Neurology

Question 1

Include variability of symptoms, closing of eyes, long duration of shaking that waxes and wanes, and lack of postictal confusion; confirmation with video electroencephalographic monitoring usually is required?

Answer 1

Psychogenic nonepileptic spells/events

Question 2

What is the treatment for a patient who has dementia with Lewy bodies and acute agitation?

Answer 2

Donepezil

Haloperidol is absolutely contraindicated in dementia with Lewy bodies; donepezil is a safer alternative and may improve the behavioral and cognitive symptoms associated with dementia.

Question 3

Is appropriate treatment for patients with Parkinson disease who derive a continued benefit from carbidopa-levodopa but experience medication-related complications, such as dyskinesia (involuntary choreic movements).

Answer 3

Deep brain stimulation

Question 4

In patients with severe head injury, fever must be controlled aggressively with an agent such as

Answer 4

Acetaminophen

Question 5

In ischemic stroke due to intracranial atherosclerosis, the use of __________________________ for secondary stroke prevention is associated with a reduced long-term risk of ischemic stroke.

Answer 5

high-intensity atorvastatin therapy

Question 6

Multiple sclerosis–related fatigue is most appropriately treated with

Answer 6

A stimulant medication, such as modafinil.

Question 7

In a patient with an unprovoked, first-time seizure, what is the most appropriate initial study?

Answer 7

Head CT is the most appropriate initial study to rapidly exclude emergent pathologic issues

Question 8

Treat the symptoms of behavioral-variant frontotemporal dementia, where OCD is the most troublesome manifestations?

Answer 8

SSRIs e.g. citalopram to control her obsessive-compulsive behaviors.

Question 9

Evaluate a patient who has a cryptogenic stroke for atrial fibrillation?

Answer 9

Outpatient rhythm monitoring may yield a new diagnosis of atrial fibrillation in almost one third of patients.

Question 10

Are the diagnostic procedures of choice for reversible cerebral vasoconstriction syndrome, the second most frequent source of thunderclap headache?

Answer 10

Brain magnetic resonance angiography or head CT angiography

Question 11

Is the standard treatment for multiple sclerosis exacerbations.

Answer 11

High-dose glucocorticoids

Question 12

A type of tremor occurs both at rest and with action and is characterized by associated dystonic posturing and the presence of a null point at which a change in the position of the affected limb resolves the tremor?

Answer 12

Dystonic tremor

Rubral tremor is caused by focal injury to cerebellar outflow pathways and is characterized by a coarse tremor that is present at rest but most severe during action. This type of tremor has a prominent proximal component and interferes with various actions, such as feeding, typing, and writing, in a nonselective way. Also, MRIs of the brain reveal a focal causative lesion that is not present in this patient.

Question 13

Treat convulsive status epilepticus (CSE) in a patient allergic to phenytoin?

Answer 13

Valproic acid is an appropriate second-line therapy for convulsive status epilepticus for patients allergic to phenytoin.

IM midazolam, IV lorazepam & IV diazepam are equivalent & are first-line agents. Phenytoin, a longer-acting antiseizure drug, should then be administered; if available, fosphenytoin, a prodrug of phenytoin, is preferable to phenytoin for initial treatment because it can be administered faster & does not carry the risk of thrombophlebitis or skin necrosis (purple glove syndrome) that is associated with phenytoin extravasation.

Question 14

In older patients, _________ can frequently masquerade as cognitive impairment; screening and treatment is appropriate in these patients.

Answer 14

Depression

Question 15

This diagnosis is suggested by the presence of choreoathetosis, psychiatric symptoms, seizures, autonomic instability & positive anti–N-methyl-D-aspartate receptor antibody?

Answer 15

Ovarian teratoma–associated anti–N-methyl-D-aspartate receptor antibody encephalitis

Question 16

Prevention of episodic migraine and should be considered for migraine occurring at a frequency of at least 5 days per month?

Answer 16

Metoprolol, propranolol, timolol, divalproex sodium, and topiramate

Question 17

Treat juvenile myoclonic epilepsy in a woman with childbearing potential?

Answer 17

Levetiracetam and lamotrigine are the most appropriate treatment options because of their relatively low risk of teratogenicity.

