Neuro

Question 1

Besides a traumatic tap, what condition is often associated with red blood cells in the cerebrospinal fluid on lumbar puncture?

Answer 1

HSV encephalitis

Question 2

Bilateral lateral rectus palsy is often seen with what vascular condition?

Answer 2

Cavernous sinus thrombosis

Question 3

Blood pressure greater than or equal to what value is a contraindication for t-PA therapy in patients with ischemic stroke?

Answer 3

Systolic blood pressure greater than185mmHg or Diastolic blood pressure greater than 110mmHg

Question 4

An obese individual with headaches is found to have a high opening pressure during lumbar pressure. What Is the best medication for this pt’s likely condition?

Answer 4

Acetazolamide (Carbonic anhydrase inhibitor)

Question 5

Name four commonly prescribed medications that can cause aseptic meningitis.

Answer 5

TMP-SMX (Trimethoprim-Sulfamethoxazole), IVIG (Immunoglobulin),NSAIDS, Carbamazepine

Question 6

Patient is found to have left homonymous quadrantanopia. Where is the lesion?

Answer 6

Right optic radiation

Question 7

What are the MRI T1 (increased/decreased)and T2 (increased/decreased) signal changes seen in patients with multiple sclerosis?

Answer 7

Decreased T1 and Increased T2

Question 8

Optic chiasm compression will lead to what eye abnormality?

Answer 8

Bitemporal hemianopsia

Question 9

What area of the brain is affected with the diagnosis featuring bradykinesia, cogwheel rigidity, postural instability and resting tremor?

Answer 9

Substantia nigra (likely diagnosis is Parkinson’s disease)

Question 10

Rapid fire txt: Tonic-clonic seizures

Answer 10

Levetiracetam, phenytoin, valproate, carbamazepine

Question 11

Rapid fire txt: Trigeminal neuralgia (tic douloureux)

Answer 11

Carbamazepine

Question 12

Atrophy of the mammillary bodies associated w/what dz?

Answer 12

Wernicke encephalopathy (thiamine deficiency causing ataxia, ophthalmoplegia, and confusion)

Question 13

Guillain Barre Syndrome tx?

Answer 13

Rx: IVIG and Plasmapheresis

Question 14

Don’t confuse GBS w/what dz that has descending paralysis?

Answer 14

Botulism

Question 15

Rapid fire txt: Absence seizures

Answer 15

Ethosuximide (treatment)

Question 16

Rapid fire assoc: Yellowish CSF

Answer 16

Xanthochromia (eg, due to subarachnoid hemorrhage)

Question 17

Rapid fire txt: Malignant hyperthermia

Answer 17

Dantrolene

Question 18

Rapid fire txt: Migraine

Answer 18

Abortive therapies (eg, sumatriptan, NSAIDs); prophylaxis (eg, propranolol, topiramate, CCBs, amitriptyline)

Question 19

Rapid fire txt: Temporal arteritis

Answer 19

High-dose steroids

Question 20

Rapid fire assoc:Silver-staining spherical aggregation of tau proteins in neurons

Answer 20

Pick bodies (Pick disease: progressive dementia, changes in personality)

Question 21

Rapid fire assoc: Protein aggregates in neurons from hyperphosphorylation of tau protein

Answer 21

Neurofibrillary tangles (Alzheimer disease) and Pick bodies (Pick disease)

Question 22

Rapid fire assoc:Eosinophilic cytoplasmic inclusion in neuron

Answer 22

Lewy body (Parkinson disease and Lewy body dementia)

Question 23

Rapid fire assoc:Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons

Answer 23

Negri bodies of rabies

Question 24

Rapid fire assoc:Extracellular amyloid deposition in gray matter of brain

Answer 24

Senile plaques (Alzheimer disease)

Question 25

Rapid fire assoc: Degeneration of dorsal column fibers

Answer 25

Tabes dorsalis (3º syphilis), subacute combined degeneration (dorsal columns, lateral corticospinal, spinocerebellar tracts affected)

Question 26

Rapid fire assoc:Depigmentation of neurons in substantia nigra

Answer 26

Parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)

Question 27

Rapid fire assoc: Bloody or yellow (xanthochromia) tap on lumbar puncture

Answer 27

Subarachnoid hemorrhage

Question 28

Toe extension/fanning upon plantar scrape

Answer 28

Babinski sign (UMN lesion)

Question 29

Unilateral facial drooping involving forehead

Answer 29

LMN facial nerve (CN VII) palsy; UMN lesions spare the forehead

Question 30

Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia

Answer 30

Multiple sclerosis

Question 31

Ptosis, miosis, anhidrosis

Answer 31

Horner syndrome (sympathetic chain lesion)

Question 32

Pupil accommodates but doesn't react

Answer 32

Neurosyphilis (Argyll Robertson pupil)

Question 33

Rapidly progressive limb weakness that ascends following GI/upper respiratory infection

Answer 33

Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculopathy subtype)

Question 34

Resting tremor, rigidity, akinesia, postural instability, shuffling gait

Answer 34

Parkinson disease (loss of dopaminergic neurons in substantia nigra pars compacta)

Question 35

Chorea, dementia, caudate degeneration

Answer 35

Huntington disease (autosomal dominant CAG repeat expansion)

Question 36

Conjugate horizontal gaze palsy, horizontal diplopia

Answer 36

Internuclear ophthalmoplegia (damage to MLF, may be unilateral or bilateral)

Question 37

Lucid interval after traumatic brain injury

Answer 37

``` Epidural hematoma (middle meningeal artery rupture) ```

Question 38

What is the triad of symptoms you would expect in a patient with normal pressure hydrocephalus (NPH)?

Answer 38

Ataxia (wide based gait), dementia,and urinary incontinence (Wet, wobbly, wacky)

Question 39

Bilateral acoustic schwannomas dx?

Answer 39

Neurofibromatosis type 2

Question 40

Which class of medication is used to prevent vasospasm in patients with subarachnoid hemorrhage?

Answer 40

Calcium channel blockers (eg.nimodipine, nifedipine)

Question 41

What is POUND criteria for migraine?

Answer 41

Pulsatile quality, one day duration, unilateral, nausea or vomiting, disabling intensity

Question 42

Persistent vertigo, limb ataxia, bidirectional nystagmus, symptoms greater than 72 hours suggest what diagnosis?

Answer 42

cerebellar stroke

Question 43

Highly aggressive cancer. Pts p/w seizures, n/v, headache, rapid neuro decline. What's the dx?

Answer 43

Glioblastoma multiforme

Question 44

Scattered ovoid shaped, periventricular white matter lesions on MRI suggest what diagnosis?

Answer 44

Multiple sclerosis

Question 45

What diagnosis is suggested by foot or wrist drop as well as pain, nausea, loss of reflexes?

Answer 45

Mononeuritis multiplex