Neuro

Question 1

Next steps when brain death is suggested by clinical findings.

Answer 1

Should have two neuro exams to confirm with also an apnea test (no spontaneous respirations when off ventilator for 20 minutes - positive with this and CO2 increase 20 above baseline or to >60)

Question 2

Interval to receive ASA/hep after received tPA for stroke

Answer 2

24 hours after TPA and after 24 hour imaging has been completed

Question 3

Ataxia, encephalopathy and oculomotor dysfunction in chronically malnourished. Can be precipitated if dextrose given before thiamine

Answer 3

Wernicke Encephalopathy

Question 4

Reasons to hospitalize after recent TIA due to higher risk of stroke within next 24-48 hours

Answer 4

TIA duration > or = 1 hour, symptomatic ICA stenosis >50%, multiple recurrent TIAs, a fib, hypercoaguable state, high risk TIA according to ABCD^2 score

Question 5

patients over 50 with recently diagnosed or relatively well controlled diabetes presenting with acute onset focal asymmetric limb pain with associated weakness and orthostasis and weight loss

Answer 5

Diabetic amyotrophy

Question 6

Fever, rash, lymphadenopathy, facial edema, eosinophilia, and other organ involvement (nephritis, hepatitis) with recent initiation of anticonvulsant

Answer 6

Anticonvulsant Hypersensitivy Syndrome - a type of DRESS

Question 7

Timing of interventions for acute ischemic strokes

Answer 7

TPA within 4.5 hours. Large anterior circulation strokes can undergo mechanical thrombectomy within first 24 hours of symptom onset

Question 8

Rinne test is abnormal in affected ear (bone > air conduction), weber test localized to affected ear

Answer 8

Conductive hearing loss

Question 9

Rinne test is normal in both ears (air > bone conduction), weber test localizes to unaffected ear

Answer 9

Sensorineural hearing loss

Question 10

Most probable cause of spontaneous ICH in patients >75 years old with prior spontaneous ICH

Answer 10

Cerebral amyloid angiopathy

Question 11

Cut offs for dementia on MMSE

Answer 11

<24, however if highly educated adn the question stem seems like dementia - do dementia regardless of normal MMSE

Question 12

CSF with normal WBCs and glucose, high protein

Answer 12

Guillan-barre syndrome

Question 13

Myashtenia gravis with anterior mediastinal mass

Answer 13

thymoma

Question 14

Unilateral headache in trigeminal distribution with ipsilateral autonoimc symptoms, duration 2-30min, > or = 5 attacks per day. Complete resolution with indomethacin

Answer 14

Paroxysmal hemicrania

Question 15

Painful asymmetric sensory and motor neuropathy. Affects 2 or more nerves in different parts of the body. More common in patients with vasculitidies, CT disorders or systemic diseases like diabeetes

Answer 15

mononeuritis multiplex

Question 16

What blood test is needed prior to adminstering TPA?

Answer 16

Blood glucose - should not give TPA if BG < 60. Hypoglycemia can both mimic strokes and worsen ongoing ischemic injury

Question 17

Major cause of death within first 24 hours of subarachnoid hemorrhage diagnosis

Answer 17

Rebleed - should do an angiogram with potential for endovascular intervention to stabilize the aneurysm.

Question 18

What occurs around day 3 of a SAH?

Answer 18

Vasospasm. Hyperdynamic therapy (modest hemodilution, induced HTN and hypervolemia) and nimodipine can effective reduce this risk.

Question 19

Acute onset dizziness with nausea/vomiting, unsteady gait, dysarthria and diplopia with underlying lung, gynecologic or breast cancer

Answer 19

Paraneoplastic cerebellar degeneration

Question 20

Bluish tinting to vision, blurring vision and photophobia in a patient with erectile dysfunction

Answer 20

Can occur as a side effect of phosphodiesterase inhibtiors.

Question 21

Next steps after a first seizure unprovoked

Answer 21

MRI imaging to identify structural abnormalities and EEG to identify predisposition. If either abnormal - will require anti-epileptics. If normal can manage without anti-epileptics