Rapid Style Questions Flashcards
1
Q
What is the most common cause of delirium in hospitalized elderly patients?
A
Medications (polypharmacy)
Especially anticholinergics and sedatives
2
Q
Which neurotransmitter is primarily implicated in the pathophysiology of delirium?
A
Acetylcholine deficiency
3
Q
What diagnostic tool is commonly used to assess delirium?
A
Confusion Assessment Method (CAM)
4
Q
Name two common risk factors for delirium
A
- Advanced Age
- Underlying dementia
- Polypharmacy
- ICU Admission
- Dehydration
5
Q
What differentiates delirium from dementia?
A
Acute onset and fluctuating coarse
6
Q
Which type of delirium is most often missed by healthcare providers due to its presentation?
A
Hypoactive delirium
7
Q
What class of drugs is considered the first-line pharmacological treatment for severe agitation in delirium?
A
Antipsychotics (e.g. haloperidol)
8
Q
Which electrolyte imbalance is commonly associated with delirium?
What is a non-pharm intervention that can prevent delirium inpatients?
A
Hyponatremia
Early mobilization and ensuring adequate hydration
9
Q
What is the most common cause of dementia in elderly adults?
A
Alzheimer’s Disease
10
Q
Which area of the brain is most affected in Alzheimers disease?
A
Hippocampus
11
Q
What protein accumulation is seen in Alzheimer’s disease?
A
Beta-amyloid plaques and tau tangles
12
Q
Which form of dementia is associated with a stepwise cognitive decline and history of stroke?
A
Vascular Dementia
13
Q
What are the core features of Lewy Body Dementia?
A
- Visual hallucinations
- Parkinsonism
- Cognitive fluctuations
14
Q
What is the most common early symptom of Alzheimer’s Disease?
A
Memory loss, especially short-term memory
15
Q
Which cognitive screening tool is commonly used for dementia?
A
Mini-Mental State Examination (MMSE)
16
Q
Name some reversible causes of dementia that should be ruled out prior to diagnosis?
A
- Vitamin B12 deficiency
- Hypothyroidism
- Normal Pressure Hydrocephalus
17
Q
Which neurotransmitter is most deficient in Alzheimer’s disease?
A
Acetylcholine
18
Q
Which type of dementia is associated with “wet, wobbly, and wacky” (urinary incontinence, gait disturbance, and cognitive impairment)?
A
Normal Pressure Hydrocephalus
19
Q
What are the components of Charcot neurological triad that are associated with multiple sclerosis?
A
- Nystagmus
- Intention tremor
- Scanning speech
20
Q
Which cranial nerve is affected in Bell’s Palsy?
A
Cranial Nerve VII (facial nerve)
21
Q
What is the most common cause of Bell’s Palsy?
A
Idiopathic, though herpes simplex virus (HSV) reactivation is commonly suspected
22
Q
What is the first line treatment for Bell’s Palsy?
A
Corticosteroids (prednisone)
23
Q
What is a key distinguishing feature of Bell’s Palsy from a central cause of facial weakness (e.g., stroke)?
A
Bell’s Palsy affects both the upper and lower face, whereas central causes spare the forehead.
24
Q
What is the inheritance pattern of Huntington Disease?
Which type of genetic mutation causes Huntington Disease?
A
Autosomal Dominant
Trinucleotide (CAG) repeat expansion on chromosome 4
25
What are the three primary clinical features of Huntington Disease?
| At what age do symptoms typically present?
* Motor Dysfunction (chorea)
* Cognitive Decline
* Psychiatric symptoms
| Between 30 and 50 years of age
26
What is the definitive test for diagnosing Huntington disease?
Genetic testing to identify the CAG repeat expansion in the HTT gene.
27
What is the characteristic location of pain in cluster headaches?
| What is the typical duration of cluster headaches?
Unilateral, typically around the eye or temporal
| 15 minutes to 3 hours
28
What is the first-line abortive treatment for cluster headaches?
100% oxygen therapy
29
What is a common autonomic symptom associated with cluster headache?
Lacrimation, rhinorrhea, or ptosis on the affected side
30
What is the first-line prophylactic medication for preventing cluster headaches?
