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Internal Medicine > Neuromedicine > Flashcards

Neuromedicine Flashcards

1
Q

Types Of Gait

Remember GCS PV

A

G Gait Apraxia
C cerebellar
S Steppage

P Parkinsonian
V Vestibular

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2
Q

What are the Causes of Gait Apraxia?

A

Frontal lobe Degeneration

NPH

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3
Q

Triad Of Gait Apraxia

A

Magnetic gait with incontinence and Dementia

Strength, Co ordination and sensory functions are intact

Imaging shows dilated ventricle on CT/MRI

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4
Q

T/m of Gait Apraxia

A

Serial Lumber puncture

Definitive t/m is ventriculoperitoneal shunts

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5
Q

How cerebellar gait disorder present?

A

Wide based staggering gait with ataxia

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6
Q

Impairment of which part of cerebellum cause truncal ataxia

A

Vermis

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7
Q

Impairment of which part of cerebellum cause limb ataxia

A

Cerebellar hemispheres

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8
Q

How Parkinson gait disorder present?

A

Short steps with shuffling

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9
Q

Causes of Steppage Gait (Foot drop)

A

L5 radiculopathy Or
common peroneal nerve neuropathy

  • Associated with motor neuropathy
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10
Q

How patient avoid foot drop?

Foot drop due to weakness in dorsiflexion

A

Flexes hip and knee to raise foot

Avoid dragging the toe with each step

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11
Q

How Common Peroneal nerve neuropathy occurs?

A

Due to compression of nerve on lateral aspect of fibula (eg due to prolonged crossing of legs or squatting)

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12
Q

How to d/f Steppage Gait due to L5 Radiculopathy and Common Peroneal nerve Neuropathy?

A

Both present with foot drop.

L5 Radiculopathy:
Radiating pain with weakness of foot eversion

Common Peroneal nerve Neuropathy:
Limited to foot only

Associated with paresthesias and sensory loss of Dorsum of the foot

No loss of inversion and planter flexion (tibial nerve)

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13
Q

How Vestibular gait disorder presents?

A

Unsteady and falling to one side
Associated with Normal sensation, reflexes and motor strength
Nausea and vertigo

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14
Q

Causes of Vestibular gait disorder

A

Meniere disease

Acute Labyrinthitis

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15
Q

How spastic gait disorder present?

A

The gait appears stiff or rigid with circumduction (the spastic leg is abducted and advanced while in extension and internal rotation) and plantar flexion of the affected limb

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16
Q

Cause of spastic gait disorder

A

Pyramidal tract or corticospinal tract (CST) lesions can cause spastic ataxia.

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17
Q

Causes of Peripheral Facial nerve palsy

A

Bells palsy usually after HSV reactivation
Lyme disease

Herpes zoster (Ramsay hunt syndrome)
Sarcodosis

Parotid gland tumor
Diabetes mellitus

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18
Q

Important information

A

U/L Peripheral bell palsy is a clinical diagnosis

Need no test to dx it

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19
Q

Important information of UMN Or Corticospinal lesion

A

UMN lesion causes more weakness in supinator than pronator muscles of upper limbs arm drifts downwards and palm turns (pronates) towards the floor

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20
Q

What are the causes of Spinal Cord Compression?

Remember SIM

A

Spinal Injury viz motor vehicle accident

Infection viz epidural abscess

Malignancy

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21
Q

Triad of Spinal Cord Compression

A

Gradual worsening Lower back pain esp at night

Early signs are symmetric lower limb weakness with depress deep tendon reflex

Late signs are lower limb weakness with b/l babinski positive, low rectal tone with increased DTR

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22
Q

How to d/f back pain due to spinal cord compression and degenerative joint disease?

A

Pain is usually worse in the recumbent position (due to distension of the epidural venous plexus when lying down)

In contrast to back pain from degenerative joint disease, which improves with recumbency

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23
Q

Which level of spine mostly affected due to spinal cord compression?

A

Thoracic spine is most frequently involved level (60%) followed by lumbar spine

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24
Q

How central cord syndrome occurs?

A

Occur with hyperextension injuries in elderly pt with pre-existing degenerative changes in cervical spine

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25
Q

What tracts damaged in Central Cord Syndrome?

A

specifically central portion of corticospinal tracts and decussating fibres of lateral spinothalamic tract

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26
Q

SxS of Central cord Syndrome

Loss of pain and temperature sensation

A

Motor Weakness more in upper extremities than lower

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27
Q

Why Motor Weakness more in upper extremities than lower in central cord syndrome?

A

motor fibers serving arms are closer to the central part of corticospinal tract

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28
Q

What is the cause of Anterior Cord syndrome?

