Neuro

Question 1

Man loses consciousness during coughing fit / during micturition at night

Answer 1

Situational Syncope

Question 2

Dix-Hallpike maneuver shows upward beating torsional nystagmus, with the upper poles of the eye beating toward the floor, lasting 30 seconds

Answer 2

Benign paroxysmal positional vertigo (BPPV).

Question 3

Asterixis, increased BUN, MS changes, distended abd w/ shifting dullness; dx/rx?

Answer 3

Hepatic Encephalopathy from increased ammonia due to cirrhosis/liver dysfunction (ascites); rx Lactulose

Question 4

MS CSF finding

Answer 4

Oligoclonal bands increased IgG, normal total protein

Question 5

20yof p/w urinary distention; cystometry w/ bethanicol produces exaggerated detrusor contraction; dx?

Answer 5

Upper motor neuron dysfnction, probably MS

Question 6

Internuclear ophthalmoplegia, lesion?

Answer 6

Medial Longitudinal Fasciculus, common in MS

Question 7

Lesion in abducens n?

Answer 7

Convergent strabismus, horizontal diplopia

Question 8

Lesion in medial lemniscus?

Answer 8

Touch and vibration sensations b/l

Question 9

Lesion in trochlear n?

Answer 9

Vertical diplopia and eye torsion

Question 10

Lesion in oculomotor n?

Answer 10

ptosis and down and out eye (unopposed LR and SO)

Question 11

Headache, vomiting, bilateral eyelid edema and extraocular movement restriction; dx?

Answer 11

Cavernous sinus thrombosis, may cause CN 3,4,5,6 deficits

Question 12

Painful red eye, opacification and ulceration of the cornea, yellow discharge, contact lense use; dx?

Answer 12

Contact lense-associated infective keratitis, most commonly Pseudomonas

Question 13

Acute bacterial meningitis CSF?

Answer 13

elevated opening pressure (100–300 mm H2O), 100–10,000 WBCs, Protein elevated (100–500 mg/dL), glucose decreased to

Question 14

3-Hz spike-and-wave pattern EEG dx?

Answer 14

Absence seizures, lasting only a few seconds, and occur many times per day in affected children

Question 15

triphasic discharge pattern in sporadic fashion on EEG?

Answer 15

Creutzfeldt-Jakob disease.

Question 16

high-frequency electrographic discharge in the β frequency (“beta buzz”) with relatively low amplitude, an evolve into slow spike-and-wave complexes or diffuse polyspikes.

Answer 16

Tonic seizures consist of sudden-onset tonic extension or flexion of the head, trunk, and/or extremities

Question 17

Fluent speech, good comprehension, can’t repeat sentences, dx?

Answer 17

Conductive aphasia, the lesion occurs at the arcuate fasciculus between Broca’s and Wernicke’s area.

Question 18

Stroke w/ coma, cranial nerve palsies, apnea, visual symptoms, drop attacks, or dysphagia?

Answer 18

Basilar stroke

Question 19

Loss of pain/temp sensation ipsilateral in face contralaterl body, vestibullocerebellar signs (vertigo, nystagmus), ipsilateral bulbar weakness (dysphagia, hoarseness), horner’s sx (ipsilateral autonomics); dx/location?

Answer 19

Wallenberg’s sx, lesion in lateral Medulla, occlusion on vertebral artery or PICA

Question 20

Contralateral hemiparesis UE/LE (lateral corticospinal tract), decreased proproception (Medial lemniscus, later sign), ipsilateral hypoglossal dysfunction (tongue deviates ipsi); dx/location?

Answer 20

Medial Medullary sx occlusion of paramedian branches of ASA or vertebral artery

Question 21

Ipsilateral facial n palsy w/ contralateral ataxia or hemiplegia

Answer 21

“alternate syndrome” facial nerve nucleus of the (lateral) Pons lesion/stroke, AICA occlusion

Question 22

Ipsilateral oculomotor n palsy w/ contralateral ataxia or hemiplegia

Answer 22

“alternate syndrome” Vertibro basilar (midbrain/brainstem) lesion/stroke

Question 23

Stroke w/ leg paresis, amnesia, personality changes, foot drop, gait dysfunction, also may show urinary incontince, cognitive changes, sensory deficits; dx?

