Neuro uworld

Question 1

describe gait typically seen in pts with NPH?

Answer 1

slow, broad-based, shuffling gate

Question 2

Osteophyte-mediated spinal cord compression (spondylotic myelopathy) causes what S/Sxs?

Answer 2

gait dysfxn, extremity weakness, vibratory/ proprioception abnormalities, both upper/ lower motor neuron findings

Question 3

Manifestations of this dementia typically develop in a stepwise fashion over yrs and inc cognitive changes, a short shuffling gait and postural instability?

Answer 3

Vascular dementia- caused by multiple small infarctions

Question 4

This may cause spinal cord degeneration and early S/Sxs inc ataxia, symmetric paresthesia, and a loss of vibratory/ proprioception sensation

Answer 4

Vit B12 deficiency

Question 5

Over wks to months pts develop wide-based gait, postural incoordination (abnormal tandem walk and heel-knee-shin testing) w relatively preserved cognition and finger to nose test? due to?

Answer 5

Alcoholic cerebellar degeneration- d/t more than 10yrs of heavy alcohol use which causes degeneration of purkinje cells of cerebellar vermis

Question 6

Donepezil is ? used in Tx of?

Answer 6

an acetyl-cholinesterase inhibitor used in Tx of Alzheimer dementia

Question 7

An Ant. spinal artery injury can cause anterior cord Syndrome which is c/b?

Answer 7

absent motor fxn and decr pain and temp sensation bilaterally (proprioception, light touch and vibratory sensation are intact d/t sparing of dorsal columns)

Question 8

blunt injury causing hemisection of spinal cord can lead to Brown-Sequard syndrome which is c/b?

Answer 8

ipsilateral hemiparesis and diminished proprioception, vibr, and light touch at level of injury and below, and diminished pain/ temp contralaterally 1-2 levels below injury

Question 9

T10 corresponds to the level of what based on the dermatomes?

Answer 9

umbilicus

Question 10

the only anti-platelet agent effective in reducing the risk of early recurrence of ischemic stroke?

Answer 10

aspirin

Question 11

Alteplase?

Answer 11

thrombolytic therapy

Question 12

If pt w evidence of ischemic stroke is past window for thrombolytics and is already on aspirin what should be given?

Answer 12

Aspirin plus dipyridamole OR Clopidogrel

Question 13

these anticoagulants do not reduce risk of recurrent stroke and should be avoided in the mgmnt of acute stroke d/t high risk of bleeding?

Answer 13

unfractioned heparin and LMWH (enoxaparin)

Question 14

this occurs in chronic alcohol abusers, Sxs inc gait instability, truncal ataxia, trouble w rapid alternating mvmts, hypotonia (can lead to pendular reflexes) and intention tremor

Answer 14

Cerebellar dysfxn

Question 15

Presents with transient vision loss lasting a few secs w/ changes in head position? requires urgent diagnostic eval including?

Answer 15

Papilledema (caused by incr ICP);

ophthalmologic exam, CT or MRI of the brain and/or lumbar puncture

Question 16

Acute angle closure glaucoma usually occurs in pts after what age? exam findings?

Answer 16

60yo; conjunctival redness and a mid-dilated pupil that is poorly reactive to light

Question 17

most sign. cause of morbidity in pts w TBI’s, frequently d/t traumatic deceleration injury and results in vegetative state, CT shows numerous minute punctate hemorrhages w/ blurring of grey-white matter interface

Answer 17

Diffuse axonal injury

Question 18

hemi-neglect syndrome is c/b ignoring the L side of a space and responding to stimuli coming only from the R side, caused by a lesion/stroke where?

Answer 18

R (non-dominant) parietal lobe, which is responsible for spatial organization

Question 19

c/b fluctuating, fatiguable m. weakness that worsens w repetitive motions of the same m. groups and improves with rest. Ocular or bulbar dysfxn is typically the presenting Sx

Answer 19

Myasthenia gravis

bulbar dysfxn inc. dysarthria, dysphagia and fatiguable chewing

Question 20

Pts usually present with asymmetric limb weakness and bulbar dysfxn, Sxs do not improve with rest and are progressive
neuro exam reveals upper and lower motor neuron signs

Answer 20

ALS

Question 21

MMSE score less than what is suggestive of dementia?