Question 18

Spinal cord compression from metastatic disease requires emergent use of?

Answer 18

High-dose glucocorticoids and urgent surgical decompression followed by radiation.

Question 19

Characterized by rapidly progressive dementia, myoclonus, sleep problems, and other psychiatric symptoms; typical imaging findings include an increased signal in the cortex and subcortical structures on diffusion-weighted MRI sequences?

Answer 19

Creutzfeldt-Jakob disease is a transmissible prion-related disorder

Question 20

In a patient with a transient ischemic attack, what is the most appropriate initial imaging test?

Answer 20

Carotid duplex ultrasonography is an inexpensive, readily available, and noninvasive imaging modality for identifying high-grade stenosis and the possible need for surgery. Preferred over even a head CT/MRI.

Question 21

Characterized by psychiatric disease, impulsivity, and clinical examination findings of executive dysfunction, dysarthria, incoordination, and ataxia; chorea is a major manifestation? Also, this condition as high suicidality among patients.

Answer 21

Huntington disease, an autosomal dominant disorder

Question 22

For patients with mild traumatic brain injury (TBI) who are exposed to dangerous mechanisms of injury, such as falls from greater than 3 feet or 5 stairs, vehicular ejection, or vehicle-pedestrian motor vehicle collisions, what is the next step in management?

Answer 22

CT head w/o contrast

Question 23

In a patient with fluctuating weakness of the cervical muscles that worsens in the evening, what condition should be suspected?

Answer 23

Myasthenia gravis.

Note: Weakness of cervical extension is a hallmark of muscle-specific kinase (MuSK) antibody–positive myasthenia gravis.

Question 24

Is a cognitive state between normal aging and dementia characterized by a decline in cognitive functioning that is greater than what is expected with normal aging but has not resulted in significant functional disability.

Answer 24

Mild cognitive impairment

Question 25

In a patient with multiple sclerosis and mixed urinary symptoms that suggest both a hypertonic and a hypotonic bladder, what is the most appropriate next step?

Answer 25

Urodynamic testing to guide medication choices is appropriate, as are the potential use of urinary catheterization and monitoring of postvoid residuals while the patient is treated.

Question 26

In patients with glioblastoma multiforme and pulmonary embolism, anticoagulation with?

Answer 26

Heparin is the most appropriate treatment

Question 27

Is characterized by the presence of a monoclonal plasma cell disorder, peripheral neuropathy, and one or more of the following: osteosclerotic myeloma, Castleman disease (angiofollicular lymph node hyperplasia), elevated serum vascular endothelial growth factor, organomegaly, endocrinopathy, edema, typical skin changes, and papilledema.

Answer 27

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes).

POEMS syndrome is typically secondary to an underlying cancer; identification and treatment of the underlying cancer leads to improvement of the neuropathy.

Question 28

Type of seizure were altered awareness typically are infrequent, are associated with warning symptoms (aura), last more than 30 seconds, have associated mouth or limb automatisms (semipurposeful repetitive movements), and are followed by confusion and/or exhaustion.

Answer 28

Focal seizures

Question 29

Is characterized by subacute severe pain followed by resolution of pain and progressive weakness and atrophy involving the shoulder girdle and upper extremity muscles; this syndrome often is triggered by a preceding event, such as an infection or surgery?

Answer 29

Idiopathic brachial plexopathy (also known as neuralgic amyotrophy and Parsonage-Turner syndrome)

Question 30

First-line agents used to treat Tourette syndrome when the associated tics interfere with education, daily function, or work are

Answer 30

Clonidine, guanfacine, topiramate, and tetrabenazine

Second-line treatments include antipsychotic agents (such as haloperidol), but their benefit should be weighed against risk of tardive dyskinesia.

Question 31

For patients with a history of episodic migraine with typical aura that no longer responds to appropriate NSAIDs, guidelines recommend the use of

Answer 31

Triptans

Question 32

Typically associated with tunnel vision, palpitations, short duration of loss of consciousness (<1 minute), movements and shaking, and immediate and complete neurologic recovery?

Answer 32

Convulsive syncope

Question 33

Sleep-disordered breathing is a leading cause of fatigue, headaches, and difficult-to-control hypertension & is highly prevalent in patients with any form of stroke, and the best diagnostic test is

Answer 33

Polysomnography

Question 34

Treat multiple sclerosis in a patient with hepatic disease?

