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Level 2 Boards > MSK/ Neurology > Flashcards

MSK/ Neurology Flashcards

1
Q

Humerus fracture can injury

A

Radial nerve

Radial nerve palsy

  • wrist drop
  • loss of thumb extension
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2
Q

Fall on outstretch hand

Dorsiflexion

A

Colles fracture

Distal radius

Damage Median nerve w/ dorsal displacement

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3
Q

Posterior hip dislocation

A

internally rotated, flexed, adducted

Car crash

Sciatric nerve injury risk

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4
Q

Anterior dislocation of hip can injury

A

Obturator nerve

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5
Q

+ valgus stress test

A

MCL injury

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6
Q

+ varus stress test

A

LCL injury

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7
Q

+ Thompson test

A

Pressure on gastrocnemius leading to absent foot plantar flexion

Achilles tendon rupture

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8
Q

Painless bulge in popliteal space

A

Popliteal (Baker) cyst rupture

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9
Q

Acute calf pain

A

Popliteal (Baker) cyst rupture

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10
Q

Unhappy triad of knee injury

A

ACL
MCL
Medial meniscus

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11
Q

Saturday night palsy affects

A

Radial nerve

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12
Q

Wrist drop

A

Radial nerve

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13
Q

Radial nerve innervates

A

Wrist extension

Dorsal forearm and hand (frist 3 1/2 fingers)

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14
Q

Weak wrist flexion and flat thenar eminence

A

Median nerve injury

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15
Q

Median nerve does

A

Forearm pronation, thumb opposition

Palmar surface (first 3 1/2 fingers)

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16
Q

Loss of pronation

A

Median nerve injury

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17
Q

Elbow dislocation injures

A

Ulnar nerve

Claw hand

Loss of finger abduction

Loss of sensation over last 2 fingers

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18
Q

Claw hand

A

Ulnar nerve injury

inability to open the fourth to fifth digits

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19
Q

Dorsal foot and lateral leg

A

Peroneal nerve

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20
Q

Foot drop

A

Peroneal nerve

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21
Q

Knee dislocation can injure

A

Peroneal nerve

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22
Q

Loss of dorsiflexion and eversion

A

Peroneal nerve

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23
Q

Loss of sensation over lateral thigh

A

Lateral femoral cutaneous nerve injury

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24
Q

Shortened, internally rotated leg

A

Posterior hip dislocation

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25
Q

Lengthened, extrenally rotated leg

A

Anterior hip dislocation

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26
Q

Shortened, externally rotated leg

A

Hip fracture

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27
Q

Anterior knee pain

Reproduced by extension

Decreased ROM

A

Patellofemoral pain syndrome

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28
Q

Elbow pain worse with resisted extension

A

Lateral epicondylitis

Tennis elbow

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29
Q

Elbow pain worse with resisted flexion

A

Medial epicondylitis

Golfer’s elbow

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30
Q

Median nerve injury

A

Benediction sign

inability to close first through third digits

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31
Q

Lower back pain

+ passive straight leg raise

+ contralateral (crossed) straight leg raise

A

Herniated disk

MRI

Surgery if > 6 weeks

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32
Q

Nerve root for foot dorsiflexion

A

L4

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33
Q

Nerve root for big toe dorsiflexion

foot eversion

A

L5

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34
Q

Nerve root for plantarflexion

A

S1

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35
Q

Tibial fracture risk for

A

Compartment syndrome

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36
Q

Septic arthritis

Organism

Tx

A

Staphylococcus
Streptococcus
Gram (-) rods

Ceftriaxone and vancomycin

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37
Q

Osteophytes
Subchondral sclerosis
Subchondral bone cysts

A

Osteoarthritis

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38
Q

Child with gout and inexplicable injuries

A

Lesch-Nyhan syndrome

Hypoxanthine-guanine phosphoribosyltransferase deficiency

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39
Q

Numbness, pain and paresthesias between third and fourth toes

Clicking sensation

Worse with high heels

A

Morton Neuroma

Neuropathic degeneration of nerves

Tx: padded shoe inserts

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40
Q

Punched out erosions with overhanging cortical bone

A

Gout

“rat bite”

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41
Q

Gout Tx

A

Acute

  • High dose NSAID (indomethacin)
  • Steroids if NSAID CI due to renal disease

Maintenance
- allopurinol

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42
Q

Gout shape

A

Needle shaped

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43
Q

Rhomboid crystals

A

Pseudogout

Due to hemochromatosis or hyperparathyroidism

Chondrocalcinosis on imaging (calcification of articular cartilage)

Associated with meniscal calcification

Wrists and knee affected

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44
Q

Ulnar deviation of fingers with MCP joint hypertrophy

A

RA

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45
Q

RA tx

A

1) Methotrexate

2) Symptoms > 6 months add
Hydroxychlorquine
sulfasalazine

or TNF inhibitor

Hydroxychlorquine can cause retinal toxicity

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46
Q

Cant see
Cant pee
Cant climb a tree

A

Reactive arthritis

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47
Q

HLA-DR4

A

RA

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48
Q

HLA-B27

A

Ankylosing spondylitis

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49
Q

Young man

Arthritis
Uveitis
Conjunctivitis
Urethritis

A

Reactive arthritis

Previous infection with Campylobacter, Shigella, Salmonella, Chlamydia, or Ureaplasma

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50
Q

Sausage shaped digits

A

Psoriatic arthritis

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51
Q

Anti-Jo

A

Polymyositis

Dermatomyositis

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52
Q

Papular rash with scales on dorsa of the hands over bony prominences

A

Gottron papules

Dermatomyositis

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53
Q

Symmetric, progressive proximal muscle weakness and pain

Difficulty getting up from seat

Labs(3)

A

Polymyositis

Elevated creatine kinase, aldolase, AST

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54
Q

ANA

A

SLE

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55
Q

Anti-CCP

A

RA

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56
Q

Anti-dsDNA

A

SLE

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57
Q

Antihistone

A

Drug induced SLE

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58
Q

Anti-Ro/ Anti-a

A

Sjogren syndrome

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59
Q

Anti-Sm

A

SLE

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60
Q

Anti-smooth muscle

A

Autoimmune hepatitis

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61
Q

c-ANCA

A

Vasculitis, especially granulomatosis w/ polyangiitis (Wegener)

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62
Q

p-ANCA

A

Microscopic polyangiitis

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63
Q

CREST syndrome

A

Anti-centromere

Calcinosis
Raynaud phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasis
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64
Q

Tx Raynaud

A

CCB

  • Nifedipine
  • Amlodipine
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65
Q

Tx Giant cell arthritis

A

High dose prednisone to prevent ocular involvement

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66
Q

Asian

Aortic claudication

Differential BP in both upper extremtities

Absence of palpable pulses

ESR and CRP elevated

A

Takayasu arteritis

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67
Q

Middle eastern man

Recurrent painful oral ulcers

uveitis

Genital ulcers

A

Behcet syndrome

Thormbosis is common cause of morbidity

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68
Q

Aching and stiffness in shoulders, hips and neck

No weakness

A

Polymyalgia rheumatica

Elevated ESR
Elevated C-reactive protein

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69
Q

Colles fracture indicates

A

Osteoporosis

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70
Q

Causes of osteoporosis

A

Hyperthyroidism

Hyperparathyroidism

Hypercortisolism

Hypogonadism

Calcium/ Vit D deficiencies

Malabsorption

  • Celiac
  • Crohns

CKD

MM
RA

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71
Q

Boy 6 y.o
Insidious hip pain
Limp

Limited internal rotation and abduction

A

Legg-Calve Perthes disease

Idiopathic avascular necrosis of femur

Early X ray maybe normal

Later: Femoral head flattening, fragmentation, sclerosis

MRI: Avascular necrotic head

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72
Q

Newborn

Rigid medial and upward deviation of both forefoot and hindfoot

A

Congenital clubfoot

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73
Q

Associated with Dermatomyositis

A

Malignancy

Ovarian
Lung
Pancreatic
Stomach
Colorectal
Non-Hodgkin
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74
Q

Back pain

Step off

A

Spondylolysis

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75
Q

Disease modifying antirheumatic drugs (5)

