Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

UWorld > Neurology > Flashcards

Neurology Flashcards

1
Q

Restless Leg Syndrome (RLS) is often associated with …

A

Iron deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Best test to order in patient with newly-diagnosed RLS?

A

Ferritin level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Best treatment for patients with moderate-to-severe RLS?

A

Pramipexole, Ropinirole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MOA of Pramipexole, Ropinirole?

A

Dopamine agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2 alternate DOCs for patients with moderate-to-severe RLS?

A

Benzodiazepines, Gabapentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Next step of workup in patient with (+) clinical criteria suggesting brain death?

A

Neurologic examination to document absent cerebral + brainstem reflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Next step of workup for patients with (+) neurologic testing for brain death?

A

Apnea testing to confirm brainstem failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Next step of workup for patients with (–) neurologic testing for brain death, but still high clinical suspicion?

A

EEG, CT angiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Next step of workup for patient with suspected paradoxical embolism?

A

ECHO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

5 types of CA that commonly metastasize to spinal cord?

A

Breast, Non-Hodgkin lymphoma, Lung, Prostate, Renal CC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical presentation of epidural spinal cord compression?

A

Thoracic radicular pain that wraps around upper abdomen + weakness/numbness/tingling in LEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

2 aspects of treatment for suspected epidural spinal cord compression?

A

High-dose corticosteroids, MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Best treatment of radiosensitive spinal cord tumors?

A

Radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Best treatment of radioresistant spinal cord tumors?

A

Neurosurgery consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

R-sided motor symptoms usually indicate a vascular lesion in the distribution of …

A

L MCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MCA is a branch of …

A

ICA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Best treatment for patients with symptomatic carotid artery disease, and high-grade (70-99%) stenosis?

A

Carotid endarterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Best treatment for patients with asymptomatic carotid artery disease, and low-grade (<70%) stenosis?

A

ASA + Statin + modification of HTN/DM/Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Inheritance pattern of frontotemporal dementia?

A

AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Best treatment for patients with vasovagal syncope?

A

Education + Reassurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Alternate name for vasovagal syncope?

A

Neurocardiogenic syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Specific education piece for patients with vasovagal syncope?

A

Physical counterpressure maneuvers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Patient is unable to copy simple line drawings … this is an example of ___ apraxia

A

Construction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Construction apraxia results from lesion in ___ lobe

A

Non-dominant parietal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Patient is unable to wear clothes … this is an example of ___ apraxia

A

Dressing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Dressing apraxia results from lesion in ___ lobe

A

Non-dominant parietal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

CVA associated with confusion results from lesion in ___ lobe

A

Non-dominant parietal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Patient is unable to perform simple math equations, recognize own fingers, differentiate R vs. L … diagnosis?

A

Gerstmann Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Gerstmann Syndrome results from lesion of …

A

Dominant parietal lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Clinical presentation for lesions of non-dominant temporal lobe?

A

Visual disorders; Impaired auditory perception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Clinical presentation for lesions of dominant temporal lobe?

A

Difficulty with language

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Patient with CVA presents with L-sided weakness, dysarthria; Symptoms began 7 hours ago – what is best initial management?

A

Bedside swallow evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Patient with CVA presents with L-sided weakness, dysarthria; Symptoms began 7 hours ago;

A

Bedside swallow evaluation is normal – what is best management?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Most common cause of early death in acute CVA patients?

A

PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Risk of DVT and PE is particularly high in CVA patients with …

A

Hemiparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Best DVT prophylaxis in patients with hemorrhagic CVA?

A

Pneumatic compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

4 clinical features that may be present in patient with Lewy Body Dementia?

A

Confusion, Visual hallucinations, Parkinsonism, REM sleep disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

4 drugs used to treat Lewy Body Dementia?

