Neurology Flashcards
1
Q
Restless Leg Syndrome (RLS) is often associated with …
A
Iron deficiency
2
Q
Best test to order in patient with newly-diagnosed RLS?
A
Ferritin level
3
Q
Best treatment for patients with moderate-to-severe RLS?
A
Pramipexole, Ropinirole
4
Q
MOA of Pramipexole, Ropinirole?
A
Dopamine agonists
5
Q
2 alternate DOCs for patients with moderate-to-severe RLS?
A
Benzodiazepines, Gabapentin
6
Q
3 clinical criteria suggesting brain death?
A
Clinical/imaging evidence of devastating cause; Absence of confounding factors, Hemodynamic stability (T>97°, SBP>100)
7
Q
Next step of workup in patient with (+) clinical criteria suggesting brain death?
A
Neurologic examination to document absent cerebral + brainstem reflexes
8
Q
5 reflexes that need to be checked in patient with suspected brain death?
A
Motor response to pain, Pupillary light reflex, Corneal reflex, Oculocephalic reflex, Cough reflex during tracheal suctioning
9
Q
Next step of workup for patients with (+) neurologic testing for brain death?
A
Apnea testing to confirm brainstem failure
10
Q
Next step of workup for patients with (–) neurologic testing for brain death, but still high clinical suspicion?
A
EEG, CT angiogram
11
Q
Next step of workup for patient with suspected paradoxical embolism?
A
ECHO
12
Q
5 types of CA that commonly metastasize to spinal cord?
A
Breast, Non-Hodgkin lymphoma, Lung, Prostate, Renal CC
13
Q
Clinical presentation of epidural spinal cord compression?
A
Thoracic radicular pain that wraps around upper abdomen + weakness/numbness/tingling in LEs
14
Q
2 aspects of treatment for suspected epidural spinal cord compression?
A
High-dose corticosteroids, MRI
15
Q
Best treatment of radiosensitive spinal cord tumors?
A
Radiation
16
Q
Best treatment of radioresistant spinal cord tumors?
A
Neurosurgery consult
17
Q
R-sided motor symptoms usually indicate a vascular lesion in the distribution of …
A
L MCA
18
Q
MCA is a branch of …
A
ICA
19
Q
Best treatment for patients with symptomatic carotid artery disease, and high-grade (70-99%) stenosis?
A
Carotid endarterectomy
20
Q
Best treatment for patients with asymptomatic carotid artery disease, and low-grade (<70%) stenosis?
A
ASA + Statin + modification of HTN/DM/Smoking
21
Q
Inheritance pattern of frontotemporal dementia?
A
AD
22
Q
How can you distinguish frontotemporal dementia from Alzheimer dementia?
A
Memory is initially intact in setting of frontotemporal dementia; Early memory impairment typically characterizes Alzheimer dementia
23
Q
Best treatment for patients with vasovagal syncope?
A
Education + Reassurance
24
Q
Alternate name for vasovagal syncope?
A
Neurocardiogenic syncope
25
Specific education piece for patients with vasovagal syncope?
Physical counterpressure maneuvers
26
Patient is unable to copy simple line drawings … this is an example of ___ apraxia
Construction
27
Construction apraxia results from lesion in ___ lobe
Non-dominant parietal
28
Patient is unable to wear clothes … this is an example of ___ apraxia
Dressing
29
Dressing apraxia results from lesion in ___ lobe
Non-dominant parietal
30
CVA associated with confusion results from lesion in ___ lobe
Non-dominant parietal
31
Patient is unable to perform simple math equations, recognize own fingers, differentiate R vs. L … diagnosis?
Gerstmann Syndrome
32
Gerstmann Syndrome results from lesion of …
Dominant parietal lobe
33
Clinical presentation for lesions of non-dominant temporal lobe?
Visual disorders; Impaired auditory perception
34
Clinical presentation for lesions of dominant temporal lobe?
Difficulty with language
35
Patient with CVA presents with L-sided weakness, dysarthria; Symptoms began 7 hours ago – what is best initial management?
