Kneurology: Kaplan Companion To First Aid For Usmle Step 2 Ck

Front 1

Q001. Parkinson's Disease - What is it; When does it start; Life expectancy

Back 1

A001. ACh and dopamine must be in balance for normal, balanced movement; decreased levels of dopamine in substantia nigra; idiopathic hypokinetic; usually starts ~50-60 y/o; life expectancy ~ 9 yrs.

Front 2

Q002. Parkinson's Disease - Insults that lead to; "parkinsonism"

Back 2

A002. Most cases are idiopathic; insults decreased dopamine - postencephalitic; toxic insults - (carbon disulfide,"",manganese, MPTP); bihemispheric ischemic; traumatic; iatrogenic (neuroleptic meds)

Front 3

Q003. Parkinson's Disease - History/PE

Back 3

A003. Tremor at rest (pill rolling); cogwheel rigidity; bradykinesia; festinating gait; stooped posture; unstable posture; masked faces; memory loss; micrographia; shy-dragger- any autonomic dysfunction

Front 4

Q004. Parkinson's Disease - Tx

Back 4

A004. 1st - is it from a secondary cause that can be reversed?; then - how does patient function daily?; tremor but functioning - > 60 y/o – amantidine; < 60 y/o - anticholinergic; if can't function - l-dopa-carbidopa, most effective but most side effects; "response fluctuations": Tx fluctuations - COMT or selegiline list of meds:; L-dopa/carbidopa - mainstay; bromocriptine; selegiline; entacapone (COMT inhib); amantadine & anticholinerg - limited efficacy; If meds fail & disease advanced - deep brain stimulation of GPi and subthal nucleus, or pallidotomy - ablation of GPi (posteroventral GP), rarely done now

Front 5

Q005. Huntington's - What is it

Back 5

A005. Hyperkinetic; AD; atrophy of caudate; lose GABA; CAG triple repeats on C4p; anticipation - progression expansion; > 39 repeats - mutant genes

Front 6

Q006. Huntington's - History/PE

Back 6

A006. Presents ~30-50 y/o; gradual onset of - chorea; dementia; altered behavior; depression

Front 7

Q007. Huntington's - Dx

Back 7

A007. Clinical; CT; MRI; molecular genetic testing

Front 8

Q008. Huntington's - Tx

Back 8

A008. No cure; disease cannot be halted; genetic counseling; haloperidol - psychosis; reserpine - minimize unwanted movements

Front 9

Q009. Alzheimer's - What is it

Back 9

A009. MCC of dementia in elderly; senile plaques - B amyloid; neurofibrillary tangles - abnorm phosphorylated tau protein; loss of ACh in cortex - basal nucleus of Meynert; amyloid angiopathy => lg lobar hemorrhage; hippocampus affected early

Front 10

Q010. Alzheimer's - Risk factors

Back 10

A010. Age - most important; family history; Down's (> 35 y/o); female gender; chromosomes 21, 14; chromosome 1 - younger age; chromosome 19 - older; homozygous for ApoE4 - high rate of Alzheimer's

Front 11

Q011. Alzheimer's - History/PE

Back 11

A011. Amnesia usually 1st sign; then language deficits; acalculia; depression; agitation; apraxia

Front 12

Q012. Alzheimer's - Evaluation

Back 12

A012. Dx of exclusion; definitive Dx only on autopsy; MRI or CT - diffuse cortical and subcortical atrophy; Neuropsych testing - distinguish between dementia and depression

Front 13

Q013. Alzheimer's - Tx

Back 13

A013. Supportive therapy; Cholinesterase inhibitors - first-line therapy; donepezil; rivastigmine; galantamine; Vit E (a-tocopherol) - may slow cognitive decline

Front 14

Q014. Alzheimer's - Complications

Back 14

A014. Survival is 5-10 yrs from onset of sxs; death usually secondary to aspiration pneumonia or other infections

Front 15

Q015. Delirium - What is it caused by; Timing of onset; Course

Back 15

A015. Caused by acute illness, infection or drug toxicity; Sudden onset; Reversible (usually); impairment of consciousness - decreased awareness of your environment; can't maintain attention

Front 16

Q016. Dementia - What is it caused by; Timing of onset; Course

Back 16

A016. Caused by anatomic changes in the brain; Slow, gradual onset; Irreversible

Front 17

Q017. Subarachnoid Hemorrhage - What is it

Back 17

A017. Due to bleeding from ruptured aneurysm; MCC - head trauma (Circle of Willis) (considered separate disorder); spontaneous ruptured aneurysm, usually congenital berry, associated with APKD, coarctation of aorta; other cause - AV malformation, ~50-60 y/o; high mortality

Front 18

Q018. Subarachnoid Hemorrhage - History/PE

Back 18

A018. Sudden-onset headache; "worst headache of my life"; loss of consciousness; fever; n/v; neck stiffness; seizure; CN3 palsy - if berry aneurysm; may be preceded by milder sentinel headaches, weeks earlier

Front 19

Q019. Subarachnoid Hemorrhage - Dx

Back 19

A019. CT without contrast immediately. blood appears white; if CT neg - LP immediately, check for xanthochromia; no LP if increased ICP - sudden decreased in CSF pressure can cause further bleeding; 4-vessel angiography to pinpoint location

Front 20

Q020. Subarachnoid Hemorrhage - Tx

Back 20

A020. Prevent 2nd rupture - most likely in 1st 48 hrs; obliterate aneurysm; IV fluids; keep BP OK; nimodipine -prevent vasospasm; phenytoin; lower ICP - raise head of bed, hyperventilation; pain meds - no NSAIDs; surgery - clip aneurysm; IR (stent-assisted) coiling

Front 21

Q021. Subarachnoid Hemorrhage - Complications

Back 21

A021. 2nd rupture - especially with aneurysm; extend into brain parenchyma- especially with AVM; arterial vasospasm; obstructive hydrocephalus

Front 22

Q022. Epidural Hematoma - What is it

Back 22

A022. Often due to blunt trauma; usually lateral skull fracture; tear of Middle Meningeal Art.

Front 23

Q023. Epidural Hematoma - History/PE

Back 23

A023. Lucid interval - min. to hrs. then headache; progressive obtundation; hemiparesis; "blown pupil"

Front 24

Q024. Epidural Hematoma - Dx

Back 24

A024. CT - lens-shaped convex hyperdensity; close observation and serial neuro exams before surgery

Front 25

Q025. Epidural Hematoma - Tx

Back 25

A025. Neurosurgical evacuation

Front 26

Q026. Subdural Hematoma - What is it

Back 26

A026. Usually after head trauma; rupture of bridging veins; cortex to dural sinuses; especially elderly & alcoholics

Front 27

Q027. Subdural Hematoma - History/PE

Back 27

A027. Headache; change in mental status - days to weeks; can present as dementia in elderly; contralateral hemiparesis; may have remote history of fall

Front 28

Q028. Subdural Hematoma - Dx

Back 28

A028. CT - crescent-shaped; concave hyperdensity

Front 29

Q029. Subdural Hematoma - Tx

Back 29

A029. Neurosurgical evacuation; blood may regress spontaneously if chronic; corticosteroids; phenytoin

Front 30

Q030. Parenchymal Hemorrhage - Causes

Back 30

A030. HTN (usually in basal ganglia); tumor; amyloid angiopathy - elderly; vascular malformations - AVM; cavernous hemangiomas

Front 31

Q031. Parenchymal Hemorrhage - History/PE

Back 31

A031. lethargy; headache; focal mtr & sensory deficits; some obtundation

Front 32

Q032. Parenchymal Hemorrhage - Dx

Back 32

A032. CT without contrast; check for mass effect or edema

Front 33

Q033. Parenchymal Hemorrhage - Tx

Back 33

A033. Raise head of bed; antiseizure prophylaxis; neurosurgical evacuation - if mass effect, especially in posterior fossa

Front 34

Q034. Coma - What is Rule of 4

Back 34

A034. 1. Thiamine, D50, naloxone, coma cocktail; 2. 2 mechanisms: bilateral hemisphere or RAS; 3. 3 general disease processes: structural, metabolism, seizures; 4. 4 key aspects to exam

Front 35

Q035. Coma - General Processes: Structural

Back 35

A035. Hematoma; Infarction; Abscess; Tumor; Abnormal imaging lesion that occupies space

Front 36

Q036. Coma - General Processes: Metabolism

Back 36

A036. Electrolyte, endocrine or metabolic functions; substrate deprivation - O2, glucose, vitamin deficiency; organ failure – kidney; toxins – meds, etoh, drugs; infections; inflammatory disease; Normal imaging

Front 37

Q037. Coma - General Processes: Seizures

Back 37

A037. Status epilepticus; postictal

Front 38

Q038. Coma - 4 aspects of exam

Back 38

A038. Pupils; eye movement; motor response; ventilation pattern - acid-base status

Front 39

Q039. Coma - Tx

Back 39

A039. Stabilize the patient; Airway; Breathing; Circulation; Reverse the reversible - coma cocktail; O2; ID and tx underlying cause; Prevent further damage

Front 40

Q040. Broca's Aphasia - What is it; What part of brain affected

Back 40

A040. Disorder of language production; motor; broken speech; comprehension is intact; expressive or nonfluent aphasia; posterior inferior frontal gyrus

Front 41

Q041. Broca's Aphasia - Features

Back 41

A041. Repetition is impaired; frustration - cuz aware; associated with - arm and face hemiparesis, hemisensory loss, apraxis of oral muscles; often secondary to left superior MCA stroke

Front 42

Q042. Broca's Aphasia - Tx

Back 42

A042. Speech therapy; tx underlying condition; wide range of outcomes; intermediate prognosis

Front 43

Q043. Wernicke's Aphasia - What is it

Back 43

A043. Disorder of language comprehension; nonsensical production; Wernicke's is wordy; left posterior superior temporal; receptive or fluent aphasia

Front 44

Q044. Wernicke's Aphasia - Features

Back 44

A044. Neologisms; word substitutions; unaware - no comprehension; secondary to left inferior/post MCA stroke

Front 45

Q045. Wernicke's Aphasia - Tx

Back 45

A045. Speech therapy; tx underlying condition; poorer prognosis than Broca's

Front 46

Q046. Brain Neoplasms - Mets vs. Primary

Back 46

A046. Benign usually > 65 y/o Metas - Lots of Bad Stuff Kills Glia: Lung Breast Skin Kidney GI; metas > primary; supratentorial; at junction of gray and white matter; MC primary in adults - glioblastoma and meningioma; most 1o are supratentorial; MC primary in kids - medulloblastoma & astrocytoma; most 1o are infratentorial

Front 47

Q047. Brain Neoplasms - Dx

Back 47

A047. CT with contrast; MRI with gadolinium; CT-guided Biopsy; Biopsy during surgical tumor debulking

Front 48

Q048. Brain Neoplasms - General Principles of Tx

Back 48

A048. Resection (if possible); radiation; chemo; palliative tx; corticosteroids - reduce vasogenic edema; type of therapy depends on - type of tumor, histology, progression, site

Front 49

Q049. Brain Neoplasms:; Glioblastoma - Characteristics and; Presentation

Back 49

A049. Grade IV astrocytoma; MC primary brain tumor; prognosis grave, < 1 year to live; can cross corpus callosum; progresses fast; headache; ICP

Front 50

Q050. Brain Neoplasms:; Glioblastoma - Tx

Back 50

A050. Surgical resection; radiation and chemo; have variable results

Front 51

Q051. Brain Neoplasms:; Meningioma - Characteristics and; Presentation

Back 51

A051. 2nd MC primary; often incites osteoblastic reaction in overlying cranial bones; originate from dura or arachnoid; good prognosis; incidence increased with age

Front 52

Q052. Brain Neoplasms:; Meningioma - Tx

Back 52

A052. Surgical resection; radiation for unresectable

Front 53

Q053. Brain Neoplasms:; Acoustic Neuroma (Schwannoma); Characteristics and; Presentation

Back 53

A053. Derived from schwann cells; bilateral schwannoma in NF2; Ipsilateral hearing loss; tinnitus; vertigo; signs of cerebellar dysfunction; facial weakness; facial sensory loss

Front 54

Q054. Brain Neoplasms:; Acoustic Neuroma (Schwannoma); Tx

Back 54

A054. Surgical removal

Front 55

Q055. Brain Neoplasms:; Astrocytoma - Characteristics and; Presentation

Back 55

A055. Grades 1 - pilocytic, mainly kids; grade 2 - diffuse; grade 3 - anaplastic; grade 4 - glioblastoma multiforme; headache; increased ICP; can cause unilateral paralysis in CN 5-7 & CN10

Front 56

Q056. Brain Neoplasms:; Astrocytoma - Tx

Back 56

A056. Resection if possible; radiation

Front 57

Q057. Brain Neoplasms:; Medulloblastoma - Characteristics and; Presentation

Back 57

A057. Highly malignant; arises from cerebellum and 4th ventricle; can compress 4th ventricle; may seed subarachnoid space; increased ICP; morning headaches

Front 58

Q058. Brain Neoplasms:; Medulloblastoma - Tx

Back 58

A058. Surgical resection; coupled with radiation and chemo

Front 59

Q059. Brain Neoplasms:; Ependymoma - Characteristics and; Presentation

Back 59

A059. Common in kids; arises from ventricles and spinal cord; commonly found in 4th ventricle; can cause hydrocephalus

Front 60

Q060. Brain Neoplasms:; Ependymoma - Tx

Back 60

A060. Surgical resection; radiation

Front 61

Q061. Neurofibromatoses - What are they

Back 61

A061. NF1 - von Recklinghausen, AD, chromosome 17; NF2 - chromosome 22

Front 62

Q062. Neurofibromatoses - History/PE

Back 62

A062. NF1 - 2 or more of: neurofibromas (2), cafe-au-lait spots (6), freckling - axillary or inguinal, optic Glioma, lisch nodules (2), osseous abnorm, 1st degree relative with NF1; NF2 - bilateral acoustic neuromas or 1st deg. relative with NF2 and unilateral acoustic neuroma or 1st deg. relative with NF2 and neurofibroma, meningioma, Glioma or schwannoma

Front 63

Q063. Neurofibromatoses - Dx

Back 63

A063. MRI – brain, brain stem, spine; derm exam; ophthal exam; family History; hearing test

Front 64

Q064. Neurofibromatoses - Tx

Back 64

A064. No cure; tx symptoms; surgical removal for; acoustic neuromas

Front 65

Q065. Tuberous Sclerosis - What is it

Back 65

A065. Seizures - start as infant; mental retardation; skin and eye lesions; small benign tumors – brain, face, eyes, kidney, other organs; very variable clinical course; AD; chromosome 9

Front 66

Q066. Tuberous Sclerosis - History/PE

Back 66

A066. Infantile spasms; ash-leaf lesions – hypopigmentation, trunk and extremities; shagreen patch - lumbosacral; sebac. adenoma - nose, cheeks; mulberry tumors; phakomas

