Uncovered High-Yield Topics

Question 1

What does a normal CSF study look like?

Answer 1

• Opening pressure 5-20 cm water
• Glucose 50-80 mg/dL (or ~2/3 of serum glucose)
• Protein 15-40 mg/dL
• WBC < 3 (<30 in neonates)
• RBC < 5

Question 2

AIP vs Wilson’s disease

Answer 2

AIP is acute in onset while Wilson’s is gradual

AIP is associated with neuropathic sensations (abdominal pain w/o tenderness, tingling sensations) while Wilson’s is assocaited with movement disorders.

Question 3

Five P’s of AIP

Answer 3

• Painful abdomen (often confused for acute abdomen, leading to a belly full of scars)
• Purple urine (urine is colorless initially, but exposure to light causes PBG in urine to oxidize and gives urine its color).
• Peripheral neuropathy (patchy numbness and paresthesias)
• Psychological disturbances (anxiety, confusion, psychosis, dementia)
• Precipitated by drugs or dietary changes (drugs that enhance cytochrome P-450 activity, sulfa drugs, barbiturates, some antipsychotics, alcohol)

Question 4

Myotonic dystrophy

Answer 4

Question 6

Myotonia

Answer 6

Delayed muscle relaxation

Should make you think of myotonic dystrophy

Question 7

In whom should you use amitryptaline with caution?

Answer 7

1. Patients over age 65 (it has anticholinergic activity)
2. Patients on multiple other drugs that can cause serotonin syndrome

Question 8

Steroid psychosis

Answer 8

People on high dose steroids can have steroid-induced psychosis!

Little is known about underlying risk factors, but if someone develops new psychosis on high-dose steroids you should trial holding the steroids.

Question 9

Classic onset of ALS

Answer 9

• Dysphagia
• Dysarthria
• Tongue fasciculations
• Paradoxical breathing (expansion of abdomen on expiration rather than inspiration, caused by diaphragmatic weakness)

Question 10

Things that mess with anterior horn cells

Answer 10

• Heritable syndromes (spinal muscular atrophy)
• Lead poisoning
• Polio myelitis
• West Nile Virus myelitis

Question 11

Treatment of PCP intoxication

Answer 11

• Involves treatment of agitation and aggression
• Benzodiazepines

Question 12

Really, most parotid gland masses are benign. But, if they grow to involve ___, they are probably malignant.

Answer 12

Really, most parotid gland masses are benign. But, if they grow to involve the facial nerve, they are probably malignant.

Question 13

What diseases does a negative ANA likely exclude?

Answer 13

• SLE
• Scleroderma
• MCTD
  
  • The sensitivity for these diseases is quite high (>90%), but still not entirely perfect. Other diseases you really shouldn’t take a negative ANA into much consideration since it is closer to ~50% positivity

Question 14

Wilson’s disease pathophysiology

Answer 14

• Autosomal recessive disorder
  
  • Mutation in ATP7B, a transport protein
  • It is genetic!! Not just copper toxicity
• Characterized by the reduced excretion of copper into the bile secondary to a transport abnormality, leading to the pathologic accumulation of copper in the liver and other tissues, particularly the brain

Question 15

Copper chelators

Answer 15

• Penicillamine – pee out copper
• Trientine – poop out copper

Question 16

Delayed facial nerve palsy

Answer 16

Sometimes occurs after trauma to the head

Basically, the facial palsy does not develop until ~24-48 hours later, when the edema becomes more significant

When this occurs, it will be a complete facial nerve palsy, not an isolated lower facial nerve palsy. The latter should be concerning for epidural hemorrhage.

Question 17

Connection of the frontal eye field to the cranial nerves

Answer 17

Question 18

Chiari malformation

Answer 18

Type I: Cerebellum into the spinal cord

Type II: More cerebellum into the spinal cord, and a myelomeningocele

Question 19

COAT RACK for Wernicke’s and Korsakoff’s

Answer 19

Question 20

A lesion above the red nucleus leads to resting ___.

A lesion below the red nucleus leads to resting ___.

Answer 20

A lesion above the red nucleus leads to resting flexion.

A lesion below the red nucleus leads to resting extension.

Basically think of the red nucleus as sending out a default “extend” signal to the body, which is overridden by cortical input.

