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Neurology Flashcards

1
Q

Myoclonic seizure clinical features

A

Very brief (less than 1 second) + synchronous jerking or shaking of the limbs + *retained awareness and no postictal confusion

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2
Q

Management of acute agitation in DLB

A

Donepezil

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3
Q

Management of patient with parkinson disease who is having medication-related complications of carbidopa-levodopa

A

DBS (This is advanced parkinson disease. DBS reduces total levodopa dosage)

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4
Q

Management of severe TBI

A
  • Aggressive management of fever (Acetaminophen)
  • Maintain PO2 greater than 60
  • Maintain SBP greater than 90
  • steroids are contraindicated and have been shown to worsen its prognosis
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5
Q

Battle sign indicates

A

Basilar skull fracture

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6
Q

LDL goal in secondary stroke prevention

A

There isn’t a goal – High intensity statin REGARDLESS of baseline LDL cholesterol level (This is because statins have other benefits, including plaque stabilization, anti-inflammatory properties, and slow progression of carotid arterial disease.)

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7
Q

Evidence for intracranial stenting for atherosclerotic disease

A

Bad – 2x higher risk of stroke compared with medical therapy

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8
Q

Treatment of fatigue in MS

A

Stimulant (modafinil, amantadine)

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9
Q

First step in evaluation of unprovoked seizure

A

Head CT (rule out bleed)

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10
Q

Treatment of FTD

A

Symptom based because there are no disease modifying therapies (SSRIs) (often associated with apathy, diminished interest, loss of empathy)

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11
Q

Work up of suspected reversible cerebral vasoconstriction syndrome (RCVS)

A

Brain MRA or CTA

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12
Q

reversible cerebral vasoconstriction syndrome (RCVS) clinical features

A

Thunderclap headache + multiple episodes within short time frame + precipitated by vasoactive drugs or sertraline or emotion/showering/exertion

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13
Q

Treatment of choice for reversible cerebral vasoconstriction syndrome

A

CCB’s

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14
Q

Treatment of MS exacerbation

A

High dose oral steroids (can also use IV

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15
Q

Features of dystonic tremor

A

Rest and action + dystonic rhythmic posturing

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16
Q

treatment of refractory status epilepticus in patient allergic to phenytoin

A

Valproic acid

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17
Q

Initial management of status epilepticus

A

ABCs
Accucheck
Thiamine with glucose if needed

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18
Q

Meds with evidence for migraine prophylaxis

A

Betablockers
Divalproex
Topamax

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19
Q

AED’s for pregnant patients

A

Keppra

Lamotrigine

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20
Q

Management of spinal cord mets

A

Emergent steroids

Then urgent surgery with post op radiation

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21
Q

CJD features

A

Rapidly progressive dementia
*Myoclonus
Sleep problems

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22
Q

Evaluation of TIA

A

Carotid duplex US (cheaper than CT-A or MRA)

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23
Q

When you need head CT for patients with mild TBI

A
  • dangerous mechanism of injury (cars, high falls)
  • imaging
  • Severe headache, vomiting
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24
Q

MCI definition

A

Stage between normal aging and dementia (greater than what is expected with normal aging but no significant functional disability)
- cognitive testing below normal range

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25
Q

Management of urinary symptoms in MS patients

A

Urodynamic testing

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26
Q

PE management in patient with primary brain tumor

A

IV heparin (short half life in case tumor bleeds)

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27
Q

What is POEMS syndrome? Clinical features?

A
  • Monoclonal plasma cell disorder typically arising secondary to an underlying cancer
    P - polyneuropathy
    O - organomegaly
    E - endocrinopathy
    M - monoclonal gammopathy (monoclonal protein on SPEP)
    S - skin changes
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28
Q

What are UMN signs?

