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step II > amboss 7/7 > Flashcards

amboss 7/7 Flashcards

1
Q

what causes cystercicosis

A

T. solium eggs

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2
Q

where are T solium eggs transmitted to humans

A

fecal oral route from ingestion of undercooked pork

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3
Q

what is the usual course of Guillain-barre

A

30% require mechanical ventilation, majority recover completely and 5% die because of acute complications

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4
Q

what is the treatment for botulism

A

human derived immunoglobulin

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5
Q

what is the treatment for GBS

A

plasmapheresis is an option

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6
Q

what is the presentation of CMV retinitis

A

most commonly found in AIDS patients with CD4 <50. pizza pie appearance on fundoscopic exam, due to the red and white lesions. causes retinal detachment.

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7
Q

what is the initial treatment for carpal tunnel syndrome

A

volar splinting. local triamcinolone injections are the next step. surgical decompression is also an option.

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8
Q

what is radial nerve compression presentation

A

this is Saturday night palsy. when there is lack of sensation and wrist drop due to radial nerve compression from sleeping on a park bench.

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9
Q

what is the mechanism of treatments for myasthenia gravis

A

Acetylcholinesterase inhibitors.

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10
Q

what are the Acetylcholinesterase inhibitors.

A

physostigmine and rivastigmine

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11
Q

what is atropine the treatment for atropine OD

A

antimuscarinic physostigmine and rivastigmine

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12
Q

what is the treatment of choice for an immunocompromised individual with suspected meningitis

A

empiric treatment is vancomycin, ampicillin, cefepime

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13
Q

what is the treatment of choice for someone with a high suspicion of strep pneumonia meningitis AND NOT IMMUNOCOMPROMISED

A

empiric treatment is vancomycin, ampicillin, cefepime and dexamethasone.

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14
Q

what is the treatment of choice for herpes encephalitis

A

IV acyclovir

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15
Q

what is the presentation of herpes encephalitis

A

typically characterized by a prodromal phase (fever, headache) followed by acute or subacute encephalopathy with symptoms of focal neurological deficits (such as the paresis exhibited by the patient), seizures, altered mental status, and behavioral changes.

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16
Q

when is tetanus vaccination required for PEP

A

if the vaccine was given 5 or more years prior

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17
Q

what is the protocol for 1st time rabies PEP

A

rabies vaccine and immunoglobulin.

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18
Q

what is the protocol for 2nd time rabies PEP

A

rabies vaccine only

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19
Q

do we give tetanus for animal bites

A

yes, if the bite occurred 5 or more years after the last vaccination

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20
Q

what is the diagnosis for someone that has weakness of the hand when grasping objects, has numbness and tingling and pain that wakes them up night. elevating the hand above the head reproduces the symptoms

A

carpel tunnel syndrome

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21
Q

what is the diagnostic test of choice for carpal tunnel

A

nerve conduction studies

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22
Q

when you are unsure of someones immunization status what is the proper tetanus PEP

A

they must be given active immunization and if the wound is dirty or extensive must be given TIG
however, if the wound is minor or clean, then Tdap/DTaP is used depending on age

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23
Q

when is DTaP used

A

this is the primary prophylaxis agent and given to children as PEP under the age of 7

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24
Q

what is the treatment for cluster headache

A

oxygen therapy is effective in treating 80% of clusters

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25
Q

what is the presentation of cluster headache

A

severe unilateral headache, lacrimation. stabbing/burning pain. flushing, rhinorrhea, nasal congestion. occurs in clusters

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26
Q

what are the triggers for cluster headache

A

alcohol, insomnia, nitrates, bright lights

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27
Q

who gets a cluster headache

A

men are three times more likely 20-40 years of age

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28
Q

what is the presentation of rabies

A

drooling, tense muscles, combativeness

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29
Q

what is the presnetation of HSV-1 conjunctivitis

A

unilateral conjuctivitis with watery discharge and vesicles

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30
Q

what is the treatment for HSV1 conjunctivitis

A

self-limiting and usually resolves in 2 weeks.

