Med-Neuro

Question 1

Cerebral Salt Wasting etx

Answer 1

⬇︎Brain adrenergic output to Kidney –> ⬇︎PCT Na+ Reabsorption–> hypOvolemic hypONatremia

Question 2

[Wernicke Korsakoff Syndrome] Clinical Presentation (3)

Answer 2

Wernicke problems come in a CAN of beer!

[Confusion & Confabulation]

Ataxia (Gait & Postural)

[Nystagmus + Oculomotor Dyf] (Opthalmoplegia)

beer = chronic alcoholism is most common cause

Question 3

Causes of [Wernicke Korsakoff Syndrome] (2)

Answer 3

Wernicke Problems come in a CAN of beer!

[Thiamine B1 Deficiency] from (below) –> BL circuit dysfunction between mammillary bodies & ANT Thalamus:

1. Chronic Alcoholism = MOST COMMON
2. Giving [Glucose that doesn’t have B1] to a B1-deficient pt (i.e. homeless malnutrition pt)

Question 4

Tx for [Wernicke Korsakoff Syndrome] (2)

Answer 4

1. IV [Thiamine B1]
2. Glucose administration

Question 5

What’s the major complication of [SubArachnoid Hemorrhage] during recovery? How do you tx this?

Usually in the Suprasellar Cistern

Answer 5

Severe Cerebral Vasospasm 4-12 days post SAH onset –> morbidity vs. mortality. Prevent with [Nimodipine CCB]

Other complications: Rebleeding, SIADH, Seizures

Question 6

Describe the Demographic for the HA:

Migraine-2

Tension

Cluster

Answer 6

Migraine = Female and Kids(will be bifrontal)

Tension = Female

Cluster = Male (100% O2 tx)

Question 7

Describe the Onset for the HA:

Migraine

Cluster

Tension

Answer 7

Migraine = Variable but possibly during menstruation

Cluster = During Sleep (100% O₂ tx)

Tension = When Stressed “think tense”

Question 8

Describe the Location for the HA:

Migraine

Cluster

Tension

Answer 8

Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

Cluster = Behind 1 eye (100% O2 tx)

Tension = [Bilateral & Band-like around the head]

Question 9

Describe the Character for the HA:

Migraine

Cluster (3)

Tension (2)

Answer 9

Migraine = POUND = [Pounding/One Day-3 day Duration/Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

Cluster = [Excruciating, sharp & steady] (100% O2 tx)

Tension = Dull & tight

Question 10

Describe the Duration for the HA:

Migraine

Cluster

Tension

Answer 10

Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

Cluster = 15 - 90 MINUTES (100% O2 tx)

Tension = 30 min to 7 DAYS!!!! (Tammy’s Entire Work Week)

Question 11

Describe the Associated Sx for the HA:

Migraine

Cluster - 4

Tension

Answer 11

Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

Cluster = [Sweating/ Pupil Change / Lacrimation / Rhinorrhea]

Tension = [Muscle “Tension” in Head, Neck or Shoulders]

Question 12

Which vessels are affected by [TUMTL-Transtentorial Uncal Medial Temporal lobe] Herniation? (3) What manifestations result from this?

Answer 12

[TUMTL Hernation–> Compression of [POP- PCA / Oculomotor CN3 / Paramedian Pontine vessels] –>

1. [PCA compression] –> Occipital lobe infarct –> CTL homonymous hemianopsia w/Macular sparing
2. Oculomotor CN3 compression –> [Ipsilateral “Down & Out” Eye + Ptosis + Dilated Pupil]
3. Paramedian Pontine vessel compression –> Duret Hemorrhage

Question 13

Which bone is associated with Epidural Hematoma?

Answer 13

Sphenoid

Question 14

Violent Infant Shaking —> ________. This is characterized by what 3 things?

B: How is this differentiated from similar conditions?

Answer 14

Violent Infant Shaking –> [AHT- Abusive Head Trauma]! =

1. Subdural Hemorrhage (from tearing bridging veins between Dura and Arachnoid)
2. Retinal Hemorrhages Bilaterally (from congested retinal vein ruptures)
3. POSTERIOR rib fractures

B: Usually Accidental Fall is not sufficient for Subdural Hemorrhage OR [BL Retinal Hemorrhage]

AHT is formely known as Shaken Baby Syndrome

Question 15

What lab values differentiate seminomatous vs. NonSeminomatous Germ cell tumors?

Answer 15

seminomatous = ⬆︎bHCG

NonSeminomatous(yolk sac/choriocarcinoma/embryonal) = [⬆︎bHCG AND AFP]

Question 16

[Thiamine B1] deficiency causes ____ and BeriBeri.

Describe BeriBeri (2)

Answer 16

[Wernicke Korsakoff Syndrome] and [BeriBeri]

BeriBeri (Wet vs. Dry vs. BOTH) is associated with…

1. Heart involvement = WET
2. Symmetrical Peripheral Neuropathy = DRY

[Thiamine B1] is needed to Decarboxylate a-ketoacids (carb metabolism)

Question 17

Clinical Presentation for [Bells Palsy] (4)

Answer 17

​Bells Palsy = Facial CN7 paralysis from inflammatory edema

Loss of F –> Entire half Unilateral Paralysis

Loss of A –> Hyperacusis

Loss of C–> DEC Eye lacrimation (tearing)

Loss of E –> Loss of ANT 2/3 Tongue Taste

FACE

1. Facial Muscles
2. Afferents(Somatic) from [External Auditory Canal (stapedius m.)] & [Ear Pinna (Pain/Temp)]
3. Cry: Parasympathetics to [Lacrimal/Salivary/Sublingual/Submandibular/]
4. Eat: Taste from ANT 2/3 Tongue
   * Note: Forehead sparing = Intracranial lesion and NOT Bells Palsy*

Question 18

Early Findings of Alzheimer’s - 4

Answer 18

CLAV –> HANDU

Cognitive PROGRESSIVE ⬇︎

Language ⬇︎

Anterograde immediate memory loss

Visualspatial disorientation (loss in ur own neighborhood)

Onsets after 60 yo

Question 19

Clinical Criteria for diagnosing Alzheimer’s -5

Answer 19

CLAV –> HANDU

1. GOE 2 Cognitive deficits
2. Worsening Memory
3. Consciousness intact
4. Onsets after 60 yo
5. No other Systemic/Neuro DO to cause cognitive defects

Question 20

Normal Pressure Hydrocephalus Sx (3); Which is earliest to present?

Answer 20

⬇︎CSF absorption –> Wacky, Wobbly & Wet!

Wacky (memory loss)

Wet (Urinary Incontinence from compressing periventricular cortico-cortical white fibers traveling to sacral micturition center)

Question 21

Normal Pressure Hydrocephalus characteristics - 4

Answer 21

Wacky, Wobbly & Wet!

1. Idiopathic
2. Episodic
3. Elderly
4. Does not ⬆︎ SubArachnoid space volume

Etx: ⬇︎Arachnoid villi CSF Absorption vs obstruction

Question 22

ANY Clinical Suspicion of Stroke warrants _____. Why?-2

Answer 22

NonContrast Head CT; Ischemic stroke benefits from Thrombolytics vs ICH requires neurosurgery

Question 23

How do ICH (IntraCranial Hemorrhage) stroke appear on NonContrast Head CT? How long does this take?

Answer 23

[HYPERdense White]; IMMEDIATELY!

Ischemic Stroke = [hypOdense dark] and takes >24 hrs to appear

Question 24

Clinical Presentation for Diabetic Ophthalmoplegia (3); Etx?

Answer 24

DM –> Oculomotor CN3 Central ISCHEMIA

1. Ipsilateral Down & Out Eye
2. Ptosis (from Levator Palpebrae paralysis)
3. NORMAL PERRL (since Parasympathetic fibers are spared)

Question 25

Ethosuximide Indication

Answer 25

**Sux** to have **S**ilent **S**eizures Silent (Absent) Seizures

Question 26

Features of Absence Seizures -5

Answer 26

1. Staring spells **mid-activity** 2. Patient PAUSES activity 3. Last \< 20 seconds 4. Not responsive to tactile/vocal stimulation 5. NO recollection or postictal ## Footnote * Provoked by Hyperventilation or photic stimulation / Dx = 3 Hz EEG spike* * ADHD staring spells occur only DURING BOREDOM!*

Question 27

Name a common trigger for Absence Seizures-2 ; Dx?

Answer 27

1. Hyperventilation 2. photic stimulation ; **3 Hz** EEG spike

Question 28

Why is it so important to recognize ____ in children with epilepsy?

Answer 28

ADHD; **ADHD is common in Peds Epilepsy (includes Absence seizures)** and if treated will ⬆︎ life quality

Question 29

Newborn Galactosemia etx

Answer 29

inability of [(GALT) Galactose 1 Phosphate Uridyl Transferase] to convert Galactose1P --\> Glucose, so Galactose accumulates *Susceptible to E.Coli !!!*

Question 30

S/S of newborn Galactosemia -7

Answer 30

1. BL Cataracts 2. Jaundice 3. Vomiting 4. Convulsions 5. Failure to Thrive 6. Hepatomegaly 7. Irritability ## Footnote *Susceptible to E.Coli!!*

Question 31

[Cavernous Sinus Thrombosis] Presentation (3)

Answer 31

Infection of face vs teeth spreads thru facial veins --\> cavernous sinus * [CN3 / 4 / 6 / CN5B1 and B2] ipsilateral involvement * Proptosis (protrusion of eye) * HA

Question 32

[Cavernous Sinus Thrombosis] etx

Answer 32

Infection of face vs teeth spreads thru facial veins --\> cavernous sinus

Question 33

Lacunar Stroke etx

Answer 33

*lenticulostriate vessels perfuse [**B**e **TI**P**C**] (not Pons)* Lacunar Stroke= [**Thrombotic** **HTN Arteriolosclerosis** & **Thrombotic** **microatheromas**] of lenticulostriate vessels --\> [cystic infarcts \< 15 mm] --\> Lacunar Syndrome

Question 34

Describe the Lacunar **Syndrome** CP

Answer 34

*lenticulostriate vessels perfuse [**B**e **TI**P**C**] (not Pons)* Lacunar Stroke= [**Thrombotic** **HTN Arteriolosclerosis** & **Thrombotic** **microatheromas**] of lenticulostriate vessels --\> [cystic infarcts \< 15 mm] --\> Lacunar Syndrome 1A: **B**asal Ganglia--\>Hemiballismus & involuntary writhing 1B: [**I**nternal Capsule-POST limb/**P**ons/**C**orona Radiata]--\> pure Motor stroke vs ataxia vs. clumsy hand-dysarthria 1C: **T**halamu*S* VPL --\> CTL *S*ensory Stroke VPL=VentroPosteroLateral nc

Question 35

What is Dejerine Roussy Syndrome

Answer 35

*lenticulostriate vessels perfuse [**B**e **I C**]* S/p Lacunar Thalamus Sensory stroke eventually --\> Severe Paroxysmal BURNING worst w/light touch = Allodynia

Question 36

Clinical Presentation of Congenital Syphilis -7

Answer 36

1. Frontal Bossing 2. Deaf 3. Saddle nose 4. Rhinitis 5. Hutchinson Mulberry Molars 6. Liver/Spleen Dz 7. Saber Shins

Question 37

Clinical Presentation for Fetal Hydantoin Syndrome -6

Answer 37

*Etx = Exposure to Phenytoin vs Carbamazepine during utero* 1. Microcephaly 2. Cleft Lip / Palate 3. Digital and Facial hypOplasia 4. Hirsuitism 5. Retardation 6. Neonatal bleeding (Phenytoin ⬇︎ Neonate VitK)

Question 38

Classic signs of Fetal Alcohol Syndrome - 4

Answer 38

1. Microcephaly 2. Small Palpebral fissures 3. Long Smooth Philtrum 4. Thin Upper Lip

Question 39

Sturge Weber Syndrome Clinical Presentation -5

Answer 39

1. **Seizures** 2. Port Wine Stain vs Red Nevus along CN5 territory = congenital UL cavernous hemangioma 3. CTL Homonoymous Hemianopsia 4. Hemiparesis 5. Ipsilateral Glaucoma ## Footnote *Tramline Gyriform Calcifications on CT*

Question 40

Sturge Weber Syndrome Dx

Answer 40

Tramline Gyriform Calcifications on CT

Question 41

Sturge Weber Syndrome Tx -3

Answer 41

1. Control Seizures 2. ⬇︎ Intraocular pressure from Glaucoma 3. Argon laser for [Port wine stain vs Red nevus along CN5 territory] ## Footnote *Tramline Gyriform Calcifications on CT*

Question 42

Tuberous Sclerosis Clinical Presentation (12)

Answer 42

**HAMARTOMASSS** ## Footnote [**H**amartomas benign] [**A***ngiofibroma on Face-triad*] - *image* **M**itral Regurgitation [**A**sh Leaf Macules] [**R**habdomyoma Cardiac --\> Valvular Obstruction] **T**uberous Sclerosis AUTO D**O**M **M***ental Retard-triad* [**A**ngioMyoLipoma Kidney] **S***eizures-triad* **S**EGA (SubEpendymal Giantcell Astrocytoma) [**S**hagreen forehead patches]

Question 43

Genetic Cause of Neurofibromatosis Type 1

Answer 43

[chromo 17 mutation]--\> [NeurofibroMin loss]. NeurofibroMin tumor suppresses (RAS GTPase activating protein

Question 44

Characteristics of Neurofibromatosis **Type 1** (6)

Answer 44

**CLAP** **ON** type 1!" 1. **N**eurofibroma PLEXIFORM 2. **A**coustic Schwannoma-Unilateral (HA/Tinnitus/Vertigo) 3. [**O**ptic n. Glioma] 4. **L**isch nodules 5. [**C**afe Au Lait Spots] 6. **P**heochromocytoma * Note: NF1 in Newborns will present w/Macrocephaly, ⬇︎Feeding ,learning idsabilities*

Question 45

Neurofibromatosis **Type 2** Clinical Presentation - 3

Answer 45

- [**Bilateral** Acoustic Schwannomas] (HA/Tinnitus/Vertigo) - Multiple Meningiomas benign - BL Cataracts ***Bilateral** Acoustic Schwannomas @ Cerebellopontine angle*

Question 46

In [Neurofibromatosis Type 1], Fleshy cutaneous neurofibromas are made of ______ which embryologically come from \_\_\_\_\_. These pts may also have hyperpigmented spots known as \_\_\_\_

Answer 46

In NF1, Fleshy cutaneous neurofibromas are made of **Schwann cells**, which are embryologically from **Neural _Crest_**. May also have [**Cafe Au Lait Spots** (*image*)] ## Footnote *Image: Cutaneous Neurofibromas & Cafe Au Lait Spots*

Question 47

Main features of Narcolepsy -4

Answer 47

1. \> [3x/week for more than 3 mo.] of sudden entry into REM sleep 2. hypnagogic/hypnopompic hallucinations 3. Sleep Paralysis (temporary paralysis after sleeping) 4. Cataplexy ## Footnote *hypno**go**gic = when **go**ing to sleep*

Question 48

Cataplexy may be treated with \_\_\_-suppressing drugs. Name 2 examples

Answer 48

**REM Sleep**-Suppressing drugs; Antidepressants and Sodium Oxybate

Question 49

List the 3 main causes of HemipLegia in Kids

Answer 49

1. Seizure w/Todds Paralysis 2. Hemorrhagic Stroke 2/2 AVM 3. HemipLegic Migraine (Teens w/Fam hx, self-resolving)

Question 50

Describe Todds Paralysis

Answer 50

Self-limited focal (ipsilateral UE and LE) paralysis after seizure that **resolves naturally within 36 hours**

Question 51

What Dz occurs from [Tetrahydrobiopterin BH4] deficiency? Explain the etx

Answer 51

(PKU) Phenylketonuria; Dihydropteridine Reductase becomes deficient w/out [Tetrahydrobiopterin BHF] cofactor --\> Inability to convert Phenylalanine --\> Tyrosine

Question 52

Phenylketonuria tx (2) ; Why is Newborn screening important for these?

