Neuro

Question 1

What are the characteristic features of NF1?

Answer 1

Cafe-au-lait spots
Macrocephaly
Feeding problems
Short stature
Learning disabilities

Later, they develop:
Fibromas
Neurofibromas
Other tumors

Question 2

What are the characteristic features of NF2?

Answer 2

Bilateral acoustic neuromas

Cataracts

Question 3

What is Alteplase?

Answer 3

IV Thrombolytic

Give within 3.5 - 4 hours of stroke symptom onset

Question 4

A patient is on ASA therapy and has a stroke anyway. What do you give them?

Answer 4

ASA

+

Dipyridamole or Clopidogrel

Question 5

CGG’ trinucleotide repeat expansions are associated with

Answer 5

Fragile X Syndrome

Question 6

Syndrome:
ADHD features
Autism-like features
Speech delay
Motor delay

Head abnormalities
Macroorchidism

Answer 6

Fragile X Syndrome

Question 7

Arachnodactyly

Answer 7

Long slender fingers

Most commonly found in Marfan Syndrome

Question 8

Marfan Syndrome

Answer 8

Tall
Thin
Ectopia Lentis
Pectus Carinatum
Aortic Root Dilation

Question 9

Internuclear Ophthalmoplegia

Answer 9

Affected eye can’t adduct
Contralateral eye abducts with nystagmus
Accommodation intact

From damage to MLF
If bilateral, it is likely MS

Question 10

Bilateral MLF Lesions

Answer 10

Bilateral Internuclear ophthalmoplegia

Classically seen in MS

Question 11

Unilateral MLF Lesion

Answer 11

Unilateral internuclear ophthalmoplegia

Lacunar stroke in pontine artery distribution

Question 12

Damaged Edinger-Westphal Nucleus

Answer 12

Interrupted Preganglionic Parasympathetic outflow to the eye

Ipsilateral fixed dilated pupil nonreactive to light or accommodation

Question 13

Common complication in premature and underweight neonates

Answer 13

Interventricular hemorrhage
Blood in subarachnoid space impairs arachnoid villi from absorbing CSF
Leads to communicating hydrocephalus

Question 14

2 Components of Occulomotor Nerve

Answer 14

Inner Somatic Fibers - Levator, EOMs

Superficial Parasympathetic Fibers - Iris Sphincter, Ciliary Muscles

Question 15

Ischemic CN III Injury

Answer 15

Inner somatic fibers are further from blood supply
Ptosis + Down-and-Out
Preserved pupillary response (this is compromised in compressive neuropathy)

(Microvascular complication from diabetes)

Question 16

What age is normal for breath holding spells?

Answer 16

6 months to 2 years

Question 17

Management of breath holding spells

Answer 17

Reassurance - Does not affect development

Some will stop by age 5
Some will develop vasovagal syncope later in life

Question 18

Hypertensive hemorrhagic stroke affects which arteries?

Answer 18

Small penetrating arteries

Like a lacunar stroke

Question 19

Sudden focal neurologic deficits that gradually worsen over minutes to hours

Answer 19

Intraparenchymal brain hemorrhage

Occur during routine activity
Precipitated by exertion
Progresses to headache, vomiting, seizures (if lobar) and AMS

Question 20

Stroke where symptoms are maximal at onset

Answer 20

Embolic Stroke

Also true of subarachnoid hemorrhage

Question 21

Stroke where symptoms progress in a stuttering fashion

Answer 21

Ischemic stroke

Question 22

Most frequent locations for hypertensive hemorrhagic stroke

Answer 22

Basal Ganglia
Cerebellar Nuclei
Thalamus
Pons

Question 23

Putaminal Hemorrhage

Answer 23

Almost always involves adjacent Internal Capsule

Contralateral hemiparesis
Contralateral hemianesthesia
Conjugate gaze deviation (toward side of lesion)

Question 24

Cerebellar Hemorrhage

Answer 24

Occipital Headache
Nausea/Vomiting
Dizziness
Ataxia/Dysmetria

No hemiparesis

Question 25

Difference between thrombotic/embolic MCA stroke & Putaminal Hemorrhage

Answer 25

Both give you contralateral hemiparesis and conjugate gaze towards the lesion Headache & sudden neuro deficits that gradually worsen indicate hemorrhage

Question 26

Medial medullary syndrome

Answer 26

Branch occlusion of Vertebral Artery or ASA Contralateral arm & leg paralysis (Lateral Corticospinal) Contralateral loss of position sense (Dorsal Column) Tongue deviation towards lesion (Hypoglossal)

Question 27

Midbrain Ischemic Stroke

Answer 27

Ipsilateral occulomotor nerve palsy Ataxia (Superior cerebellar peduncle) Contralateral hemiparesis (Basis pedunculi)

Question 28

Bilateral Pontine Hemorrhage

Answer 28

``` Coma (Reticular Activating System) Total paralysis (Corticospinal & corticobulbar) Pinpoint Pupils (Descending sympathetics) ```

Question 29

Type B Adverse Drug Reaction

Answer 29

Unexpected, dose-independent pharmacologic effect Stevens-Johnson Syndrome (Lamotrigine) Neuroleptic Malignant Syndrome (Antipsychotics)

Question 30

Type A Adverse Drug Reaction

Answer 30

Dose-dependent Respiratory depression (Opioids)

Question 31

Treatment for Neuroleptic Malignant Syndrome

Answer 31

Cessation of offending agent | Dantrolene

Question 32

Serotonin Syndrome

Answer 32

AMS Autonomic instability Neuromuscular excitability (tremor, hyperreflexia, myoclonus)

Question 33

Brainstem ischemic strokes

Answer 33

Crossed Signs Ipsilateral cranial nerve deficit Contralateral hemiplegia

Question 34

NPH Classic Triad

Answer 34

``` Cognitive Dysfunction Gait difficulty (Wide-based) Urinary Incontinance ```

Question 35

Spinal Cord Infarct

Answer 35

Abrupt Symptoms Weakness (may progress) Loss of pain & temp (ASA Infarct) Autonomic Dysfunction

Question 36

Naproxen vs. Ibuprofen

Answer 36

Naproxen has a longer duration | Better for patients who require more frequent dosing

Question 37

Topical Capsaicin

Answer 37

Used for mild to moderate neuropathic pain Postherpetic neuralgia

Question 38

Medications most commonly leading to torticollis

Answer 38

Typical Antipsychotics Metoclopramide Prochlorperazine

Question 39

Hemiballismus

Answer 39

Unilateral, violent arm flinging Caused by damage to contralateral STN Tends to be self-limited

Question 40

Headache - Warning Signs that indicate early imaging

Answer 40

Neuro Findings: Seizure, consciousness changes, specific deficits Difference from prior headaches: Change in frequency, intensity, characteristics Other: New at age >40, sudden onset, trauma, present on awakening

Question 41

Patient is in myasthenic crisis and has to be intubated

Answer 41

Hold cholinesterase inhibitors (reduce excess airway secretions) IVIG or Plasmapheresis (preferred) + Corticosteroids Consider mycophenolate or azathioprine if steroids don't work

Question 42

Brain CT/MRI - Butterfly appearance with central necrosis

Answer 42

Glioblastoma multiforme

Question 43

Brain CT/MRI - Heterogenous & Serpiginous contrast enhancement

Answer 43

High-grade astrocytoma

Question 44

LP - Elevated CSF protein, normal white count

Answer 44

Guillain Barré