Neurology

Question 1

Myasthenia Gravis

Answer 1

MyastheniaGravis
• Patient will be complaining of proximal muscle weakness,ptosis, anddiplopiathat isworse at the end of the day
• PE will showice test improvessx
• Diagnosis is made byedrophonium(tensilon)test,EMG
• Most commonly caused byautoimmune destruction ofacetylcholinereceptors
• Treatment isacetylcholinesteraseinhibitors, such aspyridostigmine
• Comments:associated withthymoma

Question 2

Muscle weakness that gets worse with use and better with rest

Answer 2

Myasthenia gravis, if first presentation/crisis can confirm with edriphonium (AchI) - will get better

Question 3

Ptosis, diplopia and proximal muscle weakness - worse at the end of the day

Answer 3

Myasthenia gravis

Question 4

Most common finding cauda equine syndrome

Answer 4

Urinary retention or overflow incontinence

Question 5

Back pain, fever, focal neurological deficit

Answer 5

Spinal epidural abscess - especially in IV drug user! The focal neurological deficit can be urinary retention/overflow incontinence

Will have elevated ESR
Can have NORMAL WBC count

Question 6

Risk factors for spinal epidural abscess

Answer 6

IV drug user
Immunocompromised state
Recent spinal surgery
Cancer

Question 7

Phenytoin BBW & ADR

Answer 7

Phenytoin has a black box warning against intravenous infusion faster than 50 mg/min due to increased risk of severe hypotension and cardiac dysrhythmias

Gingival hyperplasia
Hypocalcemia

Question 8

GBS CSF

Answer 8

Elevated protein with only a mild pleocytosis on cerebrospinal fluid analysis (termed albuminocytologic dissociation) is highly specific in the clinical setting of suspected GBS.

Question 9

40 YO M who develops irritability, personality changes, and antisocial behaviors

Answer 9

Huntington’s disease

Question 10

papilledema, CN VI palsy

Answer 10

Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
• Patient will be a young obese female
• With a history of vitamin A toxicity, use of steroids or tetracyclines
• Complaining of HA and visual sx
• PE will show papilledema, CN VI palsy
• Labs will show ↑ opening pressure on LP
• Treatment is acetazolamide, serial LPs, weight loss

Question 11

Reduced dexterity, foot or wrist drop, extremity weakness, slurred speech, or difficulty swallowing

Answer 11

ALS

Question 12

ALS -common presentation (5)

Answer 12

reduced dexterity, foot or wrist drop, extremity weakness, slurred speech, or difficulty swallowing

Question 13

PD -common presentation (5)

Answer 13

tremor, rigidity, bradykinesia, postural instability, and “masked” or emotionless facial features

Question 14

Mild decline in intellectual function, a decreased blink rate, a softened voice, impairment of fine motor skills, anosmia

Answer 14

PD

Question 15

CN VII nerve palsy that does not spare the forehead

Answer 15

Aka forehead does not wrinkle on affected side = PERIPHERAL nerve issue (Bells palsy)

Question 16

CN VII nerve palsy that does spare the forehead

Answer 16

= CENTRAL nerve palsy = stroke

Old ppl are wrinkly, forehead will wrinkle in stroke bc the nerve palsy spares the forehead aka forehead can wrinkle

Question 17

MCC Bell’s palsy
A. Unilateral
B. Bilateral

Answer 17

A. HSV

B. Lyme disease

Question 18

Anterior cord

Answer 18

Loss of motor function below the lesion and preservation of position, touch and vibration sensation

Question 19

loss of motor function below the lesion and preservation of position, touch and vibration sensation.

Answer 19

Anterior cord syndrome

Question 20

Ipsilateral motor function loss and contralateral pain and temperature sensation loss.

Answer 20

Brown-séquard syndrome

Question 21

Central cord

Answer 21

bilateral motor paresis and sensory impairment.

Question 22

Tx trigeminal neuralgia

Answer 22

The treatment is carbamazepine 100 mg twice daily. Carbamazepine is thought to work by reducing postsynaptic tetanic contractions. It is used to treat trigeminal neuralgia and is used as an antiepileptic

Question 23

Shock-like bursts of pain on right side of face

Answer 23

Trigeminal neuralgia - tx= carbamazepine 100 mg BID

Question 24

Central transtentorial herniation

Answer 24

Occurs with midline lesions and results from herniation of the diencephalon through the tentorium cerebelli.

Pupils are pinpoint and there is spastic motor paresis

Question 25

Tonsillar herniation

Answer 25

Results from the herniation of the cerebellar tonsils through the foramen magnum. Physical exam findings include pinpoint pupils and flaccid motor paresis. Upward transtentorial herniation

Question 26

Upward transtentorial herniation

Answer 26

Occurs when lesions in the posterior fossa force the cerebellum upwards through the tentorium cerebelli, leading to compression of the midbrain. Physical exam findings include pinpoint pupils and downward gaze without vertical eye movements

Question 27

Uncal transtentorial herniation

Answer 27

Occurs when the uncus of the temporal lobe is pushed inferiorly through the medial edge of the tentorium. This leads to compression of parasympathetic fibers running with the third cranial nerve resulting in a fixed and dilated pupil due to unopposed sympathetic tone.

Question 28

Cushing triad - of increased intracranial pressure

Answer 28

Bradycardia
Hypertension
Irregular breathing

All 2/2 inc intracranial pressure

Question 29

Cushing a triad of ICP

Answer 29

Hypertension
Bradycardia
Diminished respiratory effort

Question 30

Migraine abortive therapy

Answer 30

Abortiverx: triptans, DHE, antiemetics, NSAIDs

Question 31

Migraine pox

Answer 31

◦ Abortiverx: triptans, DHE, antiemetics, NSAIDs
◦ Prophylaxis: Beta-blockers,CCBs, TCAs
• Comments: Triptans, DHE: contraindicated in HTN or CV disease