Bedside swallow evaluation
36
Patient with CVA presents with L-sided weakness, dysarthria; Symptoms began 7 hours ago;
Bedside swallow evaluation is normal – what is best management?
37
Most common cause of early death in acute CVA patients?
PE
38
Risk of DVT and PE is particularly high in CVA patients with …
Hemiparesis
39
Best DVT prophylaxis in patients with hemorrhagic CVA?
Pneumatic compression
40
4 clinical features that may be present in patient with Lewy Body Dementia?
Confusion, Visual hallucinations, Parkinsonism, REM sleep disorder
41
4 drugs used to treat Lewy Body Dementia?
Melatonin, Antipsychotics, Cholinesterase inhibitors, Carbidopa-Levodopa
42
After initial presentation and management, patient with Lewy Body Dementia presents with worsening confusion, parkinsonism, and autonomic dysfunction – what is causing her symptoms?
Extreme sensitivity to Antipsychotics
43
Best Antipsychotic to use in patient with Lewy Body Dementia?
2nd generation, low potency … Quetiapine
44
Best next test in symptomatic infant with retinal hemorrhages on exam?
Head CT
45
Value of head CT in symptomatic infant with retinal hemorrhages on exam?
Identify subdural hematomas
46
Characteristic of subdural hematomas in setting of non-accidental head trauma?
Mixed-density pattern … due to varying stages of injury
47
Characteristic of subdural hematomas in setting of accidental head trauma?
Homogenous-density pattern
48
3 categories for Glasgow Coma Scale (GCS)?
Ocular, Verbal, Motor
49
Maximum Motor GCS score?
6
50
Maximum Verbal GCS score?
5
51
Maximum Ocular GCS score?
4
52
Intubation is recommended for GCS of …
< 8
53
Cerebral palsy is a common complication of …
Prematurity
54
5 aspects of clinical presentation for cerebral palsy in infants?
Delayed disappearance of neonatal reflexes, hypertonia, hyperreflexia, sustained clonus, delayed motor milestones
55
Next step of work up for infant with suspected cerebral palsy?
Brain MRI
56
Purpose of Brain MRI in infant with suspected cerebral palsy?
Look for abnormal findings – periventricular leukomalacia, brain malformation, ischemia
57
Clinical presentation of neurocardiogenic vasovagal episode?
Autonomic prodrome of nausea, pallor, diaphoresis, warmth
58
How can you distinguish neurocardiogenic vasovagal syncope from cardiogenic syncope (arrhythmia)?
Symptoms persist after episode
59
3 aspects of clinical presentation for SAH?
Sudden-onset HA, nausea, nuchal rigidity
60
60 yo female presents with sudden-onset HA, nausea, nuchal rigidity; Reports 3 months of mild diplopia; PE shows R-sided ptosis, anisocoria – which vessel is involved in SAH?
Posterior communicating artery
61
Unique aspect of clinical presentation for Posterior Inferior Cerebellar Artery (PICA)?
Ataxia, Bulbar dysfunction
62
Meralgia paresthetica is caused by entrapment of which nerve?
Lateral femoral cutaneous nerve
63
Clinical presentation of Meralgia paresthetica?
Decreased sensation over anterolateral thigh
64
Which structure typically entraps the Lateral femoral cutaneous nerve in Meralgia paresthetica?
Inguinal ligament
65
Best management of Meralgia paresthetica?
Conservative treatment …reassurance, weight loss for obese patients, avoidance of tight-fitting clothing
66
Definition of brain death?
Irreversible absence of cerebral + brain stem function
67
A (+) apnea test can confirm brain death by documenting an absent respiratory response off the ventilator for ___ minutes … with PaCO2 > 60, pH < 7.28
8-10
68
What accounts for spontaneous twitching movements (especially in feet/toes) in patients with brain death?
Originate from peripheral nerves + spinal cord
69
Most significant risk factor for CVA?
HTN … (more significant than smoking)
70
9 yo male presents to ED for seizure; HX of epilepsy, currently taking carbamazepine; Parents are going through divorce – what is best initial step of evaluation?
Measure serum carbamazepine levels
71
Definition of of breakthrough seizure?
