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ABIM IM Recert > Board Vitals Neurology > Flashcards

Board Vitals Neurology Flashcards

1
Q

What is the first test when papilledema and increased intracranial pressure is suspected?

A

MRI without contrast and venography

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2
Q

What should you do before a lumbar puncture if papilledema and increased intracranial pressure is suspected?

A

MRI brain to exclude a large space occupying lesion

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3
Q

Do symptoms of myasthenia gravis improve after applying an ice pack to the affected area?

A

Yes

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4
Q

Why do symptoms of myasthenia gravis improve after applying an ice pack to the affected area?

A

Cold temperatures improve receptor response to acetylcholine.

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5
Q

How is the diagnosis of myasthenia gravis confirmed?

A

Antibody testing (autoantibodies against the acetylecholine receptor)

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6
Q

What is the first line treatment of myasthenia gravis?

A

Pyridostigmine

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7
Q

Is glycopyrrolate used to treat myasthesia gravis?

A

No

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8
Q

What is glycopyrrolate used for in myasthenia gravis patients?

A

To counteract the cholinergic side effects of pyridostigmine

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9
Q

In which myasthenia gravis patients is thymectomy recommended to decrease the need of immunosuppressive therapy?

A

Patients younger than 50 years

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10
Q

When is Azathioprine used in patients who have myasthenia gravis?

A

When patients remain symptomatic after pyridostigmine

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11
Q

Oligoclonal bands are found in the CSF of a patient with varying neurological symptoms.

Diagnosis?

A

Multiple sclerosis

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12
Q

What is the treatment of trigeminal neuralgia?

A

Carbamazepine or oxcarbamazepine

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13
Q

What is the treatment of trigeminal neuralgia?

A

Carbamazepine or oxcarbazepine

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14
Q

What is an acephalgic migraine?

A

Visual aura without the headache

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15
Q

What should you suspect in a patient with headache, fever, altered mental status and neurological changes - when there is an apparent embolic source (such as infective endocarditis)?

A

Brain abscess

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16
Q

What is the mechanism of action of tripans?

A

Selective serotonin agonists (5-HT1B and 5-HT1D) receptors

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17
Q

Which imaging study is the most sensitive for detecting brain metastasis?

A

MRI with contrast

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18
Q

Can ataxia occur in central cause of vertigo?

A

Yes

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19
Q

Can ataxia occur in peripheral cause of vertigo?

A

No

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20
Q

Can nystagmus occur in central cause of vertigo?

A

Yes

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21
Q

Can nystagmus occur in peripheral cause of vertigo?

A

Yes

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22
Q

Can tinnitus occur in central cause of vertigo?

A

No

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23
Q

Can hearing loss occur in central cause of vertigo?

A

No

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24
Q

Can tinnitus occur in peripheral cause of vertigo?

A

Yes

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25
Q

Can hearing loss occur in peripheral cause of vertigo?

A

Yes

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26
Q

Can vomiting occur in central cause of vertigo?

A

Yes

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27
Q

Can vomiting occur in peripheral cause of vertigo?

A

Yes

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28
Q

Should you use triptans in coronary artery disease?

A

No - they are contraindicated.

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29
Q

What is the mechanism of action of lasmiditan?

A

Serotonin 5-HT-IF agonism

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30
Q

What is lasmiditan used for?

A

Migraines

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31
Q

What is the mechanism of action of ubrogepant and rimegepant?

A

CGRP (calcitonin gene-related peptide) antagonist

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32
Q

What are ubrogepant and rimegepant used for?

A

Abortive therapy for migraines

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33
Q

Do all patients with community-acquired bacterial meningitis need a CT head to rule out mass effect prior to lumbar puncture?

A

No

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34
Q

What should be done first in case of bacterial meningitis - blood cultures or lumbar puncture?

A

Lumbar puncture

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35
Q

Do patients with community-acquired bacterial meningitis who are immunocompromised need a CT head to rule out mass effect prior to lumbar puncture?

A

Yes

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36
Q

Do patients with community-acquired bacterial meningitis who have a history of CNS disease e.g. mass, stoke, focal infection need a CT head to rule out mass effect prior to lumbar puncture?

A

Yes

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37
Q

Do patients with community-acquired bacterial meningitis and new onset seizures within a week of presentation need a CT head to rule out mass effect prior to lumbar puncture?

A

Yes

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38
Q

Do patients with papilledema who are immunocompromised need a CT head to rule out mass effect prior to lumbar puncture?

A

Yes

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39
Q

Do patients with community-acquired bacterial meningitis and altered mental status need a CT head to rule out mass effect prior to lumbar puncture?

A

Yes

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40
Q

Do patients with community-acquired bacterial meningitis and focal neurological deficits need a CT head to rule out mass effect prior to lumbar puncture?

A

Yes

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41
Q

Do patients with community-acquired bacterial meningitis who are > 60 years old need a CT head to rule out mass effect prior to lumbar puncture?

A

Yes

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42
Q

What is suggested by a magnetic gait i.e. difficulty raising feet from floor?

A

Normal pressure hydrocephalus

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43
Q

What maneuver can be used to diagnose benign paroxysmal positional vertigo (BPPV)?

A

Dix-Hallpike maneuver

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44
Q

Which medication is FDA approved to prevent episodic cluster headaches?

A

Galcanezumab

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45
Q

What is the standard of care for aborting cluster headaches?

A

Oxygen

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46
Q

What is the pathogenesis/cause of Guillain-Barre syndrome?

A

Molecular mimicry (between the infectious agent and the patient’s Schwann cells)

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47
Q

Do 5-HT-IF agonists (lasmiditan) cause dizziness and sedation?

A

Yes

48
Q

Do 5-HT-IF agonists (lasmiditan) cause esophageal spasm?

A

No

49
Q

Do 5-HT-IF agonists (lasmiditan) cause constipation?

A

No

50
Q

Do 5-HT-IF agonists (lasmiditan) cause liver toxicity?

A

No

51
Q

Do 5-HT-IF agonists (lasmiditan) cause bleeding?

A

No

52
Q

What is the next step in refractory status epilepticus?

A

Intubation

53
Q

Patient has gait difficulties (shuffling steps), incontinence, and cognitive impairment.

Diagnosis?

A

Normal pressure hydrocephalus

54
Q

Which condition is Lewy body dementia associated with?

A

Parkinsonism

55
Q

What kind of dementia is primary progressive aphasia a subtype of?

A

Frontotemporal dementia

56
Q

Which type of primary progressive aphasia involves word-finding difficulty and trouble naming and understanding individual words, particularly nouns?

A

Semantic variant

57
Q

In which type of primary progressive aphasia is grammatical usage and spoken language not intact?

A

Non-fluent variant

58
Q

Where does the atrophy primarily occur in frontoparietal dementia?

A

Frontal lobes

59
Q

Which dementia do cholinesterase inhibitors treat?

A

Alzheimer’s dementia

60
Q

Does hippocampal volume decrease in Alzheimer’s dementia?

A

Yes

61
Q

Cape-like distribution of sensory loss.

Diagnosis?

A

Syringomyelia

62
Q

Patient is unresponsive to verbal and tactile stimuli, not rousable, and has no voluntary eye movements.

What state is this?

A

Coma

63
Q

Are people in persistent vegetative state rousable?

A

Yes

64
Q

Do people in persistent vegetative state have normal sleep wake cycles?

A

Yes

65
Q

Are people in a coma rousable?

A

No

66
Q

Do people in a coma have normal sleep wake cycles?

A

No

67
Q

Cortical spreading depression is the mechanism underlying what kind of symptoms?

A

Migraine symptoms

68
Q

Excess excitation or impaired inhibition resulting in abnormal discharges is a mechanism underlying what condition?

A

Seizures

69
Q

Adenosine triphosphate depletion; and glutamate release into the synapse happens in which condition?

A

Ischemic stroke

70
Q

Aberrant neurotransmitter signaling, cytokine activation, or disruption in normal brain networks is the probable mechanism for which condition?

A

Delirium

71
Q

Which structural elements are primarily affected in Gullian-Barre syndrome?

A

Schwann cells

72
Q

What is the prognosis of patients with Bell’s palsy and incomplete paralysis?

A

Excellent

73
Q

What is the gold standard for diagnosis of progressive multifocal leukoencephalopathy?

A

Brain biopsy

74
Q

What is the indication for natalizumab?

A

Relapsing-remitting multiple sclerosis

75
Q

Natalizumab is associated with increased risk of which neurological condition?

A

Progressive multifocal leukoencephalopathy

76
Q

What is the indication for glatiramer acetate?

A

Relapsing-remitting multiple sclerosis

77
Q

Patient presents with fever, altered mental status and level of consciousness, headache, and focal neurologic deficits (e.g., cranial nerve deficits, seizures). Neuroimaging reveals temporal lobe abnormalities.

Diagnosis?

A

HSV type 1 encephalitis

78
Q

Is dexamethasone used to prevent complications in bacterial or viral meningitis?

A

Bacterial meningitis

79
Q

What is the mechanism of action of acyclovir?

A

Herpesvirus DNA polymerase inhibitor

80
Q

The prognosis for recovery from Ramsay-Hunt associated facial paralysis is worse than that of idiopathic Bell’s palsy.

True or false?

A

True

81
Q

How long do you give valacyclovir (and prednisone) for in Ramsay-Hunt syndrome?

A

7 - 10 days

82
Q

What is the most common symptom associated with isolated sphenoid sinus diseases?

A

Intractable headache

83
Q

Can herpes simplex virus trigger anti-NMDA receptor encephalitis?

A

Yes

84
Q

Is the CSF examination usually normal in HSV encephalitis?

A

No

85
Q

What testing is recommended for patients with moderate to severe symptoms from carpal tunnel syndrome?

A

Electromyography and nerve conduction studies

86
Q

What is the mechanism of action of atropine?

A

Muscarinic acetylcholine receptor antagonist

87
Q

What can mushroom ingestion cause?

A

Muscarinic toxicity

88
Q

Can vascular risk factors (hypertension, hyperlipidemia, diabetes mellitus) cause increased incidence of mild cognitive impairment and progression to dementia?

A

Yes

89
Q

Why does meningitis result in hydrocephalus?

A

Impaired absorption of CSF from arachnoid granulations

90
Q

What can cause an overproduction of CSF?

A

Choroid plexus tumor

91
Q

Is migraine without neurologic aura a contraindication to oral contraceptive pills?

A

No

92
Q

Is migraine with neurologic aura a contraindication to oral contraceptive pills?

A

Yes

93
Q

Is smoking when above the age of 35 years an absolute contraindication to oral contraceptive pills?

A

Yes

94
Q

What kind of transmission occurs in cryptococcus neoformans infection?

A

Airborne transmission

95
Q

What kind of transmission occurs in Neisseria meningitidis infection?

A

Droplet transmission

96
Q

India ink preparation of CSF is positive in which infection?

A

Cryptococcal meningitis/encephalitis

97
Q

What are neurofibrillary tangles formed from?

A

Hyperphosphorylated tau protein

98
Q

What kind of neurological condition are neurofibrillary tangles associated with?

A

Alzheimer’s dementia

99
Q

What are alpha-synuclein aggregates?

A

Lewy bodies

100
Q

Can depression be a post-stroke complication?

A

Yes

101
Q

Can sumatriptan be used in patients with prior stroke?

A

No

102
Q

Can NSAIDS be used in patients taking warfarin?

A

No

103
Q

What is ubrogepant used for?

A

Abortive treatment of migraine

104
Q

How is the anti-coagulation with elevated INR rapidly reversed in case of an intracranial bleed?

A

4-factor prothrombin complex concentrate (4F-PCC)

105
Q

Is acupuncture of benefit in migraine headaches?

A

Yes

106
Q

Is acupuncture of benefit in fibromyalgia?

A

Requires further study

107
Q

Is acupuncture of benefit in complex regional pain syndrome?

A

Requires further study

108
Q

Is acupuncture of benefit in peri-operative pain?

A

Requires further study

109
Q

Is acupuncture of benefit in carpal tunnel syndrome?

A

No

110
Q

What is a necessary diagnostic criterion for dementia with Lewy bodies?

A

Cognitive impairment resulting in loss of function

111
Q

What is a common side effect of ubrogepant?

A

Nausea

112
Q

Which cells drive the primary immune response in multiple sclerosis?

A

T cells

113
Q

What tests are needed to confirm vitamin B12 deficiency?

A

Serum methylmalonic acid and homocysteine levels

114
Q

Does erenumab require a loading dose?

A

No

115
Q

Does galcanezumab require a loading dose?

A

Yes

116
Q

Are any of the calcitonin gene-related peptide (CGRP) used to prevent migraines dosed more than once a month?

A

No

ABIM IM Recert (42 decks)

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