Answer 34

Interferon beta preparations or glatiramer acetate are considered first-line agents for relapsing-remitting multiple sclerosis, given their favorable risk profiles; glatiramer acetate is preferred in patients with liver disease.

Liver dysfunction is a potential adverse effect of fingolimod, the interferon beta preparations, and natalizumab. Also, use of natalizumab as a first-line agent would be inappropriate.

Question 35

Characterized by upper motor neuron signs (hyperreflexia, spasticity, and an extensor plantar response) coexistent with lower motor neuron findings (atrophy and fasciculation); sensory deficits are characteristically absent.

Answer 35

Amyotrophic lateral sclerosis

Question 36

Painful ophthalmoplegia affecting multiple nerves involved with extraocular movement indicates a pathologic process in the

Answer 36

Cavernous sinus or superior orbital fissure

Question 37

In patients with TIA or non disabling stroke with > 70% carotid stenosis, what is the next step in management?

Answer 37

Carotid endarterectomy within 2 weeks

Question 38

Diagnose normal pressure hydrocephalus (NPH)?

Answer 38

Lumbar puncture with removal of a large volume of cerebrospinal fluid (CSF) and subsequent measurement of CSF opening pressure can help confirm the diagnosis and determine if the NPH is reversible.

Question 39

The presence of new-onset status epilepticus and progressive confusion in a previously healthy patient strongly suggests a diagnosis of?

Answer 39

Autoimmune limbic encephalitis.

This condition is marked by the presence of hyponatremia, myoclonus, and limbic encephalitis (amnesia, temporal lobe seizures, and confusion). Although many neurologic autoimmune disorders are paraneoplastic, primary autoimmune disorders with no accompanying cancer may occur.

Question 40

In a patient with treatment-refractory depression who also has cognitive and functional decline?

Answer 40

Neuropsychological testing can be useful in identifying a pattern or degree of cognitive impairment that is not typical of depression-related cognitive impairment.

Question 41

Patients having ongoing focal seizures with altered awareness (formerly known as complex partial seizures) because of temporal lobe epilepsy despite taking two antiepileptic drugs and should be referred to an epilepsy center for?

Answer 41

Video electroencephalography (EEG)

Video EEG is the first step in determining candidacy for surgery by confirming that the seizures seen on video EEG match the location of abnormal findings on MRI. Use of a vagus nerve stimulator is a palliative measure, is unlikely to result in freedom from seizures, and should be offered only if resection is not an option.

Question 42

In patients with symptomatic aneurysms or aneurysms of 7 millimeters or greater in the posterior circulation (posterior communicating and basilar arteries)?

Answer 42

Surgical treatment with clipping or endovascular coiling can be considered

Question 43

For a Parkinson’s patient displaying psychosis, impulse control disorder, punding (which is a complex prolonged, purposeless, and stereotyped behavior such as collecting, sorting, cataloguing, or assembling and disassembling common objects), sleep attacks, ankle edema, and confusion, considered

Answer 43

Discontinuing dopamine agonist such as Pramipexole.

Note: Pimavanserin, a nondopaminergic atypical antipsychotic agent and selective serotonin 5-hydroxytryptamine receptor 2A inverse agonist, is the only FDA-approved medication for Parkinson psychosis. Quetiapine and clozapine also can be considered in this setting, but most other atypical antipsychotic agents (including aripiprazole, risperidone, and olanzapine) and all typical (first-generation) antipsychotic agents should be avoided.

Question 44

In a patient with a thunderclap headache and normal findings on a CT scan of the head, which test should be performed next?

Answer 44

Lumbar puncture in order to diagnose subarachnoid hemorrhage.

This test has a higher yield 12 hours or longer after headache onset when erythrocyte breakdown products will produce a yellow color (xanthochromia).

Question 45

In a patient with progressively worsening headaches, nausea, visual disturbance, difficulty speaking & multiple ocular palsies, where primary central nervous system lymphoma (PCNSL) is suspected, but inaccessible, how to diagnosed?

