Neuro Shelf

Front 1

Patient from East Coast presenting with rash on leg . Rash enlarges. Arthralgia, then meningitis happens. Optic neuritis can appear. Schwannoma may develop on 7th nerve. Causes one sided facial paralysis, followed by signs of

Back 1

Lyme disease

Front 2

Though we give pyridoxine for isoniazid

Back 2

Overdose can cause peripheral neuropathy. Excess is also linked to hypochondriasis or compulsive behavior.

Front 3

Treatment for lyme meningitis

Back 3

Ceftriaxone. If intolerant, give erythromycin.

Front 4

Dorsiflexion of foot is controlled by the anterior tibial muscle. Supplied by deep peroneal nerve, arises from common peroneal nerve. Lyme radiculopathy causes painful radiculopathies and peripheral neuropathies. TB meningitis can do the same thing, but steroids are helpful in suppressing the complaint.

Back 4

Noncompressive sciatica

Front 5

Twitching of the mouth when the eyes blink in a patient recovering from Lyme disease

Back 5

Regenerating aberrant fibers, more often seen after injury to the 3rd, rather than 7th nerve. Regenerating nerves miss their original target and innervate new destinations. Can also be seen with sarcoidosis.

Front 6

Patella reflex sensory

Back 6

L2-L3

Patella percieves, quadriceps does motor.

Damage to corticospinal tract causes hyperreflexia due to disinhibition.

Front 7

Metal poisoning that causes painless peripheral neuropathy

Back 7

Lead. Can cause increased ICP and cognitive dysfunction in children.

Front 8

Metal poisoning that causes hair loss , GI distress, seizures

Back 8

Thallium

Front 9

Metal poisoning that causes Parkinsonism

Back 9

Manganese.

Front 10

Most common cause of mononeuritis multiplex. Individual nerves are transiently disabled.

Back 10

Diabetes Mellitus is the most common cause.

Rheumatoid diseases and sarcoidosis produce a similar picture.

And it is reversible compared to temporal arteritis (ischemic optic neuropathy

Front 11

Supplies the extensors of the wrist

Back 11

Radial nerve, derives from posterior cord of brachial plexus.

Front 12

Weakness in upper brachial plexus (5th and 6th cervical spine roots)

Back 12

Birth trauma, when head and shoulder are forced widely.

Front 13

Lower plexus injury

Back 13

Pancoast tumor and node dissection in axilla

Front 14

Degeneration of the spinal cord. Problems in the dorsal and ventral spinocerebellar tracts. posterior column and lateral corticospinal tract can be involved.

Back 14

Friedreich disease

Front 15

Friedreich disease is associated with what endocrine abnormality?

And what chromosome is the defect on?

Back 15

Diabetes Mellitus. Optic atrophy and cardiac conduction defects are also associated with Friedreich's ataxia.

Chromosome 9 (Frataxin, AR). Problems start in juvenile period. Kyphoscoliosis, pes cavis, gait difficulty are seen in childhood. Visual loss, syncope, vertigo and dysarthria are seen decades after gait ataxia.

Front 16

Associated with surgical procedures, exposure to thrombolytic agents, lymphoma and certain vaccines

Back 16

Guillain-Barre syndrome

Front 17

What levels are elevated in CSF in Guillaine Barre?

What is the therapy for the disease?

Back 17

Protein.

Plasma exchange and IVIG are mainstay. This reduces hospitalization time.

Front 18

Treatment of Lambert-Eaton?

Back 18

3,4-Diaminopyridine

Front 19

Acute Brachial plexopathy... Acute onset of pain in neck, shoulder, upper arm, then evolution of weakness to proximal muscles of the arm, hand or respiratory muscles. Sensory loss happens too.

Back 19

Parsonage-Turner syndrome aka Brachial neuritis/ neuralgic amyotrophy.

Can be familial (AD) or after vaccination.

