Neurologic/Psychiatric Disorders

Question 1

CSF findings in bacterial meningitis

Answer 1

neutrophils
high protein
low glucose
positive culture/positive gram stain

Question 2

CSF findings in viral meningitis

Answer 2

lymphocytes
high protein
normal glucose
viral PCR may be positive

Question 3

CSF findings in viral encephalitis

Answer 3

lymphocytes
high protein
normal glucose
viral PCR may be positive

may also see frontotemporal hemorrhage and RBCs in HSV encephalitis

Question 4

CSF findings in tuberculosis meningitis

Answer 4

lymphocytes
high protein
very low glucose
positive for acid-fast bacilli

Question 5

CSF findings in guillain-barre syndrome

Answer 5

no cells
high protein
normal glucose

Question 6

CSF findings in multiple sclerosis

Answer 6

few lymhocytes
slightly high protein
normal glucose
oligoclonal bands

Question 7

CSF findings in acute disseminated encephalomyelitis

Answer 7

lymphocytes
high protein
normal glucose
oligoclonal bands

Question 8

CSF findings in subarachnoid hemorrhage

Answer 8

lymphocytes and many RBCs
high protein
normal glucose
xanthochromia

Question 9

CSF: RBCs and no xanthochromia

Answer 9

traumatic tap

Question 10

CSF: positive EBV PCR

Answer 10

highly suggestive of CNS lymphoma

Question 11

CSF: oligoclonal bands

Answer 11

multiple sclerosis, CNS infections, or non-infectious inflammatory processes (SLE)

Question 12

CSF: low glucose

Answer 12

bacterial or mycobacterial infections

Question 13

CSF: lymphocytes

Answer 13

viral, fungal, or mycobacterial infection, demyelination, CNS lymphoma

Question 14

normal CSF pressure

Answer 14

70-180 mmH2O

Question 15

where olfactory nerve exits

Answer 15

cribiform plate

Question 16

where optic nerve exits

Answer 16

optic canal

Question 17

where oculomotor nerve exits

Answer 17

superior orbital fissure

Question 18

where trochlear nerve exits

Answer 18

superior orbital fissure

Question 19

where trigeminal V1 exits

Answer 19

superior orbital fissure

Question 20

where trigeminal V2 exits

Answer 20

foramen rotundum

Question 21

where trigeminal V3 exits

Answer 21

foramen ovale

Question 22

where abducens nerve exits

Answer 22

superior orbital fissure

Question 23

where facial nerve exits

Answer 23

internal auditory meatus

Question 24

where vestibulocochlear nerve exits

Answer 24

internal auditory meatus

Question 25

where glossopharyngeal nerve exits

Answer 25

jugular foramen

Question 26

where vagus nerve exits

Answer 26

jugular foramen

Question 27

where accessory nerve exits

Answer 27

jugular foramen

Question 28

where hypoglossal nerve exits

Answer 28

hypoglossal foramen

Question 29

pupillary reflex

Answer 29

CNII (afferent fibers) and CNIII (efferent fibers) | shine line in each pupil and observe reaction and accomodation

Question 30

oculocephalic (doll's eyes) reflex

Answer 30

CNVIII (afferent) and CN III, IV, and VI (efferent) forcibly turn head horizontally and vertically and observe for conjugate eye movement in opposite direction

Question 31

gag reflex

Answer 31

CNIX (afferent) and CN X, XI (efferent) | stimulate posterior pharynx with cotton tip and observe for gag

Question 32

biceps reflex

Answer 32

C5

Question 33

brachioradialis reflex

Answer 33

C6

Question 34

triceps reflex

Answer 34

C7

Question 35

finger flexor reflex

Answer 35

C8/T1

Question 36

patellar reflex

Answer 36

L4

Question 37

hip adductor reflex

Answer 37

L3

Question 38

ankle jerk reflex

Answer 38

S1

Question 39

PCA stroke

Answer 39

occipital cortex, visual cortex | contralateral hemianopsia with macular sparing

Question 40

amygdala lesion

Answer 40

kluver-bucy syndrome: hyperorality, hypersexuality, disinhibited behavior

Question 41

friedreich ataxia

Answer 41

progressive ataxia that affects ares more than legs, onset usually in childhood, impaired vibration and position sense

Question 42

slapping gait

Answer 42

dorsal column neuropathy | vitamin B12 deficiecny, tabes dorsalis

Question 43

waddling gait

Answer 43

hip-girdle weakness | muscular atrophy, proximal myopathy, muscular dystrophy

Question 44

simple v. complex seizures

Answer 44

complex seizures have a loss of consciousness, simple seizures do not

Question 45

best predictor of prognosis in astrocytomas

Answer 45

degree of anaplasia

Question 46

first line therapy for delirium in the elderly

Answer 46

haloperidol

Question 47

prion disease that may cause myoclonus

Answer 47

creutzfeldt-jakob disease

Question 48

children under 7 who have a wide array of seizure types accompanied by mental retardation

Answer 48

lennox-gastaut syndrome

Question 49

progression from absence seizures beginning age 10 to myoclonic seizures around age 15 to tonic-clonic seizures around age 16, may be worsened by sleep deprivation