A

Due to occlusion of Anterior spinal artery (Aortic dissection/surgery)

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29
Q

What are the causes of posterior cord syndrome?

A

Multiple sclerosis and vascular disruption (eg vertebral artery dissection) are most common

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30
Q

Impairment of what part cause Cauda Equina Syndrome?

A

Compression of spinal nerve roots by disk herniation or rupture, tumor, spinal stenosis, infection, hemorrhage, or iatrogenic injury

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31
Q

Important information

A

A sensory level at the umbilical excluded cauda equina syndrome

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32
Q

What are the SxS of Cauda Equina Syndrome?

A

Severe b/L Radicular pain with depress reflexes of lower limb

Asymmetric motor weakness with saddle
Anaesthesia

Late onset bowel and bladder Dysfunction

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33
Q

What part of Body innervated by Cauda Equina?

A

Sensory innervation to saddle area
Motor innervation to sphincters (anal and urethera)

Parasympathetic innervation to bladder and lower bowel

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34
Q

What are the SxS of Conus Medullaris Syndrome?

A

Sudden onset severe back pain with hyperreflexia

Symmetric motor weakness with perianal anesthesia

Early onset bowel and bladder Dysfunction

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35
Q

ARP in Tabes Dorsalis

A

ARP accomodation reflex present

PRA Pupillary reflex absent

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36
Q

T/m of Tabes Dorsalis

A

IV penicillin for couple of weeks

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37
Q

SxS of Weber Syndrome

A

Ipsilateral CN 3 impairment
And
C/L Hemiplegia

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38
Q

SxS of Benedikt syndrome

A

Ipsilateral CN impairment
And
C/L Ataxia

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39
Q

Damage to which artery of brain leads to Alexia without Agraphia

A

PCA occulsion

Also loss of both vertical and horizontal movements of eye

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40
Q

Damage to which artery of brain leads to reappearnce of Primitive reflexes

A

ACA occlusion

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41
Q

Impairment of which part of brains ends up with motor aprosodia

A

Non dominant frontal lobe lesion

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42
Q

Impairment of which part of brains ends up with Sensory aprosodia

A

Non dominant Temporal lobe lesion

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43
Q

Triad of Lesion in non-dominant parietal lobe

A

Hemineglect
Anosognosia
Contralateral apraxia

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44
Q

What syndrome arises due to Lacunar Stroke?

A

Pure Motor Hemiparesis
Pure Sensory stroke

Ataxic hemiparesis
Dysarthria clumsy hand.

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45
Q

What is lacunar stroke?

A

Type of stroke that occurs when blood flow to one of the small deep arteries within the brain becomes blocked

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46
Q

Important point of Carotid dissection

A

commonly causes partial ipsilateral Horner syndrome (ptosis and miosis without anhidrosis) due to damage of postganglionic sympathetic fibers supplying the head.

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47
Q

What will be seen on CT Scan of Epidural hematoma?

A

Biconvex (lens shaped) hyper-density that doesn’t cross suture lines

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48
Q

Risk factors of Subdural Hematoma

A

Elderly and alcoholic
Infants (Thin wall vessels)
Anticoagulant use

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49
Q

What will be seen on CT scan of subdural hematoma?

A

Crescent shaped hyper density (Acute) Or hypo-density (chronic) crossing suture lines

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50
Q

Triad of Uncal Herniation

A

Ipsilateral Hemiparesis
Ipsilateral Oculomotor nerve palsy
C/L Homonymous Hemianopsia

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51
Q

How Diffuse Axonal Injury occur?

A

Due to traumatic acceleration and deceleration injury of brain

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52
Q

Imaging findings of Diffuse Axonal Injury

A

CT scan characteristically shows numerous minute punctate hemorrhages with blurring of grey white interface.

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53
Q

Important information for stroke

A

Heparin doesn’t have any role in curing Stroke

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54
Q

How Intracerebral haemorrhage presents?

A

FNDs appear early followed by features of increased ICP

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55
Q

Name the medication to give in thrombotic stroke if patient present within 4 hours of symptoms onset and w/o contraindications

A

IV tPA

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56
Q

Which antiplatelet to give in stroke if patient has no Hx of antiplatelet?

A

Aspirin

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57
Q

What to give if patient develop stroke on aspirin therapy?

A

Aspirin with Dipyridamole Or Clopidogrel

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58
Q

What to give if patient develop stroke on aspirin therapy and have large intracranial artery atherosclerosis?

A

Aspirin with Clopidogrel .

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59
Q

What are the inclusion criteria for thrombolytics in Stroke?

I

A

schemic stroke with measurable neurodeficits

SxS onset less than 3-4.5hours before initiating t/m

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60
Q

How much blood pressure Should be to contraindicate thrombolytics?

