Board Vitals Neurology Flashcards
(116 cards)
1
Q
What is the first test when papilledema and increased intracranial pressure is suspected?
A
MRI without contrast and venography
2
Q
What should you do before a lumbar puncture if papilledema and increased intracranial pressure is suspected?
A
MRI brain to exclude a large space occupying lesion
3
Q
Do symptoms of myasthenia gravis improve after applying an ice pack to the affected area?
A
Yes
4
Q
Why do symptoms of myasthenia gravis improve after applying an ice pack to the affected area?
A
Cold temperatures improve receptor response to acetylcholine.
5
Q
How is the diagnosis of myasthenia gravis confirmed?
A
Antibody testing (autoantibodies against the acetylecholine receptor)
6
Q
What is the first line treatment of myasthenia gravis?
A
Pyridostigmine
7
Q
Is glycopyrrolate used to treat myasthesia gravis?
A
No
8
Q
What is glycopyrrolate used for in myasthenia gravis patients?
A
To counteract the cholinergic side effects of pyridostigmine
9
Q
In which myasthenia gravis patients is thymectomy recommended to decrease the need of immunosuppressive therapy?
A
Patients younger than 50 years
10
Q
When is Azathioprine used in patients who have myasthenia gravis?
A
When patients remain symptomatic after pyridostigmine
11
Q
Oligoclonal bands are found in the CSF of a patient with varying neurological symptoms.
Diagnosis?
A
Multiple sclerosis
12
Q
What is the treatment of trigeminal neuralgia?
A
Carbamazepine or oxcarbamazepine
13
Q
What is the treatment of trigeminal neuralgia?
A
Carbamazepine or oxcarbazepine
14
Q
What is an acephalgic migraine?
A
Visual aura without the headache
15
Q
What should you suspect in a patient with headache, fever, altered mental status and neurological changes - when there is an apparent embolic source (such as infective endocarditis)?
A
Brain abscess
16
Q
What is the mechanism of action of tripans?
A
Selective serotonin agonists (5-HT1B and 5-HT1D) receptors
17
Q
Which imaging study is the most sensitive for detecting brain metastasis?
A
MRI with contrast
18
Q
Can ataxia occur in central cause of vertigo?
A
Yes
19
Q
Can ataxia occur in peripheral cause of vertigo?
A
No
20
Q
Can nystagmus occur in central cause of vertigo?
A
Yes
21
Q
Can nystagmus occur in peripheral cause of vertigo?
A
Yes
22
Q
Can tinnitus occur in central cause of vertigo?
A
No
23
Q
Can hearing loss occur in central cause of vertigo?
A
No
24
Q
Can tinnitus occur in peripheral cause of vertigo?
A
Yes
25
Can hearing loss occur in peripheral cause of vertigo?
Yes
26
Can vomiting occur in central cause of vertigo?
Yes
27
Can vomiting occur in peripheral cause of vertigo?
Yes
28
Should you use triptans in coronary artery disease?
No - they are contraindicated.
29
What is the mechanism of action of lasmiditan?
Serotonin 5-HT-IF agonism
30
What is lasmiditan used for?
Migraines
31
What is the mechanism of action of ubrogepant and rimegepant?
CGRP (calcitonin gene-related peptide) antagonist
32
What are ubrogepant and rimegepant used for?
Abortive therapy for migraines
33
Do all patients with community-acquired bacterial meningitis need a CT head to rule out mass effect prior to lumbar puncture?
No
34
What should be done first in case of bacterial meningitis - blood cultures or lumbar puncture?
Lumbar puncture
35
Do patients with community-acquired bacterial meningitis who are immunocompromised need a CT head to rule out mass effect prior to lumbar puncture?
Yes
36
Do patients with community-acquired bacterial meningitis who have a history of CNS disease e.g. mass, stoke, focal infection need a CT head to rule out mass effect prior to lumbar puncture?
