Neurological disorders

the diagnosis of parkinsons relies on findings of:

clinical evaluation of its cardinal clinical features

A 34 yo mother of two daughters is being evaluated following a new-onset seizure that caused a momentary loss of consciousness. Before being discharged, she asks if she can still drive her car. The NP responds that:

driving is restricted until a seizure free period is achieved that is as determined by state law

The most common cause of new-onset unprovoked seizure is

epilepsy

Which of the following antieleptic medications is least likely to cause a significant drug-drug interaction?

gabapentin

when evaluating the person who has bacterial meningitis, the NP expects to find CSF results of:

glucose at about 30% of serum levels

limitations associated with the use of butalbital with acetaminophen and caffine (Fioricet) inlude its:

high rate of rebound headache if used frequently

Triptans should be used with caution with the concomitant use of:

high-dose SSRI

Bells Palsy is also known as

idiopathic facial paralysis

a 68 yo man presents with new-onset headaches. he describes the pain as bilateral frontal to occipital and most severe when he arises in the morning and when coughing. He feels much better by mid-afternoon. the hx is most consistent with headache cause by:

increased ICP

a 19 yo college sophomore was diagnosed with meningococcal meningitis today. you speak to the school health officers about the risk to the other students on campus. You inform them that:

individuals with household-type or more intimate contact are considered to be at risk

Treatment options in MS to attenuate disease progression include:

interferon beta-1b

Which of the following oral agents has the most rapid analgesic onset?

liquid ibuprofen

WHen providing ongoing care for a pt with recent TIA, you consider that:

long-term antiplatelet therapy is likely indicated

Parkinsons is primarily caused by:

loss of the pigmented dopaminergic neurons

a 35 yo normotensive woman with a hx of bilateral tubal ligation presents with a 6 month hx of gradual bilateral facial nerve paralysis, difficulty swallowing, altered EOMs and diminished DTRs in all four extremities. The NP consideres:

making a prompt referral to neurology

In prescribing systemic corticosteroid for a patient with Bells Palsy, the NP considers that its use:

should be initiated asap after the onset of paralysis

Risk of cluster headaches

-heavy etoh -tobacco -male gender

A TIA is characterized as an episode of reversible neurological symptoms that can last

24 hours

The average incubation period for the organism N meningitidis is:

3 to 4 days

You examine a 29-year-old woman who has a sudden onset of right-sided facial asymmetry. She is unable to close her right eyelid tightly, frown, or smile on the affected side. Her examination is otherwise unremarkable. This presentation likely represents paralysis of CN: A. III B. IV C. VII D. VIII

C. VII

Acute cerebral hemorrhage is best identified with which of the following imaging techniques?

CT scan

THe use of neuroleptics such as prochlorperazine (Compazine) and promethazine (Phenergan) in headache therapy should be limited to less than 3x per week b/c of their:

EPM risk

Which of the following describes Kernig sign?

Elicited with the patient lying supine and the hip flexed 90 degrees, it is present when extension of the knee from this position elicits resistance or pain in the lower back or posterior thigh

a 64 yo man recently diagnosed with PD asks about exercising. He states, "I usually like to walk briskly around my neighborhood for 30 minutes atleast 4-5x per week. The NP responds:

Exercise is encouraged and likely has a neuroprotective effect.

Which of the following vaccines is not typically recommended for individuals over 5 years of age?

Hib

A 22 yo woman presents with a 3 year hx of recurrent, unilateral, pulsating headaches with vomiting and photophobia. The headache generally lasts 3 hours, can be minimized by resting in a dark room. she can usually tell shes going to get one "i see little squiggles before my eyes for about 15 minutes before the headache starts". This presentation is most consistent with:

Migraine with aura

Which of the following is most closely linked to migraines

Motion sickness

tonic-clonic (grand mal)

Rigid extension of arms and legs followed by sudden jerking movements with loss of consciousness; bowel and bladder incontinence common with postictal confusion

which of the following is a likely candidate for the use of CGRP inhibitor?

a 45 yo woman who experiences about 15 migraine days per month despite propranolol therapy

Which of the following patients would you consider neuroimaging with MRA to screen for the presence of a cerebral aneurysm

a 46 yo with four 1st degree relatives with subarachnoid hemorrhage

The cause of MS is best described as:

a destructive process of the nerve fiber protecting myelin

when evaluating the person who has aseptic or viral meningitis, the NP expects to find CSF results of:

a predominance of lymphocytes

which of the following signs and symptoms most likely suggests meningitis caused by N meningitidis?