Front 67

Q067. Tuberous Sclerosis - Dx

Back 67

A067. CT - calcified tubers, periventricular areas, can => astrocytomas (rare); Wood's UV lamp - skin lesions; EKG; renal US

Front 68

Q068. Tuberous Sclerosis - Tx

Back 68

A068. Clonazepam or valproic acid; increased ICP - may indicate a tuber obstructing Foramen of Munro, surgery

Front 69

Q069. Von Hippel-Lindau - What is it

Back 69

A069. AD; deletion of VHL gene on ch 3; hemangioblastoma – cerebellum, medulla; retinal angioma; RCC; pheochromocytoma

Front 70

Q070. Von Hippel-Lindau - History/PE

Back 70

A070. Headache; N/V; cerebellar Sxs; retinal angiomas - usually periphery, can => retinal detachment

Front 71

Q071. Von Hippel-Lindau - Dx

Back 71

A071. CT - head, abdomen; MRI - posterior fossa emphasis, serpentine signal voids; angiography - vascularity; CBC - polycythemia; VMA levels in urine; ophthal US

Front 72

Q072. Von Hippel-Lindau - Tx

Back 72

A072. Surgical resection; or radiation

Front 73

Q073. Osler-Weber-Rendu - What is it

Back 73

A073. AD; also called - Hereditary Hemorrhagic Telangiectasia (HHT); telangiectasia and AVM in lungs, GI, brain; recurrent epistaxis

Front 74

Q074. Osler-Weber-Rendu - History/PE

Back 74

A074. Recurrent epistaxis; painless bleeding in bowel; hepatic AV fistula - (hepatomegaly, RUQ pain, pulsatile mass, palpable thrill, audible bruit, high-output CHF, liver failure); hepatic encephalopathy - portosys shunt; neuro complications; rightt-to-left shunt - (cyanosis, clubbing, hypoxemia, secondary polycythemia, exertional dyspnea)

Front 75

Q075. Osler-Weber-Rendu - Tx

Back 75

A075. Iron; folate; symptomatic tx of epistaxis; ASA - contraindicated; embolization,; surgical excision or ligation of AV fistulas

Front 76

Q076. Closed-Angle Glaucoma - What is it

Back 76

A076. Med emergency; usu older patients and Asians; iris root plugs opening of trabecular meshwork; acutely pupillary dilation; anterior uveitis; dislocation of lens

Front 77

Q077. Closed-Angle Glaucoma - History/PE

Back 77

A077. Intraocular pressure increased very fast; extreme periocular pain; acute red eye; blurred vision

Front 78

Q078. Closed-Angle Glaucoma - Dx; Tx

Back 78

A078. Best diagnostic test - tonometry; Tx – acetazolamide, pilocarpine - when P drops; laser iridotomy - curative

Front 79

Q079. Open-Angle Glaucoma - What is it

Back 79

A079. Most common form; almost always bilateral; risk factors - > 40 y/o, Black, diabetic, myopic, family History; diseased trabecular meshwork obstructs proper drainage => intraoc P increased gradually; progressive vision loss; vision loss - moves periph to central => blindness

Front 80

Q080. Open-Angle Glaucoma - History/PE

Back 80

A080. Asymp initially; suspect if patient - > 35 y/o, freq. lens changes, mild headaches, vision disturbances, impaired adaptation to dark; earliest defect - periph nasal fields; cupping of optic disk

Front 81

Q081. Open-Angle Glaucoma - Dx

Back 81

A081. Tonometry; ophthalmic exam of optic nerve. central field testing; evaluate on long-term basis; can be hard to Dx until advanced stages

Front 82

Q082. Open-Angle Glaucoma - Tx

Back 82

A082. Prevention; > 40 y/o - exam every 3-5 yrs; with increased risk factor - annually; timolol, betaxolol; pilocarpine; acetazolamide; laser trabeculoplasty - if meds fail

Front 83

Q083. Macular Degeneration - What is it

Back 83

A083. MCC of permanent bilateral vision loss in elderly; vision loss – central, do not lose peripheral vision; atrophic - gradual loss; exudative – faster, damage more severe

Front 84

Q084. Macular Degeneration - History/PE

Back 84

A084. painless loss of central vision; atrophic - irreg pigmentation of macular region; exudative – hyperpigmentation, pimple-like elevation of macula - from hemorrhage

Front 85

Q085. Macular Degeneration - Tx

Back 85

A085. Laser photocoagulation - may delay loss of central vision in exudative

Front 86

Q086. Retinal Artery Occlusion - What is it; History/PE

Back 86

A086. From emboli or thrombi; sudden, painless, unilateral blindness; pupil accommodates but reacts sluggishly to direct light; cherry-red spot on fovea; artery may look bloodless; retinal edema

Front 87

Q087. Retinal Artery Occlusion - Tx

Back 87

A087. Thrombolysis within 8 hrs of onset of Sx; decreased intraoc P - drain anterior chamber; IV acetazolamide

Front 88

Q088. Retinal Vein Occlusion - What is it; History/PE

Back 88

A088. Sudden, painless; retinal hemorrhages; cotton wool spots; edema of fundus; elderly; MCC - HTN; can => macular disease, glaucoma

Front 89

Q089. Retinal Vein Occlusion - Tx

Back 89

A089. Laser photocoagulation

Front 90

Q090. Increased ICP - Causes

Back 90

A090. Blood - EDH, SDH, SAH, ICH; spontaneous or traumatic; CSF - hydrocephalus; idiopathic intracranial HTN; brain mass - tumor; trauma -cerebral contusions; edema – trauma, tumors

Front 91

Q091. Increased ICP - Signs in approx. order; of appearance

Back 91

A091. N/V and headache; altered mental status; in kids - bulging fontanelles; papilledema; CN palsies - especially CN6; Cushing's Triad - (HTN, bradycardia, irregular breathing); end-stage - cerebral herniation

Front 92

Q092. Increased ICP - Tx - in order

Back 92

A092. Make sure BP and respiratory good; sedation; elevate head of bed; IV mannitol; hyperventilate to CO2 30-35; ventriculostomy; surgery - removal of hematoma, decompressive craniectomy

Front 93

Q093. Herniation - What is it; Types; Dx

Back 93

A093. Endpoint of untreated masses or increased ICP; specific signs and Sxs depends on type of hernia and mass lesion; uncal herniation - CN3 compression: ipsilat dilated pupil; midbrain compression: ipsilat hemiplegia; tonsillar herniation - respiration compromise; Dx - CT without contrast - rule out mass lesion or hemorrhage

Front 94

Q094. Guillain-Barre - What is it

Back 94

A094. Acute, rapidly progressive, acquired demyelinating autoimmune disorder of periph nerves; recent C. jejuni infection; viral infection; recent vaccination

Front 95

Q095. Guillain-Barre - History/PE

Back 95

A095. Rapidly progressive; ascending paralysis; involves trunk, diaph and CN; autonomic Sxs; areflexia

Front 96

Q096. Guillain-Barre - Dx

Back 96

A096. Diffuse demyelination on - EMG & nerve conduction studies; albuminocytologic dissociation; CSF protein > 55 mg/dL

Front 97

Q097. Guillain-Barre - Tx

Back 97

A097. ICU - risk of respiratory failure; plasmapheresis or IVIG; aggressive rehab

Front 98

Q098. MS - What is it

Back 98

A098. Acquired demyelinating disease; may have T cell-mediated autoimmune pathogenesis; environmental and genetic; female-to-male 2:1; 20-40 y/o; increased prevalence with greater distance from equator; risk - related to where lived the 1st 15 yrs. of life; subtypes – benign, relapsing/remitting, 2o progressive, chronic progressive

Front 99

Q099. MS - History/PE

Back 99

A099. Multiple neuro complaints in time and space, can't be explained by a single lesion; limb weakness; optic neuritis; paresthesias; diplopia; internuclear ophthalmoplegia; urinary retention; vertigo; Sxs wax & wane or progress; exacerbations – stress, infections, heat, trauma, vigorous activity

Front 100

Q100. MS - Dx

Back 100

A100. Multiple, asymmetric periventricular lesions in white matter; corpus callosum lesions - pathognomonic; active lesions enhance with Gado on MRI; increased CSF IgG, oligoclonal bands

Front 101

Q101. MS - Tx

Back 101

A101. Acute - steroids treat Sxs:; spasticity: baclofen or zanaflex; pain: phenytoin; fatigue: amantadine or provigil; avoid hot climates; prophylaxis: immunomodulators, reduce number of attacks, disability; Avonex - once weekly IM; Betaseron- every other day subq; Copaxone - daily subq

Front 102

Q102. Stroke - Types

Back 102

A102. Ischemic - 80%; emboli; thrombi; systemic hypoperfusion; hemorrhagic

Front 103

Q103. Stroke - Risk Factors

Back 103

A103. Age; male; race; HTN; diabetes; obesity; smoking; hypercholesterolemia; AF; carotid stenosis; coke; alcohol; IV drug user

Front 104

Q104. Stoke - History/PE; MCA

Back 104

A104. Aphasia; neglect; gaze preference; homonymous hemianopsia; contralateral hemiparesis - arm/face > leg

Front 105

Q105. Stoke - History/PE; ACA

Back 105

A105. Amnesia; personality changes; foot drop; gait dysfunction; cognitive changes; contralateral hemiparesis - leg > arm/face

Front 106

Q106. Stoke - History/PE; PCA

Back 106

A106. Homonymous hemianopia; memory deficits; dyslexia/alexia

Front 107

Q107. Stoke - History/PE; Basilar

Back 107

A107. Coma; CN palsies; apnea; visual Sxs; drop attacks; dysphagia

Front 108

Q108. Stoke - History/PE; Lacunar

Back 108

A108. Unilateral pure motor or sensory; dysarthria - clumsy hand syndrome; ataxic hemiparesis

Front 109

Q109. Stoke - History/PE; TIA

Back 109

A109. Transient neuro deficits; last < 24 hours; most last < 1 hour

Front 110

Q110. Stoke - Dx

Back 110

A110. CT without contrast - ischemic vs. hemorrhagic; MRI; EKG; echocardiogram; vascular studies - carotid US; MRA; transcranial doppler or MRA; screen for hypercoagulability; PE

Front 111

Q111. Stoke - Tx; Preventive and Long-Term

Back 111

A111. Vigilance for signs of - brain swelling: increased ICP, herniation; tPA - ischemic stroke if admin within 3 hrs. of onset of Sxs; ASA - ischemic stroke presenting within 48 hours; no hypotension, hypoxemia, hypoglycemia; tx aspiration pneumonia, UTI or DVT; Preventive & long-term Tx - * ASA, clopidogrel or dipyridamole/ASA; carotid endarterectomy; anticoags; management of HTN, DM and hypercholesterolemia

Front 112

Q112. Carpal Tunnel Syndrome - What is it; Risk factors

Back 112

A112. Median nerve compression where; passes thru carpal tunnel; women 30-55; Risk factors - repetitive use injury; pregnancy; DM; hypothyroidism; acromegaly; RA; obesity

Front 113

Q113. Carpal Tunnel Syndrome - History/PE

Back 113

A113. Wrist pain; numbness & tingling of 3 1/2; weak grip; decreased thumb opposition; thenar atrophy; nocturnal pain & paresthesias; Sxs may awaken patient at night; relieved by shaking wrist

Front 114

Q114. Carpal Tunnel Syndrome - Workup

Back 114

A114. Tinel's sign – tap, tingle; Phalen's sign - ph-lex (flex), paresthesias; EMG - to confirm; NCV - to confirm; evaluate for risk factors

Front 115

Q115. Carpal Tunnel Syndrome - Tx

Back 115

A115. Neutral wrist splint; modify activity; create ergonomic work environment; NSAIDs; corticosteroids - direct injection; surgery if Sxs persist - carpal tunnel release

Front 116

Q116. Myasthenia Gravis - What is it

Back 116

A116. Autoimmune: Ab that bind to postsynaptic Ach receptors (nicotinic); block receptors; lose receptors; young adult women; can be associated with – thymoma, thyrotoxicosis

Front 117

Q117. Myasthenia Gravis - History/PE

Back 117

A117. Muscle weakness increased in periods of activity; decreased after rest; Sx come and go; onset can be sudden; fluctuating fatigable ptosis; diplopia (double vision); dysphagia (swallowing); dysarthria (speech); Sxs worsen throughout day; myasthenic crisis - so severe, respiratory failure and aspiration, secondary to weakness, often secondary to infection (respiratory muscles compromised); ocular myasthenia - common variant, if doesn't spread in 2-3 yrs, probably won't

Front 118

Q118. Myasthenia Gravis - Dx

Back 118

A118. Edrophonium (tensilon test) - diagnostic; abnormal single-fiber EMG: decreased response to repetitive nerve stimulation; antistriatal ab if thymoma; chest CT - evaluate for thymoma

Front 119

Q119. Myasthenia Gravis - Tx

Back 119

A119. Neostigmine (treat Sx); pyridostigmine (treat Sx); prednisone; plasmapheresis or IVIG - temp relief (wks) if severe; thymoma resection

Front 120

Q120. Amyotrophic Lat. Sclerosis - What is it

Back 120

A120. Progressive neurodegenerative disease; unknown etiology; degeneration of motor neurons; UMN and LMN degenerate => respiratory failure and death

Front 121

Q121. Amyotrophic Lat. Sclerosis - History/PE

Back 121

A121. Slowly progressive weakness; may have fasciculations initially; UMN and LMN

Front 122

Q122. Amyotrophic Lat. Sclerosis - Dx

Back 122

A122. Clinical presentation; EMG and nerve conduction studies; CT/MRI - cervical spine, check for lesions; rule out systemic causes - CBC TSH SPEP UPEP; Ca2+ PTH PFTs; urine for heavy metal - (if history of exposure)

Front 123

Q123. Amyotrophic Lat. Sclerosis - Tx

Back 123

A123. Supportive; patient education; pulmonary specialist; riluzole

Front 124

Q124. Thiamine (B1) Deficiency - What are Signs/Sxs

Back 124

A124. Wernicke's: inadeq intake or absorption; excessive alcohol interferes with GI absorption and liver storage; acute onset – confusion, opthalmoplegia – nystagmus, lateral rectus palsy, conjugate gaze palsy, abnormal pupils, ataxia - vestibular dysfunction, cerebellar dysfunction

Front 125

Q125. Thiamine (B1) Deficiency - Patients

Back 125

A125. Alcoholics; dialysis; hyperemesis; starvation; cancer; AIDS; can be triggered by large-dose glucose admin if deficient

