1 ⼀NEUROLOGY I

Question 1

identify

Answer 1

Question 2

Answer 2

Question 3

Answer 3

Question 4

A: MIOS seen in Younger pts indicates ⬜

B: MIOS seen in OLDER pts indicates ⬜

C: What is the purpose of the MLF

Answer 4

[MIOS-MLF Internuclear Ophthalmoplegia Syndrome]

1) Younger pts= Multiple Sclerosis
2) Older pts= [Pontine a. lacunar stroke]

________________

MLF coordinates CN3 with CN6

________________

Image: Left MIOS

Question 5

CP for [MIOS-MLF Internuclear Ophthalmoplegia Syndrome] (3)

Answer 5

[MIOS-MLF Internuclear Ophthalmoplegia Syndrome]

*[Impaired ADDuction of affected eye]

+

[Normal ADDuction of affected eye during [near reflex convergence]

+

*[Nystagmus of UNaffected eye when attempting to ABduct]👣

Image: L MIOS

👣{(2/2 [Abducens CN6] overfiring in an attempt to stimulate [Oculomotor CN3]}

Question 6

1st line tx for Heat Stroke is ⬜, which should be used to ⬇︎core body temperature by ⬜C/min .

Describe it

________________

List 3 adjunct Heat Stroke therapies

Answer 6

[augmentation of EVAPORATIVE COOLING] ; [0.2C/min]

(naked pt is sprayed with tepid (warm) water mist or pt is covered in wet sheet – while large fans circulate air ➜ ⇪ evaporative heat loss)

________________

ice water lavage / ice packs / cold IVF

Question 7

3 main causes of pinpoint pupils

Answer 7

1. Opiate OD
2. Pontine lesion destroying sympathetic fibers
3. Cholinergic eyedrops for Glaucoma

Question 8

3 Main causes of Spinal Cord Compression

Answer 8

1. DJD Disc Herniation (Smoking risk factor)
2. [Epidural Staph a. Abscess (think IV drug user vs DM)]
3. Tumor (Prostate/Renal/Lung/Breast/Multiple Myeloma mets)

Dx = MRI, Positive Straight Leg, Classic S/S

DJD=Degenerative Joint Disease

Question 9

6 major causes of Syncope

Answer 9

MVC BSD

1. ⬇︎ Cardiac Output (Valvular Dz/HOCM/Pulm HTN/PE/Tamponade/myxoma/aFib)
2. Bradyarrhythmia (SA Node dysfunction/AV Block)
3. [VANS - Vasovagal Autonomic Neurocardiogenic Syncope]
4. Dehydration
5. Stroke
6. Metabolic (⬇︎Glucose vs ⬇︎Na+)

OBTAIN ECHOS ON ANY PT WITH SUSPICIOUS SYNCOPE!

Question 10

A patient taking metoclopramide develops involuntary next flexion known as ⬜

Tx? (2)

Answer 10

[Torticollis Dystonia] ; [Benztropine IV 🆚 Diphenhydramine IV]

Question 11

A pt complains of inabilty to recognize previously known faces

What is this called? ; Where is the lesion?

Answer 11

[ProsoPagnosia visual agnosia] ; BL Temporo-Occipital

Question 12

a. Tx for PostFall syndrome (2)

_________________

b. What is PostFall syndrome?

Answer 12

a.
-URGENT PHYSICAL THERAPY^{(to ⇪ mobility which ➜ ⇪ functionality)}
-URGENT BEHAVIORAL THERAPY^{(to improve thinking/behavior about falls)}

_________________

b. maladaptive fear of falling after a fall that ➜ restricted mobility ➜ functional decline in the elderly

Question 13

Describe the 4 main sx for [Brown Sequard Syndrome]

Answer 13

1.[DCP: Ipsilateral 2TVP loss]

2.[^LateralCST: Ipsilateral [UMN (Weak MESH)]

3.[STT: Contralateral Pain/Temp loss 2 LEVELS BELOW ORIGINAL LESION]

4.[+/- Horner’s MAP]^{(if hemisection is above T1 since this → oculosympathetic pathway damage)}

|💡 Brown Sequard = SpinalHemisection

🖊2TVP-2point/Touch/Vibration/[Position Proprioreception]

Question 14

Causes of [Brown Sequard Syndrome] - 3

Answer 14

1. [(Extramedullary Tumor]
2. Trauma
3. [DJD Disc Hernation (Smoking risk factor)]

Question 15

A: Describe Opsoclonus-Myoclonus Syndrome

B: What Childhood tumor is it associated with?

Answer 15

A: [Non-Rhythmic Conjugate Eye mvmnts] with myoclonus= “Dancing Eyes and Feet”

B: Neuroblastoma (onset 2 y/o)

Arises from Neural crest

Question 16

PCiiH [Pseudotumor Cerebri Idiopathic Intracranial HTN] Dx - 3

Answer 16

1st: [CT to r/o space occupying lesion]

➜ 2nd: [Lumbar Puncture with opening pressure >250 mmH20 (from ⬇︎Arachnoid villi CSF absorption)]

3rd: [MRI +/- MRV revealing BL tortuous Optic N]
* _________________*
* This HA will make you go Blind!*

Question 17

⊕Papilledema is a ctx to Lumbar puncture

When is ⊕Papilledema not a ctx to Lumbar puncture? Explain

Answer 17

[PCiiH (Pseudotumor Cerebri Idiopathic Intracranial HTN)];

As long as there are no signs of obstructive/noncommunicating hydrocephalus or mass, then it is ok

LP with CSF opening pressure > 250 mmH20 = PCIIH

Question 18

[Pseudotumor Cerebri Idiopathic Intracranial HTN] Clinical Presentation - 4

Answer 18

PCiiH girls like to VAPE

1. [Vision ∆ +/- papilledema]
2. [Abducens CN6 palsy]
3. Pulsatile Tinnitus
4. [Eye-blinding HA (worst at sleeping times) & with head position ∆]
   * This HA will make you go Blind!*

Question 19

What is Wallerian Degeneration?

Answer 19

Degeneration of Axons after trauma, but in the setting of [preserved perineurium and epineurium] which later acts as scaffolding to allow axonal sprouting and regeneration within the PNS

Question 20

Describe the Lacunar Syndrome CP

Answer 20

👀
lenticulostriate vessels perfuse [BTiC]

1A: {[Basal Ganglia^{Subthalamic nc}] → [^CTLHemiballismus & involuntary writhing]}

1B: {[ThalamuS^VPL]→[^CTL Sensory Stroke]}

1C: {[internal Capsule^{POST limb}/Corona Radiata]-→ [^CTLMotor stroke_{(ataxia|clumsy hand-dysarthria)}]}

👀Lacunar Stroke= [Thrombotic HTN Arteriolosclerosis & Thrombotic microatheromas] of lenticulostriate vessels (BTiC) –> [cystic infarcts < 15 mm] –> Lacunar Syndrome
VPL=VentroPosteroLateral nc

Question 21

List the n. roots associated with Common Peroneal n.

Answer 21

L4-S2

foot is dropPED (Peroneal Everts & Dorsiflexes)

• Commonly caused by L5 Radiculopathy*
• Dx: Knee MRI vs EMG*

Question 22

List the n. roots associated with Tibial n.

Answer 22

L4-S3 (Three)

can’t walk on TIPtoes (Tibial Inverts & Plantarflexes)

Commonly caused by L5 Radiculopathy

Question 23

What are the functions of the Common Peroneal n. -2

Answer 23

L4-S2

foot is dropPED (Peroneal Everts & Dorsiflexes)

_________________

🔬 Commonly caused by L5 Radiculopathy
🩺 Knee MRI vs EMG

Question 24

What are the functions of the Tibial n. (2)

Answer 24

L4-S3 (Three)

can’t walk on TIPtoes (Tibial Inverts & Plantarflexes)

Commonly caused by L5 Radiculopathy

Question 25

CP of **Craniopharyngioma****s** - 3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Demographic?-2

Answer 25

1. BiTemporal Hemianopsia 2. HA 3. Pituitary Hormonal Deficiencies (i.e. ⬇︎Libido) Demographic: **MOSTLY KIDS**, but some adults

Question 26

A: What is **Cheyne-Stokes Breathing**? B: What is this breathing associated with? - 3

Answer 26

A: Cyclic breathing in which apnea is followed by [INC and then DEC tidal volumes] all the way up until the next apneic period B: 1. [**Advanced** CHF] 2. [Comatosed BL metabolic encephalopathy] 3. Elderly during sleep

Question 27

[Myasthenia Gravis] Tx-4

Answer 27

**P DDD F** ## Footnote 1st: [Pyridostigmine AChesterase inhibitor] 2nd: Cyclosporine 3rd: Thymectomy 4th: \*\*[Intubate + Plasmapharesis + IVIG + Steroids] if Crisis \*\*

Question 28

Pts with Myasthenia Gravis may develop Myasthenia CRISIS, which presents clinically as ⬜ !!! What are precipitants of this?-3

Answer 28

**P DDD F** Respiratory Failure! Precipitants = FIS: 1. Fluoroquinolones 2. Infection 3. Surgery *Crisis Tx: [Intubate + Plasmapharesis + IVIG + Steroids]*

Question 29

[**LEMS** - Lambert Eaton Myasthenic Syndrome] etx

Answer 29

[Autoimmune attack against (Presynpatic Ca+ channel)--\> No ACh release]

Question 30

[Myasthenia Gravis] Clinical Presentation (5)

Answer 30

"*Give me Mya's* **P DDD F**" [**P**tosis [**D**iplopia from Disconjugate gaze] **D**ysarthria-*bulbar dysfunction* **D**ysphagia w/nasal regurgitation-*bulbar dysfunction* [**F**ATIGABLE progressive Weakness Muscularly (Extraocular/RESP/Proximal/limbs/worst w/repetition/impvd with rest)] *Tx: Pyridostigmine AChesterase inhibitor*

Question 31

[Myasthenia Gravis] Dx-5

Answer 31

P DDD F 1. **ACh R Ab Assay** 2. **MuSK** (**Mu**scle-**S**pecific tyrosine **K**inase) **Ab Assay** (only if #1 is neg) 3. [**Tensilon Edrophonium**]--\> Improves all sx 4. **Ice Pack** to eyelids --\> Improves Ptosis by inhibiting ACh breakdown at NMJ 5. *BE SURE TO GET **CT CHEST** AFTER DX TO COVER FOR THYMOMA, POSSIBLE THYMECTOMY!!!!*

Question 32

[**LEMS** - Lambert Eaton Myasthenic Syndrome] Clinical Presentation - 3

Answer 32

1. **Weakness of [Proximal limbs and trunk]** mimicking myopathy, better with exercise 2. Autonomic sx (Dry mouth /Orthostasis / Impotence) 3. ⬇︎Deep Tendon Reflexes

Question 33

[Myasthenia Gravis] etx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Demographic?-2

Answer 33

Autoantibodies block and degrade [**postsynpatic** _nicotinic_ ACh Receptors]] --\> [⬇︎ motor end plate potential] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[Women 20-30] [Men 60-80] yo*

Question 34

Migraine etx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How are the Trigeminal nerves associated-2 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote _{"***VTAP** the migraine BEFORE it comes, and **SEND** it on its way when it does!"*}

Answer 34

Genetic [GainOfFunction mutation in *excitatory NMDA receptor*]--\>burst of cerebral activity _when triggered_---\>hyperemia (*usually occipital lobe*)--\> aura_sx. Burst is followed by **Cortical Depolarization** tht has slow but deliberate forward advance --\> Triggers Trigeminal pathway Trigeminal afferents : 1. send impulses--\>[Brain Stem APCTZ] & hypothalamus--\> Nausea/Photophobia/Phonophobia 2. retroactively depolarize--\>release of substance P --\> neurogenic inflammatory pain + vasoDilation

Question 35

A: **Primary CNS Lymphoma** is the ⬜ most common cause of ⬜ in HIV pts B: What *virus* is this associated with? C: What WBCs would you expect to see in the brain tissue

Answer 35

A: **2nd** most common cause of **ring enhancing lesions** in HIV pts (*1st = Toxoplasmosis Gondi*) B: **EBV** C: B-lymphocytes

Question 36

_*Pontine*[Basilar Artery] occlusion CP

Answer 36

Locked In Syndrome!!! | *LIS🔒={**[✅QB VP] but [⛔HO]**}* ## Footnote [**Q**uadriplegia w intact consciousness]

Question 37

PCA occlusion CP-4

Answer 37

1. [CTL Homonymous Hemianopia^{with macular sparing} (*K in image*)] 2. Visual hallucinations 3. [Alexia with NO agraphia]^{Dominant Hemisphere involvement} 4. [DOPe^{Oculomotor CN3 involvement}] ## Footnote 🔎[DOPe= Down & Out + Ptosis + eyeDilated]

Question 38

ACA occlusion CP-3

Answer 38

1. CTL Weakness worst in LE 2. CTL Numb worst in LE 3. Urinary Incontinence

Question 39

AICA occlusion CP-4

Answer 39

*Somewhat like [PICA Lateral Medullary Syndrome of Wallenberg]* 1. Hearing Loss 2. FACE Paralysis (Similar to Bells Palsy) 3. Ipsilateral ⬇︎Facial Pain/Temp 4. CTL ⬇︎BODY Pain/Temp

Question 40

PICA occlusion causes what syndrome? what other vessel abnormality can cause the same CP?