Answer 23

Anterior cerebral artery strokes, c/l motor and/or sensory deficits more pronounced in LE

Question 24

Stroke w/ pure motor (subcoritcal white matter/brainstem) with more face and UE than leg weakness, some dysarthria; dx?

Answer 24

Lacunar stroke; contralateral pure motor via lipohyalinosis of small vessels at post internal capsule

Question 25

Hemisensory loss with severe dysesthasia and athetosis or hemibalismus; dx/ location of lesion?

Answer 25

VPL Thalamus stroke (Dejerine-Roussy sx) w/ contralateral hemi-anaesthesia

Question 26

Weakness more prominent in the legs with poor ipsi leg arm coordination; dx?

Answer 26

Ataxic-sensory Lacunar stroke in the anterior limb of the internal capsule

Question 27

Unilateral numbness, paresthesias, hemisensory deficits of arm, trunk legs and face; dx/location?

Answer 27

Pure sensory lacunar stroke at the ventroposterolateral limb of the thalamus

Question 28

Pure motor dysarthria with hand weakness, No sensory deficits; dx location?

Answer 28

Dysarthria-Clumsy hand syndrome, lacunar stroke at the basis pontis

Question 29

Stroke w/ homonymous hemianopsia, memory deficits, alexia w/o agraphia (dom hemisphere), visual hallucination (calcarine cortex), sensory sx (thalamus); dx?

Answer 29

Posterior cerebral artery strokes; also may p/w 3rd N palsy w/ paresis of horizontal/ vertical eye movements, c/l motor deficits (cerebral peduncle)

Question 30

Stroke w/ aphasia (dominant hemisphere), neglect (non-dominant), contralateral hemiparesis, gaze preference, or homonymous hemianopsia.

Answer 30

Middle cerebral artery (MCA) stroke; conjugate eye deviates towards side of stroke

Question 31

Hemorrhage location? Contralateral hempiparesis and hemisensory loss, homonymous hemianopsia, gaze palsy

Answer 31

Basal Ganglia

Question 32

Hemorrhage location? Contralateral hempiparesis and hemisensory loss, nonreactive pupils, upward gaze, eyes deviate Towards hemiparesis

Answer 32

Thalamus

Question 33

Hemorrhage location? Facial weakness, nystagmus, ataxia, occipital headache

Answer 33

Cerebellum

Question 34

Immigrant p/w recent L sided weakness, hx of nocturnal cough, hemoptysis, exersional dyspnea, hrt palpitations; dx?

Answer 34

Rheumatic heart dz -\> mitral stenosis -\> pulm HTN (hemoptysis, dyspnea) and LA dilatation -\> aFib -\> atrial thrombus embolizes causing stroke

Question 35

Hypertensive brain bleed, location?

Answer 35

The basal ganglia and thalamus are the classic sites of a hypertensive bleed.

Question 36

Papilledema; dilated ipsilateral pupil; palsies of CN3 (most common), CN4 and 6; nuchal rigidity. Dx/ late signs?

Answer 36

Increased ICP; Hemiparesis, hypertonia, hyperreflexia, or Cushing’s triad (HTN, bradycardia, and respiratory depression) are late signs

Question 37

Damage to lateral spinothalamic tract?

Answer 37

Loss of pain and temp contralaterally 2 levels bellow lesion

Question 38

Ipsilateral ataxia, nystagmus, intentional tremor, loss of coordination?

Answer 38

Cerebellar tumor; sways towards affected side,

Question 39

Elder w/ impaired gait, cognitive difficulties, urinary incontinence; dx

Answer 39

NPH Normal Pressure Hydrocephalus; enlarged ventricles on CT

Question 40

20yof p/w headache, N&V, papilledema, vision loss, pulsatile tinitus, normal CSF except P\>250, taking isoretinoin for acne; dx?

