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MC Qs 2 Flashcards

1
Q

Triad of findings in tuberous sclerosis

A
  1. Intellectual disability (MR)
  2. Seizures
    - cortical tubers on MRI
    - subependymal nodules/giant cell astrocytomas
  3. Dermatologic findings
    - ash leaf spots (hypomelanotic macules)
    - Shagreen’s patch = elevated hardened skin patch usually on lower back
    - angiofibromas in butterfly pattern on face

Other: renal, eye, lung findings

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2
Q

Differentiate classic from common migraine

A

Classic migraine = w/ aura

Common migraine = w/o aura

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3
Q

Name features of these specific types of migraines

(a) Basilar migraines
(b) Opthalmoplegic migraines

A

(a) Basilar migraine = symptoms referable to the basilar artery: visual disturbance, vertigo, confusion, brainstem dysfunction
(b) Opthalmoplegic migraines = associated w/ retroorbital pain or CN nerve palsies of CN 3,4,6

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4
Q

2 tests to help confirm Dx of myasthenia gravis

A
  1. Tensilon test = edrophonium = readily reversible AChE inhibitor that improves muscle weakness (by decreasing ACh breakdown)
  2. Ice pack test- putting ice pack on pt’s forehead for several minutes temporarily relieves ptosis
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5
Q

60 yo M develops asymmetric distal muscle weakness

  • modestly elevated CK
  • wheelchair bound after 7 yrs of gradual progression

Dx

A

Dx = inclusion body myositis

-over 50 yo, distal asymmetric inflammatory myopathy (see inflammatory infiltrate on biopsy)
No tx :-(

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6
Q

Distinguishing features of PSP vs. Parkinsons

A

PSP: restricted vertical gaze, prominent falls

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7
Q

Name 2 other types of chorea that are not Huntington’s

A

Chorea gravidarum- in women of child-bearing age get a pregnancy test!

Sydenham’s chorea in children w/ rheumatic fever (check group A strep titer)

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8
Q

Triggers for

(a) Absence seizures
(b) Juvenile myoclonic epilepsy seizures

A

Triggers

(a) Hyperventilation can reliably reproduce absence seizures
(b) Juvenile myoclonic epilepsy seizures can be triggered by sleep deprivation, classically a teenager who p/w seizure after pulling an all nighter

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9
Q

Pt w/ known brain tumor experiences shaking of right hand that progresses up to r. arm and shoulder that continuous until LOC and tonic-clonic mov’t of entire body

Type of seizure?

A

Secondary generalized seizure

Generalized b/c entire brain involved
Secondary b/c initially it’s focal, than spreads

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10
Q

(a) What is epilepsia partialis continua?
(b) Body parts most commonly involved
(c) Possible complication

A

(a) Epilepsia partialis continua = persistent focal motor seizure (repetitive focal myoclonus or Jacksonian march) that recur every few seconds to minutes for days to years
(b) Often hand, foot, or face
(c) Possibe complicated by Todd’s phenomenon where involved body part afterwards has transient weakness (conceptually due to exhaustion of motor cortex)

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11
Q

Differentiate chorea from athetosis

A

Chorea- irregular, asymmetric random and continuous movements

Athetosis- slow twisting/writhing movements, typically distal muscles

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12
Q

Differentiate ballism from chorea

A

Ballism is an extreme form of chorea, where there is involuntary, violent flailing of extremities

Chorea = irregular, asymmetric random and continuous movements

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13
Q

Before diagnosing pt w/ idiopathic carpel tunnel, what should be ruled out?

A

R/o pregnancy and endocrinopathies (diabetes, thyroid hormone irregularities)

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14
Q

Mov’t d/o in pt who survived CO poisoning

A

Parkinsonism

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15
Q

76 yo M started a new medication 2 mo ago, p/w muscle aches/pains and slightly elevated CK

What med?

