Neuro

Question 1

What are the signs/symptoms of a tension headache?

Answer 1

Non-pulsating, band-like pain
Tends to worsen over the course of the day

Question 2

What is the treatment for a tension headache?

Answer 2

NSAIDs
Lifestyle changes
Triptans for refractory/severe symptoms

Question 3

What are the signs/symptoms of a migraine?

Answer 3

Gradual onset
Periodic, throbbing/pulsatile pain (mod-severe) (typically lateralized)
N/V
Photo/phonophobia
Fatigue
Irritability

Question 4

What is the treatment for a migraine?

Answer 4

If new, full workup of new acute HA
NSAIDs
Sleep
Vasoconstrictors
Triptans
Avoid triggers

Question 5

When/how would you give prophylaxis for migraines?

Answer 5

More than 4 HA/month (beta blockers, SSRIs, gabapentin)

Question 6

Which type of HA is more common in men than women?

Answer 6

Cluster HA

Question 7

What are the signs/symptoms of a cluster HA?

Answer 7

Sudden, unilateral, transient, very severe/incapacitating pain
Non-throbbing
Not worse w/activity
Pt appears restless
Ipsilateral nasal congestion
Lacrimation/tearing

Question 8

What is the treatment for a cluster HA?

Answer 8

100% O2
Triptans
Ca+ channel blocker (verapamil)
Prophylaxis (if meets criteria)

Question 9

What is your suspected diagnosis if a pt presents with complaints of a unilateral HA w/tenderness to palpating temporal artery, and their labs reveal an elevated ESR/CRP?

Answer 9

Temporal arteritis

Question 10

What is the treatment for temporal arteritis?

Answer 10

Temporal artery biopsy
High dose oral prednisone
Monitor ESR/CRP

Question 11

What is your suspected diagnosis if a pt presents with pain and paresthesias in thumb, index, middle, and ring finger that gets worse as night and also describes feeling as if their extremity is “weak”?

Answer 11

Carpal tunnel syndrome

Question 12

What is a test that can be ordered to confirm suspected carpal tunnel syndrome?

Answer 12

Nerve conduction test

Question 13

What are the treatment options for carpal tunnel syndrome?

Answer 13

Splint
Injections
Surgery

Question 14

What are the signs/symptoms of diabetic peripheral neuropathy?

Answer 14

Stocking glove distributed numbness
Mild (progressive) weakness of lower legs
Decreased DTRs
Gait abnormalities
Distal hair loss
Muscle wasting

Question 15

What is the definition of syncope?

Answer 15

Abrupt onset LOC lasting a few seconds to a few mins. w/a full recovery
May be mildly disoriented (no post-ictal state)

Question 16

What is ataxia?

Answer 16

Loss of muscle control in the arms and legs
May lead to a lack of balance, coordination, and trouble walking
May affect the fingers, hands, arms, legs, body, speech, and even eye movements

Question 17

What are the signs/symptoms of MS?

Answer 17

Sensory disturbances: weakness, visual disturbances, balance issues, tightness in trunk & chest, diplopia
Relapse Presentation: new or worsening symptoms that develop acutely and last 24 hours w/o fever or infection, visual changes (optic neuritis), unilateral numbness, Lhermitte’s Sign (electrical sensation)

Question 18

What is the treatment for MS?

Answer 18

Refer to neuro
Manage symptoms
Prevent relapse & disability
Exercise
Injections (copaxone - can use in pregnant pts)
Oral meds for mild cases
Infusions (Ocrevus)
Steroids for relapse IV or PO (IV Solumedrol PO Prednisone)
Plasma exchange if refractory

Question 19

What is your suspected diagnosis if a pt presents with sudden unilateral paralysis of their face and dryness in the ipsilateral eye?

Answer 19

Bell’s Palsy

Question 20

What is the treatment for Bell’s Palsy?

Answer 20

Corticosteroids (Prednisone)
Lubricating eye drops
Neuro consult

Question 21

What are the signs/symptoms of Guillain-Barre Syndrome?

Answer 21

Dysesthesias
Paresthesias of feet and hands that spreads by the hour
Acute symmetric ascending weakness of limbs
Areflexia
Back & leg pain
Cardiac arrhythmias
Respiratory muscle paralysis can cause death

Question 22

Guillain-Barre Syndrome is commonly preceded by what?

Answer 22

URI (campylobacter Jejuni)

Question 23

What is the treatment for Guillain-Barre?

Answer 23

Admit to hospital
Pain mgmt
DVT prophylaxis
Plasma exchange
IVIG

Question 24

What are the signs/symptoms of Myasthenia Gravis?

Answer 24

Insidious onset
May be preceded by infection/illness
Ptosis
Diplopia
Swallowing difficulties
Respiratory difficulties
Limb weakness
Symptoms fluctuate
Increased weakness at the end of the day

Question 25

What is a diagnostic test specific to Myasthenia Gravis work up?