Seizure that has occurred despite previously successful anti-epileptic therapy
72
Most common cause of breakthrough seizure?
Sub-therapeutic drug levels
73
Most common cause of Sub-therapeutic drug levels in a patient with HX of epilepsy and recent psychologic stressors?
Medication non-adherence
74
Alternate name for idiopathic intracranial HTN?
Pseudotumor cerebri
75
Epidemiology of Pseudotumor cerebri?
Overweight females of child-bearing age
76
Primary physical exam finding for Pseudotumor cerebri?
Papilledema on ophthalmoscopic exam
77
In a patient with high clinical suspicion for SAH, what is next step of workup if CT scan is (-)?
LP
78
LP finding that is diagnostic for SAH?
Xanthochromia
79
Inheritance pattern of Tuberous Sclerosis?
AD
80
Clinical presentation of Tuberous Sclerosis?
Ash-leaf spots, seizure, cardiac rhabdomyomas
81
4 aspects of initial workup for Tuberous Sclerosis?
Cutaneous examination, Fundoscopy, Brain MRI, EEG
82
Most common cause of death in Tuberous Sclerosis?
Neurologic impairment (seizure)
83
Most common cause of excessive daytime sleepiness?
Insufficient sleep
84
Best diagnostic test for narcolepsy?
Polysomnography
85
Characteristic of narcolepsy on polysomnography?
Latency of REM sleep
86
Initial drug of choice for narcolepsy?
Modafinil
87
___ refers to sudden episodes of muscle weakness triggered by intense emotion, seen in patients with narcolepsy
Cataplexy
88
Best management of cataplexy in patients with narcolepsy?
SSRI, SNRI, TCAs
89
2 drugs associated with Pseudotumor Cerebri (aka – idiopathic intracranial HTN)?
Isotretinoin, Minocycline
90
6 contraindications to TPA use in patients with ischemic CVA?
HTN > 180/110; Active bleeding; Platelets < 100,000; Hypodensity in > 33% of arterial territory on CT; Intracranial hemorrhage on head CT; Intracranial surgery within past 3 months
91
After patients with ischemic CVA have been treated with TPA, what are 3 additional steps of workup?
MRA or CTA of carotids + intracranial vasculature; EKG; ECHO
92
Role of EKG in CVA workup?
ID arrhythmia or ischemia that may have lead to thrombus + embolus formation
93
Role of ECHO in CVA workup?
Detect intracardiac thrombus
94
Earliest sign of phenytoin toxicity?
Nystagmus
95
Best management of early nystagmus toxicity, as evidenced in patient with nystagmus?
Reduce dose of phenytoin
96
Clinical presentation of multiple sclerosis?
Neurological defects separated by space and time
97
Ocular manifestation of multiple sclerosis?
Optic neuritis … monocular vision loss, eye pain that worsens with EOM
98
Diagnostic test for Optic neuritis?
Hyperintense lesions on T2 MRI, periventricular white matter
99
LP results associated with multiple sclerosis?
Oligoconal banding, Elevated IgG index
100
Best management of acute exacerbations of MS?
Oral or IV corticosteroids
101
If a patient with acute MS exacerbation also presents with optic neuritis, what is best management?
IV steroids (not oral steroids)
102
Why are oral steroids contraindicated in patients with MS acute exacerbation?
Oral steroids are associated with increased risk of recurrent optic neuritis
103
Best management of acute MS exacerbation that is refractory to steroid treatment?
Plasmapheresis
104
Best chronic management for MS?
IFN-B, Glatiramer
105
Role of IFN-B and Glutiramer therapy in chronic management of MS?
Decreasd frequency of relapses, Reduced incidence of brain lesions
106
Complications of MS in pregnant patients?
Increase in assisted delivery
107
How should acute MS exacerbations be treated in pregnant patients?
Short term IV steroids
108
DOC for muscle spasticity in MS patients?
Baclofen, Tizanidine
109
Which types of neurons are affected by ALS?
Both upper and lower motor neurons
110
5 functions that are preserved in setting of ALS?
Sensory, bowel, bladder, ocular motility, cognitive function
111
Medication that has been shown to prolong survival and delay the need for tracheostomy in ALS patients?
