526 Neuro

Question 1

secondary or primary headaches are most common

Answer 1

primary

Question 2

trigeminal autonomic cephaligias (TAC) are primary or secondary headaches

Answer 2

primary

Question 3

what type of headache has a relationship with epilepsy, depression, raynaud, and cardiac shunting

Answer 3

migraines

Question 4

what is a fortification spectrum

Answer 4

aura that presents as jagged lines like in a stone fortification

Question 5

cluster headaches are what time of primary headache

Answer 5

TAC (trigeminal autonomic cephalagias)

Question 6

what type of headache would present with a partial horner sign? what would that look like?

Answer 6

cluter/TAC
ptosis of eyelid

Question 7

what does the acronym SNOOP stand for

Answer 7

for serious headaches
systemic symptoms
neuro signs
older >50
onset new or progressive
previous history (first or different from others)

Question 8

why might you do a CBC, ESR or CRP, and TSH in a patient with headach

Answer 8

CBC - to exclude anemia
ESR or CRP - to exclude temporal arteritis
TSH - to exclude thyroid disease

Question 9

when would you consider preventative therapy for headaches

Answer 9

unable to deal with attacks
have more than 4 a month
headaches are prolonged or refractory to medication

Question 10

when might you use divalproex or topiramate in headache therapy

Answer 10

as a preventative for migraines

Question 11

how does metoclopramide aid in headache treatment

Answer 11

treats n/v and aids in absorption of NSAIDs

Question 12

true or false: if a triptan is ineffective as a headache treatment you should try a different class of medication

Answer 12

false, there are differences across brands so you may try a different triptan

Question 13

when should you use triptans with caution

Answer 13

cardiac disease patients as they are arterial constrictors

Question 14

what is 1st line and 2nd line therapy for severe headaches

Answer 14

1st = triptans
2nd = ergots

Question 15

what should you be aware of when prescribing ergots

Answer 15

high potential for misuse and should premedicate with antiemetics

Question 16

what is prevenatitive and abortive treatment for cluster headaches

Answer 16

preventatitve = verapamil/CCB or lithium
abortive = oxygen, analgesics, triptansw

Question 17

what is the difference between primary and secondary trigeminal neuralgia

Answer 17

primary = vascular compression
secondary = neuro cause like MS, tumor, trauma

Question 18

the pain of trigeminal neuralgia is described as ___ in what location

Answer 18

burning, stabbing, sharp, shocky
in any branch of the trigeminal nerve

Question 19

when is trigeminal neuralgia more likely to be bilateral

Answer 19

with MS

Question 20

what is a trigger zone in trigeminal neuralgia

Answer 20

one specific spot that pt can identify as where it sets off an attack

Question 21

primary or secondary trigeminal neuralgia may have an abnormal corneal reflex

Answer 21

secondary

Question 22

true or false: trigeminal neuralgia will usually have an unremarkable physical exam

Answer 22

true

Question 23

when would you get diagnotic investigation for trigeminal neuralgia and what would you get

Answer 23

usually none needed unless considering a secondary cause
then get MRI to check for lesions or compression of CN5

Question 24

what is first and second line treatment for trigeminal neuralgia

Answer 24

first = anticonvulsants (carbamazepine)
second or add on = baclofen, lamotrigine, phenytoin

Question 25

what needs to be monitored when patients are put on anticonvulsants

Answer 25

liver CBC Na

Question 26

what medication is used for trigeminal neuralgia for patients with MS

Answer 26

gabapentin or misoprostol

Question 27

how are acute attacks of trigeminal neuralgia treated

Answer 27

IV fosphenytoin botox sumatriptan intranasal lidocaine

Question 28

when is surgical management considered for trigeminal neuralgia

Answer 28

not responding to pharmacological

Question 29

true or false: when initially diagnosing trigeminal neuralgia, referral to neurologist should be done to confirm

Answer 29

true

Question 30

which cranial nerve is affected in bells palsy

Answer 30

CN VII, the facial nerve

Question 31

acute unilateral weakness or paralysis of face that resolves in under 72 hours is indicative of what condition

