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Neuro review 1

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A 41-year-old female presents to the ED with complaint of sudden onset of "worst headache of my life." A stat CT scan of her head is normal. Next appropriate step to diagnose the patient is:   Lumbar puncture*  
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most common abdominal cancer in children   neuroblastoma  
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To look for brain tumor in a CT, use   Contrast  
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Cranial nerve associated with the Sense of smell   I Olfactory*  
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Cranial nerve that transmits visual information to brain   II Optic*  
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Cranial nerve that innervates superior oblique muscle, which depresses, rotates laterally, and medially rotates the eyeball.   IV Trochlear*  
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Cranial nerve associated with sensation from face and innervates muscles of mastication. V1- ophthalmic. V2- maxillary. V3- mandibular.   V Trigeminal  
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Cranial nerve which innervates lateral rectus (abducts eye)   VI Abducens*  
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Cranial nerve with motor to muscles of facial expression, special sense of taste from anterior 2/3 of tongue, and secretomotor to salivary glands (except parotid) and lacrimal gland   VII Facial  
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Cranial nerve associated with senses sound, rotation and gravity (balance and movement)   VIII Vestibulocochlear  
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Cranial nerve associated with taste from posterior 1/3 of tongue. Secretomotor to parotid gland. Motor to stylopharyngeus.   IX Glossopharyngeal*  
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Cranial nerve associated with motor to muscles of tongue and other glossal muscles. important for swallowing (bolus formation) and speck articulation   Hypoglossal*  
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Cranial nerve that controls sternocleidomastoid and trapezius. Overlaps fxn with vagus. Damage: inability to shrug, weak head movement   Accessory  
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Glasgow comma scale assesses   Eye opening, verbal response, and motor response*  
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Untreated phenylketonuria results in   Mental retardation*  
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Increased muscle tone is called   Spasticity  
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Decreased muscle tone is called   Flaccidity  
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Rigidity that persists throughout the range of motion is called   Lead pipe rigidity  
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MCC of bacterial meningitis in a child less than 4 weeks   Group B strep*  
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MCC of bacterial meningitis in a child 4 to 6 weeks   H. flu, N. meningitides*  
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MCC of bacterial meningitis in a child over 6 weeks   S. pneumonia, N. meningitides*  
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Gold standard for diagnosis of meningitis   Lumber puncture*  
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Degenerative organic mental disease characterized by progressive intellectual deterioration and dementia   Alzheimer's disease  
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Paralysis or weakness of the muscle of the face supplied by the facial nerve   Bell's palsy  
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Demyelization disease of the peripheral nerves causing acute progressive weakness (an ascending paralysis)   Guillain-Barre syndrome  
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An autoimmune disorder of neuromuscular transmissions involving the production of auto-antibodies directed against the nicotinic acetylcholine receptors   Myasthenia gravis  
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First line therapy for myasthenia gravis is   Cholinesterase inhibitors  
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Treat acute cluster headache with   Oxygen and sumatriptan (Imitrex)*  
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Peak incidence of viral meningitis is in   Summertime*  
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Sensorium in encephalitis is   Impaired  
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Sensorium in meningitis is   normal  
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Most common cause of viral meningitis   Enteroviruses*  
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Inflammation in response to bacterial infection of the pia-arachnoid & fluid of the ventricles   Bacterial meningitis  
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Etiology of bacterial meningitis in in adults   Strep. pneumoniae  
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Treatment for bacterial meningitis in ages 3 months to 50 year old   Ceftriaxone & Vancomycin*  
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Involuntary repetitive contraction of agonist & antagonist muscles producing rhythmic oscillation about a joint at a regular frequency   Tremor  
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Treat Parkinson's disease with   Entacapone, carbidopa, levodopa*  
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Inherited disease characterized by dementia & chorea   Huntington's disease*  
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Huntington's disease is a genetic   Autosomal dominant  
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To treat choreoathetosis in Huntington's use   Clonazepam (klonopin)*  
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To treat dyskinesia and/or behavioral problems in Huntington's use   Haloperidol (Haldol)  
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To treat rigidity in Huntington's use   Baclofen (lioresal)  
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To treat depression in Huntington's use   Fluoxetine (Prozac)  
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Ataxia, Babinski sign, & optic neuritis are seen in   Multiple sclerosis*  
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Treat spasticity in multiple sclerosis with   Baclofen (lioresal)  
