Neurology disorder

Question 1

Bell’s palsy

Answer 1

Idiopathic facial nerve
palsy.
Acute, spontaneous, unilateral facial paralysis
cranial nerve VII palsy

Question 2

Bell’s palsy presentation

Answer 2

Disappearance of the nasolabial fold

decrease tearing on the affected side

inability to wrinkle the forehead

loss of taste sensation
inability to pucker lips

Question 3

treatment of Bell’s palsy

Answer 3

prednisone

Question 4

concussion

Answer 4

mild traumatic brain injury
GCS =13 or > Glasgow coma scale

Question 5

concussion treatment

Answer 5

physical rest 24-48h with a gradual return to activity

cognitive rest minimizes cognitive activities that exacerbate symptoms

Question 6

recurrent concussion

Answer 6

may indicate overexertion during recovery

if a migraine history, a concussion may trigger migraine HA

promote sleep it help recovery

cognitive recovery may be longer than physical recovery

refer for symptoms lasting >21 days or escalating symptoms after injury or multiple concussions

Question 7

After a concussion when back to school or work?

Answer 7

when able to focus for 30-45 mins at a time

Question 8

back to sports?

Answer 8

return-to-school success

symptoms free, no meds

normal neuro exam

Question 9

Back to sports ?

Answer 9

light aerobic exercise (increase HR)

sport-specific exercises (add movement

noncontact participation

full contact practice (assess status)

normal game/physical activity

Question 10

Headaches?

Answer 10

primary headaches: migraine, tension, cluster

Secondary headaches: underlying pathology “ red flag” headache

Question 11

NB

Answer 11

New onset headache in a middle/older adult (>50) is usually secondary

Question 12

papilledema

Answer 12

swelling of the optic disc due to increase ICP
Almost always bilateral

Question 13

CT vs MRI

Answer 13

CT : radiation,look at cavities, intracranial hemorrage, tumor, hard thing, bones
quick 5min

MRI: no radiation. look at soft tissue, brain , spinal cord, ligament, tendon, injuries
nonemergent

Question 14

Dx of migraine without aura

Answer 14

-headaches last 4-72 hours
has 2 of these characteristics unilateral, pulsating quality, mod to severe intensity, aggravated by routine activity
-during headache: N and /or V , photophobia or phonophobia (at least 1)
-5 or more attacks have occurred with these characteristics
-no other reason for the headaches occurrence

Question 15

Dx migraine with aura

Answer 15

25% of pt have aura
-2 attacks of migraine with aura
-visual. sensory, motor, and brainstem. retinal. or speech change fully reversible
-develops over 5-60mins , headache develop within 60minutes

Question 16

treatment

Answer 16

first line -Acetaminophen
NSAIDs
triptans
calcitonin gene-related peptide CGRP
prophylactic agents : beta blockers propranolol, timolol
antidepressant amitriptyline, venlafaxine

anticonvulsants: valproate, topiramate

Question 17

Vertigo

Answer 17

either peripheral or central etiology

peripheral etiology involves the vestibular system (BPV)

central involves the brainstem or cerebellum (stroke)

Question 18

is vertigo peripheral or central

Answer 18

peripheral (vestibular)
-visual fixation stops nystagmus
-walking preserved
-hearing may be impaired
-normal neuro check
Central
-visual fixation does not stop nystagmus
-often falls with walking
-hearing usually intact
-abnormal neuro exam

Question 19

clue to etiology of vertigo

Answer 19

-Less than 1 minute, single episode - BPV
-Few minutes to hours, single, episode-migraine, TLA of labyrinth or brain stem
-Several mins or hours, recurrent- Meniere;s , vestibulopathy
-Days, prolonged and severe - vestibular neuritis, MS, brain stem infarct

Question 20

The Dix-Hallpike

Answer 20

The Dix-Hallpike maneuver is the gold standard for diagnosing benign positional paroxysmal vertigo caused by a posterior canal otolith. The patient is positioned recumbent with the head back and toward the affected ear, causing the otolith to progress superiorly along the natural course of the canal.

The Dix-Hallpike test diagnoses the condition and the Epley maneuver treats it by encouraging the tiny calcium carbonate crystals to move back where they belong.

Question 21

Treatment

Answer 21

-Meclizine-Antivert
-Dimenhydrinate-Dramamine
-Diphenhydramine-Benadryl

Question 22

Diabetic Neuropathy

Answer 22

-Distal symmetric polyneuropathy
DSPN= diabetic neuropathy
-15-20% of DM neuropathy patients have pain
-symptomatic neuropathy is not usually reversible

Question 23

Differential diagnosis of

Answer 23

=Metabolic-diabetes, B12, deficiency, hypothyroidism
=Toxic- Alcohol
= Diffuse motor without sensory- Guillain-barre syndrome, myasthenia gravis
=inflammatory infectious - sarcoidosis, lupus, Lyme disease

Question 24

Preventive care

Answer 24

-glycemic control
-modify risk factors (BMI, Bp, A1c, minimal EtOH consumption , avoidance of smoking ect)
-foot care

Question 25

Pharm treatment

Answer 25

SNRI: duloxetine (Cymbalta, Venlafaxine (Effexor)
TCA: amitriptyline, desipramine, nortriptyline
Gabapentinoid: pregabalin (Lyrica) , gabapentin (Neurontin)

Question 26

patient evaluation

Answer 26

-Screening in asymptomatic patients is NOT recommended
- history of cognitive/behavioral changes (from family or significant other)
-Med history asks about analgesics anticholinergics, psychotropics, sedative-hypnotics

Question 27

patient evaluation

Answer 27

-MMSE
-Montreal cognitive assessment (MoCA)
-if there is a discrepancy between cognitive testing and physical exam, further testing is need

Question 28

Depression

Answer 28

Depression can worsen cognitive impairment
Always screen for depression (consider PHQ2)

Question 29

Treatment of AD

Answer 29

Cholinesterase inhibitors: Donepezil, rivastigmine, galantamine.

NMDA receptor antagonist, memantine.
Advanced AD:
use in combo with cholinesterase inhibitors (donepezil/memantine)

Question 30

pharm for severe , persistent symptoms

Answer 30

Olanzapine (consider first)
Quetiapine (consider as an alternative)
May increase mortality. side effects

Question 31

cranial nerves

Answer 31

Oh Oh Oh To Touch And Feel Very Good Velvet AH
O-Olfactory
O-Optic
O-Oculomotor
T-Trochlear
T-Trigeminal
A-Abducens
F-Facial
V-Vestibulocochlear
G-Glossopharyngeal
V-Vagus
A-Accessory
H-Hypoglossal