A

More than 185/110

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61
Q

How much platelets and glucose level should be to contraindicate thrombolytics?

A

Platelets<100,000/mm3

And Glucose<50mg

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62
Q

How much brain area should be affected to contraindicate thrombolytics?

A

Hemorrhage Or Multilobar infarct involving >33% of cerebral hemispheres on CT

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63
Q

What are the contraindications of thrombolytics in stroke?

A

Stroke Or Head trauma in past 3 months

Hx of intracranial neoplasm, hemorrhage Or vascular malformations

Recent intracranial/spinal surgery

Active bleeding Or arterial puncture in past 7 days at non compressible sites

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64
Q

Important information

A

Blood pressure control is critical in patients undergoing fibrinolytic therapy, and should be kept below 185/110 during in the 24 hours after it is administered.

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65
Q

Important information

A

Aspirin should be held for 24 hours in patient who received fibrinolytic therapy

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66
Q

Important points for aspirin in t/m of stroke

A

Reduces the risk of early recurrence of ischemic stroke

Given to those who are not candidates for fibrinolytic therapy

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67
Q

What to give if CHADS2 score is 2-6?

A

Stroke risk is high so give anticoagulation

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68
Q

What to give if CHADS2 score is 1?

A

Stroke risk is intermediate so anticoagulations is preferred Or give aspirin

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69
Q

What to give if CHADS2 score is zero?

A

Stroke risk is low so no anticoagulation Or give aspirin

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70
Q

What parts of brain affected most by intracranial Hx if patient is having hypertension?

A

Basal ganglia
Thalamus
Pons
Cerebellum

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71
Q

Clinical SxS of Intracranial Hx affecting thalamus

A

C/L hemiparesis with hemisensory loss
Eyes deviate towards hemiparesis with upgaze palsy
Non reactive miotic pupils

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72
Q

How patient presents with pontine haemorrhage?

A

Pinpoint reactive pupils
Deep coma
Total paralysis within minutes

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73
Q

What lobes affected due to lobar haemorrhage?

A

Occipital

And Parietal lobe

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74
Q

What are the main complications of Sub Arachnoid haemorrhage?

A

Rebleeding occur within first 24 hours

Vasopasm after 3 days

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75
Q

How to t/m Vasopasm occur due to subarachnoid haemorrhage?

A

Nimodipine and hyper dynamic therapy to reduce vasopasm

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76
Q

How cluster headache occur?

A

Due to alterations in the circadian pacemaker which due to hypothalamic dysfunction

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77
Q

How to t/m cluster headache prophylactically?

A

Verapamil
Lithium

Ergotamine
Prednisone

Methysergide
Cypoheptadine

Indomethacin

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78
Q

How to t/m cluster headache in acutely?

A

Inhalation of 100% O2 and subcutaneous Or nasal sumatriptans

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79
Q

How to t/m subarachnoid haemorrhage surgically?

A

Surgery (craniotomy with aneurysm clipping)

Endovascular methods (coiling and/or stenting of the aneurysm)

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80
Q

What are the methods to lower the ICP?

A

1) Increase Brain volume by decompressive Craniectomy

2) Decrease CSF volume via shunt
3) Decreases Brain parenchymal volume via mannitol or Hypertonic saline

4) decreases cerebral blood volume via sedation ,hyperventilation and head elevation

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81
Q

How venous sinus thrombosis occur?

A

Intracerebral hx along the courses of major cerebral draining veins due to backup pressure
Leads to headache for several days

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82
Q

What are the risk factors for Pseudotumor cerebri?

A

Overweight female

Use of Vit-A/ OCPs/ Growth hormone/ Steroids/ tetracycline

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83
Q

How patient present with Pseudotumor cerebri?

A

Holocranial headache increases with lying flat and decrease with standing

Pulsatile headache

Transient vision loss
And diplopia

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84
Q

What are the finding of LP in Pseudotumor cerebri?

A

Increases pressure with normal analysis

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85
Q

Important information of Pseudotumor cerebri

A

Empty sella but it is non dx
Short term use of steroids/serial LP uses patient awaiting definitive surgical t/m but cannot used as primary intervention

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86
Q

How to t/m Pseudotumor cerebri medically?

A

Acetazolamide

Also add loop diuretics if Sx continues

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87
Q

How to t/m Pseudotumor cerebri Surgically?

A

Surgical intervention with Optic nerve sheath decompression

Or Lumboperitoneal shunt

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88
Q

What is the imaging morality of choice for diagnosis of cavernous sinus thrombosis?

A

MRI with MRV

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89
Q

Important information

A

Be cautious when using over the counter medication (contains acetaminophen) with warfarin
Increases the toxicity of warfarin

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90
Q

How Neuroleptic malignant syndrome presents?