Answer 52

1. low phenylalanine diet 2. BH4 supplementation **NEWBORN SCREENING--\> early dx --\> early tx --\> Normal lives!!**

Question 53

PKU-Phenylketonuria S/S (4)

Answer 53

1. Musty Odor 2. Seizures (look for upward eye deviation) 3. Eczema 4. Retard

Question 54

*Newborn screening is ESSENTIAL for early dx of PKU* How do you diagnose PKU?

Answer 54

**Tandem mass spectrometry** of dried blood spots --\> detects PKU products

Question 55

Name the classic complaint pts with Presbycusis will give regarding conversations - 2

Answer 55

Can hear **one-on-one** BUT can not hear if there's ANY background noise + BL tinnitus ## Footnote *Sensorineural hearing loss secondary to age*

Question 56

What conditions are associated with [Berry Saccular Aneurysm]? (5)

Answer 56

"**E**ating **A**pple*Berries* **C**an **S**ound **H**eavenly" 1. **ADPKD\*\*** 2. [**E**hlers Danlos Syndrome] 3. **H**TN 4. **S**AH (from Trauma \> Berry Saccular Aneurysm) 5. **C**oarctation of Aorta (associated w/HTN) *Image: Blood around Brainstem & Basal Cisterns*

Question 57

[Communicating Hydrocephalus] cause

Answer 57

[Meningitis vs. SAH/Intraventricular Hemorrhage] --\>Disrupts communication of CSF with [Arachnoid Granulation Villi] ReAbsorption

Question 58

[**SubArachnoid Hemorrhage**] Dx-3? Tx-2? ## Footnote *Usually in Suprasellar Cistern*

Answer 58

Dx: 1. NonContrast Head CT 2. Lumbar Puncture revealing Xanthochromia (6 hrs after onset) 3. Cerebral Angiography Tx: [Endovascular Coiling/Stenting to stabilize aneurysm] + Nimodipine *Xanthochromia comes from Blood breakdown products*

Question 59

What's the major complication of [SubArachnoid Hemorrhage] **24 hrs post onset**?

Answer 59

**REBLEEDING WITHIN 6 HRS --\> MAJOR CAUSE OF DEATH!** ## Footnote *Other complications: Rebleeding, SIADH, Seizures*

Question 60

What are Risk factors for PCiiH [Pseudotumor Cerebri Idiopathic Intracranial HTN] - 4

Answer 60

1. Overweight Women taking OCP (*will usually have Empty Sella Turcica*) 2. Tetracyclines 3. Vitamin A OD (Isotretinoin) 4. Growth Hormone ## Footnote *This HA will make you go Blind!*

Question 61

Lumbar puncture with CSF pressure of _____ = Intracranial HTN

Answer 61

\> 250 mmH20

Question 62

PCiiH [Pseudotumor Cerebri Idiopathic Intracranial HTN] Tx - 3

Answer 62

Big Girl with PCiiH just **SAT** on her problems 1. **S**urgery (*Shunt vs Optic N sheath fenestration*) 2. **A**cetazolamide (*inhibits Choroid Plexus Carbonic Anhydrase*) 3. **T**opiramate (*will also --\> Wt loss :-)* ) *This HA will make you go Blind!*

Question 63

PCiiH [Pseudotumor Cerebri Idiopathic Intracranial HTN] Dx - 2

Answer 63

1. Lumbar Puncture with opening pressure **\>250** mmH20 (from ⬇︎Arachnoid villi CSF absorption) 2. MRI +/- MRV revealing BL tortuous Optic N ## Footnote *This HA will make you go Blind!*

Question 64

Papilledema is typically a ctx to Lumbar puncture. When is it not a ctx to Lumbar puncture? Explain

Answer 64

[PCiiH (Pseudotumor Cerebri Idiopathic Intracranial HTN)]; As long as there are no signs of obstructive/noncommunicating hydrocephalus or mass, then it is ok ## Footnote *LP with CSF opening pressure \> **250** mmH20 = PCIIH*

Question 65

[**Pseudotumor Cerebri Idiopathic Intracranial HTN]** Clinical Presentation - 4

Answer 65

1. [HA **worst at sleep times (night/morning)** **& with head position ∆**] 2. Vision changes +/- Papilledema 3. Pulsatile Tinnitus 4. CN6 Abducens Palsy ## Footnote *This HA will make you go Blind!*

Question 66

[**Syringomyelia** central cord syndrome] etx ; CP-2?

Answer 66

Formation of [CSF filled syrinx cavity] in **C8-T1** region of spinal cord --\> damages [Ventral white commissure (crossing fibers for STT)] --\> 1. [**BL Cape distribution Pain/Temp Loss in Arms & Hands**] 2. \*\*\*Eventually Ventral Horns are also destroyed --\> LMN signs (**FAAW**) - **F**asciculations / **A**trophy & **A**reflexia / **W**eakness

Question 67

Parkinsonism Clinical signs (8)

Answer 67

**PARK** & **hamp** [**P**ill Rolling Resting 4-6 Hz **unilateral** Tremor] worst with Rest & Mental Task [**R**igidity Cogwheel] Brady**K**inesia [**A**Reflexia posturally] --\>Shuffling Gait/Fall when turning or stopping + - **h**ypOphonic speech - **A**utonomic ⬇︎ (constipation / bladder problems / orthostatic hypOtension) - **m**icrographia - **p**oker masked face * PARK = primary signs*

Question 68

Name the Major UMN signs (5)

Answer 68

UMN signs = **W**eak **MESH** ## Footnote **W**eakness [**S**pastic Gait & Paralysis] (*partially from disproportionate Extensor weakness*) [**E**xaggerated Reflexes (_Babinski_)] **M**ental Status change **H**emipLegia

Question 69

Name the Lower Motor Neuron signs - 4

Answer 69

LMN signs (**FAAW**) - **F**asciculations / **A**trophy & **A**reflexia / **W**eakness

Question 70

3 Main causes of Spinal Cord Compression

Answer 70

1. **DJD Disc Herniation** (Smoking risk factor) 2. [Epidural Staph a. Abscess (think IV drug user vs DM)] 3. Tumor (Prostate/Renal/Lung/Breast/Multiple Myeloma mets) ## Footnote Dx = MRI, Positive Straight Leg, Classic S/S *DJD=Degenerative Joint Disease*

Question 71

Causes of [Anterior Spinal Cord Syndrome] - 2

Answer 71

**Thoracic** AAA Repair vs Vertebra Burst Fracture

Question 72

Describe the 3 main sx for [**Brown Sequard Syndrome**]

Answer 72

1. **Contralateral** STT Loss of Pain/Temp **2 LEVELS BELOW ORIGINAL LESION** 2. Ipsilateral DCP Loss of **2TVP**-***2**point/**T**ouch/**V**ibration/[**P**osition Proprioreception]* 3*.* Ipsilateral CST Loss --\> Muscle Weakness

Question 73

Causes of [**Brown Sequard Syndrome**] - 3

Answer 73

1. [(Extramedullary Tumor] 2. Trauma 3. [DJD Disc Hernation (Smoking risk factor)]

Question 74

[Cauda Equina Syndrome] etx ; Clinical Presentation - 5

Answer 74

(Compression of S2 - S4 n. roots) --\> 1. Saddle Anesthesia (*image*) 2. ⬇︎ **Ano**cutaneous Reflex (perianal pinpoint does NOT cause anal sphincter contraction) 3. Incontinence (urinary AND fecal) 4. uL (uniLateral) Radiculopathy 5. **hypOreflexia** (*Conus Medullaris syndrome has HYPEReflexia*) *Decompression required within 72 hours!!!*

Question 75

Where does **Charcot Bouchard Aneurysms** occur (4)

Answer 75

**C**harcot **B**ouchard **T**ears **P**ink * **B**asal Ganglia * **C**erebellum * **T**halamus (shown in image below) * **P**ons *Acute ICHH [Intraparenchymal CharcotBouchard HTN Hemorrhage] in image*

Question 76

What causes Hemiballismus

Answer 76

Damage (i.e. lacunar stroke) to **Subthalamic nc.**, important in modulating basal ganglia output --\> CTL Hemiballismus ## Footnote *Note: Basal Ganglia is in Subcortical nuclei*

Question 77

Etx of Huntington's Disease

Answer 77

[AUTO DOM [Chromo 4 CAG repeats]] ---\> Degeneration of (**Caudate** nc. inside the ((**I**)ndirect Striatum w/ [Gross Caudate atrophy] ) --\> [**⬇︎ GABA release**] ## Footnote *"Hunting **4** food is way too aggressive & dancey"*

Question 78

Huntington's Dz Clinical Presentation (2)

Answer 78

* "Hunting 4​ food is way too **aggressive** & **dancey**"* 1st: **Aggressive** Dementia w/ strange behavior 2nd: **D****ance**-like Chorea mvmnts * AUTO DOM = Affects BOTH sexes equally!!*

Question 79

When does Huntington's Dz onset

Answer 79

30 - 50 y/o ## Footnote *AUTO DOM = Affects BOTH Sexes Equally!!*

Question 80

Describe Essential Tremor-2 ; What is it relieved by

Answer 80

1. BUE Action Tremor **worst w/Action** (can also affect head & voice) 2. **No additional neuro ∆ present** relieved with EtOH *Onsets at 45 yo and 50% cases are AUTO DOM*

Question 81

Tx for Essential Tremor - 6

Answer 81

Propranolol \> [**PAT** - **P**rimodone vs **A**nticonvulsants vs **T**opiramate] \> Benzo \> Surgery ## Footnote *Onsets at 45 yo and 50% cases are AUTO DOM*

Question 82

Parkinson's Dz Tx - 6

Answer 82

"Eat **SALADS** after you Park" ## Footnote 1. [**L**evodopa (Dopamine Precursor) + Carbidopa] 2. **A**mantidine 3. **A**nticholinergics 4. [**D**opamine PostSynaptic Agonist] (NonErgot: Ropinirole vs. Pramipexole) & (Ergot:Bromocriptine) 5. **S**elegiline 6. **S**urgery - Pallidotomy: Destructive of [Globus Pallidus:internal] - SubThalamic nuc. inhibition with electrode - ANT Choroidal a ligation

Question 83

Lesch Nyhan etx

Answer 83

**MALE** DO in which HGPRT deficiency --\> ⬆︎ Purine --\> Uric Acid accumulation ## Footnote *Presents in Males 6 mo. old with hypOtonia + vomiting eventually --\> **CROUG** ( **UE Self-Injury (Biting)** / **C**horeoathetosis / **R**etardation / **G**out / **O**bstructive Nephropathy*

Question 84

Lesch Nyhan Clinical Presentation - 7

Answer 84

Presents in Males 6 mo. old with hypOtonia + vomiting eventually --\> **CROUG** ( **UE Self-Injury (Biting)** / **C**horeoathetosis / **R**etardation / **G**out / **O**bstructive Nephropathy

Question 85

Dx for **Multiple Sclerosis** - 5

Answer 85

1. Clinical (SLUM SiiiN) 2. T2 MRI: [**Periventricular** white matter demyelinating plaques with lipid laden macrophages] 3. T1 MRI Black holes 4. CSF Oligoclonal IgG bands 5. Visual conduction velocity test ## Footnote *Sx will be disseminated in time and space*

Question 86

CP for [**MIOS**-**M**LF **I**nternuclear **O**phthalmoplegia **S**yndrome] (3)

Answer 86

[**MIOS**-**M**LF **I**nternuclear **O**phthalmoplegia **S**yndrome] \*[Impaired **ADD**uction of affected eye] + [Normal **ADD**uction of affected eye during [near reflex convergence] + \*[Nystagmus of **UN**affected eye when attempting to ABduct] *Image: L MIOS*

Question 87

Clinical Manifestation of **Multiple Sclerosis** (9)

Answer 87

Charcot classic triad of MS is a [**SLUM** **SiiiN**] ! ## Footnote **S**ensory sx (think BL Trigeminal Neuralgia) **L**hermittes sign = "electric tingling" down spine into arm & legs when chin is touched to chest **U**hthoff phenomenon (sx ⬆︎ during heat) **M**otor sx **S**canning Speech [**I**nternuclear Ophthalmoplegia (MIOS)] / **I**ntention Tremor / **I**ncontinence **N**euritis Optic - (uL eye pain + vision loss + Marcus Gunn afferent pupillary defect) = ALSO RISK FACTOR

Question 88

Which drugs are used to treat Multiple Sclerosis Exacerbation?-2 ; Which are used for maintenance?-3

Answer 88

1st: High Dose IV Methylprednisolone 2nd: (Refractory): Plasmapharesis Maintenance: 1. β-interferon 2. Glatiramer acetate 3. Natalizumab

Question 89

Myotonia Dystrophy Clinical Manifestation - 6

Answer 89

**My T**onia, **My T**oupee, **My T**V Viewers, **My T**hroat, **My T**icker, **My T**esticles, **T**onia = Myo**T**onia = [⬇︎ relaxation after volitional muscle contraction with Weakness & Atrophy] (*cant let go of doorknob*) **T**oupee = Frontal Balding **T**V viewer = Cataracts **T**hroat = SEVERE DYSPHAGIA --\> Aspiration PNA **T**icker = Arrhythmia **T**esticle = Testicular Atrophy *Auto DOM CTG Repeat*

Question 90

Main features of Duchenne Muscular Dystrophy - 5

Answer 90

1. **CALF PSEUDOHYPERTROPHY** requiring gower manuever 2. Scoliosis\*\* 3. Cardiomyopathy 4. Wheelchair by Teenage years 5. Death by 20-30 yo 2/2 Cardiopulm failure\*\* ## Footnote * Onsets at 2 yo / X-Link Recessive deletion on Chromo Xp21* * \*\* = also seen in Becker Muscular Dystrophy*

Question 91

Main features of Becker Muscular Dystrophy - 2

Answer 91

1. Scoliosis\*\* 2. Death by **40-50** yo 2/2 Cardiopulm failure\*\* ## Footnote * Onsets at 5 yo / X-Link Recessive deletion on Chromo Xp21* * \*\* = also seen in Duchenne Muscular Dystrophy*

Question 92

What are the Risk Factors for Alzheimer's Dz - 6

Answer 92

CLAV--\> HANDU 1. \> 60 yo 2. Female 3. Family hx 4. Head Trauma 5. Apolipoprotein E positive 6. Down's Syndrome (they have ⬆︎ [**chromo 21** transmembrane amyloid precursor glycoprotein])

Question 93

Frontotemporal Pick's Dementia Sx -2

Answer 93

Prounouced Frontal & Temporal lobe atrophy --\> [**Socially inappropriate** Behavior] + aphasia *OCCURS MORE IN FEMALES!!!*

Question 94

A: Demographic of Frontotemporal Pick's Dementia? B: Mode Of Inheritance

Answer 94

A: 50-60 yo Females (Alzheimer = \> 60) B: Auto Dominant

Question 95

Dementia with Lewy Bodies (DLB) CP - 3

Answer 95

DLB at the **DMV** 1. **D**ementia confusion periodically 2. **M**ichaelJFox Parkinsonism (PARK + hamp) tht **does NOT respond to dopaminergic tx** 3. **V**isual Hallucinations *Lewy Body= [**LABS** (**L**ewy **α**-synuclein **B**odie**S**)] that are Eosinophilic intracytoplasmic accumulations*

Question 96

*Tick Paralysis and Gullain Barre both present with ascending paralysis* What differentiates Tick Paralysis? - 3

Answer 96

Tick Paralysis has... 1. NO Autonomic Dysfunction 2. Normal CSF (GBS CSF=High Protein \> 40) 3. Can be **A**symmetrical (GBS=Symmetrical)

Question 97

CP of Cerebellar Damage - 7

Answer 97

Cere is def on **GRINDRR** **G**ait Ataxia IPSILATERAL **R**apid alternating mvmnt impairment **I**ntention tremor/Dysmetria IPSILATERAL **N**ystagmus IPSILATERAL (medial AND Lateral Vermis) **D**ysarthria (Lateral Vermis only) **R**ebound phenomenon (pt hits themself in face if flexing bicep and examiner releases arm-*image*) **R**eflex Pendular (knee swings \>4x after Deep tendon reflex is elicited) *Vermis is midline*

Question 98

Describe the "Clasp Knife" phenomenon ; What disease is this related to?

