neuro 2

Question 1

does essential tremor and tremor of PD have opposite presentations?

Answer 1

yes - PD is resting, whereas essential is worse with activity

Question 2

this reflex is concerning for brainstem compression

Answer 2

cushing reflex - hypertension, bradycardia, respiratory depression

Question 3

*** sensory ataxia, lancinating pains, urinary incontinance, argyll robertson pupils

Answer 3

tabes dorsalis of syphilis - give penicillin for tx

Question 4

fluctuating cognitive impairment, recurrent visual hallucinations, parkinsonism

Answer 4

dementia with lewy bodies

Question 5

*** decreased sensation over 4th and 5th fingers, prolonged leaning on elbows

Answer 5

ulnar nerve entrapment at epicondylar groove of the elbow

Question 6

fasiculations

Answer 6

LMN damage

Question 7

spasticity, bulbar symptoms, exaggerated DTR

Answer 7

UMN damage

Question 8

ALS is a mix of both _____

Answer 8

LMN and UMN damage

Question 9

*** which patients with vertigo should have non contrast CT of head

Answer 9

prominent stroke risk factors
new onset HA
neurologic signs/symptoms

Question 10

eosinophillic intracytoplasmic inclusions

Answer 10

Lewy bodies

Question 11

key differentiation between LBD and PD

Answer 11

LBD = early appearance of cognitive fluctuations and dementia; comes LATE with PD

Question 12

tx of pseudotumor cerebri

Answer 12

acetazolamide

Question 13

tx of trigeminal neuralgia

Answer 13

carbamazepine

Question 14

tx of temporal arteritis

Answer 14

glucocorticoids

Question 15

*** What is the single most POWERFUL risk factor for stroke

Answer 15

hypertension

Question 16

erythema migrans, HA, arthralgias, myalgias

Answer 16

burgedorfi, lymes

Question 17

periodic sharp wave complexes on EEG, 14-3-3 CSF assay, caudate nucleus and putamen, spongiform changes on path, rapid deterioration with dementia and muscle movement

Answer 17

CJD

Question 18

*** old homes, microcytic anemia with basophilic stippling, calcium disodium EDTA

Answer 18

chronic lead toxicity

Question 19

*** what is major cause of death in first 24 hours of SAH presentation?

Answer 19

REBLEED

Question 20

Day 3-10 after SAH, what’s patient at risk for?

Answer 20

Vasospasm

Question 21

*** role of nimodipine in SAH

Answer 21

prevent vasospasm

Question 22

*** bilateral motor function loss, diminished pain and temperature sensation, preserved proprioception, vibratory sensation, light touch

Answer 22

anterior cord syndrome - damage to anterior spinary arter

Question 23

*** painless, rapid, transient monocular vision loss “curtain coming down over visual field”

Answer 23

amaurosis fugax - atherosclerotic emoboli from carotid artery

Question 24

first thing to do with someone who has amaurosis fugax episodes

Answer 24

duplex US of the neck

Question 25

unilateral HA, jaw claudication, fever, fatigue, monocular vision loss

Answer 25

think giant cell arteritis - check ESR

Question 26

*** stroke with sudden-onset contralateral sensory loss involving all sensory modalities

Answer 26

thalamic stroke

Question 27

stroke in this area is called a "pure sensory stroke"

Answer 27

thalamus

Question 28

after a thalamic stroke, can patients develop a burning pain over the affect area, exacerbated by light touch?

Answer 28

yes - thalamic pain syndrome

Question 29

stroke with contralateral pure motor or combined sensorimotor deficits

Answer 29

internal capsule

Question 30

stroke with ipsilateral oculomotor nerve palsy, ataxia, contralateral hemiparesis

Answer 30

midbrain

Question 31

is the internal capsule often involved in stroke to putamen?

