ADULT - NEUROLOGIC PROBLEMS (Primary Care, Dunphy,
Winland-Brown, Porter, & Thomas) Questions with 100% Correct
Answers Latest 2024 Version
MIXED H/A: Vascular Headaches - ✔✔Combination of 1ST 2: Muscular & Vascular = Tension H/A
& Migraine H/A
TRACTION/ INFLAMMATORY Headaches - ✔✔**Increasing intensity; **Med. Rmergency
HEADACHES: DIAG. Tests - ✔✔LABS: R/O Systemic illness= ESR for Temporal Arteritis; **Possible CT/MRI
if "Atypical Pattern": **CT for subdural hemorrhage/hematoma;
**MRI/ angiography for hematoma;
**See Headache Classification System of International Headache Society
TENSION H/A: MANAGEMENT - ✔✔NSAIDs, cool compresses, stress reduction; Muscle relaxants;
Complementary Alternative Med (CAM)(p.131-2): Massage,acupuncture,chiropractor
MIGRAINE H/A: MANAGEMENT - ✔✔**Nonpharmacologic: eliminate triggers, biofeedback; **PHARM:
**Abortive therapy - Imitrex, Maxalt pain relief; **Prophylactic TX: B-Blockers, CCB,
Antiseizure; **CAM(p. 132)
TRIPTANS: MECH. for TX - ✔✔Triptans bind to serotonin receptors in cranial blood vessels (causing
constriction), & inhibition of pro-inflammatory neuropeptide release (CGRP [calcitonin gene-related
peptide] & substance P); (works on Trigeminal nerve to relieve pain?)
HEADACHES: PT. EDUC. - ✔✔**Education (Iceberg, p.122)- MOH, spiral;
**F/U - Neuro consult for Pts. w/ transient neuro. deficits, increasing freq., severity of unilateral
H/A's, atypical auras, new onset of "Progressive Deficit," suggesting Lesion.
ALS: Degenerative Dis. - ✔✔PATHO: Progressive; Destruction of motor cells & spinal cord; **SX's:
Motor: Muscle weakness, Gait Disturbance, Motor problems, except for eyes & bladder; **DIFF DX's:
MS, Myasthenia Gravis, Hyperthyroidism;
, **DIAG's: Protein electrophoresis; **TSH, T3, T4--> R/O Hyperthyroidism; **Check Parathyroid--> R/O
Hyperthyroidism; 24-Hr. Urine for heavy metals; Spinal tap; EMG; Nerve Conduction Velocity;
**RX: Riluzole (PO) - slows progression, Edaravone (Radicava)(IV), Flexeril, Baclofen (symptomatic)
MS: Degenerative Dis. - ✔✔PATHO: Unknown Etiology; Genetic susceptibility or Autoimmune;
Viral; Environmental; **Progressive, Stemming fr. axon demyelination; **SX's: Motor/Sensory,
Paralysis, Weakness,
Blindness (Sensory);
**DIFF DX's: Lyme Dis., HIV, Systemic Lupus; **DIAG's: Immunoglobulin; CSF- check Lymphocytes; No
spec. tests; LP; CT of Brain/MRI; **RX: Glucocort's, Depomedrol (IV), DMARDS
PARKINSON's: Degenerative - ✔✔**CAUSE: Unknown, Multifactorial - genetic,
exogenous and endogenous toxins (pesticides), Familial component, Normal aging;
**PATHO: Progressive, Chronic, Degenerative dis. of Basal Ganglia in CNS; Insidious onset;
**S/SX's: Motor tremor, Cogwheel rigidity, Akinesia /bradykinesia, Postural disturbance;
**DIFF DX's: Essential tremor, MS, ALS, Alzheimer's;
**DIAG's: Ser. Calc. level R/O Hypoparathyroidism,
Brain CT to differentiate PD & Essential Tremor; MRI of Brain to exclude structural brain lesions;
**TX: Control SX's, no drugs/surgical Tx. prevents progression; "Falls" Risk; Health maint. screenings;
*RX: Levodopa/Carbidopa; Requip; Bromocriptine
ALZHEIMER's: Degenerative - ✔✔**CAUSE: Not known; Genetic mutation changes sequence of
chemical pairs;
**PATHO: Progressive Irreversible cortical disconnection causes formation of neurologic plagues (cortex,
hippocampus, amygdala & neurofibrillary tangles) inside neurons that cause neuron cell death; Increase
of Tou protein;
**SX's: Motor, Sensory, Cognitive, Speech; Difficulty accomplishing tasks; Memory probs.; Lost
in familiar places; Word finding difficulty (anomia);
**DIFF. DX's: Delirium, Drug/alcohol abuse, Psychosis;
**LABS: CBC, CMP, Thyroid levels, LFT's,
CT/MRI Brain, MMSE (20-25 early, 10-19 middle, <10 late stage);
