Neuro

Question 1

Neurofibromatosis type 1 (Von Recklinghausen disease)

Answer 1

Autosomal dominant disorder caused by mutation in the NF1 tumor surprsso right gene. Pts develop numerous cutaneous neurofibromas comprised mostly of Schwann cells, which are embryologically derived from neural crest cells

Question 2

Location of lumbar puncture

Answer 2

Optimal location is space btwn L3/L4 or L4/L5 as this is well below the spinal cord termination site (L1 in adults).
L4 vertebral body lies on a line drawn btwn the highest points of the iliac crest

Question 3

Major depression

Answer 3

SIGECAPS

Sleep disorder
Interest deficit (anhedonia)
Guilt (worthlessness, regret)
Energy deficit
Concentration deficit 
Appetite disorder
Psychomotor retardation or agitation
Suicidality

Question 4

Germinoma

Answer 4

Most common pineal gland tumor and present with obstructive hydrocephalus (papilledema, headache and vomitting) and dorsal midbrain (Parinaud) syndrome. Germinomas in the suprasellar region cause endocrinopathies due to pituitary/ hypothalamic dysfunction

Parinaud syndrome: limitation of upward gaze w a downward gaze preference, bilateral eyelid retraction and light-near dissociation

Question 5

Cerebellum

Answer 5

• vermis and 2 cerebellar hemispheres
• cerebellar hemispheres: motor planning and coordination of the ipsilateral extremities via lateral descending motor systems; lesions result in dysdiadochokinesia (impaired rapid alt movement), limb dysmetria (undershoot/overshoot during targeted movement) and intention tremor
• cerebellar vermis: axial/truncal posture and coordination via medial descending motor systems; lesions result in truncal ataxia
• vertigo and nystagmus may occur due to disruption of flocculonodular lobe

Question 6

Spontaneous deep intracerebral hemorrhage

Answer 6

Typically caused by hypertensive vasculopathy involving the penetrating branches of the major cerebral arteries. Most commonly infected include the basal ganglia (putamen), cerebellar nuclei, thalamus and pons. BG is supplied by the lenticulostriate arteries, which are small branches off the middle cerebral artery

Question 7

Liquidation necrosis

Answer 7

Complete digestion and removal of necrotic tissue with formation of cystic cavity. Hypoxic CNS injury is often followed by liquifactive necrosis. Abcess formation due to bacterial or fungal infection is another example of this type of necrosis.

Lysosomal enzymes from ischemic neurons degrade tissue

Question 8

Liquidation necrosis

Answer 8

Complete digestion and removal of necrotic tissue with formation of cystic cavity. Hypoxic CNS injury is often followed by liquifactive necrosis. Abcess formation due to bacterial or fungal infection is another example of this type of necrosis.

Lysosomal enzymes from ischemic neurons degrade tissue

Question 9

Lithium induced diabetes insipidus

Answer 9

Lithium induced nephrotoxic diabetes insipidus reduces the ability of the kidneys to concentrate urine primarily by antagonizing the action of ADH in the collecting duct and tubule. Sx: polydypsia, polyuria, and inappropriate low urine specific gravity after water restriction.

Question 10

Treatment of insomnia in elderly

Answer 10

Ramelteon- melatonin agonist, safe and effective in reducing time to sleep onset in the elderly