Neurology 1

Question 1

Eye closure, facial redness, intermittent breathing, limpness, Variable limb movement, Rapid breathing WITHOUT Post-ictal confusion. Dx? Definitive test?

Answer 1

Psychogenic Non-Epileptic Spells/Events (PNES)

Video EEG monitoring

Question 2

Treatment for delirium in Dementia with Lewy body?
AND

Treatment of Cognitive Impairment in a patient with Vascular Cognitive Impairment?

Answer 2

Donepezil

Question 3

Rx for patients with medication related complications of Parkinson’s medications ?

Answer 3

Deep Brain Stimulation

Question 4

Appropriate medication to use after severe head injury (i.e. basilar skull fracture)?

Answer 4

Acetaminophen

Need to prevent fever which can cause secondary brain injury.

Question 5

Medications for Secondary Stroke Prevention after Ischemic Stroke?

Answer 5

Aspirin, Plavix, Statin

       Or 

Aspirin-Dypradmidole

Question 6

1. Pt who never experienced relapse in MS but still have progressive disability accumulation from the time of disease onset.
2. Disappearance of relapses in relapsing-remitting, more progressive disability?
3. First line agent for relapsing-remitting MS?
4. Rx for MS Flare?
5. Rx of MS related fatigue?
6. Rx for MS with cognitive impairment ?
7. Rx for impaired mobility with MS ?
8. Appropriate test for MS patient with mixed urinary symptoms (hypertonic and hypotonic bladder)?

Answer 6

1. Primary progressive
2. Secondary progressive
3. Glatiramer Acetate and Interferone beta (Self injections) Glatiramer is favorable with patients with liver disease.
4. High Dose IV Steroids
5. Modafinil
6. Cognitive Rehab
7. Dalfampridine (potassium channel antagonist) helps boost conductance through axonal pathway
8. Urodynamic testing

Question 7

Rx for Behavioral-Variant Fronto-Temporal dementia?

Answer 7

Citalopram

Question 8

Test and Rx for the 2nd most common cause of Thunder Clap HA (multiple worse HA of life episodes with negative CT and LP)

Answer 8

Brain MRA to diagnose Reversible Cerebral Vasoconstriction Syndrome.

Rx: CCB

Question 9

Imaging Test after patient has TIA? Next step if this is positive?

Answer 9

Carotid duplex US. (evaluate for stenosis and need for surgery) CT Angiography or MRA next strep if US positive

Question 10

Impulsivity, Executive dysfunction, Dysarthria, Incoordination, Ataxia and Chorea. Dx?

Answer 10

Huntington Disease

Question 11

Bulbar cervical weakness, Tongue fasciculations and Upper and Lower motor neuro signs?

Answer 11

ALS

Question 12

Bulbar, Forearm flexor and Quadriceps Weakness with Elevate CK level?

Answer 12

Inclusion body myositis

Question 13

Progressive diffuse weakness, Burning sensation, Hx of Hypothyroidism and Splenomegaly. Dx?

Answer 13

POEMS syndrome. (Polyneuropathy, Oraganomegaly, Endocrinopathy, Monocolonal gammopathy and skin changes)

Question 14

After surgery or infection a patient develops subacute Severe Pain followed by Resolution of Pain and Progressive Weakness and Atrophy involving shoulder girdle and upper extremity muscles.

Answer 14

Idiopathic brachial plexopathy

Question 15

Treatment for episode migraines that occur < 5x a month and non responsive to NSAID?

Answer 15

Sumatriptan

Question 16

After stroke, 1> month pt presents with fatigue, HA and difficult BP control.

Answer 16

Sleep-Disordered Breathing

Pt will need a sleep study

Question 17

Abrupt onset right Retro-Orbital Throbbing HA and dDplopia, right proptosis with lid edema, right pupil dilated, sluggish reactive, CN3, CN 4, CN 6 Palsies present on right. for 12 hrs, fever, DENTAL Procedure 6 Days ago. ESR 60

Dx?

Answer 17

Cavernous Sinus Thrombosis.

Do Brain MRI to confirm diagnosis and LP to r/o meningitis

Question 18

This patient is Post TIA and has 80 % stenosis of carotid noticed on US and confirm on MRA. Next step?

Answer 18

Carotid endarterectomy ( to prevent ischemic stroke)

Question 19

Increasing cognitive deficits, walking difficulties, falls, depression/withdrawn and irritable, frequent urination at night, shuffling feet. What can help confirm this diagnosis?

Answer 19

LP removing large volume of CSF and measuring opening pressure.

(It is reversible)

Question 20

New onset Status Epilepticus In previously healthy person. It is associated with hyponatremia, myoclonus, amnesia/memory loss, temporal lobe seizures and confusion.

Dx?

Answer 20

Auto-immune Limbic Encephalitis (neurologic autoimmune disorder)

Question 21

Test to determine candidacy for epilepsy surgery in patients with medically intractable epilepsy ( ppl on 2 drugs but still having seizures)?

Answer 21

Video EEG for Temporal Lobectomy

Question 22

Rx for patients with symptomatic aneurysms or aneurysms > 7mm?

Answer 22

Neurosurgical intervention

Clip and Coil of aneurysm to prevent Subarachnoid Hemorrhage.

Question 23

What medication should be avoided in parkinsons disease psychosis (sleep attacks, punding (collecting and sorting objects repeated), gambling, hypersexual)?

Answer 23

Pramipexole (Dopamine agonist)

Question 24

Pt with severe thunder clap HA, neck stiffness and unequal pupils with normal CT findings. Next step?

Answer 24

LP r/o Herniation

Question 25

Discomforting sensations in legs at rest or when falling asleep and urge to move legs and immediate relief after moving the legs or walking. Dx? What lab to check?

Answer 25

Restless legs syndrome.

Pt should receive Iron supplements in presence of Deficiency or Low Ferritin levels.

Question 26

Frequently kicking legs during sleep. No Urge to move legs or sensory discomfort. Dx?

Answer 26

Periodic limb movements

Question 27

Exercise intolerance, cramping and myalgia, weakness after working out myoglobinuria. Dx?

Answer 27

McArdle disease (metabolic myopathy)

Question 28

Disorder that distinguishes Alzheimer’s for Dementia with Lewy Body?

Answer 28

Rapid Eye Movement Sleep Disorder- occurs in Dementia with lewy body and PD Dementia

Question 29

Rx for intracerebral hemorrhage without elevated ICP whos systolic BP > 180mmg

Answer 29

IV nicardipine treat to 140mmg Hg