16 - Neuro

Question 1

CN I:

Answer 1

Olfaction / smell

Question 2

CN II:

Answer 2

Vision - newborns 20/200, by 6mos 20/20

Question 3

Features of Horner syndrome

Answer 3

Interruption of sympathetic innervation to the pupil

1. Ptosis
2. Miosis
3. Facial anhydrosis

Question 4

Rooting reflex is associated with which cranial nerve?

Answer 4

V (trigeminal)

Question 5

What is Gower sign?

Answer 5

Patient arises from lying on floor by using arms to “climb up” legs and body

Question 6

Lower motor neuron lesions and cerebellar lesions result in muscle tone increase or decrease?

Answer 6

Decrease (hypotonia)

Question 7

Upper motor neuron lesions result in muscle tone increase or decrease?

Answer 7

Increase (hypertonia or spasticity)

Question 8

What is the MC recurrent pattern of primary HA’s in children and adolescents?

Answer 8

Tension HA

Question 9

Triptans are contraindicated for:

Answer 9

Focal neuro deficits with migraines or basilar migraines (syncope) -> stroke risk

Question 10

Who gets migraine prophylaxis?

Answer 10

> 1 disabling migraine per week

BB’s (propanolol)(CI: asthmatics and DM)

TCA’s

Anti-convulsants

CCB’s

SSRI’s

Antihistamines

Question 11

Jacksonian march?

Answer 11

Complex partial seizure spreading from face to arm to leg

Question 12

Txt for absence seizures?

Answer 12

Ethosuximide or valproic acid

Question 13

Stat-ep

Answer 13

> 30mins

Causes: new-onset epilepsy, drug intox or withdrawal, electrolytes, hypoxia, stroke, head trauma

Lorazepam, diazepam, midazolam

Question 14

MCC of seizure between 6mo and 6yrs?

Answer 14

Febrile seizure

Question 15

What is spinal muscular atrophy?

Answer 15

SMA

Progressive anterior horn cell degeneration

“Floppiness”

Absent DTR’s

Tongue fasciculations

Question 16

Where is polio endemic?

Answer 16

Nigeria
India
Pakistan
Afghanistan

Question 17

MCC of acute flaccid paralysis in children?

Answer 17

Guillain Barre syndrome

Postinfectious autoimmune peripheral neuropathy

Symmetrical ascending weakness over hours to weeks

Cam affect respiratory function

Slow spontaneous resolution

Tx: IVIG, plasma exchange, immunosuppresive drugs

Question 18

Charcot-Marie-Tooth dz

Answer 18

Ankle-weakness, frequent tripping, pes cavus

Slow progression

No txt

Question 19

What are the three types of childhood myasthenia gravis?

Answer 19

Juvenile myasthenia gravis

Transient neonatal myasthenia gravis

Congenital myasthenia gravis (not AI - genetic mutations)

Question 20

Txt for MG?

Answer 20

Acetylcholinesterase inhibitor (pyridostigmine)

Thymectomy (reduced antibody burden)

Steroids

Question 21

Seizures and concussion?

Answer 21

At time of injury - ok

Within 7 days - ok

After seven days - can lead to epilepsy (glial scarring)

Question 22

Sxs for concussion last how long?

Answer 22

Less than 3 days

Most resolve within a week

Question 23

Return to play after concussion

Answer 23

1. Rest
2. Walking
3. Sport-specific exercise
4. Non-contact resistance training
5. Full-contact
6. Game play

Q24h step-up

Question 24

Epidural hemorrhage

Answer 24

Onset minutes to hours
Lucid interval followed by progressive neuro deficits

Lens-shaped extra-cerebral hemorrhage compressing the brain

Txt - surgical evactuation

Question 25

Subdural hemorrhage

Answer 25

Onset over hours

Focal neuro deficits

Crescentic shape on CT

Surgical evacuation

Question 26

Subarachnoid hemorrhage

Answer 26

Worst headache of my life

Stiff neck

Supportive care

Question 27

Neurofibromatosis Type 1

Answer 27

Neurofibromas composed of schwann cells

Cafe au lait spots

Axillary or inguinal freckling

Iris hamartomas (Lisch nodules)

Malignancy risk

Learning disabilities, scoliosis, seizures - reduced life-span (10-15yrs)

Question 28

Cardinal features of tuberous sclerosis?

Answer 28

Facial angiofibromas (adenoma sebaceum)

MR

Epilepsy

Question 29

Ash leaf spots and Shagreen patches, think:

Answer 29

Tuberous sclerosis