Neuropardy!

Anatomy

100

What are the names of the cranial nerves that control extraocular eye movements?

What is A) Optic nerve, oculomotor, abducens B) Trigeminal, trochlear, oculomotor C) Facial nerve, glossopharyngeal, spinal accessory D) Oculomotor, trochlear, abducens

200

Localize bitemporal hemianopsia

What is A.) Right optic nerve B.) Left superior occipital lobe C.) Optic chiasm D.) Right superior occipital lobe

300

49 year old Caucasian male with a past medical history of HTN, HLD, and eTOH abuse presents to the hospital confused. Initial exam patient is obtunded but non-focal, moving all extremities. VS 152/85, 112, 94% on RA, 98.3. Initial HCT shows NAP. Blood work reveals ALT 115, AST 225, ammonia 72, WBC 13.5, Na 110, BUN 35, Cr 1.2. Patient is admitted to medicine with correction of his metabolic derangement with routine consult to neurology. The following morning upon evaluation patient is now awake and alert but with flaccid quadriplegia. What is your next step?

What is A) Lumbar puncture B) Lactulose and IV fluids C) Obtaining a CMP, MRI of the brain D) MRI Cervical spine

400

62 year old patient with a history of atrial fibrillation, HTN, HLD, and CAD presents with acute onset diplopia, vertigo, dysphagia, and ataxia. On neurologic examination the patient is noted to have right sided ptosis with miosis, dysphonia, right UE dysmetria, right facial numbness to pain and pinprick, with left sided hemiparesis and loss of temperature. Localize the lesion

What is A) Right Lateral Medulla B) Left Medial Medulla C) Left Lateral Medulla D) Right Pons

500

Localize the lesion https://www.youtube.com/watch?v=_rXQmDZva8Y

What is: A.) Optic nerve B.) CN III C.) Right medial longitudinal fasciculus D.) Left medial longitudinal fasciculus

Stroke

100

72 year old RHD CC female with a history of atrial fibrillation not on anti-coagulation, HTN, HLD, DM presents with acute onset dysarthria and flaccid left hemiparesis. On exam VS 185/92, 110, 98%, 98.2. Exam demonstrates a decreased left NLF with dysarthria, 2/5 weakness left UE/LE with reduced reflexes and an extensor plantar response. HCT with NAP. Describe the stroke

What are: A.) Large vessel right hemispheric ischemic stroke B.) Small vessel right hemispheric hemorrhagic stroke C.) Small vessel right hemispheric ischemic stroke D.) Right cerebellar ischemic stroke

200

62 year old RHD male with a history of tobacco abuse and poorly controlled HTN presents with acute onset headache and flaccid right hemiparesis. HCT shows the following. What is your next step in management? PIC 1

What is: A.) IV tPA B.) Transfer for neurosurgical intervention C.) Allow permissive HTN and support blood pressure >185/110 D.) Blood pressure control, goal <140/90

300

73 yo male with a history of DM, HTN, and HLD presents with speech difficulty. On exam, patient is alert and awake with no obvious expressive dysphasia. He can follow commands without any difficulty. However, when asked to repeat questioning he has difficulty. No focal deficits. Localize the lesion.

What are: A.) Superior temporal lobe B.) Inferior frontal lobe C.) Arcuate fasciculus D.) Left parietal lobe E.) Right parietal lobe

400

65 yo female with a history of CAD, PAD, DM, CKD presents with acute onset vertigo, diplopia, and dysphagia. Symptom onset was within 1 hour. On exam, she receives an NIH of 2 for mild dysarthria with a decreased right nasolabial fold. She is hypertensive and vomiting, BP 205/92. HCT shows NAP. What is your next step in management?

What is: A.) IV tPA followed by STAT MRI of the brain and close ICU monitoring with neurosurgical consultation B.) Antivert, Zofran, aggressive BP control C.) Admit on stroke pathway, antiplatelet, statin, and ACE inhibitor D.) OMT

500

35 yo healthy female presents after a visit to her hairdresser with a severe headache and facial pain. On exam, she is hypertensive BP 182/95 but afebrile. Neurologically you see below. HCT with NAP. What is your next step in management? PIC

What is: A.) Aggressive BP control with migraine cocktail B.) MRI of the brain C.) CTA head and neck followed by anticoagulation D.) CTA head and neck followed by antiplatelet

Seizure & Infection

100

8 year old healthy female brought in for ADD evaluation. Family and teachers describe her as a "daydreamer" as she has multiple episodes during the day where she appears to be just staring off briefly with no associated tonic-clonic activity or postictal state. Neurologic exam is normal. You obtain an EEG as part of your workup which appears as below. What is the best treatment? PIC

What is: A.) Adderall B.) Zoloft C.) Ethosuximide D.) Dilantin

200

28 year old CC female with a history of juvenile myoclonic epilepsy is now 8 weeks pregnant. Seizures are well controlled on Depakote. Exam is normal. What is your next step in management?

What is: A.) Nothing she is doing well B.) D/C Depakote and change to Keppra. Add Folic acid 4mg daily C.) D/C Depakote and change to Topamax D.) Take off of all seizure medication due to risk of fetal defects

300

36 year old patient with Down's Syndrome and epilepsy presents from her ECF with 4 witnessed GTC seizures. She is maintained on Depakote 500mg BID. She is in the ED now unresponsive with a left gaze preference with nystagmus. No tonic-clonic movements. UA is positive for UTI. HCT with NAP. What is your next step in management?

