Neurology

Question 1

What type of dementia is this- frontal and temporal lobe atrophy with speech abn, decr executive function, mood change, hyper-ORAL movement

Answer 1

Pick’s disease - can also find on biopsy- gliosis, neuronal loss, neuronal swelling, silver containing cytoplasmic inclusions

Question 2

What type of dementia is this- visual hallucinations, parkinsons like motor probs (rigid, intention tremor)?

Answer 2

Lewy body dementia- also see cytoplasmic inclusions

Question 3

Statis epilepticus tx and management (labs)

Ie if still see twitching

Answer 3

Cbc, bmp, glc, utox

Need to tx bc stress and neuronal damage assoc w m&m

Tx w benzo ggt

Question 4

Give thiamine in wernickes to prevent

Answer 4

Korsakoff psychosis - injury in mammillary bodies

Question 5

Carbamezepine side effect

Answer 5

Neutropenia (bone marrow suppression)

And siadh hyponatremia

Question 6

Which nerve is affected?

Loss sensation anterior and medial thigh, shin, and foot arch. Cant extend knee.

Answer 6

Femoral nerve

Question 7

Which nerve is affected? Foot drop and loss sensation dorsum of foot?

Answer 7

Common peroneal nerve

Question 8

If incr carbidopa impr parkinson symptoms but worsens psychosis what do u do next?

Answer 8

Add seroquel

Cutting down on dopa would make pt rigid again

Question 9

Acute onset double vision, ptosis, muscle weakness, sluggish and dilated pupils, dysarthria in a 33 yo woman.

Answer 9

Botulism

Esp if just had CANNED food

Presynaptic NMJ disorder. Botulism toxin inhi release of ach into synaptic cleft.

Confirm with serum botulinum toxin

Vs MG is a POSTsynaptic NMJ disorder causes by ab to ach-r

Question 10

What do you get with following lesions

• nondom parietal lobe
• dom parietal love
• nondom temporal lobe
• dom temporal

Answer 10

• nondom parietal lobe difficulty copying drawing and wearing clothes
• dom parietal lobe cant do math, cant name fingers, cant write. Confused w left and right
• nondom temporal lobe homonymous quadrantopia
• dom temporal lobe - homonomous quandrantopia and wernikes aphasia (wordy and doesnt make sense)

Question 11

Elderly lady w ams, normal ct, cxr, lp, cbc, bmp, ua. Next test?

Answer 11

Tsh!!! Esp in elderly

Not abg bc bmp normal

Question 12

Shoulder pain in smoker, horners syndrome, hand muscle atrophy with weakness is what? What finding needs urgent intervention?

Answer 12

Asymmetric DTRs in setting of BACK pain suspicious for spinal cord compression

Question 13

Large prolactinoma tumor impinging on optic chiasm

Answer 13

Is dopaminergic agonist which will shrink tumor in days. Rarely do surgery anymore. Surgery is for nonfunctioning pituitary adenoma

Question 14

20s yo f with gait prob, weakness, 2 days ago w eyevision loss w eye pain. A yr ago w numbness and unsteady that resolved. What does pt have?

Tx in acute flare?

Tx to prevent relapses?

Answer 14

MS- relapsing remitting- lesions disseminated in time and space.

50% get optic neuritis

If have optic neuritis- IV steroids then oral steroids

Prevent relapse w disease modifying agents like b interferon and glatiramer acetate. Dont want long time steroids.

Question 15

Tx if spasticity in MS with

Answer 15

Baclofen or tizanidine

Question 16

Headache with occasional vision change and hearing rhymic pulsations when bending down. Ophthalmic exam w venous engorement, hard exudate, and peripapillary flame hemorrhage

Answer 16

Pseudotumor cerebri which is idiopathic intracranial htn causing papilledema and may lead to optic atrophy and blindness
some meds like isotretinoin cause

Question 17

After stroke, and giving tpa, what is goal bp?

What is dont give tpa, what is goal bo

Answer 17

185/105 or less

If no tpa goal is

Question 18

Pt found to have pituitary tumor w mildly high prolactin level, high alpha subunit should get what tx?

Answer 18

Transphenoidal resection for nonfunctioning tumor (high alpha cells)

Note that mild elevation of prolactin dhe to increase in pituitary stalk. Vs prolactinoma would have levels like 200/

Question 19

Tx for teen w few months of arm jerks and now w generalized tonic clonic seizure, eeg showing bl polyspike and slow discharge

Answer 19

Has juvenile myoclonic epilepsy

Tx is valproic acid

Wouldnt be meningitis this chronic onset

Question 20

What is tx for cluster ha proph?

Answer 20

Verapamil!!

Could even use sumatriptan for acute episode but 100% o2 via mask is best

Question 21

Pt w stroke 7 hrs ago. Next step in tx is

Next next step?

Answer 21

Do a s&s study to assess if pt can take meds or eat!!

Hepsq for dvt ppx!! Most frequent cause death in stroke pt is PE!!!

Question 22

Vertigo, dizziness, and neuro signs like diplopia, dysarthria, numbness due to

Answer 22

Vertebrobasilar insuff

Vs labyrinthitis- get vertigo, tinnitus, n, loss of balance but in setting if recent viral illness

Question 23

If facial weakness and cant even raise eyebrow on that side, suspicious for… What additional workup?
If facial weakness and can raise eyebrow

Answer 23

If entire one side of face w weakness it is due to peripheral n palsy like bells palsy - neuropathy of cn7.

Forehead sparing suggests intracranial lesions

Even if bells palsy dont need lyme serology unless travel edemic area
Tx is bells is eye drops and steroid

Question 24

What improves survivial in metastatic brain?

Answer 24

Whole brain radiation by 3-6 months

Question 25

Sudden severe headache w high bp and vomiting should get what first

Answer 25

Cth to ro sah! If that is neg and high suspicion then do lp!!!

Question 26

60 yo woman w headache and now diplopia, ptosis, mild anoscoria of eye due to

Answer 26

Subarach hemm of PCA aneurysm posterior communicating artery