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MKSAP 19 > Neurology > Flashcards

Neurology Flashcards

1
Q

Headache + high ESR

A

Giant cell arteritis

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2
Q

Headache + extra ocular muscle palsies

A

CVT

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3
Q

Worst headache in my life

A

SAH

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4
Q

Frontal headache made worse by bending over

A

Sinus headache

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5
Q

Women with migrain aura should avoid

A

OCP due to high risk of stroke

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6
Q

all triptans are contraindicated in the presence

A
  1. coronary, cerebral, or peripheral vascular disease

2.uncontrolled hypertension

3.migraine with brainstem or hemiplegic auras.

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7
Q

indications use of triptans

A

in patients with moderate to severe migraine who have not responded to NSAID therapy

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8
Q

triptans

A

Almo-
Ele-

Nara-
Riza-

Suma-
Zolmi-

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9
Q

Ditans

A

Lasmiditan

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10
Q

gepants

A

Ubrogepant

Rimegepant

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11
Q

status migrainosus

A

Migraine with a duration lasting longer than 72 hours

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12
Q

status migrainosus can be treated with

A

several days of glucocorticoids

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13
Q

chronic migraine

A

> 15 days per month

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14
Q

episodic migraine prevention.

A

Venlafaxine, propranolol, timolol, metoprolol,

amitriptyline, topiramate, sodium valproate,

erenumab, fremanezumab, eptinezumab and galcanezumab

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15
Q

Neuroimaging is recommended for all patients with a first seizure.

A

CT of the head is adequate initially to rapidly exclude emergent pathology, including hemorrhage,

but MRI is recommended in most patients.

*The use of contrast may be deferred unless infection, tumor, or vascular lesions are suspected

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16
Q

lumbar puncture is recommended in seizure only if

A

an infectious cause, such as meningitis or encephalitis, is suspected.

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17
Q

First-line treatment of convulsive status epilepticus

A

IV benzodiazepines, then IV fosphenytoin

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18
Q

Epilepsy drug therapy for reproductive-age women

A

Levetiracetam or lamotrigine

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19
Q

First-line treatments for epilepsy in older patients

A

Gabapentin, lamotrigine, levetiracetam

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20
Q

Test to determine candidacy for epilepsy surgery

A

Video EEG monitoring

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21
Q

Seizure type requiring lifelong treatment

A

Juvenile myoclonic epilepsy

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22
Q

Unprovoked seizure treatment indications

A

2 unprovoked seizures or 1 unprovoked seizure with EEG or MRI abnormalities

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23
Q

Temporal lobe epilepsy symptoms

A

Aura, loss of awareness, staring, behavior arrest, amnesia

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24
Q

the only thrombolytic agent approved for use in acute ischemic stroke

A

alteplase

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25
Q

1.BP should be ……… before alteplase.

2.if higher, should start ……..

A
  1. BP < 185/110 mm Hg.
  2. IV labetalol or nicardipine
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26
Q

both antiplatelet and anticoagulant agents should be held for the first ………. after alteplase administration

A

24 hours

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27
Q

treatment with dual antiplatelet therapy, who did not receive IV alteplase ?

A

minor noncardioembolic ischemic stroke (NIHSS score ≤3)

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28
Q

Intracerebral Hemorrhage Treatment

A

1.acutely treating the SBP in ICU 130-140 TARGET

2.antiepileptic medications, IF there are definitive clinical or EEG seizures.

3.Elevated intracranial pressure is a major determinant of morbidity and mortality in ICH. Short-term bolus osmotherapy with mannitol or hypertonic saline may temporarily reduce intracranial pressure in ICH

Ventricular drainage is preferred over medical therapy when elevated intracranial pressure and hydrocephalus result in decreased level of consciousness.
Surgical procedures may be considered in patients with moderate to severe ICH and intraventricular hemorrhage, hydrocephalus, and infratentorial hematoma location.

4.With cerebellar hemorrhages > 3 cm in diameter or volume > 15 mL, early surgical evacuation is necessary to prevent hydrocephalus, brainstem compression, and neurologic deterioration.

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29
Q
  • low risk of Aneurysm rupture?

-how to manage ?

A

if Aneurysms
1. < 7 mm in the posterior circulation

  1. < 12 mm in the anterior circulation

can be managed conservatively with annual noninvasive neuroimaging.

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30
Q

DVT prophylaxis initiation in patients with hemorrhagic stroke?

A

intermittent pneumatic compression beginning the day of hospital admission.

After 24 hours, if there is no evidence of hematoma expansion, then LMWH is recommended for VTE prophylaxis.

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31
Q

essential tremor presents with mild additional neurologic signs, such as mild ataxia or isolated tremor at rest without bradykinesia, it would be classified as “

A

essential tremor plus.