Front 126

Q126. Thiamine (B1) Deficiency - Tx

Back 126

A126. Reversible almost immediately with thiamine admin

Front 127

Q127. Korsakoff's Psychosis - What is it

Back 127

A127. Late complication of untreated patients with Wernicke's; can be triggered by severe or repeated DTs; can be triggered by SAH and thalamic injuries; immediate memory affected; confabulation

Front 128

Q128. Korsakoff's Psychosis - Tx

Back 128

A128. Prognosis good - head injury and SAH; irreversible - others

Front 129

Q129. B12 deficiency - What are Signs/Sxs

Back 129

A129. Subacute combined degeneration

Front 130

Q130. B12 deficiency - Patients

Back 130

A130. Patients with pernicious anemia

Front 131

Q131. B12 deficiency - Tx

Back 131

A131. B12 injections or large oral doses

Front 132

Q132. Folate Deficiency - What are Signs/Sxs

Back 132

A132. Irritability; glossitis; diarrhea; depression; neural tube defects

Front 133

Q133. Folate Deficiency - Patients

Back 133

A133. Alcoholics – alcohol interferes with absorption; Patients with pernicious anemia

Front 134

Q134. Folate Deficiency - Tx

Back 134

A134. Reversible if corrected early

Front 135

Q135. Seizures - General Evaluation

Back 135

A135. Epilepsy - seizure disorder, 2+ seizures not related to reversible stressors; was seizure epileptic – History, increased prolactin = epileptic VITAMINS - seizure caused by; vascular; infection; trauma; autoimmune; metabolic; idiopathic; neoplasm; sychiatric (faking it); 1st seizure not treated when underlying cause unknown

Front 136

Q136. Partial Seizures - What are they

Back 136

A136. Arise from focus; limited to one side; consciousness usually not lost; simple partial & complex part; can progress to generalized

Front 137

Q137. Partial Seizures - History/PE

Back 137

A137. Simple partial - consciousness not impaired; motor - Jacksonian march; sensory - parietal; autonomic - BP, HR, PVR; psychic - fear, deja vu; postictally - Todd's paralysis; resolves in 1-2 days Complex partial - consciousness impaired; temporal lobe: auditory or visual hallucination, déjà vu, automatisms; postictal – confusion, amnesia

Front 138

Q138. Partial Seizures - Workup

Back 138

A138. EEG; rule out systemic causes – CBC, electrolytes, Ca2+, fasting glucose, LFTs, tox screen, RPR, renal panel, ESR; rule out mass - MRI or CT with contrast

Front 139

Q139. Partial Seizures - Tx

Back 139

A139. Tx underlying cause; recurrent partial – phenytoin, oxcarbazepine, tegretol, phenobarbital, valproic acid; kids - phenobarbital; intractable temporal lobe - WADA testing, anterior temporal lobectomy

Front 140

Q140. Generalized Seizures - What are they

Back 140

A140. Begin diffusely throughout both sides; consciousness always lost; postictal confusion; most common types - tonic-clonic (grand mal), absence (petit mal)

Front 141

Q141. Tonic-Clonic Seizures - History/PE

Back 141

A141. Start suddenly with tonic extension of back and extremities; repetitive symmetric clonic movements; incontinence; tongue biting; may look cyanotic; consciousness slowly regained; may complain of - muscle ache, headache

Front 142

Q142. Tonic-Clonic Seizures - Tx

Back 142

A142. Tx underlying cause; idiopathic - valproate - 1st line; lamotrigine - adjunctive; topiramate - adjunctive; symptomatic - same therapy as partial seizure.

Front 143

Q143. Absence (Petit Mal) Seizures-; What are they

Back 143

A143. Begin in childhood; subside before adulthood; often familial

Front 144

Q144. Absence (Petit Mal) Seizures-; History/PE

Back 144

A144. Brief, often unnoticeable episodes of impaired consciousness; lasts 5-10 seconds; have 100's of times/day; amnestic during and immediately after eye flutters or lips smack; can be precipitated by hyperventilation

Front 145

Q145. Absence (Petit Mal) Seizures-; Evaluation

Back 145

A145. EEG - 3 Hz per sec. spike & wave discharges

Front 146

Q146. Absence (Petit Mal) Seizures-; Tx

Back 146

A146. Ethosuximide - 1st line; valproic acid; zonisamide

Front 147

Q147. Infantile Spasms; (West Syndrome) - What is it; Tx

Back 147

A147. Syndrome - infantile spasms (generalized seizures); symmetric, tonic, 5-10 at a time while drowsy or upon awakening; abnormal interictal EEG; arrest of psychomotor development at age of onset; starts at 3-12 months; usually male; MR; Tx – ACTH, prednisone, clonazepam, valproic acid

Front 148

Q148. Status Epilepticus - What is it; Common Causes

Back 148

A148. Brain in persistent state of Seizure; consistent seizure or recurrent without regaining consciousness > 30 min. med emergency - 20% mortality; common causes - anticonvulsive withdrawal/noncompliance, anoxic brain injury, alcohol withdrawal, metabolic disturbance (hypoNa+), trauma, infection; usual cause - subtherapeutic or noncompliance

Front 149

Q149. Status Epilepticus - Evaluation

Back 149

A149. Airway, breathing, circulation; labs – electrolytes, anticonvulsants; get History; look for etiology if no prior History (tumor, encephalitis, SAH); (EEG, CT only when stable)

Front 150

Q150. Status Epilepticus - Tx

Back 150

A150. Diazepam or lorazepam; if continues - phenytoin or fosphenytoin; if continues - phenobarbital; if continues - midazalom or propoful

Front 151

Q151. Headache - Things to think about; (Evaluation)

Back 151

A151. Headache new or old; characteristics; any associated Sxs; any neurological Sxs; SAH suspected?

Front 152

Q152. Migraine Headache - What is it

Back 152

A152. More commonly affects women and those with family History; vascular & 5HT abnorm; triggers – menses, OCP, chocolate, fasting, stress, bright lights

Front 153

Q153. Migraine Headache - History/PE

Back 153

A153. Throbbing > 2 hrs, usually lasts < 24 hrs; n/v; photophobia; sensitive to noise; "classic" migraine - visual aura precedes, unilat; "common" migraine - 80%, can be bilateral, periorbital

Front 154

Q154. Migraine Headache - Dx

Back 154

A154. History; if have focal neuro deficits - CT or MRI; Sxs acute in onset - rule out meningitis or SAH

Front 155

Q155. Migraine Headache - Tx

Back 155

A155. Avoid known triggers; aspirin/NSAIDs; sumatriptan; prophylaxis - beta-blockers, TCAs, Ca2+ channel blockers, valproic acid

Front 156

Q156. Cluster Headache - What is it

Back 156

A156. Men, ~ 25 y/o - age of onset

Front 157

Q157. Cluster Headache - History/PE

Back 157

A157. Unilateral, periorbital; 30 min. - 3 hrs. attacks in clusters - same part of head, same time of day, same time of year; can be precipitated by alcohol or vasodilators; ipsilateral tearing of eye

Front 158

Q158. Cluster Headache - Dx

Back 158

A158. History

Front 159

Q159. Cluster Headache - Tx

Back 159

A159. Acute therapy with high-flow O2 (100% nonrebreather O2); sumatriptan; corticosteroids; prophylaxis - Ca2+ channel blockers, valproic acid, methylsergide; prophylaxis important - by the time abortive meds take effect, has already resolved; methylsergine (sansert) - need drug holiday every several months to avoid risk of retroperitoneal fibrosis

Front 160

Q160. Tension Headache - What is it

Back 160

A160. MC type diagnosed in adults; chronic

Front 161

Q161. Tension Headache - History/PE

Back 161

A161. Tight, bandlike pain; occipital and neck; exacerbated by – noise, bright lights, stress, fatigue

Front 162

Q162. Tension Headache - Dx

Back 162

A162. Dx of exclusion

Front 163

Q163. Tension Headache - Tx

Back 163

A163. Avoid exacerbating factors; NSAIDs - 1st line; prophylaxis - Ca2+ channel blockers; alpha blockers; TCAs

Front 164

Q164. Benign Paroxysmal; Positional Vertigo - What is it

Back 164

A164. Peripheral vertigo; otoliths dislodge from usual position; migrate over time into semicircular canals; abnorm fluid displacement => vertigo

Front 165

Q165. Benign Paroxysmal; Positional Vertigo - History/PE

Back 165

A165. Sudden onset of severe vertigo and nystagmus; vertigo with head movement in direction of affected ear; happens turning head in bed; 5 sec. - 1 min. n/v; Sxs decreased with repetitive tests; usually history of recent trauma

Front 166

Q166. Benign Paroxysmal; Positional Vertigo - Dx

Back 166

A166. Nylen-Barany Maneuver; (Dix-Hallpike)

Front 167

Q167. Benign Paroxysmal; Positional Vertigo - Tx

Back 167

A167. Usually subsides spontaneously in weeks to months; Epley Repositioning Maneuver

Front 168

Q168. Meniere's Disease; (Endolymphatic Hydrops) - What is it

Back 168

A168. Peripheral vertigo from buildup of endolymphatic fluid in inner ear = V and P change; risk factors - head trauma, syphilis

Front 169

Q169. Meniere's Disease; (Endolymphatic Hydrops) - History/PE

Back 169

A169. Sudden attacks of vertigo; lasts up to 24 hours; attacks can last hours to days; n/v; ear fullness; tinnitus; hearing loss; significant permanent hearing loss; can occur over period of years

Front 170

Q170. Meniere's Disease; (Endolymphatic Hydrops) - Dx

Back 170

A170. Audiometry - low-freq. pure tone hearing loss

Front 171

Q171. Meniere's Disease; (Endolymphatic Hydrops) - Tx

Back 171

A171. Low-salt diet; acetazolamide; acute – antihistamines, antiemetics, benzos; if refractory - surgical decompression

Front 172

Q172. Deep Fibular Nerve

Back 172

A172. FOOT DROP, paresthesia in webspace between big toe and second toe

Front 173

Q173. Femoral Nerve

Back 173

A173. (from posterior division of L2, L3, L4); longest branch is saphenous nerve - sensation over area of great saphenous vein;; impaired ability to flex at hip and extend knee;; decreased patellar reflex

Front 174

Q174. Superior Gluteal Nerve

Back 174

A174. (L4, L5, S1 - exits via greater sciatic foramen above piriformis); innervates gluteus medius, minimus and tensor fascia latae;; impaired hip abduction,; in walking - "Trendlenburg" gait: pelvic tilt (sag) toward opposite side form lesion

Front 175

Q175. Inferior Gluteal Nerve

Back 175

A175. (L5-S2; gluteus maximus - exits greater sciatic foramen below piriformis w/ pudendal and sciatic); impaired lateral rotation and extension of thigh at hip, DIFFICULTY GETTING UP FROM A CHAIR, gluteus minimus gait = thrust torso posteriorly

Front 176

Q176. Superficial Fibular Nerve

Back 176

A176. impaired eversion and dorsal sensation, but extension is intact

Front 177

Q177. Tibial Nerve

Back 177

A177. "tarsal tunnel syndrome"; decreased flexion of big toe, difficulty standing on tiptoe

Front 178

Q178. Obdurator Nerve

Back 178

A178. (L2-4, anterior division, medial thigh-adductors- exits via obdurator canal); impaired adduction of thigh at hips

Front 179

Q179. Terrible triad

Back 179

A179. anterior cruciate ligament; medial collateral ligament; medial meniscus

Front 180

Q180. Anterior drawer sign

Back 180

A180. tibia displaced anteriorly to femur in flexed knee; indicated ACL tear

Front 181

Q181. Sx of torn Medial collateral ligament

Back 181

A181. pain when leg is rotated medially at the knee; (abnormal passive abduction)

Front 182

Q182. Foot drop (loss of dorsiflexion)

Back 182

A182. tibialis anterior; Common peroneal nerve (L4-S2); (PED: Peroneal Everts and Dorsiflexes)

Front 183

Q183. Loss of plantar flexion

Back 183

A183. gastroc and soleus; Tibial N (L4-S3); TIP: Tibial Inverts and Plantarflexes (if injured, can't stand on TIPtoes)

Front 184

Q184. Loss of knee jerk

Back 184

A184. Femoral Nerve; L2,3,4

Front 185

Q185. Loss of hip adduction

Back 185

A185. Obdurator (L2,3,4)

Front 186

Q186. Vertebral disk herniation usu occurs between which vertebrae?

Back 186

A186. between L5 and S1; Sciatica!

Front 187

Q187. Lumbar puncture pierces which structures?

Back 187

A187. SLEDsA to CSF; Skin/superficial fascia; Ligaments (supraspinous, interspinous and ligmentum flavum if puncture is off midline); Epidural space and intralaminal space; Dura mater; subdural potential space; Arachnoid; CSF is in the subarachnoid space

Front 188

Q188. Which nerve extends the knee?

Back 188

A188. femoral

Front 189

Q189. Which nerve flexes the knee?

Back 189

A189. Tibial

Front 190

Q190. Nerves that contain fibers from the superior rami of the plexus (L2-L4) innervate muscles in the

Back 190

A190. anterior compartment; (that act at the hip and knee joint).

