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1
Q

Limited upward gaze, upper eyelid retraction, and pupils non reactive to light but reactive to accommodation. What syndrome? What mass is it associated with?

A

Parinaud syndrome associated with pineal gland masses

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2
Q

Strokes less than ___ hours old are not usually visible on ct

A

Six

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3
Q

How to identify ischemic changes of stroke not detected on ct

A

MRI

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4
Q

Function of lateral corticospinal tract

A

Movement of ipsilateral limbs and body

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5
Q

Lesion of lateral corticospinal tract causes

A

Ipsilateral paresis at and below level of lesion

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6
Q

Lesion of dorsal column medial meniscus tract causes

A

Ipsilateral loss of fine touch, vibration, proprioception at and below level of lesion

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7
Q

Lesion of spinothalamic tract causes

A

Contralateral loss of pain and temp at and below level of lesion

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8
Q

Dorsal column medial meniscus has what function

A

Fine touch, vibration, conscious perception

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9
Q

Spinothalamic tract has what function

A

Pain, temperature

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10
Q

Affects what part of the spinal cord?
Causes what?

Polymyositis

A

Anterior horns

Lmn lesions and flaccid paralysis

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11
Q

Affects what part of the spinal cord?

Ms

A

Mostly white matter in cervical region; dcmm and spinothalamic

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12
Q

Affects what part of the spinal cord?
Causes what?

Ams

A

Anterior horns and lateral corticospinal

Fasiculations, atrophy and weakness of muscles, commonly of hands

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13
Q

Tx of Lou Gehrig’s

A

Riluzole might help

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14
Q

Affects what part of the spinal cord?

Occlusion of anterior spinal artery

A

Front, but spares dorsal columns

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15
Q

Affects what part of the spinal cord?
Causes what?

Tabes dorsalis

A

Dcmm

Impaired sensation and proprioception, ataxia, poor coordination

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16
Q

Affects what part of the spinal cord?
Causes what?

Syringomyelia

A

Syrinx (csf filled cavity in the spinal cord), expanding to damage spinothalamic tract

Capelike bilateral loss of pain and temp in upper extremities

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17
Q

Affects what part of the spinal cord?
Causes what?

Vit b12 def

A

Dcmm and lateral corticospinal

Ataxia, paresthesia, impaired posture and vibration sense

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18
Q

What five diseases can cause facial nerve palsy

A 
Aids
Lyme
Sarcoidosis
Tumors
Diabetes

Alexander Bell had STDs

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19
Q

Tx of increased icp

A

Mannitol and hyperventilation

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20
Q

If it has been <3hrs since onset of stroke treat with

A

Tpa

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21
Q

If it has been > 3hr since onset of stroke, treat with

A

Aspirin

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22
Q

In Mca stroke gaze preference is to side of

A

Lesion

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23
Q

Mca stroke of the ___ hemisphere results in neglect

A

Non dominant

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24
Q

Mca stroke of the ___ hemisphere results in aphasia

A

Dominant

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25
Q

Stroke of the ___ causes contralateral paresis and sensory loss in the leg and cognitive or personality changes

A

Aca

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26
Q

Stroke of the ___ causes contralateral paresis and sensory loss in the face and arm

A

Mca

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27
Q

Sx of lacunar strokes

A

Pure motor, pure sensory, ataxic hemiparesis or dysarthria

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28
Q

Triceps nerve root

A

C7

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29
Q

Biceps nerve root

A

C5

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30
Q

Patella nerve root

A

L4

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31
Q

Achilles nerve root

A

S1

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32
Q

Lp in subarachnoid hemorrhage May show

A

Rbcs and xanthochromia

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33
Q

After subarachnoid hemorrhage how do you prevent vasospasm and subsequent ischemic stroke

A

Ccbs eg nimodipine

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34
Q

—- is major cause of delayed morbidity and mortality in pt with sah

A

Vasospasm

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35
Q

Blown pupil suggests impending

A

Ipsilateral brainstem compression

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36
Q

Onset of sx in subdural hematoma is fast or slow?

A

Slow (days to weeks)

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37
Q

Etiology of subdural hematoma

A

Rupture of bridging veins

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38
Q

Etiology of epidural hematoma

A

Head trauma -> tear of middle meningeal artery

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39
Q

Demographic of epidural hematoma

A

Severe trauma pts

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40
Q

Appearance of subdural hematoma

A

Crescent shape and mass effect with midline shift

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41
Q

Appearance of epidural hematoma

A

Biconvex lens shape

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42
Q

Dx of cavernous thrombosis

A

MRI with gadolinium and mr venography

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43
Q

Tx of cavernous sinus thrombosis

A

Penicillinase-resistant penicillin (nafcillin or oxacillin) plus third or fourth gen cephalosporin

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44
Q

Woman with high BMI with retro orbital headache, n/v, diplopia, papilledema. If not brain tumor what is it?

