Neuro

Question 1

How do you diagnose pseudo-seizure disorder?

Answer 1

Inpatient 24 hour EEG with video monitoring and induction of seizure with stimuli and sleep deprivation.

Question 2

What is a possible treatment for neurogenic bladder?

Answer 2

neurogenic bladder can be side effect of MS

Use bethanechol to induce spasms in the bladder

Question 3

How is stroke related to depression?

Answer 3

Stroke places patients at high risk for depression. Use of SSRI or SNRIs is indicated, unless contraindications exist.

Question 4

What is the diagnosis of cluster headache?

Answer 4

Cluster headaches require one time brain imaging.

Question 5

What is pseudodementia?

Answer 5

do not have dementia at all, just the depression that manifests as it

Fix the depression, fix the dementia. Treat depression with anti-depressants such as citalopram.

Question 6

What is Eaton-lambert syndrome?

Answer 6

Paraneoplastic syndrome that presents with large-muscle weakness that improves with use.

Caused by the production of antibodies against presynaptic calcium channels.

Question 7

How do you treat status epilepticus?

Answer 7

Escalation of therapy for status epilepticus is Benzos –> Levetiracetam –> Midazolam and Propofol –> Phenobarbital

Question 8

How will Creutzfeldt-Jakob disease present?

Answer 8

Young dementia, rapid decline, and myoclonus is CJD.

Question 9

What is myasthenia gravis?

Answer 9

Antibodies against acetylcholine-receptors

Weakness that worsens with use

Can be due to thymoma (do thymectomy)

Treat with stigmine (pyridostigmine)

Question 10

What is Normal pressure hydrocephalus?

Answer 10

Weird, Wobbly, and Wet patient. This is dementia, ataxic gait, and urinary incontinence.

Get LP to diagnose

Question 11

What is the treatment for Normal pressure hydrocephalus?

Answer 11

Removal of CSF is key to improve the condition and prevent worsening, a Ventriculoperitoneal shunt (VP Shunt) is required to maintain intracranial pressures at normal levels and reverse the dementia.

Question 12

What is Cauda Equina syndrome?

Answer 12

Saddle anesthesia, loss of bowel and bladder continence in the setting of back pain.

Treat with IV steroids

Question 13

How is a stroke diagnosed?

Answer 13

1st test- CT

Best test- MRI

Question 14

Carotid stenosis treatment?

Answer 14

If carotid stenosis > 70% or > 60% with symptoms then you do a carotid endarterectomy.

If DVT, then heparin to Coumadin bridge.

If no clot, then just start Coumadin (no need for heparin bridge)

Question 15

What is non-convulsive status?

Answer 15

Seizing but no outward signs of seizure activity

considered in the ICU setting with continued altered mental status after anoxic brain injury or trauma

Question 16

Diagnosis of Myasthenia Gravis?

Answer 16

acetylcholine receptor antibody testing and positive anti-muscle-specific tyrosine kinase antibodies

a CT scan of the chest should be obtained to rule out thymoma.

Question 17

What is Fronto-temporal dementia, or Pick’s disease?

Answer 17

loss of social graces often presenting as hypersexuality or violence, later in dz will lose memory.

Question 18

What is Parkinson’s disease?

Answer 18

Pill rolling tremor at rest
cog- wheel rigidity

α- synuclein (intracellular eosinophilic inclusions)

< 65 + functional we use dopamine agonists (pramipexole) –> levodopa/carbadopa later in dz

Question 19

What is brain death?

Answer 19

Absence of brainstem reflexes AND the absence of cortical function.

Question 20

What is persistent vegetative state?

Answer 20

Brainstem reflexes are intact (eyes open/close, cough, pupillary, corneal reflex etc) BUT cortical function is lost forever (speech, memory, personality etc)

Question 21

What if seen in a patient is indication of death?

Answer 21

Presence of either lividity (dark blue pooling of venous blood in dependent areas) or rigor mortis

Question 22

What is lewy body dementia?

Answer 22

combination of dementia and Parkinsonian symptoms

verbal problems and visual hallucinations

Question 23

First thing to do for a stroke?