Answer 40

*This is AKA [PICA Lateral Medullary Syndrome of Wallenberg]* **Intracranial Vertebral A occlusion** = MOST COMMON CAUSE OF THIS!

Question 41

ALL Elderly should be screened for "*Falls* " ⬜ a year with ⬜. How do you manage patients with ⊕*Fall* screen? (2)

Answer 41

once; [inquiry on how many (*if any*) falls they've had] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶if fall screen ⊕ → assess gait/balance with [psGUGT (postural stability “Get Up and Go” test)] ▶ … --*(if psGUGT also ⊕)*--\> [extensive “fall” workup]_(image) * * * psGUGT: *Without assistance, pt stands from armless chair, walks short distance, turns around, returns to chair and sits down again.* [If **unsteady/difficulty** = ⊕ result]

Question 42

# ALL Elderly should be screened for "Falls " ⬜ a year with ⬜. *Patient has ⊕fall screen → ⊕psGUGT → requires elderly [extensive fall workup] now* Describe the 6-part differential that outlines *elderly* [extensive fall workup]

Answer 42

once; [inquiry on how many (*if any*) falls they've had] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Question 43

All patients (especially elderly) s/p **FALL** require ⬜ by a ⬜ for the purposes of ⬜

Answer 43

[home safety assessment] ; occupational therapist \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ optimizing HOME safety and ADL

Question 44

Altered Mental Status workup -7

Answer 44

**GOT** **CLUB** 1. G[Glucose level ➜ Thiamine B1 f/b glucose admin (dextrose **IV**)] 2. Oxygen level 3. T3/T4 level 3. B12 level 4. Lumbar puncture 5. [UDS/CMP/CBC] 6. CT head

Question 45

Although Parkinson's disease is a clinical diagnosis *< *E + 2S **-** R - X* >*, what's the most important supportive feature for confirming the diagnosis?

Answer 45

excellent response to dopaminergic tx (Levodopa/Carbidopa) ## Footnote ⊡established PD = < *E + 2S **-** R - X* >

Question 46

# [Parkinson's Disease] is a ⬜ diagnosis Diagnosing Parkinson's Disease consist of 4 criteria blocks Name them

Answer 46

clinical \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ < ***ESRX*** > critertion 1. {[**E**ssential (for PD)] = *AKA "PARKINSONISM"* } 2. [**S**upportive (of PD)] 3. [**R**edFlags (atypical for PD)] 4. e**X**clusion (excludes PD dx)] ## Footnote ⊡established PD = < *E + 2S **-** R - X* >

Question 47

# [Parkinson Disease] = ⬜ diagnosis made of 4 criteria blocks < *ESRX* > the [< *E* > criteria^{(AKA ⬜ )}] = ⬜, and is made of what 3 items?

Answer 47

clinical ; \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ < *ESRX* > ⭐[< *E* >ssential (for *any* Parkinson Disease diagnosis) = AKA "*parkinsonism​*​"] ▶requires ([**P** or **R**] ▶requires (+ **K**) | *E*ssential (for PD) = [ (**P**|**R**) **+K** ] ## Footnote **PRK** = -**P**ill Rolling resting tremor -**R**igiditiy cogwheel -brady**K**inesia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ⊡established PD = < *E + 2S **-** R - X* >

Question 48

# [Parkinson Disease] = ⬜ diagnosis made of 4 criteria blocks < *ESRX* > the < *S* > criteria = ⬜, and is made of what 3 items?

Answer 48

clinical ; \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ < *ESRX* > ⭐[< *S* >upportive (of PD diagnosis)] ▶[Excellent response to levodopa/Carbidopa = MOST IMPORTANT SUPPORTIVE FEATURE] ▶Asymmetric limb findings (tremor, rigidity) ▶Olfactory dysfxn ## Footnote ⊡established PD = < *E + 2S **-** R - X* >

Question 49

# [Parkinson Disease] = ⬜ diagnosis made of 4 criteria blocks < *ESRX* > the < *R* > criteria = ⬜, and is made of what 6 items?

Answer 49

clinical ; \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ < *ESRX* > ⭐[< *R* >ed Flags (atypical for PD diagnosis)] ▶ [early **A**reflexia posturally (recurrent falls) ▶early SEVERE orthostatic hypOtension] ▶ [early bulbar dysfxn (dysarthria)] ▶ having NO [nonmotor signs] (i.e. having NO sleep ∆ is atypical for PD ) ▶ Symmetric findings ▶Hyperreflexia ## Footnote ⊡established PD = < *E + 2S **-** R - X* >

Question 50

# [Parkinson Disease] = ⬜ diagnosis made of 4 criteria blocks < *ESRX* > the < *X* > criteria = ⬜, and is made of what 5 items?

Answer 50

clinical ; \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ < *ESRX* > ⭐[< *X* >clusionist (automatically eXcludes Parkinson Disease diagnosis)] ❌vertical palsy ❌[cerebellar sx^(*GRINDRR*) ] ❌cortical sensory loss ❌worsening aphasia ❌[pt taking antidopaminergic rx (ie haloperidol)] ## Footnote ⊡established PD = < *E + 2S **-** R - X* >

Question 51

# [Parkinson Disease] = ⬜ diagnosis made of 4 criteria blocks < *ESRX* > What is the diagnostic criterion arrangement neccessary to diagnose a patient with [**ESTABLISHED** Parkinson's Disease] ?

Answer 51

clinical \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ < *E + 2S **-** R - X* >

Question 52

# [Parkinson Disease] = ⬜ diagnosis made of 4 criteria blocks < *ESRX* > What is the diagnostic criterion arrangement neccessary to diagnose a patient with [**probable** Parkinson's Disease] ?

Answer 52

clinical \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ < *e + (s **≥**r) - x* >

Question 53

Alzheimer's Dz etx (5)

Answer 53

Alzheimers etx = **NaTPO** ①. **N**eurofibrillary tangles = intracell hyperphosphorylated insoluble tau cytoskeleton = [ ⇪ Neurofib tangles = ⇪ Alzheimer dementia] + ② . ⭐**a**ccumlation of {**β-amyloid** *(derived from [cleavage of **chromo 21** t.A.P.P.]*} in: 2a. **T**emporal lobe early on ➜ [Neuritic Senile plaques] 2b.{[**P**arietal & occipital] lobe cerebral blood vessels} ➜ [P\o Spontaneous Hemorrhages📷] 2c .{hipp**O**campus & [Basal nc. of meynert]} ➜ defective [{O\B} Choline AcetylTransferase] ➜ [⬇︎ {O\B} ACh] ➜ {Alzheimer [**CLAV** ➜ **HANDU**]_sx} 🖊{P\o} = {[Parietal & occipital]} | 🖊{O\B} = {hipp**O**campus & [Basal nc. of meynert]} ## Footnote 🩺**NaTPO** ↪ [**CLAV** ➜ **HANDU**]_sx 👓*t.A.P.P.* = transmembrane Amyloid Precursor _glycoProtein

Question 54

*An Unconscious, Unresponsive patient with unremarkable vitals and normal Deep Tendon Reflex presents c/f coma* ▶How do you differentiate true coma from psychogenic coma? * * * ▶ Explain (2)

Answer 54

obtain **VCR** [⊕**VCR** = NO true COMA] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **▶** [**V**estibular **C**aloric_stimulation **R**eflex] = tests' [oculovestibular *brainstem* and *cortex* reflex] by irrigating auditory canal with cold water. ▶[⊕**VCR** = NO true COMA] = irrigating auditory canal with cold water ➜ {[conjugate slow deviation of gaze to side of cold water (*brainstem*)] ➜ [saccadic correction to midline (*cortex*)]} = [COMATOSED BRAINS CAN NOT DO THIS] =[⊕**VCR** = NO true COMA] = [⊕psychogenic Coma]

Question 55

[Parkinson Disease Tx] can cause psychosis due to ⬜ How do you manage this? -2

Answer 55

dopaminergic activation of mesolimbic pathway \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ {DEC [PD Tx] dosage (starting with least potent)} --(if sx persist)--\> [add D2 R Blocker (Quetiapine/Clozapine/PimaVanserin)]

Question 56

Aside from CSF analysis revealing ⬜³, name the typical manifestations of [Herpes Simplex Encephalitis] -6

Answer 56

- [⇪ **P**rotein] - [⇪ **W**BC lymphocyte pleocytosis] - [⇪ RBC ^{(from temporal lobe destruction)}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *encephalitis* _sx = **FAVORS**: [**F**ocal neuro ∆ ^{*(aphasia, hemipLegia, hemiparesis)*}] , ⭐**A**MS⭐, **V**omiting, **O**uch HA, **R**eally hot fever, **S**eizure ## Footnote *⭐= [encephalitis AMS] distinguishes encephalitis from meningitis*

Question 57

Atomoxetine Indication

Answer 57

**Non**Stimulant ADHD Rx

Question 58

Benzos can cause an *uncommon* SE known as **Paradoxical Agitation**. Describe this

Answer 58

[⬆︎Agitation, confusion and disinhibition] within a hour of benzo admin. GIVING MORE BENZOS WILL WORSEN THIS!

Question 59

Benztropine & Trihexyphenidyl are in what class of drugs? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How can pts on these develop Retro-Orbital HA during OD?

Answer 59

Anticholinergics; OD can --\> Acute Glaucoma --\> RetroOrbital HA^{(from pupil Dilation and cyclopLegia)} ## Footnote *Blind as a bat, Dry as a bone, Hot as a hare, Mad as a hatter, Red as a beet, Bowel & Bladder lose their tone, and the Heart runs alone*

Question 60

Between DM, Smoking and HTN, which carries the GREATEST STROKE Risk?

Answer 60

**HTN**

Question 61

# Both Mannitol and [Hypertonic Saline (3%/5%/23%)] are used to ⬇︎ ICP List the differences in using Hypertonic saline? - 4

Answer 61

1. HTS Anti-Inflammatory 2. [HTS does NOT cross into interstitial space like Mannitol ( Mannitol causes Rebound Edema!) ➜ 3. ➜ HTS eventually expands systemic volume 4. HTS **ONLY** given via Central line | HTS = Hypertonic Saline

Question 62

Brachial Plexus damage of [lower Trunk {(C8) (T1)}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **clinical presentation?**

Answer 62

[klumpke palsy claw hand]

Question 63

Brachial Plexus damage of [long thoracic {(C5)(C6)(C7)} n ] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **clinical presentation? -2**

Answer 63

1. [winged scapula] 2. [inability to **AB**duct shoulder \> 90º]

Question 64

Brachial Plexus damage of [Axillary {(C5)(C6)} n] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ clinical presentation?