Verapamil
31
What is the most common initial presentation of multiple sclerosis?
Optic neuritis (painful vision loss) or sensory disturbances (numbness or tingling)
32
Which diagnostic test is most useful in confirming a diagnosis of multiple sclerosis?
MRI of the brain and spinal cord with gadolinium, showing demyelinating lesions
33
What is the hallmark finding in the cerebrospinal fluid (CSF) of patients with multiple sclerosis?
Oligoclonal Bands
34
What is the primary treatment for acute exacerbations of multiple sclerosis?
High-dose corticosteroids (methylprednisolone)
35
What class of medications is commonly used for long-term disease-modifying treatment in multiple sclerosis?
Disease-modifying therapies (DMTs), such as interferon beta or glatiramer acetate.
36
What is the typical duration of symptoms in a transient ischemic attack (TIA)?
Symptoms typically last less than 24 hours, often resolving within minutes to an hour
37
What is the most common cause of TIA?
Atherosclerosis leading to transient occlusion of cerebral blood flow
38
What imaging modality is most commonly used to assess for acute ischemic changes in a TIA?
MRI with diffusion-weighted imaging (DWI)
39
What is the first-line medication for secondary prevention after a TIA?
Antiplatelet therapy (ASA or clopridogrel)
40
What is the most common cause of viral encephalitits in the U.S.?
Herpes Simplex Virus (HSV-1)
41
Which lobe of the brain is most commonly affected in HSV encephalitis?
Temporal Lobe
42
Which diagnostic test is most sensitive for identifying HSV encephalitis?
PCR of cerebrospinal fluid (CSF)
43
Name two key symptoms that differentiate encephalitis from meningitis?
Altered mental status and seizures
44
What is the first-line antiviral treatment for suspected HSV encephalitis?
Acyclovir
45
What type of encephalitis is associated with mosquito bites?
Arboviral encephalitis (aka West Nile Virus)
46
Which autoimmune condition is associated with anti-NMDA receptor encephalitis?
Ovarian teratoma
47
What are the two most common symptoms of viral encephalitis?
* Fever
* Headache
48
What type of cell is seen on CSF analysis in viral encephalitis?
Lymphocytes
49
What type of encephalitis may present with psychiatric symptoms like hallucinations or paranoia?
Anti-NMDA receptor encephalitis
50
What neurotransmitter is deficient in Parkinson’s disease?
Dopamine
51
What is the pathologic hallmark of Parkinson’s disease?
Lewy bodies (alpha-synuclein aggregates)
52
What genetic abnormality is seen in Huntington’s disease?
Trinucleotide CAG repeat expansion on chromosome 4
53
What is the pathophysiology behind multiple sclerosis?
Autoimmune demyelination of CNS neurons
54
What antibodies are found in myasthenia gravis?
Anti-acetylcholine receptor antibodies
55
What is the pathophysiology of Guillain-Barré Syndrome?
Autoimmune demyelination of peripheral nerves
56
What protein accumulates in Alzheimer’s disease?
Beta-amyloid plaques and tau tangles
57
What neurotoxic excitatory neurotransmitter is implicated in ALS pathogenesis?
Glutamate excitotoxicity
58
What is the mechanism of Wernicke’s encephalopathy?
Thiamine (B1) deficiency leading to neuronal damage
59
What is the pathophysiology of migraine headaches?
Cortical spreading depression with trigeminal activation
60
What is the most common cause of intracerebral hemorrhage?
Hypertension
61
What is the pathophysiology of a subarachnoid hemorrhage?
Ruptured berry aneurysm leading to bleeding into the subarachnoid space
62
What is the underlying mechanism of Bell’s palsy?
Inflammation of the facial nerve (CN VII) often due to HSV
63
What part of the brain is primarily affected in Alzheimer’s disease?
Hippocampus
64
What is the characteristic CSF finding in bacterial meningitis?
Increased neutrophils, decreased glucose, elevated protein
65
What class of medication is first-line for Parkinson’s disease?
Dopamine agonists or Levodopa/Carbidopa
66
What is the mechanism of action of levodopa?