A

Melatonin, Antipsychotics, Cholinesterase inhibitors, Carbidopa-Levodopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

After initial presentation and management, patient with Lewy Body Dementia presents with worsening confusion, parkinsonism, and autonomic dysfunction – what is causing her symptoms?

A

Extreme sensitivity to Antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Best Antipsychotic to use in patient with Lewy Body Dementia?

A

2nd generation, low potency … Quetiapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Best next test in symptomatic infant with retinal hemorrhages on exam?

A

Head CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Value of head CT in symptomatic infant with retinal hemorrhages on exam?

A

Identify subdural hematomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Characteristic of subdural hematomas in setting of non-accidental head trauma?

A

Mixed-density pattern … due to varying stages of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Characteristic of subdural hematomas in setting of accidental head trauma?

A

Homogenous-density pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

3 categories for Glasgow Coma Scale (GCS)?

A

Ocular, Verbal, Motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Maximum Motor GCS score?

A

6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Maximum Verbal GCS score?

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Maximum Ocular GCS score?

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Intubation is recommended for GCS of …

A

< 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Cerebral palsy is a common complication of …

A

Prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

5 aspects of clinical presentation for cerebral palsy in infants?

A

Delayed disappearance of neonatal reflexes, hypertonia, hyperreflexia, sustained clonus, delayed motor milestones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Next step of work up for infant with suspected cerebral palsy?

A

Brain MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Purpose of Brain MRI in infant with suspected cerebral palsy?

A

Look for abnormal findings – periventricular leukomalacia, brain malformation, ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Clinical presentation of neurocardiogenic vasovagal episode?

A

Autonomic prodrome of nausea, pallor, diaphoresis, warmth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How can you distinguish neurocardiogenic vasovagal syncope from cardiogenic syncope (arrhythmia)?

A

Symptoms persist after episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

3 aspects of clinical presentation for SAH?

A

Sudden-onset HA, nausea, nuchal rigidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

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?

A

Posterior communicating artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Unique aspect of clinical presentation for Posterior Inferior Cerebellar Artery (PICA)?

A

Ataxia, Bulbar dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Meralgia paresthetica is caused by entrapment of which nerve?

A

Lateral femoral cutaneous nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Clinical presentation of Meralgia paresthetica?

A

Decreased sensation over anterolateral thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Which structure typically entraps the Lateral femoral cutaneous nerve in Meralgia paresthetica?

A

Inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Best management of Meralgia paresthetica?

A

Conservative treatment …reassurance, weight loss for obese patients, avoidance of tight-fitting clothing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Definition of brain death?

A

Irreversible absence of cerebral + brain stem function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

A (+) apnea test can confirm brain death by documenting an absent respiratory response off the ventilator for ___ minutes … with PaCO2 > 60, pH < 7.28

A

8-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What accounts for spontaneous twitching movements (especially in feet/toes) in patients with brain death?

A

Originate from peripheral nerves + spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Most significant risk factor for CVA?

A

HTN … (more significant than smoking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

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?

A

Measure serum carbamazepine levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Definition of of breakthrough seizure?

A

Seizure that has occurred despite previously successful anti-epileptic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Most common cause of breakthrough seizure?

A

Sub-therapeutic drug levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Most common cause of Sub-therapeutic drug levels in a patient with HX of epilepsy and recent psychologic stressors?

A

Medication non-adherence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Alternate name for idiopathic intracranial HTN?

A

Pseudotumor cerebri

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Epidemiology of Pseudotumor cerebri?

A

Overweight females of child-bearing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Primary physical exam finding for Pseudotumor cerebri?

A

Papilledema on ophthalmoscopic exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

In a patient with high clinical suspicion for SAH, what is next step of workup if CT scan is (-)?

A

LP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

LP finding that is diagnostic for SAH?

A

Xanthochromia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Inheritance pattern of Tuberous Sclerosis?

A

AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Clinical presentation of Tuberous Sclerosis?