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31
Q

what is the gold standard for diagnosing HSV1 conjunctivits

A

cell culture

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32
Q

what is therapy for HSV1conjuvitis and who gets it

A

immunocompromised and children.

topical, oral or IV acyclovir

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33
Q

what is the treatment for postherpetic neuralgia

A

TCAs

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34
Q

what is a contraindication to TCA treatment in post herpetic neuralgia

A

MI, cardiac dysfunction, arrhythmias

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35
Q

what is a risk of ethmoidal or maxillary sinusitis

A

orbital cellulitis

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36
Q

diagnosis of pain and swelling of the eyelids with pain on movement of the extra ocular muscles

A

orbital cellulitis

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37
Q

diagnosis of pain and swelling of the eyelids with NO pain on movement of the extra ocular muscles

A

preseptal cellulitis

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38
Q

what is the PEP for neisseria meningitides

A

rifampin for close contacts.

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39
Q

what is the treatment of cerebral toxoplasmosis

A

pyrimethamine, sulfadiazine, leucovorin (folic acid)

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40
Q

what is the presentation of cerebral toxoplasmosis

A

Cerebral toxoplasmosis is a common AIDS-defining condition that presents with fever, impaired vigilance, and seizures. Multiple ring-enhancing lesions that involve the basal ganglia on neuroimaging are also strongly indicative of cerebral toxoplasmosis in an immunocompromised patient with CD4 count < 100/mm3.

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41
Q

which herpes is more likely to cause meningitis

A

HSV 2

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42
Q

which herpes is more likely to cause encephalitis

A

HSV1

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43
Q

what are the most common causes of viral meningitis

A

enteroviruses such as the coxsackie viruses

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44
Q

what is the proper diagnostic procedure for mastoididits

A

CT scan

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45
Q

what is the treatment for mastoididits

A

vancomycin; tympanostomy and possibly mastoidectomy

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46
Q

what is the treatment of choice for someone with acute otitis media and a penicillin allergy

A

macrolides such as azithromycin

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47
Q

what is the treatment for GBS

A

IVIG

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48
Q

are steroids used for GBS

A

NO. they are associated with worse outcomes

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49
Q

what is the treatment of primary brain lymphoma

A

high-dose methotrexate is the treatment of choice

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50
Q

what are the alternatives to treatment for primary lymphoma of the brain

A

first line is methotrexate.

temozolamide and cytarabine are alternative

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51
Q

what is empiric treatment for infant (<1 month) bacterial meningitis

A

ampicillin, gentamicin and cefotaxime

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52
Q

why is ceftriaxone contraindicated in infants

what alternative therapies are used

A

high risk of biliary slugging and kernicterus

cefotaxime, ceftazadime

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53
Q

what is the presentation of trachoma conjunctivitis

A

Trachoma initially presents as follicular conjunctivitis and then progresses to a mixed papillary and follicular conjunctivitis, as seen in this case. The patient’s corneal haziness with neovascularization is called pannus and is a classic presentation of active trachoma.

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54
Q

what is the presentation of hydroxchloroquine/chloroquine blindness

A

irreversible retinopathy with the key feature of bullseye maculopathy.

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55
Q

what is the treatment for chloroquine retinopathy

A

discontinue

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56
Q

what is the presentation of methanol toxicity

A

Symptoms begin 12–24 hours after ingestion and can include perceived flashes of light, blurring of vision, abdominal pain, nausea, headache, and altered mental status. Methanol rarely causes the macular damage

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57
Q

what is the presentation of age related macular degeneration

A

leading cause of blindness in the US, commonly affects individuals > 55 years. Although it often presents with difficulty adapting to changes in lighting, it would typically cause central vision impairmentfundoscopy of patients would typically reveal small, discrete, yellowish-white spots (drusen) in the macula in the case of dry AMD (80% of cases) or proliferation of abnormal new blood vessels in the case of wet AMD (much less common)

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58
Q

Vitamin A deficiency blindness presentation

A

is a leading cause of blindness in developing countries, but it is rarely seen in developed countries. Vitamin A deficiency may cause night blindness, but it would typically present with keratomalacia and Bitot’s spots.

