415 Approach To Neurologic Disease

Question 1

combination of optic neuritis and spastic ataxic paraparesis suggests optic nerve and spinal cord disease which may include

Answer 1

multiple sclerosis (MS), CNS syphilis, and vitamin B 12 deficiency

Question 2

Lhermitte symptom

Answer 2

electric shock–like sensations evoked by neck flexion

due to ectopic impulse generation in white matter pathways and occurs with demyelination in the cervical spinal cord; among many possible causes, this symptom may indicate MS in a young adult or compressive cervical spondylosis in an older person.

Question 3

Primary neuronal (gray matter) disorders

Versus white matter involvement

Answer 3

Primary neuronal (gray matter) disorders may present as early cognitive disturbances, movement disorders, or seizures, whereas white matter involvement produces predominantly “long tract” disorders of motor, sensory, visual, and cerebellar pathways.

Question 4

Slowly advancing visual scotoma with luminous edges, termed ___________. indicates spreading cortical depression, typically with migraine.

Answer 4

fortification spectra

Question 5

Tests of walking a 7.5-m (25ft) distance (normal, _____ note assistance, if any), repetitive finger or toe tapping (normal is:

Answer 5

5-6s

20–25 taps in 5 s

Question 6

MMSE sensitivoty and specificity

Answer 6

Using age-adjusted values for defining normal performance, the test is ~85% sensitive and 85% specific for making the diagnosis of dementia that is moderate or severe, especially in educated patients.

Question 7

Reaction of spinal origin

Triple flexion response

Answer 7

flexion at the ankle, knee, and hip in response to a painful stimulus to the foot

Question 8

the changes in pitch and accentuation of syllables and words

Answer 8

Prosody

Question 9

Vincristine side effect

Answer 9

Pwripheral neuropathy

Question 10

SE Cyclosporine

Answer 10

Encephalopathy

Question 11

SE Aminoglycoside

Answer 11

May exacerbate neuromuscular disorders

Question 12

Pseudotumor cerebri

Answer 12

Viramin Aa

Question 13

biceps (C5, C6), brachioradialis (C5, C6), and triceps (C7, C8) reflexes in the upper limbs and the patellar or quadriceps (L3, L4) and Achilles (S1, S2) reflexes in the lower limbs

Answer 13

Notes

Question 14

Reflexes may be enhanced by asking the patient to voluntarily contract other, distant muscle groups

Answer 14

Jendrassik maneuver

Question 15

ipsilateral elevation of the testicle following stroking of the medial thigh; mediated by L1 and L2

Answer 15

cremasteric reflex

Question 16

Contraction of the anal sphincter when the perianal skin is scratched; mediated by S2, S3, S4

Answer 16

Anal reflex

Question 17

decreased arm swing on one side (corticospinal tract disease), a stooped posture and short-stepped gait (parkinsonism), a broad-based unstable gait (ataxia), scissoring (spasticity), or a high-stepped, slapping gait (posterior column or peripheral nerve disease), or the patient may appear to be stuck in place (apraxia with frontal lobe disease).

Answer 17

Notes

Question 18

Nonlocalizing EEG in focal seizures

Answer 18

Medial temporal lobe or inferior frontal lobe