2010

Question 1

adem or ms?

Answer 1

MRI - MS: multiple lessions, diffrent time
ADEM: similar age
CSF - MS: mild lymphocytosis, mild increased protein. IgG
ADEM: mononuclear increased, protein low

MS - focal weakness, numbness, optic neuritis, diplopia; disequilibrium;bladder-function disturbance
ADEM - headache, fever, and confusion

Question 2

Carotid endarterectomy is indicated for patients with

Answer 2

#anterior circulation + transient monocular blindness or TIAs + 70%
#(50%-70%) stenosis—on the side appropriate to
account for the symptoms
#Asymptomatic , 70% to 99%, low morbidity

not to do:
acute - high risk but doable
stenosis of

Question 3

LEWY BODY DEMENSIA

מה שונה מפרקינסון?
מה שונה מאלצהיימר?

Answer 3

פרקינסוניזם + הלוצינציות מוקדמות + דמנציה

הלוצינציות ראיה
פרקינסוניזם - בעיקר רגידיות וברדיקינזיה

שונה מפרקינסון - בפרקינסון תפקוד קוגניטיבי תקין עד לשלבים מאוחרים
שונה מאלצהיימר - בגופפי לוי יש פלוקטואציות במשך זמן קצר. בנוסף בעיות מוטוריות

Question 4

אלצהיימר

קליניקה

Answer 4

שלב ראשון - ירידה איטית בקוגניציה
פגיעה בזיכרון לטווח קצר

אחרי שנים - הפרעות זמן ומרחב, אפאזיה, אקלקוליה, אנומיה
רפלקסים פרימטיבים
הליכה בצעדים קטנים, איטית, בסיס רחב

שלבים מאוחרים -
פגיעה בתפקודים סוציאלים, תסמינים פסיכיאטרים, הזיות,
יכול להיות פרכוסים
ריגידיות וברדיקינזיה

Question 5

טיפול גופפי לוי דמנציה

Answer 5

anticholinesterase drugs - tacrine or donepezil

avoid antipsychotics - extrapyramidal side effects !!!

Question 6

גרציליס וקוניטוס

Answer 6

מסלול מערכת פרופריוספטיבית
גרציליס - רגליים
קוניטוס - ידיים

Question 7

SPINAL EPIDURAL ABSCESS

clinical findings

Answer 7

Fever, backache, tenderness, headache, and malaise
pain in the distribution of a spinal nerve root.

followed by rapidly progressive paraparesis
sensory disturbances in the legs, and urinary and fecal
retention

Question 8

pellagra

Answer 8

nicain (B3) deficiancy

dementia, diarrhea, dermatitis

Question 9

TABES DORSALIS

Answer 9

degeneration posterior columns
unsteadiness, sudden lancinating somatic pains, and
urinary incontinence.

impairment of vibration and joint position sense in the legs,
ataxic gait and Romberg sign.
Deep pain sensation is impaired,
overflow incontinence.
Tendon reflexes are lost, and the limbs are hypotonic. neurosyphilis,

Treatment - underlying infection.

Question 10

Trigeminal neuralgia

treatment

Answer 10

carbamezapine
oxcarbazapine
phenytoin - acute attack
Lamotrigine - refracory

Question 11

intracerebral hemmorhage causes

Answer 11

most common - HTN
other:
trauma
AVM
HEMORRHAGE INTO CEREBRAL INFARCTS or TUMORS
amphetamine or cocaine
amyloid
coagulopathies
ANTICOAGULATION & THROMBOLYTIC
THERAPY
ACUTE HEMORRHAGIC LEUKOENCEPHALITIS

Question 12

intracerebral hemmorhage

treatment

Answer 12

lower systolic blood pressure
to approximately 180 mm Hg
diuretics - if overload
steroids - if edema

Question 13

CJD causes - very deatailed

Answer 13

sporadic (85%) - PRP conformational change
genetic - AD. mutation to PRNP gene
infectious - PRPsc is inserted to the body

Question 14

wilson disease

clinical findings

Answer 14

onset 11
ocular and hepatic cirrhosi
Kayser-Fleischer rings

rest tremor
chorea
parkinsonism
dysarthria, dysphagia
psychologic
ataxia
cognition - memory, slow thinking

Question 15

PSP

clinical findings

Answer 15

falls, supranuclear ophthalmoplegia, pseudobulbar palsy, axial dystonia, extrapyramidal rigidity and dementia.

Vertical saccades - slowed.
vertical gaze palsies.
neck - extended posture

PARKINSONISM - Rigidity of the limbs and bradykinesia but tremor is less common

PSEUDOBULBAR PALSY - facial weakness, dysarthria, dysphagia, jaw jerk and gag reflexes;
inappropriate emotional responses

DEMENTIA- forgetfulness, slowed thought processes,

Question 16

carbidopa MOA

Answer 16

DOPA Decarboxylase inhibitor

Question 17

Selegiline MOA

Answer 17

MAO inhibitor

Question 18

Trihexyphenidyl MOA

Answer 18

anti cholinergic

Question 19

Pramipexole MOA

Answer 19

dopamin receptor agonist

Question 20

lateral medulary syn

artery involved?

Answer 20

PICA

Question 21

lateral pontine synd

artery involved

Answer 21

AICA

Question 22

benedikt syndrome
artery involved
clinical presentation

Answer 22

branches of basilar ar to the brain

ipsilateral - medial rectus palsy + fixed dilated pupil
contralateral - ataxia (usually one arm)

Question 23

Noradrenergic pathways

Answer 23

Locus coeruleus

Question 24

Serotonergic pathways

Answer 24

Caudal nuclei (CN):
Raphe magnus, raphe pallidus, and raphe obscuris

Question 25

Cholinergic pathways:

Answer 25

Nucleus basalis of Meynert

Question 26

WERNICKE ENCEPHALOPATHY

clinical

Answer 26

thiamine deficiency
confusional state, ataxia, ophthalmoplegia.
Amnesia

ocular abnormalities - nystagmus, abducens (VI)
nerve palsy, and horizontal or combined horizontal–vertical gaze palsy.
Ataxia affects gait primarily

Question 27

HUNTINGTON DISEASE

clinical findings

Answer 27

chorea, psychiatric symptoms, and dementia