular apparatus) or result from systemic causes |
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Vertigo: Central causes |
Neoplastic or vascular in origin: ---vascular causes: vascular insuff., TIA/stroke, migraines Brainstem and cerebellar dysfunction, multiple sclerosis and migraine headaches |
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Brainstem/Cerebellar Dysfunction (Central Vertigo) |
Brainstem/cerebellum associated with --NEOPLASMS: gradual onset; manifest as issue w equilibrium; --VASCULAR: acute onset; long-lasting; recurrent transient vertigo Brainstem: reports diplopia, dysarthria, dysphagia and paresthesia; sensory/motor deficits Cerebellar: reports gait disturbances, fine motor coordination diff including rapid alternating movements (RAM) and finger-finger testing |
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Multiple Sclerosis (Central Vertigo) |
Onset in 3rd/4th decade of life; no findings or may have neuro symptoms MS can produce a range of neuro symptoms; 50% patient's have vertigo MRI shows demyelinating plaques |
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Migraine (Central Vertigo) |
30% of patient's w migraines have vertigo; which can be present before/during HA or independent of the HA Vestibular-type migraines: photophobia and visual aura during vertigo Basilar-type migraines: visual changes, tinnitus, decreased hearing, ataxia or paresthesia (vertebrobasilar vascular abnormalities) Diagnosis made based on history |
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Vertigo: Peripheral causes |
Disruptions of inner ear or vestibular apparatus ---common causes idiopathic, canalithiasis (tiny calcium crystals), vestibular nerve inflammation, inner ear inflammation or infection or tumor Vestibular neuronitis, Meniere's and Labyrinthitis |
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Vestibular Neuronitis (Peripheral Vertigo) |
Precedes acute viral infection; presents w severe vertigo and N/V; lasts days-weeks; auditory function not affected; lying motionless helps
Nystagmus intensifies in amplitude when gaze is directed away from the affected ear; visual ocular reflex will lateralize to symptomatic ear |
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Meniere's Disease (Peripheral Vertigo) |
Classic triad symptoms of vertigo, hearing loss and tinnitus; sensation of ear fullness Attacks abrupt and recurrent, lasts minutes-hours and interval b/t attacks weeks-months Sensorineural hearing loss to affected ear or bilateral; nystagmus is lateral or rotary; visual ocular reflex will lateralize to symptomatic ear |
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Labyrinthitis (Peripheral Vertigo) |
Associated w concurrent viral/bacterial illness; produces severe vertigo lasting several days Can be complication of otitis media or meningitis Distinguished from Meniere's: no tinnitus with labyrinthitis |
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Vertigo Diagnostics |
Orthostatic BP (volume issue); carotid doppler (esp if auscultate bruit); holter monitor (arrhythmia); CBC, BMP (anemia, electrolyte imbalance) |
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Syncope |
Transient loss of consciousness and postural tone that results from a sudden decrease in cerebral perfusion |
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Near Syncope |
Lightheadedness: think presyncope and near syncope about to "about to faint;" orthostatic hypotension common cause; risk factors: anemia, dehydrated, hypoglycemia, hyperventilate Disequilibrium: unsteadiness when ambulating; decreased cerebral perfusion Medications causes: steroids, ethocrin, streptomycin, gentamicin, aspirin, lasix |
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CVA |
Risk factors: manage smoking, obesity, sedentary lifestyle, ETOH abuse, Afib, carotid artery diseaseHTN, HLP, Blood thinner (INR): afib (prevent stroke=high risk); risk for fall concerns manage HTN, HLP, and BS |
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TIA |
Varied symptoms; may not be noticeable; symptoms resolve within 24 hours |
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Seizures |
Absence (petit mal): ---CM: sudden brief lapse of consciousness w momentary blinking, starting or movements of the lips and hands but no falling. Typical <10 sec; Atypical >10 sec. ---Postictal: No aura; typical - prompt return to normal; atypical - some confusion Febrile ---fever not actual cause but rate of change; not underlying neurological disorder - should be no neurological deficit |
