Neurology

Question 1

What causes bells palsy?

Answer 1

Acute neuritis of the facial nerve d/t virus, autoimmune or idiopathic cause (HSV can cause)

Question 2

What is the key sign of Bells Palsy?

Answer 2

Acute unilateral facial paralysis

Question 3

What are some risk factors for bells palsy?

Answer 3

Diabetes, pregnancy, recent infection, family hx, HTN, hypothyroidism

Question 4

Aside from unilateral facial paralysis, what are some other accompanying symptoms of bells palsy?

Answer 4

Inability to close one eye, sagging of the affected side eyelid, mouth drawn to affected side, ipsilateral retroauricular pain

Question 5

What is another syndrome that can be confused with Bells palsy?

Answer 5

Ramsey Hunt syndrome

Question 6

What are some differentials for a pt with symptoms consistent with bells palsy?

Answer 6

Ramsey Hunt, stroke, Lyme disease, parotid gland tumour/neoplasm

Question 7

When are symptoms expected to resolve with Bell’s Palsy?

Answer 7

Symptoms should resolve within 4 weeks, if not, refer to neuro

Question 8

What are the two types of vertigo?

Answer 8

Central and peripheral

Question 9

What are potential causes of central vertigo?

Answer 9

Brainstem dysfunction affecting vestibular nuclei/their connections, can be secondary to structural lesion such as neoplasm or ischemia

Question 10

What is common with central vertigo?

Answer 10

Have spinning feeling but likely also have other symptoms such as diplopia, dysphagia, weakness, sensation disruption, etc.

Question 11

What is the most common cause of peripheral vertigo?

Answer 11

BPPV (benign paroxysmal positional vertigo)

Question 12

What are common symptom’s of Meneires disease?

Answer 12

Severe vertigo, tinnitus, hearing loss

Question 13

What is Menieres disease?

Answer 13

Disorder of the inner ear (labrinyth)

Question 14

What are risk factors for BPPV?

Answer 14

Age, recent infection, family hx, gender (female), trauma, stress, emotions, positions

Question 15

What test should you complete when assessing for peripheral vertigo?

Answer 15

Dix-Hallpike (gold standard for BPPV)

Question 16

What are the three types of migraine?

Answer 16

Migraine with aura, migraine without aura, and chronic migraine

Question 17

What are some possible triggers for migraines?

Answer 17

Family hx, chronic use of OTC analgesics, trauma, food/lack of food/light/sleep/weather/hormones, menstruation, obesity, estrogen use, daily habitual snoring?

Question 18

What are common findings of migraines?

Answer 18

Unilateral headache, photophobia, phonophobia, osmophobia (hypersensitivity to smell), nausea with/without vomiting

Question 19

What are typical aura symptoms and when do they occur?

Answer 19

Usually precede the onset of the headache by 20-30 minutes. Sensory disturbances (dots, sparks, etc.) dizziness, inability to speak, etc.

Question 20

Headache red flags?

Answer 20

Fever, weight loss, night sweats, altered mental status/confusion, seizures, thunderclap headache, neck stiffness, headache with papilledema

Question 21

What are the triad of symptoms for meningitis?

Answer 21

Nuchal rigidity, fever, altered mental status

Question 22

What are two physical tests to screen for meningitis?

Answer 22

Brudinski’s sign and Kernig’s sign

Question 23

What labs should be done for meningitis?

Answer 23

LP**, CBC, coags, metabolic panel, blood cultures

Question 24

What is Parkinson’s?

Answer 24

Progressive, chronic neurologic syndrome characterized by combo of akinesia/ bradykinesia, reduction of spontaneous activity and movement, rigidity, increase in spontaneous muscle tone and involuntary movement/tremor

Question 25

Risk factors for Parkinson?

Answer 25

Idiopathic, atherosclerosis, hx of head trauma, toxins, drugs, presence of Lewy bodies

Question 26

What are the cardinal symptoms of Parkinsons?

Answer 26

Resting tremor, rigidity (joints rigid, increased resistance to passive movement), bradykinesia (slow voluntary movement)

Question 27

What key exams should be done in Parkinsons?

Answer 27

Neuro exam, rapid alternating movements, assessing for tremor, cogwheel phenomenon (can see the rigidity of movement), MSE, scales

Question 28

What are focal seizures?

Answer 28

Generally only involve one portion of the brain, is most common type

Question 29

What are the different types of generalized seizures?

Answer 29

Tonic-clonic, absent, myoclonic, atonic

Question 30

What is the gold standard diagnostic test for temporal arteritis?

Answer 30

Temporal artery biopsy

Question 31

What diagnostic test aids in diagnosing BPPV?

Answer 31

Dix-Hallpike

Question 32

When to complete HINTS exam?

Answer 32

When suspecting vestibular neuritis or cerebellar stroke

Question 33

What should be completed in a physical exam for headache?

Answer 33

Neurologic exam including cranial nerves, neck examination, BP/vitals, jaw assessment for TMJ if relevant

Question 34

What are the criteria for medication-overuse headache?

Answer 34

Headache on 15 or more days a month, assess medications (triptans, ergots, combination analgesia, opioids for greater than 10 days, tylenol greater than 15 days)

Question 35

When should a CT be considered prior to a LP?

Answer 35

Focal neurologic signs, presence of papilloedema, continued/uncontrolled seizures, decreased LOC

Question 36

Is imaging recommended for migraines?

Answer 36

No-not if pt meets criteria for migraines and has a normal neurologic exam

Question 37

What is the diagnostic criteria for chronic migraines?

Answer 37

Pt meeting migraine criteria with headache for 15 days or greater for longer than 3 months

Question 38

What are hallmark signs of a tension-type headache?

Answer 38

Bilateral mild-moderate band-like squeezing pain across the forehead, usually episodic and gradual onset, can occur from minutes to days

Question 39

What is the typical cause of vestibular neuritis?

Answer 39

Unilateral inflammation of CN8 (acoustic) following a viral infection

Question 40

What is the usual cause of labyrinthitis?

Answer 40

Inflammation of the labyrinth following infection

Question 41

What are some triggers for Menieres attacks?

Answer 41

Alcohol, travel, smoking, stress, fatigue, hormones, weather

Question 42

What are some risk factors for Meneires?

Answer 42

40-60 years, women, autoimmune hx, fam hx, head trauma

Question 43

Criteria to diagnose Meniere's disease?

Answer 43

2 or more episodes of vertigo, each lasting 20 min to a day

Question 44

What are the hallmark signs of Parkinsons?

Answer 44

TRAP- tremor, rigidity, akinesia/bradykinesia, postural instability

Question 45

What is the dsm-5 diagnostic criteria for dementia?

Answer 45

Decline in 1 or more cognitive domain: memory, language, visuospatial, executive function

Question 46

What is temporal arteritis?

Answer 46

Vascular illness that can affect the entire body, especially the blood vessels. Inflammation begins in aortic arch and branches out to cranial arteries

Question 47

What are some risk factors for temporal arteritis?

Answer 47

Older age, Scandinavian ethnicity, women

Question 48

What symptoms accompany pain in fibromyalgia?

Answer 48

Fatigue, sleep, memory and mood issues

Question 49

What can cause sciatica?

Answer 49

Herniated disc, broken bone, torn muscle, tumor that presses on the spine

Question 50

What is trigeminal neuralgia?

Answer 50

Usually caused by pressure on the trigeminal nerve, causes unilateral electrical shock to one side of the face

Question 51

What triggers trigeminal neuralgia?

Answer 51

Actions such as brushing teeth, putting on makeup, etc.