Neurology Flashcards
1
Q
Myoclonic seizure clinical features
A
Very brief (less than 1 second) + synchronous jerking or shaking of the limbs + *retained awareness and no postictal confusion
2
Q
Management of acute agitation in DLB
A
Donepezil
3
Q
Management of patient with parkinson disease who is having medication-related complications of carbidopa-levodopa
A
DBS (This is advanced parkinson disease. DBS reduces total levodopa dosage)
4
Q
Management of severe TBI
A
- Aggressive management of fever (Acetaminophen)
- Maintain PO2 greater than 60
- Maintain SBP greater than 90
- steroids are contraindicated and have been shown to worsen its prognosis
5
Q
Battle sign indicates
A
Basilar skull fracture
6
Q
LDL goal in secondary stroke prevention
A
There isn’t a goal – High intensity statin REGARDLESS of baseline LDL cholesterol level (This is because statins have other benefits, including plaque stabilization, anti-inflammatory properties, and slow progression of carotid arterial disease.)
7
Q
Evidence for intracranial stenting for atherosclerotic disease
A
Bad – 2x higher risk of stroke compared with medical therapy
8
Q
Treatment of fatigue in MS
A
Stimulant (modafinil, amantadine)
9
Q
First step in evaluation of unprovoked seizure
A
Head CT (rule out bleed)
10
Q
Treatment of FTD
A
Symptom based because there are no disease modifying therapies (SSRIs) (often associated with apathy, diminished interest, loss of empathy)
11
Q
Work up of suspected reversible cerebral vasoconstriction syndrome (RCVS)
A
Brain MRA or CTA
12
Q
reversible cerebral vasoconstriction syndrome (RCVS) clinical features
A
Thunderclap headache + multiple episodes within short time frame + precipitated by vasoactive drugs or sertraline or emotion/showering/exertion
13
Q
Treatment of choice for reversible cerebral vasoconstriction syndrome
A
CCB’s
14
Q
Treatment of MS exacerbation
A
High dose oral steroids (can also use IV
15
Q
Features of dystonic tremor
A
Rest and action + dystonic rhythmic posturing
16
Q
treatment of refractory status epilepticus in patient allergic to phenytoin
A
Valproic acid
17
Q
Initial management of status epilepticus
A
ABCs
Accucheck
Thiamine with glucose if needed
18
Q
Meds with evidence for migraine prophylaxis
A
Betablockers
Divalproex
Topamax
19
Q
AED’s for pregnant patients
A
Keppra
Lamotrigine
20
Q
Management of spinal cord mets
A
Emergent steroids
Then urgent surgery with post op radiation
21
Q
CJD features
A
Rapidly progressive dementia
*Myoclonus
Sleep problems
22
Q
Evaluation of TIA
A
Carotid duplex US (cheaper than CT-A or MRA)
23
Q
When you need head CT for patients with mild TBI
A
- dangerous mechanism of injury (cars, high falls)
- imaging
- Severe headache, vomiting
24
Q
MCI definition
A
Stage between normal aging and dementia (greater than what is expected with normal aging but no significant functional disability)
- cognitive testing below normal range
25
Management of urinary symptoms in MS patients
Urodynamic testing
26
PE management in patient with primary brain tumor
IV heparin (short half life in case tumor bleeds)
27
What is POEMS syndrome? Clinical features?
- Monoclonal plasma cell disorder typically arising secondary to an underlying cancer
P - polyneuropathy
O - organomegaly
E - endocrinopathy
M - monoclonal gammopathy (monoclonal protein on SPEP)
S - skin changes
28
What are UMN signs?
