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American Board of Internal Medicine > Neurology > Flashcards

Flashcards in Neurology Deck (53):
1

If the Anterior Cerebral Artery is ischemic, what clinical feature manifests?

Contralateral leg weakness

2

If the Middle Cerebral Artery is ischemic, what clinical feature manifests?

1. Contralateral face and arm weakness >> leg
2. Sensory loss
3. Visual field cut
4. Aphasia or neglect

3

If the Posterior Cerebral Artery is ischemic, what clinical feature manifests?

Contralateral visual field cut

4

If the Lacunar brain is ischemic, what clinical feature manifests?

1. Contralateral motor/sensory without cortical signs:
- aphasia
- apraxia
- neglect
- loss of higher cognitive functions

2. Clumsy hand-dysarthria syndrome
3. Ataxic hemiparesis

5

If the Basal Artery is ischemic, what clinical feature manifests?

1. Oculomotor deficits
2. Ataxia with "crossed" sensory/motor deficits
- crossed = sensory and motor opposite sides

6

If the Vertebral Artery is ischemic, what clinical feature manifests?

1. Lower cranial nerve deficits:
- dysphagia
- dysarthria
- tongue/palate deviation
2. Ataxia with "crossed" sensory/motor deficits
- crossed = sensory and motor opposite sides

7

1. How is Myasthenia Gravis diagnosed (5)?
2. What is the treatment for Myasthenic Gravis?
3. What is the treatment for Myasthenic Crisis?

1. a. Acetylcholine antibodies
b. If negative, Anti-MuSK (muscle-specific kinase antibodies)
c. TSH (associated with MG)
d. EMG
e. CT scan to exclude thymoma

2. Pyridostigmine
3. Plasma exchange

8

What drugs should be avoided in patients with a history of Myasthenia Gravis (5)?

1. Fluoroquinolones
2. Aminoglycosides (gent, tobra)
3. Macrolides
4. Magnesium
5. Lithium

9

What are contraindications to tPA (11)?

1. Rapidly improving symptoms
2. Intracerebral hemorrhage
3. Seizure with stroke
4. CVA or head trauma in 3 months
5. Major surgery or trauma in 2 weeks
6. BP > 185/110
7. Heparin in 48 hours
8. INR >1.7
9. Plt 400

10

What is the size threshold for treatment of a cerebral aneurysm?

> 7 mm

11

When should Nimodipine be given in the setting of a CNS event, and why?

After SAH to reduce risk of secondary ischemia

12

What is treatment for a prochlorperazine-induced dystonic reaction?

1. Anticholinergics: Benztropine/Diphenhydramine
2. Benzodiazepines

13

1. What is used in Mild Cognitive Impairment?
2. What is used in Mild-Moderate Alzheimers (3)?
3. What is used in Moderate-Severe Alzheimers?

1. COGNITIVE REHAB!!
2. Acetylcholinesterase Inhibitors:
a. Donepezil
b. Rivastigmine
c. Galantamine
3. Memantine

14

What are treatments for Relapsing-Remitting Multiple Sclerosis (5)? Which of these have caveats?

1. HIGH-DOSE Methylprednisolone
2. Interferon-beta (unless liver dz or depression)
3. Glatiramer
4. Natalizumab - risk progressive multifocal leukoencephalopathy
5. Mitoxantrone - risk cardiotoxicity

15

1. What features are not consistent with ALS (3)?
2. What is treatment for ALS?

1. a. Sensory or pain symptoms
b. Cognitive impairment
c. Ocular muscle weakness
2. Riluzole - additional three months

16

1. Which Parkinson medications are used in younger patients less than 65?
2. In older patients more than 65?

1. Dopamine agonists:
a. Pramipexole
b. Ropinirole
2. Levodopa-carbidopa

17

What are the key features to Migraines (5)?

POUND
Pulsatile quality
One-day duration (4-72 hours)
Unilateral location
Nausea or vomiting
Disabling intensity

18

1. What is treatment for Tension Headaches?
2. What is prophylaxis for Tension Headaches?

1. NSAIDs
2. (previously) Tricyclic Antidepressants

19

1. What is treatment for Cluster Headaches?
2. What is prophylaxis for Cluster Headaches?

1. Triptans or corticosteroids and oxygen
2. Verapamil

20

1. What is treatment for Trigeminal Neuralgia?
2. What is prophylaxis for Trigeminal Neuralgia?

1. Carbamazepine
2. None

21

1. What is treatment for Migraines (3 scenarios)?
2. WHEN is prophylaxis for migraines indicated?
3. What is prophylaxis for Migraines (7)?