Answer 64

[Deltoid paralysis]

Question 65

Brachial Plexus damage of [Radial {C5⼀T1} n] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ clinical presentation? -2

Answer 65

1. [Saturday night palsy wrist drop] 2. [No Tricep Reflex]

Question 66

Brachial Plexus damage of [Radial {C5⼀T1} n] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ causes -3

Answer 66

1. [Crutches/Axilla damage] 2. [anteroLateral⼀**pFSF**] 3. Midshaft Humerus ## Footnote 👓{[anteroLateral⼀**pFSF**] = {[anteroLateral⼀**p**roximal _{humerus displacement}] _iTSo [**F**OOSA **S**upracondylar **F**x]}

Question 67

Brachial Plexus damage of [Axillary {(C5)(C6)} n] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ causes -3

Answer 67

1. [Surgical NECK humerus] 2. [ANTERIOR humerus displacement] 3. Shoulder Injury

Question 68

Brachial Plexus damage of [long thoracic {(C5)(C6)(C7)} n ] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **causes -3**

Answer 68

- STABS - [MASTECTOMY] - [AXILLARY NODE DISSECTION]

Question 69

*Brain Death is a clinical diagnosis and involves [absent cortex functions] and [absent brain stem functions]* What are the legal complications of disabling artificial life support for a pt who is newly diagnosed with Brain Death?

Answer 69

None - Brain death is a legally acceptable definition of death

Question 70

*Brain Death is a clinical diagnosis and involves absent cortical and brain stem reflexes* In correct diagnostic order, name the 5 Criteria Blocks used to diagnose Brain Death?

Answer 70

**(*****"CNaPL"*****​)** ## Footnote [**⁵****C**linical (*evidence of **_C_**NS catastrophe, NO **_C_**onfounders, NO **_C_**hemicals-drug intox, \>36**_C_**, **_C_**ore\>100 SBP*)] [**⁵****N**euro exam(*coma, NO cortex rflx, NO brainstem rflx, NO rooting/sucking rflx, spinal rflx ok*)] ➜ [**⁴a**ncillary testing if (C) (N) (P) inconclusive] = [EEG isoelectric line] vs [EEG NO SSensory activity] vs [EEG NO brainstem activity] vs [NO intracranial blood flow] [**³****P**ulmonary aPnea test (*Preoxygenate ➜ disconnect ventilator = positive if NO spontaneous breath x 8m + PaCO2\>60 + arterial pH\<7.28]* [**L**ocal requirements]

Question 71

*Brain Death is a clinical diagnosis and involves [absent cortex reflexes] and [absent brainstem reflexes]* There are 5 Criteria Blocks (**CNaPL**) used to diagnose Brain Death \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶ Describe the [**C**linical] criteria block (5)

Answer 71

**(*****"CNaPL"*****​)** [ **⁵****C**linical^{prerequisites}] * *[**_C_**NS catastrophic evidence is present],* * *[NO **_C_**onfounders of CNS_metabolic ∆]* * *[NO **_C_**hemicals_sedatives/drug intox/poisoning*] * *\>36**_C_**,* * ***_C_**ore\>100 SBP*)]

Question 72

*Brain Death is a clinical diagnosis and involves [absent cortex reflexes] and [absent brainstem reflexes]* There are 5 Criteria Blocks (**CNaPL**) used to diagnose Brain Death \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶ Describe the [**N**euro exam] criteria block (5)

Answer 72

**(*****"CNaPL"*****​)** ## Footnote [**⁵****N**euro exam(*coma, NO cortex rflx, NO brainstem rflx, NO rooting/sucking rflx, spinal rflx ok*)]

Question 73

*Brain Death is a clinical diagnosis and involves [absent cortex functions] and [absent brain stem functions]* There are 5 Criteria Blocks (**CNaPL**) used to diagnose Brain Death \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶ Describe the [**a**ncillary testing] criteria block (4)

Answer 73

**(*****"CNaPL"*****​)** ## Footnote ➜ [**⁴a**ncillary testing_{⼀if (**C**)| (**N**) |(**P**) inconclusive} ] = *(positive if)*... [*EEG* isoelectric line] + [*EEG* NO SomatoSensory activity] + [*EEG* NO brainstem activity] + [NO intracranial blood flow]

Question 74

*Brain Death is a clinical diagnosis and involves [absent cortex reflexes] and [absent brainstem reflexes]* There are 5 Criteria Blocks (**CNaPL**) used to diagnose Brain Death \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶ Describe the [**P**ulmonary aPnea test] criteria block (3) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶▶What 3 factors prevent this test from being done?

Answer 74

**(*****"CNaPL"*****​)** [ **³****P**ulmonary aPnea test * Preoxygenate * ➜Pull vent ( disconnect ventilator) * ➜ ➜ Positive = [(NO spontaneous breath x 8m) + PaCO2\>60 + arterial pH\<7.28] ] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ❌if active drug intoxication ❌if heart disease ❌if lung disease

Question 75

*Brain Death is a clinical diagnosis and involves absent cortical and brain stem reflexes* There are 5 Criteria Blocks (**CNaPL**) used to diagnose Brain Death \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶ Explain the Order these criteria blocks should be followed when diagnosing brain death

Answer 75

Question 76

On EEG, what is a [burst suppression pattern]? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What does it indicate? (2)

Answer 76

isoelectric periods punctuated by high amplitude activity \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Deep Coma - Anesthesia

Question 77

# *pt exhibits ⊕Deep Tendon Reflexes* T or F: this finding effectively r/o brain death

Answer 77

FALSE | {[🧠 Death*Reflexes*] = [(⊕Spinal Cord) ➖Cortex ➖Brainstem ➖Suck/root]} ## Footnote ....because **[Spinal Cord reflexes^{*(i.e. Deep Tendon Reflex)*}] are still intact** during Brain Death →

Question 78

Bromocriptine MOA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Indication

Answer 78

[^PostSynapticDopamine🟢 (ergot)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Parkinson's

Question 79

Carbamazepine side effects -3

Answer 79

1. [bone marrow suppression (neutropenia)] 2. SIADH hypOnatremia 3. AntiCholinergic

Question 80

[Carpal Tunnel Syndrome] etx

Answer 80

**BILATERAL** Median n Compression by the [Flexor Retinacular Transverse carpal ligament] --\> Peripheral **mono**neuropathy + [ABductor pollicis brevis atrophy] ## Footnote * [Flexor Retinaculum Transverse Carpal ligament] can be surgically incised for relief* * CARPAL TUNNEL STARTS uL and --\> BL*

Question 81

Carpal Tunnel Syndrome Clinical Presentation - 6

Answer 81

1. [Paresthesia vs Pain with **Median n. Distribution** worst at night] 2. CARPAL TUNNEL STARTS uL and --\> BL 3. {[Thenar (ABP, FBP, O_P,)] atrophy* ^{[ABductor Pollicis Brevis] atrophy ➜ (⬇︎flexion/ ⬇︎ABduction/ ⬇︎Opposition}*)]} 4. Tinel Sign (tapping over flexor surface ⬆︎ sx) 5. Phalen Sign (flexing Wrist ⬆︎ sx) 6. HOH Sign (Hand over Head ⬆︎ sx)

Question 82

*Pregnancy is associated with Carpal Tunnel* What should these particular pts also be worked up for?

Answer 82

**Preeclampsia** ## Footnote *CARPEL TUNNEL starts uL and then --\> BL*

Question 83

[Carpal Tunnel Syndrome] dx ## Footnote *excluding clinical s/s*

Answer 83

Nerve Conduction studies ## Footnote *EMG is not necessary for Carpal Tunnel Syndrome*

Question 84

[Carpal Tunnel Syndrome] tx - 5

Answer 84

1. **[WRIST SPLINT** (sx \< 10 mo)] 2. Remove exacerbating factors 3. NSAIDs 4. CTS injection -IF MODERATE 5. [Flexor Retinaculum Transverse Carpal ligament] can be surgically incised for relief - IF SEVERE ​ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *wrist splint maintains wrist in neutral position to avoid movements that narrow the tunnel more*

Question 85

Risk factors for Carpal Tunnel Syndrome - 4

Answer 85

1. Obesity 2. [Pregnancy (*c/s Preeclampsia*)] 3. DM 4. hypOthyroidism ## Footnote *CARPEL TUNNEL STARTS uL and --\> BL*

Question 86

[Conus Medullaris Syndrome] etx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Clinical Presentation - 7

Answer 86

(Compression of S2 - S4 n. roots @ Conus Medullaris) --\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ "**RIM sara**!?" 1. [**R**eflexia: HYPER]reflexia (*Cauda Equina has hypOreflexia)* 2. [**I**ncontinence EARLY] 3. **M**otor weakness SYMMETRICALLY 4. **s**addle anesthesia 5. **a**nocutaneous reflex loss 6. **r**adiculopathy 7. [**a** MRI, CTS IV and Neurosurg consult = tx]

Question 87

[cauda equina syndrome] etx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Clinical Presentation - 7

Answer 87

(Compression of S2 - S4 n. roots @ Cauda Equina) --\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ "**RIM sara**!?" 1. [**R**eflexia: hypO]reflexia (*Conus Medullaris has HYPERreflexia)* 2. [**I**ncontinence LATE] 3. **M**otor weakness Asymmetrically 4. **s**addle anesthesia 5. **a**nocutaneous reflex loss 6. **r**adiculopathy 7. [**a** MRI, (CTS IV) and Neurosurg consult = tx]

Question 88

What Spinal Columns are affected in [Subacute Combined Degeneration]?-3 ​ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How do this manifest?-3

Answer 88

[Su**BAC**ute Combined Degeneration] [Demyelinating lesions] in 3 **Thoracic** Spinal Columns: 1. [Dorsal--\> Loss of 2TVP] 2. [Lateral CST --\> UMN *Weak MESH*] 3. [Spinocerebellar --\>Ataxia] * FriEdreich Ataxia affects the SAME 3 columns*

Question 89

Causes of [Subacute Combined Degeneration] (3)

Answer 89

[Su**BAC**ute Combined Degeneration] 1)**B**12 Deficiency (demyelinates peripheral nerves also) 2.**A**IDS/HIV 3.**C**opper deficiency * Affects Dorsal / Lateral CST / Spinocerebellar Tracts (Combined)*

Question 90

# B12 deficiency is common in the elderly In the elderly B12 deficiency can present as ⬜ and [Subacute Combined Degeneration]. How do you address this?

Answer 90

Dementia ; \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ SX REVERSIBLE WITH B12 SUPPLEMENTATION ## Footnote 🩺SAC = demyelination of DCP/ CST-L, /SpinoCerebellar tracts

Question 91

Central Pontine Myelinolysis dx (2) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx (3)

Answer 91

1. [Brain MRI: demyelinating lesions] 2. [CP: rapid Na+ correction of *hrhh* → delayed paralysis days later] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - irreversible - supportive care - eye computer interface ## Footnote *🔎hrhh = high risk hypOtonic hypOnatremia*

Question 92

# Central Pontine Myelinolysis → ⬜ syndrome Name the clinical features of this syndrome(6)

Answer 92

**_LOCKED IN SYNDROME_** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *"CPM, you have the* **QB-VP** but no **HO** for him" ⊕ ✅[**Q**uadriplegia w intact consciousness {LOCKED IN SYNDROME}] ✅[**B**link reflex^{(*upper CN intact*)}] ✅[**V**ertical EOM^{(*upper CN intact*)}] ✅[**P**upilllary reflex^{(*upper CN intact*)}] ⊝ ⛔[**H**orizontal EOM^{(*lower CN paralyzed*)}] ⛔[**O**ral movements^{(*lower CN paralyzed*)}]

Question 93

Central Pontine Myelinolysis etx (4)

Answer 93

1a. *hrhh* = {[prolonged hypOnatremia_≤120] x ≥2 days} 1b. Rapid correction of *hrhh* ➜ 1c. [osmotic shock → oligodendrocyte death → demyelination → 🔒LIS \_\_\_\_\_\_\_\_OR_\_\_\_\_\_\_\_\_ ## Footnote *2 Also can be caused by {_{Pontine (infarct)} io\ [Basilar Artery (occlusion)]}* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 🔒LOCKED IN SYNDROME{***[✅QB VP] but [⛔HO]**} *🔎hrhh = high risk hypOtonic hypOnatremia*

Question 94

*Cerebral Palsy is a group of clinical syndromes generally characterized as \_\_\_\_\_\_* How does it present? - 3

Answer 94

Nonprogressive motor dysfunction (Prematurity\>EtOH = RF) ; ## Footnote "Cerebral Palsy is a *young*, *SAD** **BUM**" 1. **B**L equinovarus club feet (image) 2. {[UMN (**W**eak **MESH**)_sx] *LE \>UE*} 3. Mental Retardation *Greatest RF = prematurity ( \< 32 wks gestation)*

Question 95

*Cerebral Palsy is a group of clinical syndromes generally characterized as \_\_\_\_\_\_* What are the 3 types? What's the greatest risk factor for Cerebral Palsy?

