Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

STEP 5: NEURO SHELF > Miscellaneous_PretestStepup > Flashcards

Miscellaneous_PretestStepup Flashcards

1
Q

In a pt with vertigo, what is the best test to r/o ischemic event = central vertigo - more worrisome vs peripheral vertigo?

A

MRI w/ contrast - Detect stroke, tumor, demyelination (MS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the main distinguishing Sx of CENTRAL VERTIGO? of PERIPHERAL VERTIGO?

A

CENTRAL: + Neighborhood focal neurologic deficits (hemiparesis, hemisensory deficits, diplopia, dysarthria, dysphagia)

PERIPHERAL: + Tinnitus/hearing loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the clinical triad of MENRIERS?

A

TINNITUS + VERTIGO + HEARING LOSS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a very useful agent for vertigo? What properties does this medication have?

A

MECLIZINE - Anti-emetic, anti-cholinergic, anti-histamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the typical Tx for BPPV?

A

EPPLEY MANEUVER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the typical Tx for VESTIBULAR NEURITIS/LABYRINTHITIS?

A

Steroids + Meclizine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the typical Tx for MENRIER’S DISEASE?

A

Salt restriction + HCTZ + Meclizine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 2 main ways to distinguish between SYNCOPE and SEIZURE?

A

1) LOC Duration - Syncope LOC duration &laquo_space;Seizure LOC if there is LOC
2) Bladder control - Seizure (+ Urinary/fecal incontinence) and Syncope (- Urinary incontinence= bladder control is NOT retained)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 2 types of SYNCOPE that occur when pt is upright (sitting or standing)?

A

VASOVAGAL (Neurocardiogenic, vasodepressor, simple faints)

VASCULAR: ORTHOSTATIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are possible life-threatening causes of SYNCOPE if it is exertional?

A

HCM

AORTIC STENOSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which type of syncope can a TILT-TABLE STUDY reproduce Sx in particularly susceptible people?

A

VASOVAGAL SYNCOPE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the proposed pathophysiology of VASOVAGAL SYNCOPE?

A

NORMAL: Standing up (Venous pooling -> Decrease ECV -> Decrease SV -> Decrease CO -> Decrease MAP) -> Enhanced SNS (tachy + vasoconstriction) + Decreased PNS

VASOVAGAL: Paradoxical withdrawal of SNS + Enhanced PNS -> Bradycardia, Vasodilation, Marked Decrease BP, Decreased cerebral perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a physical maneuver to treat VASOVAGAL? What are two possible pharmacological medications to treat VASOVAGAL SYNCOPE?

A

Recumbent position + raise legs

BETA BLOCKERS/ DISOPYRAMIDE (Class IA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the treatment of VASCULAR: ORTHOSTATIC syncope?

A

Na+ intake
Fluids

Possible consideration of FLUDROCORTISONE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most important decision making factor in SYNCOPE pts?

A

GOAL #1: To determine if it is CARDIOGENIC or NON-CARDIOGENIC: Determine if pt has/doesn’t have structural heart disease + Abnormal EKG

CARDIOGENIC = Worst prognosis 
NON-CARDIOGENIC = Better prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If pt does NOT have heart disease and SYNCOPE is unexplained, what becomes the most important test for evaluating for VASOVAGAL or VASCULAR: ORTHOSTATIC?

A

TILT TABLE TEST- Will be POSITIVE in vasovagal and orthostatic syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What test is done on ALL syncopal pts?

A

EKG - Because it can identify any life-threatening causes (Vtach, other arrhythmia, MI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common age group of ALS? What is affected in this pathology?

A

Between 50-70

Anterior horn + CST + CBT - Only MOTOR involvement (PROGRESSIVE MUSCLE WEAKNESS) = LMN + UMN signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What major organ is involved in END-STAGE ALS? What is the progression to end-stage?

A

RESPIRATORY MUSCLE WEAKNESS

Initially -> DOE dyspnea on exertion -> ORTHOPNEA at rest -> SLEEP APNEA -> RESPIRATORY FAILURE (END-STAGE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the classic presentation of an ALS pt? (Remember Dr. Belsh’s pts)

A

A 50yo male whose muscles have atrophied, fasciculations seen in triceps, increased tone, hyper-reflexic, slurred speech, weight loss/fatigue, but has no associated pain

NORMAL/unaffected: Sensory, cognition, bowel/bladder control, extra-ocular muscles, sexual fn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the etiology of ALS?

A

10% familial, 90% sporadic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the prognosis of ALS?

