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UWORLD ABIM > Neuropsych > Flashcards

Neuropsych Flashcards

1
Q

T/F: ssris are effective for anorexia and bulimia

A

false

bulimia: ssri
anorexia: olanzapine

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2
Q

Contraindications to Buproprion

A

Hx of seizures

Active eating disorder

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3
Q

T/F: Cervical myelopathy causes UMN signs in the UE and LE

A

False. Causes

  • UE deficits with LMN signs
  • LE weakness with UMN signs
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4
Q

timing for tpa for CVA

A

within 4.5 hours of sx onset

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5
Q

when does mechanical thrombectomy need to be initiated for CVA

A

within 24 hours

doesnt matter if tpa has been given . hold asa in patients who undergo thrombolysis for 24 hours

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6
Q

How would a brainstem stroke present?

A

Acute CN deficit + contralateral hemiparesis or hemisensory loss (crossed signs)

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7
Q

Lateral medulla stroke (wallenberg syndrome)

A

ipsilateral Horner
loss of facial pain/temp
contralateral loss of body pain/temp
hoarseness, dysphagia

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8
Q

cerebellar stroke

A

nystagmus/falling to the side of the lesion, limb ataxia, n/v, vertigo, inability to ambulate

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9
Q

midbrain stroke

A

ipsilateral CN 3 palsy +. contralateral lower facial weakness/hemiplegia

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10
Q

when might neuroleptic malignant syndrome present in a parkinson pateint

A

after withdrawal, dose reduction, or a switch in dopamine agents

look for lead-pipe rigidity, hyperthermia, autonomic instability (CK will be high, >1000)

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11
Q

T/F: Buproprion induces fewer sexual side effects and less wt gain when compared with out antidepressants

A

true.

it is also activating (good for low energy, hypersomnia patients)

avoid if hx of seziures or active eating disorders

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12
Q

typical LP findings in GBS

A

increased CSF protein with normal wbc count

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13
Q

Scores < *** on MMSE are sensitive/specific for dementia

A

<24/30 (so 26/30 is a good score)

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14
Q

What is the most common etiology of transverse myelitis?

A

Autoimmune process following a viral infection

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15
Q

What will MRI and LP show for transverse myelitis

A

MRI: enhancing cord segments with surrounding edema

CSF: elevated protein, moderate lymphocytosis, normal glucose, no oligoclonal bands

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16
Q

how do cauda equina and transverse myelitis present?

A

Cauda Equina (lumbosacral roots): severe unilateral pain in saddle region. radiates down to legs. assymmetrical LE weakness.

TM: Acute onset weakness and sensory loss below a spinal level + bowel/bladder/sphincter dysfunction

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17
Q

acute monocular vision loss, central scotoma (black spot), loss of color vision, eye pain

A

optic neuritis (screen for MS).

Exam may show afferent pupillary defect, hyperemia. MRI of brain and orbits with gadolinium can show optic nerve inflam and findings of MS (periventricular white matter lesions)

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18
Q

T/F: IDA is commonly associated with RLS

A

true, measure ferritin in all patients

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19
Q

Factitious vs malingering

A

Factitious: they want the attending of assuming the sick role

Malingering: working the system for external rewards (i.e. disability pay, meds)

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20
Q

best AED to start in female of reproductive age

A

Lamotrigine or Levetiracetam

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21
Q

medications for Parkinsons disese

A

Age >65: levodopa/carbidopa

Age <65: Dopamine agonists (bromocriptine, pramipexole, ropinirole) due to fewer motor fluctuations

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22
Q

T/F: Donepezil is a dopamine agonist used in PD

A

False. It is an AChesterase inhibitor, increases ACh levels in dementia patients

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23
Q

Tx of myasthenic crisis

A
  • Measure VC q2 hours
  • Consider intubation (VC <20 or MIF >-30)
  • hold Pyridostigmine aka Acetycholinesterase inhibitors (to reduce secretions)
  • PLEX or IVIg, + high dose steroids
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24
Q

T/F: Metoclopramide can cause tardive dyskinesia

A

True, stop it if it develops. Best tx for even antipsychotic-induced TD = drug discontinuation or switching to a second -gen. If you can’t, add valbenazine (NOT benztropine).

