Neuro

Question 1

ABCD2 score

Answer 1

to predict risk of recurrent stroke
age>=60
BP >=140/90
unilateral weakness (2 points) or isolated speech disturbance (1 point)
TIA Sx duration >=60min (2 points) or 10-59min (1 point)
DM
admit for score of 3+ or shady follow up

Question 2

Meningioma features

Answer 2

Lightbulb sign = intense homogenous contrast enhancement

Dural tail

Question 3

Mild cognitive impairment

Answer 3

MMSE less than 26/30

Question 4

When to offer daily migraine prophy

Answer 4

HA frequency or use of acute meds>2d/wk or >8d/mo

Question 5

Temporal lobe seizure features

Answer 5

Rising (“roller coaster”) sensation in epigastrium

Anxiety w or w out autonomic signs

Question 6

Myotonic dystrophy

Answer 6

weakness, fatigue, and a myopathic waddling gait who also have muscle stiffness and delayed grip relaxation.
myotonia—an impairment of muscle relaxation secondary to increased cellular membrane hyperexcitability

Question 7

AED in setting of OCP requirement

Answer 7

Keppra

Question 8

oxcarbazepine AE

Answer 8

hyponatremia

Question 9

topiramate contraindications

Answer 9

nephrolithiasis

gluacoma

Question 10

AEDs for elderly pts

Answer 10

lamotrigine
levetiracetam
gabapentin

Question 11

multiple system atrophy

Answer 11

parkinsonism, cerebellar ataxia, and early postural instability and falls

Question 12

when to perform decompression surgery for carpal tunnel

Answer 12

active denervation on nerve conduction studies, weakness, and atrophy on exam
or if Sx uncontrolled with more conservative measures

Question 13

chronic inflammatory demyelinating polyradiculopathy

Answer 13

progressive weakness
areflexia
sensorimotor neuropathy
progression lasting beyond 8 weeks
(similar to Guillan Barre but more slowly progressing)

Question 14

idiopathic intracranial hypertension

Answer 14

elevated CSF opening pressure (normal is 60-250mm H20) in the absence of space occupying lesion

Question 15

Crutzfeld Jakob

Answer 15

Rapidly progressive dementia
Myoclonus
Bland CSF
Non diagnostic imaging vs hyperintensities on diffusion-weighted imaging (DWI): basal ganglia, cortex, thalamus

Question 16

initial treatment mild Parkinsonism

Answer 16

MAO inhibitor
selegiline
rasagiline
*can also worsen dyskinesia

Question 17

initial treatment for moderate severity PD based on age

Answer 17

> 70yrs: levodopa

Question 18

meds for prolonging levodopa effect

Answer 18

catechol-O-methyltransferase inhibitors:
entacapone
tolcapone
*can cause dyskinesia

Question 19

refractory epilepsy

Answer 19

disabling seizures for longer than 1 year despite treatment with adequate doses of two or more AEDs

Question 20

treatment of Parkinsons hyperpyrexia syndrome

Answer 20

resume Parkinson’s meds

Question 21

status migranosis

Answer 21

migraine >72hrs
initial Tx: IVF, anti-emetics
then try IV dihydroergotamine if inpt or oral steroids if outpt

Question 22

best MS med to use in pregnancy

Answer 22

glatiramer (class B)
but also reasonable to trial off meds in pregnancy given protective MS effect

Question 23

treatment of aneurysmal sub arachnoid hemorrhage

Answer 23

nimodipine

Question 24

migraine definition

Answer 24

headache lasting 4-72hrs 
PLUS 2 of the following 4:
unilateral location
throbbing quality
moderate to severe intensity
worsening with physical activity

Question 25

treatment of ALS

Answer 25

riluzole (inhibitor of glutamate release, exact mechanism of action unknown)

Question 26

diagnosis of Parkinson's disease

Answer 26

bradykinesia (=generalized slowing of movement) plus one of: 1) resting tremor 2) rigidity 3) postural instability

Question 27

when to think of cerebral artery vasospasm after SAH

Answer 27

decline in neuro function | 5-10d post bleed

Question 28

AEDs to use in the setting of chemo

Answer 28

valproic acid lacosamide lamotrigine levetiracetam

Question 29

chronic migraine Dx and Tx

Answer 29

HA 15 or more days per month for more than 3 months often increasingly frequent attacks of migraine that are eventually accompanied by an interval milder headache - on at least 8 days of the month, the headache of chronic migraine must be severe, possess migraine features, or respond to migraine-specific therapy need to check MRI Tx: topiramate and onabotulinumtoxinA

Question 30

Tx MS related fatigue

Answer 30

modafinil armodafinil amantadine

Question 31

less likely to cause statin myopathy

Answer 31

hydrophilic statins (vs lipophilic statins) rosuvastatin pravastatin fluvastatin

Question 32

stroke BP goals

Answer 32

for hemorrhagic stroke SBP

Question 33

anti epileptics for chemo pts

Answer 33

valproic acid, lacosamide, lamotrigine, and levetiracetam