Answer 25

Tensilon challenge

Question 26

What is the treatment for Myasthenia Gravis?

Answer 26

Anticholinesterase (pyridostigmine) Thymectomy Immunosuppressants IVIG Pt education Refer to neuro

Question 27

What are signs/symptoms of ALS?

Answer 27

Focal wasting of muscle groups Limb weakness w/varying symmetry & distribution Gait disturbance Dysphagia Dysphonia Fasciculations Cognition typically intact

Question 28

Is there a treatment for ALS, if so what is?

Answer 28

No curative treatment Outpatient supportive care Refer to neuro

Question 29

What are similar symptoms seen in bacterial and viral meningitis?

Answer 29

HA Fever Stiff neck

Question 30

What are symptoms specific to bacterial and viral meningitis?

Answer 30

Bacterial: N/V, malaise, rash, AMS Viral: may have viral prodrome, less ill than bacteria

Question 31

What is the treatment for bacterial meningitis?

Answer 31

Abx (cephalosporin & vanc) Corticosteroids

Question 32

What is your suspected diagnosis if a pt presents with facial droop, drowsiness, confusion, focal neurological deficits, and upper extremity weakness?

Answer 32

Ischemic stroke

Question 33

What is the treatment for an ischemic stroke?

Answer 33

tPA if < 3 hours since onset of symptoms Allow for higher BP PT/OT

Question 34

What are the signs/symptoms of hemorrhagic stroke?

Answer 34

Lacunar infarcts HA N/V LOC Seizures Increased ICP

Question 35

What commonly presents with pts stating they are experiencing "the worst headache of their life", or describe it as a thunderclap headache?

Answer 35

Subarachnoid hemorrhage

Question 36

What is the treatment for subarachnoid hemorrhage?

Answer 36

Moderate control of BP Surgical clipping or endovascular coil of aneurysms Ca+ channel blocker More aggressive treatment of HTN at discharge

Question 37

What is the most common and most aggressive of the primary brain tumors?

Answer 37

Glioblastoma Multiforme

Question 38

What is the prognosis/treatment options for Glioblastoma Multiforme?

Answer 38

Poor prognosis and rapidly progressing Radiation and chemo may prolong life Full surgical resection unlikely

Question 39

What is the presentation of a seizure?

Answer 39

Usually begin w/arrest of motion & blank stare May have convulsions May lose control of bowel/bladder May have a prodrome Post-ictal state following event

Question 40

What are common meds used to treat seizures?

Answer 40

Keppra Ethosuximid for absence

Question 41

What are the different types of seizures?

Answer 41

Partial (localized) or generalized (global) Simple partial: no impairment of consciousness, motor signs Complex partial: consciousness impaired Generalized: non focal origin; Absence seizures (typical - staring/lack of attention or atypical - associated w/movement) Myoclonic seizures (tonic, clonic, or tonic-clonic) Atonic seizures

Question 42

What is status epilepticus?

Answer 42

Active seizure lasting 5 mins or longer, a 2nd seizure w/o recovering from 1st, or repeated seizures for 30 mins or longer

Question 43

What is the treatment for status epilepticus?

Answer 43

O2 Ativan (IV or rectum) Anticonvulsants

Question 44

What are the signs/symptoms of Parkinson's?

Answer 44

Tremor (pill-rolling that stops w/ purposeful use of hand) Bradykinesia Rigidity (cogwheel) Postural instability Flat affect Cognitive dysfunction/maybe psychosis or depression Seborrheic dermatitis Fatigue

Question 45

What is the treatment for Parkinson's?

Answer 45

Carbidopa/Levodopa MAO-B inhibitors Amantadine Botox DBS PT/OT

Question 46

How do patients get Huntington's disease?

Answer 46

It is inherited

Question 47

What are the signs/symptoms of Huntington's?

Answer 47

Dysarthria Dysphagia Apraxia Involuntary movements Cognitive decline Impulsivity, irritability, depression

Question 48

What diagnosis has been called "mad cow disease"?

Answer 48

Creutzfeld-Jacob Disease (CJD)

Question 49

What are the signs/symptoms of Creutzfeld-Jacob Disease (CJD)?

Answer 49

Personality changes Anxiety/depression Impaired motor coordination Insomnia Blurred vision Speech difficulties

Question 50

What is your suspected diagnosis if a pt presents with complaints of loud snoring w/gaps in breathing, waking up tired, and daytime sleepiness?

Answer 50

Obstructive sleep apnea

Question 51

What is the treatment for obstructive sleep apnea?

Answer 51

CPAP BiPAP Surgical removal of uvula Dental device Weight loss Tracheotomy (gold standard)