Neurology Flashcards
(96 cards)
1
Q
Include variability of symptoms, closing of eyes, long duration of shaking that waxes and wanes, and lack of postictal confusion; confirmation with video electroencephalographic monitoring usually is required?
A
Psychogenic nonepileptic spells/events
2
Q
What is the treatment for a patient who has dementia with Lewy bodies and acute agitation?
A
Donepezil
Haloperidol is absolutely contraindicated in dementia with Lewy bodies; donepezil is a safer alternative and may improve the behavioral and cognitive symptoms associated with dementia.
3
Q
Is appropriate treatment for patients with Parkinson disease who derive a continued benefit from carbidopa-levodopa but experience medication-related complications, such as dyskinesia (involuntary choreic movements).
A
Deep brain stimulation
4
Q
In patients with severe head injury, fever must be controlled aggressively with an agent such as
A
Acetaminophen
5
Q
In ischemic stroke due to intracranial atherosclerosis, the use of __________________________ for secondary stroke prevention is associated with a reduced long-term risk of ischemic stroke.
A
high-intensity atorvastatin therapy
6
Q
Multiple sclerosis–related fatigue is most appropriately treated with
A
A stimulant medication, such as modafinil.
7
Q
In a patient with an unprovoked, first-time seizure, what is the most appropriate initial study?
A
Head CT is the most appropriate initial study to rapidly exclude emergent pathologic issues
8
Q
Treat the symptoms of behavioral-variant frontotemporal dementia, where OCD is the most troublesome manifestations?
A
SSRIs e.g. citalopram to control her obsessive-compulsive behaviors.
9
Q
Evaluate a patient who has a cryptogenic stroke for atrial fibrillation?
A
Outpatient rhythm monitoring may yield a new diagnosis of atrial fibrillation in almost one third of patients.
10
Q
Are the diagnostic procedures of choice for reversible cerebral vasoconstriction syndrome, the second most frequent source of thunderclap headache?
A
Brain magnetic resonance angiography or head CT angiography
11
Q
Is the standard treatment for multiple sclerosis exacerbations.
A
High-dose glucocorticoids
12
Q
A type of tremor occurs both at rest and with action and is characterized by associated dystonic posturing and the presence of a null point at which a change in the position of the affected limb resolves the tremor?
A
Dystonic tremor
Rubral tremor is caused by focal injury to cerebellar outflow pathways and is characterized by a coarse tremor that is present at rest but most severe during action. This type of tremor has a prominent proximal component and interferes with various actions, such as feeding, typing, and writing, in a nonselective way. Also, MRIs of the brain reveal a focal causative lesion that is not present in this patient.
13
Q
Treat convulsive status epilepticus (CSE) in a patient allergic to phenytoin?
A
Valproic acid is an appropriate second-line therapy for convulsive status epilepticus for patients allergic to phenytoin.
IM midazolam, IV lorazepam & IV diazepam are equivalent & are first-line agents. Phenytoin, a longer-acting antiseizure drug, should then be administered; if available, fosphenytoin, a prodrug of phenytoin, is preferable to phenytoin for initial treatment because it can be administered faster & does not carry the risk of thrombophlebitis or skin necrosis (purple glove syndrome) that is associated with phenytoin extravasation.
14
Q
In older patients, _________ can frequently masquerade as cognitive impairment; screening and treatment is appropriate in these patients.
A
Depression
15
Q
This diagnosis is suggested by the presence of choreoathetosis, psychiatric symptoms, seizures, autonomic instability & positive anti–N-methyl-D-aspartate receptor antibody?
A
Ovarian teratoma–associated anti–N-methyl-D-aspartate receptor antibody encephalitis
16
Q
Prevention of episodic migraine and should be considered for migraine occurring at a frequency of at least 5 days per month?
A
Metoprolol, propranolol, timolol, divalproex sodium, and topiramate
17
Q
Treat juvenile myoclonic epilepsy in a woman with childbearing potential?
