Neuroscience clerkship

Question 1

MC primary brain tumor

Answer 1

Adults-astrocytoma

children-astrocytomas and medulloblastomas (infratentorial tumors)

Question 2

Von hippel lindau

Answer 2

hemangioblastomas in the brainstem, retina, cerebellum, spine. Angiomatosis in skin, mucosa and organs, bilateral renal cell carcinomsa, and pheochromocytomas

Question 3

contrast or noncontrast CT or MRI for abscess or tumor

Answer 3

noncontrast

Question 4

Rim enhancing brain lesions in AIDs patients

Answer 4

CNS lymphoma & toxoplasma gondi

Question 5

MC form of acute encephalitis

Answer 5

Herpes encephalitis (increased number of lymphocytes in the CSF)

Question 6

primary amebic meningoencephalitis

Answer 6

usually caused by Hartmonella or Acanthamoeba. Parasites enter CNS through cribiform plant at the perforation for the olfactory nerves. Mode of infection, swimming in fresh water.

Question 7

Brain finding in HIV and CMV

Answer 7

microglial nodules
HIV-nodules in brain and spinal cord
CMV- nodules are subpial and subependymal

Question 8

Gumma definition

Answer 8

largely avascular granuloma

Question 9

hypercalcemia symptoms

Answer 9

increased calcium causes decreased membrane excitability leading to fatigibility, generalized weakness and areflexia

Question 10

MC cause of fungal abcess

Answer 10

Aspergillus

Question 11

MC cause of brain abscess in patients with AIDs

Answer 11

Toxoplamsa gondii

Question 12

Listeria monocytogenes meningitis Tx

Answer 12

ampicillin and gentamicin

-Listeria is the MC cause of rhomoencephalitis (brainstem encephalitis)

Question 13

PML brain findings

Answer 13

inclusion bodies in the oligodendrocytes from the JC virus

Question 14

spongiform encephalopathy

Answer 14

• spongy degenration, neuronal loss and astrocytic proliferation.
• symptoms: dementia, ataxia and myoclonic jerks with a rapid clinical progression
• elevated levels of CSF 14-3-3 and tau protein are seen indicating rapid destruction of neurons.

Question 15

SSPE

Answer 15

up to 9 years after measles

CSF pattern similar to MS with increased IgG and oligoclonal bands

Question 16

Hypothalamic hamartoma

Answer 16

nonneoplastic malormation involving the hypothalamus

• can cause changes in the neuroendocrine functions, such as percocious puberty or acromegaly
• patients experience paroxysms of laughter, known as gelastic seizures

Question 17

Neurofibromatosis 1

Answer 17

cafe-au-lait spots, freckling in the axillary or inguinal area, optic glioma, lishc nodules (pigmented iris hamatomas)

Question 18

Neurofibromatosis 2

Answer 18

Bilateral vestibular schwannomas, meningiomas, gliomas

Question 19

prinaud syndrome

Answer 19

loss of vertical gaze, loss of pupillary light reflex, and lid retraction, convergence-retraction nystagumus

Question 20

Tay-Sachs

Answer 20

Sx: menal retardation, seizures, and blindness
(early onset form will produce macrocephaly and cherry red spot on the fndus)
MOA: hexaminase A deficiency

Question 21

Gaucher Disease

Answer 21

Sx:Hepatosplenomegaly, pancytopenia, osteoporosis, aseptic necrosis of femur
MOA: accumulation of glucosylceramide,deficiency of glucocerebrosidase in fibrblasts or leukocytes

Question 22

changes in the brain with long-standing hepatic disease

Answer 22

increase in Alzheimer type II astrocytes

Question 23

Fetal hydantoin syndrome

Answer 23

exposure to anticonvulsives during fetal devellopment

-Sx: midfacial hypoplasia, microcepghaly, cleft lip and palate, digital hypoplasia, hirsutism and developmental delay

Question 24

symptoms of uncal hernition

Answer 24

dilation of ipsilateral eye due to CN3 compresion and ipsilateral hemiparesis ( due to contralteral crus cerebri compression)

Question 25

anterior cord syndrome

Answer 25

spinal cord infarct, damagin the anterior spinal artery.

-supplies the anterior corticospinal tract and the spinothalmaic tract

Question 26

swelling on babies scalps that croos the midline vs don’t

Answer 26

• doesn’t corss the midline- cephalohematoma (usually doesn’t require tx, sometimes use phototherpapy for hyperbilirubinemia)
• crosses the midline Caput succedaneum

Question 27

Marfan syndrome vs homocystinuria

Answer 27

same body habitus

• marfan- normal intellect, aortic root dilation, upwards lens dislocation
• homocystinuria- intellectual disbility, thromnosis, downwards lens dislocation

Question 28

Hypokalemia Sxs

Answer 28

Sx: weakness, fatigue, and muscle cramps

-when sever- paralysis and arrhythmia ( U waves and flat broad T waves)

Question 29

location of pure sensory stroke

Answer 29

thalamus

Question 30

Creutzfedlt-Jacob disease sxs

Answer 30

rapidly progressive dementia
(2 out of 4)
-myoclonus,
-Akinetic mutism,
-cerebellar or visual disturbance
-pyrimidal/extrapyrmaidal dsfunction

Question 31

Metoclopramide

Answer 31

dopamine receptor antagonist

• used to treat nausea, vomiting, and gastroparaesis
• SE: aggitation, looose stools, and EPS

Question 32

Brain abscess
organisms
and symptoms

Answer 32

organisms: viridans streptocooci, staph aureus, and gram negative bacteria
Sx: headache, fever, focal deficits, seizure, ring enhancing lesion on imaging

Question 33

Tx for parkinsons when tremor is the only symptom

Answer 33

Trihexyphenidyl for it’s anticholingeric sie effects

Question 34

Marfan syndrome vs homocystinuria

Answer 34

homocystinuria- fair hari and eyes, developmental delay, and thrombosis, downward lens dislocation (tx with vitamin b6, folate, and B12 to decrreased homocysteine levels)
marfans- normal intellect, upwards lens dislocation