Neurology Qs Flashcards
adjunctive treatment in multiple sclerosis?
Vit D
In order to meet criteria for dementia, a patient’s cognitive deficits must?
interfere with daily functioning and result in some loss of independence.
Managemetn of asymptomatic meningiomas without evidence of invasion of other intracranial structures and without surrounding edema?
followed clinically and radiographically
signal abnormalities typically seen on MRIs of patients with migraine? Significance?
White matter signal abnormalities in the posterior circulation
benign and unrelated to neurologic examination abnormalities or cognitive anomalies
most common epileptic aura if originates in the temporal lobe?
rising epigastric sensation
Classically, frontal lobe seizures cause?
motor manifestations (focal jerking, bicycling movements) that awaken patients from sleep.
Myotonic dystrophy type 1 v 2. Which is more common? Preferentially involves?
1
distal limb and facial muscles VS proximal muscles
Differentiating hallmark of myoonic dystrophy?
Difficulty with relaxation
Inclusion body myositis - time of progression? predominantly affects? Not a feature?
slow
distal upper extremity flexors and quadriceps
myotonia
Primary progressive aphasia is most commonly associated with what type of dementia?
frontotemporal dementia
shown to be superior to aspirin alone in reducing the risk of recurrent stroke
aspirin and dipyridamole
dual antiplatelet agents - role post-stroke?
don’t use - increased risk of hemorrhagic complications that offset any potential clinical benefit
narrow-spectrum AEDs used to treat partial-onset epilepsies? may provoke?
Carbamazepine, gabapentin, and phenytoin
absence status epilepticus.
Typical features suggestive of partial onset seizures?
specific auras (déjà vu or a rising epigastric sensation) and unilateral clonic shaking before onset
Topiramate - broad or narrow spectum AED?
Broad
Horner syndrome?
miosis, ptosis, and anhidrosis
characteristic of carotid artery dissection?
ipsilateral neck pain and ischemic complications (monocular visual loss and Horner syndrome)
Oxcarbazepine - side effect?
hypoNa
First line medications for essential tremor?
propranolol and primidone
Spinal cord compression by skeletal lesions resulting from plasmacytoma should be treated with? unless?
Radiation (even with minor neurologic deficits); spinal instability
combat veterans, particularly those with posttraumatic stress disorder (PTSD), are at high risk for?
nonepileptic seizures
levetiracetam should be avoided patients with PTSD because?
exacerbate anxiety and irritability
Tx for urgency, frequency, and incontinence in MS?
anticholinergic agents (oxybutnin) - decrease bladder spasms
Antiepileptic drugs that are better tolerated in the elderly?
lamotrigine, levetiracetam, and gabapentin
hunderclap headaches that recur over several days or weeks - dx? May also present with? CTA shows?
reversible cerebral vasoconstriction syndrome
focal neurologic deficits
multifocal areas of vasospasm without evidence of aneurysm
Primary stabbing headache - usually lasts for how long? responds to?
seconds; indomethacin
Treatment for primary CNS lymphoma?
Methotrexate-based chemotherapy and whole brain radiation
Standard-of-care treatment of an accessible solitary brain metastasis in patients with good functional status?
Complete resection followed by radiation therapy
can initially aggravate symptoms of myasthenia gravi? when to start them?
High-dose glucocorticoids;
These agents can be started after therapy with plasmapheresis or IVIG has been initiated.
most effective acute cluster headache treatments?
drug of choice for cluster headache prevention?
Oxygen therapy and subcutaneous sumatriptan
verapamil
How many days/month of opiates does it take to develope medication overuse headache?
10
standard of care for multiple sclerosis relapses?
IV methlyprednisone
Treatment guidelines advise treatment of hypertension in patients with acute ischemic stroke only if blood pressure is greater than?
220/120 mm Hg or evidence of other end-organ damage exists
appropriate next step in management for patients with incomplete recovery 3 months after onset of facial nerve palsy?
MRI Brain
+ evaluation for lyme, DM, vasculitis, HIV, sarcoid, Sjogren
Antiepileptic drugs that should not overlap due to risk of Stevens Johnson syndrome?
