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Neurology – Awesome
Random neuro problems
| Question | Answer |
|---|---|
| when to prophylax for migraines and what medication? | > 2/wk use B blockers or TCAs, if >15/mo use topiramate or botox |
| side effects of topiramate | lose weight and + kidney stones |
| what sz med to use in pregnancy | carbemazepine |
| prevention of cluster HA | verapamil |
| prevention of tension HA | B blockers or TCA |
| an orbital one sided HA | cluster |
| a throbbing HA | migraine |
| a band like HA | tension |
| HA with rhinorrhea, ipsilateral Horner's, unilateral lacrimation | cluster |
| treatment for cluster HA | 100% O2, intranasal lidocaine, sumatriptan |
| In which diseases should you NOT use triptans | CAD, vasculitis, and pregnancy |
| prochlorperazine or metronidazole - what class? | dopamine antagonaist |
| prochlorperazine and metoclopramide - what class of drugs and what are they used for? | dopamine antagonists - for migraine abortive therapy, antiemetics |
| Dihydroergotamine - what is it, what is the mechanism, when do you use it? | similar to riptans, agonist to serotonin 5-HT(1D) receptors and causing vasoconstriction of the intracranial blood vessels; also acts on dopamine and adrenergic receptors. It can be used to treat acute intractable headache or withdrawal from analgesics. |
| when would you not use Dihydroergotamine | DHE and triptans should not be taken within 24 hours of each other due to the potential for coronary artery vasospasm. |
| prevention of menstrual HA | mefenamic acid 2 days prior and up to end of menstruation |
| pt has asthma and needs migraine ppx - what to use? | no B blockers. use amitriptyline or topiramate |
| pt with recurring HA >5-6/day lasting 15-20 min, unilateral and retro-orbital - what is dx and tx | chronic paroxysmal hemicrania, tx with indomethacin; indomethacin-responsive HA |
| who shouldn't use indomethacin and why | most potent vasoconstrictor of afferent arteriole --> kidney insufficiency, don't use in old people |
| pt with blurring of disc margins on funds exam - wtd | CT head (figure out reason for intracranial HTN) --> MRV --> LP |
| how to tx pseudo tumor cerebri? | acetazolamide |
| what do you use acetazolamide for? | pseudotumor cerebri and to ppx against acute mountain sickness |
| how does pseudo tumor cerebri affect your vision | peripheral visual field loss --> central vision loss |
| how to treat trigeminal neuralgia | carbemazepine |
| what is a side effect of Dihydroergotamine | nausea, can take ondansetron prior to the medication |
| what is a side effect of carbamazepine | neutropenia |
| how to treat Bell's Palsy | artificial tears, patch the eye at night (because weak lid can't close by itself and eye gets dry) and give steroids |
| one-side facial paralysis sparing the forehead | supranuclear lesion of CN7 |
| one-side facial paralysis | infranuclear lesion of CN7 |
| Pt with hyperthyroidism and ophthalmopathy has double vision. What is the muscular defect and how to treat? | thyroid ophthalmopathy causing the problem - - can't completely ABduct eyes. Tx with steroids or surgery |
| veil in front of eye; where would other neuro deficits be? | amaurousis fugax - ipsilateral carotid artery stenosis; have contralateral motor or sensory problems. |
| new onset dizziness in an elderly person with h/o HTN | must r/o vertebrobasilar syndrome from brainstem stroke - get MRA brainstem |
| 4 bulbar signs | diplopia, dysarthria, dysphonia, dysphagia |
| drop attacks in an elderly person | must r/o vertebrobasilar syndrome from brainstem stroke - get MRA brainstem |
| how to tx vertebrobasilar syndrome? | ASA |
| Pt comes with TIA. How to decide whether or not they are admitted? | 1 pt each for: sx's >10 min, >60 yo, DM; 2 pt for sx's > 20 min and speech disturbance. Admit if 3 points or higher. |
| most important risk factor for stroke | uncontrolled HTN |
| TIA and carotid US with > 70% stenosis - wtd | CEA with ASA |
| TIA and carotid US shows > 90% stenosis and inoperable, wtd | stent |
| TIA and < 50 % stenosis - wtd | ASA + clopidogrel (Plavix) |
| If pt h/o TIA, what med must they be on? | ASA |
| If TIA but pt already on ASA, ACEi (decreases recurrence, improves BP control), and statin, wtd next | d/c ASA and start clopidogrel (don't use the two together in stroke! increases the risk of bleed) |