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Treat neuropathic pain in multiple sclerosis with   Gabapentin (Neurontin)  
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Treat multiple sclerosis with   Methylprednisolone*  
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Treat chronic fatigue in multiple sclerosis with   Amantadine  
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Treat relapsing multiple sclerosis with   Methotrexate & Azathioprine (Imuran)  
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Seizure manifested by focal motor symptoms (convulsive jerking), spread to different parts of the body   Simple partial seizure*  
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Seizure with impaired consciousness and automatisms (lip smacking, chewing)   Complex partial seizure*  
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Paroxysmal loss of consciousness & brief discontinuation of activity followed by abrupt recovery, with no recollection of the event   Absent seizure  
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Brief stare and change in facial expression, < 20 sec   Absence (petit mal) seizure*  
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Epileptic seizure longer than 30 minutes or absence of full recovery of consciousness between seizures   Status epilepticus  
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To treat an acute seizure use   Lorazepam (Ativan)*  
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If seizure persists for more than 5 minutes and Ativan has been given, give   Fosphenytoin (cerebyx)  
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In cerebral vascular disease, an LP will show   Xanthochromia (yellowish color)  
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Abrupt onset of headache associated with stiff neck & photophobia   Subarachnoid hemorrhage*  
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Subarachnoid hemorrhage is bleeding into the   Subarachnoid space  
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"worst headache of my life"   Subarachnoid hemorrhage*  
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The sudden onset of a focal and transient (< 24 hrs) neurological deficit due to brain ischemia   Transient ischemic attack (TIA)  
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Vise like headache   Tension headache*  
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Boring, peri-orbital headache   Cluster headache*  
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Shape of subdural hematoma   Crescent shape*  
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Shape of epidural hematoma   Lenticular hematoma  
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Type of bleed in subdural & epidural hematomas   Subdural - venous; epidural - arterial  
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Nuchal signs in meningitis are   Kernig's and brudzinski's signs*  
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Chronic deterioration of mental function sufficiently severe to interfere with daily living   Dementia  
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HA with aura symptoms   Migraine  
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Classic signs of Migraines   Pulsatile, throbbing  
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Migraine H/A are associated with what hormone imbalance?   Estrogen  
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treat vertigo with   meclizine  
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Headache behind the eyes, painful, lasting 2 hours at night.   cluster  
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A writing cramp   Focal dystonic  
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VIII. Vestibulocochlear Nerves   Hearing and balance  
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XI. Accessory Nerves   Control neck, larynx, and shoulder muscles  
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XII. Hypoglossal Nerves   Control tongue movements  
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Most common intracerebral neoplasm is a   Glioma*  
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Scoliosis treatment at 20 -40 degrees   Brace  
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Wernicke's area is located in the posterior of the   Superior Temporal gyrus  
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Most common solid brain tumor in kids   Astrocytoma*  
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Scoliosis is more common in   Females*  
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extensor hallucis longus (EHL) strength   L5  
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LR6 SO4 all others 3 stands for   LR6--Lateral rectus (VI abductens) SO4--Superior Oblique ( IV Trochlear) 3--The remaining 4 eyeball movers = III  
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Thymine is given before glucose to prevent   Wernicke Encephalopathy  
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winning of the scapula is due to   Serratus anterior paralysis caused by damage to the long thoracic nerve  
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Define Tenosynovitis   inflammation of a tendon sheath  
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Cranial nerve that is a hook that closes the eyes   Facial (CN 7)*  
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Cranial nerve that are pillars that open the eyes   Oculomotor (CN 3)*  
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If the forehead and eye are not affected in a palsy, think   Stroke  
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Cranial nerve associated with the gag reflex   Vagus (X)*  
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Dermatomes C6   Thumb  
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Dermatomes T4   Nipple  
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Dermatomes T10   Umbilicus  
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Dermatomes L5   Great toe  
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Dermatomes S5   Anal sphincter  
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Most common cause of subarachnoid hemorrhage   trauma  
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Most common cause of atraumatic subarachnoid hemorrhage   Ruptured brain aneurysm  
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Thunderclap headache or worst headache of my life   Subarachnoid hemorrhage  