Answer 31

yes - contralateral hemiparesis, sensory loss, conjugate gaze palsy toward side of the lesion

Question 32

this medication inhibits choroid plexus carbonic anhydrase and is mainstay of pseudotumor cerebri treatment

Answer 32

acetazolamide

Question 33

*** lateral medullary infarction, intracranial vertebral artery, sx of nystagmus, vertigo, difficulty sitting upright, loss of pain and temp sensation of ipsilateral face and contralateral trunk, ipsilateral bulbar, dysphagia, hoarseness, diminished gag reflex

Answer 33

Wallenberg syndrome

Question 34

lateral mid-pontine lesions

Answer 34

motor and sensory fibers of trigeminal nerve

Question 35

Which nerves are typically involved in lateral medullary infarction and lateral mid-pontine lesions

Answer 35

lateral medullary = 9 and 10 (dysphagia, hoarseness, diminished gag) lateral mid-pontine - 5 (weak mastication, diminished jaw jerk reflex, impaired face sensation)

Question 36

contralateral paralysis of the arm and leg and tongue deviation toward the lesion

Answer 36

medial medullary syndrome

Question 37

contralateral ataxia and hemiparesis fo the face, trunk and limbs

Answer 37

medial mid-pontine infarction

Question 38

*** cortical laminar necrosis

Answer 38

hallmark of prolonged seizures, results in persistent deficits and recurrent seizures

Question 39

*** periorbital edema, unable to move the eye, HA, vomiting

Answer 39

cavernous sinus thrombosis

Question 40

hemineglect syndrome

Answer 40

non-dominant parietal lobe

Question 41

left temporal lobe involvement

Answer 41

receptive aphasia

Question 42

frontal cortex lesion

Answer 42

hemiparesis

Question 43

occipital lobe damage

Answer 43

visual disturbance

Question 44

urinary incontinence/urgency, broad-based shuffling gait, memory/cognitive deficits, decreased CSF absorption by arachnoid granulations

Answer 44

normal pressure hydrocephalus - ultimately need VP shunt for tx

Question 45

accumulation of alpha-synuclein within dopaminergic neurons

Answer 45

PD

Question 46

charcot-bouchard aneurysm, lenticulostriate arteries, deep intracerebral hemorrhgae (basal ganglia/putamen, cerebllar nucle, thalamus, pons)

Answer 46

hypertensive vasculopathy

Question 47

nipple dermatome

Answer 47

T4

Question 48

*** corneal sensation

Answer 48

CN 5

Question 49

*** CN for swallowing, palate elevation, phonation

Answer 49

CN X

Question 50

*** CN that carries visual information and mediates the afferent limb of the pupillary light reflex

Answer 50

CN II

Question 51

*** CN for eyelid opening, pupillary constriction, eye movement

Answer 51

CN III

Question 52

crohn disease/ileal resection/gastritis, chronic malabsorption, macrocytic anemia, smear with macro-ovalocytes + hypersegmented neutrophils, methylmalonic acid, build-up of homocysteine

Answer 52

B12 deficiency

Question 53

suspect this kind of stroke if pt presents initially with focal symptoms which then progress to signs of elevated ICP (vomiting, HA, bradycardia, decreased alertness)

Answer 53

hemorrhagic stroke

Question 54

pt with solitary brain metastases and in good function health with stable extracranial disease. tx option?

Answer 54

surgical resection - if more than one, whole-brain radiation

Question 55

gait instability, truncal ataxia, difficulty with rapid movements, hypotonia, intention tremor

Answer 55

cerebellar dysfunction - common in alcoholics

Question 56

atrophy of frontal lobes

Answer 56

frontotemporal dementia

Question 57

atrophy of TEMPORAL lobes

Answer 57

alzheimer disease

Question 58

broad flat T waves, U waves, ST depression, PVR, a fib, torsades de pointes, v fib

Answer 58

cardiac abnormalities 2/2 hypokalemia <2.5

Question 59

muscle wekaness, fatigue, cramps and cardiac abnormalities

Answer 59

think electrolyte abnormalities - potassium!

Question 60

weakness, difficulty chewing, swallowing, coughing, breathing, hyperreflexia, spasticity, fasiculations

Answer 60

ALS