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Flashcards in Cases Deck (55):
1

Which of the following is most likely to result in primary neurogenic orthostatic hypotension?

Parkinson disease

2

COMT inhibitors, such as Tolcapone and Entacapone block the peripheral metabolism of Levodopa into an inactive metabolite, allowing higher doses of Levodopa to reach the CNS. What must be monitored biweekly in patients taking these drugs?

LFTs

3

Which of the following statements regarding benzodiazepines is true?

IV administration can result in respiratory depression, so access to flumazenil is important

4

Which of the following medications is used as a first line therapy in the treatment of progressive-relapsing multiple sclerosis?

Interferon beta1a

5

A 14 year old male patient is brought into the ED via ambulance and is accompanied by his parents who state that he had a seizure. According to the boy's parents, he was sitting on the couch watching television when he began to cry out and go into convulsions. Hi parents state that the convulsions lasted approximately 3 minutes. He has had 1 other seizure like this in the past, so they knew how to keep him safe from harm prior to the ambulance's arrival. On arrival to the ED the patient appears confused, but is stable. His muscles are flaccid and he is drooling. Which of the following is the most likely diagnosis?

Grand mal seizure

6

What medication is a centrally acting, reversible Ach inhibitor used to treat symptoms associated with mild to moderate Alzheimer disease?

Donepezil

7

Which of the following nutrients, when low, will result in the most dramatic neuronal response?

Oxygen

8

Which of the following statements is not true regarding Phenytoin?

It is used to treat partial, generalized, and absence seizures

9

. In what age group are we most concerned about valproate-related hepatotoxicity?

Children under the age of 2

10

A 69 year old female patient presents to the ED via ambulance with left sided flaccid paralysis. Her daughter accompanies her and states that her symptoms began approximately 2 hours ago with left-sided weakness. A non-contrast head CT reveals a hemorrhagic stroke. Given the patients symptoms, what is the most likely location of the hemorrhage?

Basal ganglia

11

A 15 year old female patient presents to the clinic with complaints of a "passing out" episode. She states that she cut her finger while slicing an apple. When she saw the blood she began to sweat and feel dizzy. She states "my heart started racing, I felt sick to my stomach, and then I passed out." She feels fine now, but is worried because she has never passed out before. Her vitals and PE are unremarkable. Which of the following is best described by this patient's symptoms?

Vasovagal neurally mediated syncope

12

Which of the following statements regarding Amitriptyline is true?

It is associated with suicidal ideation

13

A 28 year old male patient presents to the ED with complaints of a severe headache and stiff neck. He has a low grade fever and a positive Brudzinski's sign. He states that his symptoms began 1 day ago and are getting progressively worse. CSF analysis from a lumbar puncture reveals increased WBCs, increased protein, and normal glucose; no organism is found on culture. How should this patient be managed?

Conservative care

14

Why do we vaccinate against meningitis?

comorbidities

15

Which of the following drugs has not been linked to the development of dementia?

Memantine

16

Which of the following patients should not be treated with Sumatriptan?

70 year old male patient with hyperlipidemia and 1-2 migraines per week

17

A 79 year old, Asian female is seen in the office for a routine follow up. You have cared for this patient for many years and notice a change in her mood since the last visit, which was 6 months ago. You note signs of apathy and anxiety, which are unusual for this patient. On PE, you note left-sided hemiparesis and a positive Babinski sign on the left side. Which of the following diagnoses is most likely?

Vascular dementia

18

A 72 year old female with a history of shingles presents to the ED with complaints of a rash. She has severe right-sided facial palsy. She also complains of piercing, stabbing sensations along the rash, which a dermatome pattern. She denies dizziness, weakness, diplopia, and HA. On PE, you note several vesicles in her EAC. A right-sided facial palsy is appreciated; neurological exam is otherwise unremarkable. What is the most likely cause of this patient's symptoms?

Ramsay Hunt syndrome

19

What area of the brain is responsible for speech?

Left frontal hemisphere

20

What is the preferred acute therapy for status epilepticus?

Lorazepam

21

Which form of dementia is associated with Capgras syndrome?

Lewy body dementia

22

What is the biggest risk factor of Parkinson disease?

Age

23

An 86 year old, diabetic patient presents to the ED with complaints of increasing syncopal episodes when rising from his reclining chair after sitting for a while. He states that his "dizzy spells" started a couple weeks ago and have been getting worse. His diabetes is well managed with Metformin and diet; his random blood glucose in the ED today is 125. His vitals are as follows: BP 125/82, HR 72, RR 12, SPO2 100%. An EKG is unremarkable. During a tilt table test, his BP drops to 98/70 and his HR increases to 88. What is the most likely cause of this patients orthostatic hypotension?

Volume depletion

24

. What is the most common form of diabetic neuropathy?

Length-dependent polyneuropathy

25

What is the most common complaints associated with an epidural abscess?

Back pain

26

Which of the following is true regarding Rizatriptan?

It is more lipophilic/bioavailable than Sumatriptan, allowing for increased drug concentration in the CNS

27

What is the primary function of the parietal lobes?

Spatial relations

28

Which of the following neuroglia serve as essential components of the blood brain barrier?

Astrocytes

29

Which of the following drugs is contraindicated in pregnancy?

Dihydroergotamine

30

Which of the following is a common side effect associated with tricyclic antidepressants?

Dry mouth

31

A 46 year old female presents to the clinic with complaints of pains in the area of her right cheek and jaw. She describes the pain as severe, stabbing sensations and states that they recur frequently throughout the day and night. The pain is so bad that it wakes her from sleep. A neurological exam is normal. Which of the following best describes the pathophysiology of this patient's symptoms?

