Neurology

Question 1

Friedreich’s ataxia

Answer 1

1. Spinocerebellar degeneration (gait ataxia, dysarthria, UMN signs, sensory neuropathy - but cognition intact)
2. Skeletal abnormalities (scoliosis, high arch, hammer toe)
3. Cardiac disease (concentric hypertrophic cardiomyopathy, CHF and arrhythmias)
   (Diabetes is also commonly seen)

Question 2

Most common cause of death in Friedreich’s ataxia

Answer 2

Cardiac disease (concentric hypertrophic cardiomyopathy, myocarditis, CHF, arrhythmias)

Question 3

Pendular reflexes

Answer 3

Cerebellar disease (e.g. alcoholic cerebellar deeneration)

Question 4

Region classically affected in Huntington’s chorea

Answer 4

Caudate nucleus

Question 5

Rapidly progressive dementia with myoclonus. EKG sign? CSF finding?

Answer 5

Creuteld-Jakob disease.
EEG: Sharp triphasic synchronous discharges.
CSF: 14-3-3- protein

Question 6

Dementia with subcortical effects early and memory loss later

Answer 6

HIV-associated dementia

Question 7

Medications that can cause pseudotumor cerebri (IIH)

Answer 7

Tetracyclines, vitamin A and systemic retinoids

Question 8

Treatment for pseudotumor cerebri (IIH)

Answer 8

Acetazolamide (+/- furosemide)

Question 9

Signs of transtentorial uncal herniation

Answer 9

1. Hemiparesis (often ipsilateral due to compression of contralateral cerebral peduncle, but can be the other way around)
2. Blown pupil early, oculomotor palsy late (CN III compression)
3. Contralateral homonymous hemianopsia (PCA compromise to occipital lobe)
4. Depressed MS and coma (reticular formation compression)

Question 10

Presentation of tick-borne paralysis

Answer 10

Ascending paralysis without autonomic involvement

Question 11

What is suggested by pronator drift

Answer 11

UMN lesion

Question 12

Monocular vision loss (washed-out colors, central scotoma, APD), +/- painful eye movements

Answer 12

Optic neuritis

Question 13

CNs that travel through cavernous sinus

Answer 13

III, IV, V1, V2, and VI

Question 14

Cause of intranuclear ophthalmoplegia

Answer 14

Lesion to medial longitudinal fasciculis (unilateral in stroke, can be bilateral in MS)

Question 15

Parkinson’s med that can led to closed-angle glaucoma

Answer 15

Trihexyphenidyl (anticholinergic that dilates the pupil)

Primarily for tremor in early disease

Question 16

Parkinson’s med that can lead to ankle edema and livedo reticularis

Answer 16

Amantidine

Question 17

Peripheral neuropathy with GI symptoms and sideroblastic anemia

Answer 17

Lead poisoning

Question 18

Peripheral neuropathy with skin thickening and pigment changes

Answer 18

Chronic arsenic poisoning

Acute poisoning: garlic breath, V/D, long QT, potentially pancytopenia and hepatitis

Question 19

Treatment for arsenic poisoning

Answer 19

Dimercaprol (chelates arsenic as well as mercury, gold, and lead)

Question 20

Treatment for myasthenic crisis

Answer 20

Steroids + plasmapheresis/IVIG, potentially intubation

Question 21

Sudden onset of bilateral cranial neuropathies, symmetric descending weakness, and potentially respiratory failure

Answer 21

Foodborne botulinism (kinda like MG, but rapid and with no history)

Question 22

How can you tell the different between carpal tunnel syndrome and more proximal median nerve injury (e.g. supracondylar humerus fracture?

Answer 22

Sensation to thenar eminence spared in carpal tunnel but not more proximal lesion
(Both have sensation to palmar first 3.5 fingers and thenar weakness/atrophy)

Question 23

Cause of radial nerve injuries

Answer 23

Mid-shaft humeral fracture or improper crutches/saturday night palsy

Question 24

Cause of ulnar nerve injury

Answer 24

Fracture of medial epicondyle (see claw hand)

Question 25

Cause of axillary nerve injury

Answer 25

Anterior shoulder dislocation (wraps around humerus) | See weakness in shoulder abduction and sensation to lateral arm

Question 26

How can you differentiate between foot drop due to peroneal nerve injury and L5 root injury?

