Neuro Test 2

Front 1

What is an Acute change in mental status – Hours TO days

Back 1

Delirium

Front 2

Hallmark description is waxing and waning levels of consciousness.

Back 2

Delirium

Front 3

WHAT ARE THE KEY ELEMENTS OF DELIRIUM?

Back 3

- Typically acute
- Responds to some stimuli
- Can appear sleepy, disoriented, inattentive
- LOC may be impaired
- Any age
- Typically reversible

Front 4

WHAT ARE THE KEY ELEMENTS OF DEMENTIA?

Back 4

- Typically chronic and worsening over time
- Appear “normal” but confused
- Normal level consciousness
- Content of consciousness impairment
- more elderly
- rreversible

Front 5

What is a Progressive decline in cognitive function beyond what is expected in normal aging

Back 5

Dementia

Front 6

What are the Three different types of memory

Back 6

Working memory
Episodic memory
Lasting memory

Front 7

Which type of menory is <30 seconds, 7 bits of information (+/- 2), Vulnerable to distraction, Anatomically related to RAS, Prefrontal cortex, and Parietal lobe.

Back 7

Working memory

Front 8

Which type of memory lasts minutes to months, “Lay down” significant memories throughout the day, Anatomically related to Hippocampus, Dorsomedial nuc of thalamus

Back 8

Episodic memory

Front 9

which type of memory is affected in thiamine deficiency

Back 9

Episodic memory

Anatomically related to Hippocampus, Dorsomedial nuc of thalamus

Front 10

How do you test the Episodic memory

Back 10

• Tested with word recall @ 3-5 min, or by asking of trivial events of the day – “What did you have for breakfast?”

Front 11

which type of memory is Lifelong – related to new protein synthesis/creation of synapses, Lt. Anterior temporal lobe, Frontal lobe

Back 11

Lasting memory

Front 12

What is a Generalized loss of memory

Back 12

Amnesia

Front 13

What are Mental activities involved in planning, initiating, and regulating behavior, Considered the central organizing function of the brain

Back 13

Executive Function

Front 14

What HPI info would you consider to approach a diagnosis of Altered Mental Status

Back 14

- May need to obtain HPI from family member
- Time course
- Changes in personality, mood, memory, etc?

Front 15

What PMH info would you consider to approach a diagnosis of Altered Mental Status

Back 15

- Cardiovascular dz
- DM, Seizures
- Head trauma,
- Alcoholism/drug use
- Psych hx

Front 16

Which H/A is described as the worst HA of my life, thunderclap onset!

Back 16

SAH

Front 17

SAH is typically from a ruptured

Back 17

cerebral arterial “berry” aneurysm

Front 18

WHAT ARE THE PAIN SENSITIVE STRUCTURES OF CRANIUM

Back 18

Scalp
Middle Meningeal Artery
Dural Sinus
Falx Cerebri
Proximal segment of the pial artery

Front 19

Chorea is defined as which of the following?

Back 19

Involuntary arrhythmic rapid purposeless movements that appear dance-like.

Front 20

Restless leg syndrome can be associated with which of the following deficiencies?

Back 20

Iron

Front 21

Which of the following medications is used to treat acute dystonic posturing?

Back 21

Benadryl (diphenhydramine)
Cogentin (benztropine)

Front 22

Which of the following patient descriptions charecterizes the findings of parkinson's disease?

Back 22

Slow shuffling gait
Masked faces
Resting tremor
Rigidity

Front 23

A stroke affecting the subthalamic nucleus is associated with which of the following movement disorders?

Back 23

Hemiballismus

Front 24

Which of the following medications is proven effective at improving symptoms associated with parkinson's disease?

Back 24

Sinemet (levodopa/carbidopa)

Front 25

Which of the following charectizes the inheritance pattern in Huntinton's disease?

Back 25

Autosomal dominant

Front 26

Tardive dyskinesia is associated with which of the following?

