MKSAP Neuro V

Question 1

The combination of parkinsonism, cerebellar ataxia, dysautonomia, and early postural instability characterizes _______.

Answer 1

Multiple system atrophy

Question 2

Markedly asymmetric parkinsonism and frequent association with dystonia, myoclonus, cortical sensory deficits, prominent cognitive dysfunction, and apraxia (impaired motor planning). MRI typically shows asymmetric posterior parietal and frontal cortical atrophy.

Answer 2

Corticobasal degeneration

Question 3

Prominent postural instability, impairment in vertical extraocular movements (supranuclear gaze palsy)

Answer 3

Progressive supranuclear palsy

Question 4

Postthrombolytic BP goal (post tPA for stroke)

Answer 4

180/105 mm Hg

Question 5

______ of the head is the most appropriate test to determine candidacy for endovascular therapy in patients with a cardioembolic stroke who have undergone thrombolysis.

Answer 5

CT angiography

Question 6

Brain herniation in a patient with a malignant primary brain tumor should be emergently treated with _____.

Answer 6

Dexamethasone

(Also elevation of HOB to 30, artificial hyperventilation and possible osmotic diuresis with mannitol or hypertonic saline)

Question 7

Cushing triad

Answer 7

Elevated BP, irregular respirations, bradycardia

Question 8

Although evidence is limited, (3 abx groups) may lower the seizure threshold and thus should be avoided in patients with epilepsy.

Answer 8

1. carbapenems
2. FQ
3. Fourth gen cephalosporins

Question 9

What is the first thing you give when somebody has a cardioembolic stroke (i.e. from afib) and is outside tPA window?

Answer 9

Aspirin (not heparin/apixaban)

Question 10

______ should be part of a comprehensive mild traumatic brain injury management strategy for patients with persistent symptoms.

Answer 10

neuropsychological testing

Question 11

MOA of donepezile

Answer 11

acetylcholinesterase inhibitor

Question 12

_____ has been shown to be effective in treating the severe apathy often associated with vascular cognitive impairment.

Answer 12

Methylphenidate

Question 13

_________ is a form of statin myopathy that is associated with antibodies to hydroxymethylglutaryl coenzyme A reductase and biopsy evidence of muscle necrosis without inflammation; treatment with a glucocorticoid or other immunosuppressive agents can reverse the myopathy.

Answer 13

Immune-mediated necrotizing myopathy

Question 14

Placement of an _____ is the initial treatment of choice for patients with intracranial hypotension; CT myelography is appropriate for those who do not respond to this treatment.

Answer 14

Epidural blood patch

Question 15

Orthostatic headache (worse when standing) . Presentation may be thunderclap (maximum onset within 1 minute) or subacute. Associated features include tinnitus, diplopia, neck pain, nausea, photophobia, and phonophobia.

Clinical examination findings are typically normal but occasionally reveal a “falsely localizing” abducens nerve (cranial nerve VI) palsy. Female sex, middle age, and connective tissue disorders are risk factors.

Brain MRI with contrast is abnormal in 80% of affected patients, with possible findings of diffuse nonnodular pachymeningeal enhancement, cerebellar tonsillar abnormalities, and subdural fluid collections.

Answer 15

Intracranial hypotension

Result of cerebrospinal fluid (CSF) leakage that can arise as a result of lumbar puncture, surgery, or trauma or can occur spontaneously.

Question 16

Because multiple sclerosis (MS) is the most common cause of transverse myelitis, ____ should be performed in patients with new-onset transverse myelitis to evaluate for MS lesions.

Answer 16

MRI of the brain (testing for oligoclonal bands is poorly specific and sensitive)

Question 17

_________ can be started 48 hours after a hemorrhagic stroke to prevent development of deep venous thrombosis as long as there is no evidence of active bleeding on neuroimaging

Answer 17

P rophylactic heparin

Question 18

_____ can be resumed in patients with intracerebral hemorrhage caused by hypertension 2 to 4 weeks after stroke onset if the hematoma has resolved on imaging and there is an appropriate high-risk indication.

Answer 18

Aspirin

Question 19

Relative contraindications for the use of cholinesterase inhibitors in the treatment of dementia (donepezil)…. (5)

Answer 19

include sick sinus syndrome, left bundle branch block, uncontrolled asthma, angle-closure glaucoma, and ulcer disease

Use memantine instead