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59
Q

what is a bitot spot and what is the cause

A

gray triangular patch on the conjunctiva.

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60
Q

conjunctivitis is most commonly caused by what

A

bacterial –staph aureus; strep pneumoniae, H flu

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61
Q

what is the treatment of choice for conjunctivitis

A

topical erythromycin

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62
Q

what is the treatment of choice for allergic conjunctivitis

A

ketotifen antihistamine drops

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63
Q

Brown-Sequard syndrome

A

Hemisection of the spinal cord. Common causes include penetrating trauma and demyelinating diseases (e.g., multiple sclerosis, transverse myelitis). Presents with ipsilateral loss of proprioception, tactile discrimination, and vibration sense due to dorsal column damage, ipsilateral flaccid paralysis due to corticospinal tract damage, and contralateral loss of pain and temperature sensation due to spinothalamic tract damage.

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64
Q

what does retinal parlor indicate

A

ischemia

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65
Q

what is Cushing’s triad

A

hypertension, bradycardia and Bradycapnea

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66
Q

what % of patients with thymoma get MG

A

30%

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67
Q

what is the treatment of choice for a subarachnoid hemorrhage

A

surgical clipping or coiling

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68
Q

what is peripheral facial nerve palsy treated with

A

high dose steroids with taper

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69
Q

what do ependymomas within the 4th ventricle usually cause

A

cerebralspinal fluid outflow tract obstruction

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70
Q

what is given after subarachnoid hemorrhage to prevent ischemia

A

calcium channel blockers

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71
Q

what is indicative of basilar skull fracture

A

bilateral periorbital ecchymoses with CSF leak

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72
Q

what is the difference between cervical disk prolapse and trauma-induced syringomyelia

A

cervical disk prolapse is usually unilateral

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73
Q

what is the treatment for septic cavernous sinus thrombosis

A

vancomycin, ceftriaxone, metronidazole

the treatment is Long term because the bacteria can sequester in thrombi

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74
Q

what is a preventative for otitis externa

A

acetic acid or alcohol based ear drops after swimming activities

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75
Q

what is a method for reducing cerebral blood flow

A

hyperventilation

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76
Q

what side does motor weakness occur in brain herniation

A

the ipsilateral side which is contradictory

this is called kernohan phenomenon

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77
Q

what is the typical presentation of creutzfeld Jacob

A

Rapidly progressing mental decline combined with myoclonus and mutism, as seen in this patient, are typical clinical findings in patients with Creutzfeldt-Jakob disease. The disease has a rapid course that often leads to death within 12 months.

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78
Q

what is the most common cause of hypopituitarism in children

A

craniopharyngioma

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79
Q

when are pituitary adenomas most common

A

30-60

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80
Q

what should be given with IV methylprednisolone

A

PPI to prevent gastritis and a LMWH for thrombophylaxis

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81
Q

what do we use to visualize the anterior chamber of the eye and for diagnosing angle-closure glaucoma

A

gonioscopy

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82
Q

what is the treatment for narcolepsy

A

modafinil; alternatives/additives are methylphenidate or amphetamines

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83
Q

what are the characteristics of narcolepsy

A

excessive daytime sleepiness (EDS). EDS along with cataplexy (tilting of the head and jaw dropping), hypnagogic hallucinations, and sleep paralysis

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84
Q

what is a rare and serious SE of metaclopramide use

A

neuroleptic malignant syndrome

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85
Q

trochlear nerve damage does what to the eye

A

produces vertical diplopia or extreme upward gaze.

