Clin Med 2

Question 1

Signs of neuromuscular jxn vs peripheral nerve problems vs muscle myositis

Answer 1

Diffuse weakness w/o sensory changes, worse/improving w/ exer, double vision vs numb/tingling, sensory changes; if there’s pain or dec reflexes —> radiculopathy/nerve root vs Proximal weakness, atrophy +/- pain, high CK & ESR

Question 2

Signs of cerebellum ataxia. How is bil cerebellum is affected?

Answer 2

Ipsi ataxia w/o weakness, eye movement abnlities. By VZV —> immune system attacks both sides of cerebellum

Question 3

Signs of Brown-Sequard syndrome

Answer 3

Ipsi motor weakness, contralat sensory, Ipsi DCML

Question 4

arm fl>ex, leg ex>fl, sustained clonus, inc reflexes, spastic, memory change = sign of? Muscle fascicuations = sign of? Signs of motor neuron dz?

Answer 4

UMN sxs. LMN sxs. Mix of U/LMN sxs, involves 3+ limbs including head/face/tongue, progressive weakness, spastic, fasc, atrophy, cramps

Question 5

If there are crossing of sxs, which structure should you think is affected? If you have urin retention or incont, which structure should you think is affected?

Answer 5

Brainstem. Spinal cord

Question 6

aphasia vs naming (2nd order)

Answer 6

can’t produce or comprehend spoken/written lang vs ability to produce proper names of objects’ parts (2nd order)

Question 7

clin features of parietal/sup MCA syndrome

Answer 7

all contralat hemiparesis/plegia, lower facial weakness, hemisensory loss, homonymous hemianopsia, Broca’s

Question 8

anomic aphasia, Wern aphasia, amnesia, Kluver Bucy, contralat sup quadrantinopsia, visual/olf halluc

Answer 8

clin features of temporal/inf MCA syndrome

Question 9

clin features of Gerstmann (special MCA)

Answer 9

acalculia, agraphia (can’t write despite know lang), finger agnosia, L/R confusion

Question 10

clin features of acute internal carotid occlusion

Answer 10

contralat hemiplegia, lower facial weakness, homonymous hemianopsia, sensory deficit; mute, aphasia, dysarthria; eye dev towards lesion, ipsi Horner’s; cerebral edema

Question 11

clin features of frontal lobe/ACA syndrome

Answer 11

contralat hemiparesis leg>arm; akinetic mute (no movements or speech, medial); dysarthria, transcortical motor aphasia; eye toward lesion; urin incont (medial), disinhibition

Question 12

alexia w/o agraphia (can’t read but write), visual agnosia/Anton’s syndrome, optic apraxia/absent optokinetic nystagmus; contralat homonymous hemianopsia

Answer 12

clin features of occ lobe/PCA syndrome

Question 13

how does CNS demyelinate?

Answer 13

T cells enter BBB –> macs come & eat myelin and axons –> demyelinated nerve fibers send signals slowly & irreg –> sclerotic/scarred plaques

Question 14

risk factors of MS

Answer 14

females, Af-Am, teens to 40s, neuro impairment

Question 15

what does CSF look like in MS?

Answer 15

inc markers in CSF v serum –> primary CNS inflamm; >2 oligoclonal bands, inc igG

Question 16

optic neuritis sxs. how to eval? tx?

Answer 16

inflamm optic n, loss vision/color, pain w/ eye movement. ophthal eval: optic disc pallor; pupillary eval: afferent pupillary defect/Marcus Gunn pupil; VEP shows slowed conduction thru pupil; optical coherence tomography shows thick (acute) or thin (optic neuritis) retinal fibers. IV methylprednisolone

Question 17

exec fxn vs attn vs agnosia vs apraxia

Answer 17

ability to organize, sequence, abstract info vs sel conc vs inability to recognize sensory input; occiptotemporal vs inability to carry out familiar actions; dom inf par lobe

Question 18

how does hippo vs amygdala contribute to mem?

Answer 18

spatial learning vs emotional mem

Question 19

cortical vs subcortical vs neurodegen amnesia w/ examples of each

Answer 19

changes in mem, lang, perception, fxn; temp, par, front. Alz, Lewy, vasc, frontotemporal dementia vs behavior, emotional, motor fxn, exec fxn; striatum, thal, midbrain. Parkinson, progressive supranuclear palsy, nml pressure hydrocephalus, CJakob dz, Huntington vs primary degen CNS dz. Alz, Lewy, frontotemporal dementia

Question 20

dementia w/u

Answer 20

H&P
Serum, UA, CBC w/ diff
folate, B12
Neuroimging: <65yo, <2y hx, focal neuro sxs, nml pressure hydrcephalus, trauma, neuropsych test

Question 21

examples of neuropsych testing

Answer 21

Mini Mental state Exam for mem & lang fxn
clock drawing test for visuospatial processing
“comb your hair”, “blow out match” for apraxia

Question 22

sxs of Alzheimers. chrm? gait?

Answer 22

dec mem & lang, disorientation, impaired reason/judge, decline in performing routine tasks. early = 1, 14, 21; late = APOE in 17. dementia-related gait changes –> dec in walking speed & stride, inc support phase; dual task-related gait changes –> in Alz & non-Alz dementia

Question 23

how to dx Alz? tx?

Answer 23

comprehensive hx, PE, labs, neuroimging of parietotemporal cortices; post mortem bx = definitive. cog enhancers (cholinesterase inhibitors, gluE antagonists), behavior (antipsychotics, antidepress, mood stabilizers, pain meds)

Question 24

carotid a dissection sxs. dx? tx?

Answer 24

HA, neck pain, ocular pain, partial Horner’s. duplex, CTA, MRA. anticoag w/ IV heparin, lovenox, ASA, plavix, tPA

Question 25

lacunar infarcts = caused by?

Answer 25

occlusion of deep penetrating aa

Question 26

brain venous infarct leads to?

Answer 26

venous congestion –> hemorrhagic changes

Question 27

arteriovenous malformation. tx?

Answer 27

abnl vessels b/w aa & vv w/o capillaries –> steals oxygenated blood –> hypoxic adjacent tissue –> axs, hemorrhage, sz. glue embolotherapy

Question 28

high altitude cerebral edema. tx?

Answer 28

going too high too fast –> vasogenic edema –> hypoxic cerebral vasodil –> capillary HTN, brain petechial bleed, CC edema –> atax, confusion, incont. acetazolamide, dexamethasone

Question 29

delirium confusion assessment method

Answer 29

presence of 1+2, or 3+4:
1. acute change in mental status
2. inattn
3. altered thinking
4. disorg thinking

Question 30

dementia

Answer 30

personality change, mem loss, impaired intellect from dz or trauma (NOT from age)

Question 31

Parkinson’s sxs vs dx vs tx

Answer 31

triad; bradykin, exec fxn, depression vs sensitive to psychotic & delirium meds –> must rule out before dx w/ dementia; Lewy in brainstem; DaT scan = sPECT scan w/ iodine labeling dopamine containing cells (not sensitive for early stage) vs dopamine/agonists, acetylcholine blockers (too much dopamine –> dyskinesia)

Question 32

Lewy body dementia. sxs?

Answer 32

Lewy bodies in brainstem, limbic system, cortex; can overlap w/ Alz or Park’s –> do PET to differentiate. visual halluc, abnl gait

Question 33

nml pressure hydrocephalus sxs vs dx vs tx. vasc dementia dx vs tx

Answer 33

wet, wobbly, wacky vs CT –> spinal tap vs shunt. MRI vs tx their HTN

Question 34

Creutzfeldt-Jakob dz

Answer 34

dementia, myoclonus, abnl EEG (periodic spikes) caused by prions. assoc w/ spongiform encephalopathy

Question 35

Wern vs Korsakoff. how to tx for both?

Answer 35

ocular, cerebellar, confusion, malnut vs anterograde, confab, malnut. IV thiamine, other B vit before B12

Question 36

AIDs. transient global amnesia. TBI. psychogenic amnesia

Answer 36

apathy, behavioral, cog decline, IVDU. antero/retrograde >50yo, temporal & spatial disorient, vasc insufficeny in midbrain. retrograde post fall/trauma. recent & remote mem loss, indifferent to deficits

Question 37

subdural hematoma. ca-related cog decline

Answer 37

fall, HA, lateralized sxs (hemianopsia, hemiplegia, CN abnlities). chemo + brain fog + weakness

Question 38

Huntington’s cause vs sxs vs tx

Answer 38

CAG rpt + loss cholinergic neurons in striatum –> GABA dec GPe to inc subthal to dec GPi –> inc thal –> inc movement vs dementia + chorea vs dopamine blockers for movement, bal dopamine & acetylcholine

Question 39

signs of unfavorable prog?

Answer 39

> 6cm, astrocytoma histo, cross midbrain, neuro deficits before resect

Question 40

hedgehog pathway

Answer 40

hedgehog make ligand to bind to PTCH –> initiates degradation –> SMO released –> activates Gli –> mostly for basal cell ca or medulloblastoma