Front 20

Jewish boy with with history of poor sucking at birth and multiple respiratory infections in childhood. Pain and temperature impaitment. Autonomic signs (eg orthostatic hypotension) are seen too. Absence of tongue papillae

Back 20

Familial dysautonomia/ Riley-Day disease (AR)

Front 21

Similar to Guillaine-Barre but has a slower course. It's a radiculoneuropathy (affects proximal portions of nerves where they exit the spinal cord at root level, leading to rise in protein. Slowly worsening numbness, EMG shows slowing nerve conduction.

Back 21

Chronic inflammatory demyelinating polyneuropathy (CIDP)

Front 22

Recurrent attacks of abdominal pain, gastroparesis, constipation, psychosis after getting barbiturates, phenytoin, sulfonamides, estrogen, alcohol

Back 22

Acute intermettent porphyria.

Tx. with IV hematin, if supportive measures are not adequate.

Front 23

Anesthetic that could cause megaloblastic anemia and and pointing to central rather than peripheral problems. Kind of mimics B12 deficiency.

Back 23

Nitrous oxide.

Front 24

May be confused with MS in the beginning. Optic atrophy and facial nerve palsy may be seen.

Back 24

Sarcoidosis

Peripheral neuropathy may be seen with MS after Cyclophosphamide.

Front 25

Opthalmoparesis, nystagmus, and ataxia in alcoholic.

What to do for him???

Back 25

Thiamine replacement, or he could just die. Yup die! Periaqueductal and mamillary body lesions can develop.

Purkinje cells in cerebellar vermis could be lost

Front 26

Decremental response of muscle to repetitive stimulation at 2-5Hz

Incremental response to stimulation at high frequency (20-50Hz)

Back 26

Botulism (NMJ disorder). Look for someone who ate expired jam or poison.

Response to high frequency not seen with Myesthenia Gravis

Front 27

Between birth and age 1, what to do if presents with febrile seizures?

Back 27

Spinal tap (to rule out meningitis, which can also have a meningitis picture). If meningitis, start with antibiotics fast.

Front 28

Acute Demyelinating encephalomyelitis (ADEM) messes up the white matter. How is it different from MS?

Back 28

Similar MRI...

However, it is monophasic, not waxing and waning fashion of MS. Develops days or weeks after viral illness.

Front 29

Loss of bladder bowel control and paraplegia or paraparesis.

Back 29

Cauda equina syndrome.

Surgical emergency.

Osteomyelitis can also produce Cauda equina syndrome. So surgery and antibiotics.

Front 30

What to do with slipped disc?

Back 30

Slipped disc is not a surgical emergency. Metastatic cancers (breast and prostate) may mimic slipped disc picture. So make sure to rule that out. If cancer, give corticosteroids and radiation therapy, rather than surgery.

Front 31

Headache with lacrimation and running nose? Occurs usually at night.

Back 31

Cluster headache. Give O2, can terminate headache in minutes.

Methysergide can prevent cluster headache, but adverse effect of fibrosis.

Sublingual NG can trigger headache in cluster and migraine.

Front 32

Migraine prophylaxis

Back 32

Propanolol.

Useless in cluster.

Front 33

Alcoholic given IV fluids who then becomes disoriented, ataxic, and dysrthric????

Back 33

Wernicke. IV fluid probably contained glucose. Remember, don't give glucose without thiamine. Glucose will deplete the thiamine left in the poor man.

Mammilary bodies in trouble.

Front 34

What to give for malignant hyperthermia, seen after halothane or succinylcholine.

Back 34

Dantrolene.

If not given, patient can become acidotic and develop rhabdo. Due to abnormal calcium release. Ryanodine receptors messed up.

Front 35

Down and out CN, pupillary dilation???

Difficulty looking down. Trouble walking down stairs. What CN?

Horizontal diplopia. What CN

Back 35

CN 3 (can happen in diabetes)

CN 4

CN 6

Front 36

Aniscoria (different pupil colors in different eyes) caused by what?

Back 36

Congenital Horner Syndrome (sympathetic innervation required for change in color of iris after birth and infancy).

Front 37

Threshold for coma on Glasdow Coma Scale?

