Neurology JB

Question 1

Acute delirium tx

Answer 1

antipsychotic meds (risperidone, olanzapine, quetiapine)
benzo for alcohol and Benz withdrawal states (lorazepam) + thiamine and B12

Question 2

akathisia tx

Answer 2

antihistamine
maybe BB

Question 3

alzheimer dx

Answer 3

dx of exclusion
r/o other causes
cognitive testing

Question 4

Amyotrophic lateral sclerosis (ALS) sx

Answer 4

instability, upper extremity weakness
sensation, urinary sphincter, and voluntary eye movements spared
cannot control motor movements
mixed upper and lower motor neuron signs

Question 5

Bells palsy tx

Answer 5

prednisone- start 72h of sx onset
artificial tears
acyclovir- severe cases

Question 6

C5 nerve root function

Answer 6

deltoids and biceps
dermatome: outer part of upper arm down to elbow

Question 7

CN3 disorder

Answer 7

oculomotor nerve
inferior rectus, ciliary body
dilated pupil

Question 8

complex regional pain syndrome sx

Answer 8

pain out of proportion to exam w/ skin changes (raynauds)
psychologic hx

Question 9

complex regional pain syndrome tx

Answer 9

early mobilization after injury, NSAID, PT/OT
Pain: amitriptyline, gabapentin, calcitonin adjunct
tx failure: bisphosphonates, IVIG, nerve block
VitC prophylaxis after fx may decrease incidence

Question 10

drugs to avoid when having dementia

Answer 10

avoid anticholinergic, opiates and benzos

Question 11

what is Bovine spongiform encephalopathy

Answer 11

mad cow disease- from eating infected cattle meat
rapid mental deterioration within few months –> coma

Question 12

epidural hematoma CT

Answer 12

convex (lens shaped) bleed
doesn’t cross suture line

Question 13

gonococcal meningitis maintenance

Answer 13

vacine >55yo and high risk
tx close contacts w/ ciprofloxacin or rifampin

Question 14

Guillain barre syndrome sx

Answer 14

ground to brain syndrome
preceding respiratory or GI infx
decreased DTR (LMN lesion), breathing difficulty

Question 15

Guillain barre syndrome caused by

Answer 15

campylobacter jejuni

Question 16

Guillain barre syndrome tx

Answer 16

plasmapheresis
IVIG
mechanical ventilation if respiratory failure
prednisone CI

Question 17

huntington dz dx

Answer 17

CT scan: cerebral and caudate nucleus atrophy
genetic testing
PET scan: decrease glucose metabolism in caudate nucleus and putamen

Question 18

huntington dz tx

Answer 18

no cure
chorea: antidopaminergics
antipsychotics, tetrabenazine
sleep and chorea: benzo

Question 19

Lateral medullary (Wallenberg) syndrome sx/dx

Answer 19

head impulsive, nystagmus, test of skew exam
CT/MRI

Question 20

basal ganglion lesion sx

Answer 20

problems w/ speech, movement, and posture
“parkinsonianism”

Question 21

cerebellum lesion sx

Answer 21

dyssynergia, dysmetria, dysarthria, ataxia
ipsilateral

Question 22

cerebral meningioma dx

Answer 22

CT/MRI: intensely enhancing well defined lesion attached to dura
brain bx guided by imaging studies

Question 23

meningococcal meningitis sx

Answer 23

positive kernig
positive brudzinski

Question 24

Multiple sclerosis sx

Answer 24

uhthoffs phenomenon
Lhermittes sign
optic neuritis, vision loss
Marcus gunn pupil
UMN= spasticity, + upward babinski

Question 25

multiple sclerosis dx

Answer 25

clinical dx - at least 2 discrete episodes MRI w/ gadolinium TOC= white matter plaques, hyper densities (hallmark) LP: increased IgG in CSF

Question 26

multiple sclerosis tx

Answer 26

acute exacerbation: IV high dose CS 1st line. plasmapheresis if refractory relapsing-remitting/progressive: beta interferon or glatiramer acetate fatigue: amantidine spasticity: baclofen and diazepam

Question 27

Myesthinia gravis sx

Answer 27

strongest in morning, weakest in evening

Question 28

Myesthinia gravis labs

Answer 28

AChr-ab MuSK ab assays edrophonium (tensilon) test ice pack test

Question 29

Myesthinia gravis tx

Answer 29

pyridostigmine/neostigmine 1st line plasmaphoresis/IVIG thymectomy if thyoma avoid FQ or aminoglycosides

Question 30

MC brain neoplasm

Answer 30

glioblastoma- most aggressive and MC

Question 31

neoplasm in frontal lobe sx

Answer 31

dementia, personality changes, gait, expressive aphasia, seizures

Question 32

neoplasm in temporal lobe sx

Answer 32

partial complex and generalized seizures

Question 33

neoplasm in parietal lobe sx

Answer 33

receptive aphasia contralateral sensory loss hemianopsia spacial disorientation

Question 34

neoplasm in occipital lobe sx

Answer 34

contralateral homonymous hemianopsia

Question 35

neoplasm in thalamus sx

Answer 35

contralateral sensory loss

Question 36

neoplasm in brainstem sx

Answer 36

papillary changes nystagmus hemiparesis

Question 37

peroneal nerve injury sx

Answer 37

provides sensation to lateral leg innervates peroneous longus, peroneus brevis, and short head of biceps injuries can lead to foot drop

Question 38

neurogenic shock sx

Answer 38

decreased CO, warm dry skin, normal/decreased HR, wide pulse pressure decreased SVR, bradycardia decreased PCWP due to acute spinal cord injury or regional anesthesia

Question 39

ulnar nerve neuropathy sx

Answer 39

+ tinels sign + froments sign

Question 40

vagus nerve normal fx

Answer 40

CN 10 motor: voice, soft palate, gag reflex sensory: information about organs

Question 41

parkinsons dz tx

Answer 41

levodopa/carbidopa most effective DA agonist: bromocriptine, pramipexole, ropinirole (to delay use of levodopa) Ach: benztropine (<70yo w/ tremor predominance)

Question 42

restless leg syndrome tx

Answer 42

DA agonist TOC (pramipexole, ropinirole gabapentin, pregabalin benzo adjunct (clonazepam) opioids in disease resistant cases iron supplement w/ ferritin <75

Question 43

can't give to patients with seizure disorder

Answer 43

Cant drive for 2 yrs, need to balance meds buproprion lowers seizure threshold Tdap cannot give

Question 44

subarachnoid hemorrhage (SAH) sx

Answer 44

sudden onset HA thunderclap worse HA of my life

Question 45

subarachnoid hemorrhage dx

Answer 45

CT first line --> LP (looking for blood or xanthochromia) --> 4 vessel angiography after confirm SAH

Question 46

subarachnoid hemorrhage tx

Answer 46

refer to interventional radiology for surgery nimodipine, nicardipine, labetalol to lower BP supportive tx decrease ICP: mannitol, hyperventilation, head elevation

Question 47

subdural hematoma CT

Answer 47

concave (crescent shaped) bleed can cross suture line

Question 48

tardive dyskinesia tx

Answer 48

clonazepam, valbenazine, deutetrabenazine clozapine good if pt needs antipsychotic tx

Question 49

TIA dx

Answer 49

CT head BIT carotid doppler, CTA, MRA ABCD2 score to assess CVA risk

Question 50

trigeminal neuralgia (tic douloureux) tx

Answer 50

carbamazepine 1st line oxcarbazepine gabapentin, baclofen

Question 51

trigeminal neuralgia CN

Answer 51

CN5

Question 52

tumor lysis syndrome labs

Answer 52

hyperuricemia hypocalcemia kyperkalemia hyperphosphatemia acute renal failure