Front 191

Q191. Nerves that contain fibers from the inferior rami of the plexus (S1-S3) innervate muscles of

Back 191

A191. the leg (that act on ankle and foot joints)

Front 192

Q192. Dermatome paresthesia at the anterior thigh

Back 192

A192. L3

Front 193

Q193. Dermatone paresthesia at the medial leg

Back 193

A193. L4

Front 194

Q194. Dermatome paresthesia at the anterior leg and dorsum of foot

Back 194

A194. L5

Front 195

Q195. Dermatome paresthesia at the lateral foot and sole

Back 195

A195. S1

Front 196

Q196. Patellar tendon reflex

Back 196

A196. L4

Front 197

Q197. Achilles tendon reflex

Back 197

A197. S1

Front 198

Q198. Obturator nerve comes from

Back 198

A198. L2-L4 (anterior division)

Front 199

Q199. Femoral

Back 199

A199. L2-L4 (posterior division)

Front 200

Q200. Common Fibular comes from roots

Back 200

A200. L4 L5 S1 S2 (posterior division)

Front 201

Q201. Tibial nerve comes from roots

Back 201

A201. L4 L5 S1-S3 (anterior division)

Front 202

Q202. Motor weakness with obturator lesion

Back 202

A202. adduction of thigh; (affected hip flexors and hip adductors)

Front 203

Q203. motor weakness with femoral lesion

Back 203

A203. extension of knee

Front 204

Q204. motor weakness with common fibular lesion

Back 204

A204. foot drop; (dorsiflexion, foot eversion)

Front 205

Q205. motor weakness with tibial lesion

Back 205

A205. no plantar flexion or toe flexion

Front 206

Q206. Pregnancy can cause compression of

Back 206

A206. L3/obturator

Front 207

Q207. Psoas abscess can cause a lesion of

Back 207

A207. Femoral

Front 208

Q208. Common (4) injuries to the Common Fibular nerve

Back 208

A208. 1) compression at fibula neck; 2) hip fracture or dislocation; 3) misplaced gluteal injection; 4) piriformis syndrome

Front 209

Q209. Penetrating trauma to buttock or hip fracture/dislocation can cause nerve damage to

Back 209

A209. Common fibular or tibial

Front 210

Q210. AN ACUTE NEUROLOGIC DYSFUNCTION OCCURRING AS A RESULT OF A VASCULAR PROCESS

Back 210

A210. stroke

Front 211

Q211. Type of stroke?; focal ischemic necrosis of brain tissue due to occlusive vascular disease or other forms of vascular insufficiency

Back 211

A211. cerebral infarct or ischemic stroke

Front 212

Q212. Type of stroke?; BRAIN DAMAGE DUE TO SPONTANEOUS RUPTURE OF; BLOOD VESSEL

Back 212

A212. HEMORRHAGIC STROKE

Front 213

Q213. cause of ischemic stroke

Back 213

A213. occlusion of an artery, usually by:; 1. THROMBOEMBOLUS; 2. ATHEROSCLEROTIC PLAQUE (stenosis, sudden occlusion); extracranial vs. intracranial vascular lesions

Front 214

Q214. type of hemmorage?; site: basal ganglia, thalamus, pons, deep; cerebellum; usual cause: hypertensive vascular disease; outcome: often lethal

Back 214

A214. INTRAPARENCHYMAL HEMORRHAGES (IPH): ganglionic

Front 215

Q215. Site: cerebral lobes; usual cause: various (malformation, coagulopathy. etc.); outcome: variable

Back 215

A215. INTRAPARENCHYMAL HEMORRHAGES (IPH) : lobar

Front 216

Q216. site: base of brain,; convexities; usual cause: berry aneurysm, AVM; outcome: often lethal, acute; vasospasm, chronic; hydrocephalus

Back 216

A216. SUBARACHNOID HEMORRHAGES (SAH)

Front 217

Q217. hippocampus: Sommer's sector (area CA1); cerebral cortex: laminar necrosis watershed zones; cerebellum: Purkinje cells

Back 217

A217. pattern of DIFFUSE HYPOXIC/ISCHEMIC ENCEPHALOPATHY

Front 218

Q218. – acceleration of large-vessel atherosclerosis; arteriosclerosis, especially in basal ganglia, thalamus, pons,; cerebellum, deep white matter; formation of Charcot-Bouchard aneurysms; arteriolarsclerosis

Back 218

A218. CHRONIC HYPERTENSIVE CEREBROVASCULAR PATHOLOGY

Front 219

Q219. – hyperplastic arteriolosclerosis ("onion skinning"); necrotizing arteriolitis (fibrinoid necrosis)

Back 219

A219. ACUTE EFFECTS OF SEVERE HYPERTENSION

Front 220

Q220. Hematoma?; source: bridging veins; clinical feature: acute subacute chronic; causes: trauma can be mild;; brain atrophy, coagulopathy

Back 220

A220. subdural hematoma

Front 221

Q221. source: dural arteries; Hematoma?; clinical feature: LOC, then “silent (lucid)” interval; causes: skull fracture

Back 221

A221. epidural hematoma

Front 222

Q222. type of Blunt Head injury?; clinical features: TRANSIENT LOC (level of conciousnes); characteristic: ? MILD DAD = DIFFUSE AXONAL INJURY/damage = axonal spheroids (swellings) form at the torn end of the axon in white matter tracts and appear as eosinophilic globules in H&E

Back 222

A222. CONCUSSION

Front 223

Q223. type of Blunt Head injury?; clinical features: LOC +/- DEFICITS; characteristic: INTACT PIA-ARACHNOID, FRONTAL/TEMPORAL POLES, LATERAL TEMPORAL

Back 223

A223. CONTUSION

Front 224

Q224. AN ACUTE NEUROLOGIC DYSFUNCTION OCCURRING AS A RESULT OF A VASCULAR PROCESS

Back 224

A224. stroke

Front 225

Q225. Type of stroke?; focal ischemic necrosis of brain tissue due to occlusive vascular disease or other forms of vascular insufficiency

Back 225

A225. cerebral infarct or ischemic stroke

Front 226

Q226. Type of stroke?; BRAIN DAMAGE DUE TO SPONTANEOUS RUPTURE OF; BLOOD VESSEL

Back 226

A226. HEMORRHAGIC STROKE

Front 227

Q227. cause of ischemic stroke

Back 227

A227. occlusion of an artery, usually by:; 1. THROMBOEMBOLUS; 2. ATHEROSCLEROTIC PLAQUE (stenosis, sudden occlusion); extracranial vs. intracranial vascular lesions

Front 228

Q228. site: basal ganglia, thalamus, pons, deep; cerebellum; usual cause: hypertensive vascular disease; outcome: often lethal

Back 228

A228. INTRAPARENCHYMAL HEMORRHAGES (IPH): ganglionic

Front 229

Q229. Site: cerebral lobes; usual cause: various (malformation, coagulopathy. etc.); outcome: variable

Back 229

A229. INTRAPARENCHYMAL HEMORRHAGES (IPH) : lobar

Front 230

Q230. site: base of brain,; convexities; usual cause: berry aneurysm, AVM; outcome: often lethal, acute; vasospasm, chronic; hydrocephalus

Back 230

A230. SUBARACHNOID HEMORRHAGES (SAH)

Front 231

Q231. hippocampus: Sommer's sector (area CA1); cerebral cortex: laminar necrosis watershed zones; cerebellum: Purkinje cells

Back 231

A231. pattern of DIFFUSE HYPOXIC/ISCHEMIC ENCEPHALOPATHY

Front 232

Q232. – acceleration of large-vessel atherosclerosis; arteriosclerosis, especially in basal ganglia, thalamus, pons,; cerebellum, deep white matter; formation of Charcot-Bouchard aneurysms; arteriolarsclerosis

Back 232

A232. CHRONIC HYPERTENSIVE CEREBROVASCULAR PATHOLOGY

Front 233

Q233. AN ACUTE NEUROLOGIC DYSFUNCTION OCCURRING AS A RESULT OF A VASCULAR PROCESS

Back 233

A233. stroke

Front 234

Q234. – hyperplastic arteriolosclerosis ("onion skinning"); necrotizing arteriolitis (fibrinoid necrosis)

Back 234

A234. ACUTE EFFECTS OF SEVERE HYPERTENSION

Front 235

Q235. Type of stroke?; focal ischemic necrosis of brain tissue due to occlusive vascular disease or other forms of vascular insufficiency

Back 235

A235. cerebral infarct or ischemic stroke

Front 236

Q236. Hematoma?; source: bridging veins; clinical feature: acute subacute chronic; causes: trauma can be mild;; brain atrophy, coagulopathy

Back 236

A236. subdural hematoma

Front 237

Q237. Type of stroke?; BRAIN DAMAGE DUE TO SPONTANEOUS RUPTURE OF; BLOOD VESSEL

Back 237

A237. HEMORRHAGIC STROKE

Front 238

Q238. source: dural arteries; Hematoma?; clinical feature: LOC, then “silent (lucid)” interval; causes: skull fracture

Back 238

A238. epidural hematoma

Front 239

Q239. cause of ischemic stroke

Back 239

A239. occlusion of an artery, usually by:; 1. THROMBOEMBOLUS; 2. ATHEROSCLEROTIC PLAQUE (stenosis, sudden occlusion); extracranial vs. intracranial vascular lesions

Front 240

Q240. type of Blunt Head injury?; clinical features: TRANSIENT LOC; characteristic: ? MILD DAD = DIFFUSE AXONAL INJURY = axonal spheroids (swellings) form at the torn end of the axon in white matter tracts and appear as eosinophilic globules in H&E

Back 240

A240. CONCUSSION

Front 241

Q241. site: basal ganglia, thalamus, pons, deep; cerebellum; usual cause: hypertensive vascular disease; outcome: often lethal

Back 241

A241. INTRAPARENCHYMAL HEMORRHAGES (IPH): ganglionic

Front 242

Q242. type of Blunt Head injury?; clinical features: LOC +/- DEFICITS; characteristic: INTACT PIA-ARACHNOID, FRONTAL/TEMPORAL POLES, LATERAL TEMPORAL

Back 242

A242. CONTUSION

Front 243

Q243. type of hemorrhage?; Site: cerebral lobes; usual cause: various (malformation, coagulopathy. etc.); outcome: variable

Back 243

A243. INTRAPARENCHYMAL HEMORRHAGES (IPH) : lobar

Front 244

Q244. type of Blunt Head injury?; clinical features: LOC + DEFICITS; characteristic: TORN PIA-ARACHNOID

Back 244

A244. LACERATION

Front 245

Q245. type of hemorrhage?; site: base of brain,; convexities; usual cause: berry aneurysm, AVM; outcome: often lethal, acute; vasospasm, chronic; hydrocephalus

Back 245

A245. SUBARACHNOID HEMORRHAGES (SAH)

Front 246

Q246. hippocampus: Sommer's sector (area CA1); cerebral cortex: laminar necrosis watershed zones; cerebellum: Purkinje cells

Back 246

A246. pattern of DIFFUSE HYPOXIC/ISCHEMIC ENCEPHALOPATHY

Front 247

Q247. – acceleration of large-vessel atherosclerosis; arteriosclerosis, especially in basal ganglia, thalamus, pons,; cerebellum, deep white matter; formation of Charcot-Bouchard aneurysms; arteriolosclerosis

Back 247

A247. CHRONIC HYPERTENSIVE CEREBROVASCULAR PATHOLOGY

Front 248

Q248. – hyperplastic arteriolosclerosis ("onion skinning"); necrotizing arteriolitis (fibrinoid necrosis)

Back 248

A248. ACUTE EFFECTS OF SEVERE HYPERTENSION

Front 249

Q249. Hematoma?; source: bridging veins; clinical feature: acute subacute chronic; causes: trauma can be mild;; brain atrophy, coagulopathy

Back 249

A249. subdural hematoma

Front 250

Q250. source: dural arteries; Hematoma?; clinical feature: LOC, then “silent (lucid)” interval; causes: skull fracture

Back 250

A250. epidural hematoma

Front 251

Q251. type of Blunt Head injury?; clinical features: TRANSIENT LOC; characteristic: ? MILD DAD = DIFFUSE AXONAL INJURY = axonal spheroids (swellings) form at the torn end of the axon in white matter tracts and appear as eosinophilic globules in H&E

Back 251

A251. CONCUSSION

Front 252

Q252. type of Blunt Head injury?; clinical features: LOC +/- DEFICITS; characteristic: INTACT PIA-ARACHNOID, FRONTAL/TEMPORAL POLES, LATERAL TEMPORAL

Back 252

A252. CONTUSION

Front 253

Q253. type of Blunt Head injury?; clinical features: LOC + DEFICITS; characteristic: TORN PIA-ARACHNOID

Back 253

A253. LACERATION

Front 254

Q254. type of blunt head injury?; clinical feature: PROLONGED LOC; characteristic: TEARING OF AXONS (SPHEROIDS) IN CORPUS; CALLOSUM, LONG TRACTS

Back 254

A254. Diffuse axonal damage

Front 255

Q255. PENETRATION OF BRAIN OR SPINAL CORD BY PROJECTILE OR OTHER MOVING OBJECT; (bullet, knife blade, etc.); AMOUNT OF DAMAGE DEPENDS ON MASS, SHAPE, AND VELOCITY OF MISSILE

Back 255

A255. MISSILE HEAD INJURY

Front 256

Q256. type of MISSILE HEAD INJURY?; missile produces depressed fracture but does not enter skull

Back 256

A256. DEPRESSED

Front 257

Q257. type of MISSILE HEAD INJURY?; missile enters cranial cavity

Back 257

A257. PENETRATING

Front 258

Q258. type of MISSILE HEAD INJURY?; missile enters and exits cranial cavity

Back 258

A258. PERFORATING

Front 259

Q259. type of stroke?; obstruction of a feeding blood vessel or a significant reduction in blood flow

Back 259

A259. Ischemic

Front 260

Q260. type of stroke?; rupture of a blood vessel into or around the brain

Back 260

A260. Hemorrhagic

Front 261

Q261. 8 signs and symptoms of stroke

Back 261

A261. Sudden onset (usually maximum within 10 seconds); Weakness of one side of the body / face; Numbness / tingling of one side of the body or face; Incoordination / clumsiness of one side of the body, falling to one side, spinning sensation; Sudden change in speech or language; Loss of vision, especially in one eye on or one side, Double vision; Acute confusion; Sudden, severe headache

Front 262

Q262. acute stroke management

Back 262

A262. Evaluation and stabilization of patient: Vitals, cardiovascular, neurological assessment, O2 NC, HLIV x2; Diagnostic work-up begun: Labs, brain imaging (CT, MRI); Consider “clot-buster”: t-PA therapy (call Stroke Team); **must tx pt with in 60 min arrive

Front 263

Q263. focused stroke history, 11 risk factors

Back 263

A263. High blood pressure (hypertension); "High sugar" (diabetes); Heart disease, heart attacks, irregular heart beats; High cholesterol; Smoking, alcohol use, illegal drugs; No regular physical exercise; Family history of stroke; Previous stroke; Sickle-cell disease

Front 264

Q264. 5 focal symptoms for focused stroke history

Back 264

A264. Change or loss of vision (one eye? both eyes?); Numbness, tingling, weakness, clumsiness, heaviness of one side of the body; Change or loss of language (understanding, comprehension, reading, writing); Change or loss of steady walking, imbalance, falling; Headache (location, type, severity, duration)

Front 265

Q265. focused neurological findings in focused stroke history and physical

Back 265

A265. Level of consciousness (alert, lethargic / drowsy, stupor, coma); Language (comprehension, fluency, repetition, naming, reading, writing); Visual fields and eye movements (other CN); Strength (face, arms, legs, drift) and reflexes; Coordination (gait, finger to nose, heel to shin); Sensation (pinprick, temperature, joint position sense / vibration)

Front 266

Q266. t-PA criteria

Back 266

A266. Inclusion criteria: Age ≥ 18, Ischemic stroke with measurable deficit, < 3 hr since symptom onset (time of onset is critical); Clock starts when patient last seen normal; Many exclusions, but patients meeting the above criteria should be considered for thrombolytic treatment

Front 267

Q267. These are complications for what neurologic condition?; Seizures; Cardiovascular (MI, arrhythmia, sudden death); Respiratory (aspiration pneumonia, DVT / PE); Endocrine (hyperglycemia, hyponatremia); Urinary tract infection; Decubitus ulcers; Psychological / Psychiatric; Depression (40%); Confusion / combativeness / hallucinations; Abulia

Back 267

A267. stroke

Front 268

Q268. Carotid Endarterectomy

Back 268

A268. Symptomatic: NNT = 6; Asymptomatic: NNT = 100; 90% > 80% > 70% > 60% stenosis; Benefit regardless of age, but older > younger; Ulcerated plaque; Hemispheric TIA / stroke (vs. retinal); Men> women; Associated stroke risk factors: Hypertension, diabetes, tobacco, lipids

Front 269

Q269. Carotid Angioplasty and Stenting

Back 269

A269. Increasingly used, with only one RCT showing efficacy / equivalence to CEA (3 stopped early); Multiple trials underway (carotid disease); FDA approved only for high-risk patients with symptomatic high-grade stenosis; With few exceptions, vertebrobasilar and intracranial stenting should be limited to RCTs; As with CEA, ask about complication rates

Front 270

Q270. neurocutaneous disorder?; def: autosomal dominant disorder caused by; TSC gene mutation (chromosome 9: TSC1, hamartin;; chromosome 16: TSC2, tuberin); INCIDENCE: 1 in 29,000 births; CLINICAL FEATURES: Seizures/infantile spasms, Mental retardation, Behavioral abnormalities, Neoplastic and non- neoplastic tumors (cerebral tubers, retinal tumors, cardiac rhabdomyomas, renal tumors), Cutaneous lesions (ash leaf spots, facial angiofibromas, etc.)