Riluzole
112
MOA of Riluzole?
Glutamate inhibitor
113
3 aspects of clinical presentation for increased intracranial pressure (ICP)?
NV, HA, Papilledema
114
Etiology of papilledema in setting of elevated ICP?
Elevated ICP is transmitted to optic nerve
115
First step of workup for patient with suspected elevated ICP (papilledema on exam)?
Brain MRI
116
Description of Cerebral venous sinus thrombosis (CVST)?
Formation of blood clots within dural sinuses
117
Epidemiology of Cerebral venous sinus thrombosis (CVST)?
Pregnancy
118
Clinical presentation of Cerebral venous sinus thrombosis (CVST)?
Gradually-worsening HA + focal neurologic deficits
119
Best management of Cerebral venous sinus thrombosis (CVST)?
LMW Heparin
120
4 indications for CT scan after minor head trauma?
Coagulopathy, Intoxication, Age > 65 yo, Retrograde amnesia (30+ minutes)
121
Best management of minor head trauma in child with hemophilia A?
Head CT, Factor VIII or IX replacement
122
Greatest complication associated with carbamazepine?
Neutropenia … (via bone marrow suppression)
123
44 yo female presents with severe occipital HA, sudden-onset; PE reveals patient in significant distress; Non-contrast CT shows no intracranial abnormality - what is next best step?
LP
124
Role of LP in patient with severe HA and (-) Non-contrast CT?
Document xanthochromia in setting of negative Head CT
125
24 yo female presents for 2 days of progressive leg weakness, paresthesia; Now has developed inability to void; URI occured 2 weeks ago - diagnosis?
Guillain-Barre Syndrome vs. Transverse Myelitis
126
What is best next step of workup for patient with suspected Guillain-Barre Syndrome vs. Transverse Myelitis?
Spine MRI
127
85 yo male living at nursing home is evaluated for intermittent agitation; HX of dementia with current meds including olanzapine and haloperidol; PE reveals mild resting tremor, rigidity of both UEs - diagnosis?
Drug-induced Parkinsonism (due to anti-psychotics)
128
85 yo male living at nursing home is evaluated for intermittent agitation; HX of dementia with current meds including olanzapine and haloperidol; PE reveals mild resting tremor, rigidity of both UEs - what is next best step of management?
Discontinue anti-psychotics, recommend behavioral interventions
129
45 yo male presents for difficulty walking due to imbalance, and shooting/burning pain in LEs; Works as truck driver in Mid-Atlantic; PE reveals pupils that accomodate, but do not react to light; PE also shows decreased pain, temperature, vibration, and proprioception sensation in BLEs; Ankle reflexes are absent bilaterally - diagnosis?
Neurosypihilis
130
___ refers to sensory ataxia and lancinating pains felt in late neurosyphilis
Tabes dorsalis
131
___ refers to pupils that constrict with accomodation, but not with light in late neurosyphilis
Argyll-Robertson pupils
132
46 yo AA male presents for large pituitary mass seen incidentally on Head CT; Does endorse mild erectile impotence, and R upper temporal visual deficit; Labs show prolactin 5,000, low FSH and LH; MRI shows 2.5cm pituitary mass that is abutting optic chiasm - best management?
Oral dopaminergic agonist
133
2 examples of oral dopaminergic agonist used to treat prolactinomas?
Bromocriptine, Cabergoline
134
70 yo male presents with RUE and RLE weakness, occuring several hours ago; Episode lasted 15 minutes, then resolved spontaneously; Patient underwent L carotid endarterectomy for 89% stenosis of L carotid artery; Post-op eval reveals L-sided deviation of tongue - which nerve has been damaged?
L hypoglossal nerve
135
Distribution of pain in setting of Carpal Tunnel Syndrome?
Palmar farface of first 3 fingers
136
38 yo male is brought to ED unresponsive; Believe that he ingested several bottles of baclofen within past 24 hours; PE shows fixed, dilated pupils; Corneal, cough, gag, oculocephalic, and biceps reflexes are all absent; EEG shows burst suppression pattern consistent with global cerebral dysfunction - can brain death be certified in this patient?
