What would you expect to see on CT/MRI in a pt with TIA?
nothing - imaging done to r/o stroke or other etiologies of symptoms
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When is the risk of stroke after a TIA greatest?
first 3 mo after, highest in first 48 hrs
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What is the timing for doing mechanical thrombectomy in a pt with ischemic stroke?
within 6 hrs if with tpa; between 6-24 hrs if only trt
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Which type of stroke has a better prognosis - ischemic or hemorrhagic?
ischemic
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What is a common symptom seen with intracerebral hemorrhages?
LOC also have vomiting, HA, focal neuro symptoms
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What type of stroke would you be suspicious of in a pt presenting with lateral conjugate gaze palsies, small reactive pupils, and quadriplegia with preserved consciousness ("locked in")?
bilateral pontine hemorrhage
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What type of stroke is LP contraindicated in? Why?
intracerebral hemorrhages may precipitate herniation syndrome
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If you have an infarction of the spinal cord, which artery is typically affected?
anterior spinal artery (limited number of feeders)
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How would a spinal cord infarction typically present?
distal weakness (LMN) loss of pain/temp (spinothalamic) preserved vibration, proprioception, etc. (posterior column)
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What types of aphasia would you see with occlusion of different divisions of the middle cerebral artery?
hemisection of spinal cord injured from trauma, hematoma, tumor, etc.
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How does Brown-Sequard syndrome present?
weakness or paralysis on one side, loss of sensation on the other side
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What are the symptoms of central cord syndrome?
motor deficits greater in arms than legs, bladder dysfunction (retention)
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How can you diagnose myelitis?
MRI, abn CSF on LP, spinal fluid analysis
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What is the most common pathogen causing spinal epidural abscesses?
S. aureus
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What medication class do you give prophylactically to pts with subarachnoid hemorrhage to prevent vasospasm?
CCBs (nimodipine)
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What might you suspect in a pt with axial low back pain with or without radiation to the LE who also has tenderness over the spinous processes and paraspinal muscles?
disc protrusion/herniation
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What is the first choice imaging if you are suspicious for a disc protrusion/herniation?
MRI
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How would the back pain seen with ankylosing spondylitis typically present?
gradual onset worse in morning and with activity, better with rest
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What condition presents with a "bamboo spine" on imaging?
severe ankylosing spondylitis
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What is the typical trt for ankylosing spondylitis?
What condition might present with quick onset low back pain, areflexia in the legs, weakness, urinary retention, and saddle anesthesia (numbness in perineum, genitals, butt)?
cauda equina syndrome (compression)
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What T score on DEXA indicates osteoporosis?
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What is the most common symptom in pts with systemic cancer?
back pain (from mets to vertebral bodies)
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What imaging should be done to assess for spondylosis/spondylolysis?
CT or XR
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What is the gold standard imaging modality for dx of vertebral osteomyelitis?
MRI
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When is screening for AAA recommended?
one time echo for males 65-75 who have every smoked
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What are cardiac changes that are seen with increasing age and what do those changes increase the risk for?
heart and vasculature stiffens - increases risk for HTN
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What are common GI changes seen with aging?
slowed gastric emptying, stomach less elastic, decreased GI motility - leads to CONSTIPATION
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What are two major endocrine changes seen with age and what is their effect?
decreased GH - leads to decreased muscle mass decreased aldosterone - increases risk for dehydration
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When are Prevnar-13 and Pneumovax-23 given?
13: at age 65 23: at least one year after 13; can also give second dose 5 years later if immunocompromised
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What is the leading cause of injury death in the elderly?
falls
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What does the TUG test help assess?
if pt is at an increased risk for falls (TUG \= timed up & go test)
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What is the MC injury seen with falls in the elderly?
broken bones
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What is the MC type of fracture seen from falls in the elderly?
distal radius
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Is urinary incontinence a normal part of aging?
NO
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What is the first line medication for trt of urge incontinence?
oxybutynin (anticholinergic)
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What is the MC type of urinary incontinence?
stress
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What type of urge incontinence is seen in males with BPH?
overflow
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What is the Braden scale used to screen for? How does the scoring work?
individuals at risk for developing pressure ulcers lower the score, higher the risk (12 or less \= high risk)
What type of abx are recommended for individuals with pressure ulcers?
topical silver sulfadiazine do NOT recommend oral abx
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How are pressure ulcers staged?
stage I-IV based on how much of dermis is involved and if underlying tissues are exposed if managed appropriately, they should NOT progress through stages
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What is the typical timing of S/S seen with delirium vs. dementia
delirium: rapid onset over hours to days, symptoms may fluctuate throughout the day dementia: gradual onset over months to years, little/no symptom fluctuation
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What is the MCC of dementia?
Alz
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What is the MC symptom in the early stages of Alz?
memory loss - esp difficulty remembering newly learned info
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What can IV Aducanumab help to treat?
Alz - helps reduce cognitive/fxnl decline in early disease
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What is Suvorexant (Belsomra) used for?
FDA approved for insomnia with Alz
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What is the MC form of FTD?
behavioral variant - prominent changes in personality and behavior (vs. language skills or muscle/motor fxn with other variants)
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What is the classic triad of symptoms seen with normal pressure hydrocephalus?
decline in thinking/reasoning urinary incontinence difficulty walking (penguin walk)
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What symptoms will typically improve after shunting with normal pressure hydrocephalus?
walking improves thinking/incontinence will NOT improve
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What is the second MC type of dementia after Alz?
vascular dementia
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What type of dementia can be associated with uncontrolled laughing/crying in addition to impaired judgment, decreased attention, etc.?
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