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32
Q

The treatment of essential tremor is symptomatic.

A

Weighted utensils and wrist weights can help reduce tremor amplitude during feeding.

pharmacologic treatments: propranolol, primidone, and topiramate.

second-line options include atenolol, sotalol, clonazepam, gabapentin, and nimodipine.

Botulinum toxin injection can help with some tremors, especially those involving the neck and voice, but its benefit for limb tremor is limited by local weakness.

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33
Q

Dystonia treatment

A

anticholinergic agents, benzodiazepines, baclofen, levodopa,
injection with botulinum toxin
in refractory cases, DBS therapy.

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34
Q

Symptomatic treatments of chorea

A

dopamine depleters valbenazine, deutetrabenazine, and tetrabenazine;

antipsychotic agents; clonazepam; and antiepileptic drugs.

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35
Q

Management of myoclonus

A

addressing the underlying systemic or toxic causes and

administering antimyoclonic agents, such as clonazepam or valproic acid.

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36
Q

Tic Treatment

A

reassurance (in mild disease), cognitive behavioral therapy, and addressing psychiatric comorbidities.

Anti-tic medications are indicated when tics interfere with daily functioning, education, or work.

First-line treatments include aripiprazole, clonidine, guanfacine, topiramate, levetiracetam, and tetrabenazine.

Aripiprazole is the preferred agent in severe cases.

In refractory disease, antipsychotic agents, injections with botulinum toxin, and DBS therapy may be considered.

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37
Q

Corticobasal degeneration

A

is a Parkinson-plus syndrome characterized by severely asymmetric parkinsonism, fixed dystonia, myoclonus, cortical sensory deficits, apraxia, and cognitive deficits.

38
Q

In Epidural hematoma, Urgent surgical evacuation is recommended for

A
  1. GCS score < 9
  2. anisocoria
  3. hematoma > 30 mL in volume.
39
Q

acute subdural hematomas, indications for immediate surgical treatment.

A
  1. a hematoma thickness > 10 mm,
  2. GCS < 9
  3. the presence of pupillary asymmetry or fixation
40
Q

In chronic hematomas, indications for neurosurgical drainage.

A
  1. a hematoma thickness > 10 mm,
  2. midline shift > 5 mm, and
  3. significant neurologic compromise
41
Q

First-line treatment of relapsing-remitting MS

A

Glatiramer acetate or interferon beta

42
Q

Primary progressive MS treatment

A

Ocrelizumab

43
Q

Secondary progressive MS treatment

A

Mitoxantrone

44
Q

Neurologic complication of natalizumab therapy

A

Multifocal leukoencephalopathy

45
Q

MS fatigue drug treatment

A

Modafinil, armodafinil, amantadine

46
Q

MS medication for impaired mobility (gait speed and endurance)

A

Dalfampridine

47
Q

Required monitoring with fingolimod therapy

A

Ophthalmic examinations (macular edema)

48
Q

myasthenic crisis can be triggered by

A

1.infection

2.surgery

  1. medications (especially aminoglycosides, quinolones, magnesium, β-blockers, and hydroxychloroquine).
49
Q

Symptomatic treatment of ocular and mild generalized myasthenia

A

cholinesterase inhibitor pyridostigmine

50
Q

advanced disease of MG treatment

A

immunosuppressive therapy
Oral glucocorticoids often are used as first-line treatment

51
Q

prominent bulbar or generalized weakness and in myasthenic crisis, treatment with

A

IVIG or plasmapheresis

52
Q

treatment of MG in patients with thymoma

A

Thymectomy

53
Q

MuSK-positive myasthenia responds well to

A

plasmapheresis and glucocorticoids

but requires aggressive maintenance immunosuppression.

54
Q

serology of Diagnosis of MG

A

1.acetylcholine receptor antibodies

2.anti–muscle-specific kinase (MuSK)

3.anti–lipoprotein receptor-related protein 4 (LRP4) antibodies.

55
Q

Indications for thymectomy in myasthenia gravis include

A
  1. presence of thymoma

or

  1. to minimize immunotherapy requirements in patients without thymoma who have active disease and positivity for acetylcholine receptor antibodies, younger < 65 years, and are within 3 years of diagnosis.
56
Q

Lambert-Eaton Myasthenic Syndrome presents similarly to MG, except

A

that weakness improves with exercise, and hyporeflexia and dysautonomia are present

57
Q

Lambert-Eaton Myasthenic Syndrome associated with antibodies

A

against the voltage-gated calcium channel

58
Q

Treatment of Lambert-Eaton Myasthenic Syndrome

A
  1. treating any underlying malignancy or,
  2. in nonparaneoplastic disease, immunosuppression, IVIG, or plasmapheresis.
  3. Amifampridine can provide symptomatic benefit.
59
Q