Answer 23

If you think stroke get a CT scan to rule out a bleed

Question 24

What is sensorineural hearing loss?

Answer 24

Lateralization to the normal ear on Weber testing and better air conduction is indicative of a cranial nerve lesion and central cause for vertigo. Evaluate with MRI.

Question 25

What is conductive hearing loss?

Answer 25

Weber test should lateralize to the affected ear and the Rinne test should be louder when in contact with bone.--> peripheral cause

Question 26

How is myasthenia gravis daignosed?

Answer 26

1st test- anti-acetylcholine receptor antibodies that block the binding of acetylcholine to the end-plate at the post-synaptic junction Best test- EMG (electromyography)

Question 27

Indication of impending brain herniation.

Answer 27

Cushing triad 1) widening pulse pressure 2) Irregular respirations 3) Bradycardia

Question 28

Syringomyelia

Answer 28

Syringomyelia commonly occurs in patients with Arnold-Chiari malformations and is characterized by bilateral loss of pain and temperature one level below the lesion with bilateral flaccid paralysis at the level of the lesion. It is commonly caused by cystic dilation of the central spinal canal.

Question 29

consciousness can be assessed via the Glasgow coma scale (GCS)

Answer 29

``` Eye Response Spontaneous: 4 To verbal command: 3 To pain: 2 None: 1 ``` ``` Verbal response Oriented with normal conversation: 5 Confused speech: 4 Inappropriate speech: 3 Incomprehensible sounds: 2 None: 1 ``` ``` Motor response Obeys commands: 6 Localizes painful stimuli: 5 Withdrawal to painful stimuli: 4 Abnormal flexion (decorticate): 3 Abnormal extension (decerebrate): 2 None: 1 ``` Total Possible Points: 15

Question 30

GCS and need for intubation

Answer 30

GCS 13= Minor injury GCS 9-12= Moderate injury GCS 8 or less = severe injury Intubation is indicated for patients with a GCS less than 8.

Question 31

poisoning and its antidotes

Answer 31

Carbon monoxide poisoning= 100% oxygen Amyl nitrite= cyanide poisoning Dimercaptosuccinic acid or EDTA= Lead poisoning Methylene blue= methemoglobinemia

Question 32

autosomal recessive condition

Answer 32

25% normal 50% carrier 25% affected

Question 33

TCA overdose

Answer 33

most common manifestations on electrocardiogram of TCA overdose is a wide QRS complex and prolonged QT interval. Patients need immediate infusion of sodium bicarbonate (NaHCO3) to help prevent cardiac collapse and fatal ventricular tachyarrhythmias.

Question 34

Guillain- Barre syndrome labs

Answer 34

Normal opening pressure Normal white blood cell count Normal glucose Large increase in protein (100 to 1000 mg/dL) Clear yellow appearance

Question 35

Histological/Structural findings of Alzheimer's dementia

Answer 35

Neurofibrillary tangles made of hyper-phosphorylated tau protein Senile plaques made of extracellular beta-amyloid Aβ plaques.

Question 36

Huntington's disease

Answer 36

Autosomal dominant Trinucleotide cysteine-adenosine-guanine (CAG) repeat expansion on chromosome 4 Caudate atrophy choreiform movements, behavioral change (depression), and executive impairment (memory imparment not typical until LATE in Dz)

Question 37

Histological/Structural findings of Frontotemporal Dementia

Answer 37

Pick bodies (round inclusions of hyperphosphorylated tau proteins)

Question 38

Histological/Structural findings of Lewy body dementia

Answer 38

Lewy bodies (α-synuclein aggregates)

Question 39

Histological/Structural findings of Creutzfeldt-Jakob disease

Answer 39

Parenchymal vacuolation (spongiform cortex) Prions (β-pleated sheets resistant to proteases)

Question 40

Empiric Antibiotic Coverage for Less than 1 month old

Answer 40

Common Pathogens: Streptococcus agalactiae Escherichia coli Listeria monocytogenes Empiric Antibiotic choice Ampicillin plus cefotaxime OR Ampicillin plus an aminoglycoside

Question 41

Empiric Antibiotic Coverage for 1 month to 23 months

Answer 41