Back 270

A270. tuberous sclerosis

Front 271

Q271. neurocutaneous syndrome?; Facial angiomas involving V1 and rarely V2 /V3 distribution. Underlying venous pial angiomatosis causing seizures, hemiparesis hemianopsia, mental deterioration.

Back 271

A271. Sturge Weber Syndrome

Front 272

Q272. areas that are sensitive to hypoxic ischemic encephalopathy in a term infant

Back 272

A272. parasagittal, ulegyria (selective loss of cortex in depth of sulci), thalamus, BG and brainstem

Front 273

Q273. where are the following tumors located and what age group are they associated with?; astrocytomas / glioblatomas; metastatic carcinomas; menigiomas; lymphomas; pituitary adenomas

Back 273

A273. location: cerebrum; age group : adults

Front 274

Q274. where are the following tumors located and what age group are they associated with?; metastaic carcinomas; menigiomas; schwannomas (cn VIII)

Back 274

A274. location: posterior fosssa; age group: adults

Front 275

Q275. where are the following tumors located and what age group are they associated with?; PNET; ependymonas; choroid plexus tumors; optic nerve gliomas; germ cell tumors; craniopharyngiomas

Back 275

A275. location: cerebrum; age group: children

Front 276

Q276. where are the following tumors located and what age group are they associated with?; PNET (cerebellar medulloblastoma); pilocytic astrocytomas; ependymomas; brainstem gliomas

Back 276

A276. location: posterior fossa; age group: children

Front 277

Q277. type of brain tumor?; A SLOWLY GROWING NEOPLASM OF ASTROCYTES TYPICALLY ARISING IN THE CEREBELLUM OF CHILDREN

Back 277

A277. pilocytic astrocytoma, who grade 1

Front 278

Q278. what are the locations for pilocytic astrocytoma, who grade 1 in children?

Back 278

A278. cerebellum, optic nerve,; hypothalamus

Front 279

Q279. what are the locations for pilocytic astrocytoma, who grade 1 in adults?

Back 279

A279. adults: less common but usually occur in; cerebrum, spinal cord

Front 280

Q280. what brain tumor has the following features?; mostly solid growth pattern, often cystic; slowly growing; indolent clinical behavior; do not progress in grade over time

Back 280

A280. pilocytic astrocytoma, grade 1

Front 281

Q281. tumor composed of cells resembling oligodendrocytes

Back 281

A281. OLIGODENDROGLIOMA, GRADE 2

Front 282

Q282. location of OLIGODENDROGLIOMA, WHO GRADE 2

Back 282

A282. cerebral hemispheres

Front 283

Q283. what brain tumor has the following features?; often slow-growing; infiltrative or solid; often contain calcifications; often associated with epilepsy; may have anaplastic form (WHO grade 3)

Back 283

A283. OLIGODENDROGLIOMA, GRADE 2

Front 284

Q284. NEOPLASMS DERIVED FROM VENTRICULAR LINING CELLS

Back 284

A284. ependymomas and choroid plexus tumors

Front 285

Q285. what brain tumor presents as follows?; MASS EFFECT, OBSTRUCTIVE HYDROCEPHALUS

Back 285

A285. ependymomas and choroid plexus tumors

Front 286

Q286. for ependymomas (grade 2 or 3), what is the location for:; 1. children; 2. adults

Back 286

A286. 1. lateral and fourth ventricles; 2. fourth ventricle, spinal cord

Front 287

Q287. for papillomas(grade 1), what is the location for:; 1. children; 2. adults

Back 287

A287. 1. lateral or fourth ventricles; 2. fourth ventricle

Front 288

Q288. Astrocytoma

Back 288

A288. Low grade (2) glial tumor; More common in cerebral hemisphere in adults; Hits the brainstem of kids; special: Infiltrative; Progress to malignancy increases with age. 5 year survival rate; Astrocytomas can be stained with GFAP

Front 289

Q289. Glioblastoma

Back 289

A289. High grade glial tumor; They are more invasive and divide more rapidly than astrocytomas; special: Necrosis with Pseudopalisading; Survival is less than 1 year; Most common primary brain tumor.

Front 290

Q290. Pilocytic Astrocytoma

Back 290

A290. Grade 1; Slow growing, benign glial tumor of kids Does not progress to a later grade; special: Optic Nerve, cerebellum and hypothamus are affected

Front 291

Q291. Oligodendroglioma

Back 291

A291. Grade 2; Tumor of Oligodendrocytes; Affects Adults only; Milk and Eggs-fried egg appearance with calcifications. special: Calcifications, Epilepsy, Rare and slow growing

Front 292

Q292. Ependymoma

Back 292

A292. Neoplasm derived from lining of the ventricles. Low grade (II); Kids-lateral and 4th ventricles; special: May lead to hydrocephalus and has a poor prognosis. Characteristic perivascular pseudorosettes. Adults-4th and spinal cord

Front 293

Q293. Choroid Plexus tumors

Back 293

A293. Papillomas are the benign form; Carcinomas are the malignant form; Tumors mimic normal choroid and may overproduce CSF. special: Papillomas in kids-lateral and 4th; Adults-4th; Carcinomas are only in kids., Lateral ventricle. Rosettes

Front 294

Q294. Embryonal Tumors; Primitive Neuroectodermal Tumors

Back 294

A294. Embryonic Tumor; Retinoblastoma; Medulloblastoma-affects cerebellum. PNET-Cerebral Hemispheres; special: These tumors are highly metastatic, May disseminate thru the CSF; Often associated with gentic defects; Rosettes

Front 295

Q295. Medulloblastoma

Back 295

A295. Most common Embryonic tumor. Arises in the cerebellum; Dissemination into the subarachnoid space is common. special: These are very fast growing tumors, folks. Five year survival rate is 50%. Symptoms typically result from blockage of the 4th ventricle which leads to hydrocephalus.

Front 296

Q296. Meningioma

Back 296

A296. Non neuroectodermal tumor; Second most common brain tumor; Adults: Arises from arachnoid cells; Benign but mass effect causes troubles. Special: Resectable; Psammoma Bodies-calcifications commonly found in meningiomas

Front 297

Q297. Schwannoma

Back 297

A297. Arises from Schwann Cell; Often localized to the 8th nerve, causing an acoustic schwannoma-leads to unilateral hearing loss and vertigo; Adults; special: Bilateral form found in Neurofibromatosis 2

Front 298

Q298. Mass effect

Back 298

A298. Damage to the brain due the bulk of a tumor, the blockage of fluid, or excess accumulation of fluid within the skull. Mass effect often presents as seizures and dementia.

Front 299

Q299. most likely brain tumor in children

Back 299

A299. cerebellar tumors of the posterior fossa

Front 300

Q300. most likely brain tumors in adults

Back 300

A300. Adults are more likely to get tumors of the cerebral hemispheres. These include astrocytomas, meningiomas and metastases

Front 301

Q301. Low grade, may cause endocrine dysfunction. Derived from Rathkes pouch

Back 301

A301. Pituitary Adenoma - a sellar tumor

Front 302

Q302. Low-grade but locally aggressive epithelial tumor; Derived from Rathke’s pouch

Back 302

A302. Craniopharyngioma

Front 303

Q303. 20-30% of all brain tumors, with greater incidence in older people, and about 85% are multiple within the CNS. Sources: lung, breast, malignant melanoma, kidney, GI tract, others; Path: solid or cystic circumscribed mass with central necrosis and prominent vasogenic edema

Back 303

A303. Secondary Tumors – Metastatic cancer

Front 304

Q304. Diffuse tumor cell spread through the CSF pathways, often associated with high CSF protein, hydrocephalus, involvement of multiple cranial and spinal nerve roots

Back 304

A304. Leptomeningeal carcinomatosis

Front 305

Q305. Acute infection in Subarachnoid space caused by virulent bac, fungi, some protozoans

Back 305

A305. Acute Purulent Leptomeningitis; (pyogenic, bacterial)

Front 306

Q306. Acute inflam in SAS: examine CSF; ↑ pressure (200-500 mmH2O), ↑ protein (>50mg/dl), ↓ glucose (often<40mg/dl); leukoctosis (mostly PMNs); organism may be detectable by Gram stain, culture; spectrum of organisms varies w/age & clinical circumstances, commonly includes:; bac: strep, staph, hemophilus, neisseria, gram (–) rods, listeria, anaerobes; fungi: immunosuppresed: aspergillus, candida, mucor; environmental exposure: coccidoides, histoplasma; other: toxoplasma, ameba; pathogenic sequence: 10 colonization/infection in body; dissemination to CNS (usu hematogenous), infect meninges; acute inflammatory response in SAS; brain swelling, damage, outcome dissemination; inflam/overall response to infection may be modified by pt’s immune status, virulence of organism, effects of tx

Back 306

A306. Acute Purulent Leptomeningitis; (pyogenic, bacterial)

Front 307

Q307. CNS infection?; Systemic: fever, n/v, irritability, lethargy; Meningismus: nuchal rigidity, Brudzinski sign flexion hip, knee), Kernig sign (starting from flexed (passive flexion neck knee/thigh, extension of knee resisted); Direct CNS involvement: headache, photophobia, altered consciousness, seizures, focal localizing signs

Back 307

A307. Acute Purulent Leptomeningitis; (pyogenic, bacterial)

Front 308

Q308. CNS infection?; CSF findings: ↑ protein (mild), normal glucose, leukocytosis (very early: few PMNs, later: mostly lymphocytes); viral: common, includes common viruses causing URI or upper GI infections; some less virulent bacteria/other agents; non-infectious agents (cancer cells=leptomeningeal carcinomatosis,; chemicals/drugs=chemical meningitis) can produce similar syndrome

Back 308

A308. Acute Lymphocytic Meningitis; (viral, “aseptic”)

Front 309

Q309. Acute, usually self-limiting viral infection in SAS, characterized by lymphocytic inflammation

Back 309

A309. Acute Lymphocytic Meningitis; (viral, “aseptic”)

Front 310

Q310. CNS infection?; Fever, headache, signs of meningeal irritation, lethary, rash (milder than acute purulent leptomeningitis, and usu does not significantly alter consciousness)

Back 310

A310. Acute Lymphocytic Meningitis; (viral, “aseptic”)

Front 311

Q311. CNS infection?; CSF findings:; ↑ pressure or CSF blockage, ↑ protein (100-200mg/dl, higher w/CSF blockage), ↓ glucose (less than in acute purulent), leukoctosis (lymphocytes, monocytes); agent (organism, tumor cell) may be detectable; commonly “basal meningitis” w/mononuclear inflammation, fibrosis, +/- granulomas (depends on agent), most prominent at base of brain; progressive meningeal, fibrosis, -chronic inflammation in SAS hydrocephalus (non-obstructive), ↑ ICP, vasculitis, root/parenchymal involvement infarcts, focal deficits, cognitive decline

Back 311

A311. Chronic Meningitis

Front 312

Q312. Chronic inflammation in leptomeninges due to relatively indolent, persistent agent (TB, syphilis, sarcoidosis, some low-grade tumors, foreign substances)

Back 312

A312. Chronic Meningitis

Front 313

Q313. CNS infection?; often non-specific/non-localizing, slowly evolving (+/- heachache, +/- stiff neck, low grade fever, seizures, cognitive dysfunction)

Back 313

A313. Chronic Meningitis

Front 314

Q314. CNS infection?; predisposing factors: infection elsewhere (osteomyelitis, dental, sinusitis, otitis media, endocarditis, congenital heart disease), trauma skull/spine (including surgery), foreign body (catheter, gauze, bullet); bacteria, fungi, others; localized area of tissue damage & acute/chronic inflam surrounded by reactive layer; brain parenchyma may show prominent edema; Complications:; mass effect(↑ ICP, herniation; abscess rupture into ventricles or disseminate in SAS as acute purulent leptomen. infection spread to other organs or systemic (sepsis); focal permanent neurologic deficits

Back 314

A314. Empyema & abscesses; 1. subdural/epidural empyema; 2. brain parenchymal abscess; (“cerebritis”)

Front 315

Q315. Acute/chronic localized purulent or necrotizing infections due to destructive bacteria, fungi, or other organisms

Back 315

A315. Empyema & abscesses; 1. subdural/epidural empyema; 2. brain parenchymal abscess; (“cerebritis”)

Front 316

Q316. CNS infection?; Infec/inflam: Fever, malaise; Mass effects: headache, ↑ICP; Localizing signs, if brain parenchyma is involved: ex. seizures, focal deficits

Back 316

A316. Empyema & abscesses; 1. subdural/epidural empyema; 2. brain parenchymal abscess; (“cerebritis”)

Front 317

Q317. CNS infection?; Acute viral infection of brain parenchyma +/- meninges

Back 317

A317. Acute Viral Encephalitis

Front 318

Q318. CNS infection?; agent: HSV 1; site of involvement: -medial temporal lobes (Cowdry type A nuclear viral inclusions)

Back 318

A318. Acute (meningo)encephalitis; Acute necrotizing

Front 319

Q319. CNS infection?; Progressive viral infection, w/prolonged incubation following initial exposure, insidious onset, slow progression of sx, due to conventional viral agents; *prions excluded here; Sx: slowly progressive dementia or loss of particular neurologic functions

Back 319

A319. Chronic (slow) viral encephalitis

Front 320

Q320. 1) Acute Lymphocytic meningitis – often during 10 infection; 2)Chronic HIV encephalitis w/ progressive dementia (AIDS dementia); 3)Vacuolar myelopathy – uncommon degeneration of posterior & lateral columns in spinal cord in chronic AIDS pt, resembles subacute combined degeneration seen in vitamin B12 deficiency; 4)peripheral neuropathy (various types); 5)inflammatory myopathy (polymyositis-like)

Back 320

A320. HIV: syndromes

Front 321

Q321. CNS infection?; agent: CMV; site of involvement:; periventricular tissues (cytomegalic cells); occurs as congenital infection (TORCH) & immunocompromised host

Back 321

A321. Acute (meningo)encephalitis; Acute necrotizing

Front 322

Q322. CNS infection?; agent?; HIV; involved site: brain atrophy, demyelination, encephalitis w/monocytes & giant cells

Back 322

A322. AIDS Dementia

Front 323

Q323. CNS infection?; agent:; papovirus JC strain); involved site:; infection, destruction oligodendrocytes -> progressive demyelination, usu in immunocompromised host

Back 323

A323. PML(progressive multifocal leukoencephalopathy)

Front 324

Q324. the removal, treatment, and return of (components of) blood plasma from blood circulation. separates things based on molecular weight.