Treatment of ALS

A
  • Riluzole and edaravone
  • Noninvasive ventilation
  • nutritional support (including percutaneous endoscopic gastrostomy)
  • treatment of pseudobulbar affect by dextromethorphan-quinidine also have shown some benefit

Sodium phenylbutyrate–taurursodiol has been shown to slow functional decline, delay first hospitalization, and prolong tracheostomy-free and ventilation-free survival

60
Q

ALS Diagnosis is based on clinical evidence of

A

both upper and lower motor neuron signs on examination and EMG evidence of lower motor neuron signs in at least two (probable ALS) or more (definite ALS) regions.

61
Q

Upper and lower motor neuron signs without sensory involvement

A

ALS

62
Q

Peripheral neuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes

A

POEMS syndrome

63
Q

Test for Miller-Fisher variant of GBS

A

Antibodies to GQ1b ganglioside protein

64
Q

Evaluate dementia with neuroimaging

A

Either a brain MRI or a head CT without contras

65
Q

Acetylcholinesterase inhibitors should be avoided in patients with

A

pre-existing bradycardia or documented conduction disease.

66
Q

treatment of Alzheimer disease

A

The acetylcholinesterase inhibitors
1.donepezil
2.rivastigmine
3.galantamine

The N-methyl-D-aspartate receptor antagonist memantine is approved for moderate to severe dementia

The antiamyloid therapies aducanumab and lecanemab for symptomatic Alzheimer disease

67
Q

Cholinesterase inhibitor contraindications

A

Bradycardia, sick sinus syndrome, LBBB

68
Q

Medication to prevent progression of Mild Cognitive Impairment
(MCI) to dementia

A

none

69
Q

Treatment
Traumatic Encephalopathy Syndrome

A
  • acetylcholinesterase inhibitors

As in behavioral-variant FTD, treatment is often symptom directed and includes antidepressants, mood stabilizers, and (occasionally) stimulants for severe apathy.

70
Q

neuroimaging finding in Traumatic Encephalopathy Syndrome

A

-global Brain atrophy

which can help differentiate TES from FTD (which is associated with frontal lobe atrophy).

71
Q

Cognitive slowing, disorganized thought processing, parkinsonism after head trauma

A

Traumatic encephalopathy syndrome

72
Q

Which AED can cause or worse depression and anxiety and suicidal thoughts

A

Levetiracetam

73
Q

Treatment of levodopa induced dyskinesia

A

Amantadine

74
Q

Treatment of Tardive dyskinesia

A

Valbenazine

75
Q

Treatment of asymptomatic carotid stenosis < 80 %

A

No intervention

76
Q

Atypical facial palsy evaluation

A

MRI Brain

77
Q

Anticoagulant Contraindications in brain tumor

A
  1. Hx of previous ICH
  2. Plt < 50
78
Q

Treatment of brain edema & herniation

A
  1. Elevation of the head of the bed to 30 degree
  2. Hyperventilation ( usually MV)
  3. Infusion hypertonic saline or mannitol
  4. Glucocorticoids
79
Q

AED in tumors

A

Prophylaxis is not recommended

If there is seizures

Preferred to give Levetiracetam or lacosamide

80
Q

Glioblastoma treatment

A

Resection if possible followed by radiation and chemotherapy

81
Q

Meningioma treatment

A

Resection for symptomatic or large meningiomas

Observation for asymptomatic or small meningiomas

82
Q

CNS lymphoma

A

Biopsy

Pan CT or PET scan

Iv methotrexate with rituximab, followed by radiation

83
Q

Metastatic brain tumors

A

MRI
Biopsy is not indicated, if pt with active, biopsy proven systemic malignancy

Glucocorticoids are first line for parenchymal tumor

Pt with symptomatic brain metas > surgery or radiation

84
Q

Isolated exercise induced weakness, cramps and myoglobinuria

A

McArdle disease

85
Q

X linked disease, progressive weakness and cardiomyopathy

A

Becker muscular dystrophy

86
Q

Autosomal recessive, progressive weakness in proximal and respiratory muscles

A

Acid Maltese deficiency

87
Q

Fluctuating weakness and ophthalmoplegia and multiorgan symptoms and maternal inheritance

A

Mitochondrial myopathy

88
Q

Postural headache is the most common manifestation of

A

Intracranial hypotension

89
Q

Acute asymmetric pain, followed by proximal weakness and muscle loss

A

Diabetic amyotrophy
* can occur in well controlled DM

90
Q

Post stroke fatigue, should be evaluated by

A

Polysomnography

MKSAP 19 (12 decks)

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