Back 26

Prolonged exposure to dopamine-blocking agents.

Front 27

A near immediate, lightening quick body wide twitch that is often associated with stage I of sleep describes which of the following movements?

Back 27

myoclonus

Front 28

Essential tremor is best managed with which of the following medications?

Back 28

propranolol

Front 29

Which of the following explains the treatment goal in parkinson's disease?

Back 29

Controling symptoms and supplementing dopamine function

Front 30

Which of the following movements can be physiologic (i.e. seen as a sign of health)?

Back 30

myoclonus

Front 31

Which of the following movement disorders can be effectively treated with a drink of alcohol?

Back 31

essential tremor

Front 32

Huntington's disease is charecterized by which of the following features?

Back 32

Progressive choreatic movements
`progressive early onset dementia

Front 33

Athetosis is characterized by which of the following?

Back 33

Abnormal, slow sinuous and writhing in character.

Front 34

A pt presents w/ a slow shuffling gait, tremor, and stiffness. U also note moderate cog wheel rigidity. Her face is masked and her eye blink has decreased. You notice a tremor, what sort of tremor is this patient most likely to have?

Back 34

Resting tremor

Front 35

Following a bout of severe pharyngitis associated with fever, moderate odynophagia, and an oropharynx with moderate exudate, a 7 year-old boy presents with unvoluntary movements of his arms and legs. When he walks he has a characteristic lurching gait with periodic purposeless movements of both arms. Which of the following conditions is likely at this time?

Back 35

Syndeham's chorea

Front 36

What is the Tx for Essential tremor

Back 36

Inderol (propranolol)

Front 37

What is the Tx for Restless leg syndrome

Back 37

Mirapex (pramipexole)
Sinemet (levodopa/carbidopa)

Front 38

What is the Tx for Parkinson's disease

Back 38

Sinemet (levodopa/carbidopa)
Mirapex (pramipexole)

Front 39

What is the Tx for acute dystonic reaction

Back 39

Benadryl (diphenhydramine)

Front 40

After taking two doses of compazine, a patient presents to the emergency room with a very stiff neck, and fixed upward gaze of both eyes. Which of the following treatments should be offered to the patient at this time?

Back 40

Cogentin (benztropine)

Front 41

An institutionalized patient has a patterned movement of tongue flapping and generalized slowed movements. Which of the following describes this pattern of movements?

Back 41

Tardive dyskinesia

Front 42

An EEG is often performed to evaluate for the cause and likelihood of having a seizure. Which of the following can be done to improve the sensitivity of EEG testing?

Back 42

Perform the test under sleep-deprivation

Front 43

When counseling a patient who had their first seizure, which of the following must be recomended?

Back 43

- Avoid being on ladder
- Can not drive until 6 months seizure free.

Front 44

Decerebrate posturing occurs when which of the following has happened?

Back 44

Pending brainstem herniation

Front 45

A postictal state is defined as which of the following?

Back 45

A period often around 30 minutes of profound confusion and decreased awareness.

Front 46

Which of the following is the treatment of choice for absence seizures?

Back 46

Ethosuximdie

Front 47

A seizure can happen to anyone given the right circumstances. Which electrolytes can cause a seizure

Back 47

Sodium
Glucose
Caclium

Front 48

The most common cause of seizures in the world is which of the following?

Back 48

T. solium infection causing neurocysticercosis

Front 49

Status epilepticus is defined as which of the following?

Back 49

Prolonged or repetitive seizure impaired consciousness in the interictal period.

Front 50

Which of the following distinguishes a grade III concussion from a grade II concussion?

Back 50

Loss of consciousness

Front 51

A patient has had a seizure. Bystanders describe the patient collapsing to the ground, tensing his entire body for a short time then having convulsive behavior affecting his entire body. The pt was unconscious for the duration of the seizure. What describes the type of seizure your pt?

