Neurology

Question 1

Posthypoxic myoclonus

Answer 1

prolonged cardiac arrest - shocklike muscle jerks, activation of sx with exertion, negative myoclonus (sudden lapse of tone), - tx antiepileptics VPA, keppra, clonezepam

Question 2

Wernikes encephalopathy

Answer 2

Thiamine (B1) deficiency, confusion, peripheral neuropathy, etoh use, post bariatric surgery, TPN without supp vitamins, ataxia, opthalmoplegia

Question 3

Migraine without aura (unilateral pulsating h/a 4-72 hrs with photophobia, phonophobia, nausea)

Answer 3

Migraine ppx - amitryptyline, propranolol, timolol (no bb with asthma), divalproex, topriamate - not cluster if >3hrs and not tension if w/ nausea, photophobia

Question 4

Cluster headache

Answer 4

verapamil for ppx

Question 5

Restless leg syndrome

Answer 5

discomfort in legs while trying to sleep (crawling sensation) - movement of legs reduces sx, tx with opiates/dopamine agonists helps (pramipexole, ropinirole)

Question 6

Dementia with Lewy bodies

Answer 6

prominent wild visual hallucination - see’s animals in house, stranger in yard with mild parkinsonianism (tremor, shuffled gate) dream enactment - REM - don’t use dopamine agonists - use levodopa

Question 7

Frontotemporal dementia

Answer 7

Apathy, perseveration, hoarding, disinhibition, personality changes

Question 8

Advanced Parkinsons with wearing off of drug effects and dyskinesia with higher doses (so can’t raise, can’t lower)

Answer 8

Deep brain stimulation (subthalamic nucleus/globus paladus)

Question 9

Age related memory loss

Answer 9

does not interfere with social or occupational function - losing glasses, forgetting names, numbers, faces ie short term memory loss - NO FURTHER TESTING if MMSE >25

Question 10

Mild Cognitive impairment

Answer 10

loss of cognitive ability beyond age related changes - but does not interfere with daily activity - formal neuropsych testing if clinically significant MCI

Question 11

Does donezapil decrease progression to MCI or MCI to dementia

Answer 11

NO - only improves cognitive fxn in MCI or dementia

Question 12

Pseudotumor cerebri ie Idiopathic intracranial HTN

Answer 12

young woman with obesity - progressive h/a, normal brain imaging - papiledema - tinitis - partial CN VI palsy - need LP showing only increased ICP otherwise normal CSF