Neuro

Question 1

What eye movement is limited with a CN IV palsy?

Answer 1

Cannot converge eyes

Question 2

What is the classic complaint of a patient with a CN IV palsy?

Answer 2

• Cannot read a book

- Trouble walking down stairs

Question 3

Why is CN VI considered a false localizing sign?

Answer 3

Increased ICP can cause a palsy, rather than an anatomically specific lesion

Question 4

What are the CNs that are associated with the midbrain?

Answer 4

1, 2, 3, 4

Question 5

What are the CNs that are associated with the pons?

Answer 5

5, 6, 7, 8

Question 6

What are the CNs that are associated with the medulla?

Answer 6

9, 10, 11, 12

Question 7

What is the presentation of a patient that has a stroke in the pons?

Answer 7

Locked in with pinpoint pupils

Question 8

What are the three major areas of bleeding in the brain?

Answer 8

• Deep nuclei
• Pons
• Cerebellum

Question 9

Where is the most common location for a intracranial artery aneurysm?

Answer 9

Anterior communicating artery

Question 10

What is difference in the appearance of a traumatic vs spontaneous subarachnoid hemorrhage on CT scan?

Answer 10

Spontaneous will be blood diffusely throughout the brain, whereas a traumatic will be localized to area of trauma.

Question 11

When is xanthochromia reliably present on LP for diagnosing SAH?

Answer 11

12 hours

Question 12

What is the CCB used to treat SAH?

Answer 12

nimodipine–specifically for brain vasculature, and only given orally

Question 13

What type of fluids should NEVER be given to stroke patients? Why?

Answer 13

Hypotonic fluids, since this will worsen any cerebral edema.

Question 14

Why should all patients with a stroke be reversed on their anticoagulation (even those with mechanical valves)?

Answer 14

Risk of bleeding very high in ischemic area

Question 15

What is the major difference between lacunar strokes vs cortical strokes?

Answer 15

Lacunar have either motor or sensory, whereas cortical strokes have both.

Question 16

What are the tests that all patients with TIAs need to help prevent future strokes?

Answer 16

• PFO/ECHO study
• EKG/holter for a-fib
• Carotid dopplers

Question 17

How does the presentation of a venous sinus thrombosis differ from a stroke?

Answer 17

Venous clots can cause bilateral symptoms

Question 18

What is the “delta sign” on a non-contrast head CT that is diagnostic of venous sinus thrombosis?

Answer 18

Bright white appearance (clot) in the posterior confluence of sinuses

Question 19

What is the treatment for a carotid artery dissection?

Answer 19

AC

Question 20

What is the scoring system for predicting a stroke following a TIA?

Answer 20

ABCD2 scoring system

Question 21

What is the role of steroids in the treatment of meningitis?

Answer 21

Should be given before abx are given

Question 22

What are the four indications to obtain a head CT prior to performing an LP?

Answer 22

Old
Immunocompromised
AMS
Focal neuro findings

Question 23

What are the three major abx given to adult meningitis pts?

Answer 23

Ceftriaxone
Vanco
Ampicillin

Question 24

Why can you not give infants less than 1 month old ceftriaxone? What can you give instead?

Answer 24

• Can cause kernicterus

- Cefotaxime

Question 25

What are the major viruses that cause aseptic meningitis (4)

Answer 25

- Enterovirus - West nile - HSV2 - VZV

Question 26

Where does TB infect the brain, typically? Why?

Answer 26

Brainstem since this is the highest oxygenated area

Question 27

What can clinically differentiate TB meningitis from other bacterial meningitis? What treatment benefits TB meningitis the most outside of abx?

Answer 27

- CN s/sx | - Steroids early

Question 28

India ink stain = ?

Answer 28

Cryptococcal meningitis

Question 29

What is the most common cause of a mass lesion in AIDS pts?

Answer 29

Toxoplasmosis

Question 30

What blood test is pretty sensitive for CNS spinal cord infections?

Answer 30

ESR

Question 31

What is the myotome level for the: biceps?

Answer 31

C5

Question 32

What is the myotome level for the: Triceps?

Answer 32

C7

Question 33

What is the myotome level for the: Quads?

Answer 33

L4

Question 34

What is the myotome level for the: ankle?

Answer 34

S1

Question 35

What is the myotome level for the: abdominal muscles

Answer 35

T8-T12

Question 36

What is the myotome level for the: cremaster

Answer 36

L1-L2

Question 37

What is the myotome level for the: anus

Answer 37

S2-S4

Question 38

How many CCs of urinary retention is supportive of diagnosing cauda equina?

Answer 38

100-150 cc

Question 39

Is having bilateral symptoms more or less specific for cauda equina?

Answer 39

More, since it has to be higher than a peripheral nerve root

Question 40

What are the symptoms of syringomyelia?

Answer 40

Loss of pain/temp in hands

Question 41

Why are chiari malformations associated with recurrent headaches?

Answer 41

Tonsillar "herniation" blocks CSF flow intermittently

Question 42

What are the two major infections that precipitate Guillain barre syndrome?

Answer 42

Mycoplasma pneumonia and campylobacter diarrhea

Question 43

What is the treatment for Guillain barre?

Answer 43

Plasmapheresis

Question 44

What is the difference between tick paralysis and Guillain barre syndrome?

Answer 44

GBS has sensory deficits, whereas tick paralysis does not

Question 45

What are the three major cause of ptosis?

Answer 45

Horner's syndrome Third nerve palsy Myasthenia Gravis

Question 46

Which muscles are primarily affected with myasthenia gravis: proximal or distal?

Answer 46

Proximal

Question 47

What is the diagnostic test for myasthenia gravis?

Answer 47

Edrophonium test or ice pack test

Question 48

What are the major risks of edrophonium?

Answer 48

Cardiac arrhythmias and heart blocks

Question 49

How do you differentiate between myasthenia gravis and lambert-eaton syndrome?

Answer 49

Myasthenia gravis gets worse with repetitive action, whereas Lambert-Eaton syndrome gets worse

Question 50

What is Lambert-Eaton syndrome associated with?

Answer 50

Cancer (it's a paraneoplastic syndrome)

Question 51

Who is usually affected with acute periodic paralysis?

Answer 51

Young men with thyroid disorders

Question 52

Why must you be careful with replacing potassium in patients with acute periodic paralysis?

Answer 52

Not a problem of total body loss, rather of maldistribution. Thus you may overshoot potassium if giving too much

Question 53

What is the pharmacologic long term treatment for acute periodic paralysis?

Answer 53

Beta blockers