question

32yo male presents with complaint of recurring bouts of pain with lancinating pain to the left cheek and jaw. Eating, light touch, and even drafts severely worsen his pain. What do you suspect?

answer

Trigeminal Neuralgia (Tic douloureaux)

question

What medications would you subscribe to him?

answer

Baclofen, crabemazepine, phenytoin

question

72yo female presents complaining of scalp tenderness as well as jaw pain and stiffness with chewing. What condition do you suspect?

answer

Giant Cell Arteritis

question

What would confirm your diagnosis?

answer

Biopsy of temoral artery

question

What would be your treatment?

answer

Prednisone

question

What is the risk if left untreated?

answer

Blindness

question

Patient is brought in by family to the ER. They stated the patient is suffering from confusion and cognition issues. Denies N/V/D. Family states he's been complaining of a headache over the last day. Vitals show BP 113/72, HR 89, RR 14, Temp 100.7. He has weakness on the left side of the body and difficulty walking. What do you suspect?

answer

Encephalitis

question

What organism is most likely?

answer

HSV

question

What would you expect the LP to show?

answer

Normal to slightly increased protein with normal glucose.

question

What is the timeframe and medication used to tx?

answer

Acyclovir within 60 minutes

question

16yo male brought in C/O fever and chills. Has some neck stiffness and difficulty maintaining open eyes under bright light. You note a purpuric rash on his lower extremities. What is the triad associated with this disorder.

answer

Fever, AMS, Nuchal Rigidity

question

What tests would confirm your diagnosis?

answer

Brudzinkis and Kernigs

question

What is the likely causative organism? What is most common causative organism?

answer

N. meningitides. S. pneumonia

question

What is your treatment and timeframe?

answer

Rocephin and Vancomycin within 60 minutes

question

33yo pregnant female presents to your clinic complaining of her legs itching. Upon further questioning you note that it keeps her up at night and makes falling asleep difficult. It gets better when she gets up and walks around the house a bit. What do you suspect?

answer

Restless Leg Syndrome

question

What treatment would you begin?

answer

Benzos, Gabapentin, Opiates, Dopamine agonists

question

What are some risk factors?

answer

Iron deficiency anemia, folate deficiency, celiac, rheumatoid arthritis, Parkinson's, varicose veins, thyroid disease...

question

A husband accompanies his 37yo wife to the appointment. She complains she's been dropping items and having difficulty picking her sewing items. Upon further questioning her husband claims she's seemed not herself lately. She's been snapping at him for things that would not normally anger her. She's also been forgetting appointments which is very unlike her. What do you suspect?

answer

Huntington's Disease

question

What neurotransmitter excess if responsible for this disease?

answer

Dopamine

question

What areas of the brain are atrophied on CT/MRI?

answer

Caudate and Cerebral cortex.

question

What classes of medications can be used to treat?

answer

Benzos, SSRIs, Dopamine blockers, Dopamine depletors (Reserpine)

question

EMS brings in a 25yo male following an MVA in which he was thrown through the windshield head first. He is unable to recall Purple, Tree, Square after 30 seconds. What memory is affected?

answer

Working

question

What lobe do you suspect has been injured?

answer

Parietal

question

You're following up on a 25yo male 5 days S/P pituitary resection. When speaking with him you realize he is unable to tell you what he had for breakfast. What memory do you suspect has been affected?

answer

Episodic

question

What area of the brain do you think has been affected?

answer

Hippocampus

question

What other type of patient would be at risk for this?

answer

Alcoholic-thiamine deficiency

question

EMS brings in a 25yo male following an MVA in which he was t-boned and hit the side of his head on the passenger side window. What area of the brain are you concerned about and what memory is this affected?

answer

Temporal and frontal lobe, Lasting memory

question

54yo male brought into the ER by EMS after found wandering I-10. He is actively confused. You watch him walk and note an unsteady gait. He has nystagmus. He is unable to recall what he had for breakfast. What condition do you suspect and what is the underlying cause?

answer

Wernicke's encephalopathy, thiamine deficiency

question

How do you treat?

answer

Thiamine replacement

question

What is complications of untreated?

answer

Korsakoff Syndrome

question

35yo woman presents to your clinic S/P 2 months following Gastric Bypass. Routine labs show pernicious anemia. What other symptoms would you expect?

answer

Confusion, dementia, hallucinations, weakness

question

What would you treat her with?

answer

Monthly B12 injections

question

You're doing a routine examination on a coma patient in the ICU. You turn their head side to side and note that the eyes do not remain looking forward. What is this test called and what is your interpretation?

answer

Oculocephalic reflex, brain stem deat

question

In what test is cold or warm water inserted into the external auditory canal. What are the interpretations and results?

