Neuro guidelines Flashcards
Screening for carotid artery stenosis
A
C
A 75-year-old presents to the ED with acute neurological deficits in the distribution of
the middle cerebral artery
For the previous patient, which of the following test would be the best initial imaging study in the ED?
A. Carotid artery ultrasound
B. MRI of the brain
C. CT scan of the neck
D. CT scan of the brain
D
A thymoma might be associated with:
A. Ptosis, dysphonia and dysphagia
B. Headache, stiff neck and photophobia
C. Temporal artery inflammation on biopsy
(tumor of thymus gland)
B
A previously healthy 25-year-old woman presents with several hours of pain and diminished vision OS. Funduscopic examination reveals mild optic disc swelling without hemorrhages. Color vision is impaired. You tell her:
A. She has psuedotumor cerebri
B. She needs a brain CT
C. She needs a brain MRI
D. She needs a temporal artery biopsy
(think optic neuritis)
C - better for soft tissue
A previously healthy 25-year-old woman presents with several hours of pain and diminished vision OS. Funduscopic examination is normal. Color vision is impaired. She has a RAPD. You tell her:
A. She does not have optic neuritis
B. She may have retrobulbar ON
C. She needs antibiotics and an LP
D. She needs a temporal artery biopsy
B
(c - meningitis)
A previously healthy 25-year-old woman presents with several hours of pain and diminished vision OS. Funduscopic examination is normal. Color vision is impaired. She has a RAPD.
the patient in the previous question. All of the following are possibly true except:
A. Recovery of uncorrected vision in 3 weeks
B. Continued impairment in color vision despite return of visual acuity
C. No recurrent neurological problems in the next 10 years
D. An episode of transverse myelitis in 1 year
E. The following day she is diagnosed with MS
A true
B true
C true
D true
E-false (multiple episodes)
A 38-year-old presents with pulsatile, unilateral headaches that occur twice a month. The headaches last a few hours, up to 1⁄2 day. They are disabling to the point that they must lie down. Often vision is impaired; symptoms include transient partial visual field loss and jagged bright lights. The neurologic examination is normal.
A. Order brain imaging in all cases like this
B. Migraine is a reasonable diagnosis based on this history
C. There are no treatment options for a case like this
B
A 27-year-old developed a severe, rapid-onset headache and mild neck stiffness while performing pushups. They report no prior illness. The neurologic examination identifies no abnormal findings, but the symptoms persist 2 hours after onset.
A. Order brain imaging in all cases like this
B. Migraine is a reasonable diagnosis based on this history
C. Lumbar puncture may be required for diagnosis
rapid onset, first episode, neck stiffness - red flag
A
C
Migraine (true/false):
- Are rarely more than mild in severity
- Only respond to specific anti-migraine drugs
- May begin with an aura
- If visual Sx occur before or during migraine, consider an alternate diagnosis
- Can be diagnosed in people without headache
1 - false
2 - false
3 - true
4 - true
5 - true
Select the FALSE association:
- Episodic tension-type headache, pressure-like head pain, 2-day duration
- Fever, stiff neck, rash, Neisseria meningitidis
- Subarachnoid hemorrhage, chronic headache, fever and rash
- Subacute headache, nuchal rigidity, HIV, cryptococcal meningitis
3
A patient presents with frequent headaches. On examination, there is papilledema. Which of the following is INCORRECT?
A. This can be part of a clinical syndrome seen more commonly in female patients with BMI >30 (obesity)
B. A lumbar puncture will yield important diagnostic information
C. Brain CT scan will reveal the diagnosis
D. This presentation can be associated with certain drugs (e.g. isotretinoin - Acutane)
A true
B true
C (MRI would be more sensitive) false
D true
A 70-year-old man has facial angina, slower time to recovery after exposure to bright light. Your diagnosis:
A. Retinal artery occlusion
B. Optic ischemic syndrome
C. Internal carotid artery occlusion
D. Cavernous sinus mass
B
An abrupt, painless loss of visual field in a 60-year-old is most likely associated with:
A. MS
B. Leaking aneurysm
C. Retinal artery occlusion
D. Progressive muscle weakness with repeated use
C
An abrupt, painless loss of visual field in a 60-year-old, caused by retinal artery occlusion. Disease is most likely caused by:
A. Subarachnoid hemorrhage
B. Embolism
C. Demyelinating lesion
D. Myesthenia gravis
B
A
C
D
(TIA of eye)
C
(TIA)
A
B
D
C
B
B
1 - false
2 - false
3 - false
4 - true
5 - false
6 - true
7 - false