Yes
37
Do patients with community-acquired bacterial meningitis and new onset seizures within a week of presentation need a CT head to rule out mass effect prior to lumbar puncture?
Yes
38
Do patients with papilledema who are immunocompromised need a CT head to rule out mass effect prior to lumbar puncture?
Yes
39
Do patients with community-acquired bacterial meningitis and altered mental status need a CT head to rule out mass effect prior to lumbar puncture?
Yes
40
Do patients with community-acquired bacterial meningitis and focal neurological deficits need a CT head to rule out mass effect prior to lumbar puncture?
Yes
41
Do patients with community-acquired bacterial meningitis who are > 60 years old need a CT head to rule out mass effect prior to lumbar puncture?
Yes
42
What is suggested by a magnetic gait i.e. difficulty raising feet from floor?
Normal pressure hydrocephalus
43
What maneuver can be used to diagnose benign paroxysmal positional vertigo (BPPV)?
Dix-Hallpike maneuver
44
Which medication is FDA approved to prevent episodic cluster headaches?
Galcanezumab
45
What is the standard of care for aborting cluster headaches?
Oxygen
46
What is the pathogenesis/cause of Guillain-Barre syndrome?
Molecular mimicry (between the infectious agent and the patient's Schwann cells)
47
Do 5-HT-IF agonists (lasmiditan) cause dizziness and sedation?
Yes
48
Do 5-HT-IF agonists (lasmiditan) cause esophageal spasm?
No
49
Do 5-HT-IF agonists (lasmiditan) cause constipation?
No
50
Do 5-HT-IF agonists (lasmiditan) cause liver toxicity?
No
51
Do 5-HT-IF agonists (lasmiditan) cause bleeding?
No
52
What is the next step in refractory status epilepticus?
Intubation
53
Patient has gait difficulties (shuffling steps), incontinence, and cognitive impairment.
Diagnosis?
Normal pressure hydrocephalus
54
Which condition is Lewy body dementia associated with?
Parkinsonism
55
What kind of dementia is primary progressive aphasia a subtype of?
Frontotemporal dementia
56
Which type of primary progressive aphasia involves word-finding difficulty and trouble naming and understanding individual words, particularly nouns?
Semantic variant
57
In which type of primary progressive aphasia is grammatical usage and spoken language not intact?
Non-fluent variant
58
Where does the atrophy primarily occur in frontoparietal dementia?
Frontal lobes
59
Which dementia do cholinesterase inhibitors treat?
Alzheimer's dementia
60
Does hippocampal volume decrease in Alzheimer's dementia?
Yes
61
Cape-like distribution of sensory loss.
Diagnosis?
Syringomyelia
62
Patient is unresponsive to verbal and tactile stimuli, not rousable, and has no voluntary eye movements.
What state is this?
Coma
63
Are people in persistent vegetative state rousable?
Yes
64
Do people in persistent vegetative state have normal sleep wake cycles?
Yes
65
Are people in a coma rousable?
No
66
Do people in a coma have normal sleep wake cycles?
No
67
Cortical spreading depression is the mechanism underlying what kind of symptoms?
Migraine symptoms
68
Excess excitation or impaired inhibition resulting in abnormal discharges is a mechanism underlying what condition?
Seizures
69
Adenosine triphosphate depletion; and glutamate release into the synapse happens in which condition?
Ischemic stroke
70
Aberrant neurotransmitter signaling, cytokine activation, or disruption in normal brain networks is the probable mechanism for which condition?
Delirium
71
Which structural elements are primarily affected in Gullian-Barre syndrome?
Schwann cells
72
What is the prognosis of patients with Bell's palsy and incomplete paralysis?
Excellent
73
What is the gold standard for diagnosis of progressive multifocal leukoencephalopathy?
Brain biopsy
74
What is the indication for natalizumab?
Relapsing-remitting multiple sclerosis
75
Natalizumab is associated with increased risk of which neurological condition?
