Neuro + Psych

Question 0

Tx cluster HA

Answer 0

Usually unilateral

Acute:
O2
Sumatriptan

Ppx:
Verapamil
Ergotamine, methylsergide, lithium, prednisone

Question 1

Tx tension HA

Answer 1

Stress reduction (tx underlying cause)

NSAIDs, Tylenol, ASA

Question 2

Aura in what kind of migraine?

Answer 2

Classic

Common doesn’t have aura

Question 4

Tx migraines

Answer 4

Acute:
NSAIDs
Tylenol
Serotonin receptor agonist. (DHE)
Sumatriptan (limit use of)

Ppx:
TCAs (amitryptyline) - S/E constipation
Propranolol

Verapamil
Valproate
Methylsergide

Question 5

Tx menstrual migraines

Answer 5

NSAIDs

Question 6

Absolute contraindication to ECT

Answer 6

None

Ok with pacemakers, cardioverter-defibrilators, preggers, elderly

Question 7

The mechanism of the syncope seems to be

Answer 7

a period of high sympathetic tone (often induced by pain or fear),

followed by sudden sympathetic withdrawal,

which then triggers a paradoxical vasodilatation and hypotension.

Question 8

Dementia w/ Lewy Bodies

Answer 8

parkinsonian symptoms (rigidity, tremor),
 fluctuating levels of alertness and cognitive abilities, 
behavior sometimes mimicking acute delirium. Significant visual hallucinations are common, 

delusions and auditory hallucinations are seen to a lesser degree.

Question 9

Med for migraines NOT ok in preggers

Answer 9

Triptans

have the potential to cause vasoconstriction of the placental and uterine vessels

should be used only if the benefit clearly outweighs the harm

Question 10

What S/E from neuroleptics respond to tx w/ beta blockers

Answer 10

Akathisia (motor restlessness and inability to sit still)

Can also use anti-ACh

Question 11

Preventing spread of meningococcal disease when susceptibility of org is not known

Answer 11

Rifampin!

Meningococcal vaccines no help b/c protective effects take too long and only for group B

Question 12

A post-traumatic air-fluid level in the sphenoid sinus is associated with

Answer 12

basilar skull fractures

Question 13

Autonomic hyperreflexia

Answer 13

is characterized by the sudden onset of headache and hypertension in a patient with a lesion above the T6 level.

There may be associated bradycardia, sweating, dilated pupils, blurred vision, nasal stuffiness, flushing, or piloerection.

It usually occurs several months after the injury and has an incidence as high as 85% in quadriplegic patients.

Frequently, it subsides within 3 years of injury, but it can recur at any time.

Bowel and bladder distention are common causes.

Question 14

Contraindications for thrombolysis in acute stroke

Answer 14

> 3hrs after onset of deficit

blood glucose levels 400 mg/dL,

resolving transient ischemic attack

hemorrhage visible on a CT scan

Question 15

Ppx migraines

Answer 15

The goal of therapy in migraine prophylaxis is a reduction in the severity and frequency of headache by 50% or more.

amitriptyline, 
propranolol, 
timolol
divalproex sodium
topiramate

Question 16

Nightmares occur when? Sleepwalking?

Answer 16

Nightmares occur in the second half of the night, when rapid eye movement (REM) sleep is most prominent.

Parasomnias, including sleepwalking, confusional arousal, and sleep terrors, are disorders of arousal from non-REM (NREM) sleep.

Question 17

Only FDA approved antidepressant for kids

Answer 17

Fluoxetine

Question 18

Contraindications to ECT

Answer 18

No contraindications

But more complications are seen in patients with a history of recent cerebral hemorrhage, stroke, or increased intracranial pressure

Question 19

antipsychotic of choice in patients with dementia associated with Parkinson’s disease

Answer 19

Quetiapine

Question 20

Best tx for anorexia in adolescent

Answer 20

Family-based treatment

Question 21

Ppx altitude sickness

Answer 21

Acetazolamide

Dexamethasone (for sulfa allergy)

Question 22

Unipolar depression and incomplete response to therapy. What is a good adjuvant therapy?