MOA

SE

A

Methotrexate

  • Folate antimetabolite
  • Hepatotoxicity
  • Stomatitis
  • Cytopenias

Leflunomide

  • Pyrimidine synthesis inhibitor
  • Hepatotoxicity
  • Cytopenias

Hydroxychloroquine

  • TNF & IL-1 suppressor
  • Retinopathy

Sulfasalazine

  • TNF & IL-1 suppressor
  • Hepatotoxicity
  • Stomatitis
  • Hemolytic anemia

TNF inhibitors

  • Adalimumab
  • Certolizumab
  • Etanercept
  • Golimumab
  • Infliximab
  • Infection
  • Demyelination
  • CHF
  • Malignancy
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76
Q

2 y.o
Walks on toes

Elevated Creatine kinase

Associated with

Tx

A

Duchenne muscular dystrophy

Dilated cardiomyopathy
Scoliosis

Tx: Glucocorticoids

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77
Q

Slit lamp examination

A

To screen for uveitis

ANA

Juvenile idiopathic arthritis

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78
Q

Weakness
Paresthesias
Loss of fine motor control

Hyperreflexia
Upgoing plantar reflex

A

Cervical spondylotic myelopathy

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79
Q

Knee pain

Worse at end of day

Bony enlargement
Small effusion

No crystals

Tx

A

Osteoarthritis

Exercise
WL

Topical or oral NSAIDs

  • Duloxetine
  • Tramadol
  • Capsaicin
  • Diclofenac
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80
Q

Febuxostat

A

Xanthine oxidase inhibitor used in management of chronic gout

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81
Q

Cyclophosphamide SE

A

Alkylating agent used as immunnosuppressant in SLE

Hemorrhagic cystitis
Bladder carcinoma
Sterility
Myelosuppression

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82
Q

Low back pain
Muscle pain in arms and shoulders

Normal muscle strength

C reactive protein is 3 (<8 normal)

A

Fibromyalgia

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83
Q

Boy

Proximal femur
Pain at night

Small round lucency on xray

A

Osteoid osteoma

Responsive to NSAIDs

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84
Q

Dull hip pain

Referred knee pain

Altered gait

Limited internal rotation

A

Slipped capital femoral epiphysis

Anterolateral and superior displacement of proximal femur

Can be both hips

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85
Q

16 y.o

Left knee pain
Improved w/ NSAIDs

Limp

Nontender pustules on palm w/ erythematous rim

Increased leukocyte count

Negative culture

A

Disseminated gonococcal infection

Cephalosporin IV and oral azithromycin

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86
Q

Associated with giant cell arteritis and polymyalgia rheumatica

A

Aortic aneurysm

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87
Q

Stiffness

ESR > 40

> 50 y.o

Tx?

A

Polymyalgia rheumatica

Glucocorticoids

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88
Q

Physiologic genu valgum

A

Knock knee

Age 2-5

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89
Q

RA at risk for

A

Atherosclerosis
Vasculitis
Osteoporosis
Anemia

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90
Q

Raynaud phenomen

Rash over malar area and nasal bridge

Small ulcers at finger tips

Swollen and tender hand and wrist joints

+ ANA
+ Anti-U1 ribonucleoprotein

Elevated ESR

A

Mixed Connective tissue disease

SLE
Systemic sclerosis and polymyositis

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91
Q

Supracondylar fracture with posterior displacement risk for damage to

A

Brachial artery

Median nerve

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92
Q

Ulnar nerve injury due to

A

Supracondylar fracture that has anterior displacement of distal humerus

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93
Q

Movement of ipsilateral limbs and body

A

Lateral corticospinal

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94
Q

Fine touch, vibration, conscious proprioception

A

Dorsal column medial lemniscus

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95
Q

Pain and temperature

A

Spinothalamic

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96
Q

CL loss of pain and temperature

Isplateral hemiparesis and diminished dorsal column sensation (diminished proprioception,vibratory sensation, and light touch)

A

Brown Sequard hemisection

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97
Q

Combined UMN and LMN deficits with no sensory or oculomotor deficits

Fasciculations with eventual atrophy and weakness of hands

A

Amyotrophic lateral sclerosis

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98
Q

Car accident

Weakness in upper extremities more than lower

A

Central cord syndrome

Hyperextension

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99
Q

Tertiary syphilis does what

A

Degeneration (demyelination) of dorsal columns and roots —>

Impaired sensation and proprioception, progressive sensory ataxia (inability to sense or feel the legs) —> poor coordination

Absence of tendon reflex
+ Romberg sign

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100
Q

Cape like bilateral loss of pain and temp in upper extremities

A

Syringomyelia

CSF filled cavity within spinal cord, expands and damages white commissure of spinothalamic tract

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101
Q

Demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts

Ataxic gait
Paresthesia
Impaired position and vibration sense

A

Vit B12 deficiency

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102
Q

Controls knee extension and hip flexion

A

Femoral nerve

Innervates anterior thigh muscles

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103
Q

IVC filter placement can compress

A

Lateral femoral cutaneous nerve

Sensation to lateral thigh

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104
Q

Cold or minor trauma causes recurrent pain to face

A

Trigeminal neuralgia

CN V

Demyelination of the nerve axon

Tx: Carbamazepine

[If bilateral suspect MS]

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105
Q

Stroke

Speaks in two to three word choppy sentences but can follow commands. Can not repeat what you said

Lesion where?

A

Broca’s area

Posterior frontal cortex on dominant side of brain

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106
Q

Homonymous hemianopsia

A

Can only see only one side right or left

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107
Q

CL paresis and sensory loss in the face and arm

Homonymous hemianopsia toward the side of the lesion

A

Middle cerebral artery

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108
Q

CL paresis and sensory loss in the leg
Cognitive or personality changes
Urinary incontinence

A

Anterior cerebral artery

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109
Q

Hemonymous hemianopsia
Ipslateral sensory loss in face, CN IX, and CN X

CL sensory loss in limbs

Limb ataxia

A

Posterior cerebral artery

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110
Q

Loss of pain and temperature sensation on ipslateral face and contralateral body

Vertigo
Nystagmus

A

PICA/ vertebral (Wallenberg syndrome)

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111
Q

Sudden headache
Neck pain
Horner syndrome

A

Carotid artery dissection

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112
Q

Conditions associated with berry aneurysms

A

Make Subarachnoid hemorrhage more likely

MAKE an SAH

Marfan syndrome
Aortic coarctation
Kidney disease (autosomal dominant, polycystic)
Ehlers-Danlos syndrome
Sickle Cell anemia; Smoking tobacco
Atherosclerosis
History (familial); Hypertension; Hyperlipidemia

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113
Q

TX SAH

A

Neurosurgery

Prevent rebleeding
- maintain systolic BP < 150 mm Hg

Prevent vasospasm
- CCB such as nimodipine

Decrease intracranial pressure

  • Elevated head of bed
  • Instituting hyperventilation in acute setting
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114
Q

Numbness and droop on the right side of face
Difficulty talking
Numbness and weakness in the right arm

2 hrs ago

A

Left MCA

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115
Q

Blown pupil

A

Suggests ipsilateral third nerve compression

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116
Q

Xanthochormia

A

Blood on LP

Seen in two situations

  • Herpes simplex virus (HSV) encephalitis
  • SAH
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117
Q

Migraine tx

A

NSAIDs first

Triptans

Prophylaxis

  • anticonvulsants (valproate, gabapentin, topiramate
  • TCA (emitriptyline
  • Beta blockers (propranolol)
  • CCBs
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118
Q

Tx Cluster HA

A

High flow O2 or Sumatriptan injection

Prophylactic: Verapamil (first line)

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119
Q

3 per second spike and wave discharges

Triggered by hyperventilation

A

Childhood absence epilepsy

Petit mal seizures

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120
Q

What maybe elevated after a seizure

A

Prolactin levels

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121
Q

First line tx for seizure in children

A

Phenobarbital

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122
Q

Prolonged seizures

  • duration
  • name
  • tx
  • risk
A

> 5 minutes

Or two or more seizures without return of consciousness in 30 minutes

Status Epilepticus

Maintain airway
Administer thiamine followed by glucose
0-5 min: Give IV benzodiazepine (lorazepam or diazepam)
5-10 min: Give Second IV benzo
20 min: Fosphenytoin, valproate sodium, phenobarbital, levetiraetam or continuous infusion of midazolam