```
Hyperreflexia
*Spasticity
clonus
hoffman sign
Extensor plantar response
```
29
CIDP presentation
Generalized areflexia
| Progressive or relapsing symmetric sensory and motor neuropathy
30
Key feature in stem for mitochondrial myopathy
Maternal transmission
31
Features of focal seizures
- Preceded by warning/aura
- Mouth or limb automatisms (repetitive movements)
- Followed by confusion (no recollection of seizure) and/or exhaustion
32
Absence seizures vs. focal seizures
- also staring and confusion
| - BUT more frequent (multiple times per day) + immediate recovery + more common in kids
33
Myoclonic seizures clinical features
- Single jerk of the entire body
- less than 1 second
- retained awareness + no postictal confusion
34
Idiopathic brachial plexopathy clinical features
- Infection or surgery triggers:
- Subacute severe pain
- Pain then resolves and pt has progressive weakness and atrophy of shoulder girdle and upper extremity muscles
35
First line treatment of Tourette syndrome
```
FIRST line --> CBT (teaches patients diversion techniques, ie start tapping foot if it comes on)
SECOND line if CBT fails -->
- clonidine
- guanfacine
- topiramate
- tetrabenazine
```
36
Clinical features of tourette syndrome
- Usually feel it coming on (premonitory sensory cues)
- Often have other tics (eye rolling, throat clearing)
- Usually starts in childhood
- Also often have OCD
37
Migraine with aura treatment
- Start with NSAIDS
| - IF ineffective --> triptans
38
Convulsive syncope
Seizure preceeded by tunnel vision, palpitations
- then short duration of loss of consciousness
- movements and shaking of all four limbs
- immediate and complete recovery
39
Atonic seizure vs. convulsive syncope
- atonic seizure = much briefer (a few seconds) + no warning signs
40
Workup of fatigue and decreased energy post stroke
Sleep study (sleep-disordered breathing and central sleep apnea, highly prevalent in patients post stroke
41
Management of MS in patient with liver disease
Glatiramer
42
LMN signs
Atrophy, fasciculation, weakness
43
ALS core features
UMN signs
LMN signs
*Absence of sensory deficits
44
CMT clinical features
Numbness, distal extremity weakness, unsteady gait, areflexia, high arches, hammer toes, storkleg deformity, distal muscle atrophy
45
Cavernous sinus thrombosis clinical features
- painful ophthalmoplegia
| - multiple ocular nerve involvement
46
Cavernous sinus thrombosis management
STAT surgery + abx
47
Diagnosis of NPH
LP (volume removal + measurement of open pressure)
48
When is neuropsych testing performed?
- Patients with mild symptoms of cognitive impairment
- Patients with cognitive and functional decline who seem depressed but may actually have mild cognitive impairment/early dementia
49
Autoimmune limbic encephalitis clinical features
- new onset status epilepticus
| + hyponatremia + progressive confusion in previously health patient
50
Management of intractable epilepsy
Video EEG (need to confirm that seizures seen on video EEG match the location of abnormal findings on MRI before proceeding to surgery/temporal lobectomy)
51
Indications for surgery with brain aneurysms
- Symptomatic (Cranial nerve deficits)
| - 7 millimeters or greater in size
52
Management of psychosis in Parkinson disease
Discontinue dopamine agonists (pramipexole)
53
Management of thunderclap headache if CT head is normal
LP
54
Diagnosis of primary CNS lymphoma
IF biopsy inaccessible (by brainstem) --> Slit-lamp exam and vitreous fluid collection with cytology
55
Prognosis of primary CNS lymphoma
Responds well to treatment but typically recurs and has a poor prognosis
56
Periodic limb movements of sleep clinical features
Periodic leg kicks that exhibit a stereotyped triple-flexion phenomenology repeating periodically during sleep
57
Treatment of REM sleep behavior disorder
benzos (klonopin)
58
REM sleep behavior disorder clinical features
- dream enactment behavior with complex movements and vocalizations
59
McArdle disease clinical features
- exercise intolerance/cramping
- mild myalgias/weakness
- myoglobinuria + CKD
60
Acute intermittent porphyria clinical features
ACUTE + INTERMITTENT
- acute attacks of abdominal pain and vomiting
- reddish-brown urine during attacks
61
Distinguishing feature between DLB and Alzheimer
REM sleep behavior disorder
62
Treatment of acute intracerebral hemorrhage
IF SBP > 180 --> Rapidly lower BP with IV nicardipine
63
First line prophylactic medication for cluster headaches
CCBs
64
First line treatment for cluster headaches
Oxygen inhalation
| Subcue sumatriptan
65
Neurologic presentation of familial amyloidosis
Sensory and motor peripheral neuropathy + autonomic neuropathy
66
Likely diagnosis in ICU patient who develops AMS
NCSE
67
NCSE diagnosis
Continuous (24-hour) EEG
68
Clinical features of NCSE
confusion/amnesia + negative symptoms (aphasia, mutism, catatonia, not responding to commands (occasionally)) + rhythmic twitching of one or more muscle groups, tonic eye deviation, hippus, ocular movement abnormalities (sustained eye deviation, nystagmus),
69
Management of impaired mobility in MS
Dalfampridine
70
Cause of most subacute pain and paresthesia in a dermatomal pattern in the thoracic or abdominal region
Diabetic mononeuropathy (assuming no evidence of zoster)
71
MSA features
Parkinson
| *early falls and dysautonomia
72
Diagnosis of suspected idiopathic intracranial hypertension
LP
73
Treatment of idiopathic intracranial hypertension
Acetazolamide
74
First line prophylactic medication of chronic tension-type headache
Amitriptyline
75
Management of asymptomatic carotid artery stenosis
statin
76
Management of GBS patient who improves following plasma exchange
Discharge to rehab
77
AED to use in patients with osteoporosis
Lamotrigine
78
Primary stabbing headache clinical features
- Transient localized stabs of head pain + not in trigeminal location
79
First line for focal seizures in elderly patients with multiple comorbidities
Lamictal
80
Corticobasilar degeneration clinical features
Asymmetric parkinsonism
Dystonia
Myoclonus
81
Next step after patient with acute ischemic stroke is treated with TPA
CT angio of head (determine candidacy for endovascular therapy -- patients with large-vessel occlusion have low recanalization rates with IV thrombolysis)
82
Antibiotics that lower the seizure threshold
Carbapenems
Fluoroquinolones
Fourth-generation cephalosporins (cefepime)
83
Migraine diagnosis
```
At least 5 episodes lasting 4-72 hours with pain exhibiting 2 of following features:
Unilateral
Throbbing
Moderate to severe intensity
Worse with physical activity
Nausea or photo/phonophobia
```
84
Treatment of ischemic stroke in the absence of TPA
Aspirin
85
Management of mild TBI's in athletes
- symptom checklist, neuro exam
- Head CT if suspected hemorrhage
- neuropsych testing
86
Treatment of cognitive impairment in patient with vascular cognitive impairment
Donepezil (acetylcholinesterase inhibitor)
87
Vascular neurocognitive impairment clinical features
- pseudobulbar affect
- ataxia
- asymmetric neurologic findings
88
Treatment of pseudobulbar symptoms
SSRIs
89
what is immune-mediated necrotizing myopathy?
