Neuro 2

Question 1

dizziness/vertigo

Answer 1

impairment of spatial perception and stability

Question 2

peripheral dizziness/vertigo (often, majority)
2

Answer 2

often benign
majority of cases

Question 3

central dizziness/vertigo often requires what

Answer 3

often requires urgent eval/intervention

Question 4

dizziness/vertigo - patients subjective sx
3

Answer 4

1. dizzy
2. lightheaded
3. spinning

Question 5

dizziness/vertigo - history taking, ask about new or recent what

Answer 5

new or recent cessation of meds

Question 6

dizziness/vertigo - risk stratify for what two things

Answer 6

1. central dizziness/vertigo - stroke
2. vascular causes i.e. vertebral artery dissection (neck pain on one side, hearing loss on one side, HA, dizziness, dysphagia, ataxia)

Question 7

dizziness/vertigo - low risk factors for stroke or vascular cause
3

Answer 7

1. lack of stroke risk factors or trauma
2. ambulate w/o difficulty, despite symptoms
3. symptoms lasting a few seconds to minutes and aggravated/improved dependent on head position

Question 8

dizziness/vertigo - PE findings
1

Answer 8

1. often normal

Question 9

dizziness/vertigo - PE perform what
2

Answer 9

1. comprehensive neuro exam - evaluate for unsteady gait
2. HEENT exam

Question 10

dizziness/vertigo - exam for BPPV

Answer 10

dix hallpike maneuver

Question 11

dizziness/vertigo - img/testing

Answer 11

not usually needed in low risk individuals w/ normal neuro and gait exam

Question 12

dizziness/vertigo - img/testing, consider what
3

Answer 12

1. POC glucose
2. orthostatic vitals
3. EKG if concerned for cardiac etiology i.e. CHF, valvular disease, palpitations, syncope, irregular pulse)

Question 13

dizziness/vertigo - tx
2

Answer 13

1. meclizine 25-100 mg PO, once daily and brief period of observation (max dose 100 mg/day; chronic use can cause cognitive issues, see PCP for further w/u); meclizine is antihistamine that will help with NV and dizziness. Can cause drowsiness.
2. consider Epley maneuver for BPPV

Question 14

dizziness/vertigo - who can be dc home

Answer 14

low risk patients who can ambulate, tolerate PO, and have a normal neuro exam

Question 15

dizziness/vertigo - + AMS, do what

Answer 15

refer to ER

Question 16

bell’s palsy

Answer 16

peripheral palsy of the facial nerve resulting in unilateral facial weakness

Question 17

bell’s palsy - normally idiopathing but consider what
2

Answer 17

lyme disease
herpes

Question 18

bell’s palsy - more common in patients with what disease

Answer 18

DM

Question 19

bell’s palsy - sx peak and resolve when

Answer 19

peak in first 48 hours, resolve over 3 weeks to 3 months

Question 20

bell’s palsy - clinical pres
9

Answer 20

1. facial asymmetry
2. eye irritation
3. decreased lacrimation
4. numbness of tongue
5. drooling
6. posterior auricular pain
7. hyperacusis - increased sensitivity to sound
8. otalgia

Question 21

bell’s palsy - PE what must be involved

Answer 21

forehead must be involved, paralyzed

Question 22

bell’s palsy - PE findings
4

Answer 22

1. unilateral weakness and/or paralysis in upper and lower portions of the face
2. disappearance of facial creases and nasolabial fold
3. unfurrowing of forehead
4. inability to tightly close eyes

Question 23

bell’s palsy - img/testing

Answer 23

none usually req

Question 24

bell’s palsy - DD
4

Answer 24

1. stroke
2. GBS
3. lyme dis
4. otitis media

Question 25

bell’s palsy - what percent spontaneously recover

Answer 25

70-80%

Question 26

bell’s palsy - non pharm intervention
2

Answer 26

1. artificial tears
2. patch eye at night

Question 27

bell’s palsy - rx tx guidance
2

Answer 27

1. consider steroids if initiated within 72 hours of symptom onset
2. severe paralysis or high suspicion for HSV, add antiviral regimen

Question 28

bell’s palsy - steroid rx

Answer 28

prednisone 60 PO daily for 5 days then taper for 5 more days until done.

Question 29

bell’s palsy - antiviral rx
2

Answer 29

acyclovir
adults - 400 mg PO 5xday for 10 days
children >2 - 20 mg/kg PO q6h, max 200 mg/dose for 10 days

valacyclovir for patients > 12 yrs old - 1 g PO q8h for 7-10 days

Question 30

bell’s palsy - concern for stroke when
2

Answer 30

1. sparing of the forehead
2. weakness in extremities of affected side