Yellow Pages Review Flashcards

1
Q

gradual unilateral hearing loss

A

acoustic schwannoma

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2
Q

hearing loss and V and VII nerve dysfunction

A

cerebellopontine angle meningioma

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3
Q

episodes of tinnitus, vertigo and low frequency hearing loss occurring abut 3x/year for 2 years

A

meniere’s disease

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4
Q

profound dizziness, dysarthria, ataxia over a 10 day period… unable to sit or stand without assistance and has bilateral dysmetria of upper and lower extremities

A

anti-Yo paraneoplastic syndrome

-associated with small cell lung, gynecologic, and non Hodgkin’s lymphoma

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5
Q

momentary vertigo, diplopia, numbness around mouth.. transiently unable to walk and the symptoms then resolve

A

vertebrobasilar TIA

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6
Q

Parkinson-like sxs with autonomic insufficiency (ex. postural hypotension, constipation)

A

multiple system atrophy (shy-drager)

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7
Q

slow shuffling gait, difficulty with turns, urinary incontinence… recovered from meningitis 5 years ago

A
communicating hydrocephalus (NPH) 
-enlarged ventricles due to obstruction of arachnoid granulations (esp after meningitis, SAH, or head trauma)
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8
Q

how to tx NPH

A

high volume tap –> if gait improves, then shunt him

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9
Q

what is it called when ventricles are dilated due to brain atrophy, such as in Alzheimer’s disease?

A

hydrocephalus ex vacuo

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10
Q

2 places that would cause spastic paraparesis

A
  • spinal cord (would probably have sensory sxs)

- parasagittal meningioma (no sensory sxs)

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11
Q

tingling in arms and legs, sensation that limbs are “swollen”, steady on legs esp in the dark –> weakness and SOB
-on exam: no DTRs, absent proprioception and vibration in the limbs, mild bilateral facial weakness

A

GBS

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12
Q

pupils react to accommodation but not to direct light… what is this called and what is it assoc with?

A

argyll robertson pupils of neurosyphilis

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13
Q

agitated, disoriented, anterograde amnesia, FLAIR abnormality in both hippocampi but it’s not herpes encephalitis….

A

anti-Ma paraneoplastic syndrome

-assoc with testicular malignancy

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14
Q

man comes in with difficulty “multi-tasking’ after a coronary artery bypass surgery

A
  • hypoxic ischemic encephalopathy, “pump head”
  • multiple micro-emboli as possible pathophysiology
  • sxs likely to improve
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15
Q

sleep disturbance, mood change, poor concentration and memory, lightheadedness, nausea after head trauma

A

concussion

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16
Q

personality change, disinterested/apathetic, dysarthria, exaggerated startle response, difficulty navigating hallways over course of 3 months

A

CJD

  • posterior hemisphere DWI abnormalities
  • 14-3-3 protein in CSF
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17
Q

paranoia, hoarding behavior, visuospatial deficits

-what sedative would you use?

A

early AD

-quetiapine

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18
Q

discontinuation of care… who gets the say?

A

spouse

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19
Q

cognitive impairment involving more than memory AND

severe enough to interfere with occupational or social functioning

A

dementia

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20
Q

amnestic or nonamnestic (one non memory domain) dysfunction that does NOT impair occupational and social functioning

A

mild cognitive deficit (MCI)

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21
Q

disease modifying drugs for early AD and maybe MCI (3)

A

galantamine (razadyne)- AChE inhibitor
donepezil (aricept)- AChE inhibitor
rivastigmine (exelon)- AChE inhibitor

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22
Q

potent enzyme inducer…this AED makes OCPs less effective

A

phenytoin… also oxcarbazepine

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23
Q

chemotherapy associated with cerebellar ataxia (2)

A

cytosine arabinoside, 5-FU

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24
Q

chemo associated with peripheral neuropathy (4)

A

paclitaxel
docetaxel
vincristine
platinum

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25
Q

RPLS/PRES associated with which drugs…

A

chemo drugs
cyclosporine
tacrolimus

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26
Q

HTN, confusion, seizures, visual changes in transplant population or in cancer patients

