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MS3 Neurology > Questions > Flashcards

Questions Flashcards

1
Q

Bilateral MLF lesions are usually seen in?

A

MS

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2
Q

Internuclear opthalmoplegia is a disorder of conjugate horizontal gaze that results from damage to the:

A

MLF

The affected eye, ipsilateral to the lesion, is unable to adduct and the contralateral eye abducts with nystagmus

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3
Q

Unilateral MLF lesions can occur with?

A

Lacunar stroke in the pontine artery distribution

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4
Q

The femoral nerve innervates the:

A

Muscles of the anterior compartment of the thigh (Quad, sartorius, pectineus);
responsible for knee extension and hip flexion;
Sensation to inner thigh and medial leg via the saphenous branch

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5
Q

The superficial peroneal nerve does what action?

A

foot eversion

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6
Q

Imaging in Alzheimer’s disease will show:

A

Diffuse cortical and subcortical atrophy, more prominent in the temporal and parietal lobes sometimes, ie hippocampi

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7
Q

Social disinhibition and personality changes are features of:

A

frontotemporal dementia

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8
Q

What are the symptoms of meningeal irritation?

A

Nausea, vomiting, photophobia

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9
Q

SAH most common cause

A

Ruptured arterial saccular aneurysm

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10
Q

Severe headache at onset;
Meningeal irritation;
Focal deficits not common;
Dx?

A

SAH

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11
Q

Complications of SAH

A 
Rebleeding within 24 hours;
Vasospasm after 3 days;
hydrocephalus/increased intracranial pressure;
Seizures;
hyponatremia from SIADH
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12
Q

When is xanthochromia seen in LP in SAH?

A

About 6 hours after onset

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13
Q

How do you identify the source of a bleed in SAH?

A

Cerebral angiography;

can use procedure to stabilize aneurysm by coiling or stenting

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14
Q

What treatment should be considered in MS patients who are experiencing a flare, who are refractory to corticosteroid therapy?

A

Plasmapheresis

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15
Q

interferon-beta or glatiramer acetate should be considered in patients who have?

A

RR or Progressive MS

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16
Q

Progressive proximal muscle weakness and atrophy without pain or tenderness;
Lower extremity muscles are more involved;
Dx?

A

Glucocorticoid-induced myopathy;
ESR and CK normal;
Tx with cessation of steroids, can take weeks of months

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17
Q

Muscle pain and stifness in the shoulder and pelvic girdle;
Tenderness with decreased range of motion at shoulder, neck and hip;
Responds rapidly to glucocorticoids;
Dx?

A

Polymyalgia rheumatica;
ESR up;
CK normal

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18
Q

Muscle pain, tenderness and proximal muscle weakness;
Skin rash and inflammatory arthritis may be present;
Dx?

A

Inflammatory myopathies;

ESR and CK up

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19
Q

Prominent muscle pain/tenderness with or without weakness;
Rare rhabdomyolysis;
Dx?

A

Statin-induced myopathy;
ESR normal;
CK up

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20
Q 
Muscle pain, cramps and weakness involving the proximal muscles;
Delayed tendon reflexes and myoedema;
Occasional rhabdomyolysis;
Features of hypothyroidism present;
Dx?
A

Hypothyroid myopathy;
ESR normal;
CK up

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21
Q

How does herpes encephalitis present initially?

A 
Altered mentation;
FNDs;
Ataxia;
Hyperreflexia;
Focal seizures;
Kluver-Bucy;
Amnesia
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22
Q

What does an LP look like in herpes encephalitis?

A

Lymphocytic pleocytosis with increased number of erythrocytes (hemorrhagic destruction of temporal lobes), elevated protein levels

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23
Q

How is herpes encephalitis diagnosed?

A

PCR analysis of HSV DNA in CSF

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24
Q

What therapy is used in SAH to reduce vasospasm?

A

Nimodipine and hyperdynamic therapy

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25
Q

In SAH, noncontrast CT usually reveals bleeding where?

A

Around the brainstem and basal cisterns

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26
Q

What is the mgmt of a patient with stroke bu no prior antiplatelet therapy?

A

Aspirin

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27
Q

What is the mgmt of a patient with stroke who is already on aspirin therapy?

A

Aspirin + clopidogrel or dipyridamole

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28
Q

What is the cutoff BP for tPA?