Question 21

Sign of diffuse axonal injury on CT

Answer 21

“Blurring of white-gray junction”

Question 22

Various temporal lobe functions

Answer 22

Question 23

Causes of Kluver-Bucy syndrome

Answer 23

Question 24

Presentation/Features of Kluver-Bucy syndrome

Answer 24

Question 25

What do the superior colliculi regulate?

What commonly damages them?

Answer 25

They regulate vertical gaze (superior/inferior)

They are commonly damaged in Parinaud syndrome

Question 26

Quick rule of thumb for HIV infections and CD4s

Answer 26

Question 27

Mnemonic for normal pressure hydrocephalus

Answer 27

"Wet, wild, wacky" Wet -- urinary incontinence Wild -- gait unsteadiness Wacky -- dementia

Question 28

Whipple's disease

Answer 28

* Mostly in males over age 40 * Intracellular gram + bacteria that stains on **PAS** * Clinical features: * Malabsorption + abd pain + **diarrhea** * **Arthritis** * **Movement symptoms** (ataxia, myoclonia, ophthalmoparesis) * Diagnosis: Small intestine biopsy with PAS staining (if GI symptoms present). PCR testing also available for GI or CSF samples. * Treatment: **IV ceftriaxone or penicillin for 2-4 weeks, then batrim for 1 year.**

Question 29

Transient global amnesia

Answer 29

* Presentation: **Abrupt onset, transient memory loss** following **psychological stress or vigorous exercise** * Amnesia is **anterograde, sometimes with partial retrograde** * By definition, takes **\< 24 hours to resolve****, and resolution is complete** * Diagnosis: **Clinical,** but EEG and MRI have associated findings and can rule out other etiologies * EEG: rule out epilepsy/simple partial seizure * **MRI: Shows focal hyperintensities in the hippocampi** * Treatment: None. Self-resolving. Sometimes may monitor for 24 hours if the diagnosis is in question.

Question 30

Two types of infection from Taenia sollium

Answer 30

* If acquired from ingestion of larva in raw pork: **Intestinal taeniasis** * May be asymptomatic * May present with GI upset or malabsorption (similar to trichinellosis or ascariasis) * If acquired from eggs in human faeces (ie, in someone who was infected with intestinal taeniasis): **Cysticercosis** * May manifest in several tissues * **Neurocysticercosis:** Headache, elevated ICP, FNDs, seizures. MRI w/ multiple ring-enhancing lesions (early stage). LP w/ eosinophilia. * **Ocular cysticercosis:** Subretinal cysts on ophthalmologic exam

Question 31

Waterhouse-Friderichsen syndrom

Answer 31

* An **endotoxin-triggered coaguolpathy** that may be induced by **Neisseria meningitidis** * Characterized by the purple, spotty **purpura** of N. meingitidis and **acute adrenal insufficiency** or **adrenal hemorrhage.**

Question 32

Treatment for cryptococcal meningitis

Answer 32

* Induction therapy with **amphotericin B + flucytosine** * Maintenance with **8 weeks of fluconazole**

Question 33

Uncal herniation syndrome (Garret)

Answer 33

Ipsilateral CN 3 palsy Contralateral paralysis Risk of ipsilateral PCA strokes -- The medial temporal lobe is squished against the midbrain

Question 34

Diffuse cerebral edema in cardiac collapse

Answer 34

Due to hypoxic injury

Question 35

Metabolic encephalopathies may precipitate \_\_\_

Answer 35

Metabolic encephalopathies may precipitate **diffuse cerebral edema**

Question 36

ICP ladder

Answer 36

* Head of bed at 30 degrees * Hyperventilation * Hypertonic saline / mannitol * Skull decompression * Therapeutic hypothermia

Question 37

Prophylactic hemicraniectomy

Answer 37

* If you have a patient with a large territory infarct, this may result in cerebral edema that can be life threatening * Hemicraniectomy may be performed to prevent life threatening herniation

Question 38

Right MCA language changes

Answer 38

* Prosody changes * Anomia * Paraphasic errors

Question 39

Treatment for neurocysticercosis

Answer 39

Praziquantel and Albendazole

Question 40

Area postrema syndrome

Answer 40

Subtype of neuromyelitis optica (NMO), hence anti-AQP4 will be present. Characterized by episodes of **intractable nausea, vomiting, and/or hiccups** MRI shows enhancement of *just* the area postrema, which is in the **dorsal medulla** just inferior to the cerebellum.