Neurology

Question 1

What is the definitive diagnosis of Alzheimer’s disease?

Answer 1

Brain autopsy

Question 2

MC type of dementia?

Answer 2

Alzheimer disease

Question 3

What changes in the brain are seen in Alzheimers?

Answer 3

amyloid deposits (senile plaques) and neurofibrillary tangles (tau protein)

Question 4

What is the mechanism of Alzheimer?

Answer 4

cholinergic deficiency

Question 5

Treat of Alzheimer?

Answer 5

Cholinesterase inhibitors: Donepezil, Rivastigmine, and Galantamine

Question 6

What drugs should be avoided in Alzheimer?

Answer 6

anti-cholinergics drugs (cough meds too)

Question 7

What NMDA antagonist is used for mod-severe Alzheimer?

Answer 7

Memantine

Question 8

What symptoms are seen in Alzheimer?

Answer 8

Short term memory loss (1st), long term, disorientation, behavioral and personality changes

Question 9

Diagnosis for Alzheimer?

Answer 9

non-contrast CT or MRI

Question 10

What is the mechanism of ach-esterase inhibitors?

Answer 10

prevent the breakdown of acetylcholine

Question 11

What 4 medications are FDA approved for Alzheimers?

Answer 11

Tacrine
Donepezil (Aricept®, Aricept ODT)
Rivastigmine (Exelon®, Exelon patch)
Galantamine (Razadyne®, Razadyne ER)

Question 12

What is the first symptom seen in Alzheimers?

Answer 12

anterograde amnesia

Question 13

Treatment for delirium?

Answer 13

treat the cause

Question 14

Whom is delirium mostly seen in?

Answer 14

hospitalized elderly pts

Question 15

What type of hallucinations are the most common type experienced by patients with delirium?

Answer 15

Visual hallucinations

Question 16

What is a typical antipsychotic commonly used for the treatment of delirium?

Answer 16

Haloperidol

Question 17

What is the most common cause of delirium?

Answer 17

alcohol abuse

Question 18

What is the treatment of choice for delirium tremens in alcohol withdrawal?

Answer 18

Benzodiazepines

Question 19

“blind as a bat, hot as Hades, red as a beet, dry as a bone, mad as a hatter

Answer 19

Anticholinergic overdose

Question 20

How does bell palsy look?

Answer 20

unilateral facial weakness/paralysis

both upper and lower parts of the face

Question 21

What does Bell palsy forehead look like?

Answer 21

unable to lift affected eyebrow (wrinkle forehead)

Question 22

Treatment for Bell palsy?

Answer 22

Txt is not required- most cases resolve 1mo
Prednisone- 1st 72hr of sx onset
Artificial tears
Acyclovir

Question 23

MC side for Bell palsy?

Answer 23

right (60%)

Question 24

Bell palsy has strong association with?

Answer 24

Herpes simplex virus reactivation

Question 25

What nerve is affected in Bell palsy?

Answer 25

CN VII (7)

Question 26

What is the pathogenesis of bell palsy?

Answer 26

inflammation or compression of CN VII

Question 27

Bell palsy usually follows what?

Answer 27

a URI

Question 28

What should Bell palsy pt wear at night to prevent corneal abrasion?

Answer 28

eye patch

Question 29

A CVA blockage is ?

Answer 29

ischemic stroke

Question 30

A CVA rupture of blood vessel is?

Answer 30

hemorrhagic stroke

Question 31

Right sided symptoms=

Answer 31

left sided stroke

Question 32

Left sided symptoms=

Answer 32

Right sided stroke

Question 33

Dx for CVA?

Answer 33

CT without contrast

Question 34

Txt for CVA?

Answer 34

IV tPA within 3-4.5 hrs of symptom onset

Question 35

Txt for CVA after 4.5 hours?

Answer 35

Intra-arterial thrombolysis up to 6hrs

Question 36

What is the most common artery affected in a ischemic stroke?

Answer 36

middle cerebral artery (anterior circulation)

Question 37

Most important modifiable risk factor of stroke?

Answer 37

HTN

Question 38

Primarily affects frontal lobe function, with legs>arms

Answer 38

Anterior cerebral artery occlusion

Question 39

Risk factors for Lacunar stroke?

Answer 39

diabetes and hypertension

Question 40

What is the mc cause of chronic severe disability?

Answer 40

stroke

Question 41

What should the blood pressure be maintained at for tPA?