Answer 95

Nonprogressive motor dysfunction ; ## Footnote Cerebral Palsy is just **SAD** 1. **S**pastic 2. **A**taxic 3. **D**yskinetic Greatest RF = prematurity ( \< 32 wks gestation) but EtOH is second

Question 96

*Cerebral Palsy is a group of clinical syndromes generally characterized as \_\_\_\_\_\_* If Cerebral Palsy is suspected, what diagnositc test should be obtained and why?

Answer 96

Nonprogressive motor dysfunction ; brain MRI ; look for etx (periventrivcular leukomalacia or malformation)

Question 97

Classic signs of Fetal Alcohol Syndrome - 4

Answer 97

"FAS had drunk mama's baby looking like a **MULE**" 1. **M**icrocephaly 2. **U**pper THIN Lip 3. **L**ong smooth Philtrum 4. **E**yes have short Palpebral fissures

Question 98

clinical course for Guillain Barre syndrome (3)

Answer 98

[ascending motor weakness progressive over 2 wks^{(+/- paralysis)} ] ➜ [plateau x 2-4 wks] ➜ [spontaneous recovery over months] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *tx (plasma Xchange/ IVIG ) shortens course duration by 50%*

Question 99

Describe **Pseudoexacerbation** of Multiple Sclerosis

Answer 99

[**SLUM** **SiiiN**] Infection in MS pt --\>⬆︎ Body temp --\> ⬇︎Conduction in [Remyelinated healed CNS areas] --\> clinically **APPEARS** to be MS exacerbation BUT REALLY ISN'T! *Image: T1 MRI Black Holes Dx*

Question 100

Clinical Manifestation of **Multiple Sclerosis** (9)

Answer 100

Charcot classic triad of MS is a [**SLUM** **SiiiN**] ! ## Footnote **S**ensory sx (think BL Trigeminal Neuralgia) **L**hermittes sign = "electric tingling" down spine into arm & legs when chin is touched to chest **U**hthoff phenomenon (sx ⬆︎ during heat) **M**otor sx **S**canning Speech [**I**nternuclear Ophthalmoplegia (MIOS)] / **I**ntention Tremor / **I**ncontinence **N**euritis Optic - (uL eye pain + vision loss + Marcus Gunn afferent pupillary defect) = ALSO RISK FACTOR

Question 101

Demonstrate Sensory Innervation of the Hand Ulnar nerve \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Median nerve \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Radial nerve

Answer 101

Question 102

Subarachnoid Hemorrhage is most commonly due to ⬜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Clinical Presentation (6)

Answer 102

[Berry Saccular Aneurysm] rupture \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. **“worst HA of my life” ⼀*****sudden severe thunderclap HA different from previous*** 2. Nausea 3. Vomiting 4. LOC 5. meningismus 6. [focal neuro ❌]

Question 103

# Subarachnoid Hemorrhage Risk Factors (5)

Answer 103

1. HTN 2. Sympathomimetic drugs 3. Smoking 4. EtOH 5. fHX ## Footnote ✏️*Xanthochromia= yellow tinted CSF due to hgb degradation products*

Question 104

# Subarachnoid Hemorrhage ▶ ⬜ within ⬜ hours of sx onset is the initial preferred test for SAH diagnosis – - - - followed by secondary test ⬜ if initial test is negative. For secondary test, ⬜ confirms diagnosis of SAH

Answer 104

[Noncontrast Head CT^{within 2-6h sx}] ; [LP confirmatory^{[ > 6h sx]} ⼀*to document [+/- Xanthochromia] (if CT negative)*] ; **XANTHOCHROMIA** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Xanthochromia= yellow tinted CSF due to hgb degradation products*

Question 105

Clinical Presentation for **Diabetic Ophthalmoplegia** (3) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Etx?

Answer 105

DM --\> [Oculomotor CN3 **CENTRAL** ischemia] 1. *Ipsilateral* Down & Out Eye 2. Ptosis (from Levator Palpebrae paralysis) 3. **NORMAL PERRL** (since Parasympathetic fibers are spared)

Question 106

# transverse myelitis acute myelopathy dx? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx? | *SURE*

Answer 106

dx: ^GadiliniumMRI _{_________________} tx: [(CTS^HD)]^3d ⼀*give for confirmed TMAM via MRI and if high suspicion for compressive CA myelopathy* * SURE sx*

Question 107

# Patient presents with Paralysis what's your Workup? (4)

Answer 107

Question 108

Clinical presentation of [transverse myelitis acute myelopathy] (4)

Answer 108

*SURE* 1. **S**ensory level (demarcated sensory loss up to specific point) 2. **U**rinary retention 3. [**R**apid developing LE weakness *s/p URI/trauma/CA*] 4. **E**xam [hypOreflexia and flaccidity] ➜ [hyperreflexia and spasticity] *dx = MRI_Gad*

Question 109

clinical presentation of [Complex Regional Pain Syndrome] (6)

Answer 109

1. patient S/P RECENT JOINT INJURY 2. now p/w joint **POOP** 3. joint **burning** 4. joint **edema** 5. joint **skin ∆** 6. joint **⬇︎ROM** ## Footnote *etx: INC sensitivity of sympathetic nerves*

Question 110

sx of Meningoencephalitis (7)

Answer 110

"*MeningoEncephalitis* **N**eeds **FAVORS**" **N**uchal rigidity = *Meningo-* **FAVORS** = -*encephalitis* \_\_\_\_\_\_\_\_\_\_\_\_\_\_ **FAVORS**: [**F**ocal neuro ∆ ^{*(aphasia, hemipLegia, hemiparesis)*}] , ⭐**A**MS⭐, **V**omiting, **O**uch HA, **R**eally hot fever, **S**eizure

Question 111

*Viral* Etiologies of Meningoencephalitis include (⬜3) with treatment (⬜2)

Answer 111

1. [Herpesvirus^*(HSV)*] 2. [Arbovirus^{*(West Nile Virus)*}] 3. [Enterovirus^{*(Coxsackie Virus)*}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ -Acyclovir for HSV -Supportive Care ## Footnote 📄"*MeningoEncephalitis* **N**eeds **FAVORS**"

Question 112

*PML Clinically Presents like Multiple Sclerosis* Describe **PML-P**rogressive **M**ultifocal **L**eukoencephalopathy (3)

Answer 112

* Opportunistic infection by [John Cunningham Polyoma Virus]----\> [PML **multiple white** matter lesions] * demonstrated as (***Hyperintense Flair on radiology***) * --\> Death vs. Severe Neuro injury ## Footnote ⚡ *PML is also a RARE side effect of some drugs -- in [JCP virus⊕] pts*

Question 113

*PML (**P**rogressive **M**ultifocal **L**eukoencephalopathy) Clinically Presents like Multiple Sclerosis* How is **PML** related to the drug, Natalizumab?

Answer 113

PML is also a potential **Rare Side Effect** of Natalizumab (MS drug) in pts who are [ JCP Virus⊕] ## Footnote *Usual Demographic: HIV pts (reversal of immunosuppresion stops JC Polyoma virus progression)*

Question 114

Concussion is defined as [⬜ -3]

Answer 114

{any [neuro❌^{(brief Confusion, Amnesia +/- LOC)}] that occurs i\ [mild TBI **without intracranial structural injury]**} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *note: it is nml for concussion sx to wax/wane as pt returns to activity*

Question 115

# Concussion = [neuro disturbance io\mild TBI with NO structural damage] Concussion Management? (2)

Answer 115

[REST ≥24H] ➜ [gradual return to activity with progression titrated to tolerance] *note: it is nml for concussion sx to wax/wane as pt returns to activity*

Question 116

Congenital Torticollis etx

Answer 116

**Malpositioning of Head in Utero vs During birth** --\> constant contraction of SCM--\>Lateral Neck swelling ## Footnote *Torticollis also possible in Adults*

Question 117

CP for Chemotherapy Peripheral Neuropathy - 3

Answer 117

1. {***Symmetrical* STOCKING GLOVE^{*(onset fingers/toes-spreads proximally)*} ** ➜ 2. [Loss of SenTor ^{[(S:pain/temp)/(M:weakness)]}:} 3. [_*early*Loss of ankle jerk reflex] ## Footnote *Drug Culprits: Cisplatin / Paclitaxel / Vincristine* *🔎SenTor = Sensory & MoTor*

Question 118

CP of Cerebellar Damage - 7

Answer 118

Cere is def on **GRINDRR** **G**ait Ataxia ^{{[vermis → truncal ataxia] / [hemisphere → limb ataxia IPSILATERAL]}} **R**apid alternating mvmnt impairment **I**ntention tremor/Dysmetria IPSILATERAL (hemisphere) **N**ystagmus IPSILATERAL (medial AND Lateral Vermis) **D**ysarthria (Lateral Vermis only) **R**ebound phenomenon (pt hits themself in face if flexing bicep and examiner releases arm-*image*) **R**eflex Pendular (knee swings \>4x after Deep tendon reflex is elicited) *Vermis is midline*

Question 119

Alcoholic cerebellar degeneration causes damage to the ⬜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How can you differentiate Alcoholic cerebellar damage from other causes of cerebellar damage?

Answer 119

[Purkinje cells of cerebellar vermis ^{(→ truncal ataxia & dysarthria)}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Alcoholic cerebellar damage **LEAVES LIMB COORDINATION ^{(cerebellar *hemisphere*)} INTACT** (no intention tremor) | *Cere is def on **GRINDRR*** ## Footnote *cerebellum:* *-vermis^(central)❌ ➜ [truncal ataxia + dysarthria]* *-hemisphere^(Lateral)❌ ➜ {[Limb ataxia IPL(intention tremor/loses balance toward lesion)]*

Question 120

cp of [Medial Medullary syndrome] -(3)

Answer 120

1. [ hypoglossal CN12 nc❌ →IPL tongue weak ^{*deviates toward lesion ("you lick your wounds")*}] 2. [medial lemniscus❌ → CTL _FaceBodynumb^{(2TVP loss)} ] 3. [Lateral CST^{*Pyramidal Tract*}❌ → CTL _bodyweak^{(hemiparesis)}] ## Footnote [(AsA❌) +(VA❌)] → [medial medullary syndrome]

Question 121

cp of [Lateral Medullary syndrome of Wallenberg] -(6)

Answer 121

**VSINSY** **V**estibular = [VDNV]_sx [**S**tG *Spinal triGeminal*] = [IPL face pain/temp loss] **I**nferior cerebellar Peduncle = ataxia **N**ucleus ambiguus = {[dysgag ^{*(gag reflex⬇︎)*}] , dysphonia, dysphagia} [**S**TT *SpinoThalamic Tract*] = [CTL BODY pain/temp loss] **Y**sYmpathethetic descending fibers = [IPL Horners] ## Footnote VDNV = Vertigo/Diplopia/Nausea/Vomiting

Question 122

Brachial Plexus damage of [Upper Trunk {(C5)(C6)} n] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ clinical presentation?

Answer 122

[Erb Palsy Waiter's Tip]

Question 123

Brachial Plexus damage of [Upper Trunk {(C5)(C6)} n] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ cause

Answer 123

[Baby Delivery lateral neck pull]

Question 124

DDx for Clostridium Botulinum - 4

Answer 124

*Also consider...* 1. Myasthenia Gravis 2. Atypical Guillain Barre 3. Tick Paralysis 4. Brain Stem infarct *Adult tx: Equine Heptavalent Antitoxin (passive immunity)*

Question 125

*DDx of Neuromuscular Weakness has 5 origins* Describe **Upper Motor Neuron** causes of Neuromuscular weakness - 4

Answer 125

1. Vasculitis 2. Leukodystrophy 3. Mass 4. VitB12 deficiency

Question 126

*DDx of Neuromuscular Weakness has 5 origins* Describe **Anterior Horn Cell** causes of Neuromuscular weakness - 4

Answer 126

Question 127

Deficiency of what INC risk for Restless Leg syndrome? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *unpleasant LE sensation at night or during rest, relieved by moving* ​

Answer 127

IRON ## Footnote *(dx = FerriTin ≤75 )* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *other RF: Pregnancy/Uremia/DM/MS/[anti:MDD|Psychotics|Emetics]* *1st line tx = Gabapentin*

Question 128

Define Coma (6)

Answer 128

1. **Unarousable** sleep state + 2. **Unresponsive** sleep state 3. [brainstem reflexes] intact 4. [Spinal reflexes] intact 5. 2/2 diffuse cortex depression 6. can progress to vegetation / full recovery / brain death

Question 129

*DELIRIUM IS A MEDICAL EMERGENCY* Based on consciousness, how do you differentiate Delirium from Dementia ?

