Neurovascular Disorders and Neurotoxicology Flashcards
Other than addressing the underlying etiology, the treatment of posterior reversible encephalopathy syndrome (PRES) includes tight control of what?
● A. Glycemic levels
● B. Hemoglobin
● C. Hematocrit
● D. Blood pressure
● E. Input–output balance
D. Blood pressure
In crossed cerebellar diaschisis, the cerebellar cortex contralateral to a cerebral hemispheric lesion suffers from what?
● A. Autoimmune destruction
● B. Hypometabolism
● C. Increased temperature
● D. Direct pressure effects
● E. Hypermyelination
B. Hypometabolism
Which of the following has the least role in the diagnosis of giant cell arteritis?
● A. Temporal artery biopsy
● B. CT angiography of temporal artery
● C. ESR
● D. CRP
● E. CBC showing mild normochromic anemia
B. CT angiography of temporal artery
Polymyalgia rheumatica (PMR) has an increased frequency of HLA-DR4 and systemic monocyte activation. 15% of patients with PMR eventually develop which of the following?
● A. Fibromuscular dysplasia
● B. Guillain-Barre syndrome
● C. Transverse myelitis
● D. Amyotrophic lateral sclerosis
● E. Giant cell arteritis
E. Giant cell arteritis
Periarteritis nodosa is a group of necrotizing vasculitides including classic periarteritis nodosa (PAN) and systemic necrotizing vasculitis. The treatment involves which of the following?
● A. Steroids
● B. Acetaminophen
● C. Cyclophosphamide
● D. Maintaining high urine output
● E. Avoiding latex
C. Cyclophosphamide
Relapsing ocular lesions and recurrent oral and genital ulcers, with occasional skin lesions, thrombophlebitis, arthritis, and headache is what?
● A. Polyarteritis nodosa
● B. Granulomatosis with polyangiitis
● C. Behcet syndrome
● D. Wegener granulomatosis
● E. Gustatory migraine
C. Behcet syndrome
The gold standard test for the diagnosis of fibromuscular dysplasia is the angiogram, which shows multiple, irregularly spaced, concentric narrowings with normal or dilated intervening segments “string of pearls” in which type?
● A. I
● B. II
● C. III
● D. IV
● E. V
A. I
On day 5 of alcohol withdrawal, the patient presented with profound disorientation, agitation, tremor, insomnia, hallucinations, tachycardia, hypertension, diaphoresis, and fever.
What is the most probable diagnosis?
● A. Delirium tremens
● B. Wernicke-Korsakoff syndrome
● C. Malignant hyperthermia
● D. Parkinsonism
● E. Acute dementia
A. Delirium tremens
Wernicke’s encephalopathy is common in alcoholics. It has classical triad of encephalopathy, ophthalmoplegia, and ataxia. It is caused by deficiency of what?
● A. Iron
● B. Zinc
● C. Manganese
● D. Thiamine
● E. Thyroid stimulating hormone
D. Thiamine
A test dose of intravenous naloxone 0.2 mg avoids sudden complete reversal of all opioid effects. But reversal with naloxone may precipitate narcotic withdrawal symptoms in opioid-dependent patients who may require treatment with what?
● A. Vitamin B12
● B. Vitamin B6
● C. Octreotide
● D. Dopamine
● E. Clonidine
E. Clonidine
A patient presents in neurosurgical emergency with complaints of headache, seizures, and focal neurological deficit. CT and MRI of the brain were done which showed widespread vasogenic edema predominantly in parietal and occipital regions. This patient was diagnosed with posterior reversible en-
cephalopathy syndrome (PRES) (also known as reversible posterior encephalopathy syndrome). Which of the following conditions are associated with this syndrome?
● A. Malignant hypertension
● B. Infection, sepsis, and shock
● C. Autoimmune disease like lupus, scleroderma, or polyarteritis nodosa
● D. Cancer chemotherapy
● E. All of the above
E. All of the above
A patient presents in neurosurgical OPD with complaint of unilateral temporal headache from 1 year which progressed to jaw claudication and now decreased vision on the side of headache from last some days. On palpation, there is tenderness over temporal muscle on the side of headache. Biopsy of the frontal branch of superior temporal artery showed inflammatory infiltrates. What is the most likely treatment option of this condition?
