Differential Diagnosis (DDx) by Location

Differential Diagnosis (DDx) by Location


Differential Diagnosis (DDx) by Signs and Symptoms
























































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































1. True or False. The following are potential causes of myelopathy:


 


G7 p.1186:15mm


a. stenosis, cervical, or thoracic


true


 


b. anemia, chronic


true


 


c. Cushing disease


true


 


d. Lyme disease


true


 


e. acquired immunodeficiency syndrome (AIDS)


true


 


2. How does anemia produce myelopathy?


 


G7 p.1186:15mm


a. chronic: e_____ h_____, b_____ m_____ h_____, and c_____ c_____


extramedullary hematopoiesis, bone marrow hypertrophy, and cord compression


 


b. pernicious: s_____ c_____ d_____


subacute combined degeneration


 


3. How does Cushing disease produce myelopathy?


 


G7 p.1186:55mm


a. e_____ l_____


epidural lipomatosis


 


4. True or False. The following are neoplastic masses causing myelopathy, in order of most common to least common:


 


G7 p.1186:95mm


a. extradural, intradural extramedullary, intramedullary


true (It follows anatomically outside to inside, most to least common.)


 


b. intradural extramedullary, extradural, intramedullary


false


 


c. intramedullary, extradural, intradural extramedullary


false


 


d. extradural, intramedullary, intradural extramedullary


false


 


5. What is the frequency of spinal cord tumors?


 


G7 p.1186:96mm and G7 p.728:60mm


a. Extradural: _____%


55%


 


b. Intradural extramedullary: _____%


40%


 


c. Intradural intramedullary: _____%


5%


 


6. Complete the following regarding spinal cord infarction:


 


G7 p.1186:166mm


a. The most common artery involved is _____ _____ _____.


anterior spinal artery


 


b. The most common level of involvement is _____.


T4


 


c. Why?


watershed area


 


d. It spares _____ _____


posterior columns


 


e. caused by _____ and


hypotension


 


f. due to


 


 


     i. ath_____


atherosclerosis


 


     ii. emb_____


embolization


 


     iii. cla_____ a_____


clamping aorta


 


     iv. aor_____ d_____


aortic dissection


 


     v. s_____ p_____ in the presence of s_____ s_____.


sitting position in the presence of spinal stenosis


G7 p.1186:166mm


7. Necrotizing myelopathy associated with spontaneous thrombosis of a spinal cord arteriovenous malformation (AVM) presenting as spastic → flaccid paraplegia with ascending sensory level is called _____.


Foix-Alajouanine


G7 p.1187:50mm


8. True or False. Regarding acute (idiopathic) transverse myelitis:


 


G7 p.1187:85mm


a. Clinical onset is indistinguishable from acute spinal cord compression.


true


 


b. Normal imaging is expected, including CT, myelogram and MRI.


true


 


c. Cerebrospinal fluid (CSF) analysis shows pleocytosis and hyperproteinemia.


true


 


d. The thoracic region is the most common level.


true


 


e. The most common onset is 20 to 40 years of age.


false (Most common onset is first 2 decades of life, other answers define the disease.)


 


f. Usually results in a diagnosis of multiple sclerosis


false (MS is diagnosed in only 7%.)


G7 p.1187:100mm


9. Abdominal cutaneous reflexes are almost always absent in _____ _____.


multiple sclerosis


G7 p.1187:110mm


10. True or False. Regarding Devic syndrome:


 


G7 p.1187:113mm and G7 p.728:60mm


a. It is characterized by acute bilateral retinitis and transverse myelitis.


false (acute bilateral optic neuritis, not retinitis, and myelopathy)


 


b. The transverse myelitis can be a cause of complete block on myelography.


true


 


c. It is more common in Asia than in the United States.


true


 


d. It is a variant of multiple sclerosis (MS).


true


 


11. What is another name for Devic syndrome?


neuromyelitis optica


G7 p.1187:114mm


12. True or False. The following are part of the correct mechanism responsible for pernicious anemia:


 


G7 p.1187:148mm


a. malabsorption of B12 in the proximal ileum


false (malabsorption of B12 in distal ileum)


 


b. lack of secretion of intrinsic factor by pancreas


false (lack of secretion by gastric parietal cells)


 


c. dysfunction of gastric parietal cells


true (malabsorption of B12 in the distal ileum due to lack of secretion of intrinsic factor, a small polypeptide, by gastric parietal cells)


 


d. downregulation of cyclic adenosine monophosphate (cAMP)—mediated transport of B12


false


 


13. Matching. Match the disease with the important feature.


 


G7 p.1187:162mm and G7 p.1188:120mm and G7 p.1188:150mm


Disease:


 


 


pernicious anemia; Guillain-Barré; ALS


 


G7 p.1187:162mm


Important feature:


 


 


a. Ascending weakness



 


b. Atrophic weakness of hands



 


c. Symmetrical paresthesias



 


d. Posterior column involvement



 


e. Normal sensation



 


f. Dementia



 


g. Areflexia



 


h. Serum B12 levels



 


i. Fasciculations



 


j. Shilling test



 


k. Preserved sphincter control



 


l. Treat with B12



 


m. Proprioception difficulty



 


14. How might AIDS produce myelopathy?


vacuolization of spinal cord


G7 p.1188:78mm


15. Complete the following about sciatica:


 


G7 p.1188:183mm


a. The sciatic nerve contains roots from_____ to_____.