Answer 98

**Rapid SPASTIC** **RESISTANCE** to passive mvmnt of limb; UMN (Weak ME**S**H) Pyramidal Tract dz ## Footnote * Pyramidal Tract = Corticospinal and Corticobulbar* * Pronator Drift also indicates Pyramidal Tract Dz*

Question 99

Dx for Creutzfeldt Jakob disease - 6

Answer 99

1. [PRNP prion protein] genetic testing 2. EEG Biphasic vs Triphasic **sharp wave complexes** 3. Postmortem brain biopsy 4. ⬆︎CSF 14-3-3 proteins 5. MRI Cortical Ribbons 6. MRI basal ganglia hyperintensity

Question 100

[Creutzfeldt Jakob Dz] etx

Answer 100

PrP (prion protein), normally in neurons as [a-helical structure] converts--\> [**INFECTIOUS** **Beta pleated sheets**] --\> Protease resistance --\> Vacuoles in [**Gray** Matter Neurons & Neutrophils] develop --\> Cyst = [**Spongiform** Gray Matter]

Question 101

[Creutzfeldt Jakob Dz] CP - 2

Answer 101

[**RAPIDLY** Progressive Dementia] + [STARTLE Myoclonus] --\> DEATH ## Footnote *Can be Acquired vs. Inherited*

Question 102

[Amyotrophic Lateral Sclerosis] (Lou Gehrig's) etx - 2

Answer 102

1. Rare = [Superoxide Dismutase gene mutation] --\> copper-zinc dysfunction ---\>[Upper **AND** Lower Motor Neuron Disease!] 2. Common = Idiopathic ## Footnote *UMN Dz includes loss of neurons in motor nc. 5/9/10/12*

Question 103

*DDx of Neuromuscular Weakness has 5 origins* Describe **Upper Motor Neuron** causes of Neuromuscular weakness - 4

Answer 103

Question 104

*DDx of Neuromuscular Weakness has 5 origins* Describe **Anterior Horn Cell** causes of Neuromuscular weakness - 4

Answer 104

Question 105

*DDx of Neuromuscular Weakness has 5 origins* Describe **Peripheral Nerves** causes of Neuromuscular weakness - 5

Answer 105

Question 106

*DDx of Neuromuscular Weakness has 5 origins* Describe **Neuromuscular** **JUNCTION** causes of Neuromuscular weakness - 4

Answer 106

Question 107

*DDx of Neuromuscular Weakness has 5 origins* Describe **Muscle Fibers** causes of Neuromuscular weakness - 5

Answer 107

Question 108

Guillain Barre Tx - 2

Answer 108

IVIG vs Plasmapheresis ## Footnote *Guillain Barre CSF = HIGHLY ELEVATED Protein \> 40*

Question 109

What Spinal Columns are affected in [Subacute Combined Degeneration]?-3 ; How does this manifest?-3

Answer 109

[Su**BAC**ute Combined Degeneration] [Demyelinating lesions] in 3 **Thoracic** Spinal Columns: 1. [Dorsal--\> Loss of 2TVP] 2. [Lateral CST --\> UMN *Weak MESH* + Ataxia] 3. Spinocerebellar * FriEdreich Ataxia affects the SAME 3 columns*

Question 110

Causes of [Subacute Combined Degeneration] (3)

Answer 110

[Su**BAC**ute Combined Degeneration] ## Footnote 1) **B**12 Deficiency 2) **C**opper Deficiency 3) **A**IDS/HIV * Affects Dorsal / Lateral CST / Spinocerebellar Tracts (Combined)*

Question 111

Postconcussive syndrome can occur \_\_*(length of time)*\_\_ after any TBI (Traumatic Brain Injury). Describe CP for Postconcussive Syndrome - 4

Answer 111

hours-days; 1. Continued Confusion/Amnesia 2. HA 3. Mood changes 4. Vertigo *This is Self-Resolving*

Question 112

In pts with Traumatic Brain Injury (TBI), what's the major cause of morbidity?

Answer 112

**Diffuse axonal injury** at Gray-White matter junction *(since this is where density difference is highest​)* USE MRI FOR DX

Question 113

How long does it take Toradol to reach Max efficacy

Answer 113

3 hours *Dose = q4-6 hrs*

Question 114

*You suspect a baby has ingested Botulinum **spores*** What's the Clinical Presentation? - 4

Answer 114

1. Descending Flaccid Paralysis *(Floppy Baby)* 2. Ptosis 3. Poor Suck & Gag Reflex w/drooling 4. Constipation ## Footnote Tx = IMMEDIATE Botulinum Ig

Question 115

**Spinal Muscular Atrophy** etx and CP ; What's the difference between Infant type and Adult type

Answer 115

_[Spinal muscular atrophy]_ = specifically [ANT Horn Cell degeneration] from [*Chromo 5* SMN1 and 2 gene mutations]--\> LMN signs of FAW- ***W**eakness/[**a**trophy & areflexia] /**F**asciculations* *\**Infantile onset = (**Werdnig Hoffman**) --\> [Auto Recessive FATAL condition --\> *Floppy Baby* from defuse [Distal muscle atrophy] \*Milder childhood/adult onset types --\> [Non-fatal Chronic Disability]

Question 116

Why are Multiple Sclerosis pts at risk for BL Trigeminal Neuralgia

Answer 116

Demyelination may occur at Trigeminal **nucleus** --\> **BILATERAL** neuralgia ## Footnote *Sx will be disseminated in space and time*

Question 117

*After Getting Labs, NonContrast Head CT is next for dx unprovoked seizures* When would MRI be the better option? Name structural causes of epilepsy?-7

Answer 117

Use MRI in NONEmergent/elective situations; 1. Temporal Sclerosis-*shown in image* 2. Cortical Dysplasia 3. TBI (Traumatic Brain Injury) 4. Vascular Malformation 5. Infection 6. Tumor 7. Infarction

Question 118

[**LEMS** - Lambert Eaton Myasthenic Syndrome] etx

Answer 118

[Autoimmune attack against (Presynpatic Ca+ channel)--\> No ACh release]

Question 119

What other condition is [**LEMS**​ - Lambert Eaton Myasthenic Syndrome] associated with?

Answer 119

"**LEMS** has a good **SOLC**(soul)" **SOLC**-**S**mall **O**at cell **L**ung **C**arcinoma

Question 120

Name 4 Differentiating Factors for Myasthenia Gravis vs. [Lambert Eaton Myasthenic Syndrome]

Answer 120

1. [LEMS] improves with exercise/exertion during the day! 2. [LEMS] will show **no imprvmnt** with [Tensilon Edrophonium] injection OR ice pack 3. [LEMS] nerve testing shows **INC** muscle responses 4. [LEMS] has autonomic dysfunction (orthostasis, dry mouth, impotence)

Question 121

What other condition is [Myasthenia Gravis] associated with?

Answer 121

May cause Thymoma (thymic hyperplasia)

Question 122

[Myasthenia Gravis] etx ; Demographic?-2

Answer 122

Autoantibodies block and degrade [**postsynpatic** _nicotinic_ ACh Receptors]] --\> [⬇︎ motor end plate potential] ## Footnote *Presents in [Women 20-30] and [Men 60-80]*

Question 123

[Myasthenia Gravis] Clinical Presentation (6)

Answer 123

**P DDD WF** [**P**tosis [**D**iplopia from Disconjugate gaze] **D**ysarthria-*bulbar dysfunction* **D**ysphagia w/nasal regurgitation-*bulbar dysfunction* [**W**eakness Muscularly (Extraocular/RESPIRATORY/Proximal/ limbs /)] [**F**ATIGABLE Weakness Muscularly (worst w/repetition)] *Tx: Pyridostigmine AChesterase inhibitor*

Question 124

[**LEMS** - Lambert Eaton Myasthenic Syndrome] Clinical Presentation - 3

Answer 124

1. **Weakness of [Proximal limbs and trunk]** mimicking myopathy, better with exercise 2. Autonomic sx (Dry mouth /Orthostasis / Impotence) 3. ⬇︎Deep Tendon Reflexes

Question 125

*You suspect a pt had a Stroke* After FIRST, ruling out Hemorrhagic stroke with \_\_\_\_\_, when should thrombolytic therapy be given? What should be given?

Answer 125

NonContrast Head CT; **WITHIN 4.5 HOURS OF SX ONSET!** ; IV Alteplase

Question 126

How are HTN and DM mngmnt related to Acute CVA/TIA - 2

Answer 126

BP \> 185/110 in setting of stroke can --\> ICH - so Use Labetalol & Hyperglycemia augments brain injuries (*so ONLY use **Non**Dextrose IVF*)

Question 127

What is Therapeutic hypOthermia often used for? ; How low of temp can you go? ; SE of this?-4

Answer 127

Prevents hypoxic Brain injury in pts with [**out of hospital** cardiac arrest] ; 32C ; 1. HYPERKalemia 2. ⬇︎Cardiac Output 3. ⬆︎Coagulation 4. Immunosuppression

Question 128

Homocystinuria Clinical presentation-5 ; tx-2?

Answer 128

auto recessive [Cystathionine synthase] deficiency --\> Thromboembolism--\> Stroke 1. Marfanoid habitus (elongated limbs, arachnodactyly, scoliosis) 2. Stroke 3. Fair Hair & Eyes 4. Ectopia Lentis 5. Retarded tx = [Pyridoxine B6] + AntiCoag

Question 129

Homocystinuria dx-2

Answer 129

auto recessive [Cystathionine synthase] deficiency --\> Thromboembolism--\> Stroke ⬆︎ Homocysteine and Methionine

Question 130

Name the Differences in CP between Marfan and Homocystinuria - 3

Answer 130

1. Marfan are not retarded 2. Marfan has no Stroke Risk 3. Marfan are not fair complexion

Question 131

Tay-Sachs etx ; CP-3

Answer 131

auto recessive B-hexosaminidase A deficiency --\> 1. **Cherry Red Macula** 2. Seizures 3. Retarded

Question 132

Pronator Drift is a good indicator of what type of disease?

Answer 132

UMN Pyramidal Tract Dz (think stroke) * Pyramidal Tract = Corticospinal and Corticobulbar* * Clasp Knife phenomenon also indicates Pyramidal Tract Dz*

Question 133

Etx of Parkinsons Disease

Answer 133

[**LABS** (**L**ewy **α****-**synuclein**B**odie**S**)] accumulation in [substantia nigra pars compacta] --\>degeneration --\> ⬇︎Dopamine release and ⬇︎ stimulation of Striatum which --\> allows Globus pallidus internal to continuously inhibit [VA/VL Thalamus from stimulating motor cortex]

Question 134

*There are 3 Dopamine D₂ pathways in the brain* Name the pathways ; what overall effect do they have when activated?

Answer 134

Stimulation of.... **Mesolimbic** = Psychosis **Nigrostriatal** = Mvmnt Coordination **Tuberoinfundibular** = INHIBITS Prolactin when activated (*if blocked --\> infertility from hyperprolactinemia*)

Question 135

How is [Apolipoprotein E] related to Alzheimers

Answer 135

Apo E --\> impaired synthesis and clearance of AB-amyloid ---\> INC risk for **LATE** onset Alzheimers

Question 136

Alzheimer's Dz etx (3)

Answer 136

Alzheimers etx = **CHA** \*\***C**leavage, **H**emorrhage, (**A**Ch⬇︎) \*\* 1. **C**leavage of [**chromo 21** transmembrane amyloid precursor glycoprotein] --\> β-**amyloid** which accumulates--\> [Neuritic Senile plaques] in temporal lobe early on. 2. **H**emorrhages Spontaneously occur in **Occipital/Parietal** lobes (*image*) from β-**amyloid** deposition in cerebral vessels 3. **A**Ch ⬇︎ in the [Basal nc. of Meynert] & Hippocampus 2/2 β-amyloid accumulation --\> defective [Choline Acetyltransferase] in those areas --\> Alzheimer Sx (CLAV--\>HANDU)

Question 137

What type of Hemorrhage is shown in image ; What is this typically associated with?

Answer 137

**Lobar** Hemorrhage (parietal) ; Amyloid Angiopathy 2/2 Alzheimers

Question 138

Hypokalemic periodic paralysis CP-2 ## Footnote *Occurs right after vigorous activity*

Answer 138

1. **SUDDEN** generalized muscle weakness + 2. ⬇︎ Deep Tendon Reflexes ## Footnote *Occurs right after vigorous activity*

Question 139

Benzos can cause an *uncommon* SE known as **Paradoxical Agitation**. Describe this

Answer 139

[⬆︎Agitation, confusion and disinhibition] within a hour of benzo admin. GIVING MORE BENZOS WILL WORSEN THIS!

Question 140

What is a Cephalohematoma? Tx?

Answer 140

Neonatal SubPeriosteal Hemorrhage **limited to 1 cranial bone (i.e. does NOT cross suture lines)** that onsets **hours** after birth and presents as scalp swelling +/- ⬆︎jaundice; Tx = Nothing, since it self-resorbs within 2 weeks-3 mo.

Question 141

Cerebellar infarction of **medial** vermis presents as \_\_\_\_\_-2

Answer 141

1. Nystagmus 2. Vertigo

Question 142

Cerebellar infarction of **Lateral** vermis presents as \_\_\_\_\_-6

Answer 142

Cere is def on **GRINDRR** **G**ait & Coordination Ataxia - IPSILATERAL **R**apid alternating mvmnt impairment **I**ntention tremor/Dysmetria - IPSILATERAL **N**ystagmus (medial AND Lateral Vermis infarcts) **D**ysarthria (Lateral Vermis only) **R**ebound phenomenon **R**eflex Pendular (knee swings \>4x after Deep tendon reflex is elicited) *Intention tremor = worst as finger moves closer to target* ​

Question 143

Describe Features of **BENA** (**Brocas Expressive NonFluent Aphasia)** -4

Answer 143

1. Right Hemiparesis 2. Nonfluent speech 3. Impaired Repetition 4. Impaired Naming ## Footnote *BENA = Dominant Inferior Frontal*

Question 144

Describe Features of **Wernickes Aphasia** - 3

Answer 144

1. R SUP homonymous quadrantanopia 2. Comprehension problems 3. Impaired Repetition ## Footnote *Conductive AND Wernicke Area = Dominant SUP Temporal*

Question 145

Describe Features of **CONDUCTION** **Aphasia**

Answer 145

**VERY POOR** Repetition ## Footnote *This is in addition to Fluent but many phonemic errors*

Question 146

Status Epilepticus clinical criteria?-2

Answer 146

1. Single seizure \> **5** min OR 2. Cluster of Seizures w/ no return to baseline in between episodes ## Footnote *Image showing Cortical Laminar Necrosis s/p Status Epilepticus*

Question 147

What is the long term outcome of status epilepticus on the brain? ; Dx for this?