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Brain hemorrhage associated with a lucid interval   Subdural hematoma  
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Bridging vessels tear during trauma in   Subdural hematoma  
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Worst form of cerebal palsy   Spastic quadriplegia  
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Using this medication class will make Guillain Barre syndrome worse   Steroids  
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"The sheets hurt" on my legs   Diabetic neuropathy  
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Ptosis, diplopia, cannot move eyes, weakness of skeletal muscle   Myasthenia Gravis  
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Best test for myasthenia Gravis diagnosis   Acetylcholine receptor anti-bodies*  
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Most common cause of chronic daily headache   Overuse of OTC  
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Treat cluster headaches with   High flow O2 and Imitrex shots*  
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Average age of onset for Multiple sclerosis   20 to 40*  
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Key presentation for multiple sclerosis   New neurological symptom in a young person*  
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Most common type of multiple sclerosis   Relapsing remitting*  
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"Dawson's fingers" on MRI is classic for   Multiple sclerosis*  
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20 to 40 y/o female with eye issues and white spots   Multiple sclerosis*  
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Seizure that involves pelvic thrusting is a   Pseudoseizure  
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Whole body convulsions with no pelvic thrusting   Tonic clonic seizure  
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All anti-epilepsy drugs meds contain a black box warning for   Suicide risk  
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This seizure drug should be avoided in women of child bearing age   depakote  
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Major disease of memory impairment in people over 85 yo   Alzheimer's  
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Gold standard test to diagnosis Alzheimer's disease   Brain biopsy  
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Drug class to treat Alzheimer's disease   Acetylcholine esterase inhibitors  
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Memory impairment that is associated with medication   Delirium  
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An action/ postural tremor of the hands   (Benign) essential tremor  
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the hand shakes when you reach for something or a yes or no head bob   (Benign) essential tremor  
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Tremor in Parkinson's is a   Rest tremor  
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Dopamine depletion in the basal ganglia   Parkinson's disease  
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Cogwheel rigidity   Parkinson's disease  
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Most common symptom at presentation of Parkinson's disease   Rest or pillrolling tremor  
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Tyramine restricted diets are required with which medication class   MAOIs  
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Sign where resistance to flexing hip 90 degrees while knee is fully extended   Kernig sign  
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Sign where flexion of the neck causes flexion of the hip   Brudzinski sign  
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Worst form of Spina bifida   Myelomeninocele  
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Test for the optic cranial nerve include   Visual acuity with snellen chart & visual fields by confrontation  
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Test for the Oculomotor cranial nerve include   Extra ocular movements & response to light and accommodation  
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cranial nerve that is a hook that closes the eyelid   Facial nerve (CN 7)  
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Three sensory divisions of trigeminal nerve   Ophthalmic, maxillary & mandibular  
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Motor functions of the trigeminal nerve   Temporal & masseter muscle strength & lateral movement of jaw  
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Motor function of the facial cranial nerve   Symmetry of facial muscles with raising eyebrows, smile, frown, purse lips, puffing cheeks, showing teeth & squeezing eyes shut  
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Sensory function of the facial cranial nerve   Taste sensation to the anterior 2/3 of tongue  
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Function of glossopharyngeal cranial nerve   Taste sensation to posterior 1/3 of tongue  
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Function of Vagus cranial nerve   Sensory innervation of pharynx & larynx; gag reflex  
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Upper motor neuron lesions   Increased tone & spasms, hyperreflexia, Babinski, clonus  
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Lower motor neuron lesions   Flaccid tone, fasciculation's, reduced reflexes  
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Test for coordination (cerebellum)   Rapid alternating movements, pass pointing & heel to shin testing  
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Tests for gait & station include   Posture, ambulation, turning & postural stability  
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Types of ischemic strokes include   Thrombus, embolism or systemic hypoperfusion  
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Types of hemorrhagic stroke include   Intracerebral, subarachnoid & subdural  
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Posterior circulation to the brain includes   Vertebral & basilar arteries  
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Signs & symptoms of anterior carotid circulation stroke   Aphasia, amaurosis fugax, hemiparesis, hemisensory deficit  
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Amaurosis fugax is   Transient monocular blindness  
