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Neuro - kap Flashcards

1
Q

A young obese woman with headache, vision changes (blurry vision, diplopia), and pulsatile tinnitus. Dx and workup?

A

Idiopathic Intracranial hypertension (pseudotumor cerebri)
DX with ocular exam neuroimaging (MRIS, magnetic resonance venography, and LP)
Papilledema is not contraindication for LP in the abesence of obstructive /non communication hydrocephaly.
CSF will be WNL in IIH but opening pressure will be >250 mm H2O

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2
Q

Pt has Parkinson’s like symptoms + orthostatic hypertension, incontinence, impotence, and/or autonomic syx

A 
Multiple system Atrophy (Shy-Drager syndrome)
Defined by:
1. Parkinsonism
2. Autonomic dysfunction
3. Widespread neurological signs
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3
Q

Child of Ashkenzazi Jewish ancestry with gross dysfunction of the autonomic nervous system and hypotension

A

Riley-Day syndrome (familial dysautonomia)

ar

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4
Q

Pt presents with muscle pain, hyporeflexia, and flat broad T waves on EKG. Dx?

A

Hypokalemia
Causes weakness, fatigue, muscle cramps. Paralysis and arrhythmia in severe cases
ECG cahnges - U waves, flat broad T waves, premature ventricular contractions
RF’s: Thiazides, diarrhea, anorexia, hyperaldosteronism
Tx - K+ supplement

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5
Q

Pt presents with neurodegenerative syx. Sensation and cognition are preserved. Syx = weakness, difficulty chewing, swallowing, coughing, breathing, develop hyperreflexia, spasticity, fasciculations

A

ALS

Fatal within 5 years

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6
Q

Pt presents with worsening focal back pain, bilateral lower-extremity weakness,, sensory loss, and gait ataxia. Bowel and bladder disurbances in advanced dz

A

spinal cord compression
Associated with metastasis from: lung, renal, prostate, breast, and multiple myeloma
Pain is usually worst while lying down
PE - focal point tenderness in the spine, exaggerated DTR in the legs and upgoing plantar reflex
Management - Emergency MRI, IV glucocrticoids, consultations from Rad-Onc and Neurosurgery

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7
Q

Pt has acute unilateral motor weakness without sensory deficit or hemiparesis. Dx?

A

Lacunar Stroke
Affecting posterior limb of internal capsule
Associated with HTN -> arteriolar sclerosis -> occlusion of deep penetration branches of major cerebral arteries

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8
Q

First line tx for Restless leg syndrome?

A 
Dopamine agonist (pramipexole)
Alternalt - Alpha-2-delta calcium channel ligand (gabapentine, enacarbil)
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9
Q

Pt presents with Intracranial hemorrhage (acute focal deficits that gradually worsen, syx of increased intracranial pressure (HA, vomiting, altered mental status). What should be done?

A

Acute management of suspected stroke = CT w/o contrast to rule out hemorrhagic stroke
Angio should only be considered after a non contrast study

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10
Q 
Pt has syx of intraparanchymal brain hemorrhage presenting with: 
contralateral hemiparesis
Contralateral sensory loss
Gaze away from hemiparesis
Where is the hemorrhage?
A

Basal Ganglia (putamen)

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11
Q 
Pt has syx of intraparenchymal brain hemorrhage presenting with:
No hemiparesis
Facial weakness
Ataxia & Nystagmus
occipital HA & Neck Stiffness
Where is the hemorrhage?
A

Cerebellum

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12
Q

Pt has syx of intraparenchymal brain hemorrhage presenting with:
Contralateral hemiparesis and hemisensory loss
Nonreactive miotic pupils
Upgaze palsy
Eyes deviate toward hemiparesis
Where is the hemorrhage?

A

Thalamus

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13
Q

Pt has syx of intraparenchymal brain hemorrhage presenting with:
eyes deviating away from hemiparesis
High incidence of seizures
Where is the hemorrhage?

A 
Cerebral Lobes
If:
Contralateral hemiparesis (frontal lobe)
Contralateral hemisensory loss (parietal lobe)
Homonymous hemianopsia (occipital lobe)
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14
Q

Pt has syx of brain hemorrhage presenting with:
Deep coma & total paralysis within minutes
Pinpoint, non reactive pupils
Where is the hemorrhage?

A

Pons

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15
Q

Dementia pt presents with:
Generalized cortical atrophy on CT
Dx?