Answer 129

Delirium = CONSCIOUSNESS RAPIDLY FLUCTUATES \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ​Dementia = consciousness intact *note: return of Primitive reflexes is normal in Dementia*

Question 130

Describe Athetosis ; What disease is it seen in?

Answer 130

Slow, writhing mvmnts of hands & feet often occuring **with** Chorea (*Choreoathetosis*) ; Huntington's

Question 131

What are the **TRAUMATIC LUMBAR PUNCTURE** CSF lab ranges Glucose Protein WBC count RBC count

Answer 131

**GPW-R** **G** ⇪ **P** ⇪ **W** ⇪ **R**BC 6K \< *Traumatic LP (without xanthrochromia)* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *xanthochromia = discoloration of CSF 2/2 hgb breakdown that appears within 2-12h of SAH*

Question 132

What are the **Normal** CSF lab ranges Glucose Protein WBC count RBC count

Answer 132

**GPW****-R** **G**lucose: 40-70 **P**rotein: \<40 **W**BC: 0-5 **R**BC: \< 6K \< *Traumatic LP*

Question 133

Describe CSF analysis for **TB** meningitis Glucose Protein WBC

Answer 133

[**G** low \< 45] [**P** High 100-500] [**W** High 100-500]

Question 134

Describe CSF analysis for **Cryptococcal Neoformans** meningitis Glucose Protein WBC

Answer 134

[**G** low\< 40] [**P** Up \>40] [**W** Up \<50 (Lymphocytes)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ + CSF opening pressure \> 250 || Occurs in advanced HIV || Dx = India Ink Prep or Antigen test

Question 135

Describe CSF analysis for **Bacterial** meningitis Glucose Protein WBC

Answer 135

[**G** low\< 40] [**P** High \>250\*] [**W** UBER HIGH \>1,000] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *\*G might be higher & P might be lower if pt s/p abx pretx*

Question 136

Describe CSF analysis for **Guillain Barre**: Glucose Protein WBC count

Answer 136

[**P** UBER HIGH 45-1,000] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ normal **G** / **W**

Question 137

Describe CSF analysis for **Viral** meningitis Glucose Protein WBC count

Answer 137

[**P** HIGH\<150] [**W** HIGH 10-500 (Lymphocytes)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ normal **G** *Note: HSV = ⬆︎Protein and ⬆︎ RBC also from temporal lobe destruction*

Question 138

Dementia with Lewy Bodies (DLB) CP - 3

Answer 138

DLB at the **DMV** 1. **D**ementia/confusion periodically*(tx = Rivastigmine)* 2. **M**ichaelJFox Parkinsonism (PARK + hamp) tht **does NOT respond to dopaminergic tx** 3. **V**isual Hallucinations^{*(tx = SGA)*} ## Footnote ✏️*Lewy Body= [**LABS** (**L**ewy **α**-synuclein **B**odie**S**)] that are Eosinophilic intracytoplasmic accumulations*

Question 139

Pts with [Dementia with Lewy Bodies (DLB)] are extremely sensitive to _____ and it may cause what side effects?-3

Answer 139

DLB at the **DMV** ## Footnote ANTIPSYCHOTICS \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Dementia INC - MichaelJFox PARK INC - autonomic dysfunction

Question 140

Describe En-Bloc Gait \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What type of ataxia is this?

Answer 140

Minimal mvmnt of head while walking w/staggering gait \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Vestibular Ataxia ## Footnote *Will be accompanied w/Vertigo & Nystagmus*

Question 141

[Essential *(Physiologic)* Tremors] clinical features (7)

Answer 141

1.benign [**12-14 Hz** **high freq**] action tremor 2.occurs posturally (i.e. when holdings arms out); 3.worst with action 4.activated w/emotion 5.activated w/caffeine 6.[BUE/voice/head] 7. Auto DOM

Question 142

Describe the "Clasp Knife" phenomenon \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What disease is this related to?

Answer 142

**Rapid SPASTIC** **RESISTANCE** to passive mvmnt of limb \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ UMN (Weak ME**S**H) Pyramidal Tract dz * Pyramidal Tract = Corticospinal and Corticobulbar* * Pronator Drift also indicates Pyramidal Tract Dz*

Question 143

Px for Migraine HA - 4

Answer 143

**VTAP** the migraine BEFORE it comes, and **SEND** it on its way when it does! 1. **V**erapamil 2. **Topiramate** 3. **A**mitryptyline 4. **P**ropranolol

Question 144

Tx for Acute Migraine HA - 4

Answer 144

**VTAP** the migraine BEFORE it comes, and **SEND** it on its way when it does! 1. **S**umatriptan 2. **E**rgots (Bromocriptine) 3. **N**SAIDs 4. **D**₂ R Blockers (Metaclopramide/Prochlorperazine)

Question 145

Describe the **Character** for the HA: Migraine Cluster (3) Tension (2)

Answer 145

Migraine = **POUND** = [**P**ounding/**O**ne Day-3 day Duration/**U**nilateral/**N**ausea/**D**isabling] + photo vs. phonophobia & [flashing dots aura] Cluster = [Excruciating, sharp & steady] *(100% O2 tx)* Tension = Dull & tight

Question 146

Describe the **Duration** for the HA: Migraine Cluster Tension

Answer 146

Migraine = **POUND** = [**P**ounding/**O**ne-3 Day Duration /**U**nilateral/**N**ausea/**D**isabling] + photo vs. phonophobia & [flashing dots aura] Cluster = 15 - 90 MINUTES *(100% O2 tx)* Tension = 30 min to 7 DAYS!!!! (*Tammy's Entire Work Week*)

Question 147

Describe *tube* presentation of a traumatic CSF lumbar puncture

Answer 147

Elevated RBC in 1st tube, followed by declining numbers of RBC with each successive tube

Question 148

Frontotemporal Pick's Dementia Sx -2

Answer 148

Prounouced Frontal & Temporal lobe atrophy --\> [**Socially inappropriate** Behavior] + aphasia *OCCURS MORE IN FEMALES!!!*

Question 149

Demographic of Frontotemporal Pick's Dementia? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Mode Of Inheritance

Answer 149

50-60 yo Females \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ AUTO DOM | *Alzheimers \>60 yo* ## Footnote *Socially inappropriate behavior + aphasia*

Question 150

Describe Neuroleptic Malignant Syndrome - 5

Answer 150

RARE SE of Any Dopamine Blocker (Antipsychotics vs. GI meds) that --\> **FEVER** - [**F**ever \> 40C] - **E**ncephalopathy (Confusion) - **V**itals unstable (INC HR / RR / BP from autonomic dysfunction) - **E**nzymes ⬆︎ (CPK) - [**R**igitidy lead pipe] (Tremor)

Question 151

Diagnostic Criteria for Febrile Seizure - 5

Answer 151

1. 3 mo - 6 yo 2. Temp \> 38C 3. No hx of **A**febrile seizures 4. No CNS infection 5. No acute metabolic cause of seizure (*pt would have dehydration*) *Tx = Reassurance only!*

Question 152

Diagnostic criteria for Nightmare Disorder - 4

Answer 152

1. **M**akes recurrent awakenings 2. re**M**embers their nightmare 3. **M**anageable (CAN be consoled) upon awakening 4. **M**ind is alert upon awakening ## Footnote -*Night**M**ares occur during RE**M*** -*Night**M**ares are developmentally normal for kids*

Question 153

Diaphragmatic paralysis can be easily confused with ⬜ because they both cause ⬜ . What's the most common cause of bilateral diaphragmatic paralysis?

Answer 153

CHF; orthopnea \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ALS

Question 154

# Subarachnoid Hemorrhage Dx (5)

Answer 154

1st: [**NONCONTRAST HEAD CT** *(ideally within 6-12h of sx)*] 1b. CT⊕ ➜ Cerebral angiography to identify bleeding source \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2nd: CT⊝ ➜ REQUIRES [Lumbar Puncture confirmation *(ideally \>6h from sx)*]\*\* 2b. LP⊕ =[**xanthochromia = CONFIRMS DIAGNOSIS**] but other findings= [⇪ opening pressure]/[⇪ RBC in all 4 CSF tubes] 2c. LP⊝ = r/o SAH

Question 155

# Subarachnoid Hemorrhage Why do negative [Noncontrast Head CT] have to be followed with a negative ⬜ before SAH can be ruled out conclusively \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Ideally when should this subsequent test be done and why?

Answer 155

[Lumbar Puncture confirmatory *(ideally \>6h from sx)*]\*\* \*\*(*some bleeds are outside ideal 6-12h CT window and/or are too small for CT)* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ perform LP \> 6h from sx onset since.. *[CSF blood can take up to 6h to degrade and form Xanthochromia = LP ideal\>6h from sx]*

Question 156

Dx for Creutzfeldt Jakob disease - 6

Answer 156

1. [PRNP prion protein] genetic testing 2. EEG Biphasic vs Triphasic **sharp wave complexes** 3. Postmortem brain biopsy 4. ⬆︎CSF 14-3-3 proteins 5. MRI Cortical Ribbons 6. MRI basal ganglia hyperintensity

Question 157

Dx for VitB12 deficiency - 3

Answer 157

1. [⬆︎ **Methylmalonic Acid levels**] 2. CBC showing Macrocytic Anemia 3. Serum Vitamin levels

Question 158

Which drugs are used to treat Multiple Sclerosis Exacerbation?-2

Answer 158

**1st: High Dose** **IV** **Methylprednisolone** 2nd: (Refractory): Plasmapheresis

Question 159

Which drugs are used to treat Multiple Sclerosis maintenance?-3

Answer 159

Maintenance: **1. [β-interferon]** **2. [Glatiramer acetate]** 3.Natalizumab

Question 160

Dx for **Multiple Sclerosis** - 5 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Which diagnostic is the *preferred* test for MS? Which diagnostic is the *backup* test (used in equivocal cases) for MS?

Answer 160

1. T2 MRI: [**Periventricular** white matter demyelinating plaques with lipid laden macrophages] *= PREFERRED TEST* 2. [CSF Oligoclonal IgG bands = *backup test*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3. T1 MRI Black holes 4. Clinical (SLUM SiiiN) 5. Visual conduction velocity test *Sx will be disseminated in time and space*

Question 161

What do [_{MS**⊕**}[Pregnant pts] and [_{{MS**⊕ **}}[NONPregnant pts] have in common? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What additional risk does having MS pose for pregnant patients? (2) *MS: Multiple Sclerosis*

Answer 161

SAME TREATMENT for MS Exacerbation ⼀*[Methylprednisolone IV High Dose] is used for MS Exacerbation in Pregnant patients and Non-Pregnant MS patients* *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_* 1. [MS⊕ Pregnants] have INC risk for [assisted delivery (cesarean/vacuum/forceps)] 2. [MS⊕ Pregnants] have INC risk of their infant developing MS as well

Question 162

[Pregnant MS⊕] typically have {[**⬜** lower | HIGHER] *MS activity*} during pregnancy and {[**⬜** lower | HIGHER] *MS activity*} during postpartum ## Footnote *MS: Multiple Sclerosis*

Answer 162

lower; HIGHER

Question 163

**Normal Pressure Hydrocephalus** Sx (3) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Which is earliest to present?