Risk: cortical laminar necrosis

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123
Q

Tx Benign paroxysmal positional vertigo

A

Epley maneuver

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124
Q

Vertigo
Vomiting for 1 week

Viral infxn 1 week ago

A

Acute vestibular neuritis

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125
Q

Acute onset severe vertigo
Head motion intolerance
Gait unsteadiness

N/V
Nystagmus

A

Labyrinthitis or Vestibular neuritis

Labyrinthitis also have tinnitus, ear fullness or hearing loss

Tx: Corticosteriods and antivertigo agents (meclizine)

Subsides spontaneously within weeks to months

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126
Q

Recurrent vertigo

Recurrent Unilateral auditory symptoms, tinnitus, and ear fullness

Episodes last minutes to hours

A

Meniere disease

Increased volume of endolymph

[Rule out cerebellopontine angle tumor w/ MRI]

Acute: Meclizine or benzodiazepines to control spinning

Chronic: dietary changes to limit salt to avoid fluid retention

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127
Q

Vasovagal syncope triggered by

A

Prolonged standing
Emotional distress
Painful stimuli

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128
Q

Syncope work up

A

Unless obviously vasovagal in young patient with no heart conditions

Place on telemetry or Holter monitoring to evaluate for arrhythmia

Rule out MI w/ ECG and cardiac enzymes

EEG for seizures

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129
Q

Proximal muscle weakness
Double vision
Dysarthria
Dysphagia

Symptoms worsen as day goes on

A

Myasthenia gravis

Antibodies that bind to POST synaptic acetylcholine receptors at NMJ

Tx: Airway management
IVIG or plasmapheresis
IV steroids

Pyridiostigmine (AChE inhibitors)

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130
Q

Myasthenia gravis complications

A

Respiratory compromise

Aspiration

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131
Q

Myasthenia gravis test

Tx

A

Acetylcholine receptor antibody

Edrophonium (tension test) is an anticholinesterase inhibitor used as diagnostic tool

Tx: Anticholinesterase inhibitors (pyridostigmine) - symptoms relief
Prednisone, immunosuppressants (azathioprine, cyclosporine, mycophenolate) IVIG used for treatment

Resection of thymoma can be curative

Avoid certain antibiotics

  • Aminoglycosides
  • Fluroquinolones
  • Beta blockers
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132
Q

Ice Pack over eyelids improve symptoms

A

Myasthenia gravis

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133
Q

Weakness of proximal muscles along with depressed or absent tendon reflexes

Weakness improves with activity

A

Lambert Eaton Myasthenic syndrome

Paraneoplastic autoimmune disorder

Antibodies target PREsynaptic voltage gated calcium channels

Small cell lung cancer

Tx: Small cell lung cancer tx
3,4 diaminopyridine or guanidine

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134
Q

Anterior mediastinal mass

Weakness

A

Thymoma

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135
Q

Ascending paralysis

CSF protein level > 55 mg/dL

A

Guillain-Barre syndrome

Normal WBC
Normal RBC
Normal Glucose

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136
Q

UMN

A

Pyramidal (arm extensors and leg flexor weakness)

Spastic (increased)

Increased hyperreflexia

Babinski reflex
Pronator drift

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137
Q

LMN

A

Flaccid (decreased)

Decreased DTR (hyporeflexia)

Atrophy
Fasciculations

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138
Q

Delay progression of ALS

A

Riluzole

Decreases glutamate

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139
Q

Neurofibrillary tangles

Amyloid deposition

A

Alzheimer disease

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140
Q

Diffuse atrophy with enlarged ventricles

Senile plaques

A

Alzheimer disease

Especially temporal and parietal lobes

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141
Q

Round intraneuronal inclusions on imaging in frontal lobes

A

Frontotemporal dementia (pick disease)

Round intraneuronal inclusions= pick bodies

Frontotemporal atrophy

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142
Q

Ventricular enlargement

A

Normal pressure hydrocephalus

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143
Q

Spongiform degeneration

Prions

A

Creutzfeldt-Jakob disease

EEG: periodic sharp wave complexes

Abnormal protease-resistant prion protein accumulates in brain

144
Q

Clumps of alpha-synuclein proteins

A

Lewy body dementia

145
Q

Abrupt decline in cognition

A

Vascular dementia

146
Q

Tx Dementia

A

Donepezil (cholinesterase inhibitor) - first line

Memantine: an NMDA receptor antagonist may slow decline in moderate to severe

147
Q

Changes in behavior and personality

Disinhibition

A

Frontotemporal dementia (pick’s disease)

> 75 y.o

148
Q

Dementia
Gait
Urinary incontinence

A

Normal pressure hydrocephalus

[Dont see papilledema]

Monitoring ICP will see spikes of elevated pressure

Tx: surgical ventriculoperitoneal shunting

149
Q

Normal aging

150
Q

Dementia
Ataxia

Startle induced myoclonic jerks

Rapid progression (weeks to months)

A

Creutzfeldt-Jakob disease

Elevated levels of 14-3-3 and tau protein in CSF

Brain biopsy

151
Q

50-85
Parkinson movements
Hallucinations
Dementia

A

Lewy body dementia

Bradykinesia
Rigidity
Tremor
Shuffling gait

152
Q

Chorea
Irritability
Behavior disturbances

  • Name
  • Inheritence
  • What is seen
  • Dx
  • MRI shows
  • NT affected
A

Huntington disease

AD

CAG triplet repeat on chromosome 4

Purposeless involuntary dance like movements

Dx: Genetic testing
MRI: cerebral atrophy especially of caudate and putamen

GABA degeneratio

153
Q

Pill rolling

Rigidity/ Cogwheeling

A

Parkinson

Loss of dopaminergic cells in substantia nigra

Tx: Levodopa/ carbidopa combo

154
Q

Tx Restless leg syndrome

A

Dopamine agonists

  • Ropinirole
  • Pramipexole

Gabapentin

155
Q

Manage ICP with

A

Head elevation
Hyperventilation
Corticosteriods
Mannitol

156
Q

Posterior fossa/ infratentorial tumor
+ GFAP
Well circumscribed

Drowsiness
HA
Ataxia
N/V

A

Pilocytic astrocytoma

157
Q

Increased ICP

Tumor in center of cerebellum

A

Medulloblastoma

Neuroectodermal tumor

Arises from fourth ventricle or cerebellar vermis

Highly malignant but radiosensitive

Obstructive hydrocephalus

158
Q

Suprasellar tumor in child
Calcification

Bitemporal hemianopsia

A

Craniopharyngioma

[Same symptoms as pituitary adenoma]

159
Q 
Flat uniformly hyperpigmented macules
Freckling in axillary or inguinal area
Optic glioma
Pigmented iris hamartomas
Seizures
A

NF1

Neurofibromas

Flat uniformly hyperpigmented macules= cafe au lait spots

160
Q

Acoustic neuroma associated with

161
Q

Seizures
Hypopigmented lesions
Mental disability

Also see (3)

A

Tuberous sclerosis

Also see sebacious adenomas (small red nodules on nose and cheeks in butterfly pattern)

Cardiac rhabdomyoma

MRI: giant cell astrocytoma and calcified tubers (potato like nodules) in periventricular area

162
Q

Port wine stain on face associated with

Also see

A

Sturge Weber syndrome

Cavernous hemangioma in trigeminal nerve distribution

Intracranial calcifications that resemble “tram line”
Hemianopia
Glaucoma
Hemiparesis

