Neurology

Question 1

Bells Palsy etiology

Answer 1

idiopathic, U/L CN VII facial nerve palsy

Hemifacial weakness and paralysis

Strong association with HSV reactivation

Rsk Factors: DM, prego, post URI, dental nerve block

Question 2

Bells Palsy manifestation

Answer 2

Ipsilateral ear pain for 24-48 hrs: Unilateral facial paralysis
Unable to life eyebrow

Question 3

Bells Palsy Tx

Answer 3

None required
Prednisone decreases nerve inflamm if started within 1st 72 hours of sx

Artificial Tears, eye patch

Fxn returns within 2 weeks with significant improvements within 4 months

Question 4

TIA sx

Answer 4

Monocular vision loss “lamp shade down one eye”

weakness, speech change, confusion

Question 5

TIA Dx

Answer 5

CT initial TOC

W/O contrast to r/o hemorrhage

Question 6

TIA tx

Answer 6

ASA and Plavix
Thrombolytics contraindicated
Place in supine position

Question 7

Subclavian Steal Syndrome

Answer 7

Signs and sx from reversed blood flow down the ipsilateral vertebral artery to supply the affected due to occlusion or stenosis of subclavian artery

LEFT ARM MC

Question 8

Subclavian Steal Syndrome manifestations

Answer 8

RISK: arthrosclerosis

Paresthesia, claudication, blood pressure difference in each arm, nystagmus, weakness, syncope

Question 9

Subclavian Steal Syndrome Dx

Answer 9

Continuous wave doppler

Tx: revascularization or Percutaneous transluminal angioplasty

Question 10

Acoustic Neuroma etiology

Answer 10

CN VII shwannoma: benign tumor of schwann cells which produce myelin sheath

Question 11

Acoustic Neuroma sx

Answer 11

Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise, tinnitus, HA, facial numbness, vertigo

Question 12

Acoustic Neuroma Dx

Answer 12

MRI

Question 13

Acoustic Neuroma tx

Answer 13

Surgery or focused radiation therapy

Question 14

Epidural hematoma etiology

Answer 14

Arterial Bleed MC between skull and dura

MC after temporal bone fx: middle meningial artery disruption

Question 15

Epidural Hematoma Sx

Answer 15

Brief LOC, lucid interval, coma, HA, n/v, focal neuro sx, rhinorrhea d/t CSF fluid

Question 16

Epidural hematoma dx

Answer 16

CT: Lemon bleed

Does NOT cross suture lines

Question 17

Epidural hematoma tx

Answer 17

Herniate if not evacuated early; obs if small

If increased ICP: Mannitol, hyperventilation, head elevation (HOB 30 degrees), potentially a shunt

Question 18

Subdural Hematoma etiology

Answer 18

Location: MC venous bleed, between dura and arachnoid d/t tearing of cortical bridging veins, MC in elderly

Mechanism: MC blunt trauma often causes bleeding on other side of injury

Question 19

Subdural Hematoma sx

Answer 19

May have foval neuro sx

Question 20

Subdural Hematoma dx

Answer 20

CT: concave, banana shape bleed

CAN CROSS SUTURES

Question 21

Subdural Hematoma Management

Answer 21

Evacuation vs. supportive

Question 22

Subarachnoid Hemorrhage etiology

Answer 22

Location: arterial bleed a/w arachnoid and pia
Mechanism: MC berry aneurysm rupture

Question 23

Subarachnoid Hemorrhage Sx

Answer 23

Thunderclap headache: U/L, occipital area, meningeal symptoms: stiff neck, photophobia, AMS, no focal neuro deficits

Terson Hemorrhage: retinal hemorrhage

Question 24

Subarachnoid Hemorrhage Dx

Answer 24

CT scan W/O contrast first
If negative: LP

4 vessel angiography after confirmed SAH

Question 25

SAH Tx

Answer 25

Supportive: bed rest, stool softeners, lower ICP, surgical coiling Lower BP gradually

Question 26

Incracerebral Hemorrhage Etiology/dx/tx

Answer 26

Location: intraparenchymal Mechanism: HTN, AVM, Trauma Dx: CT scan, NO LP Tx: decrease BP gradually IV mannitol

Question 27

Cluster Headache sx

Answer 27

severe u/l periorbital/temporal pain, pouts lasting less than 2 hours with spontaneous remission Triggers: worse at night, ETOH, stress

