Neuro

Question 1

What is the tx for myasthenia gravis?

Answer 1

pyridostigmine

Question 2

What anticonvulsant med is known to cause hyponatremia?

Answer 2

oxcarbazepine

Question 3

What is the genetic basis of Huntington disease? How is it inherited?

Answer 3

Genetic testing in individuals with HD will show expansion of the cytosine-adenine-guanine trinucleotide repeats in the HTT gene.

autosomal dominant-inherited

Question 4

What 3 features characterize Huntington disease?

Answer 4

choreiform movements, dementia, and psychiatric disturbances

Question 5

What type of tremor is likely to occur in a pt with cerebellum disfunction?

Answer 5

intention tremor

Question 6

What dx?

Answer 6

Arteriovenous malformations (AVMs

Question 7

What is the tx for dyskinesia associated with parkinson’s?

Answer 7

reduce the dose of carbidopa-levodopa and add amantadine

Question 8

When is the risk of rebleeding the highest after a cerebral aneurysm rupture?

Answer 8

in the first 24 hours

Question 9

Where is the pain associated with trigeminal neuralgia most likely to be located?

Answer 9

Pain most often occurs in the maxillary (V2) and mandibular (V3) distributions of the trigeminal (V) nerve

Question 10

What are the most common adverse effects of levetiracetam?

Answer 10

dizziness, fatigue, somnolence, and upper respiratory infection

Question 11

What is the MOA of levetiracetam?

Answer 11

binds to the synaptic vesicle integral membrane protein 2A

Question 12

Where is levetiracetam metabolized?

Answer 12

in the blood. There is no metabolism of levetiracetam in the liver

levetiracetam = Keppra

Question 13

A 75-year-old woman is brought to your office by her daughter, who tells you that her mother has recently been exhibiting short-term memory loss and confusion over recent months. The patient’s medical history includes type 2 diabetes mellitus, hypertension, hypercholesterolemia, and osteoarthritis. She had a stroke last year and has residual mild hemiparesis. On cognitive testing, she is able to recall only one of three words, and all the numbers are on one side on the clock-drawing test. What type of dementia?

Answer 13

vascular dementia

has the risk factors: hyperlipidemia, HTN, diabetes

pts with hx of stroke are at an increased risk for vascular dementia

Question 14

What test is the single most useful test in establishing the diagnosis of multiple sclerosis?

Answer 14

MRI

Question 15

Describe how to perform bulbocavernous reflex

Answer 15

a healthcare provider will stimulate the penis or clitoris to elicit a contraction of the external anal sphincter, which can be observed or palpated

Question 16

What medication is most likely to cause a dystonic reaction?

Answer 16

think haloperidol and other first gen antipyschotics

Question 17

What is the MC inherited neurologic disorder?

Answer 17

Charcot-Marie-Tooth disease

Question 18

What is the first line medication for idiopathic intracranial hypertension?

Answer 18

acetazolamide

Question 19

MRI of the brain with contrast is the best radiologic study, and classic findings include a ring-enhancing mass with central necrosis and surrounding edema. What dx?

Answer 19

glioblastomas

Question 20

Which of the following laboratory abnormalities is most likely to be seen in a patient receiving mannitol for increased intracranial pressure?

Answer 20

increased osmolar gap

As a hyperosmotic agent, mannitol increases plasma osmolality, drawing water from the extravascular space into the intravascular compartment. This reduces brain tissue volume and ICP, improving cerebral perfusion. Mannitol also has a role in the management of acute angle-closure glaucoma by lowering intraocular pressure through a similar osmotic effect

Question 21

What dx?

Pt has abnormal brain function. may have a prodrome of flu-like illness. Symptoms often include headache, fever, change in behavior, and speech abnormalities. Seizures can also develop.

Answer 21

Encephalitis (swelling most likely in the temporal lobe as shown by brain MRI)

Question 22

What is encephalitis most commonly caused by?

Answer 22

viral infection

aka think HSV. “pt had a cold sore a few days prior”

Question 23

What CSF finding suggests encephalitis?

Answer 23

lymphocytic pleocytosis (increased WBCs)
increased RBCs
increased protein
normal glucose

Question 24

What 3 medications are considered first line for Alzheimer disease? What is the drug class?

Answer 24

rivastigmine

galantamine

donepezil

Cholinesterase inhibitors

Question 25

What are the scoring ranging for the Montreal Cognitive Assessment? When should you start medication?

Answer 25

26–30: Normal cognitive function. 18–25: Mild Cognitive Impairment (MCI). 10–17: Moderate Cognitive Impairment. < 10: Severe Cognitive Impairment start meds at mild cognitive impairment score of 25 or less

Question 26

What is the imaging study of choice for suspected causes of central vertigo?

Answer 26

MRI with angiography A noncontrast head CT is a reasonable SCREENING test with suspected central vertigo (and is most appropriate to evaluate for potential intracranial hemorrhage). Secondary to the fact that it does NOT permit adequate visualization of the cerebellum

Question 27

Basilar skull fractures can involve any of the five bones that make up the base of the skull, most commonly involving the ______ bone.

Answer 27

5 bones are: ethmoid sphenoid occipital frontal paired temporal bones

Question 28

What are 3 classic SE associated with phenytoin?

Answer 28

diplopia, gingival hyperplasia and hirsutism

Question 29

Pt presents because of persistent HA and change in personality of the last 2 months. Neuroimaging studies show a 5 cm, ill defined mass in the left parietal white matter. A ring-like zone of contrast enhancement is seen on the T1 weighted MRI images, surrounded by extensive edema appreciated on T2 weighted images. What dx?

Answer 29

glioblastoma multiforme

Question 30

Along which artery distribution are brain abscesses associated with bacteremia commonly located?

Answer 30

middle cerebral artery

Question 31

What is the most common cause of an intracranial neoplasm?

Answer 31

metastases

Question 32

Neuro condition that usually presents with urinary incontinence, impaired cognition, and gait disturbance?

Answer 32

Normal pressure hydrocephalus (NPH)

Question 33

You suspect an unresponsive patient has psychogenic coma. You decide to proceed with caloric testing and instill cold fluid into the left ear. What do you expect to see on eye movements if the patient has no brain stem abnormality?

Answer 33

RIGHT fastbeating nystagmus

Question 34

Which of the following anticonvulsant medications prevents seizures by blocking neuronal sodium channels to prolong the refractory period and inhibit action potential propagation?

Answer 34

carbamazepine

Question 35

Define anterior cord syndrome. What neck movement is it associated with?

Answer 35

Anterior cord syndrome involves significant impairment of motor function, pain, and temperature sensation below the level of the injury while preserving the sensory functions of the posterior columns such as proprioception, vibration, and some aspects of light touch. Traumatic mechanisms such as cervical hyperflexion

Question 36

What cranial nerve palsy is most likely to be present with a subarachnoid hemorrhage?

Answer 36

cranial nerve III palsy Cranial nerve III is the oculomotor nerve, which can become compressed when a cerebral aneurysm is present at the junction of the internal carotid artery and posterior communicating artery, causing a unilateral strict downward gaze, ptosis, anisocoria, and blurred vision

Question 37

Describe a patient with Brown-Sequard syndrome?

Answer 37

ipsilateral loss of motor strength, vibratory sensation and proprioception with contralateral loss of pain and temperature sensation below the level of injury