PRIMARY CARE - PRACTICE QUESTIONS AND CORRECT ANSWERS
What CN does Bell's Palsy Involve? 7
What is Bell's Palsy? Inflammation or compression of CN 7, causing unilateral facial weakness/paralysis
What side of the face is Bell's Palsy more common on? Right
What virus is Bell's palsy strongly associated with? Herpes Simplex Virus
What are some of the RFs of Bell's Palsy? DM
Pregnancy (esp. 3rd trimester)
Post URI
Dental Nerve block
What is unique about Bell's palsy in terms of It only affects the face NOT the extremities
paralysis/weakness?
If the upper face is okay, then it is NOT bell's palsy
How do we diagnose Bell's palsy? Diagnosis of Exclusion
How do we treat Bell's Palsy? No treatment is necessarily required
Can do:
- Prednisone to dec. nerve inflammation-- most useful if started within 72 hours of
sx onset
- Artifical tears
How often does it usually take for Bell's Palsy to resolve? 1 month
What usually returns first in Bells Palsy, restoration of taste Taste THEN motor
or motor activity?
What is the study of choice for evaluating acute head CT scan
injuries?
What is the study of choice for evaluating a concussion MRI
which has had prolonged symptoms of >7-14 days?
How do we treat Concussions? Cognitive and physical rest
What is Delirium? Acute, abrupt TRANSIENT confusion state that is due to an identifiable cause, such
as medications, infection.
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What is Dementia? Progressive, chronic intellectual deterioration of selective functions. MEMORY loss.
What is a TIA? TRANSIENT episodes of neurological deficits w/o acute infarction
Usually lasts <24 hours (most resolve w/in 30-60 minutes)
What is a TIA most commonly due to? Embolus
What is one of the risks of a TIA? CVA w/in 24-48 hours (esp. if DM, HTN)
What are the most common clinical manifestations of a TIA Amaurosis Fagax-- monocular vision loss-- temporary "lamp shade down on one
from the Internal Carotid Artery? eye", weakness in contralateral hand
What is the initial test of choice for a TIA? CT
Other Tests:
- Carotid Doppler- to look for internal or common carotid artery stenosis
- CT angiography, MR angiography
- Labs (BGL, BMP, CBC, coags)
- Echocargiogram-- TEE or TTE to r/o cardiac source
- EKG to r/o afib
- can use ABCD^2 score (Age, BP, Clinical Features, Duration of Sx/DM)
How do we treat TIA? Aspirin +/- Dipyridamole or Clopidogrel (Plavix)
Place in supine position to increase cerebral perfusion.
Avoid lowering BP (unless >220/120)
Reduce modifiable RFs such as DM, HTN, A fib
What is contraindicated in TIA? Thrombolytics
Is Myasthenia Gravis central or peripheral? Peripheral
What population is Myasthenia Gravis most common in? Young Women
What is the pathophysiology of Myasthenia Gravis? Autoimmunie antibodies acting against AcH postsynaptic receptors-- causes
progressive weakness with repeated muscle use and recovery after periods of rest
What reflexes do we see with Myasthenia Gravis? Normal deep tendon reflexes
What is a Myasthenia Crisis? Respiratory Failure caused by progressive weakness in respiratory muscles
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What do we use to diagnose Myasthenia Gavis? + AcH receptor antibodies**
+ MuSK antibodies
Edrophonium (Tensilon) test-- rapid reponse to short acting IV Edrophonium
Ice Pack Test
CT scan or MRI of the chest may show thymoma or thymus gland abnormality
How do we treat Myasthenia Gravis? 1st Line: Pyridostimine or Neostigmine
Other:
- Immunosuppression: Plasmapheresis or IVIG can be used for rapid response in
myasthenia crisis
- Thymectomy-- helpful if thymoma is the source of the antibodies
What medications should we avoid in Myasthenia Gravis Flourouinolones and Aminoglycosides
patients?
*may exacerbate myasthenia
Is MS a CNS or PNS disease? CNS
Degeneration of white matter of the brain, optic nerve, and spinal cord
What population is MS most common in? Women and young adults 20-40yo
If a young patient has Trigeminal Neuralgia, what should MS
we suspect?