Answer 22

lithium or low-dose T 3

atypical antipsychotics don’t work as well

Question 23

Tx cerebral malaria

Answer 23

intravenous quinidine gluconate

Question 24

Apraxia is a

Answer 24

transmission disturbance on the output side, which interferes with skilled movements. Even though the patient understands the request, he is unable to perform the task when asked, but may then perform it after a time delay.

Question 25

Agnosia is the

Answer 25

inability to recognize previously familiar sensory input, and is a modality-bound deficit. For example, it results in a loss of ability to recognize objects.

Question 26

Which antidepressant is good for old people with insomnia and weight loss?

Answer 26

Mirtazapine has serotonergic and noradrenergic properties and is associated with increased appetite and weight gain. It may be particularly useful for patients with insomnia and weight loss.

Question 27

S/E trazadone

Answer 27

Priapism sedation orthostatic hypotension

Question 28

Tx essential tremors

Answer 28

Primadone | Beta blockers

Question 29

Best initial tx PTSD

Answer 29

SSRIs - are able to reduce all three clusters of PTSD symptoms. - Sertraline - Paroxetine MAOIs are not first line - moderate to good improvement in reexperiencing and avoidance symptoms, but little improvement in hyperarousal

Question 30

essential features of the diagnosis of dementia are

Answer 30

memory loss and impairment of executive function Patients rarely report mem- ory loss; the informants are usually their family members

Question 31

Most common cause of dementia

Answer 31

Alzheimer's

Question 32

Criteria to dx Alzheimer's

Answer 32

Development of multiple cognitive deficits manifested by both memory impairment and one of the following: 1. Aphasia 2. Apraxia 3. Agnosia The deficits above are a decline from previous functioning and cause significant impairment in social or occupational functioning. The course is of gradual onset and continuing decline. The deficits are not due to other central nervous system, systemic or substance-induced conditions that cause deficits in cognition. The disturbance is not accounted for by another psychiatric diagnosis.

Question 33

Common causes of dementia like symptoms in elderly

Answer 33

Depression Hypothyroidism Vit b12 deficiency

Question 34

What is recommended by the American Academy of Neurology for the routine evaluation of dementia?

Answer 34

A noncontrast head CT or MRI

Question 35

Migraine headaches - what suggests dx?

Answer 35

moderate to severe headache with a pulsating quality; unilateral location; nausea and/or vomiting; photophobia; phonophobia; worsening with activity; multiple attacks lasting for 4 hours to 3 days; absence of history or physical examination findings that would make it likely that the headache is the result of another cause

Question 36

TENSION HEADACHE

Answer 36

Typically presenting with pericranial muscle tenderness and a description of a bilateral bandlike distribution of the pain

Question 37

CLUSTER HEADACHE

Answer 37

Unilateral headaches that may have a high male predominance, can be located in the orbital, supraorbital, or temporal region. It is generally described as a deep, excruciating pain lasting from 15 minutes to 3 hours. These headaches are usually episodic; however a small subset may have chronic headaches.

Question 38

most prevalent form of primary headache disorder

Answer 38

Tension ha

Question 39

Tx tension headache

Answer 39

aspirin, acetaminophen, and NSAIDs.

Question 40

Ppx tension headache

Answer 40

In frequent headache sufferers, the combination of antidepressant medications and stress management therapy reduces headache activity significantly. calcium channel blockers and β-blockers.

Question 41

Tx cluster headache

Answer 41

100% oxygen at 6 L/min, dihydroergotamine, Triptans.