A
Levetiracetam and lamotrigine are the most appropriate treatment options because of their relatively low risk of teratogenicity.
18
Q
Spinal cord compression from metastatic disease requires emergent use of?
A
High-dose glucocorticoids and urgent surgical decompression followed by radiation.
19
Q
Characterized by rapidly progressive dementia, myoclonus, sleep problems, and other psychiatric symptoms; typical imaging findings include an increased signal in the cortex and subcortical structures on diffusion-weighted MRI sequences?
A
Creutzfeldt-Jakob disease is a transmissible prion-related disorder
20
Q
In a patient with a transient ischemic attack, what is the most appropriate initial imaging test?
A
Carotid duplex ultrasonography is an inexpensive, readily available, and noninvasive imaging modality for identifying high-grade stenosis and the possible need for surgery. Preferred over even a head CT/MRI.
21
Q
Characterized by psychiatric disease, impulsivity, and clinical examination findings of executive dysfunction, dysarthria, incoordination, and ataxia; chorea is a major manifestation? Also, this condition as high suicidality among patients.
A
Huntington disease, an autosomal dominant disorder
22
Q
For patients with mild traumatic brain injury (TBI) who are exposed to dangerous mechanisms of injury, such as falls from greater than 3 feet or 5 stairs, vehicular ejection, or vehicle-pedestrian motor vehicle collisions, what is the next step in management?
A
CT head w/o contrast
23
Q
In a patient with fluctuating weakness of the cervical muscles that worsens in the evening, what condition should be suspected?
A
Myasthenia gravis.
Note: Weakness of cervical extension is a hallmark of muscle-specific kinase (MuSK) antibody–positive myasthenia gravis.
24
Q
Is a cognitive state between normal aging and dementia characterized by a decline in cognitive functioning that is greater than what is expected with normal aging but has not resulted in significant functional disability.
A
Mild cognitive impairment
25
In a patient with multiple sclerosis and mixed urinary symptoms that suggest both a hypertonic and a hypotonic bladder, what is the most appropriate next step?
Urodynamic testing to guide medication choices is appropriate, as are the potential use of urinary catheterization and monitoring of postvoid residuals while the patient is treated.
26
In patients with glioblastoma multiforme and pulmonary embolism, anticoagulation with?
Heparin is the most appropriate treatment
27
Is characterized by the presence of a monoclonal plasma cell disorder, peripheral neuropathy, and one or more of the following: osteosclerotic myeloma, Castleman disease (angiofollicular lymph node hyperplasia), elevated serum vascular endothelial growth factor, organomegaly, endocrinopathy, edema, typical skin changes, and papilledema.
POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes).
POEMS syndrome is typically secondary to an underlying cancer; identification and treatment of the underlying cancer leads to improvement of the neuropathy.
28
Type of seizure were altered awareness typically are infrequent, are associated with warning symptoms (aura), last more than 30 seconds, have associated mouth or limb automatisms (semipurposeful repetitive movements), and are followed by confusion and/or exhaustion.
Focal seizures
29
Is characterized by subacute severe pain followed by resolution of pain and progressive weakness and atrophy involving the shoulder girdle and upper extremity muscles; this syndrome often is triggered by a preceding event, such as an infection or surgery?
Idiopathic brachial plexopathy (also known as neuralgic amyotrophy and Parsonage-Turner syndrome)
30
First-line agents used to treat **Tourette syndrome** when the associated tics interfere with education, daily function, or work are
**_Clonidine_**, guanfacine, topiramate, and tetrabenazine
Second-line treatments include antipsychotic agents (such as haloperidol), but their benefit should be weighed against risk of tardive dyskinesia.
31
For patients with a history of episodic migraine with typical aura that no longer responds to appropriate NSAIDs, guidelines recommend the use of
Triptans
32
Typically associated with tunnel vision, palpitations, short duration of loss of consciousness (\<1 minute), movements and shaking, and immediate and complete neurologic recovery?
