Neuro Flashcards
Immunocompromised patient with gradual onset of symptoms such as hemiparesis, speech disturbances, vision, and gait with multiple, hypodense, non-enhancing lesions?
PML progressive multifocal leukoencephalopathy
Pt with a pulsatile headache and tinnitus with risk factor of steroid or OCPS, trauma, obesity with inrceased intracranial pressure?
pseudotumor cerebri
Pt with a brief episode of impaired consciousness with automatisms and post-ictal confusion?
complex partial seizure
Pt presents with contralateral hemianesthesia that can be accompanied by transient hemiparesis, athetosis, or ballistic movements?
thalamic stroke (Dejerine-Roussy syndrome)
What is the CSF analysis in a patient with Guillain-Barre syndrome?
The protein is high, and the rest are normal.
23 YOF w/ and acute headache of pulsating, unilateral with nausea and photophobia has vomited 5 times. what is the most appropriate initial mangement step?
antiemetics such as prochlorperazine or metoclopramide, chlorpromazine.
How do you dtermine a patient to be brain dead?
Absentee of cortical and brain stem functions. However spinal cord may still be intact.
Most likely finding in a patient’s CSF examination that has paraplegia, urinary incontinence and urgency and impaired vibration and proprioception in her left forearm?
Oligoclonal bands are present in 90% of MS patients.
Prominent flexing of right hip and knee and right foot slapping to the floor with each step. What is the gait abnormality?
L5 radiculopathy.
Bilateral lower extremity consitent with UMN dz with hyperrflexia, and decreased sensation. may include compromised bladder or bowel control
Spinal cord compression
Stroke that involves the internal capsule thereby resulting in pure motor dysfunction. These are ischemic strokes so small that can’t be detected in CT scans.
Small vessel hyalinosis
What is the most likely diagnosis in a female who has recurrent attacks of focal neurologic dysfunction that occur at non-predictable time intervals?
Multiple sclerosis and MRI is diagnostic test of choice for identifying demyelinating lesions.
what is the pathologic process in a ptient with cancer that has a symmetric erythematous rash in his fingers and muscle weakness?
dermatomyositis. fiber atrophy.
healthy white female w/ new onset of seizures with a 2 day history of fever and headaches. her CSF is high in lymphocytes and RBC. What is the most likely diagnosis?
Herpes simplex encephalitis. PCR analysis of HSV DNA in spinal fluid is gold standard and IV acyclovir in the TOC.
arm weakness and speech difficulty. He expresses himself slowly with difficulty, but he understands words spoken to him. Where is most likely the lesion?
Dominant frontal lobe.
Patient with severe occipital headache, ataxia right-sided facial weakness and deviation of the eyes to the left side. what is the most likely diagnosis?
Cerebellar hemorrhage
hemiparesis, Hemi-sensory loss, homonymous hemianopsia, stupor, and coma?
Putamen hemorrhage
Deep coma and paraplegia iwth pinpoint pupils reactive to light and decerebrate rigidity?
Pontine hemorrhage
Pt with essential tremors comes with abdominal pain, confusion, headaches, hallucinations, and dizziness. What caused the patient’s new symptoms?
Primidone is an anticonvulsant that may precipitate acute intermittent porphyria.
What medications slows down the long-term progression of multiple sclerosis?
Interferon-beta. High-dose corticosteroids are used during acute attacks.
Patient with pseudotumor cerebri with papiledema is at most risk of what?
blindness
How do you diagnose normal pressure hydrocephalus?
Enlarged ventricles in CT or MRI and normal opening pressure in lumbar punctures
How do you treat Normal pressure hydrocephalus?
perform serial large volume lumbar punctures and a ventriculoperitoneal shunt may be placed.
What is the best therapy for an elderly patient who is concerned with recent memory loss and very irritable and fatigue with loss of interest and sleep and appetite?
SSRI. patients with Alzheimer’s usually aren’t aware of their memory impairment
What is the DOC for trigeminal neuralgia?
carbamazepine
What is the DOC for the treatment of idiopathic benign intracranial hypertension?
Acetazolamide
What is the best way to diagnose acoustic neuromas?
MRI with gadolinium
Pt presents with nausea, vomiting, headaches that are worse in the morning, vision changes, papilledema, cranial nerve deficits, somnolence confusion, unsteadiness, and cushing’s reflex (hypertension and bradycardia) what is the most likely diagnosis?
Intracranial hypertension
What is the best next step in management in a patient with unprovoked seizures and unclear history?
CT scan w/out contrast to rule out hemorrhage
What is the best TOC for agitation in elderly patients?
low-dose haloperidol
What is the major cause of morbidity and mortality in a patient with a subarachnoid hemorrhage?
VAsospasm with symptomatic ischemia and infarction. Therefore give calcium channel blockers to prevent vasospasm
What is the most likely diagnosis in a patient with parkinsonism, orthostatic hypotension, impotence, incontinence, or other autonomic symptoms?
Multiple system atrophy
What is the most likely diagnosis in a 21 YOM with sever headaches and CT positive for a ring-enhanced lesion in the left frontal lobe and fluid collection in the left maxillary sinus?
Anaerobic bacterial infection (abscess)
What is the best potential treatment for MS?
Glatiramer acetate
What is the best way to monitor respiratory function in a patient with impending respiratory failure?
Vital capacity.
a 27 YOM with poor appetite, loss of interest, impaired sleep, weight loss, and poor memory has a PMH of past IV drug abuse. What is the best next step in management?
HIV testing
Pt tends to sway to the left even with his eyes open and cautiously lurches to the left while walking. What is the most likely diagnosis?
Cerebellar tumor which represents itself as ipsilateral ataxia, nystagmus, intention tremors, and loss of coordination.
Patient with progressive fatigue low hematocrit and elevated bilirubin levels with no family history of blood disorder. Blood smear shows spherocytes without central pallor and a positive coombs’ test. What is the most likely diagnosis?
Autoimmmune hemolytic anemia
In a patient with breast cancer witha HER2 gene amplification that will be started on trastuzumab. What important test should you perform prior to starting the regimen?
Echocardiography because trastuzumab is cardiotoxic.
What is the diagnostic criteria of monoclonal gammopathy of undetermined significance?
asymptomatic elevation of a monoclonal protein detected on protein electrophoresis and excluding multiple myeloma (renal insufficiency, hypercalcemia, anemia, and lytic bone lesions