1. a. First: APAP or NSAIDs or Aspirin
b. Second: Triptan
c. Rescue: Codeine, Hydrocodone, Oxycodone

2. Episodes 8-10 per months

3. a. Topiramate - esp epilepsy
b. Valproic Acid - esp epilepsy
c. Amitriptyline - esp depression
d. Metoprolol - esp HTN
e. Propranolol
f. Timolol
g. Butterbur extract

22

When are triptans contraindicated (2)?

1. OCP
2. Coronary Artery Disease

23

What is treatment for:
1. Partial (simple/complex) Seizures
2. Generalized Seizures

1. a. Carbamazepine
b. Phenytoin
c. Lamotrigine (esp. older)

2. a. Valproic Acid
b. Lamotrigine

24

1. Which seizure medication is "safest" in pregnancy?
2. Which seizure medications should be discontinued in pregnancy (3, highest to lowest risk)?

1. Carbamazepine

2. a. Valproic Acid (category D)
b. Phenytoin
c. Phenobarbital

25

1. What is Tarsal Tunnel Syndrome?
2. How is it treated?

1. Tingling along medial foot to great toe
2. a. Local corticosteroid injection
b. Decompression surgery

26

1. What is Bell Palsy?
2. How is it treated?

1. Upper and lower face weakness
2. Prednisone within 72 hours

27

What is the differential for Mononuritis Multiplex (8)?

1. Vasculitis (painful)
2. Lymphoma
3. Amyloidosis
4. Sarcoidosis
5. Lyme disease
6. HIV
7. Leprosy
8. Diabetes

28

What is treatment for Guillain-Barre?

1. Plasma exchange
2. IVIG

29

1. What is first-line treatment for parenchymal or leptomeningeal tumors?
2. What follows for parenchymal metaseses from known primary tumors?
3. What follows for leptomeningeal metaseses from leukemia and lymphoma?

1. Corticosteroids
2. Whole brain radiation
3. Chemotherapy with MTX and Cytarabine

30

1. What is another name for Idiopathic Intracranial Hypertension and what are its clinical features (4)?
2. What features are found on exam?
3. What is treatment?

1. Pseudotumor Cerebri
a. Headache
b. Pulsatile tinnitus
c. Transient visual obscurations
d. Occurs in obese women
2. Sixth cranial nerve palsy - impaired lateral gaze due to abducens nerve palsy
3. Acetazolamide

31

1. What medication is used for premenstrual-related migraine?
2. What migraine medications are safest during PREGNANCY, as first-line (3)?
3. What migraine medication is safest during breast-feeding (2)?

1. Mefenamic Acid 2 days prior
2. APAP + Metoclopramide/Ondansetron
3. Frovatriptan or Sumitriptan

32

What are features of Multiple System Atrophy (3)?

1. Autonomic - orthostasis
2. Cerebellar - ataxia
3. Extrapyramidal - Parkinson

33

Which seizure medications are preferred in patients with liver disease (3)?

1. Levetiracetam
2. Gabapentin
3. Pregabalin

34

Describe the MMSE scores for the different levels of Alzheimer Dementia (3). Which have recommended regimens?

24-30 = Mild Cognitive Impairment
- Cognitive Rehabiliation

19-24 = Mild ALZHEIMER
- Ach-inh Donepezil, Rivastigmine, Galantamine

10-19 = Moderate ALZHEIMER
- NMDA-blocker Memantine

<10 = Severe

35

What are features of Normal Pressure Hydrocephalus (3)?

1. Wet - Urinary incontinence
2. Wobbly - gait apraxia
3. Weird - dementia

36

1. What is the pathophysiology of Wernicke's encephalopathy?
2. What are its features (4)?

1. Thiamine (B1) deficiency
2. a. Mental status changes
b. Ophthalmoplegia
c. Nystagmus
d. Ataxia - unsteady gait

37

1. What serologic test is useful in the diagnosis of Lambert-Eaton myasthenic syndrome?
2. What nonserologic test can be performed?

1. Voltage-gated P/Q-type calcium channel antibodies
2. Pre- and post-conduction studies - positive if increase in muscle potential amplitude

38

1. Following ischemic stroke treated with tPA, what should the target blood pressures be and for what period of time?
2. What are appropriate treatment options (2)?

