Nervous System

Question 1

broca’s aphasia ( expressive aphasia)

Answer 1

” broken speech”
understands language , but has difficulty forming words

location : frontal lobe

Question 2

Wernicke aphasia ( receptive aphasia)

Answer 2

unable to understand language, they can speak but sentence doesn’t make sense

location : temporal lobe

Question 3

Migraine s/s

Answer 3

W>M

throbbing pain located behind one eye w. n/v/photophobia, may have scotomas (auras)

Question 4

Migraine TX

Answer 4

abortives: analgesics/caffeine, Nsaids, Triptans

prophalaxsis : TCA, beta-blockers,

Question 5

Cluster s/s

Answer 5

M > W
one-sided lacinating / excruciating pain behind one eye/temple with ipsilateral lacrimination, nasal congestion, Horner syndrome ( one-sided ptosis or miosis

high risk suicide
occurs several times a day for weeks to months

Question 6

Cluster TX

Answer 6

abortive : 100 % oxygen by mask, sumatritan by injection

proph: verapamil PO

Question 7

Temporal Arteritis / GCA

Answer 7

> elderly
One-sided severe pain/ burning over affected temporal artery, scalp tenderness, temporary loss of vision in one eye, jaw claudication

Polymyagia Rheumatica in 20 %

will see elevated ESR, SED rate, CRP

Question 8

GCA/TA TX

Answer 8

ED

TX : high dose steroids - predisone for 2-4 weeks w/ taper

Question 9

tension type headache s/s

Answer 9

bilateral band like “pressing” mild to moderate pain, muscle tenderness on the head, neck, shoulders. Can last several hours. Can be chronic is present > 15 days a month

Question 10

tension type headache TX

Answer 10

find triggers ( stress)
decrease medication if overuse

NSAIDs, indomethacin, chronic may respond to TCA’s

Question 11

Trigeminal Nueralgia s/s

Answer 11

one-sided excruciating “ electric shock” like pain on cheek

aggravated by chewing, talking, cold air, will not have vision loss

Pain located in CN5 branch

Question 12

Trigeminal Neuralgia TX

Answer 12

Carbamazepine, surgery

Question 13

What to tx mirgraine w/ n/v?

Answer 13

subcu sumatriptan, nasal zolmitripta

anti -emetics = IM chlorpromazine, procloperazine (risk of QT prolongation)

Question 14

What is the contraindiaction of tripitans?

Answer 14

causes vasoconstriction
dont use in
- CAD / PVD, uncontrolled HTN, complex migraine
Avoid 2 weeks with an MAOI, don’t give with ergots cafergot)

Question 15

What drugs are for prophlaxis of migraine?

Answer 15

Beta blockers ( inderal)
TCA ( amitriptyline)

Question 16

Polymyalgia Rheumatica

Answer 16

related to temporal arteritis

s/s: decreased ROM of shoulder, neck, hips, severe stifness in the AM

will have elevated CRP and ESR, normocytic anema

Question 17

PMR tx:

Answer 17

Predisone then taper for several weeks to months

Question 18

What are the side effects of long-term steroids?

Answer 18

infection, osteoporisis, weight gain, depression, cateracts, glaucoma, HPA axis supression, fluid retention

Question 19

Acute Bell’s Palsy

Answer 19

One-sided facial paralysis due to inflammation/ swelling of CN7 , ONLY motor branch is effected , most cases resolve on their own in 3 weeks to 3 months

tx: artifical tears, patch ipsilateral eye at night
predisone taper

Question 20

Absence seizure

Answer 20

suddenly stares into space can last a few seconds

Question 21

tonic - clonic sz

Answer 21

tonic phase happens first - all muscles stiffin

then clonic phase - arms and legs start to jerk

Question 22

MS presentation

Answer 22

young woman, unilateral visual loss, diplopia, optic nueritis, bilateral extremity weakness, abnormal gait, problems with balance

Lhermitte sign: shock like sensation that run down back or limbs causes neck flexsion

imaging : MRI or spine

Question 23

Risk factors for someone with a embolic stroke

Answer 23

afibb, prolonged immobilzation

Question 24

risk factors for someone with a hemmorrhagic stroke

Answer 24

poorly controlled HTN present with a severe headache, n/v , nachal rigidity

Question 25

What birth control would be contraindiacted for a person with a migraine w/ aura

Answer 25

combined estogren-progestin oral contraceptive

Question 26

What are triptans contraindications?

Answer 26

Its a vascocontriction so no one with HTN, CAD, pregnancy

Question 27

What are nutritional supplement for mirgraine?

Answer 27

butter bur, fever few, Mg, Riboflavin

Question 28

What is the complication of GCA?

Answer 28

Blindness