What is: A.) Antibiotics, IV fluids, Ativan PRN B.) Ativan 2mg IVP followed by IV Depacon load 10-20mg/kg C.) MRI brain D.) Keppra 1gm IV load

400

82 year old nursing home patient presents with 1 day history worsening confusion. On exam, VS 165/82, 112, 100.3, 92% on RA. She is lethargic and confused, aphasic, unable to follow commands with no focal deficits. Labs show normal CMP, WBC 14.2, UA negative, CXR negative. HCT shows NAP. Which of the following statements is false?

What is: A.) 50% of untreated cases of herpes encephalitis are fatal B.) Herpes encephalitis is the only treatable viral CNS infection C.) If a lumbar puncture cannot be obtained, treatment should be held as this may alter CSF results D.) Steroids are indicated to reduce brain edema and subsequent complications

500

Which statement correctly matches the most commonly associated cause of bacterial meningitis with the specific populations listed?

What is: A) Newborns- Group B Strep, Older children and young adults- Streptococcus Pneumoniae & Neisseria Meningitidis, Patients over 50- Listeria, Skull Fracture- Staphylococcus and Pseudomonas B) NewBorns-Neisseria Meningitidis, Older children and young adults- Group B Strep, Patients over 50- Listeria, Skull Fracture Staphylococcus and Pseudomonas C) NewBorns- Group B Strep, Older children and young adults- Neisseria Meningitidis, Patients over 50- Staphylococcus and Pseudomonas, Skull Fracture- Listeria D) NewBorns- Staphylococcus and Pseudomonas, Older children and young adults- Listeria, Patients over 50- Neisseria Meningitidis, Skull Fracture- Group B Strep

Autoimmune/Dementia

100

32 year old Caucasian female presents with a 3 day history of pain with eye movement of the right eye with loss of visual acuity and color saturation. What might you see on physical exam?

What is: A.) The affected eye will appear miotic with an associated ptosis B.) The affected eye will accommodate but not react C.) The affected eye will paradoxically constrict when the light is shined on it D.) The affected eye will paradoxically dilate when the light is shined on it

200

28 year old male presents with 1-2 day history of left hemisomal weakness and numbness. He denies any history of similar events in the past. MRI is obtained and shows the following. What is the diagnosis. PIC

What is: A.) Relapsing Remitting Multiple Sclerosis B.) Clinically Isolated Syndrome C.) Progressive Multiple Sclerosis D.) CADASIL

300

35 yo male presents with a 2 history of numbness and weakness which began in his feet and has ascended to his waist. He also notes some urinary hesitancy. On exam strength is graded at 1/5 in the B/L LE with loss of sensation. Reflexes are globally reduced. What is the next step?

What is A.) MRI lumbar spine B.) IV Decadron C.) CT of the head D.) Lumbar puncture

400

Brain biopsy is performed on a 84 year old patient with the following pathology. What is the diagnosis? PIC

What is: A.) Parkinson's Disease B.) Alzheimer's Disease C.) Normal Pressure Hydrocephalus D.) Creutzfeldt Jakob Disease

500

62 year old male presents with a 3 month history of rapid decline in cognition with short-term memory loss, speech difficulty, and myoclonus. He was previously healthy. MRI of the brain shows a "cortical ribbon sign." EEG demonstrates periodic epileptiform discharges. What would you test for in the CSF?

What is: A.) Beta Amyloid 42 and phosphorylated Tau protein B.) JC virus C.) CSF RBCs D.) 14-3-3 Protein

Radiology

100

18 year old male incurs a head injury during football and is knocked unconscious temporarily. He awakens for a short period and then becomes unresponsive again before arriving to the hospital. HCT shows the following. What vessel is responsible for this finding? PIC

What is: A) Middle Meningeal Artery B) Bridging Veins C) Middle Cerebral Artery D) Superficial Temporal Artery

200

Which patient populations are at risk for this?

What is: A) Newborns B) Adolescents C) Elderly and alcoholics D) Med students

300

What type of symptoms would this patient present with? PIC

What is: A.) Right homonymous hemianopsia B.) Right sided neglect C.) Receptive aphasia and right hemiparesis D.) Expressive aphasia and right hemiparesis

400

58 year old male with 30 pack year history of smoking presents with episodic headaches particularly first thing in the morning and progressive right sided weakness. MRI of the brain shows the following. What is the next step? PIC

What is: A.) Mannitol and neurosurgical consultation B.) IV tPA C.) Prednisone and neurosurgical consultation D.) Decadron and neurosurgical consultation

500

38 yo patient presents with back pain and weakness in his LE which began in his feet and has now ascended to his waist. He also notes some urinary hesitancy. On exam there is 1/4 paraparesis in the LE 3+ patellar reflexes and 4+ at the Achilles with sustained clonus. What is your next test?

What is: A.) Lumbar puncture to assess for albuminocytologic disassociation B.) MRI lumbar spine C.) MRI thoracic spine D.) MRI thoracic spine E.) XRAY lumbar spine