Case Files

Question 1

What area is damaged in Argyll Robertson Pupil

Answer 1

pretectal area of superior colliculus

Question 2

Parinaud’s Syndrome

Answer 2

pupillary constriction and inhibited vertical gaze from a lesion in the superior colliculus

Question 3

Describe a migraine prodrome

Answer 3

Depression
Euphoria
irritability
increased urination/defecation
hypersomia
photphobia
phonophobia
anorexia 
fluid retention

Question 4

Describe an aura in migraine

Answer 4

In 25% of attacks 5mins-1hour
visual scotomas
teichopsias
fortification spectta
photopsias

Question 5

teichopsias

Answer 5

zigzag luminous images

Question 6

fortification spectra

Answer 6

flashing lights with zig zag pattern

Question 7

photopsias

Answer 7

flashes of light

Question 8

Workup for Migraine if exam abnormal or abnormal presentation

Answer 8

Blood- CBC, HIV, vasculitis, thyroid, protein electrophoresis
ESR-temporal arteritis if above 60
LP-pseudotumor and subarachnoid
Imaging

Question 9

Describe Temporal arteritis

Answer 9

Pain/stiffness in shoulder, back and pelvic girdle
Head pain in the temporal region
Unilateral vision loss

Question 10

better when lying down
worse when sitting up
+N/V

Answer 10

Postspinal headaches

Question 11

Sudden, pulsatile headache after intercourse

Answer 11

Postcoital cephalgia

Question 12

increased ICP without mailignancy
headaches
visual disturbances
obese patient with menstrual abnormalities

Answer 12

Pseudotumor cerebri

Question 13

Sudden orbital pain
Nausea/vomiting
pappiledema

Answer 13

Acute Glaucoma

Question 14

Orbital or neck pain
Horner’s
trauma

Answer 14

Carotid dissection

Question 15

extreme headache
nausea and vomiting
stiff neck

Answer 15

Subarachnoid hemorrhage

Question 16

Abortive treatment of migraines

Answer 16

triptans
ergotamine
dihydroergotamine
isometheptene

Question 17

Contraindication to triptans

Answer 17

Cardiovascular RF

Question 18

Prophylactic treatment for migraine

Answer 18

When >3 headaches per month
Anticonvulsants
Beta blockers
Antidepressnts

Question 19

Two tpyes of headache
One occurs daily
Hx of migraine, tension headache and chronic medication use

Answer 19

Chronic headache

Question 20

Management of Chronic daily headache

Answer 20

MRI
CBC
Thyroid
ESR
LP

Question 21

Medical therapy for chronic daily headache

Answer 21

remove offending meds
Sodium valproate
Topirmate

Question 22

Emperic treatment for patient with symptoms of meningitis

Answer 22

third gen cephalosporin
vancomycin
IV dexamethasone
acyclovir

Question 23

Management of meningitis presentation

Answer 23

Imaging if concerns over mass effect
CSF: protein, glucose, cell count, PCR
CBC/CMP-20/coag studies
HIV/VLDL
Blood cultures\
Emperic therapy

Question 24

Kernig sign

Answer 24

inability to extend the leg with the hip flexed

Question 25

Brudzinski

Answer 25

Flexion of the neck muscle causes involuntary flexion of thighs and legs

Question 26

Most common cause viral menigitis in US

Answer 26

enterovirus

Question 27

Triad of meningitis

Answer 27

headache fever neck stiffness

Question 28

Mood changes Gait instability Motor impairment

Answer 28

HIV dementia

Question 29

Lacinating pain sensory ataxia CN abnormal bowel/bladder incontinence

Answer 29

neurosyphilis

Question 30

lacinating pain

Answer 30

stabbing pain

Question 31

transmission of toxoplasma

Answer 31

oocysts from food oocysts from food/water infected from cat feces verticle transmission

Question 32

multiple hypodense ring enhancing lesions

Answer 32

Toxoplasma

Question 33

single solitary hypodense ring enhancing lesion

Answer 33

CNS lymphoma

Question 34

Treatment of toxoplasma

Answer 34

pyrimethamine + folic acid corticosteroids TMP-SMX is alternative

Question 35

Prophylaxis for T gondii

Answer 35

TMP SMX