a purpura or petechial rash

in counseling a patient who experiences migraines, you recommend all of the following lifestyle changes to minimize the risk of triggering a headache except: a. avoiding eating within 1-2 hours of morning awakening b. limiting exposure to cigarette smoke c. avoiding trigger physical activities d. implementing strategies to reduce stress

a. avoiding eating within 1-2 hours of morning awakening

Risk factors for MS include all except: a. being older than 50 yo b. female c. northern european ancestry d. autoimmune disease

a. being older than 50

risk factors for bacterial meningitis include all of the following except: a. being over 25 yo b. living in a community setting c. having a current hx of cigarette smoking d. using immunosuppressant drugs

a. being over 25 yo

Of the following, which is the least likely bacterial source to cause meningitis? a. colonization of the skin b. colonization of the nose and throat c. extension of acute otitis media d. extension of bacterial rhinosinusitis

a. colonization of the skin

you see a 25 yo woman with a known factor V Leiden maturation who asks about contraceptives. You suggest all of the following except: a. combined oral contraceptive b. LNG-IUD c. copper IUD d. levonorgestrel implant

a. combined oral contraceptive

when evaluating a pt with acute headache, all of the following observations would indicate the absence of a more serious underlying condition except: a. onset of headache with exertion, coughing or sneezing b. hx of previous identical headache c. supple neck d. normal neurological examination results

a. onset of headache with exertion, coughing or sneezing

indicators that a headache can be the presenting symptom of a serious underlying illness and consideration for neuroimaging include all of the following except: a. similar headaches that occur periodically in clusters b. increasing frequency and severity of headaches c. headache causing confusion, dizziness, and/or lack of coordination d. sudden, abrupt onset

a. similar headaches that occur periodically in clusters

which of the following statements about ergotamines is false? a. the drug class is effective in the tx of tension-type headaches b. they act as 5-HT 1a and 5-HT1d receptor agonists c. with its use, this drug class carries a potential vasoconstrictor effect d. use should be avoided in the presence of CAD

a. the drug class is effective in the tx of tension-type headaches

you are examining a 65 yo man who has a hx of acute coronary syndrome and migraine. Which of the following agents represents the best choice of acute headache (abortive) therapy for this pt?

acetaminophen

short-term systemic corticosteroid therapy would be most appropriate in treating:

acute intractable or severe migraines and cluster headaches

A 46 yo man dx with Bells palsy and being treated with a systemic corticosteroid asks the NP about the use of an antiviral medication as he read online that an antiviral can help to "cure the disease" the NP correctly responds:

an antiviral can be considered though the benefit has not been established in clinical studies

When considering treatment for parkinsons, levodopa is typically used:

as a first-line tx in early disease

simple partial or focal seizure

awake state with abnormal motor and psychic behavior lasting seconds

Which of the following statements regarding "on" and "off" periods of PD is false? a. a person can move with relative ease during an "on" period b. an "off" period typically occurs at the max serum concentration following levodopa dosing c. mediation adjustment can usually minimize "off" periods d. surgical treatment may be needed to manage dyskinesia during "off" periods

b. an "off" period typically occurs at the max serum concentration following levodopa dosing

Which represents the most appropriate diagnostic test for Cecilia in the past question? (paralysis of CN VII) a. CBC b. Lyme disease testing c. CT head with contrast d. BUN/ Cr

b. lyme disease resting

An 18 yo college freshman is brought to the student health center with a chief complaint of a 3 day hx of progressive headache and intermittent fever. On physical exam he has positive kernig and brudzinski sighns. the most likely diagnosis is?

bacterial meningitis

Absence (petit mal) seizure

blank staring lasting 3 to 50 seconds, accompanied by impaired level of consciousness

Myoclonic seizure

brief, jerking contractions of arms, legs, trunk or all

WHich of the following conditions is least likely to contribute to an increased risk of ischemic or hemorrhagic stroke? a. HLD b. DM c. Crohn's disease d. HTN

c. Crohn's

With appropriately prescribed headache prophylactic therapy, the patient should be informed to expect: A. virtual resolution of headaches. B. no fewer but less severe headaches. C. approximately 50% reduction in the number of headaches. D. that lifelong therapy is advised.

