Neurology

Question 1

Herniation. Rapid change in mental status. Bilateral small and reactive pupils. Cheyne-stoke respiration. Flexor or extensor posturing

Answer 1

Downward transtentorial (central) herniation

Question 2

Herniation. Fixed and dilated ipsilateral pupil followed by ‘down and out’ pupil. Ipsilateral hemiparesis (false localizing).

Answer 2

Seen with epidural hematoma. Uncal herniation. Mass lesion in middle fossa. Fixed pupil due to CN III become entrapped. False localizing due to compression of cerebral peduncles (opposite the mass lesion ) against tentorial edge.

Question 3

Herniation. Medullary compression -> respiratory arrest. Rapidly fatal.

Answer 3

Cerecellar tonsillar herniation into for amen magnum

Question 4

What hormone is elevated in the immediate post ictal period

Answer 4

Prolactin

Question 5

Infantile spasm (west syndrome)

Answer 5

Form of generalized epilepsy usually secondary to other conditionp (eg PKU). Presents with bilateral symmetric jerks of the head , trunk and extremities in clusters of 5-10. Arrest of psychomotor development at age of seizure onset. treat with ACTH, prednisone and clonazepam or valproate to help spasms. No impact on prognosis

Question 6

Lennox Gastaut syndrome

Answer 6

Childhood onset epilepsy. Treatment resistant. Multiple seizure per day, usually nocturnal. Associated with mental retardation, behavior disorder and delayed psychomotor development. Treatment resistan

Question 7

What medication is contraindicated in BPPV?

Answer 7

Antivertigo medications such as meclizine because they inhibit central compensation, which may lead to chronic unsteadiness

Question 8

Labyrinthitis vs vestibular neuritis

Answer 8

Both are acu onset of sever vertigo, head motion intolerance and gait instability with n/v and nystagmus. With auditory or aural symptoms it is called Labyrinthitis, without it is called vestibular neuritis.
Usually presents in people one week after viral infection.
Usually presents with abnormal vestibuloocular reflex. Has a predominantly horizontal nystagmus that always beats in one direction, Opposite the lesion

Question 9

Menieres dz

Answer 9

Recurrent vertigo with auditory symptoms with last for hours to days. Patient progressives loses low frequency hearing over years.
Txt with low sodium diet and diuretics.

Question 10

Vestibular migraine

Answer 10

Recurrent vertigo without auditory symptoms. Affects 10% of ppl with migraines. Basically menieres dz without auditory symptoms. Can be prevented with migraine medication.

Question 11

Drugs used to slow mild to moderate alziehmers

Answer 11

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine, tacrine)
Tacrine is used less often because it is associated with hepatotoxicity

Question 12

Drugs used to slow advanced alziehmers

Answer 12

Memantine (NMDA receptor antagonist )

Question 13

Elevates CSF markers of CJD

Answer 13

Protein 14-3-3 and tau protein

Question 14

Startle induced myoclonus jerks associate with rapid cognitive decline (over weeks - month)

Answer 14

CJD

Question 15

Chorea, altered behavior, and dementia. With strong family history

Answer 15

Huntington dz. you see atrophy of caudate and putamen)

Question 16

Treatments to minimize unwanted movements in Huntington dz

Answer 16

Reserpine or tetrabenzine

Question 17

Herniations. Non specific signs

Answer 17

Cingulate

Question 18

Medulloblastoma?

Arises from which anatomical structure?

Answer 18

Most common brain neoplasm in children.

Arises from the 4th ventricle and cause increased icp due to obstruction

Question 19

Drainage of aqueous humor of eye

Answer 19

Produced by ciliary body on iris, travels through pupil -> anterior chamber -> trabecular mesh work in the angle of the anterior chamber. Disruption leads to increased ocular pressure, glaucoma

Question 20

Open vs closed angle glaucoma

Answer 20

Open is more Common.
Closed occurs when iris dilates and pushed against lens, disrupting flow of humor to anterior chamber. Presents with dilated, non reactive eye. Extreme eye pain, blurred vision, hard and red eye. MEDICAL EMERGENCY. Treat with timolol, pilocarpine, acetazolamide, mannitol. Laser iridotomy. AVIOD PUPIL DILATORS SUCH AS ATROPINE.
Open occurs when flow through trabecular meshwork is impaired. You see cupping of optic nerve head on optho exam. Less painful. Gradual increase in intra ocular pressure and progressive vision loss. Treat with topical bblocker (timolol, betaxolol) to reduce production or pilocarpine to increase outflow.