Progressive multifocal leukoencephalopathy
76
What is the indication for glatiramer acetate?
Relapsing-remitting multiple sclerosis
77
Patient presents with fever, altered mental status and level of consciousness, headache, and focal neurologic deficits (e.g., cranial nerve deficits, seizures). Neuroimaging reveals temporal lobe abnormalities.
Diagnosis?
HSV type 1 encephalitis
78
Is dexamethasone used to prevent complications in bacterial or viral meningitis?
Bacterial meningitis
79
What is the mechanism of action of acyclovir?
Herpesvirus DNA polymerase inhibitor
80
The prognosis for recovery from Ramsay-Hunt associated facial paralysis is worse than that of idiopathic Bell's palsy.
True or false?
True
81
How long do you give valacyclovir (and prednisone) for in Ramsay-Hunt syndrome?
7 - 10 days
82
What is the most common symptom associated with isolated sphenoid sinus diseases?
Intractable headache
83
Can herpes simplex virus trigger anti-NMDA receptor encephalitis?
Yes
84
Is the CSF examination usually normal in HSV encephalitis?
No
85
What testing is recommended for patients with moderate to severe symptoms from carpal tunnel syndrome?
Electromyography and nerve conduction studies
86
What is the mechanism of action of atropine?
Muscarinic acetylcholine receptor antagonist
87
What can mushroom ingestion cause?
Muscarinic toxicity
88
Can vascular risk factors (hypertension, hyperlipidemia, diabetes mellitus) cause increased incidence of mild cognitive impairment and progression to dementia?
Yes
89
Why does meningitis result in hydrocephalus?
Impaired absorption of CSF from arachnoid granulations
90
What can cause an overproduction of CSF?
Choroid plexus tumor
91
Is migraine without neurologic aura a contraindication to oral contraceptive pills?
No
92
Is migraine with neurologic aura a contraindication to oral contraceptive pills?
Yes
93
Is smoking when above the age of 35 years an absolute contraindication to oral contraceptive pills?
Yes
94
What kind of transmission occurs in cryptococcus neoformans infection?
Airborne transmission
95
What kind of transmission occurs in Neisseria meningitidis infection?
Droplet transmission
96
India ink preparation of CSF is positive in which infection?
Cryptococcal meningitis/encephalitis
97
What are neurofibrillary tangles formed from?
Hyperphosphorylated tau protein
98
What kind of neurological condition are neurofibrillary tangles associated with?
Alzheimer's dementia
99
What are alpha-synuclein aggregates?
Lewy bodies
100
Can depression be a post-stroke complication?
Yes
101
Can sumatriptan be used in patients with prior stroke?
No
102
Can NSAIDS be used in patients taking warfarin?
No
103
What is ubrogepant used for?
Abortive treatment of migraine
104
How is the anti-coagulation with elevated INR rapidly reversed in case of an intracranial bleed?
4-factor prothrombin complex concentrate (4F-PCC)
105
Is acupuncture of benefit in migraine headaches?
Yes
106
Is acupuncture of benefit in fibromyalgia?
Requires further study
107
Is acupuncture of benefit in complex regional pain syndrome?
Requires further study
108
Is acupuncture of benefit in peri-operative pain?
Requires further study
109
Is acupuncture of benefit in carpal tunnel syndrome?
No
110
What is a necessary diagnostic criterion for dementia with Lewy bodies?
Cognitive impairment resulting in loss of function
111
What is a common side effect of ubrogepant?
Nausea
112
Which cells drive the primary immune response in multiple sclerosis?
T cells
113
What tests are needed to confirm vitamin B12 deficiency?
Serum methylmalonic acid and homocysteine levels
114
Does erenumab require a loading dose?
No
115
Does galcanezumab require a loading dose?
Yes
116
Are any of the calcitonin gene-related peptide (CGRP) used to prevent migraines dosed more than once a month?
No