What is Uhthoff's Phenomenon? worsening of MS symptoms with heat
Do we see L'Hermitte's sign with MS? Yes
Neck flexion causes lightning-shock type pain radiating from spine down the leg
Is Babinski positive or negative in MS? Positive
How do we usually diagnose MS? Clinical Diagnosis-- at least 2 discrete episodes of exacerbation
What is the test of choice for helping confirm MS? MRI w/ Gadolinium-- white matter plaques seen (hyperdensities)
What would we maybe see on PE of the eyes in MS? Marcus Gunn pupil
Patient will also have Optic Neuritis-- unilateral eye pain with eye movements,
diplopia, central scotomas, vision loss (esp color)
What might we see on LP of MS patient? Inc IgG in CSF
This reflect inflammatory cells penetrating the BBB
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, PRIMARY CARE - PRACTICE QUESTIONS AND CORRECT ANSWERS
How do we treat acute exacerbations of MS? 1st Line-- high dose IV Corticosteroids
--> if unresponsive-- Plasmapheresis
What medication is helpful in treating fatigue for MS? Amantadine
What medications are helpful for treating spasticity from Baclofen and Diazepam
MS?
What do we use to treat Relapse-Remitting/Progressive Beta Interferon or Glatiramer acetate (decreases # and severity of relapses)
Disease in MS?
What are the two main types of Headaches? 1) Primary (90%)-- Migraine, Tension, Cluster
2) Secondary-- Meningitis, Subarachnoid Hemorrhage, etc
Who should we suspect a secondary cause of headache Someone with an abrupt headache or progression of severity
in?
Are Tension and Migraine headaches more common in Women
men or women?
What is overall the most common type of Headache? Tension
What are the clinical manifestations of a Tension BILATERAL
Headache? Tight band-like
Worse with noise, glare, fatigue
NO n/v, photophobia or phonophobia
How do we treat Tension Headaches? 1st Line-- NSAIDs, Aspirin, Acetaminophen
How do we treat Severe or Recurrent Tension Headaches? TCAs such as Amitryptyline
Beta Blockers
Psychotherapy
What are the 2 types of Migraine headaches? 1) Migraine w/o Aura (common)
2) Migraine w/ Aura (classic)
What is the most common cause of Morning headache? Migraine Headahce
What are the clinical manifestations of Migraine LATERALIZED
Headaches? Pulsatile/Throbbing
N/V
Photophobia, Phonophobia
Worse w/ physical activity
Visual changes is the most common type of aura
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What CN does Bell's Palsy Involve? 7
What is Bell's Palsy? Inflammation or compression of CN 7, causing unilateral facial weakness/paralysis
What side of the face is Bell's Palsy more common on? Right
What virus is Bell's palsy strongly associated with? Herpes Simplex Virus
What are some of the RFs of Bell's Palsy? DM
Pregnancy (esp. 3rd trimester)
Post URI
Dental Nerve block
What is unique about Bell's palsy in terms of It only affects the face NOT the extremities
paralysis/weakness?
If the upper face is okay, then it is NOT bell's palsy
How do we diagnose Bell's palsy? Diagnosis of Exclusion
How do we treat Bell's Palsy? No treatment is necessarily required
Can do:
- Prednisone to dec. nerve inflammation-- most useful if started within 72 hours of
sx onset
- Artifical tears
How often does it usually take for Bell's Palsy to resolve? 1 month
What usually returns first in Bells Palsy, restoration of taste Taste THEN motor
or motor activity?
What is the study of choice for evaluating acute head CT scan
injuries?
What is the study of choice for evaluating a concussion MRI
which has had prolonged symptoms of >7-14 days?
How do we treat Concussions? Cognitive and physical rest
What is Delirium? Acute, abrupt TRANSIENT confusion state that is due to an identifiable cause, such
as medications, infection.
Stuvia.com | New Version
, PRIMARY CARE - PRACTICE QUESTIONS AND CORRECT ANSWERS
What is Dementia? Progressive, chronic intellectual deterioration of selective functions. MEMORY loss.
What is a TIA? TRANSIENT episodes of neurological deficits w/o acute infarction
Usually lasts <24 hours (most resolve w/in 30-60 minutes)
What is a TIA most commonly due to? Embolus
What is one of the risks of a TIA? CVA w/in 24-48 hours (esp. if DM, HTN)
What are the most common clinical manifestations of a TIA Amaurosis Fagax-- monocular vision loss-- temporary "lamp shade down on one
from the Internal Carotid Artery? eye", weakness in contralateral hand
What is the initial test of choice for a TIA? CT
Other Tests:
- Carotid Doppler- to look for internal or common carotid artery stenosis
- CT angiography, MR angiography
- Labs (BGL, BMP, CBC, coags)
- Echocargiogram-- TEE or TTE to r/o cardiac source
- EKG to r/o afib
- can use ABCD^2 score (Age, BP, Clinical Features, Duration of Sx/DM)
How do we treat TIA? Aspirin +/- Dipyridamole or Clopidogrel (Plavix)
Place in supine position to increase cerebral perfusion.
