UWorld

Question 1

Absence - post seizure finding

Answer 1

automatisms

Question 2

Marfan syndrome vs homocysturia

Answer 2

Both: joint+skin hyperlaxity, tall, pectus deformity
Marfan: aortic root dilitation
Homocysturia: intellectual disability, thrombosis

Question 3

TBI pts - most common morbidity

Answer 3

Diffuse axonal damage at gray-white junction

Question 4

Myotonic dystrophy vs Duchenne and Becker

Answer 4

MD - Autosomal dominant, testicular atrophy, balding

D/B - X-linked Recessive

Question 5

Aminoglycoside toxicity

Answer 5

• hearing problems
• VOR can elicit vestibular problems from gentamicin
• pts can get oscillopsia (see objects moving around vision)

Question 6

lacunar stroke

Answer 6

provides blood to deep brain structures (ex: subcortical, lenticulostriae)

Question 7

Peripheral nerve compression can have intermittent symptoms

Answer 7

Peripheral nerve compression can have intermittent symptoms

Question 8

Pronator drift vs Romberg

Answer 8

• Palms up, if pronation occurs =
• UMN sign in pyramidal/corticospinal tracts

Romberg: stand with eyes closed, this tests posterior tracks and proprioception

Question 9

Absence seizure comorbidities

Answer 9

ADHD, anxiety

Question 10

Status epilepticus/continuous brain seizing - Cx

Answer 10

cortical laminar necrosis - due to chronic excitatory toxicity, leads to chronic neurologic deficits and more seizures

Question 11

Traumatic carotid injuries (internal carotid)

Answer 11

• sports, falls with toothbrush in mouth

- Sx: gradual oneste hemiplegia, aphasia, neck pain, “thunder-clap” headache

Question 12

“curtain descending over visual field”

Answer 12

amaurosis fugax - retinal ischemia from atherosclerotic emboli from ipsilateral carotid artery. Get a neck Doppler! (ICA)

Question 13

NF 1

Answer 13

• Auto-Dom
• Café-au-lait spots
• optic glioma
• neurofibroma
• lisch nodules
• freckles (axillary, inguinal)

Question 14

Multi-infarct dementia
vs
AD

Answer 14

Multi-infarct dementia = abrupt, step-wise deterioration in memory, strokes accumulate. *exec function worse than memory eary

AD = memory worse initially. poor speech = difficulty finding words. cognitive decline. Late findings: Neuropsych, lack of insight, non-cognitive neuro deficits: seizure, clonus

Question 15

Most common causes of syringomyelia:

Answer 15

• old spinal cord injuries, Arnold Chiari malformations

- symptoms develops months-years after initial injury and onset is gradual (why see hand muscle wasting)

Question 16

cervical spondylosis

Answer 16

• degenerative changes over the age of 40
• neck pain and stiffness are most common Sx
• may develop spinal stenosis –> neurologic deficits

Question 17

Posterior cord vs
Central cord vs
Anterior cord syndromes

Answer 17

Posterior cord - posterior columns/vibration/proprioception

Central anterior spinal cord - hyper extension injuries in elderly, or prior degeneration of cervical spine… results in corticospinal tracts for upper extremities, lateral spinothalamic tracts (legs would be fine)

Anterior cord - bilateral motor spastic paresis distal to the lesion (anterior spinal artery)

Question 18

Trihexyphenydil can cause acute angle-closure glaucoma

Answer 18

bc is an anti-cholinergic

Question 19

Brain tumors and differentiations:
craniopharyngioma
ependymoma
glioblastoma
medulloblastoma
neuroblastoma
pilocytic astrocytoma

Answer 19

craniopharyngioma - bitemporal hemianopsia
ependymoma - 4th ventricle, supratentorial
glioblastoma - cerebral hemispheres, seizures
medulloblastoma - cerebellar vermis, infratentorial
neuroblastoma - symp ganglion cells, from abd mass
pilocytic astrocytoma - #1 child tumor

Question 20

anterior vs posterior tumor locations

Answer 20

anterior - seizure, weakness, sensory changes

posterior - cerebellar dysfunction

Question 21

AD vs Vascular Dementia

Answer 21

AD - early short term memory loss, late personality changes

Vascular Dementia - step wise decline. abrupt decline in exec function. objective neurologic deficits (left hemiparesis, Romberg sign, pronator drift –> may suggest ischemic stroke on top of vascular dementia)

Question 22

Cerebral Palsy - Risk factors, Sx/Comorbidites

Answer 22

• Prenatal brain insults before 32 weeks gestation (most important factor–many things cause insults)
• spastic diplegia is commonly seen in toddlers (no leg use, use arms to crawl instead)
• Intellectual disability, epilepsy, strabismus, scoliosis

