Week 2

Question 1

signs of benzo OD

Answer 1

CNS depression, ataxia, normal vitals, slurred speech

Question 2

if a patient has relavent afferent pupillary defect what is the injury

Answer 2

optic nerve injury

Question 3

what is the management for microcephaly and what is considered microcephaly?

Answer 3

<3rd percentile is microcephaly and you do an MRI

Question 4

what is memantine

Answer 4

it is a NMDA receptor antagonist used in severe dementia

Question 5

describe cauda equina syndrome

Answer 5

this is where you have a severe disc herniation and the disc compresses the cauda equina. you have bowel and bladder sx, saddle anesthesia, radicular pain, and asymmetric paresis of the legs, only peripheral nerves so no UMN symptoms

Question 6

describe conus medularis syndrome

Answer 6

conus medularis syndrome is when the disc herniates and compresses the conus medularis (T12-L2). the pain is sudden and bilateral, you have spastic hyper-reflexic paralysis (bc whole spinal cord)

Question 7

describe friedrich ataxia: how it presents and inheritance

Answer 7

disorder of the frataxin protein that causes onset of gait ataxia, and slowly progressing limb paralysis. Other signs are upgoing toes, scoliosis, diabetes, and cardiomyopathy. it is autosomal recessive and a triculeotide repeat mutation

Question 8

describe autoimmune encephalitis

Answer 8

auto Ab against NMDA receptors which causes psychiatric symptoms, autonomic instability (HTN, hyperthermia, tachy), cognitive impairment, rigidity, dystonia, and focal seizures following flu-like illness

Question 9

what is strongly associated with autoimmune encephalitis

Answer 9

ovarian teratoma

Question 10

differentiate between cluster, tension, and migraine headaches

Answer 10

cluster: unilateral, autonomic sx, at night, trt oxygen // tension: bilateral, nopulsatile trt NSAIDS // migraine: unilateral, pulsatile, must have nausea or photophobia or aura abort with triptan

Question 11

what does loss of grey-white matter differentiate mean on noncontrast-CT

Answer 11

this means ischemic changes and often don’t show right away

Question 12

describe different presentations of parkinsons

Answer 12

can be mostly bulbar symtoms without tremor, ie soft voices, aspiration and eating difficulty, loss of olfactory ability, rigidity of upper limbs, and stooped posture

Question 13

describe presentation and what can cause wernicke encephalopathy

Answer 13

presentation: nystagmus, bilateral abducens palsy, postural and gait ataxia, encephalopathy. can be due to thiamine deficiency from alcohol use or malnutrition

Question 14

presentation of cryptococcal infection in HIV impatients

Answer 14

increased ICP, headaches, nausea/vomiting, confusion, scattered skin papules,

Question 15

describe physiologic tremor

Answer 15

bilateral tremor that is not caused by an underlying disorder. worsened by stress, caffeine, illness, etc.

Question 16

do you give a patient with endocarditis antiplatelet therapy

Answer 16

NO! this increases the risk of hemorrhagic conversion for them so you dont want to do that

Question 17

signs of deliriuem tremens

Answer 17

confusion, tremulousness, symptathetic overdrive (diaphoresis, high bp etc. ), hyperreflexia occurs 2-5 days post last drink

Question 18

differentiate between Imaging findings in a patient with neurocystercosis vs. coccidiodes meningitis

Answer 18

neurocystercosis will have a ring enchancing lesion presents with seizures. Coccidiodes meningitis is more typical meningitis findings but is more slowly progressive

Question 19

describe neuromyelitis optica and how to dx it

Answer 19

this is when you have intense inflammaiton and demyelination of different spinal cord segments AND the optic nerve I.e. vision loss and asymmetrical weakness. also episodes of hiccups Dx by aquaporin-4 Ab

Question 20

describe where/presentation of meningiomas vs. glioblastomas are

Answer 20

meningiomas are often in the parasaggital sinus, so you would get leg weakness and normally present with seizures // glioblastomas are often across the corpus callosum and present similarly but more acute/intensely

Question 21

what do you do for hypertensive encephalopathy and describe what this looks like

Answer 21

super high bp, tachycardia, tonic-clonic seizures, papilledema // give nitroprusside