``` Common Pathogens: Streptococcus pneumoniae Neisseria meningitidis S. agalactiae Haemophilus influenzae E. coli ``` Empiric Antibiotic choice: Vancomycin plus Third-generation cephalosporin

Question 42

Empiric Antibiotic Coverage for 2 years to 50 years

Answer 42

Common Pathogens: N. meningitidis S. pneumoniae Empiric Antibiotic choice: Vancomycin plus Third-generation cephalosporin

Question 43

Empiric Antibiotic Coverage for

Answer 43

``` Common Pathogens: S. pneumoniae N. meningitidis L. monocytogenes Aerobic gram-negative bacilli ``` Empiric Antibiotic choice: Vancomycin plus Third-generation cephalosporin plus Ampicillin

Question 44

Study phases

Answer 44

Preclinical- testing on animals Phase 1- Testing on healthy volunteers (<100)- is drug safe? Phase 2- Testing on patients (100-300)- efficacy? Phase3- Testing on patients (300-3,000)- therapeutic effect Phase 4- Post marketing surveillance- long term effects

Question 45

Brown-Sequard syndrome

Answer 45

Affects all of the tracts on one side of the spinal cord Ipsilateral loss of vibration & proprioception Ipsilateral weakness Contralateral loss of pain and temperature below the lesion

Question 46

Syringomyelia

Answer 46

Syrinx (fluid-filled cavity) then develops within the central canal Bilateral loss of pain and temperature, often in a cape-like distribution, with bilateral flaccid paralysis at the level of the lesion and relative sparing of the dorsal columns

Question 47

Middle cerebral artery (MCA) occlusion

Answer 47

Symptoms are usually more profound in the face and arms ``` Contralateral hemiparesis (weakness) Contralateral hypesthesia (decreased sensation) Contralateral hemianopia (blindness in half of the visual field) Gaze preference toward the side of the lesion. ```

Question 48

Posterior cerebral artery (PCA) occlusion

Answer 48

vision and thought, producing contralateral homonymous hemianopia, symptoms of cortical blindness, and other visual disturbances. Signs of altered mental status and memory impairment are also likely

Question 49

Emergent Treatment of Hyperkalemia (CIGAR-B)

Answer 49

C- Calcium gluconate (P IV) or Ca chloride (C IV) I- Insulin (activates NaK pump) G- Glucose (to prevent hypoglycemia) A- Albuterol ((activates NaK pump) R- Remove K from STOOL w/ Patiromer or sodium polystyrene sulfonate Remove K from urine w/ furosemide or hemodialysis if ESRD

Question 50

Budd-Chiari syndrome

Answer 50

Occlusion of hepatic veins or inferior vena cava common in myeloproliferative disorders like polycythemia vera, tumors, and hypercoagulable states Ascites

Question 51

Spectrum of Monoclonal Gammopathies

Answer 51

< 10%= MGUS, No symptoms 10-60%= No symptoms: Smoldering myeloma Symptoms (CRAB): Multiple Myeloma ≥60%= MM

Question 52

Graves disease

Answer 52

TSH Decreased Thyroxine Increased Radioactive Iodine Uptake High

Question 53

Surreptitious ingestion- Exogenous

Answer 53

TSH Decreased Thyroxine Increased Radioactive Iodine Uptake Low

Question 54

Hashimoto thyroiditis

Answer 54

TSH Increased Thyroxine Decreased Radioactive Iodine Uptake- not used for hypo

Question 55

Pulmonary embolism (PE)

Answer 55

Commonly normal findings on chest x-ray unless very large--> wedge shaped infarct (hampton hump) Lucency at the location of the embolus (Westermark sign)

Question 56

Granulomatosis with polyangiitis (Wegener granulomatosis)

Answer 56

small vessel vasculitis, C-ANCA triad of sinusitis, lung cavitary lesions, and glomerulonephritis

Question 57

Alport syndrome

Answer 57

X-linked gentic disorder Family history of hematuria Loss of kidney function and sensorineural hearing impairment

Question 58

Goodpasture syndrome

Answer 58

