Neurología Flashcards
A history of camping in an endemic region (regardless of whether patients can recall tick bites) in conjunction with multiple erythema migrans (EM) lesions and migratory arthralgia suggests early disseminated (stage Il) Lyme disease. What do you have highest risk to develop in this disease?
Cranial nerve palsy (most commonly peripheral facial nerve palsy is a common complication of stage I Lyme disease that is caused by early neuroborreliosis.
Also meningitis and poly neuropathy
A 1-year-old boy is brought to the physician for a well-child examination. He has no history of serious illness. His older sister had an eye disease that required removal of one eye at the age of 3 years. Examination shows inward deviation of the right eye. Penlight examination shows a white reflex in the right eye and a red reflex in the left eye. The patient is at increased risk for which condition?
Osteosarcoma
Patients with inherited retinoblastoma gene mutations (Rb gene mutations) have a significantly increased risk of developing osteosarcomas.
A 60-year-old woman is brought to the emergency department because of sudden, painless loss of vision in her right eye that occurred 30 minutes ago while watching TV. She has coronary artery disease, hypertension, and type 2 diabetes mellitus, and has had trouble adhering to her medication regimen. Her blood pressure is 160/85 mm Hg. Examination shows 20/50 vision in the left eye and no perception of light in the right eye. Direct pupillary reflex is present in the left eye but absent in the right eye. Accommodation is intact bilaterally. Intraocular pressure is 16 mm Hg in the left eye and 18 mm Hg in the right eye. Fundoscopic examination of the right eye shows a pale, white retina with a bright red area within the macula. The optic disc appears normal. Which of the following is the most likely diagnosis?
Central retinal artery occlusion
A 56-year-old man is brought to the emergency department by his neighbor 2 hours after ingesting an unknown substance in a suicide attempt. He is confused and unable to provide further history. His temperature is 39.1°C (102.4°F), pulse is 124/min, respirations are 12/min, and blood pressure is 150/92 mm Hg. His skin is dry. Pupils are 12 mm and minimally reactive to light. An ECG shows no abnormalities. Which of the following is the most appropriate pharmacotherapy?
Physostigmine
Physostigmine is the first-line treatment for anticholinergic syndrome because it crosses the blood-brain barrier and rapidly enhances parasympathetic signaling.
Patient with history of diabetes presents upper eyelid droop due to..
Diabetes mononeuropathy: Oculomotor nerve palsy
A 69-year-old man comes to the physician with a 2-year history of progressive hearing loss. His hearing is worse in crowded rooms, and he has noticed that he has more difficulty understanding women than men. He has no history of serious illness and does not take any medications. A Rinne test shows air conduction is greater than bone conduction bilaterally (normal). This condition is most likely associated with damage closest to which of the following structures?
Basal turn of the cochlea
Sound waves cause vibrations that resonate with the basilar membrane of the cochlea, which converts this input into nerve signals that encode the auditory information.
The sound wave’s point of optimal resonance within the cochlea depends on the frequency of the sound wave (tonotopy). The base of the cochlea, including the basal turn, responds to higher frequencies. Progressive degeneration of the organ of Corti near this region causes presbycusis.
A 39-year-old man comes to the physician for evaluation of hearing loss. He reports difficulty hearing sounds like the beeping of the microwave or birds chirping, but can easily hear the pipe organ at church. He works as an aircraft marshaller. A Rinne test shows air conduction greater than bone conduction bilaterally. A Weber test does not lateralize. Which of the following is the most likely underlying cause of this patient’s condition?
Noise-induced hearing loss is caused by the destruction of cochlear hair cells, also known as the organ of Corti.
In this unvaccinated child, the most likely cause of acute flaccid paralysis (weakness with decreased deep tendon reflexes) is anterior horn cell destruction caused by…
Poliomyelitis, which is caused by the poliovirus, manifests as acute lower motor neuron weakness that begins asymmetrically in the lower extremities and ascends over hours to days. Patients can have prodromal flu-like symptoms before the onset of weakness. Cerebrospinal fluid analysis in poliomyelitis is typically consistent with viral infection (lymphocytic pleocytosis, normal or slightly increased protein levels, and normal glucose levels). Diaphragmatic involvement ultimately results in respiratory failure and death.
This patient has a history and physical exam findings consistent with malignant otitis externa given his severe ear pain, vital sign abnormalities (i.e., high fever, tachycardia), facial droop (indicating progression to osteomyelitis of the temporal bone with associated CN VII palsy), and the presence of granulation tissue in the ear canal. It could be associated with..
Glucose intolerance
There is a strong association between diabetes mellitus and the development of malignant otitis externa, which is most commonly caused by an infection with Pseudomonas aeruginosa.
A 26-year-old man comes to the physician for a follow-up examination. Two weeks ago, he was treated in the emergency department for head trauma after being hit by a bicycle while crossing the street. Neurological examination shows decreased taste on the right anterior tongue. This patient’s condition is most likely caused by damage to a cranial nerve that is also responsible for which of the following?
Closing the eyelids is accomplished through the contraction of the orbicularis oculi muscle, which is, like all facial muscles, innervated by the facial nerve (CN VII).