answer

COWS (cold opposite, warm same) indicates brainstem function.

question

46yo male presents with to your clinic. He has trouble initiating his sentences and putting together a sentence. He expresses frustration in his inability to get his thoughts out. What type of aphasia is he presenting?

answer

Broca's aphasia

question

46yo male presents with to your clinic. He has a free flowing sentence but it does not make sense. He expresses no frustration in his inability communicate. What type of aphasia is he presenting?

answer

Wernicke's aphasia

question

A 28yo female presents to your clinic with medical hx significant medical history to include migraines. She has not had an attack in several years now. She has a new headache today that differs from her typical headaches. What do you suspect?

answer

Rebound headache from overuse of caffeine containing medications.

question

A 40yo woman presents to the ER complaining of a headache that was significantly worse when she was on the toilet having her morning bowel movement. On exam you note papilledema. She complains of a pulsing ringing in her ear. She is worried she will not be able to make her pre-op appointment for her gastric bypass today. What headache to you suspect?

answer

Pseudotumor cerebri

question

What do you expect to find on LP?

answer

Normal ICP

question

What do you expect to find on MRI?

answer

Slit ventricles

question

59yo male presents with a one sided headache that is worse when using the bathroom, coughing, or sneezing. It awakens him from sleep. You not papilledema. What headache do you suspect?

answer

Brain tumor

question

What procedure is contraindicated?

answer

LP

question

29yo female presents with a severe pulsing one sided headache. She complains of increased pain with loud noises and bright lights. Admits to N/V. Tylenol has been unsuccessful. What headache do you suspect?

answer

Migraine

question

What is the first line tx?

answer

NSAIDS, Midrin, Fiorcet

question

What prophylactic treatment would you start?

answer

Propranolol, TCA, Depakote, Gabapentin

question

18yo male presents with a band like headache that occurs daily towards the end of the work day. He denies pounding, N/V, photophobia. What type of HA is this?

answer

Tension HA

question

What is the treatment?

answer

Analgesics for acute, TCAs for chronic

question

Patient presents with a severe headache that awoke him from sleep. He has miosis of the left eye as well as lacrimation. He points to his eye when asked to localize the pain. What type of HA do you suspect?

answer

Cluster HA

question

What is your primary treatment?

answer

Oxygen, triptans, DHE, or prednisone. Prophylaxis with CCB, Triptans, DHE

question

Patient returns from a convoy in Afghanastan. The vehicle ahead of them was hit with an RPG. He presents to your clinic complaining of a constant dull headache that is worse with head movement. No focal changes are noted. What type of headache to you suspect?

answer

Post-traumatic HA

question

A headache that occurs greater than 15 days a month for more than 6 months is described as..?

answer

Chronic

question

What are the reversible causes of dementia?

answer

ETOH, depression, brain tumors, hydrocephalus

question

Generally, is dementia or delirium reversible?

answer

Delirium

question

What are the causes of delirium?

answer

I-nfection, W-ithdrawal, A-cute metabolic, T-rauma, C-NS pathology, H-ypoxia, D-deficincies, E-ndocrine, A-cute vascular, T-oxins, H-eavy metals

question

29yo male presents with a periods of lucidity followed by normal LOC, hallucinations, and inattentiveness. His wife states he can't sleep at night. He see spiders crawling on the walls. What do you suspect he has?

answer

Delirium

question

How would you treat him?

answer

Tx the underlying cause

question

Patient presents with a slow loss of memories, difficulty doing normal activities and personality changes. What do you suspect he has?

answer

Dementia

question

What is the number one risk factor for this?

answer

Age

question

What is the number one cause of this?

answer

Alzheimers.

question

What needs to be ruled out in all patients who present with suspected dementia?

answer

Depression

question

How do you differentiate this from dementia?

answer

They're aware of their deficiencies, they have primarily vegetative symptoms, no worsening at night, and no neuro changes

question

Patient presents with an abrupt onset of confusion and changes in congnition. He is brought in by his wife to the ER. What type of dementia do you suspect?

answer

Vascular dementia

question

66yo male is brought into your clinic by his wife. Her chief complaint is that he has been acting strangely and not himself lately. What type of dementia do you suspect?

answer

Frontotemporal Dementia

question

What is the pathophysiology behind it?

answer

Tau protein

question

What does CT/MRI show?

answer

Temporal and frontal lobe atrophy

question

EMS brings a 56yo male into the ER after he was found screaming in a corner about the spiders on the walls surrounding him. He appears normal upon exam, then suddenly becomes frightened of the bear behind you pointing at him. He gets up to run away but stumbles and falls repeatedly. What do you suspect?