Back 37

Scale is from 3-15. Considers motor, verbal and eye opening.

Anything less than 8 is coma.

Head injury: Mild (14-15), moderate (9-13), severe (<8).

Front 38

Raccoon eyes (presence of periorbital ecchymosis in traumatic head injury)

Battle sign (Ecchymosis over mastoid region)

Hemotympanum (blood behind ear drum)

CSF rhinorrhea

Back 38

Basilar skull fracture

Front 39

MRI shows multiple foci of punctate hemorrhage

Back 39

Diffuse axonal injury

Front 40

What improves the outcome in traumatic brain injury?

Back 40

Hypothermia. This reduces cerebral metabolism, reduces acidosis. Reduces chance of cerebral ischemia.

Front 41

Difficulty swallowing food, next few hours develops diploia, dysarthria. bifacial paresis, tongue is weak. Extremity muscle bulk is normal. Sensory nerve AP is normal. What organism?

Back 41

Clostridium botulinum: evidence by bulbar paresis and normal action potential studies.

Front 42

Fever and confusion (viral encephalitis)

Back 42

HSV (acyclovir)

PCR, MRI

Front 43

MOA of botulism

Back 43

Destroys neurotransmitter packaging

Front 44

Optic neuritis tx?

Chances of developing MS?

Back 44

IV methylprednisone works better than oral prednisone.

Chance is 75%

Front 45

IV Benzodiazepine (Lorazepam) initially for status epilepticus.

Phenytoin to reduce relapse.

Back 45

Tx for Status epilepticus

Front 46

Cushing response

Back 46

Expanding intracranial mass will produce elevated BP and slow heart rate.

Front 47

Tx. of glioblastoma multiforme

Back 47

Cranial radiotherapy.

Front 48

Acute ischemic stroke (<3 hours) tx

Back 48

rtPA

Front 49

Neurological complication of von Economo encephalitis

Back 49

parkinsonism

Front 50

What cranial nerve problem is seen with sarcoidosis?

Back 50

Facial nerve

Front 51

Viruses that attack the CNS

Back 51

SSPE, PML, kuru, HIV encephalomyellitis

Front 52

Virus that causes just motor neuron disease

Back 52

Polio. CSF shows increased protein, compared to Guillaine-barre

Front 53

Brazil, paralysis. large cysts containing numerous daughter cysts

Back 53

Schistoma mansoni. Due to granulomas crushing the cord

Front 54

Echinococcus

Back 54

From ingesting materials contaminated with fecal matter from sheep or dogs. Can cause cerebral lesions (encephalitis hydatidosis), leading to devt of major cyst of the brain, behaving like a tumor, can cause focal deficit.

Front 55

Meningitis emperic treatment

Back 55

Ceftriaxone + Vancomycin. Add ampicillin for Listeria.

Front 56

Quick degeneration of neurological function in 6-8 months

Back 56

CJD. No abnormalities will be seen on routine study. Occasionally with increase in the ratio of IgG to total protein, occasionally with oligoclonal bands. 14-3-3 proteinase inhibitor may be present.

Front 57

Recurrent meningitis

Back 57

CSF leaks.

Could leak through nose (rhinorrhea) or through ear (otorrhea).

Front 58

Infectious or malignant mass imaging?

Back 58

CT with contrast or MRI. Puncture should also be done only only after you know that there is no mass effect.

Front 59

Treatment for embolic stroke

Back 59

IV heparin.

Front 60

Ring enhancing lesions

Back 60

perform lumbar puncture and include CSF for EBV in tests ordered.

Front 61

Suspect aneurysm or vascular malformation

Back 61

Order cerebral angiogram.

Front 62

Treatment for PML

Back 62

None... HAART therapy

Front 63

Amebic meningoencephalitis

Back 63

Harmanella or Acanthamoeba. Enters through cribiform plate.

Mortal form found in Naegleria.

Front 64

Enters through skin

Back 64

Schistosomiasis cercarial phase enters through swimmer's skin.

