Neuro

Question 1

Patient with progressive MS and spastic paresis along with a neurogenic bladder. Develops increasing difficulty with lower extremity weakness and gait impairment. What is the etiology?

Answer 1

UTI resulting in worsening of previously fixed deficit

Question 2

Most likely brain met to hemorrhage

Answer 2

Renal cell carcinoma

Question 3

Pt with new onset vertigo, dysarthria, horizontal nystagmus with right facial and left appendage numbness. Localize the lesion

Answer 3

Medulla

Question 4

Infantile spasms, or west syndrome, is associated with what condition?

Answer 4

Tuberous sclerosis

Question 5

Most appropriate test to order in suspected Guillian-barre

Answer 5

LP

Question 6

Child who has worsening movement of appendages and recently recovered from strep. What test should you order to confirm the diagnosis?

Answer 6

Anti-DNase b

Question 7

What medication manages excessive daytime sleepiness and cataplexy in a patient with narcolepsy?

Answer 7

Sodium oxybate

Question 8

What feature of narcolepsy is considered specific and seldom ️Occurs outside?

Answer 8

Cataplexy

Question 9

Most appropriate treatment of a patient in a myasthenic crisis

Answer 9

IVIG

Question 10

What muscle is weak with prolonged entrapment of the median nerve at the level of the wrist?

Answer 10

Abductor pollicis brevis

Question 11

Man with recurrent falls, changes in his speech, impaired vertical eye movement, bradykinesia, increased axial tone, dysarthria. What’s causing it?

Answer 11

Progressive supra nuclear palsy

-These patients tend to fall BACKWARDS

MRI shows hummingbird sign in sagittal plane and Mickey Mouse sign in coronal plane

Question 12

Drugs use in both cluster and migraine headaches

Answer 12

Triptans

Question 13

56 year old man with a fib who has abrupt left sided hemiparesis and left visual field cut. What is absolute CI to IV tPA use in stroke even under 3 hours?

Answer 13

Major surgery in the last 14 days, of which there would be difficult holding compression should the patient experience and ️Bleeding

Question 14

Patient with increased sensitivity to sound in the left ear. MRI reveals posterior Fossa mass. What CN is damaged?

Answer 14

VII

Question 15

Proper order for documenting the neurologic exam

Answer 15

Mental status

CNS

Strength

Sensation

Coordination

Reflexes

Gait

Question 16

Paroxysmal hemicrania

Answer 16

Just like a cluster headache but only lasts for 2-30 mins

***COMPLETE response to indomethacin

Question 17

SUNCT

Answer 17

Short unilateral neuralgiform headaches

Just like cluster headaches but last from 1 second-10 minutes

Tx: Lamotrigine

Question 18

Prophylactic treatment for tension headache

Answer 18

TCAs

Question 19

Intracranial pressure in IIH

Answer 19

> 250 mmHg

Question 20

Alternative causes of a picture similar to IIH

Answer 20

Hypervitaminosis A

Tetracyclines

Dural venous thrombosis (if signs of visual changes, make sure to get an MRI to rule this out)

Question 21

Huntington’s Disease Treatment

Answer 21

Tetrabenazine

• Profound dopamine depleting agent
• Also treat other sx. as expected because obv. this drug can lead to depression

Question 22

Earliest deficit in Alzheimer’s disease

Answer 22

Physiologic lesion in the hippocampus

This area will also lose nicotinic receptors throughout the course of the disease

Question 23

Neuroimaging in PSP

Answer 23

Degeneration of the midbrain and pons

Question 24

Corticobasal Degeneration

Answer 24

Asymmetrical onset showing:

1. Akinesis
2. Apraxia
3. Alien hand syndrome
   - Pts. may have cortical involvement, increased DTRs, supranuclear gaze palsy

Neuroimaging shows contralateral loss of cortex

Question 25

CT findings in Wilson disease

Answer 25

Hypodense regions in the basal ganglia | caudate, putamen, GP

Question 26

PML

Answer 26

Presents as dementia, visual loss, and progressive hemiparesis -Oligodendrocytes contain eosinophilic intranuclear inclusions Tx: Cytarabine; vistidine

Question 27

Sporadic vCJD on MRI

Answer 27

Anterior basal ganglia high intensity signal

Question 28

New variant CJD MRI

Answer 28

High intensity signal in the pulvinar and thalamus

Question 29

CADASIL

Answer 29

Dementia onset in young person; may also have recurrent strokes Probs have depression as well

