Exam 4; Neurology

Question 1

CNS neoplasms are often diagnosed via

Answer 1

MRI

Question 2

Tx of Glioblastoma

Answer 2

1) RADIATION

2) Surgical decompression

Question 3

Epilepsy is best dx by

Answer 3

medical history

Question 4

Tx of juvenile myoclonic epilepsy

Answer 4

Anticonvulsants

Question 5

Tx of adult onset seizure

Answer 5

Anticonvulsants is first line

Question 6

MC early manifestation of alcohol withdrawal syndrome is

Answer 6

a tremor

Question 7

medical emergency in which a pt is having continuous seizures that do not permit the pt to regain consciousness between them

Answer 7

Status Epilepticus

Question 8

Tx of Status Epilepticus

Answer 8

1. Diazepam 5-10mg IV q5-10mins until seizure stops OR until 20mg IV have been given
   IF pt is still seizing 2) give loading dose of phenytoin 15-20mg/kg dose x 1; may give another 10mg/kg after 20 mins
   IF STILL SEIZING: 3) MUST Intubate and give phenobarbital

Question 9

Wernicke’s encephalopathy TRIAD is

Answer 9

• Ocular disorders
• Ataxic gait
• Mental status changes

Question 10

Tx of Wenicke’s encephalopathy

Answer 10

Thiamine 250mg-500mg IV TID x 3 days
Then 250mg IM or IV QD x 5 days

Question 11

Tx of Korsakoff’s pyschosis

Answer 11

Thiamine 250mg-500mg IV TID x 3 days
Then 250mg IM or IV QD x 5 days

Question 12

Tx of Polyneuropathy

Answer 12

Daily B vitamins

Question 13

Asterixis is a sign of

Answer 13

Hepatic Encephalopathy

Question 14

Tx of vasovagal rx

Answer 14

Reverse trendelenburg position

Question 15

what are the four major neurological symptoms of Parkinson’s disease

Answer 15

(TRAP)
- T = Tremor (resting)
- R = Rigidity (cogwheel)
- A = Akinesia (bradykinesia)
- P = Postural instability

Question 16

repetitive purposeless movements such as tongue rolling, lip smacking, or the tongue protruding from lips are all signs of

Answer 16

Tardive dyskinesia

Question 17

Tx of restless leg syndrome

Answer 17

Dopamine agonists (Pramipexol or Ropinirole)
and Iron replacement

Question 18

Tx of benign essential tremor

Answer 18

Beta blocker: Propranolol 120 mg day divided BID or TID

Question 19

Benign essential tremor is most common in

Answer 19

The hands

Question 20

Tx of tardive dyskinesia

Answer 20

• Stop the offending medication
• Tetrabenazine (depletes dopamine/serotonin)

Question 21

Tardive dyskinesia is MC caused by

Answer 21

MC a side effect of neuroleptic agents - Antipsychotic meds!

Question 22

First line Tx of Parkinson’s disease

Answer 22

Selective MAO-B inhibitors (first line bc they have very little side effects)

Question 23

Best drug to Tx Parkinson’s but is not first line due to many side effects is

Answer 23

Levodopa

Question 24

Choreiform movements, psychiatric problems (personality changes/aggression/depression), and dementia suggests

Answer 24

Huntington’s disease

Question 25

Dx of Huntington's disease is

Answer 25

Confirmed via genetic testing IT15 gene

Question 26

Tx of Huntington's disease if 1) it is interfering with function and 2) THERE IS depression, agitation, or psychosis present ...

Answer 26

2nd gen antipsychotics

Question 27

Tx of Huntington's disease if 1) it is interfering with function and 2) WITHOUT the presence of depression, agitation, or psychosis ...

Answer 27

VMAT inhibitor

Question 28

Painless and progressive weakness makes you think of what condition?

Answer 28

Amyotrophic Lateral Sclerosis (ALS) aka Lou Gehrig's disease

Question 29

What neurological functions are SPARED in ALS?

Answer 29

- Mentation (Mental status) - EOMs - Sensation - Bowel/bladder function

Question 30

ALS tx

Answer 30

Slow progression = Riluzole Another med in trials currently = Edararone

Question 31

How is Bell's palsy differentiated from Herpes zoster optics OR stroke?

Answer 31

Bell's palsy - CANNOT close eye or wrinkle forehead Herpes zoster oticus - Ear pain and herpetic rash on the external ear Stroke - CENTRAL facial weakness and SPARES the forehead and eye closure

Question 32

Excessive daytime sleepiness

Answer 32

Hypersomnia

Question 33

Inability to fall or remain asleep (Worsening quality NOT volume of sleep)

Answer 33

Insomnia

Question 34

Insomnia is dx by

Answer 34

Sleep studies and an interview

Question 35

First line tx for insomnia is

Answer 35

Cognitive behavioral therapy

Question 36

Undesirable behavior patterns associated with sleep (sleep walking/night terrors/ or bed wetting)

Answer 36

Parasomnias

Question 37

Collapse of the upper airway that results in low O2 levels leading to frequent awakenings and poor sleep is

Answer 37

Obstructive sleep apnea

Question 38

Dx of Obstructive sleep apnea

Answer 38

Polysomnography

Question 39

Tx of Obstructive sleep apnea

Answer 39

CPAP machine or surgery

Question 40

SUDDEN onset of REM sleep at any time and could have triggers such as laughing, crying, or anger

Answer 40

Narcolepsy

Question 41

Dx of narcolepsy is

Answer 41

- Polysomnography to R/O other causes - Multiple sleep latency test: MSLT testing

Question 42

UMN lesions especially in the LOWER EXTREMITES (spastic paresis, hyper flexion, clonus, and + babinski) is a hallmark of what condition?

Answer 42

Multiple sclerosis (MS)

Question 43

Dx of multiple sclerosis

Answer 43

- MRI = White matter plaques* - CSF findings = Oligoclonal bands*

Question 44

Type of MS: episodes of acute worsening with recovery and a stable course between relapses

Answer 44

Relapsing-remitting

Question 45

Type of MS: Gradual, nearly continuous neurological deterioration from the onset of Sx

Answer 45

Primary-Progressive

Question 46

Type of MS: Gradual neurologic deterioration. With or without superimposed acute relapses in pt who previously had relapsing-remitting MS

Answer 46

Secondary-progressive

Question 47

Type of MS: Gradual neurologic deterioration from onset of sx, but with subsequent superimposed relapses

Answer 47

Progressive-relapsing

Question 48

To definitively dx MS one must have:

Answer 48

- Evidence of 2 inflammatory demyelinating lesions referable to different locations in the CNS occurring at DIFFERENT times (usually >1 mo)

Question 49

Weakness due to MS can be tx with

Answer 49

Potassium channel blockers