c. approx 50% reduction in the number of headaches

the more common secondary headache etiology includes all of the following except: a. brain tumor b. intracranial bleeding c. cluster cephalalgia d. viremia

c. cluster cephalalgia

Antieleptic drugs useful for preventing migraine headaches include all of the following except: a. divalproex b. valproate c. lamotrigine d. topiramate

c. lamotrigine

Chemoprophylaxis for household contacts of an individual diagnosed with meningitis can include all of the following except: a. a single dose ceftriaxone b. multiple doses of rifampin c. multiple doses of amoxicillin d. a single dose of meningococcal conjugate vaccine

c. multiple doses of amoxicillin

a 27 yo man presents with a 5 week hx of recurrent headaches that awaken him during the night. the pain is severe, lasts about 1 hour and is located behind his left eye. Additional symptoms include lacrimation and nasal discharge. his physical examinations within normal limits, and he is currently headache fee. this presentation is most consistent with:

cluster headache

other conditions to consider in the differential diagnosis of PD can include all of the following except: a. Alzheimers dementia b. normal pressure hydrocephalus c. Huntington's disease d. multiple sclerosis

d. MS

a 37 yo woman complains of migraine headaches that typically occur within hours after eating in a restaurant. Potential triggers that can influence the onset and severity of migraine symptoms include all of the following except: a. cheese pizza b. pickled or fermented food c. freshly baked yeast products d. baked whitefish

d. baked whitefish

evidence supports the use of all of the following vitamins and supplements for migraine prevention except: a. butterbur b. riboflavin c. feverfew d. ginkgo biloba

d. ginkgo biloba

which of the following is incorrect regarding the CGRP inhibitor class? a. dosed once monthly or quarterly b. used for prevention of migraines c. dosed by subcutaneous injection d. nearly eliminates migraines for over 50% of individuals

d. nearly eliminates migraines for over 50% of individuals

Risk factors for TIA include all the following except: a. a fib b. CAD c. combined oral contraceptive use d. pernicious anemia

d. pernicious anemia

antiplatelet agents commonly used in secondary prevention of storke include all of the following except: a. asprin b. clopidogrel c. asprin plus ER dipyridamole d. rivaroxaban

d. rivaroxaban

Common symptoms of MS, especially in earlier disease, include all of the following except: a. numbness or weakness in one or more limbs b. double vision or blurring vision c. facial weakness or numbness d. symptoms improving in a warmer environment

d. symptoms improving in a warmer environment

With migraine, which of the following statements is true? A. Migraine with aura is the most common form. B. Most migraineurs are in ongoing healthcare for the condition. C. The condition is equally common in men and women. D. The pain is typically described as pulsating.

d. the pain is typically described as pulsating

a 48 yo woman presents with a monthly 4-day premenstrual migraine headache, poorly responsive to triptans and analgesics, and accompanied by vasomotor symptoms (hot flashes). the clinician considers prescribing all of the following except: a. continuous monophasic combined oral contraceptive b. phasic combined oral contraceptive with a 7 day per month withdrawal period c. low-dose estrogen patch use during the premenstrual week d. triptan prophylaxis

d. triptan prophylaxis

which of the following statements about potential drug interactions with phenytoin is false? a. phenytoin increases theophylline clearance increasing CYP 450 enzyme activity b. when taken with other highly protein-bound drugs, the free phenytoin concentration can increase to toxic levels c. phenytoin can increase the metabolic capacity of hepatic enzymes, thus leading to reduced drug levels d. when phenytoin and theophylline are given together, the result is a higher concentration of both drugs than when given separate

d. when phenytoin and theophylline are given together, the result is a higher concentration of both drugs than when given separate

a 47 yo woman experiences occasional migraine with aura and reports improvement in photophobia and phonophobia with zolmitriptan use and a small reduction in headache pain. you consider prescribing the addition of which of the following to help improve her overall migraine symptoms?

naproxen sodium

Prophylactic treatment for migraine headaches in a 28 yo woman with no chronic health problems who uses a levonorgestrel-releasing IUD includes the use of:

nortriptyline

a first-line prophylactic treatment option for the prevention of tension type headache is

nortriptyline

Physical examination findings in papilledema include:

optic disk bulging

A 45 yo man experiences rapidly progressing migraine headaches that are accompanied by significant GI upset. Appropriate acute headache (abortive) treatment includes all of the following except: a. injectable sumatriptan b. dihydroergotamine nasal spray c. oral naproxen sodium d. zolmitriptan nasal spray

oral naproxen sodium

When evaluating a patient with new-onset unprovoked seizure, the most important aspect of the diagnostic evaluation is:

patient history

which of the following medications requires ongoing therapeutic monitoring of drug levels?

phenytoin

Among the following beta blockers, which is the preferred agent to use in preventing migraine headache in a 40 year old woman with a hx of bilateral tubal ligation and no hx of airway disease?

propranolol

In tension-type headache, which of the following is true?

the pain is typically described as "pressing" in quality

the use of a DOAC for secondary prevention of stroke is most useful for:

those with ischemic stroke and cardioembolic conditions

which of the following is most consistent with findings in pts with parkinsons?

tremor at rest and bradykinesia