Picture of patient with apparent lid retraction and poor elevation. Shows you Orbital CT-Scan with muscle involvement including IR and asks is this
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1 NEUROLOGY Q: MENINGIOMAS AND SKULL (*2) Real skull is given, and you are asked to point to tuberculum sella What kind of meningioma occurs at this location? Where is the anterior clinoid process? Where is the posterior clinoid process? Q: TRO (*2) Picture of patient with apparent lid retraction and poor elevation What is Ddx? Ddx of vertical diploplia? What do you think this is? What other symptoms and signs would you look for? Shows you Orbital CT-Scan with muscle involvement including IR and asks is this consistent with Dx? How would you treat this patient? Q: TRO Patient with proptosis and lid retraction What is Dx? What is w/u? What is Tx?
2 Q: MYASTHENIA GRAVIS What is the cause of myasthenia gravis? Give me a step by step process for doing a Tensilon test (*2) What is Tensilon? What else can you use? How else would you work up a patient with Myasthenia? What is the management? Q: CAVERNOUS SINUS Picture of patient with total ophthalmoplegia with CT-Scan of cavernous sinus problem (assymetrical convex vs concave) How would you differentiate a cavernous sinus syndrome from an apex syndrome? How can you test if there is IV th nerve involvement if there is a complete III rd nerve? Q: 6 th NERVE/DUANES Video of patient with Duanes Type I with abduction deficit and palpebral narrowing What are the systemic associations of Duane s syndrome? Q: PUPILS (*3)
3 Picture of patient with miosis and ptosis once a 2 year old child looked more like lid retraction/proptosis What is the Dx/DDx? How would you confirm the Dx? (Ask for old pictures from mom) What if you do not have hydroxamphetamine? How would you manage? (amblyopia) Q: 6 th NERVE (*3) Where is the VI th nerve compressed when you have an increase in ICP? What are the causes of isolated 6 th nerve palsies? Q: ON EDEMA (*3) Picture of disc swelling What is the DDx? What is the work up? 41 yo femlae with 2 year Hx of headaches, shows picture of swollen ON OD what is DDx? How work up? (VF, Anosmia right side) Shows VF junctional scotoma Shows CT Scan Frontal lobe olfactory groove meningioma What is prognosis? Would you let her go on holiday?
4 Q: 3 rd NERVE PALSY 40 yo female with sudde onset ptosis, exotropia, mydriasis OS Dx with differential etiology in most common order? Work up and management? Q: TEMPORAL ARTERITIS picture of retinal edema in sup-temp artery What is DDx? What is the w/u/test? Q: BILATERAL DISC EDEMA/PARINAUD S/BRAIN MASS Picture of bilateral disc edema and told patient has bilateral 6 th n. palsy What is w/u? Shows MRI with hydrocephalus and pinealoma What does this show? Post excision patient has dorsal midbrain syndrome symptoms? What is the Dx? Q: INO/1 ½ SYNDROME Video of patient with 1 ½ syndrome What is the Dx? What is the exact lesion causing this please draw it? INO
5 Draw the lesion? Q: FUNCTIONAL VISUAL LOSS Patient with normal exam but vision of 20/400 How do you diagnose functional visual loss? Ddx of functional visual loss? Details of management? Q: TRAUMATIC OPTIC NEUROPATHY Picture of globe perforation OS What would you be worried about the optic nerve OD? Q: NYSTAGMUS DOWNBEAT Video of downbeat nystagmus What is Ddx? Q: NYSTAGMUS OPSOCLONUS (*2) Video of opsoclonus What is Ddx? What types of nystagmus are associated with cerebellar disease? What are cerebellar eye signs? What are the pathways for nystagmus?
6 Q: SO PALSY Picture of patient with recent onset vertical diploplia What is Dx? How would you work it up? How would you treat it? Q: GRADENIGO S SYNDROME Describes symptoms What is Dx? MRI of petrous tumor What is that? Q: ONTT What does it tell us? Q: VISUAL FIELDS VF of homonymous hemianopia with sparing of temporal crescent Where is the lesion? This patient had a scintillating scotoma -- why? VF quadrantic / right incongrous heminaopia denser below Where is lesion? What tests would you do to help confirm besides imaging? (OKN)
7 What functions do temporal and parietal lobes serve? What are the difference in symptoms? Q: VISUAL FIELDS Automated VF of bitemporal hemianopis Ddx? Shows MRI of mass in pituitary Discuss and show lesion What is the anatomy of the area? Q; MS What is the cause of MS? What is the Tx for MS? NOTES ABOUT NICOLE AS EXAMINER Do or die don t bullshit! May need to back track with him I need to check pupils Favorite expression Tell me what you are doing each step of the exam Anything you say he asks about e.g. I would do a tangent screen tell me how what size target etc. He wants specific Dx and management
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