No - brain death testing can only be performed in the absence of confounding factors that can contribute to CNS depression (metabolic derangements, drug intoxication)
137
50 yo female presents with periodic involuntary closure of R eyelid; Closure is provoked with bright lights and cigarette smoke; Attempt to check pupillary reaction induces prolonged closure of R eye - diagnosis?
Blepharism
138
Blepharism is a type of ___ dystonia
Focal
139
What is best initial step of management for blepharism?
Botulinum toxin injections
140
Which part of brain is affected by Korsakoff encephalopathy?
Mammillary bodies
141
85 yo male presents for acute-onset L-sided weakness that began 1 hour ago; Reports that he was suddenly unable to use L hand or L leg; HR 120, otherwise VSS; PE reveals L sided facial droop, 3/5 strength in LUE and LLE; Non-contrast head CT is NML - what is best initial step in management?
Administer TPA
142
After acute-onset ischemic CVA, patient’s with new onset A-Fib (cardioembolic source) require long-term anticoagulation with ___, instead of ___
DOAC or wafarin; Antiplatelet (heparin)
143
46 yo male presents with difficulty smiling, chewing on R side; HX of cold sores; PE shows inability to raise R eyebrow - what is best step in management?
Administer prednisone
144
Initial step of workup for new-onset dementia?
Rivastigmine
145
MOA of Rivastigmine?
ACHE-inhibtor
146
3 types of ACHE-inhibtors?
Donepezil, rivastigmine, galatamine
147
In addition to ACHE-inhibtors, what is another drug that is beneficial in dementia patients?
Memantine
148
MOA of memantine?
NMDA receptor antagonist
149
25 yo female presents with L-sided facial weakness, involving her forehead (inability to raise L eyebrow); Delivered at 39 weeks gestation 5 days ago - diagnosis?
Bell palsy
150
Bell palsy represents neuropathy of which nerve?
CN 7
151
Prognosis for Bell palsy?
Excellent prognosis after high-dose steroids
152
Best management of Bell palsy?
High-dose steroids +/- acyclovir
153
12 year old male presents after hit in eye with tennis ball; PE shows R pupil that is normal in shape, but with layering blood in anterior chamber, coving more than 1/2 the R pupil - diagnosis?
Traumatic hyphemia
154
12 year old male presents after hit in eye with tennis ball; PE shows T pupil that is normal in shape, but with layering blood in anterior chamber, coving more than 1/2 the R pupil - what is next step?
Admit for bed rest and monitoring of IOP
155
___ refers to blood in anterior chamber of eye
Hyphemia
156
Etiology of hyphemia?
Acute increase in IOP, leading to blood vessel rupture
157
Complication of hyphemia?
Rebleeding, Intra-ocular HTN
158
86 yo female is evaluated for behavioral changes; HX of Alzheimer dementia; Staff at nursing home report auditory hallucinations; PE shows presence of grasp reflex - which finding necessitates urgent evaluation for possible delirium?
Sudden changes in consciousness
159
62 yo male presents with urinary retention; Moving furniture 2 days ago, experienced sharp, shooting pain in lower back + R leg; PE shows (+) SLE, perianal sensation decreased - diagnosis?
Cauda equina syndrome
160
Cauda equina is composed of …
L2-L5, S1-S5, coccygeal nerve
161
Most common etiology of Cauda equina syndrome?
Lumbar disc herniation
162
Saddle anesthesia in Cauda equina syndrome reflects involvement of __ nerves
S2-S4
163
Bowel/bladder in Cauda equina syndrome reflects involvement of __ nerves
S3-S5
164
Absence of ankle reflex in Cauda equina syndrome reflects involvement of __ nerves
S1-S2
165
7 reflexes that are typically absent in brain death?
Pupillary, oculocephalic, corneal, gag, sucking, swallowing, extensor posturing
166
9 yo male presents with fever, HA, confusion, sore throat, rhinorrhea, NV; 4 yo sister had a febrile illness with mouth sores last week; PE shows T 103.1, hypotension, tachycardia; Neck flexion elicits knee flexion - diagnosis?