Convulsive syncope
33
Sleep-disordered breathing is a leading cause of fatigue, headaches, and difficult-to-control hypertension & is highly prevalent in patients with any form of stroke, and the best diagnostic test is
Polysomnography
34
Treat multiple sclerosis in a patient with hepatic disease?
Interferon beta preparations or glatiramer acetate are considered first-line agents for relapsing-remitting multiple sclerosis, given their favorable risk profiles; **_glatiramer acetate_** is preferred in patients with liver disease.
Liver dysfunction is a potential adverse effect of fingolimod, the interferon beta preparations, and natalizumab. Also, use of natalizumab as a first-line agent would be inappropriate.
35
Characterized by upper motor neuron signs (hyperreflexia, spasticity, and an extensor plantar response) coexistent with lower motor neuron findings (atrophy and fasciculation); sensory deficits are characteristically absent.
Amyotrophic lateral sclerosis
36
Painful ophthalmoplegia affecting multiple nerves involved with extraocular movement indicates a pathologic process in the
**_Cavernous sinus_** or superior orbital fissure
37
In patients with TIA or non disabling stroke with \> 70% carotid stenosis, what is the next step in management?
Carotid endarterectomy within 2 weeks
38
Diagnose normal pressure hydrocephalus (NPH)?
**_Lumbar puncture_** with removal of a large volume of cerebrospinal fluid (CSF) and subsequent measurement of CSF opening pressure can help confirm the diagnosis and determine if the NPH is reversible.
39
The presence of new-onset status epilepticus and progressive confusion in a previously healthy patient strongly suggests a diagnosis of?
Autoimmune limbic encephalitis.
This condition is marked by the presence of hyponatremia, myoclonus, and limbic encephalitis (amnesia, temporal lobe seizures, and confusion). Although many neurologic autoimmune disorders are paraneoplastic, primary autoimmune disorders with no accompanying cancer may occur.
40
In a patient with treatment-refractory depression who also has cognitive and functional decline?
Neuropsychological testing can be useful in identifying a pattern or degree of cognitive impairment that is not typical of depression-related cognitive impairment.
41
Patients having ongoing focal seizures with altered awareness (formerly known as complex partial seizures) because of temporal lobe epilepsy despite taking two antiepileptic drugs and should be referred to an epilepsy center for?
Video electroencephalography (EEG)
Video EEG is the first step in determining candidacy for surgery by confirming that the seizures seen on video EEG match the location of abnormal findings on MRI. Use of a vagus nerve stimulator is a palliative measure, is unlikely to result in freedom from seizures, and should be offered only if resection is not an option.
42
In patients with symptomatic aneurysms or aneurysms of 7 millimeters or greater in the posterior circulation (posterior communicating and basilar arteries)?
Surgical treatment with clipping or endovascular coiling can be considered
43
For a Parkinson's patient displaying psychosis, impulse control disorder, punding (which is a complex prolonged, purposeless, and stereotyped behavior such as collecting, sorting, cataloguing, or assembling and disassembling common objects), sleep attacks, ankle edema, and confusion, considered
Discontinuing dopamine agonist such as Pramipexole.
Note: Pimavanserin, a nondopaminergic atypical antipsychotic agent and selective serotonin 5-hydroxytryptamine receptor 2A inverse agonist, is the only FDA-approved medication for Parkinson psychosis. Quetiapine and clozapine also can be considered in this setting, but most other atypical antipsychotic agents (including aripiprazole, risperidone, and olanzapine) and all typical (first-generation) antipsychotic agents should be avoided.
44
In a patient with a thunderclap headache and normal findings on a CT scan of the head, which test should be performed next?
Lumbar puncture in order to diagnose subarachnoid hemorrhage.
This test has a higher yield 12 hours or longer after headache onset when erythrocyte breakdown products will produce a yellow color (xanthochromia).
45
In a patient with progressively worsening headaches, nausea, visual disturbance, difficulty speaking & multiple ocular palsies, where primary central nervous system lymphoma (PCNSL) is suspected, but inaccessible, how to diagnosed?
