NEUROLOGY FNP AANP EXAM STUDY TEST 2023/2024

NEUROLOGY FNP AANP EXAM STUDY TEST 2023/2024 Injectable products (e.g., sumatriptan [Imitrex®] and dihydroergotamine[D.H.E. 45®, Migranal®]) have a rapid onset of action, usually within - CORRECT ANSWER-15 to 30 minutes These products are best suited for patients with rapidly progressing migraines accompanied by significant GI upset. What is the name and function of Cranial Nerve I. - CORRECT ANSWER-Olfactorycarries impulse for sense of smell What is the name and function of Cranial Nerve II - CORRECT ANSWER-Optic- carries impulse for vision What is the name and function of Cranial Nerve III - CORRECT ANSWER-Oculomotorsupplies motor fibers to four muscles that direct eyeball to eyelid and internal eye muscles What is the name and function of Cranial Nerve IV - CORRECT ANSWER-Trochlear, responsible for down and inward movement of eyes What is the name and function of Cranial Nerve V - CORRECT ANSWER-Trigeminalactivate chewing muscles; sensory impulses of skin of face and mucosae of mouth and nose What is the name and function of Cranial Nerve VI - CORRECT ANSWER-Abducens, Responsible for Lateral movement of eye What is the name and function of Cranial Nerve VII - CORRECT ANSWER-Facialactivates muscle of facial expression and lacrimal and salivary glands; carries sensory impulses from the taste buds of anterior tongue What is the name and function of Cranial Nerve VIII - CORRECT ANSWERvestibulocochlear, Responsible for transmitting auditory signals What is the name and function of Cranial Nerve IX - CORRECT ANSWERGlossopharyngeal- supplies motor fibers to the pharynx(throat) that promote swallowing and saliva production; carries sensory impulses from taste buds of the posterior tongue and from pressure receptors of the carotid artery What is the name and function of Cranial Nerve X - CORRECT ANSWER-Vagus- fibers carry sensory impulses from and motor impulses to the pharynx, larynx, and the abdominal and thoracic viscera; most motor fibers are parasympathetic fibers that promote digestive activity and help regulate heart activity Bell's palsy is an acute paralysis of which cranial nerve ? - CORRECT ANSWERCranial Nerve VII Bell's palsy is often linked to what 7 viral illnesses? - CORRECT ANSWER-1. herpes simplex virus, 2. herpes zoster, 3. Epstein-Barr, 4. cytomegalovirus, 5. adenovirus, 6. rubella, and 7. mumps virus Bell's palsy is a rare finding during the secondary stage of what disease? - CORRECT ANSWER-Lyme disease How long might it take for Bell's Palsy to resolve? - CORRECT ANSWER-Symptoms start to resolve within a few weeks with complete resolve up to 6 months Treatment options for Bell's Palsy may include: (Name 3) - CORRECT ANSWER-1. Corticosteroids 2. Artificial Tears (Lubricants) 3. Eye protection may be needed There is little evidence for using antivirals to treat Bell's Palsy. Name this headache type: Lasts 30 minutes to 7 days (usually 1-24 hours) with two or more of the following characteristics: Pressing, Non pulsatile pain Mild to moderate in intensity Usually bilateral location Female to male ratio is 5:4 - CORRECT ANSWER-Tension Type This type of headache Lasts 4-72 hours with two or more of the following characteristics: Usually unilateral location, but occasionally bilateral Pulsating quality, moderate to severe Aggravation by normal activity such as walking, or causes avoidance of these activities One or more of the following: Nausea/vomiting, photophobia, phonophobia Female:male ratio 3:1 Positive family history in 70%-90% - CORRECT ANSWER-Migraine without Aura This headache occurs with or after aura Focal dysfunction of cerebral cortex or brainstem causes one or more aura symptoms to develop over 4 minutes, or two or more symptoms occur in succession Symptoms include feeling of dread or anxiety, unusual fatigue, nervousness or excitement, GI upset, visual or olfactory alteration Positive family history in 70%-90% - CORRECT ANSWER-Migraine with Aura No aura symptom should last >1 hour. If this occurs, an alternative diagnosis should be considered This headache has one to eight episodes per day, at the same time of day. Common time is ~1 hour into sleep; the pain awakens the person (hence the term "alarm clock" headache) - CORRECT ANSWER-Cluster headache This headache is often located behind one eye with a steady, intense ("hot poker in the eye" sensation), severe pain in a crescendo pattern lasting 15 minutes to 3 hours, with most in the range of 30-45 minutes. Pain intensity has helped earn the condition the name "suicide headache." - CORRECT ANSWER-Cluster