Lamotrigine and valproic acid
Anti-epileptic drugs that are safe in pregnancy?
levetiracetam and Lamotrigine
Progressive supranuclear palsy - PSP is defined by parkinsonism with? Characteristic appearance?
oculomotor abnormalities, including impairment of vertical saccades and supranuclear vertical gaze palsy
exhibit facial dystonia (with a characteristic surprised appearance)
BP med that should be avoided in this patient with a likely intracerebral hemorrhage? Why?
Intravenous nitroprusside can increase intracranial pressure
Goal blood pressure after intracerebral hemorrhage?
< 160/90
Physical exam findings of chronic inflammatory demyelinating polyradiculoneuropathy? EMG findings? of conduction velocities) detected on nerve conduction studies
diffuse areflexia and sensory and motor neuropathy; conduction blocks and slowing
Guillain-Barré versus chronic inflammatory demyelinating polyradiculoneuropathy?
GBS has a faster progression and reaches its nadir within 4 weeks,
CIDP progression continues beyond 8 weeks from onset.
Only reliable medication for idiopathic intracranial hypertension?
Carbonic anhydrase inhibitors, such as acetazolamide,
when to consider a lobectomy for epilepsy?
persistence of disabling seizures for longer than 1 year despite treatment with adequate doses of two or more antiepileptic drugs
In hospitalized patients with Parkinson disease, sudden withdrawal of dopaminergic medications can lead t?
parkinsonian-hyperpyrexia syndrome, an acute syndrome resembling neuroleptic malignant syndrome
Definition of status migrainosus?
migraine attack extending beyond 72 hours and is the most common complication of acute migraine.
Treatment of status migrainosus?
Repetitive administration of intravenous dihydroergotamine
Fingolimod?
sphingosine-1-phosphate receptor modulator that restricts activated lymphocytes to lymph nodes
Disease-modifying threrapy for MS (decreases relapse rate and acumulation of new lesions on MRI)
Nimodipine? When (timing, dose, duration) to give?
L-type calcium channel blocker that decreases vasospasm (and death) in patients with SAH
Best options for migraine without aura? Preferred option?
NSAIDs, triptans, and dihydroergotamine
NSAIDs are preferred as initial treatment because of their greater cost-effectiveness.
Treatment for ALS with a survival benefit?
Riluzole
ALS mimickers?
Lyme disease, hyperparathyroidism, vitamin B12 or copper deficiency, lead intoxication,
Cerebral vasospasm after SAH most often occurs when? and is best detected by?
5 to 10 days after the hemorrhage; CT angiography of the brain.
first-line treatment for restless legs syndrome?
Dopamine agonists, such as ropinirole, pramipexole, or rotigotine
INR that is a contraindication to TPA?
1.7
Blood pressure go after TPA?
< 180/105
appropriate as therapy for migraine without aura in patients not responding to NSAIDs or oral triptans?
Subcutaneous sumatriptan
Dissection of the left internal carotid artery typically results in? What is spared?
ipsilateral Horner syndrome with ptosis, miosis, and anhidrosis but not oculomotor nerve (cranial nerve III) palsy.
Antiepileptic drugs that do not affect liver enzymes, and are therefore used in patients getting chemotherapy?
Valproic acid, lacosamide, lamotrigine, and levetiracetam.
Chronic paroxysmal hemicrania - nerve affected? Duration of attacks compared to trigeminal neuralgia? Diagnosis also requires?
V1;
15 mins v seconds
concomitant ipsilateral autonomic findings, such as tearing, nasal congestion, or rhinorrhea
method to distinguish between a flare of inflammatory myopathy and glucocorticoid-induced toxic myopathy in a patient with persistent myopathy?
Steroid tapering
How long after administration of TPA before starting antiplatelet agents?
24 hours until a repeat head CT scan shows no hemorrhage,
only agents that have shown efficacy in studies of chronic migraine? Definition of chronic migraine?
Topiramate and onabotulinumtoxinA; >15 days a month for > 3 months