L4 to S3


 


b.


 


 


    i. The nerve passes out of the_____


pelvis


 


    ii. through the g_____ s_____ f_____.


greater sciatic foramen


 


c.


 


 


    i. In the lower third of the thigh it divides into the t_____


tibial


 


    ii. and the c_____ _____ nerves.


common peroneal


 


16. Complete the following about herpes zoster:


 


G7 p.1189:87mm


a. Rarely it might mimic_____.


radiculopathy


 


b. Lumbosacral dermatomas are involved in_____ to_____%.


10 to 15%


 


c. Significantly, pain is independent of_____.


position


 


d. Typical herpetic skin lesions follow pain in_____ to0_____days.


3 to 8


 


e. True or False. Motor weakness can occur.


true


 


f. True or False. Urinary retention can occur.


true


 


g. If so, it is due to_____ paralysis.


detrusor


 


h.


 


 


    i. If motor symptoms occur_____% have good recovery


55%


 


    ii. and_____% have fair to good recovery.


30%


 


17. Complete the following regarding differential diagnosis by signs and symptoms:


 


G7 p.1189:170mm


a. Pain produced in the sciatic distribution with weakness of external rotation and abduction of the hip is called _____.


piriformis syndrome due to sciatic nerve entrapment by piriformis muscle. (Symptoms are exacerbated by Freiberg test [forced internal rotation of hip with thigh extension]).


 


b. The Friedberg test consists of forced_____ _____ of _____


internal rotation of hip


 


c. and thigh_____.


extension


 


d. Significance of the Frieberg test is that it_____ the symptoms of the


exacerbates


 


e. p_____ s_____.


piriformis syndrome


 


18. Complete the following about extraspinal tumors causing sciatica:


 


G7 p.1190:60mm


a. Pain is almost always


 


 


    i. i_____


insidious


 


    ii. p_____


progressive


 


    iii. c_____


constant


 


    iv. not affected by_____


position


 


    v. worse at_____ in 80% and


night


 


vi. not benefited by_____ therapy


conservative


 


b. Diagnosis is best made by


 


 


    i. h_____


history


 


    ii. r_____


radiographs


 


    iii. of the entire p_____


pelvis


 


    iv. and p_____ f_____


proximal femur


 


19. Femoral neuropathy is often mistakenly identified as a radiculopathy at what level?


L4


G7 p.1190:120mm


20. Answer the following about femoral neuropathy:


 


G7 p.1190:125mm


a. Femoral neuropathy may be mistaken for radiculopathy at what level?


L4


 


b. That mistake can occur because both share weakness of the _____ muscle.


quadriceps


 


c. That mistake should be avoided because sensory distribution is different.


 


 


    i. Femoral nerve serves the_____ _____.


anterior thigh


 


    ii. L4 serves the knee to the_____ _____ and


medial malleolus


 


    iii. spares the_____ _____ motor weakness is different.


anterior thigh


 


    iv. Femoral nerve has weak_____.


iliopsoas


 


    v. Femoral nerve has strong_____ _____.


thigh adductors


 


    vi. L4 has strong_____.


iliopsoas


 


    vii. L4 has weak_____ _____.


thigh adductors


 


21. Peroneal nerve palsy may be mistaken for radiculopathy at what level?


L5


G7 p.1190:133mm


22. Complete the following regarding differential diagnosis by signs and symptoms:


 


G7 p.1191:32mm


a. Congenital degeneration of anterior horn cells leading to weakness, areflexia, tongue fasciculations, with normal sensation is W_____-H_____ d_____


Werdnig-Hoffmann disease


 


b. also known as s_____ m_____a_____


spinal muscular atrophy


 


c. also known as f_____ i_____ s_____


floppy infant syndrome


 


23. The most common etiology for pure motor hemiplegia without sensory loss is



G7 p.1192:50mm


a. l_____ i_____ of the


lacunar infarct


 


b. c_____ i_____ c_____.


contralateral internal capsule


 


24. Can hypoglycemia be associated with hemiparesis?


yes, treat with glucose— hemiparesis may clear


G7 p.1192:68mm


25. Complete the following about back pain:


 


G7 p.1192:120mm


a. Will patients with abdominal or vascular etiology of back pain keep still, or writhe in pain?


writhe in pain


 


    i. example: a_____ a_____ a_____


abdominal aortic aneurysm


 


b. Pain at bed rest. Think:_____ _____


spine tumor


 


c. Relieved by aspirin. Think:_____ osteoid osteoma


 


d. Back pain on percussion. Think:_____


infection


 


26. Complete the following regarding differential diagnosis by signs and symptoms:


 


G7 p.1192:145mm


a. Nocturnal back pain relieved by aspirin is suggestive of _____ _____.