Answer 40

IIH Idiopathic Intracranial Htn (pseudotumor cerebri); meds (vit A derivatives, tetracyclines, GH); rx wt loss, Acetazolomide

Question 41

60yo p/w sudden rt sided weakness and hemiplegia, then vomiting and headache, has uncontrolled HTN, dx?

Answer 41

Intraparenchymal hemorrhage in the Putamen, involving the internal capsule (corticospinal tract)

Question 42

Personality changes, memory deficits, compulsive behaviors; dx?

Answer 42

Pick's dz (Fronto-temporal dementia)

Question 43

Fluctuating cognition and attention, parkinsonian motor sx, hallucinations?

Answer 43

Lewy-Body Dementia

Question 44

Diabetic p/w sudden onset loss of vision, floaters, poorly visualized fundus; dx?

Answer 44

Vitreous hemorrhage; a/w diabetic retinopathy

Question 45

Ascending symmetric weakness (polyneuropathy) post GI or UR infection

Answer 45

Guillain Barre (campylobacter sequele) w/ peripheral nerve demyelination (motor, sensory, autonomic)

Question 46

55yoM p/w parkinsonism features, orthostatic hypotension, incontinence, impotence; dx?

Answer 46

Multiple system atrophy (shy-drager sx); autonomic dysfunction, widespread neural signs and parkinsonism; rx fludricortisol

Question 47

30yoF p/w central scotoma, decreased vision acuity and color changes, afferent pupillary defect, pain on eye movement; dx?

Answer 47

Optic neuritis a/w MS

Question 48

Unilateral violent hand swinging?

Answer 48

Hemiballismus; damage to contralateral subthalamic nuclei

Question 49

Funduscopy shows AV nicking, copper/silver wiring, exudates, hemorrhage, dx?

Answer 49

Hypertensive retinopathy

Question 50

Fundoscopy shows tortuos dilated veins, cotton whool spots, diffuse hemorrhage "blood and thunder", swelling of the optic disk; dx?

Answer 50

Central vein occlusion, acute or subacute vision loss/haze

Question 51

Essential tremor, gets worst with intentional movement, rx?

Answer 51

Propanolol (BB) or Primidone (SE include abd pain, neuro/psychiatric disturbances)

Question 52

Down and out gaze with normal light and accomodation reaction, dx?

Answer 52

CN3 oculomotor somatic damage with entact parasympathetic component indicates DM ischemic injury

Question 53

Down and out gaze with fixed dilated pupil dx?

Answer 53

CN3 oculomotor somatic and parasympathetic components involved, as in Nerve Compression

Question 54

Earfullness, vertigo (20min-24h), tinnitis, hearing loss; dx?

Answer 54

Menierre's disease, endolymph in inner ear; rx lifestyle mod (low salt), diuretics, antihistamine, anticholinergics

Question 55

Cranial mass, truncal dystaxia; dx/location?

Answer 55

Cerebellar Vermis, most likely Medulloblastoma

Question 56

Cranial mass, arm/leg/gait ataxia; dx/location?

Answer 56

Cerebellar hemispheres, most likely Astrocytoma

Question 57

Post seizure, pt holding shoulder adducted and internally rotated; dx?

Answer 57

Posterior shoulder dislocation

Question 58

Limited upward gaze, b/l ptosis and upper eye lid retraction, pupils minimal reactive to light but accommodate; dx?

Answer 58

Perinaud's syndrome, pressure in pretectal midbrain near CN3 and superior colliculus

Question 59

2YO boy p/w headaches, vomiting, papilledema, limited upward gaze, b/l ptosis and upper eye lid retraction, pupils minimal reactive to light but accommodate; dx?

Answer 59

Pineal Gland tumur, (hydrocephalus from sylvian duct obstruction), beta-HCG may be produced showing precocious puberty