Neurology Qs Flashcards by Michael Salgado

adjunctive treatment in multiple sclerosis?

Vit D

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In order to meet criteria for dementia, a patient’s cognitive deficits must?

interfere with daily functioning and result in some loss of independence.

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Managemetn of asymptomatic meningiomas without evidence of invasion of other intracranial structures and without surrounding edema?

followed clinically and radiographically

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signal abnormalities typically seen on MRIs of patients with migraine? Significance?

White matter signal abnormalities in the posterior circulation

benign and unrelated to neurologic examination abnormalities or cognitive anomalies

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most common epileptic aura if originates in the temporal lobe?

rising epigastric sensation

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Classically, frontal lobe seizures cause?

motor manifestations (focal jerking, bicycling movements) that awaken patients from sleep.

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Myotonic dystrophy type 1 v 2. Which is more common? Preferentially involves?

distal limb and facial muscles VS proximal muscles

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Differentiating hallmark of myoonic dystrophy?

Difficulty with relaxation

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Inclusion body myositis - time of progression? predominantly affects? Not a feature?

slow

distal upper extremity flexors and quadriceps

myotonia

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Primary progressive aphasia is most commonly associated with what type of dementia?

frontotemporal dementia

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shown to be superior to aspirin alone in reducing the risk of recurrent stroke

aspirin and dipyridamole

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dual antiplatelet agents - role post-stroke?

don’t use - increased risk of hemorrhagic complications that offset any potential clinical benefit

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narrow-spectrum AEDs used to treat partial-onset epilepsies? may provoke?

Carbamazepine, gabapentin, and phenytoin

absence status epilepticus.

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Typical features suggestive of partial onset seizures?

specific auras (déjà vu or a rising epigastric sensation) and unilateral clonic shaking before onset

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Topiramate - broad or narrow spectum AED?

Broad

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Horner syndrome?

miosis, ptosis, and anhidrosis

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characteristic of carotid artery dissection?

ipsilateral neck pain and ischemic complications (monocular visual loss and Horner syndrome)

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Oxcarbazepine - side effect?

hypoNa

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First line medications for essential tremor?

propranolol and primidone

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Spinal cord compression by skeletal lesions resulting from plasmacytoma should be treated with? unless?

Radiation (even with minor neurologic deficits); spinal instability

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combat veterans, particularly those with posttraumatic stress disorder (PTSD), are at high risk for?

nonepileptic seizures

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levetiracetam should be avoided patients with PTSD because?

exacerbate anxiety and irritability

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Tx for urgency, frequency, and incontinence in MS?

anticholinergic agents (oxybutnin) - decrease bladder spasms

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Antiepileptic drugs that are better tolerated in the elderly?

lamotrigine, levetiracetam, and gabapentin

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hunderclap headaches that recur over several days or weeks - dx? May also present with? CTA shows?

reversible cerebral vasoconstriction syndrome focal neurologic deficits multifocal areas of vasospasm without evidence of aneurysm

Primary stabbing headache - usually lasts for how long? responds to?

seconds; indomethacin

Treatment for primary CNS lymphoma?

Methotrexate-based chemotherapy and whole brain radiation

Standard-of-care treatment of an accessible solitary brain metastasis in patients with good functional status?

Complete resection followed by radiation therapy

can initially aggravate symptoms of myasthenia gravi? when to start them?

High-dose glucocorticoids; These agents can be started after therapy with plasmapheresis or IVIG has been initiated.

most effective acute cluster headache treatments? drug of choice for cluster headache prevention?

Oxygen therapy and subcutaneous sumatriptan verapamil

How many days/month of opiates does it take to develope medication overuse headache?

standard of care for multiple sclerosis relapses?

IV methlyprednisone

Treatment guidelines advise treatment of hypertension in patients with acute ischemic stroke only if blood pressure is greater than?

220/120 mm Hg or evidence of other end-organ damage exists

appropriate next step in management for patients with incomplete recovery 3 months after onset of facial nerve palsy?