163
Q

COMA tx

A

Stabilize patient- ABCS

Administer DONT

  • Dextrose
  • Oxygen
  • Naloxone
  • Thiamine
164
Q

Locked In syndrome

A

Wakeful and aware with retained cognitive abilities

Ventral brainstem injury

Central pontine myelinolysis
Brainstem stroke
Advanced ALS

Can move eyes and eyelids

165
Q

Persistent Vegetative state

A

Awake but not aware

Eyes open and close
Sleep wake cycles present

Diffuse cortical injury
Hypoxic ischemic injury

Has respiratory drive
No voluntary motor control

166
Q

Coma

A

Unconscious
Eyes closed
No sleep wake cycle

Diffuse hypoxic encephalopathy
Widespread infection
Electolyte disturbances
Toxins

Has respiratory drive

167
Q

Stocking glove sensory neuropathy

A

Cyanocobalamin Vit B 12

168
Q

Horizontal nystagmus
Confabulations
Retrograde amnesia

A

Thiamine B1 deficiency

169
Q

Open angle glaucoam vs closed angle

A

Open angle: bilaterally

  • Diseased travecualr meshwork decreased drainage
  • cupping of optic nerve
  • Tonometry
  • Timolol betaxolol to decrease aqueous humor production
  • Pilocarpien to increase aqueous outflow

Closed: unilaterally

  • Increased pressure in posterior chamber
  • Hard red eye
  • Dilated and nonreactive to light
  • Get ocular tonometry
  • Gonioscopy is gold standard
  • Timolol, pilocarpine
170
Q

Avoid what medication with closed angle glaucoma

A

Pupil dilating medications

- Atropine

171
Q

Painless central vision loss

A

Macular degeneration

Accumulation of white/ yellow extracellular material or pigmentary changes= dry macular degeneration
- no tx

Hemorrhage and subretinal fluid= wet

  • VEGF inhibitors (ranibizumab, bevacizumab)
  • pegaptanib (slow visual loss)
172
Q

Curtain coming down over eye

A

Retinal detachment

173
Q

Sudden painless unilateral blindness

Pupil sluggish to reactive to direct light

Cherry red spot on fovea
Retinal swelling (whitish appearance)
A

Central retinal artery occlusion

Ocular massage with high flow oxygen
Intra-arterial thrombolysis within 8 hours

174
Q

Rapid painless vision loss
HTN

Swollen optic disc with hemorrhages
Cotton wool spots

A

Central retinal vein fundoscopy

Laser photocoagulation

175
Q

Bilateral sensorineural hearing loss

Imbalance

Family hx hearing loss

A

Bilateral vestibular schwannomas

NF2

176
Q

N/V
Headache taht worsen with bending over

Papilledema

A

ICP

Glioblastoma

Butterfly appearance w/ central necrosis

177
Q

Idiopathic intracranial HTN caused by

A

Obese women

Medications

  • Retinoids
  • Tetracyclines
  • Growth hormones
178
Q

Headaches when she wakes up

Pain accompanied by rhythmic pulsating sound

Bilateral optic disc edema

  • Name
  • Feature
  • Due to
  • Tx (2)
A

Idiopathic intracranial HTN

Diplopia; palsy of abducens nerve (CN VI)

Tx: WL
Acetazolamide

179
Q

Enlarged blind spot

A

Idiopathic intracranial HTN

180
Q

Sharp wave complexes

A

Creutzfeldt jakob disease

181
Q

Crohns disease

Altered mental status
Right eye limited in abduction

Bilateral horizontal nystagmus

Gait is wide based

A

Wenicke encephalopathy

Thiamine deficiency

182
Q

ALS deterioration of

A

UMNs (corticospinal neurons in primary motor cortex)

LMNs
Cranial nerves, anterior horn cells

183
Q

Epidural

Perioral numbness
Metallic taste
Tinnitus

A

Local anesthetic systemic toxicity

Bupivacaine

184
Q

HIV patient

Seizure

Confusion and lethargy

CD4 26

Solitary irregular nonhomogenous ring enhancing lesions in the periventricular area

EBV + in DNA

A

Primary CNS lympoma

EBV

  • Non-hogkin lymphoma
  • primary CNS lymphoma
185
Q

HIV with HPV

A

Invasive cervical carcionma

186
Q

HIV with herpesvirus 8

A

Kaposi sarcoma

187
Q

Agitation

Confusion and aggression shortly after taking medication and heading to bed

A

Discontinue benzo

188
Q

Cavernous sinus thrombosis presents with

A

Fever
HA
Periorbial swelling

189
Q

Enlarged ventricles and intraventricular mass

A

Choroid plexus papilloma

Increased CSF production

190
Q

Migraine prevention in pregnancy

A

Beta blockers

- Propranolol

191
Q

Traumatic brain injury

Episodic HTN
Tachycardia
Diaphoresis

A

Paroxysmal sympathetic hyperactivity

Excessive sympathetic activity

192
Q

Antipsychotic medication effects on pathways

1) Mesolimbic
2) Nigrostriatal
3) Tuberoinfundibular

A

1) Meso limbic
- Antipsychotic efficacy

2) Nigrostriatal
- Extrapyramidal symptoms: acute dystonia, aakathisia, parksinsonism

3) Tuberoinfundibular
- Hyperprolactinemia

193
Q

Anorexia

Tachycardia

Confusion
Unsteady when walking

Lateral gaze is restricted on both sides and evokes a horizontal nystagmus

A

Thiamine deficiency

194
Q

Brown flecks in eye

A

NF1

At risk for Nerve sheath tumors

195
Q

Noctural episodes of movement and violence is consistent with

A

Rapid eye movement (REM) sleep behavior disorder

LIkely to develop parkinson’s

Alpha synuclein neurodegenerative disorders

196
Q 
Cherry red spot
Irritability
Can not sit
Hepatosplenomegaly
Protuberant abdomen
areflexia
A

Niemann Pick disease

Sphingomyelinase deficiency

197
Q

Hypotonia
Cherry red

Hyperreflexia

No hepatosplenomegaly

A

Tay-Sachs disase

Beta-hexosaminidase A deficiency

198
Q

Galactocerebrosidase deficiency

A

Krabbe disease

Developmental regression
Hypotonia
Areflexia

199
Q

Glucocerebrosidease deficiency

A

Gaucher disease

Anemia
Thrombocytopenia
Hepatosplenomegaly

200
Q

Mucopolysaccharidoses deficiency

A

Hurler syndrome

Coarse facial features
Hernieas
Corneal clouding
Hepatosplenomegaly

201
Q

Carotid artery injury

A

Gradual onset hemiplegia
Aphasia
Neck pain
Thunderclap headache

Unilateral headache & neck pain
Transient vision loss

202
Q

Anterior spinal artery injury

A

Anterior cord syndrome

Disrupts blood flow to anterior two-thirds of SC

Loss of pain/temp
Bilateral weakness in upper and lower extremities

[Proprioception and vibratory sensation are spared]

203
Q

Penetrating trauma to spinal cord

A

Hemisection of SC

Brown Sequard syndrome

Asymmetric (ipsilateral only) motor deficit to both upper and lower extremities

CL loss of pain and temp 102 levels below injury

204
Q

Posterior cord syndrome

A

Dorsal columns

Causing loss of vibration/ proprioception sensations

If weakness present, typically also involves lower extremities

Causes

  • Vit B 12 deficiency
  • MS
  • Tabes dorsalis
205
Q

Gait associated with parkinsonism

A

Hypokinetic gait

206
Q

Humerus externally rotated and abducted arm

At risk for

A

Anterior dislocation of humerus

At risk for axillary nerve injury

Weakened shoulder abduction

Sensation of lateral shoulder

207
Q

Infxn in prosthetic joint

A

<3 months

  • Staph aureus
  • Gram neg rods
  • Pseudomonas
3-12 months
- Staph epidermidis
(Coagulase-neg staph) 
- Propionibacterium
- Enterococci

> 12 months
- Staph aureus
- Gram neg rods
[Due to UTI]

208
Q

Episodic vertigo with nystagmus

Trouble hearing in right ear

Concussion 4 months ago

A

Perilymphatic fistulas

Complication of head injury

209
Q

Episodic vertigo
Hearing loss

Aural fullness
Tinnitus

20 min - 24 hrs

A

Meniere disease

210
Q

Stress fracture vs shin splint

A

Stress fracture

  • repetitive activities
  • Low caloric intake
  • Point tenderness at site
  • Negative x ray first 6 weeks

