Neuro

Question 1

Most significant and treatable risk factor for stroke?

Answer 1

HTN

Question 2

Strokes involving anterior circulation are likely to produce what signs and symptoms?

Answer 2

Hemispheric: aphasia, apraxia, hemiparesis, hemi-sensory loss and / or visual field defects

Question 3

Strokes involving posterior circulation are likely to produce what signs and symptoms?

Answer 3

Brainstem: coma, drop attacks, vertigo, nausea, vomiting and / or ataxia

Question 4

Best imaging to differentiate ischemic from hemorrhagic stroke - recommended during acute phase?

Answer 4

Noncontrast CT

Question 5

Thrombolytic therapy is most effective if given within how long of symptom onset?

Answer 5

3 hours

Question 6

What is the indication for carotid endarterectomy?

Answer 6

> 70% stenosis of the common or internal carotid artery

Question 7

What two diseases are associated with cerebral aneurysms?

Answer 7

polycystic kidney disease

coarctation of the aorta

Question 8

A patient presents to the ER with a generalized sudden onset headache, “the worst headache in my life.” What must you suspect / rule out?

Answer 8

subarachnoid hemorrhage

Question 9

Treatment for status epilepticus?

Answer 9

IV diazepam or lorazepam until seizure stops, with a loading dose of phenytoin or fosphenytoin

Question 10

What is pathogenesis of multiple sclerosis?

Answer 10

inflammation associated with multiple foci of demyelination in CNS white matter

Question 11

True / False: age of onset for MS is 18-45 years, and is more common in women than men.

Answer 11

True

Question 12

Two most common presenting symptoms of MS?

Answer 12

sensory complaints in the limbs and vision loss (high correlation with optic neuritis)

Question 13

What diagnostic test allows for visualization of white matter lesions in CNS?

Answer 13

MRI with gadolinium

Question 14

What is commonly found in CSF of patients with MS?

Answer 14

oligoclonal bands

Question 15

What two meds have been shown to improve spasticity commonly seen with MS?

Answer 15

Baclofen and diazepam

Question 16

Most common form of dementia?

Answer 16

Alzheimer’s

Question 17

What class of medication may be used to delay progression of Alzheimer disease and improve memory function?

Answer 17

acetylcholinesterase inhibitors

Question 18

What med has been used in treatment of moderate to severe Alzheimer disease?

Answer 18

memantine (Namenda)

Question 19

What is a potential cause of fronto-temporal dementia, and what disease is this associated with?

Answer 19

Pick disease, associated with ALS

Question 20

Common frontal lobe symptoms associated with frontotemporal dementia?

Answer 20

behavior symptoms: (euphoria, apathy, disinhibition) and compulsive disorders

Question 21

Most common type of headache?

Answer 21

tension headache

Question 22

Treatment of choice for cluster headaches?

Answer 22

oxygen and / or SC sumatriptan

Question 23

Preferred therapy for prophylaxis of cluster headaches?

Answer 23

verapamil

Question 24

What med is used to help control benign essential tremors?

Answer 24

propranolol

Question 25

Essential clinical features that establish a diagnosis of Parkinson disease?

Answer 25

Resting tremor bradykinesia rigidity postural instability

Question 26

When considering bradykinesia in patients with Parkinson disease, what are common facial features?

Answer 26

infrequent blinking | mask-like facies

Question 27

When testing passive ROM in a suspect Parkinson patient, what would you expect to find?

Answer 27

cogwheel rigidity

Question 28

One which chromosome is the gene responsible for Huntington disease found?

Answer 28

chromosome 4

Question 29

Characteristic features of Huntington's?

Answer 29

progressive chorea | dementia

Question 30

Most common initial manifestation seen with Tourette syndrome?

Answer 30

Phonic tics: grunts, barks, hisses, coughing or verbal utterances

Question 31

What disease process is characterized by chronic impairment of muscle tone, strength, coordination or movements?

Answer 31

Cerebral Palsy

Question 32

When do symptoms of restless leg syndrome most commonly occur?

Answer 32

during periods of prolonged inactivity or rest

Question 33

In addition to prescription drugs, a trial of what else is recommended in all restless leg syndrome patients?

Answer 33

Iron (except in patients with iron overload)

Question 34

On which side of the face is Bells Palsy most common?