Answer 49

juvenile myoclonic epilepsy

Question 50

cushing's triad for intracranial pressure

Answer 50

bradycardia, bradypnea, hypertension

Question 51

subarachnoid hemorrhage suspected, CT is equivocal, next step

Answer 51

lumbar puncture

Question 52

most common etiologies of bacterial meningitis in adults < 60

Answer 52

streptococcus pneumoniae neisseria menigitidis haemophilus influenzae

Question 53

treatment for various side effects of typical antipsychotics

Answer 53

acute dystonia: benztropine akathisia: benzodiazapine neuroleptic malignant syndrome: bromocriptine tardive dyskinesia: irreversible, stop offending agent

Question 54

ipsilateral motor and proprioception loss and contralateral pain loss below the level of the lesion

Answer 54

hemsection of cord

Question 55

burning pain and paralysis in upper extremities, secondary to forced hyperextension type of injury to the neck

Answer 55

central cord syndrome

Question 56

burst fracture of vertebra characterized by total loss of motor function below the level of the lesion, loss of pain and temperature bilaterally

Answer 56

anterior cord syndrome

Question 57

innervation of anterior thigh muscles

Answer 57

femoral nerve

Question 58

nerve that provides sensation to the medial leg (calf)

Answer 58

saphenous branch of femoral nerve

Question 59

innervation of medial thigh muscles

Answer 59

obturator nerve (adduction)

Question 60

innervation of posterior compartment of leg (calf), plantar muscles of foot

Answer 60

tibial nerve (flexion)

Question 61

innervation to anterolateral leg, dorsum of foot

Answer 61

fibular nerve (extension)

Question 62

vascular supply of midbrain

Answer 62

basilar artery

Question 63

vascular supply of pons

Answer 63

basilar artery and AICA

Question 64

vascular supply of medulla

Answer 64

PICA

Question 65

dorsal column function

Answer 65

vibration and proprioception

Question 66

spinothalamic tract function

Answer 66

pain and temperature

Question 67

corticospinal tract function

Answer 67

voluntary movement

Question 68

loss of spinal cord function except dorsal columns are intact

Answer 68

anterior spinal artery syndrome

Question 69

ventral horn and ventral white commissure affected, flaccid paralysis at level of lesion, loss of pain and temperature one level below the lesion

Answer 69

syringomyelia

Question 70

bilateral loss of vibration and discrimination and bilateral spastic paresis affecting legs before arms

Answer 70

vitamin B12 deficiency

Question 71

contralateral lower extremity and trunk weakness

Answer 71

anterior cerebral artery stroke

Question 72

contralateral face and upper extremity weakness and decreased sensation, bilateral visual abnormalities, aphasia or neglect

Answer 72

middle cerebral artery stroke

Question 73

contralateral visual abnormalities

Answer 73

posterior cerebral abnormalities

Question 74

focal motor or sensory deficits, loss of coordination, difficulty speaking

Answer 74

lacunar arteries

Question 75

cranial nerve abnormalities, contralateral full body weakness and decreased sensation, vertigo, loss of coordination, difficulty speaking, visual abnormalities, coma

Answer 75

basilar artery

Question 76

measures on the glascow coma scale

Answer 76

eye opening (4), verbal response (5), motor response (6)

Question 77

long-term treatment for mania

Answer 77

lithium, lamotrigine, olanzapine, or quetiapine | second line: valproate, aripiprazole

Question 78

treatment for bedwetting

Answer 78

first line: desmopressin | second line: imipramine (more side effects)

Question 79

treatment for adjustment disorder

Answer 79

psychodynamic psychotherapy

Question 80

acute treatment for panic attack

Answer 80

short-term benzo: alprazolam

Question 81

long-term treatment for panic attack

Answer 81

SSRI | second line: long-acting benzo (clonazepam, diazepam)

Question 82

treatment for ADHD

Answer 82

methylphenidate, atomoxetine | second line: bupropion, alpha-agonists, TCAs

Question 83

treatment for tourette's syndrome

Answer 83

fluphenazine, pimozide, tetrabenazine | second line: haloperidol

Question 84

autism-like symptoms that develop after age 3

Answer 84

childhood disintegrative disorder

Question 85

want to hit your wife but you hit a chair instead

Answer 85

displacement

Question 86

unfaithful husband accuses his own wife of being unfaithful

Answer 86

projection

Question 87

IV drug use gets hepatitis C through needles and blames the community for not having adequate control over hepatitis C

Answer 87

distortion

Question 88

patient rescued from a burning building and denies any memory of the event

Answer 88

dissociation

Question 89

feelings of shyness, inferiority | desire to make friends overcome by fear of rejection

Answer 89

avoidant personality disorder

Question 90

excessive need to be cared for, submissive with loved ones

Answer 90

dependent perosnality disorder

Question 91

magical thinking

Answer 91

schizotypal

Question 92

side effects of lithium in utero

Answer 92

ebstein's anomaly in first trimester | goiter and neuromuscular dysfunction in later trimesters

Question 93

injectable anti-psychotics

Answer 93

``` haloperidol decanoate (1-2 times a month) fluphenazine decanoate (twice a month) risperidone depot (twice a month) palpieridone depot (once a month) ```