Question 22

are lacunar infarcts transient

Answer 22

NO! they will still show theyre reg symptoms

Question 23

if a patient has occulomotor nerve palsy and they have signs of SAH, where was their aneurysm

Answer 23

it would be in the posterior communicating arter, anterior cerebral / anterior ocmmunicating connection is the most common still but this would be bitemporal hemianopsia

Question 24

describe findings of cervical spondylotic myelopathy

Answer 24

lower motor neuron signs in the arms and neck pain with movement. but lower motor neuron signs below the lesion, degeneration of the facet joints, vertebral bodies, or herniated discs

Question 25

signs of acute cerebellar dysfunction in a child and what dx tests to do

Answer 25

inability to walk, nystagmus, dysarthria, speech abnormalities, etc. get a stat CT

Question 26

signs of diaphragmatic paralysis in an ALS patient

Answer 26

more shortness of breath while supine

Question 27

can huntingtons patients suppress their chorea early on

Answer 27

yes!

Question 28

how do you manage NPH

Answer 28

you can do a lumbar punture to assess for elevated opening pressure

Question 29

what is a normal ESR

Answer 29

a normal value is <20

Question 30

when is the straight leg raise positive and what does it mean

Answer 30

it is positive when pain radiates down the leg, it means there is something compressing the nerve root

Question 31

what do healthcare workers need to wear when working on a patient with organophosphate poisoning

Answer 31

rubber gloves

Question 32

what is sleep paralysis and what is the treatment

Answer 32

sleep paralysis is when you cannot move after waking up because of the tranistion from REM to wakefulness, it happens more often with stress and substance use and poor sleep. no treatment unless it happens a lot

Question 33

what does cerebral toxo infection look like

Answer 33

several ring enhancing lesions, seizures, lesions are in the brainstem, corticomedullary junction, basal ganglia and pituitary

Question 34

where is the infarct if there is a pure sensory stroke

Answer 34

the thalamus!

Question 35

how do you treat an aneurysm rupture

Answer 35

surgical clipping

Question 36

what is first line treatment of open angle glaucoma

Answer 36

latanoprost

Question 37

what are signs of open angle gIaucoma?

Answer 37

optic disc cupping, headaches, blurry vision, negative goinoscopy exam (primary test for CLOSE angle glaucoma)

Question 38

what are the hallmarks of tuberous sclerosis tumor wise

Answer 38

RCC, subepyndymal giant cell astrocytoma, angiomyolipomas of the kidney, ungual (under nails) fibromas, cardiac rhabdomyomas, cerebral hamartomas

Question 39

cutaneous signs of tuberous sclerosis

Answer 39

angiofibromas of the face, shagreen patches, ash-leaf spots

Question 40

other signs (non tumor non cutaneous) of tuberous sclerosis

Answer 40

intellectual disability, seizures

Question 41

Hallmarks of NF1

Answer 41

optic gliomas, pheos, multiple neurofibromas, lisch nodules (in the eye), many a cafe-au-lait spot

Question 42

Hallmarks of NF2

Answer 42

skin schwannomas, bilateral acoustic neuromas, meningiomas, spinal ependymomas

Question 43

signs of cerebral toxo infection

Answer 43

fever, headache, low CD4 count, HIV+, seizures, focal neurological deficits, multiple ring enhanching lesions in the basal ganglia

Question 44

signs of PML

Answer 44

multiple white matter non ring lesions, seizures, impaired attention, focal neurological signs, reactivation of JC virus

Question 45

signs of primary CNS lymphoma

Answer 45

focal neuro signs, personality changes, headache, solitary ring enhancing lesion

Question 46

signs of cerebral abscess

Answer 46

solitary ring enhancing lesion, signs of elevated ICP (papilledema, altered mental status, positional headache etc. ), elevated WBCs and ESR, focal neuro deficits, fever, etc.

Question 47

signs of cryptococcal meningitis

Answer 47

subacute meningitis (i.e. signs but has been slowly progressive over weeks), high protein, low glucose, lymphocytic predominance, fever malaise headache, elevated ICP