Neuro

Question 1

Slow progressively memory loss in older patients. Dx? What labs to order? Test? Rx?

Answer 1

Alzheimers Dementia. TFTs, B12, RPR,VRDL, Head CT ( diffuse symmetrical atrophy). Aricept, Memanitine ( Anticholinesterases)

Question 2

Personality, disinhibit ion, extreme agitation, urinary incontinence. Dx? Rx?

Answer 2

Fronto-Temporal Dementia. CT head shows focal atrophy Aricept, Menantine

Question 3

Fluctuation in cognitive function, slower movements, giat dysfunction, vidid dreams. Dx? Rx?

Answer 3

Lewy body dementia. Anticholinesteraster inhibitors and dopamine agonist.

Question 4

Dementia, urinary incontinence and abnormal gait. Dx? Test? Rx?

Answer 4

Normal Pressure Hydrocephalus. MRI shows ventriculomegaly. Lumbar tap test (drain 30-50cc CSF and assess symptoms) determines if pt will benefit from VP shunt.

Question 5

Vertigo, tinnitus, nausea and loss of balance. Dx? Rx?

Answer 5

Labyrinthitis.

Question 6

Sudden onset of vertigo, dizziness, dysarthia, diplopia and numbness, that comes and goes for days on and off. Dx?

Answer 6

Vertebrobasilar insufficiency.

Question 7

Progressive degenerative brain disorder consisting of behavioral and jerky movements

Answer 7

Huntington’s Disease.

Question 8

Mental impairment, opathalmoplegia, horizontal nystagmus and cerebrellar atatxia. Addition of memory loss and confabluations.

Answer 8

Wenicke encephalopathy. Wernicke-Korsakoff syndrome

Question 9

Seizures, Hypopigmented lesions and developmental delays. What is the predominant cause of death?

Answer 9

Tuberous Sclerosis Complex (seizures, rhabdomyoma (heart), glinohumeraol harmatoma(CNS), angiomylipoma (kidney), skin lesions (ash leaf spots). Epilepsy - all pts need brain MRI and EEG.

Question 10

Worse HA of my life. Dx? Initial Test? Confirmatory test.

Answer 10

SAH. CT will show blood within the first 2-6hrs. If CT scan negative confirm with LP. Xanthocrhomia appears > 6 hrs.

Question 11

Consciousness is not altered. Movements characterized by asynchronous clonic or tonic movements. Pts complain of preictal aura.

Answer 11

Simple Partial (Focal Seziure)

Question 12

LOC + automatism? What kind of seizure?

Answer 12

Complex partial seizure

Question 13

This seizure is associated with sudden cessation of motor activity and speech, common in girls, does not occur before age 5, no post ictal state, pts can experience this daily. Dx? Rx?

Answer 13

Absence Seizures. Valproate or Ethuxsuomide

Question 14

Patients suddenly lose consciousness, their eyes roll back and their entire musculature undergoes tonic contractions, arresting breathing. There is hyperextension gives way to a series of rapid jerks. There is a period of flaccid relaxation. Prodromal symptoms occur and not auras. Dx? Rx?

Answer 14

Generalized Tonic Clonic Seizures. Valproic Acid.

Question 15

Most common seizure in childhood. It is a brieft tonic-clonic seizure associated with fever. No longterm sequelae. Dx?

Answer 15

Simple Febrile Seizure.

Question 16

These begin age 4 and 8 months and present as short lived symmetric contractions of neck, trunk and extremities. Name the 2 types. What are the differences? Rx?

Answer 16

Infantile spasms. Symptomatic Type of infantile spasm associated with CNS malformation (tuberous sclerosis, brain injury, inborn errors of metabolism)
Cryptogenic type better prognosis - birth hx is uneventful. Rx: ACTH

Question 17

Continuous seizure of greater than 30 min. First step? Rx?

Answer 17

Status Epilepticus. ABCs. IV, labs, Give lorazepam if seizure last greater than 5 min.

Question 18

Work up for seizure in children ?

Answer 18

CBC
EEG
Amino acid assay (check for inborn errors of metabolism)
Torch infections: Total cord blood IgM, cultures (blood, urine, CSF,) US of Head in preterm
Rx: Lorazepam or diazepam (rectally)

Question 19

Lesion that causes ptosis, aniscoria? Lesion that causes bulbar and ataxia dysfunction?

Answer 19

1. Posterior communicating artery. 2. Posterior inferior communicating artery

Question 20

Sudden HA associated with pitosis and miosis. Dx? Tesrt Rx?

Answer 20

Carotid artery dissection. CT Angiography. MR Angiography or Catheter angiography is the gold standard. Anti-thrombotic therapy.

Question 21

Excessive day time sleepiness, hynagogic hallucinations Dx? Test? Rx?

Answer 21

Narcolepsy, Sleep study. Modafinil.

Question 22

Rx for acute flare up of MS? Maintenance therapy? Rx for muscle spasms?

Answer 22

IV Steroids. Beta interferan, glatiremer. Baclofen

Question 23

Pt w/ ascending flaccid paralysis + respiratory failure after acute infection, gastroenteritis. Dx? Next step in management?

Answer 23

GBS. Respiratory support. Then plasmapharesis or IVIG.

Question 24

Healthy adolescent that experiences upper extremity myoclonic jerks followed by generalized tonic-clonic seizures. Dx? Test? Rx?

Answer 24

Juvenile Myoclonic Epilepsy. EEG (bilateral polyspike). Valproic Acid.

Question 25

1.2 Camping trip, ascending paralysis, ataxia in hours? 2. Sensation loss and motor weakness over weeks? 3. Followed by URI or GI infection, involving fever, ascending paralysis over weeks? 4. Descending paralysis after eating honey?

Answer 25

1. Tick paralysis. 2. Spinal cord lesion 3. GBS 4. Botulism toxin