Neuro

Question 1

Nystagmoid movements and jaw contractions
Disease?
Treatment?

Answer 1

Oculomasticatory myorhythmia
Whippe dz
Abx tx
Dx by duodenal biopsy

Question 2

What r cell types of LGB and what r functions?

Answer 2

Magnocellular
-motion, stereo, contrast sensitivity

Parvocellular
-fine spatial and color

Konio
-modulate other pathways

Question 3

Only VF defect caused by retrochiasmal that is monocular

Answer 3

Temporal crescent only mapped to nasal ipsilateral retina

Anterior occipital infarct

Question 4

Define comitant

Answer 4

Same deviation in all fields of gaze

Question 5

Gradenigos syndrome

Answer 5

Localized inflammation or extra dural abscess of petrous apex (mastoiditis) after otitis media
CN6 w ipsilateral hearing loss, facial pain and paralysis

Pseudo: nasopharyngeal cancer,
CPA tumor, petrous bone fracture, basilar aneurysm, clivus chordoma

Question 6

Where do branches of CN V go?

Answer 6

V from anterior pons
V1 (ophthalmic) - lat wall of cav sinus, splits into lacrimal, frontal, and nasociliary, thru Sup orb fissure

V2 - inferior lat wall cav sinus then Dow. They foramen Rotundum

V3 - NOT thru cav sinus

• leaves foramen Ovale
• sensory and mastication muscles (chewing)

V1,2,3 thru SRO

Question 7

Preauricular pain then couple days later facial paralysis
vesicular rash of ext auditory canal, tympanic membrane or ear
+/- hearing loss and dizziness

Dz? Treatment?

Answer 7

Ramsay-hunt syndrome

• HZV affecting CN7
• tx: acyclovir and prednisone
• poor prognosis (10% recovery)
• consider HIV, Lyme, otitis media, otitis externa (in old diabetics)

Question 8

What innervates lacrimal gland?

Answer 8

CN VII

also innervates salivary glands

Question 9

Which CN of cav sinus does not travel along wall?

Answer 9

VI

All others do (3, 4, V1 and V2)

Question 10

What tests can u do for horners syndrome?

Answer 10

Cocaine test
(give to BOTH eyes)
-blocks reuptake at 2nd synapse (sup cerv ganglion)
-determines if horners present

Hydroxyamphetamine
(give to both eyes)
-distinguishes pre vs post ganglionic. 
-releases norepinephrine 
- if positive: pupil dilates meaning this is pre ganglionic (ie postgang neuron in tact)
- if negative:

Question 11

Retinal pigment degeneration
Ophthalmoplegia 
Ptosis
Heart block
What dz?

Answer 11

Kearn-sayre syndrome
(CPEO)
- mitochondrial inheritance

Question 12

Ptosis thats not fatiguable
Proximal muscle pain and weakness
Dysarthria and dysphagia

What dz?
Mechanism?
Associated dz?

Answer 12

Eaton-lambert
Paraneoplastic with small cell lung cancer
Antibodies to calcium channel of ACh presynaptic release
With EMG- increase strength w repeat stim

Question 13

Fusiform and kinking optic nerve mass

What is it?
What is it associated w?
Who gets it?

Answer 13

ON glioma
Assoc w NF (15% of NF pts get this)
Young kids <10 yr
50% intracranial, 50% intraorbital

Question 14

Mass of ON with railroad track sign

What is it?
What is it assoc w?
Who gets it?
What’s the pathology?

Answer 14

ON meningioma
Triad: 
- dec VA, 
-optic atrophy
- shunt vessels 
F:M 3:1
Path: psammoma bodies, whorls of packed spindle cells

Question 15

Cogan’s dictum

Answer 15

Retrochiasmal cause homonymous hemianopia

Asymmetric OKN = parietal (mass usually)
Symmetric OKN = occipital (infarct usually)

Question 16

Which fxn of CN3 is contralateral?

Bilateral?

Answer 16

Contra. Super rectus

Bilateral. Levator

Question 17

Right Sup oblique and left horners

Where’s lesion?

Answer 17

Nuclear CN4 on left (4 crosses!)

Question 18

Cn6 and mastoiditis

Dx?
Tx?

Answer 18

Gradenigo syndrome
Stat ENT consult
Abx and scan

Question 19

What is characteristic pattern for congenital nystagmus?

Fast/slow phase increases/decreases in velocity over time

Answer 19

Slow phase increases in velocity over time