Neurology

Question 1

Contraindications to triptans (I.e. sumatriptan)

Answer 1

CAD
Vasculitis
Pregnancy

Question 2

Management for refractory migraines (lasting > 72 hours)

Answer 2

IV prochlorperazine or metoclopramide + IV diphenhydramine

OR

IV Dihydroergotamine

Question 3

Prophylaxis for migraines < 15x per month

Answer 3

Beta blockers
Topiramate
Valproate
Amitryptyline

Question 4

Prophylaxis for migraines > 15x per month

Answer 4

1) Topiramate

2) Botox

Question 5

Recurrent unilateral/retro-orbital headaches > 6-10x per day lasting 15-20 min.

Management

Answer 5

Dx: Chronic paroxysmal headaches

Tx: Indomethacin

Question 6

Headache with obesity and vision problems and/or blurring of optic disc margins (papilledema).

Answer 6

Idiopathic intracranial hypertension

Question 7

Management for trigeminal neuralgia

Answer 7

MRI Brain

Carbamazepine

Question 8

Ptosis, miosis, anhydrosis

Answer 8

Compression if sympathetic chain (I.e. pancoast tumor - CXR; or carotid artery dissection - CTA neck)

Question 9

Ptosis + mydriasis

Answer 9

Berry aneurysm compression of CN III

Question 10

Optic nerve lesion

Answer 10

Ipsilateral complete blindness

Question 11

Optic chiasm lesion

Answer 11

Bitemporal hemianopia

Question 12

Optic tract lesion

Answer 12

Contralateral dense homonymous hemianopia

Question 13

Optic radiation lesion

Answer 13

Contralateral homonymous quadrantanopia / dense hemianopia / macular sparing

Question 14

Carotid artery syndrome

Answer 14

Ipsilateral visual loss

Contralateral motor or sensory changes

Question 15

Vertebrobasilar syndrome

Answer 15

Dizziness
Diplopia
Dysarthria

Question 16

Most important risk factor for stroke

Answer 16

Hypertension

Question 17

Symptomatic with > 70% carotid artery stenosis

Answer 17

Carotid endarterectomy + ASA

Question 18

Symptomatic with > 70% carotid artery stenosis and NOT surgical candidate

Answer 18

Transcarotid stent + ASA

Question 19

Symptomatic with < 50% carotid artery stenosis

Answer 19

ASA

Question 20

Asymptomatic with > 80% carotid artery stenosis

Answer 20

Carotid endarterectomy + ASA

Question 21

Asymptomatic + total carotid artery occlusion

Answer 21

Medical management (collaterals present)

Question 22

HTN, visual disturbances with hemianopsia/auras/cortical blindness. MRI brain with white matter edema in parietal-occipital region