A

Alzheimer Dz

Initial syx = early, insidious short-term memory loss

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16
Q

Dementia pt with stepwise decline in function

A

Vascular dementia

Early Executive dysfunction due to cerebral infarction or deep white matter changes

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17
Q

Dementia presenting with early personality changes

A

Frontotemporal dementia
Apathy, impulsive
Frontotemporal atrophy on neuroimaging

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18
Q

Dementia pt presents with visual hallucinations and spontaneous Parkinsonism

A

Dementia with Lewy body

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19
Q

Dementia presenting with ataxia and urinary incontinence

A

Normal-pressure hydrocephalus (wacky, wet, and wobly)
Dilated ventricles on neuroimaging
LP often therapuetic

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20
Q

Rapidly progressing dementia with behavioral changes + myoclonus and/or seizures

A

Prion dz

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21
Q

What is the cutoff on the minimental exam that differentiates normal aging from dementia?

A

Normal aging >24

Dementia < 24

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22
Q

Following a trauma an former opioid addict is given and IV NSAID but doesn’t respond. What should be given next?

A

IV morphine
Acute pain management is the same for all pts regardless of substance abuse
May require close follw up to monitor for relapse

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23
Q

Most common cause of a nontraumatic subarachnoid hemorrhage?

A

Ruptured berry aneurysm
Also prsents with meningeal irritation (neck stiffness)
Order a CT scan w/o contrast
IF CT is negative, get an LP -> elevated opening pressure and xanthochromia

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24
Q

How do you tx a pt with an ischemic stroke?

A

If pt presents in under 3 hours - IV alteplase
3+ hours = Aspirin - prevents recurrence within 24 hours
Add dipyridamole or clopidogrel for pts that have had recurrent stroke on ASA therapy

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25
Q

CSF findings in a pt with acute ascending flaccid paralysis?

A

Elevated protein
WBC, RBC, glucose WNL
Guillain-Barre - often proceeded by URI or diarrhea (Campylobacter)

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26
Q

How should you treat Guillain-Barre?

A

IVIG and plasmapheresis
Monitor closely for respiratory failure
Most take several months to recover

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27
Q

Pt has a rapidly ascending progressive paralysis and CSF is WNL. Dx?

A

Tick-borne paralysis
Caused by neurotoxin release from the tick. Tick must feed 4-7 days before the neurotoxin is released
Improvement within an hour

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28
Q

What is the best study to dx an acoustic neuroma?

A

MRI with gadolinium

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29
Q

Bilateral acoustic neuroma’s + multiple cafe au lait spots?

A

NF type II

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30
Q

What study should be ordered for a pt with syx suspicious for spinal stenosis?

A

Spinal MRI
Note - pain worsens with standing, relief with movement
Most commonly caused by degenerative joint dz (herniations and osteophytes)

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31
Q

Abortive treatment for cluster headaches?

A

Inhaled Oxygen
Could also consider SubQ sumatriptan but O2 doesn’t have side effects, so why bother?
Prophylaxis = Verapamil or lithium

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32
Q

First line therapy for the tremors associated with Parkinson’s?

A

Trihexyphenidyl (anticholinergic)
Resting tremor that improves with movement, assymetric, associated with rigidity
This tremor can be the first syx of Parkinson’s
Trihexyphenidyl is commonly used in younger pts where tremor is the primary syx

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33
Q

First line therapy for essential tremor?

A

1st line -Propanolol
2nd line - Clonazepam
Tremor that worsens with movement

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34
Q

Following a head trauma a pt has daily syx of: HA, confusion, amnesia, difficulty concentrating, vertigo, mood alteration, sleep disturbance, and anxiety. Dx?

A

Postconcussive syndrome
Can occur after a TBI of any severity
Typically resolves with symptomatic treatment, can take up to 6months

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35
Q

Pt presents with encephalopathy, ocular dysfunction, gait ataxia. Dx and Tx?

A

Wernicke encephalopathy (Thiamine, V1 deficiency)
Tx - Thiamine and glucose
Exacerbated by glucose administration without Thiamine

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36
Q

What should be included in the workup for a first-time seizure in an adult?

A

Basic blood tests - serum electrolytes, CBC, Renal and Liver fxn
Toxicology screen
If no obvious cause - neuroimaging and EEG

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37
Q

Diabetic pt presents with ptosis and down and out gaze but pupillary response is WNL. What’s going on?

A

Ischemia of CN III

Only affects somatic nerves (PS intact), so the pupillary light response remains intact

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38
Q

Pt collapses on a hot day. Presents with a fever of 104F and confusion. Dx and management?

A

Heat stroke

Rehydration and rapid cooling, preferably ice water immersion

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39
Q

On PE pt has absent sensation from nipples down. Where is the damage?

A

Upper Thoracic spinal cord

Would also cause paraplegia and bladder/fecal incontinence

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40
Q

What workup should be ordered to confirm dx for a pt suspicious for myasthenia gravis?