Answer 163

⬇︎CSF absorption --\> **Wobbly**, Wet & Wacky! ## Footnote [ **Wobbly** magnetic frontal gait apraxia] = EARLIEST CLINICAL FINDING] Wet (Urinary Incontinence from compressing periventricular cortico-cortical white fibers traveling to sacral micturition center) Wacky (memory loss)

Question 164

**Normal Pressure Hydrocephalus** characteristics - 4

Answer 164

**Wobbly**, Wet & Wacky! 1. Idiopathic 2. Episodic _{*⇪ in CSF pressure*} 3. Normal _{*Pressure Hydrocephalus that Does not ⬆︎ SubArachnoid space volume*} 4. Elderly

Question 165

What's the only imaging modality for diagnosing Alzheimer's Disease? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Which areas does it reveal this in? - 3

Answer 165

**CLAV --\> HANDU** PET scan revealing [**PIB**-Pittsburgh Compound B] binding to β-amyloid and being taken up in 1. PreFrontal 2. Temporal 3. Parietal ## Footnote **NaTPO** = [**CLAV** ➜ **HANDU**]_sx

Question 166

**Early** Findings of Alzheimer's - 4

Answer 166

**CLAV --\> HANDU** **C**ognitive PROGRESSIVE ⬇︎ **L**anguage ⬇︎ **A**nterograde immediate memory loss **V**isualspatial disorientation (lost in ur own neighborhood) *Onsets after 60 yo* ## Footnote **NaTPO** = [**CLAV** ➜ **HANDU**]_sx

Question 167

Clinical Criteria for diagnosing Alzheimer's -5

Answer 167

*Alzheimer pts wear Alzheimer [**GOWNS**]* 1. **G**OE 2 Cognitive deficits 2. **O**nsets after 60 yo 3. **W**orsening Memory 4. **N**o other Systemic/Neuro DO to cause cognitive defects 5. [**S**ound (Consciousness intact)] ## Footnote {**NaTPO** = [**CLAV** ➜ **HANDU**]_sx per [**GOWNS**]}

Question 168

**Late** Findings of Alzheimer's - 5

Answer 168

**CLAV --\> HANDU** **H**allucinations **A**gnosia (lack of insight regarding deficits) **N**euro ∆ (seizure/myoclonus) **D**yspraxia (difficulty w previously Learned Motor task) **U**rinary Incontinence *Onsets after 60 yo* ## Footnote **NaTPO** = [**CLAV** ➜ **HANDU**]_sx

Question 169

Alzheimer's tx - 7 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Which medication should be used last?

Answer 169

CLAV --\> HANDU **DR TAG MR** *Alzheimer* 1. Donepezil - *AChnesterase inhibitor* 2. Tacrine - *AChnesterase inhibitor* 3. Rivastigmine - *AChnesterase inhibitor* 4. Galantamine - *AChnesterase inhibitor* 5. Memantine - *NMDA R Blocker: **USE LAST*** 6. Respite Care for Caregivers (ex: Adult day program) 7. Atypical antipsychotics - Olanzapine vs Risperidone (for acute psycosis) ## Footnote **NaTPO** = [**CLAV** ➜ **HANDU**]_sx

Question 170

[*early* Neurosyphilis] typically presents during the ⬜ syphilis stage. How does it present? -3

Answer 170

2nd; [**M**eningo-Vascular^{*(Meningitis vs CVA)*}] | _POST**U**veitis^{*MOST COMMON Sx❗️*} | **T**innitus ## Footnote *prodrome ➜* **MUT** ➜ **DAT**

Question 171

[*LATE* Neurosyphilis] presents during the ⬜ syphilis stage. How does it present? -3

Answer 171

3rd ; **D**ementia |**A**rgyll Robertson Pupils | [**T**DPCD^{(⊕Romberg, ⊝DTR)}] | *TDPCD: Tabes Dorsalis Posterior Column Disease* ## Footnote *prodrome ➜* **MUT** ➜ **DAT**

Question 172

Explain [Relative Afferent Pupillary Defect]

Answer 172

**partial** optic n vs retinal lesion --\> pupils BOTH constrict when light is shown in normal eye BUT when light is *swung* to **lesioned** eye BOTH eyes Dilates since lesioned eye has ⬇︎ afferent input

Question 173

Recall the Pupillary pathway beginning with light entering the eye (5)

Answer 173

## Footnote 1. Light enters retina 1 eye and that [Optic CN2] **uL** sends signal to [midbrain-SUP colliculus -pretectal nuclei] 2. "cross" decussates to... 3. → activate **BOTH** [Edinger Westphal nuclei]! BUT... 4. → **each** EWN sends its own **IPL** [efferent preganglionic parasympathetic outflow] to its **IPL** ciliary ganglion via [Oculomotor CN3] 5. that IPL ciliary ganglion uses short ciliary nerves to activate the pupillary sphincter muscle = *Miosis*

Question 174

*Edinger Westphal nucleus provides* ⬜ *to the* ⬜ *ganglion* CP of a pt with R damaged EW nucleus

Answer 174

PreGanglionic [ParaSympathetic efferent OUTflow] to ciliary ganglion **R** (Ipsilateral) FIXED DILATED pupil not reactive to light

Question 175

*Essential Tremor is a [ (BUE/Head/Voice) Action Tremor]* What are the 3 clinical exacerbants of Essential Tremor?

Answer 175

1. Hyperthyroid 2. Lithium 3. Valproic Acid

Question 176

Etx of Parkinsons Disease

Answer 176

[**LABS** (**L**ewy **α****-**synuclein**B**odie**S**)] accumulation in [substantia nigra pars compacta] --\>degeneration --\> ⬇︎Dopamine release and ⬇︎ stimulation of Striatum which --\> allows [Globus pallidus internal] to continuously inhibit [VA/VL Thalamus from stimulating motor cortex]

Question 177

# The Basal Ganglia consist of what 5 things? Recall the ____ Basal Ganglia pathway for movement starting with Cortex a. DIRECT (5) b. InDirect (5)

Answer 177

"**C**an **P**retty **G**ays **S**ound **S**mart?" -**C**audate -**P**utamen -**G**lobus Palidus -**S**ubthalamic nucleus -**S**ubstantia Nigra

Question 178

Explain how a Physician should approach the discussion of [Brain Death Diagnosis] and [Organ Donation]

Answer 178

1st: [Brain Death Dx] = Physician \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Later: [Organ Donation] = [OPO (Organ Procurement Organization)]**

Question 179

Explain how collateral blood flow to a "complete" circle of willis help prevent ischemic CVA/TIA?

Answer 179

**[External Carotid: Ophthalmic A]** can retrogradedly perfuse [Circle of Willis] when Internal Carotid is blocked

Question 180

Fall has 3 main etiologies ( ⬜ , ⬜ or ⬜ ) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What are the 10 crucial points of medical history to work up Fall?

Answer 180

Mechanical 🆚 Syncope 🆚 Seizure \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **HANDSTAMPED** **H**x Syncope? **A**ssociated symptoms **N**umber of episodes **D**uration **S**etting **T**ime until recovery **A**cknowledged/Witnessed? **M**edical hx **P**rodrome? **E**pilepsy hx **D**rug use? | "All *Fall* pts should be **HANDSTAMPED** by a MD"

Question 181

Febrile seizures present day ⬜ of illness, are a common complication of high fever a/w ⬜, and onset between ⬜ y/o \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What is the prognosis for children with febrile seizure (3)

Answer 181

1 ; viral infection ; [3 months - 6 yo] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ -typically [benign course (does not require *abortive* tx)] - but 30% will have **≥1 recurrence** - and 30% will also have INC risk for **Epilepsy**

Question 182

*Usually Simple Partial Seizures originate in a **single** hemisphere* **Simple** Partial Seizures may present as what 3 things?

Answer 182

1. Motor ∆ (head turning) - no LOC 2. Sensory ∆ (paresthesias)- no LOC 3. Autonomic ∆ (sweating)- no LOC

Question 183

For cp, what are 2 ways to differentiate [^NRSADSleepTerror] from [RSRBD]? ## Footnote *RSRBD = REM Sleep Related Behavioral Disorder*

Answer 183

# Output "I love Ruby" [^NRSADSleep Terror] = SUDDEN, INCONSOLABLE **N**on**R**EM **S**leep **A**rousal_{(**D**isorder)*}] \_\_\_\_\_\_\_\_*vs*\_\_\_\_\_\_\_\_\_ [**R**SRBD= **R**EM = *"**R**eally "acting out dreams"*] ## Footnote *NRSAD = Non-REM Sleep Arousal Disorder* *RSRBD = REM Sleep Related Behavioral Disorder*

Question 184

The 3 types of dream disorders are ⬜, NRSAD and ⬜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Describe characteristics of NRSAD (5) ## Footnote *NRSAD = Non-REM Sleep Arousal Disorder*

Answer 184

RSRBD | NRSAD | NightMareDisorder \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ NRSAD 1. [recurrent **incomplete** awakenings from NonREM sleep] 2. ... _{complicated by} DREAM AMNESIA ...that presents as either 3. [^NRSAD*SleepWalking*_{(blank face/unresponsive to awakening)}] or 4. [^NRSAD*SleepTerrors*_{(abrupt autonomic arousal/unresponsive to consoling)} ] 5. [self limited to ≤2y after onset ^{(give benzo qhs if severe)}] | Sleepwalking and SleepTerrors are both qualifiers (types) of NRSAD ## Footnote *NRSAD = Non-REM Sleep Arousal Disorder* *RSRBD = REM Sleep Related Behavioral Disorder*

Question 185

# NRSAD dx has 2 types = must be qualified as either ⬜ or ⬜ What is the clinical progression of NRSAD (3) ## Footnote *NRSAD = Non-REM Sleep Arousal Disorder*

Answer 185

[SleepWalking_NRSAD] ; [SleepTerror_NRSAD] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ -onset 4-12 yo -➜ **RESOLVES SPONTANEOUSLY ≤ 2 YEARS FROM ONSET** -(if SEVERE = low-dose benzo qhs)

Question 186

# It is common for AIDS pts with Cryptococcal n. meningitis to develop ⇪ ICP due to ⬜ ➜ ⬜ sx For pts with recurrent sx of ⇪ ICP from [Cryptococcal n meningitis], how is this treated?

Answer 186

[high CSF fungal burden clogging arachnoid villi] ➜ ⬇︎ CSF outflow ➜ ⇪ ICP ; [**HEAD**_sx ] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [serial LP *until sx resolve*] ## Footnote ✏️ICP_sx = **HEAD** = [**H**eadache \ [**E**ye papilledema/vision change] \ **A**MS \ [**D**ont eat_NV]

Question 187

Friedreich Ataxia involves Degeneration of the ⬜ , ⬜ and ⬜ spinal columns.

Answer 187

Fri**E**dreich Ataxia involves Degeneration of the [**Dorsal**, **Lateral CST** and **SpinoCerebellar** spinal columns] ## Footnote * Fri**E**drecih is **Frat**astic! He's your fav. **twisted** **frat** brother, always **studdering** and **falling**, but has a **sweet**, **big heart*** * etx = [auto recessive Chromo 9 GAA repeat] → impaired [frataxin (iron binding protein)] which → widespread mitochondrial impairment → sx* _{*SuBACute Combined Degeneration affects SAME 3 columns*}

Question 188

Functions of the Obturator n.-2

Answer 188

1. MOTOR Leg ADDuction 2. SENSORY medial thigh \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *usually from pelvic trauma or surgery*

Question 189

**GCS**(**G**lasgow **C**oma **S**cale) predicts Prognosis of what 4 things? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ The 3 components are **EVM** (**E**yes/**V**erbal/**M**otor) Describe the [**V**erbal Response] component (5)

Answer 189

* GCS prognosis'* *Brain **CHIT*** 1. **C**oma 2. **H**emorrhage (SAH) 3. **I**nfection (bacterial meningitis) 4. **T**rauma \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **EVM** = **E**yes / **V**erbal / **M**otor

Question 190

**GCS**(**G**lasgow **C**oma **S**cale) predicts Prognosis of what 4 things? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ The 3 components are **EVM** (**E**yes/**V**erbal/**M**otor) Describe the [**E**yes] component (4)

Answer 190

* GCS prognosis'* *Brain **CHIT*** 1. **C**oma 2. **H**emorrhage (SAH) 3. **I**nfection (bacterial meningitis) 4. **T**rauma \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **EVM** = **E**yes / **V**erbal / **M**otor

Question 191

**GCS**(**G**lasgow **C**oma **S**cale) predicts Prognosis of what 4 things? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ The 3 components are **EVM** (**E**yes/**V**erbal/**M**otor) Describe the [**M**otor] component (6)

Answer 191

* GCS prognosis'* *Brain **CHIT*** 1. **C**oma 2. **H**emorrhage (SAH) 3. **I**nfection (bacterial meningitis) 4. **T**rauma \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **EVM** = **E**yes / **V**erbal / **M**otor

Question 192

What's the marker for [Glioblastoma astrocytoma]?

