Neurology

Question 1

What are the etiologies of ischemic stroke?

Answer 1

1) Cardioembolic
2) Large vessel atherosclerosis
3) Lacunar / small subcortical
4) Cryptogenic

Question 2

ABCD2 score?

Answer 2

1) Age >60
2) BP >140/90
3) Clinical features: unilateral weakness (+2), speech imapriment without weakness (+1)
4) Diabetes
5) Duration: >60 minutes (+2), 10-59 minutes (+1)

Question 3

Maximum tolerated BP for “permissive hypertension” in acute ischemic CVA

Answer 3

220/120 mmHg

Question 4

BEFORE giving thrombolytics for acute ischemic CVA, BP should be less than:

Answer 4

< 185/110

Question 5

AFTER giving thrombolytics for acute ischemic CVA, BP should be less than:

Answer 5

< 180/105

Question 6

Exclusion criteria for thrombolytics for acute ischemic CVA pertaining to coagulation / platelets (3 total)

Answer 6

1) Heparin received within last 48 hours and PTT elevated
2) INR >1.7
3) Platelets < 100,000

Question 7

Exclusion criteria for thrombolytics for acute ischemic CVA pertaining to previous stroke, major surgery, invasive procedures (4 total)

Answer 7

1) History of hemorrhagic stroke
2) Ischemic stroke within 3 months
3) Major surgery in last 14 days
4) Arterial puncture at noncompressible site in last 7 days

Question 8

Thrombolysis for acute ischemic stroke: drug and dose

Answer 8

Alteplase (rtPA) 0.9mg/kg (maximum 90mg), with 10% as bolus over 1 min and rest over 1 hour

Question 9

First step of pharmacologic management for generalized convulsive status epilepticus:

Answer 9

IV lorazepam 2mg (or IM lorazepam 2-4mg if no IV access), repeat every 5 minutes (maximum 10mg)

(Also remember: IV thiamine 100mg and IV dextrose 50%, 50mL if glucose and alcohol history unknown)

Question 10

When to start antiplatelet and anticoagulant therapy after rtPA for acute ischemic CVA?

Answer 10

After 24 hours

Question 11

Four major CNS demyelinating syndromes

Answer 11

1) Multiple sclerosis
2) Neuromyelitis optica (Devic disease)
3) Acute disseminated encephalomyelitis
4) Idiopathic transverse myelitis

Question 12

Diagnostic criteria for neuromyelitis optica:

Answer 12

Absolute criteria:

1) Optic neuritis
2) Acute myelitis

Supportive criteria:

1) Brain MRI not meeting criteria for MS
2) Spinal cord lesion extending over three or more vertebral segments on MRI
3) Positive NMO-IgG (antibodies against aquaporin 4 antigen)

Question 13

Diagnostic criteria for multiple sclerosis (the McDonald criteria):

Answer 13

“Dissemination of lesions in space and time”.

Diagnosis is made by number of attacks and “objective clinical lesions”. [Oligoclonal bands, elevated IgG index not required].

2 attacks, 2 lesions – clinical evidence sufficient
2 attacks, 1 lesion or 1 attack, 2 lesions – need to demonstrate either DIS or DIT
1 attack, 1 lesion = clinically isolated syndrome – need to demonstrate both DIS and DIT

Of note, simultaneous presence of enhancing and nonenhancing lesions on MRI is sufficient to demonstrate DIT.

Question 14

Name all 12 cranial nerves and whether they are sensory, motor, or both

Answer 14

1) Olfactory (S)
2) Optic (S)
3) Oculomotor (M)
4) Trochlear (M)
5) Trigeminal (B)
6) Abducens (M)
7) Facial (B)
8) Vestibulocochlear (S)
9) Glossopharyngeal (B)
10) Vagus (B)
11) Accessory (M)
12) Hypoglossal (M)