Neurology Flashcards
List six meds that can be used for migraine prophylaxis
Beta blockers Tricyclics CCB NSAIDs Valproic acid
A pt presents with what appears to be an inability to understand speech. Which aphasia should be at top of your dif?
Wernicke’s aphasia
A pt presents with facial paresis, arm drift and abnormal speech. What are the first 3 tests to order?
Thinking of a stroke, you order noncontrast brain CT or MRI
Serum glucose
Oxygen saturation
A pt is brought in following a seizure in which she did not lose consciousness. What is the most likely dx?
Simple partial seizure
A pt is having a stroke and there is no evidence of hemorrhage. What is the first line medical tx?
Within 4 hrs and no contraindications, thrombolytics should be given.
A pt presents with a painful ipsilateral third nerve palsy. What is the most likely dx?
Posterior communicating artery aneurysm (PCom A)
What seizure med make cause overgrowth of the gums?
Phenytoin
A sudden thunderclap HA should make you think of what dx?
Subarachnoid hemorrhage
Describe Kernig’s sign
when the thigh is flexed at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance).
Imaging is negative for blood, but you strongly believe that there is a subarachnoid hemorrhage. What test can you order that will be definitive?
Lumbar puncture
A pt presents with a lateralized throbbing HA. He is also c/o nausea, vomiting and photophobia. What type of HA?
Migraine
A middle aged male presents c unilateral periorbital HA occurring daily for several weeks. These HA are extremely painful. What type of HA is the most likely cause?
Cluster
List 3 drugs that tx cluster HA
Oxygen
Sumatriptan
Stadol (butorphanol)
A 34 yo presents c symptoms which are relapsing and remitting over the past few weeks. These include visual problems and weakness in her right arm. What is the most likely dx?
MS
A pt has a tremor with motion in his hands. What med might you rx?
The pt has an active tremor.
a beta blocker like propranolol is a good start.
A shuffling gait should make you think of what dx?
Parkinson’s disease
Give 2 classes of drug therapy for tx’ing parkinson’s.
Dopaminergic (levodopa)
anticholinergics are 2nd line
Decreased GABA and substance P should make you think of what dx?
Huntington’s
Is Huntington’s autosomal dominant or recessive?
Dominant
A pt presents with weakness that he has felt in his lower legs and now feels in his knees and hips bilaterally. He has decreased deep tendon reflexes. This has been getting progressively worse. What is the most likely dx?
Guillain Barre
What percentage of strokes are ischemic?
What percent are hemorrhagic?
80%
20%
You believe a pt has had a stroke. He presents c aphasia, loss of hearing in one ear and loss of vision in his left eye. Is the blockage likely the anterior or posterior circulation?
Anterior
Under what conditions would aspirin or clopidogrel be used following a TIA as prophylaxis?
These are anti platelet meds.
They would be used unless there is a known cardiac etiology for the embolism. Pts with a cardiac cause should use heparin or coumadin.
A pt who is asymptomatic should consider having an endarectomy at what percent blockage of the carotid artery? How about in a symptomatic pt?
70% in asymptomatic
>60% in symptomatic pt
A pt presents c/o the worst headache of his life. What might you expect his BP to be?
Typically this is the description for a subarachnoid hemorrhage. You would expect the BP to be elevated.
Name one abortive drug for migraines.
Triptans (sumatriptan, zolmitriptan)
ergotamine
An EEG showing focal rhythmic discharges at the onset of seizure should make you think of what dx?
Simple partial seizure
What is the single most important thing to be concerned about with a patient in status epilepticus?
Airway followed by the management of hyperthermia
Describe Brudzinski’s sign
When you lift the pt’s head, the pt bends his hips.
Name 3 meds used to break a seizure.
Diazepam, lorazepam, phenytoin or fosphenytoin
There is an MRI result of multiple foci of demyelination in the white matter. What is the most likely dx?
MS
A pt presents following a seizure. Just before the seizure she remembers seeing flashing lights all around her. What dx should be a the top of your dif?
Complex partial
List 3 meds used to tx MS
Steroids
interferon beta
copolymer 1
What is the most common cause of dementia?
Alzheimer’s disease: it may be as high as 80%
What 4 chromosomes have been linked to dementia?
1,14,19,21
Is the ankle jerk reflex of lumbar or sacral origin?
Sacral
A study result comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What is the most likely dx?
Alzheimer’s
A pt c/o an aching HA which feels like a band around his head. What is the most likely dx?
Tension HA
A pt presents to your office c/o a tremor in his right hand. He states after a beer it goes away completely. What is the dx?
Benign essential tremor or familial tremor
List 2 meds you might use to tx an essential tremor.
Beta blocker (propranolol) primidone
At what age do symptoms of Huntington’s disease appear?
Around 30 yo
A 35 yo pt comes to your office because his wife made him. He has been increasingly irritable and moody. She has also noticed that he is very restless. You order a CT scan which shows cerebral atrophy as well as atrophy of the caudate nucleus. What is the most likely dx?
Huntington’s disease
What is the med of choice for a pt c tourette’s syndrome?
Haloperidol
A slit lamp shows Kayser-Fleischer rings. What is the most likely dx?
Wilson’s disease
Wilson’s disease is associated with a build up of what mineral?
There is a deficiency of the copper binding protein and therefore a buildup of copper.
What are the genetic characteristics of Wilson’s disease?
Autosomal recessive, chromosome 13
What cranial nerve is affected by Bell’s Palsy?
CN7
A lumbar puncture for a patient with bacterial meningitis will show elevated or decreased WBCs? Glucose? Protein?
elevated WBCs
decreased glucose
elevated protein
What symptom is associated with a classic migraine?
Aura
Elevated circulating acetylcholine receptor antibodies should make you think of what dx?
Myasthenia gravis
Duchenne’s and Becker’s muscular dystrophy have what genetic characteristic?
X-linked recessive
What is the age range for Duchenne’s muscular dystrophy?
3-5 yo
An EEG showing generalized spikes and associated slow waves should make you think of what dx?
Generalized or absence seizure
What is the most common primary intracranial neoplasm?
Glioma
What is the most common cause of subarachnoid hemorrhage aside from trauma?
Ruptured cerebral aneurysm
What are the most common primary cancer sites to metastasize to the brain?
Lung, breast and kidney
A resting or pill-rolling tremor should make you think of what dx?
Parkinson’s disease
Weakness and numbness in the left hand might be a blockage in which carotid artery?
Right
A pt has an intracranial neoplasm causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in?
Temporal
If you are looking for lesions associated with multiple sclerosis and you order an MRI, do you order with gadolinium or without?
With gadolinium
What is the defining symptom of Alzheimer’s?
Progressive memory impairment
Which nerve root is responsible for the knee jerk reflex?
L3-L4
An EEG showing interictal spikes should make you think of what dx?
Complex partial seizure
What is the most commonly herniated vertebral disc?
L4-L5 followed by L5-S1
What 3 symptoms are classic for a normal pressure hydrocephalus?
Gait disturbance
dementia
urinary incontinence
A pt presents with inability to speak and right sided weakness. He seems to understand speech and follows commands well. What type of aphasia should you be thinking of?
Broca’s aphasia
Alcohol may be a major factor in which encephalopathy?
Wernicke’s
A pt c/o muscle weakness and fatiguability that improves c rest. What is the most likely dx?
Myasthenia graves
Lead pipe or cogwheel rigidity should make you think of what dx?
Parkinson’s disease
