Neurology

Question 1

what is the MC chromosomal disorder and cause of mental developmental disability

Answer 1

trisomy 21

Question 2

common findings in trisomy 21

Answer 2

prominent epicanthal folds (monolid)
brush field spots - white, grey or brown spots on the iris

transverse, singular palmar crease (simian crease)

AV septal defects

Question 3

prenatal screening for trisomy 21 and findings

Answer 3

biochemical screening - first trimester; low PAPP-A

nuchal translucency US - 10-13 weeks; increased nuchal fold thickness –> chorionic villus sampling or amniocentesis should be performed

Question 4

MCC meningitis in adults

Answer 4

strep pneumo

Question 5

MCC meningitis in kids

Answer 5

Neisseria menigitidis

Question 6

meningitis in kids is associated w

Answer 6

a petechial rash on trunks, legs, conjunctiva

Question 7

MCC meningitis in neonates

Answer 7

GBS

Question 8

sx meningitis

Answer 8

fever, HA, neck stiffness, photosensitivity

Question 9

brudzinski vs kernig sign

Answer 9

brudzinski - neck flexion produces knee or hip flexion

kernig - inability to extend knee with hip flexion

Question 10

dx meningitis

Answer 10

Bacterial = LP + CSF exam - decreased glucose + increased neutrophils, increased protein
Viral = LP + CSF exam - normal glucose + normal or elevated protein, increased lymphocytes

Head CT before LP

Question 11

tx meningitis

Answer 11

cef + vanc

can use dexamethasone too

Question 12

PEP for meningitis

Answer 12

Cipro or rifampin

droplet precautions x 24 hours after starting abx

Question 13

Turner’s syndrome results from

Answer 13

the absence of one complete set of genes located on the X chromosome or a nonfunctioning X chromosome (45 XO)

Question 14

common sx in turner’s syndrome

Answer 14

hypogonadism - gonadal dysgenesis (streaked ovaries), absence of breasts, infertility

CV - coarctation of art, bicuspid aortic valve

Question 15

PE for turner’s syndrome

Answer 15

short stature
webbed neck
broad chest with widely spaced nipples “shield chest”

Question 16

dx turner’s syndrome

Answer 16

karyotyping = definitive; 45 XO

labs - low estrogen + high FSH and LH

Question 17

tx turner’s syndrome

Answer 17

human growth hormone replacement
estradiol-progestin replacement if no breast development around pubertal age

Question 18

focal (Partial) seizure with retained awareness

Answer 18

simple

Question 19

focal (partial) seizure with impaired awareness

Answer 19

complex

Question 20

what motor sx are common in focal seizure

Answer 20

jerky rhythmic movements

may start in one area and spread to other parts of affected limb/body – Jacksonian march

neurologic deficit lasting up to 24H (Todd’s paralysis)

Question 21

another name for absence seizure

Answer 21

petit mal

Question 22

sx absence seizure

Answer 22

they are “absent”

pause/stare - loss of awareness without loss of body tone

episodes last 5-10 min

Question 23

EEG for absence seizure

Answer 23

bilaterally synchronous and symmetrical 3 Hertz spike and wave discharge

Question 24

tx absence seizure

Answer 24

ethosuximide (1st)
valproate (2nd)

Question 25

tonic clonic seizures are also called

Answer 25

grand mal

Question 26

sx tonic-clonic seizure

Answer 26

loss of consciousness w tonic activity (contraction & rigidity) followed by 1-2 minutes of clonic activity (repetitive, symmetric, jerking movements) –> postictal confusion

may have cyanosis, tongue-biting, urinary incontience

Question 27

what labs are increased immediately after a seizure

Answer 27

lactic acid
prolactin

Question 28

what is status epilepticus

Answer 28

continuous seizure lasting 5 minutes or greater or 1 seizure within a 5 minute period without recovery in between episodes

Question 29

is status epilepcticus an emergency

Answer 29

YES

Question 30

tx for status epilepticus

Answer 30

benzodiazepines (lorazepam)