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86
Q

what muscle does the trachlear nerve innervate

A

superior oblique muscle

87
Q

what tumors are associated with NF2

A

bilateral acoustic schwannoma and meningioma

88
Q

what is the most common malignant brain tumor in children

A

medulloblastoma

89
Q

when is the peak incidence of medullonblastom

A

3-5

90
Q

where does medulloblastoma usually originate

A

in the cerebellum

91
Q

what is thee most common complication of medulloblastoma

A

drop mets in the spine 40% of cases

92
Q

what are the characteristics of transient global amnesia

A

repetitively asks questions about recent events (the “broken record” phenomenon) and her only cognitive impairment is in the delayed recall domain. Other cognitive functions are spared and neurological deficits are absent on physical exam. Episodes of transient global amnesia last approximately 6 hours but are never longer than 24 hours. They usually resolve with older memories returning first, and the capacity to retain new information gradually increases. After recovery, an amnesic gap remains.

93
Q

what causes tardive dyskinesia

A

this is an extrapyramidal effect from over-antagonism of dopaminergic nigrostriatal pathway

94
Q

what drugs are known for extrapyramidal symptoms

A

first gen antipsychotics

95
Q

what is the diagnosis for chronic Guillain barre?

A

chronic inflammatory demyelinating polyneuropathy

96
Q

what is the presentation of CIDP

A

ascending symmetric sensory and motor deficits that progress over a period greater than two months.

97
Q

what is the treatment for CIDP

A

IVIg, plasmapheresis, and/or glucocorticoids)

98
Q

what is found in 10-25% of patients with CIDP that can aid in the diagnosis

A

anti-GM1 antibodies

99
Q

what is the difference between conus medullaris and cauda equina

A

Conus medullaris syndrome typically manifests with both upper and lower motor neuron signs. Bladder and bowel dysfunction within hours of the injury, hyperreflexia of the ankles, symmetric lower extremity weakness, and back pain are all consistent with this diagnosis.

asymmetric muscle weakness, decreased reflexes, and saddle anesthesia due to damage of the lower motor neurons, which is not consistent with this patient’s symmetric muscle weakness and hyperreflexia. In addition, bowel and bladder dysfunction are late findings of CES and would not be expected within hours of injury. Lastly, because of nerve root compression, the pain usually radiates along the sensory distribuftion of the nerves affected.

100
Q

what is the diagnostic test of choice for epidural spinal abscess

A

MRI

101
Q

where is DHEA-S produced

A

in the adrenal glands

102
Q

what is the cause of low LH/FSH in a thin woman that works out all the time

A

functional hypothalamic amenorrhea or hypogonadotrophic hypogonadism

103
Q

what is the treatment for functional hypothalamic amenorrhea

A

The most important aspect of treatment is normalization of energy balance, and this patient should be counseled on making both dietary and exercise regimen changes to increase her BMI.
can also use GnRH to stimulate Lh./FSH

104
Q

is the progesterone IUD good for emergency contraception

A

no

105
Q

can patients with a metal allergy/metal alloy allergy have copper IUD

A

no

106
Q

what is the best choice for emergency contraception

A

copper IUD

107
Q

what is the best choice for emergency contraception iff copper IUD cannot be used

A

ulipristal acetate

108
Q

how much time do you have to administer ulipristal acetate for successful hinderance of pregnancy

A

within 5 days

109
Q

what hormones are elevated in PCOS

A

LH/FSH/testosterone

110
Q

what is anovulation and how does it present

A

this is normal within the first 2 years of menarche. girls can go several months without having a cycle. The LH and FSH levels will be low.