Slit-lamp examination and **_vitreous fluid sampling_**
PCNSL is a non-Hodgkin lymphoma that can affect any part of the central nervous system but commonly presents as a focal supratentorial lesion. Also, commonly seen in HIV pts.
46
The disorder periodic limb movements of sleep is characterized by periodic leg kicks that often exhibit a stereotyped triple-flexion phenomenology repeating periodically during sleep; if no associated sleep disorder is present, the best management is?
Reassurance
47
Typical symptoms include severe headache, nausea with vomiting, with a lucid period with eventual impairment in consciousness with neurologic deterioration.
Epidural hematoma
## Footnote
Emergent surgical evacuation is required for those with anisocoria, a Glasgow Coma Scale (GCS) score of less than 9, or a hematoma volume greater than 30 mL.
Subdural hematomas are collections of blood between the brain & the dura mater. Most involve rupture of bridging veins. Because of cerebral atrophy & stretching of these veins, older patients are particularly vulnerable. Can occur spontaneously or as a result of cranial trauma, & presentations range from acute to chronic.
48
Associated with *_exercise intolerance*_, cramping, _*myalgia, mild weakness, “second-wind” phenomenon, and myoglobinuria_*?
McArdle disease (metabolic myopathy), glycogen storage disease V. Eating a carbohydrate-rich diet before exercise can protect against severe exercise intolerance.
Note: Acute intermittent porphyria (AIP), characterized by acute attacks of abdominal pain & vomiting and by central, peripheral, sensory, motor, autonomic, & enteric nervous system abnormalities. Patients may have episodes of reddish-brown urine (porphobilin & porphyrins) during an acute attack.
49
Commonly occurs in dementia with Lewy bodies (DLB) and can help distinguish DLB from Alzheimer disease & other cognitive disorders?
Rapid eye movement sleep behavior disorder
50
Patients who have intracerebral hemorrhage without elevated intracranial pressure whose systolic blood pressure is greater than 180 mm Hg should be treated with
Nicardipine, to a target blood pressure of 140 mm Hg.
Note: Nitroprusside is not a first-line blood pressure treatment for patients with acute hemorrhagic stroke, given its potential for increasing ICP.
51
Cluster headache, the most common of the trigeminal autonomic cephalalgias, is best prevented with
Verapamil
Risk factors: Male sex a & tobacco use are two potential. Common trigger during an active cycle: alcohol. Attack duration is between 15- 180 minutes & may occur 1-8 times daily for several weeks or months. Oxygen inhalation and SC sumatriptan are first-line therapies.
52
Characterized by predominantly sensory and motor peripheral neuropathy and/or autonomic neuropathy; it is diagnosed by detecting a mutation of the transthyretin gene (TTR). Also *_B/L carpal tunnel syndrome & family h/o of neuropathy_*
Familial amyloidosis
Affected patients often have multiorgan involvement (diseases of the eye [glaucoma] and the neurologic, gastrointestinal, cardiac, and urinary systems)
53
Nonconvulsive status epilepticus (such as twitching of the shoulders & eyelids) should be suspected in patients with critical illness who develop altered mental status; the diagnosis is confirmed with
Continuous (24-hour) electroencephalography (EEG)
54
Subacute combined degeneration is a myelopathy manifesting as dysfunction of the corticospinal tracts and dorsal columns that is caused by
**_Vitamin B_****12** and copper deficiencies
previous chronic abuse of nitrous oxide can result in a functional B12 deficiency that is due to inactivation of the vitamin.
55
In patients with multiple sclerosis and impaired mobility,
Dalfampridine is the most appropriate medication
56
Acute or subacute pain and paresthesia in a dermatomal pattern in the thoracic or abdominal region in a patient with diabetes mellitus and no evidence of herpes zoster is most likely due to
Diabetic mononeuropathy
57
In a patient with suspected spinal cord compression, the next step in management is?
Emergent MRI of the lumbosacral spine is the most appropriate test both to localize the injury and to determine its cause.