Answer 147

Cortical laminar necrosis ; MRI w/cortical **hyper**intensity

Question 148

What is the most common cause of ICH in kids?

Answer 148

ArterioVenous Malformation

Question 149

Identify ; Which are Lenticulate and which are Striatum?

Answer 149

*"**G**ay **P**eople **C**ook!" = Basal Ganglia* ***G**ay **P**eople=Lenticulate // **P**eople **C**ook= Striatum* * e_g = **G**lobus Pallidus * e_s = **P**utamen * d = **C**audate

Question 150

Tx for Cluster HA *- 1st, 2nd and 3rd choice*

Answer 150

**1st = 100% O₂ Nasal Canula** 2nd = Sumatriptan 3rd = NSAIDs Px = Verapamil

Question 151

Px for Cluster HA

Answer 151

Verapamil ## Footnote *Also Px for Migraines*

Question 152

Describe CSF analysis for **Guillain Barre** Glucose Protein WBC count

Answer 152

**GPW** Normal **G**lucose / ⬆︎⬆︎**P**rotein / Normal **W**BC

Question 153

What are the **Normal** CSF lab ranges Glucose Protein WBC count

Answer 153

**GPW** **G**lucose: 40-70 **P**rotein: \<40 **W**BC: 0-5

Question 154

Describe CSF analysis for **Bacterial** Meningitis Glucose Protein WBC

Answer 154

**GPW** **⬇︎G**lucose / ⬆︎**P**rotein / ⬆︎**W**BC \>1000

Question 155

Describe CSF analysis for **TB** meningitis Glucose Protein WBC count

Answer 155

**GPW** **⬇︎G**lucose / ⬆︎**P**rotein / ⬆︎**W**BC

Question 156

Describe CSF analysis for **Viral** meningitis Glucose Protein WBC count

Answer 156

**GPW** Normal **G**lucose / ⬇︎ **P**rotein / ⬆︎**W**BC (Lymphocytes) *Note: HSV actually has⬆︎Protein and ⬆︎ RBC also from temporal lobe destruction*

Question 157

Neonatal Intraventricular Hemorrhage occurs in premies **less than** ___ weeks gestation or **less than** ___ grams. Px?

Answer 157

\< 30 weeks vs 1500g ; Antenatal Maternal Corticosteroids ## Footnote * Normal Gestation = 40 weeks* * Image: BL IVH & Dilated Vt*

Question 158

Etx of Intraventricular Hemorrhage in premature babies less than _____ weeks or ___ grams

Answer 158

\< 30 weeks vs 1500g ; Subependymal germinal matrix contains thin-walled vessels that easily rupture. Normally, these migrate before birth, but in premies they never have the chance which --\> IVH --\> ⬇︎Arachnoid CSF absorption --\> Communicating Hydrocephalus ## Footnote * Normal Gestation = 40 weeks* * Image: BL IVH & Dilated Vt*

Question 159

Choroid plexus cyst are identified ___ trimester and a marker for ____ in babies. How do they affect the baby?

Answer 159

second; Aneuploidy; They don't affect baby. Regressess spontaneously and is benign ## Footnote *Dark holes = Cyst*

Question 160

What are the 7 major complications of Newborn Prematurity ## Footnote *Less than 32 weeks gestation specfically*

Answer 160

**BURPPIN** ## Footnote **B**ronchopulmonary Dysplasia **U**cantBreathe (Neonatal Respiratory Distress Syndrome) **R**etinopathy * *P**atent Ductus Arteriosus * *P**alsy CEREBRAL **I**ntraventricular Hemorrhage **N**ecrotizing Enterocolitis (⬆︎gastric residual volume with abd distension)

Question 161

How do Traumatic Carotid Injuries occur?-3 ; Dx-2 ## Footnote *Image: Carotid Dissection*

Answer 161

1. Penetrating Trauma 2. Oropharyngeal trauma (falling w/object in mouth) 3. Neck Strain (yoga, sports) Dx = CT angio vs MR angio *These will present like Strokes*

Question 162

Lewy Body Dementia Tx

Answer 162

**Rivastigmine** AChinesterase inhibitor

Question 163

What are the hallmark pathological findings for Alzheimers-2

Answer 163

[**Tau** Neurofibrillary tangles] & [Neuritic Senile Plaques]

Question 164

Most serious complication of Guillain Barre? How do you determine when this complication gets really bad?

Answer 164

Respiratory Failure; FVC ≤ **20** mL/kg via **SPIROMETRY** means intubate! ## Footnote *HR, BP, Quadriparesis, FACIAL palsy are other serious complications*

Question 165

***Levodopa** is used to treat Parkinson's Disease* Early SE?-3 ; Late SE

Answer 165

Early SE *(HAD)* = Hallucinations/Agitation/Dizziness Late SE (5-10 yrs post tx) = Involuntary mvmnts

Question 166

Dx for VitB12 deficiency - 3

Answer 166

1. [⬆︎ **Methylmalonic Acid levels**] 2. CBC showing Macrocytic Anemia 3. Serum Vitamin levels

Question 167

*There are 3 Main causes of Spinal Cord Compression* Dx for Spinal Cord Compression-3

Answer 167

1. MRI 2. Classic S/S (BLE weakness, Worst w/spinal extension, better w/flexion, UMN signs) 3. Positive Straight Leg ## Footnote *Note: In Acute Cord Compression, pts will have spinal SHOCK x3days = AReflexia and Flaccid paralysis*

Question 168

*Brain Death is a clinical diagnosis and involves absent cortical and brain stem functions* T or F: Positive Deep Tendon Reflexes excludes a patient from being Brain Dead

Answer 168

FALSE! - Brain Death is limited to Cortex and Brainstem. **Spinal Cord can still be functioning** in Brain Death

Question 169

[Myasthenia Gravis] Tx-4

Answer 169

**P DDD WF** ## Footnote 1st: Pyridostigmine AChesterase inhibitor 2nd: Cyclosporine 3rd: Thymectomy \*\*[Intubate + Plasmapharesis + IVIG + Steroids] if Crisis \*\*

Question 170

HemiNeglect Syndrome

Answer 170

Stroke in **R Parietal Cortex (NonDominant hemisphere)** --\> Neglect of anything on the Left side ## Footnote *This is only in R handed people. It's opposite for L handed*

Question 171

*Usually Partial Seizures originate in a **single** hemisphere* **Simple** Partial Seizures may present as what 3 things?

Answer 171

1. Motor ∆ (head turning) - no LOC 2. Sensory ∆ (paresthesias)- no LOC 3. Autonomic ∆ (sweating)- no LOC

Question 172

Juvenile Myoclonic Epilepsy CP ; When do they occur mostly? ; Demographic?

Answer 172

Generalized Seizures +/- Absence seizures, **most frequently in 1st hour after waking** ; Teens

Question 173

Lennox Gastaut CP-2 ; Dx?

Answer 173

**L**ennox **G**astaut 1. **L**ala Land Retarded 2. **G**eneralized Tonic Clonic Seizures SEVERE Presents by 5 yo ; Slow Spike-Wave EEG

Question 174

Most common [1° CNS Tumors] in Adults (3)

Answer 174

**GMS** **G**lioblastoma astrocytoma (GRADE 4 - MALIGNANT - 2nd MOST COMMON to Metastasis) **M**eninGioma benign **S**ChWannoma *Brain Metastasis=MOST COMMON ADULT BRAIN CA*

Question 175

Glioblastoma Radiographic Findings - 2

Answer 175

1. **Butterfly lesion** from crossing Corpus Collosum 2. Midline shift from Lateral Vt Compression * GBM is usually a HIGH GRADE Astrocytoma*

Question 176

What's the marker for Glioblastoma astrocytoma?

Answer 176

**GFAP**

Question 177

List the n. roots associated with Common Peroneal n.

Answer 177

L4-S2 foot is drop**PED** (**P**eroneal **E**verts & **D**orsiflexes) * Commonly caused by L**5** Radiculopathy* * Dx: Knee MRI vs EMG*

Question 178

List the n. roots associated with Tibial n.

Answer 178

L4-S3 (**T**hree) can't walk on **TIP**toes (**T**ibial **I**nverts & **P**lantarflexes) *Commonly caused by L5 Radiculopathy*

Question 179

A: List the n. roots associated with [SUP Gluteal n.] B: Associated Injury (2) C: Sensory deficit D: Motor Deficit (2)

Answer 179

**[SUP Gluteal nerve]** A: L4-S1 B: [Superomedial Butt injection] vs. POST Hip dislocation C: none :-) D: [Trendelenburg gait] & [No Thigh ABduction]

Question 180

A: List the n. roots associated with [inferior Gluteal n.] B: Associated Injury (2) C: Sensory deficit D: Motor Deficit

Answer 180

**[inferior Gluteal nerve]** A: L4-S2 B: Butt injection vs. POST Hip dislocation C: none :-) D: [No Thigh Extension]

Question 181

Most common [1° CNS Tumors] in Pediatrics-3 ; what's the only one that's supratentorial?

Answer 181

**PED**s **P**ilocytic Astrocytoma = MOST COMMON and can be Supratentorial OR infratentorial **E**pendymoma (found in 4th Vt) me**D**ulloblastoma PNET = 2nd most common ***E**pendymoma and me**D**ulloblastoma are infratentorial POST fossa(image)*

Question 182

Where are Brain Metastasis typically found? - 2

Answer 182

Gray White Junction vs Watershed Zones ## Footnote * Brain metastases are multifocal and spherical* * Most common= [LUNG NonSOLC] \> Breast/Colon/Kidney/Melanoma*

Question 183

Which grade Astrocytoma is this? How can you tell? CP?

Answer 183

**LOW** grade astrocytoma; it has NO CONTRAST ENHANCEMENT ; Seizures

Question 184

Which disorder results in a Waddling gait and why?

Answer 184

Muscular dystrophy; Gluteal m weakness ## Footnote *Waddling Gait = walks like Penguin from Batman*

Question 185

Describe En-Bloc Gait ; What type of ataxia is this?

Answer 185

Minimal mvmnt of head while walking w/staggering gait; Vestibular Ataxia ## Footnote *Will be accompanied w/Vertigo & Nystagmus*

Question 186

What is Pseudodementia?

Answer 186

Severe Depression in Elderly tht **mimics Alzheimers** **dementia**. Elderly come in c/o SLEEP PROBLEMS, memory loss and attention problem, but really have depression ## Footnote *Tx = SSRI*

Question 187

How does hypOthyroidism affect Neuro system - 4

Answer 187

1. it causes ⬇︎ in DTR 2. ⬇︎ motor relaxation phase 3. Mood ∆ 4. Dementia

Question 188

Long term SE of **resolved** Bacterial Meningitis - 3

Answer 188

1. ⬇︎ Cognition (Retardation, Milestone regression) 2. Hearing loss 3. Seizures

Question 189

What is the main factor for differentiating Seizure vs Syncope

Answer 189

Seizure will have **DELAYED RETURN to baseline 2/2 postictal state** (confusion, focal neuro deficits, lethargy) ## Footnote *Seizure may also have olfactory aura & tongue lacerations*

Question 190

Pts with Myasthenia Gravis may develop Myasthenia CRISIS, which presents clinically as ______ !!! What are precipitants of this?-3

Answer 190

**P DDD WF** Respiratory Failure! Precipitants = FIS: 1. Fluoroquinolones 2. Infection 3. Surgery *Crisis Tx: [Intubate + Plasmapharesis + IVIG + Steroids]*

Question 191

Memantine MOA ; Indication

Answer 191

Blocks Glutamate from binding to NMDA Receptor; Moderate to Severe Alzheimer's

Question 192

*Vascular Dementia presents with ⬇︎executive function and dementia just like other Neuro Disorders* What is the differentiating factor for separating Vascular Dementia from other Neuro Disorders? - 2

Answer 192

VaD has [**asymmetric, focal neuro ⬇︎**]and is **abrupt**

Question 193

What causes **Charcot Bouchard Aneurysms**? Rupture of these leads to what?

Answer 193

**C**harcot **B**ouchard **T**ears **P**ink Uncontrolled HTN ; [Intraparenchymal HTN Hemorrhage]

Question 194

*Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations* Describe CP for Charcot Bouchard Aneurysm ruptured in Basal Ganglia? - 3

Answer 194

Uncontrolled HTN --\> Charcot Bouchard Aneurysm --\> [Intraparenchymal HTN Hemorrhage] **C**harcot **B**ouchard **T**ears **P**ink **B**asal Ganglia 1. CTL Hemiparesis 2. CTL ⬇︎ Sensory 3. Eye Deviation **TOWARD** side of lesion *Acute [Intraparenchymal HTN Hemorrhage] in image*

Question 195

*Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations* Describe CP for Charcot Bouchard Aneurysm ruptured in Cerebellum? - 7

Answer 195

Uncontrolled HTN --\> Charcot Bouchard Aneurysm --\> [Intraparenchymal HTN Hemorrhage] **C**harcot **B**ouchard **T**ears **P**ink **C**erebellum Cere is def on **GRINDRR** **G**ait & Coordination Ataxia - IPSILATERAL **R**apid alternating mvmnt impairment **I**ntention tremor/Dysmetria - IPSILATERAL **N**ystagmus (medial AND Lateral Vermis) **D**ysarthria (Lateral Vermis only) **R**ebound phenomenon **R**eflex Pendular (knee swings \>4x after Deep tendon reflex is elicited *Acute [Intraparenchymal HTN Hemorrhage] in image*

Question 196

*Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations* Describe CP for Charcot Bouchard Aneurysm ruptured in Thalamus? - 3

Answer 196

Uncontrolled HTN --\> Charcot Bouchard Aneurysm --\> [Intraparenchymal HTN Hemorrhage] **C**harcot **B**ouchard **T**ears **P**ink **T**halamus 1. CTL Hemiparesis 2. \*\*Eye Deviation **T**oward Hemiparesis\*\* 3. **Nonreactive** Miosis *Acute [Intraparenchymal HTN Hemorrhage] in image*

Question 197

*Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations* Describe CP for Charcot Bouchard Aneurysm ruptured in Pons? - 3

Answer 197

Uncontrolled HTN --\> Charcot Bouchard Aneurysm --\> [Intraparenchymal HTN Hemorrhage] **C**harcot **B**ouchard **T**ears **P**ink **P**ons 1. **P**inpoint REACTIVE pupils (*damaged descending sympathetic fibers*) 2. Coma 3. Total Paralysis *Acute [Intraparenchymal* *HTN Hemorrhage] in image*

Question 198

[Cauda Equina Syndrome] etx ; Clinical Presentation - 5

Answer 198

(Compression of S2 - S4 n. roots @ Cauda Equina) --\> 1. **hypOreflexia** (*Conus Medullaris syndrome has HYPEReflexia*) 2. **LATE** onset incontinence 3. **Asymmetrical** Motor weakness 4. Radiculpathy 5. Saddle Anesthesia w/loss of Anocutaneous reflex *Tx: MRI, IV Corticosteroids, Neurosurg consult*

Question 199

[Conus Medullaris Syndrome] etx ; Clinical Presentation - 5

Answer 199

(Compression of S2 - S4 n. roots @ Conus Medullaris) --\> 1. **HYPEReflexia** (*Cauda Equina syndrome has hypOreflexia*) 2. **EARLY** onset incontinence 3. **SYMMETRICAL** Motor weakness 4. Radiculpathy 5. Saddle Anesthesia w/loss of Anocutaneous reflex *Tx: MRI, IV Corticosteroids, Neurosurg Consult*

Question 200

Genetic cause for [Fragile X]

Answer 200

[CGG repeat] --\>[FMR1 gene Methylation] on [X Chromo long arm] --\>small gap near tip of [X Chromo long arm]