● A. Immunomodulators
● B. High dose steroids
● C. Interleukin 1 inhibitors like anakinra or rilonacept
● D. Cyclophosphamide and methotrexate
● E. All of the above
B. High dose steroids
A 70-year-old woman presents in neurosurgical OPD with complaints of fever, anorexia, weight loss, morning ache, and stiffness in the cervical region, shoulder, and pelvic girdle from last 2 months. On labs her ESR is more than 40 mm/h. She responded well to steroids. What is the most likely diagnosis in
this patient?
● A. ANCA-associated vasculitis
● B. Atherosclerotic occlusive disease
● C. Wegener’s granulomatosis
● D. Behcet’s disease
● E. Polymyalgia rheumatica (PMR)
E. Polymyalgia rheumatica (PMR)
Granulomatosis with polyangiitis (GPA) formerly known as Wegener’s granulomatosis is an ANCA-associated vasculitis which is treated with steroids, immune modulators, and antibodies. Which of the following are the most likely presenting symptoms of this condition?
● A. Isolated kidney involvement
● B. Joint stiffness, granulomas in kidneys, and respiratory involvement
● C. Multiple vessel disease with inflammatory infiltrates
● D. Cranial nerve involvement, peripheral neuropathies, and multiple joint pain
● E. Cough, hemoptysis, kidney involvement, cranial nerves involvement, and diabetes insipidus
E. Cough, hemoptysis, kidney involvement, cranial nerves involvement, and diabetes insipidus
A patient presents with relapsing ocular lesions, recurrent oral and genital ulcers, cerebellar ataxia, seizures, and pseudotumor cerebri. He is diagnosed with Behcet’s disease. What is the most likely treatment in this condition?
● A. Steroids
● B. Cytotoxic agents
● C. Thalidomide
● D. Antiepileptics if seizures occur
● E. All of the above
E. All of the above
Fibromuscular dysplasia (FMD) is a vasculopathy primarily affecting branches of aorta, renal artery, or internal carotid arteries with increased chances of stenosis, aneurysm formation, or dissection. The gold standard for the diagnosis of FMD is angiogram. What is the most common angiographic pattern seen in FMD?
● A. String of pearls appearance
● B. Focal tubular necrosis
● C. Atypical FMD with diverticular formation
● D. Type 4
● E. None of the above
A. String of pearls appearance
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a type of vasculopathy with subcortical infarcts, progressive dementia, depression, and migraine. What is the treatment for this condition?
● A. Aspirin
● B. NSAID
● C. Steroids
● D. Warfarin
● E. Cyclophosphamide
D. Warfarin
Pan-cerebellar degeneration is a paraneoplastic syndrome which presents with vertigo, gait disturbance, ataxia, dysarthria, diplopia, and nystagmus. What is the most common primary which can cause this?
● A. Ovarian cancer
● B. Breast cancer
● C. Lung cancer
● D. Hodgkin’s lymphoma
● E. All of the above
E. All of the above
A chronic alcohol abuser decides to quit alcohol but begins to suffer from tremulousness, insomnia, autonomic hyperactivity, myalgias, and confusion. What is the mainstay of treatment of alcohol withdrawal syndrome?
● A. Benzodiazepines like chlordiazepoxide, lorazepam, diazepam
● B. Beta blockers like atenolol
● C. Phenobarbital
● D. Thiamine
● E. All of the above
A. Benzodiazepines like chlordiazepoxide, lorazepam, diazepam
A patient presents with gait ataxia, oculomotor abnormalities, vomiting, and fever. MRI of brain shows high signal intensities on T2WI and flair around the thalamus, floor of the 4th ventricle, and periaqueductal area. This patient is diagnosed
with Wernicke’s encephalopathy. What is the mainstay of treatment for this condition?
● A. IV glucose 100 mg for 5 days
● B. Steroids in high dosage
● C. Thiamine 100 mg IV or IM for 5 days
● D. Immune modulator drugs like cyclophosphamide
● E. Ventriculoperitoneal shunt placement
C. Thiamine 100 mg IV or IM for 5 days