A

> 185/110

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29
Q

Where is a medulloblastoma seen?

A

Cerebellum vermis, extending to the fourth ventricle

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30
Q

What is the management of a patient who has developed an intracranial bleed from anticoagulation in the treatment of PE?

A

IVC Filter

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31
Q

What is the hallmark symptom of a vertebrobasilar TIA?

A

Vertigo

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32
Q 
Enlargement of the pons on MRI;
Long list of minor complaints;
Children;
Neck stiffness or discomfort proceeding to torticollis;
Dx?
A

Brain stem glioma

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33
Q 
Cranial nerve deficits;
Dysphasia;
Nasal speech;
Apnea;
Dx?
A

Medullary tumor

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34
Q 
Tumor in the Supraseller region;
Calcification above Sella in MRI;
Panhypolituitarism;
Growth failure in children;
DI;
Bitemporal hemianopsia if optic chiasm is involved?
Dx?
A

Craniopharyngioma

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35
Q

Most common type of neonatal seizure

A

hypoxic-ischemic encephalopathy;

low cord pH, low Apgar scores

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36
Q

What is the acute management of a suspected Brown-Sequard syndrome?

A

IV dexamethasone - most effective within the first 8 hours of injury

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37
Q

Two common etiologies of Brown-Sequard syndrome are:

A

trauma, progressive ie tumor ie mets to the spine

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38
Q

Ipsilateral spastic paralysis;
Ipsilateral Babinski;
Ipsilateral loss of pain and vibration sense;
Contralateral loss of pain and temperature below the lesion;
Dx?

A

Brown-Sequard syndrome

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39
Q

What is the most accurate test to determine CSF leakage?

A

Beta-2 transferrin

use in patients who present with head trauma

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40
Q

Nihilistic delusion disorder in which patiens complain about having lost their possessions, status, strength, inner organs;
Can be seen in schizophrenic or depressive episodes;
Dx?

A

Cotard’s syndrome

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41
Q

Decreased attention, slowed information processing, increased distractability, problems with memory, personality changes, depression, impulsivity;
Following blunt head trauma;
Dx?

A

Dementia pugilistica

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42
Q 
Generalized weakness and pins and needles sensation;
Loss of vibratory sensation;
Increased deep tendon reflexes;
Extensor plantar responses;
Ataxic gait
Chronic, seen in strict vegetarians
A

B12 deficiency –> pernicious anemia –> subacute combined degeneration of the spinal cord;
Tx with B12 replacement

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43
Q

Main diagnostic clue in Guillain-Barre syndrome

A

Absent deep tendon reflexes with ascending demyelinating neuropathy

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44
Q

Proximal muscle weakness;
Diplopia;
Ptosis;
Deep tendon reflexes are depressed or absent;
Repetitive nerve stimulation causes increased responses;
Dx?

A

Lambert-Eaton syndrome;

seen with small cell carcinoma of the lung

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45
Q

Are deep tendon reflexes preserved in MG?

A

Yes

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46
Q

Progressive proximal muscle weakness;
Difficulty climbing stairs and combing hair;
CK elevated;
Dx?

A

Polymyositis;

confirm with muscle biopsy and EMG

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47
Q

Multiple lesions seen in the white matter of both the brain and spine;
Signs and symptoms may include encephalopathy, acute hemiparesis, cerebellar ataxia, cranial neuropathies, spinal cord dysfunction, weakness to paralysis, bowel and bladder dysfunction;
Dx?

A

Acute diffuse encephalomyelitis (ADEM) - rapidly progressing central demyelination follows a viral illness or atypical infection;
Develops over days to weeks;
May resolve over several months;
Autoimmune;
Must differentiate from first episode of MS if recovery is rapid

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48
Q

In what patient population if progressive multifocal leukoencephalothy (PML) seen?

A

AIDS, the severely immunocomprimised, CD4 < 100

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49
Q

Inflammatory process of the gray and white matter of the spinal cord;
Axonal demyelination;
Weakness and sensory disturbances at the level of the lesion;
Dx?

A

Transverse myelitis

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50
Q

What is the treatment for trigeminal neuralgia (tic douloureux)?

A

Carbamazepine;

Baclofen can be adjunct

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51
Q

What are the treatment options for trigeminal neuralgia is medical therapy fails?