answer

Dementia with Lewy Bodies

question

Patient presents to the ER via EMS. He has been seizing for 30 minutes now without any periods of lucidity. What is this condition called?

answer

Status epilepticus

question

What is your primary treatment?

answer

Airway, IV, monitors, labs, tx underlying and give ativant and dilantin.

question

What do you do if the seizure lasts for 60 minutes?

answer

Administer anesthesia.

question

What are pregnant epileptics fetuses at risk for?

answer

Congenital deformities, micocephaly, still birth, seizure disorders

question

16yo male is brought in by his mother. She complains that in the morning he is unable to get ready for school in a timely manner as he can't seem to hold onto anything. He swings his arms randomly and knocks everything over. Rather than go to school, he pretends to have leg spasm and falls down the stairs. What is in your DDX?

answer

Myoclonic seizures.

question

6mo child is brought to the ER with mom complaining that he's shaking. She said she was in the clinic earlier for an ear infection. VS show temp of 102.3. What do you suspect and what do you tell the mother?

answer

Febrile seizures, they do not lead to seizure disorders and should grow out of them.

question

Patient presents with a sudden LOC after standing up to leave his 2 hour board meeting. Standerbys report he twitched after he fell. He is awake and alert now with no neuro changes. What do you suspect?

answer

Syncope, no post ictal, muscular twitches normal shortly following LOC

question

Patient presents with a sudden LOC after standing up to leave his 2 hour board meeting. Standerbys report he twitched after he fell. He is awake now with mild confusion. He states his ears started ringing and he saw bright lights and a metallic taste before he fell. What do you suspect?

answer

Seizure, auro and post ictal period present.

question

73yo female presents to the clinic for a routine examination. While doing the interview, you note she constantly rubs her thumb and forefinger together. As she reaches for the pen to sign her name, you note the movement is halting and stepwise. She has a slow shuffling gait and seems to have difficulty standing still unassisted. What do you suspect?

answer

Parkinson's.

question

What are the medical terms for the symptoms described?

answer

Resting tremor, cogwheel rigidity, bradykinsia, postural instability (TRAP).

question

What other symptoms would you see?

answer

Masked faces, turn en bloc, reduced arm swing, propulsion

question

What is the underlying pathophysiology?

answer

Dopamine insufficiency.

question

What are treatments?

answer

Dopamine replacements/agonists, Anticholinergics, Amantadine, PT/OT

question

What are the two categories of seizures?

answer

Generalized and partial

question

Patient presents with stiffening and jerking movements throughout his entire body. He is unresponsive at the time. As he returns to consciousness you note he is confused. What type of seizure do you suspect?

answer

Tonic-clonic

question

What hemisphere of the brain is affected?

answer

Generalized seizure therefore a central focal point radiating to all hemispheres of the brain

question

What is your treatment?

answer

Depakote, then Lamictal/Tegretol/Dilantin

question

Mother brings her child in. She states the visit was recommended by the teacher for evaluation for ADHD. She states the teacher complains the child stares out the window and doesn't pay attention in class. He disrupts the other students by smacking his lips and sticking his tongue out at them. He then refocuses and pretends it never happened. What is in your differential diagnosis?

answer

Absence seizures

question

What area of the brain is affected?

answer

Generalized seizure, therefore both hemispheres

question

A 20yo male in basic training presents to you stating he's been having this weird taste in his mouth and then precedes to have a twitching of an arm or leg, or some part of his body. Sometimes, this progresses up his arms and becomes quite severe. What kind of seizure do you suspect?

answer

Simple partial

question

What progressing phenomenon is he describing?

answer

Jacksonian March

question

What category does it fall under and what hemisphere is affected?

answer

Partial seizure, only one hemisphere is affected.

question

Mother brings her child in. She states the visit was recommended by the teacher for evaluation for ADHD. She states the teacher complains the child stares out the window and doesn't pay attention in class. He disrupts the other students by smacking his lips and sticking his tongue, clapping his hands together, and shouting uncontrollably. He seems to pass out temporarily, and then returns to consciousness. What is in your differential diagnosis?

answer

Complex partial

question

What category does it fall under and what hemisphere is affected?

answer

Partial seizure, only one hemisphere is affected.

question

How does it differentiate from simple?

answer

LOC

question

28yo female presents to your clinic. Medical history is significant for Schizophrenia for which she's been complaint with Zyprexa. She complains that she cannot stop moving her tongue and mouth. Sometimes her neck spasms to hard that she has to turn her head. You note her voice seems horse as well. She has stridor during the lung exam. What do you suspect?

answer

Acute Dystonia

question

How do you treat this?

answer

Cogentin, Benadryl, and ICU admission as airway is involved.

question

What movement disorder is described as rhythmic oscillatory that gets worse with stress of fatigue, and better when the patient sleep or drink alcohol.