A

Atorvastatin

Statins (esp high doses) are a very common cause of myopathies

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16
Q

Guillain-Barre

(a) Mechanism
(b) Clinical features
(c) Timeline

A

Guillain-Barre

(a) Autoimmune, often following GI illness (campylobacter jejuni classically)
(b) Ascending paralysis, minimal sensory findings, areflexia
- loss of reflexes is key to clinical dx
- back pain 2/2 inflammation of nerve roots
(c) Hours to days

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17
Q

Name 2 trinucleotide repeat diseases

A
  1. Huntington’s

2. Fragile X = most common inherited cause of ID, most commonly known single-gene of autism

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18
Q

Name 2 other features of Juvenile Gout (Lesch-Nyan)

A

Lesch-Nyan

  1. hyperuricemia => gout and kidney stones
  2. neurologic dysfunction
  3. cognitive and behavioral disturbances, most notably self mutilating behavior (biting lip and fingers, like even biting fingers off EW)
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19
Q

Differentiate myoclonus and dystonia

A

Myoclonus = very rapid, brief, uncontrollable jerks

Dystonia = sustained, abnormal posture caused by simultaneous activation of both agonist and antagonist muscles

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20
Q

Lennox-Gastaut Syndrome

(a) Age
(b) Difference btwn West syndrome

A

Lennox Gastaut Syndrome

(a) Btwn 2-6 yoa
(b) Many parallels, but L-G typically multiple types (not just infantile spasms) and more frequent (like can have multiple a day
- EEG findings: slow wave forms btwn seizures, not hypsarrhythmia like West syndrome
- L-G more resistant to tx

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21
Q

Main features of NF1

A

Tumors along the nervous system:

  • Neurofibromas = benign skin tumors, peripheral neurofibromas causing painful neuropathies
  • plexiform neurofibromas = large benign tumor of nerves
  • Lisch nodules = brownish-red spots in the colored part of the eye
  • cafe au lait spots, axillary freckling
  • seizures, MR**
  • thinning of long bones

Overall: seizures, cafe au lait spots, neurofibromas, plexiform neurofibromas
-often presents w/ seizures before age 5

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22
Q

Migraines

(a) Duration
(b) Dx criteria

A

Migraines

(a) 4-72 hrs duration
(b) 2/4:
-unilateral
-pulsatile quality
-inhibition of daily activity
-aggravated by physical activity
1/2:
-photo/phono-phobia
-nausea/vom

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23
Q

21 yo M wakes up in the night w/ stabbing pain behind eye, episodes last 30-60 mins during which eye looks is red/swollen w/ ptosis and unequal pupil size

Dx

A

Dx = cluster headaches

= severe unilateral pain (orbital, supraorbital, and/or temporal) lasting 15-80 minutes associated w/ eye, nose findings

  • ptosis, miosis, red conjunctivae, lacrimation, eyelid edema
  • nasal congestion/rhionrrhea
  • forehead and facial sweating
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24
Q

Differentiate simple vs. complex febrile seizures

A

Simple febrile seizure = GTC lasting less than 60 seconds w/ no recurrence w/in the next 24 hrs
-these don’t need tx

Complex febrile seizure = focal features lasting longer than 15 minutes or recurrence in 24 hrs
-these need tx

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25
Q

5 yo child w/ severe decline in ability to comprehend and produce speech

(a) Dx
(b) EEG finding

A

(a) Landau-Kleffner syndrome = infantile acquired aphasia = acquired epileptic aphasia
= aphasia (inability to understand or express speech) w/ abnormal EEG

(b) EEG: b/l spike and wave discharges (epileptiform activity) during non-REM sleep

  • basically a kid 3-7 yoa who develops speech normally but then loses it and also has epileptiform activity during non-REM sleep
  • development of aphasia in child who otherwise developed normally
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26
Q

What lab value must be monitored in pts taking oxcarbazepine/carbamazepine

A

BMP- monitor Na+ values b/c they are associated w/ hyponatremia

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27
Q

Pt w/ b/l, asynchronous ballistic mov’t of arms and legs
-pt is conscious during the events that last 30-120 seconds