A

Pseudotumor cerebri aka idiopathic intracranial htn

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45
Q

Can cluster headaches wake you from sleep

A

Yes

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46
Q

Rf of pseudotumor cerebri

A

Obesity
Tcas
Excess vit a

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47
Q

Acute tx of cluster headache

A

High flow o2 or sumatriptan injection

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48
Q

Prophylactic therapy for cluster headache

A

Verapamil

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49
Q

Pt presents with episode of lip smacking associated with impaired level of consciousness followed by confusion, think

A

Complex partial seizures

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50
Q

Aura is common in ___ seizures

A

Partial

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51
Q

Can you see a postictal focal neuro deficit in partial seizure

A

Yes

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52
Q

Impaired level of consciousness in partial simple seizure

A

No

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53
Q

Impaired level of consciousness in complex partial seizure

54
Q

Complex partial seizure usually involves the ___ lobe

55
Q

What seizure am I? Sudden loss of consciousness, possible contraction of muscles, incobtinence, tongue biting, possibly Cyanotic in octal period, postictal confusion and drowsiness

A

Tonic clonic generalized seizure

56
Q

Initial dx if you suspect brain tumor

A

Ct of the brain

57
Q

EEG finding in petit mal/absence seizures

A

3 per second spike and wave discharges

58
Q

For partial and tonic clonic seizures what is the first line tx in kids

A

Phenobarbital

59
Q

Tx of status epilepticus

A

Abcs
Thiamine, then glucose and naloxone
Iv benZos for first 20 min then iv fosphenytoin If still seizing after 20 min

60
Q

Withdrawal from what four drugs can cause seizures

A 
ABBA
Alcohol
Benzos
Barbs
Anticonvulsants
61
Q

Pt with vertigo and vomiting for one week post viral infxn think

A

Acute vestibular neuritis

62
Q

Tx of acute vestibular neuritis

A

Corticosteroids and antivertigo agents (meclizine)

63
Q

Tx of menieres

A

Meclizine or benzos acutely, chronically limit salt intake to avoid fluid retention

64
Q

Etiology of myasthenia gravis

A

Autoimmune disorder caused by antibodies that bind to the postsynaptic acetylcholine receptors at nm junction

65
Q

Ptosis or double vision, proximal muscle weakness and symptoms worsening at end of day

A

Myasthenia gravis

66
Q

Dx of myasthenia gravis

A

Acetylcholine receptor antibody or edrophonium (tensilon test)

67
Q

Myasthenia gravis is associated with __oma

68
Q

Tx of myasthenia gravis

A

Pyridostigmine (anticholinesterases) and possibly prednisone. Resection of thymoma can be curative

69
Q

Weaknsss __ with activity in lambert Eaton

70
Q

Eye involvement in myasthenia gravis or Lambert Eaton

A

Lambert Eaton

71
Q

Tx of acute ms exacerbations

A

Iv corticosteroids and plasma exchange

72
Q

Disease modifying meds for ms

A

Abcs
Avonex (interferon b1a)
Betaseron (interferon b1b)
Copaxone (copolymer 1)

73
Q

For optic neuritis in ms, give iv or oral corticosteroids

74
Q

Guillain barre is associated with __ albumin in csf

A

Increased

Csf protein level >55

75
Q

Tx of guillain barre

A

Plasmapheresis and ivig

76
Q

Older man with slowly progressive weakness in upper extremities, fasciculations and atrophy, but without bladder disturbance and normal cervical mri, think

77
Q

Many pp with als present with bulbar involvement, meaning

A

They have difficulty swallowing, loss of tongue motility and difficulty speaking

78
Q

Three w’s of normal pressure hydrocephalus

A

Wet (incontinence)
Wobbly (gait apraxia)
Wacky (dementia)

79
Q

Description of gait in normal pressure hydrocephalus

A

“Magnetic”

“Feet glued to the floor”

80
Q

Essential tremors are _- at rest and ____ with movement

A

Suppressed

Exacerbated

81
Q

Three treatments for essential tremors

A

Propanolol
Primidone
Topiramate

82
Q

Etiology of Parkinson’s

A

Dopamine deficiency

Ach excess

83
Q

Major side effect of levodopa/carbidopa

A

Hallucinations

84
Q

Major side effects of dopamine agonists (ropinirole, bromocriptine, pramipexole)