Malignant FEVER:

A 
M= Myoglobinuria
F= Fever
E= Encephalopathy
V= Vitals unstable
E= increases Enzymes (eg, CK}, 
R= muscle Rigidity ("lead pipe")
91
Q

What are the medication used for neuroleptic malignant syndrome?

A 
Dantrolene
dopamine agonist (eg, bromocriptine)
92
Q

What chemotherapy drugs cause peripheral neuropathy?

A

Vinca alkaloids (vincristine)
Platinum based med (cisplatin)
Taxanes (paclitaxel)

93
Q

How Stiff person syndrome presents?

A

Rigidity with stiffness and muscle spasm
Autonomic instability
But no changes in mental status

94
Q

What is the most specific test for MYASTHENIA GRAVIS?

A

Acetylcholine receptor antibody

And in case, test comes negative then check muscle-specific tyrosine kinase antibodies

95
Q

Important information of myasthenia gravis

A

If Both antibodies come negative, then electrophysiologic studies (eg repetitive nerve stimulation, singlefiber electromyography) may be helpful

96
Q

What are the factors precipitating myasthenia crisis?

A

Infection Or Surgery
Pregnancy Or childbirth
Tapering immunosuppressive drugs
Medication (aminoglycosides/ BB / azithyromycin)

97
Q

How to t/m Myasthenia crisis?

A

Intubation for deteriorating respiration
IVIG or plasmapheresis
Steroids (used once patient stabilise)

Used of ACHe inhibitors contraindicated in case of mysthenia crisis to avoid airway secretion and aspirations

98
Q

How to t/m Lambert Eaton syndrome?

A

Symptomatic therapy includes guanidine or 3,4-diaminopyridine to increase presynaptic acetylcholine levels.

Refractory symptoms may respond to immunologic therapy with IVIG or oral immunosuppressants (steroids / azathioprine

99
Q

What will be seen in MRI of MS?

A

Hypo/hyperintense lesions are seen on MRI—periventricular, juxtacortical and infratentorial regions.
Spinal cord may also be involved

100
Q

What will be seen in CSF report of MS?

A

Normal pressure

total cell count and total protein conc. Predominant cell type: T lymphocytes

101
Q

How to t/m Acute relapse of MS?

Steroids

A

Steroids

Plasma exchange Or Corticotropin injection gel, a purified from of adrenocorticotrophic hormone as a alternate therapy

102
Q

What are the long term medications for MS?

A

Long-term disease modifying therapy:
Glatiramer
interferon

mitoxantrone

cyclophosphamide
methotrexate and cladribine

103
Q

How infant botulism presents?

A

B/L bulbar palsies viz ptosis,sluggish pupillary response to light,poor suck and gag reflexes)
followed by symmetric descending flaccid paralysis (hypotonia

104
Q

At what place infant botulism common?

A

Highest incidence seen in California, Pennsylvania and Utah due to greatest conc. Of soil botulism spores

105
Q

How to t/m infant botulism?

A

Human derived botulism immune globulin

106
Q

What are the source of food borne botulism?

A

Improperly canned food such as fruits and vegetables

Aged seafood (cured fish)

107
Q

How to dx food borne botulism?

A

Serum analysis for toxins

108
Q

How to t/m food borne botulism?

A

Equine derived botulism antitoxin

109
Q

How to assess the respiratory functions in GBS?

A

FVC is gold standard

Peaked flow meter also used but less accurate than FVC

110
Q

When is ETT required in GBS?

A

When FVC shows less than 20ml/kg then it indicates respiratory arrest and needs intubation

111
Q

In which diseases GBS is more common?

A

Sarcoidosis

Lymphoma

SLE

112
Q

What organisms associated with GBS?

A

Campylobacter jejuni most frequently associated.

Other organisms: Herpes virus, Mycoplasma and H.influenza also associated.

Recent HIV infection and recent immunization

113
Q

Name the medication given in PARKINSON’S TREMORS

A

Anticholinergics (eg benztropine, trihexphenidyl)—treatment of choice.

Trihexphenidyl typically used in
younger pts where tremor is predominant symptom

114
Q

Important point for tremors

A

To have physiological tremors there must be underlying trigger which increases sympathetic activity such as drugs, hyperthyroidism, anxiety and caffeine.

115
Q

Important point of Parkinson disease

A

Anticholinergics do not improve bradykinesia but improves tremors and rigidity

116
Q

What are the secondary causes of Restless leg syndrome?

A

Uremia is due to ESRD/ CKD)
DM

MS / Parkinson disease
Pregnancy

Drugs viz antidepressants / Metoclopramide

117
Q

How to t/m Persistent/mod-Severe Restless leg syndrome?