A 
Hyperreflexia
*Spasticity
clonus
hoffman sign
Extensor plantar response
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29
Q

CIDP presentation

A

Generalized areflexia

Progressive or relapsing symmetric sensory and motor neuropathy

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30
Q

Key feature in stem for mitochondrial myopathy

A

Maternal transmission

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31
Q

Features of focal seizures

A
  • Preceded by warning/aura
  • Mouth or limb automatisms (repetitive movements)
  • Followed by confusion (no recollection of seizure) and/or exhaustion
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32
Q

Absence seizures vs. focal seizures

A
  • also staring and confusion

- BUT more frequent (multiple times per day) + immediate recovery + more common in kids

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33
Q

Myoclonic seizures clinical features

A
  • Single jerk of the entire body
  • less than 1 second
  • retained awareness + no postictal confusion
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34
Q

Idiopathic brachial plexopathy clinical features

A
  • Infection or surgery triggers:
  • Subacute severe pain
  • Pain then resolves and pt has progressive weakness and atrophy of shoulder girdle and upper extremity muscles
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35
Q

First line treatment of Tourette syndrome

A 
FIRST line --> CBT (teaches patients diversion techniques, ie start tapping foot if it comes on)
SECOND line if CBT fails -->
- clonidine
- guanfacine
- topiramate
- tetrabenazine
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36
Q

Clinical features of tourette syndrome

A
  • Usually feel it coming on (premonitory sensory cues)
  • Often have other tics (eye rolling, throat clearing)
  • Usually starts in childhood
  • Also often have OCD
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37
Q

Migraine with aura treatment

A
  • Start with NSAIDS

- IF ineffective –> triptans

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38
Q

Convulsive syncope

A

Seizure preceeded by tunnel vision, palpitations

  • then short duration of loss of consciousness
  • movements and shaking of all four limbs
  • immediate and complete recovery
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39
Q

Atonic seizure vs. convulsive syncope

A
  • atonic seizure = much briefer (a few seconds) + no warning signs
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40
Q

Workup of fatigue and decreased energy post stroke

A

Sleep study (sleep-disordered breathing and central sleep apnea, highly prevalent in patients post stroke

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41
Q

Management of MS in patient with liver disease

A

Glatiramer

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42
Q

LMN signs

A

Atrophy, fasciculation, weakness

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43
Q

ALS core features

A

UMN signs
LMN signs
*Absence of sensory deficits

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44
Q

CMT clinical features

A

Numbness, distal extremity weakness, unsteady gait, areflexia, high arches, hammer toes, storkleg deformity, distal muscle atrophy

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45
Q

Cavernous sinus thrombosis clinical features

A
  • painful ophthalmoplegia

- multiple ocular nerve involvement

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46
Q

Cavernous sinus thrombosis management

A

STAT surgery + abx

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47
Q

Diagnosis of NPH

A

LP (volume removal + measurement of open pressure)

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48
Q

When is neuropsych testing performed?

A
  • Patients with mild symptoms of cognitive impairment
  • Patients with cognitive and functional decline who seem depressed but may actually have mild cognitive impairment/early dementia
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49
Q

Autoimmune limbic encephalitis clinical features

A
  • new onset status epilepticus

+ hyponatremia + progressive confusion in previously health patient

50
Q

Management of intractable epilepsy

A

Video EEG (need to confirm that seizures seen on video EEG match the location of abnormal findings on MRI before proceeding to surgery/temporal lobectomy)

51
Q

Indications for surgery with brain aneurysms

A
  • Symptomatic (Cranial nerve deficits)

- 7 millimeters or greater in size

52
Q

Management of psychosis in Parkinson disease

A

Discontinue dopamine agonists (pramipexole)

53
Q

Management of thunderclap headache if CT head is normal

A

LP

54
Q

Diagnosis of primary CNS lymphoma

A

IF biopsy inaccessible (by brainstem) –> Slit-lamp exam and vitreous fluid collection with cytology

55
Q

Prognosis of primary CNS lymphoma

A

Responds well to treatment but typically recurs and has a poor prognosis

56
Q

Periodic limb movements of sleep clinical features

A

Periodic leg kicks that exhibit a stereotyped triple-flexion phenomenology repeating periodically during sleep