Question 201

Fragile X CP - 5

Answer 201

**X**-Large... ## Footnote 1. Personality (Autism, ADHD) 2. Ears 3. Forehead 4. Chin (long face) 5. Testes *Etx: C-GG repeat*

Question 202

Friedreich Ataxia involves Degeneration of the \_\_\_\_\_\_, [\_\_\_\_ and ____ spinal columns]

Answer 202

Fri**E**dreich Ataxia involves Degeneration of the [**Dorsal**, **Lateral CST** and **Spinocerebellar** spinal columns] ## Footnote * Fri**E**drecih is **Frat**astic! He's your fav. **twisted** **frat** brother, always **studdering** and **falling**, but has a **sweet**, **big heart*** * SuBACute Combined Degeneration affects SAME 3 columns*

Question 203

Deficency of what Vitamin mimics Friedreich Ataxia

Answer 203

Fri**E**dreich Ataxia Vitamin **E** (will also have Hemolytic anemia) * [Chromo 9 Auto Recessive]* * SuBACute Combined Degeneration affects SAME 3 columns*

Question 204

Describe Friedreich Ataxia (8)

Answer 204

Fri**E**dreich is **Fratastic**! He's your fav., **twisted,** **frat** brother, always **studdering** and **falling**, but has a **sweet**, **big heart** Fri**E**dreich = [Vitamin **E** Deficiency] mimics it **Fratastic** has 9 letters = [Chromo 9 Auto Recessive] **twisted** = Kyphoscoliosis @ childhood **frat** = [**frataxin** (**iron binding protein**) defect] **studdering** = Dysarthria **falling** = [Falls & Ataxia + (Pes Cavus High Foot Arch)] **sweet** = DM **big heart** = Hypertrophic Cardiomyopathy *Involves Degeneration of [Dorsal, Lateral CST & Spinocerebellar]*

Question 205

Friedreich Ataxia Mode of Inheritance

Answer 205

Fri**E**dreich Ataxia [Chromo 9 Auto Recessive] *SuBACute Combined Degeneration affects SAME 3 columns*

Question 206

[Shy Drager Multiple System Atrophy] CP - 3

Answer 206

1. Multiple System Atrophy 2. [Parkinsonism **tht doesnt respond to dopaminergic rx**] 3. [Autonomic Dysfunction (orthostasis, impotence, incontinence)] ## Footnote * Tx = intravascular volume expansion to treat orthostasis* * DO NOT CONFUSE WITH [RILEY DAY FAMILIAL DYSAUTONOMIA] WHICH HAS NO PARKINSONISM*

Question 207

[Riley Day Familial Dysautonomia] CP

Answer 207

Autonomic Dysfunction (orthostasis, impotence, incontinence) ## Footnote *auto recessive in kids of Ashkenazi Jewish decent*

Question 208

[Riley Day Familial Dysautonomia] Mode of inheritance ; demographic

Answer 208

auto recessive ; kids of Ashkenazi Jewish decent

Question 209

[Myasthenia Gravis] Dx-5

Answer 209

P DDD WF 1. **ACh R Ab Assay** 2. **MuSK** (**Mu**scle-**S**pecific tyrosine **K**inase) **Ab Assay** (only if #1 is neg) 3. [**Tensilon Edrophonium**]--\> Improves all sx 4. **Ice Pack** to eyelids --\> Improves Ptosis by inhibiting ACh breakdown at NMJ 5. *BE SURE TO GET **CT CHEST** AFTER DX TO COVER FOR THYMOMA, POSSIBLE THYMECTOMY!!!!*

Question 210

What are the causes of Oculomotor CN3 palsy?-5 ; CP?-3

Answer 210

1. POST communicating artery aneurysm 2. TUMTL herniation 3. PCA occlusion 4. Cavernous Sinus Thrombosis 5. DM n. central ischemia (will NOT have Dilated Eye) **DOP + Dilated**: Down & Out Eye + Ptosis + Dilated Eye

Question 211

Amaurosis Fugax CP ; etx

Answer 211

Painless, transient ( \< 10 min) monocular vision loss characterized as curtain being descended over eye ; Carotid Artery atherosclerotic emobil

Question 212

Ocular Tonometry indication

Answer 212

Measuring intraocular pressure in acute angle-closure glaucoma ## Footnote *Image: Acute Closed Angle Glaucoma*

Question 213

Name the 3 components of **EPS**-**E**xtra**P**yramidal**S**ymptoms

Answer 213

EPS = **DAD** [**D**rug-induced Parkinsonism] **A**kathisia (restlessness) **D**ystonia (sudden twisted posture worst with activity) *Tx = Benztropine vs Diphenhydramine*

Question 214

What is **EPS** caused by, and which drugs are the most likely to cause it?

Answer 214

[Blocking Nigrostriatal D₂]; [1st generation Antipsychotics (Haloperidol/Fluphenazine)]

Question 215

Congenital Torticollis etx

Answer 215

**Malpositioning of Head in Utero vs During birth** --\> constant contraction of SCM--\>Lateral Neck swelling ## Footnote *Torticollis also possible in Adults*

Question 216

Describe Athetosis ; What disease is it seen in?

Answer 216

Slow, writhing mvmnts of hands & feet often occuring **with** Chorea (*Choreoathetosis*) ; Huntington's

Question 217

Tourette Syndrome CP

Answer 217

Tics - BOTH MOTOR AND VOCAL AT SAME TIME ! ## Footnote (Vocal and Motor-shoulder shrugs/blinking/grimacing/[**coprolalia swearing**])​

Question 218

*Neonate comes in with Hydrocephalus, delineated by bulging fontanelles* Dx? Tx?

Answer 218

Dx: Head CT ; Tx: Ventricular Shunt

Question 219

Describe the difference between Cyanotic and Pallid [Breath Holding Spells]. ; Demographic for these?

Answer 219

**_C_**yanotic: ****_C_**rying** --\> Breath Holding, **_C_**yanosis, [LOC 2/2 syncope] **_P_**allid: ****_P_**ain from m****inor trauma** --\> Breath Holding, pallor, diaphoresis & [LOC 2/2 syncope] 6 mo - 2 yo *sometimes associated w/ iron deficiency anemia*

Question 220

ACA occlusion CP-3

Answer 220

1. CTL Weakness worst in LE 2. CTL Numb worst in LE 3. Urinary Incontinence

Question 221

ASA occlusion CP-2 ; Which syndrome is this?

Answer 221

*AKA MEDIAL Medullary Syndrome* 1. CTL UE & LE **Weakness** 2. Ipsilateral hypoglossal loss

Question 222

AICA occlusion CP-4

Answer 222

*Somewhat like PICA Lateral Medullary Syndrome of Wallenberg* 1. FACE Paralysis (Similar to Bells Palsy) 2. Ipsilateral ⬇︎Facial Pain/Temp 3. CTL ⬇︎BODY Pain/Temp 4. Hearing Loss

Question 223

Basilar Artery occlusion CP

Answer 223

Locked In Syndrome!!! (preserved consciousness but with quadriplegia)

Question 224

PICA occlusion CP-8 what other vessel abnormality can cause the same CP?

Answer 224

*This is AKA Lateral Medullary Syndrome of Wallenberg* 1. **Ipsilateral ⬇︎Facial Pain/Temp** 2. **CTL ⬇︎BODY Pain/Temp** 3. **Ipsilateral Horner (ptosis/anhidrosis/miosis)** 4. Vertigo 5. Nystagmus 6. Ataxia 7. Dysphagia 8. Dysphonia w/vocal tics **Intracranial Vertebral A occlusion** = MOST COMMON CAUSE OF THIS!

Question 225

PCA occlusion CP-3

Answer 225

1. CTL Homonymous Hemianopia + Visual hallucinations 2. Alexia only (NO agraphia) (Dominant Hemisphere involved) 3. Down & Out Eye + Ptosis (Oculomotor CN3 involved)

Question 226

What are the most common origins of Brain Metastasis?-5 ; Which of these present as **MULTIPLE** (not solitary) brain metastasis?-2

Answer 226

Most common= [LUNG NonSOLC]\>Breast/Colon/Kidney/Melanoma ## Footnote [Lung NonSOLC] & Melanoma --\> multiple rare = Oropharyngeal

Question 227

In comparing Ischemic Stroke to Hemorrhagic Stroke CP, both have \_\_\_\_\_. What are the differentiating factors?-2

Answer 227

Both = Focal neuro ∆ Hemorrhagic Stroke ALSO has [worsening **HA** + **AMS** from ⬆︎ICP] *Remember: ANY Suspicion of Stroke warrants NonContrast Head CT*

Question 228

Benztropine & Trihexyphenidyl are in what class of drugs? How can pts on these develop Retro-Orbital HA during OD?

Answer 228

Anticholinergics; OD can --\> Acute Glaucoma --\> RetroOrbital HA ## Footnote * Red as a beet, Dry as a bone, Hot as a hare, Blind as a bat, Mad as a hatter, Full as a flask* * Image: Acute Closed Angle Glaucoma*

Question 229

Bromocriptine MOA ; Indication

Answer 229

Dopamine PostSynaptic R Agonist ; Parkinson's

Question 230

**Serotonin Syndrome** Clinical Presentation (8)

Answer 230

"Serotonin gave me the **SHIVERS**!" ***S**hivering* [**H**yperreflexia & Myoclonus] **I**NC Temp *[**V**itals instability] (tachycardia vs. tachypnea vs. HTN)* ***E**ncephalopathy (Confusion vs. Agitation)* **R**estlessness **S**weating *Italicized = Triad Sx*

Question 231

How do you treat *Refractory* Serotonin Syndrome

Answer 231

Cyproheptadine (antihistamine with anti-serotonergic properties)

Question 232

Describe Neuroleptic Malignant Syndrome - 5

Answer 232

RARE SE of Any Dopamine Blocker (Antipsychotics vs. GI meds) that --\> **FEVER** - [**F**ever \> 40C] - **E**ncephalopathy (Confusion) - **V**itals unstable (INC HR / RR / BP from autonomic dysfunction) - **E**nzymes ⬆︎ (CPK) - [**R**igitidy lead pipe] (Tremor)

Question 233

What's the best way to approach treatment for [Neuroleptic Malignant Syndrome]-2

Answer 233

Treat [Rigiditiy lead pipe] with Dantrolene (inhibits Ca+ release from sk. muscle sarcoplasmic reticulum) + supportive care

Question 234

Stiff Person Syndrome etx

Answer 234

**RARE** autoimmune Disorder

Question 235

Identify disease

Answer 235

**L**isch nodules seen in Neurofibromatosis TYPE 1 **CLAP** **ON** type 1!

Question 236

Ulnar Nerve Syndrome typically occurs at the \_\_\_\_\_, usually from what scenario? CP-3?

Answer 236

**ELBOW** (where ulnar n lies at medial epicondylar groove before passing thru cubital tunnel) ; Leaning on Elbows at desk ## Footnote 1. numbness over medial forearm 2. numbness over 4th and 5th digits 3. Weak Grip of ipsilateral hand (Atrophy of hypothenar vs 1st dorsal interosseous m) *May also occur at forearm in DM pts*

Question 237

What is the most common cause of Fatal Sporadic Encephalitis in the U.S.? Should you use CT or MRI for dx?

Answer 237

Herpes Encephalitis ; MRI **(and then CSF PCR=Gold Standard Dx)**

Question 238

Tx for **Single** Brain Metastasis (likely from ____ primary) - 3

Answer 238

Surgery --\> [(SRS) Stereotactic RadioSurgery] vs Whole Brain Radio * Likely from [Lung NonSOLC] primary* * Use SRS first in non-surgical candidates*

Question 239

Tx for **Multiple** Brain Metastasis (likely from ____ primary)

Answer 239

Whole Brain Radio *Likely from [Lung NonSOLC] primary*

Question 240

Between DM, Smoking and HTN, which carries the GREATEST STROKE Risk?

Answer 240

**HTN**

Question 241

A: Describe **Opsoclonus-Myoclonus Syndrome** B: What Childhood tumor is it associated with?

Answer 241

A: [Non-Rhythmic Conjugate Eye mvmnts] with myoclonus= "**Dancing Eyes and Feet**" B: Neuroblastoma (onset 2 y/o) *Arises from Neural crest*

Question 242

Neuroblastoma Dx - 3

Answer 242

1. Calcifications on Radioimaging (Xray/CT) 2. ⬆︎ VMA and Homovanillic acid catecholamines 3. Amplification of N-myc protoOncogene

Question 243

Metanephros is the precursor of the \_\_\_. What tumor is associated with this?

Answer 243

Me**T**anephros Renal Parenchyma **T**issue ; Wilms' tumor

Question 244

Me**S**onephros is the precursor of the ___ - 3

Answer 244

**S**eminal Vesicles / Ejaculatory ducts / Vas Ductus Deferens

Question 245

ParaMesonephron is the precursor of the ___ - 3

Answer 245

Fallopian Tubes / Uterus / Part of Vagina

Question 246

Name the classic sx of ICH (IntraCranial HTN) - 4

Answer 246

1. Positional HA **worst at night/morning** 2. NV 3. AMS 4. Papilledema/Vision ∆

Question 247

S/S of Acute Angle Closure Glaucoma - 3

Answer 247

1. RetroOrbital HA w/⬇︎Vision 2. Conjunctival Erythema 3. Dilated pupil poorly responsive to light ## Footnote *Occurs in Pts \> 60 yo*

Question 248

Pts with Cerebellum lesions have _____ (*ContraLateral vs Ipsilateral*) Hemiataxia. Why is this? ; Why are Cerebellar hemorrhages so dangerous?

Answer 248

**IPSILATERAL** ; CorticoPontoCerebellar fibers decussate TWICE ; May extend down into brainstem --\> Coma & Death ## Footnote *Image: L Cerebellar hemorrhage --\> L hemiataxia*

Question 249

Identify

Answer 249

image

Question 250

Identify

Answer 250

A: Thalamus B: Dorsal Midbrain C: Pons D: Dorsal Medulla E: Cerebellum

Question 251

Diagnostic Criteria for Febrile Seizure - 5

Answer 251

1. 6 mo - 6 yo 2. Temp \> 100.4 F 3. No hx of **A**febrile seizures 4. No CNS infection 5. No acute metabolic cause of seizure (*pt would have dehydration*) *Tx = Reassurance only!*

Question 252

**Late** Findings of Alzheimer's - 5

Answer 252

**CLAV --\> HANDU** **H**allucinations **A**gnosia (unable to recognize things via 5 senses) **N**euro ∆ (seizure/myoclonus) **D**yspraxia (unable to do things from before) **U**rinary Incontinence *Onsets after 60 yo*

Question 253

Sx of mild hypOkalemia?-2 ; Sx of SEVERE hypOkalemia?-5

Answer 253

Mild: Weakness + Muscle Cramps SEVERE ( \< 2.5): 1. Flaccid Paralysis 2. hypOreflexia 3. tetany 4. Rhabdo 5. Arrhythmia

Question 254

Meniere's Disease etx

Answer 254

⬆︎endolymphatic fluid in inner ear--\> Membranous labyrinth swelling and rupture --\> [**KRE**- **K**+ **R**ich **E**ndolymph] leak into [Na+ rich perilymph] --\> abnormal hair cell function --\> **VTH** sx ## Footnote \*\***V**ery **T**errible **H**earing \*\*

Question 255

Indication of Head Thrust Test ; Describe how to do the test

Answer 255

differentiates in nystagmus pts between peripheral & central vertigo; pt looks at fixed target and their head is rapidly turned from the target. Normally, eyes remained fix on target, but in [**Peripheral** vestibular dysfunction pts] eyes move w/head and then horizontal saccade back to target after

Question 256

BPPV (Benign Paroxysmal Positional Vertigo) etx and CP-3

Answer 256

Ca+ otoliths accumulated within semicircular canals --\> Dizzines, Nystagmus and Nausea only

Question 257

**Normal Pressure Hydrocephalus** etx-2

Answer 257

Wacky, WOBBLY & Wet! ## Footnote [⬇︎**Arachnoid villi CSF absorption** vs **Obstructive Hydrocephalus**] --\> transient ⬆︎in Vt pressure --\> Enlarges Vt --\> After while, Vt Pressure NORMALIZES to the enlarged Vt

Question 258

Mngmt for Myasthenia Crisis - 4

Answer 258

**P DDD WF** Myasthenia Crisis (Precipitants=FIS) presents as Respiratory Failure! 1. Intubate + 2. Plasmapharesis + 3. IVIG + 4. Steroids

Question 259

Riluzole MOA ; Indication

Answer 259

Inhibits release of Glutamate ; ALS ## Footnote *SE: ⬆︎Transaminases, Wt loss, Dizziness*

Question 260

Identify disease process

Answer 260

Central Retinal A. occlusion ## Footnote *Note the Retinal Whitening!*

Question 261

Px for Migraine HA - 4

Answer 261

**VTAP** the migraine BEFORE it gets BAD, and **SEND** it away when it comes! 1. **V**erapamil 2. **Topiramate** 3. **A**mitryptyline 4. **P**ropranolol

Question 262

Tx for Acute Migraine HA - 4

Answer 262

**VTAP** the migraine BEFORE it gets BAD, and **SEND** it away when it comes! 1. **S**umatriptan 2. **E**rgots (Bromocriptine) 3. **N**SAIDs 4. **D**₂ Blockers (Metaclopramide/Prochlorperazine)

Question 263

*Cerebral Palsy is a group of clinical syndromes generally characterized as \_\_\_\_\_\_* What are the 3 types? What's the greatest risk factor for Cerebral Palsy?