A

Ash-leaf spots, seizure, cardiac rhabdomyomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

4 aspects of initial workup for Tuberous Sclerosis?

A

Cutaneous examination, Fundoscopy, Brain MRI, EEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Most common cause of death in Tuberous Sclerosis?

A

Neurologic impairment (seizure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Most common cause of excessive daytime sleepiness?

A

Insufficient sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Best diagnostic test for narcolepsy?

A

Polysomnography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Characteristic of narcolepsy on polysomnography?

A

Latency of REM sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Initial drug of choice for narcolepsy?

A

Modafinil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

___ refers to sudden episodes of muscle weakness triggered by intense emotion, seen in patients with narcolepsy

A

Cataplexy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Best management of cataplexy in patients with narcolepsy?

A

SSRI, SNRI, TCAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

2 drugs associated with Pseudotumor Cerebri (aka – idiopathic intracranial HTN)?

A

Isotretinoin, Minocycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

6 contraindications to TPA use in patients with ischemic CVA?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

After patients with ischemic CVA have been treated with TPA, what are 3 additional steps of workup?

A

MRA or CTA of carotids + intracranial vasculature; EKG; ECHO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Role of EKG in CVA workup?

A

ID arrhythmia or ischemia that may have lead to thrombus + embolus formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Role of ECHO in CVA workup?

A

Detect intracardiac thrombus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Earliest sign of phenytoin toxicity?

A

Nystagmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Best management of early nystagmus toxicity, as evidenced in patient with nystagmus?

A

Reduce dose of phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Clinical presentation of multiple sclerosis?

A

Neurological defects separated by space and time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Ocular manifestation of multiple sclerosis?

A

Optic neuritis … monocular vision loss, eye pain that worsens with EOM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Diagnostic test for Optic neuritis?

A

Hyperintense lesions on T2 MRI, periventricular white matter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

LP results associated with multiple sclerosis?

A

Oligoconal banding, Elevated IgG index

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Best management of acute exacerbations of MS?

A

Oral or IV corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

If a patient with acute MS exacerbation also presents with optic neuritis, what is best management?

A

IV steroids (not oral steroids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Why are oral steroids contraindicated in patients with MS acute exacerbation?

A

Oral steroids are associated with increased risk of recurrent optic neuritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Best management of acute MS exacerbation that is refractory to steroid treatment?

A

Plasmapheresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Best chronic management for MS?

A

IFN-B, Glatiramer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Role of IFN-B and Glutiramer therapy in chronic management of MS?

A

Decreasd frequency of relapses, Reduced incidence of brain lesions

106
Q

Complications of MS in pregnant patients?

A

Increase in assisted delivery

107
Q

How should acute MS exacerbations be treated in pregnant patients?

A

Short term IV steroids

108
Q

DOC for muscle spasticity in MS patients?

A

Baclofen, Tizanidine

109
Q

Which types of neurons are affected by ALS?

A

Both upper and lower motor neurons

110
Q

5 functions that are preserved in setting of ALS?

A

Sensory, bowel, bladder, ocular motility, cognitive function

111
Q

Medication that has been shown to prolong survival and delay the need for tracheostomy in ALS patients?

A

Riluzole

112
Q

MOA of Riluzole?

A

Glutamate inhibitor

113
Q

3 aspects of clinical presentation for increased intracranial pressure (ICP)?

A

NV, HA, Papilledema

114
Q

Etiology of papilledema in setting of elevated ICP?

A

Elevated ICP is transmitted to optic nerve

115
Q

First step of workup for patient with suspected elevated ICP (papilledema on exam)?

A

Brain MRI

116
Q

Description of Cerebral venous sinus thrombosis (CVST)?

A

Formation of blood clots within dural sinuses

117
Q

Epidemiology of Cerebral venous sinus thrombosis (CVST)?

A

Pregnancy

118
Q

Clinical presentation of Cerebral venous sinus thrombosis (CVST)?

