Day 12.1 Neuro

Question 1

Most common causes of meningitis in newborns–> 6mo

Answer 1

Gp B Strep
E. coli
Listeria

Question 2

Most common causes of meningitis in small kids 6mo–> 6yrs

Answer 2

S. pneumonia
N. meningitidis
HiB
Enteroviruses (Echo, Coxsackie- these cause aseptic meningitis, whereas the others cause bacterial)

Question 3

Most common causes of meningitis in kids-adults 6yr–>60yr

Answer 3

Enteroviruses
S. pneumonia
N. meningitidis
HSV (this also causes temporal lobe encephalitis)

Question 4

Most common causes of meningitis in 60+ yr elderly?

Answer 4

S. pneumonia
Gram-neg rods
Listeria

Question 5

What genes are responsible for skeletal devt?

Answer 5

Hox genes

Question 6

Clinical px of thyroglossal duct cyst?

Answer 6

Midline of neck

Moves when swallowing

Question 7

Which phase of hepatic metabolism is lost first by geriatric pts?

Answer 7

Phase I

Question 8

Which phase of hepatic metabolism is mediated by Cytochrome p450?

Answer 8

Phase I

Question 9

What are the 4 obligate aerobe bacteria?

Answer 9

Nagging pests must breathe:
Nocardia
Pseudomonas aeruginosa
Mycobacterium TB
Bacillus spp

Question 10

Vasculitis w necrotizing granulomas of lung and necrotizing glomerulonephritis

Answer 10

Wegener’s granulomatosis

Question 11

Vasculitis w necrotizing immune complex inflam of visceral/renal vessels

Answer 11

Polyarteritis nodosa

Question 12

Vasculitis in a young Asian woman

Answer 12

Takaysu’s

Question 13

Vasculitis in a young asthmatic

Answer 13

Churgg-Straus

Question 14

Vasculitis in young children; coronary arteries can be involved

Answer 14

Kawasaki dz

Question 15

Most common vasculitits

Answer 15

Temporal arteritis

Kids- Henoch-Scholein purpura

Question 16

Vasculitis a/w HBV infection

Answer 16

Polyarteritis nodosa

Question 17

Rx to prevent the neurotoxicity of isoniazid

Answer 17

Pyridoxine (Vit B6)

Question 18

Rx for TCA cardiotoxicity

Answer 18

NaHCO3 to alkalinize the plasma/urine

Question 19

Rx for Theophylline cardiotoxicity

Answer 19

B-blocker

Question 20

Where is CN III wrt the arteries in the circle of willis?

Answer 20

Between the PCA and the SCA (superior cerebellar artery).

An aneurysm in PCA or SCA can cause CN III palsy d/t mass effect.

Question 21

Where does the PICA enter the circle of willis?

Answer 21

Vertebral arteries (PICA = posterior)

Question 22

Where does the AICA enter the circle of willis?

Answer 22

Basilar arteries (AICA = anterior)

Question 23

Medial medullary syndrome is the occlusion of which artery?

Answer 23

Anterior Spinal Artery (the one that comes up in the middle of the 2 vertebral arteries)

Question 24

What are the characteristics of medial medullary syndrome?

Answer 24

Pyramid/corticospinal tract dmg –> Contralateral spastic hemiparesis of lower extremities
Medial lemniscus dmg –> Contralateral tactile and kinesthetic defects (proprioception)
Hypoglossal nucleus/nerve dmg –> tongue deviates toward lesion (ipsilateral paralysis)

Question 25

What artery is occluded in lateral medullary syndrome (aka Wallenberg's)?

Answer 25

PICA | Infarct of lateral part of rostral medulla

Question 26

What are the characteristics of lateral medullary syndrome/Wallenberg's?

Answer 26

Spinothalamic tract dmg --> Loss of contralateral pain/temp Trigeminothalamic tract dmg --> loss of pain/temp on ipsilateral face Nucleus ambiguus- glossopharyngeal and vagus dmg --> hoarseness, difficulty swallowing, loss of gag reflex (ipsilateral) Descending symp tract dmg --> Ispilateral Horner's syndrome Vestibular nuclei dmg --> vertigo, nystagmus, naus/vom Inferior cerebellar peduncle dmg --> Ipsilateral cerebellar deficits (ataxia, past pointing)

Question 27

What artery is occluded in lateral inferior pontine syndrome?

Answer 27

AICA (which comes off of basilar artery)

Question 28

What are the characteristics of lateral inferior pontine syndrome?

Answer 28

Facial nucleus/nerve dmg --> ipsilateral facial paralysis Solitary nucleus/nerve dmg --> ipsilateral loss of taste from ant 2/3 of tongue Cochlear nucleus/nerve dmg --> Ipsilateral deafness and tinnitus Vestibular nucleus/nerve dmg --> Nystagmus, vertigo, naus/vom Middle and inferior cerebellar peduncle dmg (MCP, ICP) --> ipsilateral limb and gait ataxia Spinal trigeminal nucleus/nerve dmg --> ipsilateral loss of pain/temp from face spinothalamic tract dmg --> contralateral pain/temp from body descending symp tract dmg --> ipsilateral Horner's syndrome note: contralateral motor to body and light touch/vib/kinesthetics are fine