CNS

Question 1

patient recently started on schizo meds, has torticolis, what is mechanism?

Answer 1

D2 antagonism leads to acute dystonic reaction

Question 2

demyelinating disease causes decrease in what in the neuron?

Answer 2

length (space) constant. velocity equals length/time. length constant is how far impulse can travel- because myelin creates high resistance in membrane, impulse can travel farther

Question 3

cystic degeneration of putamen is commonly caused by

Answer 3

wilson’s

Question 4

21 yo with impaired balance, tremor and difficulty speaking, sibling who has progressive neurological disease, dx and pathognomonic sign?

Answer 4

wilson’s- keyser-fleischer rings, slit lamp examination

Question 5

HIV dementia, histology?

Answer 5

microglial nodules and multinucleated giant cells

Question 6

patient with RA given anesthetic then develops quadriparesis, dx and mechanism?

Answer 6

vertebral sublaxation. RA involves atlantoaxial joint and then anesthetic worsens this sublaxation causing compression of vertebral arteries/spinal cord

Question 7

rural farmer in penn, has splinter injury, and develops lockjaw and difficulty swallowing, cannot turn neck, dx?

Answer 7

tetanus- clinical diagnosis.

Question 8

hyperkalemia after anestehtic? which one?

Answer 8

succinylcholine- dont give in burn, myopathy, quadreplegic patients

Question 9

post herpetic neuralgia given topical capsaicin, whcih substance does it regulate?

Answer 9

substance P, not NPY

Question 10

boy with papilledema, unable to look up, eyelid retraction, blurry vision. dx?

Answer 10

parinaud syndrome due to midbrain compression, by pineal gland

Question 11

HIV patient, has meningitis symptoms, organism and what would you see?

Answer 11

cryptococcus, on india ink you would see budding yeasts. can also do a latex agglutination test for the polysaccharide capsule

Question 12

isoflurane anestehtic side effect

Answer 12

increased cerebral blood flow

Question 13

upon looking right, the left eye does not adduct, dx and lesion?

Answer 13

internuclear opthalmoplegia, due to damage to MLF commonly due to lacunar stroke

Question 14

agraphia, acalculia, left-right disorientation

Answer 14

gerstmann syndrome in angular gyrus in dominant parietal lobe

Question 15

RTA, fracture at pterion (where three bones meet), what artery is damaged and what can it lead to?

Answer 15

maxillary artery branch- middle meningeal artery- epidural hematoma

Question 16

equilibrium potential given and permeability to the ion… at resting membrane potential, at ligand gated channel and voltage gated channel

Answer 16

potassium sodium chloride

Question 17

face and arm weakness, leg spared. which artery?

Answer 17

middle cerebral

Question 18

needs anesthesia for anterior thigh muscles, where should you inject?

Answer 18

inguinal crease

Question 19

brain tumor, positive for synaptophysin, negative for GFAP. what is the origin of this tumor?

Answer 19

neurons

Question 20

course of median nerve?

Answer 20

brachial plexus, between ulnar and humeral heads of pronator teres, then between FDP and FDS

Question 21

man dies with alcohol related vomitus aspiration on the sidewalk. hemorrhage of mamillary bodies. what enzyme is low?

Answer 21

transketolase - thiamine deficiency in wernicke’s. thiamine is essential for PPP, which uses transketolase

Question 22

meningitic symptoms, fever, biopsy shows clear cells, dx?

Answer 22

cryptococcus

Question 23

nerve conduction study shows delayed action potential after stimulus, what is wrong with neuron?

Answer 23

schwann cells due to compression and apoptosis. axon damage would cause decrease in amplitude

Question 24

old woman with headache with left lower limb paralysis, and tremor of hand, csf shows lymphocytic pleocytosis and RNA from virus. dx?

Answer 24

west nile virus infection

Question 25

person with diffuse muscle rigidity, hyperthermia and altered sensorium and dysautonomia on haloperidol and sertraline, dx, rx, and mecahnism?

Answer 25

neuroleptic malignant, dantrolene, blocks ryanodine receptor to inhibit Ca release from sarcoplasmic reticulum

Question 26

cherry red macula, startle reflex, macrocephaly, developmental delay in 8 month old, abdo exam normal. dx and enzyme missing and what accumulates?