A
  1. Endrophnium - AChesterase inhibitor, good bedside test
  2. Ab against ACh receptors (nicotinic end plates, very very specific)
  3. If Ab is + pt should also receive a CT or MRI of the chest to evaluate for thymoma
    Syx - proximal muscle weakness late in the day (diplopia, difficulty combing hair)
    Tx - Ach inhibitors (pyridostigmine), corticosteroids, thymectomy
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41
Q

Tx for Tabes Dorsalis?

A

IV penicillin
Syx - wobbley, absent DTR, pronator drift, Argyll Robertson pupils (normal constriction with accommodation but without light)

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42
Q

Approved Tx for ALS?

A

Riluzole - glutamate inhibitor

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43
Q

Placing an ice pack over a pts eyelids is a diagnostic test for?

A 
Myasthenia gravis (the cold inhibits AChesterase temporarily)
Improves ptosis.  Follow with testing for Ab against ACh receptors
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44
Q

Pt with proximal muscle weakness has a lung mass on CT. Dx?

A

Lambert-Eaton syndrome

Ab against presynaptic Ca2+ channels

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45
Q

Trigeminal neuralgia (recurrent severe stabbing pain along V2 and V3) is associated with?

A

Multiple Sclerosis

Trigem neuralgia us usually bilateral and caused by demylenation of the trigeminal nucleus

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46
Q

What tests do you use to confirm dx of Guillain-Barre

A

CSF study

Confirm with electrophysiological tests

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47
Q

Pt has seizure but CSF is normal. MRI with ring enhancing lesions. PCR - for toxo. Dx?

A

Cysticercosis
Larva from Taenia solium
Look for immigration hx

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48
Q

How do you manage trigeminal neuralgia that has failed medical therapy

A

Refer to neurosurgery for decompression

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49
Q

Pt has a head trauma and you suspect CSF is leaking from his ear. How do you confirm?

A

Beta-2-transferrin
CSF specific protein
Glucose content is faster, but unreliable

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50
Q

What are the neurologic findings of B12 deficiency

A

Subacute combined degeneration of the spinal cord

Presents with weakness, parethesia, ataxic gait, decreased vibratory sense, increased DTR, dementia

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51
Q

What should you instruct families to do if their loved one seizes?

A

Place them on their side, put a pillow under their head, loosen tight clothing, remove sharp objects
Don’t: put anything in their mouth, don’t call ambulance unless seizure lasts 10+ minutes, don’t restrain the patient

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52
Q

Restin tremor that improves with movement + rigidity

A

Parkinson’s

Levodopa (DA precursor)

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53
Q

abrupt stepwise deterioration in mental function

A

Vascular dementia

Will have boughts of improvement with sudden deterioration

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54
Q

Pt has drooping eyelid, dilated pupil and inability to adduct, elevate, or depress the eye

A

Intracranial aneurysm compressing CN III.

Emergency

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55
Q

What should you do if you suspect shaken baby syndrome?

A

Fundoscopic exam

Papilledema, retinal hemorrhage

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56
Q

Decreased Neck ROM

Pain in UE after neck flexion

A

Cervical spondylosis
Degenerative disc dz of cervical spine
Xray are needed in all cases of non traumatic neck pain in pts over 50 years

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57
Q

Pt has eye pain, diminished visual acuity and color perception

A 
Optic neuritis
Inflammation of the optic n. 
Usually the first syx in MS
Normal fundoscopic exam
Tx - IV methylprednisolone, IFN-beta for long term management
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58
Q

Post endartectomy pt presents with difficulty eating and speaking and tongue deviates to the right. Dx?

A

R hypoglossal n. damage

Hypoglossal, marginal mandibular, recurrent laryngeal n. and superior laryngeal n. are at risk during endartectomy’s

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59
Q

IV drug user with low back pain and fever

A

Spinal epidural abscess

MRI is needed

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60
Q

Myasthenia gravis is associated with which cancer?

A

Thymoma

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61
Q

Dizzines, unilateral tinnitus, fluctuating hearing loss

A

Meneire dz

ADA idiopathic endolymphatic hydrops

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62
Q

Huntington’s is caused by degeneration of?

A

Caudate nucleus

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63
Q

Proximal muscle weakness that improves with activity

A

Lambert-Eaton
Autoimmune attack of presynaptic calcium channels
Associated with small-cell lung cancer

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64
Q

Adolescent with bitemporal vision loss. Cystic suprasellar mass with calcifications. During excision, cystic cavities with viscous yellow fluid

A

Craniopharyngiomas
Arise from remnants of Rathke’s pouch
Benign
Difficult to fully resect so recurrence common

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65
Q

How do you manage a HIV+ pt not responding to his toxo treatment?