Levodopa is a dopamine precursor that crosses the blood-brain barrier
67
What is the primary side effect of carbidopa-levodopa therapy?
Dyskinesias
68
What medication class is used for acute migraine treatment?
Triptans (5-HT1B/1D agonists)
69
What medication is first-line for essential tremor?
Propranolol or primidone
70
What class of drugs is used to treat myasthenia gravis?
Acetylcholinesterase inhibitors (pyridostigmine)
71
What is the mechanism of action of acetylcholinesterase inhibitors?
Inhibits breakdown of acetylcholine to increase synaptic levels
72
What medication is used to slow progression in ALS?
Riluzole
73
What medication class is used for MS disease-modifying therapy?
Beta-interferons or glatiramer acetate
74
What medication is used to treat absence seizures?
Ethosuximide
75
What class of medication is used for Guillain-Barré Syndrome?
IVIG or plasmapheresis
76
What medication can be used for acute ischemic stroke within 3 hours?
Alteplase (tPA)
77
What is the antidote for benzodiazepine overdose?
Flumazenil
78
What is the primary side effect of phenytoin?
Gingival hyperplasia
79
Which epilepsy drug causes weight gain and hepatotoxicity?
Valproate (Depakote)
80
What are the three meningeal layers from outermost to innermost?
Dura mater, Arachnoid mater, Pia mater
81
What is the most common cause of bacterial meningitis in neonates?
Group B Streptococcus
82
What is the classic triad of bacterial meningitis?
Fever, nuchal rigidity, altered mental status
83
Which bacterial meningitis pathogen is associated with petechial or purpuric rash?
Neisseria meningitidis
84
What are the contraindications for lumbar puncture before obtaining a CT scan?
Age >60, history of CNS disease, immunocompromised, seizure within 1 week, focal neurological deficits
85
What CSF findings are consistent with bacterial meningitis?
Elevated WBC, elevated protein, low glucose, positive Gram stain
86
Which antibiotics are first-line for bacterial meningitis in adults?
Ceftriaxone + Vancomycin (add Ampicillin if Listeria is suspected)
87
What artery is most commonly involved in ischemic stroke?
Middle Cerebral Artery (MCA)
88
Which type of stroke is associated with a 'thunderclap' headache?
Subarachnoid hemorrhage
89
What is the first-line imaging modality for suspected stroke?
Non-contrast CT
90
What is the hallmark of an MCA stroke on physical exam?
Contralateral weakness and sensory loss, facial droop, aphasia (if dominant hemisphere)
91
What is the treatment window for tPA administration in ischemic stroke?
Within 3-4.5 hours of symptom onset
92
Which type of headache is described as unilateral, pulsatile, and associated with photophobia?
Migraine headache
93
Which type of headache is most common and described as a 'band-like' pressure?
Tension headache
94
What is the first-line abortive treatment for cluster headaches?
High-flow oxygen + sumatriptan
95
Which medication class is contraindicated in migraine with aura due to stroke risk?
Triptans
96
What is the most common cause of syncope?
Vasovagal syncope
97
What is the pathophysiology of vasovagal syncope?
Sudden loss of sympathetic tone leading to hypotension and bradycardia
98
Which type of vertigo is associated with a positive Dix-Hallpike test?
Benign paroxysmal positional vertigo (BPPV)
99
What is the first-line treatment for benign paroxysmal positional vertigo (BPPV)?
Epley maneuver
100
What protein accumulates in Alzheimer’s disease?
Beta-amyloid plaques and tau tangles
101
What is the most common cause of dementia?
Alzheimer’s disease
102
What are the three components of Wernicke’s encephalopathy triad?
Confusion, ophthalmoplegia, ataxia
103
What is the most common cause of peripheral neuropathy in the United States?
Diabetes mellitus
104
Which cranial nerve is affected in Bell’s palsy?
Facial nerve (CN VII)
105
What is the treatment for Guillain-Barré syndrome?
IVIG or plasmapheresis
106
What is the classic CT finding of an epidural hematoma?
Biconvex (lens-shaped) hyperdensity on CT
107
What is the classic CT finding of a subdural hematoma?
Crescent-shaped hyperdensity on CT
108
What are the three components of Cushing's triad?
