543 - Block Exam 1 (Neuro) Questions

Which condition is characterized by electric shock like pains of the face that may be triggered by chewing/brushing teeth?

Trigeminal neuralgia

Which CN is compressed in trigeminal neuralgia?

CN V (V2, V3)

3 multiple choice options

What is the 1st line tx for trigeminal neuralgia?

Carbamazepine

3 multiple choice options

Which condition is characterized by unilateral, facial paralysis and weakness in CN VII?

Bell's Palsy

3 multiple choice options

What is the most common cause of Bell's Palsy?

HSV

3 multiple choice options

Which of the following is NOT a typical physical exam finding in Bell's Palsy?

Shock/stabbing pains

3 multiple choice options

What is the 1st line tx for Bell's Palsy?

Prednisone

3 multiple choice options

What is the most common type of headache?

tension HA

3 multiple choice options

Which HA is characterized by non-pulsatile (bilateral) band distribution with no focal neuro sx?

Tension HA

2 multiple choice options

Which type of migraine typically presents with an aura?

Classic

1 multiple choice option

What is the first line imaging modality for migraines?

CT

3 multiple choice options

Which type of HA is characterized by a sudden onset of severe unilateral, periorbital or temporal pain which lasts less than 2 hours and spontaneously resolves?

Cluster HA

2 multiple choice options

What is the 1st line tx for Cluster HA?

O2

3 multiple choice options

What is the MC cause of viral meningitis?

HSV 2

3 multiple choice options

Which two imaging studies must be performed on pts suspected to have meningitis (bacterial and viral)?

LP & CT

3 multiple choice options

An LP has been performed on a pt you suspect has meningitis. The results below lead you to suspect that the pt has ____________ meningitis:

cell count: < 2,000 lymphocytes

glucose: normal

protein: < 150

Viral

2 multiple choice options

An LP has been performed on a pt you suspect has meningitis. The results below lead you to suspect that the pt has ____________ meningitis:

cell count: > 1000 - 2000 neutrophils

glucose: < 45 (low)

protein: > 250

Bacterial

2 multiple choice options

What is the tx for viral meningitis?

ampicillin + ceftriaxone + acyclovir

3 multiple choice options

What is the MC overall cause of bacterial meningitis?

Strep Pneumonia

3 multiple choice options

What is the MC cause of bacterial meningitis in children?

H. influenza

2 multiple choice options

What is the MC cause of bacterial meningitis in neonates?

Group B strep

2 multiple choice options

What is the "triad" that is most associated with bacterial meningitis?

fever, HA + AMS, nuchal rigidity

3 multiple choice options

Which two signs are typically observed in a pt with meningitis?

Brudzinski's & Kernigs

3 multiple choice options

What is Brudzinski's sign?

Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

1 multiple choice option

What is Kernig's sign?

After flexing the hip and knee at 90 degree angles, pain and resistance are noted.

1 multiple choice option

What is the tx for bacterial meningitis in pts ages 0-4 weeks?

ampicillin + cefotaxime

3 multiple choice options

What is the tx for bacterial meningitis in pts ages 1 mo - 50 YO?

vanco + ceftriaxone

2 multiple choice options

What is the tx for bacterial meningitis in pts 50 +?

vanco + ampicillin + ceftriaxone

2 multiple choice options

Which condition is characterized by focal purulent collection in brain parenchyma?

brain abscess

3 multiple choice options

What is the MC cause of brain abscesses?

streptococcus

3 multiple choice options

What is the MC complaint in pts w/ brain abscesses?

HA

3 multiple choice options

What is the imaging study of choice for brain abscesses?

MRI brain

2 multiple choice options

What is the tx for brain abscesses?

neurosurgical aspiration + ceftriaxone

3 multiple choice options

Which condition is characterized by dilation of the cerebral ventricles w/ normal opening pressures on LP due to impaired CSF absorption after CNS injuries?

normal pressure hydrocephalus

2 multiple choice options

Which disease is characterized by a triad of dementia, disturbed gait, and urinary incontinence (wacky, wobbly & wet)?

normal pressure hydrocephalus

What is the tx of choice for normal pressure hydrocephalus?

ventriculoperitoneal shunt

What is the MC cause of encephalitis in adults & peds?

HSV 2

3 multiple choice options

What is the MC cause of encephalitis in neonates?

HSV 1

3 multiple choice options

Which of the following are NOT typical physical exam findings in a pt with encephalitis?

hydrophobia

3 multiple choice options

Which two tests must be performed in a pt with encephalitis?

LP & MRI

What findings may be seen in an MRI in a pt with encephalitis?

cortical blurring

What is the tx for encephalitis?

acyclovir

3 multiple choice options

Which disease is defined as a neurodegenerative disease which results in idiopathic dopamine depletion and is typically associated with a stooped posture and shuffling gait?

Parkinson's disease

3 multiple choice options

Which disease is believed to have a genetic autosomal dominant link to the LRRK2/SNCA gene?

Parkinson's disease

3 multiple choice options

Which of the following is NOT part of the Parkinson's disease triad?

aphasia

3 multiple choice options

What are the hallmark findings in Parkinson's disease?

-loss of pigmented dopaminergic neurons of substantia nigra pars compacta

- (+) Lewy bodies

What is the tx for Parkinson's disease?

levodopa-carbidopa

3 multiple choice options

Which disease is an incurable, adult-onset inherited disorder that is associated with a defective CAG gene (autosomal dominant)?

