Neurology

Question 1

Botulism verses Guillain Barre Syndrome

Answer 1

Botulism = EENT sxs (dysphagia, dysarthria, diplopia, etc.), then descending paralysis. GBS = parasthesia, then ascending paralysis with hyporeflexia

Question 2

Adolescent with tics develops GTC seizures worse in the morning

Answer 2

Juvenile myoclonic epilepsy (tx = valproate)

Question 3

<24 month old, nystagmus with head nodding and torticollis, normal brain MRI and EEG

Answer 3

Dx: Spasmus Nutans (spontaneous resolution within months to years)

Question 4

Treat for infantile spasms

Answer 4

Aka West syndrome. 1st line: ACTH/corticotropin, prednisolone, and vigabatrin (preferred if suspected tuberous sclerosis)

Question 5

Seizures newborn, refractory to benzo/phenytoin/phenobarb

Answer 5

B6/pyridoxine deficiency (B6 required to make neurotransmitters including GABA => neuroexcitability)

Question 6

Benign epilepsy with centrotemporal spikes AKA Benign rolandic epilepsy to childhood

Answer 6

Focal aware seizure (no LOC with motor sxs of face), facial numbness, grunting sounds, hypersalivation, and dysphasia which occurs mainly at night or in the morning. 50% have night time GTCs. 10-20% of childhood epilepsy, self resolve by 12-13 yo

Question 7

11 yo making choking sounds, face twitching, and drooling events. Negative MRI. EEG shows centrotemperal spike with normal background

Answer 7

Benign epilepsy with centrotemporal spike AKA benign rolandic epilepsy of childhood (no LOCs or AMS with episodes)

Question 8

Associated conditions for PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infx)

Answer 8

OCD, tic disorder, and Tourette syndrome

Question 9

Chiari 1 vs Chiari 2 malformation

Answer 9

Chiari 1 = herniation of cerebellar tonsils, associated with syringomyelia; Chiari 2 = +herniation of medulla, pons, 4th ventricle; associated with hydrocephalus and myelomeningocele

Question 10

Cluster headache prophylaxis and treatment

Answer 10

Prophylaxis: Verapamil (not used in migraine) and Topiramate; Treatment: O2 and triptans

Question 11

Absence seizures EEG findings and provoking factors

Answer 11

3 Hz spike and wave discharges, provoked by hyperventilation