58
In a patient with suspected idiopathic intracranial hypertension (IIH),
Lumbar puncture is required to confirm the diagnosis.
Causes of IIH include: obesity, Minocycline or other tetracyclines, Retinoic acid, estrogen & progesterone supplements, & glucocorticoids. Papilledema is characteristic; abducens nerve (cranial nerve VI) palsy occurs occasionally. Treatment of choice is acetazolamide.
59
Treat asymptomatic extracranial carotid artery stenosis with?
Statin therapy is indicated for asymptomatic carotid stenosis of 60% to 80%.
60
A hospitalized patient with Guillain-Barré syndrome who exhibits improvement after an initial course of plasma exchange should be discharged to
Rehabilitation
Note: GBS: CSF albuminocytologic dissociation (elevated protein, normal leukocyte count)
61
Which antiepileptic does not worsen bone loss/osteoporosis in patient's with epilepsy?
**_Lamotrigine_ & Levetiracetam** do not have the potential to cause or worsen osteoporosis in patients with epilepsy.
*_Carbamazepine, phenytoin, and phenobarbital*_ are all inducers of the cytochrome p450 system; these drugs increase breakdown of vitamin D, which results in increased parathyroid hormone levels, & thus cause bone loss/osteoporosis. _*Valproic acid_* also is associated with bone loss, although the mechanism of this effect is unclear. All patients on chronic AED therapy with phenytoin, carbamazepine, phenobarbital or valproic acid should undergo initial bone densitometry testing after 5 years of therapy.
62
Is indicated for all nonhypotensive patients with subarachnoid hemorrhage and is associated with improved neurologic outcomes and survival.
Nimodipine
63
This test is the most sensitive predictor of the risk of backward falls in Parkinson disease.
The pull test
64
is characterized by transient localized stabs of head pain that occur spontaneously in the absence of organic disease and typically last seconds; this headache is common among those with a history of migraine
Primary stabbing headache (also known as an “ice-pick” headache)
65
Is the most appropriate treatment for epilepsy with focal seizure (formerly known as complex partial seizures) in older patients because of strong evidence of its safety and effectiveness.
Lamotrigine
Only a few antiepileptic drugs (AEDs): lamotrigine, levetiracetam, topiramate, valproic acid, & zonisamide are considered broad-spectrum agents & can be used to treat both generalized and partial epilepsy syndromes. Other narrow-spectrum AEDs (such as carbamazepine, gabapentin, oxcarbazepine, phenobarbital, phenytoin, & pregabalin) have the potential to exacerbate seizures in patients with generalized epilepsy.
66
Typically involves an alteration in personality and behavior that develops years before the onset of cognitive impairment.
Frontotemporal dementia
Altered behaviors typically manifest as OCD tendencies, impulsivity, apathy, impaired judgment, emotional coldness, disinhibition, excessive spending, & excessive eating, particularly of high-calorie, non-nutritional foods. Amyotrophic lateral sclerosis, the major form of motor neuron disease, is found in 20% to 30% of patients diagnosed with behavioral-variant FTD.
67
The combination of parkinsonism, cerebellar ataxia, dysautonomia, and early postural instability characterizes
Multiple system atrophy, a Parkinson-plus syndrome.
Note: Progressive supranuclear palsy is the main differential diagnosis. However, without the characteristic impairment in vertical extraocular movements (supranuclear gaze palsy), progressive supranuclear palsy is ruled out. Also, anosmia and acting out of dreams during sleep are suggestive of multiple system atrophy and Parkinson disease but not of progressive supranuclear palsy.
68
Is the most appropriate test to determine candidacy for endovascular therapy in patients with a cardioembolic stroke who have undergone thrombolysis.
CT angiography of the head
69
Brain herniation in a patient with a malignant primary brain tumor causing mass effect & compression should be emergently treated with a
Dexamethasone
70
Although evidence is limited, carbapenems, fluoroquinolones, and fourth-generation cephalosporins (e.g. Cefepime) may lower the seizure threshold and thus should be avoided in patients with epilepsy. Name 1 antibiotics that has the weakest association to trigger seizures?