A

Gradually-worsening HA + focal neurologic deficits

119
Q

Best management of Cerebral venous sinus thrombosis (CVST)?

A

LMW Heparin

120
Q

4 indications for CT scan after minor head trauma?

A

Coagulopathy, Intoxication, Age > 65 yo, Retrograde amnesia (30+ minutes)

121
Q

Best management of minor head trauma in child with hemophilia A?

A

Head CT, Factor VIII or IX replacement

122
Q

Greatest complication associated with carbamazepine?

A

Neutropenia … (via bone marrow suppression)

123
Q

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?

A

LP

124
Q

Role of LP in patient with severe HA and (-) Non-contrast CT?

A

Document xanthochromia in setting of negative Head CT

125
Q

24 yo female presents for 2 days of progressive leg weakness, paresthesia; Now has developed inability to void; URI occured 2 weeks ago - diagnosis?

A

Guillain-Barre Syndrome vs. Transverse Myelitis

126
Q

What is best next step of workup for patient with suspected Guillain-Barre Syndrome vs. Transverse Myelitis?

A

Spine MRI

127
Q

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?

A

Drug-induced Parkinsonism (due to anti-psychotics)

128
Q

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?

A

Discontinue anti-psychotics, recommend behavioral interventions

129
Q

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?

A

Neurosypihilis

130
Q

___ refers to sensory ataxia and lancinating pains felt in late neurosyphilis

A

Tabes dorsalis

131
Q

___ refers to pupils that constrict with accomodation, but not with light in late neurosyphilis

A

Argyll-Robertson pupils

132
Q

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?

A

Oral dopaminergic agonist

133
Q

2 examples of oral dopaminergic agonist used to treat prolactinomas?

A

Bromocriptine, Cabergoline

134
Q

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?

A

L hypoglossal nerve

135
Q

Distribution of pain in setting of Carpal Tunnel Syndrome?

A

Palmar farface of first 3 fingers

136
Q

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?

A

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
Q

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?

A

Blepharism

138
Q

Blepharism is a type of ___ dystonia

A

Focal

139
Q

What is best initial step of management for blepharism?

A

Botulinum toxin injections

140
Q

Which part of brain is affected by Korsakoff encephalopathy?

A

Mammillary bodies

141
Q

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?

A

Administer TPA

142
Q

After acute-onset ischemic CVA, patient’s with new onset A-Fib (cardioembolic source) require long-term anticoagulation with ___, instead of ___

A

DOAC or wafarin; Antiplatelet (heparin)

143
Q

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?

A

Administer prednisone

144
Q

Initial step of workup for new-onset dementia?

A

Rivastigmine

145
Q

MOA of Rivastigmine?

A

ACHE-inhibtor

146
Q

3 types of ACHE-inhibtors?

A

Donepezil, rivastigmine, galatamine

147
Q

In addition to ACHE-inhibtors, what is another drug that is beneficial in dementia patients?

A

Memantine

148
Q

MOA of memantine?

A

NMDA receptor antagonist

149
Q

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?

A

Bell palsy

150
Q

Bell palsy represents neuropathy of which nerve?

A

CN 7

151
Q

Prognosis for Bell palsy?

A

Excellent prognosis after high-dose steroids

152
Q

Best management of Bell palsy?

A

High-dose steroids +/- acyclovir

153
Q

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?

A

Traumatic hyphemia

154
Q

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?

A

Admit for bed rest and monitoring of IOP

155
Q

___ refers to blood in anterior chamber of eye

A

Hyphemia

156
Q

Etiology of hyphemia?

A

Acute increase in IOP, leading to blood vessel rupture

157
Q

Complication of hyphemia?

A

Rebleeding, Intra-ocular HTN

158
Q

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?

A

Sudden changes in consciousness

159
Q

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?

A

Cauda equina syndrome

160
Q

Cauda equina is composed of …

A

L2-L5, S1-S5, coccygeal nerve

161
Q

Most common etiology of Cauda equina syndrome?

