Neuro 1

Question 1

what is bell palsy

Answer 1

idiopathic, unilateral CN VII/facial nerve palsy leading to hemifacial weakness and paralysis due to inflammation or compression

Question 2

is bell palsy a LMN or UMN disorder

Answer 2

LMN

Question 3

what is responsible for most cases of bell palsy

Answer 3

reactivation of the HSV type 1 DNA in the geniculate ganglion

Question 4

risks for bell palsy

Answer 4

DM
pregnancy (esp 3rd trimester)
post URI
dental nerve block

Question 5

sx bell palsy

Answer 5

prodrome - sudden onset of ipsilateral hyperacusis (ear pain) followed by weakness

unilateral facial weakness or paralysis (forehead included) - unable to lift affected eyebrow and inability to fully close eyelid

weakness and paralysis only affects face

taste disturbance involving the anterior 2/3 of the tongue

Question 6

what is the bell phenomenon in bell palsy

Answer 6

eye on the affected side moves laterally and superiorly when eye closure is attempted

Question 7

dx bell palsy

Answer 7

dx of exclusion

Question 8

tx bell palsy

Answer 8

no tx - supportive, artificial tears

prednisone esp if started within first 72 hours of sx onset reduced time to full recovery and increases likelihood of full recuperation

Question 9

what is the MC overall cause of primary headache

Answer 9

tension headache

Question 10

sx tension headache

Answer 10

bilateral, pressing, tightening bandlike, viselike, tight-cap, non throbbing (nonpulsatile) steady or aching, occipitonuchal or bifrontal headache, usually mild to moderate in intensity

Question 11

exacerbating/relieving factors tension headache

Answer 11

exacerbating - worsened w stress, fatigue, noise, glare

not worse with routine activity

not associated w N/V, photophobia, or photophobia or focal neurological sx

Question 12

PE tension HA

Answer 12

usually normal but may have increased pericardial muscle tenderness (head, neck, shoulders)

Question 13

dx tension HA

Answer 13

clinical - diagnosis of exclusion (no specific tests)

Question 14

tx tension HA

Answer 14

simple analgesics - NSAIDs mainstay of tx

Chronic management - TCAs (amitriptyline)

Question 15

who is most likely to experience a migraine, men or women

Answer 15

75% of all persons who experience migraines are WOMEN

Question 16

2 types of migraine

Answer 16

migraine without aura - MC

migraine with aura - classic but not common

Question 17

sx migraine

Answer 17

HA - usually episodic lateralized (unilateral), throbbing (pulsatile) HA localized to the frontotemporal and ocular area; lasts 4-72 hours

associated w N/V, photophobia, phonophobia

Question 18

exacerbating factors migraine

Answer 18

worsened with routine physical activity
stress
lack or excessive sleep
alcohol
chocolate
red wine
hormonal (oral contraception/menstruatioN)
dehydration

Question 19

how long do auras typically last for migraine

Answer 19

focal neuro sx last < 60 min

Question 20

most common aura for migriane

Answer 20

visual

Question 21

PE migraine

Answer 21

usually normal

may have aphasia, dysarthria, paresthesias, weakness

Question 22

dx migraine

Answer 22

clinical - at least 2
unilateral pain
throbbing (pulsatile) pain
aggravated by movement
moderate to severe intensity

at least 1
N/V
photophobia
phonophobia

Question 23

abortive/sx tx for migraine

Answer 23

mild to moderate - simple analgesics (NSAIDs)

moderate to severe - 5-hydroxytryptamine-1 receptor agonists - triptans or ergotamines - either alone or in combo w dopamine receptor antagonists (metoclopramide, prochlorperazine); CGRP antagonists (gepants); 5-HT 1F receptor agonists (Lasmiditan)

Question 24

prophylactic tx migraines

Answer 24

anti-hypertensives - BB or CCB, candesartan, NSAIDs, rimegepant

Anticonvulsants - Topiramate, Valproate

TCAs - amitriptyline

Botox

Question 25

what is cluster headache characterized by

Answer 25

hypothalamic activation with secondary activation of the trigeminal-autonomic reflex, probably via a trigeminal-hypothalamic pathways