Antiglomerular basement membrane antibodies that activate the complement system and damage the basement membranes within the lungs and kidneys Electron microscopy reveals linear line deposition of IgG and complement component 3 (C3)

Question 59

Treatment for Goodpasture syndrome

Answer 59

Treatment includes plasma exchange and immunosuppression with corticosteroids and cyclophosphamide

Question 60

IgA nephropathy

Answer 60

Deposition of the IgA antibody in the glomerulus Episodic frank hematuria occurs in nearly 40% of all cases and usually starts within a day of an upper respiratory tract infection (compare to strep glom 2 weeks) Associated w/ henloch purpura (systemic version of this?)

Question 61

Huntington disease

Answer 61

cytosine-adenine-guanine (CAG) repeats in the huntingtin gene on chromosome 4 Autosomal dominant pattern

Question 62

Prophylactic/preventative therapy of migraine headaches

Answer 62

Amitriptyline, venlafaxine, a beta blocker (propranolol), or topiramate botox if more than 15 headaches/ month and nothing else works

Question 63

Persistent neutropenic fevers

Answer 63

If treated with antibiotics and still no improvement, Consider addition of a broad-spectrum antifungal agent in the absence of an other obvious cause.

Question 64

Lewy body dementia

Answer 64

- Fluctuating cognition with variations in attention - Recurrent, detailed visual hallucinations - REM sleep disorder - Parkinsonian features: bradykinesia, rest tremor, rigidity Eosinophilic cytoplasmic inclusion bodies within the substantia nigra and locus coeruleus of the brain.

Question 65

Alzheimer disease

Answer 65

Most common cause of dementia in the elderly Senile plaques and neurofibrillary tangles

Question 66

Postdural puncture headaches

Answer 66

Headache after getting epidural 1) Conservative management 2) Epidural blood patch (EBP)- inject patient's blood into the epidural space to create a blood clot to compress the area of cerebrospinal fluid leakage 3) Transnasal sphenopalatine block/ Greater occipital nerve block

Question 67

Malignant hyperthermia

Answer 67

Abnormal ryanodine receptors on sarcolasmic reticulum react to anesthetics with unregulated flow of calcium into the cytoplasm and resulting in muscular tetany Tx: Dantrolene (antagonizes these ryanodine receptors on the sarcoplasmic reticulum.

Question 68

Intracranial berry aneurysms are associated with what diseases?

Answer 68

1) Polycystic kidney disease 2) Ehlers-Danlos syndrome 3) Pseudoxanthoma elasticum 4) Moyamoya syndrome 5) Glucocorticoid-remediable aldosteronism

Question 69

Occlusion of the basilar artery

Answer 69

Bilateral pontine infarction--> quadriplegia, inability to speak or swallow Consciousness, vertical eye movements, and the ability to blink are spared.

Question 70

How to diagnose orbital cellulitis?

Answer 70

- Orbital cellulitis is a vision threatening condition | - Contrast enhanced CT scan or MRI needs to be urgently performed to confirm the diagnosis of orbital cellulitis

Question 71

Otosclerosis

Answer 71

Autosomal dominant (AD) inheritance pattern Overgrowth of the middle ear bones, most commonly the stapes, which interferes with sound conduction Tx: Hearing amplification or surgery (stapedectomy)

Question 72

Conductive hearing Loss

Answer 72

Rinne test: Bone conduction > air conduction Weber test: Lateralizes to affected ear, Midline if bilateral Examples include outer and middle ear etiologies

Question 73

Sensorineural Hearing Loss

Answer 73

Rinne test: Air conduction > bone conduction Weber test: Lateralizes to nonaffected ear, Midline if bilateral Examples include Inner ear etiologies

Question 74

Trinucleotide cytosine-guanine-guanine (CGG) expansion

Answer 74

Fragile X syndrome Mutation in the FMR1 gene. Clinical features include intellectual delay, facial dysmorphism, and autism

Question 75

Trinucleotide cytosine-thymine-guanine (CTG) expansion