A

Lumbar disc herniation

162
Q

Saddle anesthesia in Cauda equina syndrome reflects involvement of __ nerves

A

S2-S4

163
Q

Bowel/bladder in Cauda equina syndrome reflects involvement of __ nerves

A

S3-S5

164
Q

Absence of ankle reflex in Cauda equina syndrome reflects involvement of __ nerves

A

S1-S2

165
Q

7 reflexes that are typically absent in brain death?

A

Pupillary, oculocephalic, corneal, gag, sucking, swallowing, extensor posturing

166
Q

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?

A

Viral meningoencephalitis

167
Q

Most common cause of viral meningoencephalitis in children?

A

Coxsackie, HSV, Arbovirus

168
Q

What is best initial management for patient with suspected Viral meningoencephalitis?

A

Empiric acyclovir + Empiric ceftriaxone/vancomycin

169
Q

What is best treatment for viral meningoencephalitis once HSV encephalitis and bacterial meningitis have been excluded?

A

Supportive care

170
Q

Diagnostic tool that is necessary for diagnosis of Viral meningoencephalitis?

A

LP

171
Q

Diagnostic test for absence seizure?

A

EEG showing 3 Hz spike

172
Q

3 comorbidities associated with absence seizure?

A

ADHD, Anxiety, Depression

173
Q

Prognosis for absence seizure?

A

Spontaneously remitted by early puberty without long-term sequela on Ethosuximate

174
Q

Clinical presentation of an intracerebral mycotic aneurysm?

A

Present as an expanding mass with FNDs or aneurysmal rupture (SAH)

175
Q

Mycotic aneurysms occur in the setting of …

A

Infective endocarditis

176
Q

When should anticoagulants or anti-platelet therapy be administered to a patient who has received TPA?

A

24+ hours after TPA

177
Q

Goal BP for patients who have received TPA?

A

< 180/105

178
Q

What is the most feared complication of TPA treatment?

A

Intracerebral hemorrhage

179
Q

2 additional complications of TPA treatment?

A

Systemic bleeding, Bradykinin-mediated angioedema

180
Q

2 anti-hypertensives that can be used in BP management for patients who just received TPA?

A

Nicardipine, Labetolol

181
Q

Classic triad of clinical presentation for NPH?

A

Wet, wacky, wobbly – urinary incontinence, dementia, gait instability

182
Q

79 yo male presents with normal pressure hydrocephalus; What is the best initial management for NPH?

A

Remove 30-50 mL of CSF via LP

183
Q

If patient experiences symptomatic improvement after removal of CSF in NPH – what is the next best step of management?

A

Ventriculoperitonal (VP) shunt placement

184
Q

3 essential features of Parkinson’s disease?

A

Bradykinesia, tremor, rigidity

185
Q

What is the most accurate tool that can be used to diagnose Parkinson’s disease?

A

Physical exam

186
Q

Which imaging modality can be used to diagnose Parkinson’s disease?

A

Striatal dopamine transporter scan

187
Q

How would you describe the striatal dopamine transporter scan?

A

Nuclear medicine scan that shows low update of iodine in the striatal region

188
Q

What is the most effective medicine for controlling symptoms of Parkinson’s disease?

A

Levodopa

189
Q

What is the preferred initial treatment for patients with Parkinson’s disease who are younger than 65 years old?

A

Pramipexole

190
Q

Mechanism of action of pramipexole?

A

Dopamine agonist

191
Q

What is an additional dopamine agonist used in the treatment of Parkinson’s sees?

A

Bromocriptine

192
Q

Why are pramipexole and bromocriptine preferred in younger patients with Parkinson’s disease?

A

Concerns about the long-term efficacy of levodopa

193
Q

Carpal tunnel syndrome is caused by compression of which nerve?

A

Median

194
Q

Three actions that can reproduce symptoms of carpal tunnel syndrome?