Answer 45

Slit-lamp examination and vitreous fluid sampling

PCNSL is a non-Hodgkin lymphoma that can affect any part of the central nervous system but commonly presents as a focal supratentorial lesion. Also, commonly seen in HIV pts.

Question 46

The disorder periodic limb movements of sleep is characterized by periodic leg kicks that often exhibit a stereotyped triple-flexion phenomenology repeating periodically during sleep; if no associated sleep disorder is present, the best management is?

Answer 46

Reassurance

Question 47

Typical symptoms include severe headache, nausea with vomiting, with a lucid period with eventual impairment in consciousness with neurologic deterioration.

Answer 47

Epidural hematoma

Emergent surgical evacuation is required for those with anisocoria, a Glasgow Coma Scale (GCS) score of less than 9, or a hematoma volume greater than 30 mL.

Subdural hematomas are collections of blood between the brain & the dura mater. Most involve rupture of bridging veins. Because of cerebral atrophy & stretching of these veins, older patients are particularly vulnerable. Can occur spontaneously or as a result of cranial trauma, & presentations range from acute to chronic.

Question 48

Associated with exercise intolerance*, cramping, *myalgia, mild weakness, “second-wind” phenomenon, and myoglobinuria?

Answer 48

McArdle disease (metabolic myopathy), glycogen storage disease V. Eating a carbohydrate-rich diet before exercise can protect against severe exercise intolerance.

Note: Acute intermittent porphyria (AIP), characterized by acute attacks of abdominal pain & vomiting and by central, peripheral, sensory, motor, autonomic, & enteric nervous system abnormalities. Patients may have episodes of reddish-brown urine (porphobilin & porphyrins) during an acute attack.

Question 49

Commonly occurs in dementia with Lewy bodies (DLB) and can help distinguish DLB from Alzheimer disease & other cognitive disorders?

Answer 49

Rapid eye movement sleep behavior disorder

Question 50

Patients who have intracerebral hemorrhage without elevated intracranial pressure whose systolic blood pressure is greater than 180 mm Hg should be treated with

Answer 50

Nicardipine, to a target blood pressure of 140 mm Hg.

Note: Nitroprusside is not a first-line blood pressure treatment for patients with acute hemorrhagic stroke, given its potential for increasing ICP.

Question 51

Cluster headache, the most common of the trigeminal autonomic cephalalgias, is best prevented with

Answer 51

Verapamil

Risk factors: Male sex a & tobacco use are two potential. Common trigger during an active cycle: alcohol. Attack duration is between 15- 180 minutes & may occur 1-8 times daily for several weeks or months. Oxygen inhalation and SC sumatriptan are first-line therapies.

Question 52

Characterized by predominantly sensory and motor peripheral neuropathy and/or autonomic neuropathy; it is diagnosed by detecting a mutation of the transthyretin gene (TTR). Also B/L carpal tunnel syndrome & family h/o of neuropathy

Answer 52

Familial amyloidosis

Affected patients often have multiorgan involvement (diseases of the eye [glaucoma] and the neurologic, gastrointestinal, cardiac, and urinary systems)

Question 53

Nonconvulsive status epilepticus (such as twitching of the shoulders & eyelids) should be suspected in patients with critical illness who develop altered mental status; the diagnosis is confirmed with

Answer 53

Continuous (24-hour) electroencephalography (EEG)

Question 54

Subacute combined degeneration is a myelopathy manifesting as dysfunction of the corticospinal tracts and dorsal columns that is caused by

Answer 54

Vitamin B_<u>12</u> and copper deficiencies

previous chronic abuse of nitrous oxide can result in a functional B₁₂ deficiency that is due to inactivation of the vitamin.

Question 55

In patients with multiple sclerosis and impaired mobility,

Answer 55

Dalfampridine is the most appropriate medication

Question 56

Acute or subacute pain and paresthesia in a dermatomal pattern in the thoracic or abdominal region in a patient with diabetes mellitus and no evidence of herpes zoster is most likely due to

Answer 56

Diabetic mononeuropathy

Question 57

In a patient with suspected spinal cord compression, the next step in management is?

Answer 57

Emergent MRI of the lumbosacral spine is the most appropriate test both to localize the injury and to determine its cause.

Question 58

In a patient with suspected idiopathic intracranial hypertension (IIH),

Answer 58

Lumbar puncture is required to confirm the diagnosis.