headache This headache most often occurs with ipsilateral autonomic sign such as lacrimation, conjunctival injection, ptosis, and nasal stuffiness - CORRECT ANSWER-Cluster headache Name the 3 primary headaches - CORRECT ANSWER-1. Migraine 2. Tension 3. Cluster Abortive treatment options to relieve headache pain include the use of (Name 3) - CORRECT ANSWER-1. Acetaminophen; 2. NSAIDs; and 3. Combination products such as butalbital with acetaminophen and acetaminophen, aspirin, and caffeine Name the rapid imaging (~5-10 min; important if intracranial hemorrhage is suspected) - CORRECT ANSWER-CT Scan This imaging is better at detecting acute hemorrhage and bone abnormalities - CORRECT ANSWER-CT Scan This imaging is better at detecting small and subtle lesions but cannot be used in patients with implantable devices - CORRECT ANSWER-MRI This type of headache is also known as migrainous neuralgia, are most common in middle-aged men, particularly men with heavy alcohol and tobacco use. - CORRECT ANSWER-Cluster headache Treatment for this type of headache includes reduction of triggers, such as tobacco and alcohol use, and initiation of prophylactic therapy and appropriate abortive therapy (triptans, high-dose NSAIDs, and high flow oxygen) - CORRECT ANSWER-Cluster headache How long does it take oral migraine medications to work? - CORRECT ANSWER-30 mins to 1 hour Dihydroergotamine is usually given ___________________ for severe migraine along with parenteral hydration. - CORRECT ANSWER-intravenously Triptans act as selective serotonin receptor agonists and work at the ______________________, allowing an increased uptake of serotonin. - CORRECT ANSWER-5-HT1D serotonin receptor site Do triptans cause vasodilation or vasoconstriction? - CORRECT ANSWERVasoconstriction Triptans are contraindicated in patients with (Name 4) - CORRECT ANSWER-1. Prinz metal angina 2. Established or at high risk for coronary artery disease 3. Pregnant women 4. Individuals who have recently used ergots. What 2 types of headaches are triptans used to treat? - CORRECT ANSWER-1. Migraine 2. Tension Do ergotamine's cause vasoconstriction or vasodilation? - CORRECT ANSWERVasoconstriction For this reason their use should be avoided in the presence of coronary artery disease and pregnancy. What type of headache do ergotamines treat? - CORRECT ANSWER-Migraines How do NSAIDs work? - CORRECT ANSWER-They interfere with the conversion of arachidonic acid to COX-1/COX-2, they inhibit prostaglandins and thromboxane A2 are not produced, which leads to decreased pain, inflammation, and fever Frequent or excessive use of Fioricet® should be discouraged because of the potential for _________________________ from butalbital and ___________________________ from the acetaminophen component of the product. - CORRECT ANSWER-barbiturate dependency analgesic rebound headache ________________________________ can lead to analgesic rebound headache - CORRECT ANSWER-Excessive acetaminophen use Use of systemic corticosteroids is helpful with what 2 types of headaches? - CORRECT ANSWER-1. Intractable or severe migraine 2. Cluster headache The goal of headache prophylactic therapy is - CORRECT ANSWER-a minimum of a 50% reduction in number of headaches in about two-thirds of all patients, along with easier-to-control headaches that respond more rapidly to standard therapies and likely require less medication. Name 3 headache-provoking medications. - CORRECT ANSWER-1. Estrogen 2. Progesterone 3. Vasodilators Which 2 beta-blockers have the strongest evidence demonstrating headache preventive effects - CORRECT ANSWER-Metoprolol and propranolol Which beta-blocker has not demonstrated any effects in migraine prevention. - CORRECT ANSWER-acebutolol Name 3 Antiepileptic drugs (AEDs) that have also demonstrated effectiveness in preventing migraines. - CORRECT ANSWER-1. Divalproex sodium 2. Sodium valproate 3. Topiramate Select antidepressants, including the tricyclic antidepressants such as _________________ and ____________________as well as the selective serotonin norepinephrine inhibitors ,including ________________ , can also be considered for migraine prophylaxis - CORRECT ANSWER-nortriptyline and amitriptyline, venlafaxine Which herbal preparations, vitamins, and or minerals are recommended for the prevention of migraine headaches? (name 4-6 things) - CORRECT ANSWER-The strongest evidence supports the use of butterbur, riboflavin, magnesium, and feverfew for migraine prevention. Q10 (CoQ10) and estrogen supplementation, in particular during the premenstrual week can also be helpful