A

Bx the lesion for B cell lymphoma
Mimics toxo on imaging
B cell more likely to have B-symptoms (night sweats, rigors)

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66
Q

Older pt presents with a tension headache x 3 months and a seizure this morning following a severe headache. Ring like zone of bleeding on MRI. Dx?

A

Glioblastoma multiforme

Malignant astrocyte tumor that develops simultaneous hemorrhage and necrosis

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67
Q

Childs MRI shows enlargement of the pons, displacing but not occluding the 4th ventricle

A

Brain-stem glioma

Pt usually presents with long history of minor complaints (neck stiffness)

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68
Q

Recurrent episodes of vertigo lasting less than a minute

A

Benign paroxysmal positional vertigo
Caused by otoliths in the semicircular canals
Dix-Hallpike test - pt feels dizzy when head turned to the side and then placed in the supine position
Nystagmus can be observed

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69
Q

Adolescent male with frequent epistaxis. On PE grayish-red mass in the posterior nasal pharynx

A

Juvenile nasopharyngeal angiofibroma

benign vascular tumor

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70
Q

Common cause of breakthrough seizure in a epileptic?

A

Subtherapeutic drug levels

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71
Q

Following a trauma, pt has hyperesthesia that progresses to swelling, edema redness and ultimately progresses to atrophy, cyanosis, and contracture

A

Complex regional pain syndrome

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72
Q

Anterior spinal a. thrombosis leads to?

A

flaccid paralysis
loss of bowel/bladder fx
loss of pain and temp
thrombosis causes decreased perfusion of the anterior horn cells

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73
Q

Male with retrorbital pain, lacrimation, pupils asymmetric, ptosis

A

Cluster headache

Give oxygen

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74
Q

sudden ipsilater spastic paralysis, babinski, and loss of position and vibration sense with contralateral loss of pain and temperature

A

Brown-Sequard syndrome
due to trauma or compression (ie tumor) of the spinal cord
Tx - High dose dexamethasone, surgical eval

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75
Q

Management of polycythemia vera

A
  1. Phlebotomy
    Add Aspirin if pt has hyperviscosity syndromes (contra in gastric bleeding)
    Add Hydroxyurea if pt is >60 with a thrombotic event or cardiovascular RF’s
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76
Q

Middle aged man with tremor that worsens with movement and head bobbing

A

Benign essential tremor

Tx - propranolol, EtOH

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77
Q

Paralysis with complete lack of sensation in one limb

A

Amputate - irreversible ischemia

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78
Q

What does pronator drift mean?

A

UMN weakness
Can be a complication of anticoagulation (hemorrhage)
Get a non contrast CT scan

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79
Q

Stroke pt with weakness in the UE and LE

A

Contralateral parietal lobe (pt will neglect the affected side)
can also have contra hemianopsia due to interuption of optic fibers

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80
Q

Pt with hx of cancer that presents with sudden loss of bowel or bladder continence

A

Cauda equina syndrome
Assoc with prostate, breast and lung cancer mets
This is a late finding - most common complaint is back pain with saddle anesthesia

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81
Q

Pt has progressive muscle weakness has NL CK and EMG

Meds - statin, prednisone

A

Taper off of prednisone
This is a corticosteroid induced myopathy
Can’t be due to stating because this would have an elevated CK (10x that of NL)

82
Q

Initial tx for MS

A

IV steroids

83
Q

What neurotransmitter change is associated w/ alzheimers?

A

Decreased Acetylcholine, ACH mediates attention and memory through the basal forebrain
Mild decrease in NE causing depressive syx

84
Q

Seizure without LOC

A

Simple

85
Q

Seizure w/ LOC

A

Complex

86
Q

What causes a migraine?

A

Dysregulation of serotonergic control of cerebral blood vessels
Deficiency in serotonin
Triptains - agonist at Serotonin receptors -> vasoconstriction

87
Q

How do you confirm Myasthenia gravis?

A

Electrodiagnostic study with repeat stimulation

Edrophonium is useful, but many dz’s respond to this test so it is not a specific

88
Q

Tx for absence seizures

A

Ethosuximide
EEG - 3Hz spike and slow wave
Good prognosis, many grow out of it in their teens

89
Q

Preterm baby has many periventricular leukomalacia (white matter necrosis). Prognosis?