Answer 75

Myotonic dystrophy Muscle weakness, myotonia, cardiac-endocrine-gastrointestinal disease, and intellectual delay

Question 76

Trinucleotide guanine-adenine-adenine (GAA) expansion

Answer 76

Friedreich ataxia Clinical features include ataxia, sensory loss, weakness, diabetes mellitus, and cardiomyopathy

Question 77

Creutzfeldt-Jakob disease (CJD)

Answer 77

Rapid progression of cognitive and motor decline Myoclonus (quick involuntary muscle jerks) End-stage CJD can manifest as akinetic mutism

Question 78

Pathophysiology of CJD

Answer 78

Caused by prions | Fatal within 1 year of symptom onset

Question 79

Diagnosis of CJD

Answer 79

Periodic sharp waves seen on EEG Elevated 14-3-3 proteins in the CSF MRI abnormalities in the caudate/putamen

Question 80

Lyme Neuroborreliosis

Answer 80

Advanced Lyme disease can cause post-viral cerebellar ataxia and is tested by the finger to nose test. A positive test indicates a lesion within the cerebellum

Question 81

frontotemporal dementia (FTD)

Answer 81

Personality change, disinhibition (eating multiple meals a day), and her relatively young age of onset (in her 60s). Pick bodies consisting of hyperphosphorylated tau proteins

Question 82

Hyperphosphorylated tau proteins can be found in both Alzheimer disease (AD) and Frontotemporal dementia FTD

Answer 82

In FTD, tau proteins are found as intracytoplasmic round aggregates In AD, tau proteins are described as intracellular neurofibrillary tangles.

Question 83

Glioblastoma multiforme

Answer 83

Most common and worst prognosis “butterfly glioma” Dx: MRI- lobulated, ring enhancing lesions that cross corpus collusum Tx: Surgery, radiation, chemo (temozolomide)

Question 84

Ependymoma

Answer 84

Most commonly present in the 4th ventricle, and may result in an obstructive hydrocephalus Histology: Perivascular pseudorosettes

Question 85

Hemangioblastomas

Answer 85

Benign central nervous system vascular neoplasms and are most often found in the cerebellum May produce erythropoietin, leading to secondary polycythemia Histology: Foamy cells and high vascularity If found with retinal angiomas, is associated with von Hippel-Lindau syndrome

Question 86

Medulloblastomas

Answer 86

Tumors of childhood Obstructive hydrocephalus due to compression of the 4th ventricle Differentiated from an ependymoma with MRI by observing that an ependymoma will extend further into the lateral recess of the 4th ventricle and into the cerebellopontine angle

Question 87

Anterior cerebral artery (ACA)

Answer 87

Paralysis or weakness of the contralateral lower extremity Urinary Incontinence anosmia

Question 88

Posterior cerebral artery (PCA)

Answer 88

Supplies the occipital lobe Cortical blindness and contralateral homonymous hemianopsia with macular sparing May also not be able to recognize faces, objects, places

Question 89

Middle Cerebral artery (MCA)

Answer 89

Contralateral paralysis/ sensory loss of the face and upper limbs Aphasia if dominant (Left) hemi-neglect if non- dominant side (Right)

Question 90

Top of the basilar syndrome is caused by an embolus lodging in the rostral basilar artery.

Answer 90

If a stroke does not localize laterally, there is a good chance there is a lesion of the basilar artery.

Question 91

Basilar artery stroke

Answer 91

impaired consciousness, pupillary abnormalities, neuro-ophthalmic abnormalities, especially of vertical gaze, and acute confusional state

Question 92

Lateral medullary syndrome/ Wallenberg syndrome

Answer 92

Often caused by an ipsilateral vertebral artery or posterior inferior cerebellar artery occlusion

Question 93

Anterior Circulation arteries

Answer 93

- MCA - ACA - Lenticulostriate artery

Question 94

Posterior circulation arteries

Answer 94

- ASA - PICA - AICA - PCA - Basilar Artery