Front 65

Microglaial nodules in the brain

Back 65

HIV (distributed around blood vessels)

and

CMV (distributed subial and subependymal)

Front 66

EEG ordered for encephalitis. What do you see?

Back 66

Bilateral, periodic epileptiform discharges

Due to early seizure in temporal lobe after infection (sometimes)

Front 67

Tx for B. bugdiferi

Back 67

Ceftriaxone

Front 68

Brain absecess develop by what means?

Back 68

Hematogenous spread. Starts at junction of grey and white matter. Around enlarging absess, there's usually large area of edema.

Front 69

What is a gumma???

Back 69

Granuloma-like lesion cause by spirochete infection.

They are avascular (as opposed to tumors)

Front 70

Rabies spread by???

Back 70

Saliva. Bite of head and face carries the greatest risk of fatal disease.

Front 71

Fungal absecess

Brain abscess in AIDS

Back 71

Aspergillus

Toxo. gondii

Front 72

Most common symptom in brain abscess

Back 72

Headache.

With entry into ventricles, it is usually fatal. Tx by surgical resection.

Front 73

Sources of abscess

Back 73

Both aerobic and anaerobic Strep are most common.

Staph is common in penetrating brain injury

Enteric bacteria (E. coli, proteus, pseudomonas) account for twice as many abscess as S. aureus

Front 74

Patient with stiff neck. MRI with contrast reveals rhomboencephalitis. CSF shows pleocytosis with no organisms. Cultures are negative. What is treatment?

Back 74

Picture of Listeria meningitis.

Tx with Ampicillin + Gentamicin.

Common in Renal transplant and chronic renal disease.

Front 75

Growth hormone treatment and patient has spongiform appearance

Back 75

CJD.

Also seen with dura matter grafts, and GH preparations from cadaver pituitary glands

Front 76

Inclusions in oligodendrocyte nuclei. Diagnosis made by MRI, showing multiple foccal well-defined white matter lesions that do not enhance or have mass effect.

Back 76

JC virus.

Deadly within just a few months.

Front 77

Patient develops problems with bladder control, unsteady gait and pain in legs. absent DTR, impaired vibrationsense in feet and positive Romberg, but patient can do rapidly alternating movement of feet

Back 77

Syphilis (Tabes dorsalis).

Leptomeningits can occur and posterior and dorsal columns are hit hard. Look for Argyll Robertson pupil and optic atrophy. Check glucose and HbA1c to eliminate diabetes, a common cause of impaired position sense.

Front 78

Small girl with rapidly deteriorating school performance, temper tantrums with little provocation. New intellectual deficits, CSF shows increased gamma-globulin fraction (like in MS)

Back 78

Suspect SSPE.

Front 79

New pet cat, confusion and seizures. MRI shows increased signal in pulvinar bilaterally

Back 79

Cat scratch disease

Front 80

Seizures, CT scan with contrast reveals cysts in frontal lobe, cystic lesions with nodular focus in left frontal region. Some enhance, some do not enhance with contrast

Back 80

Neurocysticercosis (Taenia solium).

Front 81

Most common primary brain tumor

Back 81

Astrocytoma (glial cell origin)

Front 82

Most common brain tumor in children

Most common brain tumor in adults

Back 82

Infratentorial (medulloblastoma, ependymoma, cerebellar gliomas)

Astrocytoma (Glio. multif)

Front 83

Which brain tumor causes hyperosity (thickening of bone)?

Back 83

Meningioma.

Most others cause thinning.

Front 84

Precocious puberty,

Back 84

Pineal region tumor is common for germ cell tumors (germinomas and choriocarcinomas)

Front 85

Multiple angiomatoses of the retina and cysts of the kidney and pancrease.

Back 85

VHL (hemangioblastoma common in brain). Hemangioblastomas are often multiple and become symptomatic by bleeding into themselves.

Front 86

Brain metastasis

Back 86

Mostly from lung. Others are breast, lung, kidney, skin, uterus. Worst prognosis is melanoma though, because of its likelihood to bleed

Seen mostly at gray-white junction.