A

Surgical decompression of the ganglion;
Percutaneous radiofrequency;
Glycerol trigeminal rhizotomy

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52
Q

Acetylcholine is known to modulate what functions in the basal forebrain projections to the cortex and limbic structures?

A

Decreased in Alzheimer’s;

Attention, novelty-seeking, memory

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53
Q

Occurs with hyperextension injuries in elderly patients with pre-existing degeneration;
Weakness that is more pronounced in the upper extremities than the lower;
Dx?

A

Central cord syndrome

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54
Q

Loss of movement, pain and temperature below the level of the injury (aka bilateral spastic motor paresis distal to the lesion);
Dx?

A

Anterior (ventral_ cord syndrome;

Usually due to occlusion of the anterior spinal artery

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55
Q

Ipsilateral weankess, spasticity, loss of vibration sense and proprioception;
Contralateral loss of pain and temperaure;
Dx?

A

Brown-Sequard syndrome;

hemisection of the cord, can be due to penetrating injury

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56
Q

Bilateral loss of vibratory and proprioceptive sensation, often with weakness, parasthesias and urinary incontence or retention;
Dx?

A

Posterior cord syndrome;

can be due to many causes, ie MS and vascular disruption ie vertebra artery dissection

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57
Q

What are the precipitating factors for a myasthenic crisis?

A

Infection or surgery;
Pregnancy or childbirth;
Tapering immunosuppressive drugs;
Medications ie beta blockers, aminoglycosides, fluoroquinolones

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58
Q

What are the symptoms of a myasthenic crisis?

A

Increased generalized and oropharyngeal weakness (trouble swallowing);
Respiratory insufficiency/dyspnea;

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59
Q

What is the treatment for a myasthenic crisis?

A

Intubation for deteriorating respiratory status;

plasmapheresis or IVIG and corticosteroids

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60
Q

The posterior inferior frontal gyrus is aka

A

Broca’s area

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61
Q

A stroke to Broca’s area would result in:

A

Inability to verbalize and write properly (expressive aphasia)

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62
Q

In Broca aphasia syndrome, speech is:

A

sparse and nonfluent

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63
Q

In conduction aphasia, speech is

A

fluent with phonemic errors

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64
Q

In what aphasia is comprehension preserved?

A

Broca;

Conduction

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65
Q

In what aphasia is comprehension diminished?

A

Wernicke

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66
Q

In what aphasia is repetition impaired?

A

Broca;

Wernicke

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67
Q

In what aphasia is a right superior visual field defect often seen?

A

Wernicke

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68
Q

In what aphasia is right hemiparesis (face and upper limb) seen?

A

Broca

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69
Q

Meyer’s loop is in what lobe of the brain?

A

Temporal lobe

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70
Q

What is apraxia?

A

Inability to perform purposeful actions

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71
Q 
Rapid impairment of vision in one eye;
Pain on eye movement;
Marked color changes in perception;
Afferent pupillary defect and field loss occur, usually with central scotoma;
Dx?
A

Optic neuritis;
common in MS;
Fundoscopy reveals swollen disc

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72
Q

Painful and red eye with blurring of vision;
Eye usually has a perilimbal injection;
Dx?

A

Anterior uveitis;
examiniation reveals keratic precipitates;
corneal stromal edema may be present

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73
Q

Gradual loss of peripheral vision resulting in tunel vision;
On exam, pathologic cupping of the optic disc is seen;
dx?

A

Open angle glaucoma

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74
Q 
Holocranial headache;
Transient vision loss;
Pulsatile tinnitus;
Diplopia;
Dx?
A

Idiopathic intracranial HTN (Pseudotumor cerebri

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75
Q

How is idiopathic intracranial HTN diagnosed?

A

MRI +/- MRV;

Lumbar puncture CSF pressure >250 w/ normal analysis

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76
Q

What associations are there to idiopathic intracranial HTN?

A

Overweight;
female;
hypervitaminosis A, tetracyclines

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77
Q

What is the treatment for idiopathic intracranial HTN?

A

Stop the offendint medication;
weight loss;
acetazolamide

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78
Q

What kind of drug is sumatriptan?

A

5-hydroxytryptamine-1 agonist

79
Q

Timolol eyedrops are used in the treatment of:

A

glaucoma

80
Q

An embolic stroke usually means symptoms are:

A

Abrupt onset and maximal at the start

81
Q

Forced gaze preference suggests damage where?

A

Frontal eye fields

82
Q

Homonymous hemianopsia suggests damage where?

A

Lower optic radiations in the lateral temporal and parietal lobes

83
Q

How does a subcortical lacunar stroke present?

A

Pure sensory, sensorimotor, pure motor, ataxic hemiparesis, dysarthria with clumsy hand;
due to an occluded single penetrating branch of a large cerebral artery (ie MCA, basilar)

84
Q

Patients with atrial fibrillation PLUS existing structural heart disease have an increased risk of:

A

cardioembolic stroke

85
Q

What is the treatment for the motor and psychiatric manifestations in Lewy body dementia?

A

Rivastigmine - Acetylcholinesterase inhibitor

86
Q

What is the criterion for status epilepticus?

A

Any seizure >5 min at risk for excitatory cytotoxicity –>cortical laminar necrosis

87
Q

What is amaurosis fugax?

A

Transient “curtain falling down” usually monocular retinal embolus from the ipsilateral carotid artery (atherosclerosis)

88
Q

Light flashes;
Floaters;
Curtain coming across visual field;
dx?

A

Detached retina

89
Q

What are common neurological complications of infective endocarditis?

A

Embolic stroke;
Cerebral hemorrhage;
Brain abscess;
Acute encephalopathy or meningoencephalitis

90
Q

Subdural hematoma is what shape?

A

Crescent shape

91
Q

Primary solitary brain mets are commonly:

A

Breast
Colon
Renal cell carcinoma

92
Q

Multiple brain mets are commonly:

A

Lung

Malignant melanoma

93
Q

Vertigo, falling to the side of the lesion;
Difficulty sitting upright without support;
Diplopia and nystagmus (horizontal and vertical);
Ipsilateral limb ataxia;
These are all vestibulocerebellar signs of:

A

Wallenberg syndrome - lateral medulla infarction - intracranial vertebal artery, or PICA

94
Q

What autonomic dysfunction can be seen in Wallenberg syndrome?

A

Ipsilateral Horner’s syndrome;
Intractable hiccups;
Lack of automatic respiration is during sleep

95
Q

What sensory symptoms are seen in Wallenberg syndrome?

A

Abnormal facial sensation or pain;

Loss of pain and temperature in ipsilateral face and contralateral trunk and limbs

96
Q

What bulbar symptoms are seen in Wallenberg syndrome?

A

Dysphagia and aspiration;

Dysarthria, dysphonia and hoarseness

97
Q

In medial medullary syndrome, contralateral hemiparesis results from infarct in what structure?

A

Medullar pyramid

98
Q

In medial medullary syndrome, contralateral loss of tactile, vibratory and position sense indicates an infarct in what structure?

A

Medial lemniscus

99
Q

In medial medullary syndrome, ipsilateral tongue paralysis with deviation to the side of the lesion results from infarct to what structure?

A

Hypoglossal nucleus and fibers

100
Q

Medial medullary syndrome is typically due to an occlusion where?

A

Vertebral or anterior spinal artery

101
Q

Contralateral ataxia;
hemiparesis of the face, trunk, limbs;
variable loss of contralateral tactile and position sense;
Dx?

A

Medial mid-pontine infarction

102
Q

Phenytoin and carbamazepine use can result in what newborn deformities? (Fetal hydantoin syndrome)

A 
Microcephaly;
Hypoplasia;
Cleft lip and palate;
Digital hypoplasia;
Hirsuitism;
Developmental delay
103
Q

Diplopia, bitempoeral hemianopsia, vision loss;
Hormonal deficiencies ie low libido;
Can be found on brain imaging incidentally;
Dx?

A

Craniopharyngioma

104
Q

Defect: Monoculur scotoma;
Lesion:

A

Partial lesion in the retina, optic disc, optic nerve;

Causes include: Macular degeneration, optic neuritis

105
Q

Defect: Right anopia (right side totally out);
Lesion:

A

Right optic nerve;

Causes include: Retinal artery of central retinal vein occlusion

106
Q

Defect: Bitemporal hemianopsia;
Lesion:

A

Optic chiasm;

Causes include: Pressure exerted by a pituitary tumor, craniopharyngioma, aneurysm of the ACA

107
Q

Defect: Right nasal hemianopsia;
Lesion:

A

Right peri-chiasmal lesion

Causes include: Calcification or aneurysm of the internal carotid artery impinging on uncrossed, lateral retinal fibers

108
Q

Defect: Left homonymous hemianopsia (Left side both eyes totally out);
Lesion:

A

Right optic tract or radiation;

Causes include:
optic tract = occlusion of ACA
optic radiaton = occlusion of MCA branch or lesion involving posterior limb of the internal capsule

109
Q

Defect: Left homonymous superior quadrantanopia (pie in the sky);
Lesion:

A

Right Meyer’s loop (temporal lobe)

Causes include: lesion or stroke involving temporal lobe

110
Q

Defect: Left homonymous inferior quadrantanopia (pie on the floor);
Lesion:

A

Right parietal lobe (Dorsal optic radiation

Causes include: lesion or stroke involving parietal lobe

111
Q

Defect: Left homonymous hemianopia with macular sparing;
Lesion:

A

Right primary visual cortex (occipital lobe);

Causes incluse: occlusion of PCA. Macula is spared due to collateral blood from MCA

112
Q

Craniopharyngioma - benign?

A

Yes;
suprasellar;
50% >20 age

113
Q

What cranial nerves pass through the cavernous sinus?

A

III, IV, V and VI

114
Q

Because the facial/ophthalmic venous system is valveless, uncontrolled infection of the skin can result in:

A

Cavernous sinus thrombosis;

red flag symptoms include severe HA, bilateral periorbital edema, cranial nerve deficits of III-VI

115
Q

What is the main SAH complication within 24 hours?

A

Rebleeding

116
Q

What is the main SAH complication within 3 days?

A

Vasospasm

117
Q

How do you reduce the risk of vasospasm following SAH?

A

Nimodipine and hyperdynamic therapy

118
Q

Motor and sensory loss below the level of the lesion with bladder and bowel dysfunction;
Dx?

A

Transverse myelitis;

Patients initially have flaccid paralysis, followed by spastic paralysis with hyperreflexia

119
Q 
Altered mental status;
Gait instability;
Nystagmus;
Conjugate gaze palsy;
Diminished reflexes;
Dx?
A

Wernicke encephalopathy (B1 thiamine deficiency)

120
Q

Think of what bacteria in association with Guillain-Barre syndrome?

A

Campylobacter jejuni

121
Q

Flaccid paralysis in infancy, most likely diagnosis?

A

Spinal muscular atrophy;

Anterior horn cells

122
Q

After GBS is suspected, what is the next most important step in management?

A

Serial spirometry to assess breathing status (FVC)

123
Q

Every case of leukocoria (white reflex on ophthalamic exam) is considered what until proven otherwise?

A

Retinoblastoma

124
Q

Pronator drift is a physical exam finding that is relatively sensitive and specific for:

A

Pyramidal/corticospinal tract disease

125
Q

Sudden loss of vision;
Onset of floaters;
Association with diabetic retinopathy;
Dx?

A

Vitreous hemorrhage

126
Q

What is used as prophylaxis for cluster headaches?

A

Verapamil

127
Q

Painless, rapid, transient monocular vision loss;
“Curtain descending over the eye”;
Dx?

A

Amaurosis fugax

Evaluate with carotid duplex

128
Q

What are the common microbes responsible for brain abscess?

A

Viridans strep;
Staph aureus;
Gram negative organisms

129
Q

Histopathologic examination of brain tissue in Alzheimer’s patients indicates:

A

A selective loss of cholinergic neurons

130
Q

What is the first-line treatment for Alzheimer’s patients?

A

Cholinesterase inhibitors ie donepezil, galantamine, rivastigmine

131
Q

What NMDA receptor agonist is approved for moderate to severe dementia?

A

Memantine

132
Q

Painful, red eye (injection);
Ulceration of the cornea;
Dx?

A

Contact-lens associated keratitis;
usually due to gram negative organisms like pseudomonas;
medical emergency

133
Q

Painful, red eye;
blurred vision;
sometimes corneal opacification;
Dx?

A

Acute angle closure glaucoma

134
Q

Painful, red eye;

Conjunctival inflammation that spares the corrnea

A

Anterior uveitis

135
Q

Well-demarcated patch of extravastated blood beneath the conjuctiva;
Dx?

A

Subconjuctival hemorrhage

136
Q

What is the pathogenesis of tabes dorsalis?

