Random disorders

Question 1

Jaw claudication is associated with what neurologic emergency?

Answer 1

Temporal arteritis

Question 2

Who gets temporal arteritis?

Answer 2

Men over 50

Question 3

the most common intracranial neoplasm

Answer 3

glioma

Question 4

How does a glioblastoma present? How aggressive is it’s course?

Answer 4

Presents typically with nonspecific symptoms and increased intracranial pressure; it has a RAPIDLY progressing course

Question 5

This tumor is usually benign and incidence increases with age

Answer 5

meningioma

Question 6

This tumor is associated with ipsilateral hearing loss, headache, vertigo, facial weakness, numbness

Answer 6

acoustic neuroma

Question 7

A metastatic intracranial tumor is most likely from

Answer 7

lung carcinoma

Question 8

Wet, wobbly, wacky is the classic triad for what?

Answer 8

normal pressure hydrocephalus (dementia, incontinence, gait apraxia)

Question 9

What is the treatment for normal pressure hydrocephalus?

Answer 9

shunt placement

Question 10

A form of dementia caused by a series of small strokes

Answer 10

multi-infarct dementia

Question 11

This form of dementia has a step-wise deterioration

Answer 11

multi-infarct dementia

Question 12

What is the best way to control multi-infarct dementia?

Answer 12

control blood pressure since HTN is the #1 risk factor

Question 13

Many but not all people with mild cognitive impairment will develop

Answer 13

Alzheimer’s disease

Question 14

Loss of recent memory is one of the first signs of

Answer 14

Alzheimer’s disease

Question 15

What are the risk factors for Alzheimer’s?

Answer 15

family member with the disease, age >60

Question 16

losing things often, forgetting to go to events or appointments and having trouble coming up with words may be a sign of

Answer 16

mild cognitive impairment

Question 17

Brain death occurs when there are no brainstem reflexes for at least ____?

Answer 17

six hours

Question 18

most common cause of meningitis in adults and lacks a rash

Answer 18

pneumococcal (strep) meningitis

Question 19

Treatment for pneumococcal

Answer 19

IV ceftriaxone and vancomycin; dexamethasone after blood cultures have been obtained

Question 20

a meningitis more commonly found in children and adolescents

Answer 20

meningococall (Neisseria); presents with petechial rash

Question 21

You suspect meningitis but CSF culture and gram stain are negative but the LP shows 25-2000 WBC’s, which elevated glucose, what are you worried about?

Answer 21

viral meningitis

Question 22

What is the treatment for encephalitis?

Answer 22

decrease intracranial pressure via mannitol and dexamethasone

Question 23

Arises as a complication to infection of the ear, nose or other parts of the body

Answer 23

brain abscess

Question 24

what are the signs of increased intracranial pressure?

Answer 24

N/V, double vision, headache, muscle weakness, numbness, neuro deficits

Question 25

Proceed with a lumbar puncture for suspected brain abscess: true or false?

Answer 25

FALSE! It may cause brainstem herniation

Question 26

What is the treatment for brain abscess?

Answer 26

IV ceftriaxone, metronidazole and vancomycin for 6-8 weeks, followed by oral therapy for 2-3 months

Question 27

Wernicke encephalitis is due to what?

Answer 27

thiamine (B1) deficiency which can occur in alcoholics

Question 28

For flaccid and impaired sensory perception found in peripheral neuropathy, the findings are most marked distally or proximally?

Answer 28

distally

Question 29

proximal symmetric muscular weakness that is bilateral and can quickly progress to arms and face

Answer 29

guillian barre

Question 30

True or false: treat guillian barre with prednisone

Answer 30

FALSE! Plasmapharesis

Question 31

characterized by burning, numbness or tingling in the outer thigh which can be caused by pregnancy, weight gain, diabetes

Answer 31

Meralgia Paresthetica

Question 32

High arch with lack of muscles and hammer toes +/- gait disturbance that onsets in childhood or early adulthood

Answer 32

Charcot-Marie-Tooth disease

Question 33

Pt presents with a headache that is worse in the morning and worse when she bends over to pick-up her child. She's had occasional double vision. What are you worried about?

Answer 33

pseudo-tumor cerebri (increased intracranial pressure), you might expect to find papilledema on exam

Question 34

What do you use to treat intracranial pressure?

Answer 34

acetazolamide

Question 35

pt presents with symptoms of vertigo, on exam there is a difference between pulses and blood pressure between the patient's right and left arm

Answer 35

Subclavian steal syndrome

Question 36

What is an ateriovenous malformation? (AVM)

Answer 36

when arteries in the brain bypass capillaries and feed directly into veins

Question 37

What will 50% of patients with AVM develop?

