random neuro

Question 1

testing language at bedside

Answer 1

naming
repetition
commands (multi step commands without pause that crosses the midline)

Question 2

language hemi?

Answer 2

90% on L

30% of L handed people will be R side dominant

Question 3

utoff’s phenomenon

Answer 3

sx get worse in warm weather

Question 4

ms

Answer 4

inflammatory, demylinating dz of CNS, maybe autoimmune

differentiate in space and time

Question 5

neuromyelitis optica

Answer 5

effects optic n and spinal cord

-dx: ab against aquaporin 4

Question 6

single ring enhancing brain lesion vs multiple?

Answer 6

single: Lymphoma, post infectious (most likley staph or strep v)
multiple: toxo

Question 7

cushing reflex

Answer 7

sign of brainstem compression

• HTN
• bradycardia
• decreased resps

Question 8

dx of creutzfeld jakob

Answer 8

• myclonus
• akinetic mutism
• hypokinesia
• cerebellar/ visual dist

periodic sharp wave on EEG

14-3-3 CSF assay

Question 9

hemmorhagic transformation

Answer 9

<48 hour post stroke –> ischemic, embolic or one tx with TPA

more commonly seen with septic emboli

Question 10

most common etiology of “transiet curtains over my eye”

Answer 10

amarosis fugax –> from atherosclerotic emboli from carotids

Question 11

paralysis of upper and lower facial muscles on one side, what level of injury

Answer 11

bell’s palsy, lesion below the pons

if forehead muscles are spared this suggests higher lesions

Question 12

cranial nerves in cavernous sinus (and other structures)

Answer 12

III, IV, V, VI

ICA, post communicating artery

pituitary gland

optic chiasm

Question 13

insular cortex

Answer 13

autonomic functions

lateral sulcus

Question 14

causes/ treatment of peripheral facial nerve palsy

Answer 14

(FULL paralysis)

1) edema at faicla nerve canal
2) epidural hematoma
3) longitudinal fracture of temporal bone

for 1) tx with high dose short course of steroids

Question 15

albuminocytologic dissociation

Answer 15

seen in CSF in GBS –> elevated protein, normal cell count

Question 16

drooling in rabies?

Answer 16

hydrophobia form pharyngeal muscle spasm

Question 17

when do you surgically intervene on a subdural

Answer 17

> 10mm
midline shift
mental status change

Question 18

CSF in HSV encephalitis

Answer 18

lymphocytic pleocytosis
minimally elevated protein
nl glucose
nl- inc opening pressure
***look for MRI changes in temporal regions

Question 19

typical presentation of medullablastoma

Answer 19

signs of hydrocephalus

signs of cerebellar vermis involvement- n/v, headaches, gait difficulty

Question 20

cognitive impairment manifestation that comes with NPH?

Answer 20

decreased attention

Question 21

management of acute MS flair

Answer 21

high dose IV methylpred –> 500-1000mg 3-5 days

Question 22

anti gm1 antibodies

Answer 22

chronic inflammatory demylinating polyneuropathy

tx with IVIG or plasmapheresis

Question 23

tuberous sclerosis dx

Answer 23

neurocutaneous d/o characterized by benign hamartomas

• > 3 ash leaf spots (hypopigmented, ellipsoid patch)
• shagreen patches- raised, rough, dimpled skin usu on low back
• angiofibromas
• retinal

renal- RCC, cysts, angiomyolipomas

CNS- seizures, intellectual disorders

cardiac- rhabdomyomas

Question 24

ALS symmetry?

Answer 24

Als is often Asymmetric

Question 25

neurogenic shock

Answer 25

type: distributive shock

vasodilation, warm and flushed skin–> dec preload –> hypotn, bradycardia

**can be cause by spinal anesthetics in surgery

Question 26

neurogenic shock

Answer 26

type: distributive shock

vasodilation, warm and flushed skin–> dec preload –> hypotn, bradycardia

**can be cause by spinal anesthetics in surgery

Question 27

features of fetal alcohol syndrome

Answer 27

downslanting palpebral fissures – distance b/w med and lat canthi

epicanthal folds – fold of eye lid

flat philtrhum– fold between upper lip and nose

flattened, small upper lip

hypertelorism– inc space between two doubled up organs, ie eyes

microcephaly

Question 28

palpebral fissures in Downs sysndrome

Answer 28

UPSLANTING

Question 29

lisch nodules

Answer 29

hyperpigmented nodules seen in the iris in nf1

Question 30

5 P’s of acute intermittent porphyria

Answer 30

painful abdomen
psychologic disturbance
polyneuropathy
precipitant: drugs, alcohol
purple pee