Viral meningoencephalitis
167
Most common cause of viral meningoencephalitis in children?
Coxsackie, HSV, Arbovirus
168
What is best initial management for patient with suspected Viral meningoencephalitis?
Empiric acyclovir + Empiric ceftriaxone/vancomycin
169
What is best treatment for viral meningoencephalitis once HSV encephalitis and bacterial meningitis have been excluded?
Supportive care
170
Diagnostic tool that is necessary for diagnosis of Viral meningoencephalitis?
LP
171
Diagnostic test for absence seizure?
EEG showing 3 Hz spike
172
3 comorbidities associated with absence seizure?
ADHD, Anxiety, Depression
173
Prognosis for absence seizure?
Spontaneously remitted by early puberty without long-term sequela on Ethosuximate
174
Clinical presentation of an intracerebral mycotic aneurysm?
Present as an expanding mass with FNDs or aneurysmal rupture (SAH)
175
Mycotic aneurysms occur in the setting of …
Infective endocarditis
176
When should anticoagulants or anti-platelet therapy be administered to a patient who has received TPA?
24+ hours after TPA
177
Goal BP for patients who have received TPA?
< 180/105
178
What is the most feared complication of TPA treatment?
Intracerebral hemorrhage
179
2 additional complications of TPA treatment?
Systemic bleeding, Bradykinin-mediated angioedema
180
2 anti-hypertensives that can be used in BP management for patients who just received TPA?
Nicardipine, Labetolol
181
Classic triad of clinical presentation for NPH?
Wet, wacky, wobbly – urinary incontinence, dementia, gait instability
182
79 yo male presents with normal pressure hydrocephalus; What is the best initial management for NPH?
Remove 30-50 mL of CSF via LP
183
If patient experiences symptomatic improvement after removal of CSF in NPH – what is the next best step of management?
Ventriculoperitonal (VP) shunt placement
184
3 essential features of Parkinson’s disease?
Bradykinesia, tremor, rigidity
185
What is the most accurate tool that can be used to diagnose Parkinson’s disease?
Physical exam
186
Which imaging modality can be used to diagnose Parkinson’s disease?
Striatal dopamine transporter scan
187
How would you describe the striatal dopamine transporter scan?
Nuclear medicine scan that shows low update of iodine in the striatal region
188
What is the most effective medicine for controlling symptoms of Parkinson’s disease?
Levodopa
189
What is the preferred initial treatment for patients with Parkinson’s disease who are younger than 65 years old?
Pramipexole
190
Mechanism of action of pramipexole?
Dopamine agonist
191
What is an additional dopamine agonist used in the treatment of Parkinson’s sees?
Bromocriptine
192
Why are pramipexole and bromocriptine preferred in younger patients with Parkinson’s disease?
Concerns about the long-term efficacy of levodopa
193
Carpal tunnel syndrome is caused by compression of which nerve?
Median
194
Three actions that can reproduce symptoms of carpal tunnel syndrome?
Hyperflexion of risk, tapping over median nerve, and elevation overhead
195
Hyperflexion of wrists to induce carpal tunnel syndrome is referred to as …
Phelan test
196
Tapping over median nerve to induce symptoms of carpal tunnel syndrome is is referred to as …
Tinel sign
197
Initial treatment of carpal tunnel syndrome includes …
nighttime splinting
198
Which treatment is reserved for patients with carpal tunnel syndrome who have severe or chronic symptoms that fail conservative measures?
Surgical decompression
199
Classic triad of symptoms seen in Meniere’s disease?
TInnitus, Vertigo, Unilateral hearing loss
200
45 yo male presents for bilateral hand tremors, more pronounced when attempting to pick up objects; PE also shows a very subtle head tremor; Patient reports that his father developed similar symptoms in his 50-60s – diagnosis?
Familiar tremor
201
Prognosis for familial or Benign essential tremors?
Full life expectancy, without significant debility
202
Familiar tremor is a type of …
Benign essential tremor
203
Best management of Familiar tremor, or Benign essential tremor (that interferes with ADLs)?
Propranolol
204
Presbycusis is a type of ___ hearing loss
Sensorineural
205
Which supplements have been shown to help prevent dementia?