Medial tibial stress syndrome (shin splints)

  • Anterior leg pain
  • Runners
  • Diffuse tenderness (not point)
211
Q

Middle aged man with progressive ambulation difficulties

Extremity weakness

Numbness and tingling in arms
Atrophy of upper arm muscles
Vibratory and pain sensation decreased in both hands and legs

A

Cervical myelopathy

Advanced spondylosis of the cervical spine on radiography

Cord compression

Gait dysfunction
LMN signs (arm)- muscle atrophy, hyporeflexia
UMN (legs): hyperreflexia
212
Q

An elevated protein level with normal cell count on CSF

A

Acute inflammatory demyelinating polyneuropathy

A postinfectious peripheral neuropathy

Ascending paralysis
Areflexia

213
Q

A parasigittal meningioma causes

A

Compress the motor strip of the brain

Causes lower extremity weakness with UMN

214
Q

Positive Neers Test

A

Inflammation of rotator cuff tendons

215
Q

Osteomelitis infxn due to

A

Staph aureus

Pseudomonas aeruginosa

216
Q

Heel pain worse when bearing weight

Sharp pain when direct pressure on bottom of foot

A

Plantar fasciitis

Inflammation of plantar aponeurosis

May see calcificaitons “heel spurs”

217
Q

Pain at heel worse with weight bearing

Pain elicited by palpation of sides of heel (squeeze test)

A

Calcaneal stress fractures

Overuse injury to bone

218
Q

Pneumonia and septic shock
Intubated

Now worsening lower extremity weakness
Headaches
Numbness in hands and feet

Hyperactive knee reflexes
Decreased proprioception in feet

A

RA cervical myelopathy

Instability of atlantoaxial joint

219
Q

Loss of sensation over right thigh and medial leg

A

Femoral nerve

220
Q

67 y.o 2 days of back pain

Moving boxes when began

Not relieved by laying down
Pain at night
Acetaminophen doesnt help

Point tenderness

A

Vertebral compression fracture

Loss of bone mineral density

221
Q

Vertebral point tenderness

A

Consistent with spinal fracture

222
Q

Degenerative disc disease

A

Low back pain

Chronic
Worsens with activity
Relieved by rest

223
Q

Ligamentous back sprain

A

Pain relieved by rest

Tenderness in paraspinal tissues rather than midline

224
Q

30 y.o increasing muscle weakness, can grip coffee cup or open jars

Loss of sensation in the upper extremities

Motor vehicle collision 7 years ago, suffered from whiplash

Wasting of small muscles of hands

A

Syringomyelia

Progressive loss of pain and temperature sensation

225
Q

Collapse of ankle joint and arch

A 
Neurogenic arthropathy
(Charcot joint)

Diabetes

226
Q

Dull ache in left thigh of 12 y.o girl
97% for weight

Decreased internal rotation

A

Slipped capital femoral epiphysis

Shearing at the proximal femoral physis

227
Q

Weakness in both lower extremities and urinary retention

Flaccid paralysis
Loss of pain sensation in lower extremities
Vibratory sensation intact

A

Spinal cord infarction

Anterior cord syndrome

228
Q

Arthritis
Conjuntivitis
Urethritis in young men

A

Reactive arthritis

Chlamydia

Campylobacter
Shigella
Salmonella
Ureoplasma

229
Q

Elderly women presents with pain and stiffness in her shoulders and hips

Cannot lift her arms above her head

Anemia
Elevated ESR

A

Polymyalgia rheumatica

230
Q

55 y.o patient presents with acute “broken speech” Type of aphasia

Lobe?
Vascular?

A

Broca aphasia

Frontal lobe

Left MCA

231
Q

CSF findings with spontaneous arachnoid hemorrhage

A

Increased ICP
RBC
Xanthochromia

232
Q

Increased protein in CSF without a significant increase in cell count

A

Guillain Barre syndrome

Albuminocytologic dissociation

233
Q

Metastasis to brain from

A 
Lung
Breast
Skin (melanoma)
Kidney
GI tract
234
Q

Confusion
Ophthalmoplegia (paralysis of muscles around eye)
ATaxia

A

Wernicke encephalopathy caused by deficiency in thiamine

235
Q

Tx Guillain Barre syndrome

A

IVIG or plasmapheresis

Avoid steriods

236
Q

6 y.o with port wine stain in the V1 distribution as well as intellectual disability, seizures, and ipsilateral leptomeningeal angioma

A

Sturge-Weber syndrome

Tx symptomatically

Possible focal cerebral resection of affected lobe

237
Q

Hyperphagia
Hypersexuality
Hyperorality
Hyperdocility

A

Kluver-Bucy syndrome

Amygdala

238
Q

Edrophonium

A

Given to diagnose myasthenia gravis

239
Q

30 y.o for escalating low back pain

Present at rest
Worse with activity

Smokes
Drinks
Heroin use

Pain with gentle percussion over lumbar vertebrae

Increased platelets

A

Vertebral osteomyelitis

240
Q

Exercise induced arm pain, paresthesia, coolness and color change

One arm
Doesnt effect hands

A

Subclavian steal syndrome

241
Q

Fracture diagonal across tibia in child

A

Spiral fracture in ambulatory children < 3 y.os

Normal

Twisting injury

242
Q

Intraparenchymal lesion with air fluid levels and hyperdense rim on imaging

A

Brain abscess

Fever
Headache
Neurologic findings (sensoimotor deficits)

243
Q

Subependymal nodules in lateral ventricles

A

Tuberous sclerosis

Increase intracranial pressure due to obstructive hydrocephalus

244
Q

14 y.o girl

Fever and cough 1 month ago

3 weeks progressive difficulty walking
Clumsiness

Wide base gait
Trouble balancing

Decreased strength in lower extremities

Decreased vibratory and position sense

Spinal cord atrophy on MRI

A

Friedreich ataxia

AR

Genetic testing is recommended to confirm the diagnosis

245
Q

Tremor at rest or during movement, stops with distractions

Tx

A

Functional tremor

Tx Trihexyphenidyl

246
Q

Sensory symptoms in posterolateral leg and dorsolatearl foot

A

Common peroneal nerve

Fracture or compression of proximal fibula

Weakness of foot eversion, dorsiflexion, and toe extension

247
Q

Upper medial thigh and genital region sensory loss

A

Ilioinguinal nerve

248
Q

Lower extremity weakness and positive straight leg test

A

Sciatic nerve

249
Q

Lesions of brain, spinal cord and conus medullaris cause what

A

Upper motor neuron findings

Hypertonia
Spasticity
Hyperreflexia
Positive babinski

250
Q

18 y.o female

Persistent headaches for 3 months

Holocranial pulsating, bothersome especially at night

Double vision , blurry in both eyes

No nucal rigidity

Optic disc edema and left lateral rectus palsy

Normal head CT

What to do next?

A

Lumbar puncture with opening pressure

Idiopathic intracranial hypertension

251
Q

Angle-closure glaucoma cause by what medication

Patient started medication for tremors

A

Trihexyphenidyl

- anticholinergic to tx parkinson disease

252
Q

Temporal arteritis started on tx

Develops difficulty climbing stairs and getting up

A

High dose glucocorticoids

Hyperglycemia
Bone loss

Glucocorticoid induced myopathy

253
Q

Sensory ataxia

Brief stabbing pains

Urinary incontinence

Pupillary irregularities

A

Tabes dorsalis (late neurosyphilis)

Posterior spinal columns and dorsal roots

Tx: Pencillin

254
Q

Gentamicin SE

A

new onset hearing loss, imbalance and sensation of objects moving (oscillopsia)

Aminoglycoside ototoxicity

Positive head thrust test

255
Q

Vertebrobasilar insufficiency

A

Gait imbalance

No change with head thrust test

No hearing loss

256
Q

Unable to adduct and CL eye abducts nystagmus

A

Internuclear ophthalmoplegia

Results from damage to the heavily myelinated fibers fo the medial longitudinal fasciculus

