Nplex 2010 - Neurology

Front 1

Why does Lithium have a blood dose and what are signs of toxicity

Back 1

The systemic level is too close to the toxic level.
Neuro signs
Diarrhea
Renal toxicity

Front 2

What type of diet is CI in Lithium use

Back 2

Low Sodium diet

Front 3

What conditions can Gabepentin be used for

Back 3

seizures
bipolar
mania

Front 4

What do fever, HA, neck stiffness or nuchal rigidity suggest in an adults

Back 4

Meningits

Front 5

What sign of meningitis is not seen in infants that is seen in adults and what sign is seen in infants that is not seen in adults typically

Back 5

nuchal regidity
infants will often have GI complaints

Front 6

What is seen more often in encephalitis than in meningitis.

Back 6

focal neurallogical deficit

Front 7

What is the hallmark of encephalitis

Back 7

Persistent HA, had flu like sx that resolved by HA won't go away

Front 8

What can cause meningitis

Back 8

0-4 wks - Group B strep, E. Coli, L. Monocytogenase
4-12 wks - add Step pneumonea
3mo - 18 yrs - Step pneumonea, N. Meningitidis, H. Influen
18-50 yrs - Step pneumonea, N. Meningitidis
> 50 yrs - Step pneumonea, N. Meningitidis, L. Monocytogenes, arobic gram neg. bacilli

Front 9

What can cause encephalitis

Back 9

EEE, (Togaviridae, genus Alphavirus) arthropod borne; birds reservoir not horses
Measles, mumps, chicken pox, rubella can cause autoimmune encephalitis
HSV I & II (why C-section for positive mothers in the past)

Front 10

What type of parastesias are seen in MS

Back 10

glove and stocking parastesias that comes and goes

Front 11

What are some sx in MS that can come and go

Back 11

Weakness, numbness, tingling, unsteadiness, spasticity, diplopia, sphincter disturbance

Front 12

Person who has recovered from a viral infection then wakes and can't stand up d/t a paralysis that is moving from their feet up their body

Back 12

Guillain-Barre Syndrom

Front 13

What is Wernicke-Korsakoff syndrome

Back 13

Thiamine (B1) def d/t alcoholism - EtOH uses up B1
Confabulations (no short term memory) IV B1 reverses many Sn/Sx

Front 14

What is Pallegra?

Back 14

Niacin def
Dementia, Dermatitis, Diarrhea (death)

Front 15

What vit def is suggested in a macrocytic anemia that resolves with Folate supplementation
However the pt's neuro sx do not resolve

Back 15

B12 def

Front 16

Multi infarct dementia - describe

Back 16

Common in rhythm disturbances in the heart (chronic)
Slowly progressing dementia
Smokers, proinflammatory conditions, DM, HTN and hyperlipidemia

Front 17

Why should an MRI be done on all migraine pts at some point

Back 17

migraines can be d/t vascular abnormalities in the brain.

Front 18

What is at the top of a DDX when a pt has a sudden very severe HA or the worst HA of their life

Back 18

Barry Aneurysm or other vascular problem in the head

Front 19

What is seen in Hypertensive Encephalopathy?

Back 19

-Diastolic pressure over 120
-Grade 4 retinal changes
-Confusion, drowsiness, h/a, nausea. Will act very crazy.
-May lead to rupture and hemorrhage

Front 20

How is Bell's palsy dx

Back 20

by clinical evaluation of sx - only 7th CN involved
May see hyper lacrimation and salivation prior to the development of the paralysis

Front 21

How long does RIND last

Back 21

>24 hrs and sx resolve completely

Front 22

How does a TIA present

Back 22

Often will be an older person brought in by care giver saying person is not thereselves
Acute onset; last 2-30 min; abate with no permanent sequelae
90% affect carotid ipsilateral blindness/contralateral hemiparesis that are temporary
Neurological exam is normal when seen

Front 23

How are Gillion Berret differ from Botulism

Back 23

Botulism is from the top down vs GB is from the bottom down

Front 24

Describe a Stroke

Back 24

Infarction of brain tissue manifested by neurologic deficits of varying severity
Atherothrombotic: sudden, gradual, stepwise or fluctuating.
Cardiac embolus: sudden onset. High Risk-atrial fibrillation, prosthetic valve, mural thrombus, dilated cardiomyopathy, M I in previous 4 wks

Front 25

Waking in the morning with a global HA suggests what?