Back 51

Tonic-clonic seizure

Front 52

Which of the following medications is indicated for a 12-year-old boy who experiences day-dreaming spells at school multiple times a day that are felt to be secondary to absence seizure activity?

Back 52

Ethosuximide

Front 53

What is the interpretation of the following oculocephalic test performed in a soldier brought in by ambulance after being thrown from a vehicle during an ambush

Back 53

Abnormal oculocephalic test - suggestive of brainstem death

Front 54

70-y/o M suffering a fall last week with a short episode of LOC, since he has become progressively more confused, lethargic, and sleepy. wife notes that he has become incontinent of urine and his balance seems off.On exam you note inability of his OD to look Lat on oculomotor testing. What complication should you evaluate for at this time?

Back 54

Progressive subdural hematoma

Front 55

Which of the following distinguishes a simple seizure from a complex seizure?

Back 55

Loss of consciousness

Front 56

Your pt was found convulsing 3 minutes ago. P is 110 and strong; No BP obtain, Resp 35. POS
incontinent of urine and stool, and is unconscious. A medic has placed a non-rebreather mask and inserted a nasal trumpet. What med should be administered at this time?

Back 56

Valium (diazepam) 5mg IM now

Front 57

Status epilepticus can be caused by what DOs?

Back 57

Drug toxicity
CNS infection
CNS tumors

Front 58

What clinical markers predict the severity of head trauma?

Back 58

Amnesia (antegrade/retrograde)
Nausea/vomitting
Duration of Confusion

Front 59

pt arrives @ aide station by ambulance after a three minute convulsive episode described as seizure-like. On eval you find a stuporous pt in a daze w/ no responds to questions VS stable. You suspect a seizure, what labs would you order to identify a medical cause for this pt?

Back 59

Calcium level
Glucose level
Sodium level
Drug and alcohol screen (urine/blood)
Lumbar puncture
Head CT

Front 60

Is a Thrombotic stroke ischemic or hemorrhagic

Back 60

Ischemic

Front 61

Is a Embolic stroke ischemic or hemorrhagic

Back 61

Ischemic

Front 62

Is a Hypovolumic stroke ischemic or hemorrhagic

Back 62

Ischemic

Front 63

Is a intercerebral hemorrhage ischemic or hemorrhagic

Back 63

Hemorrhagic

Front 64

What is the most sensitive finding in sub-arachnoid hemorrhage?

Back 64

Headache

Front 65

A Berry Aneurysm is associated with what congenital findings?

Back 65

Polycystic Kidney Disease

Front 66

A subarachnoid hemorrhage arises from what

Back 66

Aneurysm rupture
Leaking arterio-venous malformation

Front 67

An arterio-venous malformation is.....

Back 67

A tangle of congenital anomalolou blood vessels that have a direct areterio-venous connection without a capillary bed in-between.

Front 68

A TIA is is a transient episode of cerebral ischemia with associated neurologic deficit that has complete resolution within what time frame?

Back 68

60 minutes

Front 69

Which of the following statements defines stroke?

Back 69

Neuron death resulting from impaired oxygenation

Front 70

The HALLMARK symptoms of an ischemic stroke include which of the following?

Back 70

Sudden, painless onset of neurologic dysfunction.

Front 71

Embolic strokes can result from what systemic illnesses?

Back 71

Aortic ahteroma
Atrial Fibrillation
Endocarditis
Carotid dissection

Front 72

The number one risk factor for stroke is

Back 72

Hypertension

Front 73

Aspirin therapy for stroke prevention would be indicated in which type of patients?

Back 73

A 64-year-old male with previous ischemic stroke who presented with a headache.

Front 74

Following an ischemic stroke, a patient's blood pressure should be kept between what level?

Back 74

less than 220 mm Hg systolic.

Front 75

OK, think fast - from the following list, which of the following types of neurologic injury would you pick if you were forced to experience one of the following?

Back 75

TIA

Front 76

What risk factor for stroke are not managed by primary care

Back 76

age

Front 77

Lacunar strokes often described as silent infarcts. What about this disease process makes them clinically silent?

