3B: Neurology

Question 1

myasthenia gravis antibodies

Answer 1

Anti-nicotinic acetylcholine receptor antibodies

Question 2

fingolimod

Answer 2

acts by sequestering lymphocytes in lymph nodes, preventing them from contributing to autoimmune damage

Question 3

Uhthoff’s phenomenon

Answer 3

MS symptoms temporarily worsen with heat or during a hot shower,

Question 4

Lhermitte sign

Answer 4

Electric shock sensation down their back when they bend their neck forward

Question 5

Optic Neuritis

Answer 5

swinging flashlight test will show impaired pupillary reflex pathway: Instead of pupils constricting, they will dilate, which is known as a relative afferent pupillary defect or Marcus Gunn pupil.
- decreased visual acuity
- red desaturation
- internuclear ophthalmoplegia (INO), which results from demyelinating lesions of the medial longitudinal fasciculus in the dorsomedial brainstem.

Question 6

MRI finding in MS

Answer 6

both enhancing and non-enhancing hyperintense lesions on the T2 sequence, particularly in the
periventricular-,
cortical- or
juxtacortical-,
infratentorial-, and
spinal cord regions.

sagittal imaging, you’ll see multiple demyelinating plaques radiating outward from the ventricles, known as Dawson fingers

Question 7

Diagnostic criteria for MS,

Answer 7

McDonald criteria

Question 8

Management of MS
Modifiable risks factors

Answer 8

Modifiable risks factors: smoking, Exercise, Vaccinations
Spasticity baclofen 2ln gabapentin
Routine rvs
Acute flare :MS with oral methylprednisolone 0.5 g daily for 5 days (consider plasmaphereses )

Question 9

Medications for MS

Answer 9

Oral agents include
-dimethyl fumarate,
fingolimod, and teriflunomide;
IV immunosuppressants:
natalizumab-monoclonal anti-integrin antibody ,
ocrelizumab- anti-CD20 monoclonal antibodies, such as .

Question 10

Charcot’s neurologic triad

Answer 10

• nystagmus, intention tremor, and scanning speech (or ataxic dysarthria) cerebellum sign and MS

Question 11

Signs of yellow nail syndrome

Answer 11

• yellow nail coloration
• pleural effusions, pneumonia, bronchiectasis.
  -Lymphedema
  >50y/o
  RX pneumococcal vaccine
  self resolved

Question 12

What is danish
In the nemonic danish pastries

Answer 12

Cerebella signs.
Hypotonia

Question 13

What is pastries in danish pastries

Answer 13

Causes of cerebella lesions

Question 14

Screening tests in neuro

Answer 14

Pronater drift
Fist release / myotonic squeeze
Quacking
Flexed palms / winged scapula
Closed eyes touch nose

Question 15

What is the difference of rigidity vs spasticity?

Answer 15

rigidity- increased tone regardless of speed spasticity degree of increased tone increases with speed

Question 16

What is athetosis suggestive of?

Answer 16

Damage to the basal ganglia

Question 17

What is pseudoathetosis?

Answer 17

Writhing movements caused by a proprioceptive defect rather than due to damage to the basal ganglia

Question 18

What is Holmes-Adie pupil?

Answer 18

Adie’s pupil,- one or both pupils of the eyes are abnormally dilated and react slowly or incompletely to light,
but react normally to accommodation (focusing on near objects).

Ass. w/ loss of DTR particularly the Achilles tendon reflex,

Question 19

Elements of the CN exam

Answer 19

1–> smell

Visual acuity- Snellen

(3) Visual fields – visual neglect, central fields, peripheral fields(2),

(2)relative afferent delay Fundoscopy, ptoisis
Pupil responses

Eye movement 3,4.6. H, convergence & accommodation (3)

Facial sensation (5s) (corneal reflex ), facial motor clench temporal, jaw, open jaw, jaw jerk

7: lift eyebrows , shut eye, cheeks, lips, smile

8 Hearing

9 &10 Symmetrical palate, cough, (gag reflex)

12 tongue inspect, move sided to, tongue push

11 Shoulder shrug, turn head