Answer 263

Nonprogressive motor dysfunction ; ## Footnote Cerebral Palsy is just **SAD** 1. **S**pastic 2. **A**taxic 3. **D**yskinetic Greatest RF = prematurity ( \< 32 wks gestation) but EtOH is second

Question 264

*Cerebral Palsy is a group of clinical syndromes generally characterized as \_\_\_\_\_\_* How does it present? - 3

Answer 264

Nonprogressive motor dysfunction (Prematurity\>EtOH = RF) ; ## Footnote Cerebral Palsy is **SAD** 1. BL equinovarus club feet (image) 2. UMN signs LE \>UE 3. Mental Retardation *Greatest RF = prematurity ( \< 32 wks gestation)*

Question 265

CP for Chemotherapy Peripheral Neuropathy - 4

Answer 265

1. **Stocking Glove** **symmetrical** paresthesias starting at toes/fingers and spreading proximal 2. Early loss of ankle jerk reflex 3. Loss of Pain/Temp 4. Motor weakness ## Footnote *Drug Culprits: Cisplatin / Paclitaxel / Vincristine*

Question 266

*SIDS is sudden infant death that can't be explained* What are 4 major ways to ⬇︎ risk of SIDS?

Answer 266

1. **Supine** Sleeping position 2. NO second hand smoke 3. Use Pacifier during sleep 4. ROOM sharing (NOT bed sharing)

Question 267

Causes of [Magnetic "Frontal" Gait Apraxia] ? - 2 ## Footnote *Inability to walk on command and feels like feet are magnets*

Answer 267

1. Normal Pressure Hydrocephalus 2. Frontal Lobe Degeneration

Question 268

CP of Conversion Disorder -2; Demographic-3?

Answer 268

[Sudden Vision Loss] + **Pseudo**Seizures that's idiopathic! ; 1. Teens WITH WITNESSES AROUND 2. Physically abused 3. Depressed pts

Question 269

*Edinger Westphal nucleus provides ______ to the _____ ganglion* CP of a pt with R damaged EW nucleus

Answer 269

PreGanglionic ParaSympathetic outflow to ciliary ganglion **R** (Ipsilateral) FIXED DILATED pupil not reactive to light

Question 270

What are the major functions of Vagus CN10 - 6

Answer 270

1. Swallowing 2. Palate Elevation (*Image*) 3. Vocal Cord Phonation 4. Cough Reflex - Afferent 5. Gag Reflex - EFFerent (loss of Gag = CN9 problem) 6. ParaSympathetics (Aortic baro/chemoreceptors) ## Footnote *Image: **Left** Ipsilateral CN10 palate dysfunction*

Question 271

Tx for Clostridium Botulinum poisoning - 3

Answer 271

1. Equine Heptavalent Antitoxin (passive immunity) 2. Botulinum Ig 3. Guanidine

Question 272

Describe Physiologic Tremors

Answer 272

benign [**12-14 Hz** **high freq**] tremor that occurs posturally (i.e. when holdings arms out), activated w/emotion or caffeine

Question 273

A lesion in the **Upper** Thoracic Spinal Cord produces what CP - 4

Answer 273

1. Sensory loss nipples downward 2. Paraplegia 3. Bladder Incontinence 4. Fecal Incontinence

Question 274

A lesion in the **Lower** Thoracic Spinal Cord produces what CP

Answer 274

Sensory loss Umbilicus downward

Question 275

A: What are **Craniopharyngioma****s** B: What type of tissue do they arise from

Answer 275

A: Suprasellar tumors (Mostly in Kids but NOT ALWAYS) B: Remnants of Rathke's Pouch (Embryonic Precursor of ANT Pituitary)

Question 276

Loss of **Gag Reflex** indicates what cranial nerve damage

Answer 276

Glossopharyngeal CN9 *Ipsilateral*

Question 277

**Dysphagia** indicates what n. damage (2)

Answer 277

CN9 and 10

Question 278

**Dysphonia/Hoarseness** indicates what n. damage

Answer 278

CN 10

Question 279

Atomoxetine Indication

Answer 279

**Non**Stimulant ADHD Rx

Question 280

Major risk factors for VitB12 deficiency - 3

Answer 280

1. Crohn's Dz 2. Pernicious Anemia 3. Vegans (no animal protein intake)

Question 281

Explain why a child presenting with Migraine s/s is no major concern ; Where do these occur in kids?

Answer 281

Migraine HA are most common HA in peds and occur before 20 yo in 50% ; Bifrontal *(if occipital, be suspicious!)*

Question 282

Tx of **Pediatric** Migraine - 3

Answer 282

1. Dark Quiet Room + 2. NSAID 3. Triptans (refractory) ## Footnote *Triggers = stress/lights/odors/foods*

Question 283

Parkinson's Disease Dx

Answer 283

**PHYSICAL EXAM!** revealing **at least 2/4** of PARK

Question 284

How is Carotid Artery Dissection associated with Horner Syndrome?

Answer 284

Carotid A Dissection --\> **Partial** Horner (Ptosis + Miosis only) 2/2 postganglionic sympathetic fiber damage

Question 285

CP of **Craniopharyngioma****s** - 3; Demographic?-2

Answer 285

1. BiTemporal Hemianopsia 2. HA 3. Pituitary Hormonal Deficiencies (i.e. ⬇︎Libido) Demographic: **MOSTLY KIDS**, but some adults

Question 286

How long does it take pts with Subdural hematoma to have sx? Why is this a problem for elderly?

Answer 286

1-2 days; Elderly may have insidious subdural bleeds for weeks after injury --\> Confusion/Somnolence/HA/FOCAL Neuro ∆ ## Footnote *Image: L **Chronic** Subdural Hematoma*

Question 287

Step-Wise Tx to Restless Leg Syndrome - 4

Answer 287

1st: NonPharm (Leg Massage/Heat/Exercise/Iron Supplement) 2nd: Dopamine Agonist NonErgots (Pramipexole/Ropinirole) 3rd: Gabapentin (if pt also has insomina vs chronic pain) 4th: Opioids

Question 288

Which medications should be given to a pt with stroke and no prior antiplatelet tx?-2 ; When should it be given?

Answer 288

ASA + Statin ; **Within 24 hrs** of onset

Question 289

Which medications should be given to a pt with acute ischemic stroke and on ASA already? - 2 ## Footnote *Give within 24 hr of onset*

Answer 289

*Make sure ASA is first* [Clopidogrel 75 QD vs Dipyridamole 200 BID]

Question 290

Why is Heparin NOT USED in pts with Acute Stroke?

Answer 290

⬆︎Bleeding Risk if stroke turns out to be Hemorrhagic

Question 291

Which disease process does this patient have? *Keeps R arm ADDucted and swings R leg outward in semicircle as they walk*

Answer 291

**Hemiparesis** 2/2 stroke

Question 292

What are the Afferent and Efferent nerves for Corneal Reflex?

Answer 292

Question 293

What are the Afferent and Efferent nerves for Lacrimal Reflex?

Answer 293

Question 294

A: **Primary CNS Lymphoma** is the ___ most common cause of _____ in HIV pts B: What *virus* is this associated with? C: What WBCs would you expect to see in the brain tissue

Answer 294

A: **2nd** most common cause of **ring enhancing lesions** in HIV pts (*1st = Toxoplasmosis Gondi*) B: **EBV** C: B-lymphocytes

Question 295

What is [Hydrocephalus **Ex Vacuo**] and which pts do you see it in?

Answer 295

Ventricular Enlargement **only because of cortical atrophy**, typically found in HIV pts (cortical atrophy is normal sequelae in HIV) *True Hydrocephalus is actual build up of CSF (obstruction vs. hyperproduction**)*

Question 296

*PML Clinically Presents like Multiple Sclerosis* Describe **PML-P**rogressive **M**ultifocal **L**eukoencephalopathy

Answer 296

Opportunistic infection 2º to [John Cunningham PolyomaVirus]----\> [**multiple white** matter lesions] (***Hyperintense Flair signal on radiology***) --\> Death vs. Severe Neuro injury

Question 297

Describe 2 neuro conditions associated with HIV ; What Dx should you suspect in a *Young HIV Pt witih Dementia*? Pgn?

Answer 297

1. **HIV Encephalopathy** which = [microglial nodule GREY MATTER ENCEPHALITIS] in pts with ~**CD4 \< 200** ---\> Subactue HIV associated Dementia (HAD) + parkinsonism 2. **HIV Meningitis***--\>*Persistent Pleocytosis, neuro sx and Dementia via _Direct_ Viral invasion vs. _inDirect_ inflammation C: **AIDS Dementia**= slow cognitive & behavioral decline with poor pgn. *Note: This presentation is Similar to [SubAcute Combined Degeneration]* *HIV LeukoEncephalopathy is the same thing but with White matter instead*

Question 298

*PML (**P**rogressive **M**ultifocal **L**eukoencephalopathy) Clinically Presents like Multiple Sclerosis* Where does PML typically occur in the brain? - 2

Answer 298

[SubCortical White Matter] or [Cerebellar Peduncles] ## Footnote *Usual Demographic: HIV pts (reversal of immunosuppresion stops JC Polyoma virus progression)*

Question 299

*PML (**P**rogressive **M**ultifocal **L**eukoencephalopathy) Clinically Presents like Multiple Sclerosis* How is **PML** related to the drug, Natalizumab?

Answer 299

Also can be a **Rare Side Effect** of Natalizumab (MS drug) in pts who are also JC Virus positive ## Footnote *Usual Demographic: HIV pts (reversal of immunosuppresion stops JC Polyoma virus progression)*

Question 300

[Carpal Tunnel Syndrome] etx

Answer 300

**BILATERAL** Median n Compression by the [Flexor Retinacular Transverse carpal ligament] --\> Peripheral **mono**neuropathy + [ABductor pollicis brevis atrophy] ## Footnote * [Flexor Retinaculum Transverse Carpal ligament] can be surgically incised for relief* * CARPEL TUNNEL STARTS uL and --\> BL*

Question 301

Carpal Tunnel Syndrome Clinical Presentation - 4

Answer 301

1. Paresthesia vs Pain with **Median n. Distribution** worst at night 2. [ABductor pollicis brevis] and sometimes Thenar Atrophy (⬇︎flexion/ABduction/Opposition) 3. Tinel Sign (tapping over flexor surface ⬆︎ sx) 4. Phalen Sign (flexing Wrist ⬆︎ sx) ## Footnote *CARPEL TUNNEL STARTS uL and --\> BL*

Question 302

In regards to **Carpal Tunnel**, the ______ n. courses between the _____ and ____ muscles before crossing under the _____ inside carpal tunnel

Answer 302

In regards to Carpal Tunnel, the **Median** n. courses between the [**Flexor Digitorum superficialis**] and [**Flexor Digitorum Profundus**] before crossing under the [**Flexor Retinaculum transverse carpal ligament**] inside carpal tunnel

Question 303

Name the most common pineal gland tumor and how it clinically manifest (3)

Answer 303

Germinoma * Obstructive Hydrocephalus * [Parinaud Dorsal Midbrain syndrome] * [Pituitaryhypothalamic dysfunction (if in suprasellar region)

Question 304

Parinaud Syndrome etx ; How does it clinically present?-3

Answer 304

"Parinaud loved his **PUP**" Direct Compresion of [Midbrain Pretectum SUP Colliculi] (possibly from Gemrinoma) --\> 1. **P**tosis 2. **U**pward Gaze paralysis (can NOT look up) 3. **P**upil ∆ *these can also cause obstructive hydrocephalus*

Question 305

*Pt comes in with Foot Drop* What are the 2 main DDx?

Answer 305

Common Peroneal n compression vs L**5** Radiculopathy(*will be accompanied with shooting back pain*) ## Footnote *Dx: Knee MRI vs EMG*

Question 306

Status Epilepticus Mngmt - 5

Answer 306

1st: ABCs! 2nd: Ativan IV bolus 0.1mg/kg = 4-8 mg (repeat in 5-10 min if needed) 3rd: **Fos**Phenytoin IV 20 units/kg (no faster than 150 mg/min) (Continuous IV Phenytoin --\>Purple Glove Syndrome and so is alternative) 4th (if still status): Alternate Diazepam Keppra 5th (if still status): Pentobarb coma *Image showing Cortical Laminar Necrosis s/p Status Epilepticus*

Question 307

DDx for Intra**cerebral** Hemorrhage - 5

Answer 307

1. **HTN** (Charcot Bouchard aneurysm vs Cocaine) 2. Warfarin OD 3. Tumor Metz (Papillary Thyroid/Renal/Melanoma/Testicular) 4. AVM 5. Hemorrhagic Conversion of [Ischemic infarct 3-5 days prior]

Question 308

Key points for mngmt of Intra**cerebral** Hemorrhage - 5

Answer 308

1. BP \< 140 (Use Labetalol & Nifedipine, not Hydralazine) 2. ⬇︎ICP with Mannitol vs [23% Hypertonic Saline] vs Hyperventilate 3. Osm Goal = 300-320 4. Na+ **\>\>\>\>\>\>** 145 5. Repeat CT after 6 hours

Question 309

*Pregnancy is associated with Carpal Tunnel* What should these particular pts also be worked up for?

