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Brain Tumors
Headache
Localize the Lesion
Neurological Exam
Miscellaneous
100
Name a risk factor for development of meningioma
What is radiation therapy
100
Name the three most common primary headache syndromes in the order of most prevalent to least prevalent
What is Tension type, migraine and cluster
100
35 y/o female complains of 6 months of tingling and numbness in her 2nd and 3rd right digit. The symptoms are worse at night. She is dropping objects sometimes from the hand. She denies neck pain or trauma. On examination, she has normal strength in her right hand and right arm with some decreased pin sensation in the 2nd and 3rd digits. When you tap on the volar aspect of her wrist with your reflex hammer, it makes the symptoms worse. Where is the lesion?
What is the right median nerve (Carpal tunnel syndrome)
100
What is indicated by 4+ reflexes
What is presence of clonus
100
What is the treatment for cluster headache?
What is 100% oxygen. Also can use triptans
200
Brain cells are divided into Neurons and Glia. What are 2 types of Glial Cells?
There are three types of glial cells: Astrocytes, oligodendrocytes or microglia
200
Name 5 defining features to make the diagnosis of common migraine
Common migraine has the following features: unilateral location, duration 4-72 hours, pulsatile quality, moderate to severe pain, worsened by exercise, associated with nausea, photophobia and phonophobia. Tension type headache, is more often bilateral, non-pulsatile, mild to moderate in severity, not worsened by exercise.
200
40 y/o male with history of tobacco abuse who presents with sudden onset vision loss. On the examination, you find that he has a right homonymous hemianopia. Where is the lesion?
Left Occipital Lobe
200
Name three categories of testing of the mental status
What is level of alertness, language, memory Orientation is included in memory testing. Also acceptable answers: calculations,spatial reasoning, attention
200
Name 3 of the top 5 tumors that metastasize to the brain
What are Lung, breast, colon, renalcell carcinoma and melanoma
300
Meningeal spread of a tumor can present with what finding?
What is multiple cranial neuropathies, radiculopathies or a cauda equina syndrome
300
A 25 y/o female started having migraine headache at menarche. They have increased in frequency and intensity over the years and she currently has 4-5 headaches each week. She takes an ibuprofen each time with variable degree of relief from her symptoms. She has a normal neurological exam, with no red flags. What is the first step in the management of this patient's headache condition?
Needs to stop overusing NSAID medications which is causing medication overuse headache
300
26 y/o female comes to OPD complaining of painful loss of vision. She states that her left eye hurts when she moves it. Her right eye is normal. On examination, she has a relative afferent pupillary defect on the left and blurring of the optic disc margin on fundoscopic exam. On her visual field exam she has an area of loss of vision in a circular shape in the center of her visual field (central scotoma). Where is the lesion?
What is Left Optic Nerve. A visual defect that affects only one eye must be in front of the optic chiasm. A history of pain with eye movement and an exam with a relative afferent pupillary defect is typical for an optic neuritis.
300
A cranial nerve palsy in which cranial nerve would cause Ptosis?
What is the Oculomotor Nerve, CN III
300
This disease is characterized by progressive motor weakness, dysphagia, dysarthria, respiratory failure, prominent fasciculations and a combination of upper motor neuron and lower motor neuron signs on examination
What is Motor Neuron Disease (amytrophic lateral sclerosis). The combination of upper motor neuron and lower motor neuron findings are unique.
400
If primary CNS lymphoma is SUSPECTED (not yet proven) in an AIDS patient, what treatment should be provided?
Toxoplasmosis treatment should be completed, or Antibodies against toxoplasma should be tested to rule out this diagnosis. If CNS lymphoma is confirmed, the treatment is methotrexate and antiretrovirals.
400
Name 2 medications (with Level A or Level B evidence) which can be used for prophylaxis for migraine
The following are some meds which have Level A or B evidence for prophylaxis of migraine: Depakote, propranolol, topiramate, metoprolol, timolol, amitryptyline
400
65 y/o female with history of atrial fibrillation presents with new onset Right hemiplegia, Leg> Arm and Face weakness, aphasia, incontinence, Abulia (loss of motivation). What is the most likely location and vascular territory effected, assuming this was a stroke?
What is Left frontal lobe in the vascular territory of the Left Anterior cerebral artery
400
Name 3 possible features in the motor exam in a patient witha lower motor neuron lesion?
What are atrophy, fasciculations, flaccid tone and hyporeflexia.
400
What is the definition of allodynia?
A sensation of pain caused from a non-painful stimulus. This can be seen in neuropathy (bed sheets touching feet causes pain), migraine headache (lightly touching skin on side of headache causes pain), etc
500
When describing the typical location of metastatic lesions to the brain, this term is used
What is the "grey-white junction" - where the grey matter and white matter meet in the brain. In this area, blood vessels tend to taper in diameter and tumor cells collect from hematogenous spread of the primary neoplasm.
500
What are the 3 treatments for idiopathic intracranial hypertension (pseudotumor cerebri)
What is Weight loss, acetazolamide, and CSF drainage (either by large volume lumbar puncture of CSF shunt)
500
50 y/o male presents with worsening weakness and sensory loss in his legs. He states that the sensory changes started first in his toes and then ascended. The weakness in his legs came later. On exam, he has intact pin and temperature, however, he has severely decreased vibration and position sense. You check his reflexes and he has brisk reflexes in the lower limbs compared to the upper. Where is the lesion?
This is a complex question. The ascending numbness and tingling which started in the toes is suggestive of a length-dependent peripheral neuropathy. One should expect decreased reflexes with this pathology. However, the patient has increased reflexes. Therefore, he may have a combination of myelopathy (to explain the upper motor neuron sign of hyperreflexia) and peripheral neuropathy. A presentation like this can be caused by severe B12 deficiency.
500
Please demonstrate a positive Pronator Drift test for weakness
The patient extends arms in front with palms toward the ceiling and fingers spread open. When the patient closes eyes, the weak upper limb will have pronation. If the whole limb falls down this is NOT positive. A positive pronator drift test indicates mild weakness.
500
This is a movement disorder characterized by prolonged involuntary contraction of a muscle sometimes associated with abnormal postures
What is Dystonia.