| Which is better - CEA or stent - for mortality benefit? for stroke reduction? | CEA is better because it decreases mortality and reduces risk of stroke over stents |
| In what situation would you prefer a stent over CEA? | when stenosis is at the high carotid bifurcation |
| TIA + Afib gets what med? | warfarin |
| Pt with CAD going for CABG. What study to do before the surgery? | carotid US to check if pt needs CEA as well, if needed to, CEA before CABG |
| What vessel and lesion is on which side? pt with R leg/foot weakness AND sensory loss, urinary incontinence, and upgoing babinski | anterior cerebral artery (inner brain), contralateral lesion so lesion is on L side |
| What vessel and lesion is on which side? Pt with agraphia, astereognosis, aphasia and deja vu (if temporal lobe), and can't dress themselves (if parietal lobe) | MCA (outer brain) |
| homonymous hemianopia, ipsilateral 3rd nerve palsy with dilated pupil, contralateral sensory abnormalities such as hemiplegia | posterior cerebral artery |
| pain and temp loss on ipsilateral face and contralateral body; what vessel affected | lateral medullary syndrome (Wallenberg) - vertebral artery |
| In lateral medullary syndrome, which side do you fall to? | ipsilateral side, the side that your face symptoms are on, fall because of dizziness, not weakness |
| loss of vibration and proprioception on contralateral side | medial medullary syndrome |
| locked in syndrome | basilar artery stroke |
| GI illness that resolved ---> bilateral leg weakness, loss of sensation below the umbilicus, and hyperreflexia in the lower extremities; leukocytosis in the cerebrospinal fluid; vertebral lesions with enhancement on her MRI (sign of inflammation) | transverse myelitis |
| multiple sclerosis (MS) - how to treat | Glatiramer acetate is a disease-modifying agent - reduces the relapse rate by approximately one third |
| MRI of the brain showing ovoid white matter lesions | MS |
| indications for head imaging for HA | - nonacute HA with unexplained abnl finding on exam - change in pattern/freq/severity of HA's - progressive worsening of HA despite therapy - focal neuro signs/sx's - onset of HA with exertion/cough/sex - orbital bruit - onset of HA after age 40 |
| when to get LP when pt comes in with HA | - HA + suspicion of SAHem with neg CT head - infectious process - inflammatory process |
| Dix Hallpike result: mixed upbeat-torsional nystagmus with latency 2 to 40 seconds and duration less than 1 minute | BPPV |
| how does someone with loss of proprioception walk? | high-stepping gait, feet slapping |
| unilateral ocular symptoms, afferent pupillary defect, and contrast enhancement of the optic nerve on MRI - what is diagnosis | optic neuritis |
| how to tx optic neuritis | intravenous methylprednisolone |
| what medications reduce the risk of MS development in the first 3 years after an initial demyelinating event | glatiramer acetate or interferon-beta agents |
| visual changes bilateral and associated with headache, HTN, and papilledema, no enhancement of the optic nerve on MRI. What is it and how to tx? | benign idiopathic intracranial hypertension, tx with acetazolamide |
| Dense anesthesia, severe motor impairment, and lack of Doppler vascular signals indicate what in a limb, how to tx | acutely ischemic nonviable limb; prompt amputation is warranted. |
| facial grimacing and akathisia, can be induced by dopamine receptor antagonists, such as metoclopramide and antipsychotic drugs | Tardive dystonia |
| forceful, sometimes painful sustained contraction of muscles leading to twisted postures | Tardive dystonia |
| flowing, patterned choreic movements of the face | tardive dyskinesia |
| how to treat tradeoff dystonia | therapeutic approach includes a gradual discontinuation of the offending agent, treatment with anticholinergic or dopamine receptor-depleting agents, and the judicious use of botulinum toxin injections |
| familial disorder causing generalized chorea, dementia, and behavioral changes | Huntington |
| thunderclap headache, severe and explosive headache that is maximal in intensity at or within 60 seconds of onset - how to w/u? | CT angiography or MR angiography, r/o potentially catastrophic conditions, especially subarachnoid hemorrhage |
Created by:
christinapham
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