None – there is currently no conclusive evidence that any vitamins/dietary supplements are effective in preventing dementia
206
66 yo male presents with this Head CT – diagnosis? Image 1
Paget’s disease … (cortical thickening, mixed lytic/sclerotic lesions)
207
66 yo male presents with this Head CT – next best step of management? Image 1
Serum Ca2+ and Alkaline Phosphatase … (Ca2+ will be NML, ALP will be increased in Paget’s Disease); Radionucleotide bone scan
208
Prognosis of hearing loss in patients with Paget’s Disease?
Calcitonin + bisphosphonates can slow the progression of hearing loss, but will not reverse loss that has already occurred
209
Which cells are responsible for development of NF-2?
Schwann cells
210
62 yo female presents with forgetfulness, difficulty walking; PE shows decreased vibratory sensation, spastic paresis – diagnosis?
Subacute Combined Degeneration (SCD)
211
Subacute Combined Degeneration (SCD) results from deficiency in …
Vitamin B12
212
Vitamin B12 deficiency affects which part of the spinal cord?
Dorsal columns, Lateral pyramids
213
Defects in Dorsal columns in Vitamin B12 deficiency presents as …
Loss of vibration, proprioception, (+) Romberg sign
214
Defects in Lateral pyramids in Vitamin B12 deficiency presents as …
Spastic paresis, Hyperreflexia
215
Hematologic complication of Subacute Combined Degeneration (SCD)?
Ineffective erythropoiesis
216
Etiology of Ineffective erythropoiesis in Vitamin D deficiency?
Defective DNA synthesis with megaloblastic transformation bone marrow + intramedullary hemolysis
217
3 markers of hemolytic anemia?
Elevated LDH, Low haptoglobin, Indirect hyperbilirubinemia
218
How can you differentiate normal hemolytic anemia from hemolytic anemia due to Subacute Combined Degeneration (SCD)?
In SCD, you won’t see elevation in reticulocyte count (ineffective erythropoiesis)
219
3 conditions that should be ruled-out during workup of dementia?
Depression, B12 deficiency, hypothyroidism
220
69 yo female undergoes thyroidectomy for thyroid CA; 3 hours post-op, patient develops slurred speech and R-sided weakness; Speech is incomprehensible, strength 2/5 in RUE and RLE – what is next best step of management?
CT head non-contrast
221
Most post-operative CVAs are …
Ischemic
222
70 yo male with PMHx of smoking, COPD, DM, HTN, HLD, MI presents for episodes in which he experiences dizziness, nausea, difficulty speaking/walking, tingling in lips, double vision; PE shows loss of vibration, proprioception; Also impairment of pain, light touch, temperature in bilateral stocking glove distribution; Ankle reflexes are decreased – diagnosis?
Vertebrobasilar insufficiency
223
Clinical presentation of labyrinthitis?
Vertigo, tinnitus, N, loss of balance
224
Trigger event for development of labyrinthitis?
Viral illness (flu)
225
Clinical presentation of post-concussive syndrome?
HA, confusion, amnesia, difficulty concentrating, vertigo, light/noise hypersensitivity, mood alteration, anxiety, sleep disturbance
226
Prognosis for post-concussive syndrome?
Resolves spontaneously with symptomatic treatment … but symptoms may last up to 6 months
227
63 yo male presents with difficulty sleeping, AM headaches; Reports dysphagia, difficulty walking; PE shows LE muscle atrophy, tongue fasciulations, minimal crackles in RLL; FVC is 57% of expected while upright, FVC is 42% whie supine - diagnosis?
Diaphragmatic paralysis
228
LE muscle atrophy, tongue fasciulations represent ___ motor neuron deficits
Lower
229
Hallmark finding for diaphragmatic paralysis?
SOB that is worse in supine position … (similar to CHF)
230
Most common etiology of diaphragmatic paralysis?
Neurologic disease (ALS)
231
Diagnostic workup that should be pursued after clinical diagnosis of TIA?
Advanced brain imaging (MRI), neurovascular imaging (CTA head/neck), sources of emboli (ECHO, EKG)
232
Addtional treatment for TIA?