A

Secondary degeneration of the dorsal columns;

Spirochetes directly damage the dorsal sensory roots

137
Q 
Sensory ataxia;
Lancinating pains;
Neurogenic urinary incontinence;
Argyll Robertson pupil;
Dx?
A

Tabes dorsalis

138
Q

In tabes dorsalis or B12 deficiency,

damage to the dorsal column produces:

A

Lossof position and vibration

139
Q

In tabes dorsalis, loss of the dorsal root produces:

A

Lancinating pain;

Hypo/areflexia

140
Q

In B12 deficiency, loss of the lateral corticospinal tract produces:

A

Spastic paresis

141
Q

In B12 deficiency, loss of the spinocerebellar tractproduces:

A

Ataxia

142
Q

What medications are associated with pseudotumor cerebri?

A

tetracyclines;

hypervitaminosis A

143
Q

Otitis media and Mastoiditis can cause brain abscess in which regions?

A

Temporal lobe, cerebellum

144
Q

Frontal and ethmoid sinuses, and dental infection can cause brain abscess in which region?

A

Frontal lobe

145
Q

Bacteremia from other infection sites and cyanotic heart disease can cause brain abscess by:

A

hematogenous spread;

site is multiple abscesses along the middle cerebral artery

146
Q

HA, nauseam eye pain and a nonreactive mid-dilated pupil;

Dx?

A

Acute angle closure glaucoma;

acute rise in intraocular pressure

147
Q

Common causes if acute angle closure glaucoma include:

A

decongestants (anticholinergics)

148
Q

What is tonometry?

A

Measures IOP

149
Q

How do you best differentiate between SAH and ICH?

A

In Intracerebral hemorrhage (ICH), symptoms worsen over minutes to hours

150
Q

Usually bilateral, severe radicular pain;
Saddle hypo or anesthesia;
Assymmetric motor weakness;
Hyporeflexia/areflexia;
Late onset bowel and bladder dysfunction;
Dx?

A

Cauda equina syndrome (just LMN signs)

151
Q 
Sudden onset severe back pain;
Perianal hypo/anesthesia;
Symmetric motor weakness;
Hyperreflexia;
Early onset bowel and bladder dysfunction;
Dx?
A

Conus medullaris syndrome

152
Q

What is the mgmt of cauda equina syndrome?

A

Emergency MRI;
IV glucocorticoids;
Neurosurgery eval

153
Q

What is the mgmt of conus medullaris syndrome?

A

Emergency MRI;
IV glucocorticoids;
Neurosurgery eval

154
Q 
Dysarthria/clumsy hand;
Ataxic hemiparesis;
Pure sensory stroke;
Pure motor hemiparesis;
Dx?
A

Lacunar stroke;

Absence of cortical signs ie aphasia, agnosia, neglect, apraxia, mental status change, seizure and hemianopsia

155
Q

What are the risk factors for lacunar stroke?

A

HTN;
increased LDL;
smoking, diabetes, age

156
Q

What are the affected areas of a lacunar stroke?

A

Basal ganglia;
Pons;
Subcortical white matter ie internal capsule, corona radiata

157
Q

What comorbidities can be seen with absence seizures?

A

Anxiety;

ADHD

158
Q

What is seen in EEG in absence seizures?

A

3Hz spike-wave distribution

159
Q

Orofacial clefts, microcephaly, dysmorphic facial features, cardiac defects, nail/digit hypoplasia;
Dx?

A

Fetal hydrantoin syndrome;

from phenytoin exposure

160
Q

What is athetosis?

A

Involuntary writhing movements

161
Q

A stroke to the deep branches of the PCS involves what part of the brain?

A

Thalamus

162
Q

A stoke to the PCA involves what part of the brain?

A

Occipital lobe or temporal lobe

163
Q

A stroke to the Anterior choroidal artery involves what part of the brain?

A

Posterior limb of the internal capsule

164
Q

A stroke to the deep branches of the MCA involves what part of the brain?

A

Lentiform nucleus - putamen and globus pallidus

165
Q

A stroke to the deep branches of the ACA involves what part of the brain?

A

Head of the caudate nucleus AND anterior limb of the internal capsule

166
Q

What is Dejerine-Roussy syndrome?