1. Less than 180/105 for 24 hours after rtPA treatment
2. IV labetalol or nicardipine

39

What medication is used in the setting of a carotid dissection, and why?

Heparin to prevent distal thromboembolism

40

What are features of Progressive Supranuclear Palsy, including those that distinguish it from Parkinsons (6)?

1. Gait impairment
2. Falls **early
3. Bulbar signs: Dysphagia/Dysarthria
4. OPHTHALMOPLEGIA - vertical then horizontal gaze
5. LACK of tremor
6. LACK of levodopa responsiveness

41

What are characteristic changes to personality following dopaminergic agonists(3), and what is the physiology?

1. New onset Gambling
2. Excessive shopping
3. Hypersexuality

Drugs like Ropinirole or Pramipexole affect dopaminergic reward centers in the brain

42

What scoring measurement is used to determine stroke risk after TIA?

ABCD2 score
- Age greater than 60
- Blood pressure greater 140/90
- Clinical
2 points unilateral weakness
1 points speech impairment without weakness
- Diabetes
- Duration
2 points greater than 60 mins
1 points greater than 10-59 mins

Low risk less than 4 (1.2 - 3.1%)
Moderate risk 4-5 (5.9 - 9.8%)
High risk greater than 5 (11.7 - 17.8%)

43

What are the levels of neurologic lesions (7) and how are they differentiated?

1. Brain
2. Brainstem (CN, cerebellar)
3. Spinal Cord (bowel, bladder, ED)
4. Motor Neuron (only MOTOR, fasciculation)
5. Peripheral Nerve (sensory > motor, distal)
6. Neuromuscular Junction (only MOTOR)
7. Muscle (only MOTOR)

44

1. What EEG finding suggest seizure disorder (2)?
2. What imaging modality is superior in the setting of seizures?

1. a. Sharp waves
b. Spikes

2. MRI with T1-weighted and T2-weighted

45

1. Which seizure medication treats Absence?
2. Which drug exacerbates Absence or Myoclonic?

1. Ethosuximide
2. Carbamazepine

46

What are the three Trigeminal Autonomic Cephalagias? Compare duration, frequency, acute treatment and prevention.

Trigeminal Autonomic Cephalagias - unilateral headache associated with cranial autonomic features (lacrimation, nasal congestion, rhinorrhea, conjunctival injection)

Cluster headache
- Duration 1 hour
- Frequency 1-3 per day
- Acute: Oxygen, Triptans
- Prevent: Verapamil, steriods, etc..

Paroxysmal hemicrania
- Duration 15 mins
- Frequency 11 per day
- Acute: None
- Prevent: Indomethacin

SUNCT (Short-Lasting Unilateral Neuralgiform with Conjunctival injection and Tearing)
- Duration 60 seconds
- Frequency 30-200 per day
- Acute: None
- Prevent: Lamotrigine

47

What are the grades of concussions, and how are they treated differently?

I: No LOC but momentary confusion

II: No LOC but 15 minutes of AMS
- requires medical observation
- no return that day
- imaging if persistent neuro changes

III: LOC
- minimum one week off sports

48

1. In the setting of an ischemic stroke not amenable to tPA, what is the blood pressure goal? How about HEMORRHAGIC stokes?
2. What are exceptions (6)?

1. a. Ischemic = 220/120
b. Hemorrhagic = 160/90 (if s/s ICH 140)

2. Evidence of end-organ damage:
a. Preeclampsia
b. HTN encephalopathy
c. Aortic dissection
d. Cardiac ischemia
e. CHF
f. Acute Kidney Injury

49

What test will distinguish Myasthenia Gravis from Lambert-Eaton?

Edrophonium - AchE inhibitor (reversible)
- Improve muscle strength with MG
- Does not improve with Lambert-Eaton

50

Following hemorrhagic stroke, in how many days can your resume VTE prophylaxis with heparin?

4 days

51

What is a treatment for MS-fatigue (2)?

1. Amantadine - anti-viral and anti-Parkinson
2. Modafinil

52

What migraine prophylaxis medication is contraindicated with nephrolithiasis (2)?

1. Topiramate
2. Zonisamide

**Can cause calcium crystal formation

53

When is nitroprusside contraindication?

After ischemic stroke or hemorrhage because it can lead to INCREASED INTRACRANIAL PRESSURE