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First Aid: Step 2 CS > Differential & Work-up: Numbness/Weakness, Insomnia > Flashcards

Differential & Work-up: Numbness/Weakness, Insomnia Flashcards

1
Q

53 yo M presents following a 20·minute episode of right-sided arm and face numbness. His symptoms had totally resolved by the time he got to the emergency department. He has a history of hypertension, migraine, diabetes mellitus, and heavy smoking. Physical examination is within normal limits.

A
  1. Transient ischemic attack (TIA)
  2. Stroke
  3. Migraine with sensory aura
  4. Hypoglycemia
  5. Seizure with Todd paresis
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2
Q

WORK-UP FOR:

  1. Transient ischemic attack (TIA)
  2. Stroke
  3. Migraine with sensory aura
  4. Hypoglycemia
  5. Seizure with Todd paresis
A
  1. CT-head
  2. CBC
  3. Electrolytes, glucose
  4. Fasting lipid panel
  5. ECG
  6. MRI-brain, with DWI
  7. Doppler U/S-carotid
  8. Echocardiography
  9. EEG
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3
Q

68 yo M presents with slurred speech, right facial drooping and numbness, and right-hand weakness. Babinski sign is present on the right, he has weakness of the right side of his body. and his deep tendon reflexes are brisk. He has a history of hypertension, diabetes mellitus, and heavy smoking.

A
  1. Stroke
  2. TIA
  3. Seizure with Todd paresis
  4. Intracranial neoplasm
  5. Subdural or epidural
  6. hematoma
  7. Hypoglycemia
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4
Q

WORK UP FOR:

  1. Stroke
  2. TIA
  3. Seizure with Todd paresis
  4. Intracranial neoplasm
  5. Subdural or epidural
  6. hematoma
  7. Hypoglycemia
A
  1. CT-head
  2. CBC
  3. Electrolytes, glucose
  4. PT/PTT/INR
  5. Fasting lipid panel
  6. MRI-brain, with DWI
  7. MRA
  8. Doppler U/S-carotid
  9. Echocardiography
  10. ECG
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5
Q

33 yo F presents with ascending loss of strength and numbness in her lower legs over the past 2 weeks. She had a recent URI. Examination shows weakness of her lower limbs with reduced reflexes.

A
  1. Guillain-Barre syndrome
  2. Multiple sclerosis
  3. Transverse myelitis
  4. Spinal cord compression
  5. Peripheral neuropathy
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6
Q

WORK UP FOR:

  1. Guillain-Barre syndrome
  2. Multiple sclerosis
  3. Transverse myelitis
  4. Spinal cord compression
  5. Peripheral neuropathy
A
  1. CBC
  2. Electrolytes
  3. MRI-spine
  4. CPK
  5. Electromyography
  6. Nerve conduction studies
  7. LP-CSF analysis
  8. PFTs
  9. Serum B12
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7
Q

30 yo F presents with weakness, loss of sensation, and tingling in her left leg that started this morning. She also experienced right eye pain with reduced vision that resolved transiently 3 months ago. She reports feeling “electric shocks” down her spine upon flexing her head. Examination reveals left lower limb weakness and ataxia.

A
  1. Multiple sclerosis
  2. Stroke
  3. CNS vasculitis
  4. Conversion disorder
  5. Malingering
  6. CNS tumor
  7. Vitamin B12 deficiency
  8. Neurosyphilis
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8
Q

WORK UP FOR:

  1. Multiple sclerosis
  2. Stroke
  3. CNS vasculitis
  4. Conversion disorder
  5. Malingering
  6. CNS tumor
  7. Vitamin B12 deficiency
  8. Neurosyphilis
A
  1. CBC
  2. ESR
  3. ANA, ANCA
  4. VDRL/RPR
  5. SerumB12
  6. MRI-brain, spine
  7. LP-CSF analysis
  8. Visual evoked potentials
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9
Q

55 yo M presents with tingling and numbness in his hands and feet (glove-and-stocking distribution) for the past 2 months. He has a history of diabetes mellitus, hypertension, and alcoholism. There is decreased soft touch, vibratory, and position sense in the feet, reflexes are absent.

