Neuro

Question 1

Kernig’s sign

Answer 1

Like the patient’s hips one at a time then attempt to straighten the leg while keeping the hip flexed at 90°.

Positive if: There is a resistance to leg straightening because of painful hamstring due to inflammation of the lumbar nerve root and or patient complains of back pain.

Question 2

Brudzinski sign

Answer 2

Passively Flex/bend the patient’s neck towards the chest.

Positive; if patient reflexively flexes the hips and knees to relieve pressure and pain. Due to the inflammation of the lumbar nerve roots.

Question 3

CN

Answer 3

CN I: olfactory
CN II: optic 
CN III: oculomotor
CN IV: trochlear
CN V: trigeminal 
CN VI: abducens 
CN VII: facial
CN VIII: Acoustic
CN IX: glossopharyngeal
CN X: vagus
CN XI: spinal accessory 
CN XII: hypoglossal

Question 4

Bacterial meningitis

Answer 4

Acute onset of high fever severe headache stiff neck and rapid change in mental status and level of consciousness.

Labs
Lumbar puncture: CSF containing large number of WBCs. Definitive diagnosis made by bacteria isolated from CSF with presence of elevated protein and low glucose levels in CSF.
CBC with neutrophilia and left shift

Treatment: IV third gen cephalosporins

Send to ER

Question 5

Abortive migraine medication

Answer 5

NSAIDS
triptans - avoid in heart disease
Ergotamine - avoid in heart disease
Antiemetics

Question 6

Prophylactic treatment for migraine

Answer 6

Beta blockers; propanolol daily or b.i.d. It’s also safe with pregnancy

Tricyclics antidepressant (TCA) remember: over dose potential - amitriptyline

Anti epileptics; topamax BID- requires titration to max dose 100mg/day. Do not take with BC of kidney stones

Question 7

Temporal arthritis (giant cells arteritis)

Answer 7

Unilateral headache but it’s located on the temple and is associated with temporal artery inflammation. A systematic inflammatory disorder or vasculitis of the medium and large arteries of the body. Visual loss is not uncommon and will occur in 20% of patients may be unilateral

Temple may be pulseless due to inflammation

Check ESR and CRP
Temporal artery biopsy definitive

• send to ER

Question 8

Polymyalgia rheumatica (PMR)

Answer 8

Bilateral joint stiffness and aching located in the shoulders neck and hips and torso. May have difficulty putting on clothes, bra having difficulty getting out of bed or out of a chair.

Check ESR and CRP
Treat with long term steroid treatment.

High risk of developing GCA

Question 9

Tinel’s sign

Answer 9

Tap anterior wrist briskly.

Positive finding: pins and needles sensation of the median nerve over the hand after lightly percussing the wrist.

Test for carpel tunnel

Question 10

Phalen’s sign

Answer 10

Engage in full flexion of rest for 60 seconds
Positive findings: tingling sensation of the median nerve over the edge and evoked by passive flexion of the rest for one minute

Top aspect of hands are pushed together, palms away from each other