A

Spastic diplegia or quadriplegia (cerebral palsy)
Occurs because the choroid plexus does not mature until 35 wks -> fills with blood at preterm birth -> hydrocephalus -> liquefactive necrosis
This causes cerebral palsy (spasticity)

90
Q

Tremor that is worse with movement

A

Essential Tremor

91
Q

Tremor that is worse at rest

A

Parkinson’s

92
Q

Head CT with hyperdense crescentic mass

A

Subdural hematoma
Tearing of bridging veins
Waxing waning of mental status in older pt w/ recent fall

93
Q

Dementia with hallucinations

A

Lewy body dementia

Can also have cogwheel rigidity and bradykinesia

94
Q

Ptosis with down and out eye, dilation of affected eye

A

CN III palsy

Can by caused by aneurysm of the PCA ORuncal herniation due to a mass

95
Q

Upward deviation of the eye with failure to depress on adduction, vertical diplopia

A

CN IV palsy

96
Q

1st line tx for trigeminal neuralgia

A

Carbamazepine

97
Q

Peripheral neuropathy presenting with neurologic deficits in two asynchronous sites (ie median and ant peronial n.)

A

Mononeuropathy multiples

Caused by systemic vasculitis (Churg-Strauss, SLE, cryoglobulinemia)

98
Q

Initial tx for pt in myasthenic crisis (ie, respiratory failure requiring intubation)

A

Plasmaphaeresis or IVIG - take several days to be effective

Crisis can be precipitated by recent infection

99
Q

b/l loss of pain and temperature

If allowed to progress - muscle weakness and atrophy in UE and UMN signs in the LE

A

Arnold-Chiari malformation
Congenital
Displacement of cerebellar hemispheres and the medulla oblongata through the foramen magnum in the spinal canal w/o displacing the lower brainstem

100
Q

Following a URI, pt has multifocal CNS deficits (from ataxia to incontinence)

A

Acute Diffuse encephalomyelitis
Looks a lot like MS in clinic and on imaging
Autoimmune demyelination following a viral infection or vaccination
Multiple inflammatory lesions in the brain and spinal cord

101
Q

5 classic syndromes of lacunar stroke

A
  1. Pure motor
  2. Pure sensory
  3. Sensorimotor
  4. Ataxic hemiparesis
  5. Clumsy-hand dysarthria
    PMH typically includes HTN or DM
    Tx - aggressive medical management and anti-platelet meds
102
Q

Describe findings of pure motor lacunar stroke

A

Unilateral motor weakness w/o cortical signs (aphasia, neglect, etc)
Occur at genu or posterior limb of internal capsule where descending corticospinal and corticobulbar tracts are.

103
Q

downward displacement of cerebellar vermis and medulla through the foramen magnum w/ a SMALL posterior fossa

A

Arnold-Chiari type 2 malformation

Tends to present in childhood, can include syringomyelia and myelomeningocele

104
Q

Downward displacement of cerebellar tonsils through the foramen magnum

A

Arnold-Chiari type 1 malformation

More common, typically and inidental finding in teens and adults

105
Q

Abn large posterior fossa, absence of cerebellar vermis, large ependyma-lined cyst that represents an expanded 4th ventricle

A

Dandy-Walker malformation

106
Q

How do you manage a cerebellar hematoma (cerebellar hemorrhagic stroke)?

A

Immediate surgical evacuation to prevent cerebellar tonsil herniation
Can get nearly complete neurologic recovery if caught early
Presents with inability to walk due to imbalance, n/v, HA, neck stiffness, gaze palsy, facil weakness

107
Q

Waxing/waning tinnitus, vertigo, progressive hearing loss

A

Meniere dz
Caused by distention of the entire enolymph system
tx - rest, low salt, dimenhydrinate, cyclizine or meclizine

108
Q

Unilateral vision loss x days, pain with eye movement

A

Optic neuritis
Need an MRI, LP
Tx - Iv steroids

109
Q

Tx for Alzheimer

A

Neuroprotective NMDA receptor antagonist (memantine) and/or

Ach esterase inhibitors (donepezil, rivastigmine, galantamine)

110
Q

Disorientation/indifference +
nystagmus, lateral rectus palsy, conjugate gaze palsy +
Gait ataxia

A

Wernicke

Give thiamine + mg before dextrose

111
Q

AIDS pt with multifocal neuro abnormalities and multiple non enhancing lesions on CT

A

Progressive multifocal leukoencephalopathy (PML)
Caused by JC virus
Bad prognosis

112
Q

Occlusion of which a. can cause wernicke aphasia?

A

Left MCA (superior temporal gyrus)
Pt’s speech is fluent and voluminous, but has no meaning
Pt unaware of deficit
Can present without weakness

113
Q

Choreiform movements + progressive demnetia

A

Huntington’s
expansion of CAG repeats
Atrophy of the caudate nucleus

114
Q

1st line tx for mild to mod Alzheimer?

A

Doneprazil (Ach estrase inhibitor)

Memantine (NMDA antagonist ) is reserved for mod to severe

115
Q

Tx for acute torticollis?