Question 21

Manifestation of basilar stroke

Answer 21

Locked in syndrome
cranial nerve palsy
Drop attacks, dysphasia, dysarthria, vertigo
Crossed weakness and sensory loss affecting ipsilateral face and contralateral body

Question 22

Manifestations of basal ganglia lacunar strokes

Answer 22

Pure motor (posterior limb of internal capsule)
Pure sensory (contralateral thalamus VPL)
dysarthria clumsy hands syndrome; (anterior limb)
ataxia hemiparesis (posterior limb)
Mixed motor/sensory thalamus and adjacent posterior limb

Question 23

Gaze preference with cortical stroke

Answer 23

Gaze preference toward side of the lesion

Question 24

Indications for carotid endarterectomy

Answer 24

Stenosis greater than 60% in symptomatic patients or greater than 70% in asymptomatic patients
contraindicated in 100% percent occlusion

Question 25

Single greatest respect for stroke

Answer 25

Hypertension

Question 26

Cranial nerve palsy associated with Berry aneurysms

Answer 26

Cranial nerve three palsy with pupillary involvement

Question 27

Timing for LP in the setting of subarachnoid hematoma

Answer 27

First attempt CT without contrast if CT is negative perform LP LP can be falsely negative and first 6 to 12 hours (not developed) and first 24 to 28 hours (resolved )

Question 28

Classic versus common migraine

Answer 28

classic: unilateral and preceded by visual aura. | Common migraine: maybe bilateral and Perporbital without proceeding Ora

Question 29

Treatment for migraines

Answer 29

Trpitans; metocolopramide (and other anti-emetics such as chlorpromazine and prochlorpermaine) Prophylaxis for frequent or severe migraines include anticonvulsants (gabapentin and topiramate), TCAs (amitriptyline), beta blockers (propranolol) and calcium channel blocker's

Question 30

Treatment and prophylaxis for cluster headaches

Answer 30

100% O2 is the most effective and rapid treatment modality Acute therapy: high flow oxygen, dihydroergotamine, octreotide, sumatriptan or zolmitriptan Prophylactic therapy: transitional (prednisone, ergotamine), maintenance (verapamil, methysergide, lithium, valproic acid, topiramate)

Question 31

Most common cause of cavernous sinus thrombosis: micro organism

Answer 31

Staph aureus

Question 32

Treatment for Cavernous sinus thrombosis

Answer 32

Treat aggressively and empirically with Penicillinase resistant penicillin (nafcillin or oxacillin) plus a third or fourth generation cephalosporin (Ceftriaxone or cefepime) to provide broad coverage pending blood cultures. Metronidazole can be added to cover anaerobes and vancomycin can be added to cover MRSA. IV antibiotics are required for at least 3 to 4 weeks. Surgical drainage may be necessary if no response antibiotics within 24 hours

Question 33

What hormone is elevated in the immediate postictal period

Answer 33

Elevated prolactin levels

Question 34

First line for partial seizures in children

Answer 34

Phenobarbital

Question 35

EEG findings in grand mal seizures

Answer 35

10 Hz activity during tonic phase and slow waves during the clonic phase

Question 36

First line for grand mal seizures

Answer 36

Phenytoin or then valproic acid

Question 37

First and second line treatment for absence seizures

Answer 37

First line: Ethosuximide | Second line:valproic acid

Question 38

Steps in status epilepticus

Answer 38

Continual seizure activity for more than 10 minutes First ABCs Then administer thiamine ->glucose and naloxone for presumed potential etiologies Give IV benzodiazepine plus a loading dose of fosphenytoin If Seizure continues intubate and load phenobarbital

Question 39

Labyrinthitis appears similar to which stroke

Answer 39

Lateral Pontine/cerebellar stroke (a I C a territory)

Question 40

Vestibular neuritis mix with stroke

Answer 40

Lateral medullary/cerebellar stroke (PICA territory)

Question 41

Treatment of acute peripheral vestibulapathy (Labyrinthitis and vestibular neuritis)

Answer 41

Gets diffusion weighted MRI if high-risk patient | Give IV steroids

Question 42

Treatment of myasthenia gravis

Answer 42

Pyridostigmine for symptomatic treatment (get rid of MG) Prednisones and immunosuppressants are mainstay Plasmapheresis an IV IG for resection of thymoma may be curative Avoid aminoglycoside and b-blockers

