Neurology

Question 1

who is at high risk of delirium during hospitalization?

Answer 1

elderly pts with dementia

Question 2

medical indications for catheter

Answer 2

relieve urinary retention
monitor fluid status in acutely ill pts
pts with stage 3/4 pressure ulcers on butt
- aside of these indications, remove urinary catheter to prevent things like infection and delirium

Question 3

which sedatives should be avoided in elderly?

Answer 3

benzodiazepines and diphenhydramine

- can precipite delirium

Question 4

pt post-op presents with acute, fluctuating mental status changes with difficulty focusing or maintaining attention and disorganized thinking

Answer 4

think of delirium

Question 5

patients with chronic dementia are at great risk of what after surgery with general anesthesia?

Answer 5

delirium

Question 6

recommended therapy for delirium in the ICU when supportive care is insufficient?

Answer 6

antipsychotic agents - haloperidol

Question 7

pt presents with mental status changes, nystagmus, opthalmoplegia and unsteady gait - what should you consider?

Answer 7

Wernicke encephalopathy - due to thiamine deficiency

Question 8

conditions assoc with Wernicke encephalopathy

Answer 8

AIDS, alcohol abuse
cancer
hyperemesis gravidarum
prolonged TPN
post-surgical status
glucose loading

Question 9

cognitive impairment with fluctuating lethargy/inattention, hallucinations and asterixis implies..

Answer 9

toxic encephalopathy - ie. medication induced delirium

Question 10

what types of drugs can provoke delirium in a elderly pts with mild cognitive impairment, early dementia of Parkinson’s disease?

Answer 10

anticholinergic drugs (ex. nortriptyline)

Question 11

migraine with aura consists of..

Answer 11

neurologic abnormalities including visual loss, hallucinations, numbness, tingling, weakness or confusion (diffuse symptoms)

Question 12

aura associated with partial seizures is characterized by..

Answer 12

feeling of deja vu, rising epigastric sensation or autonomic disturbances; automatisms (lip smacking) can also be suggestive of partial seizure

Question 13

pt presents with a headache that is dull, bilateral or diffuse described as a pressure or squeezing sensation; the pain is usually not disabling

Answer 13

tension headache

Question 14

chronic daily headache

Answer 14

headache is present on > 15 days/month for at least 3 months

Question 15

disabling headache assoc with tearing or rhinorrhea; typically unilateral and periorbital/temporal

Answer 15

cluster headache

- cluster episodes usually last 6-8 weeks with remission lasting 2-6 months

Question 16

what is a cluster headache classically assoc with?

Answer 16

lacrimation
rhinorrhea/nasal congestion
eyelid edema
facial/forehead sweating
miosis/ptosis

Question 17

common visual symptoms associated with migraine

Answer 17

perceptions of flashes of light
arcs of flashing light that forms zig-zag pattern
area of loss of vision surrounded by normal visual field

Question 18

work-up order for “thunderclap headache” as in subarachnoid hemorrhage

Answer 18

1. CT scan without contrast - if neg,
2. do lumbar puncture, - if neg,
3. CT or MR angiography

Question 19

prophylactic tx. of migraine headaches

Answer 19

pt should have 2+ headaches per week
first line - propranolol
- can also use: amitriptyline, valproic acid, topiramate, other BB, petasites hybridus

Question 20

dementia characterized by prominent memory loss, anomia, constructional apraxia, anosognosia (impaired recognition of illness) and personality change

Answer 20

Alzheimer’s dementia

Question 21

dementia the progresses over months and startle myoclonus; also: visual/cerebellar disturbance, pyramidal/extrapyramidal dysfunction and akinetic mutism

Answer 21

Creutzfeld Jakob disease

Question 22

dementia accompanied by Parkinsonism, visual hallucinations and fluctuating symptoms; MC includes impaired learning and attention, psychomotor slowing and visuospatial impairment (vs. memory)

Answer 22

Dementia with Lewy Bodies

Question 23

pt presents with behavioral and personality changes ranging from apathy to social disinhibition and emotional lability - dementia?

