Neuro/Psych

Question 1

How long does it take for a CT head to reach 95% sensitivity for a stroke? How long for an MRI?

Answer 1

CT head - 4-5 days, MRI 1-2 days

Question 2

If a patient is on aspirin and has a stroke what are 2 options for the next step in prevention?

Answer 2

Add dipyramidole or SWITCH to clopidogrel

Question 3

What is the time frame for thrombolytics in an ischemic stroke?

Answer 3

Less than 4.5 hours

Question 4

What metabolism altering drug must be added to a patient’s regimen after an ischemic stroke?

Answer 4

A statin

Question 5

What anticoagulation treatment is recommended after an ischemic stroke?

Answer 5

Heparin followed by warfarin - INR 2-3

or Rivaroxaban/dabigatran

Question 6

What does the CHADS VAsc score measure?

Answer 6

Risk for stroke from atrial fibrilation

Question 7

What is the recommended treatement for a patient with of symptomatic cerebrovascular disease with >70% carotid stenosis? What about <50% stenosis?

Answer 7

> 70% stenosis - endarterectomy

<50% - no endarterectomy is indicated

Question 8

Does angioplasty or stent have value for stroke patients?

Answer 8

NO

Question 9

What is the goal LDL post stroke?

Answer 9

<70 mg/dL

Question 10

What is another name for pseudotumor cerebri?

Answer 10

Idiopathic Intracranial HTN

Question 11

What physical exam findings are present for cluster headaches?

Answer 11

Red eye with tearing, rhinorrhea, possible horner syndrome

Question 12

What physical exam findings are present for giant cell arteritis

Answer 12

Visual loss with tenderness in the temporal area

Question 13

What physical exam findings are present for pseudotumor cerebri?

Answer 13

Papilledema with abducens palsy

Question 14

What other eye pathology can cause headache with a red eye?

Answer 14

glaucoma

Question 15

What is the treatment for a tension headache/

Answer 15

NSAIDs/oral analgesics

Question 16

What are 4 abortive treatments for migraine?

Answer 16

NSAIDs/excedrin/triptans/ergotamine

Question 17

What 2 abortive treatments are available for cluster headaches?

Answer 17

triptans/ergotamines + 100% oxygen

Question 18

What is the initial treatement for giant cell arteritis?

Answer 18

prednisone

Question 19

What is the initial treatment of pseudotumor cerebri?

Answer 19

weight loss + acetazolamide

Question 20

What tests are necessary for diagnosis of IIH?

Answer 20

Head CT/MRI to rule out intracranial mass + LP to show increased pressure

Question 21

What is prophylactic treatement for cluster headaches?

Answer 21

Verapamil

Question 22

What are 3 intial prophylactic treatments for migraines?

Answer 22

Beta blocker (e.g. propranolol), TCA (e.g. amytriptiline), topiramate

Question 23

What is inital treatment for trigeminal neuralgia?

Answer 23

Oxcarbazapine or carbamazapine

Question 24

What is the order of drugs (4) for status epilepticus?

Answer 24

IV benzodiazapine –> phenytoin/fosphenytoin –> phenobarbitol –> succinylcholine/vecuronium + intubation

Question 25

What anti-seizure has the fewest side effects?

Answer 25

Levatiracitam

Question 26

Can you take away a driver's license for seizures?

Answer 26

No - have to strongly recommend it

Question 27

What are the components of the mental status exam (10)?