Question 28

Cluster headache PE/tx

Answer 28

Ipsilateral horners syndrome: ptosis, miosis, anhidrosis Tx: 100% O2 1st line, antimigraine meds Sumatriptan PPX: verapamil 1st line

Question 29

Complex Regional Pain Syndrome (CRPS) etiology

Answer 29

Formerly known as reflex sympathetic dystrophy

Question 30

CRPS sx

Answer 30

MC: upper extremities Stage I: pain out of proportion to injury Stage II: waxy/pale skin, brittle nails, loss of hair Stage III: joint atrophy, contractures

Question 31

CPRS Tx

Answer 31

NSAIDS initial treatment | Vit C ppx after fx

Question 32

GCS

Answer 32

Eye opening Verbal response Motor Response Best: 15 Comatose <8 Unresponsive: 3

Question 33

Concussion etiology

Answer 33

mild traumatic injury, alteration in mental status with or without LOC

Question 34

Concussion sx

Answer 34

Confusion: confused or blank expression Amnesia HAs, dizziness Signs of increased intracranial pressure: vomiting, increasing disorientation

Question 35

Concussions Dx

Answer 35

CT scan: study of choice | MRI: study of choice IF prolonged sx >7-14 days

Question 36

Concussion Tx

Answer 36

Cognitive and physical rest

Question 37

Delirium

Answer 37

acute, abrupt, transient confused state d/t an identifiable cause (meds, hospital stay, infections. Usually full recovery in 1 week

Question 38

Dementia

Answer 38

Progressive, chronic intillectual deterioration of selective functions; memory loss and loss of impulse control, motor/cog fxns Risk: >60 years old, vascular disease

Question 39

Alzheimer's Disease

Answer 39

MC type of dementia, amyloid deposits Dx: CT scan shows cerebral cortex atrophy Tx: Ach-esterase inhibitors: Donepezil NMDA Antagonist: memantine

Question 40

Vascular dementia

Answer 40

2nd MC type, chronic ischemic and multiple infarctions HTN most important risk

Question 41

Fronttemporal dementia

Answer 41

Localized brain degeneration of the FT lobes MARKED PERSONALITY CHANGES

Question 42

Lewy Body Disease

Answer 42

Abnl neuronal protein deposits VISUAL HALLUCINATIONS, delusions, episodic delirium, dementia occurs later in disease

Question 43

Viral (aseptic) meningitis

Answer 43

MC: enterovirus, then mumps/HSV HA, fever, mild confusion, nuchal rigidity, photophobia

Question 44

Viral meningitis dx

Answer 44

CSF analysis: MOST IMPORTANT TO DIFFERENTIATE CT scan done 1st to rule out intracranial mass

Question 45

Viral meningitis tx

Answer 45

supportive, antipyretics, IVF usually self limited

Question 46

Encephalitis etiology

Answer 46

MC cause: HSV-1 enterovirus | Infection of parenchyma

Question 47

Encephalitis sx

Answer 47

HA, fever, lethargy, AMS, Abnl cerebral fxn

Question 48

Encephalitis Dx

Answer 48

CSF analysis: lymphocytosis, normal glucose, increased protein

Question 49

Encephalitis Tx

Answer 49

Supportive care, control edema, antipyretics, seizure ppx Valcyclovit if HSV Higher morbidity than viral meningitis

Question 50

Acute bacterial meningitis | etiology/sx

Answer 50

hx of sinusitis or pneumonia prior to meningitis sx: fevers, chills, meningeal sx

Question 51

Acute bacterial meningitis dx

Answer 51

LP: neutrophils, decreased glucose, increased total protein, increased CSF pressure CT: r/o mass before LP

Question 52

Bacterial meningitis <1 month old

Answer 52

Organism: GBS Tx: Ampicillin + cefotaxime

Question 53

Bacterial meningitis 1m -18y

Answer 53

Organism: N meningitis Tx: Ceftriaxone + Vanc

Question 54

Bacterial Meningitis 18y-50y

Answer 54

Organism: S. Pneumo and N. Meningitis Tx: Ceftriaxone + Vanc

Question 55

Bacterial Meningitis >50yo

Answer 55

Organism: S. pneumo, listeria monocytogenes Tx: Ampicillin, Ceftriaxone, and Vanc