Front 87

Worst complication of colloid cysts

Back 87

Transient or persistent obstruction of CSF. So shunt CSF, rather than try to excise cyst.

Front 88

9 year old girl with precocious puberty and poorly controlled seizures. Seizures preceeded by episodes of uncontrollable laughter

Back 88

Hypothalamic hamartoma.

Front 89

Mass in posterior fossa enlarges. What is a feared complication

Back 89

Transforaminal herniation can cause death.

If herniation were up, it is called transtentorial because it is across the tentorium cerebelli.

Front 90

Two tumors present in AIDS people

Back 90

Primary CNS tumor
Kaposi sarcoma.

Front 91

OPtics gliomas that can cause blindness

Back 91

NF-1

Front 92

Vestibular schwannoma, can cause tinnitus and hearing loss

Back 92

NF-2

Front 93

14 yo girl with headache and diplopia. Impaired upward gaze, lid retraction and convergence-retraction nystagmus. What tumor?

Back 93

Parinaud syndrome.

Pineocytoma (affecting region of pineal gland).

Other tumors appearing in the pineal gland area can have the same presentation. This is due to lesion in superior colliculus.

Front 94

Person with histry of lung cancer who presents with nausea, vomiting, becomes lethagic, disoriented and inattentive. Weak proximally and has diminished reflexes

Back 94

Hypercalcemia from PTHrP

Front 95

Patient with smoking history, with weak hip and shoulder weakeness. Weakness spares bulbar musculature and eyes. Increasing muscle strength with repetitive activity

Back 95

Lambert-Eaton syndrome.

Removing underlying tumor may be curative.

Front 96

Polyneuropathy in patient with back pain and plasma cell dyscrasias

Back 96

Can happen with Myesthenia Gravis.

Front 97

TaySacks

Back 97

Hexosaminidase A def.

Ganglioside storage disease. GM2 ganglioside accumulates

Front 98

Spasticity, head retraction, difficulty swallowing... Abnormal accumulation of glucoseylceramide. Will die in 3 years

Back 98

Gaucher disease (Beta glucosidase deficiency).

Front 99

Accumulation of trihexosylceramide.

Back 99

Fabry

Front 100

Galactosyl sulfatides accumulation

Back 100

Metachromatic leukodystrophy.

Front 101

Asterexis

Back 101

metabolic. Hepatic encephalopathy.

Front 102

Progressive chronic liver failure... Changes in what cells would you expect at time of death?

Back 102

Astrocytes

Increase in type II Alzheimer typer II astrocytes. Neuronal loss and focal necrosis is common.

With alcoholism, purkinje cells in cerebellum are lost.

Front 103

What can we observe in CSF protein content?

Back 103

Increase with hypertensive crisis.

Front 104

Neuropathy in renal problem

Back 104

Axonal degeneration, leading to peripheral neuropathy. Improves with dialysis.

Front 105

Restless leg at night

Restless leg in the day

Back 105

Restless leg syndrome, is associated with anemia, peripheral neuropathy and DM. Give clonazepam, L-Dopa, pramipexole/ropinirole, opiates.

Akathisia

Front 106

Treatment of peripheral neuropathy associated with dialysis

Back 106

Renal transplant

Front 107

Romberg sign seen in B12 deficiency is due to damage to what?

Which visual field cut is seen with B12 deficiency

Back 107

Spinal cord posterior columns

Centrocecal scotoma

Front 108

Should be administered to alcoholics before surgery to prevent neurologic problems when they wake up

Back 108

Thiamine.

Front 109

Good to prevent the malignant presentations of alcohol and benzodiazepine withdrawal.

Back 109

Chlordiazepoxide. This is a benzo itself.

Front 110

Chronic alcoholic and chronic smoker who develops optic nerve injury.

Back 110

Deficiency amblyopia

Due to combined effects of def of B1, B12 and riboflavin.

Front 111

What vitamin deficiency in a child can cause spinocerebellar degeneration, polyneuropathy, and pigmentary retinopathy?

Back 111

Vitamin E,

Most obvious symptom is most likely ataxia.

Front 112

9 month old from Ethiopia with sparse hair growth, edema in ankles, short in height, with some neuroproblems like transient tremors

Back 112

Think kwashiorkor

Front 113

Patient with chronic blood transfussion with neuro problems

Back 113

Girl, she probably got AIDS, Look for AIDS encephalopathy.

Front 114

Fat dude with sleep attacks.

Back 114

Pickwickan syndrome = Obesity associated hypersomia associated with sleep apnea.

Smoking increases the risk of this syndrome.

Front 115

What signs can be found in someone who is NOT immunocompromised and who has herpes encephalitis?

Back 115

Psychiatric. Dude be fighting with his wife, arguing with people and all confused. The organic basis becomes evident when the patient presents with seizure. Initial seizure is likely to be complex partial because of temporal lobe involvement.

Front 116

Post ictal state

Back 116

After trauma to head, seizure can happen soon. While asleep, seizure threshold is lower. When patient improves, it's called postictal state. Best to check for subdural hematomas.

Front 117

Damage to posterior spinal cord

Back 117

Areflexia, rather than hyporeflexia, seen in lower motor neuron disease.

Front 118

Damage to purkinje cells

Back 118

Ataxia.

Front 119

Fluid in cord

Back 119

Syringomyelia, common in Cervical area

Front 120

Spinal shock (commonly seen in spinal cord injuries)

Back 120

After damage to fibers from UMN. Initially flaccidity and areflexia happens, but then it evolves into hyperreflexia and spasticity within 3 days to 3 months.

Front 121

Winged scapula, what nerve?

Back 121

Long thoracic (serratus anterior; C5, C6, C7).

Front 122

Fracture of the vertebral body seen in MVA while wearing seat belt. What contributed to this?

Back 122

Flexion of the lumbar spine

Front 123

Contralateral loss of pain and temp

ipsilateral loss of proprioception and motor paralysis

Back 123

Brown-Sequard (hemisection) syndrome

Front 124

Bilateral spastic paralysis

Back 124

Complete transection.

Front 125

Dude injured cervical spine in swimming pool. After initial sever quadriparesis, there is recovery of much motor function over several weeks, What will you find in patient 12 months from now?

Back 125

Spastic paralysis

Front 126

Impaired joint proprioception is due to dysfunction of neurons that decussate at what level?

Back 126

Medulla.

Fibers from leg travel in medial fasciculus gracilis. Those from arms and neck travel laterally in fasciculus cuneatus. These then synapse in medulla. Second order then goes from there and decussate at the internal arcuate fibers and ascend in the medial lemniscus and synapse in VPL of thalamus, the next one then goes to somatosensory cortex.

Front 127

Bilateral leg weakness, dilated abdominal aorta with normal thoracic aorta

Back 127

Syphylis

Front 128

What artery is implicated when person has preserved joint proprioception, bilateral lower extermity weakness without cranial nerve or mental status findings

Back 128

Anterior spinal artery

Front 129

This artery may supply the lower 2/3 of the spinal cord. Artery of Adamkiewicz enters the cord at what level?

Back 129

T10 to L1.

Other branches of the aorta or internal iliac arteries may also supply the thoracic and lumbar cords.

Front 130

Spinothalamic lesion

Back 130

Loss of pain and temperature seen 1 or 2 levels below the lesion

Front 131

Sensory dermatome for periumbilical area?

Back 131

T10

Front 132

Atrophy of dorsal interosseous muscle

Back 132

C8 to T1. The first dorsal interosseous muscle is innervated by the ulnar nerve, hence C8-T1.

Front 133

After cervical contusion, cyst formation may occur as damaged tissue is removed.

Back 133

Syringomyelia.

Ischemic damage may produce the same presentation

Front 134

What do you do when 19 yo returns from Puerto Rico after swimming in pond and has paraplegia and neurological decline (in terms of spinal cord) and later then develops bladder dysfunction etc

Back 134

MRI

Front 135

Granuloma in spinal cord

Ovum in spinal cord

Back 135

T. pallidum

S. mansoni (brazil) and S. japonicum (puerto rico). Give praziquantel.

Front 136

Describe the path of the lateral corticospinal tract...

