Circle of Thrillis
What are contraindications to tPA (Name 3)
This petechial rash is considered pathognomonic for meningitis caused by this specific Gram-negative diplococcus.
What is the pathogen?
What is Neisseria meningitidis?
A heritidary disorder which causes personality changes, choreiform movements, and progressive dementia
What is the most likely pathology for this disease?
What is the treatment of choice (name 1 drug)?
1. Huntington's autosomal dominant condition characterized by a trinucleotide repeat (CAG) in caudate nucleas
2. Tetrabenazine
Patient presents with weakness of SCM and lateral winging of scapula. Which cranial nerve is affected
What are the functions of the dorsal and spinothalamic tract?
Where do each decussate?
Dorsal Column: Fine Touch, Vibration, Conscious Proprioception --> decussate in medulla
Spinothalamic Tract: pain, temp, decussate in cord
An 81-year-old female presents with sudden onset 2/5 strength in the right lower extremity and 4/5 strength in the right upper extremity; the face is spared. What artery being affected?
What is a Left Anterior Cerebral Artery (ACA) Stroke?
Which hemodynamic findings distinguish POTS from vasovagal syncope?
An increase in heart rate 30 bpm upon standing WITHOUT a drop in blood pressure (absence of postural hypotension)
A 58-year-old female presents with burning pain, shiny skin, and diffuse edema 8 weeks after an ankle fracture, with pain noted to be significant to initial injury. This is the most appropriate next step in management?
What diagnostic test is best to evaluate this condition?
Progressive physical therapy and mobilization
NSAID / Prednisone / etc
bone density scan to show osteopenia / bone degeneration on effected side (early) Xray (later)
Abrupt onset of unilateral ear pain followed by an inability to wrinkle the forehead or fully close the eyelid on the same side.
Condition? Which nerve?
Treatment?
Bell's Palsy - CN VII
Tx: usually supportive but prednisone / antivirals if herpetic lesion in ear
During nerve condition studies, there was reduced nerve conduction velocity with preserved action potential amplitude.
What specific pathological process is indicated by this finding?
DEMYELINATING neuropathies cause a decreased nerve conduction velocity.
A 55-year-old male presents with the "worst headache of his life" , nuchal rigidity, and vomiting, but no focal neurologic deficits.
What is the diagnosis?
What pathology is this diagnosis most commonly associated with
Subarachnoid Hemorrhage?
Berry aneurysm
A 28-year-old female presents with acute onset of severe neck pain and a partial ptosis, meiosis, and anhidrosis after a chiropractic neck manipulation. What is the most likely diagnosis?
Carotid artery dissection
A brief "staring spell" in a child with no postictal state, then begins fiddling with close afterwards. An EEG shows bilateral, symmetric 3-Hz spike-and-wave activity
What is the most likely seizure type?
Absence seizure
A 48-year-old man presents with a 6-month history of progressive left-sided hearing loss, left ear tinnitus, and mild unsteadiness.
What is the most likely diagnosis?
Acoustic Neuroma
What are the brainstem reflexes (name at least 3) and what is needed for the diagnosis of brain death
Brainstem reflects: Gag, pupillary, corneal, dolls eye reflex, cold caloric reflex
• Comatose state
• Loss of brainstem reflexes demonstrated on 2 separate exams by special physician
• Loss of respiratory drive
A 71-year-old woman with a history of poorly controlled hypertension is brought to the emergency department 1 hour after the sudden onset of right facial drooping, severe right arm weakness, and loss of fluent speech. On initial evaluation:
What is this patient's Glasgow Coma Scale (GCS)
Which cerebral artery is most likely occluded?
11
Left middle cerebral artery
A 26-year-old overweight woman complains of daily, throbbing headaches that worsen when bending forward, along with "whooshing" sounds in her ears and double vision.
What is the most likely diagnosis?
What would CSF / imaging show?
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
Dx findings: increased opening pressure, empty sella turcica
The clinical tetrad of resting tremor, rigidity, akinesia/bradykinesia, and postural instability defines this pathology.
What is the condition? What is the clinical MOA of how this condition occurs?
Parkinsons / Parkinsonism - oxidative stress --> lewy body accumulate --> effect substantial nigra in basal ganglia --> dopamine decrease and Ach overactivity
On physical examination of an unconscious patient, gentle stimulation of the posterior pharynx fails to elicit a gag reflex on the left side, and the uvula deviates to the right side upon phonation.
Which cranial nerve is damaged, and on which side is the lesion located
Left Vagus nerve
deviates AWAY from lesion
A 52-year-old woman presents with a HA that occasionally wake her from sleep. Brain MRI with contrast reveals a well-circumscribed, extra-axial mass with homogeneous enhancement and a prominent "dural tail".
What is the most likely diagnosis?
Meningioma
** DOUBLE PTS***
A 40 year old woman fell down an entire flight of stairs into her basement, became confused and starting fighting EMTs on arrival. During transport to the trauma center, she briefly coherently answered questions, then later deteriorated on arrival.
What is the most likely diagnosis?
What would the CT findings show?
Which vessel was most likely lacerated?
1. Epidural hemotoma
2. convex hyper density that does NOT cross suture lines
3. middle meningeal artery
- Obtain CT scan of head
- Obtain LP
- Draw Blood Culture
- Administer ABX / Steroid / Antifungal
First-line pharmacotherapy for a patient with brief attacks of severe, stabbing, unilateral pain in the V2 and V3 distribution.
What is most common cause of this condition?
What condition may this hint at if onset is before 40 years of age?
trigeminal neuralgia - Carbamazepine
Compression of nerve due to anomalous artery or vein
may signal MS if before 40
A 28-year-old man presents to the clinic complaining of vertical diplopia (double vision) that is noticeably worse when he looks down. On ocular examination, his right eye is slightly elevated and extorted.
WHAT IS THE CORRECT MANUEVER THIS PATIENT DOES TO CORRECT THE NERVE PALSY (name palsy and maneuver)
TROCHLEAR NERVE IV -
corrective movement --> TILT HEAD LEFT - AWAY FROM AFFECTED SIDE to reduce diplopia
A survivor of a diving accident presents with bilateral loss of motor function and loss of pain and temperature sensation below the level of the lesion, but retains the ability to feel vibration and light touch.
Which syndrome is most likely?
Anterior Cord Syndrome