Anti-platelet agent
233
Why is TIA considered a neurologic emergency?
Signals an acutely-increased risk of CVA
234
What the risk of CVA in 48 hours after TIA?
5%
235
What the risk of CVA in 30 days after TIA?
12%
236
63 yo male presents with sharp, stabbing pain over R face, weakness in R hand; PE shows nystagmus, ptosis, diminished Gag reflex - where is patient’s brain lesion?
Lateral medulla
237
Alternate name for lateral medullary syndrome?
Wallenberg
238
4 aspects of clinical presentation for lateral medullary syndrome?
Nystagmus, decreased pain/temperature sensation over ipsilateral face, contralateral body weakness, ipsilateral Horner’s syndrome
239
65 yo male presents with severe HA over L frontal regio, transient vision loss in L eye; Lives in rural Connecticut, smokes 1 PPD; PE shows BP 152/96; Non-contrast head CT shows no bleed or mass effect - diagnosis?
Carotid artery dissection
240
65 yo male presents with severe HA over L frontal regio, transient vision loss in L eye; Lives in rural Connecticut, smokes 1 PPD; PE shows BP 152/96; Non-contrast head CT shows no bleed or mass effect - next best step?
CTA head/neck
241
2 aspects of clinical presentation that suggest Carotid artery dissection?
Horner’s syndrome + Unilateral HA
242
7 reflexes that are typically absent in brain death?
Pupillary, oculocephalic, corneal, gag, sucking, swallowing, extensor posturng
243
Definition of status epilepticus?
Single seizure lasting > 30 minutes … OR … multiple seizures occuring with no return to baseline
244
First step of management for status epilepticus?
Assess ABCs
245
When is abortive therapy for seizures recommended?
For seizure lasting > 5 minutes
246
Initial DOC for status epilepticus?
Benzodiazepine
247
Next DOC for status epilepticus?
Fosphenytoin
248
65-year-old male with Parkinson's disease (diagnosed 2 years ago) presents for decreased activity, impaired sleep, masklike facies, slowed movements. Currently takes levodopa/carbidopa; what is next step in pharmacologic management of this patient?
Add SSRI
249
To signs of depression that can be difficult to detect in patients with Parkinson's disease?
Blunted affect, psychomotor slowing
250
62-year-old male presents with headache, hearing loss on the left side, persistent tinnitus; history of small cell lung cancer, treated with CTX and XRT; contrast brain MRI shows circumscribed mass in left cerebellopontine angle, and small mass in left frontal cortex with significant edema surrounding lesion; diagnosis?
Metastasis
251
What is the most common cause of brain tumor?
Metastatic lesions
252
What are the 4 most common origin sites of brain metastasis?
Lung, breast, melanoma, colon
253
34-year-old female presents for amenorrhea; MRI demonstrates a 5 mm pituitary mass; labs demonstrate prolactin 500 -- diagnosis?
Prolactinoma
254
Complication of untreated prolactinoma?
Osteoporosis, infertility
255
27-year-old male presents with progressively worsening headaches for 3 months; now reports losing balance; PE reveals pupils that do not react to light bilaterally, impaired upward gaze, loss of optokinetic nystagmus; on tandem walking, patient falls on both sides -- diagnosis?
Pineal tumor
256
4 Hallmark aspects of clinical presentation seen in the setting of pineal tumor?
Vertical gaze paralysis, loss of pupillary reaction, loss of optokinetic nystagmus, ataxia
257
12-month-old female presents after an episode of tonic-clonic seizure, which lasted 7 minutes; T104; on exam, patient is difficult to arouse --which of the following is an indication for LP in this patient?
Neurologic exam with prolonged AMS
258
Duration of seizure in theatric patients that suggests need for LP?
>30 minutes
259
54-year-old male presents for episodes dizziness, which passes after approximately 1 minute; PE reveals positional nystagmus; diagnosis?
Benign paroxysmal positional vertigo
260
Past treatment for benign paroxysmal positional vertigo?
Perform canalith repositioning procedure
261
Some pineal tumors are able to secrete ...
hCG
