Neuro Cases

Question 1

headache qs

Answer 1

acute vs chronic, location / lateralization, duration, timing, photophobia/auras, neck stiffness, n&v, jaw claudication, trauma / Sx, sinusitis, exacerbating/ alleviating facctors

Question 2

workup headache

Answer 2

cbc, ct, mri, lp, crp / dopper us/biopsy for temporal arteritis

Question 3

sudden, severe headache

Answer 3

subarachnoid hem, use NCC to image, pt/ptt/inr

Question 4

sinusitis imaging

Answer 4

xr sinus, ct, lp (csf anaysis)

Question 5

pseudotumor cerebri

Answer 5

urine hCG, cbc, head ct, opening pressure

Question 6

trigeminal neuralgia

Answer 6

cbc, esr, mri brain

Question 7

memory loss qs

Answer 7

course of deficits, collateral info (from family etc), delirium screen (waxing/waning?), falls, med changes/polypharmacy, associated Sx (incontinence, fevers, chills, weight loss, ataxia, hypothyroid, depression), Hx stroke or vascular dz, etoH, b12 deficiency, FHx of Alzheimer’s etc

Question 8

memory loss workup

Answer 8

cbc, b12, tsh, MRI/ct, vdrl/rpr, LP

Question 9

alz dz imaging

Answer 9

MRI preferred

Question 10

cjd workup (myoclonus, ataxia, startle)

Answer 10

elecrolytes/ Ca, EEG, LP, brain Bx

Question 11

hypoglycemia w/u

Answer 11

glucose, cbc, electrolytes, cpk-mb, troponin, echo, ecg, mri brain, doppler u/s carotid

Question 12

vision loss qs

Answer 12

acute vs chronic, time course, pain, discharge, itching tearingn, redness, photophobia, weakness/uimbness. Hx cardiac, rheum, thrombotic, autoimmune, neuro. jaw claudication, meds, trauma

Question 13

retinal artery occlusion (a fib, vision loss in one eye) wu

Answer 13

fluorescein angio, echo, dopper carotids, intraocular tonometry, esr, temporal artery bx, cbc

Question 14

retinal artery occlusion differential

Answer 14

vein occlusion, acute angle closure, retinal detachment, temporal arteritis

Question 15

depression qs

Answer 15

sig e caps (sleep, interest/anhedonia, guilt, concentration, psychomotor agitation/retardation…), previous episodes, drugs/etoh/meds, social

Question 16

depression exam and wu

Answer 16

MSE, appearance, behavior, speech, mood, affect, thoughts. tsh, cbc, u tox, Beck depression inventory

Question 17

psychosis qs

Answer 17

+ (hallucinations, delusions, thought disorganization), - (blunted affect, social withdrawl, decreased motivation/speech/thought)

Question 18

substance induced psychosis

Answer 18

u tox, tsh, cbc, MSE, electrolytes, bun/cr, ast/alt

Question 19

dizziness qs

Answer 19

vertigo vs lightheaded (is the room spinning or? ), duration, positioing or post head trauma, visual disturbance, URI, nausea, neck pain, meds, atherosclerotic vascular dz

Question 20

dizziness ex

Answer 20

vitals, neuro ex (+romberg, nystagmus, dix halpike, weber/rinne), ent, cardio.

Question 21

diziness wu

Answer 21

/cbc, electrolytes, mri brain. vdrl / rpr (for Meniere’s dz), orthostatic bp change/flurosemide or hydrochlorothiazide etc use/ stool or diarrhea hx for dehydration, dix/mri brain/audiogram from bph. mri/mra for labryinth and vestibular neuronitis

Question 22

dizziness ddx

Answer 22

Meniere’s, vestibular neuronitis, labryinthitis, bpv, acoustic neuroma if sensorineural, vertebrobasilar insufficiency, brainstem or cerebellar tumor, cervical spine dz/injury vertigo

Question 23

vestibular neuronitis vs labryinthtis

Answer 23

both morning, n& v, URI a few days ago, but vestibular has no hearing loss while labryinth does

Question 24

LOC hx

Answer 24

nausea, diaphoresis, palpitations, pallor, lightheaded, exertional/postural/calustrophobic/dehydration/trauma/stress. tongue biting, incontinence, tonic cllonic, prolonged confusion, dypsnea or PE risk, arrythmia, htn, diabetes, etoh and alcohol use.

Question 25

LOC ex

Answer 25

vitals (bp standing vs sitting), neuro, carotid and cardiac, lung, lower limbs

Question 26

LOC w/u

Answer 26

cbc, electrolytes, glu, u tox. eeg, mri/ct (seizures). echo, ecg, holter (syncome via orthostatic hypotension or arrythmia). v/q, cta, d-dimers for PE

Question 27

numbness/weakness Hx, ex

Answer 27

distribution (prox, distal...unilateral or not), progression, pain, diabetes, athero, etoh. ex neuro, msk, vitals, vascular

Question 28

numbness w/u

Answer 28

ct head/mri, cpc, electolytes, glu, lipid panel, ecg, echo, dopper u/s. nerve conduction/ edrophonium for myastheia ruleout for gbs, retinal evoked potentials for MS

Question 29

fatigue hx, ex

Answer 29

sleep hygeine, stress etc, thyroid, anemia, meds/etoh/caffeine/drugs. vitals, ent (conjnctival pallor, tonsils, lymph nodes, thyroid), heart, lung, abdo quickly. pallor, coolness at distal extremeties

Question 30

fatigue wu

Answer 30

cbc, tsh, u tox, electrolytes, bun/cr, Ca, fasting glucose, hba1c, UA, std tests. polysomnography and noctural pulse ox for sleep apnea (evaluate if cpap useful),

Question 31

glove and stocking numbness and tingling

Answer 31

diabetic or alcoholic peripheral neuropathy, hypocalcemia, hyperproteinemia/myeloma, hyperventilation(?)

Question 32

tingling/numb median nerve distrib, progressive, fatigue, weight gain

Answer 32

carpal tunnel 2ndary to hypothyroidism. overuse injury median nerve, medial epicondylitis

Question 33

fatigue, weight loss, constipation. FHx of this dz

Answer 33

colon ca. hypothyroidism, renal failure (hypercalcemia-constipation, stones, abdo moans, psych groans), depression.

Question 34

fatigue, thirst, polyuria, increased appetite

Answer 34

DM (type 1), primary polydipsia, DI, atypial depression

Question 35

insomnia Hx, Ex

Answer 35

duration, earning morn vs multiple awakenings vs trouble sleeping, daytime sleepiness. arthritis, diabetes. snoring, nightmares, depression. substances (caffeine, etoh, meds, illegal), shift work, jet lag, sleep hygiene, stress, psychiatric ex: vitals, mse, thyroid

Question 36

insomnia wu

Answer 36

cpc, tsh, mse, polysomnography, ecg

Question 37

insomnia ddx

Answer 37

circadian rhythm sleep disorder, depression, primary hypersomnia, osa, caffeine or stress induced

Question 38

neck mass hx

Answer 38

socrates, mobility, mvmt with swallowing (thyroglossal duct cyst or not), obstructive(sob, dysphagia), associated sx (heme, constitutional-likelier ca, GI, endo, pulm), sick contacts, other masses like lymph nodes

Question 39

neck mass ex

Answer 39

heent, lymph nodes, spleen, tonsils. heart, lung, abdo

Question 40

neck mass wu

Answer 40

cbc (& differential ie wbc), euc, esr/crp, lymph node bx, ppd, cxr, tsh, thyroid us, upper endoscopy

Question 41

neck mass ddx

Answer 41

hodgkin's/nhl, tb, thyroid nodule