Dx

A

Dx = non-epleptic seizures = pseudoseizures

Differentiating factor = not stereotypic (like true epileptic seizures)- last different amounts of time, differ in time and clinical presentation

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28
Q

65 yo being treated for Parkinson’s develops paranoia and hallucinations

Mgmt

A

First step = reduce Sinemet (carbadopa-Levadopa) dose

But if his Parkinsonian symptoms worsen, then can restart Sinemet while adding antipsychotic
-best choice of antipscyhotic = Quetiapine (seroquel)

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29
Q

Similarities btwn Rett’s syndrome and autosim

A

Lack of social reciprocity, young age of onset, loss of speech

-but Rett’s has known molecular etiology

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30
Q

Define akathisia

A

‘Motor restlessness’

subjective sense of inner restless in which pt feels compelled to move continuously

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31
Q

Differentiate movement d/o from extrapyramidal d/o

A

Synonymous, b/c movement d/o don’t affect the pyramids (spare the corticospinal tract), they are disorders of the basal ganglia

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32
Q

What is the most common primary CNS tumor in children?

(a) What kind of tumor is this?
(b) Clinical presentation

A

Medulloblastoma

a) PNET = primary neuroectodermal tumor
(b) Presents w/ cerebellar features: ataxia, signs of increased ICP (HA, vom

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33
Q

75 yo w/ trouble initiating gait, but once he gets started his steps become faster until he has trouble stopping

(a) Name this gait
(b) Associated d/o

A

(a) Festinating gait
2/2 postural instability from loss of dopaminergic signals

(b) Idiopathic Parkinson’s

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34
Q

Duchenne’s muscular dystrophy

(a) Pattern of inheritance
(b) Mutated gene
(c) Clinical presentation
(d) Associated findings

A

Duchenne’s muscular dystrophy

(a) X-linked recessive- hence why only boys get it
(b) Mutated dystrophin gene- encodes for protein that connects muscle fiber’s cytoskeleton w/ the extracellular matrix to allow for contraction/relaxation
(c) Presents in boys around 3-5 w/ trouble walking, rising from sitting (Gower’s sign), unable to ambulate by teenage and death by 20s
(d) Dilated cardiomyopathy

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35
Q

2 yo girl seemed healthy until 11 mo when she seemed floppy, continued to develop but lost skills around age 2 particularly in her hands

Dx

A

Dx = Rett’s syndrome

  • only in girls, starts around 1-4 yoa w/ cognitive and physical deficits/decline
  • normal early development followed by stagnation and eventual regression
  • grey matter disease
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36
Q

Define status epilepticus

A

Status epilepticus = life-threatening condition of seizures lasting more than 5-10 minutes, or recurrent seizures w/o regain of consciousness in between lasting 30 minutes

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37
Q

Name two examples of primary generalized seizures

A

Absence seizures, tonic-clonic seizures

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38
Q

7 yo boy w/ day-dreaming spells numerous times during the day
-child has no recollection of these events, his grades start to suffer

Dx

A

Dx = absence seizures

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39
Q

Distinguishing features of MSA-Parkinson’s type over Idiopathic Parkinson’s

A

MSA-Parkinson’s type: b/l onset of symptoms, lack of tremor, prominent orthostatic hypotension

Recall: hot cross buns sign on neuroimaging

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40
Q

Pt w/ known brain tumor experiences shaking of right hand that progresses up to right arm and shoulder before terminating.
-no LOC

Type of seizure?

A

Simple partial seizure

Simple b/c no LOC
Partial bc specific definitive (not entire) part of brain involved

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41
Q

Most common reason why pts discontinue Depakote

A

Wt gain

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42
Q

3 most common brain mets that bleed

A

Bleeding brain mets: melanoma, renal cell, choriocarcinoma

43
Q

Differentiate the 4 kinds of seizures

A

Simple partial seizures = one definitive area of the brain (partial) involved, no LOC (simple)

Complex partial seizure = one definitive area of the brain involved (partial), some alteration in consciousness (complex)

Primarily generalized = entire brain affected at once, loss of consciousness

Secondarily generalized (Jacksonian march) when single area of brain affected initially, then spreads to include the rest

44
Q

2 mo w/ colic pain causing baby to bend over in pain, 3 hypopigmented lesions on skin that are more apparent w/ UV light

Suspected diagnosis?

