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Neuro Logic
Sympto-matic
I Want a New Drug
Pharmacopia Cornucopia
Odds and Ends
100
This type of headache is unilateral and associated with a “stabbing” pain in the region of the eye.
What is cluster headache. Other associated symptoms include lacrimation, conjuctival injection, ptosis, swelling. This is most commonly seen in males in their 20s - 50s. The headaches often occur or “cluster” around the same time of day, rarely last longer than 2- 3 hours and treatment includes oxygen.
100
This is the diagnosis that is given to a patient who does not meet full criteria for major depression but has symptoms lasting two years or longer.
What is dysthymia. Patients with dysthymia can still develop major depressive episodes, and this is often termed “double depression".
100
This class of medications is most helpful in the long term treatment of most anxiety disorders.
What are SSRIs. Benzodiazepines have their place in the treatment of anxiety, but SSRIs and related antidepressants have more evidence and FDA indications across the spectrum of anxiety disorders, especially for long term treatment.
100
This anticonvulsant is used to treat bipolar disorder in the manic stages and can also be used for prophylactic treatment in patients with refractory migraines.
What is divalproex (depakote).
100
This personality disorder is characterized by feelings of emptiness, emotional lability and volatile behavior, as well as tumultuous relationships and chronic thoughts of self harm.
What is borderline personality disorder.
200
Patients with this type of aphasia exhibit broken, non-fluent speech and have preserved auditory comprehension.
What is Broca’s aphasia. Often results from strokes involving the superior division of the middle cerebral artery.
200
These are the so-called positive symptoms of schizophrenia.
What is Hallucinations, delusions, and disorganized speech or behavior.
200
This class of medication can be helpful in the short term treatment of social anxiety, especially if the anxiety is limited to circumscribed situations such as public speaking or other performances.
What are beta blockers, especially propranolol. These are often more helpful than benzodiazepines in social anxiety. Taking benzodiazepines for social anxiety can lead to disinhibition and poor performance, similar to what can be seen with alcohol use.
200
This antipsychotic has 5 FDA black box warnings.
What is clozapine. The 5 black box warnings are; agranulocytosis, seizures, myocarditis, orthostatic hypotension, and increased risk of death in elderly patients with dementia. Despite these warnings clozapine is still considered the gold standard of antipsychotic treatment and is often used in patients with schizophrenia who are refactory to other treatments.
200
A person who is perceived as “aloof” and a loner, and who has no desire to interact with others, could have this personality disorder.
What is schizoid personality disorder. In contrast to those with avoidant personality disorder, those with schizoid have little to no desire to interact with individuals or society, unless it is required.
300
Patient with this disorder are said to have lesions/neurological deficits that are “separated in time and space".
What is multiple sclerosis. The lesions involve white matter and diagnostic evaluation can include lumbar puncture (oligoclonal bands) and MRI. Treatment of acute episodes includes corticosteroids.
300
In addition to schizophenia, hallucinations and delusions can be seen in these disorders. (3 answers receives full credit)
What is delirium, bipolar disorder, depression, dementia of any kind, including late stages of parkinsons, and substance abuse (cocaine/stimulant intoxication and alcohol/benzo/barb withdrawal).
300
These three medications have an FDA indication for the treatment of alcohol dependence.
What are naltrexone, disulfiram (antabuse), and acamprosate.
300
One of the earliest established treatments for abnormal movements for parkinson’s disease, this medication is still considered one of the first line treatments for this movement disorder.
What is levodopa. While there are a number of other treatments for parkinson’s disease, levodopa is still one of the mainstays of pharmacologic therapy for this disorder.
300
This is the most critical step in the treatment of patients who are actively seizing, including patients in status epilepticus.
What is checking ABCs (or CAB’s).
400
A patient that experiences seizures of 90 seconds duration that include repetitive movements in his right arm and hand as well as lip smacking that eventually culminates in diffuse shaking throughout the body would be said to experience this type of seizure.
What is partial with generalization. Partial = involves only a portion of the brain. Complex = loses consciousness. Simple partial = would be the above without the generalization. If the above patient lost consciousness then the patient would be said to have complex partial seizures.
400
A patient experiencing a series of seizures without regaining consciousness in between the seizure activity would be said to be in this condition.
What is status epilepticus. This term is used to define continuous seizure activity without interruption, as well as the above.
400
Withdrawal from these three substances/medications can lead to seizures, delirium and death.
What are alcohol, benzodiazepines and barbiturates. All bind to the GABA-A receptor. Withdrawal from other substances, including opioids, can be very uncomfortable and distressing, but is not life threatening.
400
This is the treatment of choice for an acute episode of multiple sclerosis.
What are corticosteroids. While there are a number of maintenance treatments used, corticosteroids are a mainstay for treating acute episodes associated with this disorder.
400
This neurologic illness is characterized by fluctuating levels of weakness in commonly used muscles, with activity leading to increased weakness.
What is myasthenia gravis. Extraocular muscles are classically involved. Tensilon testing can be done as part of the diagnostic evaluation.
500
These two aphasias are notable because of the preservation of repetition found on examination.
What are transcortical motor and transcortical sensory aphasia. All other aphasias have poor repetition as important findings on exam.
500
People with this personality disorder are said to be “odd” or eccentric and they often have magical beliefs, though they do not have frank psychotic symptoms.
What is schizotypal personality disorder.
500
This medication is a partial agonist at the mu opioid receptor and is used to treat opioid dependence.
What is buprenorphine. This can be prescribed in any outpatient setting by a physician with the training and DEA license to prescribe this medication. It is thought to be safer than methadone, though methadone is still commonly used to treat opioid dependence.
500
This medication is quite literally the “salt of the earth” and is one of the mainstays of treatment for bipolar disorder.
What is lithium. A natural element, lithium salts have been used for decades in the treatment of bipolar disorder. It can be used to treat the manic stages of the illness and is also used in maintenance treatment, to prevent relapses to mania and depression. Lithium levels, thyroid labs, and kidney function must be monitored. Complete blood counts should be monitored due to increased WBC counts, but this is not as critical as the thyroid & renal labs. EKGs should be checked at baseline and intervals in patients with heart disease & the elderly.
500
A classic presentation for this illness would include asymmetric limb weakness in the upper extremities, upper and lower motor neuron findings and no sensory findings on neurologic exam.
What is Amyotrophic lateral sclerosis (ALS).