Answer 309

**Preeclampsia** ## Footnote *CARPEL TUNNEL starts uL and then --\> BL*

Question 310

[Carpal Tunnel Syndrome] dx

Answer 310

Nerve Conduction studies ## Footnote *EMG is not necessary for Carpal Tunnel Syndrome*

Question 311

[Carpal Tunnel Syndrome] tx - 4

Answer 311

1. **Wrist Splint** 2. Remove exacerbating factors 3. NSAIDs 4. [Flexor Retinaculum Transverse Carpal ligament] can be surgically incised for relief - IF SEVERE

Question 312

Ulnar Nerve Syndrome tx-3

Answer 312

1. Elbow Protectors 2. Avoid direct elbow pressure or mvmnt 3. Surgery ## Footnote *May also occur at forearm in DM pts*

Question 313

Ulnar Nerve Syndrome Risk Factors - 3

Answer 313

1. Surgery Malpositioning 2. Male 3. DM ## Footnote *May also occur at forearm in DM pts*

Question 314

Tx for Bell's Palsy - 4

Answer 314

1. PO Steroids within 3 days of onset (self resolves within 6 mo.) 2. Valacyclovir 500 mg BID (HSV may be inciting factor) 3. Artificial Tear to affected eye **during day** 4. Ophthalmic ointment to affected eye **at night**

Question 315

Where is the hypoglossal nucleus located?

Answer 315

Dorsomedial Medulla

Question 316

*Isolated Hypoglossal CN12 palsy is not common* What's the most common cause of this **when it's isolated**? What are other causes?-6

Answer 316

1. **TUMOR** 2. Guillain Barre 3. Multiple Sclerosis 4. Surgery 5. Infection 6. Trauma

Question 317

*Pt has CHRONIC burning tingling dysthesia* Tx? - 3

Answer 317

1. TCA (Amitriptyline or Nortriptyline) 2. Gabapentin 3. Carbamazepine ## Footnote *dysthesia = unpleasant sensation*

Question 318

Top DDx for CHRONIC Sensory Neuropathy - 5

Answer 318

1. VitB12 deficiency 2. Sjogren's Syndrome (check SSA Ro and SSB La) 3. [Pyridoxine B6] toxicity 4. Cisplatin toxicity 5. Inflammatory ganglionopathy (viral vs immune)

Question 319

Where do most disc herniations occur? - 2 ; Risk factor for disc hernation?

Answer 319

between * L4 - L5 OR * L5 - S1 SMOKING = Risk factor *Positive **Crossed** Straight Leg = **Lumbar** Disc hernation*

Question 320

What 4 locations is pain radiated to in L5 Radiculopathy?

Answer 320

1. Lower Back 2. Butt 3. Lateral Thigh 4. LateralAntero Calf ## Footnote *L5 Radiculopathy can also cause Foot dropPED*

Question 321

Which reflexes are **spared** in L5 Radiculpathy? - 2

Answer 321

Patellar and Ankle Jerk

Question 322

DDx for an expanding intramedullary mass? - 6 ## Footnote *Image: Intramedullary mass + expanding edema*

Answer 322

1. Sarcoidosis 2. Ependymoma (usually in 4th vt) 3. Meningioma benign 4. Demyeliating Disease (Multiple Sclerosis) 5. Metastasis 6. Transverse Myelitis ## Footnote *Image: Intramedullary mass + expanding edema*

Question 323

Tx for Sarcoid Myelopathy ## Footnote *Image: Intramedullary mass + expanding edema*

Answer 323

Corticosteroids *Image: Intramedullary mass + expanding edema*

Question 324

What regions of the spinal cord does the Anterior Spinal Artery perfuse? - 3

Answer 324

1. ANT horns 2. Lateral Corticospinal Tract 3. Lateral Spinothalamic Tract ## Footnote *POST Spinal Artery perfuses Dorsal Column*

Question 325

What is Aphasia?

Answer 325

⬇︎Language Processing (speech/writing vs comprehension + repetition)

Question 326

HYPERdensity on CT represents what? - 3

Answer 326

1. Blood 2. Bone 3. Calcification (normal and often seen in choroid plexus)

Question 327

Most common cause of Spinal Cord Ischemia?-2 ; Other causes?-3

Answer 327

[**Aortic** Disease (thromboembolic)] or [**Aortic** Surgery] Others= Hematomyelia, AVM, Fracture/Dislocation

Question 328

When is [CEA-Carotid Endarterectomy] indicated?

Answer 328

**Only** when pt has a [**SYMPTOMATIC** 70-99% Stenosis]

Question 329

*Essential Tremor is a BUE Action Tremor worst w/Action, and can affect head & voice* What are the exacerbants of Essential Tremor? - 3

Answer 329

1. Hyperthyroid 2. Lithium 3. Valproic Acid

Question 330

The VertebroBasilar arterial system (Posterior Circulation) perfuses which major structures? - 4

Answer 330

1. Brainstem 2. Cerebellum 3. Spinal Cord 4. Labyrinths

Question 331

What areas of the brain are involved in **CONDUCTION** Aphasia? - 4

Answer 331

**VERY POOR** Repetition 1. Arcuate Fasciculus = MOST COMMON 2. Supramarginal Gyrus 3. Auditory Cortex 4. Large Posterior Perisylvian area

Question 332

Main Features of TIA - 2

Answer 332

1. Transient ( No more than 1 day long but typically **\< 20 min**) 2. Leaves NO residual deficits or radiomanifestations

Question 333

CP of VertebroBasilar TIA - 4

Answer 333

Brainstem: **Diplopia**, **Dysarthria** Cerebellum: **BL Clumsiness** Spinal Cord: **BL Weakness** Labyrinths

Question 334

What is the most common cause of Lateral Medullary Syndrome of Wallenberg? 2nd most common?

Answer 334

**Intracranial Vertebral a occlusion** ; PICA occlusion

Question 335

*Surgery is a LAST OPTION for treating Essential Tremor* List the Surgical Procedures available-2 ; What is the goal of the surgery?

Answer 335

1. Stereotactic VIM Thalamotomy 2. VIM Thalamic Stimulation ## Footnote Goal = VIM (Ventralis InterMedius) thalamic nc *Onsets at 45 yo and 50% cases are AUTO DOM*

Question 336

What should you suspect in a pt who has Down & Out Eye with Miosis and Ptosis?

Answer 336

**DOP + miosis** = Oculosympathetic Cavernous Sinus Compression! - There will also be Horners ## Footnote Oculosympathetic fibers cross thru Cavernous Sinus *Image: Sympathetic Pathway*

Question 337

Both Mannitol and [Hypertonic Saline (3%/5%/23%)] are used to ⬇︎ ICP List advantages of using Hypertonic saline? - 3

Answer 337

1. Anti-Inflammatory 2. Does NOT cross into interstitial space like Mannitol does eventually (Mannitol causes rebound edema!) 3. Expands systemic volume ## Footnote *Hypertonic Saline can ONLY be given via Central line :-(*

Question 338

*Myasthenia Gravis, LEMS and [Myopathies (polymyositis/dermatomyositis)] can be similar* How can you differentiate these based on reflexes?

Answer 338

**Myopathies[polymyositis/dermatomyositis]** and **LEMS** have ⬇︎ Reflexes. ## Footnote Myasthenia is normal

Question 339

How are migraines associated with Pregnancy?

Answer 339

Migraines commonly start **2nd** **trimester** of Pregnancy ## Footnote *But also be suspicious of [Pseudotumor Cerebrii]*

Question 340

*Memory depends on a BL 4-way circuit* What is this circuit?-4

Answer 340

"***H**aving **F**un **M**emories **A**round"* [**H**ippocampus temporal lobe] --\> **F**ornix --\> **Mammillary Bodies** ---\> **ANT Thalamus**

Question 341

*Memory depends on a BL 4 way-circuit* How is this Memory circuit often damaged?-3

Answer 341

*"**H**aving **F**un **M**emories **A**round"* [Hippocampus temporal lobe] --\> Fornix --\> **Mammillary Bodies** --\> **ANT Thalamus** 1. [Thiamine B1 deficiency] --\> disruption between Mammillary Body ANT Thalamus 2. Anoxia --\> BL [Hippocampus temporal lobe] damage 3. HSV --\> BL [Hippocampus temporal lobe] damage

Question 342

Describe Constructional Apraxia ; Describe Dressing Apraxia ; What causes both of these?

Answer 342

* Constructional = Can't Draw or Copy a House * Dressing = Can't get Dressed Both caused by **Parietal** Lobe lesion

Question 343

Name 2 examples of Frontal Lobe release signs? When is this normal? When is it abnormal?

Answer 343

Findings **normal during infancy** when descending inhibitory pathway myelination was incomplete; Abnormal in Adults and is 2/2 **Frontal lobe damage** 1. Sucking examiner finger when corner mouth is lightly stroked 2. Toes latching onto examiner finger when rubbed

Question 344

What is Anton's syndrome

Answer 344

Unawareness of Vision loss from Occipital lobe damage --\> Denial of vision loss

Question 345

*A pt complains of inabilty to recognize previously known faces* What is this called? ; Where is the lesion?

Answer 345

[ProsoPagnosia visual agnosia] ; BL Temporo-Occipital

Question 346

What's the only imaging modality for diagnosing Alzheimer's Disease? What does it reveal?

Answer 346

**CLAV --\> HANDU** PET scan revealing [**PIB**-Pittsburgh Compound B] binding to β-amyloid and being uptaken in 1. PreFrontal 2. Temporal 3. Parietal

Question 347

Which 3 Neuro Diseases Cross the Corpus Callosum?

Answer 347

1. Gliomas (*AGE - i.e. Glioblastoma*) 2. Multiple Sclerosis 3. CNS Lymphoma

Question 348

20% of patients with ______ go on to develop Multiple Sclerosis

Answer 348

[**SLUM** **SiiiN**] **N**euritis Optic - (uL eye pain + vision loss + Marcus Gunn afferent pupillary defect) = ALSO RISK FACTOR *Image: T1 MRI Black Holes Dx*

Question 349

Answer 349

*SAH usually occur in **Suprasellar** Cistern*

Question 350

*Usually Partial Seizures originate in a **single** hemisphere* What happens when Partial seizures involve **BOTH hemispheres** (i.e. COMPLEX Partial Seizure)? - 2

Answer 350

ONLY If BOTH hemispheres _become_ involved --\> 1. **IMPAIRED BUT NOT LOST OF consciousness** (won't follow commands and will have postictal amnesia) 2. **+/-automatisms** (repetitive chewing, sucking, swallowing) =COMPLEX Partial Seizure

Question 351

*Usually Partial Seizures originate in a **single** hemisphere* What happens when Partial seizures spread **DIFFUSELY** to **bilateral cortex areas** - 3

Answer 351

= *Secondary* GENERALIZED TONIC CLONIC 1. **Generalized** Convulsions 2. **LOST** of Consciousness may occur 3. Postictal Amnesia

Question 352

List the difference between Primary and Secondary Generalized Tonic Clonic Seizures

Answer 352

*Primary* GTC occur when electrical discharge simultaneously comes from **diffuse bilateral cortical areas** (i.e. Absence) vs *Secondary GTC* comes from the spread of a partial focal seizure

Question 353

List the sequence of events for a Seizure - 5

Answer 353

Seizure **ATTCK** ## Footnote 1st: **A**ura (nausea/dizziness) vs Simple Partial 2nd: **T**onic: Sudden Stiffness--\>Falling and cry out 3rd: **T**ime Out: APNEA --\> Cyanotic, dusky face 4th: **C**lonic **c**onvulsions + oral involvement 5th: **K**razed: Postictal Amnesia & Lethargy (pt only recalls aura) + incontinence

Question 354

What are some triggers of *Primary* GTC Seizure? - 8

Answer 354

Seizure **ATTCK** 1. Flashing lights 2. Sleep Deprivation 3. Hyperventilation 4. EtOH 5. Infection 6. Cocaine 7. Whole Brain Anoxia 8. Rapid Na+ or Glucose ⬇︎

Question 355

Describe NonEpileptic Pseudoseizures ; Demographic-2?

Answer 355

Episodic jerking movements that occur **WITH NO** **cortical discharge** (falls under conversion disorder); 1. Teens WITH WITNESSES AROUND 2. Physically abused pts 3. Depressed pts

Question 356

What are the major triggers of [Partial Seizures and *Secondary* GTC] - 3

Answer 356

1. Infarct 2. Tumor 3. Viral Encephalitis

Question 357

*Pt just fell and started GTC seizing right in front of you!* How should you manage them? - 4

Answer 357

Seizure **ATTCK** ## Footnote 1st: Roll pt onto side 2nd: Stabilize Head BUT NOT THEIR MVMNTS 3rd: KEEP THINGS OUT OF MOUTH OR AROUND PT 4th: ER if \> 5 min

Question 358

Carbamazepine, Phenytoin, Gabapentin are **only** used to treat what type of seizures? - 3

Answer 358

1. Simple **Partial** 2. Complex **Partial** 3. Simple/Complex **Partial** convert --\> *Secondary* GTC

Question 359

Name the CNS Neoplasms that are of **Glial** Origin (i.e. Glioma) - 3

Answer 359

**AGE** comes from Glia 1. **A**strocytoma (i.e. Glioblastoma) 2. Oligodendro**Gli**oma (adult frontal lobe) 3. **E**pendymoma (*ependymal cells line ventricles*) *These stain positive for **GFAP***

Question 360

What should be used to treat **edema** surrounding brain tumors? ## Footnote *Image: MRI showing Tumor with Hyperdense surrounding edema*

Answer 360

Dexamethasone ## Footnote *NOT effective in ⬇︎ICP during Stroke*

Question 361

What is Meningeal Carcinomatosis? Tx?

Answer 361

Spread of CA to **CSF** which diseminates to Meninges, Cortex, Cranial n, spinal nerve roots Tx = Intrathecal Chemo

Question 362

Which CNS tumors affect Spinal Cord?-3 ; Tx?-2

Answer 362

1. Meningioma benign 2. Ependymoma (usually 4th Vt) 3. Metastasis (Prostate/Renal/Lung/Breast/Multiple Myeloma) ## Footnote ​Tx = Radio + Dexamethasone

Question 363

Explain how collateral blood flow to a "complete" circle of willis help prevent ischemic CVA/TIA?

Answer 363

[External Carotid: Opthalmic A] can retrogradedly perfuse Circle of Willis when Internal Carotid is blocked

Question 364

What structures does the **lenticulostriate vessels** perfuse (4)

Answer 364

lenticulostriate vessels perfuse everything in [**B**e **TI**P**C**] EXCEPT PONS! **B**asal Ganglia **T**halamus = pure sensory stroke [**I**nternal Capsule / / **C**orona Radiata] = pure motor stroke

Question 365

*Describe the likely regions involved for the following deficits* ## Footnote A: Weakness of Face and UE B: Weakness of LE C: Numbness of Face and UE D: Numbness of LE

Answer 365

A: CTL Precentral MCA territory (*Face and UE weak*) B: CTL Precentral ACA territory (*LE weak*) C: CTL PostCentral MCA terrtory (*Face and UE numb*) D: CTL PostCentral ACA territory (*LE numb*)

Question 366

Which imaging should be obtained for CVA/TIA w/u and why? - 4

Answer 366

1. NonContrast Head CT 2. TTEchocardiography (evaluate for cardioembolism) 3. Carotid cervical US 4. CTA/MRA (CTA shown in image-evaluate for Vertebrobasilar abnormalities)

Question 367

Why is Altered mental status in a pt who had a large **ischemic** stroke 4 days prior alarming? - 2

Answer 367

Within 3-5 days (below) can develop: 1. Hemorrhagic conversion of infarct 2. Brain Edema

Question 368

What's the most common cause of SubArachnoid Hemorrhage? What's the 2nd? ## Footnote *Usually in the Suprasellar Cistern*

Answer 368

**Trauma** \> Berry Saccular Aneurysm

Question 369

In order from Most to least common, name sites of Berry Saccular Aneurysm? - 4 ## Footnote *SAH occur usually in Suprasellar Cistern*

Answer 369

ANT communicating \> [POST communicating (*will result in CN3 palsy*)] \> MCA \> POST Circulation

Question 370

What is Prosody? ; A stroke in what part of the brain creates Aprosody?