Back 324

A324. Plasmapheresis

Front 325

Q325. autoimmune CNS disease?; auto-antibodies attack AchR; Weakness and Muscle Fatigue; Distribution of affected muscles is variable. **Eye muscles are the 1st thing involved. Reflexes and sensation is unaffected

Back 325

A325. Myasthenia Gravis

Front 326

Q326. Lab Tests for MG

Back 326

A326. Anti AchR antibody is 85-90% positive.

Front 327

Q327. can induce Myasthenia and antibodies to AchR

Back 327

A327. Thymoma and Penicillamine can induce Myasthenia and antibodies to AchR. FYI: A thymoma is a tumor of the thymus gland that leads to an autoimmune response.

Front 328

Q328. Treatment Myasthenia Gravis

Back 328

A328. Plasmapheresis; Pyridostigmine blocks Ach Esterase which makes more Ach available. Thymectomy

Front 329

Q329. Lambert-Eaton Syndrome

Back 329

A329. Autoantibodies against the presynaptic voltage-gated calcium channels; caused by circulating antibodies to Voltage gated Calcium Channels which block Ach release. Clinical Features:; Weakness and fatigability; Autonomic Dysfunction-sexual dysfunction, dry mouth,; Reflexes are depressed; 60% of cases are associated with small cell lung cancer

Front 330

Q330. Lab Tests for Lambert Eaton

Back 330

A330. Antibody to Voltage Gated Calcium Channels

Front 331

Q331. treatment for Lambert-Eaton Syndrome

Back 331

A331. Search for and treat the tumor if it’s present (often paraneoplastic syndrome of small cell lung cancer); Pyridostigmine works, but is less effective than in Myasthenia gravis (MG). Plasmaphereisis works well too.

Front 332

Q332. CNS autoimmune disease?; degenerations are disorders of the cerebellum, the part of the brain responsible for coordination, which are associated with tumors (neoplasms). They arise when tumors express proteins that are normally found only in neurons, and it is believed that the immune system, in its attempt to kill the tumor, also damages the cerebellum. current thought is that "killer T-cells", or cytotoxic CD8+ T lymphocytes, are the most likely mediator of neuronal injury.

Back 332

A332. Paraneoplastic Syndromes

Front 333

Q333. Examination of patients with anti-Purkinje cell antibodies, especially anti-Yo, is usually dominated by a rapidly progressive unsteadiness, and downbeating nystagmus.

Back 333

A333. Paraneoplastic Syndromes

Front 334

Q334. rare complication of cancer characterized by chaotic, synchronous eye movements (opsoclonus), spontaneous muscle jerks (myoclonus), and ataxia.

Back 334

A334. Paraneoplastic opsoclonus-myoclonus syndrome (OMS)

Front 335

Q335. autoimmune disease in CNS?; almost exclusively associated with neuroblastoma

Back 335

A335. children OMS; Paraneoplastic opsoclonus-myoclonus syndrome (OMS)

Front 336

Q336. autoimmune disease in CNS?; associated with small cell lung cancer (SCLC) and breast cancer are the most frequent tumors associated; It’s also known as dancing eye, dancing feet syndrome.

Back 336

A336. adult OMS; Paraneoplastic opsoclonus-myoclonus syndrome (OMS)

Front 337

Q337. Difficulty in finding works (dysnomia); Impaired visuospatial memory (misplace things ,not finding their way home); Impaired recent memory. Delusion ,insomnia, depression

Back 337

A337. early sx of alzheimer's disease

Front 338

Q338. Increasingly impaired remote memory; Non confluent speech; Agitation, aggression

Back 338

A338. later sx of alzheimer's disease

Front 339

Q339. Recent and remote memory obliterated; Mute; Severe rigidity

Back 339

A339. final stage of alzheimer's disease

Front 340

Q340. What disease has the following MRI features?; Marked reduction in brain volume; Cortical atrophy, frontal ,parietal; Ventricular dilatation (hydroceplus ex vacuo )

Back 340

A340. alzheimer's disease

Front 341

Q341. what disease is associated with the following?; Positron emission tomography (PET) : (fluorodeoxyglucose); Early changes: impaired glucose utilization in posterior cingulate gyrus and parietal cortex (cf. DLBD: anterior cingulate gyrus )

Back 341

A341. alzheimer's disease

Front 342

Q342. What disease has the following?; Key Pathological makers:; 1. Neurofibrillary tangles, Flame shaped; globose; 2. Senile plaques, diffuse, primitive, mature and burnt-out

Back 342

A342. alzheimer's disease

Front 343

Q343. What is the AD pathlogic criteria for the following ages?; < 50 years; 52-65 years; 66-75 years; 75 years & over

Back 343

A343. < 50 years = 5 or more senile plaques per 200 x field. 52-65 years = 8 or more; 66-75 years = 10 or more; 75 years & over = 15 or more

Front 344

Q344. What disease has the following pathogenic mechanism?; B-secretase and G-secretase cleave APP (amyloid protien) to form A-beta with 1-40 (accum. in vessel walls) or 1-42 (accum. in neurons); change in amyloid protien leads to alteration in 2nd and 3rd structure of normal protein

Back 344

A344. Alzheimer's disease

Front 345

Q345. what chromosomes are associated with the following AD genetic cases?; presenilin 1:; presenilin 2:; amyloid precursor protein (APP);; associated with late onset AD (sporadic).

Back 345

A345. - presenilin 1: Chromosome 14; presenilin 2: Chromosome 1; amyloid precursor protein (APP); Chromosome 21; Apo-E ε 4 allele associated with late onset AD (sporadic).

Front 346

Q346. what disease has the following sx?; changes in sensation, visual problems, muscle weakness, depression, difficulties with coordination and speech, severe fatigue, cognitive impairment, problems with balance, overheating, and pain.

Back 346

A346. MS

Front 347

Q347. What disease requires the following for dx?; Clinical history and examination; Multiple CNS lesions in time and space; CSF examination: mild pleocytosis (5-50 lymphs) during acute attack, increased protein with high IgG, oligoclonal bands (persistent); MRI shows multiple plaques, active plaques; may enhance

Back 347

A347. MS

Front 348

Q348. what disease has the following common manifestations?; Optic neuritis: visual loss; Limb weakness; Sensory symptoms (paresthesias, hypesthesia); Cerebellar ataxia; Nystagmus; Diplopia (CN VI palsy or INO)

Back 348

A348. MS

Front 349

Q349. what disease presents as follows?; Age 15-50, but most cases start in the 20’s; Women are effected 2 times more than men; Optic Neuritis; Limb weakness which often presents as difficulty walking down stairs; Imbalance

Back 349

A349. MS

Front 350

Q350. what disease has the following?; CSF examination: Mild pleocytosis (increase in cell count) during an acuteü attack, Increased IgG); Oligoclonal Bands-due to high Ig levels on electrophoresis.

Back 350

A350. MS

Front 351

Q351. what drug used to tx MS are thought to interfere with INF Gamma which enhances attacks?

Back 351

A351. INTERFERONs

Front 352

Q352. what drug used to tx MS is a synthetic medication made of four amino acids that are found in myelin? This drug stimulates T cells in the body's immune system to change from harmful, pro-inflammatory agents to beneficial, anti- inflammatory agents that work to reduce inflammation at lesion sites.

Back 352

A352. GLATIRAMER ACETATE: (trade name Copaxone)

Front 353

Q353. what drug has been approved by the USA´s FDA for secondary progressive, progressive-relapsing, and worsening relapsing-remitting MS?

Back 353

A353. MITOXANTRONE: (trade name Novantrone)

Front 354

Q354. what drug used for MS is used to reduce the occurrence of clinical exacerbations. It is recombinant IgG directed against Alpha Integrin. Alpha Integrin inhibition prevents the inflammatory response?

Back 354

A354. NATALIZUMAB: (trade name Tysabri)

Front 355

Q355. what are 2 epidemiologic factors associated with MS

Back 355

A355. -MS incidence increases with latitude. Prior to age 15, risk is correlated with geographic location.

Front 356

Q356. CNS disease?; characterized by a brief but intense attack (punctate) of inflammation in the brain and spinal cord that damages myelin – the protective covering of nerve fibers. It often follows viral infection, or less often, vaccination for measles, mumps, or rubella. The symptoms come on quickly, beginning with encephalitis-like symptoms such as fever, fatigue, headache, nausea and vomiting, and in severe cases, seizures and coma.

Back 356

A356. Acute disseminated encephalomyelitis (ADEM)

Front 357

Q357. what CNS disease has the following pathology?; Multiple focal areas of small perivascular areas of demyelination and inflammation in white matter

Back 357

A357. Acute disseminated encephalomyelitis (ADEM); **be able to distiguish from Leukodystrophy and MS

Front 358

Q358. CNS disease?; Rare inherited disease which manifest as damage to myelin. Most have an early onset, are progressive and lethal. The majority are Autosomal Recessive. bilateral, symetric, and diffuse

Back 358

A358. Leukodystrophy; **be able to distiguish from ADME and MS

Front 359

Q359. CNS disease?; Caused by mutations or conformational changes of the prion-protein (PrPSC) or glycated PrPSC

Back 359

A359. prion disorders

Front 360

Q360. Formation of vacuoles in neural cytoplasm and nuclei. The size of the vacuole varies in the different sporadic forms. The vacuoles harbor the abnormal PrPSC-protein.

Back 360

A360. Spongiform Degeneration:

Front 361

Q361. type of amyloid plaque?; characteristic of the cerebellar form of sporadic CJD

Back 361

A361. Kuru-plaques

Front 362

Q362. type of amyloid plaque?; seen in the human form of bovine spongiform encephalopathy.

Back 362

A362. Cortical amyloid plaques

Front 363

Q363. prion disorder?; 85% of all cases (annually 1 per 1 milj) . Peak age of onset 60 – 65 years; Usually rapidly progressive dementia 4 -12 mo . With myoclonus, periodic sharp-wave EEG.

Back 363

A363. Sporadic Creutzfeldt-Jakob disease

Front 364

Q364. type of prion disease?; all defined by genotype at codon 129 of the prion gene. Differences in the methionine / valine polymorphism of this site and degree of protease resistance of conformationally changed protein do determine the type ,i.e., clinical symptoms and distribution of; pathology.

Back 364

A364. Sporadic Creutzfeldt-Jakob disease

Front 365

Q365. all cases occur with an autosomal dominant mode of inheritance. Twenty different mutations of the PrP have been identified. Each type shows a relatively uniform clinical and pathological picture.

Back 365

A365. familial Creutzfeldt-Jakob disease

Front 366

Q366. prion disease?; pathological picture is characterized by; spongiform degeneration, excessive gliosis and sometimes deposition of ß-pleated amyloid plaques which are made up of insoluble protease-resistant accumulation of the altered PrPSC.

Back 366

A366. Creutzfeldt-Jakob disease

Front 367

Q367. TYPES OF SPORADIC CJD?; clinical sign: Dementia, ataxia; EEG: Sharp waves; Pathology: Occipital-parietal cortex

Back 367

A367. M/M type 1

Front 368

Q368. TYPES OF SPORADIC CJD?; clinical sign: Dementia; EEG: Diffuse slowing; Pathology: Cerebral cortex

Back 368

A368. M/M type 2

Front 369

Q369. TYPES OF SPORADIC CJD?; clinical sign: Ataxia, Dementia; EEG: Diffuse slowing; Pathology: Cerebellum (Kuru plaques)

Back 369

A369. M/V type 2

Front 370

Q370. TYPES OF SPORADIC CJD?; clinical sign: Dysarthria,; dysphagia, dementia; EEG: Periodic sharp waves; Pathology: Subcortical Involvement (thalamus)

Back 370

A370. V/V type 2

Front 371

Q371. what effect does Pathological PrPSC have on Schematic flow of pathogenetic mechanisms in prion disorders?

Back 371

A371. Β-sheet conformation/ plaques; Protease resistant disease; also, Variations due to polymorphism and glycation of PrPSC give rise to specific disease entities.