Piperacillin-tazobactam & non–fourth-generation cephalosporins
71
Requires at least five episodes lasting 4 to 72 hours when untreated (or unsuccessfully treated), with pain exhibiting two of the following characteristics: unilateral location, throbbing nature, moderate to severe intensity, and worsening with physical activity; associated features must include either *_nausea or a combination of photophobia and phonophobia_*.
Migraines
72
In the absence of thrombolytic therapy for cardioembolic stroke, short-term therapy with
Aspirin reduces the risk of stroke at 2 weeks.
Note: Heparin is not effective in reducing the risk of recurrent stroke within the acute hospitalization period in patients with all stroke subtypes, including ischemic strokes with a cardioembolic cause. Intravenous heparin can be considered in patients with a high short-term risk of recurrent ischemic stroke, such as those with mechanical heart valves, but the benefit of this approach must be weighed against the risk of hemorrhagic conversion.
73
When managing mild TBI in an athlete, besides initial screening with a symptom checklist and a neurologic examination, including assessments of cognition and balance, what else should be done for a patient that is still. symptomatic?
Neuropsychological testing should be part of a comprehensive mild traumatic brain injury management strategy for patients with persistent symptoms.
74
Treatment of vascular cognitive impairment should focus on identifying and treating cerebrovascular risk factors; off-label use of
Acetylcholinesterase inhibitors such as **_Donepezil_** has shown modest benefit in clinical trials and thus is generally recommended for this condition.
75
Immune-mediated necrotizing myopathy is a form of statin myopathy that is associated with antibodies to hydroxymethylglutaryl coenzyme A reductase and biopsy evidence of muscle necrosis without inflammation; treatment with a
Glucocorticoid or other immunosuppressive agents can reverse the myopathy
76
What is the initial treatment of choice for patients with intracranial hypotension that presents with orthostatic headaches; CT myelography is appropriate for those who do not respond to this treatment?
Placement of an epidural blood patch
77
Because multiple sclerosis (MS) is the most common cause of transverse myelitis, ______________ should be performed in patients with new-onset transverse myelitis to evaluate for MS lesions.
MRI of the brain
Note: The presence or absence of oligoclonal bands is not part of multiple sclerosis diagnostic criteria because of poor sensitivity and specificity for the disease. Approximately 10% to 15% of patients with MS have normal cerebrospinal fluid on testing; additionally, oligoclonal bands are sometimes elevated in other inflammatory conditions.
78
To prevent venous thromboembolism after a hemorrhagic stroke?
Prophylactic LMW heparin can be started 48 hours after a hemorrhagic stroke to prevent development of DVT as long as there is no evidence of active bleeding on neuroimaging.
Note: Aspirin can be resumed in patients with ICH caused by hypertension 2 to 4 weeks after stroke onset if the hematoma has resolved on imaging and there is an appropriate high-risk indication.
79
Most patients with chronic cervical and lumbar stenosis respond well to
conservative measures, such as **_physical therapy_** and pain control.
80
Relative contraindications for the use of cholinesterase inhibitors (such as Donepezil) in the treatment of dementia include sick sinus syndrome, left bundle branch block, uncontrolled asthma, angle-closure glaucoma, and ulcer disease. Thus, what's an alternative treatment?
Memantine
81
Is the most appropriate diagnostic study for patients with a suspected secondary headache and should be performed before additional testing is considered.
Brain MRI
82
In patients with multiple sclerosis who take fingolimod as a disease-modifying therapy, monitoring for this specific adverse effect with?
Regular ophthalmic examinations are necessary because of the increased risk of macular edema with this medication.
Fingolimod also requires first-dose monitoring because of the first-dose bradycardia that occurs in most patients & should not be used in patients with heart block.
83
Is a language-predominant neurodegenerative dementia in which language is often the only cognitive domain affected for years before the development of additional cognitive deterioration; structural brain imaging often shows asymmetric involvement of the left temporal lobe.
