Neuro

Question 1

a left MCA stroke results in what visual field deficit?

Answer 1

Right homonymous hemianopsia: loss of right visual fields in both eyes
eyes deviate to the left since they cannot see right
“look towards the side of lesion”

Question 2

speech is on what side of brain

Answer 2

dominant: typically LEFT in Right handed individuals

Question 3

ACA stroke

Answer 3

Leg more than arm weakness
Personality/cognitive defs
Urinary incontinence

Question 4

PCA stroke

Answer 4

SAME side face sensory loss + CN 9/10
OPPOSITE limb sensory loss
limb ataxia

Question 5

best treatment for nonhemmorhagic stroke

Answer 5

less than 3 hrs: tPa
more than 3 hrs: ASA, if already on, add dipyridamole OR switch to clopidogrel
NOT ASA and clopidogrel together
everybody gets a statin

Question 6

treatment if cardiac thrombi

Answer 6

heparin followed by warfarin for INR 2-3

alternatives: rivaroxaban, dabigatran

Question 7

more than 70% but not 100% carotid stenosis?

Answer 7

endarterectomy > carotid angioplasty

Question 8

unique HA findings
red, tearing eye with rhinorrhea, Horners?
papilledema with diplopia from 6th CN palsy?

Answer 8

Cluster HA

pseudotumor cerebri

Question 9

How to abort migraine and cluster headaches

Answer 9

Both: ergot or triptans

Only cluster: 100% oxygen, prednisone, lithium, prophylaxis with verapamil

Question 10

Best migraine prevention

Answer 10

Propranolol, then CCBs, TCAs, SSRI, topiramate, Botox injections, Sodium valproate

Question 11

When can patients discontinue seizure medication

Answer 11

Seizure free for two years

Question 12

Severe headache, stiff neck, photophobia, fever

Answer 12

SAH, may present with fever due to blood irritating the meninges
Very similar to meningitis, but more sudden in onset and LOC in 50%

Question 13

CSF wbc: rbc ratio

How is this different between SAH and meningitis

Answer 13

Normal: 1 WBC : 500 RBC
SAH: both increased but normal ratio
Meningitis: elevated (more WBCs)

Question 14

EKG findings in ICH

Answer 14

Large or inverted T waves suggestive of myocardial ischemia

Question 15

Cape like distribution of loss of pain and temp bilaterally across upper back and arms

Answer 15

Syringomyelia

Question 16

Differentiating between cancer and abscess with imaging

How to treat if abscess

Answer 16

Both are ring enhancing, need biopsy
Empiric: penicillin plus metronidazole plus ceftriaxone/cefepime, vancomycin if risk of MRSA
Switched more specific regimen when culture results get back

Question 17

Tuberous sclerosis

Answer 17

Neuro abnormalities
Adenoma sebaceum – red facial nodules
Shagreen patches – leathery on trunk
Ash leaf spots
Retinal lesions
Cardiac rhabdomyomas

Question 18

Neurofibromatosis

Answer 18

Neurofibromas
Eighth cranial nerve tumors
Café au lait spots
Meningioma and gliomas

Question 19

Sturgeon – Weber

Answer 19

Port wine stain on face, seizures, Visual changes, hemiparesis, mental delays, calcification of angiomas on skull x-ray

Question 20

Treatment for mild Parkinson’s

Answer 20

Anti-cholinergic: benztropine, trihexyphenidyl

Amantadine

Question 21

Treatment for severe Parkinson’s

Answer 21

Dopamine agonist: pramipexole and ropinirile
Levodopa/carbidopa: most effective
COMT inhibitors: Tolcapone, entaCapone
MAO inhibitors: selegiline, may slow progression
Deep brain stimulation: highly effective for tremors and rigidity

Question 22

What to do if Parkinson’s patient and levodopa/carbidopa presents with psychosis

Answer 22

Start clozapine or other antipsychotics with few EPS side effects, do not stop Parkinson’s meds the patient will become locked in with severe bradykinesia

Question 23

Parkinsonism with orthostasis

Answer 23

Shy – Drager syndrome

Question 24

Treatment for Huntington’s disease

Answer 24

Tetrabenazine for dyskinesia

Psychosis: haldol, seraquel, other antipsychotics

Question 25

Tourette disorder treatment

Answer 25

Antipsychotics:Fluphenazine, clonazepam

Also methylphenidate and other ADHD treatments

Question 26

Most common presentation of MS

Answer 26

Focal sensory symptoms with gait and balance problems, no longer visual disturbances

Question 27

MS patient develops worsening neuro deficits with new, multiple white matter hypodense lesion is think what medication is causing this?

Answer 27

Natalizumab, has been associated with development of PML

Question 28

ALS, most worrisome presentation? What is not lost?

Answer 28

Most serious: difficulty and chewing and swallowing and decreased gag reflex
No sensory loss in sphincters are spared
EMG for diagnosis, elevated CPK

Question 29

Distal weakness and sensory loss, wasting in legs, decreased DTRs, hi foot arch, abnormal leg contour, think?

Answer 29

Charcot – Marie – tooth disease diagnosed with EMG, no treatment

Question 30

Additional features in bell palsy

Answer 30

Since it is seventh cranial nerve palsy, may see hyperacusis, and taste disturbances as it supplies taste of the anterior 2/3 of the tongue
Also, difficulty with closing the eye, so corneal ulcerration may occur, tape shut at night

Question 31

Diagnosis of myastenia gravis

Answer 31

Initial: acetylcholine receptor antibodies, better than edrophinium
If negative get anti-– MUSK antibodies
Best: EMG, it shows decreased strength with repeated stimulation
Imaging: chest x-ray, CT or MRI to look for thymoma or thymic hyperplasia, CT with contrast is best

Question 32

Myasthenia gravis treatment

Answer 32

Neostigmine or Pyridostigmine

Thymectomy if patient under 60, if over, prednisone, other into metabolites to suppress T cell function

Question 33

Acute myasthenia crisis

Answer 33

Treat with IVIG or plasmapheresis

Question 34

Management of cerebral palsy, comorbidities?

Answer 34

PT, OT, ST, baclofen and Botox for spasticity

Intellectual disability, epilepsy, strabismus, scoliosis