hoppe neuro

Question 1

What is the most common neurological complaint in pregnancy?

Answer 1

headache

Question 2

Why do migraines improve in pregnancy

Answer 2

because of the high levels of estrogen. Low levels are associated with worse migraines

Question 3

Which headache type is unlikely to improve in pregnancy?

Answer 3

tension type headache

Question 4

Which drug is really the only headache medication that is safe in pregnancy?

Answer 4

acetaminophen

Question 5

High caffiene intake early in pregnancy is associated with _______

Answer 5

miscarriage

Question 6

Codiene and barbiturate use near term is associated with ________

Answer 6

neonatal withdrawal

Question 7

T/F the triptans are safe in pregnancy

Answer 7

false they should be avoided even in women of child bearing years having unprotected sex

Question 8

Why is ergotamine absolutely contraindicated in pregnancy?

Answer 8

it can induce uterine contractions

Question 9

What is a common way to prophylax against headaches in pregnancy?

Answer 9

beta blockers and CCBs

Question 10

When should the presentation of headache make you consider pre-ecclampsia on your DDx?

Answer 10

ANY woman with a headache after 20 weeks

Question 11

What is the triad of pre-ecclampsia?

Answer 11

HTN, proteinuria, and edema

Question 12

What is the DOC for controlling ecclamptic seizures?

Answer 12

magnesium sulfate

Question 13

Though they don?t know exaclty how magnesium works for seizures, it is known to antagonize these receptors

Answer 13

NMDA

Question 14

Why do you need to check reflexes when administering magnesium sulfate?

Answer 14

it causes neuromuscular blockade

Question 15

What is the classic demographic for pseudotumor cerebri (idiopathic intracranial HTN)?

Answer 15

young obese female (will have papilledema)

Question 16

Explain the reciprocal effects that oral contraceptives and anti-epileptic drugs have on each other

Answer 16

they both essentially decrease the effectiveness of each other by inducing hepatic enzymes

Question 17

What effect do convulsive seizures have on the fetus?

Answer 17

they can cause fetal bradycardia

Question 18

What is the worst anti-epileptic drug with respect to its ability to cause fetal issues?

Answer 18

VALPROIC ACID

Question 19

Name 4 SE in the fetus from exposure to phenobarbital and phenytoin

Answer 19

cleft lip and palate, cardiac, GU, fetal hydantoin syndrome

Question 20

What is valproate most notorious for causing?

Answer 20

neural tube defects (elevated AFP)

Question 21

Describe the pre-pregnancy planning regarding a woman’s anti-epileptic drugs if she has been SEIZURE FREE FOR 2 YEARS

Answer 21

consider a TAPERING and withdrawal of AED’s at least 6 months prior to becoming pregnant

Question 22

When is valproate acceptable to give to a pregnant epileptic?

Answer 22

if no other drug will control her seizures

Question 23

What 2 vitamins are important to give to a woman on AED’s?

Answer 23

folate (neural tube defects) and vitamin K (vitamin K is given late to prevent hemorrhagic disease of the newborn)–note, vitamin K is given in EVERY baby anyway upon birth as their gut flora are not yet present and so they produce no vitamin K

Question 24

Which brain tumors may present in pregnancy due to the fact that they grow in size from stimulation of sex hormone receptors?

Answer 24

meningiomas and schwannomas

Question 25

What clinical manifestations may lead you to think that a pregnant woman has a brain tumor?

Answer 25

nausea and vomiting LATE IN THE PREGNANCY is a big one; headache also, for obvious reasons

Question 26

When is stroke the most common in pregnancy?

Answer 26

in the puerperium

Question 27

tPA (alteplase) is pregnancy category ____

Answer 27

C

Question 28

What is the most common cause of stroke in pregnancy?

Answer 28

preecclampsia/ecclampsia

Question 29

When is central venous thrombosis most likely to present?

Answer 29

postpartum (puerperium)

Question 30

T/F: A woman with MS is likely to have an exacerbation of the disease while pregnant but have a reprieve after delivery

Answer 30

false . Pregnancy is associated with a decrease in relapses but there is an increase in them post-partum

Question 31

What is the most common neuropathy for a pregnant woman to develop? When is the most common time to develop it?

Answer 31

Carpal tunnel syndrome, in the 3rd trimester

Question 32

This nerve is ___________ is being compressed by this structure __________ in meralgia parasthetica

Answer 32

lateral femoral cutaenous, inguinal ligament

Question 33

Why shouldn’t you treat Bell palsy with corticosteroids in first 9 weeks?

Answer 33

increases risk of cleft palate

Question 34

T/F : a woman with myasthenia gravis will have a very predictable clinical course in pregnancy

Answer 34

false. Recall the 1/3 rule? 1/3 exacerbate, 1/3 stay the same, 1/3 go into remission

Question 35

This drug, which is used to Tx a particularly important complication of pregnancy, is relatively contraindicated in myasthenia gravis d/t its ability to precipitate myasthenic crisis

Answer 35

magnesium sulfate

Question 36

If a child born to a woman with myasthenia gravis shows Sx should you be worried?

Answer 36

not in a long term sense, this is most likely transient neonatal myasthenia from “passive autoimmunity” from moms IgG Ab’s

Question 37

What are 3 possible causes of restless leg syndrome?

Answer 37

folate deficiency, iron deficiency, and hormonal changes

Question 38

Define chorea gravidarum? What are the causes?

Answer 38

Chorea from ANY cause during that presents itself during pregnancy; can be from anything but circulating hormones and birth control pills can do it