57
Q

Treatment of REM sleep behavior disorder

A

benzos (klonopin)

58
Q

REM sleep behavior disorder clinical features

A
  • dream enactment behavior with complex movements and vocalizations
59
Q

McArdle disease clinical features

A
  • exercise intolerance/cramping
  • mild myalgias/weakness
  • myoglobinuria + CKD
60
Q

Acute intermittent porphyria clinical features

A

ACUTE + INTERMITTENT

  • acute attacks of abdominal pain and vomiting
  • reddish-brown urine during attacks
61
Q

Distinguishing feature between DLB and Alzheimer

A

REM sleep behavior disorder

62
Q

Treatment of acute intracerebral hemorrhage

A

IF SBP > 180 –> Rapidly lower BP with IV nicardipine

63
Q

First line prophylactic medication for cluster headaches

A

CCBs

64
Q

First line treatment for cluster headaches

A

Oxygen inhalation

Subcue sumatriptan

65
Q

Neurologic presentation of familial amyloidosis

A

Sensory and motor peripheral neuropathy + autonomic neuropathy

66
Q

Likely diagnosis in ICU patient who develops AMS

A

NCSE

67
Q

NCSE diagnosis

A

Continuous (24-hour) EEG

68
Q

Clinical features of NCSE

A

confusion/amnesia + negative symptoms (aphasia, mutism, catatonia, not responding to commands (occasionally)) + rhythmic twitching of one or more muscle groups, tonic eye deviation, hippus, ocular movement abnormalities (sustained eye deviation, nystagmus),

69
Q

Management of impaired mobility in MS

A

Dalfampridine

70
Q

Cause of most subacute pain and paresthesia in a dermatomal pattern in the thoracic or abdominal region

A

Diabetic mononeuropathy (assuming no evidence of zoster)

71
Q

MSA features

A

Parkinson

*early falls and dysautonomia

72
Q

Diagnosis of suspected idiopathic intracranial hypertension

A

LP

73
Q

Treatment of idiopathic intracranial hypertension

A

Acetazolamide

74
Q

First line prophylactic medication of chronic tension-type headache

A

Amitriptyline

75
Q

Management of asymptomatic carotid artery stenosis

A

statin

76
Q

Management of GBS patient who improves following plasma exchange

A

Discharge to rehab

77
Q

AED to use in patients with osteoporosis

A

Lamotrigine

78
Q

Primary stabbing headache clinical features

A
  • Transient localized stabs of head pain + not in trigeminal location
79
Q

First line for focal seizures in elderly patients with multiple comorbidities

A

Lamictal

80
Q

Corticobasilar degeneration clinical features

A

Asymmetric parkinsonism
Dystonia
Myoclonus

81
Q

Next step after patient with acute ischemic stroke is treated with TPA

A

CT angio of head (determine candidacy for endovascular therapy – patients with large-vessel occlusion have low recanalization rates with IV thrombolysis)

82
Q

Antibiotics that lower the seizure threshold

A

Carbapenems
Fluoroquinolones
Fourth-generation cephalosporins (cefepime)

83
Q

Migraine diagnosis

A 
At least 5 episodes lasting 4-72 hours with pain exhibiting 2 of following features:
Unilateral
Throbbing
Moderate to severe intensity
Worse with physical activity
Nausea or photo/phonophobia
84
Q

Treatment of ischemic stroke in the absence of TPA

A

Aspirin

85
Q

Management of mild TBI’s in athletes

A
  • symptom checklist, neuro exam
  • Head CT if suspected hemorrhage
  • neuropsych testing
86
Q

Treatment of cognitive impairment in patient with vascular cognitive impairment

A

Donepezil (acetylcholinesterase inhibitor)

87
Q

Vascular neurocognitive impairment clinical features

A
  • pseudobulbar affect
  • ataxia
  • asymmetric neurologic findings
88
Q

Treatment of pseudobulbar symptoms

A

SSRIs

89
Q

what is immune-mediated necrotizing myopathy?