Back 25

CO poisoning

Front 26

Pt with sx of ½ of ring finger and 5th finger on palm surface suggests the involvement of what nerve

Back 26

Ulnar n

Front 27

What sx are seen in Botulism

Back 27

Dry mouth, diplopia, ptosis, loss of accommodation and pupillary light reflex
G.I. Sx precede neuro sx and include n/v, cramps and diarrhea
No fever

Front 28

How can a migraine and a cluster HA be differentiated from each other

Back 28

Cluster HA - gremlin beats you on the side of the head at specific times throughout the day. Big pain burst that causes them to be violent. M>F young>old. May see autonomic stuff - stuffy nose
Migraines - Giant bear that you see coming and you know what is coming (big long crescendo) so you want to hibernate

Front 29

What is CI in the use of sumatriptan

Back 29

Basilar artery abnormalties - can cause vessel rupture!!!

Front 30

What are the sx of Giant cell arteritis

Back 30

Half sided HA often triggered by pressing on the temporal artery.
Needs to be tx b/c can lead to blindness.
Labs show ESR >100+ need to do biopsy to dx

Front 31

What type of tremor is seen in Parkinson's dzs

Back 31

resting tremor
Pill rolling

Front 32

What are the movements that are characteristic of Huntington's

Back 32

Chorea

Front 33

How is the dx of Alzheimer's made

Back 33

it is a dx of exclusion - dementia w/o any other known cause - tumor, strokes, cardiovascular, meds ect.

Front 34

How is Muscular Dystrophy dx

Back 34

mm biopsy

Front 35

Mytonic dystrophy

Back 35

Stiffness, unable to release a grasp, thick speech, muscle atrophy in face and neck  swan neck deformity
Autosomal dominant; slowly progressive
Onset in 20’s
Cataract, frontal baldness, testes atrophy, diabetes, cardiac and intellectual changes.

Front 36

Cerebral palsy

Back 36

Motor manifestations of nonprogressive brain damage sustained during prenatal/postnatal life.

Front 37

ALS

Back 37

Lower motor neuron involvement—atrophy, weakness of arms/legs, normal sensation,  DTR’s, fasciculations of muscles, dorsal interosseous spaces become hollow
Upper motor neuron involvement—spasticity, clonus,  DTR’s, + Babinski
Bulbar involvement—dysarthria, dysphagia, tongue atrophy
Sensation and gait are maintained
Muscle biopsy will show neurogenic process
CK may be very high (>1000)

Front 38

Myasthenia gravis

Back 38

Autoantibodies to Ach receptors
weakness, particularly of ocular, bulbar, pharyngeal, respiratory, proximal extremities
Weakness on exertion!
No sensory loss

Front 39

What meds are CI with cyclobenzapine

Back 39

MAO inhibitors

Front 40

What effect do opiods have on pain sensation

Back 40

Doesn't stop the pain, only causes a disassociation from the pain - you don't care about the pain

Front 41

Most common side effects of opiates and what is the most concerning side effect

Back 41

N/V
Constipation
Most concerning - too high of dose stop breathing

Front 42

What meds are opiates

Back 42

codeine, morphine, oxycodone, hydrocodone

Front 43

What is the #1 overdose medication in the world and what dose is considered the toxic dose. Why is it toxic

Back 43

Tylenol/Acetaminophen - should not exceed 4 g in 24 hours or 7-10 g in one dose!!! It is hepatotoxic

Front 44

What is a possible side effect of people who do long term chronic NSAIDs use (even w/in) the recommended dose

Back 44

Renal failure

Front 45

What is the concern for celecoxib (Cox 2 inhibitor)

Back 45

Heart and Liver failure

Front 46

What strength difference of prednisone to hydrocortisone

Back 46

hydrocortisone is 1/4 the strength of prednisone

Front 47

What are the CI in colchicine

Back 47

CV, hepatic, renal or GI dz

Front 48

What is the dose equivalent of prednisone to cortisone

Back 48

dose from Prednisone to Cortisone conversion is a 4 to 1 ratio.
5 mg. Prednisone = 20 mg Cortisone
Physiologic dose of Cortisone is 25 to 40 mg. orally.