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Meningitis |
Bacterial & aseptic (enteroviruses or mumps virus) Associated: severe HA, photophobia, stiff neck, fever, ICP, chills, myalgia; toxic child or adult; petechial skin rash PE: Meningeal signs + Neck Mobility/Nuchal Rigidity - neck stiffness with resistance to flexion + Kerning's sign (sciatic nerve) - pain and increased resistance to extending the knee + Brudzinski signs (femoral nerve) - flexion of both the hips and knees while flexing neck Normal fundoscopic exam |
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Bacterial Meningitis causes |
Bacteria colonize nasopharynx and enter CNS through the dural venous sinuses or choroid plexus in the subarachnoid space Adults: staph pneumoniae and meningitis Children: staph pneumonia and Haemophilus influenzae Neonates: group B strep and E. coli Accompanied by severe systemic toxicity and AMS (encephalitis) |
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Meningococcal Vaccination |
Types: MCV4 (9 months - 55 yo); MPSV4 (>55 yo) Recommendation: 2 doses of MCV4 b/t 11-18 yo; first dose @ 11-12 yo, with booster @ 16 yo. *If first dose given after 16 yo, no booster is required Adolescents with HIV should get 3 doses (2 doses 2 months apart @ 11-12 plus a booster @ 16) High risk: college freshmen dorms; lab staff; military; travel africa; damaged spleen/ectomy; |
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Parkinson's |
Progressive neurodegenerative disorder caused by degeneration of dopaminergic neurons (substantia nigra pars compacta); pathologic hallmark selective loss of dopamine CM: resting tremor, rigidity, bradykinesia and gait dysfunction Diagnosis: history and neuropathologic exam (gold standard); must have 2 of the 3 - tremor, bradykinesia and rigidity |
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Multiple Sclerosis |
Autoimmune destruction of myelin sheath; more common young women PE: Loss of sense of vibration; trigeminal neuralgia; optic neuritis (blurred vision); painful EOM |
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Cranial Nerves |
Bell's Palsy: cranial nerve VII (facial) Vertigo: cranial nerve VIII (vestibulocochlear) |
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Infant Reflexes (Primitive) |
Palmer grasp (flex fingers): birth to 3-4 months Plantar grasp (toes curl): birth to 6-8months Rooting reflex (turns mouth open): birth to 3-4 months Moro reflex (lower/startled): birth to 4 months Tonic neck (head turn opposite extension): birth to 2 months |
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Reflexes |
Grading: 4+ = very brisk, 2+ normal, 0 = no response Biceps reflex: C5, C6 Brachioradialis: C5, C6 Triceps reflex: C6, C7 Patellar (knee) reflex: L2, L3, L4 Achilles (ankle) reflex: S1 |
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Bursitis |
Inflammation of the Bursa Elbow, hip, knee; often r/t trauma; seen w gouty arthritis or RA PE: edematous, warm to touch, painless Will resolve on own |
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Tendonitis |
Often seen with repetitive motions, young athletes PE: tenderness over tendon; redness; warmth Immobilize tendon (REST), ice, NSAIDS de Quervains's tenosynovitis --pain with thumb movement maneuver |
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Carpal Tunnel Syndrome |
Typical numbness/tingling (2,3,4 finger) esp at night Tests Nerve Conduction Velocity or EMG = definitive --Thumb abduction: raise thumb w resistance; + test = weakness --Tinel's sign: tap over median nerve; + test = aching and numbness --Phalen's sign: wrists flexion for 60 secs; + test = numbness/tingling <60 sec |
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Osgood Schlatters (Knee) |
Painful swelling of the anterior aspect of the tibial tubercle; caused by strenuous activity esp quadricep muscles; Most common in adolescent males, young athletes, accelerated growth pattern CM: limp and pain that worsens w activity (stair climbing and kneeling) PE: warm, swollen, tender tibial tubercle; flexion and extension will increase pain; normal knee joint exam |
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Legg Perthe Calve disease (Femoral head) |