Question 30

Treatment of Sydenham's Chorea

Answer 30

Pimozide (dopamine antagonist)

Question 31

Primary dystonia in childhood

Answer 31

Begins in the foot; responds to L-dopa

Question 32

Treatment of a drug induced dystonia

Answer 32

Benadryl; Cogentin

Question 33

PANDAS

Answer 33

Pediatric Autoimmune Neuropsychiatric Disorders Associated w/ Strep ***Tics that appear after a Strep Infxn ***DO NOT treat w/ antibiotics; treat w/ normal tic treatments

Question 34

Narcolepsy tetrad

Answer 34

Sleep Attacks Hallucinations Sleep paralysis Cataplexy

Question 35

Majority of sleep is spent in what stage

Answer 35

2 NREM

Question 36

Antibody in generalized mg

Answer 36

Anti-MUSK

Question 37

Antibody in my with Thymic mass

Answer 37

Anti-striated muscle ab

Question 38

CMT Type 1

Answer 38

Demyelinating AD Inheritance Disorder of the PMP22 gene (peripheral myelinating) Presentation: Distal weakness and muscle wasting that affects the legs first; HIGH FOOT ARCHES AND HAMMER TOES *Might be described as champagne bottle legs

Question 39

CMT Type 2

Answer 39

Axonal Type Damage to the axon Pts. can usually continue walking with ambulatory assistance

Question 40

CMT Type III

Answer 40

Dejerine-Sottas Disease AR demyelinating neuropathy that leads to delayed developmental milestones

Question 41

Miller-fisher variant of GBS

Answer 41

GBS that also causes Ophthalmoplegia, ataxia, facial weakness, and dysarthria *Pt will have anti-GQ1 antibodies

Question 42

Chronic Inflammatory Demyelinating Neuropathy

Answer 42

Antibody mediated reaction w/ interstitial and perivascular infiltration of the endoneurium w/ T cells and macrophages Think of it like purely peripheral MS Tx: Immunosuppresants; IVIG; plasmapharesis -Good recovery due to them just being peripheral nerves

Question 43

Gilenya

Answer 43

MS drug that sequesters lymphocytes into lymph nodes ADRs: Headache, diarrhea, lymphopenia, cough

Question 44

Teriflunomide

Answer 44

Limits an enzyme in the pyrimidine synthesis pathway decreasing the proliferation of immune cells ***SEVERELY TERATOGENIC; if pt. becomes pregnant, remove from system w/ cholestyramine

Question 45

Dimethyl Fumarate

Answer 45

Activates the Nrf2 pathway which responds to oxidative stress

Question 46

Natalizumab

Answer 46

Monthly IV fusion that acts as an anti-a4-integrin blocking the trafficking of lymphocytes across the BBB ***CAN CAUSE PML

Question 47

Transverse myelitis

Answer 47

Demyelination of the spinal cord Results in limb weakness, bowel and bladder dysfnxn, possibly automatic dysfnxn _Possible in patients w/ MS

Question 48

Treatment of Neuromyelitis Optica

Answer 48

Rituximab

Question 49

Oxybutinin

Answer 49

Anticholinergic used to treat a hypertonic bladder

Question 50

Acute labyrinthitis

Answer 50

Typically associated w/ an infection and causes vertigo along with hearing loss -If bacterial abx; if viral, will resolve on own

Question 51

Acute idiopathic vestibular neuropathy

Answer 51

Intense vertigo w/ head movements that arises due to a post-viral etiology Tx: Corticosteroids

Question 52

Where are migraines thought to begin?

Answer 52

The Brainstem; is why you can get other symptoms with the aura

Question 53

Pain in migraines

Answer 53

Opthalmic branch of CN V activates the superior salivatory ️Nucleus

Question 54

Neuropeptide that may mediate migraine

Answer 54

Orexin

Question 55

Agent of choice for cluster headache

Answer 55

Verapamil

Question 56

Ct stroke protocol

Answer 56

Ct of head w/o contrast Then CTA of head and neck Then CTP

Question 57

Other presenting signs of Wilson's Disease

Answer 57

Dysphagia, dysarthria, rigidity, tremor, psychosis, Due to Subcortical dementia

Question 58

Primary dystonia of childhood

Answer 58

Usually begins in foot Try treating with l-dopa If no response... It's probably idiopathic generalized torsion dystonia and it will generalize within 5 years

Question 59

Chorea in a newborn

Answer 59

Could be glutamic acidemia Supplement with carnitine