A

IM diphenhydramine, DA agonists, muscle relaxants, or benzo’s
chronic focal dystonia -> botox
Higher incidence in PD

116
Q

Symmetric descending flaccid paralysis

A

Botulism

117
Q

Cause of wigned scapula

A

Defect in long thoracic n.
Causes paralysis of serratus anterior (C5,6,7)
Recent hx of surgery, weightlifting, use of crutches, etc.
Difficulty lifting arms overhead

118
Q

Hereditary cause of conductive hearing loss

A

Otosclerosis
AD
Presents in late teens/early twenties, pregnancy increases rate of progression

119
Q

How do you tx HIV + PML?

A

HAART

120
Q

MS pt has urge incontinence, hypotonic bladder and urinary retention

A

Bethanechol

Mild bladder cholinergic agent

121
Q

Sensory loss in a cape-like distribution w/ or w/o LMN signs

A

Syringomyelia

Associated with Arnold chiari type II

122
Q

Most common cause of meningitis secondary to CSF leakage?

A

Step pneumo

123
Q

dysfunction of multiple peripheral nerves in succession

A

Mononeuropathy multiplex
Presents as pain
Associated with system dz (vasculitis, metabolic, rheumatic)

124
Q

What is the plexus for the upper body?

A

Brachial

125
Q

Plexus for the lower body?

A

lumbosacral

126
Q

problem involving a nerve root

A

Radiculopathy (1) or polyradiculopathy

tingling, pain radiating from the back

127
Q

What is the UMN?

A

info moving down the corticospinal tract (ie from brain to anterior horn of the appropriate level in the spinal cord, CNS)
spasticity, hyperreflexic, Babinski
Weakness of lower face

128
Q

What is the LMN?

A

info moving from the spinal cord to the muscle (ie, peripheral, nerve root to NMJ of the innervated m.)
Fasiculations, atrophy
face - bell’s palsy, weak upper and lower face

129
Q

Lesion affecting ipsi face but contra arm

A

Base of the pons

Descending motor fibers of the face have crossed, but the body has not yet

130
Q

What causes cerebral amyloid angiopathy?

A

Deposition of AB amyloid (but unrelated to Alzheimer)

Most probably cause of lobar hemorrhage in a pt w/o other RF’s

131
Q

Weakness that improves w/ movement

A

Lambert-Eaton
Abs against terminal Ca2+ channel -> decreased transmission of ACh
Associated with small-cell lung cancer -> get a CT of the chest

132
Q

What is the COD in ALS?

A

Respiratory failure in 3-5 years

90% of cases are sporadic

133
Q

Baby is born with thin membrane over the lower lumbosacral vertebrae that contains neuronal tissue

A

Myelomeningocele (a NTD)
Needs a brain CT prior to surgery to identify if hydrocephaly secondary to type II Chiari is present. Surgeon can shunt the defect at the same time

134
Q

Pt with hx of breast cancer has a persistant HA x 1 month

A

Get a CT w/ contrast. Suspicious for brain metastases which is a frequent cause of elevated ICP. HA is often worse in the morning when caused by ICP

135
Q

Child with a hx of neck stiffness presents with torticollis, and cranial nerve deficits

A

Get an MRI

suspicious for brainstem glioma (enlarged pons that does not occlude the 4th ventricle)

136
Q

Brain tumor of childhood growing from the cerebellar vermis and presents with s/s of hydrocephaly

A

Medulloblastoma
One of the most frequent tumors in childhood
Causes hydrocephly due to compression of the 4th ventricle
Neuroectodermal, anaplastic
Sheets of undifferentiated cells with scanty cytoplasm
Rapidly growing so highly responsive to radiation/chemo

137
Q

Tumor of childhood that fills the 4th ventricle

A

Ependymoma
Prognosis dependent on complete excision
Tend to recur

138
Q

Benign tumor with a prominent capillary network in the cerebellar hemispheres

A

Hemangioblastoma

Hippel-Lindau

139
Q

Benign well circumscribed tumor in children presenting in the cerebellum and/or diencephalic region

A

Pilocytic astrocytoma

Resection is curative

140
Q

Tx options for postherpatic neuropahty

A

TCA’s (desipramine), gabapentin, pregabalin

141
Q

Hemangioblastoma + angioma of the retina

A

Hippel-Lindau syndrome
AD, Ch 3
cerebellum tumor, erythrocytosis because they may produce epo

142
Q

Newborn w/ late decels during delivery, acidotic cord pH, and low apgar scores is at risk of?

A

Hypoxic-ischemic encephalopathy

Expect seizures during nursery stay

143
Q

Most appropriate diagnostic test for Guillain-Barre?