osteoid osteoma (or benign osteoblastoma)


 


b. Morning back stiffness, hip pain, hip swelling, failure to get relief at rest, and improvement with exercise is suggestive of_____ or_____ _____.


sacroiliitis or early ankylosing spondylitis


 


27. Complete the following regarding cauda equina. Cauda equina syndrome has the following criteria:


 


G7 p.1193:62mm


a. p_____ a_____


perineal anesthesia


 


b. u_____ i_____


urinary incontinence


 


c. p_____ w_____


progressive weakness


 


28. Complete the following regarding annular tears:


 


G7 p.1193:103mm


a. assymptomatic in 50- to 60-year-old patients in _____%


40%


 


b. assymptomatic in 60- to 70-year-old patients in _____%


75%


 


29. Complete the following regarding Schmorl nodes:


 


G7 p.1193:179mm


a. defined as d_____ h_____


disc herniation


 


b. through the c_____ e_____ p_____


cartilaginous end plate


 


c. into the v_____ b_____


vertebral body


 


d. seen in_____% of asymptomatic patients


19%


 


30. Complete the following about chronic low back pain:


 


G7 p. 1194:19mm


a. Symptoms persist after 3 months in_____%.


5%


 


b. Structural diagnosis is possible in only_____% of these.


50%


 


c. Erosive changes adjacent to sacroiliac (SI) joint and positive test for human leukocyte antigen-B27 (HLA-B27) suggest the diagnosis of a_____ s_____.


ankylosing spondylitis


G7 p. 1194:40mm


d. In foot drop of unknown etiology, which muscle strength tests help differentiate peroneal nerve palsy from L4/L5 radiculopathy?


 


G7 p. 1194:85mm


    i. p_____ t_____ (f_____ i_____)


posterior tibialis (foot inversion)


 


    ii. g_____ m_____ (i_____ r_____ f_____ h_____)


gluteus medius (internal rotation flexed hip)( Both are spared in a peroneal nerve palsy, and both are involved with radiculopathy.)


 


e. Which division of the sciatic nerve is more sensitive to injury, the peroneal or the tibial division?


peroneal division is more sensitive to injury


G7 p. 1195:16mm


31. For a patient with foot drop, lesion could be at


 


G7 p.1195:26mm


a. main trunk of_____ _____


sciatic nerve


 


b. p_____ d_____


peroneal division


 


c. L_____ or L_____ radiculopathy


L4 or L5


 


d. c_____ p_____ nerve


common peroneal


 


e. s_____ p_____ nerve


superficial peroneal


 


f. d_____ p_____ nerve


deep peroneal


 


32. Study Chart. Examine the following functions tests and the muscles for a patient with foot drop:


 


G7 p.1195:27mm


a. Adduct thigh


Adductors L2-3


 


b. Extend knee


Quadriceps L2-3-4


 


c. Internally rotate thigh


Gluteus medius L4-5 S1


 


d. Dig heel into bed


Gluteus maximus L5 S1-2


 


e. Flex knee with thigh flexed


Biceps femoris L5 S1-2


 


f. Foot planter flexion


Gastrocnemius


 


g. Invert plantar flexed foot


Tibialis posterior L4-5


 


h. Evert foot


Peroneus longus and brevis L5 S1


 


33. Adduct thigh.


 


G7 p.1195:35mm


a. Utilizes_____ muscles


adductor


 


b. Nerve:_____


obturator


 


c. Roots:_____


L2, 3


 


d. If weak means lesion includes more than the_____ _____


sciatic roots


 


34. Extend knee.


 


G7 p.1195:35mm


a. Utilizes_____ muscles


quadriceps


 


b. Nerve:_____


femoral


 


c. Root:_____


L2, 3, 4


 


d. If weak means lesion includes more than_____ _____


sciatic roots


 


35. Internally rotate thigh.


 


G7 p.1195:62mm


a. Utilizes_____ _____ muscles


gluteus maximus


 


b. Nerve:_____


superior gluteal


 


c. Root:_____


L4, 5, S1


 


d. If weak means lesion is very_____


proximal


 


36. Dig heel into bed.


 


G7 p.1195:62mm


a. Utilizes_____ _____ muscles


gluteus maximus


 


b. Nerve:_____


inferior gluteal


 


c. Roots:_____ _____ and_____


L5-S1, 2


 


d. If weak the injury is very_____


proximal


 


37. Flex knee with thigh flexed.


 


G7 p.1195:76mm


a. Utilizes_____ _____ muscles


lateral hamstrings


 


b. Nerve: _____


sciatic


 


c. Roots:_____ _____ and_____


L5, S1, 2


 


d. If weak there is injury to the_____ _____


sciatic nerve


 


38. Foot plantar flexion.


 


G7 p.1195:76mm


a. Utilizes_____ _____ muscles


gastrocnemius


 


b. Nerve:_____


sciatic


 


c. Roots:_____


L5


 


d. If weak there is injury to the_____ _____


sciatic nerve


 


39. Invert plantar flexed foot.


 