257
Q

Posterior cerebrum hemorrhage

Parietal lobe hemorrhage

A

Parietal lobe hemorrhage most likely due to cerebral amyloid angiopathy

beta-amyloid deposition in small to medium size cerebral arteries

*Amyloid angiopathy

258
Q

Carbon monoxide poisoning causes

A

Cerebral hypoxia

Anion gap metabolic acidosis

Lactic acidosis

Bilateral hyperintensity of globus pallidus

259
Q

Patient with myasthenis gravis

What testing to get

A

Chest CT or MRI to evaluate for thymoma

260
Q

T10

261
Q

Motor only hemiparesis

Weakness, face, arm and leg

A

Lacunar infarcts

Posterior cerebral artery

Due to microatheroma formation and lipohyalinosis —> thrombotic small vessel occlusion

262
Q

Increases risk of multiple sclerosis

A

Vit D deficiency

263
Q

Severe burning pain over area affected by previous stroke

Exacerbated by light touch

A

Allodynia

Thalamic pain syndrome

264
Q

Huntington disease affects

A

Caudate nucleus

265
Q

Myotonic dystrophy caused by

A

Cytosine-thymine-guanine trinucelotide repeat

266
Q

21 y.o had seizure

HIV negative

3 cm ring enhancing lesion in left frontal lobe

A. HSV
B. Neoplastic cells
C. Nocardia
D. Rhizopus
E. Toxoplasma
F. Viridans streptococi
A

F. VIridans streptococci

Brain abscess

267
Q

Elevated serum transaminases

Low serum ceruloplasmia

Tx?

A

Wilson’s disease

Tx: Penicillamine

268
Q

Ptosis

Proximal muscle weakness

  • holding head up
  • brushing hair
Disorder of what
A. Motor cortex
B. Motor end plate
C. Motor neuron axons
D. Motor neuron cell body
E. Muscle fascicles
F. Subcortical nuclei
G. White matter tracts
A

Myasthenia gravis

B. Motor end plate

Acetylcholine receptors in POSTsynaptic membrane

269
Q
  1. Damage to motor cortex
  2. Damage to motor end plate
  3. Damage to Motor neuron axons
  4. Damage to motor neuron cell body
  5. Damage to muscle fascicles
  6. Damage to subcortical nuclei
  7. Damage to white matter tracts
A
  1. Stroke
    - motor cortex= upper motor neuron
    - Acute CL flaccid paralysis followed by spastic paralysis and hyperreflexia
  2. Guillain-Barre syndrome
    - inflammatory demyelination and/or axoanl neuropathy
    - rapidly progressive symmetric ascending muscle paralysis
  3. Myasthenia gravis
    - autoantibodies against acetylcholine receptors in the motor end plate
    - symmetric proximal muscle weakness involving neck and upper limbs
    - Ocular and bulbar weakness
  4. ALS
    - Progessive motor neuron degeneration
    - Upper spastic paralysis and lower (muscle atrophy and fasciculations)
  5. Statin-induced myopathy and polymyositis
    - inflammation of the muscle fascicles
    - proximal muscle weakness (difficultly rising from chair) and mild tenderness
  6. Parkinson or Huntington’s
    - Lesions of the subcortical nuclei (basal ganglia) result in EPS (rigidity, bradykinesia, tremor, chorea)
  7. Multiple sclerosis
    - Autoimmune demyelination of the white matter tracts in CNS
270
Q

30 y.o female

Worsening bilateral lower extremity weakness and numbness for 4 days

Incident of urinary incontinence today

Bilateral lower extremity DTR are increased with extensor plantar response

Sensation to pinprick is decreased below the level of the umbilicus and vibratory sensation is absent in the toes

A. Autoimmune demyelination of the peripheral nerves
B. Compression of cauda equina nerve roots
C. Embolic occlusion of the anterior spinal artery
D. Segmental inflammation of the spinal cord
E. Vit B12 deficiency

A

D. segmental inflammation of the spinal cord

Transverse myelitis
- immune mediated disorder characterized by the infiltration of inflammatory cells into a segment of the spinal cord

Leading to neuron and oligodendrocyte cell death and demyelination

[Thoracic cord]
Motor weakness
Autonomic dysfunction
Sensory dysfunction

IV glucocorticoids

271
Q

Elderly with delirium and agitation give what

A

Halperiodol

272
Q
  1. Left hemineglect
  2. CL hemiplegia loss
  3. CL hemisensory loss
  4. Pin point pupils
  5. Right eye monocular vision loss
A
  1. Left hemineglect= lobar hemorrhage on nondominant parietal lobe (right)
  2. Cortical, subcortical, or upper brainstem lesions that injure the descending corticospinal tract
    - Intracerebral hemorrhage affectign the basal ganglia, thalamus or frontal lobe
  3. Cortical, subcortical (thalamic) or upper brainstem lesions that injure the ascending somatosensory pathways (dorsla column medical lemniscal and anterolateral pathways)
  4. Pin point pupils= large pontine hemorrhage due to damage to descending sympathetic fibers
  5. Right eye monocular vision loss= damage to ipsilateral retina (retinal detachment, retinal artery occlusion) and/ or optic nerve (optic neuritis)
273
Q

Seen with brain death

A

Spinal cord may be functioning
- DTR could be present

HR fails to accelerate after atropine because vagal control of heart is lost

Apnea test shows no spontaneous respiration at PCO2 values of 50

Absent

  • Pupillary light rxn
  • Oculovestibular rxn
274
Q

CL sensory loss

Pain
Vibration

Agraphesthesia (inability to identify number traced on skin)
Asterognosis (inability to identify an object by tough)

What love

A

Dominant parietal lobe

275
Q

Tremor when at risk

Stops when reaching for something

Dysfunction in what

A

Basal ganglia dysfunction

276
Q

Herniation

L2-L4

L5

S1

S2

A

L2-L4

  • Patellar reflex
  • Anterior medial thigh and medial shin sensory loss

L5
- Lateral shin and dorsum of the foot sensory loss

S1

  • Achilles tendon
  • Posterior calf, sole and lateral foot sensory loss

S2
- Perineum sensory loss

277
Q

Difficulty swallowing and blurred vision

Mild SOB that started today

Speech slurred
Pupils dilated and react sluggishly to light

Neck muscles are weak
Difficulty holding up head

Muscle strenght 1/5 in bilateral upper limbs 5/5 in lower limbs

A

Food borne botulsim

Give: horse-derived antitoxin

278
Q

Alzheimer disease with memory loss, word finding difficulty and getting loss in familiar place

See what on imaging

A

Temporal lobe atrophy

279
Q

Bilateral nonrhythmic alternate flexion and extension movement at the wrist (Flapping)

High BUN

A

Asterixis

Associated with hepatic encephalopathy or uremic encephalopathy (renal failure) and CO2 retention

Kidney injury

Urgent hemodialysis

280
Q

Migraine prophylaxis

A

Topiramate

Divalproex sodium
Tricyclic antidepressants
Propranolol

281
Q

Middle cerebral artery vs anterior cerebral artery

A

Middle cerebral artery
- CL motor and sensory deficits in face and upper limb

Anterior cerebral artery
- CL motor and sensory deficits in lower limbs and can include urinary incontience

282
Q 
Dysphagia
Dysarthria
Muscle wasting
Fasciculations
Hyperreflexia

Positive babinski

A

ALS

Degeneration of upper motor neurons in the corticospinal tracts and corticobulbar tracts and lower motor neurons (cranial nerves, and spinal nerves)

283
Q

Eye is down and out
Ptosis

Caused by

A

Oculomotor nerve palsy

Common cause: ischemic neuropathy from poorly controlled diabetes
[ Normal pupil]

Dilated pupil caused by mass effect and should be considered due to intracranial aneurysm [Get CT angiography of head]

[Nerve compression also has pupillary response, mydriasis]

284
Q

Increased INR

White lesions in brain

What tx

A

Intracerebral hemorrhage

Warfarin associated intracerebral hemorrhage

Tx: Prothrombin complex concentrate

285
Q

Recurrent forceful contractions of the eyelid muscles

A

Blepharospasm form of focal dystonia

286
Q

Broad based unsteady gait

Tap on patellar tendon elicits persistent slow back and forth swinging of leg

Nystagmus

Truncal ataxia

Also see

A

Intention tremor

Cerebellar dysfunction

Likely alcoholic cerebellar degeneration

287
Q

Falling to right side

Difficulty sitting up right

Nystagmus (horizontal and vertical)