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Signs & symptoms of vertebrobasilar stroke   Bilateral visual loss, diplopia, ataxia, vertigo, syncope, dysarthria & vomiting  
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Non-modifiable vascular disease risk factors   Age, male, African American, & family history of stroke  
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Modifiable vascular disease risk factors   Smoking, HTN, hypercholesterolemia, diabetes, atrial fibrillation  
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A stroke that affects both sides of the brain or multiple vascular distributions   Embolic stroke  
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MOA Plavix (clopidogrel)   Irreversibly binds P2Y receptor causing impaired aggregation for the life of the platelet  
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Adverse effects of Plavix (clopidogrel)   Rash, bleeding & rare reports of fatal TTP  
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Chronic stroke treatment   Aggrenox, Coumadin or pradaxa  
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Aggrenox is   Dipyridamole 200 mg/ aspirin 25 mg  
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MOA Aggrenox   ASA permanently inhibits thromboxane A2 via cyclooxygenase; dipyridamole limits adenosine uptake into platelet  
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Side effects of Aggrenox   HA, GI intolerance, bleeding  
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MOA of Dabigatran (Pradaxa)   Direct thrombin inhibitor  
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Patients with an acute stroke ipsilateral to a carotid stenosis of 70 - 95% should undergo   Endarterectomy (or stinting)  
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Patients with < 70% carotid stenosis, do   Serial imaging  
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Intracranial hemorrhage risk factors   Age, HTN, pregnancy, black, hemodialysis & amphetamine & cocaine use  
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Risk factors for brain aneurysm   Smoking, HTN, family members  
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Major risk for subarachnoid hemorrhage   Vasospasms & hydrocephalus  
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Tx of subarachnoid hemorrhage   Swallow, seizure prophylaxis & Nimotop (Nimodipine (CCB))  
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Subdural hematoma will progress to   Chronic hygroma  
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Convex lesion on imaging   Epidural hematoma  
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Causes of cerebral palsy   Prematurity, intrauterine growth restriction, antepartum bleed & placental pathology  
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Define cerebral palsy   A group of non-progressive clinical syndromes characterized by motor and postural dysfunction  
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Spastic syndrome cerebral palsy   Hypertonia, hyperreflexia, clonus, Babinski sign, difficulty initiating individual movements  
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Spastic diplegia cerebral palsy   Affecting the legs  
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Spastic hemiplegia cerebral palsy   Affects more arms then legs, cortical  
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Athetosis   Slow smooth writing movements  
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chorea   Rapid unpredictable movements  
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Dystonia   Repetitive twisting of limbs & trunk  
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Dyskinetic syndromes seen in cerebral palsy   Athetosis, chorea, dystonia  
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Tx of generalized spasms in cerebral palsy   Tizanidine, benzodiazepine, lioresal, dantrium  
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Dorsal rhizotomy   Selective cutting of the dorsal root of the nerve root, interruption of the reflex arc; done in cerebral palsy  
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Cerebral palsy is associated with   Mental retardation, epilepsy & sensory impairment  
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Bell's Palsy   Sudden onset of unilateral facial weakness with hyperacusis, taste changes & post auricular pain  
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Treatment of Bell's palsy   Steroids started within 72 hrs  
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Classic finding of Guillain Barre is   Elevated CSF protein with no white cells  
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MC infections agent to cause Guillain Barre   campylobacter  
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Treatment of Guillain Barre includes   IVIG or plasmapheresis  
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Presentation of diabetic neuropathy   Pain, burning, numbness in legs, Allodynia  
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Allodynia is   The sheets hurt  
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MC muscle to become weak with Myasthenia Gravis   Ocular  
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Myasthenia Gravis   Disorder of the neuromuscular junction in which antibodies bind acetylcholine receptors preventing muscle contraction  
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Presentation of Myasthenia Gravis   Ptosis, diplopia, dysarthria, dysphagia, chewing, neck muscles, & limb muscle weakness  
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Treatment for Myasthenia Gravis   IVIG or plasmapherisis, mestinon  
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MOA of Mestinon (pyridostigmine)   Blocks breakdown of acetylcholine allowing more to stay in neuromuscular junction  
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Treatment of migraine headache   Triptans, ergotomine, antiemetics  
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Prophylaxis drugs in migraine   Propranolol, verapamil, lisinopril, & candesartan  
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Antidepressants for migraine headache   Elavil (amitriptyline)  
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Biggest risk factor for temporal arteritis   Age over 50  
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Confirm temporal arteritis with a   Biopsy  
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Treatment for giant cell temporal arteritis   Long term steroids  