Osetochondritis of the femoral head epiphysis; avascular necrosis if femoral head then revascularization and bone healing Groin & medial thigh pain and LIMP; loss of medial hip motion early sign Most common in boys 3-11 yo High incidence of hernia, undescended testicles and kidney abnormalities Hip Xray (AP/frog lateral) : ossific nucleus of the femoral head combined w widened articular carriage space compared to other hip |
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Musculoskeletal maneuvers to determine injury, joint health, abnormalities |
Inspection: for joint symmetry, alignment, bony deformities, and swelling Inspection and palpation: of surrounding tissues for skin changes, nodules, muscle atrophy, tenderness Range of motion and maneuvers to test joint function and stability, and integrity of ligaments, tendons, bursae, especially if pain or trauma Assessment of inflammation, especially swelling, warmth, redness Test muscle strength: joint function |
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Fibromyalgia |
Diagnosis of exclusion; chronic fatigue, generalized symmetrical MS (above/below waist) pain and multiple trigger points on exam. Most common in women 20-50; symptoms worse in morning Associated with stage IV sleep disturbance, anxiety or depression, OCD and IBS; symptoms exacerbated by stress PE: focal tenderness without signs of synovitis Diagnostic criteria include diffuse pain present for 3 months and tenderness at 11 or more of 18 trigger points Lifestyle change is needed; no narcotics! |
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Gouty Arthritis |
Joint inflammation caused by deposits of urate crystals and associated with inborn error of uric acid secretion or metabolic disorders; males >30 yo & family hx most common CM: recurrent, sudden onset of pain early in the morning subsides over several days PE: warm, tender and red first metatarsophalangeal (MTP) joint; Tophi (chalky urate deposits) on extensor surfaces; differentiated by presents of calcium crystals, involved large joints and secondary OA D: elevated serum uric acid, ESR and WBC count during acute attack Educate: dietary issue (etoh, red meats); stay hydrated (risk for stones);Allopurinol, Uloric are preventative no help for acute |
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Osteoarthritis versus Rheumatoid Arthritis |
OA: degenerative; asymmetrical, involves a joint; pain when rising, disappears after moving RA: autoimmune disease; symmetrical joint involvement; takes hour or more to work through discomfort in AM; weakness and fatigue |
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Osteoporosis |
RISKS: Most common in postmenopausal women; >50 yo with family hx; associated w smoking/ETOH; high risk also thyroid disease (replacement/supplement); celiac sprue (absorption issues); CKD SCREENING: >65 yo women or high risk; Check males too not limited to women |
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Low Back Pain |
85% population; worry about chronic and acutely uncomfortable and have limited ROM; trauma/injury needs XR if not, treat symptoms Risks: osteoporosis (compression fx lumbar/thoracic) Goes away with rest/ICE |
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Sciatica |
Acute back pain with radiculopathy; associated with degenerative disc dz; unilateral or bilateral; described as burning/tingling radiate to groin, knee, etc |
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Bell's Palsy |
Facial paralysis resulting from dysfunction of CN VII (facial) causing inability to control facial muscles on the affected side; eye on affected side cannot be closed Affects both upper and lower face; loss of taste, hyperacusis and increase/decrease tearing |
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Upper vs Lower Motor Neuron Disease |
Upper motor neuron: nerve cell bodies in the motor strip above anterior horn i.e. cerebral cortex/brainstem --Symptoms: ++DTR, hyperreflexive/spasticity, babinski reflex --Disorders: tumors, blunt trauma & CVA - contralateral area of infarct Lower motor neuron: nerve cell bodies located in spinal cord (in/distal anterior horn) --Symptoms: paralysis, atrophy, fasciculations --Disorders: polio, Guillian-Barre & cauda-equina Mixed motor neuron dz (both upper/lower) --ALS plus syndrome (asymmetric arm weakness is most common sign) --Progressive bulbar palsy |
