NEURO

Question 1

What is the most common form of dementia?

Answer 1

Alzheimer’s

Question 2

What form of dementia has a slow/gradual onset, over 8-10 years?

Answer 2

Alzheimer’s

Question 3

If a patient is having difficulties with memory, they can’t seem to learn new info but their motor and sensory function is spared – what disorder?

Answer 3

Alzheimer’s

Question 4

What form of dementia has gradual onset, but also involves hallucinations, visuospatial fluctuations along with Parkinsonism?

Answer 4

Lewy Body dementia

Question 5

If a patient is having difficulties with language and executive functioning – what disorder?

Answer 5

Frontotemporal dementia

Question 6

If on MRI a pt has cortical & subcortical changes with sudden almost stepwise changes in function – what disorder?

Answer 6

Vascular dementia

Question 7

What should be done on PE in a pt with dementia?

Answer 7

neuro exam, mental status, functional status (SLUMS, mini-cog, MMSE)

Question 8

What type of labs should we order in a pt we suspect dementia?

Answer 8

CBC
Na
BUN/Cr
Fasting Glucose
RPR
TSH
B12
Possible UA
folic acid
and liver function

Question 9

In a pt we suspect dementia, when would we consider imaging?

Answer 9

onset <65; focal sxs; concern from hydrocephalus; recent fall or head trauma

Question 10

What are some non-pharm options for tx dementia?

Answer 10

cognitive rehab
therapy
physical & mental activity
attention to safety

Question 11

What is being broken down too quickly with dementia?

Answer 11

Acetylcholine

Question 12

What medications slow the breakdown of acetylcholine and are prescribed for dementia? Give some examples

Answer 12

Cholinesterase inhibitors

Ex: Donepezil or memantine

Question 13

What should you always keep on your DDx in a patient you’re concerned has dementia, and thus we may treat them for this as well?

Answer 13

Depression

Question 14

Parkinson’s disease is a disease involving what NT?

Answer 14

Dopamine

Question 15

What are some of the hallmark sxs of Parkinsons? (5)

Answer 15

• Tremor = worse at REST – pill rolling
• Bradykinesia = slowness of voluntary movements (lack of swinging arms, slow speech)
• Rigidity = Cogwheel (normal DTRs)
• Fixed Face
• *Festination Gait = turn “en bloc”

Question 16

At what point do we start to treat Parkinson’s?

Answer 16

When sxs interfere with function

Question 17

With what meds can we treat Parkinson’s?

Answer 17

• Dopamine reuptake inhibitors = Amantadine
• Dopamine = Levodopa
  * Start low and titrate up

Question 18

If a pt is presenting with acute changes in mental status – what should you always think of first?

Answer 18

MEDICATIONS

Question 19

What 3 meds a classic for causing acute changes in mental status?

Answer 19

anticholinergics, prednisone, benzo’s

Question 20

Besides medications, what other things may we need to change in order to help with mental status changes?

Answer 20

sleep deprivation
immobility
visual/hearing impairment
INFECTION
DEHYDRATION

Question 21

What are some of the risk factors to a stroke?

Answer 21

HTN!! (MOST POWERFUL RF)
Smoking*
atherosclerosis elsewhere
DM*
AFib

Other: male, ETOH, hyperlipidemia, AIDS, previous stroke

Question 22

A lacunar infarct is occurring where? What type of sxs are associated with these?

Answer 22

SMALL VESSEL Disease

May be without findings – incidental on CT

Question 23

A cerebral emboli stroke is what?

Answer 23

Embolism from heart or artery breaks off and occludes a distant vessel à in the brain

Question 24

What type of stroke is often associated with Afib and is the reason why it’s so important to anticoagulate pt’s with afib?

Answer 24

Cardioembolism

Question 25

What artery is affected when a pt has contralateral hemiplegia (hemiparalysis) after a stroke?

Answer 25

Middle Cerebral Artery

Question 26

What artery is most commonly occluded during a stroke?

Answer 26

Middle Cerebral Artery

Question 27

If this artery is occluded during a stroke it can lead to loss of several reflexes (grasp, suck), paralysis of foot/leg, urinary incontinence, and behavioral changes.

Answer 27

Anterior Cerebral Artery

Question 28

If an occlusion occurs in this area of the brain it will results in visual deficits and changes in pupils/sensations?

Answer 28

Posterior Circulation

Question 29

If a pt has transient monocular blindness – what does that mean, what is it called?

Answer 29

Embolism of ophthalmic artery

Amaurosis Fugax

Question 30

If it is an acute stroke, what imaging do you need? What are you ruling out?

Answer 30

CT scan

R/O Hemorrhage

Question 31

After a CT scan what’s the next imaging needed? What’s technically the gold standard?

Answer 31

MRI

Gold Standard = Arteriography

Question 32

During an acute stroke what do we do if their BP is 180/90?

Answer 32

LEAVE IT – avoid rapid BP reduction

Question 33

During an acute stroke what do we do if their BP is 203/100?

Answer 33

Okay now you need to lower it – SLOWLY!

Question 34

So, how do we treat an acute stroke?

Answer 34

Once hemorrhage has been ruled out…

<3 hours = TPA + full anticoagulation

Question 35

What are contraindications to TPA?

Answer 35

• Previous stroke or recent bleeding/major surgery
• BP >185/110
• Neoplasm
• Glucose <50 & platelets <100,000
• Heparin use within 48 hours

Question 36

What’s the difference between a stroke & TIA?

Answer 36

Stroke = sxs >24 hours, irreversible damage
TIA = sxs <24 hours, reversible

Question 37

What surgical treatment is available for a TIA?

Answer 37

carotid endarterectomy or carotid angioplasty/stenting

Question 38

What pharm Tx is available for TIA? When do we initiate it?

Answer 38

ASA

If Pt is a poor operative candidate, <70% stenosis