A

First line such as Dopamine agnostic (pramipexole)

Alternate such as alpha 2 delta Calcium channel ligand (Gabapentin / enacarbil)

118
Q

What is the t/m of mild/intermittent symptoms?

A

Supplement iron when serum ferritin less than 75ug/L

Use supportive measures (leg massage/heating pad/exercise)

Avoid aggravating factors (sleep deprivation/medications)

119
Q

How much MMSE should have to consider dementia?

A

Less than 24

120
Q

Important information

A

Normal aging will have expressive aphasia

Whereas dementia will have both expressive and receptive aphasia

121
Q

What clinical features suggest CJ disease?

A

Rapidly Progressive Dementia

Myoclonus

Ataxia with mutism

Cerebellar Or visual disturbance

122
Q

What will be seen in CSF and EEG of patient who have CJ diseases?

A

CSF:: 14-3-3 assay

EEG:: Periodic sharp waves complexes

123
Q

What is the gold standard test to Dx CJ diseases?

A

Brain biopsy

124
Q

Which gene mutated in CJ disease?

A

PRNP

125
Q

What test help in distinguishing dementia and pseudo-dementia?

A

Dexamethasone suppression test is abnormal in 50% of pseudo-dementia

126
Q

Triad of Lewy body dementia

A

Dementia with SxS of Parkinson

Fluctuating cognition and visual hallucination

Rapid eye movement sleep behaviour disorder
(Dream enactment behaviour during loss of normal REM sleep atonia)

127
Q

How to distinguish Lewy body dementia and Alzheimer diseases?

A

Visual spatial decline before memory deficit in Lewy body dementia

128
Q

How to distinguish Lewy body dementia and Parkinson disease?

A

Early appearance of dementia in Lewy body dementia

Motor symptoms in Parkinson disease

129
Q

What will be seen in autopsy of Lewy body dementia?

A

Lew bodies (eosinophilic Intracytoplasmic inclusions

It represents accumulation of alpha synuclein protein seen in neurone of the substantia migration / Locus ceruleus / dorsal raphe / substantia innominata

130
Q

What will be unchanged in Pick disease?

A

Visuo spatial functions usually remain intact

131
Q

What lobes of brain most affected in Alzheimer’s diseases?

A

Parietal and temporal lobes esp hippocampus

132
Q

How to t/m moderate to severe Alzheimer’s dementia?

A

Memantine (NDMA Receptor blocker)

133
Q

How to t/m mild to moderate Alzheimer’s dementia?

A

ACEI viz Donepezil / Galantamine /Rivastigmine / Galantamine ER

134
Q

Triad of Multiple System Atrophy / Shy Drager Syndrome

A

Symptoms of Parkinsonism

Autonomic dysfunction

Wide spread neurological signs (cerebellar / pyramidal Or lower motor neuron)

135
Q

How to t/m Multiple system Atrophy?

A

Increase IV volume with steroids / salt supplementation / alpha adrenergic agonist and application of constrictive garments to lower body

136
Q

Features of familial Dysautonomia (Or Riley day syndrome)

A

Gross dysfunction of the autonomic nervous system

With

Severe orthostatic hypotension

137
Q

How to t/m delirium?

A

Regardless the cause, t/m of agitation in elderly is low dose haloperidol

138
Q

Important point

A

Avoid to use typical antipsychotic in Lewy body dementia who may exhibit neuroleptic hypersensitivity

139
Q

Triad of Exertional heat stroke

A

Core temperature of >40’c (104f) immediately after collapse

CNS dysfunction

Organ damage/DIC

140
Q

Name the medication which can cause exertional heat stroke

A

Anticholinergics
Antihistamines

Phenothiazines
Tricyclics

141
Q

How to t/m exertional heat stroke?

A

No role for antipyretic therapy

Ice immersion preferred with fluid resuscitation

Electrolyte correction

142
Q

How to t/m non exertional heat stroke (Or Classic heat stroke)

A

Evaporative cooling (ie spraying the naked patient with lukewarm water and running fans to circulate air) is preferred for nonexertional or classic heat stroke

Avoid to use ice water immersion

143
Q

What’s the work up for first time seizure?

A

Baseline tests—>ECG—>Neuroimaging—>lumber puncture—>Routine EEG

144
Q

What’s the hallmark on Neuroimaging of prolong seizures (STATUS EPILEPTICUS)?

A

Cortical laminar necrosis leads to persistent neurologic deficits and recurrence seizures

145
Q

How to t/m trigeminal neuralgia?

A

Carbamazepine

If medication fails then surgical Ganaliolysis Or sub occipital craniectomy for decompression Of trigeminal nerve

146
Q

Important point

A

Multiple sclerosis should be suspected when trigeminal neuralgia presents B/L

147
Q

what is the carotidynia?