A

POOR

80% 5-year mortality, 100% 10-year mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the specific diagnostic test for ALS?

A

NONE

EMG and Nerve conduction studies - useful for confirming LMN degeneration + r/o NMJ d/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the clinical diagnosis of PROBABLE ALS?

A

Involvement of 2 regions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the clinical diagnosis of DEFINITE ALS?

A

Involvement of 3-4 regions - bulbar, cervical, thoracic, and lumbosacral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the Tx of ALS?

A

Mostly supportive

RILUZOLE = Glu-blocking agent but not much evidence supporting it (only delays death by 3-5mo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the purpose of an EMG study? Which types of pathologies can be detected using an EMG?

A

EMG Study - Measures contractile property of skeletal muscles

1) LMN LESION - FIBRILLATIONS/fasciculations at rest
2) MYOPATHY - NO ACTIVITY at rest, DECREASING AMPLITUDE with muscle contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the purpose of a NERVE CONDUCTION STUDY? Which types of pathologies can be detected using a NCS?

A

NCS: Tests speed of conduction through the nerve

1) DEMYELINATION - MS, GBS (Decreased conduction velocity)
2) MYASTHENIA GRAVIS - Repetitive stimulation causes fatigue (worsened with muscle use)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Ddx of FACIAL NERVE PALSY?

A

1) STROKE - Pontine stroke
2) BELLS PALSY - Idiopathic, diabetic mononeuropathy, viral etiology
3) VIRAL - HSV, HIV, Lyme, VZV, GBS (bilateral palsy)
4) NEOPLASTIC - Leptomeningeal carcinomatosis, acoustic neuroma, schwannoma NF2, cholesteatoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the Tx of TRIGEMINAL NEURALGIA? Which pathology is this most commonly associated with?

A

CARBAMAZEPINE

Most commonly associated with MULTIPLE SCLEROSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the 1st line Tx for SYMPTOMATIC MENINGIOMA (p/w HA, seizure, FND due to mass effect)?

A

SURGICAL RESECTION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the 1st line Tx for DIFFUSE METASTATIC BRAIN DISEASE?

A

WHOLE BRAIN RADIATION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Compare NF-1 and NF-2 (gene mutation, location of mutation gene, main clinical features).

A

NF-1 = VON RECKLINGHAUSEN, NF1 tumor suppressor protein NEUROFIBROMIN (Chrom 17), CAFE AU LAIT/ MULTIPLE NEUROFIBROMAS/ LISCH NODULES/ Macrocephaly, feeding problems, short stature, learning disabilities

NF-2 = CENTRAL NEUROFIBROMATOSIS, NF2 tumor suppressor protein MERLIN (Chrom 22), BILATERAL ACOUSTIC NEUROMAS + CATARACTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the most common type of INTRACRANIAL LESION in NF1 that typically manifests during toddlerhood? What should be ordered if the NF1 pt starts having HOLOCRANIAL HEADACHES?

A

OPTIC PATHWAY GLIOMA

Order MRI of BRAIN/ORBIT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which neurocutaneous syndrome is associated with CORTICAL HAMARTOMAS + ASH LEAF HYPOPIGMENTED MACULES + FACIAL ANGIOFIBROMAS + CARDIAC RHABDOMYOMA + RENAL ANGIOLEIOMYOMAS?

A

TUBEROUS SCLEROSIS (TSC1, TSC2)

36
Q

What is a common neurological complication in PREMATURE BABIES (<30wks gestation) or <3.3lbs)? How do they present with this side effect?

A

INTRAVENTRICULAR HEMORRHAGE -

CP: LETHARGY + DECREASED TONE + RAPIDLY INCREASING HEAD CIRCUMFERENCE + BULGING FONTANELS + HIGH PITCHED CRY + SEIZURES

37
Q

What is a common complication of PREMATURE/UNDERWEIGHT NEONATES with INTRAVENTRICULAR HEMORRHAGE?

A

COMMUNICATING HYDROCEPHALUS - Blood in subarachnoid space -> impairs ability of arachnoid villi to absorb CSF

38
Q

How do MIGRAINES in children differ from MIGRAINES in adults?

A

CHILDREN - More BIFRONTAL, shorter duration

ADULTS - Typically more UNILATERAL, can last up to 72hrs

39
Q

What is the FIRST LINE OF TX for ACUTE MIGRAINE HEADACHES in children <12yo?

A

NSAIDS + SUPPORTIVE (Lying in a dark, quite room with a cool cloth on forehead)

40
Q

What is CUSHING REFLEX?

