Neurology & Psychiatry

Question 1

What is the mnemonic for syncope causes?

Answer 1

HEAD: Hypoxia, Epilepsy, Anxiety, Dysautonomia

HEART: Heart disease, Embolism, Aortic stenosis, Rhythm abnormality, Tachycardia/bradycardia.

Question 2

How is syncope evaluated (4)?

Answer 2

1. Orthostatics
2. ECG
3. Holter monitor
4. echo (if structural heart disease suspected)

Question 3

What is the treatment for vasovagal syncope (3)?

Answer 3

1. Reassurance
2. hydration
3. beta-blockers (if recurrent)

Question 4

• If they ask for the most ACCURATE test for Alzheimer →
• Test for clinical diagnosis →

Answer 4

• Brain biopsy
• MRI

Question 5

Dementia tx

Answer 5

• Mild-to-Moderate Dementia → Acetylcholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine)
• Moderate-to-Severe Dementia → NMDA receptor antagonist (Memantine)

Question 6

Workup for dementia (5)

Answer 6

1. MMSE (Mini-Mental Status Exam) → Quick screening
2. MoCA (Montreal Cognitive Assessment) → More sensitive for early dementia
3. Neuroimaging (CT/MRI) → Rule out reversible causes (normal pressure hydrocephalus, tumors, strokes)
4. B12 & TSH → Rule out metabolic causes
5. RPR → Rule out neurosyphilis

Question 7

What are the items on the SAD PERSONS suicide risk factors?

Answer 7

Question 8

When would you treat a patient indefinitely for major depression?

Answer 8

If patient had ≥3 major depressive episodes

(first episode = tx for 6 months)

Question 9

first line depression tx

Answer 9

1. fluoxetine
2. sertraline
3. venlafaxine

Question 10

SUD evaluation

Answer 10

1. CAGE questions
2. UA tox screen

Question 11

tx for opioid use disorder
tx for alcohol use disorder

Answer 11

• Opioid Use Disorder → Methadone or Buprenorphine/Naloxone (Suboxone)
• Alcohol Use Disorder → Naltrexone (first-line), Disulfiram (second-line, for abstinent patients)

Question 12

Prognosis: SUD

Answer 12

Relapse is common → Best outcomes with long-term therapy (MAT, therapy, social support)

Question 13

timeline of alcohol w/d

Answer 13

• 6-12 hours: tremor, HA, anxiety
• 12-48 hours: seizure
• 48-96 hours: DTs (hallucination, fever, autonomic instability)

Question 14

delirium tremens tx

Answer 14

IV benzos

Question 15

Ddx for altered mental status (AMS)

Answer 15

AEIOU TIPS mnemonic
Alcohol
Electrolytes
Infection
Overdose
Uremia
Trauma
Insulin
Poisoning
Stroke

Question 16

If a comatose patient is found down, give …

Answer 16

“Coma Cocktail” = Dextrose (Glucose), Thiamine, Naloxone!

Question 17

Triptan contraindications (3)

Answer 17

1. CAD
2. uncontrolled HTN
3. stroke

Question 18

migraine abortive treatment

Answer 18

NSAIDs
then triptans

Question 19

Other than periorbital pain, lacrimation and rhinorrea, what are two other signs of cluster headache?

Answer 19

circadian pattern
ptosis

Question 20

which headache can be caused by sex?

Answer 20

subarachnoid hemorrhage (SAH) - thunderclap headache

Question 21

Red flag symptoms of headache?

Answer 21

SNOOP:
Systemic sx
Neuro Deficit
Onset Sudden
Older age > 50
Pattern change or Progressive

Question 22

First-line treatment for cluster headaches?

Answer 22

1. 100% oxygen
2. subQ sumatriptan

(prevent with Verapamil)

Question 23

Tx to prevent cluster headaches

Answer 23

verapamil

(first line to tx acute: O2 + subQ sumatriptan)

Question 24

MCC of rebound headaches (caused by overuse of which 3 meds?)

Answer 24

1. NSAIDs
2. Acetominophen
3. Triptans