Answer 34

Right: 60% of cases

Question 35

In what two patient populations is Bells Palsy more prominent?

Answer 35

pregnant women | diabetics

Question 36

What cranial nerve supplies the muscles affected in Bells palsy?

Answer 36

CN VII

Question 37

When does the facial weakness of Bells palsy peak?

Answer 37

about 21 days or less

Question 38

What other disease processes lead to facial palsy that should be ruled out prior to a diagnosis of Bells palsy?

Answer 38

``` Stroke Tumors Lyme AIDS Sarcoidosis ```

Question 39

Most common neuropathy in western hemisphere?

Answer 39

diabetic neuropathy

Question 40

What med has recently been approved for treatment of diabetic neuropathy?

Answer 40

Duloxetine (Cymbalta): SNRI

Question 41

Most common precipitant of Guillain-Barre syndrome (acute idiopathic polyneuropathy)?

Answer 41

Campylobacter jejuni

Question 42

Pattern of weakness with Guillain-Barre syndrome?

Answer 42

symmetrical extremity weakness, beginning distally and ascending.

Question 43

In what percentage of patients with Guillain-Barre syndrome are cranial nerves affected?

Answer 43

45-75%

Question 44

What treatment has been shown to reduce the recovery time and may reduce likelihood of residual deficits in Guillain-Barre syndrome?

Answer 44

plasmapheresis

Question 45

What form of treatment of Guillain-Barre syndrome is preferred over plasmapheresis in children, and adults with cardiovascular instability?

Answer 45

IV immunoglobulin (IVIG)

Question 46

Characteristics of myasthenia gravis?

Answer 46

muscle weakness and fatigability, which improves with rest

Question 47

What is the mainstay of treatment for myasthenia gravis?

Answer 47

cholinesterase inhibitors, such as pyridostigmine

Question 48

Three primary causes of bacterial meningitis?

Answer 48

Strep pneumo Group B strep Neisseria meningiditis

Question 49

Most common bacterial cause of meningitis in neonates <1m old?

Answer 49

group B strep

Question 50

Clinical feature of neisseria meningiditis?

Answer 50

petechial rash

Question 51

Prompt lumbar puncture (LP) and CSF analysis are essential in making the diagnosis of bacterial meningitis. Prior to LP, what diagnostic test needs to be performed, and why?

Answer 51

Head CT to rule out space-occupying lesion

Question 52

Neonates with bacterial meningitis are commonly treated with what antibiotic?

Answer 52

ampicillin and cefotaxime

Question 53

Treatment of choice for bacterial meningitis in immunocompetent children >3m old, and adults <55yrs old?

Answer 53

Cefotaxime or Ceftriaxone PLUS vancomycin

Question 54

What two potential med combos are used for bacterial meningitis in patients >55yrs old, or with Hx of alcoholism / debilitating illness (regardless of age)?

Answer 54

ampicillin + cefotaxime OR | ceftriaxone + vancomycin

Question 55

What med is recommended in adults with meningitis secondary to strep pneumo, and in children >1m old with meningitis secondary to H. flu type B (HIB)?

Answer 55

dexamethasone

Question 56

Treatment for suspect herpes viral meningitis?

Answer 56

acyclovir

Question 57

Presenting symptoms in patient with brain abscess?

Answer 57

vomiting, fever, altered mental status, focal neurologic signs

Question 58

Lumbar puncture is contraindicated in patients with what type of presenting symptoms / signs?

Answer 58

focal neurological symptoms or signs - brain stem herniation may occur

Question 59

In head trauma patients, loss of consciousness greater than what duration implies a worse prognosis?

Answer 59

2 minutes

Question 60

What would you expect to find on exam in a patient with central cord syndrome?

Answer 60

Lower motor neuron deficit, loss of pain / temperature with sparing of posterior column functions

Question 61

Most common primary intracranial neoplasms?

Answer 61

gliomas

Question 62

Most common sources of intracranial metastasis?

Answer 62

Lung, breast, kidney and GI cancers

Question 63

6 major hormones produced by anterior pituitary?

Answer 63

``` ACTH TSH LH FSH GH prolactin ```

Question 64

Two hormones stored in posterior pituitary?

Answer 64

ADH (vasopressin) | oxytocin