111
Q

can risperidone change mestrual cycles

A

yes. there should be elevated prolactin with risperidone treatment

112
Q

what is the first thing that is done when menopause is suspected

A

measure TSH t rule out hyperthyroidism f

113
Q

what is the next step after finding a high grade intraepithelial lesion on pap smear

A

colposcopy with endcervical sampling or LEEP

114
Q

when is LEEP used instead of colposcopy

A

25 or greater

115
Q

when is colposcopy used

A

35 or over

116
Q

what is the presentation of menopause/primary ovarian failure

A

low estrogen, increased FSH and Lh due to loss of inhibition from estrogen
there will be an increased FSH to LH ratio

117
Q

what is the next step with blood tinged nipple discharge

A

subareolar ultrasound

118
Q

what is atrophic vaginitis

A

thinning of the vaginal mucosa which leads to tissue inflammation.

119
Q

what are the signs and symptoms of atrophic vaginitis/thinning of the vaginal mucosa

A

decreased vulvovaginal secretions and sensation of vulvovaginal dryness, loss of vaginal elasticity and rugal folds, a decreased labial fat pad, vaginal discharge, and recurrent urinary tract infections.

120
Q

what is the most common cause of delirium

A

electrolyte abnormalities

121
Q

what are the first steps in assessing delirium

A

CBC, serum glucose, electrolytes and urinalysis

122
Q

what are the main symptoms of delirium

A

acute onset (hours to days), alteration in the level of awareness and attention. also can include illusions, hallucinations, reversal of sleep-wake cycle, emotional lability, deficits in memory, agitation and combativeness. the severity tends to fluctuates throughout the day

123
Q

what is the treatment for episodic tension headache

A

acetaminophen

124
Q

what is episodic tension headache vs.chronci

A

episodic tension headache, which is defined as 1–14 episodes of headache per month. chronic is more often
occurring at least 15 days per month for more than 3 months

125
Q

what is the treatment for chronic tension headache

A

amitriptyline

126
Q

what are lifestyle modifications for tension headache

A

exercise, sleep, avoiding stress

127
Q

what does CSF analysis for CJD return

A

increased levels of 14-3-3

128
Q

what is a cholesteatoma and how does it present

A

unilateral hearing loss, otorrhea, tinnitus, vertigo and a past history of multiple ear infection with a pearly white mass.
chronic otitis media in which keratinizing squamous epithelium grows from the tympanic membrane or the auditory canal into the middle ear mucosa. Can be congenital or acquired later in life.

129
Q

what is cubital tunnel sydnrome

A

In occupations that involve hammering and lifting heavy objects, such as carpentry, the ulnar nerve can be compressed proximally within the cubital tunnel (cubital tunnel syndrome) as a result of repetitive elbow flexion, which decreases the volume of the cubital tunnel. Decreased pinch strength occurs as a result of weakness of the adductor pollicis muscle, which appears as the Froment sign.

130
Q

what is the guyon tunnel

A

this is the medial aspect of the wrist and contains the ulnar nerve and artery.

131
Q

what is guyon tunnel syndrome

A

Compression of the ulnar nerve within the Guyon canal (ulnar tunnel syndrome) can also result in decreased pinch strength (due to adductor pollicis weakness) as well as sensory deficits or paresthesias over the little finger and, in some cases, the palmar surface of the medial aspect of the hand. However, the dorsal surface of the hand would be spared because the dorsal surface of the medial aspect of the hand is usually innervated by the dorsal cutaneous branch of the ulnar nerve, which arises more proximally in the forearm.

132
Q

what is the difference between guyon tunnel and cubital tunnel syndrome

A

in cubital tunnel there will dorsal hand paresthesia

133
Q

what is one of the main differences between conus medullaris and cauda equine

A

equina is asymmetric differences in strength

134
Q

what causes lateral medullary syndrome/wallenberg sydnrome

A

infarct of the PICA

135
Q

what is the presentation of Wallenberg

A

dizziness (vestibular nucleus), ipsilateral ataxia (inferior cerebellar peduncle), impaired pain and temperature sensations in the ipsilateral side of the face (inferior part of the trigeminal nerve nucleus) and contralateral side of the body (spinothalamic tract), ipsilateral Horner’s syndrome as suggested by ptosis and miosis (descending sympathetic fibers), and dysphonia (hoarseness) with an ipsilaterally impaired gag reflex (nucleus ambiguus). Rapid nystagmus and miosis result in blurry vision.