Answer 21

less than 24/30

Question 22

Social disinhibiton and personality changes are the early features of what type of dementia? age of onset?

Answer 22

Frontotemporal (marked atrophy of frontal and temporal lobes seen on CT) ;
40-60yrs

Question 23

CT scans of pts with Early Alzheimer’s are typically normal, what is seen in later stages of disease?

Answer 23

Cortical and subcortical atrophy, more prominent atrophy in the parietal and temporal lobes

Question 24

on attempted L gaze, pts L eye abducts and has horizontal nystagmus, R eye remains stationary. on attempted R gaze, the R eye abducts w horizontal nystagmus but L eye remains stationary. eyes can converge, pupillary reflex nml..this is?

Answer 24

Internuclear ophthalmoplegia due to bilateral medial longitudinal fasciculus lesions, classically seen in MS

Question 25

PE often shows worsening tremor w outstretched arms or finger-to-nose testing, tremor usually arises in bilateral hands and forearms, head sometimes involved but legs usually spared, FH of tremors often present? 1st line therapy?

Answer 25

essential tremor ; | beta blockers such as propanolol , another option is the anticonvulsant primidone

Question 26

Trigeminal neuralgia is usually treated with? | what must you monitor while on this?

Answer 26

Carbamazepine ; | CBC d/t ADRs leukopenia and aplastic anemia

Question 27

Trihexyphenidyl?

Answer 27

an anticholinergic med sometimes used in Tx of young pts with Parkinson's disease where tremor is the primary Sx

Question 28

Ischemic oculomotor (CNIII) palsy which manifests w ptosis, "down-and-out" gaze, diplopia, and nml pupillary response is MC assoc with?

Answer 28

poorly controlled DM

Question 29

key distinction btwn Lewy body dementia and PD ?

Answer 29

early cognitive fluctuations and dementia in DLB; whereas dementia occurs late in course of PD, much later after motor Sxs start

Question 30

Preventative migraine meds?

Answer 30

Topiramate, divalproax sodium, TCAs (ie amitriptyline), or BBs (ie propanolol)

Question 31

Best tool to confirm Dx of PD?

Answer 31

Physical exam (Dx can be made w at least 2/3 of the cardinal signs of disease: rest tremor, rigidity, bradykinesia)

Question 32

the MC presenting sign of PD is?

Answer 32

asymmetric resting tremor in hand 4-6 Hz (may slowly generalize to involve other hand and lower extremities)

Question 33

the biggest risk factor for stroke is?

Answer 33

HTN

Question 34

disease c/b rapidly progressive dementia, myoclonus and sharp, triphasic, synchronus discharges on EEG, most pts die w/in one yr of Sx onset

Answer 34

Creutzfeld-Jakob, this spongiform encephalopathy is caused by prion

Question 35

Both cause bowel/bladder dysfxn, Compare differences btwn Cauda equina syndrome vs conus medullaris Sy

Answer 35

Cauda equina: severe radicular pain, saddle hypo/anesthesia, Asymmetric motor weakness, hypo/areflexia; Conus medullaris: sudden-onset severe low back pain, perianal hypo/anesthesia, Symmetric motor weakness, HYPERreflexia

Question 36

Mx of acute spinal cord compression? (presents w loss of motor and sensory fxn, loss of rectal tone and urinary retention)

Answer 36

Immediate neurosurgery consult, MRI of spine while waiting for surgeon, possible high-dose glucocorticoids esp if malignant compression is suspected

Question 37

Lesions to what lobe/side can cause expressive (Broca's) aphasia, contralateral (typically R) hemiparesis of face/upper limb, conjugate daze deviation to the side of the lesion

Answer 37

Dominant frontal lobe

Question 38

characterisitic CSF findings in HSV encephalitis?

Answer 38

lymphocytic pleocytosis, incr RBCs, and elevated protein

Question 39

Gold standard for Dx of HSV encephalitis? TxOC?

Answer 39

PCR analysis of HSV DNA in CSF; | IV Acyclovir

Question 40

Pts who develop serious bleeding (ie intracerebral hemorrhage) d/t excess anticoagulation w Warfarin (elevated INR, should be given what to reverse their anticoagulation?