Front 49

What are the two types of Absence (petit mal) seizures? What are the concrns when seen in childhood

Back 49

Simple - like a pause button was pushed
Complex - out of it long enough it is noticeable.
If seen in children can develop tonic clonic (grand mal) in adulthood

Front 50

what is at the top of the ddx when someone has a 1st episode of syncope, what is first test to be done

Back 50

First episode of heart block
EKG

Front 51

What is most common iatrogenic cause of syncope

Back 51

Overdose of HTN meds or alcohol consumption

Front 52

What is the DDX for altered mental status

Back 52

Alcohol
Endocrine, electrolytes
Infection
Oxygen, opiates
Uremia

Trauma, Temp
Insulin (DM)
Psychiatric, porphryria
Subarachnoid, Space occupying lesion

Front 53

What image is used to diagnose dementia such as alzhiemers

Back 53

SPECT

Front 54

What NT speed up someone's brain "uppers"

Back 54

Seratonin
Ach
Dopa
NE

Front 55

What NT slow down the brain "downers"

Back 55

GABA
Glycine
NO
Histamines
Neurosteroids

Front 56

What condition do we want to speed the brain up

Back 56

Depression

Front 57

What sort of condition do you want to slow the brain down

Back 57

Seizure disorders

Front 58

What are bromocriptine and pramipexole used for and what are the side effects

Back 58

it is a dopamine agonist and is used for the tx of Parkinson's dz (late stage)
SE: HTN, aggressive behavior, NV

Front 59

What are the side effects to chatacholomine like drugs

Back 59

HTN and constipation d/t alpha 1 receptor stimulation
tachycardia and maybe some lung effects

Front 60

Why do you want to use caution with SAMe and hyperthyroid

Back 60

It is a stimulant so you can get over stimulated

Front 61

What are the two amino acids that can be stimulating and what are they precursors for

Back 61

Phenylalanine and Tyrosine
They are precursors to Dopamine and NE and Thyroid hormones

Front 62

What are the concerns with giving Phenylalanine and Tyrosine

Back 62

They can have insomnia, pychotic, can seem similar to ADHD etc

Front 63

What vitamins need to be closely regulated in the case of Dopamine therapy

Back 63

B vitamins especially B6

Front 64

Why can people go hypertensive on SAMe

Back 64

it is a methyldonor and therefore can push NE to Epi in the periphery

Front 65

What is phenelzine and what does it do

Back 65

It is a MAO inhibitor and blocks the break down of catacholomines. Don't use with anything else!!! Over the counter stimulant is the WORSE thing you can do!!! like psuedafed

Front 66

What is buproprion

Back 66

Can be used for depression or quitting smoking. The caution is that it lowers the seizure threshold. Therefore can see seizures with it.
It is a NE & Dopa enhancer can be used with SSRIs

Front 67

What is VMA, how is it used and how is it measured

Back 67

It is a biproduct of catacholine metabolism and it is found in the urine. It is used to screen for a chatecholamine producing tumor. Dec MAO will dec VMA

Front 68

What B vitamin does MAO require for activity

Back 68

B6

Front 69

What is the amino acid that is a precursor for Serotonin, Melatonin, Niacinamide (B3)

Back 69

Tryptophan

Front 70

What is the required B vitamine for B3/Niacinamide production

Back 70

B6

Front 71

What is the caution of SSRI use with nutrient use

Back 71

You can induce serotonin syndrome so you don't want to use too much of one

Front 72

What are the sx of serotonin syndrome

Back 72

Fever
Hyperflexia
BP changes
Coma
Death

Front 73

How is serotonin syndrome progression stopped?

Back 73

STOP ALL Serotonin manipulating nutrients and drugs!!! Wait for all sx to go away then slowly reintroduce the a therapy.

Front 74

What drugs do you need to be cautious with when someone is on a serotonin augmenting substance

Back 74

Tryptophan
B6
Niacinamide

Front 75

What is amitriptyline? What are the main SE?

Back 75

It is a tricyclic antidepressant. They inhibit re-uptake of MAO and therefore increase NE and Serotonin.
SE - High dose - suicidal, any dose - insomnia
Use - depression (rarely), modified pn syndromes & sleep

Front 76

What is the enzyme that makes acetylcholine

Back 76

choline acetylase

Front 77

What is the enzyme that breaks acetylcholine down

Back 77

acetylcholine esterase

Front 78

What is a mineral that blocks AcH release at the synaps

Back 78

Mg

Front 79

What is are rivastigmine and donepezil

Back 79

Cognitive Agent - ach sparing

Front 80

What is trazodone

Back 80

Serotonin transport inhibitor used for depression and insomnia (esp insomnia)

Front 81

What is the generic name of benadryl

Back 81

diphenhydramine

Front 82

What is loratadine

Back 82

H1 receptor antagonist - antihistamine

Front 83

What are the drugs that effect GABA in most specific to least specific - what is the caution with these?

Back 83

The 3 Bs:
benzodiazapine
barbituates
booze alcohol
&neural steroids
DON'T Ever MIX these!!! They can lead to death together!

Front 84

What effect does GABA receptors have on a cell

Back 84

Open Cl channels and is therefore inhibitory! What else does this
Marijuana also opens Cl channels

Front 85

What is GABA synthesized from

Back 85

Glutamine

Front 86

What is given IV in acute seizure?

Back 86

Diazepam and Calcium Gluconate Given IV in acute seizure!

Front 87

What amino acid can be given to have a calming effect

Back 87

glycine (also open's Cl channels) can help in anxiety, wound healing and mm spacity.

Front 88

What condition must you use caution when using glycine

Back 88

Bipolar disorder

Front 89

What is excitatory at NMDA receptors

Back 89

Glycine, Zn, Glutamate

Front 90

What effect does NO have on the nervous system

Back 90

increases cGMP and therefore -
Retina: Photoreception
Vascular Smooth Muscle: Vasodilatation
AMPA (Excitatory) receptors: probable desensitization

Front 91

How long must you wait to give a MAO inhibitor after they have come off of reserpine?

Back 91

Do NOT administer MAO inhibitors and Reserpine within two weeks of each other

Front 92

What type of diet is CI with Lithium use

Back 92

Low sodium

Front 93

What organisms typically cause brain accesses

Back 93

Staph and strep

Front 94

What increase risk for bran abscess

Back 94

Increased risk in orbital infections!!, bacterial endocarditis, bronchiectasis, congenital heart dz.

Front 95

Describe TB meningitis

Back 95

Mycobacterium TB,
Well formed granulomas with caseous necrosis & giant cell infiltrates
Seen with acid fast stain

Front 96

Describe Neurosyphilis: tertiary;

Back 96

Asymptomatic meningitis;
Paralytic = brain atrophy from cell death
Tabes Dorsalis
spirochete destroys dorsal roots = impaired sensation & ataxia, absent DTR’s

Front 97

Describe Poliomyelitis

Back 97

Non-specific gastroenteritis
secondary invasion of lower motor neurons,
flaccid paralysis, hyporeflexia;
Post polio syndrome
progressive weakness 25-35 yrs later, muscle wasting, pain; virus not found

Front 98

When does cerebral edema commonly occur

Back 98

Common after injury, radiation, long term HTN

Front 99

Describe a benign essential tremor

Back 99

Most common movement disorder
FH found in 50% of cases
Increased with skilled movements and made worse with tension
Absent at rest
Tremor of head and voice also common

Front 100

What causes motor, sensory loss, as well as a nystagmus

Back 100

MS

Front 101

What are neur dz that involve motor and sensory

Back 101

MS
Guillen-Barre

Front 102

How is a grand mal seizure characterized

Back 102

generalized major motor convulsions, tonic mm contractions, loss of consciousness, possibly followed by aura of giddiness, mood change, confusion or involuntary twitching

Front 103

What is another name of petit mal

Back 103

Absence seizures

Front 104

What is another name for grand mal seizure

Back 104

Tonic clonic seizure

Front 105

How can you differentiate an upper motor neuron from a lower motor neuron lesion of the facial n

Back 105

Lower neuro lesion involves full half of the face
Upper only involves the lower half of the face (on r or l)

Front 106

What neural deficits are common with B12 deficiency

Back 106

Paresthesias and ataxia

Front 107

What is Wernikey's syndrome

Back 107

B1 Deficiency it can cause memory and cognitive problems

Front 108

What B vitamin def doesn't cause a neural deficit

Back 108

Folic acid

Front 109

What CN are affected by lesions in the following areas
Midbrain lesions affect:
Pons lesions affect
Medulla lesions affect

Back 109

Midbrain lesions affect: CN 1,2,3,4
Pons lesions affect: CN 5,6,7,8
Medulla lesions affect: CN 9,10,11,12