Back 136

Begins in precentral gyrus (primary motor cortex), then travels in posterior limb of the internal capsule and then the middle section of the cerebral peduncle. down through the basal pons and into pyramids of medulla. At junction of medulla and spinal cord, then decussates and goes down spinal cord.

Front 137

In which artery is ischemia most common?

Back 137

Anterior spinal artery. Posterior spinal artery is more of a plexus of arteries with extensive anastomoses.

Anterior does pain and temp, two point discrimination and graphesthesia.

Posterior column does position and vibration.

Front 138

Pain and weakness with exertion

X-ray of spine reveals no abnormalities (rules out spondylolisthesis and spondylolysis).

Back 138

Spinal claudication.

With exertion, blood that would be available to the spinal cord under resting conditions is shunted to the more patent blood vessels of the limb muscles.

Front 139

With spinal cord infarction, just like with cerebral infarction, CSF is relatively normal. Any abnormality will most likely be what?

Back 139

Increase in CSF protein (gamma globulin would not be increased like MS though).

Front 140

Normal Rhinne test (patient can hear sound after you take it off mastoid process) but patient came in with hearing degeneration.

Back 140

Middle ear deafness is not present.

If the person is old, most likely presbycusis (spiral ganglion neurons of cochlea of ear problem)

Front 141

Conductive hearing loss

Back 141

Sound waves conducted effectively to cochlear through the bones of the skull than through the air and along the pathway that starts at the external auditory meatus.

Front 142

Mastoiditis can extend supratentorially into the temporal lobe or infratentorially into the cerebellum.

Back 142

Cerebellar involvement will cause ataxia, vertigo, nausea, vomitting etc

Temporal lobe extension causes fluent aphasia by damaging the Wernicke area.

Surgical removal of abscess is essential.

Front 143

Hearing loss in explosions

Back 143

High tone sensorineural loss (due to acoustic trauma) due to damage to cochlear

Perforation of eardrum gives high tone conductive loss.

Front 144

Cerebellar damage leading to vertigo

Back 144

Due to damage to PICA.

medial branches supply the vestibular nuclei, leading to vertigo.

Cerebellar flocculonodular lobule injury may also induce vertigo.

Front 145

Vertigo on head rotation

Back 145

Due to insufficiency or atherosclerotic disease, flow through the vertebrobasilar system may be transiently reduced. Rule out cerebellar tumor first though.

Front 146

Diabetic dude with vertigo. Which medication is he on?

Back 146

ASA (aspirin), as well as alcohol, quinine, aminoglycosides.

Stops symptoms of vertigo: promethazine, dimenhydrinate and meclizine.

Front 147

Most common tumor with NF

Back 147

Neurofibromas

Front 148

Seen in puberty/adulthood, anosmia and hypogonadism. Anosmia usually neglected that's why.

Back 148

Kallman syndrome (it's congenital, not acquired).

Front 149

Anosmia in MVA.

Back 149

Due to sheering force that severs the filaments of the receptor cells as they cross the cribiform plate, person fit get anosmia.

Front 150

Unilateral anosmia + Ipsilateral optic atrophy + Contrallateral papilledema

Back 150

Olfactory groove meningioma (Foster Kennedy syndrome).

Front 151

BPPV/BPV

Put patient at 45 degrees and turn head to affected side, you will see rotational nystagmus with latency of up to 40 seconds.

Caused by calcified otholithic material

Back 151

Recurrent attack of rotational vertigo as head position changes. Diagnosed by Nylan-Barany or Hallpike maneuver confirms that it is due to preipheral cause of vestibulopathy rather than central cause affecting brainstem

Front 152

Fullness of ear, tinutus, hearing loss and severe vertigo

Back 152

Meniere disesase.