answer

Tremors

question

What are the types of tremors?

answer

Postural, Benign Essential, Intentional, and Resting

question

How can you treat this?

answer

Propranolol, gabapentin, lyrica, benzos

question

What movement disorder is described as slow and writhing with alternating flexion, extension, and rotation?

answer

Athetosis

question

Is it present during sleep?

answer

No

question

Involuntary movements of the face and tongue typically associated with long term use of Dopamine blockers or anti-psychotics are called what?

answer

Tardive dyskinsia

question

The movement disorder described as involuntary, arrhythmic, rapid, jerking, purposeless movements is called what? Sometimes

answer

Chorea, St Vitus Dance

question

What do they have difficulty with during the neuro exam?

answer

Strength testing

question

What diseases are associated with this?

answer

Wilson's, Huntingtons, Iron deficiency anemia, Acute rheumatic fever

question

A sustained muscle contraction with twisting, repetitive movements or abnormal postures is known as what?

answer

Dystonia

question

What is blepharospasm?

answer

Dystonia of the eyelid

question

What is opishtotonus?

answer

Dystonia of the paravertebral muscles

question

What movement disorders involves only a single muscle group and can occur spontaneously or with initiation of movement.

answer

Myclonus

question

Patient presents with a sudden headache that he complains is the worst of his life. What do you suspect?

answer

Subarachnoid hemorrhage

question

What are the two risk factors for this?

answer

AVM and Berry Aneurysm

question

What is the blood pressure goal for your patient?

answer

Less than 140mmHg

question

What type of stroke involves bleeding into the brain, presents with vomiting and gradual onset of headache associated with depression of consciousness.

answer

Intracerebral hemorrhage

question

What is the blood pressure goal for your patient?

answer

140-160mmHg, initiate drugs at 170mmHg (Labatelol)

question

What is the blood pressure goal associated with ischemic strokes?

answer

Less than 220/120

question

What are the top findings associated with an acute stroke?

answer

Asymmetric facial paralysis, arm drift/weakness, and abnormal speech (dysarthia)

question

What findings on CT are consistent with a subdural bleed?

answer

Initially midline shift, later downward displacement of the cerebrum, late is herniation of hippocampus through tentorial notch then cerebellar tonsils through the foramen magnum.

question

What results are seen on a non contrast CT associated with ischemic stroke?

answer

Dark spots that can take as long as 24 hours to show

question

What results are seen on a non contrast CT associated with a hemorrhagic stroke?

answer

Bright white spots that appear soon

question

A stroke in this area would affect the side of the face, affect eyesight in one eye and cause the opposite eye to drift?

answer

Putamen, from MCA occlusion

question

A pure motor stroke is seen in what?

answer

Lacunar stroke, contralateral side affected

question

Profound abulia (motor and verbal delay) with bilateral pyramidal signs indicates a stroke where?

answer

Anterior Cerebral Artery (ACA)

question

Third nerve palsy with contralateral ataxia (Claude's syndrome) is seen in what type of stroke?

answer

PCA affecting the thalamus and subthalamus

question

Contralateral homonymous hemianopia with macular sparing indicates a stroke where?

answer

PCA affecting the medial temporal and occipital lobes.

question

What other complication may occurs?

answer

Anton's syndrome. They're blind but don't know it, PERRLA intact...from bilateral PCA occlusion

question

A soldier undergoes a blast injury. He has confusion for approximately 23 minutes following the event, but suffered no loss of consciousness. What grade of concussion does he have?

answer

Grade 2

question

What are his care instructions?

answer

RTD in one week, CT or MRI only S/S persist

question

A soldier undergoes a blast injury. He has confusion for approximately 12 minutes following the event, but suffered no loss of consciousness. What grade of concussion does he have?

answer

Grade 1

question

What are his care instructions?

answer

RTD once cleared.

question

A soldier undergoes a blast injury. He has confusion for approximately 22 minutes following the event and suffered no loss of consciousness. What grade of concussion does he have?

answer

Grade 3

question

What are his care instructions?

answer

RTD no sooner than 2 weeks, CT or MRI STAT

question

Memory involved in planning, initiating, and regulating behavior is known as?

answer

Executive function, involved in working memory

question

Memory that contains unchanging facts, principles, associates, and rules (days of the week) is what?

answer

Semantic memory

question

Memory that deals with facts about the world, and past personal events that must be consciously retrieved to be remembered?

answer

Declarative (explicit) memory

question

What type of memory is involved in learning and retaining a skill or procedure, such as riding a bike, getting dressed, or driving a car?

answer

Procedural (Implicit) memory

question

What are the four stages of memory development?

answer

Registration, retention, stabilization, and retrieval

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