neuro

Question 1

cold calorics

Answer 1

intact- eyes deviate with cold toward the water, then nystagmus away back to middle - if brainstem is hurt then it wont deviate to the side at all, if cortex hurt it will deviate and wont come back

Question 2

bilateral intranuclear opthalmoplegia (cant look at nose )

Answer 2

MS - lesion in MLF

Question 3

when does CT scan sens dec in SAH

Answer 3

after 12 hours

Question 4

steroids in meningitis?

Answer 4

steroids first then abx in seriously ill with WBC >1000 did better

Question 5

when to CT before LP

Answer 5

age 60, HIV, CNS dz, sz, abnormal neuro

Question 6

0-1 month meninigitis abx and bugs

Answer 6

listeria, e coli, gbs - ampt and gent (or 3rd gen cef but not ceftriaxone bc of jaundice )

Question 7

meninigits VP shunt

Answer 7

staph epi staph aureus

Question 8

LP positive for cells but negative gram stain

Answer 8

HSV encephalitis

Question 9

unilateral vision loss, painful, papilledema, pain with eye movements

Answer 9

optic neuritis- MS - might have bilaterael ION- cant look at nose

Question 10

LP of MS

Answer 10

ncrease protein, IGG, oligoclonal bnds- lots of protein

Question 11

rapid progressive extreity weakness, limb paralysis after exercise, Low K

Answer 11

acute periodic paralysis, asian male, K shifted into cells after exercise, assn hypo K ***thyrotoxicosis- AD - avoid high carb diet

Question 12

muscle weakness, fatiguability with diplopia, ptosis

Answer 12

MG classicaly starts in face, wake up in AM ok, worse during the day, worse during counting

Question 13

autoab vs ach receptors

Answer 13

MG, assn thyoma

Question 14

tensilon (edrophonium) test

Answer 14

tensilon test- blocks ACHi- ach sticks around longer , patient gets better - side effect brady/sycope

Question 15

tx MG

Answer 15

physostigmine/neostigmine

Question 16

exacerbations of MG causes

Answer 16

either exacerbation- or overtreatment - comes in cholingeric BBBB sludge

Question 17

hx Ca, decreased DTR, calcium channels- failure to release Ach from terminal presynaptic axons of motor neurons

Answer 17

Lambert EAton- weakness improves with use

Question 18

tx lambert eaton

Answer 18

remove tumor, plamapheresis

Question 19

ach release blocked at NMJ

Answer 19

botulism- motor and autonomic fxn

Question 20

causes of botulism

Answer 20

foodborne, wound, infant

Question 21

diplopia, dysphagia, ptosis, descneding flaccid paralysis, antiAch sxs- drymouth, dilated pupils, normal sensation

Answer 21

botulism

Question 22

floppy baby, constipation, feeble cry

Answer 22

botulism

Question 23

tx botulsims

Answer 23

antitoxin, debride wound, high dose pcn

Question 24

reversible, rapidly ascending paralysis, no paresthesias

Answer 24

tick paralysis - no paresthesias diff from GBS

Question 25

upper and lower motor neurons- m wasting, fascuclartions, weakess, spasticitys

Answer 25

ALS

Question 26

expanding central cavity in spinal cord- usually cervical

Answer 26

syngomyelia- weakness in arms

Question 27

patient with poor motor function in hand, loss of pain and tep- vibration and position preserved

Answer 27

synringomyelia, central cord- IO wasting, assn Chiari cerebella defect- MRI

Question 28

contralateral motor and sensory, CN defects

Answer 28

cortical- cerebral

Question 29

cranial n one side and cortocispinal tract other side-

Answer 29

crossed- brainstem

Question 30

stroke with coma, miosis, gze paresis, rsp

Answer 30

pontine

Question 31

stroke numb and weak in opposite leg

Answer 31

ACA

Question 32

stroke contralateral arms and face paralysis, sensory, asphaia (dominant left) or neglect (nontominat right), homonoymous hemianipsia

Answer 32

MCA

Question 33

stroke with contralateral homonymous hemoanipsia

Answer 33

PCA

Question 34

locked in syndrome

Answer 34

CPM and pons stroke from basilar A occlusion- only have vertical eye mvmt left

Question 35

pure motor stroke

Answer 35

pons, IC (lacunar)

Question 36

pure sensory stroke

Answer 36

thalamus (lacunar)

Question 37

myopathy weakness vs perinheeral neuropathy

Answer 37

myopathy is proximal, peurpheral neuropathy is distal

Question 38

buring pain and hyperalgeisa after injury

Answer 38

CRPS (RSD) blocks, gabapentin

Question 39

lead pipe rigidity, elevated CPK, fever, encephalopathy, change in vitals

Answer 39

NMS- IVF benzos, consider dantrolene - usually early after start of antipsychotics

Question 40

altered mental, fever, BP and tachy, irritabiility, myoclonus and twitching

Answer 40

serotonin syndrome tx IVF, benzos, serotonin blockers like chlorpromazine or cyproheptadine