Increase in the endolymph fluid volume

Front 153

Progressive vertigo, ataxia, sensory loss, dysphagia, hiccups

Back 153

Vertebral artery occlusion.

Front 154

Lung cancer, Proximal muscle weakness

Back 154

Dermatomyositis

Front 155

Person with ALS need?

Back 155

Chest physical therapy (conscientious pulmonary toilet).

Front 156

Adenoma Sebaceum + Shagreen patches

Back 156

Tuberous sclerosis.

Front 157

Telangiectasis + Ataxia

Back 157

Ataxia telangiectasia

Front 158

For a female child to have DMD, she must have what?

Back 158

Turner syndrome (XO)... think about the parents

Men with DMD do not reproduce because they die before they get there (or too impaired after adolesce to mate).

Intellecual function is slightly impaired in DMD.

Front 159

Baldness, Testicular atrophy, cataract

Back 159

Myotonic dystrophy:

EMG shows "dive bomber pattern"

Cardiac defect requires pacemaker.

Front 160

Diagnosis of anterior horn damage

Back 160

EMG and NCS (fibrillation)

Front 161

Atrophy of muscle fibers supplied by damaged neuron or atrophy of neuron. Some of them recover if innervated by adjacent neurons that have not been damaged.

Back 161

Denervation atrophy

Front 162

In ALS, which cranial nerve group denervation has the worst prognosis?

Back 162

The cranial nerves.

eg tongue, difficulty swallowing, with recurrent aspiration etc.

Front 163

When stroke patient comes in, what do you do first?

Back 163

Order head CT

Front 164

What to order with Cerebral aneurysm

Back 164

Cerebral angio.

Front 165

Pure motor deficits

Back 165

Posterior limb of internal capsule problem

Front 166

Purely sensory deficit

Back 166

Thalamus

Front 167

Lateral medulla infarction (including the nucleus and descending tracts of CN5 causing ipsilateral loss of pain and temp and impairment of corneal reflex). Ipsilateral ataxia, ipsilateral Horner syndrome

Back 167

Wallenberg/ Lateral medullary syndrome (Vertebral artery occlusion)

Front 168

Lobar hemorrhage in elderly patients without hypertension.

Back 168

Amyloid angiopathy, leads to dysruption of blood vessel, leading to hemorrage. You will see hemosiderin etc.

Front 169

Look at CSF for mycotic aneurysm

Back 169

Mycotic aneurysms can cause bleeding during exertion, like during sexual intercourse or defecation. CSF will be xanthochromic.

Front 170

Seizure in hemorrhagic stroke

Back 170

Tx seizure with Levetiracetam

Lamotrigine can cause rash, so you should titrate it slowly... SO use the other one.

Front 171

Weakness after seizure activity.

Back 171

Todd paralysis/ Postictal weakness

It does not suggest bleeding or new areas of cerebrocortical damage. Do CT to rule these out though.

Front 172

Leptomeningeal angioma, mental retardation, skin coloration in trigerminal distribution.

Back 172

Sturge Weber syndrome.

Front 173

Occulomotor involvement. Which artery

Back 173

Posterior communicating artery aneurysm.

Front 174

Ipsilateral transient monocular blindness (amaurosis fugax) and contralateral TIA

Back 174

Do doppler ultrasound of carotid arteries (to check for carotid stenosis). Because there is a high likelihood of developing stroke after TIA.

Front 175

Transient monocular blindness in carotid artery disease is embolism to the central retinal artery or one of its branches.

Back 175

Could be due to cholesterol emboli

Front 176

What can prevent a future stroke in someone after stenosis

Back 176

Carotid endarterectomy. Give aspirin after.

Front 177

Damage to FEF on left

Back 177

You look to the left

Front 178

Comprehension and repetition preserved, but speech on its own is impaireed

Back 178

Transcortical motor aphasia (similar to Broca aphasia, but with the exception of preserved repetition.

Front 179

Similar to Wernicke aphasia, but repetition is preserved.

Back 179

Transcortical sensory aphasia.

Prognosis for improvement is better than Wernicke.