A

PRES/RPLS

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27
Q

HTN, confusion, seizures, visual changes in pregnant hypertensive

A

RPLS, eclampsia, cerebral venous thrombosis

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28
Q

how to tx dystonia brought on by haldol or other antipsychotic

A

anticholingergic (diphenhydramine/benadryl)

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29
Q

drugs that cause dystonic rxn (4)

A

antipsychotics
metoclopramide (reglan)
valproic acid (depakote)
amphotericin B

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30
Q

patient is on steroid and AED… develops rash and psychosis… what’s happening

A
  • Stevens Johnson rxn to AED in context of steroid taper

- psychosis from the steroids –> may need to tx with neuroleptics

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31
Q

neural tube defects, hair loss, weight gain, Parkinson-like dystonic rxn

A

depakote (valproic acid)

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32
Q

what abx interacts with carbamazepine?

A

erythromycin causes elevated levels of carbamazepine

-ataxia, nystagmus, diplopia (also assoc with high levels of phenytoin and oxcarbazepine)

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33
Q

which AED causes hyponatremia

A

oxcarbazepine, esp when combined with keppra or thiazide diuretics

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34
Q

which antidepressant lowers the seizure threshold

A

bupropion

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35
Q

tachycardia, blurred vision, fever, AMS, urinary retention in older patients

A

anticholinergics

TCAs have significant anticholinergic effects

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36
Q

agitation, tachycardia… is what withdrawal

A

benzos

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37
Q

tremor agitation, tachycardia, tachypnea, hyperthermia… what two meds interacting

A

serotonin syndrome (SSRI + triptans)

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38
Q

what causes neuroleptic malignant syndrome

A

DA antagonist

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39
Q

what causes malignant hyperthermia

A

inhalational anesthetics

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40
Q

adrenal insufficiency and bitemporal hemianopsia after giving birth

A

pituitary apoplexy (Sheehan syndrome)

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41
Q

chronic steroid use can cause this in the eye

A

cataracts

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42
Q

this type of HA occurs more often with men than women

A

cluster headache

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43
Q

fancy term for lay eye or poor vision due to disuse of the eye

A

amblyobia ex anopia

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44
Q

causes of INO in young and old

A

young- MS

old- stroke of the paramedic pontine perforating vessel

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45
Q

pain on eye movement with central scotoma

A

optic neuritis

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46
Q

fundus exam of optic neuritis

A

normal fundus with poor vision

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47
Q

fundus exam of papilledema

A

enlarged blindspot and highly abnormal fundus

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48
Q

polymyalgia rheumatic associated with ______ (headaches) and _____ which causes blindness

A

giant cell/temporal arteritis

central retinal artery occlusion

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49
Q

dizziness, slurred speech, double vision –> severe HA and vomiting

  • in young person?
  • in old person?
A
  • young: basilar migraine

- old: vertebrobasilar TIA

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50
Q

painful, pupil-involving 3rd nerve palsy
what is it and what are the next steps
deterioration in first 24 hours
deterioration in 3 days… how to tx?

A

PCOM aneurysm

  • CT, LP, angiography, clipping or coiling
  • first 24 hours: rebreeding
  • 3 days later: vasospasm –> tx with nimodipine
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51
Q

drug that precipitates angle closure glaucoma

A

topiramate

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52
Q

Meyer’s loop

A

optic radiations subserving superior visual fields in the temporal lobe

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53
Q

visual field does not change as you change distance from the testing screen

A

tunnel vision… conversion disorder or malingering

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54
Q

neurofibromatosis 1… what eye finding?

A

optic glioma

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55
Q

raised ICP causing papilledema causes what visual field disturbance

A
  • transient visual obscurations
  • pulsatile tinnitus
  • enlargement of the blindspot and then a “nasal step” of field loss eventually leading to concentric peripheral constriction
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56
Q

cortical blindness but pupils are reactive

A

PRES/RPLS- HTN, confusion, seizures, vision

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57
Q

retina has a dual blood supply… both are derived from ______

A

ophthalmic artery of the ICA

  • choroidal/ciliary: choroid, outer retinal layers, optic nerve head
  • central retinal artery: inner retinal layers
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58
Q

ischemic optic neuropathy often presents with an _______ defect

A

altitudinal (ex. pie in the sky)

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59
Q

risk factors for ischemic optic neuropathy

A

amiodarone, interferon alpha, nasal decongestants, PDE inhibitors, spinal surgery in prone position, systemic blood loss, diabetes, HTN

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60
Q

ischemic optic neuropathy is generally (stable/improving/deteriorating)

A

stable

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61
Q

trigeminal neuralgia/tic douloureux tx

A

carbamazepine… concern for MS

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62
Q

jaw claudication, anemia, HA

A

temporal arteritis

63
Q

MOA of the triptans

A

serotonin 1B/1D agonist

64
Q

who should NOT receive triptans

A

uncontrolled HTN, coronary artery disease

65
Q

RBC and WBC in CSF, b/l temporal lobe abnormalities

how to tx

A

HSV encephalitis

acyclovir

66
Q

infection with really high opening pressure (in the 30s at least)… how to tx

A

cryptococcal meningitis

amphotericin B and flu cytosine

67
Q

hearing loss and visual loss with this type of meningitis

A

bacterial… low glucose and super high PMNs

68
Q

multiple cranial neuropathies, raised ICP, hydrocephalus.. what kind of meningitis?

A

basilar meningitis due to TB… low glucose

69
Q

normal CSF except high protein

A

albuminocytologic dissociation… GBS

70
Q

CN VII palsy, red lesions in external auditory canal, red tympanic membrane, pain in ear, taste loss in ant 2/3 of tongue, dry mouth and eyes

A

Ramsay Hunt syndrome due to VZV… tx with acyclovir

71
Q

associated with primary CNS lymphoma

72
Q

bilateral facial weakness after camping

A

lyme (borrelia burgdorferi)

73
Q

how to dx cryptococcal meningitis

A

cryptococcal antigen

74
Q

most common cause of epilepsy in 3rd world

A

neurocysticercosis… tx with albendazole

75
Q

ppx for bacterial meningitis

A

rifampin or ciprofloxacin

76
Q

how to tx bell’s palsy

A

prednisone within first 48 hours

valcyclovir, acyclovir, or famcyclovir

77
Q

hearing loss, spasticity, microcephaly, retardation, hyper intensities along the ventricular margins on MRI in a new born

A

congenital CMV

78
Q

raw honey to a newborn

A

tetanus?? botulism

79
Q

gait disorder in 6 year old; hyperreflexia, Babinski, heel cord contracture, upper limb writhing

A

cerebral palsy

80
Q

_______ fibers are preferentially affected in Charcot Marie Tooth

A

myelinated (proprioception and vibration)

81
Q

myoclonic dystrophy is associated with a variety of systemic signs including (4)

A

type II diabetes
frontal balding
ptosis
slow relaxation of grip (myotonia)

82
Q

skin lesions, dumbbell enhancing lesion in spinal cord, pain radiating to thumb and 1st finger

A

NF1 (10x more common than NF2)

83
Q

autism, seizures, subependymal nodules around foramen of Monro

A

tuberous sclerosis

84
Q

tx for Tourette’s (2)

A

haloperidol or risperidone (APD)

85
Q

weak, areflexic, decreased pinprick in stocking glove pattern, abdominal pain, constipation

86
Q

drugs that cause AIP

A

sulfonamides, hormones, barbiturates

87
Q

how to tx AIP

A

IV hematin

88
Q

muscle cramping, weakness, dark urine after exercise

A

McArdle’s disease (glycolysis problem)

89
Q

kyphoscoliosis, pes cavus, gait difficulty, retinitis pigmentosa-associated visual loss, spinocerebellar signs (limb ataxia, dysarthria), DM, cardiac conduction issues, asymmetric septal hypertrophy

  • major pathways affected: posterior columns, dorsal and ventral spinocerebellar tracts, lateral corticospinal tracts
  • autosomal recessive
A