G7 p.1195:92mm


a. Utilizes_____ _____ muscles


posterior tibial


 


b. Nerve:_____


tibial


 


c. Roots:_____ and_____


L4, 5


 


d. If weak there is injury to the_____ _____


tibial nerve


 


e. If strong but there is foot drop, it means that there is injury distal to the take-off of the_____ _____


common peroneal


 


40. Evert the foot.


 


G7 p.1195:92mm


a. Utilizes_____ _____ muscles


peroneus longus and brevis


 


b. Nerve:_____


superficial peroneal


 


c. Roots:_____ and _____


L5, S1


 


d. Preservation of these with foot drop means lesion is in the _____ _____ nerve


deep peroneal


 


41. What are ways to differentiate foot drop from injury to the


 


G7 p.1195:162mm


a. deep peroneal nerve?


 


 


    i. motor weakness manifests by_____ _____


foot drop (weak foot extension)


 


    ii. muscle that is weak is the_____ _____


anterior tibial (dorsiflexion)


 


    iii. sensory loss_____ _____


web space


 


b. common peroneal nerve?


 


 


    i. deficit is a _____ _____


foot drop


 


    ii. muscles involved are a_____ t_____ and p_____ l_____ and b_____


anterior tibial and peroneus longus and brevis


 


    iii. weakness of_____ and_____ _____


eversion and foot drop


 


    iv. sensory loss of_____ _____ and _____


lateral leg and foot


 


42. List the ways to differentiate.


 


G7 p.1195:182mm


a. plexus lesions on electromyography (EMG) _____ _____


paraspinals normal


 


b. root lesion on EMG_____ _____


paraspinals abnormal


 


c. superficial peroneal nerve


 


 


    i. motor weakness of _____


eversion


 


    ii. muscles that are weak are the_____ _____ and_____


peroneus longus and brevis


 


    iii. Any foot drop?


no


 


    iv. sensory loss at the_____ _____ and_____


lateral leg and foot


 


43. Complete the following regarding differential diagnosis by signs and symptoms:


 


G7 p.1196:29mm


a. Painless foot drop is likely due to_____ _____.


peroneal palsy


 


b. Painful foot drop is likely due to_____.


radiculopathy


 


c. Painless foot drop with no sensory loss could be due to _____ _____.


parasagittal lesion


 


d. If so how might the reflexes be?


hyperactive


 


e. This is called the_____ _____ _____.


spastic foot drop


 


44. A central nervous system (CNS) cause of foot drop is


 


G7 p.1196:60mm


a. the result of a_____ lesion


parasagittal


 


b. and may produce a_____ reflex


Babinski


 


c. or a hyperactive_____ reflex.


Achilles (= spastic foot drop)


 


45. Complete the following regarding symptoms in the hands:


 


G7 p.1196:155mm


a. Central cord syndrome shows more involvement in_____ than_____.


UE; LE


 


b. Syringomyelia has b_____ d_____ in the hands.


burning dysesthesias


 


46. Complete the following regarding lesion location and findings in “cruciate paralysis”:


 


G7 p.1196:180mm


a. Physical exam shows_____


atrophy of hands


 


b. due to pressure on the_____


pyramidal decussations


 


c. at the level of the_____.


foramen magnum


 


47. Complete the following about radiculopathy, upper extremity:


 


G7 p.1197:120mm


a. The “empty can” test suggests s_____ p_____.


shoulder pathology


 


b. Interscapular pain suggests c_____ r_____.


cervical radiculopathy


G7 p.1197:135mm


48. Myocardial infarction (MI) may present with symptoms similar to a radiculopathy at what level?


left C6


G7 p.1197:142mm


49. Matching. Match the symptom with the position of the disc most likely to produce it. Disc: central cervical disc; lateral cervical disc Symptom:


 


G7 p.1198:23mm


a. pain


lateral


 


b. myelopathy


central


 


c. bilateral symptoms


central


 


d. upper extremity symptoms


lateral


 


e. lower extremity symptoms


central


 


f. numb clumsy hands


central


 


50. Electric shock-like sensation radiating up or down the spine, usually with flexion and attributed to dysfunction of posterior columns is called the_____.


Lhermitte sign


G7 p.1198:170mm


51. True or False. Lhermitte’s sign can be seen in Hint: mc5rs


 


G7 p.1198:180mm


a. multiple sclerosis


true


 


b. cervical spondylosis


true


 


c. cervical disc


true


 


d. cervical cord tumor


true


 


e. Chiari I


true


 


f. central cord syndrome


true


 


g. radiation myelopathy


true


 


h. subacute combined degeneration


true


 


52. Complete the following regarding one or more episodes of brief loss of consciousness (LOC):


 


G7 p.1199:70mm


a. referred to as s_____


syncope


 


b. prevalence is_____


≈ 50% (higher in elderly)


 


c. presumed etiology is_____


vasovagal


 


53. What are the causes of syncope?


 


G7 p.1199:112mm


a. Disorder of AV node conduction is called_____


Stokes-Adams


 


b. Tight short collar, shaving, passing out is called_____


carotid sinus syncope


 


c. Fainting aka_____ syncope


neurocardiogenic


 


d.


 


 


    i. Micturition, cough called_____


triggered syncope


 


    ii. Usually associated with elevation of_____-_____ pressure


intra-thoracic


 


e. Orthostatic hypotension defined as a drop in BP of_____mm Hg on standing


25


 


f. Unknown etiology occurs in_____%


40%


 


54. Complete the following about transient neurological deficit (TIA):


 


G7 p.1200:175mm


a. By definition it lasts less than_____ hours


24


 


b. but usually subsides within_____.


20 minutes


 


c. They are_____.


temporary


 


d. They are a result of_____.


ischemia


 


55. Complete the following regarding the etiology of diplopia secondary to VI nerve palsy:


 


G7 p.1201:85mm


a. i_____ _____ _____


↑ ICP (pseudotumor cerebri)


 


b. s_____ _____


sphenoid sinusitis


 


c. t_____


tumor/mass etc.


 


56. Complete the following regarding transient ischemic attacks (TIAs):


 


G7 p.1200:175mm


a. By definition TIAs last less than_____.


24 hours


 


b. Most resolve within_____.


20 minutes


 


c. Migraine paresis differs from TIA in that it_____ over several minutes.


progresses (marches)


 


d. TIA-like symptoms from cerebral amyloid angiopathy (CAA) require avoidance of_____ or_____ drugs


antiplatelet or anticoagulation


G7 p.1201:29mm


e. because the CAA patient is more prone to_____.


hemorrhage


 


57. Complete the following about anosmia:


 


G7 p.1202:80mm


a. Most common cause is s_____ r_____ infection.


severe respiratory


 


b.


 


 


    i. Second most common cause is_____ _____.


head injury


 


    ii. For severe such cases_____ to_____% occurence.


7 to 15%


 


58. Complete the following about cranial neuropathies:


 


G7 p.1202:52mm


a. Congenital facial diplegia is also known as_____.


Möbius syndrome


 


b. It affects which half of the face more?


Upper


 


c. True or False. It may also involve other cranial nerves. If so, which ones?


true CN VI, III, or XII


 


d. Lyme disease can cause_____.


unilateral or bilateral seventh nerve palsy


 


e. Affects which half of the face?


lower (as in Bell palsy)


 


f. True or False. It may also involve other cranial nerves.


false


 


59. Complete the following about cavernous sinus syndrome:


 


G7 p.1204:60mm


a. A cavernous sinus aneurysm can compress the third nerve and cause_____


diplopia


 


b. due to_____.


ophthalmoplegia


 


c. In this form of third nerve palsy the pupil will be_____


not dilated


 


d. because the_____ that dilate the pupil


sympathetics


 


e. are_____.


also paralyzed


 


60. Complete the following about osteopetrosis:


 


G7 p.1204:75mm


a. It is also known as_____


marble bone


 


b. a_____ disorder


genetic


 


c. of defective_____ resorption of bone


osteoclastic


 


d. resulting in increased_____ _____.


bone density


 


e. The most common neurologic manifestation is_____.


blindness


 


f. Treatment consists of bilateral_____ _____decompression.


optic nerve


 


61. Complete the following about monocular blindness:


 


G7 p1204:178mm


a. Giant cell arthritis aka t_____a_____


temporal arthritis


 


b. Usually due to ischemia of the


 


 


    i. o_____ n_____ or


optic nerve


 


    ii. o_____ t_____


optic tract


 


    iii. less likely the c_____ r_____artery


central retinal


 


62. Complete the following about exophthalmos:


 


G7 p. 1205:73mm


a. aka p_____


proptosis


 


b. Following trauma, think: c_____c_____ fistula


carotid cavernous


 


c. Following frontal-orbital surgery, think:_____ in_____ _____


defect in orbital roof


 


63. Complete the following about arachnoid cyst:


 


G7 p.1207:40mm Also see


a. aka_____ _____


leptomeningeal cyst


G7 p. 222


b. Due to a d_____ of the_____


duplication; arachnoid


 


c. Reach maximum size in_____ _____


1 month


 


d. Need surgery in about_____%


30%


 


64. Complete the following regarding differential diagnosis by signs and symptoms:


 


G7 p.1208:87mm


a. Hemifacial spasm may produce tinnitus because of s_____ m_____spasms.


stapedial muscle


 


b. High cervical lesion may cause facial sensory changes due to compression of the s_____ t_____ t_____


spinal trigeminal tract


G7 p.1208:40mm


c. at cervical levels down to_____.


C2-C4


 


d. Causes of mutism include injury to


 


 


    i. f_____l_____


frontal lobes


 


    ii. c_____g_____


cingulate gyrus


 


    iii. c_____c_____t_____


corpus callosum plus thalamus


 


    iv. c_____


cerebellum


 


e. Swallowing difficulties can be caused by ossification of the_____ _____ _____.


anterior longitudinal ligament


G7 p.1209:53mm


65. Complete the following about CPA lesions:


 


G7 p.1210:133mm


Hint: amem


 


 


a.


 


 


    i. Acoustic neuroma more accurately known as v_____s_____


vestibular schwannoma


 


    ii. Occurs in_____to_____%


80 to 90%


 


b. Meningioma occurs in_____to_____%.


5 to 10%


 


c. Epidermoid occurs in_____to_____%.


5 to 7%


 


d. Metastatic_____


rarely


 


66. Matching. Match the characteristic with the condition.


 


G7 p.1211:120mm


Condition:


 


 


vestibular schwannoma;


 


 


meningioma


 


 


Characteristic:


 


 


a. Hearing loss occurs early in_____.



 


b. Facial weakness occurs early in_____.



 


c. Internal auditory canal (IAC) is enlarged in_____.



 


d. Calcification is seen in_____.



 


e. It represents 90% of cerebellopontine angle (CPA) tumors.



 


f. It represents 5 to 10% of CPA tumors.



 


67. Complete the following about posterior fossa tumor:


 


G7 p.1209:134mm


a. Most likely a solitary lesion in an adult is a_____.


metastasis


 


b. Most likely primary tumor is the_____.


hemangioblastoma


 


c. Radiologic characteristics include


 


 


    i. v_____n_____


vascular nodule


 


    ii. c_____


cyst


 


    iii. s_____ _____on_____


serpentine vessels on surface


 


d. The tumor that is common in young adults is p_____a_____.


pilocytic astrocytoma


 


68. Complete the following regarding differential diagnosis by location:


 


G7 p.1210:60mm


a. The modern name for medulloblastoma is_____ _____ _____.


primitive neuroectodermal tumor (PNET)


 


b. It usually begins at the_____,


fastigium


 


c. which is located at the_____.


roof of the fourth ventricle


 


d. The consistency is_____.


solid


 


69. For posterior fossa tumors in children, give types and percentage.


 


G7 p.1210:87mm


a. a_____ (p_____),_____%


astrocytoma (pilocytic), 27%


 


b. b_____ _____ _____,_____%


brain stem glioma, 28%


 


c. P_____(i.e., m_____),_____%


PNET (i.e., medulloblastoma), 27%


 


70. Complete the following about atlantoaxial subluxation:


 


G7 p.1230:144mm


a. Incompetence of the_____ligament


transverse


 


b. Results in increased_____ _____interval


atlantodental


 


71. Complete the following regarding differential diagnosis by location:


 


G7 p.1231:23mm


a. Morquio syndrome is hypoplasia of the_____


dens


 


b. due to a m_____.


mucopolysaccharidosis


 


c. It may result in_____subluxation.


atlantoaxial


 


72. Complete the following about multiple intracranial lesions on CT or MRI:


 


G7 p.1212:103mm


a. Glioma—what % are multicentric?_____%


6%


 


b. Herpes simplex usually occurs in the_____lobe.


temporal


G7 p.1213:117mm


c. MS lesions are p_____.


periventricular


G7 p.1213:25mm


d. Dural sinus thrombosis cause multiple_____ _____.


venous infarcts


G7 p.1213:721mm


e. Multiple hypertensive hemorrhages is likely_____ _____.


amyloid angiopathy


G7 p.1213:110mm


73. Name the ring-enhancing lesions on computed tomography and magnetic resonance imaging (CT/MRI).


 


G7 p.1214:100mm


Hint: haam


 


 


a. h_____


hematoma


 


b. a_____


astrocytoma


 


c. a_____


abscess


 


d. m_____


metastases


 


74. Complete the following about ring-enhancing lesions on CT/MRI:


 


G7 p.1214:100mm


a. A continuous ring suggests r_____h_____.


resolving hematoma


 


b. An interrupted ring suggests m_____.


malignancy


 


75. List the conditions that cross the corpus callosum.


 


G7 p.1215:70mm


Hint: ms-glld


 


 


a. m_____ s_____


multiple sclerosis


 


b. g_____


glioblastoma


 


c. l_____


lymphoma (primary CNS)


 


d. l_____


lipoma


 


e. d_____


diffuse axonal injury


 


76. Complete the following regarding sellar and parasellar lesions:


 


G7 p.1215:95mm


a. Adults: most common is_____ _____


pituitary adenoma


 


b.


 


 


    i. Children: most common are c_____


craniopharyngioma


 


    ii. and g_____


germinoma


 


77. Complete the following regarding sellar lesions:


 


G7 p.1215:150mm


a. Pituitary pseudotumor is due to_____,


hypothyroidism


 


b. which causes chronic pituitary stimulation by_____-_____ _____.


thyrotropin-releasing hormone


 


78. Germ cell tumors in the suprasellar area are


 


G7 p.1215:150mm


a. more common in_____.


women


 


b. have a triad of


 


 


    i. d_____ _____


diabetes insipidus


 


    ii. v_____ _____ _____


visual field defects


 


    iii. p_____


panhypopituitarism


 


79. Complete the following about juxtasellar masses:


 


G7 p.1216:16mm


a. Craniopharyngioma


 


