Neurology

Question 1

most common pituitary tumor? tx?

Answer 1

prolactinoma. dopamine agonists (bromocriptine) or transphenoid resection

Question 2

55 yo pt presents w/ acute “broken speech.” what type of aphasia? what lobe and vascular distribution?

Answer 2

broca’s aphasia and frontal lobe, left MCA distribution

Question 3

most common cause of SAH

Answer 3

trauma, the second most common is berry aneurysms

Question 4

crescent-shaped hyperdensity on CT that does not cross the midline

Answer 4

subdural hematoma - 2/2 torn bridging veins

Question 5

hx of initial AMS w/ an intervening lucid interval. Dx? most likely source? tx?

Answer 5

epidural hematoma. middle meningeal artery. neurosurgical evacuation

Question 6

CSF findings w/ SAH

Answer 6

elevated ICP, RBCs, xanthochromia

Question 7

albuminocytologic dissociation (increased protein in CSF w/o a significant increase in cell count)

Answer 7

guillain-barre syndrome

Question 8

most common primary source of mets to the brain

Answer 8

lung, breasts, skin (melanoma), kidney, and GI

Question 9

seizures seen in children who are accused of inattention in class; may be confused w/ ADHD

Answer 9

absence seizures

Question 10

most frequent presentation of intracranial neoplasm

Answer 10

HA

Question 11

most common cause of seizures in children (2-10 yo)

Answer 11

infection, febrile seizures, trauma, idiopathic

Question 12

most common cause of seizures in young adults (18-35 yo)

Answer 12

trauma, alcohol withdrawal, brain tumors

Question 13

first line med for status epilepticus

Answer 13

IV BZDs

Question 14

confusion, confabulation, ophthalmoplegia, ataxia

Answer 14

wernicke’s encephalopathy due to def of thiamine

Question 15

what % lesion is an indication for carotid endarterectomy

Answer 15

70% if the stenosis is symptomatic

Question 16

most common causes of dementia

Answer 16

alzheimer’s and multi-infarct

Question 17

combined UMN and LMN disorder

Answer 17

ALS

Question 18

rigidity and stiffness w/ unilateral resting tremor and masked faces

Answer 18

parkinson’s dz

Question 19

mainstay of parkinson’s dz therapy

Answer 19

levodopa/carbidopa

Question 20

tx for guillain-barre syndrome

Answer 20

IVIG or plasmapheresis. avoid steroids

Question 21

rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior

Answer 21

huntington’s dz

Question 22

multiple cafe-au lait spots on skin

Answer 22

NF1

Question 23

hyperphagia, hypersexuality, hyperorality, and hyperdocility

Answer 23

kluver-bucy syndrome (amygdala)

Question 24

unilateral, severe, periorbital HA w/ tearing and conjunctival erythema

Answer 24

cluster HA

Question 25

signs of UMN damage

Answer 25

hyperreflexia, hypertonia, + babinski

Question 26

signs of LMN damage

Answer 26

hyporeflexia, hypotonia, atrophy, fasciculations

Question 27

hallmarks of this neuro dz include a mask-like, immobile facial expression, bradykinesia, resting tremor, rigidity, and festinating gait (hypokinetic, shuffling gait - pt appears as if he was chasing his center of gravity). dx? cause? tx?

Answer 27

parkinson's dz - caused by overactivity of cholinergic neurons and underactivity of dopaminergic neurons in the substantia nigra. tx include dopaminergic and/or anti-cholinergic drugs

Question 28

HA triggered by darkness

Answer 28

closed-angle glaucoma (due to pupillary dilation)

Question 29

HA triggered by light

Answer 29

migraine HA

Question 30

differentiate between open angle and closed angle glaucoma

Answer 30

open angle = bilateral, gradual loss of peripheral vision w/ cupping (increased cup-to-disk ratio) of optic nerve head vs closed angle = unilateral, extremely painful, blurred vision, HA, N/V w/ hard, red eye, dilated pupil that is non-reactive to light

Question 31

tx for closed angle glaucoma

Answer 31

medical emergency - consult + decreased IOP (eye drops - timolol, pilocarpine; systemic meds - oral or IV acetazolamide/mannitol; laser peripheral iridotomy)

Question 32

pt presents w/ loss of visual acuity and difficulty w/ night vision. dx?

Answer 32

cataracts

Question 33

pt presents w/ painles loss of central vision (distortion of straight lines is early sign). dx?

Answer 33

age-related macular degeneration

Question 34

pt presents w/ sudden, painless, unilateral loss of vision. fundoscopic exam shows optic disk swelling, retinal hemorrhage, dilated veins, and cotton wool spots. dx?

Answer 34

central retinal vein occlusion

Question 35

pt presents w/ sudden, painless, unilateral loss of vision. fundoscopic exam shows pallor of the optic disk, cherry red fovea, retinal swelling, boxcar segmentation of blood in retinal veins. dx?

Answer 35

central retinal artery occlusion

Question 36

pt w/ throbbing HA (may be unilateral or bilateral) triggered by stress, food, light, etc that is associated w/ N/V, photophobia, +/- aura, and noise sensitive, usually relieved by sleep and darkness. dx? tx?

Answer 36

migraine HA. tx includes avoidance of known triggers, abortive therapy includes NSAIDs, triptans (5HT agonist), metoclopramide; prophylactic therapy includes anti-convulsants (topiramate), TCAs (amitriptyline), B-blockers (propranolol), and CCBs

Question 37

pt w/ brief, excruciating, unilateral periorbital HA that may cause ipsilateral lacrimation of the eye, conjunctival injection, horner's syndrome, and nasal stuffiness. dx? tx?

Answer 37

cluster HA. tx includes acute therapy - high flow O2, dihydroergotamine, octreotide, or sumatriptan and prophylactice therapy - CCB, lithium, valproic acid, topiramate

Question 38

pt w/ HA at the end of the day that worsens w/ stress and improves w/ relaxation or massage, may describe as tight, bandlike pain. dx? tx?

Answer 38

tension-type HA. tx includes relaxation, avoidance of stressors, NSAIDs and acetaminophen

Question 39

``` lewy body dementia vs pick's dz vs alzheimer's dz vs multi-infarct dementia ```

Answer 39

lewy body - fluctuating cognitive impairment, recurrent visual hallucinations, and motor features of parkinsonism pick's dz - personality changes, compulsive behaviors, and impaired memory w/ intact visual-spatial functions alzheimer's dz - subtle memory loss, language difficulties, apraxia, followed by impaired judgement and personality changes multi-infarct dementia - step-wise decrease in cognitive function w/ motor and sensory neurological dysfunction