A

TRIAD: HTN + BRADYCARDIA + RESPIRATORY DEPRESSION in response to increased ICP

41
Q

What are the typical sx of INTRACRANIAL HTN?

A

HEADACHE (worse at night), N/V, AMS, Papilledema, FND, Cushing reflex

42
Q

Multiple brain lesions in BOTH HEMISPHERES + Surrounding edema is highly suggestive of ___?

A

BRAIN METASTASIS

43
Q

Where are the most common sites of brain metastasis?

A

LUNG&raquo_space; BREAST > UNKNOWN> MELANOMA > COLORECTAL

44
Q

Where is the most common INJURY resulting in ACUTE EPIDURAL HEMATOMA/?

A

SPHENOID BONE - laceration of middle meningeal artery

45
Q

COMA PT: Traumatic acceleration/deceleration shearing forces of BRIDGING VEINS

CTH: Diffuse, small bleeds at gray-white matter junction

A

DIFFUSE AXONAL INJURY (diffuse damage to small axons)

46
Q

NEWBORN (e.g. 10hr old) Pt: SWELLING limited to SURFACE OF ONE CRANIAL BONE

No visible pulsations (swelling) until several hours later + No discoloration of overlying scalp = ?

Tx = ?

A

CEPHALOHEMATOMA

Subperiosteal hemorrhage (SLOW process)

Tx = Generally spontaneously resorbs within 2wks-3mo

47
Q

NEWBORN Pt: DIFFUSE, ECCHYMOTIC SWELLING OF THE SCALP usually involving portion of the head presenting during vertex delivery. Extends across midline + across suture lines

A

CAPUT SUCCEDANEUM

48
Q

NEWBORN Pt: PULSATIONS + INCREASED PRESSURE UPON CRYING + ROENTGENOGRAPHIC evidence of bony defects = ?

A

CRANIAL MENINGOCELE

49
Q

NEONATES: APNEA + PALLOR/CYANOSIS + POOR SUCKLING + ABNORMAL EYE SIGNS + HIGH-PITCHED CRY + MUSCULAR TWITCHING/CONVULSIONS + HYPOTONIA/PARALYSIS + decreased hematocrit/ metabolic acidosis + shuck + TENSE/BULGING FONTANELS = ?

A

INTRACRANIAL HEMORRHAGE - commonly associated with PREMATURITY

50
Q

NEWBORN Pt: INDENTATIONS OF CALVARIUM similar to a dent in a ping-pong ball as a complication of FORCEPS DELIVERY or FETAL HEAD COMPRESSION

A

DEPRESSED FRACTURES

51
Q

What are the normal milestones for 3yo, 4yo, 5yo, 6yo?

A

3yo - Able to copy a cross/circle
4yo - Able to copy square/rectangle
5yo - Able to copy triangle
6yo - Able to copy a diamond

52
Q

PORT-WINE STAIN (Red flat lesion) on CNV distribution + FOCAL/GENERALIZED SEIZURES + MENTAL RETARDATION = ?

A

STURGE WEBER SYNDROME

Other possible findings: HEMIANOPIA + HEMIPARESIS + HEMISENSORY DISTURBANCE + IPSILATERAL GLAUCOMA

53
Q

SKULL X-RAY: “TRAMLINE” Gyriform intra-cranial calcifications seen in a child >2yo = ?

A

STURGE WEBER SYNDROME

54
Q

What is the Tx of STURGE WEBER SYNDROME?

A

1) Control seizure
2) Reduce IOP
3) Argon laser therapy - Remove skin lesions

55
Q

BILATERAL RETINAL HEMORRHAGES in an INFANT<1yo is pathognomonic for?

A

ABUSIVE HEAD TRAUMA - Subdural bleeding (accel/decel causing shearing of dural veins + coup-contrecoup injury + VITREORETINAL TRACTION) + AMS/SEIZURES/INCREASED HEAD CIRCUMFERENCE + Bulging/tense anterior fontanelle = SHAKEN BABY SYNDROME

56
Q

What type of toxicity is seen with TRIHEXPHENIDYL or BENZTROPINE?

A

ANTI-CHOLINERGIC TOXICITY:

Dry skin, dry mouth, constipation, urinary retention, vision changes, flushing, confusion

57
Q

IPSILATERAL ATAXIA (Pt tends to fall Towards side of lesion, asked to stand with feet tog, sways towards side of lesion) + IPSILATERAL HYPOTONIA + INTENTION TREMOR + NYSTAGMUS + RAM DEFICITS

+ INCREASED ICP - headache, nausea, vomiting, papilledema = ?