Form of statin myopathy -- even after stopping stain, muscle weakness and CK is high
- biopsy has evidence of muscle necrosis without inflammation
90
Treatment of immune-mediated necrotizing myopathy
steroids
91
Management of intracranial hypotension
Epidural blood patch
92
Key feature of intracranial hypotension
orthostatic headache (Due to CSF leak)
93
First step in MS evaluation
MRI brain and spine
| *LP for oligoclonal bands has poor test characteristics
94
VTE management post hemorrhagic stroke
Should start prophylactic heparin 48 hours after bleed (assuming imaging rules out active bleeding) (patients with hemiparesis are at high VTE risk)
95
Management of patient with Alzheimer and contraindication to donepezil
Memantine
96
Contraindications to acetylcholinesterase inhibitors in Alzheimer's patients
Sick sinus syndrome
LBBB
Uncontrolled asthma
PUD
97
Diagnostic study for patients with a suspected secondary headache
Brain MRI
98
Red flags for secondary headache condition
- new headache after age 50
- use of anticoagulant
- progressive headache pattern
99
SE to know about with fingolimod
Macular edema so need regular ophthalmic exams
100
Primary progressive aphasia clinical features
Language deficits before additional cognitive deterioration
101
Bell palsy vs stroke
Bell palsy = can't elevate eyebrow (forehead involvement) (CVA does not involve forehead because of bilateral innervation)
102
Bell palsy treatment
Prednisone
103
Other features of bell palsy
- alteration in taste
| - hyperacusis (intolerance of loud noise due)
104
First and second line for idiopathic transverse myelitis
1) high dose IV steroids
| 2) plasma exchange therapy
105
Healthcare maintenance in MS patients
- more evidence suggest that disease activity is highly correlated with serum vitamin D levels
- vitamin D supplementation has now been shown to provide additional control of disease activity
106
Best test for Alzheimer's disease
CSF analysis (decreased AB42 and incrreased tau protein)
107
Management of epilepsy in a patient with psychiatric disease
Lamotrigine (also a mood stabilizer)
108
Myoclonus clinical features
Rapid, nonsuppressible, jerky movements
109
Dystonia definition
Sustained muscle contractions leading to stereotyped and directional twisting and posturing movements
110
Management of cognitive dysfunction in MS
Cognitive rehabilitation therapy
111
NCSE treatment
ativan 2 mg challenge
112
management of severe refractory migraine with aura
IV dopamine antagonists (prochlorperazine or metoclopramide)
113
MRI findings with migraine
Punctate white matter lesions
114
Secondary prevention of ischemic stroke
- Aspirin + Plavix for 21 days
| - then continue plavix as monotherapy
115
Treatment of lewy body dementia
- levodopa when symptomatic therapy required
116
Goal SpO2 in CVA
93% (higher is harmful, as in many other acute illnesses)
117
Type of patients who experience myoclonus
anoxic brain injury (posthypoxic myoclonus) (patients who've coded)
118
Relation of neck pain to headache
- nonspecific and does not necessarily indicate pathology in cervical region
119
Limbic encephalitis clinical fatures
- new-onset status epilepticus
- progressive confusion
- previously healthy person
- rapidly progressive (so seems like prion disease)
- myoclonus
- hyponatremia
120
Adjuvant therapy of MS
vitamin D
121
Medication that improves ambulatory function in MS patients
Dalfampridine
122
Term for syndrome of recurrent thunderclap headaches
Reversible cerebral vasoconstriction syndrome