A

Post stroke, severe paroxysmal burning pain over the affected area, classically exacerbated by light touch (allodynia)

167
Q

Ipsilateral oculomotor nerve palsy, ataxia, contralateral hemiparesis;
Stroke where?

A

Midbrain

168
Q

Contralateral hemiparesis, sensory loss, conjugate gaze palsy toward the side of the lesion;
Stroke where?

A

Putamen with internal capsule involvement - common site of hyperintensive intraparenchymal brain hemorrhage

169
Q

Contralateral sensory loss involving all sensory modalities;

Stroke where?

A

Lacunar stroke of posterior thalamus

170
Q

What is the primary risk factor for neonatal intraventricular hemorrhage?

A

Low birth weight

171
Q

Infant with pallor, cyanosis, focal neurologic signs, bulging or tense fontanel, apnea and bradycardia;
Dx?

A

IVH

172
Q

What medication is used in Parkinson’s patients where tremor is the predominant symptom?

A

Trihexyphenidyl

173
Q

What will EEG show in a patient with CJD?

A

Periodic sharp wave complexes

174
Q

Deep come and total paralysis within minutes;
Pinpoint reactive pupils;
Area of hemorrhage?

A

Pons

175
Q 
Contralateral hemiparesis and hemisensory loss;
Nonreactive miotic pupils;
upgaze palsy;
eyes deviate toward hemiparesis;
Area of hemorrhage?
A

Thalamus

176
Q 
Usually no hemiparesis;
Facial weakness;
Ataxia and nystagmus;
Occipital headache and neck stiffness;
Area of hemorrhage?
A

cerebellum

177
Q

Contralateral hemiparesis and hemisensory loss;
homonymous hemianopsia;
gaze palsy;
Area of hemorrhage?

A

Basal ganglia

178
Q

Eyes deviate away from hemiparesis;

Area of hemorrhage?

A

Cerebral lobe

179
Q

Early executive dysfunction;

Cerebral infarction and/or deep white matter changes on neuroimaging?

A

Vascular dementia

180
Q

Visual hallucinations;

Fluctuating cognition?

A

Lewy body dementia;

Spontaneous parkinsonism

181
Q

What is physiologic tremor?

A

Low amplitude (10-12Hz);
acute onset with increased symptheticactivity ie caffeine, anxiety;
Usually worse with movement and can involve the face and extremities

182
Q

What is pseudodementia?

A

Dementia like symptoms in an elderly person with major depressive disorder

183
Q

Patients >50;
Progressive and bilateral loss of central vision;
Dx?

A

Macular degeneration;

degenertaion and atrophy of the outer retina etc.

184
Q

Why does putaminal hemorrhage often produce contralateral hemiparesis and contralateral sensory loss?

A

Injury to adjacent internal capsule

185
Q

What is the triad of Wernicke encephalopathy?

A
  1. Encephalopathy
  2. Gait ataxia
  3. Ocular dysfunction
186
Q

Common causes of cerebellar (ataxic, wide-based gait) include:

A

cerebellar degeneration;
stroke;
drug/alcohol intoxication;
vitamin B12 deficiency

187
Q

Associated symptoms with ataxic gait include:

A

dysdiadokinesia;
dysmetria;
nystagmus;
Romberg sign

188
Q

Gait apraxia, aka freezing start and turn hesitation gait, have what common causes?

A

Frontal lobe degeneration;

Normal pressure hydrocephalus

189
Q

Common causes of steppage gait include:

A

L5 radiculopathy;

Neuropathy of the common peroneal nerve

190
Q

What are the characteristics of a cluster headache?

A 
Starts suddenly;
Usually lasts about 2 hours;
Intense, unilateral, retroorbital pain;
Pain peaks rapidly, usually at night;
May be accompanied by redness of the ipsilateral eye, tearing, stuffy or runny nose, Horner's syndrome
191
Q

What prophylaxis is recommended for cluster headaches?

A

Verapamil;
Lithium;
Ergotamine

Use 100% O2 and Subq sumatriptan for attacks

192
Q

Progressive bilaterally symmetric hearing loss with subjective tinnitus;
Dx?

A

Presbycusis - sensorineural

193
Q

Descending flaccid paralysis in infant;
Poor suck/gag reflexes;
Sluggish pupils bilateral ptosis;
Dx?

A

Botulism spore ingestion

MS3 Neurology (9 decks)

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