A

Hyperflexion of risk, tapping over median nerve, and elevation overhead

195
Q

Hyperflexion of wrists to induce carpal tunnel syndrome is referred to as …

A

Phelan test

196
Q

Tapping over median nerve to induce symptoms of carpal tunnel syndrome is is referred to as …

A

Tinel sign

197
Q

Initial treatment of carpal tunnel syndrome includes …

A

nighttime splinting

198
Q

Which treatment is reserved for patients with carpal tunnel syndrome who have severe or chronic symptoms that fail conservative measures?

A

Surgical decompression

199
Q

Classic triad of symptoms seen in Meniere’s disease?

A

TInnitus, Vertigo, Unilateral hearing loss

200
Q

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?

A

Familiar tremor

201
Q

Prognosis for familial or Benign essential tremors?

A

Full life expectancy, without significant debility

202
Q

Familiar tremor is a type of …

A

Benign essential tremor

203
Q

Best management of Familiar tremor, or Benign essential tremor (that interferes with ADLs)?

A

Propranolol

204
Q

Presbycusis is a type of ___ hearing loss

A

Sensorineural

205
Q

Which supplements have been shown to help prevent dementia?

A

None – there is currently no conclusive evidence that any vitamins/dietary supplements are effective in preventing dementia

206
Q

66 yo male presents with this Head CT – diagnosis? Image 1

A

Paget’s disease … (cortical thickening, mixed lytic/sclerotic lesions)

207
Q

66 yo male presents with this Head CT – next best step of management? Image 1

A

Serum Ca2+ and Alkaline Phosphatase … (Ca2+ will be NML, ALP will be increased in Paget’s Disease); Radionucleotide bone scan

208
Q

Prognosis of hearing loss in patients with Paget’s Disease?

A

Calcitonin + bisphosphonates can slow the progression of hearing loss, but will not reverse loss that has already occurred

209
Q

Which cells are responsible for development of NF-2?

A

Schwann cells

210
Q

62 yo female presents with forgetfulness, difficulty walking; PE shows decreased vibratory sensation, spastic paresis – diagnosis?

A

Subacute Combined Degeneration (SCD)

211
Q

Subacute Combined Degeneration (SCD) results from deficiency in …

A

Vitamin B12

212
Q

Vitamin B12 deficiency affects which part of the spinal cord?

A

Dorsal columns, Lateral pyramids

213
Q

Defects in Dorsal columns in Vitamin B12 deficiency presents as …

A

Loss of vibration, proprioception, (+) Romberg sign

214
Q

Defects in Lateral pyramids in Vitamin B12 deficiency presents as …

A

Spastic paresis, Hyperreflexia

215
Q

Hematologic complication of Subacute Combined Degeneration (SCD)?

A

Ineffective erythropoiesis

216
Q

Etiology of Ineffective erythropoiesis in Vitamin D deficiency?

A

Defective DNA synthesis with megaloblastic transformation bone marrow + intramedullary hemolysis

217
Q

3 markers of hemolytic anemia?

A

Elevated LDH, Low haptoglobin, Indirect hyperbilirubinemia

218
Q

How can you differentiate normal hemolytic anemia from hemolytic anemia due to Subacute Combined Degeneration (SCD)?

A

In SCD, you won’t see elevation in reticulocyte count (ineffective erythropoiesis)

219
Q

3 conditions that should be ruled-out during workup of dementia?

A

Depression, B12 deficiency, hypothyroidism

220
Q

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?

A

CT head non-contrast

221
Q

Most post-operative CVAs are …

A

Ischemic

222
Q

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?

A

Vertebrobasilar insufficiency

223
Q

Clinical presentation of labyrinthitis?

A

Vertigo, tinnitus, N, loss of balance

224
Q

Trigger event for development of labyrinthitis?

A

Viral illness (flu)

225
Q

Clinical presentation of post-concussive syndrome?