Answer 26

tay sachs, hexosaminidase A, GM2 ganglioside. contrast with niemann-pick has hepatosplenomegaly (sphingomyelinase deficiency)

Question 27

fragile X syndrome baby, what is genetic abnormality?

Answer 27

hypermethylation of FMR1 gene

Question 28

male patient has myclonic epilepsy, muscle biopsy shows blotchy red appearance, what is probability that offspring will get disease?

Answer 28

0% because mitochondrial inheritance. MERRF, LHON, MELAS

Question 29

posterior triangle dissection, shoulder abduction weakness later. what muscle is affected?

Answer 29

trapezius. posterior triangle dissection led to spinal accessory nerve injury

Question 30

MS patient with painful spasticity of muscles, rx?

Answer 30

baclofen- GABA-B agonist and tizanidine alpha 2 agonist can also be used

Question 31

SAH, 5 days later, new FND. what is dx? and Rx?

Answer 31

vasospasm causing infarct. can give CCB

Question 32

high levels of acetylcholinesterase in amniocentesis of week 18 baby, dx?

Answer 32

neural tube defect

Question 33

4 yo patient w difficulty walking, frequent respi infections, high rate of radiation induced genetic mutation, dx?

Answer 33

ataxia-telangiectasia. cerebellar atrophy

Question 34

japanese restaurant eating fish, neurotoxicity, where in action potential?

Answer 34

binds to voltage gated sodium channels, prevents depolarization

Question 35

battle sign, racoon eyes/orbital floor fracture?

Answer 35

basilar skull fracture, infraorbital nerve damaged

Question 36

orninthine cannot get into mitochondria, what should be restricted in the diet?

Answer 36

protein; because urea cycle is defective

Question 37

retinoic acid inhibits what in fetus?

Answer 37

hox pathway- face, thymus, cartilage

Question 38

endorphins are structurally similar to what normal hormone?

Answer 38

ACTH. both made from POMC

Question 39

treatment for cryptococcal meningitis?

Answer 39

Ampho B and flucytosine, then long-term fluconazole

Question 40

hydrocephalus, intracranial calcification and chorioretinitis?

Answer 40

toxoplasmosis, from cat droppings, in-utero infection TORCHES

Question 41

long term parkinsons patient on levodopa carbidopa treatment. why on-off?

Answer 41

because of nigrostriatial destruction

Question 42

why, in mitochondrial diseases, is there such varaibility in phenotype?

Answer 42

heteroplasmy because mitochondria are unequally distributed

Question 43

anestehtic has increased arteriovenous concentration gradient which means that it has a _______; how about high blood gas coefficient

Answer 43

slower onset of action; because peripheral tissue is taking up the anesthetic a lot, must be replaced; this means that more is being solubilized so more needs to be given

Question 44

what does adding carvidopa to levodopa do?

Answer 44

dopa decarboxylase inhibitor so it can go into brain more. peripheral side effects of dopamine such as postural hypotension and hot flashes and vomitng/nausea are reduced, but brain activity increases so anxiety and agitation might get worse

Question 45

SVT ablation at RA, crysta terminalis. what nerve can be injured?

Answer 45

R phrenic nerve, elevation of diaphragm will show it

Question 46

camping trip to new mexico, torticolis, mydriasis, drooling, painful esophageal spasms, cannot eat or drink, dx and where is the entry point?

Answer 46

rabies encephalitis, muscle ACh receptor

Question 47

perivenular inflammatory infiltrates in brain and astrocyte hyperplasia -glial scarring, dx?

Answer 47

MS

Question 48

what anesthetics lead to liver failures?

Answer 48

halogenated- esoflurane etc

Question 49

trendelenburg sign nerve

Answer 49

superior gluteal nerve

Question 50

sponteaneous local recurrent lobar hemorrhage in elderly , dx?

Answer 50

cerebral amyloid angiopathy

Question 51

TMJ dysfunction and hearing issues, what nerve?

Answer 51

mandibular (V3)