Front 372

Q372. inability to produce and/or comprehend language b/c brain damage

Back 372

A372. Aphasia

Front 373

Q373. inability to name, .e., “word finding” difficulty

Back 373

A373. Anomia

Front 374

Q374. acquired impairment in reading

Back 374

A374. Alexia

Front 375

Q375. impairment in writing

Back 375

A375. Agraphia

Front 376

Q376. inability to do arithmetic

Back 376

A376. Acalculia

Front 377

Q377. impairment in the execution of a motor act in the absence of weakness, sensory loss, or incoordination

Back 377

A377. Apraxia

Front 378

Q378. type of aphasia?; speech: poor; comprehension: intact; repetition: poor

Back 378

A378. broca's aphasia

Front 379

Q379. type of aphasia?; speech: fluent; comprehension: poor; repetition: poor

Back 379

A379. wernicke's aphasia

Front 380

Q380. type of aphasia?; speech: intact; comprehension: intact; repetition: poor

Back 380

A380. conducion aphasia

Front 381

Q381. type of aphasia?; speech: Poor; comprehension: poor; repetition: poor

Back 381

A381. global aphasia

Front 382

Q382. Dominant parietal lobe lesion (angular; gyrus = area 39); Finger agnosia; Left-right disorientation; Acalculia; Alexia with Agraphia; Usually not all 4 are present

Back 382

A382. Gerstmann's syndrome

Front 383

Q383. Deficits due to inability to transmit information from one area of cortex to another; After a complete callosotomy the right hand does not know what the left is doing, or what is in the left visual field

Back 383

A383. Disconnection syndromes

Front 384

Q384. type of amnesia?; Inability to form new memories; Korsakoff's syndrome

Back 384

A384. Anterograde

Front 385

Q385. type of amnesia?; Loss of premorbid memories; Ribot's law: more recent memories are most affected

Back 385

A385. Retrograde

Front 386

Q386. Bilateral limbic system lesions; Medial temporal lobes; Medial thalamic nuclei; Usually a mixture of anterograde and retrograde amnesia; Common after traumatic brain injury

Back 386

A386. Amnestic Syndrome

Front 387

Q387. type of amnesia?; Acute onset profound transient anterograde amnesia; Benign usually (migraine, seizure, TIA); Leaves a permanent memory gap; Full recovery of anterograde memory

Back 387

A387. Transient Global Amnesia

Front 388

Q388. type of amnesia?; Loss of personal identity and past; Intact memory for recent events; Occurs most often in fiction

Back 388

A388. Psychogenic Amnesia; (psychogenic fugue)

Front 389

Q389. Loss of multiple cognitive abilities in a person with a clear sensorium (no delerium)

Back 389

A389. Dementia

Front 390

Q390. DSMIV-R requires memory impairment plus impairment in one of:; language; judgement; abstract thinking; praxis; constructional abilities; visual recognition

Back 390

A390. Dementia

Front 391

Q391. Memory complaint, preferably corroborated by an informant; Objective memory impairment; Normal general cognitive function; Intact activities of daily living; Not demented

Back 391

A391. Mild Cognitive Impairment Criteria

Front 392

Q392. lesion: Left occipital and splenium of CC; associated deficits: Right hemianopia, color anomia or achromatopsia

Back 392

A392. Alexia without Agraphia

Front 393

Q393. lesion: Left hemisphere, angular gyrus; associated deficits: Right hemisensory, hemiparesis, and aphasia

Back 393

A393. Alexia with Agraphia

Front 394

Q394. Blind but preserved PLR

Back 394

A394. Cortical Blindness

Front 395

Q395. cortical blindness with anosognosia

Back 395

A395. Anton’s Syndrome

Front 396

Q396. type of syndrome?; Oculomotor apraxia—saccades; Optic ataxia—visually guided limb movements,; Simultanagnosia—foreground/background; Sometimes prosopagnosia—face recognition

Back 396

A396. Balint’s syndrome

Front 397

Q397. drug class used to tx AD?

Back 397

A397. cholinesterase inhibitors should be considered for mild to moderate AD; donepezil (aracept); rivastigmine (exelon); galantamine (renimyl)

Front 398

Q398. What disease do the following relate to?; Memory loss that affects job skills; Difficulty performing familiar tasks; Problems with language; Disorientation to time and place; Poor or decreased judgment; Problems with abstract thinking; Misplacing things; Changes in mood or behavior; Changes in personality; Loss of initiative

Back 398

A398. Ten Warning Signs of AD

Front 399

Q399. What disease requires the following evaluation?; Complete blood cell count; Serum electrolytes; Glucose; BUN/creatinine; Serum B12 levels; Liver function tests; Thyroid function tests; Depression screening

Back 399

A399. Routine Evaluation of the; Demented Patient

Front 400

Q400. drug?; indicated for the treatment of moderate to severe dementia of the Alzheimer's type (FDA); a low-affinity N-methyl-D-aspartate (NMDA) receptor antagonist

Back 400

A400. Memantine (Namenda)

Front 401

Q401. T or F?; Estrogen should be prescribed to treat AD

Back 401

A401. False

Front 402

Q402. type of headache?; Recurring headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of headache are unilateral location, pulsating quality, moderate or; severe intensity, aggravation by routine physical activity, and association with nausea, photo- and phonophobia

Back 402

A402. Migraine without aura

Front 403

Q403. type of headache?; Headache has at least two of :; Unilateral location; Pulsating quality; Moderate or severe intensity; Aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs); During headache at least one of :; Nausea and/or vomitng; Photophobia and phonophobia

Back 403

A403. Migraine without aura

Front 404

Q404. type of headache:; least one of the following, but no motor weakness:; 1. fully reversible visual symptoms including positive features (eg, flickering lights, spots or lines) and/or negative features (ie, loss of vision); 2. fully reversible sensory symptoms including positive features (ie, pins and needles) and/or negative features (ie, numbness); 3. fully reversible dysphasic speech disturbance; At least two of the following:; 1. homonymous visual symptoms and/or unilateral sensory symptoms; 2. at least one aura symptom develops gradually over ≥5 minutes; and/or different aura symptoms occur in succession over ≥5 minutes; 3. each symptom lasts ≥5 and ≤60 minutes; Headache fulfilling criteria B–D for 1.1 Migraine without aura begins during the aura or follows aura within 60 minutes

Back 404

A404. Typical aura with migraine headache

Front 405

Q405. Warning signs in headache

Back 405

A405. First & worst headache comes to the ER: needs a CT & LP to rule out subarachnoid hemorrhage (SAH); Headaches that awaken a patient at night or occur first thing in the morning suggest increased ICP; Palpable tender temporal arteries suggest GCA: check ESR; Cherry-red headache patients in winter: think CO; Virtually all headaches can cause nausea & vomiting

Front 406

Q406. Headaches that awaken a patient at night or occur first thing in the morning is suggestive of what?

Back 406

A406. suggest increased ICP

Front 407

Q407. Palpable tender temporal arteries suggest GCA, check for what?

Back 407

A407. ESR

Front 408

Q408. clinical characteristic of virtually all headaches?

Back 408

A408. Virtually all headaches can cause nausea & vomiting

Front 409

Q409. Cherry-red headache patients in winter

Back 409

A409. think CO

Front 410

Q410. type of headache?; Excrutiating, penetrating, non-throbbing pain unilaterally, usually in the trigeminal distribution; Associated conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, & ptosis; Peaks in 10-15 minutes, lasts 45-60 minutes; Occurs 1-3 times per day during cluster, often nocturnal; Typical cluster lasts 2-3 months and occurs every year or two; Affect men more often than women, 4-7:1

Back 410

A410. Cluster Headache

Front 411

Q411. type of headache?; Diffuse, bilateral, pressing or “tightening” quality, “like a band around the head”; Mild to moderate in severity; Usually episodic, may become chronic; Phonophobia, photophobia, or mild nausea occur rarely; Not really due to muscle tightness; Prevalence is 69% for men, 88% for women

Back 411

A411. Tension-type Headache

Front 412

Q412. Migraine is a _______ disorder

Back 412

A412. neurovascular

Front 413

Q413. what system is activated when Local vasodilatation of intracranial extracerebral blood vessels occurs; causes the release of vasoactive sensory neuropeptides, especially CGRP, that increase the pain response

Back 413

A413. 'trigeminovascular system'; The activated trigeminal nerves convey nociceptive information to central neurons in the brain stem trigeminal sensory nuclei

Front 414

Q414. drugs to tx migrane?; cause vasoconstriction through 5-HT1B receptors that are expressed in human intracranial arteries; inhibit nociceptive transmission through an action at 5- HT1D receptors on peripheral trigeminal sensory nerve terminals in the meninges and central terminals in brain stem sensory nuclei

Back 414

A414. The 'triptan' anti-migraine agents (e.g. sumatriptan, rizatriptan, zolmitriptan, naratriptan) are serotonergic agonists

Front 415

Q415. What should be avoided to abort a migraine except in the ER?

Back 415

A415. Avoid narcotics except in ER

Front 416

Q416. what is the specific tx for cluster headaches?

Back 416

A416. 100% oxygen, ipsilateral intranasal 4% lidocaine for cluster headache

Front 417

Q417. prophylaxis for migraine therapy

Back 417

A417. Dietary: find precipitants; Caffeine, chocolate, nuts, aged cheeses, processed meats, alcohol (especially red wine); Beta blockers (especially propranolol); Daily naproxen; Calcium channel blockers; Amitriptyline and other tricyclics; Valproic acid (Depakote); Prednisone (short course) to break status migrainosus or cluster; Lithium for cluster headaches

Front 418

Q418. type of headache?; Signs and symptoms of increased intracranial pressure without hydrocephalus; Usually small, slit-like ventricles; Mean age at onset 30 years, F:M 9:1; 90% of patients are obese, also associated with endocrinopathies, pregnancy, oral contraceptives, steroids, lithium, tetracycline, vitamin A intoxication

Back 418

A418. Pseudotumor cerebri

Front 419

Q419. What type of headache presents 100% of the time with papilledema?

Back 419

A419. Pseudotumor cerebri

Front 420

Q420. What type of headache requires the following treatment?; Weight loss; Acetazolamide; If there is progressive visual loss:; Optic nerve sheath fenestration; Lumbar-peritoneal shunting

Back 420

A420. Pseudotumor cerebri

Front 421

Q421. type of headache?; Paroxysmal, severe lancinating unilateral pain in the distribution of one or more branches of the trigeminal nerve; Episodes last <30-60 seconds evoked by stimulation of trigger points by touch, chewing or talking; Age is >40 years in 90%, F:M 3:2; Examination is normal

Back 421

A421. Trigeminal Neuralgia or Tic Doloreux

Front 422

Q422. what drugs are effective in 70-80% of cases in treating trigeminal neuralgia?

Back 422

A422. Carbemazepine and phenytoin

Front 423

Q423. what headache type can be treated in one of the following ways?; Carbemazepine and phenytoin each are effective in 70-80% of cases; • Tricyclics, baclofen, clonazepam, valproic acid, gabapentin can also be effective; Surgical treatments include microvascular decompression, percutaneous radiofrequency ablation of the trigeminal ganglion, local neurolysis and trigeminal rhizotomy

Back 423

A423. Trigeminal Neuralgia

Front 424

Q424. type of headache?; Patients are usually >60 years old Symptoms:; headache, often in temporal or occipital areas; fever, malaise, weight loss; jaw claudication; sudden vision loss Signs and findings; tenderness over the temporal arteries; elevated ESR; vasculitis on biopsy Treatment: oral prednisone

Back 424

A424. Giant Cell or Temporal Arteritis

Front 425

Q425. location of diffuse astrocytoma in adults?

Back 425

A425. AGE/LOCATION:; adults: most common in cerebral hemispheres

Front 426

Q426. location of diffuse astrocytoma in children?

Back 426

A426. children: most common in brainstem, diencephalon (thalamus, hypothalamus)

Front 427

Q427. sx of a lacunar thalamic stroke

Back 427

A427. sensory

Front 428

Q428. sx of a lacunar pontine stroke

Back 428

A428. dysarthria, clumsy hands

Front 429

Q429. most common locations for a berry aneurysm in brain

Back 429

A429. pca > aca > mca

Front 430

Q430. medical tx for SAH

Back 430

A430. CCB to prevent vasospasms; gradually decrease BP

Front 431

Q431. complications of SAH

Back 431

A431. 30% re-rupture; 50% vasospasm

Front 432

Q432. which way do eyes deviate in a stroke involving the pons

Back 432

A432. away

Front 433

Q433. which way do eyes deviate in a stroke involving the cortex

Back 433

A433. towards

Front 434

Q434. which way do eyes deviate in a stroke involving the thalamus

Back 434

A434. eyes deviate downwards

Front 435

Q435. most common cause of ICP

Back 435

A435. sudden increase in BP

Front 436

Q436. most common cause of SAH

Back 436

A436. ruptured aneurysm

Front 437

Q437. most common cause of ischemic stroke

Back 437

A437. embolic stroke

Front 438

Q438. most common cause of lacunar stroke

Back 438

A438. microathetroma and lipohylinosis; in small penetrating arteries of brain

Front 439

Q439. where is the lesion:; paralysis of left side of tongue with right limb weakness

Back 439

A439. paramedian medulla oblongata

Front 440

Q440. where is the lesion:; left facial pain, vertigo and vomiting at onset with loss of pain and temp in L face; loss of pain and temp in R limbs adn trunk; L horner's syndrome; dysphagia

Back 440

A440. wallenberg syndrome; (2/2 PICA or vertebral artery branch infarct)

Front 441

Q441. where is the lesion:; left 3rd nerve palsy and right hemiplegia; (if awake); if unconscious

Back 441

A441. midbrain involving basis pedunculi and cn III; left cerebral mass lesion with increased icp

Front 442

Q442. where is the lesion:; left 3rd nerve palsy with involuntary movements and incoordination of right limbs

Back 442

A442. midbrain involving red nucleus and cn iii

Front 443

Q443. cogwheel rigidity; tremor at rest; postural instability; Lewy bodies; depigmentation of Snc

Back 443

A443. PARKINSON'S; possible link to MPTP

Front 444

Q444. contralateral subthalamic nucleus damage

Back 444

A444. hemiballismus

Front 445

Q445. Huntington cerebral appearance

Back 445

A445. caudate atrophy; enlarged ventricles; (loss of GABAergic neurons)

Front 446

Q446. depression; chorea; progressive dementia; chromosome 4 defect

Back 446

A446. Huntington

Front 447

Q447. Friedrich's ataxia; inheritance; defect; sx

Back 447

A447. auto Recessive; GAA repeat; ataxia; hypertrophic cardiomyopathy; spasticity; loss of joint sensation; decreased joint sensation; posterior spinal cord; spasticity; lateral spinal cord

Front 448

Q448. Werdnig-Hoffman; inheritance; defect; sx

Back 448

A448. auto recessive; anterior horn LMN degeneration; floppy baby; spinal muscular atrophy; tongue fasiculations; death median 7 mts

Front 449

Q449. severe abdominal pain; psychosis; peripheral neuropathy; dementia

Back 449

A449. Acute intermittent prophyra; autoD; (-)uroporphyrogen snythase; PBG, delta-ALA accumulation; wine urine on oxidation

Front 450

Q450. Acute intermittent porphyra; inheritance; defect; accumulation; sx

Back 450

A450. autoD; (-)uroporphyrogen synthase; PBG, delta-ALA accumulation; wine urine on oxidation; severe abdominal pain; psychosis; peripheral neuropathy; dementia

Front 451

Q451. Broca lesion

Back 451

A451. expressive aphasia; difficulty speaking; understanding intact

Front 452

Q452. fluent speech; difficulty understanding; poor repetition

Back 452

A452. Wernicke's receptive aphasia; neologisms

Front 453

Q453. fluent speech; good understanding; poor repetition

Back 453

A453. Arcuate conduction aphasia

Front 454

Q454. poor speech; good understanding; poor repetition

Back 454

A454. Broca's expressive aphasia

Front 455

Q455. fluent speech; difficulty understanding; repetition intact

Back 455

A455. transcortical sensory

Front 456

Q456. poor speech; difficulty understanding; repetition intact

Back 456

A456. transcortical mixed; can only repeat

Front 457

Q457. poor speech; difficulty understanding; poor repetition

Back 457

A457. global; profound; nonverbal

Front 458

Q458. bilateral amygdala lesion

Back 458

A458. amygdala-la land of sex; Kluver-Bucy syndrome; disinhibition; hyperorality; hypersexuality