A

CEREBELLAR TUMOR

compression and obstructing CSF causes INCREASED ICP

58
Q

WIDE BASED GAIT + Feet lifted higher than usual + Feet make SLAPPING SOUND when contacting the floor (to help them know where their LL are relative to the floor) + POSITIVE ROMBERG= AFFECTING WHAT?

A

POSTERIOR/DORSAL COLUMNS

TABES DORSALIS (manifestation of neurosyphilis) or VitB12 deficiency

59
Q

GAIT: Affected arm is ADDUCTED + Affected leg is EXTENDED/swings outward in a semicircle. What happened to the pt most likely?

A

HEMIPARETIC PT (Due to stroke)

60
Q

GAIT: WADDLING gait due to weakness of gluteal muscles

A

MUSCULAR DYSTROPHY

61
Q

RISPERIDONE
AE 1: Decreased dopamine in TUBEROINDFUNDIBULAR pathway = ?
AE 2: Decreased dopamine in NIGROSTRIATAL PATHWAY = ?

A

AE 1: HYPERPROLACTINEMIA - Decreased dopamine in D2R (tuberoinfundibular path) - Decreased inhibition of PRL -> ERECTILE DYSFN + DECREASED LIBIDO + BILATERAL BREAST ENLARGEMENT + AMENORRHEA + GALACTORRHEA

AE 2: PARKINSONIANISM (SN to basal ganglia) - Mvmt coordination

62
Q

RISPERIDONE THERAPEUTIC EFFECT = ?

A

Decreased dopamine in MESOLIMBIC PATHWAY (ventral tegmentum to limbic) - Antipsychotic effect

63
Q

INCREASED DOPAMINE in MESOLIMBIC PATHWAY is associated with? DECREASED DOPAMINE in MESOLIMBIC PATHWAY is associated with?

A

INCREASED DOPA IN MESOLIMBIC = EUPHORIA (drug use) + delusions/hallucinations in schizophrenics

DECREASED DOPA in mesolimbic = ANTI-PSYCHOTIC EFFICACY

64
Q

INCREASED DOPAMINE in NIGROSTRIATAL PATHWAY is associated with? DECREASED DOPAMINE in NIGROSTRIATAL PATHWAY is associated with?

A

INCREASED DOPA IN NIGROSTRIATAL = HUNTINGTON SX (Chorea/tics)

DECREASED DOPA IN NIGROSTRIATAL = PARKINSON’S

65
Q

INCREASED DOPAMINE IN TUBEROINDFUNDIBULAR PATHWAY is associated with? DECREASED DOPAMINE in NIGROSTRIATAL PATHWAY is associated with?

A

INCREASED DOPA IN TUBULOINFUNDIBULAR = HYPO-PRL

DECREASED DOPA IN TUBULOINFUNDIBULAR = HYPER-PRL (Gynecomastia, breast enlargement, decreased libido, amenorrhea, galactorrhea

66
Q

How does a TRANSTENTORIAL HERNIATION OF UNCUS (parahippocampal gyrus) during HEAD TRAUMA present?

A

1) Compression of IPSILATERAL CN III: IPSILATERAL DOWN/OUT/MYDRIASIS
2) Compression of CONTRALATERAL CRUS CEREBRI against tentorial edge: IPSILATERAL HEMIPARESIS
3) Compression of IPSILATERAL PCA: CONTRALATERAL HOMONYMOUS HEMIANOPIA
4) Compression of RETICULAR FORMATION: Altered LOC, COMA

67
Q

How does TROCHLEAR N. PALSY present?

A

VERTICAL DIPLOPIA
Worsens - Eye looks down and towards nose (walking downstairs or reading)

Gets better - tilt head away and chin towards lesion

68
Q

ABNORMAL HEAD THRUST TEST (Rapid head movement away from a fixed target causes eye mvmt AWAY from target followed by HORIZONTAL SACCADE twd it) is indicative of __? (Hint: drug toxicity)

A

GENTAMICIN (AMINOGLYCOSIDE) Toxicity

1) Damage to cochlear cells = HEARING LOSS
2) Damage to motion-sensitive hair cells = VESTIBULOPATHY

Vestibulopathy +/- ototoxicity (hearing loss)

NORMAL: Rapid head movement away from target causes eyes to remain FIXED on target

69
Q

ENLARGED BLIND SPOTS + HEADACHE/VISION LOSS that gets worse with changes in head position (Comes on in the morning when she stands up suddenly OR stoops fwd abruptly) = ?