 


    i. In this region account for_____% of tumors in adults


20%


 


    ii. and_____% in children


54%


 


b. Meningioma. To differentiate from pituitary macroadenoma use gadolinium. Meningiomas have:


 


 


    i. b_____h_____ e_____


bright homogeneous enhancement


 


    ii. Epicenter is_____


suprasellar


 


    iii. Tapered extension aka_____ _____


dural tail


 


    iv. Sella is usually_____ _____


not enlarged


 


    v. Rarely produce_____disturbances


endocrine


 


    vi. Tend to_____carotid artery


encase


 


80. True or False. Regarding lymphocytic hypophysitis:


 


G7 p.1212:15mm


a. It is rare.


true


 


b. It may cause hypopituitarism.


true


 


c. Most cases occur in women.


true


 


d. It tends to selectively affect a single hormone.


true


 


e. It requires surgery.


false (self-limiting or Rx with steroids)


 


f. It may produce diabetes insipidus (DI).


true


 


81. Complete the following about cavum septum pellucidum (CSP):


 


G7 p.1218:45mm


a. It is present in all_____ _____.


premature babies


 


b. Adults have them in_____%.


10%


 


c. It is commonly seen in_____.


boxers


 


82. Complete the following about cavum vergae:


 


G7 p.1218:45mm


a. posterior to_____


CSP


 


b. often communicates with the_____


CSP


 


83. Complete the following about cavum velum interpositum:


 


G7 p.1218:45mm


a. due to separation of the_____


crura


 


b. of the_____


fornix


 


c. with the_____above and


thalami


 


d. the_____ _____ below


third ventricle


 


e. present under 1 year of age in_____%


60%


 


f. present between 1 and 10 years old in_____%


30%


 


84. True or False. The most common benign primary intraorbital neoplasm is


 


G7 p.1218:128mm


a. capillary hemangioma


false


 


b. lymphangioma


false


 


c. optic nerve sheath meningioma


false


 


d. cavernous hemangioma


true


 


e. optic glioma


false


 


85. Matching. Match characteristics of orbital lesions with pathology (may match with more than one).


 


G7 p.1218:145mm


Pathology:


 


 


capillary hemangioma; lymphangioma; lymphoma; thyroid ophthalmoplegia


 


 


Characteristic:


 


 


a. infantile proptosis


,


 


b. regresses spontaneously



 


c. does not regress



 


d. painless proptosis ,


 


e. bilateral (80% of the time)



 


86. The most common primary ocular malignancy of childhood is_____.


melanoma


G7 p.1218:152mm


87. Complete the following about skull lesions:


 


G7 p.1220:27mm


a. Multiplicity suggests_____.


malignancy, especially if six or more


 


b. Expansion of diploë suggests_____.


a benign lesion


 


c. Peripheral sclerosis suggests_____.


a benign lesion


 


d. Full-thickness lesions suggest_____.


malignancy


 


e. Sharply demarcated, punched-out defects suggest_____.


myeloma


 


88. Complete the following about skull lesions:


 


G7 p.1220:80mm


a. Name the skull lesion that shows a


 


 


    i. trabecular pattern


hemangioma


G6 p.930:120mm


    ii. sunburst pattern


hemangioma


 


    iii. islands of bone pattern


fibrous dysplasia


 


    iv. site of tenderness to palpation


eosinophilic granuloma


 


b. Another name for Paget disease that is only osteolytic is_____ _____.


osteoporosis circumscripta


G7 p.1221:87mm


c. Eosinophilic granuloma is the mildest form of_____ _____.


histiocytosis X


 


89. Complete the following about skull lesions:


 


G7 p.1223:35mm


a. There is no_____lesion


intra-axial


 


b. that grows out of the_____.


skull


 


90. Choroid plexus calcification has the following characteristics:


 


G7 p.1224:45mm


a. % calcified between age 40 and 50 is_____


75%


 


b. rare under age_____


3


 


c. Under age 10 consider choroid plexus_____.


papilloma


 


d. If you see calcified choroid plexus in the temporal horn consider_____.


neurofibromatosis


 


91. Complete the following about basal ganglia calcifications:


 


G7 p.1224:55mm


a. Are common in the_____


elderly


 


b. May be due to_____


hyperparathyroidism


 


c. Or long-term use of_____


anticonvulsants


 


d. Or_____disease


Fahr


 


e. Correlated with psychiatric diseases if >_____cm


0.5


 


92. Complete the following about Fahr disease:


 


G7 p.1224:75mm


a. Cause is_____


idiopathic


 


b. Course is_____


progressive


 


c. What do we see in x-rays?


intracranial calcifications


 


d. Where?


 


 


    i. b_____ g_____


basal ganglia


 


    ii. s_____


sulci


 


    iii. d_____n_____


dentate nuclei


 


93. What are the characteristics of intraventricular lesions? Which:


 


G7 p.1224:150mm


a. is most common?


astrocytoma


 


b. is at foramen of Monro?


colloid cyst


 


c. has punctate calcification?


craniopharyngioma


 


d. fills the fourth ventricle?


medulloblastoma


 


e. is the most common fourth ventricle low density lesion?


epidermoid


 


f. has free-floating fat in ventricles?


dermoid


 


g. has fat and calcification?


teratoma


 


h. is at the septum pellucidum?


central neurocytoma


 


94. Intraventricular meningiomas are fed by the


 


G7 p.1224:180mm


a. a_____ c_____ a_____


anterior choroidal artery


 


b. and less commonly by the


 


 


    i. m_____ p_____ c_____a_____ medial posterior choroidal artery


 


    ii. l_____ p_____ c_____a_____


lateral posterior choroidal artery


 


c. and are thought to arise from the _____ _____ _____.


arachnoidal cap cells


 


95. True or False. The following intraventricular lesion is least likely to be found in the frontal horn:


 


G7 p.1225:130mm


a. astrocytoma


false


 


b. meningioma


false


 


c. dermoid


false


 


d. choroid plexus papilloma


true


 


96. Matching. Match most common tumor type with location.


 


G7 p.1225:125mm


Location: frontal horn; body; atrium; third ventricle; fourth ventricle


 


 


Tumor type:


 


 


a. Colloid cyst



 


b. Medulloblastoma



 


c. Meningioma



 


d. Ependymoma



 


e. Astrocytoma



 


f. Choroid plexus papilloma



 


g. Choroid plexus carcinoma



 


h. Subependymoma_____ or_____


or


 


    i. teratoma



 


97. Complete the following about tumors within the lateral ventricles. In adults all enhance except


 


G7 p.1226:65mm


a. c_____ and the


cysts


 


b. s_____.


subependymoma


 


98. Periventricular enhancing mass lesions. First consideration should be _____.


lymphoma


G7 p.1227:138mm


99. With periventricular low density, consider:


 


G7 p.1227:138mm


a. t_____ edema


transependymal


 


b. m_____ s_____


multiple sclerosis


 


c. acute arteriosclerotic encephalopathy aka_____ _____


Binswanger disease


 


d. leukoaraiosis


 


 


    i. representing_____ _____


normal aging


 


    ii. or w_____ i_____


watershed infarction


 


100. Ependymal enhancement can be due to


 


G7 p.1227:142mm


a. v_____


ventriculitis (pyogenic or viral)


 


b. l_____


lymphoma


 


c. m_____


metastasis


 


d. g_____


granuloma (TB)


 


101. What does the pattern of enhancement suggest?


 


G7 p.1228:35mm


a. Thin linear suggests v_____.


virus (CMV)


 


b. Nodular suggests l_____.


lymphoma


 


102. Complete the following about intraventricular hemorrhage:


 


G7 p.1228:95mm


a. Extension from


 


 


    i. t_____ in hypertensive adult


thalamus


 


    ii. p_____ in hypertensive adult


putamen


 


    iii. s_____ in premature newborn


subependyma


 


b. True or False. Occurs commonly with aneurysm of the


 


 


    i. MCA


false


 


    ii. A-comm


true


 


    iii. P-comm


false


 


    iv. distal basilar


false


 


    v. vein of Galen


false


 


    vi. carotid bifurcation


true


 


    vii. pericallosal


false


 


     viii. vertebral


true


 


     ix. PICA


true


 


     x. dissecting vertebral type


true


 


103. The most common medial temporal lobe lesions are


 


G7 p.1128:145mm


a. h_____


hamartoma


 


b. m_____ t_____ s_____ mesial temporal sclerosis


 


c. g_____


glioma (low grade)


 


104. True or False. Esthesioneuroblastoma most commonly presents with


 


G7 p.1230:42mm


a. pain


false


 


b. nasal obstruction


false


 


c. epistaxis


true


 


d. tearing


false


 


e. proptosis


false


 


105. To differentiate:


 


G7 p.1230:80mm


nasal encephalocele


 


 


nasal glioma in the newborn


 


 


a. pulsatile



 


b. swells with Valsalva



 


c. hypertelorism



 


d. attachment to CNS



 


106. Destructive spondylo-arthropathy is


 


G7 p.1233:30mm


a. the name for bone changes seen in c_____ r_____ f_____.


chronic renal failure


 


b. It resembles i_____.


infection


 


107. True or False. Destruction of the disc space is highly suggestive of


 


G7 p.1233:70mm


a. tumor


false


 


b. infection


true


 


c. degenerative disease


false


 


d. metabolic disease


false


 


108. Matching. Match the destructive lesion of the spine with its cause.


 


G7 p.1233:71mm


Cause: infection; tumor; Paget disease Destructive lesion:


 


 


a. Destruction of disc space suggests_____.



 


b. Disc space not destroyed suggests _____.



 


c. Single-level involvement suggests _____.



 


d. Multiple-level involvement suggests _____.



 


e. Dense vertebra on x-ray suggests _____.



 


109. True or False. Pott disease is confined to the disc space.


false (The disc may be relatively resistant to tuberculous involvement.)


G7 p.1233:88mm


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Aug 6, 2016 | Posted by in NEUROSURGERY | Comments Off on Differential Diagnosis (DDx) by Location

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