Answer 41

<185/105

Question 42

Exclusion criteria for tPA use in strokes?

Answer 42

``` suggest SAH Head trauma or prior stroke within 3mo MI within 3mo GI or gastric ulcer hemorrhage within 21 days Major surgery within 14days Elevated BP >185/ 110 Active bleeding Taking anticoagulants ```

Question 43

Extended exclusion criteria for tPA?

Answer 43

``` Age >80yrs All pts taking oral antigcoagulants regardless of INR Stroke scale > 25 Hx of stroke and diabetes Oral aspirin ```

Question 44

What causes a essential tremor?

Answer 44

autosomal dominant inheritance

Question 45

Presentation of a essential tremor?

Answer 45

shaking with task, handwriting, or shaving, tremors with outstretched arms or performing movement WITHOUT resting component

Question 46

What makes essential tremors better?

Answer 46

alcohol

Question 47

What is the first line txt for essential tremor?

Answer 47

Propranolol or atenolol

Question 48

2nd and 3rd line txt for essential tremor?

Answer 48

Primidone (barbiturate) | Alprazolam (benzodiazepine)

Question 49

What makes essential tremors worse?

Answer 49

anxiety, fatigue, caffeine, or stimulants, drugs for asthma and emphysema

Question 50

Three cardinal features of Parkinson?

Answer 50

Rest (pill rolling), tremor, cogwheel rigidity, bradykinesia, shuffling gait

Question 51

Gold standard for Parkinson dx?

Answer 51

neuropathologic exam

Question 52

Txt for Parkinson < 65yr?

Answer 52

bromocriptine, pramipexole, ropinirole (dopamine agonist)

Question 53

Txt for Parkinson > 65yr?

Answer 53

Levodopa/carbidopa (Sinemet)

Question 54

What are sde of L-dopa?

Answer 54

GI upset w/ n/v, vivd dreams or nightmares, psychosis, and dyskinesias

Question 55

Mechanism of Parkinson?

Answer 55

idiopathic dopamine depletion, failure to inhibit Ach in the basal ganglia

Question 56

What is seen in brains of Parkinson pts?

Answer 56

lewy bodies, loss of pigment cells seen in substantia nigra

Question 57

T/F Parkinson tremor is present at rest?

Answer 57

True

Question 58

T/F essential tremor is absent at rest?

Answer 58

True

Question 59

What is a positive Myerson's sign?

Answer 59

tapping the bridge of the nose causes sustained blink

Question 60

What is the most effective txt for Parkinson?

Answer 60

Levodopa/Carbidopa (Sinemet)

Question 61

Side effect of dopamine agonist?

Answer 61

orthostatic hypotension

Question 62

What are two additional treatment classes that can me used for Parkinson?

Answer 62

Monoamine oxidase type B inhibitors | Catechol-O-Methyltransferase COMT inhibitors

Question 63

What are focal seizures?

Answer 63

no alteration in consciousness

Question 64

What are complex partial seizures?

Answer 64

focal seizures with altered consciousness

Question 65

Abnormal movements or sensations?

Answer 65

Focal seizures (simple partial)

Question 66

Lip smacking, confusion and loss of memory

Answer 66

complex partial

Question 67

Treatment for focal seizures?

Answer 67

Phenytoin and carbamazepine

Question 68

What are absence (petit mal) seizures?

Answer 68

brief impairment of consciousness , most miss them

Question 69

What are tonic clonic seizures (grand mal)?

Answer 69

classic seizures with postictal phase: confused

Question 70

What are atonic seizures?

Answer 70

drop attacks, looks like syncope with loss of muscle tone

Question 71

Treatment for Absence Petit Mal seziures?

Answer 71

Ethosuximide

Question 72

Treatment for Status Epilepticus?

Answer 72

Lorazepam or Diazepam-> Phenytoin (Dilantin)-> Phenobarbital

Question 73

Treatment for Myoclonus seizures?

Answer 73

Valproic acid, Clonazepam

Question 74

What are sde of Phenytoin?

Answer 74

gingival hyperplasia, SJS, hirsutism

Question 75

What is the diagnosis of seizures?

Answer 75

EEG

Question 76

What are the sde of Valproic acid?

Answer 76

pancreatitis, heptotoxicity

Question 77

What are the sde of benzo?

Answer 77

sedation

Question 78

MC cause of syncope?

Answer 78

Vasovagal syncope