Huntington's disease

3 multiple choice options

Which disease is most associated with the triad below?

↳ behavioral disturbances

↳ extrapyramidal movement

↳ dementia

Huntington's disease

3 multiple choice options

What is the dx test for Huntington's disease?

genetic testing (CAG allele)

2 multiple choice options

Which condition is associated with a tremor that worsens w/ intentional movement (stress) and improves w/ small amount of EtOH & rest?

Essential tremor

3 multiple choice options

If needed, what is the 1st line tx for essential tremors?

propanolol

3 multiple choice options

Which neuro disorder is manifested by sudden, brief, intermittent motor and phonic tics?

Tourette syndrome

What are the hallmark clinical manifestations of Tourette's syndrome?

tics

3 multiple choice options

What is the 1st line tx for Tourette's?

habit reversal

2 multiple choice options

Which condition is suspected in a pt with childhood exposure to dx head CTs?

meningioma

3 multiple choice options

What is the imaging study of choice for meningiomas?

MRI brain w/ & w/o contrast

3 multiple choice options

Which condition is defined as the buildup of blood vessels IN skin/internal organs?

hemangioma

3 multiple choice options

Which condition is defined as growth from stromal cells in the blood vessel lining?

hemangioblastoma

3 multiple choice options

Which disease is most associated with Von Hippel-Lindau disease?

hemangioblastoma

3 multiple choice options

Where are hemangiomas/hemangioblastomas typically found?

posterior fossa

Which disease is described as a benign tumor of astrocytes which originates in glial cells?

pilocytic astrocytoma

Which type of astrocytoma is low grade and slow growing?

diffuse

3 multiple choice options

Which type of astrocytoma is described as ventricular tumors associated with/ tuberculosis sclerosis?

subependymal giant cell

3 multiple choice options

What is the study of choice for grade I & II astrocytomas?

MRI w/ & without contrast (non-enhancing)

3 multiple choice options

What is the study of choice for grade III & IV astrocytomas?

MRI w/ & without contrast (enhancing)

3 multiple choice options

Which astrocytoma histopathology may show sacs of fluid?

grade I

3 multiple choice options

Which astrocytoma histopathology may show microcyts?

grade II

3 multiple choice options

Which astrocytoma histopathology may show tentacle-like projections?

grade III

3 multiple choice options

Which astrocytoma histopathology may show cystic material & calcium deposits?

grade IV

3 multiple choice options

Which astrocytoma is considered to be the most malignant/lethal and most common primary brain tumor?

glioblastoma

3 multiple choice options

What is the imaging study of choice for glioblastomas?

MRI brain w/ & w/o contrast

3 multiple choice options

What may be seen on an MRI in a pt w/ glioblastomas?

butterfly gliomas

What may be seen on bx in a pt with glioblastoma?

malignant astrocytes + necrotizing hemorrhagic center

What tumor is described as an embryonal tumor originating from fetal brain cells and is also considered to be the MC malignant peds brain tumor?

medulloblastoma

3 multiple choice options

Defective WNT and SHH proteins are most associated with:

medulloblastoma

3 multiple choice options

Which condition is the MC primary ocular cancer in peds?

retinoblastoma

2 multiple choice options

A pt with retinoblastoma that has a genetic etiology will have a:

germline RB1 gene mutation

3 multiple choice options

A pt with retinoblastoma that has a nongenetic etiology will have a:

somatic RB1 gene mutation

3 multiple choice options

What is the MC initial presentation/complaint in a pt with retinoblastoma?

leukocoria

What may be see on bx in a pt with retinoblastoma?

Flexner-Wintersteiner Rosettes

What is the 1st line tx for retinoblastoma?

focal techniques

Which tumor is most commonly found in white matter and brain cortex?

oligodendroglioma

3 multiple choice options

Where are oligodendrogliomas MC found?

frontal & temporal lobe

3 multiple choice options

Abnormalities in which chromosomes may result in oligodendrogliomas?

1p & 19q

What may be found on bx in a pt with oligodendrogliomas?

fried-egg appearance/chicken wire vessels

What is the imaging study of choice for oligodendrogliomas?

MRI brain w/ & w/o contrast

3 multiple choice options

What is the standard and initial tx for oligodendrogliomas?

surgical resection

Ependymomas are MC in:

children

3 multiple choice options

Where are ependymomas typically found?

4th ventricle, spinal cord, & medulla

3 multiple choice options

Which type of ependymoma is MC in peds?

supratentorial

3 multiple choice options

Which type of ependymoma is MC in adults?

infratentorial

3 multiple choice options

What may be seen on bx in a pt with ependymoma?

pervascular pseudorosettes

What is the mainstay tx for ependymoma?

surgical resection & adjuvant RT

Which virus is present in 90% of cases in CNS lymphoma?

EBV

3 multiple choice options

What is the MC clinical manifestation of CNS lymphoma in an immunocompetent pt?

focal sx indicative of mass lesion

3 multiple choice options

What is the MC clinical manifestation of CNS lymphoma in an immunocompromised pt?

encephalopathy

3 multiple choice options

What is the 1st line tx for a pt with CNS lymphoma?

methotrexate + folinic acid

What is the MC intracranial malignancy in adults and is MC found at the gray-white matter junction?

metastatic brain cancer

2 multiple choice options

Which condition is described as an ACUTE, abrupt, transient confused state and typically has an identifiable cause?

delirium

3 multiple choice options