Hypertension, bradycardia, irregular respiration
109
What is the most common initial presentation of multiple sclerosis?
Optic neuritis (painful monocular vision loss)
110
What test is used to confirm multiple sclerosis if MRI is inconclusive?
CSF analysis showing oligoclonal bands
111
Which autoimmune disorder is characterized by fluctuating muscle weakness and ptosis?
Myasthenia gravis
112
What is the pathophysiology of myasthenia gravis?
Autoantibodies against acetylcholine receptors at the neuromuscular junction
113
Which test is used to diagnose myasthenia gravis?
Edrophonium (Tensilon) test
114
What is the first-line treatment for myasthenia gravis?
Pyridostigmine
115
Which class of medication is first-line for migraine prophylaxis?
Beta-blockers (propranolol), anticonvulsants (topiramate, valproate), or TCAs (amitriptyline)
116
What is the mechanism of action of acetylcholinesterase inhibitors?
Inhibit breakdown of acetylcholine to increase synaptic levels
117
Which medication is used to slow progression in ALS?
Riluzole
118
What are the major risk factors for stroke?
Hypertension, diabetes, smoking, atrial fibrillation, hyperlipidemia
119
What is the mechanism of action of alteplase (tPA)?
Converts plasminogen to plasmin, breaking down fibrin clots
120
Which artery is affected in locked-in syndrome?
Basilar artery
121
What is the classic triad of Parkinson’s disease?
Resting tremor, bradykinesia, rigidity
122
Which medication is first-line for Parkinson’s disease?
Levodopa-Carbidopa
123
What trinucleotide repeat expansion is seen in Huntington’s disease?
CAG repeat on chromosome 4
124
What is the most common muscular dystrophy in adults?
Myotonic muscular dystrophy
125
What genetic mutation causes Duchenne muscular dystrophy?
Dystrophin gene mutation (X-linked recessive)
126
What clinical sign is commonly seen in Duchenne muscular dystrophy?
Gowers' sign
127
What is the most common cause of dementia?
Alzheimer’s disease
128
What vitamin deficiency is associated with Wernicke-Korsakoff syndrome?
Thiamine (Vitamin B1) deficiency
129
What are the three classic findings of Wernicke’s encephalopathy?
Confusion, ophthalmoplegia, ataxia
130
Which type of dementia is characterized by hallucinations and fluctuating cognition?
Lewy body dementia
131
What is the best initial imaging study for acute head trauma?
Non-contrast CT of the head
132
What is the hallmark symptom of a subarachnoid hemorrhage?
Thunderclap headache
133
Which spinal cord syndrome results in loss of pain and temperature sensation but preserved proprioception?
Anterior cord syndrome
134
What is the most common level for cervical spinal cord injuries?
C5
135
What is the treatment for neurogenic shock following spinal cord injury?
Fluids and vasopressors
136
What is the most common cause of peripheral neuropathy in the United States?
Diabetes mellitus
137
Which autoimmune disorder presents with ascending weakness and areflexia?
Guillain-Barré syndrome
138
Which cranial nerve is affected in Bell’s palsy?
Facial nerve (CN VII)
139
What is the characteristic hand deformity seen in radial nerve palsy?
Wrist drop
140
What is the most common primary malignant brain tumor in adults?
Glioblastoma multiforme
141
What imaging modality is preferred for diagnosing CNS tumors?
MRI with contrast
142
Which disorder is characterized by repetitive, involuntary tics?
Tourette’s syndrome
143
What is the pathophysiology of ALS?
Degeneration of upper and lower motor neurons
144
What is the hallmark triad of Parkinson’s disease?
Resting tremor, bradykinesia, rigidity
145
Which movement disorder is caused by a trinucleotide repeat expansion?
Huntington’s disease (CAG repeat expansion)
146
What artery is most commonly involved in ischemic stroke?
Middle cerebral artery (MCA)
147
What is the treatment window for IV tPA in acute ischemic stroke?
Within 3-4.5 hours of symptom onset
148
Which stroke syndrome presents with contralateral leg weakness more than arm weakness?
Anterior cerebral artery (ACA) stroke
