Neurology

Question 1

Progressive supranuclear palsy

Answer 1

Hallmark findings:

• impairment of vertical eye movements
• square wave jerks (couplets of inappropriate horizontal saccades)
• a supranuclear gaze paresis
• facial dystonia
• axial rigidity (typically falls backward)

Question 2

Treatment of MS-related fatigue

Answer 2

Amantadine or modafinil

Question 3

Treatment of MS-related spasticity

Answer 3

Baclofen, tizanidine, cyclobenzaprine

Question 4

Goal BP in ischemic stroke (not eligible for tPA)

Answer 4

<220/120

Question 5

Goal BP in ischemic stroke (eligible for tPA)

Answer 5

<185/110

Presentation within 3 hours of stroke onset

Question 6

Treatment of Guillain-Barre syndrome

Answer 6

Plasma exchange + IVIg

Question 7

Anti-epileptic(s) safe in pregnancy

Answer 7

• Carbamazepine

Question 8

Options to reduce BP in ischemic stroke (including post-tPA)

Answer 8

• Nicardipine

- Labetalol

Question 9

Only FDA-approved drug for ALS

Answer 9

Riluzole

Question 10

Subacute inflammatory demyelinating disorder in children and young adults characterized by simultaneous demyelination in multiple regions of the central nervous system.

Answer 10

Acute disseminated encephalomyelitis (ADEM)

Question 11

Mild parkinsonism + Visual hallucinations

Answer 11

Lewy body dementia

Question 12

Apathy, perseveration, hoarding, disinhibition, and other personality changes

Answer 12

Frontotemporal dementia

Question 13

Antibody against muscle-specific tyrosine kinase (MuSK)

Answer 13

Myasthenia gravis

Question 14

Antibody against post-synaptic acetylcholine receptor

Answer 14

Myasthenia gravis

Question 15

First-line therapy for myasthenia gravis

Answer 15

Pyridostigmine

Question 16

Anti-NMDA receptor encephalitis

Answer 16

Ovarian teratomas

Question 17

Anti-Hu receptor antibodies

Answer 17

Paraneoplastic syndrome associated with small cell lung cancer

Question 18

Gait impairment, urinary incontinence, and cognitive change

Answer 18

Normal Pressure Hydrocephalus

Dx: Brain MRI

Question 19

First-line drug for treating partial and generalized epilepsy that is well tolerated, has the highest rate of retention, and has the best efficacy among older patients (>60 y/o)

Answer 19

Lamotrigine

Question 20

Most common neurologic presentation of Wilson disease

Answer 20

Parkinsonism

Question 21

Cut-off to start statin on a stroke patient

Answer 21

LDL>100

Question 22

Multiple sclerosis medication associated with progressive multifocal leukoencephalopathy

Answer 22

Natalizumab

Question 23

Punding

Answer 23

Excessive, compulsive, repetitive complex activity that serves no essential purpose; associated with dopamine agonist medication

Question 24

ABCD2 score

Answer 24

Score >3 needs hospital admission for TIA

• Age>60
• BP>140/90
• Clinical symptoms (e.g. hemiparesis) - 2pts
• Diabetes
• Duration >60min

Question 25

Feature that is most pathognomonic for Parkinson’s disease

Answer 25

Resting tremor

Other features: Rigidity, bradykinesia, loss of postural reflexes, gait freezing

Question 26

Absolute exclusion criteria for IV tPA

Answer 26

1) Recent major surgery
2) Arterial puncture at noncompressible site
3) Recent systemic hemorrhag
4) Prior h/o hemorrhagic stroke
5) Coagulopathy

Question 27

Relative exclusion criteria

Answer 27

1) Rapidly improving
2) Minor symptoms
3) Seizure at onset
4) Hyper/Hypoglycemia
5) Age