Neuroanatomy
60 yo R-handed Male, getting lost, only writes on right half of paper. Left-sided hemineglect. Where is the lesion? (10x)
Right parietal lobe
DA release in what structure represents common final event associated with reinforcing effects of opiates, cocaine, amphetamines, nicotine, PCP, and alcohol? (5x)
NUCLEUS ACCUMBENS
Severe occipital HA, b/l papilledema, no other abnormalities. Chronic acne treated with isotretinoin. Lumbar puncture elevated opening pressure with no cells, 62 mg/dl glucose, and 22mg/dl protein. CT is normal. Dx? (8x)
Pseudotumor cerebri
62M w/ DM not making sense, saying “Thar szing is phrumper zu stalking." Normal intonation but no one in the family can understand it. Verbally responds to Qs w/ similar utterances but fails to successfully execute any instruction. Dx? (8x)
Wernicke's aphasia
35M awakens frequently in the middle of night with severe HAs, which sometimes occur nightly and lasts approx 1-2 hrs, so severe that pt is afraid to go to sleep, located around L eye and associated w/ lacrimation, ptosis, & miosis. Likely dx? (16x)
Cluster Headache
66 year old with HTN develops vertigo, diplopia, nausea, vomiting, hiccups, left face numbness, nystagmus, hoarseness, ataxia of limbs, staggering gait, and a tendency to fall to the left. What is the diagnosis? (8x)
Lateral Medullary Stroke
In addiction, dopaminergic neurons project to the nucleus accumbens. Cell bodies of these neurons reside in which area of the brain? (3x)
Ventral tegmental area
79 yo w/ a deteriorating mental state over a 3 week period has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the patient. Myoclonic jerks present. Dx? (5x)
Spongiform Encephalopathy
65M w/ 6 month h/o confusion episodes, disorientation, VHs of children playing in his room. VH are fully formed, colorful, vivid and patient has little insight into their nature. No AH. Wife says he is normal between episodes. Exam: Normal language, memory, moderate difficulty w/ trails test, mild difficulty with serial subtractions, mild symmetric rigidity and bradykinesia. Brain MRI unremarkable. CSF, routine labs and UDS normal. Dx? (8x)
Lewy Body Dementia
Abortive tx of common migraines is best achieved w/ which med? (8x)
Rizatriptan
26 year old with headache and right-hand clumsiness for weeks. Exam shows difficulty with rapid alternating movements of the hand, overt intention tremor on finger-to-nose, and mildly dysmetric finger tapping. CNS intact and no papilledoema. Where will damage show on MRI? (5x)
Cerebellum
Visual problem in pituitary tumor compressing optic chiasm: (10x)
Bitemporal hemianopsia
Patient presents with a slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilloedema or headaches are reported. Likely dx? (4x)
NORMAL PRESSURE HYDROCEPHALUS
When combined with functional neuroimaging, which biomarker is most likely to identify those geriatric patients w/ mild cognitive impairment most at risk for developing Alzheimer’s? (7x)
E-4 APOLIPOPROTEIN E ALLELE
Young pt with new onset severe HAs associated w/ periods of visual obscuration. Neuro exam normal except for papilledema. MRI: normal and shows no mass effect. Next test? (8x)
Lumbar puncture to assess pressure
78 yo had ischemic stroke that left him with a residual mild hemiplegia. Pt appeared to be unaware that there was a problem of weakness on 1 side of his body. When asked to raise the weak arm, the patient raised his normal arm. When the failure to raise his paralyzed arm was pointed out to him, he admitted that the arm was slightly weak. He also neglects the side of the body when dressing and grooming. He did not shave 1 side of his face, had difficulty putting a shirt on when it was turned insight out. Which area of the brain was likely affected by stroke? (4x)
Right parietal lobe
66 yo c/o frequent falls, several month hx of anxiety, unwillingness to leave home. On exam, mild impairment ot vertical gaze on smooth pursuit/saccades, mild axial rigidity & minimal rigidity of upper extremities, along w/ mild slowness of movement on finger tapping, hand opening & wrist opposition. Posture normal. Gait tentative/awkward, but w/o shuffling, ataxia, tremor. Patient is slow in arising from a chair. Most likely dx? (10x)
Progressive supranuclear palsy
65 yo patient fell several times past 6 mos. MSE nml. Smooth pursuit, saccadic movements impaired. Worse w/ vertical gaze. Full ROM w/ doll head maneuver. Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/labs unremarkable. Dx? (4x)
80 yo with VH and worsening gait, episodic confusion, fighting in sleep, bilateral rigidity, masked facies. Levodopa/carbidopa improved movement temporarily. Dx? (5x)
Lewy Body Dementia
A characteristic of post LP headache: (4x)
headache worse with sitting upright
Adult neurogenesis happens in which area of the brain? (4x)
Unsteady gait, appendicular ataxia in LE only and normal eye movement. Walks with lurching broad-based gait. Dx? (8x)
Cerebellar degeneration (alcoholic)
Patient w/ acute onset of pain and decreased vision in R eye. Colors look faded when viewed through the R eye. On exam, has a R afferent pupillary defect and swollen R optic disc. Patient spontaneously recovers over the next 6 wks. Likely to develop what later? (4x)
Which brain pathology associated w/ 69F w/ progressive behavioral changes, rudeness, interrupting conversations, watching excessive TV (turned off), large meals despite no hunger, stooped posture w/slow shuffling gait: amyloid deposition, dopamine depletion, intraneural tau deposits, ubiquitinated inclusions, alpha synuclein accumulation? (4x)
Intramural Tau deposits
Role of the hippocampus and parahippocampal gyrus (4x)
Declarative memory (facts)