Block 3

Question 1

nucleus (tractus) solitarius vs dorsal motor nucleus vs paramedian pontine reticular formation vs cerebellopontine angle contains?

Answer 1

CN 7/9/10; can help w/ vomiting -> CN8/9/10 vs CN 10 to send parasymp to heart, lungs, upper GI vs ipsi CN6 nucleus for horiz gaze vs CN5/7/8

Question 2

CN reflexes: corneal/lac vs jaw jerk vs cough

Answer 2

5.1 -> 7 vs 5.3/masseter; jaw deviates towards lesion vs 10

Question 3

Gerstmann syndrome

Answer 3

dom parietal cortex/angular gyrus -> agraphia, acalculia, finger agnosia, L/R disorient

Question 4

Parinaud syndrome affects which part of brain? reticular activating system in midbrain?

Answer 4

dorsal midbrain. dec arousal & wakefulness like coma

Question 5

restless leg syndrome assoc vs tx. acute dystonia vs regular dystonia tx?

Answer 5

iron defic, CKD vs DA ag -> pramipexole, ropinarole. benzotropine (M3 antag), diphenhydramine vs botulinum

Question 6

MS dx vs tx

Answer 6

MRI = gold; periventricular white matter lesions space/time, oligoclonal bands, inc igG & myelin basic protein in CSF vs beta IFN, glatiramer, natalizumab, steroids

Question 7

phys of cerebral edema. explain tramadol

Answer 7

from failed ADP dependent ion transporters. very weak opioid ag & “SNRI” for chronic pain, AE sero syndrome, dec sz threshold

Question 8

what happens in cavernous sinus thrombosis vs cavernous sinus syndrome vs carotid sinus aneurysm?

Answer 8

proptosis, no CN 4/5.1/5.2/6 (tho this sinus also contains CN3 too) vs dec corneal & maxillary sensation, Horner, ophthalmoplegia, mass effect, carotid-cavernous fistula, infected cavernous sinus thrombosis vs asx or compressed CN6

Question 9

red nucleus/pons lesion: decorticate vs decerebrate (opisthotonic) posturing

Answer 9

lesion above red nucleus/pons -> flex UE, extend LE vs lesion at or below red nucleus/pons -> extend both U/LE

Question 10

labs vs tx of Guillain Barre. Charcot Marie Tooth

Answer 10

inc CSF protein, dec/absent DTR, endoneurial inflam vs support, plasma exchange, IVIG. AD CMT1A PMP22 dup -> no protein in periph n or myelin sheath -> foot deform & sensation

Question 11

Friedrich ataxia

Answer 11

AR frataxin (iron binding protein) GAA on chrm 9 -> no lat corticospinal tract, DRG, spinocerebellar tract -> atax, DM, HCM, hammertoes, kyphoscoliosis

Question 12

retinitis pigmentosa

Answer 12

genetic degen of retinal pig epith & photoreceptors -> optic disc pallor, bone spicule deposits, retinal vessel atten, nyctalopia, periph vision loss

Question 13

Alz meds

Answer 13

galantamine, rivastigmine, donezepil +/- memantine; improves cog fxn but not dz process

Question 14

cauda equina syndrome. what color CSF in subarach hem?

Answer 14

No L2 & below -> no knee & ankle reflexes, incont, saddle anesthesia; d/t hern disc or tumor. bloody or yellow; nimodipine to prevent more spasms; inc risk communic hydroceph

Question 15

how to tx status epilepticus. causes vs labs for NTDs

Answer 15

acutely w/ IV BZD -> phenytoin for maintenance. carbamez & phenytoin, MTX, GDM vs inc AFP & AchE in amnio

Question 16

details you forget: central occlusion ASA vs tabes dorsalis

Answer 16

bil pain/temp LE vs Charcot joints, Argylle pupil, no DTRs

Question 17

gabapentin txs? vigab vs tiagab

Answer 17

fibromyalgia, chronic pain, painful DM nephropathy, VZV postherpetic neuralgia. inhib GABA transaminase vs inhib GABA reuptake

Question 18

PML

Answer 18

by JCV; reactivated by immunosuppress/HIV -> rapidly progressive. destroy oligo, par/occ, worse w/ ritux & natalizumab

Question 19

cingulate vs central transtentorial vs uncal transtentorial vs tonsilar hern

Answer 19

ACA, primitive reflex vs ruptured paramedian BA branches -> Duret hem vs early -> ipsi blown pupil, contralat hemiparesis; late -> Kenoch phenom vs HA & cerebellar sxs kinda like Chiari I; coma & death

Question 20

periph vs central vertigo

Answer 20

by semicirc canal debris/BPPV, Menier -> tx low Na +/- diuretics, vestib neuritis, endolymph pressure; tx w/ antihist/chol/emetic vs by CNS lesion/tumor; diplopia, vertical nystag, skew deviation