A
  1. Diabetic peripheral neuropathy
  2. Alcoholic peripheral neuropathy
  3. B12 deficiency
  4. Uremic nephropathy
  5. Hypocalcemia
  6. Hyperventilation
  7. Paraproteinemia/ myeloma
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10
Q

WORK UP FOR:

  1. Diabetic peripheral neuropathy
  2. Alcoholic peripheral neuropathy
  3. B12 deficiency
  4. Uremic nephropathy
  5. Hypocalcemia
  6. Hyperventilation
  7. Paraproteinemia/ myeloma
A
  1. HbA1C
  2. Glucose
  3. ESR
  4. Calcium
  5. SerumB12
  6. UA
  7. TFTs
  8. Urea, electrolytes
  9. Serum and urine protein electrophoresis
  10. Electromyography
  11. Nerve conduction studies
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11
Q

40 yo F presents with occasional double vision and droopy eyelids at night with normalization by morning. Her past medical history is significant for hypothyroidism.

A
  1. Myasthenia gravis
  2. Multiple sclerosis
  3. Intracranial neoplasm compressing CN III, IV, VI
  4. Horner syndrome
  5. Botulism
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12
Q

WORK UP FOR:

  1. Myasthenia gravis
  2. Multiple sclerosis
  3. Intracranial neoplasm compressing CN III, IV, VI
  4. Horner syndrome
  5. Botulism
A
  1. Ice pack test
  2. Tensilon ( edrophonium) test
  3. Anti-ACh receptor antibodies
  4. Electromyography
  5. Nerve conduction studies
  6. CXR
  7. CT-chest
  8. MRI-brain
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13
Q

25 yo M presents with hemiparesis after a tonic-clonic seizure that resolved within a few hours.

A
  1. Todd paralysis
  2. TIA
  3. Stroke
  4. Intracranial neoplasm
  5. Hemiplegic migraine
  6. Head injury
  7. Hypoglycemia
  8. Malingering
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14
Q

WORK UP FOR:

  1. Todd paralysis
  2. TIA
  3. Stroke
  4. Intracranial neoplasm
  5. Hemiplegic migraine
  6. Head injury
  7. Hypoglycemia
  8. Malingering
A
  1. CBC
  2. Glucose, electrolytes
  3. Toxin levels
  4. EEG
  5. CT-brain
  6. MRI-brain
  7. Doppler U/S-carotid
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15
Q

56 yo obese F c/o tingling and numbness of her thumb, index finger, and middle finger for the past 5 months. Her symptoms are constant, have progressively worsened, and are relieved with rest. She works as a secretary. She has a history of fatigue and a 20~lb (9~kg) weight gain over the same period.

A
  1. Carpal tunnel syndrome secondary to overuse
  2. Overuse injury of median nerve
  3. Cervical disc disease
  4. Medial epicondylitis
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16
Q

WORK UP FOR:

  1. Carpal tunnel syndrome secondary to overuse
  2. Overuse injury of median nerve
  3. Cervical disc disease
  4. Medial epicondylitis
A
  1. TSH
  2. CBC
  3. Electromyography
  4. Nerve conduction study
17
Q

25 yo F presents with a 3~week history of difficulty falling asleep. She sleeps 7 hours per night without nightmares or snoring. She recently began college and is having trouble with her boyfriend. She drinks three to four cups of coffee a day.

A
  1. Stress induced insomnia
  2. Caffeine induced insomnia
  3. Insomnia with circadian rhythm sleep disorder
  4. Insomnia related to major depressive disorder
18
Q

WORK UP FOR:

  1. Stress-induced insomnia
  2. Caffeine induced insomnia
  3. Insomnia with circadian rhythm sleep disorder
  4. Insomnia related to major depressive disorder
A
  1. Polysomnography
  2. Urine toxicology
  3. CBC
  4. TSH
19
Q

55 yo obese M presents with several months of poor sleep, daytime fatigue, and morning headaches. His wife reports that he snores loudly.

A
  1. Obstructive sleep apnea
  2. Daytime fatigue in primary hypersomnia
  3. Insomnia with circadian rhythm sleep disorder
  4. Insomnia related to major depressive disorder
20
Q

WORK UP FOR:

  1. Obstructive sleep apnea
  2. Daytime fatigue in primary hypersomnia
  3. Insomnia with circadian rhythm sleep disorder
  4. Insomnia related to major depressive disorder
A
  1. Polysomnography
  2. ECG
  3. CBC
  4. TSH
21
Q

33 yo F presents with 3 weeks of fatigue and trouble sleeping. She states that she falls asleep easily but wakes up at 3 AM and cannot return to sleep. She also reports unintentional weight loss of 8 lbs {3.6kg) and an inability to enjoy the things she once liked to do.

A
  1. Insomnia related to major depressive disorder
  2. Primary hypersomnia
  3. Insomnia with circadian
  4. rhythm sleep disorder

First Aid: Step 2 CS (23 decks)

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