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ABIM > Neurology 2 > Flashcards

Neurology 2 Flashcards

1
Q

Acute onset headache (Thunderclap), Altered Mental Status, Vision changes, Hallucinations, Seizures in the setting of Very High blood pressure (210/100) or chemotherapy.

MRI show Symmetrical Hyperintense T2/FLAIR signal abnormalities in white matter of posterior occipital-parietal lobes. Dx? Rx?

A

PRES (Posterior Reversal Encephalopathy Syndrome.)

(Hypertensive Emergency + Hallucinations)

Lower BP and start Anti-seizure therapy.

Most recover in 2 weeks.

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2
Q

Chronic unilateral throbbing head pain ( that occurs multiple times a day last for ONLY 2-30 minutes at at time) associated with lacrimation, miosis, conjunctival injection that IMPROVES WITH Indomethacin?

A

Paroxysmal Hemicrania

Cluster HA DOES NOT Improve with indomethacin AND can last from minutes to hours.

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3
Q

65 yo M presents with left arm weakness and slurred speech that improved after 2 hrs but worsened again. He has left homonymous hemianopsia, right forced gaze deviation, reduced sensation on left side of face, left lower facial paresis. Dx?

A

Atherothrombosis of Large Artery

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4
Q

Name that stroke:

  1. Athersclerotic risk factors (DM, HTN), local obstruction of artery.
    Symptoms Alternate with periods of improvement (stuttering progression)
    Dx?
  2. Hx of Cardiac disease (Afib, endocarditis), Symptoms are Abrupt.
    Multiple infarcts in Different Vascular Territories. Dx?
  3. Hx of Uncontrolled HTN, Coagulopathy, illicit drug use. Symptoms progress over minutes to hours. Focal neurologic symptoms then features of increased intracranial pressure.
A
  1. Ischemic (Thrombotic) Stroke
  2. Ischemic (Embolic) stroke
  3. Intracerebral hemorrhage
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5
Q

Pt presents with Severe Unilateral Lancinating pain in the Saddle region that radiates down the legs causing significant Weakness, Loss of Bowel, Bladder and Sphincter control. Dx?

A

Cauda Equina Syndrome

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6
Q

Abrupt onset (minutes to hours) of back pain, weakness, loss of sensation and reflexes and autonomic dysfunction. Dx?

A

Spinal Cord Infarction

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7
Q

Young patient after a Viral Infection presents Progressive Leg Weakness and Difficulty Walking. Also reports problems with Urination. There is evidence of Flaccid, Areflexia, Absent Banbinski sign. MRI shows enhancing cord segments with Surrounding Edema.

A

Transverse Myelitis

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8
Q

Anorexic Woman (BMI 17) comes in the ED with syncope, weakness, hypokalemia, hypoglycemia . She is given IV dextrose then suddenly develops double vision, lethargy and lateral gaze palsy on the right side. Dx? How to prevent this?

A

Wernicke Encephalopathy. (Seen in Chronic alcoholism and Chronic malnutrition)
Give thiamine before OR with dextrose. Dextrose alone depletes remaining stores of thiamine.

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9
Q

Testing to confirm Brain Death?

A

Bedside Apnea Testing

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10
Q

Vertigo that is associated with FATIAGABLE Nystagmus. Usually a latent period. NO issues with Gait. Hearing loss may be associated. Dx?

A

Peripheral Vertigo. (BPPV, Meniere disease, Vestibular Neuritis)

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11
Q

Vertigo that is associated with Gait disturbance. Nystagmus occurs in any direction with NO latency period. Usually associated with other neurological signs.

Dx?
Next step in management?

A

Central Vertigo

MRI to r/o Acute Stroke

Can be MS or CNS tumor as well

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12
Q

Pt is s/p MVA develops Acute onset HA pain that radiates to left side of neck. Pt has loss of speech, Right sided weakness and right homonymous hemianopsia and left pupillary miosis and partial ptosis with left gaze preference.

Dx?
Test?

A

Carotid Artery Dissection

Associated with Ipsilateral Horner syndrome.

CT Angiography

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13
Q

Treatment for Serotonin Syndrome.

A

IV Lorazepam (Benzodiazepine)

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14
Q

A Pt presents with right thigh numbness that started a few weeks prior to delivering her child. Reports decreased sensation and temperature sensation.

Symptoms resolved after delivery of her child. Dx? Rx?

A

Meralgia Paresthetica

Reassurance. (Occurs due to compression at the waist)

Seen in obese patients. Tight clothes also culprit. Seat Belt.

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15
Q

Pt with hx of Stroke and Seizure presents with Fever, Malaise, Lymphadenopathy and Erythematous Papules and Pustules diffuse throughout skin.

Pt recently started on Phenytoin. Dx? Rx?

A

Anticonvulsant Hypersensitivity Syndrome.

Stop phenytoin, Steroids and Supportive Care

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16
Q

Name the nerve injury:

  1. Pt presents with Burning pain of the foot and heel, Paresthesias and Sensory loss in the sole. Dx?
  2. Pt presents with Steppage gait, / Foot drop. Paraesthesia and sensory loss in the Dorsum of the foot and lateral shin.
    Dx?
A
  1. Tarsal Tunnel Nerve Injury
  2. Common Peroneal Nerve compression near the Fibular Head from prolonged immobilization, leg crossing, squatting, casting
17
Q

Pt presents with Fatigue, Diplopia, Dyspha
gia and a Anterior Mediastinal Mass on chest CT. Dx?