A

Neurological condition caused by inflammation of the carotids and the vagus

  • Sharp pain which is localised to the carotid artery distribution in the neck
148
Q

Triad of Burning Mouth syndrome

A

Facial pain aggravate by dryness

Caused by virus

Reddened mucosa

149
Q

What lobe of brain would be involved if otitis media and mastoiditis occur?

A

Temporal lobe

And cerebellum

150
Q

What lobe of brain would be involved if frontal and ethmoid sinusitis occur?

A

Frontal lobe

151
Q

What lobe of brain would be involved if Dental infection occur?

A

Frontal lobe

152
Q

Triad of Brain abscess

A

Fever
Headache
And Focal neurological deficits

153
Q

What is the most common cause of Spinal Epidural abscess?

A

S.aureus

154
Q

Triad of Spinal Epidural abscess

A

Fever
Lower back pain
Neurological deficits

155
Q

What would be cause of Spinal epidural abscess ?

A

Staph aureus

156
Q

Triad of herpes Encephalitis

A

Fever

FNDs

Behavioural changes can be seen and behavioural syndromes like hypomania, Kluver-Bucy syndrome (hyperphagia, hypersexuality) and amnesia have been reported

157
Q

What is the gold standard diagnosis of Herpes encephalitis?

A

PCR analysis of HSV DNA in CSF

158
Q

What will be seen EEG report of herles encephalitis?

A

Prominent intermittent high amplitude slow waves in 70-80% cases

159
Q

What is the drug of choice for heroes encephalitis?

A

IV acyclovir

160
Q

Triad of Tick Borne Paralysis

A

Ascending Paralysis with Or without fever and prodromal SxS

Normal autonomic system (Unlike GBS)

Normal CSF findings

161
Q

Important information of Tick borne paralysis

A

Ascending paralysis due to tick will take time to develop at least 7 to 8 days

162
Q

Triad of PRIMARY CNS LYMPHOMA IN HIV PATIENT

A

Altered mental status

EBV DNA in CSF
and solitary weakly ring-
enhancing periventricular mass on MRI

163
Q

How to dx acoustic Neuroma?

A

Audiometry is the best initial screening laboratory test for acoustic neuroma

Best diagnosed by MRI with gadolinium staining—preferred over CT.

164
Q

Different types of mutation which cause NF 2

A

Autosomal dominant caused by a mutation in tumor suppressor gene on chromosome 22

Severe variant: Wishart caused by frameshift or nonsense mutation

Milder variant: Gardner result from splice site or missense mutation

165
Q

What will be seen in Neuroimaging of GLIOBLASTOMA MULTIFORME?

A

Butterfly lesion with central necrosis is classic and heterogeneous,

serpiginous contrast enhancement is typical of high grade astrocytoma

166
Q

How to t/m meningioma?

A

complete surgical resection in symptomatic cases cures in most cases.

Focused tumor radiation (stereotactic radiosurgery) can be considered
in partially resected or unresectable tumors

167
Q

Cancer which cause Primarily Solitary Brains Mets

A

Breast
Colon Cancer
Renal cell carcinoma

168
Q

Cancer which cause Multiple Brains Mets

A

Lung cancer

Malignant melanoma

169
Q

How to t/m Single Brain mets?

A

Single brain metastasis in surgically accessible location and good performance status->surgical resection is best therapeutic option.

This is typically followed by stereotactic radiosurgery (SRS) or whole brain radiation therapy (WBRT) to tumor bed

170
Q

How to t/m Multiple Brain mets?

A

WBRT or supportive care is typically recommended

171
Q

How nasal hemianopia occurs?

A

Due to lesion in ipsilateral peri chiasmal

Causes are calcification or aneurysm of Internal Carotid artery impinging on “”Uncrossed”” lateral retinal fibers

172
Q

How mono-ocular Scotoma occurs?

A

Partial lesion in the retina, optic disc, optic nerve

Causes are macular degeneration / Optic neuritis

173
Q

How optic nerve lesion occur?

A

Due to central retinal vein occlusion Or Retinal artery

174
Q

What Optic function doesn’t affect in INTERNUCLEAR OPHTHALMOPLEGIA?

A

Convergence and the pupillary light reflex are preserved.

175
Q

How unilateral MLF occurs?

A

lacunar stroke in the pontine artery distribution

176
Q

What are the clinical findings of EDINGER WESTPHAL NUCLEUS INJURY?

A

Ipsilateral fixed and dilated pupil

that is nonreactive to light or accommodation

177
Q

Impairment of which cranial nerve leads to vertical Diplopia

A

Cranial nerve 4

178
Q

What are the causes of compression oculomotor neuropathy occur?