Answer 22

Posterior reversible encephalopathy syndrome

Question 23

Ipsilateral loss of pain/temp in face

Contralateral loss of pain/temp in body

Answer 23

Lateral medullary syndrome

Wallenberg syndrome - posterior inferior cerebella artery

Question 24

Hemiparesis with involuntary shaking movements
Quadriplegia
Locked-in syndrome

Answer 24

Basilar artery stroke

Question 25

Hyperdense lesion in parietal area suggestive of subarachnoid hematoma

Answer 25

Amyloid angiopathy

Question 26

Management for subarachnoid hemorrhage

Answer 26

angiogram and endovascular clip

Question 27

Management for Vasospasm In subarachnoid hemorrhage

Answer 27

Nimodipine

Question 28

ONLY horizontal nystagmus

Answer 28

Peripheral vertigo

Question 29

Peripheral vertigo + hearing loss

Answer 29

Labyrinthitis | Meniere’s disease

Question 30

Veritgo, tinnitus + 1) fluctuating hearing loss 2) progressive hearing loss

Answer 30

1) Ménière’s disease | 2) acoustic neuroma

Question 31

``` Brain atrophy (enlarged sulci) on CT/MRI with dilated ventricles. Increased Beta amyloid. Telomere short lengthened. ```

Answer 31

Alzheimer’s disease (most common cause of dementia)

Question 32

Management for Alzheimer’s

Answer 32

Mild (MMSE 21-25): anticholinesterase (donepezil, galantamine, rivastigmine) Mod (MMSE 11-20): anticholinesterase + memantine (NMDA antagonist) Severe (MMSE < 10): palliative

Question 33

Adverse effects of cholinesterase inhibitors

Answer 33

Syncope Bradycardia with increased PPM placement Hip fracture

Question 34

60 y/o. Cognitive impairment. Poor short-term memory. Can’t recall names. Paranoid delusions.

Answer 34

Alzheimer’s disease

Question 35

Dementia with Visual hallucinations. | Cytoplasmic inclusion bodies and alpha-synuclein protein

Answer 35

Dementia with Lewis Bodies

Question 36

Dementia Hereditary Choreiform movement

Answer 36

Huntington disease

Question 37

Loss of interest. Disinhibition. Urinates on neighbors lawn. Hypersexual.

Answer 37

Frontotemporal dementia

Question 38

Dementia. Urinary incontinence. Wide-based gait. Enlarged ventricles. Not enlarged sulci

Answer 38

Normal pressure hydrocephalus

Question 39

Internuclear ophthalmoplegia | Inability to addiction ipsilateral eye. Nystagmus of Contralateral abducting eye

Answer 39

Medial longitudinal fasciculus

Question 40

Paresthesias Vibration/position sense loss Weakness, spasticity, hyperreflexia Optic neuritis

Answer 40

Multiple sclerosis | demyelination of white matter

Question 41

Management for acute relapse of Multiple sclerosis (INO, optic neuritis, functional impairment)

Answer 41

IV methylprednisolone 1g OD x 3-5 days

Question 42

Check for JC antibodies prior to starting this.

Answer 42

Natalizumab

Question 43

Resting pronation/supination tremor Cog wheel rigidity Retarded movement Loss of reflex (frequent falls)

Answer 43

Parkinson’s disease | Decreased dopamine in substantia nigra

Question 44

Adverse effects of levodopa

Answer 44

Involuntary movements Psychiatric symptoms On-off phenomenon (alternating hyper/hypokinesia

Question 45

Management for on-off phenomenon with levodopa

Answer 45

Take with low protein meal Increase dose/dosing frequency consider adding selegiline/rasagiline

Question 46

Antero-posterior flapping tremor Exacerbates with anxiety Alleviates with alcohol Management

Answer 46

Dx: Essential tremor Tx: propranolol. Then primidone

Question 47

Progressive weakness throughout the day. Diplopia/ptosis. DTRs normal.

Answer 47

Myasthenia Gravis

Question 48

Work-up for myasthenia gravis

Answer 48

1) Ach receptor Abs (post-synaptic) 2) nerve stimulation studies 3) CT chest (r/o thymoma)

Question 49

Management for myasthenia crisis

Answer 49

1) PLEX 2) immunoglobulins 3) steroids

Question 50

Weakness gets better with activity Hyporeflexi +ptosis No diplopia

Answer 50

Lambert-Eaton syndrome

Question 51

Only motor deficits UMN and LMN lesions Sensation intact Management

Answer 51

Dx: ALS Tx: Riluzole

Question 52

LMN (UL weakness, starts in hands and moves proximal) and sensory (pain/temp sensation loss) changes

Answer 52

Syrinogomyelia | Cavitation of central spinal cord

Question 53

Foot drop Cannot invert foot Cannot evert foot

Answer 53

L5 radiculopathy | Lumbar vertebral foramina

Question 54

Foot drop Can Invert foot Cannot evert foot

Answer 54

Peroneal n. Injury | Fibular head

Question 55

Management for foot drop with high steppage gait

Answer 55

Foot ankle orthosis

Question 56

Etiology and management of spinal stenosis

Answer 56

Etiology: hypertrophy of ligamentum flavum Tx: PT. Not surgery

Question 57

CSF value in Guillain-Barré syndrome

Answer 57

Increased protein | Normal WBCs

Question 58

Descending paralysis Blurred vision, diplopia, dysarthria, dysphagia, diarrhea Dilated pupils

Answer 58

Botulism toxicity

Question 59

Extreme focal tenderness with light touch | Bluish discoloration

Answer 59

Complex regional pain syndrome | Reflex sympathetic dystrophy

Question 60

Antiepileptic that causes kidney stones

Answer 60

Topiramate

Question 61

Best AED with depression

Answer 61

Lamotrigine

Question 62

AED that causes hyperammonemia

Answer 62

Valproate

Question 63

Seizure with epigastric rising sensation, psychic sensation, deja vu

Answer 63

Focal unaltered awareness seizure (temporal lobe)

Question 64

Seizure that spreads from UE to ipsilateral LE followed by weakness

Answer 64

Jacksonian seizure (frontal lobe)

Question 65

Enhancing lesion | T cells < 50

Answer 65

Lymphoma

Question 66

Ring enhancing lesion | Gray-white matter junction

Answer 66

Brain abscess

Question 67

Multiple ring enhancing lesions | T cells < 100

Answer 67

Toxoplasmosis

Question 68

Multiple non-enhancing lesions | T cells < 200

Answer 68

Progressive multifocal leukoencephalopathy

Question 69

White matter plaques, enhance with activity

Answer 69

Multiple sclerosis

Question 70

High frequency hearing loss

Answer 70

Presbycusis

Question 71

Brachial plexopathy (lower) + Horners Syndrome

Answer 71

Cancer invasion

Question 72

Brachial plexopathy (upper) + Paresthesias, fasciculations

Answer 72

Radiation injury