neuro SM

Question 1

What headaches need an immediate referral?

Answer 1

SNOOP - bleed, stroke, brain tumor (dull/persistent)
Systemic - fever, chills, myalgias, weight loss, jaw pain
Neurologic - visual, pulsatile, tinnitus, weakness, ataxia
Onset - new/sudden, worst HA of their life
Onset age - elderly >65 or <5 years
Pattern/positional - aggravated by posture/valsalva, pregnancy, cough, sex, exercise

Question 2

Atrial fibrillation increases risk of:

Answer 2

ischemic stroke

Question 3

Hypertension increase risk of:

Answer 3

hemorrhagic stroke
constant increase pressure, possible burst of blood vessel
may see TIA first

Question 4

How are TIAs differentiated from a stroke? What mnemonic is helpful for a stroke?

Answer 4

TIA - symptoms resolves
Stroke - symptoms longer than an hour

BE FAST
balance
eyes
face
arms
speech
time

Question 5

Wernicke’s area affects?

Broca’s area?

Answer 5

WeRnicke’s - Receptive

Broca’s - Expressive (B & E are close in the alphabet)

Question 6

What is aphasia?

Answer 6

ability to understand or express speech

Question 7

What vitamin deficiency leads to Wernicke-Korsakoff Syndrome?

Answer 7

vitamin B1 - thiamine

alcoholics

Question 8

Headache: one sided, tearing, runny nose, occurs at the same time every day
How is this treated?

Answer 8

Cluster

100% oxygen - unless COPD/interferes with disease process
Calcium channel blockers - Verapamil

Question 9

Headache: one sided, possible visual impairment, temple pain/pulsing, increased ESR
How is this treated? What is a definitive diagnosis? What can this headache lead to?

Answer 9

temporal arteritis - giant cell arteritis

long term steroids
dx: temporal artery biopsy
blindess

Question 10

Headache: Occipital and typical upon awakening

Answer 10

Hypertension headache

Question 11

Headache: difficulty with lights/noise, throbbing/pulsating with possible nausea/vomiting

Answer 11

Migraine

Question 12

Headache: what headache presents bilaterally?

Answer 12

tension

Question 13

What type of headache is associated with polymyalgia rheumatica? Why?

Answer 13

PMR - inflammatory disorder with lots of muscle pain
elevated inflammatory markers
15% will develop temporal arteritis/giant cell

Question 14

Triptans are what type of treatment? What are absolute contraindications?

Answer 14

Sumatriptan

NO uncontrolled hypertension, CV disease, NO serotonin/MAOi medications in past 14 days (SSRIs)

Question 15

What drug is used to treat Parkinson’s disease?

Answer 15

levodopa-carbidopa

will stop working over time for symptoms

Question 16

What are symptoms commonly seen with Parkinson’s disease? What symptom tends to be the most debilitating?

Answer 16

bradykinsia, tremor, rigidity

bradykinsia is the most debilitating

Question 17

Brudzinski versus Kernig

What are we assessing for?

Answer 17

meningitis
Brudzinski - Back of head
Kernig - Knee

Question 18

What are the 3 A’s of Alzheimer’s disease?

Answer 18

Apraxia, Agnosia, Aphasia
movement
no sense
speech

Question 19

What assessment tool can be used to assess cognitive decline?

Answer 19

MMSE

Question 20

What CN is associated with trigeminal neuralgia? What are expected symptoms? Treatment?

Answer 20

CN 5
s/s: severe, stabbing pain in their face
TX: Tegretol/Carbamazepine (both start with T)

Question 21

What CN is associated with Bell’s palsy? What should be done for their eyes?

Answer 21

CN VII

corneal abrasions = eye lubricant

Question 22

What two tests can asses CN VIII

Answer 22

Acoustic

Rinne and Weber

Question 23

What is the Weber test? How is it performed? What are the test findings if sensorineural vs conductive?

Answer 23

weber - tuning fork on head
Sensorineural - will lateralize to this side UNAFFECTED
Conductive - will lateralize to AFFECTED side
Normal - NO lateralization, equal on both sides

Question 24

What are symptoms of Meniere’s disease? Biggest concern?

Answer 24

s/s: vertigo, tinnitis, nystagmus, ear pressure
concern: potential permanent hearing loss
Sensorineural