A

Tuberous sclerosis = aut dom inherited neurocutaneous d/o characterized by tons of benign tumors of the head (cortical tubers), kidneys, skin

  • Hypopigmented macules = ash-leaf macules
  • GERD is common
45
Q

Cornerstones of tx for myasthenia gravis

A
  • maintenance w/ pyridostigmine = cholinesterase inhibitor
  • steroids
  • immunosuppressants (ex: azathioprine)

Last resort: IVIG, plasmaphoresis

-ppx thymus removal

46
Q

10 yo w/ seizures characterized by laughing fits

(a) What type of seizure is this?
(b) Most likely due to neoplasm at what location?

A

(a) Gelastic seizures = sudden burst of energy (usually laughing or crying)
(b) Many causes, but most likely 2/2 hypothalamic neoplasm

47
Q

3 MC mets to the brain

A

Lung, lung, lung, lung…

then breast and melanoma

48
Q

Compare and contrast acute disseminated encephalomyelitis and multiple sclerosis

A

Both ADEM and MS are autoimmune demyelinating d/o
-similar MRI findings w/ multiple periventricular lesions

ADEM- acute onset, usually uniphasic, often in children following viral infection or atypical vaccination, p/w seizure, encephalopathy

MS- adult, recurring/remitting, no fever, more asymmetric unilateral findings not seizure/encephalopathy

49
Q

Triad of NF2

A

Multiple schwannomas (usually b/l vestibular schwannomas), meningiomas, and ependymomas

Ependyma = epithelial lining of the ventricles, can be intra-axial or in the spinal cord

50
Q

Tx for carpel tunnel

(a) First line
(b) Refractory disease

A

Carpel tunnel syndrome

(a) Conservative therapy: night brace/splint, avoidance of repetitive movements
(b) Release of transverse carpal ligament

51
Q

Name one factor that differentiate tics from other movement disorders

A

Tics are considered semi-voluntary, in that w/ great effort they can be temporarily suppressed

52
Q

Most focal epilepsies arise from which location?

A

Mesial temporal areas/hippocampus

53
Q

Differentiate presentation of NF1 vs. NF2

(a) Which is more common?

A

NF2 presents before 20 usually from symptoms of CNS (benign) tumor compression of cranial nerves
ex: hearing loss from b/l vestibular schwannomas

NF1 presents before 5 yoa w/ seizures, painful neuropathies from peripheral neurofibromas, cafe au lait spots
(a) NF1 much more common than NF2

54
Q

Why is lorazepam preferred over pheyntoin for acute seizure eradication?

A

Lorazepam has very rapid onset

Can’t give IV phenytoin too quickly 2/2 risk of cardiac arrhythmia

55
Q

Infxn w/ what commonly precedes Guillain-Barre

A

Campylobacter jejuni = infectious febrile diarrheal illness

56
Q

Which child w/ febrile seizures has higher risk of developing seizures as an adult

(a) Seizures lasting 5 or 30 minutes?
(b) W/ or w/o strong FHx of febrile seizure
(c) Focal vs. generalized features

A

HIgher risk of developing seizures as an adult if

(a) Seizure lasts longer than 15 minutes
(b) W/o strong Fhx
- so having strong family h/o febrile seizures doesnt increase risk
(c) Focal features
- generalized seizures is not a RF for seizures as adult

57
Q

Buzzword: 2 yo w/ self-mutilating behavior

Dx

A

Dx = Lesch-Nyan disease
-X linked mutation in enzyme HGPRT => build up of uric acid

3 features

  • neurologic dysfxn
  • cognitive and behavioral disturbances, most notably self-mutilating behaviors (chewing lip/fingers)
  • hyperuricemia => gout and kidney stones
58
Q

Juvenile myoclonic epilepsy

(a) Typical presentation
(b) Tx

A

Juvenile myoclonic epilepsy = idiopathic generalized epilepsy

(a) 12-18 yo w/ brief episodes of involuntary muscle twitching early in the morning
- myoclonic jerks, typically upon wakening

(b) Valproic acid (depakote)
- seizures do not remit, tx is needed
- Keppra also a good first choice

59
Q

Electrical stimulation of which cranial nerve is used to help control epilepsy?