A

Confusion
Hallucinations
Compulsive gambling

85
Q

Etiology of Alzheimer’s

A

Ach and norepinephrine deficiencies

86
Q

Medulloblastomas are primitive ___ tumors

A

Neuroectoderm

87
Q

Medulloblastomas arise from

A

Fourth ventricle or cerebellar vermis

88
Q

Pilocytic astrocytomas and medulloblastomas are located where

A

Posterior fossa/infratentorial tumor

89
Q

Bilateral vestibular schwannomas are seen in nf 1 or 2

90
Q

Lisch nodules (pigmented iris hamartomas) are seen in nf 1 or 2

91
Q

Freckling in axillary or inguinal area is seen in nf 1 or 2

92
Q

Optic gliomas are seen in nf1 or 2

93
Q

Nf1 is clinically evident by age

94
Q

Nf2 is clinically evident by

95
Q

61 yo man with 6 mo hx of progressively worsening nausea and morning headache in no acute distress. What is it and what is preferred study.

96
Q

Brocas aphasia is due to insult to what area in brain

A

Posterior inferior frontal cortex

97
Q

Initial treatment of coma

A

Dextrose
Oxygen
Naloxone
Thiamine

98
Q

Classic triad of wernicke encephalopathy

A

Encephalopathy
Ophthalmoplegia
Ataxia

99
Q

Closed angle glaucoma headaches are triggered

By

A

Darkness due to pupillary dilation

100
Q

Which occurs bilaterally and which unilaterally? Open vs closed angle glaucoma

A

Open-bilateral

Closed-unilateral

101
Q

Left hemianopsia with macular sparing is due to ___ infarction

102
Q

Open angle glaucoma is due to what etiology

A

Disease of the trabecular meshwork resulting in decreased drainage

103
Q

Rfs for open angle glaucoma

A

> 40 yrs
Black
Diabetes
Myopia

104
Q

Rfs for closed angle glaucoma

A

Asian

Prolonged pupillary dilation

105
Q

Cupping is associated with open or closed angle glaucoma

106
Q

Sudden eye pain and Red-hard eye seen in open or closed angle glaucoma

107
Q

Tx of acute closed angle glaucoma

A 
Eye drops (timolol, pilocarpine)
Iv mannitol
Laser peripheral iridotomy
108
Q

What med shouldn’t you give in closed angle glaucoma

A

Atropine or meds that can cause pupillary dilation

109
Q

Painless unilateral blindness and cherry Ted spot on fovea of old person

A

Central retinal artery occlusion

110
Q

Presentation of detached retina

A

Light flashes, floaters, curtain across visual field

111
Q

Newborn with cyanosis that is aggravated by feeding and relieves by crying

A

Choanal atresia

112
Q

Cerebellar hemorrhage presents with

A

Occipital headache
Neck stiffness
Ipsilateral hemiataxia

113
Q

Best treatment for cluster headaches

A

100% oxygen by face mask

114
Q

Babies should be able to respond to name and babble by how many months

115
Q

Acetazolamide is used to treat

A

Open angle glaucoma and benign intracranial htn

116
Q

Can you get intention tremor with cerebellar degeneration

117
Q

Migraines in children are __ frontal

118
Q

Occipital headaches in children are common or rare ?

119
Q

___ hematomas in children are most common as a result of tbi, following fracture of __ bone

A

Epidural

Sphenoid

120
Q

Ophthalmic artery branches off the

A

Internal carotid

121
Q

Csf in Ms reveals

A

Oligoclonal IgG bands

122
Q

Csf in guiallan barre shows

A 
Albuminocytologic dissociation (increased albumin (protein) >55 in
Csf without elevation in wbcs
123
Q

Someone got something blown into their eye but you can’t see it with a penlight. What do you do?

A

Fluorescein exam or slit lamp exam

124
Q

MRI of metastatic brain cancer will show

A

Well circumscribed lesions with vasogenic edema at gray and white matter junction

125
Q

Most common cause of deep intracerebral hemorrhage

A

Hypertensive vasculopathy

126
Q

How does hypertensive vasculopathy cause spontaneous deep intracerebral hemorrhage

A

Chronic hypertension leads to formation of Charcot Bouchard aneurysms which may rupture and bleed within the deep brain structures

127
Q

Triad of normal pressure hydrocephalus

A

Abnormal gait
Incontinence
Dementia

128
Q

Tx of rls

A

Ropinerol and pramipexole (dopamine agonists)

129
Q

Alzheimer’s causes atrophy of what lobes

A

Temporal and parietal lobes

130
Q

Nontraumatic subarachnoid hemorrhage is most commonly due to

A

Ruptured berry aneurysm

131
Q

Achilles’ tendon reflex can be absent or decreased in what age group

132
Q

What is dacrocystitis?

A

Infection of the lacrimal sac

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