Causes of IIH include: obesity, Minocycline or other tetracyclines, Retinoic acid, estrogen & progesterone supplements, & glucocorticoids. Papilledema is characteristic; abducens nerve (cranial nerve VI) palsy occurs occasionally. Treatment of choice is acetazolamide.

Question 59

Treat asymptomatic extracranial carotid artery stenosis with?

Answer 59

Statin therapy is indicated for asymptomatic carotid stenosis of 60% to 80%.

Question 60

A hospitalized patient with Guillain-Barré syndrome who exhibits improvement after an initial course of plasma exchange should be discharged to

Answer 60

Rehabilitation

Note: GBS: CSF albuminocytologic dissociation (elevated protein, normal leukocyte count)

Question 61

Which antiepileptic does not worsen bone loss/osteoporosis in patient’s with epilepsy?

Answer 61

Lamotrigine & Levetiracetam do not have the potential to cause or worsen osteoporosis in patients with epilepsy.

Carbamazepine, phenytoin, and phenobarbital* are all inducers of the cytochrome p450 system; these drugs increase breakdown of vitamin D, which results in increased parathyroid hormone levels, & thus cause bone loss/osteoporosis. *Valproic acid also is associated with bone loss, although the mechanism of this effect is unclear. All patients on chronic AED therapy with phenytoin, carbamazepine, phenobarbital or valproic acid should undergo initial bone densitometry testing after 5 years of therapy.

Question 62

Is indicated for all nonhypotensive patients with subarachnoid hemorrhage and is associated with improved neurologic outcomes and survival.

Answer 62

Nimodipine

Question 63

This test is the most sensitive predictor of the risk of backward falls in Parkinson disease.

Answer 63

The pull test

Question 64

is characterized by transient localized stabs of head pain that occur spontaneously in the absence of organic disease and typically last seconds; this headache is common among those with a history of migraine

Answer 64

Primary stabbing headache (also known as an “ice-pick” headache)

Question 65

Is the most appropriate treatment for epilepsy with focal seizure (formerly known as complex partial seizures) in older patients because of strong evidence of its safety and effectiveness.

Answer 65

Lamotrigine

Only a few antiepileptic drugs (AEDs): lamotrigine, levetiracetam, topiramate, valproic acid, & zonisamide are considered broad-spectrum agents & can be used to treat both generalized and partial epilepsy syndromes. Other narrow-spectrum AEDs (such as carbamazepine, gabapentin, oxcarbazepine, phenobarbital, phenytoin, & pregabalin) have the potential to exacerbate seizures in patients with generalized epilepsy.

Question 66

Typically involves an alteration in personality and behavior that develops years before the onset of cognitive impairment.

Answer 66

Frontotemporal dementia

Altered behaviors typically manifest as OCD tendencies, impulsivity, apathy, impaired judgment, emotional coldness, disinhibition, excessive spending, & excessive eating, particularly of high-calorie, non-nutritional foods. Amyotrophic lateral sclerosis, the major form of motor neuron disease, is found in 20% to 30% of patients diagnosed with behavioral-variant FTD.

Question 67

The combination of parkinsonism, cerebellar ataxia, dysautonomia, and early postural instability characterizes

Answer 67

Multiple system atrophy, a Parkinson-plus syndrome.

Note: Progressive supranuclear palsy is the main differential diagnosis. However, without the characteristic impairment in vertical extraocular movements (supranuclear gaze palsy), progressive supranuclear palsy is ruled out. Also, anosmia and acting out of dreams during sleep are suggestive of multiple system atrophy and Parkinson disease but not of progressive supranuclear palsy.

Question 68

Is the most appropriate test to determine candidacy for endovascular therapy in patients with a cardioembolic stroke who have undergone thrombolysis.

Answer 68

CT angiography of the head

Question 69

Brain herniation in a patient with a malignant primary brain tumor causing mass effect & compression should be emergently treated with a

Answer 69

Dexamethasone

Question 70

Although evidence is limited, carbapenems, fluoroquinolones, and fourth-generation cephalosporins (e.g. Cefepime) may lower the seizure threshold and thus should be avoided in patients with epilepsy. Name 1 antibiotics that has the weakest association to trigger seizures?