Answer 37

brain hemorrhage, a smaller amount will go on to have seizures

Question 38

Acute onset of neurological deficits that resolves within 24 hours

Answer 38

TIA

Question 39

What are the risk factors most commonly associated with stroke?

Answer 39

DM, atherosclerosis, HTN, valvular heart disease

Question 40

Ptosis, diplopida, difficulty chewing, swallowing with fluctuating muscle weakness. Activity increases weakness

Answer 40

Myasthenia gravis

Question 41

Eyebrow droop, with drooping corner of the mouth an smoothing out of the forehead creases

Answer 41

myasthenia gravis

Question 42

myasthenia gravis can be associated with what disorders?

Answer 42

thymic tumor, thyrotoxicosis, RA and lupus

Question 43

complications of myasthenia gravis

Answer 43

myasthenic crisis--> respiratory weakness that requires immediate ICU admission

Question 44

45 yo patient with episodic neurologic symptoms who has an MRI showing several lesions of the white matter of the brain and spinal cord

Answer 44

MS

Question 45

Optic neuritis is commonly associated with what disorder?

Answer 45

MS

Question 46

Initial MS presentation

Answer 46

weakness, tingling, spastic paraparesis, spincter dysfunction

Question 47

After initial MS episode, when can you expect new sx to arise?

Answer 47

months-years after initial episode

Question 48

Characterized as weakness without sphincter involvement

Answer 48

ALS

Question 49

Describe the prevalence of ALS

Answer 49

men, more likely in western pacific decent (Guam)

Question 50

This is a 40 yo M presenting with upper extremity/lower extremity weakness, difficulty swallowing, chewing and talking. On exam he has a drooping palate and a depressed gag reflex. No changes to bowel or bladder function

Answer 50

ALS

Question 51

What is needed to diagnosis ALS?

Answer 51

at least 3 spinal regions involved OR 2 spinal regions plus bulbar musculature

Question 52

A 4 yo patient presenting with muscular weakness. On exam you notice he has difficulty moving from a seated to a standing position

Answer 52

Duchenne muscular dystrophy (with Gower's sign)

Question 53

A common comorbid condition associated with muscular dystrophy

Answer 53

mental retardation

Question 54

Pt presents with progressive speech loss and depressed gag reflex

Answer 54

progressive bulbar palsy

Question 55

You're worried because your patient is having spontaneous outburst of laughing and crying on exam, you also notice an atrophic tongue with weak jaw and facial muscles

Answer 55

progressive bulbar palsy

Question 56

Pt presents complaining of shaky hands which she notices before she does any public speaking. Alcohol seems to improve her symptoms.

Answer 56

benign essential tremor

Question 57

What are the key diagnostic features of Parkinson's?

Answer 57

1. Bradykinesia 2. Resting tremor 3. rigidity 4. postural instability

Question 58

True or false: Parkinson's has a strong genetic component

Answer 58

False!

Question 59

Amantadine is used for treatment of what?

Answer 59

Parkinson's, specifically the treatment of bradykinesia and rigidity

Question 60

MOA of amantadine

Answer 60

increase dopamine release and inhibit it's reuptake

Question 61

amantadine adverse effects

Answer 61

* CNS depression, restlessness, agitation, confusion, hallucinations * Orthostatic hypotension, peripheral edema

Question 62

Gradual progression of chorea and dementia

Answer 62

Huntington Disease

Question 63

Huntington has a strong familial component: true or false

Answer 63

True

Question 64

The gene responsible for Huntington

Answer 64

chromosome 4

Question 65

Restless leg syndrome can be secondary to what conditions

Answer 65

Parkinson's Iron deficiency anemia Pregnancy Peripheral neuropathy

Question 66

Cerebral insult or injury before birth, during delivery or in the perinatal period

Answer 66

cerebral palsy

Question 67

what are some risk factors for cerebral palsy?

Answer 67

small for gestational age or extreme prematurity, intrauterine hypoxia, neonatal hypoglycemia

Question 68

Most common comorbid condition associated with cerebral palsy

Answer 68

spasticity, followed by seizures (50%)

Question 69

True or false: cerebral palsy is a progressive neurological disorder

Answer 69

false, nonprogressive

Question 70

onset for Tourette's syndrome

Answer 70

before age 21 (typically)

Question 71

In Tourette's syndrome, which occurs first, motor or phonic tics?

Answer 71

motor tics (80%)

Question 72

what are some examples of phonic tics?

Answer 72

throat clearing, coughs, grunts, obscene speech (coprolalia), repeating others (echolalia) and repeating phrases (palilalia)