A

Vagus nerve

-direct electrical excitation of the vagus can suppress the onset of seizures

60
Q

Pt suffers completely lacerated median nerve. What would an EMG 3 months later show?

A

Fibrillations and positive sharp waves = finding of spontaneous depolarization of individual muscle fibers
-while normally innervated muscles are responsive as an entire motor unit (not individual fibers)

=> fibrillations and positive sharp waves indicate acute (weeks to 12 mo) motor axonal injury

61
Q

Anti-epileptic most strongly associated w/ neural tube defects when given to pregnant women

A

Depakote

62
Q

Distinguishing factor btwn absence seizures and complex partial seizures

A

No post-ictal state w/ absence seizures

63
Q

Good test for absence seizures

A

Hyperventilation is a very reliable way of bringing out absence seizures

64
Q

34 yo M p/w 3 mo of irritability and personality changes, enlarged liver and coarse tremor of UE. Mov’ts are slow and he is dysarthric

(a) Dx
(b) Additional expect physical exam finding

A

(a) Dx = Wilson’s disease = hepatolenticular degeneration
- lenticular nucleus = caudate and putamen

(b) Kaiser-Fleischer rings around the cornea 2/2 copper deposition

65
Q

Pseudotumor cerebri

(a) Physiology
(b) RF
(c) Confirm dx

A

Pseudotumor cerebri

(a) Impaired CSF absorption
(b) Typically young obese F
- endocrine d/o
(c) Confirm dx w/ LP showing elevated opening pressure

66
Q

Manifestations of Von-Hippel-Lindau disease

A

Autosomal dominant 2/2 mutation in VHL tumor suppressor gene => multiple hemangioblastomas (mostly of the eye and brain)
-also pheos, renal cell carcinomas, pancreatic cysts

See angiomas in the eye, brain imaging shows hemangiomas (not symptomatic unless ruptured), pheo/RCC/pancreatic cyst in family members

67
Q

(a) What is the most common epilepsy syndrome in children?

(b) Prognosis

A

(a) Benign rolandic epilepsy = epilepsy w/ centrotemporal spikes
- characterized by noctural seizures

(b) Rarely needs tx, children only have a few seizures, always remits by age 16

68
Q

What is Miller-Fischer Syndrome?

A

Variant of Guillain-Barre (acquired neuropathy) that presents w/ descending symptoms and most prominently opthalmoplegia (weakness of eye muscles
-also w/ areflexia and ataxia (but usually no limb weakness)

-associated w/ Anti-GQ1b antibodies

69
Q

25 yo referred for episodes of altered behavior lasting 2 mins w/ lip-smacking and repetitive behavior
-pt doesn’t remember events, feels “butterflies in my stomach” and a sense of fear, and smells burning rubber, before they occur

Most likely dx

A

Complex partial seizure

70
Q

What are meningiomas?

(a) imaging finding
(b) Prognosis

A

Meningiomas = tumors arising from the meninges = membranous layer covering of the CSF

(a) Dural tail
(b) 90% benign => often don’t even require tx (can observe)

71
Q

What feature strongly suggests a non-epleptic seizure?

