Neurology and Psychiatry

Question 1

most common cause of syncope

Answer 1

neurally-mediated (vasovagal)

Question 2

transient loss of consciousness secondary to acute decrease in cerebral blood flow

Answer 2

syncope

*from the clinical standpoint, a fall in systemic systolic BP to 50mm Hg or lower will result in syncope

Question 3

best test for syncope if arrhythmia is suspected

Answer 3

Holter monitoring

Question 4

most common type of seizure

Answer 4

generalized tonic-clonic

Question 5

most important diagnostic step in seizures

Answer 5

EEG

Question 6

best initial diagnostic test for stroke

Answer 6

plain cranial CT scan

Question 7

presents exactly like stroke but last <24 hours and resolve completely

Answer 7

transient ischemic attack

Question 8

most common site of hypertensive bleed that causes stroke

Answer 8

basal ganglia (putamen, internal capsule)

Question 9

gold standard for diagnosis of subarachnoid hemorrhage

Answer 9

lumbar puncture (xanthochromia*)

• blood in CSF (hallmark of aneurysmal rupture)
• *but if CT is conclusive, no need for LP

Question 10

“worst headache of my life”

Answer 10

SAH

*hallmark: acute onset severe headache

Question 11

excluding trauma, what is the MCC of SAH?

Answer 11

ruptures saccular aneurysm

Question 12

definitive test to detect site of aneurysmal bleed in SAH

Answer 12

4-vessel cerebral angiography

*both carotids and verterbals

Question 13

common causes of bacterial meningitis in adults

Answer 13

Strep pneumoniae
Neisseria menigitidis
Hemophilus influenza

Question 14

best initial test for bacterial meningitis

Answer 14

cranial CT then CSF analysis

Question 15

most accurate test for bacterial meningitis

Answer 15

CSF culture

Question 16

best initial test for cryptococcal meningitis

Answer 16

India ink stain of CSF

Question 17

most accurate test for cryptococcal meningitis

Answer 17

cryptococcal antigen

Question 18

best initial therapy for cryptococcal meningitis

Answer 18

Amphotericin B and 5-flucytosine

Question 19

acute inflammatory demyelinating polyradiculoneuropathy that occurs 1-3 weeks after acute infectious process, vaccination, or allergic reaction

Answer 19

Guillain-Barre syndrome

Question 20

infections commonly associated with Guillain-Barre syndrome

Answer 20

Campylobacter and Herpes

Question 21

ascending leg paralysis + loss of DTRs + cytoalbuminologic dissociation

Answer 21

Guillain-Barre syndrome

Question 22

CSF finding in Guillain-Barre syndrome

Answer 22

elevated protein with normal cell count (cytoalbuminologic dissociation)

Question 23

tx for Guillain-Barre syndrome

Answer 23

IVIg antibody or plasmapheresis

Question 24

patients develop antibody against acetylcholine receptors

Answer 24

myasthenia gravis

Question 25

best initial test for myasthenia gravis

Answer 25

anti-acetylcholine receptor antibodies (ACHR) immunoassay

Question 26

most accurate test for myasthenia gravis

Answer 26

clinical presentation and ACHR