Neuro

Question 1

Common bugs that cause meningitis in ppl > 60 yo? ABX coverage?

Answer 1

This patient has classic findings of bacterial meningitis: fever, confusion, Brudzinski sign, and CSF analysis showing ↑ cell count, ↑ protein, and ↓ glucose. The most common causes of community-acquired bacterial meningitis in patients older than 60 years are the gram-positive bacteria S. pneumoniae and L. monocytogenes, and the gram-negative bacteria H. influenzae and E. coli.

Coverage: 3rd gen cephalosporin, vancomycin, ampicillin.

Third generation cephalosporins (e.g., cefotaxime, ceftriaxone) are broad-spectrum antibiotics that are effective against most gram-negative and gram-positive bacteria with the exception of Enterococcus and Listeria. Since L. monocytogenes is an important cause of bacterial meningitis in patients > 60 years, empiric antibiotic therapy in this group should include ampicillin, an anti-listerial antibiotic. Ampicillin would also provide coverage against gram-positive and gram-negative bacteria, but its spectrum of activity is not as broad as 3rd generation cephalosporins. Vancomycin, which acts only against gram-positive bacteria, should be included in the antibiotic regimen because the incidence of penicllin- and cephalosporin-resistant pneumococcal infection has increased in recent years. Vancomycin, while effective in Listeria bacteremia, is not very effective against CNS Listeria infections. Therefore, ampicillin should be used despite the addition of vancomycin to the regimen.

Question 2

Alzheimers drugs + MOAS

Answer 2

Patients with mild-to-moderate Alzheimer’s disease show improved cognition and ability to perform everyday activities when treated with acetylcholinesterase inhibitors, such as donepezil, galantamine, or rivastigmine, because they promote an increase of the neurotransmitter acetylcholine, which is decreased in Alzheimer’s disease. If this patient’s disease progresses to moderate-to-severe (≤ 18/30 MMSE), memantine (an NMDA-receptor antagonist) is also indicated, which may be given in addition to an acetylcholinesterase inhibitor.

Question 3

Crescent-shaped hyperdensity on CT that does not cross midline. Ex?

Answer 3

Subdural hematomoa-torn bridging vein

Question 4

PPX tx for migraine

Answer 4

antihypertensives (beta-blockers), antidepressants (TCAs), anticonvulsants (topiramate or valproate), diet changes

Question 5

50 yo w broken speech pattern. what type of aphasia? lobe? vascular distribution?

Answer 5

Broca aphasia. frontal lobe. left MCA most likely

Question 6

Confusion, ophthalmoplegia, ataxia. Dx?

Answer 6

Wernicke Encephalopathy. 2/2 Thiamine deficiency

Question 7

What % lesion in a symptomatic pt is an indication for carotid endarderectomy?

Answer 7

70%

Question 8

Most common causes of dementia?

Answer 8

Alzheimer disease and vascular/multi-infarct dementia

Question 9

Hyperphagia, hypersexuality, hyperorality, and hyperdocility. Dx?

Answer 9

Kluver-Bucy syndrome (amygdala)

Question 10

Drug used to dx myasthenia gravis

Answer 10

erdrophonium.

Question 11

Define internuclear ophthalmopelegia

Answer 11

A disorder of conjugate gaze in which the affected eye shows impairment of adduction.

Question 12

Define optic neuritis

Answer 12

painful unilateral vision loss, red color desaturation

Question 13

Normal CSF Findings?

Answer 13

Opening pressure: 100-200
Protein 20-45
Glucose 50-100
Cells 0-3

Question 14

Sensory/wernicke aphasia. Location in brain?

Answer 14

Dominant temporal lobe

Question 15

Memory impairment, hyperaggression, hypersexuality. lobe impacted?

Answer 15

Temporal

Question 16

Inability to read, write, name, or do math. lobe impacted?

Answer 16

Dominant parietal lobe

Question 17

Ignoring one side of body, trouble dressing. lobe affected?

Answer 17

nondominant parietal lobe

Question 18

Visual hallucinations/illusions. lobe affected?

Answer 18

occipital

Question 19

CN III and IV. Area of brain?

Answer 19

midbrain

Question 20

CN 5, 6, 7, 8. Area of brain?

Answer 20

pons

Question 21

CN 9, 10, 11, 12. Area of brain?

Answer 21

medulla

Question 22

Ataxia, dysarthria, nystagmus, intention tremor, dysmetria, scanning speech. Area of brain?

Answer 22

cerebellum

Question 23

What treatable causes of demetia must always be ruled out?

Answer 23

B12 deficiency and hypothyroidism

Question 24

What part of the brain is affected in Huntington Dz?

Answer 24

Caudate nucleus

Question 25

What part of the brain is affected in Parkinsons dz?

Answer 25

Loss of dopaminergic neurons of the substantia nigra

Question 26

Common disease w cerebellar findings in kids?

Answer 26

Neoplasms: Medulloblastoma, pilocytic astrocytoma
Hydrocephalus (enlarging head under 6 months), think arnold-chiari malformation or dandy walker malformation
Friderech-Ataxia

Question 27

Cushing triad? What does it represent?

Answer 27

Bradycardia, HTN, respiratory irregularity/depression. Represents increased ICP.

Question 28

Pt w unilateral motor impairment, no sensory or cortical deficits, no visual field abnormalities. Where’s the lesion?

Answer 28

Posterior limb of internal capsule (lacunar infarct)

Question 29

Pt with contralateral somatosensory and motor deficits (face, arm, leg), conjugate deviation towards side of infarct, homonymous hemanopia, aphasia (dominant hemisphere), hemineglect (nondominant hemisphere). Where’s the lesion?

Answer 29

MCA occlusion

Question 30

Pt with contralateral somatosensory and motor deficit, predominantly in lower extremity, abulia (lack of will or initiative), dyspraxia, emotional disturbances, urinary incontinence. Where’s the lesion?

Answer 30

ACA occlusion

Question 31

Pt with ataxia and either contralateral hemipelegia or ipsilateral cranial nerve involvement. Where’s the lesion?

Answer 31

Vertebrobasilar system (brainstem supply)

Question 32

______ is characterized by recurrent vertigo attacks associated with ear fullness, tinnitus, and hearing loss.

Answer 32

Meniere disease

Question 33

The first imaging test in acute stroke is a __________.

Answer 33

The first imaging test in acute stroke is a noncontrast CT scan of the head. At 12 hours out, it may show ischemic strokes, but more importantly, it will diagnose hemorrhagic strokes, for which reperfusion and antiplatelet therapies are contraindicated.

Question 34

Dx of GBS

Answer 34

Cerebrospinal fluid
Albuminocytologic dissociation: elevated protein levels and normal cell counts in cerebrospinal fluid (CSF)

Electroneurography: reduced nerve conduction velocity (NCV) due to demyelination

Question 35

Definition of Lacunar Stroke

Answer 35

A subcortical stroke that is primarily associated with hypertension and diabetes mellitus. Lipohyalinotic thickening of vessel walls results in the occlusion of small, penetrating arteries that supply the subcortical regions of the brain (internal capsule, pons, thalamus, putamen, and caudate). Typically presents as specific lacunar syndromes that are characterized by the absence of cortical signs (e.g., aphasia, hemianopsia, agnosia, apraxia).

Question 36

Most common type of lacunar stroke: location and sx?

Answer 36

Pure Motor: Posterior limb or the angle of the internal capsule
Often caused by occlusion of the lenticulostriate artery
Contralateral hemiparesis of the face, arm, and leg