A

Nerve conduction studies to look for demyelinating neuropathy
And
CSF for albuminocytosis

144
Q

Tx for trigeminal neuralgia (tic douloureux)

A

Carbamazepine

145
Q

Infant in first month of life presents with feeding difficulties, progressive hypotonia, weakness, absent DTR’s, tongue fasciculations, respiratory distress

A

Spinal motor atrophy type I (Werdnig-Hoffman dz)
Progressive degenerative diz of the motor neurons -> denervation and atrophy of the muscle
Dx w/ muscle bx showing pattern of perineural denervation, or test for presence of SMN gene

146
Q

Tx for ALS

A

Riluzole

Modest survival benefit

147
Q

A pt on heparin presents with hemorrhagic stroke. Now wht?

A

IVC filter
60% of PE arise from DVT, so IVC can fxn as anticoag
However, IVC’s can themselves cause thrombi

148
Q

Delirium + dilated nonreactive pupils

A

OD of anticholinergic agen
Red as a beet, dry as a bone, hot as a hare, blind as a bat, mad as a hatter, full as a flask
Benztropine is used in PD
Reverse with physostigmine (cholinesterase inhibitor)

149
Q

Infant with hypo-pigmented ash-leaf macule more visible under the woods lamp, infantile spasms of the neck/trunk/extremities

A

Tuberous sclerosis
Neurocutaneous syndrome
Tx - ACTH

150
Q

Inherited progressive ataxia affecting the arms more than the legs, dysarthria, childhood onset

A

Friedreich ataxia
ar
Loss of reflexes, spasticity, impaired vibration and positional sense

151
Q

Ataxia, areflexia, and ophthalmoplegia

A

Miller-Fisher syndrome

152
Q

Sudden onset of cerebellar ataxia + vomiting + decreased conciousness

A

Cerebellar stroke

153
Q

B/l Facial n. palsy + pulmonary nodules + hypopyon

A

Neurosarcoidosis

154
Q

Which antiepileptic can decrease the efficacy of estrogen OCP’s?

A

Topiramate

155
Q

Pt with new onset seizures has failed two different antiepileptics. Now what?

A

Refer for epilepsy monitoring evaluation

156
Q

Pathophys of delirium

A

General acute slowing of brain activity
Astrerixis, tremor, dysphagia, incontinence
Anticholinergics worsen delirium

157
Q

RF’s for delirium?

A 
Poor nutrition
Surgery
Drugs
Male gender
Environment
158
Q

Which child hood seizures have a higher risk of reoccurence?

A

Complex febrile seizures
Family Hx of childhood epilepsy
Nocturnal seizures
Hx of developmental delay

159
Q

Which antipsychotics do have long acting injectable options?

A

Fluphanazine (Prolixin)
Aripiprazole (Abilify)
Olanzapine (Zyprexa)
Haloperidol (Haldool)

160
Q

What should be chekced prior to starting clozapine?

A 
CBC w/ diff (PMN count x 6 months)
Fasting glucose
Lipid panel
LFT's
Risks of T2DM, hyperlipidemia, elevated LFT's
161
Q

Pt presents with acute rigidity + torticolis + nystagmus

A

PCP intoxication

162
Q

Tx options for acute vertigo

A

Meclizine

Scopolamine

163
Q

Migrain prophylaxis

A

Propanolol, timolol
Valproate
Amitriptyline
Give 2-3 months trial to determine efficacy

164
Q

Stroke like syx that resolve in less than 24 hours

A

Transient ischemic attack (TIA)

165
Q

Pt has acute vertigo, blurry vision, and slurred speech. Where is the lesion?

A

Vertebrobasilar artery
Hallmark is acute vertigo but other syx are diplopia, drowsiness, dysphagia, dysarthria, hemi-sensory loss, facial numbess, syncope

166
Q

Tx for Huntington Dz

A

Haloperidol

DA antagonistic agents are effective in decreasing the involuntary movements

167
Q

Tx with multiple brain mets

A

Cranial radiation

Surgery is only recommended when there is a single lesion

168
Q

What should be included in a elderly pt w/ frequent falls

A

Get up and go test

Can demonstrate deficits in leg strength, balance, vestibular dysfunction, and gait

169
Q

Pick dz is

A

Frontotemporal demntia

170
Q

Pt has acute on set of dizziness, dysphagia
Left sided sensory loss over the face
Right sided sensory loss of the lower extremities

A

Left Posterior inferior cerebellar a. occlusion

171
Q

Increased pressure in the posterior fossa is concerning for?

