Neurology

Question 1

What drug class is absolutely contraindicated for treatment of delirium in patients with underlying dementia?

Answer 1

Atypical antipsychotics (haldol, etc) - can precipitate worsening of the dementia syndrome. Consider donepezil

Question 2

What are common side effects of levodopa?

Answer 2

1) Motor fluctuations
2) Medication-induced dyskinesia (involuntary chorea)
3) Nausea, orthostatic hypotension

Question 3

What are supportive care targets for severe TBI (evidence of hemotympanum, basilar skull fracture, CSF rhinorrhea)

Answer 3

1) treat fever (acetaminophen)
2) PaO2 > 60 mmHg
3) SBP >90

Question 4

What drug class is indicated for treatment of secondary prevention of ischemic stroke in intracranial atherosclerosis

Answer 4

Statins
- note: stenting associated with 2x increased risk of ischemic stroke in symptomatic patients with atherosclerotic intracranial disease

Question 5

What should be ordered for outpatient follow up in cryptogenic stroke?

Answer 5

telemetry monitoring

Question 6

Thunderclap headache, recurrent, with normal head CT and LP

Answer 6

Reversible cerebral vasoconstriction syndrome

Diagnose with MR angiography or CT angiography
Triggered by stimulants (cocaine, sympathomimetics, triptans), valsalva, emotion, showering/bathing

Treatment: CCB (verapamil, nimodipine)

Question 7

Causes of thunderclap headache

Answer 7

1) SAH (25%)
2) Intracranial or venous sinus thrombosis
3) Cervical artery dissection
4) Reversible Cerebral Vasoconstriction Syndrome (second most common cause)
5) PRES
6) Ischemic Stroke, TIA
7) SDH
8) Pituitary Apoplexy
9) Pheochromocytoma
10) Colloid cyst of third ventricle
11) Acute Hydrocephalus
12) Acute-angle closure glaucoma
13) Primary thunderclap headache
14) Primary stabbing headache

Question 8

Trigeminal neuralgia treatment

Answer 8

Carbamazepine

Question 9

Migraine prophylaxis options

Answer 9

1) Amitriptyline
2) Metoprolol
3) Propanolol
4) Timolol
5) Topiramate
6) Valproic Acid
7) Venlafaxine
8) Onabotulinum toxin A

Question 10

Cluster headache treatment

Answer 10

1) Triptan
2) Oxygen therapy
3) Verapamil for long-term prevention

Question 11

Treatment for status epilepticus in phenytoin-allergic patients

Answer 11

Valproic Acid (after benzo x2, IV glucose and thiamine have been administered)

Question 12

Anti-NMDAR encephalitis is associated with which tumor type?

Answer 12

Ovarian Teratoma (>50% of cases) 
Anti-NMDAR encephalitis symptoms: choreoathetosis, psychiatric symptoms, seizures, autonomic instability
Treatment: steroids, IVIg, surgery to remove tumor

Question 13

Antibodies associated with SCLC paraneoplastic syndrome

Answer 13

Anti-Hu
Anti-LGI1
Anti-CRMP5

Common presentation: dementia, chorea, ataxia, brainstem encephalitis, and neuropathies

Question 14

Antibodies associated with breast adenocarcinoma paraneoplastic syndrome

Answer 14

Anti-Ri
Anti-Glutamic Acid Decarboxylase

Common presentation: ataxia, brainstem encephalitis, ophthalmoplegia, and parkinsonism

Question 15

What are the components of POEMS syndrome?

Answer 15

1) Peripheral neuropathy (polyneuropathy)
2) Organomegaly
3) Endocrinopathy
4) Monoclonal gammopathy
5) Skin Changes

Usually associated with: Osteosclerotic myeloma, Castelman disease (angiofollicular lymph node hyperplasia), and/or elevated VEGF

Question 16

Features of myoclonic seizures

Answer 16

1) Single jerk of the entire body
2) Last <1 second
3) No associated confusion

Question 17

First line medications for treatment of Tic Disorders

Answer 17

1) Clonidine
2) Guanfacine
3) Topiramate
4) Tetrabenazine (dopamine-depleter)
5) Levetiracetam

Consider atypical antipsychotics for refractory disease, but keep in mind risk of tardive dyskinesia

Question 18

Presentation/Features of Miller Fisher variant of GBS

Answer 18

1) ataxia
2) areflexia
3) ophthalmoplegia
4) Ab to GQ1b (ganglioside component of the nerve)

Question 19

Signs/symptoms of limbic encephalitis

Answer 19

1) Amnesia
2) Temporal lobe seizures
3) Confusion

Consider autoimmune encephalitis if present with rapid-onset dementia, hyponatremia, myoclonus
- most common Ab is to LGI1

Question 20

Vitamin B12 Deficiency Presentation

Answer 20

1) Gait abnormalities, ataxia, pareshtesias
2) Posterior spinal columns and corticospinal tracts are affected
3) May be associated with NO2 abuse
4) Not all cases have abnormal blood count or macrocytosis
5) Homocysteine and methylmalonic acid levels elevated

Question 21

What is Dalfampridine?

Answer 21

A voltage gated potassium channel antagonist used for the treatment of MS-induced impaired mobility. Boosts conduction through longer axons.

Make sure patient is using assistive devices as well (braces, canes, etc).

Question 22

Medial therapy for Huntington’s Disease?

Answer 22

1) Tetrabenazine

2) Deuterbenazine

Question 23

AED that does not cause osteoporosis

Answer 23

Lamotrigine

Carbamazepine, phenytoin, and phenobarbital all increase breakdown of vitamin D via cytochrome p450 and can induce osteoporosis