Answer 370

Using changes in vocal pitch/inflection to convey language (i.e. You gave this to me? vs You gave this to me) ; [**NonDominant** Cortex opposite to Wernicke's area] ## Footnote *example: Sensory receptive Aprosody*

Question 371

What is Sensory receptive aprosody? ; How does it occur?

Answer 371

Inability of pt to understand prosody/vocal inflections **by other people**; Damage to [NonDominant Cortex opposite to Wernicke's area]

Question 372

What is the action of the Inferior Oblique m? ; Superior Oblique m?

Answer 372

**IOUO SODO** **I**nferior**O**blique = **U**p and **O**ut **S**uperior**O**blique (*innervated by CN4*) = **D**own and **O**ut

Question 373

What is unique about Trochlear CN4?

Answer 373

Only cranial nerve to exit **DORSAL** midbrain and then decussate and innervate **CTL** Superior Oblique muscle ## Footnote IOUO SODO

Question 374

What is the difference in clinical presentation between [neuro nystagmus (cerebellum/vestibular)] vs drug nystagmus? -2

Answer 374

neuro nystagmus = **asymmetrical(slow jerk toward side of lesion)** & **occurs only with certain eye positions** vs drug nystagmus = **symmetrical** & **occurs all the time**

Question 375

What does the PPRF have to do for **Right** Horizontal Gaze

Answer 375

* Activate **Right** Abducens nc in Pons * Activate **Left** EdingerWestphal in Dorsal Midbrain * MLF connects all this, leaving R PPRF, decussating and then joining L oculomotor nc* * Image: Left MIOS*

Question 376

A: **MIOS** seen in Younger pts indicates \_\_\_\_\_ B: **MIOS** seen in OLDER pts indicates \_\_\_\_\_\_ C: What is the purpose of the MLF

Answer 376

[**MIOS**-**M**LF **I**nternuclear **O**phthalmoplegia **S**yndrome] 1) Younger pts= Multiple Sclerosis 2) Older pts= Pontine a. lacunar stroke D: MLF coordinates CN3 with CN6 *Image: Left MIOS*

Question 377

Explain [Relative Afferent Pupillary Defect]

Answer 377

**partial** optic n vs retinal lesion --\> pupils BOTH constrict when light is shown in normal eye BUT when light is *swung* to **lesioned** eye BOTH eyes Dilates since lesioned eye has ⬇︎ afferent input

Question 378

Recall the Oculosympathetic Horner's pathway - 9

Answer 378

1. Hypothalamus 2. Passes as hypothalamospinal tract in **lateral medulla** 3. [IML C8-T1 Cilospinal Center of Budge] 4. Under Subclavian Artery as sympathetic trunk 5. Lung Apex 6. SUP cervical ganglion near carotid bifurcation 6A. Facial Sweat Glands 6B. carried with CN5B1 **thru cavernous sinus** & then **SUP orbital fissure** to Pupil Dilator 6C. Innervates [Muller's superior tarsal muscle] *2 / 5 / 6 / 6B are most common sites of Horner's syndrome*

Question 379

What are the most common causes of Horner's Syndrome? - 4

Answer 379

* Lateral Medullary syndrome of Wallenberg * Lung Apex tumor * Neck Carotid Trauma * Cavernous Sinus Thrombosis ## Footnote *2 / 5 / 6 / 6B are most common sites of Horner's syndrome*

Question 380

Medial Midbrain Syndrome of Weber etx ; CP-2

Answer 380

PCA infarct **with CN3 and Crus Cerebri**(CST/corticobular) involvement--\> 1. [*Ipsilateral* DOP + Dilation] (Down & Out eye + Ptosis + Dilated Pupil) = CN3 involved 2. CTL Hemiparesis (Face, UE, LE) = Crus Cerebri involved

Question 381

What would a [**R** **Partial Retinal lesion**] manifest as

Answer 381

R Monocular scotoma

Question 382

Lesion at which letter would result in [**R Nasal Hemianopia**]

Answer 382

D

Question 383

Lesion at which letter would result in [**L Pie on the Floor (Homonymous INF quadrantanopia)**] lesion

Answer 383

G

Question 384

Parkinsonism is often caused by ____ or \_\_\_\_\_ Name 2 *rare* causes of Parkinsonism

Answer 384

Common = [Substantia nigra pars compacta degeneration] vs [D2 Blocker Drugs] rare = Toxic levels of CO₂ or ManGanese **PARK** & **hamp**

Question 385

What causes [Lateral ventricle frontal horn] enlargement in Huntington's disease?

Answer 385

\*\***Gross Caudate atrophy**\*\* ## Footnote [AUTO DOM [Chromo 4 CAG repeats]] ---\> Degeneration of (**Caudate** nc. inside the ((**I**)ndirect Striatum w/ [**Gross Caudate atrophy**] ) --\> [⬇︎ GABA release] *"Hunting **4** food is way too aggressive & dancey"*

Question 386

Risk Factors for Migraines - 2

Answer 386

1. Fam Hx 2. Menstruation (hormones during cycle ⬆︎ risk)

Question 387

Migraine etx ; How are the Trigeminal nerves associated-2

Answer 387

Genetic [GainOfFunction mutation in *excitatory NMDA receptor*]--\>burst of cerebral activity _when triggered_---\>hyperemia (*usually occipital lobe*)--\> sx. Burst is followed by **Cortical Depolarization** tht has slow but deliberate forward advance --\> Triggers Trigeminal pathway Trigeminal afferents : 1. send impulses--\>[Brain Stem APCTZ] & hypothalamus--\> Nausea/Photophobia/Phonophobia 2. retroactively depolarize--\>release of substance P --\> neurogenic inflammatory pain + vasoDilation

Question 388

*Pt has advancing foot crossing over opposite foot similar to closing scissor blades* What causes Scissors Gait?

Answer 388

UMN (Corticospinal Tract spasticity) lesions ## Footnote **S**pasticity causes **S**cissors Gait

Question 389

What causes a Broad based Ataxic gait? - 2

Answer 389

Cerebellar vs [Dorsal Column Pathway] dysfunction

Question 390

Tx for **EPS**-**E**xtra**P**yramidal**S**ymptoms - 2

Answer 390

EPS = **DAD** Benztropine vs Diphenhydramine

Question 391

How do you differentiate Tunnel Vision 2/2 [Glaucoma or Retinal Degeneration] from Psychiatric etiology?

Answer 391

As examiner moves further away ... ## Footnote [Glaucoma or Retinal degeneration] = Tunnel Vision **enlarges** in cone pattern vs Psychiatric = Tunnel vision stays Tunnel

Question 392

Which Artery of the Base of Brain can cause unilateral hearing loss if occluded?

Answer 392

**AICA** ## Footnote *Other causes: [Petrous bone trauma]*

Question 393

Meniere's Disease CP-3?

Answer 393

\*\***V**ery **T**errible **H**earing \*\* *that is* ***recurrent*** 1. **V**ertigo 2. **T**innitus 3. **H**earing loss which --\> Permanent eventually

Question 394

Acute Labyrinthitis CP - 4?

Answer 394

\*\***V**ery **T**errible **N**ystagmus & **H**earing \*\* 1. **V**ertigo 2. **T**innitus 3. **N**ystagmus 4. **H**earing loss which --\> Permanent eventually

Question 395

What is the **ARAS** - **A**scending **R**eticular **A**ctivating **S**ystem important for? ; Lesions of the ____ where ARAS is located leads to what? - 2

Answer 395

**A****RAS**(**A**lways**R**etaining**A**wake**S**tate) = keeps you awake! ; lesions of**upper brain stem** --\> Somnolence or Coma

Question 396

DSM5 Criteria For Narcolepsy (2)

Answer 396

[Recurrent and sudden entry into **REM** sleep **at least (3 x/week) x 3 mo.**] + 1 of the following: a. Cataplexy b. [Low CSF hypOcretin1 orexin A] c. [REM latency ≤ 15 min] (*goes into REM in less than 15 min*)

Question 397

What is Hypocretin 1 and 2 also known as, and what is their function?

Answer 397

[Hypocretin 1 (Orexin A)[and [Hypocretin 2 (Orexin B)] are [Lateral hypothalamus neuropeptides] that promote wakefullness & inhibit [REM sleep-related phenomena] ## Footnote *These are deficient in Narcolepsy*

Question 398

Tetanus takes __ days to onset after exposure to endospores ; Tx? - 4

Answer 398

**2** days; 1. Mechanical ventilation ICU 2. Human Tetanus Immune Globulin 3. Abx 4. Diazepam *Comes from puncture wound vs burn*

Question 399

DDx for Clostridium Botulinum - 4

Answer 399

*Also consider...* 1. Myasthenia Gravis 2. Atypical Guillain Barre 3. Tick Paralysis 4. Brain Stem infarct *Adult tx: Equine Heptavalent Antitoxin (passive immunity)*

Question 400

How do Adults present after Lead Poisoning? ; How do Children present after Lead Poisoning?-2

Answer 400

A: Adults: [Workplace paint vs. lead battery] --\> Peripheral neuropathy B: Children: [ingeting lead paint flakes] --\> [Encephalopathy + Abd pain]

Question 401

What part of the cerebellum is affected by Alcoholic degeneration?

Answer 401

ANT SUP vermis ## Footnote *Explains Dysmetria of LE \> UE*

Question 402

Which areas of the brain are affected by [HSE-Herpes Simplex Encephalitis]? - 2

Answer 402

1. Medial temporal 2. Inferior frontal

Question 403

Brain Contusions are superficial hemorrhages that usually occur where? - 2 ; What type of motion causes these?-2

Answer 403

Basal or Ventral [Frontal and ANT Temporal lobes] ; Angular or Rotational (NOT LINEAR)

Question 404

Define **Concussion**

Answer 404

TBI that causes Brief Confusion and Amnesia +/- loss of consciousness ## Footnote *Repetitive Concussions --\> Permanent Cognitive Decline*

Question 405

Define Coma

Answer 405

**Unarousable**, **Unresponsive** Sleep State in which only brainstem reflexes are testable. 2/2 diffuse cortical depression *Can progress to vegetation, full recovery or brain death*

Question 406

A: What is **Cheyne-Stokes Breathing**? B: What is this breathing associated with? - 3

Answer 406

A: Cyclic breathing in which apnea is followed by [INC and then DEC tidal volumes] all the way up until the next apneic period B: 1. [**Advanced** CHF] 2. [Comatosed BL metabolic encephalopathy] 3. Elderly during sleep

Question 407

Dorsal tectal midbrain lesions selectively involve \_\_\_\_\_(*Sympathetic vs Parasympathetic*) fibers. How does this affect Pupils?

Answer 407

ParaSympathetic ;**FIXED** Dilated BL Pupils from unopposed Sympathetics

Question 408

3 main causes of pinpoint pupils

Answer 408

1. Opiate OD 2. Pontine lesion destroying sympathetic fibers 3. Cholinergic eyedrops for Glaucoma

Question 409

How is the [Oculocephalic Dolls eye Reflex] used to assess brainstem function?

Answer 409

Eyes should **remain stationary** **and fixed** as head is rotated = normal brain stem function

Question 410

What is the confirmatory test for diagnosing Brain Death?

Answer 410

**Radioisotope brain scan** revealing NO cerebral blood flow \> 10 min (typically 2/2 brain edema)

Question 411

What is Wallerian Degeneration?

Answer 411

Degeneration of Axons after trauma, **but in the setting of preserved peri and epineurium** which later acts as scaffolding to allow axonal sprouting and regeneration within the PNS

Question 412

Describe **Pseudoexacerbation** of Multiple Sclerosis

Answer 412

[**SLUM** **SiiiN**] Infection in MS pt --\>⬆︎ Body temp --\> ⬇︎Conduction in [Remyeliated healed CNS areas] --\> clinical **APPEARS** to be MS exacerbation BUT REALLY ISN'T! *Image: T1 MRI Black Holes Dx*

Question 413

Nerve roots for Ankle Jerk Reflex

Answer 413

*"1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight"* S**1** - S**2**

Question 414

Nerve roots for Patellar Reflex

Answer 414

*"1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight"* L**3** - L**4**

Question 415

Nerve roots for Biceps Reflex

Answer 415

*"1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight"* C**5** - C**6**

Question 416

Nerve roots for Triceps Reflex

Answer 416

*"1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight"* C**7** - C**8**

Question 417

Sciatica etx ; Clinical Presentation - 3

Answer 417

"Having Sciatica makes you break **LAWS**" * [**L**ower Back pain w/radiation down POSTERIOR thigh --\> lateral foot] * **A**nkle jerk reflex ABSENT (this can occur naturally with age!) * **W**eak Hip Extension * [**S**1 n PosteroLateral compression at L4-5 or L5-S1] --\> UMN signs

Question 418

Alzheimer's tx - 7 ; Which medication should be used last?

Answer 418

CLAV --\> HANDU 1. Donepezil - *AChnesterase inhibitor* 2. Tacrine - *AChnesterase inhibitor* 3. Rivastigmine - *AChnesterase inhibitor* 4. Galantamine - *AChnesterase inhibitor* 5. Memantine - *NMDA R Blocker: **USE LAST*** 6. Respite Care for Caregivers (ex: Adult day program) 7. Atypical antipsychotics - Olanzapine vs Risperidone (for acute psycosis)

Question 419

**Neonatal Abstinence Syndrome** Classic Signs - 5

Answer 419

**TYT D**oes **H**eroin 1. **T**remors 2. **Y**awning 3. **T**achypnea 4. **D**iarrhea 5. **H**igh Pitched Cry *Caused by maternal opioid (**H**eroin) use during pregnancy*

Question 420

Major causes of Altered Mental Status-20

Answer 420

**AEIOU TIPS**

Question 421

Where do most Medulloblastomas occur? ; How does this present clinically?

Answer 421

Cerebellar VERMIS ; Truncal ataxia

Question 422

Risk factors for Carpal Tunnel Syndrome - 4

Answer 422

1. Obesity 2. Pregnancy 3. DM 4. hypOthyroidism ## Footnote *CARPEL TUNNEL STARTS uL and --\> BL*

Question 423

Meniere's Disease tx - 5

Answer 423

1st: Diet change (restrict Na+, caffeine, Nicotine, EtOH) 2nd: Benzo, antihistamines, antiemetics 3rd: Diuretics for long term Sx = VTH (Vertigo, Tinnitus, Hearing loss)

Question 424

Alcoholic cerebellar degeneration causes damage to the \_\_\_\_\_\_ How can you differentiate Alcoholic cerebellar damage from other causes of cerebellar damage?

Answer 424

Purkinje cells of cerebellar vermis Alcoholic cerebellar damage **LEAVES LIMB COORDINATION INTACT** (no intention tremor) Cere is def on **GRINDRR**

Question 425

What are the neurological manifestations of DM in the extremities

Answer 425

Symmetrical loss of **2TVP** (2point,Touch,Vibration,Proprioception) distally GAIT IS INTACT

Question 426

Sciatica tx ; dx?

Answer 426

"Having Sciatica makes you break **LAWS**" NSAIDs + APAP = 1st line as Sciatica sx are self limited Dx = **CLINICAL** (Only use MRI for confirmation of disc herniation if sensory/motor deficit, cauda equina syndrome sx or epidural abscess r/o)

Question 427

*Brain Death is a clinical diagnosis and involves absent cortical and brain stem functions* What are the legal complications of disabling articial life support for a pt who is newly diagnosed with Brain Death?

Answer 427

None - Brain death is a legally acceptable definition of death

Question 428

How does Papilledema present in pts with Pseudotumor Cerebrii Idiopathic Intracranial HTN?

Answer 428

transient vision loss when changing head positions that last a few seconds Can --\> Vision Loss!