A

transtentorial (uncal) herniation or

aneurysm of posterior communicating artery

179
Q

How ischemic oculomotor neuropathy occurs?

A

Diabetes

180
Q

Name the test used to assess vestibular dysfunction due to gentamicin.

A

head thrust test

181
Q

What are MRI findings of CJ disease?

A

Wide spread atrophy of cerebrum and cerebellum

Cortical enhancement (cortical ribboning)

Hockey stick signs (enhancement of putamen & caudate test)

182
Q

What is the CSF findings of CJ disease?

A

Positive 14-3-3 protein Titers

Positive RT-QuIc test

Rest indices are normal

183
Q

What is the EEG finding of CJ disease?

A

Sharp , triphasic, synchronous discharge

184
Q

Name the medicine for General Tonic clonic seizures?

A

First IV benzo like lorazepam, diazepam Or IM dormi to terminate

IV non benzo like fosphenytoin, Phenytoin, valprolate, Lerrace

185
Q

How to t/m Acute LBP that is less than 4 wks?

A

1) Maintain Moderate activity
2) NASIDs or acetaminophen
3) otherwise muscle relaxants / spinal manipulation

186
Q

How to t/m Subacute (4-12wks) Or Chronic (>12 wk) LBP?

A

1) I/M use of NASIDs or acetaminophen
2) Exercise therapy (strengthening/ stretching, Aerobic)
3) TCA / SSRI if considered

187
Q

How Idiopathic transverse myelitis occurs?

A

Infiltration of inflammatory cells into segment of spinal cord leading to death of neuron, oligodendrocytes and demyelination

188
Q

Triad of Idiopathic transverse myelitis

A

B/L loss of sensory function with autonomic instability

Distinct sensory level

B/L motor weakness with early flaccid then spastic

189
Q

Name the test to DX Idiopathic transverse myelitis

A

MRI shows no compression lesion with T2 hyper intensity

LP shows increase WBC and increase IgG index

190
Q

How to treat Idiopathic transverse myelitis?

A

High dose steroid

Plasmapheresis

191
Q

What are Red flag associated with U/L facial paralysis?

A

If these are absent consider it Bell palsy
FNDs or sparing of upper face

Or
Rash or arthritis like Lyme disease

Or
Hearing loss vertigo

Or

Lower limb weakness / Deceased DTR like in GBS

192
Q

How to t/m bell palsy?

A

Steroid
Eye lubricant
±Anti virals

If weakenss worsen over 3 wks or no improvement in 4months consider imaging

193
Q

How to Manage Migraine In pregnancy?

NI—-> no improvement

A

Non pharma like rest —->NI—-> Acetaminophen

Still NI—->Antiemetics/codeine/caffeine

Still NI —-> NASID like naproxen only in 2nd trimester

Still NI —-> Opioid

194
Q

Important point of Treatment of migraine in pregnancy

A

Metacolon used only acutely

Ergotamine is not used due to hypertonic uterine contractions and Vasoconstriction

Triptans Also not used due to above reason and LBW / Preterm birth.

195
Q

Name the types of Herniation

A

Subfalcine herniation

Uncal

Tonsillar

196
Q

Difference b/w Subfalcine and Uncal

A

In Subfalcine, only C/L leg weakness seen without pupillary changes

In uncal I/L motor weakness with pupillary involvement

Tonsillar herniation shows fixed and mid position pupil due to disruption of both para and sympathetic innervation

197
Q

Name the bacteria causing meningitis in age 2-50 yrs and Abx for it

A

Strep pnemonia and N.meningitis

Abx vancomycin and 3rd Generation cephalosporin

198
Q

Name the bacteria causing meningitis in age over 50 yrs and Abx for it

A

Strep pnemonia and N.meningitis
Listeria

Abx vancomycin and 3rd Generation cephalosporin/ ampicillin

199
Q

Name the bacteria causing meningitis in immunocompromised

A

Strep pnemonia and N.meningitis

Listeria and Gram negative rod
Abx vancomycin and ampicillin
Cefepime

200
Q

Name the bacteria causing meningitis in neuro surgery procedure/ penetrating trauma and Abx

A

MRSA , Coagulase negative staphylococci and Gram negative rod

Abx vancomycin and cefepime

201
Q

Alternative medicine for meningitis

A

For listeria—-> ampicillin or TMX-SD

Cefepime—->meropenem Or Ceftazidime

202
Q

Name the cancer in terms of frequency which spread in brain

A

Lung>breast>unknown>melanoma>colon

203
Q

Name the cancer which shows single or Multiple brain mets

A

Single brain mets—-> breast, colon, RCC

Multiple brain mets—-> lung cancer, malignant melanoma

204
Q

Categories the tremor when they occur?