A

Non-epileptic (pseudo) seizure suggested by convulsion in the doctor’s office or waiting room

-not associated w/ comorbid mood d/o

72
Q

Differentiate the location of CNS tumors in children vs. adults

A

Majority (2/3) in adult are supratentorial (in the cortex) while majority (2/3) in children are infratentorial

ex of infratentorial = medulloblastoma (cerebellar)

73
Q

Tuberous sclerosis

(a) Etiology
(b) Characteristic lesion
(c) First step in tx

A

Tuberous sclerosis

(a) Aut dom inherited neurocutaneous d/o
(b) Benign tumors in brain (cortical tubers/glioneuronal hamartomas, kidney, skin, lungs)
(c) ACTH, to suppress CRH release in hope of preventing associated infantile spasms

74
Q

Diagnostic criteria for Tourette’s

A

Need both motor and at least one vocal tic

-starting before age 18 and lasting for 1+ year w/o tic-free period of more than 3 mo

75
Q

Tx for Guillain Barre

A

Best tx = IVIG and supporitve care (airway protection, required by about 30%)
-equal in efficacy, but much easier and fewer side effects, than plasmaphoresis

-no role for steroids in tx of GB

76
Q

CNS presentation of Wilson’s disease

A

Most commonly will present w/ liver failure, but can present initially w/ CNS signs: generally any movement d/o and dysarthria (speech disturbance) 2/2 basal ganglion abnormality

-classic finding = wing-flapping tremor

77
Q

Temporal arteritis

(a) Most feared complication
(b) Tx

A

Temporal/giant cell arteritis

(a) unilateral vision loss
(b) Start prednisone ASAP

78
Q

Differentiate genetics of Prader-Willi vs. Angelman’s

A

Prader-Willi = deletion of normal paternal contribution of chrom 15
-hypotonia, MR, obesity

Angelman’s = deletion of normal maternal contribution of chrom 15
-MR, hand flapping/jerky mov’ts, seizures

79
Q

Differentiate conduction velocity and conduction amplitude findings on nerve conduction studies

A

Decrease in conduction velocity = demyelinating process
-same amount of nerves, signal just going slower

Decrease in amplitude = axonal process
-fewer nerves, but speed of those nerves is preserved

80
Q

Mentally retarded infant develops seizures, facial birthmark

(a) Dx
(b) Expected MRI findings
(c) Additional expected findings

A

(a) Sturge-Weber syndrome
(b) Ipsilateral (same side as port-wine stain) leptomeningeal angioma causing gradual calcification and atrophy of underlying brain
(c) Seizures starting in infancy: can be severe enough to warrant hemispherectomy
- glaucoma
- port-wine stain 2/2 capillary overgrowth, most commonly in V1 (opthalmic) distribution
- neuronal loss and calcification in cerebral cortex ipsilateral to birth mark

Overall: MR, seizures, port-wine stain, glaucoma, ipsilateral leptomeningeal angioma

81
Q

Differentiate tremor from chorea

A

Tremor- rhythmic
-alternating contraction btwn agonist and antagonist muscles

Chorea- not repetitive or rhythmic
-flow from one muscle group to the next

82
Q

Pt observed to suddenly lose consciousness and have tonic-clonic mov’ts, you hear your pager and arrive w/in 1 minute
-pt is still seizing at this time, next step?

A

Next step at this point = observation
-ABCs

Tx for IV Lorazepam if it lasts 5-10 minutes or more

83
Q

(a) What is Todd’s paralysis?

(b) Most common manifestation?

A

(a) Todd’s paralysis/phenomenon = focal neurologic deficit that persists for an extended period (but under 28 hrs) after a seizure
(b) Usually transient weakness of involved limb (arm, hand, leg), but can be sensory, visual, speech etc depending on part of brain where the seizure activity occured

84
Q

35 yo M falls off bike and hits head on the ground, no LOC

  • 30 mins later: turns white as a ghost and falls to the ground, some shaking mov’t of arms and legs
  • gets up w/in mins and seems fine

Dx

A

Dx = syncopal event

-vasovagal syncope, specifically convulsive syncope: many pts can have convulsive movements during syncope

85
Q

Name 2 meds that can cause myopathy

A

Muscle aches/pains

  • statins (high dose)
  • chronic corticosteroids
86
Q

Features of Rett’s syndrome

A

Normal development until 1-4 yoa, stagnation then decline in both cognitive and physical fxn