Answer 192

**GFAP**

Question 193

HemiNeglect Syndrome

Answer 193

Stroke in **[*NonDominant* Parietal cortex])** --\> Neglect of anything on the CTL side ## Footnote *Most R handed have [L hemisphere Dominance] = HemiNeglect Syndrome will occur if [NonDom (R) parietal ❌]➜ [pt neglects entire OPPOSITE (L) side]* *It's opposite for L handed*

Question 194

What Dx should you suspect in a *Young HIV^⊕ pt witih Dementia*? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Pgn?

Answer 194

[**AIDS Dementia** HIV Encephalopathy]= slow cognitive & behavioral decline with POOR PGN . *Note: This presentation is Similar to [SuBACute Combined Degeneration]* | *HIV _Leuko_Encephalopathy is same thing but with White matter instead*

Question 195

Homocystinuria tx -2?

Answer 195

[Pyridoxine B6] + AntiCoag ## Footnote 🔬*MOA = auto recessive [Cystathionine synthase] deficiency --\> Thromboembolism--\> Stroke*

Question 196

Homocystinuria dx-2

Answer 196

[Homocysteine⬆︎] and [Methionine⬆︎] ## Footnote *etx = auto recessive [Cystathionine synthase] deficiency --\> Thromboembolism--\> Stroke*

Question 197

Homocystinuria Clinical presentation-5

Answer 197

**{1. Stroke -h}** **{2. Retarded -h}** **{3. Fair_{*(Fair Hair /Fair Eyes)*} -h}** \_\_\_\_\_\_\_\_*vs*\_\_\_\_\_\_\_\_\_ 4.[Marfanoid habitus (elongated limbs, arachnodactyly, scoliosis)] - MH 5.Ectopia Lentis - MH | *auto recv [Cystathionine synthase] deficiency --\> Clotting--\> Stroke* ## Footnote *MH = MARFAN and HOMOCYSTINURIA* *h = homocystinuria only*

Question 198

How are HTN and DM mngmnt related to Acute CVA/TIA - 2

Answer 198

BP \> 185/110 in setting of stroke can --\> ICH - so Use Labetalol & Hyperglycemia augments brain injuries (*so ONLY use **Non**Dextrose IVF*)

Question 199

# [transverse myelitis] and [Guillain Barre Syndrome] both p/w LE paralysis How do they differ in \_\_\_\_\_\_ a. Motor b. Sensory

Answer 199

Question 200

# [transverse myelitis] and [Guillain Barre Syndrome] both p/w LE paralysis How do they differ in \_\_\_\_\_\_ a. autonomics b. Cranial Nerves c. EMG/nerve conduction velocity

Answer 200

Question 201

# [transverse myelitis] and [Guillain Barre Syndrome] both p/w LE paralysis How do they differ in \_\_\_\_\_\_ a. MRI b. CSF

Answer 201

Question 202

How is Carotid Artery Dissection associated with Horner Syndrome?

Answer 202

Carotid A Dissection --\> **Partial** Horner (Ptosis + Miosis only) 2/2 postganglionic sympathetic fiber damage

Question 203

Name the most important things to do when administering tPA to a stroke patient? (3)

Answer 203

1.STRICT IV BP CONTROL{[< 180/110 *before tPA*] [< 180/105 *after tPA* ] ## Footnote (avoid HTN to ⬇︎risk of hemorrhagic conversion but avoid hypOtension to maintain perfusion to the ischemic penumbra) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3.wait ≥24h before ANY BLOOD THINNER

Question 204

What test is used to determine definitive tx for Normal Pressure Hydrocephalus? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Describe the test​

Answer 204

• MFLT (Miller Fisher Lumbar Tap) test = predicts if VPS placement will be helpful (and worth surgical risk) for definitive treatment in a NPH patient • (GC_baseline ➜ [CSF MFLT] ➜ GC_IMPROVED ➜ VPS)​ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *VPS = VentriculoPeritoneal Shunt // (G/C=Gait/Cognition )* ​

Question 205

Why is a [rapid bedside dysphagia screening] required for Acute Stroke patients?

Answer 205

Stroke patients (especially if +dysarthria) have ⇪ risk for oropharyngeal dysphagia and aspiration = CAN NOT RECEIVE ANY MEDS BY MOUTH (like ASA) until [rapid bedside dysphagia screening performed]

Question 206

How do you manage Ischemic Stroke? (4)

Answer 206

Question 207

How do you treat Febrile Seizure? -3

Answer 207

1. 🟩**REASSURANCE** 2. 🟩APAP for fever 3.*🟨[abortive tx if ≥5 min]*

Question 208

How do you treat *Refractory* Serotonin Syndrome

Answer 208

Cyproheptadine (antihistamine with anti-serotonergic properties)

Question 209

*prior to diagnosing Dementia, reversible causes of Cognitive impairment must be r/o* How do you workup Cognitive impairment ? (10)

Answer 209

Question 210

how does hyperventilation reduce intracranial pressure?

Answer 210

*(reduce to 25-30 mmHg)* hyperventilation ➜ DEC pCO2 ➜ cerebral arteriole vaso**constriction** ➜ DEC ICP

Question 211

How does Papilledema present in pts with Pseudotumor Cerebrii Idiopathic Intracranial HTN?

Answer 211

transient vision loss when changing head positions that last a few seconds Can --\> Vision Loss!

Question 212

What role does Steroids play in [Intracerebral processes^{(tumor, infection, trauma)}] ?

Answer 212

*CTS* DEC **edema** /swelling (in intracerebral processes 2/2 to *C*A|*T*umor|*S*ickness_infxn) | *"**S**top **M**y **H**ead **S**welling ^(**C**ancer) !"*

Question 213

How is the [Oculocephalic Dolls eye Reflex] used to assess brainstem function?

Answer 213

Eyes should **remain stationary** **and fixed** as head is rotated = normal brain stem function ## Footnote "Dolls Eyes a NORMAL GUY" (Dolls Eyes = Brainstem intact)

Question 214

How is [Apolipoprotein E] related to Alzheimers (2)

Answer 214

✔︎ ApoE2^{*"brings you 2 safety"*} = actually DEC Alzheimer risk \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ✔︎ ApoE**4**^{*"is bad **4** you!"*} --\> impairs synthesis and clearance of AB-amyloid ---\> INC risk for **LATE** onset Alzheimers ## Footnote **NaTPO** = [**CLAV** ➜ **HANDU**]_sx

Question 215

How long does it take pts with Subdural hematoma to have sx? Why is this a problem for elderly?

Answer 215

1-2 days; Elderly may have insidious subdural bleeds for weeks after injury --\> Confusion/Somnolence/HA/FOCAL Neuro ∆ ## Footnote *Image: L **Chronic** Subdural Hematoma*

Question 216

DDx for patient p/w [1/2 facial paralysis^{*(with ⊝ forehead sparing)*}] ?

Answer 216

[**Lyme** serology 1st] ➜ [**P7BP**^{Bells palsy (dx of exclusion!)}] ## Footnote ⚠️{[⊕**S**paring^{*of forehead*} ] = [⊕**S**troke^{*in patient*} ]!}

Question 217

What causes [Lateral ventricle frontal horn] enlargement in Huntington's disease?

Answer 217

\*\***Gross Caudate atrophy**\*\* ## Footnote [AUTO DOM [Chromo 4 CAG repeats]] ---\> Degeneration of (**Caudate** nc. inside the ((**I**)ndirect Striatum w/ [**Gross Caudate atrophy**] ) --\> [⬇︎ GABA release] *"Hunting **4** food is way too aggressive & dancey"*

Question 218

Huntington's Dz Clinical Presentation (2)

Answer 218

* "Hunting 4​ food is way too **aggressive** & **dancey**"* 1st: **Aggressive** Dementia w/ strange behavior 2nd: **Dance**-like Choreoathetosis (dancing/writhing movements) * AUTO DOM = Affects BOTH sexes equally!!*

Question 219

Etx of Huntington's Disease

Answer 219

[AUTO DOM [Chromo 4 CAG repeats]] ---\> Degeneration of (**Caudate** nc. inside the ((**I**)ndirect Striatum w/ [Gross Caudate atrophy] ) --\> [**⬇︎ GABA release** /⬇︎ACh release / but ( ⇪ dopamine releasae) ] ## Footnote *"Hunting **4** food is way too aggressive & dancey"*

Question 220

Identify ; Which are Lenticulate and which are Striatum?

Answer 220

*"**G**ay **P**eople **C**ook!" = Basal Ganglia* ***G**ay **P**eople=Lenticulate // **P**eople **C**ook= Striatum* * e_g = **G**lobus Pallidus * e_s = **P**utamen * d = **C**audate

Question 221

In Neurology, evoked potentials are used to identify what?

Answer 221

silent CNS lesions

Question 222

The 3 types of dream disorders are ⬜, NRSAD and ⬜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Name the primary characteristics of [NRSAD: Sleep Terrors] ? (4)

Answer 222

RSRBD | NRSAD | NightMareDisorder \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Sleep terrors are : 1. NRSAD (NonREM) 2. accompanied with recurrent incomplete awakenings 3. can NOT be consoled upon wakening 4. **S**eems to forget the dream = Dream Amnesia/No Dream Recall ## Footnote *NRSAD = Non-REM Sleep Arousal Disorder*

Question 223

# *identify (12)*

Answer 223

Question 224

# *identify (21)*

Answer 224

Question 225

A: Identify Boxes (4) B: Clinical Presentation for lesion at A? B? C? D?

Answer 225

| A=[central scotoma 2/2 macular degeneration] ## Footnote 👓when image hits 1º visual cortex, it is *upside down* and *R-L reversed* #visual field defect.hemianopia.Meyer loop

Question 226

A: Identify Boxes (4) B: Clinical Presentation for lesion at E? F? G? H C: Explain how [H] is special (*** )?

Answer 226

C: [**H**] is actually {[**K**]-{CTL Homonymous Hemianopia*with macular sparing*} if [PCA occluded]

Question 227

# *identify (14)*

Answer 227

Question 228

# cp for conduction aphasia? (3) What areas of the brain are involved in **CONDUCTION** Aphasia? - 4

Answer 228

⛔[**VERY POOR** Repetition]^{(CAN NOT REPEAT phrases such as *"No ifs, ands or buts"*)} but ✔︎ intact speech fluency ✔︎ intact comprehension ## Footnote 1. Arcuate Fasciculus = MOST COMMON 2. Supramarginal Gyrus 3. Auditory Cortex 4. Large Posterior Perisylvian area

Question 229

What is Kluver-Bucy syndrome?

