NBME Flashcards
Transfusion of RBCs - when? (guidelines)
Hgb under 7 (= about 21% Hct)
Lambert Eaton Syndrome
vs MG
Lambert Eaton Syndrome:
- Ab vs voltage gated Ca2+ channels
- Small cell lung cancer
- Proximal muscle weakness
- Absent DTRs
- Autonomic (decreased Ach) findings (dry mouth)
- No sensory findings
MG
- Ptosis, diplopia, weakness Worsens with muscle use
- *does not have to be tested for worsened muscle use
- Cx: thymoma
craniopharyngioma vs pituitary adenoma
same: bitemporal hemianopsia, frontal headache
pituitary adenoma - will also cause secondary sex characteristic traits
microcytic anemia + foot drop + neurologic Sx= ?
- lead poisoning
- moonshine has lead in it
Froment’s sign
Froment’s sign: ulnar nerve lesion at wrist
-perform electrophysiology testing to find dmg
visual acuity decreased in one eye, fundoscopy normal, accompanied by headache
-optic neuritis seen in MS
PANDAS (pediatric autoimmune neuropsychiatric disorders)
PANDAS: pediatric population 1-2 months after strep infection. Symptom is Tic+OCD. Usually occurs in prepuberty, sudden onset. Motor hyperactivity and choreiform movements. Treated with antibiotics+SSRI+CBT
Polymyalgia rheumatica
- SYMPTOMS: Pain/stiffness in shoulders and hips, fever, malaise, weight loss
- NO muscular weakness
- giant cell (temporal) arteritis
- FINDINGS: inc ESR, inc CRP, normal CK
- TREATMENT: Rapid response to low-dose corticosteroids
Polymyositis/dermatomyositis
inc CK, ⊕ ANA, ⊕ anti-Jo-1, ⊕ anti-SRP, ⊕ anti-Mi-2 antibodies. Treatment: steroids followed by long-term immunosuppressant therapy (eg, methotrexate).
Polymyositis vs dermatomyositis
Polymyositis: Progressive symmetric proximal muscle weakness *Test: EMG/NCS
Dermatomyositis: polymyositis with skin:
-malar rash (similar to SLE), Gottron papules A , heliotrope (erythematous periorbital) rash B, “shawl and face” rash C, “mechanic’s hands.” risk of occult malignancy
Diabetic radiculopathy
band-waist pattern (can be half waist)
Steroids and spinal cord mass - immediate Tx
steroids have been found to be effective in reducing the neurological deficit
What controls urination (micturition)
-inhibitory action of midbrain upon the parasympathic nerve S2-S4 which is responsible for micturition
Tx narcolepsy and cataplexy
Modafanil in the morning for Daytime sleepiness & Sodium Oxybate for Cataplexy at bed time & night
Neurocysticercosis - on MRI
- see calcifications and brain mass (in most likely healthy individual)
- immigration?
Flame hemorrhage
hypertensive encephalopathy
Acoustic Neuroma (schwannoma)
-impacts facial movement (CN7) and can impact hearing and balance (bc CN 8 is next to CN 7)
NMS “FEVER”
-bc decreased DA! Fever Encephalopathy Vitals unstable Enzymes Rigidity of muscles
Balbar palsy
-CN 9, 10, 11, 12 involvement in medulla
Atrophic gastritis
-dmg parietal cells –> no intrinsic factor –> no B12 = decreased vibration, proprioception, numbness and tingling
CO poisoning affects brain where?
Globus pallidus (above middle)
Tx cervical artery dissection
1 - can use clopidogrel and ASA
2 - IV heparin (followed by warfarin)
*goal is to stop clot formation
Stroke vs idiopathic bells palsy
If pt is healthy/fit and gets facial paralysis = idiopathic bells palsy (not a stroke without risk factors)
uremic encephalopathy vs hepatic encephalopathy
uremic = renal, hepatic = liver (alcoholics)
spondylosis = ?
cervical osteoarthritis
Ballder UMN signs
detrusor hyperreflexia!
Acute cerebellar ataxia of childhood
- childhood condition characterized by an unsteady gait, most likely secondary to an autoimmune of postinfectious cause, drug induced or paraneoplastic.[1] Most common virus causing acute cerebellar ataxia are Chickenpox virus and Epstein Barr Virus. It is a diagnosis of exclusion.[2]
- 2-3 wks after initial infection
- 50% bilateral horizontal nystagmus
Rx to quickly lower high BP
1 - Labetalol
2 - Nicardipine
3 - Hydralizine
4 - Nitroprusside