136
Q

how to remember Wallenberg syndrome

A

how to PIC-A Horse

137
Q

otitis media with effusion can do what

A

mild hearing loss and speech delay.

138
Q

what is the treatment for OME

A

usually resolves on its own. However, when a child is becoming language delayed, prompt surgical intervention is required. tubes will equalize the pressure in the ears and allow for drainage of the fluid

139
Q

what is PCA syndrome

A

contralateral homonymous hemianopia with macular sparing, as seen in this patient. As the PCA also supplies the thalamus, patients often have thalamic syndrome and report contralateral sensory abnormalities such as numbness or paresthesia in the limbs, trunk, or chest, as seen in this patient with numbness of the right leg. Patients with left-sided PCA strokes, as is the case here, present with alexia without agraphia or anomic aphasia (due to ischemic damage to the splenium of the corpus callosum, which carries visual information from the visual cortex to Broca’s and Wernicke’s areas).

140
Q

what is the treatment for neuroleptic syndrome

A

danrtrolene, bromocryptine or amantadine though there is little evidence that they work
benzo are also given to reduce the psychomotor agitation

141
Q

what is the treatment for ALS

A

riluzole which can only slow the deterioration

142
Q

absence of deep tendon reflexes in an elderly person is

A

NORMAL

143
Q

what is the presentation of pyogenic brain abscess

A

usually from dental caries. as the abscess grows it will cause ICP and papilledema. the patient will show signs of meningeal inflammation. there will be fver

144
Q

what is the mainstay of Alzheimers treatments and what is an adjuvant therapy

A

donepezil and and memantine

145
Q

what is Lewy body dementia

A

characterized by dementia with visual hallucinations and parkinsonism (e.g., tremor, rigidity).

146
Q

what is the cause of NPH

A

decreased reabsorption of CSF from the arachnoid villi

147
Q

what is the preferred method for imaging an infants brain/head

A

ultrasound

148
Q

what is the presentation of brain abscess

A

ring enhancing lesion, history of infections (ear infections), seizure, fever

149
Q

what is the treatment for brain abscess

A

immediate sterotactic drainage

150
Q

what is the most common cause of chronic ataxia in patients with alcohol use disorder

A

cerebellar ataxia

151
Q

how do you confirm IIH

A

lumbar puncture

152
Q

what is the treatment for IIH

A

azectazolamide

153
Q

what is the cause of intention tremor

A

cerebellar demyelination

154
Q

what is the presentation of open-angle glaucoma

A

slowly progressive increase in intraocular pressure causes optic nerve atrophy. there is increased cup to disk ratio

155
Q

what are thee treatments for open-angle galucoma

A

Topical prostaglandins such as latanoprost are the first-line treatment for primary open-angle glaucoma. They lower intraocular pressure by improving the drainage of aqueous humor. Side effects include increased pigmentation of the iris, elongated eyelashes, and burning/stinging during instillation.

156
Q

what are the alternative treatments for open angle glaucoma

A

topical timolol or beta blockers

157
Q

Typical symptoms caused by cerebellar tumors include

A

gait ataxia, truncal ataxia, dysarthria, nystagmus, dysmetria, dysdiadochokinesia, and pronator drift.

