List six medications that can be used for migraine prophylaxis?
Beta blockers, tricyclics, calcium channel blockers, NSAIDs and valproic acid.
A patient presents with what appears to be an inability to understand speech. Which aphasia should be at the top of your differential?
A patient presents with signs of a stroke to the ED what is the most important test to get?
A patient is brought in following a seizure in which she did not lose consciousness. What is the most likely diagnosis?
Simple partial seizure
What is the medical treatment for a stroke in which the CT has shown no evidence of a hemorrhage?
Heparin/coumadin, thrombolytics, steroids, hyperosmotics.
A patient presents with a painful ipsilateral third nerve palsy. What is the most likely diagnosis?
Posterior communicating artery aneurysm (PCOM).
What siezure medication may cause overgrowth of the gums?
A sudden thunderclap headache should make you think of what diagnosis?
Describe Kernig’s sign.
The patient lies supine, flex hip while keeping knee straight. Back pain is positive.
If CT is negative and you still believe there is a stroke what is the next best test to order?
A patient presents with lateralized throbbing headache. He is also complaining of nausea, vomiting and photophobia. What type of headache is most likely?
A middle age male presents with unilateral periorbital headaches occurring daily for several weeks. These headaches are extremely painful. Which type of headache is the most likely cause?
List three drugs that treat cluster headaches.
Oxygen, sumatriptan, butoprophal
A 34 year old presents symptoms which are relapsing and remitting over the past few weeks. These include visual problems and weakness in her right arm. What is the most likely diagnosis?
A patient has a tremor with motion in his hands. What medication might you prescribe?
This patient has an active tremor. A beta blocker like propranolol is a good start.
A shuffling gait should make you think of what diagnosis?
Give two classes of drug therapy for a treating Parkinson’s.
Dopaminergic (levodopa), anticholinergics are second line.
Decreased GABA and substance P should make you think of what diagnosis?
Is Huntington’s autosomal dominant or recessive?
A patient presents with weakness that he has felt in his lower legs and now feels in his knees and hips bilaterally. He has decreased deep tendon reflexes. This has been getting progressively worse. What is the most likely diagnosis?
What percentage of strokes are ischemic? What percentage are hemorrhagic?
You believe a patient has had a stroke. He presents with aphasia, loss of hearing in one ear and loss of vision in his left eye. Is the blockage likely in the anterior or posterior circulation?
Under what conditions would aspirin or clopidogrel be used following a TIA as prophylaxis?
These are antiplatelet medications. They would be used unless there is a known cardiac etiology for the embolism. Patients with a cardiac cause should use heparin or coumadin.
A patient who is asymptomatic should consider having an endarterectomy at what percent blockage of the carotid artery? How about in a symptomatic patient?
70% in an asymptomatic patient and greater than 60% in a symptomatic patient.
A patient presents complaining of the worst headache of his life. What might you expect their blood pressure to be?
Typically this is the description for a subarachnoid hemorrhage. You would expect the blood pressure to be elevated.
Name one abortive drug for migraines.
Triptans (sumatriptan, zolmitriptan), Ergotamine
An EEG showing focal rhythmic discharges at the onset of the seizure should make you think of what diagnosis?
Simple partial seizure
What is the single most important thing to be concerned about with a patient in status epilepticus?
Airway, followed by management of hyperthermia.
Describe Brudzinski’s sign.
When you lift the patient’s head the patient bends his hips.
Name three medications used to break a seizure?
Diazepam, lorazepam, phenytoin or fosphenytoin.
There is an MRI result of multiple foci of demyelination in the white matter. What is the most likely diagnosis?
List three medications used to “treat” multiple sclerosis?
Steroids, interferon-beta, copolymer
What is the most common cause of dementia?
Alzheimer’s disease, it may be as high as 80%.
What four chromosomes have been linked to dementia?
Is the ankle jerk reflex of lumbar or sacral origin?
A study result comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What is the most likely diagnosis?
A patient complains of an aching headache which feels like a band around his head. What is the most likely diagnosis?
A patient presents to your office complaining of a tremor in his right hand. He states after a beer it goes away completely. What is the most likely diagnosis?
Benign essential tremor or familial tremor.
List two medications you might use to treat an essential tremor.
Beta blocker (propranolol), Primidone
At what age do symptoms of Huntington’s disease appear?
Around 30 years old
A 35 year old patient comes to your office because his wife made him. He has been increasingly irritable and moody. She has also noticed that he is very restless. You order a CT scan which showes cerebral atrophy as well as atrophy of the caudate nucleus. What is the most likely diagnosis?
What is the medication of choice for a patient with Tourette’s syndrome?
A slit lamp shows Kayser-Fleischer rings. What is the most likely diagnosis?
Wilson’s disease is associated with a build up of what mineral?
There is a deficiency of the copper binding protein and therefore a buildup of copper.
What are the genetic characteristics of Wilson’s disease?
Autosomal recessive, chromosome 13
What cranial nerve is affected with Bell’s palsy?
A lumbar puncture for a patient with bacterial meningitis will show elevated or decreased wbc’s? Glucose? Protein?
Elevated wbc’s, decreased glucose and elevated protein.
What symptom is associated with a classic migraine?
Having an aura
Elevated circulating acetylcholine receptor antibodies should make you think of what diagnosis?
Duchenne’s and Becker’s muscular dystrophy have what genetic characteristic?
X linked recessive
What is the age range for Duchenne’s muscular dystrophy?
3-5 years old
An EEG showing generalized spikes and associated slow waves should make you think of what diagnosis?
Generalized or absence seizure
What is the most common primary intracranial neoplasm?
What is the most common cause of subarachnoid hemorrhage aside from trauma?
Ruptured cerebral aneurysm
What are the most common primary cancer sites that metastasize to the brain?
Lung, breast and kidney
A resting or pill rolling tremor should make you think of what diagnosis?
Weakness and numbness in the left hand might be a blockage in which carotid artery?
A patient has an intracranial neoplasm causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in?
If you are looking for lesions associated with multiple sclerosis and you order an MRI do you order with gadolinium or without?
What is the defining symptom of Alzheimer’s?
Progressive memory impairment
Which nerve root is responsible for the knee jerk reflex?
An EEG showing interictal spikes should make you think of what diagnosis?
Complex partial seizure
Which is the most commonly herniated vertebral disc?
L4-L5 followed by L5-S1
What three symptoms are classic for a normal pressure hydrocephalus?
Gait disturbance, dementia and urinary incontinence
A patient presents with inability to speak and right sided weakness. He seems to understand speech and follows commands well. What type of aphasia should you be thinking of?
Alcohol may be a major factor in which encephalopathy?
A patient complains of muscle weakness and fatigability that improves with rest. What is the most likely diagnosis?
Lead pipe or cogwheel rigidity should make you think of what diagnosis?