Avoid lowering BP (unless >220/120)
Reduce modifiable RFs such as DM, HTN, A fib
What is contraindicated in TIA? Thrombolytics
Is Myasthenia Gravis central or peripheral? Peripheral
What population is Myasthenia Gravis most common in? Young Women
What is the pathophysiology of Myasthenia Gravis? Autoimmunie antibodies acting against AcH postsynaptic receptors-- causes
progressive weakness with repeated muscle use and recovery after periods of rest
What reflexes do we see with Myasthenia Gravis? Normal deep tendon reflexes
What is a Myasthenia Crisis? Respiratory Failure caused by progressive weakness in respiratory muscles
Stuvia.com | New Version
, PRIMARY CARE - PRACTICE QUESTIONS AND CORRECT ANSWERS
What do we use to diagnose Myasthenia Gavis? + AcH receptor antibodies**
+ MuSK antibodies
Edrophonium (Tensilon) test-- rapid reponse to short acting IV Edrophonium
Ice Pack Test
CT scan or MRI of the chest may show thymoma or thymus gland abnormality
How do we treat Myasthenia Gravis? 1st Line: Pyridostimine or Neostigmine
Other:
- Immunosuppression: Plasmapheresis or IVIG can be used for rapid response in
myasthenia crisis
- Thymectomy-- helpful if thymoma is the source of the antibodies
What medications should we avoid in Myasthenia Gravis Flourouinolones and Aminoglycosides
patients?
*may exacerbate myasthenia
Is MS a CNS or PNS disease? CNS
Degeneration of white matter of the brain, optic nerve, and spinal cord
What population is MS most common in? Women and young adults 20-40yo
If a young patient has Trigeminal Neuralgia, what should MS
we suspect?
What is Uhthoff's Phenomenon? worsening of MS symptoms with heat
Do we see L'Hermitte's sign with MS? Yes
Neck flexion causes lightning-shock type pain radiating from spine down the leg
Is Babinski positive or negative in MS? Positive
How do we usually diagnose MS? Clinical Diagnosis-- at least 2 discrete episodes of exacerbation
What is the test of choice for helping confirm MS? MRI w/ Gadolinium-- white matter plaques seen (hyperdensities)
What would we maybe see on PE of the eyes in MS? Marcus Gunn pupil
Patient will also have Optic Neuritis-- unilateral eye pain with eye movements,
diplopia, central scotomas, vision loss (esp color)
What might we see on LP of MS patient? Inc IgG in CSF
This reflect inflammatory cells penetrating the BBB
Stuvia.com | New Version
, PRIMARY CARE - PRACTICE QUESTIONS AND CORRECT ANSWERS
How do we treat acute exacerbations of MS? 1st Line-- high dose IV Corticosteroids
--> if unresponsive-- Plasmapheresis
What medication is helpful in treating fatigue for MS? Amantadine
What medications are helpful for treating spasticity from Baclofen and Diazepam
MS?
What do we use to treat Relapse-Remitting/Progressive Beta Interferon or Glatiramer acetate (decreases # and severity of relapses)
Disease in MS?
What are the two main types of Headaches? 1) Primary (90%)-- Migraine, Tension, Cluster
2) Secondary-- Meningitis, Subarachnoid Hemorrhage, etc
Who should we suspect a secondary cause of headache Someone with an abrupt headache or progression of severity
in?
Are Tension and Migraine headaches more common in Women
men or women?
What is overall the most common type of Headache? Tension
What are the clinical manifestations of a Tension BILATERAL
Headache? Tight band-like
Worse with noise, glare, fatigue
NO n/v, photophobia or phonophobia
How do we treat Tension Headaches? 1st Line-- NSAIDs, Aspirin, Acetaminophen
How do we treat Severe or Recurrent Tension Headaches? TCAs such as Amitryptyline
Beta Blockers
Psychotherapy
What are the 2 types of Migraine headaches? 1) Migraine w/o Aura (common)
2) Migraine w/ Aura (classic)
What is the most common cause of Morning headache? Migraine Headahce
What are the clinical manifestations of Migraine LATERALIZED
Headaches? Pulsatile/Throbbing
N/V
Photophobia, Phonophobia
Worse w/ physical activity
Visual changes is the most common type of aura
Stuvia.com | New Version
