Neuro

Question 1

Muscle group test for C-5

Answer 1

Biceps

Question 2

Muscle group test for C-7

Answer 2

Triceps

Question 3

*Anterior Cord Syndrome

Answer 3

• Loss of pain/temperature and motor but not light touch
• Due to contusion of the anterior cord or occlusion of the anterior spinal artery
• Associated with burst fractures of the spinal column with fragment retropulsion by the axial compression

Question 4

Initial treatment for spinal cord compression (with defects) due to malignancy/neoplasm:
(If confirmed or suspected, ie sx’s in pt w/ known malignancy)

Answer 4

Steroids:
Dexamethasone 10 mg IV loading dose followed by 4 mg oral/IV every 6 hours as maintenance

Question 5

*Initial treatment for epidural abscess:
(Sx’s with known infection or suspected ie IVDU)

Answer 5

Draw blood cultures and ESR
- An ESR of less than 20 has excellent sensitivity for excluding a diagnosis
of spinal epidural abscess
Start empirical antibiotics with broad-spectrum coverage
- Abscesses are often multi-microbial
- MRSA coverage – start vancomycin
- Gram-negative coverage – start third or fourth generation cephalosporin
- Anaerobic coverage with metronidazole should be considered

Question 6

Neuro exam in a headache pt:

Answer 6

• Mental status
• Cranial nerves
• Meningeal signs (nuchal rigidity, Kernig and Brudzinski’s)
• Motor strength
• Reflexes?
• Gait and coordination

Question 7

When is it safe to do an LP without imaging?

Answer 7

• Normal sensorium
• No focal neurologic deficit
• No hx of immunosuppression

Question 8

*Internal carotid dissection presents with:

Answer 8

Anterior circulation symptoms

Question 9

*Vertebral artery dissection presents with:

Answer 9

Posterior circulation symptoms

Question 10

Tool for ruling out subarachnoid hemorrhage:

Answer 10

Ottawa Subarachnoid Hemorrhage Rule

Question 11

Reversal agent for heparin

Answer 11

Protamine

Question 12

Dosing of protamine

Answer 12

1 mg per 100 units of heparin (over the last 3 hours). Max dose 50 mg.

Question 13

*Comatose pt with normal results on CT, consider thrombosis of:

Answer 13

Basilar artery - only finding may be by a hyperdense basilar artery.

Question 14

Vertigo in 2 minute (or less) episodes, initiated by head movement.

Answer 14

Benign paroxysmal positional vertigo

Question 15

Vestibular neuritis:

Answer 15

Prolonged, continuous bout of vertigo that is intense for several days and then resolves over days, weeks, or months. No ear pain, hearing loss, or tinnitus. Likely caused by a virus.

Question 16

Labyrinthitis:

Answer 16

A complication of acute otitis media, days of ongoing continuous vertigo that is associated with ear pain, hearing loss, or tinnitus as well as vertigo.

Question 17

Ramsay Hunt Syndrome (herpes zoster oticus)
Sx, findings, tx

Answer 17

Deafness, vertigo, and facial nerve palsy. Confirmed by grouped vesicles on an erythematous base inside the external ear canal. Treat with antivirals within 72 hours of vesicles.

Question 18

Wallenberg’s syndrome (lateral medullary infarction)

Answer 18

Ipsilateral facial numbness, loss of corneal reflex, Horner’s syndrome, and paralysis or paresis of the soft palate, pharynx, and larynx (dysphagia & dysphonia). Contralateral loss of pain and temp in trunk and limbs. Emergent MRI

Question 19

CN II (name and function/test)

Answer 19

Optic Nerve
- afferent function of light and visual perception
- Test w/ swinging flashlight test

Question 20

CN III (name and function/test)

Answer 20

Oculomotor nerve
- eyelid opening, eye movement (except those of IV & VI), consensual light reflex
- Test w/ eye movement, light reflex

Question 21

CN III palsy findings:

Answer 21

• ptosis
• mydriasis (dilated pupil)
• eye turned down and out

Question 22

CN IV (name and function/test):

Answer 22

Trochlear nerve
- motor function of superior oblique muscle
- On H eye movement unable to lookdown when eye adducted

Question 23

CN V (name and function/test)

Answer 23

Trigeminal nerve
- motor: muscles of mastication (test for masseter bulk)
- sense: facial sensation (V1-3)
- corneal reflex

Question 24

CN VI (name and function/test)

Answer 24

Abducens nerve
- abduction of the eye (lateral movement)
- H eye movement

Question 25

CN VII (name and function/test)

Answer 25

Facial Nerve - Motor: facial expression - Sense: taste Test w/ facial movements

Question 26

CN VIII (name and function/test)

Answer 26

Vestibulocochlear nerve - hearing and vestibular movement/position sensation Test w/ hearing

Question 27

CN IX (name and function/test)

Answer 27

Glossopharyngeal nerve - taste and muscles of swallowing - gag reflex

Question 28

CN X (name and function/test)

Answer 28

Vagus nerve - Motor: pharynx and larynx muscles - Taste - Visceral sensation Test by assessing for uvula deviation (deviates to normal side)

Question 29

CN XI (name and function/test)

Answer 29

Accessory nerve - Motor: sternocleidomastoid and trapezius muscles Test w/ shoulder shrug, neck rotation

Question 30

CN XII (name and function/test)

Answer 30

Hypoglossal nerve - Motor: tongue muscles Test w/ tongue protrusion (deviates toward affected side)

Question 31

Sedations meds s/p RSI in status epilepticus

Answer 31

Ketamine, versed or propofol

Question 32

Causes to consider in persistent seizures:

Answer 32

Eclampsia Isoniazid overdose Hypoglycemia Hyponatremia Hypocalcemia Other causes of provoked seizures Theophylline toxicity

Question 33

Most common complications from status epilepticcus:

Answer 33

Hyperthermia Rhabdomyolysis Pulmonary edema Resulting injuries, eg, tongue laceration, shoulder dislocation, etc.

Question 34

Second line drugs in status epilepticcus:

Answer 34

Phenytoin/fosphenytoin: 20 mg/kg (max 1.5 g) Valproic acid (depakote): 40 mg/kg (max 3g) Levetiracetam (keppra) : 60 mg/kg (max 4.5g)

Question 35

Presentation of cartoid artery dissection:

Answer 35

Sudden onset, severe headache usually unilateral with neck pain and pulsatile tinnitus. Symptoms of retinal or cerebral ischemia. May have partial Horner Syndrome (ptosis & miosis).