Answer 26

Plantarflexion spared in peroneal nerve injury but weak in L5 injury

Question 27

Cause of Trendelenberg gait

Answer 27

Injury to superior gluteal nerve (to gluteus medius and minimus muscles)

Question 28

Most common superior fossa tumor in children

Answer 28

Low-grade astrocytomas (e.g. pilocytic astrocytoma)

Question 29

2 most common posterior fossa tumors in children. Where are they classically located?

Answer 29

1. Most common is cerebellar astrocytoma, in lateral cerebellar hemispheres (limb ataxia) 2. 2nd most common is medulloblastoma, in cerebellar vermis (truncal ataxia)

Question 30

Cause of loss of vertical gaze and pupillary light reflex with lid retraction and convergence-retraction nystagmus when look up

Answer 30

Parinaud syndrome due to pineocytoma (compresses superior colliculi and pretectum)

Question 31

Most common cause of hemorrhagic stroke overall? In patients over 60? In children?

Answer 31

Overall: Hypertensive vasculopathy Over 60: Cerebral amyloid angiopathy Children: Vascular malformations (e.g. AVMs)

Question 32

Common features and differences between hemorrhagic stroke of basal ganglia and thalamus

Answer 32

Both: contralateral hemiparesis and hemisensory loss (internal capsule involved in basal ganglia strokes) Basal ganglia: conjugate gaze deviation (look towards BG stroke) (also see homonymous hemianopsia) Thalamus: contralateral gaze deviation (look away from thalamic stroke (also see upgaze palsy and nonreactive constricted/miotic pupils)

Question 33

Deep coma and reactive pupils

Answer 33

Pontine hemorrhagic stroke

Question 34

Ipsilateral hemiataxia, facial weakness and nystagmus, and HA and nystagmus

Answer 34

Cerbellar hemorrhagic stroke (unlike thalamic and basal ganglia, no hemiparesis)

Question 35

Stroke with sensorimotor deficits in legs

Answer 35

ACA stroke

Question 36

Contralateral sensorimotor deficit with cojugate gaze deviation and homonymous hemianopsia, with aphasia or hemineglect

Answer 36

MCA stroke (Note that basal ganglia hemorrhagic stroke can also lead to contralateral sensorimotor deficit with conjugate gaze deviation, but won't see aphasia or hemineglect)

Question 37

Most common lacunar infarct

Answer 37

Pure motor hemiparesis (e.g. due to internal capsule infarct) (Others: pure sensory, ataxic hemiparesis, and dysarthria-clumsy hand)

Question 38

Common features of lateral medullary and lateral mid-pontine syndrome? Differentiating features?

Answer 38

Common: 1. Ipsilateral pain/temp to face (trigeminal nucleus) 2. Contralateral loss of pain/temp to body (lateral spinothalamic tract) (DCML and motor spared) 3. Vertigo/nystagmus (vestibular nucleus) 4. Ataxia and ipsilateral dysmetria (cerbellar peduncles) 5. Ipsilateral Horner syndrome Lateral pontine only (AICA stroke) 1. Ipsilateral LMN facial paralysis 2. Ipsilateral hearing loss (cochlear nucleius) Lateral medullary only (Vertebral artery or PICA stroke): 1. Dysphagia/dysarthria/dysphonia (nucleus ambiguus, motor to glossopharyngeal and vagus)

Question 39

2 complications of SAH. When do they occur, and how can they be prevented?

Answer 39

1. Rebleed: early (24 hrs), prevent with clipping/coiling 2. Vasospasm: delayed (3 days), prevent with nimodipine) (Can also see hydrocephalus, elevated ICP, and SIADH)