Answer 229

**[BL Amygdala❌ (associated with HSV1)]** → *hyper*disinhibited behavior^{*(hypersexual, hyperphagia, hyperorality)*}

Question 230

In patients with lesions of the *PPRF*, Eyes stare [⬜ _opposite | _toward] the *PPRF* lesion | *PPRF = Paramedian Pontine Reticular Formation*

Answer 230

opposite

Question 231

In patients with a {*Frontal Eye Field* lesion}, Eyes stare [⬜ _opposite | _toward] the {*Frontal Eye Field* lesion}

Answer 231

toward | *"eyes Front Toward me!"*

Question 232

# pt present s/p trauma to the **BL Hippocampus** lesions of **BL Hippocampus** → ⬜

Answer 232

anterograde amnesia ^{(inability to make **new** memories)}

Question 233

clinical features of Cerebral "Watershed Zones" (4)

Answer 233

✔︎ areas between [ACA_pz & MCA_pz] and ✔︎ areas between [MCA_pz & PCA_pz] ✔︎ susceptible to [irreversible brain damage io\ischemic hypoxia] ^{*(Cerebellum, Neocortex, Hippocampus - also)*} ✔︎ [WZ❌ → upper arm weakness and/or upper leg weakness] | [pz🔎perfusion zone]

Question 234

**MCA (Middle Cerebral Artery)** A: What 5 sites does MCA perfuse? (5) B: For each site, list Sx when compromised^{(*i.e. Stroke)*} (5)

Answer 234

Question 235

**AsA (ANT spinal Artery)** A: What all does it perfuse? (3) B: Sx if compromised^{(*i.e. Stroke)*} (3)

Answer 235

## Footnote [(AsA❌) +(VA❌)] → [medial medullary syndrome]

Question 236

# clinical features epidural hematoma (6)

Answer 236

1. fx of temporal bone 2. → rupture of [middle meningeal artery _{(from Maxillary artery)}] 3. → Lucid interval f/b [hyperdense biconvex/lentiform epidural hematoma w transtentorial herniation] + DO3P 4. [⛔ suture lines_Xing] 5. [ ✅ falx_Xing] 6. [✅ tentorium_Xing] ## Footnote *🔎DO3P = ["DOPe" Oculomotor CN3 Palsy]* *🔎Xing = Crossing*

Question 237

Why is the period after a SubArachnoid Hemorrhage important? (2)

Answer 237

[*3d s/p SAH*] can → 1. [cerebral vasospasm ^{(tx = Nimodipine)}] 2._***repeat***SAH

Question 238

3 most common locations for [Intraparenchymal HTN Hemorrhage]

Answer 238

1. basal ganglia 2. internal capsule_{(Charcot Bouchard ruptured aneurysm of lenticulostriate)} 3. lobar

Question 239

# Irreversible brain damage begins after ⬜ min of hypoxia Which areas of the brain are most susceptible to [hypoxic-irreversible brain damage] during 🔲 < *ischemic* stroke? (4) > \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ <*hemorrhagic* stroke? >

Answer 239

5; ## Footnote *ischemic*: "Clots Never Help Watershed"[hippocampus|neocortex|cerebellum|watershed] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *hemorrhagic*: basal ganglia

Question 240

A: Name the 3 types of *ischemic* stroke B. What type of necrosis develops from *ischemic* stroke?

Answer 240

_{"**THE** *ischemic* stroke, smh"} [**T**hrombotic🆚**H**ypoxic🆚**E**mbolic] ## Footnote b. Liquefactive

Question 241

post [*ischemic* stroke] management ⼀ (6)

Answer 241

**BALTIC** 1. [(**A** SA + ADP R Blocker)_*DAPT* ] 2. [**B** P control ♨]^{x *24h*} 3. [**C**arb (Glucose) control] 4. [**L**]ipid control 5. [**I** nvestigate possible causes ^{(CTA h/n, Carotid US, TTE)}] 6. [**T**reat possible causes (afib)] ## Footnote *🔎DAPT = [Dual AntiPlatelet Therapy (ASA + ADP R Blocker)]* ♨[(< 180/105^{*[if thrombolytic given]*)] vs [< 220/110 *[if thrombolytic NOT given]*) ]*24h*}

Question 242

# pt presents with r/o ischemic stroke How long does it take 🔲 to detect cerebral **ischemic** changes? -NCHC -MRI ## Footnote *🔎NCHC = NonContrast Head CT*

Answer 242

NCHC: [6-24^HOURS] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ MRI: [3-30_min]

Question 243

# There are ⬜_# [Spinal Cord Nerves] total describe the arrangement of [Spinal Cord *Nerves*] around the [Spiny Vertebra *Bone*] -3

Answer 243

*31* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. {[C1-C7🅽 ] 🅽 sits ^*above* 🄱} 2. {C8🅽 exits [_*below* C7 bone]} 3. [ALL OTHER: 🄱 sits _*above* 🅽 ] ## Footnote *🔎🅽= [Spinal Cord 🅽erves]* *🔎🄱= [Spiny Vertebra 🄱one]* ⚡ {C8🅽 exits [_*below* C7 bone] and [^*above* T1 bone]}

Question 244

▶In adults, spinal cord extends to ⬜ vertebra(e), ▶ [Subarachnoid space (which contains CSF)] extends to ⬜ vertebra(e).

Answer 244

[L1🄱 - L2🄱]; [S2🄱 _{(lower border)}] ## Footnote *🔎🄱= [Spiny Vertebra 🄱one]* 💡*^{*Lumbar Puncture*}[L3🄱 - L5🄱]*

Question 245

Where are lumbar punctures performed?

Answer 245

L3🄱 - L5🄱 | (at level of caudal equina) ## Footnote *🔎🅽= [Spinal Cord 🅽erves]* *🔎🄱= [Spiny Vertebra 🄱one]*

Question 246

# *fill-in-blank (18)*

Answer 246

Question 247

Diaphragm pain and Gallbladder pain are referred to the ⬜ via the ⬜ nerve

Answer 247

R shoulder ; phrenic

Question 248

# Name physioanatomic significance for following dermatomes: a. L1 b. S2-S3-S4 c. T10 d. T4 e. T7

Answer 248

a. inguinal ligament = L1 b.[*"S2,3,4 ⼀my |**Dick** **FEELS**| |**HARD**|⼀and my |**HOLE** |**wants more**|*" ✏️] c. umbilicus (site for early appendicitis referred pain) = T10 d. @ nipple = T4 e. @ xiphoid process = T7 ## Footnote ✏️{[*"S2,3,4*_S2-S3-S4 *⼀my Dick Feels*_{**[Penis sensation]**} *Hard*_{**[Penis Erection]**} *⼀and my hole*_{**[anal wink reflex]**} *wants more!_{**[anal wink only S3-S4)]**} "* ] = [penis sensation, penis Erection, (anal wink reflex^{S3-S4 only)} ,]}

Question 249

Nerve root(s) for Cremasteric reflex

Answer 249

L1🅽 ,L2🅽 | *"L1,L2 his testicles move"* ## Footnote [*"S2,3,4 ⼀my **DICK** **FEELS** **HARD**⼀and my **HOLE** **wants more***"]

Question 250

What are Primitive reflexes? (2) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Name them (6)

Answer 250

✔︎ [infantile reflexes *(present before Frontal Lobe dvlops)* ] that dissolve by 1 y/o after Frontal Lobe develops ✔︎ may reemerge with Frontal Lobe❌

Question 251

Brimonidine MOA (2)

Answer 251

[⬇︎aqueous humor **synthesis**^(⬇︎IOP)]_α2🟢 | for Glaucoma

Question 252

Pilocarpine is a ⬜_*MOA* sometimes used in emergency Glaucoma tx. Why?

Answer 252

{[**miosis and cyclospasm^{(ciliary m CTN)}**]_{[Muscarinic🟢*Direct* cholinomimetic]}} | *(carbachol has same MOA)* ## Footnote 📝**Pilocarpine = [very effective^{(via cyclospasm)}**] at opening trabecular meshwork into canal of Schlemm *🔎CTN = Contraction*

Question 253

# clinical features Von Hippel Lindau (4) | disease

Answer 253

1. hemangioblastoma in retina/brain stem/cerebellum/spine 2. angiomatosis 3. BL renal cell carcinoma 4. PHEOCHromocytoma

Question 254

*Describe the likely regions involved for the following deficits* ## Footnote A: Weakness of Face and UE B: Weakness of LE C: Numbness of Face and UE D: Numbness of LE

Answer 254

A: CTL Precentral MCA territory (*Face and UE weak*) B: CTL Precentral ACA territory (*LE weak*) C: CTL PostCentral MCA terrtory (*Face and UE numb*) D: CTL PostCentral ACA territory (*LE numb*)

Question 255

Describe how an action potential occurs (5)

Answer 255

**RANHP** {**R**esting}: [-70mV resting potential (maintained with Na+/K+ pump)] becomes more positive (via preceding Na+ influx) {**A**ction Potential: ➜ at [-55mV = action potential occurs] {[**N**a+ infux stop _with K+ efflux start] ^{*at +30mV*} = repolarization}: ➜ at [+30 mV] = [voltage gated Na+ influx stops] and [K+ voltage gated K+ efflux starts] → membrane becomes more negative = repolarization {**H**yperpolarization}: 4. ➜ [K+ efflux] occurs more negative than [-70mV resting potential] = HYPERPOLARIZATION {**P**ump} → eventually climbs up to [-70mV resting potential] via Na+/K+ pump

Question 256

Describe how NTS is released from presynaptic nerve terminals (11)

Answer 256

Question 257

describe Malignant Hyperthermia (4)

Answer 257

***m**alignant* ***hyper***thermia 1.**m**uscle contraction + **hyper**thermia 2.{succinylcholine & [inhaled anesthetics (except N2O)} are causes 3.[rare hereditary condition] 4.potentially fatal ## Footnote ✏️inh*a*led *ane*sthetics = *-ane* (halothane, Sevoflurane, etc)

Question 258

Tx for Huntington's Disease (3)

Answer 258

1.[(Tetrabenazine + reserpine)^{*(inhibits VMAT → limits dopamine vesicle packaging and dopamine release)*} ] 2.[ Haloperidol_{(D2 R Blocker)}] ## Footnote etx = chromo 4 CAG repeat → caudate nc atrophy→ ⬇︎GABA, / ⬇︎ACh / ⇪dopamine] *"Hunting **4** food is way too aggressive & dancey"*

Question 259

[Glioblastoma Astrocytoma] Radiographic Findings - 2

Answer 259

1. **Butterfly lesion** from crossing Corpus Collosum 2. Midline shift from Lateral Vt Compression ## Footnote *GBM is usually a HIGH GRADE Astrocytoma*

Question 260

A: List the n. roots associated with [inferior Gluteal n.] B: Associated Injury (2) C: Sensory deficit D: Motor Deficit

Answer 260

**[inferior Gluteal nerve]** A: L4-S2 B: ❗️[Supero*medial*^{*"[(Up) and (In)] ➜ IS A SIN!"*} Butt injection] ❗️[POST Hip dislocation] C: none D. 🔧 [No Thigh Extension] ## Footnote "[(up) and (in) *IS A SIN*] < BUTT > [*WITHOUT A DOUBT INJECT* **(UP)** and **(OUT)**!]" "All Butt Injections go **Up** and **Out** (SuperoLateral)"

Question 261

A: List the n. roots associated with [SUP Gluteal n.] B: Associated Injury (2) C: Sensory deficit D: Motor Deficit (2)

Answer 261

**[SUP Gluteal nerve]** A: L4-S1 B: {[(up) and (in) *IS A SIN*] Superomedial Butt injection} vs. [POST Hip dislocation] C: none D: 🔧[Trendelenburg CTL hip drop ^{*(hip drop points opposite the lesion)*}] 🔧[No Hip ABduction] ## Footnote "[(up) and (in) *IS A SIN*] < BUTT > [*WITHOUT A DOUBT INJECT* **(UP)** and **(OUT)**!]" "All Butt Injections go **Up** and **Out** (SuperoLateral)"

Question 262

etx of stroke is classified into what 5 categories?

Answer 262

1. Large vessel 2. small vessel 3. cardioembolic 4. cryptogenic 5. [Other (vasculitis/drug/infxn/PFO/dissection/paradoxical)]

Question 263

# When localizing a stroke lesion, use the 7pt-Neuroaxis Name the 7 points of the Neuroaxis

Answer 263

1) Brain 2) Spinal Cord 3)ANT Horn [of Spinal Cord] 4) ROOTS [from ANT Horn of Spinal Cord] 5) Peripheral Nerves 6)NMJ 7)Muscle ________ [Use the 7-star Neuroaxis to locate stroke lesions]

Question 264

As apart of (BALTIC - post stroke mgmt) you have to (I)nvestigate etx _________________________________ Name 4 common stroke imaging workup and why they're indicated

Answer 264

-[MRI brain] = determines stroke distribution pattern -[CTA head/neck] = evaluates vessel abnormalities -[TTE] = looks for embolic etx (PFO/valvular❌/clot) -[Telemetry] = looks for afib/arrhythmia

Question 265

absolute contraindications to receiving [tPA thrombolysis] -7

Answer 265

1. active brain bleeding 2. active internal bleeding 3. prior brain bleed (hemorrhagic stroke) 4. Platelets < 100K 5. INR > 1.7 6. HTN > 185/110 7. major surgery recently