Answer 27

``` Appearance Behavior Speech Mood/Affect Thought Process Thought Content Perceptual Disturbances Cognition Insight Judgment/Impulse Control ```

Question 28

What are the 4 P's of a psychiatric HPI?

Answer 28

Predisposing features Precipitating factors Perpetuating factors Protective factors

Question 29

What is circumstantiality?

Answer 29

Will eventually reach the point of the converstion but a lot of trivial info is added in

Question 30

What is tangentiality?

Answer 30

Point of conversation is never reached - responses usually ballpark relevant

Question 31

What is loosening of associations?

Answer 31

no logical connection from one though to the next

Question 32

What is flight of ideas?

Answer 32

Thoughts change abruptly from one idea to another + pressured speech

Question 33

What is neologisms?

Answer 33

Made up words

Question 34

What is clang associations?

Answer 34

Words connecting through rhyming rather than content

Question 35

What is the Tarasoff rule?

Answer 35

If a patient expresses imminent threats against anyone - physician must warn them

Question 36

What are ideas of reference?

Answer 36

Thoughts that external cues (e.g. billboards/TV) are specifically addressing the patient

Question 37

What are 2 examples of delusions of control?

Answer 37

Though broadcasting and thought insertion

Question 38

What is an illusion?

Answer 38

misinterpretation of an existing stimulus

Question 39

What is the most common cause of auditory hallucinations?

Answer 39

schizophrenia

Question 40

What is the most common cause of visual hallucinations?

Answer 40

Drug intoxication/drug withdrawal or delirium

Question 41

What is the most common cause of olfactory hallucinations?

Answer 41

Aura associated with epilepsy

Question 42

What is the most common cause of tactile hallucinations?

Answer 42

Drug use or alcohol withdrawal

Question 43

What is anhedonia?

Answer 43

Inability to feel pleasure

Question 44

What is alogia?

Answer 44

Poverty of speech

Question 45

What are the 3 stages of schizophrenia?

Answer 45

Prodromal - decline in functioning before first episode Psychotic - positive symptoms with disordered thought content Residual - predominantly negative symptoms

Question 46

What is the time requirement for schizophrenia?

Answer 46

At least 6 months (including prodromal time)

Question 47

When is schizophrenia most likely to present for men? When for women?

Answer 47

Men - early to mid 20s | Women - late 20s

Question 48

Are men or women more likely to have negative predominant symptoms in schizphrenia?

Answer 48

Men - generally have poorer outcomes

Question 49

What is the MoA of 1st generation antipsychotics?

Answer 49

D2 antagonists

Question 50

What is the MoA of 2nd generation antipsychotics?

Answer 50

5-HT2 antagonist and D4/D2 antagonist

Question 51

What should be added to treatment if extrapyramidal symptoms occurs while on an antipsychotic?

Answer 51

Anticholinergic (e.g. benztropine, diphenhydramine)

Question 52

What should be added to treatment if anticholinergic side effects occur while on an antipsychotic?

Answer 52

Per-symptom treatment (e.g. stool softener for constipation, eye drops for dry eyes)

Question 53

What treatment change should be considered for metabolic syndrome on 2nd generation antipsychotics?

Answer 53

Switch to 1st gen antipsychotic or use aripiprazole/ziprasidone which are weight neutral

Question 54

What is the last line 2nd gen antipsychotic? Why?

Answer 54

Clozapine - due to agranulocytosis risk

Question 55

What treatment change should occur if a patient on 1st generation antipsychotic has tardive dyskinesia?

Answer 55

Discontinue/reduce drug and can use benzodiazapines/botox for symptoms

Question 56

What is the cumulative risk of developing tardive dyskinesia while on antipsychotics?

Answer 56

5% per year

Question 57

Who is at greatest risk for tardive dyskinesia on antipsychotics?

Answer 57

Older women

Question 58

What is the distiniguishing requirement for schizophreniform disorder diagnosis?

Answer 58

1-6 months of schizophrenia-like symptoms

Question 59

What is the diagnostic criteria for schizoaffective disorder?

Answer 59

Major depression/mania diagnosis + delusions and hallucinations for at least 2 weeks WHILE NOT AFFECTED BY MOOD DISORDER

Question 60

What is the diagnostic requirement for brief psychotic disorder?

Answer 60

Schizophrenia-like symptoms from 1 day to 1 month