NBME

Question 1

Transfusion of RBCs - when? (guidelines)

Answer 1

Hgb under 7 (= about 21% Hct)

Question 2

Lambert Eaton Syndrome

vs MG

Answer 2

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

Question 3

craniopharyngioma vs pituitary adenoma

Answer 3

same: bitemporal hemianopsia, frontal headache

pituitary adenoma - will also cause secondary sex characteristic traits

Question 4

microcytic anemia + foot drop + neurologic Sx= ?

Answer 4

• lead poisoning

- moonshine has lead in it

Question 5

Froment’s sign

Answer 5

Froment’s sign: ulnar nerve lesion at wrist

-perform electrophysiology testing to find dmg

Question 6

visual acuity decreased in one eye, fundoscopy normal, accompanied by headache

Answer 6

-optic neuritis seen in MS

Question 7

PANDAS (pediatric autoimmune neuropsychiatric disorders)

Answer 7

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

Question 8

Polymyalgia rheumatica

Answer 8

• 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

Question 9

Polymyositis/dermatomyositis

Answer 9

inc CK, ⊕ ANA, ⊕ anti-Jo-1, ⊕ anti-SRP, ⊕ anti-Mi-2 antibodies. Treatment: steroids followed by long-term immunosuppressant therapy (eg, methotrexate).

Question 10

Polymyositis vs dermatomyositis

Answer 10

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

Question 11

Diabetic radiculopathy

Answer 11

band-waist pattern (can be half waist)

Question 12

Steroids and spinal cord mass - immediate Tx

Answer 12

steroids have been found to be effective in reducing the neurological deficit

Question 13

What controls urination (micturition)

Answer 13

-inhibitory action of midbrain upon the parasympathic nerve S2-S4 which is responsible for micturition

Question 14

Tx narcolepsy and cataplexy

Answer 14

Modafanil in the morning for Daytime sleepiness & Sodium Oxybate for Cataplexy at bed time & night

Question 15

Neurocysticercosis - on MRI

Answer 15

• see calcifications and brain mass (in most likely healthy individual)
• immigration?

Question 16

Flame hemorrhage

Answer 16

hypertensive encephalopathy

Question 17

Acoustic Neuroma (schwannoma)

Answer 17

-impacts facial movement (CN7) and can impact hearing and balance (bc CN 8 is next to CN 7)

Question 18

NMS “FEVER”

Answer 18

-bc decreased DA!
Fever
Encephalopathy
Vitals unstable
Enzymes 
Rigidity of muscles

Question 19

Balbar palsy

Answer 19

-CN 9, 10, 11, 12 involvement in medulla

Question 20

Atrophic gastritis

Answer 20

-dmg parietal cells –> no intrinsic factor –> no B12 = decreased vibration, proprioception, numbness and tingling

Question 21

CO poisoning affects brain where?

Answer 21

Globus pallidus (above middle)

Question 22

Tx cervical artery dissection

Answer 22

1 - can use clopidogrel and ASA
2 - IV heparin (followed by warfarin)
*goal is to stop clot formation

Question 23

Stroke vs idiopathic bells palsy

Answer 23

If pt is healthy/fit and gets facial paralysis = idiopathic bells palsy (not a stroke without risk factors)

Question 24

uremic encephalopathy vs hepatic encephalopathy

Answer 24

uremic = renal, hepatic = liver (alcoholics)

Question 25

spondylosis = ?

Answer 25

cervical osteoarthritis

Question 26

Ballder UMN signs

Answer 26

detrusor hyperreflexia!

Question 27

Acute cerebellar ataxia of childhood

Answer 27

• 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

Question 28

Rx to quickly lower high BP

Answer 28

1 - Labetalol
2 - Nicardipine
3 - Hydralizine
4 - Nitroprusside