Hoarseness

Left pupil larger than right
Reduced corneal reflex
Partial ptosis of right eye

Gag reflex diminished

Loss of pain and temperature sensation in the right face and left trunk and limbs

A

Lateral medulla

Wallenberg syndrome

[Occluded intracranial vertebral artery]

288
Q

Weakness of muscles of mastication

Diminished jaw jerk reflex

Impaired tactile and position sensation over the face

Dysphagia
Hoarseness
Diminished gag reflex

A

Lateral mid-pontine lesions

289
Q

C/L paralysis of the arm and leg

Tongue deviation toward the lesion

CL loss of tactile and position sense

A

Medial medullary syndrome

290
Q

C/L ataxia and hemiparesis of the face, trunk and limbs

A

Medial mid-pontine infarction

291
Q

Unilateral, violent arm flinging

A

Hemiballismus

Caused by damage to the contralateral subthalamic nucleus

Self limited

292
Q

Restless leg syndrome Tx

Targets what NT

A

Dopamine agonists

  • Pramipexole
  • ropinirole

Targets dopamine

293
Q

Lesion of what nerve would result in not having eye pain from corneal abrasion

A

Trigeminal nerve (CN V)

294
Q

HIV hx

HA
N/V
Confusion
Left eye does not move laterally with leftward gaze

Skin shows scattered small, umbilicated papules with surrounding erytehma

CT scan: enlarged ventricles
[ No hemorrhage, infarction or mass lesions]

Dx?
Get what tests?

A

Cryptococcus neoformans

Encapsulated yeast

Replicated in CNS and clogs the arachnoid villi —> CSF obstruction and increased intracranial pressure

Skin lesions resemble molluscum contagiosum

Lumbar puncture + India ink stain

295
Q

Severe dizziness and nausea

Spinning began suddenly when head tilted back and to left getting hair washed at salon

HTN
Hyperlipidemia
Smoker

Nystagmus
Equal pupils

Impaired pinprick sensation is present on left side of face and right upper and lower extremities

A

Dissection of the left vertebral artery

296
Q

Myasthenic crisis tx

A

Increased generalilzed and oropharyngeal weakness

Respiratory insufficiency

Intubation
Plasmapheresis or IVIG as well as corticosteriods

297
Q

Just had stroke give

298
Q

Cancer pain management

A
  1. NSAIDS
  2. Codeine, Hydrocodone (weak opioids)
  3. Strong short acting opioids (morphine, hydromorphone)
  4. Fentanyl patch
    Oxycodone

[Injections not helpful]

299
Q

Hand clumsiness
Ataxia
Vertigo

Pronator drift

A

Multiple sclerosis

Pronator drift is a finding for upper motor neuron or pyramidal/ corticospinal tract disease

300
Q

Basal ganglia dysfunction signs (5)

A 
EPS
Resting tremor
Rigidity
Bradykinesia
Choreiform movement
301
Q

Tremor of upper extremities

More pronounced with extension of arms and with finger to nose testing

Tx

A

Essential tremor

Tx

  • Beta blockers: propranolol
  • Anticonvulsants: primidone
302
Q

Passed out while standing at grocery store

Warmth beforehand

Weak pulse

A

Vasovagal (neurocardiogenic) syncope

303
Q

Management of traumatic brain injury

A
  1. Maintain Cerebral perfusion pressure

A. Maintain mean arterial pressure

  • Isotonic fluids
  • Vasopressor therapy

B. Reduce intracranial pressure

  • Head elevation
  • Decompressive interventions (CSF removal, craniectomy)
  1. Prevent Intracranial hemorrhage
    - Antifibrinolytic therapy
    - Reverse preexisting anticoagulation
  2. Prevent seizures (phenytoin)
  3. Control blood glucose
    - insulin
  4. Maintain normothermia
304
Q

Lung mass

Proximal muscle weakness in upper and lower limbs

Weakness due to?

A

Autoantibodies to PREsynaptic voltage gated calcium channels

Lambert- Eaton syndrome

Proximal muscle weakness
Autonomic dysfxn (dry mouth)
Ptosis
Diminished or absent DTR

305
Q

Speech arrest and right arm weakness

Resolves in 30 min

Tx

A

Transient ischemic attack (TIA)

Tx Aspirin and statin

306
Q

Inability to close eye

Mouth drooping

Tx

A

Inability to close eye= upper face

Bells palsy

Tx Prednisone

307
Q

Signs of heat stroke (3)

A

Severe hyperthermia > 104

Encephalopathy

Epistaxis

308
Q

HTN hemorrhages generally occur

A

Basal ganglia (putamen)

Cerebellar nuclei

Thalamus

Pons

309
Q

HTN

1) Develops CL hemiparesis and hemisensory
Homonymous hemianopsia
Gaze palsy

2) Develops CL hemiparesis and hemisensory loss
Non reactive miotic pupils
Upgaze palsy

3) Deep coma
Total paralysis in minutes
Pinpoint pupils

A

1) Basal ganglia
- Eyes deviate toward side of lesion

2) Thalamus
* Eyes deviate Toward hemiparesis

3) Pons

310
Q

Young woman

Blurry vision left eye

“Smudge” for 2 days

Smudge enlarged to be whole visual field

Color washed out

Left pupil dilates when light flashed in right

  • Name
  • Assoc with
  • MOA
  • Dx
  • Tx
A

Optic neuritis

Associated with multiple sclerosis

Immune mediated demyelination

*Washed out color viisoin

Dx: MRI of orbits and brain

Tx Corticosteriods

311
Q

TB meningitis vs viral meningitis

Glucose
Protein

A

TB
Glucose: < 45
Protein 100-500

Viral
Glucose: 45-70
Protein: < 150

312
Q

Gait unsteadiness

Shock sensation in spine

Atrophy and weakness in upper extremities

Increased tone/ reflex in lower extremities

A

Spinal cord compression (myelopathy) in cervical spine

313
Q

Inflammation and pain at shoulder, heels, iliac crest and tibial tuberosities

A

Enthesitis

Characteristic finding of sponyloarthropathies such as

Ankylosing spondylitis

314
Q

RA affects what parts of body

A

Hands
Wrist
Knees

Metacarpophalangeal
Proximal interphalangeal joints of fingers

Progress to involve knees, elbows and shoulders

Cervical spine (sparing rest of axial skeleton) 
- Atlantoaxial subluxation
315
Q

60 y.o with 15 lb weight loss

Fatigue and muscle weakness in extremities

Smoker

Proximal muscle weakness symmetrically

Erythematous to violaceous papules involving dorsum of his fingers.

Ill defined mass in right lower lobe

Muscle weakness due to?

A. Muscle fibers
B. Peripheral nerves
C. Postsynaptic membrane
D. Presynaptic membrane
E. Spinal cord
A

A. Muscle fibers

Dermatomyositis

Muscle fiber injury

Erythematous rash on fingers= Gottron’s sign

316
Q

70 y.o female

Swollen deformed hand joints

Elevated ESR

Neutropenia
Splenomegaly

Recurrent skin infxn
Acute sinusitis

  • Name
  • Due to
  • Dx
A

Felty syndrome

Complication of long standing, erosive rheumatoid arthritis

Anti-citrullinated peptide antibodies

Rheumatoid factor

317
Q

Proximal muscle weakness

Dyspahgia

Elevated creatine kinase

Elevated ESR

  • Name
  • Tx
A

Polymyositis

Tx: Glucocorticoids (prednisone)

318
Q

Stiffness in shoulders and hips

Elevated ESR

Elevated C-reactive protein

A

Polymyalgia rheumatica

319
Q

78 y.o with muscle pain.