Question 43

Lambert Eaton is associated with

Answer 43

Small cell lung carcinoma

Question 44

what cell line mediate multiple sclerosis

Answer 44

T-cell mediated

Question 45

Treatment for multiple sclerosis

Answer 45

``` High-dose steroids in the acute setting Interferon B (avonex, betaseron) is main treatment Natalizumab in an effective second line therapy for caries risk of JC virus ```

Question 46

Causes of Guillain-Barré syndrome

Answer 46

Campylobacter, upper respiratory viral illnesses

Question 47

What treatment slows down progression of ALS

Answer 47

Riluzole

Question 48

Cause of normal pressure hydrocephalus

Answer 48

Impaired in CSF outflow from the rain

Question 49

Major difference between gait Abnormality inParkinson's and normal pressure hydrocephalus

Answer 49

Preservation of arm swing in normal pressure hydrocephalus

Question 50

Nero transmitter abnormalities in Parkinson's, Alzheimer's and myasthenia gravis

Answer 50

Parkinson's disease = dopamine deficiency Alzheimer's disease = acetylcholine and Norepinephrine Myasthenia gravis = absent acetylcholine activity

Question 51

Treatment for Parkinson's

Answer 51

Levodopa/carbidopa is the mainstay other dopamine agonist such as (ropinirole, pramipexole, bromocriptine) can be used in early disease as well as Apomorphine ( another dopamine agonist) Anticholinergic: trihexyphendyl and benztropine Selegiline (MAO-B inhibitor) maybe neuroprotective and decreased need for levodopa COMT inhibitors (entacapone or tolcapone) can help increase the availability of levodopa Amantadine has mild antiparkinsonian activity and may improve akinesia, rigidity and tremor

Question 52

Most common sources of brain metastases

Answer 52

Mneumonic Lung and Skin Go to the BRain | Lung, skin, GI, breast, Renal

Question 53

Neuroectodermal tumor arising from the fourth ventricle in children

Answer 53

Medulloblastoma | May seed subarachnoid space. May cause obstructive hydrocephalus

Question 54

Tumor arising from ependyma of the ventricle

Answer 54

Ependymoma. May cause obstructive hydrocephalus

Question 55

Tumor arising from the suprasellar in children

Answer 55

Craniopharyngioma. Calcification is common. May cause hypopituitarism

Question 56

Café au lait spots, freckles in the axilla or inguinal area, optic glioma, Lisch nodules (pigmented iris hamartomas).

Answer 56

Neurofibromatosis 1 | Chromosome 17

Question 57

Bilateral acoustic neuroma

Answer 57

Neurofibromatosis 2 | Chromosome 22

Question 58

Ash leaf (hypo pigmented lesions) lesions on trunk and extremities, mental retardation, sebaceous Adenomas (small red nodules on the nose and cheeks in the shape of a butterfly) and shagreen patch (a rough papule and the lumbosacral region with orange peel consistency)

Answer 58

Tuberous sclerosis

Question 59

Iris dilates and pushes against the lens of the eye thus disrupting flow of aqueous humor into anterior chamber

Answer 59

Closed angle glaucoma. Generally occurs unilaterally Presents with extreme Eye pain, blurry vision. Hard red eye. Eyes dilated and nonreactive Medical emergency. Avoid pupil dilating medication such as atropine Treat with eyedrops (Tamala, pilocarpine, apraclonidine) or systemic medications as acetazolamide or mannitol

Question 60

Diseased trabecular meshwork limiting flow of aqueous humor | Leads to gradual increase in pressure and progressive vision loss

Answer 60

Open angle glaucoma,. Generally occurs bilaterally Seen an African-American. You see cupping of the disc

Question 61

What's drop foot caused by

Answer 61

L5 radiculopathy | Impingement of common peroneal nerve

Question 62

Cauda equine vs conus medullarus symptoms

Answer 62

Caudal equina compressions causes LMN signs since it come from nerve roots and conus medullarus caused both LMN and UMN signs because it is a part of the spinal cord. Cauda equina syndrome presents as unilateral radiculopathy, Hyporeflexia ,saddle area anesthesia and asymmetric lower extremity weakness Both are managed with emergent MRI, intravenous steroids and neurosurgery consult Conus medullarus presents as symmetric Lower extremity weakness, hyperreflexia, perry anal anesthesia and early onset bowel and bladder dysfunction

Question 63

Nighttime akinesia of the feet feeling like there but the need to move Diagnosis and treatment

Answer 63

Restless leg syndrome. Treat with dopamine agonist similar to those used in Parkinson

Question 64

Diagnostic testing for Duchenne's muscular dystrophy

Answer 64

Genetic testing | not muscle biopsy

Question 65

Sudden loss of vision and presence of floaters Funduscopic exam

Answer 65

Vitreous hemorrhage usually caused by diabetic retinopathy | The fundus is usually very hard to visualize or details are not visualable

Question 66

In a migraine patient who has taken sumatriptan, what medications should be avoided and why?

Answer 66

Ergot derivatives such as (dihydroergotamine ) should be avoided Both sumatriptan and dihydroergotamine are used as abortive for migraines. However they both cause significant vasoconstriction and thus reduce neurogenic inflammation. Together they can cause severe, prolonged vasoconstriction which can lead to HTN, MI or stroke.