Inservice deck 8 - neuro and psych

Question 1

HTN patient awakens with arm paralysis. Two prior episodes that resolved. Consistent with what type of stroke?

Answer 1

thrombolic

Question 2

tPA dose affected in 85 year old with stroke symptoms that has no contraindications?

Answer 2

no change in dose

Question 3

name of med given for vaospasm in patient with headache, meningismus, and RBC’s in LP?

Answer 3

nimodipine

Question 4

65 year old female with right eye vision loss and localized headache requires what treatment in the ED?

Answer 4

temporal arteritis

tx = prednisone 60 mg

Question 5

BP tretament for ischemic stroke patient with pressure of 180/100?

Answer 5

None, tx if BP > 220/115

Question 6

patient with vertebro-basilar artery stroke will present with what findings?

Answer 6

cerebellar findings: ipsilateral CN deficits, contralateral hemiplegia, contra sensory deficits

Question 7

Most common cause of seizure in the elderly?:

Answer 7

CVA

Question 8

most common complication of taenia soleum?

Answer 8

cysticercosis

Question 9

patient with progress weakness, diplopia, and ptosis worsening throughout the day has what diagnosis?

Answer 9

myasthenia gravis

Question 10

patient in his 60s presents with facial droop, decreased taste. what is the next phys exam test to differentiate serious from benign

Answer 10

forehead for sparing

Question 11

60 year old with no trauma, unable to move anything but eyes?

Answer 11

locked in syndrome - basilar pontine hmorrhage

Question 12

virus in patient who has unilateral facial droop that includes forehead?

Answer 12

herpes simplex in bell’s palsy

Question 13

patient with torticollis, protruding tongue after receiving nause meds for gastritis has what complication of med?

Answer 13

dystonic reaction

Question 14

next tx for patient on haldol who presents with dystonia, no help with benadryl?

Answer 14

benztropine

Question 15

patient presents with headache aned meningisum, is febrile and nontoxic; normal neuro exam. Next step?

Answer 15

LP

CT in age > 55, HIV, immunocompromied, neuro findings

Question 16

what adjustemtn at the time of LP has decreased incidence of post LP headache?

Answer 16

using a small gauge non-cutting needle

Question 17

hematologic abnormality is associated with lead tox?

Answer 17

anemia

Question 18

earliest sign in cavernous sinus thrombossi?

Answer 18

lateral gaze palsy, isolated CN VI palsy

Question 19

patient presents 1 week s/p URI. Now with weakness and absent refloexes of lower extremities. Dx? what will CSF show?

Answer 19

GBS, CSF shows high protein

Question 20

bacteria associated with development of GBS

Answer 20

campylobacter

Question 21

25 y/o no trauma, develops bilateral leg sweakness, incontinence, increased DTRs with normal tone and upgoing plantar reflexes most likely has what diagnosis?

Answer 21

transverse myelitis

Question 22

most common cause of delirium in elderly

Answer 22

meds

Question 23

patient with SLE has mental status changes. most likely diagnosis? what radiology study?

Answer 23

cerebritis

CT brain with contrast

Question 24

AMS, ataxia and incontinence?

Answer 24

NPH

Question 25

60 y/o with hemorrhage CT brain loss of pupillary reflexes, loss of EOM and coma. Where is the lesion?

Answer 25

posterior fossa

Question 26

HIV pt with focal seizure and ring lesions on noncontrast CT has what?

Answer 26

toxoplasmosis

Question 27

patient with chronic alcohol intake presents with taxia, confusion, normal speech, inability to adduct eyes, nystagmus. dx and disposition? inability to adduct called? thiamine?

Answer 27

wernicke encephalopathy

admit to neuro

intranuclear ophthalmoplegia

give thiamine before glucose

Question 28

elderly patient with head trauma less likely to have what?

Answer 28

epidural bleed

Question 29

tx for 30 year old who presents febrile, altered with CT showing temporal lobe hemorrhage?

Answer 29

acyclovir

cefotaxime

Question 30

tx for patient with shock like sensations on one side of hte face?

Answer 30

trigemincal neuralgia

carbamazepine

Question 31

25 y/o with grandiose thinking, auditory hallucinations and unable to accomplish goal directed activity. Dx?

Answer 31

schizophrenia