A

Thymoma with MG.

Thymectomy is recommended for patients < 60

18
Q

Many with hx of PD reports very painful involuntary contractions affecting his toes and feet. Reports contractions occur in AM and awake him from Sleep. He is on Immediate Release Carbidopa/Levodopa. Management?

A

Switch to Long acting Carbidopa/Levodopa

19
Q

32 yo F presents with Migraine in ED. She is treated with IV Metochlopramide. One hour later she develops Neck pain with sustained contractions of the Posterior neck muscles and associated neck extension.
Dx?
Rx?

A

Acute Dystonia due to Metochlopramide ( D2 Receptor Antagonist- Parkinsonism) side effect.

Give Diphenhydramine or Benztropine ( Anti-cholingergics)

20
Q

Tremor that increases in intensity as it gets closer to target (intention tremor) Dx?

A

Cerebellar Stroke

21
Q

Name all the Test that Need to be completed for Eval of Peripheral Neuropathy?

A
  1. B12
  2. A1c
  3. TSH
  4. RPR
  5. ANA
  6. ESR
22
Q

Next step in Management before starting Natalizumab?

A

Check for JC virus antibody. If positive Start Fingolimod.

23
Q

What medications are best for Idiopathic Parkinsons Disease In MILD to MODERATE Disease for Patients Age < 65 ?

A

Dopamine Agonist (Bromocriptine, Pramipexole, Ropinirole)

24
Q

Pt With Cognitive Decline, Visual Hallucinations and REM Sleep Behavior With fighting and yelling during sleep? Dx? Rx?

A

Dementia with Lewy Bodies.

Donepzil- cognition
Quetiapine- Psychosis
Melatonin- Sleep
Carbidopa/Levodopa - Parkinsons symptoms

25
Q

Common Drugs associated with Drug Induced Parkinsonism?

What are alternative medications to avoid this?

A

D2 recepter Antagonist
Haloperidol, Risperidone and Metoclopramide.

Better to switch to a low risk Agent: Quetiapine, Clozapine.

26
Q

Presents with Painful, Asymmetrical, Sensory and Motor Peripheral Neuropathy. It affects 2 or more nerves in Different parts of the body. Associated with Vasculitis, Connective tissue disease or DM2. Dx?

A

Mononeuritis Multiplex

27
Q

Presents with back pain that radiates down the lateral surface of the leg into the foot. Dx?

A

L5 Radiculopathy

28
Q

Elderly patient presents with Altered Mental Status, Fever, Seizure. Next step in management?

A

IV Acyclovir, Ampicillin, Vancomycin, Cefepime.

29
Q

An inflammatory demyelinating condition. Pt presents with Acute Monocular Vision Loss over a period of Hours to Days.
Associated with:
EYE PAIN
Central Scotoma
Loss of Color Vision out of Proportion to loss of Visual Acuity.

On eye exam there is Afferent Pupillary Defect, Hyperemeia/Swelling of the Optic Disc and Blurring of the disk margins with Distended Veins.

Dx? Rx?

A

Optic Neuritis
- Pt has 50% chance of developing MS

Rx: IV Methylprednisolone

30
Q

Management of RLS?

A
  1. Check Iron and Ferritin (< 75)
  2. Exercise, Leg Massage, Warm/Cold Compress
  3. If No improvement then Gabapentin, Pregabalin
31
Q

Migraine Medications that are safe to use in pregnancy.

A

Acetaminophen, Metoclopramide, Codeine, Fiorcet or Propanolol

32
Q

Management of Myasthenia Gravis Crisis?

What to do when patient is ventilated?

What to avoid initially?

What is disease is commonly associated with MG?

A

Plasma exchange and IVIG and then Steroids.

Stop Pyridostigmine (Anti-cholinesterase inhibitors) while Ventilated to minimize Secretions and Aspiration risk

Add Steroids After Plasma Exchange to PREVENT worsening of crisis. TAKES ABOUT 3 WEEKS TO WORK. Peak is 5 months.

Thymoma (Mediastinal mass order Chest CT)
Thyroid disease (Check TSH)

33
Q

Pt with a Hx of Diabetes presents with Acute Asymmetric Lower Extremity Pain + Weakness, Muscle atrophy, Areflexia and Autonomic Dysfunction as well as Weight-loss. Dx?

A

Diabetic Amyotrophy

34
Q

This happens over 8 weeks with No Anticedent Illness. Pt presents with Progressive Muscle weakness, Distal sensory loss (numbness) and diminished reflexes.

A

Chronic Inflammatory Demeylinating Polyradiculopathy

CIDP- Like GBS but no infection

35
Q

What labs should be checked with a patient on Valproic Acid presenting with Encephalopathy?

A

Serum Ammonia levels

36
Q
  1. HIV patient with Single or Multiple Ring Enhancing lesions w/ mass affect & Edema on Brain MRI with CD4> 100
  2. HIV patient presents with Progressive Dementia.
    CT W/WO contrast shows Brain Atrophy ?
A
  1. Brain Abscess (Caused by Endocarditis, Dental, Ear, Sinus infection)
  2. HIV-Associated Encephalopathy

ABIM (45 decks)

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