Neurology

Question 1

Unilateral, severe, periorbital headache with tearing and conjuncitval erythema

Answer 1

Cluster headache

Question 2

Prophylactic treatment for migraine

Answer 2

Antihypertensives, antidepressants, anticonvulsants, dietery changes

β-blokkers
anti-epileptica: valproïnezuur en topiramaat
flunarizine
amitriptyline (Antidepressivum).

beperkte plaats:
riboflavine (magistraal, 400 mg p.d.)
lisinopril of candesartan
venlafaxine (Noradrenaline- en serotonine-heropnameremmer).

Question 3

The most common pituiary tumor. Treatment?

Answer 3

Prolactinoma. Dopamine agonists (eg, bromocriptine)

Question 4

A 55-year-old patient presents with acute “broken speech”. What type of aphasia? What lobe and vasular distribution?

Answer 4

Broca aphasia. Frontal lobe, left MCA distribution.

Question 5

The most common cause of subarachnoid hemorrhage (SAH)

Answer 5

Trauma; the second most common is berry aneurism

Question 6

A crescent-shaped hyperdensity on CT that does not cross the midline

Answer 6

Subdural hematoma-bridging veins torn

Question 7

A history significant for initial altered mental status with an interveneing lucid interval. Diagnosis? Most likely source? Treatment?

Answer 7

Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation.

Question 8

CSF finding with SAH

Answer 8

elevated ICP, RBCs, xanthochromia

Question 9

Albuminocytologic dissociation

Answer 9

Guillain-Barrésyndrome (elevated protein in CSF without a signigicant elevated cell count)

Question 10

Cold water is flushed into a patient’s ear, and the fast phase of the nystagmus is toward the oppisite side. Normal or pathologic?

Answer 10

Normal

Question 11

The most common 1° sources of metastases to the brain

Answer 11

Lung, breast, skin (melanoma), kidney, GI tract

Question 12

May be seen in children who are accused of inattention in class and are often confused wth ADHD

Answer 12

Absence seizures

Question 13

The most frequent presentation of intracranial neoplasm

Answer 13

Headache. 1° neoplasms are quch less common than brain metastases

Question 14

The most common cause of seizures in children (2-10 years)

Answer 14

Infection, febrile seizures, trauma, idiopathic

Question 15

The most common cause of seizures in young adults (18-25 years)

Answer 15

Trauma, alcohol withdrawal, brain tumor

Question 16

First-line medication for status epilepticus

Answer 16

IV benzodiazepine

Question 17

Confusion, ophtalmoplegia, ataxia

Answer 17

Wernicke encephalopathy due to a deficiency of thiamine

Question 18

What % lesion in a symptomatic patient is an indication for carotid endarterectomie?

Answer 18

Seventy percent

Question 19

The most common causes of dementia

Answer 19

Alzheimer disease and vascular / multi-infarct

Question 20

A combined upper motor neuron (UMN) and lower motor neuron (LMN) disorder

Answer 20

Amyotrophic lateral sclerosis (ALS)

Question 21

Rigidity and stiffness with unilateral resting tremor and masked facies

Answer 21

Parkinson disease

Question 22

The mainstay of Parkinson therapy

Answer 22

Levopoda + carbidopa (merknaam = duodopa)

Bij patiënten ouder dan 60 jaar, kwetsbare patiënten, patiënten met comorbiditeit en patiënten met ernstige symptomen start men de behandeling meestal met levodopa + dopadecarboxylase-inhibitor (carbidopa of benserazide). Bij jongere patiënten wordt vaak gestart met een dopamine-agonist.

Question 23

Treatment for Fuillain-Barré syndrome

Answer 23

IVIG or plasmapheresis. Avoid steroids.

Question 24

Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.

Answer 24

Huntington disease

Question 25

A 6-year old girl presents with a port-wine stain in the V, distribution as well as with intellectual disability, seizures, and ipsilateral leptomeningeal angioma

Answer 25

Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection ot the affected lobe

Question 26

Multiple café au lait spots on skin

Answer 26

Neurofibromatosis type 1

Question 27

Myperphagia, hypersexuality, hyperorality, and hyperdocility

Answer 27

Klüver-Bucy syndrome (amygdala)

Question 28

May be administered to a symptomatic patient to diagnose myasthenia gravis

Answer 28

Edrophonium (acetyl choline esterase inhibitor)