A

If on action only—> essential and cerebellar

If on rest only —-> Parkinson

If both on action and rest —> physiologic

205
Q

Difference b/w lithium induced physiological tremor and Lithium toxicity tremor

A

Lithium induced physiological tremor::
Symmetric and limited to hand and upper limbs
Rx:: just observe

Lithium toxicity tremor::
Irregular, coarse tremor
Involved multiple part of body with GIT and neurological SxS
Rx:: dialysis

206
Q

Name the brain tumor which shows Butter fly lesion with central necrosis

Serpiginous contrast enhancement is typical of high grade Astrocytoma

A

Glioblastoma Multiforme

207
Q

What are the neuropsychological consequence of Wilson disease?
Autosomal dominant due to mutation in ATP7B

A

Sxs like parkinson
Gait disturbance
Dystharia and “hype reflexia”

Depression with psychosis or personality changes

208
Q

How to Prevent and abort Migraine?
Abortive (TANE)
Preventive ABA

A

Abortive::
(Triptans, Antiemetic, Acetaminophen, NSAIDs, Ergotamine)

Prevent::
Anticonvulsant like topiramate Or Valproate
B BB (given in pregnancy unlike others )
A antidepressants ( TCA or Venlafaxine)

209
Q

How RILEY DAY SYNDROME OR FAMILIAL DYSAUTONOMIA present?

Autosomal recessive seen predominantly in children of Ashkenazi Jewish ancestry

A

Gross dysfunction of the autonomic nervous system with severe orthostatic hypotension

210
Q

How B12 deficiency present?

A

Ataxia due to spinocerebellar

Loss of vibration and position sensation due to dorsal column

Upper motor neuron SxS due to lateral corticospinal tract

211
Q

How Chronic inflammatory demyelinating Polyneuropathy Occur?

A

Subacute to chronic condition (>8wk)

Occur due to immune mediated demyelination of peripheral nerves and nerves roots independent of length

212
Q

How Chronic inflammatory demyelinating Polyneuropathy present?

A

Both sensory and motor SxS occur With LMN signs

Proximal and distal symmetrical muscles weakness

213
Q

How to dx and manage Chronic inflammatory demyelinating Polyneuropathy?

A

Dx—-> (1) increase protein with Normal WBCs in CSF

(2) segmental demyelination on nerve bx
(3) NCS shows decreases conduction velocity

214
Q

Name the d/f subtypes of Hepatic Neualgia and How to Rx it?

A

NASID AND Analgesic for first two types
Last type—-> TCA , Gabapentin and pregabalin

1) Acute —>persist less than 30 days from rash onset
2) Subacute—>persist more than 30 days but resolves within 4 months of rash onset
3) Postherpatic ->persist more than 4 months from rash onset

215
Q

How Autoimmune encephalitis(Anti NMDR receptor encephalitis) present?

A

Condition seen in Tumor esp ovarian teratoma

Psychiatric SxS with autonomic instability and SxS like UMN after flu like syndrome

216
Q

How to dx and tx Autoimmune encephalitis ?

A

Dx (1) CSF—> Ab against GIuN1 subunit of NMDR

(2) Neuroimaging

Rx is Immunosuppressants

217
Q

How Cervical spondylosis leads to myelopathy?

A

Degenerative condition associated with spinal canal narrowing

due to the formation of osteophytes in the lateral vertebral bodies and ossification of posterior longitudinal ligament / ligmentum flavum

218
Q

How cervical myelopathy present?

A

SxS just like ALS

Sensory SxS

Neck pain and current like sensation on neck flexion

219
Q

How Miller fisher GBS present?

Positive GQ1B antibody

A

Ataxia like cerebellar

Ophthalmopalegia

Loss of reflex without loss of motor
strength

220
Q

How ALS present?

A

UMN
•SxS of UMN with presence of pathological reflexes like jaw jerk and up going planters

  • LMNs
  • bulbar symptoms like dysphagia and dysarthria
221
Q

What are the causes of Cervical Radiculopathy and How does it present?
(Sxs depend on nerve involvement)

A

Causes are disk herniation Or spondylosis

Sxs are loss of upper limb reflexes with pain and paresthesia

222
Q

Name the test which is Dx and therapeutic for cervical Radiculopathy

A

Shoulder abduction relief test

Abduction relief the tension on impinged nerve root and improve radicular pain when hand is placed on the top of hand

223
Q

Triad of Marchiafava bignami disease

A

Dementia
dysarthria
Motor dysfunction

224
Q

How Marchiafava bignami disease occur?

A

Due to alcoholic or severe malnutrition result severe damage to corpus callosum and surrounding white matter

Internal Medicine (14 decks)

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