A

Upward herniation

Cerebellum moves up through the tentorial opening

172
Q

Pt has involuntary extension of the UE in response to stimuli. Head is arched back, arms extended at sides with internal rotation

A

Decerebrate posture

Indicates brain stem (posterior fossa) damage

173
Q

After vaginal delivery, mom has weakness in dorsiflexion and eversion of the R ankle

A

Common peroneal n. deficit

Gets damamged as baby’s head crosses the lumbosacral plexus

174
Q

On elderly woman with a long hx of steroid use and new onset of difficulty using her hands should get

A

A DEXA scan

175
Q

Alcoholic w/ new seizure presents with macrocytosis w/ no other neurologic findigns

A

Folate deficiency

B12 would have parathesia

176
Q

Adult has difficulty walking, hx of seizures, and exam reveals increased muscle tone in the lower extremities + spasticity + briks reflexes

A

Parasagittal cerebral cortex

CP baby that is presenting in adulthood

177
Q

Patient has vertigo and hearing loss when flying, riding in elevators, or sneezing

A

Endolymphatic fistula
ABN connection between the inner ear (liquid) and middle ear (air)
Occurs when there is an increase in intracerebral pressure

178
Q

If you suspect compartment syndrome in a leg you should get a

A

Measurement of the compartment pressures and plan a fasciotomy

179
Q

Young patient with progressive incordination of gait, hands, speech, and eye movement

A

Spinocerebellar ataxia

Genetic

180
Q

Management of carotid stenosis

A

Clopidogrel

181
Q

Urine incontinence in a pt with UMN findings

A

Detrusor hyperreflexia

182
Q

Pt presents with urinary retention and recent onset of leg weakness

A

Conus medullaris syndrome
Lesion at L2
Flacid paralysis of the bladder and rectum, impotence, saddle anesthesia.
Caused by disc herniation, spinal fx, tumor

183
Q

Which n. innervates the deltoid m.?

A

Axillary n. (C5-C6)

Injured in anterior dislocation of the shoulder

184
Q

Pt presents with back radiating into the legs, absent S1 reflex, bladder/rectal incontinence, sensory loss

A

Cauda equina syndrome

Caused by disc herniation, epidural abscess, tumor, spondylosis, etc

185
Q

Pt is comatose w/ a battle sign

A

Basilar skull fx

Risk of epidural hemorrhage

186
Q

Significance of HLA 1502

A

Higher risk of Stevens-Johnson syndrome
Seen in SE Asian descent
Be careful using carbamazapine

187
Q

Highest teratoginic impact?

A

Valproic acid

Lamotragine - safest, but titrate up slowly due to risk of Stevens-Johnsons

188
Q

Gingival Hyperplasia

A

Phenytoin

189
Q

When do you see myoclonus?

A

Major hypoxic injury (give keppra)
Juvenile myoclonic epilepsy (poly spike wave on EEG) - kids randomly throw stuff (like a toothbrush) first thing in the morning, child is aware of the event but cannot control it

190
Q

EEG finding in absence seizures

A

3 Hz spikes

191
Q

What drug can make absence of JME worse?

A

Carbamazapine

192
Q

Acute management of status epilepticus

A
  1. Lorazapam 4-8mg x 2

2. Phenytoin 20mg/kilo

193
Q

Otoliths causing vertigo

A

Benign paroxysmal positional vertigo (BPPV)

Nystagmus during Dix-Hallpike manuver

194
Q

Dementia + visual hallucinations + Parkinsonianism

A

Lewy Body

195
Q

Pathophys of acute diffuse encephalomyelitis (ADEM)

A

Autoimmune inflammatory condition following a viral infection or vaccine.
Presenting syx similar to MS

196
Q

Compare cauda equina, conus medullaris, and anterior spinal a. occlusion

A

Cauda equina - flaccid paralysis, defect in sensation, incontinence
Conus medullaris - motor and sensory defect of LE, urinary retention
Anterior spinal a. occlusion motor defect of LE, urinary retention, sensory INTACT

197
Q

Periventricular leukomalacia in a neonate

A

CP (spastic diplagia, quadriplegia)

Preterm infants

198
Q

Pathophys of Lambert Eaton

A

Ab-mediated destruction of presynaptic Calcium channels

Look for small cell cancer

199
Q

Pure motor lacunar stroke is caused by damage to?

A

Posterior limb of internal capsule

200
Q

What is Spurling sign

A

Increased pain in the unilateral UE due to extension and lateral bending of the neck toward the side of the lesions (radicular pain)
Indicates cervical spondylosis (Spurling sign + L’hemitte + decreased ROM)
Get an X-ray

201
Q

Most common cause of neonatal seizures?

A

Hypoxic-ischemic encephalopathy

Seen in severe late decels, acidotic cord pH, low Apgar scores

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