Neuro

Question 1

findings in CSF of HSV encephalitis?

Answer 1

• lymphocytic pleocytosis (abnormally increased lymphocytes)
• increased RBCs
• elevated protein count
• normal glucose

Question 2

describe a focal seizure with impaired awareness

Answer 2

episodes of unresponsiveness with repetitive actions and postictal state.

Occur in a single hemisphere

Question 3

most common intracranial tumor in adults?

Answer 3

brain metastasis

Question 4

most common cancers that metastasize to brain?

Answer 4

lung, breast, melanoma, renal cell

Question 5

how do brain metastases show up on MRI?

Answer 5

peripheral, circumscribed, enhancing lesions with vasogenic edema

Question 6

which area of the brain is affected in HSV encephalitis?

Answer 6

frontotemporal

Question 7

name a common manifestation of temporal lobe epilepsy?

Answer 7

focal seizures

Question 8

what is the treatment for Dementia with Lewy Bodies?

Answer 8

• carbidopa-levodopa; parkinsonism
• cholinesterase inhibitors (rivastigmine); cognitive impairment
• melatonin; REM sleep

Question 9

which drug class are Dementia with Lewy Body patients extrememly sensitive to?

Answer 9

• antipsychotics (esp first generation, risperidone, haloperidol)
• causes worsening confusion, parkinsonism, and autonomic dysfunction

Question 10

old man acting out dreams is at risk for developing _______

Answer 10

Parkinson’s diesease (alpha synuclein degeneration);

He has REM Sleep Behavior Disorder (RSBD)

Question 11

what is the most common cause of spontaneous lobar hemorrhage in elderly people with Alzheimer dz?

Answer 11

cerebral amyloid angiopathy

Question 12

bilateral trigeminal neuralgia is a common sign of ?

Answer 12

multiple sclerosis

Question 13

CSF findings in Guillain-Barre’ syndrome?

Answer 13

• elevatex protein count
• normal WBC count
• normal glucose

Question 14

treatment of guillain-barre’?

Answer 14

IV Ig or plasmapheresis

Question 15

where is the stroke?

• contralateral motor and/or sensory deficits, more pronounced in the lower limb
• may have urinary incontinence

Answer 15

anterior cerebral artery

Question 16

where is the stroke?

• well-recognized syndromes: pure motor hemiparesis, pure sensory stroke sensorimotor, dysarthria-clumsy hand, and ataxic hemiparesis
• face, arm, and leg all affected with sensorymotor stroke
• no urinary incontinence

Answer 16

lacunar infarct

Question 17

where is the stroke?

• contralateral motor and/or somatosensory deficits more pronounced in face an upper limb
• homonymous hemianopia or quadrantopia

Answer 17

Middle cerebral artery stroke

Question 18

where would a stroke causing sudden onset aphasia be?

Answer 18

left lobe (dominant hemisphere); left middle cerebral artery

Question 19

where would a stroke causing sudden onsetheminaglect or ansognosia be located?

Answer 19

right hemisphere (nondominant hemisphere), middle cerebral artery

Question 20

pt with brain injury has random episodes fo htn, tachycardia, tachypnea, fever, diaphresis. what is this?

Answer 20

paroxysmal sympathetic hyperactivity; don’t let morphine trip you up

Question 21

how does “central vertigo” present?

Answer 21

• non-fatigueable nystagmus, which cannot be suppressed by visual fixation
• headache
• difficulty walking

Question 22

what are some causes of central nystagmus?

Answer 22

cerebellar stroke, MS

diagnose with non-contrast CT

Question 23

how do you treat idiopathic intracranial hypertension/pseudotumor cerebri?

Answer 23

first line= acetazolamide +/- furosemide

then surgery/shunt

Question 24

pt has loos of feeling and motor function in legs and cannot urinate. what test do you get?

Answer 24

cauda equina syndrome; get MRI of lumbosacral spine

Question 25

management of organophosphate (acetylcholinesterase inhibitor) toxicity?

Answer 25

1. remove clothes and irrigate eyes and skin
2. give atropine (acetylcholine antagonist)
3. then give pralidoxime (cholinesterase reactivating agent) after atropine

Question 26

what is the difference between heat exhaustion and heat stroke?

Answer 26

• heat exhaustion=
  
  • hyperthermia (>104F), weakness, dizziness, profuse sweating, headache, nausea
• heat stroke=
  
  • all of the above, but there is CNS dysfunction and mentation is abnormal

treatment=cooling and oral hydration with salt containing fluids

Question 27

PT WITH SUPRATHERAPEUTIC INR (OVER 3) PRESENTS WITH SERIOUS BLEEDING (INTRACEREBRAL HEMORRHAGE) WHAT SHOULD YOU DO?

Answer 27

vitamin K + prothrombin complex

Question 28

pt with MS has sudden onset neurologic sx. how can you differentiate and MS flare from a TIA?

Answer 28

Sx of MS flares last for days to weeks.

Sx of TIAs last less than 24 hours.

Treat assumed TIA with aspirin and statin.

Question 29

werinicke aphasia (cannot comprend language) affects which part of the brain?

Answer 29

posterior superior temopral lobe of the dominant hemisphere, left in right handed people

Question 30

common finding with Brocas aphasia?

Question 31

bilateral 6-10 Hz tremor that gets better with alcohol

Answer 31

esstential tremor; often genetic and treated with beta blockers

Question 32

Myasthenia gravis pathophysiology involves an autoantibody against what?

Answer 32

nicotinic post-synaptic acetyulcholine receptors

Question 33

Botulism pathophysiology involves autoantibodies against what?

Answer 33

pre-synaptic nicotinic acetylcholine receptors; botulinum toxin produces an irriversible blockade of the release of acetylcholine

Question 34

Lambert-eaton myasthenic syndrome pathophysiology involves autoantibodies against what?

Answer 34

against pre-synaptic calcium channels at the motor endplate; paraneoplastic syndrome of small cell carcinoma of the lungs

Question 35

treatment for postherpetic neuralgia?

Answer 35

focused on pain control;

tricyclic antidepressant (amitriptyline), topical analgesic, gbapentin/pregabablin

Question 36

first line treatment for resless leg syndrome?

Answer 36

dopamine agonists (pramipexole, ropinirole, levodopa/carbidopa, and bromocriptine)