Neurology

Question 1

What type of headache? Unilateral, pulsatile, lasting 4-72 hrs, recurrent, +/- nausea/vomiting, photo-sensitivity

Answer 1

migraine headache

Question 2

ESR level in temporal arteritis?

Answer 2

> 50

Question 3

Tx of Temporal Arteritis

Answer 3

Prednisone 40-60 mg daily for 1-2 months with slow taper + ASA to reduce the risk of stroke and vision loss

Question 4

Treatment for Pseudotumor cerebri

Answer 4

start acetazolamide +/- diuretic, stop offending rx, weight loss for obese patients, may need repeat LP or shunt for refractory cases

Question 5

HTN cut off in ischemic stroke

Answer 5

do not treat unless >220 SBP or DBP >110; if TPA >185/110

Question 6

Absolute C/I for TPA

Answer 6

active bleeding, current use of anticoagulant, hx of IC hemorrhage, stroke in previous 3 months, platelets <100,000

Question 7

When do you start ASA/Plavix for stroke?

Answer 7

if not TPA start immediatly; if TPA given then start 24hr before starting

Question 8

Time window for TPA

Answer 8

3-4.5 hr

**aafp uses 3hr cut off

Question 9

BP range for hemorrhagic stroke

Answer 9

gradually lower BP & keep between 130-120

Question 10

Broca vs Wernicke aphasia

Answer 10

Broca: speech is nonfluent, effortful, monotone with impaired naming, repetition & writing. Comprehension preserved

Wernicke: Fluent, possibly excessive speech with frequent paraphasias(substituting words). Comprehension impaired with impaired reading, writing, naming and repetition.

Question 11

Triad for wernicke encephalopathy

Answer 11

encephalopathy, oculomotor dysfunction, gait ataxia

*in reality confusion is the MC symptom - will also develop korsakoff syndrome over time

Question 12

Korsakoff syndrome

Answer 12

permanent and significant impairment of short term memory with inability to form new memories and impaired remote memory. apathy & lack of insight to the disorder but alert and responsive.

Question 13

Meniere’s disease vs labyrinthitis vs vestibular neuritits

Answer 13

Meniere’s Disease: episodic vertigo w/tinnitus/hearing loss during episodes

Labyrinthitis: inflammation of the labyrinith w/persistent vertigo, usually follows URI and has hearing loss/tinnitus

Vestibular neuritis: inflammation of the vestibular nerve resulting in persistent vertigo w/o hearing loss, usually follows URI

Question 14

Inheritance pattern and symptoms of Friedreich Ataxia

Answer 14

AR mutation w/expanded GAA repeat on chrom 9.

*ataxia, kyphoscoliosis, restrictive lung dz, cardiomyopathy

Question 15

Inheritance and mutation in huntington disease

Answer 15

AD, CAG repeats

Question 16

When do you need dual antiplatelet therapy for a TIA?

Answer 16

Dual antiplatelet therapy with aspirin and Plavix are recommended for the first 21 days in patients with a high-risk TIA. After that continue with aspirin alone

Question 17

What is DRESS syndrome?

Answer 17

Drug reaction with eosinophilia and systemic symptoms

Question 18

Best rx to prevent cluster headache?

Answer 18

Verapamil

Question 19

Best rx for chronic tension headache

Answer 19

(More than 15 headaches a month) topamax or valproate

Question 20

Best prevention rx for migraines associated with menses?

Answer 20

Frovatriptan