  • lose of purposeful hand movements, inability to speak
  • almost only female
  • gray matter disease
  • small hands/feet, decelerated head growth
  • repetitive stereotyped hand movements
87
Q

Classification for primary CNS tumors

A

Glial origin
-astrocytoma, glioblastoma, oligodendroglioma, ependymoma, choroid plexus papilloma/carcinoma

Non-Glial Origin

  • meningioma
  • primary CNS lymphoma
88
Q

Surgical procedures done in epilepsy

(a) Most common
(b) Most aggressive

A

(a) Removal of the temporal lobe

(b) Corpus callostomy- used in refractory epilepsy to prevent partial seizures from spreading into generalized

89
Q

In which pt would IV phenytoin be indicated as seizure ppx

A

Pt w/ severe head trauma: in pts w/ severe head trauma ppx anticonvulsants decreases initial seizure rate, but does not have any impact on long-term seizure rate

-no role for seizure ppx in brain tumors or intracerebral bleeds

90
Q

What presents w/

(a) Ascending paralysis
(b) Descending paralysis

A

(a) Ascending paralysis = Guillaine-Barre, tick paralysis, transverse myelitis, spinal cord compression
(b) Descending paralysis = Botulsim

91
Q

West syndrome

(a) What is it?
(b) Best tx

A

West syndrome = epilepsy d/o of infantile spasms

(a) Triad:
1. infantile spasms
2. pathognomonic EEG pattern of hypsarrhythmia (high amplitude waves and a background of irregular spikes
3. mental retardation/developmental regression

(b) Hard to tx, mainstay is to give ACTH

92
Q

Tx for pseudotumor cerebri

(a) First line
(b) Next steps
(c) Treating RF

A

Pseudotumor cerebri

(a) Acetazolaminde = carbonic anhydrase inhibitor to decrease CSF production
(b) Optic nerve sheath fenestration to prevent blindness, can do serial LPs or VP shunt
(c) Bariatric surgery for wt loss shown to be effective

93
Q

Test to confirm myasthenia gravis in first visit

A

Tensilon test = edrophonium = readily reversible AChE inhibitor that improves muscle weakness, while worsening weakness seen in cholinergic crisis

94
Q

Concern when starting pt on lamotrigine

A

Lamotrigene (Lamictal) has to be titrated slowly to therapeutic dose 2/2 association w/ Steven-Johnson syndrome

-when starting lamotrigine, be cautious of new onset rash

95
Q

Familial hemiplegic migraine

A

Aut dom migraine d/o w/ hemiparesis during the migraine aura

96
Q

Otherwise 65 yo M has first seizure of his life, suspected dx?

A

Brain tumor

-rate of epilepsy declines significantly after 60 (highest in early childhood ages 0-14)

97
Q

What anti-epileptic med is contraindicated in pt w/ a h/o kidney stones

A

Topiramate (Topamax)

98
Q

Pt has sudden LOC and tonic-clonic mov’t of extremities w/ urinary incontinence and tongue-biting

Type of seizure?

A

Primary generalized seizure

99
Q

Define epilepsy

A

2 or more unprovoked seizures

100
Q

Albuminocytologic dissociation

A

CSF finding of high protein w/ normal cell count seen in Guillain-Barre
-but not seen acutely, takes about a week to develop

101
Q

MRI findings in tuberous sclerosis

A
  • cortical tubers (tubers…tuberous)
  • subependymal nodules
  • subependymal giant cell astrocytomas = benign but can enlarge and obstruct CSF flow
  • ventriculomegaly
102
Q

76 yo M develops constant dull pain in the side of his head that is worse w/ chewing

Dx

A

Dx = temporal arteritis- over 60 yoa, indolent headache in the temple, jaw claudication

103
Q

Distinguishing features of Lew Body Dimentia vs. Parkinsons

A

Early onset dementia, hallucinations, hypersensitivity to antipyschotics

LBD: fluctuating alertness/awareness

Neuro Shelf (12 decks)

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