Question 26

risks for cluster HA

Answer 26

male age > 30 consumption of alcohol tobacco

Question 27

triggers cluster HA

Answer 27

worse at night alcohol stress hot weather TV

Question 28

sx cluster HA

Answer 28

severe, unilateral, periorbital, deep (retroorbital), or temporal pain that is sharp, lancinating, and excruciating. HA last < 2 hours with spontaneous remission occurs several times per day

Question 29

PE cluster HA

Answer 29

ipsilateral autonomic sx: partial Horner's syndrome - ptosis and/or miosis nasal congestion or rhinorrhea conjunctival injection or lacrimation eyelid edema forehead/facial swelling occurs only during pain attack

Question 30

dx cluster HA

Answer 30

clinical neuroimaging is suggested to exclude a cranial lesion (MRI or CT)

Question 31

tx cluster HA

Answer 31

100% oxygen first line - 6-12 L for 15-20 min anti-migraines help during attack - sumatriptan preferred

Question 32

prophylaxis cluster HA

Answer 32

verapamil first line

Question 33

causes of meningitis and their associations

Answer 33

streptococcus pneumoniae - most common cause in adults neisseria meningitides - most common in older kids; may be associated w petechial (purpuric) rash group B strep - most common in neonates < 1 month listeria monocytogenes - neonates, > 50, immunocompromised

Question 34

sx meningitis

Answer 34

HA neck stiffness photosensitivity fever N/V may develop AMS or seizures

Question 35

PE meningitis

Answer 35

meningeal signs: nuchal rigidity positive brudzinski - neck flexion produces knee and/or hip flexion positive kernig sign - inability to extend the knee/leg with hip flexion)

Question 36

dx meningitis

Answer 36

LP + CSF exam - decreased glucose < 45, increased neutrophils, increased protein, increased pressure Head CT scan - best initial prior to LP if you need to rule out mass effect if any of these findings are present - papilledema, seizures, confusion, focal neurologic findings, > 60, immunopromised, hx of CNS dz

Question 37

tx meningitis

Answer 37

abx along with dexamethasone ASAP after LP or prior to head CT dexamethasone reduces mortality > 1 month - 50: vancomycin + ceftriaxone > 50: vancomycin + ceftriaxone + ampicillin neonates up to one month - ampicillin + either gentamicin and/or cefotaxime head trauma or post-euro procedure - vancomycin + either ceftazidime or cefepime

Question 38

additional precautions for meningitis

Answer 38

droplet precautions for 24 hours after initiation of abx post-exposure prophylaxis - ciprofloxacin or rifampin for close contacts w prolonged exposure > 8 hours or direct exposure to respiratory secretions

Question 39

MC cause aseptic meningitis

Answer 39

enteroviruses (coxsackievirus and echovirus)

Question 40

dx aseptic meningitis

Answer 40

dx of exclusion after ruling out bacterial meningitis LP - normal glucose, lymphocyte predominance, protein count usually < 200

Question 41

tx aseptic meningitis

Answer 41

supportive

Question 42

what is encephalitis

Answer 42

infection of the brain parenchyma

Question 43

what is the MC identified virus in encephalitis

Answer 43

Herpes simplex virus 1

Question 44

sx encephalitis

Answer 44

HA neck stiffness photosensitivity fever N/V focal deficitis - the presence of AMS, changes in personality speech, and movement distinguishes from aseptic meningitis

Question 45

PE encephalitis

Answer 45

focal neurologic deficits - hemiparesis, sensory deficits, cranial nerve palsies

Question 46

dx encephalitis

Answer 46

CT scan of head must be performed first to rule out space-occupying lesions LP - normal glucose, increased lymphocytes MRI - temporal lobe involvement characteristic of HSV PCR testing of CSF fluid is the most accurate test for herpes encephalitis

Question 47

tx encephalitis

Answer 47

IV acyclovir - ASAP if encephalitis with no obvious cause