module 3

Question 1

The rTPA exclusion criteria are the ff, except:
A Pretreatment SBP>185, DBP>110
-B Major surgery at least 6 days previously
C. age <18
D. Current oral anticoagulation PT INR>1.7

Answer 1

B

Question 2

Management of ICP in acute stroke

Answer 2

Mannitol: 0.5 - 2 g/kg/dose

Question 3

T or F: Patients who are potential candidates for rtPA therapy but who have persistent elevations in SBP >185 mmHg or DBP > 100 mmHg may be treated with large doses of IV anti-hypertensive medication (apresaline/beta blockers)

Answer 3

F

Question 4

A stuporous and moderately hemiparetic px has a Hunt and Hess grade for subacute hemorrhage of

Answer 4

4

Question 5

BP value in permissive hypertension in px w/ ischemic stroke

Answer 5

160/100

Question 6

An ischemic penumbra will have the ff, except:

• Increase in K+ levels
• marginal perfusion
• Depleted ATP
• increase in creatinine phosphate

Answer 6

D

Question 7

Reduction of cerebral blood flow (CBF) below 10-12 ml/100g per minute leads to

Answer 7

Cerebral infarction

Question 8

T or F: If there is involvement of lingual gyrus or the visual cortex of both sides, will you still have an intact pupillary light reflex

Answer 8

T

Question 9

This structure is involved when the eyes look towards the side of the weakness w/ the lesion on the other side; also the final nuclei for gaze

Answer 9

paramedian pontine reticular formation

Question 10

T or F: Horner syndrome can be seen in both posterior and anterior circulation stroke

Answer 10

F

Question 11

This midbrain stroke syndrome presents with CN III palsy ipsilaterally and hemiplegia contralaterally

Answer 11

Weber Syndrome

Question 12

This clinical term describes the occurrence of transient monocular or binocular visual loss due to retinal artery ischemia

Answer 12

Amaurosis fugax

Question 13

This condition is characterized by a cluster of neurological abnormalities arising from the partial or complete severing or lesioning of the corpus callosum, the bundle of nerves that connects the right and left hemispheres of the brain.

Answer 13

Split-brain syndrome (callosal disconnection syndrome)

Question 14

T or F: Embolization before microsurgical resection is thought to increase the complication rates associated with surgical excision of AVMs in eloquent brain areas

Answer 14

F

Question 15

Definitive study for assessment of intracranial vascular malformations

Answer 15

Cerebral angiography

Question 16

The ff are risk factors of ischemic stroke in children

• RHF
• TOF
• child abuse
• meningitis

Answer 16

AOTA

Question 17

These are factors associated with successful AVM radiosurgery except:

• Mean nidus diameter of 2 cm or less
• Patient 12 years old or older
• Nidus volume of 3.8 cm or less
• Maximum diameter of the nidus less than 3 cm

Answer 17

B

Question 18

This is a type of CNS vascular formation without an apparent arterial component and consists of a myriad of small tapering veins arranged in a radial fashion in the deep white matter.

Answer 18

Venous angioma

Question 19

Pedia px w/ unprovoked cerebral sinovenous thrombosis has a therapy duration of

Answer 19

6 – 12 months with a target INR of 2 – 3

Question 20

Current recommendation for early aspirin therapy for most px w/ TIA

Answer 20

160 to 325 mg/day

Question 21

W/c drugs are the cornerstone of pill therapy in the secondary prevention of stroke

Answer 21

Antihypertensives and statin

Question 22

T or F: warfarin is indicated for embolic stroke px w/ valvular arrhythmia

Answer 22

T

Question 23

IV of choice for IV repletion and maintenance fluid therapy

Answer 23

Isotonic saline without dextrose (NSS)

Question 24

As part of acute stroke evaluation, px with suspected stroke should have the ff studies urgently except:

• CBC w/ platelet
• O2 sat
• non-constrast CT
• finger stick blood glucose

Answer 24

A

Question 25

The goal for mean arterial pressure in ischemic stroke px is

Answer 25

110-130 mmHg

Question 26

Clippable aneurysms except: - Giant aneurysm (>25 mm) - paraclinoid segment aneurysm - Blister-type aneurysm - Fusiform aneurysm

Answer 26

NOTA

Question 27

The ff describe non-surgical px, except: - massive bleed of >60cc - alert w/ subtle signs of hemiparesis - has no brainstem fxn - <24 from onset of neuro degeneration

Answer 27

D

Question 28

On WFNS grading, px with aphasia and GCS 11 is w/c grade?