Ectopic stimulation of small fibers of CN V

32

Which of the following statements regarding cardiogenic shock is true?

It is more likely to occur at rest if caused by an arrhythmia and on exertion if caused by structural heart disease

33

A 22 year old male patient is brought to the ED via ambulance following a snowboarding accident. The EMTs inform you that the patient took a jump in the terrain park and landed on his head. He was unconscious at the scene and has not regained consciousness since. GCS is 7; the patient is intubated and placed on cervical spine precautions prior to arrival. On arrival, you note decerebrate posturing and labored breathing. Which of the following best classifies this patient's head trauma?

Severe TBI

34

What is the treatment of choice for patients with Myasthenia Gravis?

Pyridostigmine

35

Which of the following nerve fiber tracts crosses at the spinal level to carry pain and temperature to the thalamus?

Spinothalamic tract

36

Which drug class prevents free radical formation from dopamine metabolites, slowing the metabolism of Levodopa to increase its anti-Parkinsonian effects?

MAO-B inhibitors

37

Which of the following statements regarding Pramipexole is true?

It has been shown to be useful in treating Parkinson-related depression

38

Which of the following should be monitored regularly in patients taking Modafinil?

Blood pressure

39

Which of the following is not one of the 3 most common nerves affected by asymmetric diabetic neuropathy?

V

40

All of the following are hyperkinetic disorders except:

Akinesia

41

A 32 year old, obese female presents to the ED complaining of a generalized, throbbing headache x 4 days. She states that the pain is worse in the morning and with exercise, coughing, or lying down. She has never had headaches like this before and is concerned because NSAIDs have failed to relieve the pain. A neurological exam is unremarkable; papilledema is noted on fundoscopy. A CT of the brain w/o contrast is unremarkable. How should this patient be managed?

Acetazolamide to reduce CSF production by the choroid plexus

42

Which of the following best describes pregabalin's mechanism of action?

Reduction of calcium-dependent release of pro-nociceptive neurotransmitters

43

Which of the following refers to the inability to recognize and interpret objects, people, sounds, or smells despite intact primary sense organs?

Agnosia

44

All of the following are signs of pyramidal tract pathology except:

Hyporeflexia

45

A 42 year old male patient complains of back and leg pain x 1 week after lifting heavy boxes during a move. He states that the pain starts in his lower back and radiates down the posterolateral aspect of his left thigh to the top of his left foot. On PE, you note pain at 20° on a left-sided single leg raise. Dorsiflexion of the left great toe and foot is weak. Paresthesias and numbness are noted on the top of the left foot and great toe; reflexes are normal. You diagnose your patient with lumbar monoradiculopathy, which you suspect is from a herniated disc. Given the patient's symptoms, at which level is the disc herniation most likely?

L4/L5

46

Which of the following statements best fits the description of a functional movement disorder?

Abnormal movements or positioning of parts that are not caused by neurological disease

47

An 82 year old woman is brought to the ED via ambulance from the nursing home after falling and hitting her head. Another nursing home resident told the EMTs that the woman was walking to the bathroom when her foot caught on the rug, causing her to lose her balance. She fell, striking her entire face/forehead on the ground. The other resident states that the patient lost consciousness "for a few minutes" immediately following the fall. The patient is alert, but confused on arrival to the ED. She complains of a headache and does not remember the fall. She has significant bruising on her face and forehead. Neurological exam shows mild impairments; GCS 13. What is the most appropriate next step in the management of this patient?

Send to radiology for a non-contrast head CT

48

Which of the following drugs is an antiviral used to treat rigidity and akinesia in patients with Parkinson disease?

Amantadine

49

What type of stroke is most likely to result in 3rd nerve palsy, ataxia, and decebrate rigidity?

Posterior cerebral artery stroke

50

A 55 year old male patient with a history of paraneoplastic syndrome presents to the office with complaints of increasing muscular fatigue. He states that he feels fine for the first few hours in the morning, but then his eyes get heavier until the end of the day when he can barely hold them open. He states that his legs also feel weak by the end of the day, making it difficult to rise from a seated position. On PE, you note absent DTRs. What is the most likely pathophysiology behind this patient's symptoms?

Production of antibodies against calcium channels at the motor end plate of the presynaptic cleft

51

Lamotrigine is a 2nd generation antiepileptic used to treat partial and primary generalized tonic-clonic seizures. In what patients should serum levels be regularly monitored?

Pregnant patients

52

Which of the following statements regarding Benztropine is true?

It is useful in the treatment of Parkansonian tremors, but not akinesia, or gait disturbances

53

In which of the following patients would you consider giving 2 doses of meningococcal vaccine 2 months apart?

2 year old toddler with asplenia

54

A 43 year old female patient presents to the office with complaints of bilateral hand tremors. She states that the tremors worsen when she is stressed or tired and improve with relaxation. She has been drinking a glass of wine every night at dinner because it seems to help calm the tremors. On PE, you note bilateral hand tremors that improve with walking. No reflex or gait abnormalities are noted and hand muscle tone is normal, bilaterally. Which of the following medications is most often used to treat your patient's symptoms?

Propanolol

55

A 54 year old, male patient with a history of type II diabetes presents to the office with complaints of numbness and tingling in his distal extremities. His symptoms began several months ago in his lower legs, but have since then taken on a stocking-glove distribution. On PE, you note symmetric distal sensory loss of pain, temperature, touch, and vibratory sensation in his distal legs and distal arms. Ankle DTRs are 1/4, compared to his previous 2/4 and toe weakness is noted. Which of the following medications should be used to treat this patient's symptoms?

Pregabalin