Neuro - MTB And SU2M

Question 1

Presentation of MCA stroke?

Answer 1

C/L weakness/sensory loss
Homonymous hemianopsia —> “eyes look towards lesion”
Aphasia

Question 2

MC sx of PCA stroke?

Answer 2

I/L sensory loss of face, CN 9 and 10
C/L sensory loss of limbs
Limb ataxia

Question 3

MC sx of ACA stroke?

Answer 3

Personality/cognitive defect like confusion
Urinary incontinence
Leg weakness

Question 4

Thrombolytic standard of care for stroke?

Experimental?

Answer 4

Under 3 hours

3-4.5 hours

Question 5

Best prophylaxis for cluster HA?

Migraine?

Answer 5

Verapamil

Propanolol

Question 6

Trigeminal neuralgia NOT improved by meds, treat how?

Answer 6

Gamma knife surgery

Question 7

What is the treatment of status epilepticus in escalating order?

Answer 7

Lorazepam/Diazepam
Fosphenytoin
Phenobarbital
General anesthesia

Question 8

When do you need to initiate antiepileptic drugs for a SINGLE seizure?

Answer 8

Status epilepticus or w/FND
Abnormal EEG or lesion on CT
FHx of seizures

Question 9

Most accurate test for SAH?

Shows what.

Answer 9

LP

Xanthochromia - yellow discoloration of CSF from breakdown of rbc’s
Normal ratio of wbc/rbc is 1:500-1000

Question 10

What presents w/loss of ALL function except for the post column
Flaccid paralysis
Loss of DTRs?

Answer 10

Anterior spinal artery infarct

Question 11

What is syringomelia?

Answer 11

Fluid-filled lesion inside the center of the cord resulting in a cape like distribution of sensory loss across the neck and UE

Question 12

What sx does Tuberous Sclerosis have?

Answer 12

Seizure, mental retard
Skin - adenoma sebaceous (red face nodules), Shagreen patches (leathery plaques on trunk), Ash leaf (hypopigmented) patches
Retinal lesions
Cardiac rhabdomyomas

Question 13

Sturge-Weber presents how?

Answer 13

Port-wine stain of face
Seizure
CNS: homonymous hemianopsia, hemiparesis, mental subnormality
Skull has xray calcifications

Question 14

Pathophys of Parkinsonism?

Answer 14

Loss of cells in the SN leading to decreased Dopamine

Question 15

Treatment for PD if it is mild?

If allergy to 1st med?

Answer 15

Benztropine, trihexyphenidyl

Amantidine

Question 16

What med is associated w/the possibility of slowing the progression of Parkinsonism?

Answer 16

MAO-i’s

Question 17

What is Shy-Drager syndrome?

Answer 17

Parkinsonism w/mostly orthostasis

Question 18

What meds are the best 1st choice to prevent relapse of M.S.?

Answer 18

Glatiramer

IFN-Beta

Question 19

What presents w/distal weakness and sensory loss, wasting in the legs, dec DTRs, tremor and foot deformity as a high arch?

Most accurate test?

Answer 19

Charcot-Marie-Tooth

EMG

Question 20

How to tell if facial paralysis is from stroke or Bell’s palsy?

Answer 20

Stroke - paralyze ONLY the lower half of face bc upper half gets inner action from BOTH cerebral hemispheres
Pt will be able to wrinkle their forehead

Question 21

MC complication of Bell’s Palsy?

Best initial tx?

Answer 21

Corneal ulceration

Prednisone

Question 22

What are some wrong answers for treatment of GBS?

Answer 22

Prednisone

Combining IVIG + Plasmapharesis

Question 23

What is the most dangerous thing that can happen in GBS?

How to detect?

Answer 23

Dysautonomia of respiratory muscles

Peak inspiratory pressure or a dec in FVC —> get PFTs

Question 24

What tests do you need to do when evaluating for dementia?

Answer 24

MRI brain
VDRL/RPR to r/o syphilis
B12 and MMA level
TSH

Question 25

Reversible ischemic neurologic deficit is what?

Answer 25

Same as TIA but lasts LONGER than 24 hours, resolves in less than 2 weeks

Question 26

TIA etiology is what MC?

What set of circumstances can lead to one?

TIAs carry what 5 year risk of stroke?

Answer 26

Embolic

HoTN w/Severe carotid stenosis (> 75%)

30%

Question 27

Pt that has stroke and has pure motor hemiparesis, what origin?

Dysarthria w/clumsy hand?

Pure sensory deficit?

Answer 27

All lacunar
Internal capsule

Pons

Thalamus