3 weeks achy pain and stiffness in shoulders and hips

Fatigue
Low grade fever

Increased pain with active abduction of humerus above horizontal

Elevated ESR

Resolves in 1 week with glucocorticoids

A

Polymyalgia rheumatica

320
Q

Right knee pain
Right heel pain
Low back pain

Has STI previously

Mouth ulcers

Synovial shows WBC 10,000 with polymorphonuclear leukocytes but negative gram stain

  • Name
  • Tx
A

Reactive arthritis

NSAIDS

321
Q

Elevated alkaline phosphatase means

A

Highest expression in bone and heptobiliary tissues

Marker for cholestatic liver disease and diseases of bone causing increased bone turnover and new bone formation

322
Q

Enlarged distal interphalangeal joints

Elevated alk phos only

A

Paget disease of bone

323
Q

Pain and paresthesia in lateral thigh

A

Meralgia paresthetia

Caused by compression of lateral femoral cutaneous nerve as it passes under inguinal ligament

No weakness

Tight clothing
Seat belt injury

324
Q

Monoarticular arthritis with chondrocalcinosis and moderate effusion

DM
Hepatomegaly

A

Calcium pyrophpospahte dihydrate crystal deposition (CPPD) disease

(pseudogout)

Evaluate for hyperparathyroidism, hypothyroidism and hemochromatosis

  • Hemochromatosis given hx of DM
  • Get Iron studies
325
Q

Esophageal dysmotility

Arthralgias

Decrease in lower esophageal sphincter tone

  • Disease
  • MOA
  • Dx (3)
A

Systemic sclerosis

Smooth muscle atrophy and fibrosis

ANA
Anti-topoisomerase (anti-Scl-70)
Anticentromere ab

326
Q

Suspect Raynaud

What test to get

A

ANA to rule out secondary raynaud phenomenon caused by SLE, scleroderma and thromboangiitis obliterans

327
Q

Acute Pain in left knee

Pain in right wrist 4 days ago

Left ankle pain 2 days

Fever

ROM limited by pain

Synovial fluid shows elevated WBC with neutrophil predominance

A. Acute HIV infection
B. Acute rheumatic fever
C. Crystal induced arthritis
D. Gonococcal septic arthritis
E. Infective endocarditis
F. Non-gonococcal septic arthritis
G. Reactive arthritis
A

D. Gonococcal septic arthritis

Disseminated gonococcal infection

Neutrophilic inflammatory joint effusion

Migratory polyarthralgia
(asymmetric polyarthralgias)

328
Q

Claw toe deformity associated with

A

Diabetic peripheral neuropathy

329
Q

Tx Raynaud

A

CCB

  • Amyloidipine
  • Nifedipine
330
Q

Long term management of RA

A

Antifolate immunosuppressant
- Methotrexate

[Start w/ NSAIDS and glucocorticoids]

Periarticular erosions

331
Q

Anti-citrullinated peptide

332
Q

Sausage digit

A

Dactylitis

Psoriatric arthritis

333
Q

Anterior knee pain

Atrophy of quadriceps

A

Patellofemoral pain syndrome

Pain with isometric contraction of the quadriceps

334
Q

Painless nonpruritic purple lesions on legs

Fatigue
Weakness
Fleeting joint pains in knees and elbows

Elevated serum creatinine
Elevated LFTs

Low C3
Low C4
+ Rheumatoid factor

3+ blood
3+ protein

A

Cryoglobulinemia

Get viral hepatitis serology

335
Q

Methotrexate can cause SE

A

Impaired DNA synthesis

Oral ulcers/ stomatitis

Macrocytic anemia (Bone marrow suppression)

Hepatotoxicity

336
Q

Numbness or pain between 3rd and 4th toes

Clicking sensation when palpating space between 3rd and 4th toes

A

Interdigital (Morton) neuroma

Neuropathic degeneration of the interdigital nerves

337
Q

Medial knee pain

Focal tenderness over medial tibia below knee

A

Pes anserinus pain syndrome

Overuse

338
Q

Fingers turn bluish color

Bibasilar fine inspiratory crackles

What test?

A

Systemic sclerosis

Anti-topoisomerase I antibodies

Anticentromere

339
Q

Nail pitting associated with swelling of hands and wrist

A

Psoriatic arthrits

340
Q

Altered mental status

Intermittent vision changes

Skin on hands is shiny and thickened with multiple telangiectasias

Edema on shins

1+ Proteinuria

Tx

A

Systemic sclerosis

Telangiectasia
Sclerodactyly
Digital ulcers
Calcinosis cutis

Arthralgia
Esophageal dysmotility
Raynaud

Interstital lung disease

ACE Inhibitors

341
Q

36 y.o with confusion and agitation

Not sleeping well

Twitching of her right arm this morning

Fever

Neck is supple

EEG: HIgh amplitude slow waves over the left temporal and frontal lobes

A

Herpes simplex virus encephalitis

Elevated protein
Elevated RBC
Normal glucose
Lymphocytic pleocytosis

342
Q

Midshaft humerus fracture can damage

343
Q

71 y.o with impaired cognition and memory loss.

1 year ago difficulty balancing check book and preparing meals

5 months ago unsteady on feet

Past month isolating from family and sadder

Increased urinary frequency and urgency

A. Cerebrovascular disease
B. Eosinophilic inclusions in neurons of the substantia nigra
C. Loss of dopamine producing cells
D. Low acetylcholine activity
E. Silver staining inclusions in neurons of the hippocampus

A

A. Cerebrovascular disease

344
Q

Eosinophilic inclusions of the substantia nigra

A

Dementia with Lewy body

345
Q

Loss of dopamine producing cells

A

Parkinson disease

346
Q

Impaired acetylcholine synthesis

A

Alzheimer disease

347
Q

Silver staining cytoplasmic inclusion within neurons of the hippocampus

A

Frontotemporal dementia (pick disease)

348
Q

Lennox Gastaut syndrome

A

< 5 y.o

Seizures
Intellectual disability

349
Q

Meningitis Tx

A

Cephalosporins
- Ceftriaxone

Add Vancomycin to cover S pneumoniae

If Immunocompromised (chronic glucocorticoids) or > 50 at risk for Listeria
- Ampicillin
350
Q

CSF of Guillain Barre

A

Elevated PROTEIN

Normal Leukocyte count

Normal glucose

351
Q

Spinal epidural abscess first step in tx

A

Broad spectrum antibacterial therapy

  • Vancomycin
  • Plus ceftriaxone

[ If young, injection drug, glucocorticoids likely to worsen epidural infection]

352
Q

Seizure disorder found unresponsive. Evidence of urinary incontinence.

HTN

Flattening of P wave
PR prolongation
Widening of QRS

Hyperkalemia
Elevated Bicarb
Elevated BUN
Elevated creatinine
17,000 CPK
AST 230
ALT 400
Alk phos 110
Tx
A. Calcium gluconate
B. Hypotonic saline infusion
C. Amiodarone
D. Atropine
E. Glucagon
A

A. Calcium gluconate

Has seizure in post-ictal state

Infection due to elevated white count

Elevated CPK and creatinine — rhabdomyolysis

Flattening of P wave, PR prolong, QRS widening= hyperkalemia

Tx Calcium gluconate to stabilize membrane

353
Q

Rhabdomyolysis

Blood
RBC
WBC
Casts

A

2+ blood (positive but actually detecting heme)

RBC 0-5

WBC 1-2

Pigmented Casts

354
Q

Tx Scleroderma

A. Metoprolol
B. Gabapentin
C. Tamoxifen
D. Nifedipine
E. Prednisone
A

CCB
- Nifedipine

Promotes vasodilation

355
Q

Carpal tunnel tx

A

Wrist splinting

Glucocortiocoid injection

356
Q

Migraine given sumatripin

Becomes disoriented and has seizure. 220/110.

What medication

A

Received Ergot derivative (5-HT agonist) within past 24 hrs
- Ergotamine

—> prolonged vasoconstriction

Sumatriptan= vascular serotonin agonist
- causes vasoconstriction

357
Q

Shot in back. Ipsilateral paralysis and loss of proprioception and contralateral loss of pain perception

A. Anterior cord
B. Central cord
C. Complete transection of spinal cord
D. Hemisection of spinal cord
E. Posterior cord
A

Hemisection of spinal cord

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