Back 77

Individual strokes seldom have any overt symptoms.

Front 78

Following a TIA, a transesophageal echocardiogram is indicated to eliminate what disease process?

Back 78

Left atrial thrombus formation

Front 79

LDL goal following an ischemic stroke is which of the following?

Back 79

less than 100

Front 80

According to the National Institutes of Health, which of the following are the most predictive examination findings for acute stoke?

Back 80

Abnormal speech
Asymmetric facial paresis
Arm drift/weakness

Front 81

what are the steps in brain herniation in order

Back 81

- Midline Shift
- Downward displacement of the cerebrum
- Uncus and hippocampus herniate into the tentorial notch
- Cerebellar tonsils herniate through the foramen magnum

Front 82

What medications can be used as prophylactic medications for migraine therapy?

Back 82

Inderal (propranolol)
Topamax (topiramate)

Front 83

Drug rebound headaches are most commonly associated with chronic use of which of the following?

Back 83

Caffeine

Front 84

What is considered first line treatments for migraine therapy

Back 84

NSAID

Front 85

Cluster headaches respond best to what?

Back 85

Oxygen therapy

Front 86

A man complains of sudden onset of severe stabbing pain behind his right eye that is associated with tearing and blepharospam. Episodes of pain occur nightly and wake him from sleep. Which of the following is mostly likely causing his pain?

Back 86

Cluster headache

Front 87

Tension headache is classically associated with which of the following features?

Back 87

Daily occurrence, nonthrobbing pain that feels like a tight band around the head.

Front 88

Onset of migraine headache is rare after what age?

Back 88

50

Front 89

Features of migraine headache include what

Back 89

Unilateral headache
Throbbing
Often associated with an aura

Front 90

Patients with brain tumor have a headache as their first presenting symptoms what percentage of the time?

Back 90

30%

Front 91

Idiopathic intercranial hypertension is associated with what eatures

Back 91

Headache
Papilledema
Pulsatile tinnitus

Front 92

A 40 year-old man has frequent headaches for several days every few months, with pain-free intervals between. He has tried ibuprofen with no effect. The pain localizes around his right eye, lasts over 40 minutes and recurs several times daily, usually at night. "It's driving me crazy!", he tells you. His right eye is injected and tearing.

Back 92

Concentrated oxygen

Front 93

Pain sensitive structures of the cranium include?
Answer

Back 93

Dural Sinus

Front 94

An elderly male presents with jaw-claudication, visual changes, and severe left-sided temporal headache. Which of the following labs would help confirm the diagnosis of temporal arteritis?

Back 94

ESR

Front 95

Triptans can be used effectively for which of the following headaches?

Back 95

migraine headache
drug rebound headaches
cluster headache

Front 96

Which of the following patients should have head imaging as part of their initial evaluation?

Back 96

A 52-year-old female who presents with new onset headache associated with coughing, and valsalva.

Front 97

You are considering prescribing zolmitriptan (Zomig) to treat a headache. Which of the following is a relative contraindication to the use of this drug?

Back 97

Coronary artery disease

Front 98

A 44-year-old female presents with daily headaches that are assocaited with visual changes. She notices worsening pain with coughing and straining. On exam you notice her BMI is 35, her vitals are stable though the pulse is 96. Your patient has bilateral papilledema. Which of the following studies would likely be diagnostic

Back 98

LP with opening pressure measurement

Front 99

what are the abortive meds for migraine management

Back 99

Relpax (rizatriptan)
Ergotamine
Reglan (metoclopromide)

Front 100

what are the prophylactic meds for migraine management

Back 100

Inderal (propranolol)

Front 101

A 42-year-old female has a diagnosis of migraine headaches. She had been using ergotamine to abort her headaches, but she is now having one or two headaches per week that are interfering with work.

Back 101

Depakote (divalproate)

Front 102

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