Answer 28

4

Question 29

On Spetzler-Martin grading, 6cm, accessible, non-eloquent, with cortical venous drainage is considered which grade?

Answer 29

Grade I-II

Question 30

T or F: Stereotactic Radiosurgery is an administration of a very high dose of radiation to the nidus of the AVM inducing endovascular fibrosis

Answer 30

T

Question 31

The ff are local complications of conventional angiography, except: hematoma at puncture site, infection at puncture site, cotton fiber embolus, arterial thrombus

Answer 31

Cotton fiber embolus

Question 32

At what level of the spine is the end of conus medullaris seen?

Answer 32

Between L1 and L2

Question 33

T or F: Intramedullary lesions enlarge the spinal cord and impinge on the thecal sac

Answer 33

F

Question 34

Request for conventional angiography for the ff reasons except - equivocal CTA, MRA or/and carotid ultrasound - evaluation of vasculitis - If cardiac output is too low to produce a diagnostic CTA - evaluation of complex aneurysms or vascular malformations responsible for intracranial hemorrhage

Answer 34

NOTA

Question 35

Delta sign on MR is specific for…

Answer 35

superior sagittal sinus thrombosis

Question 36

Best diagnostic clue for holoprosencephaly

Answer 36

Monoventricle + fused/uncleaved frontal lobes (absent anterior midline falx/fissures

Question 37

On MRI, this posterior fossa malformation shows schwannoma arising from the dorsal nerve roots, having a “dumbbell” configuration and may compress the spinal cord

Answer 37

Arnold-Chiari Malformation (Chiari II)

Question 38

This is the most common neurologic symptom of microgyria

Answer 38

seizure

Question 39

This central neurofibromatoses manifests with schwannoma arising from the dorsal nerve roots, what is its characteristic lesion

Answer 39

Vestibular/acoustic schwannoma (usually bilateral)

Question 40

Most common phakomatoses presenting with Café au lait spots, axillary freckling, cutaneous neurofibromas, Lisch nodules

Answer 40

Von Recklinghausen

Question 41

Which Brunnstrom stage will patients usually be seen walking

Answer 41

3

Question 42

T or F: Most patients with non-dominant temporal lobe lesion have neglect and may ignore opposite side of the body

Answer 42

F

Question 43

Among therapy systems for dev’t of motor control, which two mostly improve motor function

Answer 43

Proprioceptive Neuromuscular Facilitation and Neurodevelopmental treatment

Question 44

This approach encourages development of flexor and extensor synergies during early phase of recovery, with the intention that synergic muscular activation, with training, will convert into voluntary muscular activation.

Answer 44

Brunnstrom Approach

Question 45

This therapy uses guided or facilitated movements as a treatment strategy to ensure correlation of input from tactile, vestibular, and somatosensory receptors within the body

Answer 45

Neurodevelopmental Treatment (NDT)/Bobath

Question 46

W/c of the ff neuronal systems are vulnerable in Alzheimer’s Dse: hippocampal circuits, basal forebrain cholinergic system, monoamine systems, limbic thalamocortical system

Answer 46

AOTA

Question 47

NMDA glutamate antagonist and what drug are most commonly used for Alzheimer’s Disease

Answer 47

``` Acholinesterasee INH (rivastigmine, donepezil, galantamine) ```

Question 48

T or F: If dementia presents before onset of movement disorder symptoms, it’s called Lewy Body Dementia, not Parkinson’s Disease

Answer 48

F

Question 49

T or F: If dementia presents before onset of movement disorder symptoms, it’s called Lewy Body Dementia, not Parkinson’s Disease

Answer 49

NOTA

Question 50

The main clinical criterion of Alzheimer’s Disease

Answer 50

Amnestic syndrome of the ‘hippocampal type’