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25
Q

T/F: ASA should be started in the first 24 hours after tpa

A

False. ASA should be avoided in the first 24 hours until repeat non-con CT shows no bleeding. This applies to early enteral feeding and anticoagulants also

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26
Q

features of idiopathic intracranial hypertension

A

Usually young obese female. HA, visual sxs, diplopia and tinnitius. Can be pulsatile and worse by laying flat. Most important sign = papilledema, can lead rapidly to vison loss.

Empty sella syndrome is commonly seen.

LP demonstrating opening pressure elevation is dx. Tx = wt loss, acetazolamide.

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27
Q

tx of depression when life expectancy <4-6 weeks

A

Psychostimulants: Methylphenidate, dextroamphetamine, modafinil

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28
Q

features of phenytoin toxicity

A

Dose independent: gingival hyperplasia, folic acid deficiency, peripheral neuropathy, vit d def, drug-induced lupus, anticonvulsant hypersensitivity syndrome (rash, LN, fever, eosinophilia, elevated LFTS/CK)

Dose dependent: rash, horizontal nystagmus, ataxia, slurred speech, lethargy

IV infusion: hypotension, bradyarrythmias and asystole

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29
Q

main meds once MS confirmed

A 
Either: 
-interferon beta (+ vit D)
(CI in liver dz or depression)
or
-glatiramer acetate

steroids for acute flares, tx fever and underlying infx if present. normal immunization including annual influenza

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30
Q

Optic neuritis features

A
  • Monocular vision loss
  • eye pain w/movement
  • Afferent Pupillary Defect (paradoxical dilation of pupil when light rapidly shifted to affected eye)
  • “washed out” color vision (colors look more dull)
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31
Q

what is clinically isolated syndrome (CIS)?

A

First episode of CNS dysf(x) caused by demyelination but doesn’t have all features yet of MS

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32
Q

fatigue, diplopia, dysphagia and anterior mediastinal mass

A

Thymoma + Myasthenia Gravis

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33
Q

Anterior mediastinal mass

A

4 T’s:

  • thymoma (most common)
  • teratoma
  • thyroid tumors (goiter)
  • Terrible lymphoma
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34
Q

Lambert Eaton myasthenic syndrome is associated with

A

small cell lung cancer

35
Q

myelopathy after bariatric surgery or zinc supplementation

A

Copper deficiency (mimics vit b12 def)

36
Q

vit b12 def sxs

A 
paresthesias 
LE weakness 
gait instability 
-anemia can be absent 
-loss of MVP, sensory ataxia 
-check MMA and homocysteine for borderline vit b12 levels
37
Q

what is the first manifestation of MG in most patients?

A

Ptosis or Diplopia

38
Q

common precipitants of myasthenic crisis

A 
Fluoroquinolones
Beta blockers
CCB
Magnesium 
Aminoglycosides (gentamicin, tobramycin, amikacin)
39
Q

how are Botulism and MG different?

A

Botulism: sluggish/non-reactive pupils
MG: normal pupils
ocular sxs also rare in LE

40
Q

Dx of LE

A

detected of serum anti-voltage-gated calcium channel antibodies

EMG: facilitation of motor response to rapid repetitive stimulation (diminished tendon reflexes that improve with repetitive movements of affected mm)

41
Q

T/F: MG is associated with autoimmune thyroid disorders

A

True, look for elevated serum TSH

42
Q

dementia with sparing of memory and visuospatial function (not getting lost)

A

Frontotemporal dementia (note: no drug is beneficial for FTD)

43
Q

How do you slow decline of cognitive decline in Alzheimer patients?