A

HA, confusion, amnesia, difficulty concentrating, vertigo, light/noise hypersensitivity, mood alteration, anxiety, sleep disturbance

226
Q

Prognosis for post-concussive syndrome?

A

Resolves spontaneously with symptomatic treatment … but symptoms may last up to 6 months

227
Q

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?

A

Diaphragmatic paralysis

228
Q

LE muscle atrophy, tongue fasciulations represent ___ motor neuron deficits

A

Lower

229
Q

Hallmark finding for diaphragmatic paralysis?

A

SOB that is worse in supine position … (similar to CHF)

230
Q

Most common etiology of diaphragmatic paralysis?

A

Neurologic disease (ALS)

231
Q

Diagnostic workup that should be pursued after clinical diagnosis of TIA?

A

Advanced brain imaging (MRI), neurovascular imaging (CTA head/neck), sources of emboli (ECHO, EKG)

232
Q

Addtional treatment for TIA?

A

Anti-platelet agent

233
Q

Why is TIA considered a neurologic emergency?

A

Signals an acutely-increased risk of CVA

234
Q

What the risk of CVA in 48 hours after TIA?

A

5%

235
Q

What the risk of CVA in 30 days after TIA?

A

12%

236
Q

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?

A

Lateral medulla

237
Q

Alternate name for lateral medullary syndrome?

A

Wallenberg

238
Q

4 aspects of clinical presentation for lateral medullary syndrome?

A

Nystagmus, decreased pain/temperature sensation over ipsilateral face, contralateral body weakness, ipsilateral Horner’s syndrome

239
Q

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?

A

Carotid artery dissection

240
Q

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?

A

CTA head/neck

241
Q

2 aspects of clinical presentation that suggest Carotid artery dissection?

A

Horner’s syndrome + Unilateral HA

242
Q

7 reflexes that are typically absent in brain death?

A

Pupillary, oculocephalic, corneal, gag, sucking, swallowing, extensor posturng

243
Q

Definition of status epilepticus?

A

Single seizure lasting > 30 minutes … OR … multiple seizures occuring with no return to baseline

244
Q

First step of management for status epilepticus?

A

Assess ABCs

245
Q

When is abortive therapy for seizures recommended?

A

For seizure lasting > 5 minutes

246
Q

Initial DOC for status epilepticus?

A

Benzodiazepine

247
Q

Next DOC for status epilepticus?

A

Fosphenytoin

248
Q

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?

A

Add SSRI

249
Q

To signs of depression that can be difficult to detect in patients with Parkinson’s disease?

A

Blunted affect, psychomotor slowing

250
Q

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?

A

Metastasis

251
Q

What is the most common cause of brain tumor?

A

Metastatic lesions

252
Q

What are the 4 most common origin sites of brain metastasis?

A

Lung, breast, melanoma, colon

253
Q

34-year-old female presents for amenorrhea; MRI demonstrates a 5 mm pituitary mass; labs demonstrate prolactin 500 – diagnosis?

A

Prolactinoma

254
Q

Complication of untreated prolactinoma?

A

Osteoporosis, infertility

255
Q

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?

A

Pineal tumor

256
Q

4 Hallmark aspects of clinical presentation seen in the setting of pineal tumor?

A

Vertical gaze paralysis, loss of pupillary reaction, loss of optokinetic nystagmus, ataxia

257
Q

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?

A

Neurologic exam with prolonged AMS

258
Q

Duration of seizure in theatric patients that suggests need for LP?

A

> 30 minutes

259
Q

54-year-old male presents for episodes dizziness, which passes after approximately 1 minute; PE reveals positional nystagmus; diagnosis?

A

Benign paroxysmal positional vertigo

260
Q

Past treatment for benign paroxysmal positional vertigo?

A

Perform canalith repositioning procedure

261
Q

Some pineal tumors are able to secrete …

A

hCG

UWorld (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions