General

Question 1

Morquio Syndrome

Answer 1

A mucopolysaccharidosis.

Atlantoaxial subluxation occurs due to hypoplasia of the odontoid process and joint laxity

Question 2

Seizure Management

Answer 2

Ativan 2-4 mg ----> 1 minute, repeat x1
Keppra 1000mg load, 500 mg bid
------>
Phenytoin 1000mg bid, 100mg tid
------>
Infusion Pentobarbital 10mg/kg load over 30 minutes THEN 5 mg/kg/hr x3 doses THEN 1mg/kg/hr WITH AIRWAY PROTECTION

Question 3

tPA admin

Answer 3

Within 4.5 hours of onset of ischemic stroke

Question 4

tPA contraindications

Question 5

AIN (Anterior Interosseus Neuropathy)

Answer 5

Weakness of flexor pollicis longus and flexor digitorum profundus (Index, middle finger) and pronator quadratus

Unable to make “O” sign

Question 6

PIN

Answer 6

Lack of extensor carpi ulnaris

Question 7

Foster-Kennedy Syndrome

Answer 7

1) Anosmia
2) Contralateral papilledema
3) Unilateral optic atrophy

Olfactory groove meningiomas frequently present with FKS

Question 8

Medical Management of ICP

Answer 8

• Raise HOB
• Check for no constriction around neck
• Mannitol or Hypertonic saline
• EVD csf drainage
• 1000 mg Keppra prophylaxis
• CPP 60-70 mmHg
• Hyperventilation contraindicated
• Steroids contraindicated
• Sedation with propofol (2-10mg load then 5mg/kg/hr) or low dose pentobarb to minimize coughing, agitation, etc…

Question 9

Kernohan’s notch phenomenon

Answer 9

With temporal lobe herniation, the brainstem (cerebral peduncle) can be pushed against the contralateral incisura (temporal notch) causing ipsilateral rather than contralateral hemiparesis

Question 10

Stupp Protocol

Answer 10

1) 6 weeks fractionated radiation (60 Gy in 30 fractions) WITH concomitant TMZ DAILY during XRT
THEN
2) 6 cycles of adjuvant TMZ for 5 days every 28 day cycle