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Casey: Panre > Neurology > Flashcards

Neurology Flashcards

1
Q

List six meds that can be used for migraine prophylaxis

A 
Beta blockers 
Tricyclics 
CCB
NSAIDs
Valproic acid
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2
Q

A pt presents with what appears to be an inability to understand speech. Which aphasia should be at top of your dif?

A

Wernicke’s aphasia

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3
Q

A pt presents with facial paresis, arm drift and abnormal speech. What are the first 3 tests to order?

A

Thinking of a stroke, you order noncontrast brain CT or MRI
Serum glucose
Oxygen saturation

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4
Q

A pt is brought in following a seizure in which she did not lose consciousness. What is the most likely dx?

A

Simple partial seizure

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5
Q

A pt is having a stroke and there is no evidence of hemorrhage. What is the first line medical tx?

A

Within 4 hrs and no contraindications, thrombolytics should be given.

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6
Q

A pt presents with a painful ipsilateral third nerve palsy. What is the most likely dx?

A

Posterior communicating artery aneurysm (PCom A)

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7
Q

What seizure med make cause overgrowth of the gums?

A

Phenytoin

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8
Q

A sudden thunderclap HA should make you think of what dx?

A

Subarachnoid hemorrhage

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9
Q

Describe Kernig’s sign

A

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).

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10
Q

Imaging is negative for blood, but you strongly believe that there is a subarachnoid hemorrhage. What test can you order that will be definitive?

A

Lumbar puncture

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11
Q

A pt presents with a lateralized throbbing HA. He is also c/o nausea, vomiting and photophobia. What type of HA?

A

Migraine

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12
Q

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?

A

Cluster

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13
Q

List 3 drugs that tx cluster HA

A

Oxygen
Sumatriptan
Stadol (butorphanol)

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14
Q

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?

A

MS

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15
Q

A pt has a tremor with motion in his hands. What med might you rx?

A

The pt has an active tremor.

a beta blocker like propranolol is a good start.

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16
Q

A shuffling gait should make you think of what dx?

A

Parkinson’s disease

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17
Q

Give 2 classes of drug therapy for tx’ing parkinson’s.

A

Dopaminergic (levodopa)

anticholinergics are 2nd line

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18
Q

Decreased GABA and substance P should make you think of what dx?

A

Huntington’s

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19
Q

Is Huntington’s autosomal dominant or recessive?

A

Dominant

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20
Q

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?

A

Guillain Barre

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21
Q

What percentage of strokes are ischemic?

What percent are hemorrhagic?

A

80%

20%

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22
Q

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?

A

Anterior

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23
Q

Under what conditions would aspirin or clopidogrel be used following a TIA as prophylaxis?

A

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.

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24
Q

A pt who is asymptomatic should consider having an endarectomy at what percent blockage of the carotid artery? How about in a symptomatic pt?

A

70% in asymptomatic

>60% in symptomatic pt

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25
Q

A pt presents c/o the worst headache of his life. What might you expect his BP to be?

A

Typically this is the description for a subarachnoid hemorrhage. You would expect the BP to be elevated.

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26
Q

Name one abortive drug for migraines.

A

Triptans (sumatriptan, zolmitriptan)

ergotamine

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27
Q

An EEG showing focal rhythmic discharges at the onset of seizure should make you think of what dx?

A

Simple partial seizure

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28
Q

What is the single most important thing to be concerned about with a patient in status epilepticus?

A

Airway followed by the management of hyperthermia

29
Q

Describe Brudzinski’s sign

A

When you lift the pt’s head, the pt bends his hips.

30
Q

Name 3 meds used to break a seizure.

A

Diazepam, lorazepam, phenytoin or fosphenytoin

31
Q

There is an MRI result of multiple foci of demyelination in the white matter. What is the most likely dx?

A

MS

32
Q

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?

A

Complex partial

33
Q

List 3 meds used to tx MS

A

Steroids
interferon beta
copolymer 1

34
Q

What is the most common cause of dementia?

A

Alzheimer’s disease: it may be as high as 80%

35
Q

What 4 chromosomes have been linked to dementia?

A

1,14,19,21

36
Q

Is the ankle jerk reflex of lumbar or sacral origin?

A

Sacral

37
Q

A study result comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What is the most likely dx?

A

Alzheimer’s

38
Q

A pt c/o an aching HA which feels like a band around his head. What is the most likely dx?

A

Tension HA

39
Q

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?

A

Benign essential tremor or familial tremor

40
Q

List 2 meds you might use to tx an essential tremor.

A 
Beta blocker (propranolol)
primidone
41
Q

At what age do symptoms of Huntington’s disease appear?

A

Around 30 yo

42
Q

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?

A

Huntington’s disease

43
Q

What is the med of choice for a pt c tourette’s syndrome?

A

Haloperidol

44
Q

A slit lamp shows Kayser-Fleischer rings. What is the most likely dx?

A

Wilson’s disease

45
Q

Wilson’s disease is associated with a build up of what mineral?

A

There is a deficiency of the copper binding protein and therefore a buildup of copper.

46
Q

What are the genetic characteristics of Wilson’s disease?

A

Autosomal recessive, chromosome 13

47
Q

What cranial nerve is affected by Bell’s Palsy?

A

CN7

48
Q

A lumbar puncture for a patient with bacterial meningitis will show elevated or decreased WBCs? Glucose? Protein?

A

elevated WBCs
decreased glucose
elevated protein

49
Q

What symptom is associated with a classic migraine?

A

Aura

50
Q

Elevated circulating acetylcholine receptor antibodies should make you think of what dx?

A

Myasthenia gravis

51
Q

Duchenne’s and Becker’s muscular dystrophy have what genetic characteristic?

A

X-linked recessive

52
Q

What is the age range for Duchenne’s muscular dystrophy?

A

3-5 yo

53
Q

An EEG showing generalized spikes and associated slow waves should make you think of what dx?

A

Generalized or absence seizure

54
Q

What is the most common primary intracranial neoplasm?

A

Glioma

55
Q

What is the most common cause of subarachnoid hemorrhage aside from trauma?

A

Ruptured cerebral aneurysm

56
Q

What are the most common primary cancer sites to metastasize to the brain?

A

Lung, breast and kidney

57
Q

A resting or pill-rolling tremor should make you think of what dx?

A

Parkinson’s disease

58
Q

Weakness and numbness in the left hand might be a blockage in which carotid artery?

A

Right

59
Q

A pt has an intracranial neoplasm causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in?

A

Temporal

60
Q

If you are looking for lesions associated with multiple sclerosis and you order an MRI, do you order with gadolinium or without?

A

With gadolinium

61
Q

What is the defining symptom of Alzheimer’s?

A

Progressive memory impairment

62
Q

Which nerve root is responsible for the knee jerk reflex?

A

L3-L4

63
Q

An EEG showing interictal spikes should make you think of what dx?

A

Complex partial seizure

64
Q

What is the most commonly herniated vertebral disc?

A

L4-L5 followed by L5-S1

65
Q

What 3 symptoms are classic for a normal pressure hydrocephalus?

A

Gait disturbance
dementia
urinary incontinence

66
Q

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?

A

Broca’s aphasia

67
Q

Alcohol may be a major factor in which encephalopathy?

A

Wernicke’s

68
Q

A pt c/o muscle weakness and fatiguability that improves c rest. What is the most likely dx?

A

Myasthenia graves

69
Q

Lead pipe or cogwheel rigidity should make you think of what dx?

A

Parkinson’s disease

Casey: Panre (12 decks)

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