A

Mild to moderate disease: Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine…note they can have cholinergic side effects i.e. bardycarida, diarrhea, n/v, heart block, syncope)

Moderate to advanced (MMSE 3-14): Memantine

can also use ACHesterase inhibitors for Lewy Body Dementia, vascular dementia

44
Q

T/F: Benzos are not recommended for tx of behavioral sxs in dementia patients

A

true

atypical antipsychotics also carry black box warning for increasing mortality, used when patient safety is jeapordized

45
Q

lobar hemorrhage in an older patient (>75)

A

usually Cerebral amyloid angiopathy (second most common cause of ICH)

Tx similar to other ICH:

  • reverse anticoag
  • mannitol /hyperventilation/barbiturate coma to reduce ICP
  • IV nicardipine or labetalol for SBP between 140-160

if warfarin associated ICH, give IV vitamin K and PCC

46
Q

when to use naltrexone and disulfuram in EtOH use disorder?

A

Naltrexone: FIRST LINE. Decreases cravings and heavy drinking, can be initiated in patients still drinking (CI is opioids and liver dz)

Disulfiram: does not reduce cravings. reserved for abstinent patients highly motivated or taking medication in a supervised setting. it is SECOND-line

47
Q

What is next step if you suspect SAH (worst HA of my life) but CT negative?

A

CSF exam to look for rbc or xanthochromia

48
Q

T/F: Oral nimodipine is used for patients with SAH to prevent vasospasm and improve outcomes

A

True

49
Q

T/F: Vertebral-basilar stroke can present as older patient with persistent, acute-onset vertigo

A

True

50
Q

high risk features for TIA patient to be admitted

A 
Age>60
Blood pressure >140/90
Weakness
Duration >60 min 
Diabetes
51
Q

blood pressure rules ofr tpa for ischemic stroke

A

CI if SBP >185 or DBP >110

Don’t really tx BP in first 48 hours of ischemic stroke unless SBP >220, DBP >120 OR thrombolytic therapy planned and SBP >185 or DBP >110

Use IV Nicardipine or Labetolol

52
Q

T/F: All stroke patients get 325mg asa

A

False. This is generally true but the exception = if thrombolysis (tpa) is planned

53
Q

after what period is anticoag started post ischemic stroke

A

after 48 hours (this is also when DVT prophy is started if no cardiac etiology)

54
Q

when is revascularization performed (endarterctomy or stenting) for stroke?

A

within 2 weeks (not right away)

55
Q

T/F: Do not select heparin for most patients with ischemic stroke

A

true

56
Q

Mgmt of trigeminal neuralgia (V2, V3 distribution unilateral pains, often by light touch

A

Obtain MRI to r/o intracranial lesions and MS

Carbamazepine for tx

57
Q

when would tx for HA = withdraw pain medications?

A

Medication overuse HA…chronic HA >10-15 days/mo with a bunch of HA or pain meds (and not migraine)

58
Q

1st line for mild-moderate migraine

A

ASA or NSAIDS

Triptan or dihydroergotamine used for severe acute migraines or poor response to first line tx

Nasal/subq triptans for those present on awakening and associated with vomiting

Triptans CI when CAD or CVD

59
Q

Prophylactic medications for migraines:

A 
Amitriptyline
Metoprolol
Propranolol 
Timolol 
Topiramate 
Valproic Acid 
Venlafaxine

watch out for things like lung disease (no BB) or pregnancy

60
Q

T/F: Myasthenic Crisis you can use PLEX/IVIG + steroids, in GBS you don’t use steroids

A

true! steroids can slow recovery times in GBS, just use PLEX or IVIG

61
Q

T/F: Romberg and pronator drift tests assess cerebellar function

A

False.
Romberg = proprioception (i.e. peripheral neuropathy)

Pronator drift = cerebellar

62
Q

general workup for patients with peripheral neuropathy

A 
Blood glucose 
B12 
TSH
ANA
RPR 
HbA1c
ESR
CBC
SPEP (don't be fooled, find anemia and hypercalcemia)
63
Q

tx for serotonin syndrome

A

DC agent + Cyproheptadine

64
Q

what distinguishes NMS and SS?

A

NMS: Lead-pipe rigidity. Key finding is increased CK from muscle necrosis. Leukocytosis usually present.

SS: Neuromuscular irritability (hyperreflexia, myoclonus) + GI sxs

Both have autonomic instablility and AMS

65
Q

Precipitating factors for NMS

A

-antipsychotics
-antiemetics (metoclopramide, promethazine)
-antiparkinson (dopamine agonist) medication withdrawal
-infection
surgery

66
Q

tx of NMS

A

stop offending agent, restart dopamine agents if held, supportive care. Low evidence to support dantrolene/bromocriptine (not the first thing)

67
Q

most common glaucoma

A

open-angle. 90% of cases. gradual painless loss of vision. Increased cup-to-disk ratio.

