Neurology

Question 1

First step if concerned about wernicke’s encephalopathy?

Answer 1

give IV thiamine, before glucose

Question 2

definitive tx of SAH?

Answer 2

surgical clipping, embolization of vessel

Question 3

tx of myasthenia graqvis?

Answer 3

cholinesterase inhibitors - pyridostigmine
plasmapheresis, IVIG
immunosuppression

Question 4

brain tumor: rare, slow growing, often found in frontal lobe

Answer 4

oligodendroglioma

Question 5

brain tumor: benign, most common childhood supratentorial tumor

Answer 5

craniopharyngioma

Question 6

brain tumor: most common malignant primary brain tumor in adults, rapidly progressive

Answer 6

gliobastoma

Question 7

brain tumor: most commonly secretes prolactin, may cause bitemporal hemianopia

Answer 7

pituitary adenoma

Question 8

brain tumor:highly malignant cerebellar tumor in children

Answer 8

medulloblastoma

Question 9

brain tumor: common primary brain tumor, typically benign

Answer 9

meningioma

Question 10

tx of absence seizure?

Answer 10

ethosuximide

Question 11

leg pain when walking, worsening, pain when walking downhill, equal pulses, DTR absent in ankles and knees, normal motor and sensory. Negative SLR. Dx?

Answer 11

lumbar spinal stenosis

Question 12

tx of multiple sclerosis?

Answer 12

steroids

Question 13

tx of parkinsons dx?

Answer 13

levodopa/carbidopa

Question 14

weakness and numbness in right hand as though asleep. Cannot extend right wrist or fingers after falling asleep on chair with arm hanging over. Dx? tx?

Answer 14

radial nerve palsy

usually no tx

Question 15

tx of restless leg syndrome, intermittent? persistent?

Answer 15

intermittent - levodopa, benzos

persistent - pramipexole, ropinirole, gaba, pregabalin

Question 16

dx of cryptococcus meningitis?

Answer 16

india ink stain or cryptococcal antigen of CSF

Question 17

tx of cryptococcus meningitis?

Answer 17

ampho + flucytosine x 2 weeks

oral azole x 6 weeks

Question 18

patient has loss of sensation and motor paralysis of both lower extremities. PEx reveals loss of pain and temperature senstion and motor function at level of T10 and below. Vibration sense and proprioception are intact in the feet. Dx? why are vibration sense and proprioception preserved?

Answer 18

anterior spinal artery syndrome

dorsal columns spared

Question 19

tx of NPH?

Answer 19

ventricular shunting

Question 20

15 year old with tingling and weakness in legs for a week. Decreased coordination and difficulty with jogging. Admitted for gastroenteritis 2 weeks ago. Absent bilateral patellar and achilles reflexes. Motor strength is 3/5 in lower extremities. Sensation intact. Dx? analysis of CSF? tx?

Answer 20

Guillain=barre syndrome

increased protein, normal cell count
albuminocytologic dissociation

ICU monitoring, plasmapheresis and IVIG

Question 21

Cause of acute self limited vertigo with hearing loss and tinnitus?

Answer 21

acute labyrinthitis

Question 22

Vertigo is independent of head movement, no hearing loss or tinnitus, may result from viral infection?

Answer 22

vestibular neuritis

Question 23

Vertigo + ataxia, hearing loss, and tinnitus, MRI shows tumjor near internal auditory canal

Answer 23

acoustic neuroma

Question 24

Vertigo with change of head position, no hearing loss, tinnitus or ataxia. Positive Dix-Hallpike maneuver

Answer 24

BPPV

Question 25

Chronic vertigo and hearing loss and tinnitus, treat with salt restriciton and diuretics

Answer 25

meniere’s disease

Question 26

58 yera old woman with 2 week history of lower back pain, urinary incontinence and fficulty walking. Diagnosed with lung cancer. Bilateral weakness in lower extremities, decreased sensation in dermatomes L2 and lower, and 1+ deep tendon reflexes in lower extremities. No XR findings. Dx? tx?

Answer 26

spinal cord compression

steroids

Question 27

47 year old with muscle weakness in hands and progressively worsened over past two months, weakness in legs, worsening of balance, slurred speech. Muscle atrophy and fasciculations in hands and calves. Handgrip strength is 1/5. Motor strength is 2/5 in other major muscle groups of upper and lower extremities. Sensory exam is normalo. Biceps, patellar and achilles are all 3_. Babinski positive bilaterally. Dx? tx?

Answer 27

amyotrophic lateral sclerosis

riluzole

Question 28

Loss of sensation of pain and temp in cape-like distribution over the neck, shoulders, and down both arms. MRI shows dilated cavitation in cervical spinal cord. Dx? Tx?

Answer 28

syringomyelia

surgical shunt