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Associated features of multiple sclerosis   Sphincter incontinence, depression, fatigue, sexual dysfunction, & cognitive decline  
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Treatment for multiple sclerosis   Interferon Beta  
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Side effects of interferon Beta include   Injection site reactions, flu like syndrome, depression, elevated LFTs & depression  
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Treatment for absence seizure   Ethosuximide, depakote, lamictal & klonopin  
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Treatment for tonic clonic seizures   Depakote, Topamax, Dilantin  
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Side effect of carbamazepine (Tegretol)   Dizzy, somnolence, Has, Hyponatremia, increased LFTs & low WBCs  
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Treatment in Alzheimer's disease   Aricept (Donepezil); Exelon (Rivastigmine); Razadyne (Galantamine) & Namenda (Memantine)  
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Treatment for essential tremor   Propranolol, mysoline, Topamax  
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MOA cardiodopa   Inhibit peripheral metabolism of levodopa into dopamine reducing side effects and allowing it to cross the blood brain barrier  
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Side effects of dopamine   Motor fluctuations, dyskinesia, nausea, somnolence, dizziness, & hallucinations  
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Classic triad of meningitis   Fever, nuchal rigidity & change in mental status  
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Strokes associated with A-fib are more likely to involve   Large cerebral vessels  
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Risk factors for stroke after an MI   Low ejection fraction, A-fib, advanced age, smoking, prior stroke  
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MCC of subarachnoid hemorrhage   trauma  
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Triptans include   Sumitripan, zolmitriptan, rizatriptan  
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MOA of triptans   inhibit release of vasoactive peptides, promote vasoconstriction, & block pain pathways  
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selective agonist for serotonin receptors in cranial arteries   triptans  
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Triptans are used for   Migraine  
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triptans with SSRI & MAOI can lead to   serotonin syndrome  
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ADRs of triptans   AMI type symptoms  
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Cholinesterase inhibitors include   donepezil, rivastigmine, galantamine, tacrine  
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Cholinesterase inhibitors are used for   alzheimer's disease  
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MOA of Cholinesterase inhibitors   increase cholinergic transmission by inhibiting cholinesterase at synaptic cleft  
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first line treatment for parkinson's disease is   levodopa with carbidopa (+/-) entacapone  
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dopamine agonist include   pramipexole, ropinirole  
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anticholinergics include   trihexyphenidyl, benztropine  
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selective MOA B Inhibitors include   selegiline, rasagiline  
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NMDA antagonist   amantidine  
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MOA of levodopa   circulates in plasma to BBB where it crosses & is decarboxylated to dopamine  
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Levodopa is metabolized in the periphery by what 2 enzymes   dopa decarboxylase & Catechol-O-methyl-transferase (COMT)  
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ADRs of parkinson therapeutics include   N/V, anorexia, orthostatic hypotension, vivid dreams, hallucinations, delusions, confusion, sleep disturbance  
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ADRs associated with Levodopa   On-Off syndrome & wearning off phenomenon  
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Anti-Epileptic drugs include   Phenytoin, Carbamazepine, Valproate, Gabapentin, Lamotrigine  
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Use of phenytoin   prevention of seizures following head trauma /NS  
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ADRs of Phenytoin include   Gingival Hypertrophy, fetal hydantoin syndrome, fetal anticonvulsant syndrome, SJS, Vit D deficiency, osteomalacia, drug fever, hepatotoxicity, nystagmus, death  
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Uses of carbamazepine   bipolar disorder, chronic pain syndromes, trigeminal neuralgia, seizures  
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ADRs of carbamazepine   SJS, Bone marrow suppression, drug fever, Vit D deficiency, osteomalacia, neural tube defects, IUGR  
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Uses of Valproic acid   mania associated with bipolar disorder, migraine prophylaxis  
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ADRs of Valporic acid   Hepatotoxicity, Hepatic failure, neural tube defects, increased riks of impaired cognitive function at 3 years  
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Uses of Gabapentin   postherpetic neuralgia  
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ADRs of Gabapentin   sedation  
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Uses of Lamotrigine   manage/ treat bipolar disorder  
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ADRs of Lamotrigine   Rash; SJS/TEN  
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Cushings triad is   HTN, respiratory depression & bradycardia  
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Cushings triad (reflex) relates to   Brain stem compression  
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Close contacts of patient with bacterial meningitis are given   Rifampin  
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Drug of choice for absence or petit mal seizure   Ethosuximide or valproic acid  
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Normal pressure hydrocephalus presents with   Dementia, gait disturbance & urinary incontinence  
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