Answer 70

Piperacillin-tazobactam & non–fourth-generation cephalosporins

Question 71

Requires at least five episodes lasting 4 to 72 hours when untreated (or unsuccessfully treated), with pain exhibiting two of the following characteristics: unilateral location, throbbing nature, moderate to severe intensity, and worsening with physical activity; associated features must include either nausea or a combination of photophobia and phonophobia.

Answer 71

Migraines

Question 72

In the absence of thrombolytic therapy for cardioembolic stroke, short-term therapy with

Answer 72

Aspirin reduces the risk of stroke at 2 weeks.

Note: Heparin is not effective in reducing the risk of recurrent stroke within the acute hospitalization period in patients with all stroke subtypes, including ischemic strokes with a cardioembolic cause. Intravenous heparin can be considered in patients with a high short-term risk of recurrent ischemic stroke, such as those with mechanical heart valves, but the benefit of this approach must be weighed against the risk of hemorrhagic conversion.

Question 73

When managing mild TBI in an athlete, besides initial screening with a symptom checklist and a neurologic examination, including assessments of cognition and balance, what else should be done for a patient that is still. symptomatic?

Answer 73

Neuropsychological testing should be part of a comprehensive mild traumatic brain injury management strategy for patients with persistent symptoms.

Question 74

Treatment of vascular cognitive impairment should focus on identifying and treating cerebrovascular risk factors; off-label use of

Answer 74

Acetylcholinesterase inhibitors such as Donepezil has shown modest benefit in clinical trials and thus is generally recommended for this condition.

Question 75

Immune-mediated necrotizing myopathy is a form of statin myopathy that is associated with antibodies to hydroxymethylglutaryl coenzyme A reductase and biopsy evidence of muscle necrosis without inflammation; treatment with a

Answer 75

Glucocorticoid or other immunosuppressive agents can reverse the myopathy

Question 76

What is the initial treatment of choice for patients with intracranial hypotension that presents with orthostatic headaches; CT myelography is appropriate for those who do not respond to this treatment?

Answer 76

Placement of an epidural blood patch

Question 77

Because multiple sclerosis (MS) is the most common cause of transverse myelitis, ______________ should be performed in patients with new-onset transverse myelitis to evaluate for MS lesions.

Answer 77

MRI of the brain

Note: The presence or absence of oligoclonal bands is not part of multiple sclerosis diagnostic criteria because of poor sensitivity and specificity for the disease. Approximately 10% to 15% of patients with MS have normal cerebrospinal fluid on testing; additionally, oligoclonal bands are sometimes elevated in other inflammatory conditions.

Question 78

To prevent venous thromboembolism after a hemorrhagic stroke?

Answer 78

Prophylactic LMW heparin can be started 48 hours after a hemorrhagic stroke to prevent development of DVT as long as there is no evidence of active bleeding on neuroimaging.

Note: Aspirin can be resumed in patients with ICH caused by hypertension 2 to 4 weeks after stroke onset if the hematoma has resolved on imaging and there is an appropriate high-risk indication.

Question 79

Most patients with chronic cervical and lumbar stenosis respond well to

Answer 79

conservative measures, such as physical therapy and pain control.

Question 80

Relative contraindications for the use of cholinesterase inhibitors (such as Donepezil) in the treatment of dementia include sick sinus syndrome, left bundle branch block, uncontrolled asthma, angle-closure glaucoma, and ulcer disease. Thus, what’s an alternative treatment?

Answer 80

Memantine

Question 81

Is the most appropriate diagnostic study for patients with a suspected secondary headache and should be performed before additional testing is considered.

Answer 81

Brain MRI

Question 82

In patients with multiple sclerosis who take fingolimod as a disease-modifying therapy, monitoring for this specific adverse effect with?

Answer 82

Regular ophthalmic examinations are necessary because of the increased risk of macular edema with this medication.

Fingolimod also requires first-dose monitoring because of the first-dose bradycardia that occurs in most patients & should not be used in patients with heart block.

Question 83

Is a language-predominant neurodegenerative dementia in which language is often the only cognitive domain affected for years before the development of additional cognitive deterioration; structural brain imaging often shows asymmetric involvement of the left temporal lobe.

