Neuro Stuff

Question 1

Parkinsonism + Autonomic dysfunction (eg hypotension, impotence)
Widespread neurologic signs

Answer 1

Multiple system atrophy (Shy-Drager)

Anti-PD drugs generally ineffective. Tx aimed at intravascular volume expansion

Question 2

Ashkenazi Jew

Gross dysfunction of autonomic nervous system (severe orthostatic hypotension)

Answer 2

Riley-Day

But if +Parkinsonism, consider Shy-Drager

Question 3

What kind of stroke gives you pure motor hemiparesis?

Answer 3

Lacunar infarcts in the internal capsule (due to hypohyalinosis and microatheroma of those small vessels). CT may be normal.

Note: can’t obliterate motor without sensory for cortical stroke!

Question 4

Lead poisoning symptoms

Answer 4

GI: abd pain, constipation
Neuro: cognitive, neuropathy (extensor weakness, stocking-glove)
Microcytic anemia (2/2 disruption of heme synthesis)
Basophilic stippling

Question 5

Sources of lead poisoning

Answer 5

Battery manufacturing, plumbing, home restoration, distillation of alcohol through parts with lead soldering…

Question 6

Ptosis
Down and out
Normal pupillary response

Answer 6

Ischemic CN III palsy from poorly controlled diabetes

Damages inner somatic nerves but spares peripheral parasympathetic fibers

Question 7

Fluctuating, fatigable muscle weakness that worsens with repetitive motions of the same muscle groups. Improves with rest.

Answer 7

Myasthenia gravis.

Autoantibodies (from thymus, eg thymoma) against nicotinic acetylcholine receptors at NMJ.

Question 8

Defense mechanism: transferring feelings to a more vulnerable object/person

Answer 8

Displacement

Question 9

Defense mechanism: attributing one’s own feelings to others (person having an affair but accusing their spouse of having affair)

Answer 9

Projection

Question 10

Defense mechanism: responding to manner opposite to one’s actual feelings

Answer 10

Reaction formation

Question 11

Timing of acute stress disorder vs PTSD vs adjustment disorder

Answer 11

Acute stress disorder: >3 days but <1month
PTSD: 1mo or more

Adjustment disorder: within 3 months of identifiable stressor

Question 12

Timing of GAD

Answer 12

GAD: 6mo

Question 13

Drugs causing prolactin elevation

Answer 13

Antipsychotics due to dopamine blockade
(eg risperidone especially)

Note that prolactinomas in contrast will result in VERy high levels of prolactin (>200)

Question 14

hearing loss in meniere’s

Answer 14

Sensorineural!

Question 15

cause of meniere

Answer 15

increased volume or pressure of endolymph (due to defective resorption of endolymph?)

Question 16

visual hallucinations
spontaneous parkinsonism
fluctuating cognition

Parkinsonism seem with severe sensitivity to potent dopamine antagonists (eg antipsychotics, risperidone)

Answer 16

dementia with lewy bodies

Question 17

stepwise decline
early executive dysfunction
cerebral infarction or deep white matter changes on neuroimaging

Answer 17

vascular dementia

Question 18

ataxia early in dz
urinary incontinence
dilated ventricles

Answer 18

NPH

Question 19

Triad:

Confusion
Oculomotor dysfunction (horizontal nystagmus, bilateral VI palsy)
Gait ataxia (wide-based gait)

Answer 19

Wernicke encephalopathy

2/2 long-term thiamine deficiency

Question 20

Most common cause of pediatric stroke?

Answer 20

Sickle cell

Question 21

Prophylaxis for migraines

Answer 21

Topiramate
Beta blockers
Amitriptyline

Question 22

Discrete lesions at gray white junction with surrounding edema

Answer 22

Lungs Mets

Question 23

Tx for restless leg syndrome

Answer 23

Dopamine agonists (pramipexole, ropinirole)

Question 24

Tx for prolactinoma

Answer 24

dopamine agonists (cabergoline, bromocriptine)

dopamine will reduce prolactin levels and make tumor shrink

Question 25

risk of status epilepticus

Answer 25

cortical laminar necrosis (permanent injury due to excitatory cytotoxicity). risk is increased even with >5min of seizure.

Question 26

nightmare vs night terror

Answer 26

nightmare: when awakened, fully alert and can usually recall nightmare night terror: cannot be fully awakened during episode, and no memory of incident

Question 27

brain death

Answer 27

absent cortical and brainstem functions spinal cord may still function, thus deep tendon reflexes still present

Question 28

contralateral hemiparesis hemianesthesia conjugate gaze deviation toward side of lesion headache!

Answer 28

putaminal hemorrhage (involves internal capsule) most frequent region in hypertensive hemorrhage (less likely to have headache in ischemic MCA stroke)

Question 29

treatment for foodborne botulism

Answer 29

equine antitoxin

Question 30

treatment for this toxicity: bradycardia, miosis, bronchospasm, vomiting, diarrhea

Answer 30

cholinergic toxicity (organophosphate etc) ``` tx: atropine (blocks peripheral effects of Ach at muscarinic receptors) and pralidoxime (aids in reactivation of acetylcholinesterase) ```

Question 31

diagnostic drug trial in myasthenia gravis | vs. treatment

Answer 31

edrophonium (short-acting acetylcholinesterase inhibitor that temporarily improves muscle weakness) treat with pyridostigmine +/- thymectomy

Question 32

bilateral action tremor relieved by alcohol hereditary?

Answer 32

essential tremor

Question 33

What nerve damaged in anterior shoulder dislocation

Answer 33

Axillary

Question 34

What nerve damaged in humeral mid shaft fractures

Answer 34

Radial

Question 35

What nerve damaged in medial epicondyle fracture

Answer 35

Ulnar nerve

Question 36

Bilateral flaccid paralysis and loss of pain

Answer 36

Infarction of anterior spinal artery

Question 37

headache that worsens with leaning forward, valsalva, ocugh

Answer 37

intracranial HTN these maneuevers increase intracranial pressure

Question 38

hyperreflexia, spasticity, muscle atrophy, fasciculations

Answer 38

ALS (upper + lower motor neuron signs)

Question 39

What is, and how to treat, catatonia?

Answer 39

Seen in severe psychiatric and medical illness. Immobility, mutism, and posturing Treat with benzos and ECT

Question 40

GBS vs botulism

Answer 40

GBS: ascending symmetrical paralysis, often with autonomic dysfunction, rare to have pupillary abnormalities Botulism: descending paralysis, early cranial nerve involvement, often pupillary abnormalities