Question 42

Ppx cluster headache

Answer 42

``` Verapamil, lithium, divalproex sodium, methysergide, prednisone ```

Question 43

TIA vs stroke vs RIND

Answer 43

TIA is defined as a focal neurologic deficit lasting less than 24 hours. Most TIAs last for less than 1 hour. A stroke is presumed to have occurred if the symptoms persist for more than 24 hours. A residual ischemic neurologic deficit (RIND) is defined as a neurologic deficit of greater than 24 hours and less than 3 weeks.

Question 44

What is the single most important risk factor for stroke

Answer 44

Hypertension

Question 45

Tx HTN in stroke

Answer 45

Tx if SBP is > 220 mm Hg or the diastolic blood pressure is greater than 120 mm Hg. Unless a hypertensive encephalopathy, aortic dissection, acute renal failure, or pulmonary edema is present, the treatment of arterial hypertension should be cautious Can use: IV labetalol, nicardipine, and sodium nitroprusside

Question 46

Tx stroke

Answer 46

ASA tPA if not hemorrhagic and within 3 hrs

Question 47

The occurrence of stroke after TIA is

Answer 47

as high as 5.3% within 2 days and 10.5% within 90 days

Question 48

Management of stroke after it happens

Answer 48

Patients with stroke but no detected sources of embolism benefit from antiplatelet agents, not anticoagulants. Aspirin, clopidogrel, or a combination of aspirin and dipyridamole are acceptable regimens. For patients with recent TIA or ischemic stroke and ipsilateral severe (>70%) carotid artery stenosis, carotid endarterectomy is recom- mended. When the degree of stenosis is less than 50%, there is no indi- cation for CEA. Patients with a history of symptomatic cerebrovascular disease should be treated to an LDL goal of less than 100 mg/dL.

Question 49

NSAID S/E w/ propensity to produce more central nervous system adverse effects than other NSAIDs

Answer 49

Indomethacin

Question 50

Pseudotumor cerebri imaging on CT

Answer 50

CT is usually normal or shows small ventricles.

Question 51

The cardinal physical signs of Parkinson's

Answer 51

``` distal resting tremor, rigidity, bradykinesia, postural instability, asymmetric onset. ```

Question 52

Tx Tourette's

Answer 52

Pharm dopamine receptor blockers haloperidol and pimozide α-receptor agonists clonidine and guanfacine are effective for treating mild tics

Question 53

Tx huntingtons

Answer 53

There is currently no treatment available to slow the progression of disease. The chorea can also be treated with reserpine, tetrabenazine, and clonazepam. The chorea does respond favorably to haloperidol and fluphenazine, though such treatment often makes voluntary movements worse.

Question 54

Antidepressant less likely to gain wt? And gain wt?

Answer 54

Bupropion is the antidepressant least likely to cause weight gain, and may induce modest weight loss. Among SSRIs, paroxetine is associated with the most weight gain and fluoxetine with the least. Mirtazapine has been associated with more weight gain than the SSRIs.

Question 55

How to establish a prognosis in a comatose patient after a cardiac arrest.

Answer 55

The duration of CPR is not a factor, the absence of pupillary and corneal reflexes, as well as motor responses to pain, are not reliable predictors before 72 hours. Myoclonic status epilepticus at 24 hours suggests no possibility of a recovery.

Question 56

Tx generalized anxiety disorder

Answer 56

paroxetine, escitalopram, duloxetine, venlafaxine

Question 57

Progressive supranuclear palsy

Answer 57

is characterized by early falls, vertical (especially downward) gaze, axial rigidity greater than appendicular rigidity, and levodopa resistance.

Question 58

Initial tx of status epilepticus?

Answer 58

Lorazepam, 0.1–0.15 mg/kg intravenously, should be given as anticonvulsant therapy after cardiopulmonary resuscitation. This is followed by phenytoin, given via a dedicated peripheral intravenous line. Fosphenytoin, midazolam, or phenobarbital can be used if there is no response to lorazepam

Question 59

Dystonia can be caused by any agent that

Answer 59

blocks dopamine, including prochlorperazine, metoclopramide, and typical neuroleptic agents such as haloperidol. The acute treatment of choice is diphenhydramine or benztropine.

Question 60

brachial neuritis

Answer 60

can be difficult to differentiate from cervical radiculopathy, shoulder pathology, and cerebrovascular accident. The pain preceded the weakness, no trauma was involved, and the weakness is in a nondermatomal distribution, making brachial neuritis the most likely diagnosis. Electromyography is most likely to show this lesion, but only after 3 weeks of symptoms.