Answer 40

IV Vit K (takes 12-24hrs) and Prothrombin complex concentrate (contains Vit K-dep clotting factors II, VII, IX, X for rapid reversal

Question 41

Amitriptyline is commonly used for depression, pain disorders and insomnia, some common side effects?

Answer 41

Orthostatic hypoTN, lethargy, and anticholinergic Sxs (dry mouth, constipation, urinary retention)

Question 42

A single brain abscess usually results from direct extension of an adjacent infection (OM, sinusitis, dental infection), may present w/ HA, fever (only 1/2 the time), focal neuro deficits, and seizure, 2 MC isolated organisms?

Answer 42

Viridans strep and Staph aureus

Question 43

The characteristic CSF findings in Guillain-Barre is Albuminocytologic dissociation which is?

Answer 43

high protein with normal WBC count, (CSF RBC and glucose levels should be nml)

Question 44

always consider this Dx when a pt w. Parkinsonism has orthostatic hypoTN, impotence, incontinence, or other autonomic Sxs

Answer 44

Multiple system atrophy

Question 45

painless, progressive loss of central vision that occurs in older pts w vascular risk factors, often affects both eyes ? funduscopic abnormalities are prominent ie will show what?

Answer 45

Macular degeneration; | drusen (yellow deposits)

Question 46

c/b acute onset of monocular vision loss w central scotoma, changes in color perception, pain w eye mvmt, and afferent pupillary defect (paradoxical pupillary dilation of affected eye w swinging flashlight test)

Answer 46

Optic neuritis

Question 47

Brain tumors are often clinically silent until they grow large enough to compress structures and raise ICP, the MC Sx is? assoc with at least 1 more of these Sxs..

Answer 47

dull HA; N/V d/t incr ICP, focal neuro deficits, Sxs worsening at night or w positions that raise ICP (bending, coughing) so may feel worse in the AM from laying down all night

Question 48

Amaurosis fugax is?

Answer 48

painless, rapid and transient (less than 10 mins) monocular vision loss

Question 49

if pt has transient monocular vision loss described as "a curtain descending over visual field", highly suggestive of? MC due to?

Answer 49

Amaurosis fugax; retinal ischemia d/t atherosclerotic emboli originating from ipsilateral carotid artery

Question 50

75 yo w h/o HTN/HLD presents w intermittent monocular vision loss 3x over the last 2 months that lasted several mins then resolved, denies eye pain, HA, focal weakness. Nml neuro exam, what test is most likely to yield Dx?

Answer 50

Duplex U/S of the neck (amaurosis fugax is MC d/t atherosclerotic emboli from ipsilateral carotid a.)

Question 51

MC early side effects of Levodopa/Carbidopa?

Answer 51

somnolence, confusion, hallucinations (older pts), agitation, dizziness, N

Question 52

first line med Tx for IIH? MOA? If patients on this cont to have Sxs you can add?

Answer 52

Acetazolamide - inhibits carbonic anhydrase thus decreasing CSF production and IH; Furosemide

Question 53

exertional heat stroke is c/b temp of atleast 104 and CNS dysfxn (confusion, irritability, seizures). Preferred Mx?

Answer 53

Ice water immersion (if not available then other ways to rapidly cool pt), (there is NO role for antipyretic therapy)

Question 54

Carotid a. thrombosis typically leads to profound neuro deficits inc... , on CT scan the ischemic stroke typically appears as an area of?

Answer 54

contralateral homonymous hemianopsia, hemiparesis, hemisensory loss; HYPOdensity (darker)

Question 55

acute Parietal lobe hemorrhage presents as progressive confusion/lethargy over several hours and contralateral hemisensory loss (possible contra hemineglect), head CT shows? MCC of this in pts over 60? assoc w what condition?

Answer 55

area of hyperdensity (bright) in parietal lobe; Cerebral amyloid angiopathy d/t beta- amyloid deposition in cerebral aa. ; Alzheimers dementia

Question 56

DANISH stands for what cerebellar signs?

Answer 56

Dysdiadochokinesia, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia