Misc

Question 1

Pronator drift. Described and neurological significance.

Answer 1

Arms out and supinated. Positive sign when arm falls and supinates. Indicative of upper motor neuron disease.

Question 2

Effective abortive treatment for cluster headaches?

Answer 2

100% oxygen

Question 3

Todd’s paralysis

Answer 3

Transient paralysis that occurs during a post-ictal state.

Question 4

Most dangerous complication of pseudotumor cerebri?

Answer 4

Idiopathic intracranial hypertension can cause blindness! Remember the papilledema should tip you off here

Question 5

Most common nerve palsy associated with pseudotumor cerebri?

Answer 5

IIH can cause a CN VI palsy. You could argue CN II as well because IIH patients are at risk of losing vision (think papiledema)

Question 6

Mechanism of action for Acetazolamide?

Answer 6

Inhibits carbonic anhydrase in ventricular choroid plexus cells.

Question 7

Patient with sudden onset facial droop 45 mins ago. Imaging modality options?

Answer 7

Diffusion weighted imaging shows earliest signs of ischemia.

Question 8

Two factors that predispose patients to having brain abscesses? Mechanism/Explanation?

Answer 8

Recurrent sinusitis (direct spread through ethmoid/frontal sinuses)
Congenital heart disease (Tetrology of Fallot cause blood to bypass the pulmonary circulation where phagocytes usually clear the blood of any bacteria present)

Question 9

Young patient presents with ptosis, poor suck & gag reflexes, that progress to weakness/paralysis in neck then upper body. Diagnosis? Association? Treatment?

Answer 9

Descending flaccid paralysis of botulinum spores from Clostridium botulinum ingestion. Associated with eating raw honey (though can also come from environmental dust particles).
Rx: botulism immune globulin

Question 10

Thalamic pain phenomenon? (Cause and clinical manifestations)

Answer 10

Dysesthesia (abnormal, unpleasant sense sensation of touch - often painful) on one side of the body. Occurs after a thalamic stroke in the ventral posterio-lateral (VPL) brain region where sensory modalities are relayed.

Question 11

Threshold for carotid stenosis requiring endarterectomy?

Answer 11

> 70% stenosis

Question 12

Treatment for carotid dissection?

Answer 12

Heparin

Question 13

Patient with fatigable weakness invovling occular muscles and oropharynx cranial nerves. Diagnosis? What neoplasm is associated with this diagnosis that should be screened for?

Answer 13

Myasthenia gravis. 15% of patients have thymomas! Chest CT is indicated

Question 14

Most common side effects of levodopa/carbidopa for Parkinsons? (Early and later)

Answer 14

Hallucinations early on. Involuntary movement later on in therapy

Question 15

33 year old, overweight woman presents with headaches and papilledema. Diagnosis? What will visual fields look like?

Answer 15

Pseudotumor cerebri

VF: peripheral constriction and enlarged blindspot

Question 16

Visual fields of a patient with optic neuritis?

Answer 16

Central scotoma: alteration in visual field with diminished/altered vision immediately surrounded by normal vision

Question 17

Elderly patient with episodes of decreased vision over last few hours presents now with blindness in one eye. Fundoscopic exam shows severe disc edema, enlarged retinal veins (e.g. Pizza retina). Diagnosis?

Answer 17

Central retinal vein occlusion

Remember a patient with high Hgb is more susceptible because of viscocity of blood!

Question 18

Patient presents with decreased sensation on the left and right facial droop and nystagmus. Diagnosis? Localization and treatment?

Answer 18

Lateral medullary syndrome with crossed sensory and motor signs
Most often vertebral artery occlusion (though could be PICA)
Rx: heparin is given!! Even outside of 3hr TPA window

Question 19

Extensor hallicus longus innervation?

Answer 19

Exclusively L5

Question 20

Elderly man with neck pain radiating down arm to left hand. Mild weakness and atrophy of hands with absent triceps reflex. Increased reflexes in ankle and knee. Diagnosis? Pathophysiology?

Answer 20

Cervical spondylotic myelopathy: degeneration of intervertebral disc that happens with old age.
Flattening of disc, narrowing of intervertebral space, osteophyte formation, and hypertrophy of ligamentum flavum causing compression of cervical spine
Likely patient will need surgery (especially with lower extremity signs)

Question 21

Middle aged man with diabetes presents with recent onset right leg weakness particularly of his quads. Diabetes is poorly controlled. Diagnosis?

Answer 21

Diabetic amyotrophy. High blood sugars can cause a denervation of quad muscles/femoral nerve ischemia

Question 22

AIDP vs CIDP treatment?

Answer 22

Acute inflammatory demyelinating polyneuropathy is Guillain Barre syndrome and is treated with IVIg and plasmapheresis. Steroids don’t work in GBS!
Chronic inflammatory demyelinating polyneuropathy is the chronic version of GBS and does respond to steroids!

Question 23

Charcot Marie Tooth disease manifestations

Answer 23

Peroneal muscular atrophy is another name for it. Patients present with foot drop (peroneal nerve) and wasting of muscle in the distal lower extermities. High foot arch and curled toes are common too.
Genetic disease!

Question 24

Middle aged woman comes in complaining of spells of true vertigo. They usually subside without any intervention, but are concerning. Diagnosis? Test and expected clinical finding?

Answer 24

Benign positional paroxysmal vertigo (BPPV). Diagnosed with the Dix-Hallpike Maneuver. Expect to see vertical and torsional nystagmus. Ear towards the ground when nystagmus is elicited is the offending ear.

Question 25

What is Friedreich ataxia?

Answer 25

Autosomal recessive disease which causes damage to the cerebellum and peripheral nerves. Young age onset: 10-15yo.
Can also cause skeletal deformities you might mistake for Charcot-Marie Tooth (arched foot, etc)

Question 26

Patient presents with difficulty verbalizing words. He comprehends all your questions and responds hesitantly with one or two words. You ask him to repeat “the dog jumped over the moon” and he is able to repeat that back to you. Diagnosis? Sister diagnosis?

Answer 26

Transcortical motor aphasia: preservation of comprehension and repetition with impaired fluency. Lesion near Broca’s area. (Similar to Broca’s aphasia, except Broca’s lesion has lost repetition)
Transcortical sensory aphasia: preservation of fluency and repetition with impaired comprehension. Lesion near Wernicke’s area (Similar to Wernicke’s aphasia except WA has lost repetition)