Question 23

Intraparenchymal hemorrhage -locations, desc order

Answer 23

• basal ganglia (putamen)(contralat hemiparesis/sensory loss, gaze preference)
• cerebellar nuclei (NO HEMIPARESIS!)
• thalamus (contra hemiparesis, eyes deviate towards)
• pons (Pinpoint* reactive pupils)
• cerebral cortex (Sx depends on location)

-gradual onset Sx (min-hr)

Question 24

Intraparenchymal hemorrhage vs embolic stroke

Answer 24

Intraparenchymal hemorrhage = will have focal findings that then progress to show increased ICP (vomiting)

Embolic stroke - abrupt and Sx are maximal from the start

Question 25

neurogenic claudication vs cauda equine vs vascular claudication/PVD

Answer 25

- neurogenic claudication = spinal stensosis, secondary to DJD --> worse Sx by spinal extension, relived by flexion (going uphill) *still painful when standing still* - cauda equine syndrome = saddle anesthesia, ANS sx - vascular claudication/PVD = worsened by walking, relived by standing still

Question 26

Greatest CVA risk factor

Answer 26

-having HTN (not sedentary lifestyle or Fhx)

Question 27

DiGeorge Syndrome - mnuemonic + neuro risk

Answer 27

- thymic aplasia (T cell deficiency) - hypocalcemia (no parathyroid development) - tetralogy of Fallot (PROVe) - neuro risk: from recurrent sinusitis -> brain abscess (triad: fever, nocturnal/morning headaches, neurologic findings)

Question 28

Pseudo dementia and MDD

Answer 28

Pseudo dementia and MDD

Question 29

Evaluation head trauma 2-18 yo

Answer 29

- no CT needed if only minor head trauma without other sx (vomiting) - otherwise, CT non-con

Question 30

Single vs multiple brain abscesses

Answer 30

``` Single = direct spread (otitis, sinusitis, dental infection) multiple = hematogenous spread (endocarditis, osteomyelitis) ```

Question 31

Most common single brain lesion species

Answer 31

- virdans streptococci, staph aureus - direct spread (otitis, sinusitis, dental infection) - focal brain lesion: enhancing with central necrosis

Question 32

Subacute Combined Degeneration

Answer 32

- B12 deficiency Cx - starts with dorsal/posterior tracts --> dec vib/proprio, then gait - Dz progression: cortico-spinal tract degeneration UMNs, spastic paresis, hyperreflexia - Other Cx: peripheral neuropathy, memory loss, dementia

Question 33

Example of how uncal herniation can occur

Answer 33

MVC -> Epidural hematoma -> uncal herniation -> CN 3 issues/hemiplegia and hemisensory loss

Question 34

Cushin's Reflex:

Answer 34

1 - HTN 2 - Bradycardia 3 - Respiratory depression

Question 35

vasovagal/neuro-mediated syncope vs | orthostatic hypotension

Answer 35

vasovagal syncope = prolonged standing, emotional stress, painful stimuli (prodromal Sx: warmth, nausea, diaphoresis) orthostatic syncope = postural changes

Question 36

MS - CSF

Answer 36

- Nrm opening pressure - Nrm cell count (inc T-cell) - Nrm total protein (IgG elevated) *Albuminocytologic dissociation = in GBS*

Question 37

Work up for distribution of weakness and numbness

Answer 37

- start with distribution - localize by muscle or reflex - localize further by dermatomal distribution

Question 38

Viral meningitis CSF -odd finding

Answer 38

protein is <100

Question 39

Tx for pseduotumor cerebri / IIH

Answer 39

Tx = Acetazolamide (inhibits CSF production via choroid plexus carbonic anhydrase) +/- furosemide (TX IS NOT MANNITOL!)(Mannitol is for severely obtunded pts/those with severe cerebral edema)

Question 40

Cushing Reflex

Answer 40

HTN, bradycardia, respiratory depression --> concerning for brainstem compression

Question 41

Intracranial HTN (pseudo tumor cerebri)

Answer 41

- Sx: can be HA, mental status changes, blurred vision - PEx: +/- papilledema - Tx: weight loss / acetazolamide

Question 42

Wernicke Encephalopathy vs alcohol cerebellar degeneration

Answer 42

- due to Thiamine deficiency-neuronal loss - Sx: gait ataxia, oculomotor dysfunction (horizontal nystagmus), encephalopathy - alcohol cerebellar degeneration: purkinje damage to cerebellar vermis. - Sx: slowly progressive ambulation difficulties (ex: wide-based gait)

Question 43

GTC pt no severe risk factors w/u algo:

Answer 43

1 - basic blood tests, check urine drug screen (rule out toxic/metabolic 1st) 2 - then, maybe get MRI for seizure