Friedreich’s ataxia

90
Q

chromosome and gene in Friedreich’s ataxia

A

9q13, frataxin

91
Q

tx of Friedreich’s ataxia

92
Q

AD disease assoc with failure of muscles to relax, ptosis, DM2, hypothyroidism, frontal balding, slow course in mid-adult life

A

myotonic dystrophy

93
Q

numbness and tingling in legs, diminished proprioception and vibration to mid calf with absent DTRs in the setting of taking TB meds (esp isoniazid)

A

B6/pyridoxine deficiency

94
Q

farmer with nausea, vomiting, diaphoretic, diffusely weak, pinpoint pupils

A

organophosphate intoxication, sarin gas

95
Q

how to treat organophosphate poisoning

A

atropine (anti muscarinic) and pralidoxime (anti nicotinic)

96
Q

excess of vitamin _____ can cause pseudo tumor cerebri

97
Q

_______ poisoning can cause HA, nausea, forgetfulness, and globes pallidus necrosis

A

CO poisoning

98
Q

Wernicke’s triad

A

dementia/confusion, gait ataxia, ophthalmoplegia

99
Q

recent weight loss, broad based ataxic gait, can’t stand with feet together even when eyes are open, absent ankle reflexes, diminished proprioception at toes and ankles, no Babinski

A

spinal and cerebellar signs –> vitamin E deficiency

100
Q

abdominal pain, constipation, microcytic anemia, weakness of limbs esp involving the extensor muscles = __________ poisoning

101
Q

subacute combined degeneration

A

posterior and lateral column dysfunction due to B12 deficiency

102
Q

pt receiving TPN, cog wheeling, stiffness

A

Manganese intoxication

  • T1 signal in the basal ganglia
  • cirrhosis, excess manganese consumption
103
Q

nausea, vomiting, tinnitus, oval skin patches, decreased pinprick sensation, gray lines on nails

A

arsenic poisoning

104
Q

smells sweet and causes profound peripheral nerve and cranial nerve dysfunction

A

ethylene glycol (antifreeze)

105
Q

localization of hemiballismus

106
Q

easier to walk uphill, relief of pain when bending over

A

spinal stenosis

107
Q

ankle reflex relies on this spinal cord level

108
Q

syringomyelia is associated with _________

slow evolution of pain and kyphoscoliosis

A

arnold chiari malformation
type I- cerebellar tonsils are low
type II- meningomyeloceles

109
Q

axillary nerve function and where its injured

A

shoulder abduction

clavicular or shoulder injury

110
Q

anterior interosseous nerve

A

inability to make a pinch with thumb and index, normal sensation

111
Q

how to dx myasthenia gravis

A

edrophonium or tensilon test

112
Q

tx myasthenia

A

AChE inhibitors- pyridostigmine

-consider thyroid dz and thymoma

113
Q

pathophys of Lambert Eaton syndrome

A

antibodies to pre-synaptic Ca channels

114
Q

pathophys of botulism

A

presynaptic (failure of ACh release)

115
Q

patellar reflex… what level is it?

116
Q

pain in lateral thigh and anterolateral leg with sensory loss primarily in the dorsal aspect of the foot, inversion is affected

A

L5 radiculopathy

117
Q

incorrect positioning during surgery –> weakness of right hand

A

probably brachial plexus injury

118
Q

acute tx for suspected spinal cord compression

A

high dose methylprednisolone

119
Q

where do you do DBS for Parkinson tremors

120
Q

eating disorder (overeating like crazy)… where is the lesion

A

supraoptic nucleus of the hypothalamus

121
Q

muscle weakness that improves with repeated muscle strength testing… normal sensation

A

Lambert Eaton Syndrome

122
Q

pathophys of Lambert Eaton syndrome

A

antibodies to presyn Ca channels

123
Q

Lambert Eaton syndrome assoc with what malignancy

A

small cell lung cancer

124
Q

when you’re not guarding an injured joint…what is it called?

