Neurology

Question 1

ACA embolism

Answer 1

Feet and leg deficits

Question 2

MCA embolism

Answer 2

Hands, Arms, Face, Speech deficits

Question 3

PCA embolism

Answer 3

Visual Cortex deficits

Question 4

Cerebellar embolism

Answer 4

Coordination deficits (Ataxia)

Question 5

Stroke Presentation

Answer 5

Focal neurologic deficit localized to the brain

Question 6

Stroke Diagnostic steps

Answer 6

1. Non-Con CT head
   negative blood-Ischemic Stroke
   Positive blood-Hemorrhagic stroke

Question 7

Ischemic Stroke Diagnostic Steps

Answer 7

give tPA maybe
next day do 2d echo
EKG
Carotid U/S

Question 8

Hemorrhagic stroke treatment

Answer 8

Decrease Blood pressure

neurosurgery

Question 9

2D echo shows thrombus

Answer 9

Warfarin
Noac
Heparin bridge

Question 10

EKG shows A-fib/flutter stroke

Answer 10

Warfarin

Noac

Question 11

Carotid artery Stenosis Treatment

Answer 11

<70% occlusion + Asx
>70% + Sx or >80% occlusion
Surgery within two weeks

Question 12

Contraindications to tPA

Answer 12

Bleeding
Recent surgery within 2 weeks
ICH

Question 13

When to use tPA

Answer 13

<3hr BP-180/105

<4.5 DM BP-180/105

Question 14

Causes of 1st time seizure

VITAMIN

Answer 14

Vascular
Infection
Trauma 
Autoimmune
Metabolic
Ingestion/wIthdrawl
Neoplasm
pSych

Question 15

Seizures Presentation

Answer 15

Loss of consciousness, Jerking
Bowel/Bladder incontinence
Tongue Biting
Post ictal state

Question 16

Seizure no epilepsy (1st time)

Answer 16

Currently seizing, (>5m or failure to return to baseline after >20 min)
Benzos
Fosphenytoin
Midozolam + propofol
Phenobarbital

Question 17

Seizure with h/o of epilepsy

Answer 17

Check medication levels
increase drug dose
Add drug
change drug

Question 18

General Seizure coverage

Answer 18

Valproate, Lamotrigine, Levatiracetam

Question 19

Atonic seizure presentation treatment

Answer 19

No LOC, (+) LOT, Suddenly fall

Valproic acid, valproate

Question 20

Myoclonic Presentation, Treatment

Answer 20

No LOC, too much tone

Valproic acid, Valproate

Question 21

Trigeminal Neuralgia Treatment

Answer 21

Carbamazepine

Question 22

Parkinsons Presentation

Answer 22

Bradykinesia
Cogwheel Rigidity
Resting tremor (Pill rolling)
Gait/postural instability-Shuffling steps

Question 23

Parkinsons treatment <70, good function

Answer 23

dopamine agonists

Ropinerol, Promipexole

Question 24

Parkinsons treatment >70 with decline in function

Answer 24

levodopa + carbidopa

Question 25

Essential tremor presentation

Answer 25

tremor with movement or use, no tremor at rest | Tx: Propanolol

Question 26

Intention tremor Presentation

Answer 26

cerebellar dysfunction alcohol stroke tremor with movement none at rest worsens closer to the target

Question 27

Tension headache Presentation, Treatment

Answer 27

Most common Muscular pain, Bilateral Starts in front and radiates to the neck Tx: NSAIDs

Question 28

Analgesic Rebound Presentation, treatment

Answer 28

Withdrawl Pt: Takes medication more than 10x/month HA when they stop their meds Tx: Let them withdraw

Question 29

Cluster Headache Presentation, treatment

Answer 29

``` Asx for months then happens 8-10x/day unilateral pain with Horner Syndrome Tx: Acute-O2 Sumitriptan ppx-CCB (verapamil) f/u with MRI ```

Question 30

Migraine presentation, treatment

Answer 30

``` unilateral pulsatile, debilitating HA, photphobia, phonophobia, N/V, aura, trigger Tx: Acute, Mild-NSAIDs Mod/severe-Triptans ppx-b-blockers Valproate topiramate ```

Question 31

Migraine Prophylaxis

Answer 31

B-blockers Valproate Topiramate

Question 32

Cluster Headache Prophylaxis

Answer 32

CCB=Verapamil

Question 33

Idiopathic Intracranial Hemorrhage Presentation, treatment

Answer 33

``` Woman, increased ICP, Papilledema, N/V, FND, negative CT, OCP use Dx: LP, OP >25 Tx: Acetazolamide Serial LP VP shunt ```

Question 34

Musculoskeletal pain Presentation, Tx

Answer 34

``` Vague symptoms 30-50 y/o h/o heavy lifting Tx: Exercise and NSAIDs reassess after 4 weeks ```

Question 35

Disc Herniation Presentation, Dx, Tx

Answer 35

``` Sciatica pain Positive Straight Leg test 30-50 heavy lifting Dx: X-ray MRI Tx: NS > conservative @ 6mo NS=conservative @ 1 year ```

Question 36

Compression Fracture presentation, Dx, Tx

Answer 36

``` >50 F Fall on coccyx (+) vertebral step off (+) pinpoint tenderness Dx: X-ray best MRI Tx: Surgery ```

Question 37

Spinal Stenosis Presentation, Dx, Tx

Answer 37

``` Narrow Canal >50 Pseudoclaudication positional, Hunched over Dx: x-ray MRI Tx: Laminectomy ```

Question 38

Osteophyte (bone spur) Presentation, Dx, Tx

Answer 38

``` >50 No heavy lifting Sciatica positive straight leg raise Dx: X-ray MRI Tx: Surgery ```

Question 39

Alarm symptoms for lower back pain

Answer 39

bowel/Bladder incontinence Saddle Anesthesia New FND/rapidly progressing

Question 40

Alzheimers Presentation, Dx, Tx

Answer 40

``` Associated with downs Memory goes first Down syndrome spares social graces Dx: CT=diffuse cortical atrophy Tx: Supportive care Family education Donepezil ```

Question 41

Creutz-feld Jakob Presentation, Dx, Tx

Answer 41

Undercooked meat, Sporadic mutation young dementia with myoclonus Dx: MRI Tx: Supportive

Question 42

Normal Pressure Hydrocephalus Presentation, Dx, Tx

Answer 42

``` Increased ICP Pt: Wet, Wobbly, Weird Dx: CT- Hydrocephalus LP- will provide improvement Tx: VP Shunt ```

Question 43

Neiman Picks disease Presentation, Tx

Answer 43

Personality goes 1st, Hypersexual | Tx: Supportive

Question 44

Vascular Dementia presentation, Dx, Tx

Answer 44

Stepwise decline with each stroke Dx: Ct=infarcts Tx: CVA, supportive

Question 45

Lewey-Body Dementia Presentation, Tx, Dx

Answer 45

Parkinsonian Sx and dementia Visual Hallucinations Tx: Supportive

Question 46

Vertigo (-) tinnitus, hearing loss (+) FND

Answer 46

Posterior Fossa insult | MRI

Question 47

Posterior Fossa Insult Presentation, Dx, Tx

Answer 47

``` MS, Stroke, Tumor, Abscess, Seizure, Migraine FND (-) ear Sx Dx: MRI Tx: Disease Specific ```

Question 48

BPPV presentation, Dx, Tx

Answer 48

Reccurrent and reproducible vertigo lasts <1 min Dx: Dix Hallpike (Rotary Nystagmus) Tx: Epley Maneuver

Question 49

Menier's Disease Presentation, Dx, Tx

Answer 49

``` Hearing loss, tinnitus, Vertigo Lasts >30m <1hr Tx: Salt restriction Thiazide diuretics Meclizine ```

Question 50

Vestibular Neuritis Labrynthitis Presentation, Tx

Answer 50

``` 4 wks after URI Vertigo 1-10m (+) Hearing loss N/V Tx: Steroids Meclozine ```

Question 51

Multiple Sclerosis Presentation, Dx

Answer 51

``` AI, Demyelinating 20-40 Any neuro Sx separated by time and space Optic neuritis Dx: MRI=periventricular white matter ```

Question 52

Multiple Sclerosis Tx

Answer 52

Acute Flare=Steroids Chronic= Interferon Glatramer Finoglonad

Question 53

Multiple Sclerosis Complications and treatment

Answer 53

Urinary retention=bethanachol Urinary incontinence=Amitryptiline Spasms=Baclofen Neuropathic pain=Gabapentin

Question 54

ALS presentation, Dx, Tx

Answer 54

UMN and LMN lesions Dx: EMG Tx: Supportive

Question 55

Guillain Barre Syndrome Presentation, Dx, Tx

Answer 55

``` Watery diarrhea or presenting after a flu shot Ascending paralysis, Distal to proximal Hyporeflexia Dx: LP=alot of proteins few cells Tx: Intubation IVIg=plasmapheresis NEVER STEROIDS ```

Question 56

Myasthenia Gravis Presentation, Dx, Tx

Answer 56

``` >50 Fatigue of the eyes, throat, fine movements Worse in the evening Dx: Abs against AChR EMG CT scan for thymoma (assoc) Tx: Cholinesterasei(Stigmine) Steroids refractory IVIg=plasmapheresis Crisis ```

Question 57

Eaton Lambert Presentation, Dx, Tx

Answer 57

``` Presynaptic CaR Paraneoplastic Syndrome >50 Improvement w/use Proximal muscles-problems combing hair, rising out of a chair Dx: Abs EMG CT Small cell Tx: Treat CA ```