Answer 23

frontotemporal dementia

Question 24

stages of dementia based on MMSE

Answer 24

MMSE 21-25 = mild dementia
MMSE 11-20 = moderate dementia
MMSE 0-10 = severe dementia

Question 25

first line initial therapy for mild-moderate Alzheimer's dementia

Answer 25

Ach-esterase inhibitors: donepezil, rivastigmine or galantamine

Question 26

first line tx of moderate to advanced Alzheimer dementia

Answer 26

memantine | - better effects when added to donepezil

Question 27

what types of drugs are implicated in acute dystonic reactions?

Answer 27

neuroleptic, antiemetic and serotonergic agents - dystonic reactions typically occur w/in 5 days of initiating therapy

Question 28

pt presents with resting tremor, bradykinesia, rigidity and postural instability

Answer 28

Parkxtinson's disease

Question 29

upper extremity, high frequency tremor present with both limb movement and sustained posture of the involved extremities and is absent at rest; usually bilateral

Answer 29

essential tremor | - usually improved with alcohol and worsens with stress

Question 30

first line therapy of essential tremor

Answer 30

propranolol | - others include: primidone, gabapentin, topiramate

Question 31

CSF findings in viral meningitis

Answer 31

lymphocytic pleocytosis glucose > 45 protein < 200 negative gram stain

Question 32

which serogroup of meningococcus does the vaccine not protect against?

Answer 32

serogroup B

Question 33

clues to diagnosis of RMSF?

Answer 33

headache, fever, myalgia, abdominal pain rash begins on wrists and ankles thrombocytopenia, leukopenia and elevated transaminases infection in spring/early summer

Question 34

CSF and blood cultures with gram positive diplococci

Answer 34

strep. pneumo meningitis

Question 35

empiric tx. for bacterial meningitis

Answer 35

vancomycin ampicillin ceftriaxone - adjunctive tx. with dexamethasone

Question 36

what is the recommended strategy for reducing complications after acute stroke?

Answer 36

early mobilization with physical and occupational therapy

Question 37

tx. of ischemic stroke w/in 3 hours of presentation

Answer 37

thrombolysis with tPA | - if not eligible for tPA, give aspirin or clopidogrel

Question 38

threshold for acute BP lowering in pts with acute stroke who are eligible for thrombolysis

Answer 38

185/110 mmHg | - use IV labetalol or nicardipine

Question 39

threshold for BP lowering in pts with acute stroke

Answer 39

IV labetalol or nicardipine if SBP > 220 mmHg or diastolic < 120 mmHg (or manifestations of end organ damage)

Question 40

Tx. of subarachnoid hemorrhage

Answer 40

surgical clipping of aneurysm with cerebral angiography w/in 72 hours of onset

Question 41

in whom are sumitriptan and other triptan drugs C/I in?

Answer 41

pts with stroke and uncontrolled HTN

Question 42

findings in Bell's palsy

Answer 42

complete facial neuropathy impairing the entire hemiface, including foreheard corrugators which are spared by cerebral lesions

Question 43

Bell phenomenon

Answer 43

reflexive rolling upwards of the globe during eye closure

Question 44

sensory loss and limb weakness beginning in LE and moving up with absent deep tendon reflexes

Answer 44

Guillain-Barre

Question 45

electromyography result in Guillain-Barre

Answer 45

demyelinating polyradiculoneuropathy

Question 46

CSF findings in Guillain-Barre

Answer 46

albuminocytologic dissociation - spinal fluid cell count is normal but spinal fluid protein level is elevated

Question 47

Tx. of Guillain Barre

Answer 47

IVIG and plasma exchange

Question 48

aching wrist pain, numbness and tingling in median nerve sensory distribution of fingers and weakness of thenar muscles; usually worse at night

Answer 48

Carpal tunnel syndrome

Question 49

pain elicited by flexing the thumb into the palm, closing fingers over thumb and bending wrist in ulnar direction (Finkelstein test)

Answer 49

painful in de Quervain tenosynovitis | - tenderness in anatomic snuffbox

Question 50

synovia filled cysts arising from joints or tendon sheaths that typically appear on dorsal hand or ventral wrist

Answer 50

Ganglion cyst | - usually compress other structures and cause pain

Question 51

Guyon tunnel syndrome

Answer 51

ulnar nerve compression

Question 52

loss of sensation in a stocking glove distribution that is associated with paresthesias or painful dysesthesias

Answer 52

diabetic neuropathy