N4

Question 1

structural causes of epilepsy

Answer 1

temporal sclerosis, cortical dysplasia, vascular malformations, TBI, cerebral, infarction, CNS tumors, infections

Question 2

purpose of EEG in a patient with first unprovoked seizure

Answer 2

helps to stratify patient risk and the need for maintainence antiepileptic agents

Question 3

patient with recurrent seizure activity

Answer 3

candidate for benzodiazepine or antiepileptic drugs

Question 4

another name for IIH

Answer 4

indiopathic intracranial hypertension = pseudotumor cerebri

Question 5

patient presentation for IIH

Answer 5

features of inc ICP in an alert patient, absence of focal neuro signs except for sixth nerve palsy, no ecidence for other causes of inc intracranial hypertension on neuroimaging, normal CSF exam except for inc CSF opening pressure

Question 6

treatment goals for IIH

Answer 6

prevention of vision loss, surgical intervention with optic nerve sheath decompression or lumboperitoneal shunting

Question 7

IIH patient requirement to prevent vision loss

Answer 7

fundoscopy and routine monitoring of visual acuity and visual fields

Question 8

IIH may be caused by meds

Answer 8

tetracyclines, isotretinoin

Question 9

first line treatment for IIH

Answer 9

acetazolamide

Question 10

mechanism for acetazolamide in IIH

Answer 10

inhibits choroid plexus carbonic anhydrase - dec CSF production and IH

Question 11

IIH patients on acetazolamide that are unresponsive

Answer 11

add furosemide

Question 12

IIH pateints refractory to medical treatment

Answer 12

surgical intervention -optic nerve sheath decompression -lumboperitoneal shunting

Question 13

IIH patients waiting for definitive surgical treatment

Answer 13

short term use of corticosteroids, serial LP, can serve as bridging therapy

Question 14

patients on manitol require

Answer 14

careful monitoring of renal function and electrolytes

Question 15

autism neuroimaging

Answer 15

inc total brain volume

Question 16

OCD neuroimaging

Answer 16

abnormalities in orbitofrontal cortex and striatum (basal ganglia)

Question 17

panic disorder neuroimaging

Answer 17

decreased volume of the amygdala (and left temporal lobe)

Question 18

PTSD neuroimaging

Answer 18

dec hippocampal volume

Question 19

schizophrenia neuroimaging

Answer 19

enlargement of cerebral ventricles esp lateral ventricular enlargement

Question 20

after the diagnosis of MG is established, what should be ordered

Answer 20

CT of the chest - screen for thymoma if the pt is younger than 60

Question 21

benefits of CT of the chest in an MG pt

Answer 21

thymectomy is mostly useful in such cases - results are seen 3-4 years after surgery

Question 22

edrophonium test

Answer 22

less sensitive than MG antibodies and is difficult to interpret if the pt has only mild findings

Question 23

anti Jo antibodies

Answer 23

polymyositis

Question 24

anti RNP antibodies

Answer 24

MCTD

Question 25

when myositis is suspected or if the diagnosis of MG is difficult what is done

Answer 25

muscle biopsy

Question 26

predisposing risk factors for delirium

Answer 26

dementia, parkinson's , prior stroke, advanced age, sensory impairment

Question 27

precipitating factors for delirium

Answer 27

drugs, infections, electrolyte disturbances, metabolic derangements, systemic illness, CNS

Question 28

drugs relation to delirium

Answer 28

narcotics, sedatives, antihistamines, muscle relaxers, polypharmacy

Question 29

infections relation to delirium

Answer 29

pneumonia, UTI, meningitis

Question 30

electrolyte disturbances relation to delirium

Answer 30

hyponatremia, hypercalcemia

Question 31

metabolic derangements relation to delirium

Answer 31

volume depletion, vit B12 def, hyperglycemia

Question 32

systemic illness relation to delirium

Answer 32

congestive heart failure, hepatic failure, malignancy

Question 33

CNS relation to delirium

Answer 33

seizure, stroke, head injury, subdural hematoma

Question 34

acute confusional state consistent with reduced or fluctuating level of consciousness and inability to sustain attention

Answer 34

delirium

Question 35

initial evaluation for a patient with delirium

Answer 35

focused history and physical evaluation inc pulse ox, review of all medications, complete blood count, serum electrolytes and urinalysis

Question 36

independence in daily activities preserved

Answer 36

normal aging

Question 37

person becomes dependent on others for ADL

Answer 37

dementia

Question 38

person complains of memory loss but can provide details about incidents of forgetfulness

Answer 38

normal aging

Question 39

may complain of memory problems only if asked; unable to remember specific instances where memory loss was noticed by others

Answer 39

dementia

Question 40

patient is more concerned about memory loss

Answer 40

normal aging

Question 41

close family members are more concerned about memory loss

Answer 41

dementia

Question 42

recent memory for important events and conversations intact

Answer 42

normal aging

Question 43

notable decline in memory for recent important events and conversations

Answer 43

dementia

Question 44

occasional word-finding difficulties (expressive aphasia)

Answer 44

normal aging

Question 45

frequent word finding difficulty and substitutions; also some receptive aphasia

Answer 45

dementia

Question 46

does not get lost in familiar territory; may have to pause briefly to reorient

Answer 46

normal aging

Question 47

can get lost for hours in familiar territory while walking or driving

Answer 47

dementia

Question 48

able to operate common appliances

Answer 48

normal aging

Question 49

becomes unable to operate common appliances

Answer 49

dementia

Question 50

maintains previous interpersonal social skills

Answer 50

normal aging

Question 51

shows loss of interest in social activities and inappropriate behavior

Answer 51

dementia

Question 52

normal performance on mental status examination

Answer 52

normal aging

Question 53

abnormal mental status exam

Answer 53

dementia