Primary progressive aphasia (AKA language-variant frontotemporal dementia)
84
Can be caused by exposure to dopamine-blocking agents, such as neuroleptic and antiemetic agents, and may persist for more than 6 months with constant choreiform movements of the face, lips, & hands after removal of the offending medication or become permanent?
Tardive dyskinesia
85
After the initial hospitalization, however, the risk of recurrent ischemic and hemorrhagic stroke remains increased if the blood pressure is higher than 130/80 mm Hg, and should be treated with?
Antihypertensive such as Lisinopril
86
Treat Bell palsy?
BP: Unilateral facial weakness involving both upper & lower parts of the face, while a stroke typically spares the upper facial muscles because of bilateral innervation. Features of classic Bell palsy include alteration in taste (due to involvement of the chorda tympani) & hyperacusis (intolerance of loud noise due to involvement of stapedius muscle); & ipsilateral sensory paresthesia & pain without objective sensory loss.
**_Oral prednisone_** administered within 72 hours of symptom onset expedites the speed and rate of recovery.
Note: The effectiveness of valacyclovir, is controversial. Currently, no available evidence suggests that adding antiviral therapy improves prognosis.
87
the treatment of choice for trigeminal neuralgia?
Carbamazepine; management with this agent requires serum monitoring for hyponatremia & agranulocytosis.
88
In a patient with signs and symptoms of idiopathic transverse myelitis in whom first-line treatment with a high-dose intravenous glucocorticoid has been ineffective, the next treatment should be?
Plasma exchange therapy
Note: Presentation of subacute onset of weakness, sensory changes, & bowel or bladder dysfunction, which is sometimes preceded by back pain or a thoracic banding sensation.
89
Adjuvant therapy with _____________________ in patients with relapsing-remitting multiple sclerosis provides additional disease activity control.
Vitamin D supplementation
90
In a patient with mild cognitive impairment, what additional test could be used to identify Alzheimer disease?
*Decreased Aβ42 peptide and increased tau protein and p-tau levels* in the **_cerebrospinal spinal fluid_** have a greater than 80% sensitivity and specificity in identifying Alzheimer disease as the cause.
Note: Serum apolipoprotein-E (*ApoE*) allele testing provides no useful information for diagnosing cognitive disorders. *ApoE* is a gene that can indicate a patient's risk for Alzheimer dementia but adds little to the prediction of progression of symptoms from MCI.
91
After thrombolytic therapy for acute stroke, when should BP be treated?
**_Antihypertensive treatment is not necessary_** if blood pressure is *_less than 180/105 mm Hg_* and there are no symptoms of intracerebral hemorrhage.
92
The three core phenotypes of multiple sclerosis can be modified by:
the *_presence of activity*_ (clinical relapse or new/enlarging MRI lesion); _*primary and secondary progressive*_ multiple sclerosis can be further _*modified as “progressive”_* if there is ongoing accumulation of neurologic deficits independent of clinical relapses.
93
In a patient with generalized epilepsy and psychiatric disease, which AED is best?
Lamotrigine is an appropriate medication to use not only because of its effectiveness as treatment for generalized tonic-clonic seizures, but also because of its mood-stabilizing effects.
It is commonly prescribed in women with childbearing potential & is a good option for older patients.
94
Is characterized by prominent action-induced myoclonus that impairs ambulation because of a combination of positive (rapid jerky movements) and negative (lapses in muscle tone) myoclonus.
Posthypoxic myoclonus, which occurs in patients with a history of hypoxic brain injury
95
This should be performed in a patient with minor symptoms of cognitive impairment and self-reported daytime sleepiness who scores normally on cognitive and depression assessments?
Polysomnography
96
What is the treatment of cognitive deficits in Multiple sclerosis?
**_Cognitive rehabilitation_** approaches, such as the development of accommodative strategies & training with challenging cognitive tasks, have been shown to improve symptoms.
Note: No pharmaceutical agent has been shown to improve these symptoms in MS patients.