A

Charcot joint

125
Q

pure motor hemiparesis stroke… where is the lesion? and how do you tx (aspirin, warfarin, CEA, other)

A

lacune in the internal capsule

tx with aspirin and probably a statin as well

126
Q

IV drug user with sudden severe headache and decrease in alertness… right leg appears to move less than left leg

A

hemorrhagic stroke to the ACA…. do NOT anticoagulate him, give him abx

127
Q

alcoholic man wakes to find weak elbow, finger, and wrist extension… with no sensory loss

A

Saturday night palsy (radial nerve palsy)

tx with wrist splint

128
Q

sudden vertigo, dysphagia, left facial numbness, right arm and leg numbness, left palatal paresis, left Horner’s, and right beating nystagmus
what is it and how do you tx it?

A

wallenberg (lateral medullary) syndrome

  • lower CN dysfunction and crossed sensory signs
  • mechanism: vertebral artery occlusion or PICA occlusion
  • would probably anticoagulate this person with warfarin
129
Q

major indications for anticoagulation

A
valvular afib
mechanical prosthetic valves
cerebral venous sinus thrombosis
decreased EF
mural thrombus
venous thromboembolism
130
Q

65 M with 2 days of fluctuating facial and arm numbness

  • for last 12 hours, weak in face/arm/leg of symptomatic side and has a significant sensory deficit on that side as well
  • where is the stroke and what do you tx him with?
A

internal carotid occlusion

-tx with aspirin

131
Q

stroke with agitation, inferior quadrantanopsia, and sensory neglect
-where is the lesion?

A

nondominant parietotemporal (inferior MCA branch) stroke

132
Q

which scoring system predicts risk of stroke in the setting of TIAs

133
Q

treatment for essential tremor

A

propranolol and topiramate

134
Q

how to tx cerebral sinus thrombosis

A

anticoagulation

135
Q

biggest risk factor for stroke

136
Q

what to give for dissection

137
Q

awake without being alert

A

persistent vegetative state

-it takes 6 weeks to formally meet the criteria

138
Q

tx for cataplexy

A

modafinil (provigil)

139
Q

what is REM sleep disturbance a harbinger of?

A

Parkinson’s

140
Q

after getting haldol –> hyperthermia (around 104), rigidity, masked facies, resting tremor
what is this and how do you tx it?

A

neuroleptic malignant syndrome

-tx with dantrolene (direct skeletal muscle relaxant) or with benzos

141
Q

Parkinson sxs + eye movement abnormalities (limited vertical gaze)

A

progressive supranuclear palsy

142
Q

detrusor hyperreflexia

A

small capacity, upper motor neuron bladder

143
Q

how to treat detrusor hyperreflexia

A

oxybutynin (ditropan)
tolterodine (detrol)
*beware cognitive problems on anticholinergics in patients with or without pre-existing cognitive dysfunction

144
Q

Severe right sided headache for 3 weeks –> MRI shows heterogeneously enhancing mass in right temporal lobe… What med do you give?

A

Dexamethasone to reduce swelling

145
Q

Tx for neuropathic pain

A

Gabapentin
Pregabalin
Duloxetine
TCA like amitriptyline

146
Q

Findings consistent with myopathy on EMG

A

EMG findings

  • no insertional fibrillations
  • low amplitude motor units
  • early recruitment but normal interference pattern
147
Q

EMG findings for neuropathy

A
  • insertional fibrillations
  • large motor units
  • decreased interference when patient asked to contract
148
Q

Tx for toxoplasmosis

A

Pyrimethamine and sulfadiazine

149
Q

Which cholinergic nucleus might be affected in Alzheimer’s

A

Nucleus basalis of meynert

150
Q

Stuck in mine. After awakening slowly, he has significant bilateral tremor

A

Globus pallidus necrosis due to CO poisoning

151
Q

Pathology of hemiballismus

152
Q

Thiamine deficiency can cause lesions in this structure

A

Mammillary bodies

153
Q

HA, unreactive dilated pupils, can’t look up, when she tried to look up refractory nystagmus occurs

A

Parinauds or dorsal midbrain syndrome: pathology in pineal region