158
Q

what drug is used to treat acute angle-closure glaucoma

A

topical pilocarpine

159
Q

what drug is contraindicated in acute angle closure glaucoma

A

epinephrine

160
Q

what is the treatment for spinal epidural hematoma s

A

immediate surgical decompression

161
Q

what are the signs of supranuclear palsy

A

Midbrain atrophy with an intact pons (hummingbird sign) is seen in patients with progressive supranuclear palsy. Atrophy of structures in the tectum of the midbrain (e.g., the superior colliculus) results in vertical gaze palsy, the hallmark of PSP, or, less commonly, complete external ophthalmoparesis. Patients with PSP often have postural instability, which leads to gait impairment and frequent falls. Furthermore, frontal lobe dysfunction manifests with behavioral changes (e.g., apathy, disinhibition, impaired reasoning). Patients usually also present with signs of parkinsonism (e.g., bradykinesia, rigor) and may develop features of pseudobulbar palsy such as dysarthria and dysphagia, as seen in this patient.

162
Q

Status epilepticus can cause potentially irreversible tissue damage of the CNS, resulting in

A

cortical laminar necrosis (CLN), which is often characterized by permanent neurological deficits.

163
Q

what does pronator drift indicate

A

upper motor neuron lesion

164
Q

what is the definition of orthostatic hypotension

A

drop in systolic of 20 or more or a drop in diastolic 10 or more

165
Q

what are the defining features of suprnuclear palsy

A

disinhibition and vertical gaze palsy

166
Q

what is long term prevention of migraine

A

propanolol

167
Q

what are the treatments for migraines

A

NSAIDs are first line followed by sumatriptans and ergotamine as abortives.

168
Q

do you ever combine sumatriptans and ergotamine

A

no. this can cause stroke.

169
Q

what can be used as monotherapy for migraines with nausea and vomiting

A

antiemetics such as prochlorperazine

170
Q

what is first line therapy for children with migrainwe

A

NSDAIDs or tyleno.

171
Q

what do you do for a child with migraine if acetaminophen fails

A

give NSAID in addition

172
Q

what is the risk of treatment for MS with natalizumab

A

PML you idiot

173
Q

what is the likely cause of isolated ocular nerve palsy

A

uncontrolled diabetes causing mononeuropathy

174
Q

what is an accompanying feature of oculomotor nerve palsy (eye is down and out)

A

ptosis because the levator palpebrae is innervated by the oculomotor nerve

175
Q

is physostigmine used for MG

A

no. doesnt cross the BBB

176
Q

what is the next step for someone with MG

A

CT scan of the chest top rule out thymoma

177
Q

what is treatment of choice for MG

A

pyridostigmine; can give steroids

178
Q

should people with MG get thymectomy

A

yes, can be beneficial even for people without thymoma

179
Q

which MG patients shouldn’t get thymoma

A

MuSK-associated patients

180
Q

what is the treatment for brain mets

A

surgical resection

181
Q

what is the presentation of myotonic dystrophy

A

Abduction of the thumb followed by slow relaxation upon percussion indicates myotonia. Myotonia in a 9-year-old boy with muscle aches and weakness in the distal muscles (hand and/or foot), face, as well as extraocular muscles is highly suggestive of type 1 myotonic dystrophy. Reduced fetal temporalis and pterygoid muscle growth results in a high-arched palate. About 50% of patients with myotonic dystrophy have some degree of cognitive impairment.

182
Q

what is focal to bilateral tonic-clonic seizure

A

formerly called partial with secondary generalization. this begins in one focal area and then spreads to the general hemispheres. they often begin with aura

183
Q

will Parkinson’s show increased or decreased amplitude on foot tapping

A

decreased

184
Q

where are medulloblastomas usually located

A

at the midline of the cerebellum at the roof of the fourth ventricle

185
Q

pylocytic astrocytomas prognosis

A

good after resection

186
Q

what is a treatment for Parkinson for patients that are younger than 65 for initial monotherapy

A

trihexyphnidyl -an anticholinergic

dopamine agonists are the treatment of choice

187
Q

what is the presentation of friedrichs ataxia

A

It affects multiple spinal cord tracts, causing muscle weakness and impaired coordination of all limbs. A staggering gait in childhood is the resulting main symptom. Other features include skeletal abnormalities, cardiomyopathy, and diabetes.