Answer 83

Primary progressive aphasia (AKA language-variant frontotemporal dementia)

Question 84

Can be caused by exposure to dopamine-blocking agents, such as neuroleptic and antiemetic agents, and may persist for more than 6 months with constant choreiform movements of the face, lips, & hands after removal of the offending medication or become permanent?

Answer 84

Tardive dyskinesia

Question 85

After the initial hospitalization, however, the risk of recurrent ischemic and hemorrhagic stroke remains increased if the blood pressure is higher than 130/80 mm Hg, and should be treated with?

Answer 85

Antihypertensive such as Lisinopril

Question 86

Treat Bell palsy?

BP: Unilateral facial weakness involving both upper & lower parts of the face, while a stroke typically spares the upper facial muscles because of bilateral innervation. Features of classic Bell palsy include alteration in taste (due to involvement of the chorda tympani) & hyperacusis (intolerance of loud noise due to involvement of stapedius muscle); & ipsilateral sensory paresthesia & pain without objective sensory loss.

Answer 86

Oral prednisone administered within 72 hours of symptom onset expedites the speed and rate of recovery.

Note: The effectiveness of valacyclovir, is controversial. Currently, no available evidence suggests that adding antiviral therapy improves prognosis.

Question 87

the treatment of choice for trigeminal neuralgia?

Answer 87

Carbamazepine; management with this agent requires serum monitoring for hyponatremia & agranulocytosis.

Question 88

In a patient with signs and symptoms of idiopathic transverse myelitis in whom first-line treatment with a high-dose intravenous glucocorticoid has been ineffective, the next treatment should be?

Answer 88

Plasma exchange therapy

Note: Presentation of subacute onset of weakness, sensory changes, & bowel or bladder dysfunction, which is sometimes preceded by back pain or a thoracic banding sensation.

Question 89

Adjuvant therapy with _____________________ in patients with relapsing-remitting multiple sclerosis provides additional disease activity control.

Answer 89

Vitamin D supplementation

Question 90

In a patient with mild cognitive impairment, what additional test could be used to identify Alzheimer disease?

Answer 90

Decreased Aβ42 peptide and increased tau protein and p-tau levels in the cerebrospinal spinal fluid have a greater than 80% sensitivity and specificity in identifying Alzheimer disease as the cause.

Note: Serum apolipoprotein-E (ApoE) allele testing provides no useful information for diagnosing cognitive disorders. ApoE is a gene that can indicate a patient’s risk for Alzheimer dementia but adds little to the prediction of progression of symptoms from MCI.

Question 91

After thrombolytic therapy for acute stroke, when should BP be treated?

Answer 91

Antihypertensive treatment is not necessary if blood pressure is less than 180/105 mm Hg and there are no symptoms of intracerebral hemorrhage.

Question 92

The three core phenotypes of multiple sclerosis can be modified by:

Answer 92

the presence of activity* (clinical relapse or new/enlarging MRI lesion); *primary and secondary progressive* multiple sclerosis can be further *modified as “progressive” if there is ongoing accumulation of neurologic deficits independent of clinical relapses.

Question 93

In a patient with generalized epilepsy and psychiatric disease, which AED is best?

Answer 93

Lamotrigine is an appropriate medication to use not only because of its effectiveness as treatment for generalized tonic-clonic seizures, but also because of its mood-stabilizing effects.

It is commonly prescribed in women with childbearing potential & is a good option for older patients.

Question 94

Is characterized by prominent action-induced myoclonus that impairs ambulation because of a combination of positive (rapid jerky movements) and negative (lapses in muscle tone) myoclonus.

Answer 94

Posthypoxic myoclonus, which occurs in patients with a history of hypoxic brain injury

Question 95

This should be performed in a patient with minor symptoms of cognitive impairment and self-reported daytime sleepiness who scores normally on cognitive and depression assessments?

Answer 95

Polysomnography

Question 96

What is the treatment of cognitive deficits in Multiple sclerosis?

Answer 96

Cognitive rehabilitation approaches, such as the development of accommodative strategies & training with challenging cognitive tasks, have been shown to improve symptoms.

Note: No pharmaceutical agent has been shown to improve these symptoms in MS patients.