Question 61

Atypical antipsychotic that won't cause as much wt gain

Answer 61

aripiprazole

Question 62

Antipsychotics causing wt gain

Answer 62

Second-generation, or “atypical,” antipsychotics are associated with weight gain, elevated triglycerides, and type 2 diabetes mellitus. Olanzapine and clozapine are associated with the highest risk.

Question 63

How do tell pseudoseizure vs seizure

Answer 63

obtained within 20 minutes of the event, a serum prolactin level may be useful in differentiating a true seizure from a pseudoseizure. An elevated level has a sensitivity of 60% for generalized tonic-clonic seizures and 46% for complex partial seizures. Other features suggestive of seizure activity include tongue biting, the presence of an aura, postictal confusion, and focal neurologic signs.

Question 64

The workup of patients with syncope begins with a history and a physical examination to identify those at risk for a poor outcome. Then....

Answer 64

In most cases, the recommended test is an EKG. Patients who have a prodrome of 5 seconds or less may have a cardiac arrhythmia. Patients with longer prodromes, nausea, or vomiting are likely to have vasovagal syncope, which is a benign process. Patients who pass out after standing for 2 minutes are likely to have orthostatic hypotension.

Question 65

What is most effective in depressed older patients.

Answer 65

Electroconvulsive therapy

Question 66

What herb is assoc w/ serious intracerebral bleeding?

Answer 66

Ginkgo biloba

Question 67

Which antidepressant has less sex side effects

Answer 67

Buproprion

Question 68

Motor side effects of the antipsychotic drugs can be separated into five general categories:

Answer 68

dystonias, parkinsonism, akathisia, withdrawal dyskinesias, and tardive dyskinesia. Akathisia is a syndrome marked by motor restlessness. Affected patients commonly complain of being inexplicably anxious, of being unable to sit still or concentrate, and of feeling comfortable only when moving.

Question 69

OCD - traits - tx

Answer 69

- characterized by obsessive thoughts and compulsive behaviors that impair everyday functioning. Tx: - SSRIs: - fluoxetine - fluvoxamine - second line: risperidone, clonazepam

Question 70

How decrease the risk of postherpetic neuralgia from zoster?

Answer 70

Give famciclovir/ acyclovir/valcyclovir within 72 hrs of herpes zoster presentatio

Question 71

In the geriatric population, what is the most common cause of seizures?

Answer 71

cerebrovascular disease - 10% of stroke victims developing epileptic seizures. - Seizures are more common following hemorrhagic strokes compared to nonhemorrhagic strokes

Question 72

What are the most appropriate first-line pharmacologic treatment for depression in nursing-home residents.

Answer 72

SSRIs

Question 73

Causes of serotonin syndrome | - Sx?

Answer 73

Sx: mental status changes, agitation, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, diarrhea, incoordination, and fever SSRI + ``` MAOIs tramadol, sibutramine, meperidine, sumatriptan, lithium, St. John’s wort, ginkgo biloba, atypical antipsychotic agents. ```

Question 74

Childhood simple febrile seizure | - tx

Answer 74

- finding a source for the fever; this should include a lumbar puncture if meningitis is suspected. most common infections: - viral upper respiratory infections, - otitis media, - roseola. Tx: - Antipyretics -->Phenytoin and carbamazepine are ineffective for febrile seizures. Phenobarbital is sometimes used for prevention of recurrent febrile seizures, but is not indicated as an initial therapy.

Question 75

The most appropriate initial pharmacologic treatment of panic disorder is

Answer 75

SSRI

Question 76

Which SSRI has less CYP 450 inhibition?

Answer 76

Citalopram

Question 77

Tx prepratry grief in dying pateitn

Answer 77

Live a few days - methylphenidate Longer - SSRIs

Question 78

Antipsychotics w/ S/E hyperglycemia

Answer 78

Olanzapine Clozapine --- atypicals

Question 79

Tx depression adn insomnia

Answer 79

Trazodone + antidepressant Amitriptyline can be used but not in someone with cardiac arrhythmia