UWorld 1

Question 1

Name the Dx : Newborn noted to have swelling in scalp not present at birth. Swelling limited to surface of one cranial bone. No visual pulsations, indentations, or discoloration of overlying scalp.

Answer 1

Cephalohematoma. This is subperiosteal hemorrhage (slow bleed) so it’s limited to the surface of one cranial bone. No discoloration. Generally resolve in 2 weeks without treatment.

Question 2

How does intracranial hemorrhage present in neonates?

Answer 2

Presents as periods of apnea, pallor or cyanosis, poor suckling, abnormal eye signs, high pitch cry, muscular twitching, convulsions, decreased muscle tone and paralysis w/shock. Fontanels can be pulsating.

Question 3

How does presentation for migraine headaches differ for pediatric vs adult population?

Answer 3

Migraines are the MCC of HA in pediatric population (~50% of cases). Migraines in kids are often bifrontal and shorter in duration. If occipital this would raise suspicion for structural lesion. First line Rx consists of supportive therapy (APAP/NSAID)&raquo_space; oral/nasal/injectable triptans if not resolved.

Question 4

T/F: Absence seizures have postictal state.

Answer 4

False

Question 5

T/F: There is loss of postural tone in absence seizure.

Answer 5

False

Question 6

What’s the acute mgmt. for guillain barre?

Answer 6

IV Ig and plasmapheresis.

Monitor for autonomic dysfunction (arrhythmia, ileus) and respiratory compromise.

Question 7

How would LP look in a case of GBS?

Answer 7

WBC - low/normal
Glucose - low/normal
Protein - normal/elevated

*GBS is primarily is a motor polyneuropathy, but can have Sx of paresthesia and sensory ataxia and dysautonomia (arrhythmia, sweating, orthostatic hypotension).

Question 8

Cyclosporine and pyridostigmine can be used to treat what CNS Dz?

Answer 8

Myasthenia Gravis.

Cyclosporine = immunomodulator (calcineurin inhibitor) 
Pyridostigmine = anticholinesterase

Question 9

Riulozole is primarily indicated for use in what neurologic Dz?

Answer 9

ALS. It inactivates VG Na+ channels and inhibits glutamate release and inhibits effects of excitatory neurotransmitters.

Question 10

What are components of fetal hydantoin syndrome and what drug is associated with this syndrome?

Answer 10

Phenytoin. Causes orofacial clefts, microcephaly, cardiac defects, dysmorphic facial features, and nail/digit hypoplasia.

Question 11

Optic gliomas are low grade glial tumors that are found along the optic nerve and chiasms and are assoc with what neurologic disease?

Answer 11

NF1 (neurofibromatosis I)

Question 12

What’s the first line medical Rx for IIH (idiopathic intracranial hypertension)?

Answer 12

Acetazolamide (inhibits carbonic plexus carbonic anhydrase)&raquo_space; decreased CSF production.

NOT mannitol

Question 13

Left sided hemineglect would be due to damage in ___

Answer 13

R (nondominant) parietal lobe

Question 14

What Sx are seen with central cord syndrome?

Answer 14

Decreased sensation and motor function in the arms with relative sparring of the legs after forced hyperextension. Can have bladder involvement. Generally seen in elderly with underlying cervical spondylytic myelopathy.

Question 15

What function is preserved in locked in syndrome?

Answer 15

Ventral brainstem injury = locked in syndrome. Pt can blink and vertical eye mvmt due to sparring of supranuclear ocular pathway.

Question 16

What areas are affected with lacunar stroke?

Answer 16

basal ganglia, subcortical white matter (internal capsule, corona radiata), pons

Lacunar infarct = pure motor stroke, over minutes to hours. Absence of cortical signs (aphasia, agnosia, neglect, apraxia)

Question 17

Carotid dissection can cause a partial ipsilateral Horner syndrome (ptosis and miosis without anhidrosis) due to damage of:

Answer 17

postganglionic sympathetic fibers of head.

Question 18

Vertebral artery dissection can cause Wallenberg syndrome and present with:

Answer 18

Lateral medullary syndrome. Vertigo and ipsilateral ataxia. Due to damage of inferior cerebellar peduncle and vestibular nuclei.

Question 19

Is pronator drift a sign of cerebellar or pyramidal tract damage?

Answer 19

Pyramidal Tract lesion. This is an UMN problem.

UMN damage&raquo_space; weakness in supinators so affected arm drifts down and turns inward (pronates) to floor.

** Cerebellar dysfunction = ataxia, intention tremor, and impaired rapid alternating movements.

Question 20

Why do you get nonlocalizing symptoms with hypertensive encephalopathy?

Answer 20

hypertensive encephalopathy&raquo_space; marked BP elevation w/progressive headaches , nausea/vomiting, and nonlocalizing sx due to cerebral edema.

Question 21

What are the Sx of Wallenberg syndrome ?

Answer 21

vertigo/nystagmus, ipsilateral cerebellar signs, loss of pain/temp in ipsilateral face and contralateral body, bulbar weakness, ipsilateral Horner’s

Question 22

How does presentation differ between cauda equine syndrome vs conus medullaris syndrome?

Answer 22

Cauda equina syndrome = severe lower back pain with unilateral radiculopathy, saddle anesthesia, hyporeflexia, profound asymmetric motor weakness and late onset bowel/bladder dysfunction (loss of parasymp innervation to bowel and bladder)

Conus medullaris syndrome = severe back pain (with less radiculopathy), perianal anesthesia, hyperreflexia, mild bilateral motor weakness, and early onset bowel/bladder dysfunction.

BOTH require emergency MRI, IV glucocorticoids, and neurosurgical eval.

Question 23

What underlying condition should be considered if a patient presents with bilateral trigeminal neuralgia?

Answer 23

MS
- Demylination of the nucleus of the trigeminal nerve or the nerve root&raquo_space; improper signaling of the nerve and paroxysms of pain.

Question 24

What part of the brain is affected in Huntington’s?

Answer 24

Caudate and striate (putamen)

Can be seen as ventricle enlargement.

Question 25

What part of the brain is affected in Wilson’s Dz?

Answer 25

Lenticular nucleus degeneration

Question 26

What’s the major cause of morbidity and mortality in SAH in the first 24 hrs vs delayed?

Answer 26

Rebleeding in first 24 hrs.

Vasospasm in days 3-10 post SAH. Due to arterial narrowing at base of brain from breakdown of blood products + metabolites&raquo_space; infarction

** Detected with CT angio. Prevented with nimodipine prophylaxis.

Question 27

What are the characteristics of Shy-Drager syndrome?

Answer 27

Multiple System Atrophy. Happens in Pt with PD who present with orhotstatic hypotension, impotence, or other types of autonomic symptoms.

Shy-Drager = PD + autonomic dysfunction + widespread neurologic signs