Front 459

Q459. Frontal lobe lesion

Back 459

A459. disinhibition; mood changes; difficulty concentrating

Front 460

Q460. parietal lobe lesion

Back 460

A460. contralateral hemineglect

Front 461

Q461. Midbrain reticular activating system

Back 461

A461. reduced arousal, activity

Front 462

Q462. bilateral mammary bodies

Back 462

A462. Wernicke-Korsakoff; ataxia, confusion, confabulation; ophthlamoplegia; psychosis; anterograde amnesia

Front 463

Q463. ataxia, confusion, confabulation; ophthlamoplegia; psychosis; anterograde amnesia

Back 463

A463. Wernicke's-Korsakoff

Front 464

Q464. truncal ataxia; poor motor speech/dysarthria

Back 464

A464. cerebellar vermis

Front 465

Q465. contralateral hemiballismus

Back 465

A465. subthalamic nucleus; basal ganglia

Front 466

Q466. anterograde amnesia

Back 466

A466. hippocampus

Front 467

Q467. paramedian pontine reticular formation (PPRF); location; unilateral lesion

Back 467

A467. pons; eyes look AWAY from side of lesion; contralateral gaze deviation; uPP(RF) and AWAY

Front 468

Q468. Frontal eye fields lesion

Back 468

A468. inability to initiate voluntary mvmt; eyes look TOWARDS lesion; sit TOWARDS the FRONTal

Front 469

Q469. Broca's area location

Back 469

A469. inferior frontal gyrus

Front 470

Q470. Wernicke's location

Back 470

A470. superior temporal gyrus

Front 471

Q471. contralateral loss of pain, temp; visual field loss w/ macular sparing; ispilateral oculomotor nerve palsy hemiparesis,hemiplegia. Horner's

Back 471

A471. PCA; midbrain; optic tracts; thalamus

Front 472

Q472. foot and leg paralysis; foot and leg sensory loss; gait disturbance; transcortical motor aphasia; (left stroke)

Back 472

A472. contralateral ACA; (stroke prior to the anterior communicating artery okay b/c collateral circulation)

Front 473

Q473. face-trunk-arm paralysis; face-trunk-arm loss of sensation; Broca's/Wernicke's aphasia; hemineglect (parietal lobe); vision loss

Back 473

A473. contralateral MCA

Front 474

Q474. oculomotor palsy

Back 474

A474. posterior communicating artery; PCA

Front 475

Q475. bitemporal hemianopsia

Back 475

A475. Acomm a. aneurysm; Pituitary adenomas; Craniopharyngiomas.

Front 476

Q476. pure motor hemiparesis following stroke; artery; patholocation

Back 476

A476. lateral striate/ MCA; lacunar infarct of internal capsule

Front 477

Q477. severe vertigo; nystagmus; ipsilateral ataxia; difficulty swallowing; Horner's

Back 477

A477. PICA

Front 478

Q478. paralysis of all extremities; profound loss of sensation; respiratory difficulty

Back 478

A478. basilar artery infarct; "locked in syndrome"

Front 479

Q479. nuchal rigidity; worst headache of life; bloody, xanthrochromic tap

Back 479

A479. subarachnoid hemorrhage; berry aneurysm rupture; AVM

Front 480

Q480. cresentic hematoma; crosses sutures; delayed onset of symptoms; flux of consciousness; bridging veins; elderly, alcohol, shaken baby; whiplash

Back 480

A480. subdural hematoma

Front 481

Q481. hematoma crosses falx, tentorum

Back 481

A481. epidural

Front 482

Q482. hematoma crosses suture

Back 482

A482. subdural

Front 483

Q483. () biconvex hematoma; lucid interval; middle meningeal artery; temporal bone fracture

Back 483

A483. epidural hematoma; middle meningeal artery

Front 484

Q484. hydrocephalus; paralysis of upward gaze; dilated lateral, munro, 3rd ventricle

Back 484

A484. congenital stricture of aqueduct of sylvius

Front 485

Q485. dilated lateral, munro, 3rd ventricle, sylvian aqueduct, 4th ventricle

Back 485

A485. Dandy Walker; foramen of Luschka, Magendie stenosis

Front 486

Q486. spinal tap structures are pierced ...

Back 486

A486. SLED SAS; skin/superficial fascia; ligaments:; supraspinatus; interspinatous; flavus; epidural space; dura mater; subdural space; arachnoid; subarachnoid space

Front 487

Q487. LMN destruction in anterior horn

Back 487

A487. Polio; Werdnig-Hoffmann

Front 488

Q488. asymmetric diffuse spinal and cortical lesions in white matter

Back 488

A488. MS

Front 489

Q489. lesions in ventral column; anterior horn; corticospinal

Back 489

A489. ALS; axial motor defects (ant horn); UMN/LMN motor defects (corticospinal)

Front 490

Q490. anterior spinal artery occulsion

Back 490

A490. spares dorsal column; anterior horn; corticospinal tract; spinothalamic tract

Front 491

Q491. posterior spinal artery occlusion

Back 491

A491. dorsal column

Front 492

Q492. degeneration of dorsal roots, columns; disease; sx

Back 492

A492. tabes dorsalis; locomotor ataxia, (proprioception); impaired touch

Front 493

Q493. degeneration of region between anterior horn; disease; sx

Back 493

A493. syringomyelia; bilateral loss of pain and temperature sensation; damages crossing fibers of spinothalamic tract

Front 494

Q494. dorsal column; lateral corticospinal; spinocerebellar tracts; demylenation; disease; sx

Back 494

A494. B12 defiency; Fridrick's ataxia; hyperreflexia; neuropathy; ataxia; impaired position sense

Front 495

Q495. anterior horn destruction; fasciculations, fibrillation; muscle weakness, atrophy; CSF lymphocytic pleocytosis

Back 495

A495. poliomyelitis; virus replicates in oropharyx, intestines; cx from stool, throat

Front 496

Q496. anterior horn destruction; floppy baby; tongue fasiculations; death at 7 mths

Back 496

A496. Werdnig-Hoffman

Front 497

Q497. superoxide dismutase defect; hand atrophy; spasticity; weakness; +babinski

Back 497

A497. ALS

Front 498

Q498. rapid sensory motor loss; immunocompromised state; oligocyte inclusions; disease, agent

Back 498

A498. progressive multifocal leukoenephalopathy; JC virus

Front 499

Q499. parkinsonism; putamen/basal ganglia; atrophy, cavitary necrosis; hyperpigmentation; liver cirrhosis

Back 499

A499. Wilson's disease

Front 500

Q500. history of measles; personality change, seizures, myoclonus, ataxia, photosensitivity,; progressive psychomotor decline/death; oligodendrocyte inclusions

Back 500

A500. subacute sclerosising panencephalitis; chronic measles infection

Front 501

Q501. loss of joint sensation; shooting pain; history of sexual activity; loss of DTR; locomotor ataxia

Back 501

A501. tabes dorsalis

Front 502

Q502. staggering gait; nystagmus; hypertrophic cardiomyopathy; childhood kphoscoliosis; familial frataxin gene repetition

Back 502

A502. Friedrich's ataxia

Front 503

Q503. trauma, TB, MS; Hemiparaplesia; ispi UMN symptoms; ipsi loss of touch, vibration below; loss of all motor/sensation at lesion; contralateral loss of pain, T; +/- Horner's symptoms (above T1)

Back 503

A503. hemisection of spinal cord; Brown-Sequard

Front 504

Q504. HIV; periventricular calcifications; intranucelar basophlic inclusions

Back 504

A504. CMV meningitis

Front 505

Q505. Horner's syndrome; sx; lesion

Back 505

A505. ptosis; miosis; anhydrosis; spinal cord lesion above T1

Front 506

Q506. history of MS; normal convergence; nystagmus on abduction of eye; medial rectus palsy on lateral gaze

Back 506

A506. MLF syndrome; medial longitudinal fasculus lesion

Front 507

Q507. sudden loss of vision; MLF; hemiparesis/sensory sx; bladder/bowel incontinence; scanning speech; intention tremor; nystagmus

Back 507

A507. MS

Front 508

Q508. MS associated with what HLA class

Back 508

A508. DR2; 2 Drs can't cure MS

Front 509

Q509. postviral; acute perivenular inflammation; demyleination

Back 509

A509. acute disseminated encephalomyelitis

Front 510

Q510. Metachromatic leukodystophy; inheritance; deficiency; accumulated substance; disease

Back 510

A510. autorecessive; arylsulfatase A deficiency; sulfatides buildup; impaired myelin sheath

Front 511

Q511. CNS symptoms with; adrenal insufficiency; familial

Back 511

A511. Adrenoleukodystrophy; autorecessive; LCFA buildup destroys myelin

Front 512

Q512. unilateral periorbital pain; brief repetitive headaches; ipsilateral lacrimation; rhinorrhea; Horner's

Back 512

A512. cluster headache

Front 513

Q513. medullary cerebral vermis herniation through foramen magnum; dilation of lateral, 3rd, sylvian duct; flatten base of skull; meningomyocele, syringomelia

Back 513

A513. Arnold Chiari

Front 514

Q514. vermis hypoplasia; cystic dilation of lateral, 3rd,sylvian, 4th ventricles,; hydrocephalus; obstructed foramen Luska/Magn

Back 514

A514. Dandy Walker

Front 515

Q515. loss of pain, T in hands; atrophy of intrinsic hand muscles; fluid filled cervical cord enlargement; anterior horn destruction; +/- Chiari herniation

Back 515

A515. syringomyelia

Front 516

Q516. port wine stains; leptominingeal angioma, AVM; glaucoma; seizure; hemiparesis; MR

Back 516

A516. Sturge-Weber

Front 517

Q517. cafe au lait; pigmented iris harmartomas; neurofibromas; auto d

Back 517

A517. neurofibromatosis 1

Front 518

Q518. cavernous hemangiomas; RCC; hemangioblastoma in retina

Back 518

A518. VHL

Front 519

Q519. corticocerebellar atrophy; central pontine myelosis

Back 519

A519. alcholism

Front 520

Q520. mouth drop; difficulty speaking; inability to close eye; unilateral facial paralysis

Back 520

A520. Bell's palsy

Front 521

Q521. Bell's palsy; unilateral causes; bilateral causes

Back 521

A521. HIV, Sarcoidosis; bilateral = LYME

Front 522

Q522. + GFAP; pseudopalisading tumor; central necrosis, hemorrhage; can cross corpus callosum

Back 522

A522. GBM astrocytoma

Front 523

Q523. spindle cells; arachnoid cell origin; can invade bone; psammoma bodies

Back 523

A523. meningioma

Front 524

Q524. chicken wire capillaries; frontal lobe calcification; fried egg cells

Back 524

A524. olgiodendroglioma

Front 525

Q525. Positive GFAP; posterior fossa; eosinophilic corkscrew rosenthal fibers; cystic

Back 525

A525. pilocystic astrocytoma

Front 526

Q526. neuroectodermal; can compress 4th ventricle; hydrocephalus; rosettes, perivascular pseudorossets

Back 526

A526. medulloblastoma

Front 527

Q527. perivascular pseduorosettes; rod shaped basal ciliary bodies near nucelus; hydrocephalus if in 4th ventricle

Back 527

A527. ependymoma

Front 528

Q528. vascular tissue; foamy cells; polycythemia; associated with VHL; cerebellar

Back 528

A528. hemangioblastoma

Front 529

Q529. dilated pupils; eye down adducted; ptosis; herniation of medial temporal lobe; occipital infarct

Back 529

A529. uncal herniation

Front 530

Q530. tonic clonic first line

Back 530

A530. phenytoin; carmnbamazepime; depakote

Front 531

Q531. absence first line

Back 531

A531. ethosuximide; (depakote ok)

Front 532

Q532. phenytoin; MOA; toxicity

Back 532

A532. Na channel inactivation; nystagmus, gingival hyperplasia; decreases warfarin

Front 533

Q533. BDZ; MOA; toxicity

Back 533

A533. increase GABA conc; sedation, dependence

Front 534

Q534. Carbamazepine; MOA; toxicity

Back 534

A534. Na channel inactivation; teratogenic, agranulocytosis, aplasic anemia, diplopia, hepatotoxicity

Front 535

Q535. Phenobarbital; MOA; toxicity

Back 535

A535. increases GABA a activity; dependence; decreases warfarin

Front 536

Q536. Valproic acid; MOA; toxicity

Back 536

A536. Na channel inactivation, increases GABA; teratogenic; weight gain; fatal hepatotoxcicity; spina bifida; inhibits phenobarital metabolism

Front 537

Q537. Lamotrigine; MOA; toxicity

Back 537

A537. blocks Na channels; Steven Johnsons

Front 538

Q538. Gabapentin; MOA

Back 538

A538. GABA analog

Front 539

Q539. Topiramate

Back 539

A539. blocks Na channels; renal stones; mental dullness; weight loss

Front 540

Q540. Ethosuximide

Back 540

A540. blocks thalamic T-Ca channels

Front 541

Q541. Dantrolene MOA

Back 541

A541. prevents release of Ca from SR of skeletal muscle

Front 542

Q542. Bromocriptine; MOA

Back 542

A542. dopamine receptor agonist

Front 543

Q543. Amantadine; MOA

Back 543

A543. increases dopamine release

Front 544

Q544. Ldopa/carbidopa; MOA

Back 544

A544. increases dopamine concentration in synapse

Front 545

Q545. Selegline; MOA

Back 545

A545. selective MAO B inhibitor; prevents dopamine degradation

Front 546

Q546. Benztropine

Back 546

A546. antimuscarinic (like atropine); improves parkinsonian tremor

Front 547

Q547. Ldopa overdose give _________

Back 547

A547. clozaprine

Front 548

Q548. Memantine

Back 548

A548. NMDA receptor antagonist; prevents excitotoxicity in Alzhemier's

Front 549

Q549. Donepezil

Back 549

A549. Ach inhibitor for parkinsons

Front 550

Q550. dilated pupil; +tachy, hypertension; tremor, seizure; overdose on _________?

Back 550

A550. cocaine; amphetamine; caffiene; pseudoephedrine

Front 551

Q551. dilated pupil; hypervigilence; agitation; hallucination; delirum, coma

Back 551

A551. antihistamine; TCA; atropine; scopolamine; Jimson weed; antiparkinsonins

Front 552

Q552. dilated pupil; hyperthermia, tachy, htn; agitation, nystagmus

Back 552

A552. PCP (vertical nystagmus); LSD; mescaline; MDMA

Front 553

Q553. seizure; chorea; arrhythmia; tachycardia; hyper-->hypotension

Back 553

A553. TCA overdose

Front 554

Q554. hypothermia; bradycardia; CNS depression; hyporeflexia; pulm edema

Back 554

A554. heroin; oxycodone; morphine; meperidine

Front 555

Q555. confusion; coma; salivation; incontenence; diaphroesis; bronchoconstriction; fasciulation

Back 555

A555. organophosphates; pilocarpine; phyostigme; edrophonium; bethanecol