A

PSEUDOTUMOR CEREBRI (IDIOPATHIC INTRACRANIAL HTN) - Papilledema

Headaches worse in morning are generally 2/2 INCREASED ICP

70
Q

Hours to days after a mild TBI: HA + Confusion/amnesia + Difficulty concentrating + vertigo + mood alteration/anxiety + sleep disturbance = ?

A

POST-CONCUSSIVE SYNDROME (Can last >=6mo)

71
Q

OCULAR DISTURBANCES + ALTERED CONSCIOUSNESS + ATAXIA + SIGNIFICANT MEMORY IMPAIRMENT = ?

A

KORSAKOFF SYNDROME

Can occur concurrently or BEFORE Wernicke encephalopathy
Both caused by VitB1 deficiency

72
Q

How do you differentiate between PSEUDOTUMOR CEREBRI and NPH on MRI?

A

NPH: Dilated ventricles compared to sulci

PSEUDOTUMOR CEREBRI: Slit-like (shrunken) 3rd ventricle

73
Q

GENERALIZED SYMMETRIC PROXIMAL MUSCLE WEAKNESS (LE weakness >UE weakness) + HYPOREFLEXIA

A

WERDNIG-HOFFMAN DISEASE (SPINAL MUSCULAR ATROPHY)

74
Q

ALTERED MENTAL STATUS + GAIT INSTABILITY (ATAXIA) + OCULAR DISTURBANCES (HORIZONTAL NYSTAGMUS/CONJUGATE GAZE PALSY) = ?

A

WERNICKE ENCEPHALOPATHY

75
Q

CORE TEMP >40 + AMS (Acute confusion + hyperthermia + tachycardia + persistent epistaxis/coagulopathic bleeding)

A

HEAT STROKE

76
Q

When do pts get MALIGNANT HYPERTHERMIA?

A

Genetically susceptible individuals under anesthesia such as HALOTHANE + SUCCINYLCHOLINE

77
Q

CONTRALATERAL SENSORY (Pain, vibration, agraphesthesia, astereognosis) + Contralateral inferior quadrantanopsia = Where is the lesion?

A

DOMINANT PARIETAL LOBE

78
Q

ANOSOGNOSIA (Denial of one’s disabilities) + CONTRALATERAL apraxia = Where is the lesion?

A

NON-DOMINANT PARIETAL LOBE

79
Q

HA + FEVER + PROPTOSIS + IPSILATERAL DEFICITS IN CN 3,4,5,6 + BILATERAL PERIORBITAL EDEMA = ?

A

CAVERNOUS SINUS THROMBOSIS 2/2 infection of the medial face or sinuses spreading into cavernous sinus

80
Q

What is the management for SOLITARY BRAIN METASTASIS in pts with good performance status and stable extracranial disease? How about for MULTIPLE BRAIN METASTASES?

A

SURGICAL RESECTION for solitary brain mass

WHOLE BRAIN RADIATION for diffuse metastasis brain

81
Q

Which cord syndrome is commonly associated with a BURST FRACTURE OF THE VERTEBRA or Anterior spinal artery infarct after repair of a thoracic aorta aneurysm?

A

ANTERIOR CORD SYNDROME

82
Q

FEVER (>40 generally) + GENERALIZED MUSCLE RIGIDITY + AUTONOMIC INSTABILITY (diaphoresis, dry mucous membranes, labile BP, tachypnea, tachy)

A

NEUROLEPTIC MALIGNANT SYNDROME - IDIOSYNCRATIC drug rxn to dopamine antagonists (most commonly HALOPERIDOL)

83
Q

TRIAD: Altered mental status + autonomic instability + NM excitability (tremor, HYPER-REFLEXIA, MYOCLONUS) = ?

A

SER SYNDROME

84
Q

What is the Tx of NEUROLEPTIC MALIGNANT SYNDROME 2/2 DOPAMINE ANTAGONISTS?

A

1) REMOVE offending agent
2) Supportive care (hydration, cooling)
3) DANTROLENE, BROMOCRIPTINE

85
Q

STEPPAGE GAIT (Foot slaps due to weakness in foot dorsiflexion) with NEGATIVE romberg sign is most commonly associated with __?

A

L5 RADICULOPATHY - COMMON PERONEAL/FIBULAR NEUROPATHY

STEP 5: NEURO SHELF (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions