PreTest

Question 1

acute disseminated encephalomyelitis

Answer 1

demyelinating dz of brain, brainstem and spinal cord indistinguishable from MS on MRI; however, it is monophasic and develops within weeks of a viral illness or immunization

Question 2

thyroid opthalmopathy

Answer 2

diplopia
proptosis or lid retraction
- inferior and medial recti are most affected
- limitations of passive movements of eye

Question 3

sixth nerve palsy

Answer 3

weakness of lateral rectus muscle –> horizontal diplopia

Question 4

fourth nerve palsy

Answer 4

weakness of superior oblique mm with resultant difficulty looking down and medially (trouble walking down stairs)

Question 5

what is a common cause of third nerve palsy? (think common diseases)

Answer 5

Diabetes
- spares the pupillomotor PNS fibers which travel on the outside of the nerve (infarction affects the interior nerve but spares external fibers)

Question 6

congenital horner syndrome

Answer 6

inherited as AD trait

- failure of one eye to develop normal iris color (heterochromia iridis)

Question 7

what is required for change in iris color after birth and infancy?

Answer 7

sympathetic innervation

Question 8

evidence of basilar skull fracture (4)

Answer 8

• periorbital ecchymosis (raccoon eyes)
• ecchymosis over mastoid region (Battle sign)
• hemotympanum (blood behind ear drums)
• CSF rhinorrhea or otorrhea

Question 9

what does diffuse axonal injury look like

Answer 9

• diffusely spread axonal swelling of white matter, corpus callosum and upper brainstem
• punctate foci of hemorhage

Question 10

what tx is recommended to improve outcome of pt with severe traumatic head injury

Answer 10

hypothermia

- decreases cerebral metabolism, reduces acidosis, attenuates changes in BBB and inhibits release of excitatory nts

Question 11

what do motor nerve conduction studies show with botulinum toxin

Answer 11

low amplitude compound muscle APs with normal velocities

Question 12

MOA of botulinum toxin

Answer 12

reduces the amt of Ach available for release when a motor neuron is depolarized (interfere with vesicle release)

Question 13

DOC for acute exacerbation of MS i.e. optic neuritis

Answer 13

IV methylprednisone

Question 14

what pain syndrome is common in pts with MS?

Answer 14

trigeminal neuralgia

Question 15

tx of trigeminal neuralgia

Answer 15

carbamazepine

alternatively, phentyoin or baclofen

Question 16

tx of bladder incontinence in MS

Answer 16

spastic bladder –> tx with anticholinergics (i.e imipramine, oxybutynin)

Question 17

tx of spasticity (in for example an MS pt)

Answer 17

baclofen

• may cause considerable sedation
• tizanidine: centrally active a2-agonist

Question 18

first line tx of status epilepticus

Answer 18

IV lorazepam

Question 19

tx of glioblastoma multiforme

Answer 19

gross total resection and radiation therapy