MRI Brain + evaluation for lyme, DM, vasculitis, HIV, sarcoid, Sjogren

Antiepileptic drugs that should not overlap due to risk of Stevens Johnson syndrome?

Lamotrigine and valproic acid

Anti-epileptic drugs that are safe in pregnancy?

levetiracetam and Lamotrigine

Progressive supranuclear palsy - PSP is defined by parkinsonism with? Characteristic appearance?

oculomotor abnormalities, including *impairment of vertical saccades and supranuclear vertical gaze palsy* exhibit facial dystonia (with a characteristic surprised appearance)

BP med that should be avoided in this patient with a likely intracerebral hemorrhage? Why?

Intravenous nitroprusside can increase intracranial pressure

Goal blood pressure after intracerebral hemorrhage?

< 160/90

Physical exam findings of chronic inflammatory demyelinating polyradiculoneuropathy? EMG findings? of conduction velocities) detected on nerve conduction studies

diffuse areflexia and sensory and motor neuropathy; conduction blocks and slowing

Guillain-Barré versus chronic inflammatory demyelinating polyradiculoneuropathy?

GBS has a faster progression and reaches its nadir within 4 weeks, CIDP progression continues beyond 8 weeks from onset.

Only reliable medication for idiopathic intracranial hypertension?

Carbonic anhydrase inhibitors, such as acetazolamide,

when to consider a lobectomy for epilepsy?

persistence of disabling seizures for longer than 1 year despite treatment with adequate doses of two or more antiepileptic drugs

In hospitalized patients with Parkinson disease, sudden withdrawal of dopaminergic medications can lead t?

parkinsonian-hyperpyrexia syndrome, an acute syndrome resembling neuroleptic malignant syndrome

Definition of status migrainosus?

migraine attack extending beyond 72 hours and is the most common complication of acute migraine.

Treatment of status migrainosus?

Repetitive administration of intravenous dihydroergotamine

Fingolimod?

sphingosine-1-phosphate receptor modulator that restricts activated lymphocytes to lymph nodes Disease-modifying threrapy for MS (decreases relapse rate and acumulation of new lesions on MRI)

Nimodipine? When (timing, dose, duration) to give?

L-type calcium channel blocker that decreases vasospasm (and death) in patients with SAH

Best options for migraine *without aura*? Preferred option?

NSAIDs, triptans, and dihydroergotamine NSAIDs are preferred as initial treatment because of their greater cost-effectiveness.

Treatment for ALS with a survival benefit?

Riluzole

ALS mimickers?

Lyme disease, hyperparathyroidism, vitamin B12 or copper deficiency, lead intoxication,

Cerebral vasospasm after SAH most often occurs when? and is best detected by?

5 to 10 days after the hemorrhage; CT angiography of the brain.

first-line treatment for restless legs syndrome?

Dopamine agonists, such as ropinirole, pramipexole, or rotigotine

INR that is a contraindication to TPA?

1.7

Blood pressure go after TPA?

< 180/105

appropriate as therapy for migraine without aura in patients not responding to NSAIDs or oral triptans?

Subcutaneous sumatriptan

Dissection of the left internal carotid artery typically results in? What is spared?

ipsilateral Horner syndrome with ptosis, miosis, and anhidrosis but not oculomotor nerve (cranial nerve III) palsy.

Antiepileptic drugs that do not affect liver enzymes, and are therefore used in patients getting chemotherapy?

Valproic acid, lacosamide, lamotrigine, and levetiracetam.

Chronic paroxysmal hemicrania - nerve affected? Duration of attacks compared to trigeminal neuralgia? Diagnosis also requires?

V1; 15 mins v seconds concomitant ipsilateral autonomic findings, such as tearing, nasal congestion, or rhinorrhea

method to distinguish between a flare of inflammatory myopathy and glucocorticoid-induced toxic myopathy in a patient with persistent myopathy?

Steroid tapering

How long after administration of TPA before starting antiplatelet agents?

24 hours until a repeat head CT scan shows no hemorrhage,

only agents that have shown efficacy in studies of chronic migraine? Definition of chronic migraine?

Topiramate and onabotulinumtoxinA; >15 days a month for > 3 months