A

Form of statin myopathy – even after stopping stain, muscle weakness and CK is high
- biopsy has evidence of muscle necrosis without inflammation

90
Q

Treatment of immune-mediated necrotizing myopathy

A

steroids

91
Q

Management of intracranial hypotension

A

Epidural blood patch

92
Q

Key feature of intracranial hypotension

A

orthostatic headache (Due to CSF leak)

93
Q

First step in MS evaluation

A

MRI brain and spine

*LP for oligoclonal bands has poor test characteristics

94
Q

VTE management post hemorrhagic stroke

A

Should start prophylactic heparin 48 hours after bleed (assuming imaging rules out active bleeding) (patients with hemiparesis are at high VTE risk)

95
Q

Management of patient with Alzheimer and contraindication to donepezil

A

Memantine

96
Q

Contraindications to acetylcholinesterase inhibitors in Alzheimer’s patients

A

Sick sinus syndrome
LBBB
Uncontrolled asthma
PUD

97
Q

Diagnostic study for patients with a suspected secondary headache

A

Brain MRI

98
Q

Red flags for secondary headache condition

A
  • new headache after age 50
  • use of anticoagulant
  • progressive headache pattern
99
Q

SE to know about with fingolimod

A

Macular edema so need regular ophthalmic exams

100
Q

Primary progressive aphasia clinical features

A

Language deficits before additional cognitive deterioration

101
Q

Bell palsy vs stroke

A

Bell palsy = can’t elevate eyebrow (forehead involvement) (CVA does not involve forehead because of bilateral innervation)

102
Q

Bell palsy treatment

A

Prednisone

103
Q

Other features of bell palsy

A
  • alteration in taste

- hyperacusis (intolerance of loud noise due)

104
Q

First and second line for idiopathic transverse myelitis

A

1) high dose IV steroids

2) plasma exchange therapy

105
Q

Healthcare maintenance in MS patients

A
  • more evidence suggest that disease activity is highly correlated with serum vitamin D levels
  • vitamin D supplementation has now been shown to provide additional control of disease activity
106
Q

Best test for Alzheimer’s disease

A

CSF analysis (decreased AB42 and incrreased tau protein)

107
Q

Management of epilepsy in a patient with psychiatric disease

A

Lamotrigine (also a mood stabilizer)

108
Q

Myoclonus clinical features

A

Rapid, nonsuppressible, jerky movements

109
Q

Dystonia definition

A

Sustained muscle contractions leading to stereotyped and directional twisting and posturing movements

110
Q

Management of cognitive dysfunction in MS

A

Cognitive rehabilitation therapy

111
Q

NCSE treatment

A

ativan 2 mg challenge

112
Q

management of severe refractory migraine with aura

A

IV dopamine antagonists (prochlorperazine or metoclopramide)

113
Q

MRI findings with migraine

A

Punctate white matter lesions

114
Q

Secondary prevention of ischemic stroke

A
  • Aspirin + Plavix for 21 days

- then continue plavix as monotherapy

115
Q

Treatment of lewy body dementia

A
  • levodopa when symptomatic therapy required
116
Q

Goal SpO2 in CVA

A

93% (higher is harmful, as in many other acute illnesses)

117
Q

Type of patients who experience myoclonus

A

anoxic brain injury (posthypoxic myoclonus) (patients who’ve coded)

118
Q

Relation of neck pain to headache

A
  • nonspecific and does not necessarily indicate pathology in cervical region
119
Q

Limbic encephalitis clinical fatures

A
  • new-onset status epilepticus
  • progressive confusion
  • previously healthy person
  • rapidly progressive (so seems like prion disease)
  • myoclonus
  • hyponatremia
120
Q

Adjuvant therapy of MS

A

vitamin D

121
Q

Medication that improves ambulatory function in MS patients

A

Dalfampridine

122
Q

Term for syndrome of recurrent thunderclap headaches

A

Reversible cerebral vasoconstriction syndrome

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