Answer 31

bells palsy

Question 32

a neurological disorder that specifically spares the forehead muscles has what cause

Answer 32

upper motor neuron or central lesion

Question 33

a prodrome of pain behind unilateral ear, hyperacusis and dysgeusia is indicative of what condition

Answer 33

bells palsy

Question 34

what facial findings would you expect in bells palsy

Answer 34

smooth forehead widened palpabral fissure inability to close eye flattened nasolabial fold asymmetric smile

Question 35

true or false: bells palsy will only affect the lower portion of one side of the face

Answer 35

false, it will affect the full face both upper and lower, on one side

Question 36

what is the house-brackmann classification

Answer 36

classification of facial function to determine severity of bells palsy

Question 37

when would you consider an MRI for a suspected bells palsy

Answer 37

bilateral palsies central nerve findings instead of peripheral does not recover in 3 months

Question 38

what is the most important treatment goal in bells palsy

Answer 38

protecting the eye - eye lubricant, tape shut at night

Question 39

what medication is used to treat bells palsy

Answer 39

corticosteroids within 72 hours of symptoms onset

Question 40

what test is used to test sleep overnight

Answer 40

polysomnography

Question 41

true or false: trazadone, diphenhydramine and melatonin are all good first line options for insomnia

Answer 41

false, new guidelines suggest not to use these agents for sleep

Question 42

true or false: CPAP is more effective than surgery for managing OSA

Answer 42

true

Question 43

when might overnight PAP be recommended

Answer 43

for central sleep apnea

Question 44

what are the primary hypersomnias

Answer 44

narcolepsy idiopathic post traumatic

Question 45

what is the predominant characteristic of CNS hypersomnias

Answer 45

excessive daytime sleepiness not caused by disturbed nocturnal sleep

Question 46

what would reduced hypocretin levels in CSF indicate? when would you do this test

Answer 46

narcoplepsy this test is not routinley done

Question 47

how is narcolepsy diagnosed

Answer 47

presence of sleep-onset REM on MSLT (multiple sleep latency test) after getting a normal polysomnography

Question 48

what is cataplexy and what condition is it associated with

Answer 48

sudden loss of muscle tone while awake narcolepsy

Question 49

what types of medications are used to treat hypersomnias

Answer 49

stimulants wakeful promoting agents REM suppressing medication

Question 50

what REM suppressing agents are used to treat cataplexy

Answer 50

TCAs, SSRIs, SNRIs

Question 51

modafinil and armodafinil are what kind of medication and used to treat what

Answer 51

wakeful promoting agents to treat central hypersomnias

Question 52

dextramphetamine and methylphenidate are what kind of medication and used to treat what

Answer 52

stimulants to treat central hypersomnias

Question 53

what are the 4 principle diagnostic criteria for RLS

Answer 53

1. urge to move legs, usually with uncomfortable sensation 2. urge worse during inactivity 3. at least partially relieved with activity 4. worsened or exclusive to the evening

Question 54

what blood work should be done for RLS and why

Answer 54

iron panel because low iron is associated with RLS

Question 55

true or false: first line treatment for RLS if pharmacotherapy

Answer 55

false, should not be used unless severe

Question 56

what 1st pharmacotherapy may be used for severe RLS

Answer 56

dopamine agonsits pramipexole, rotigotine, ropinirole

Question 57

what pharmacotherapy may be used for RLS with concomitant neuropathy

Answer 57

gabapentin, pregabalin

Question 58

what are parasomnias

Answer 58

undesirable events or experiences related to sleep

Question 59

what is rem sleep behavior disorder and what type of sleep disorder is it

Answer 59

pt enacts dreams in a possibly dangerous fashion parasomnia

Question 60

sleep terrors and sleep walking are what kind of sleep disorder

Answer 60

parasomnias

Question 61

RBD and nightmare disorder are an NREM or REM disorder

Answer 61

REM

Question 62

true or false: polysomnography is not needed for RBD

Answer 62

false

Question 63

what is the pharmacological treatment for RBD

Answer 63

clonazepam or melatonin