-if papilledema, probably closed-angle

68
Q

T/F: ALS = both UE and LE signs

A

False, it is both UMN and LMN signs. relative sensory sparing. asymmetric limb weakness (hand weak, foot drop) = most common presenting sx

69
Q

T/F: Majority of people with REM sleep behavior disorder will develop Parkinsons or Lewy body dementia

A

True. Look for this plus excessive daytime somnolence, mood disturbance, anosmia, constipation as manifestations of Early Parkinson disease (prior to motor sx onset)

70
Q

how do you distinguish MG ptosis from horner syndrome and bells palsy?

A

MG: spared pupillar response, vs in Horners not spared

Involvement of extraocular muscles, palate helps distinguish from Bells (which is only CN 7)

71
Q

if you suspect MG but AchR antibodies negative, whats the next test

A

Muscle-specific tyrosine kinase antibodies (MuSK)

So first AchR, then MuSK. if still negative then EMG. don’t choose edrophonium or ice pack test.

Check TSH in all patients due to autoimmune thyroid abnormality. CT scan or MRI chest shoudl be performed once MG dx confirmed

72
Q

Time course between acute stress disorder and PTSD

A

<30 days = acute stress disorder

more than a month = PTSD

73
Q

T/F: For RLS< supplement Iron when ferritin <75 and non pharm measures, in addition to dopaminergic agents

A

TRUE. non pharm measures = leg massage, warm/cold compress, sleep hygiene, regular exercise

74
Q

MOCA and MMSE scoring

A

MMSE: >24 is normal, less is MCI/dementia

MoCA (montreal) :>25 is normal, and less is MCI/dementia

75
Q

Tx of eating disorders

A

Anorexia: CBT, nutritional rehab; olanzapine if no response

Bulimia: CBT, nutirtional rehab, SSRI (fluoextine)

Binge eating: CBT, behavioral weight loss therapy, SSRI, lisdexamfetamine

76
Q

complications of SAH

A

first 24 hour: rebleeding (prevent with angiogram with coiling/stenting aka endovascular)

After 72 hours: vasospasm (nimodipine and hyperdynamic therapy)

77
Q

Presentation of carotid artery dissection

A
  • unilateral head/neck pain
  • transient vision loss
  • ipsilateral Horner syndrome (ptosis and miosis but usually no anhidrosis)
  • focal weakness
78
Q

mgmt of carotid artery dissection

A

TPA if <4.5 hours, aspirin + anticoag

because the blood in the different layers can clot and lead to embolic stroke

79
Q

ICA dissection and Vertebral dissection

A
  • ICA: after head/neck trauma. acute ipsilateral horner syndrome with cerebral ischemia (focal weakness), maybe aphasia
  • vertbral a dissection: thunderclap headache, wallenberg syndrome (ipsilateral horner, loss of sensation on contralateral face and body), nystagmus, ataxia, dysarthria
80
Q

tx of cluster HA

A
  • 100% oxygen
  • sumatriptan

add on preventative tx: Verapamil (or lithium, topiramate)

81
Q

what do you screen patients for while on second gen antipsychotics (clozapine, olanzapine)

A

metabolic syndrome i.e. glucose/lipis, BP, waist etc

82
Q

T/F: Intracerebral hemorrhage will have focal neuro sxs early following by features of increased ICP (vomiting, HA, bradycardia, lethargy) vs SAH will have severe HA at onset, meningeal irritation without many focal neuro deficits

A

true

83
Q

Does peripheral or central vertigo have more gait disturbance?

A

Central: Severe gait/postural disturbance, usually no hearing loss or tinnitus, other CNS sxs present

Peripheral: Hearing loss/tinnitus may be present, walking preserved with minimal gait problems

84
Q

T/F: Clonus and Crproheptadine go with Serotonin Syndrome

A

true

UWORLD ABIM (10 decks)

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