188
Q

what causes F ataxia

A

An autosomal recessive disorder involving trinucleotide repeat expansion in the frataxin that leads to progressive neurodegeneration.
GAA repeats

189
Q

what are the SE of amantidine

A

livedo reticularis and peripheral edema

190
Q

what is the treatment of choice for relapsing remitting MS

A

interferon B

191
Q

what are the other first line medications for MS (relapsing(

A

glatiramer acetate, dimethyl fumarate, teriflunomide, and fingolimod.

192
Q

what is peroneal neuropathy

A

the most common peripheral nerve lesion of the lower extremity. due to peroneal compression. foot drop. due to the peroneal nerve wrapping around the head of the fibula

193
Q

what does a CT scan show of vascular dementia

A

hypodense periventricular lesions

194
Q

what is a medication to treat chorea in huntingtons

A

tetrabenazine

195
Q

what is a treatment for vascular dementia

A

cognitive training

196
Q

what is the difference between PML and HIV encephalopathy

A

HIV encep will have periventricular white matter lesions and cortical atrophy.
PML will be more superficial white matter

197
Q

what is the presentation of lithium toxicity

A

nausea, vomiting, dry mucous membranes, tremor.

198
Q

what is the treatment for lithium tox

A

hemodialysis

199
Q

presentation of serotonin syndrome and treatment

A

hypertension, tremor, diaphoresis, hyperthermia, clonus, hyperrelexia, tachycardia; cyproheptadine

200
Q

what is intranuclear ophthalmoplegia

A

demyelination of the medial longitudinal fasciculus.

This is when there is limited adduction of the eyes causing contralateral nystagmus

201
Q

what is the most common cause of INO

A

MS

202
Q

what is the MRI findings for cerebral palsy

A

periventricular leukomalacia

203
Q

what is the presentation and treatment for allergic rhinitis

A

conjunctival erythema and watery discharge, prominent itchiness. NO lymphadenopathy
oral cetrizine

204
Q

what is the presentation and treatment of adenovirus conjunctivitis

A

Inflammation of the conjunctiva and, possibly, the cornea (keratitis), most commonly caused by adenovirus. FOLICLES on slit lamp. Conjunctival erythema (pink eye) is accompanied by pruritus, and edema. Extra-ocular manifestations commonly include mild fever and preauricular lymphadenopathy. A distinguishing feature is the development of symptoms in one eye with rapid migration to the other eye
treatment is supportive cold compresses and artificial tears

205
Q

what is the presentation and treatment for herpes simplex kerittis

A

unilateral conjunctivitis accompanied by a foreign body sensation. The classic finding on ocular examination is linearly branching corneal ulcers (dendritic ulcers).
treat with oral acyclovir

206
Q

bacterial conjunctivitis presentation and treatment

A

which presents with erythematous conjunctiva, purulent discharge, upper lid papillae on slit-lamp examination, and possibly fever and lymphadenopathy.
treat with topical moxifloxacin/erythromycin

207
Q

what is the current recommendation for mild concussion

A

observation and refrain from contact sports for one week

208
Q

what is klumpke palsy

A

when there is brachial nerve damage during birthing and the ipsilateral hand shows no grasp reflex

209
Q

what is the presentation of superior gluteal nerve inquiry

A

trendelenberg gait -the contralateral hip will sag

210
Q

if someone is on benzos and you give Flumazenil what can happen

A

you can send them into withdrawal and cause seizres

211
Q

what is the difference between hordeleum and chalazon

A

chalazons are not painful and are classically chronic and typically NOT purulent

212
Q

what is the presentation of bacterial kerititisd

A

contact lens wearing patient presents with unilateral eye pain, impaired vision and eye discharge. Together with a round corneal infiltrate and a hypopyon, this is highly suggestive of severe bacterial keratitis.

213
Q

what is the topical treatment for bacterial kerititis

A

ofloxacin

step II (22 decks)

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