Brainscape's Knowledge GenomeTM

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


See full index

MCCQE1 > Neurology > Flashcards

Neurology Flashcards

1
Q

Patient comes to the ER with a focal neurological deficit in the right leg/foot. Which artery is blocked?

A

Left anterior cerebral atery

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

Patient comes to the ER with a focal neurological deficit in the left face, left arm and afasia. Which artery is blocked?

A

Right middle cerebral atery

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

Patient comes to the ER with stroke a focal neurological deficit (right blindness). Which artery is blocked?

A

Left posterior cerebral atery

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

Patient who had a stroke and has locked-in syndrome. Which arteries is blocked?

A

Basilar and pons

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

Patient has a syncope comes to the ER with stroke a focal neurological deficit (ataxia). Which artery is blocked?

A

Vertebral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Young woman, pain in the neck after trauma and focal neurological deficit. Etiology of stroke?

A

Carotid dissection

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

Patient with Thunderclap headache “worst headache of my life”. On physical has bradycardia, HTN, apnea. Dx?

A

Hemorrhagic stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DM patient comes to the ER with a focal neurological deficit in the left face, left arm and aphasia. Sx started < 3 hrs. Non-hemorrhagic stroke on CT. Next steps?

A

o Imaging: ECG, Echocardiogram, carotid U/S
o Meds: tPA, ASA 325, high-potency statin
o Vitals: permissive HTN
o Labs: HgA1C, TSH, lipid panel, comprehensive metabolic panel (CMP), CBC
o Ancillary: speech therapy, occupational therapy, physical therapy

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

Non-DM patient comes to the ER with a focal neurological deficit in the left face, left arm and aphasia. Sx started < 4.5 hrs. Non-hemorrhagic stroke on CT. Next steps?

A

o Imaging: ECG, Echocardiogram, carotid U/S
o Meds: tPA, ASA 325, high-potency statin
o Vitals: permissive HTN
o Labs: HgA1C, TSH, lipid panel, comprehensive metabolic panel (CMP), CBC
o Ancillary: speech therapy, occupational therapy, physical therapy

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

Patient comes to the ER with a focal neurological deficit in the left face, left arm and aphasia. The patient was ASx last night and was like that this morning. Non-hemorrhagic stroke on CT. Next steps?

A

o Imaging: ECG, Echocardiogram, carotid U/S
o Meds: ASA 325, high-potency statin (no tPA)
o Vitals: permissive HTN
o Labs: HgA1C, TSH, lipid panel, comprehensive metabolic panel (CMP), CBC
o Ancillary: speech therapy, occupational therapy, physical therapy

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

Indications of tPA in stroke?

A

Ischemic stroke < 3 hrs + DM
Ischemic stroke < 4.5 hrs + not DM

Contraindicated with ICH, Bleeding, recent surgery or trauma

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

Patient who had a stroke, allergic to ASA. How to prevent future stroke?

A

Copidogrel

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

Patient with Hx of stroke on ASA 81 mg who has a second stroke. How to prevent future stokes?

A

ASA 81 mg + Dipyridamole

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

Chronic management of stroke?

A

ASA 81 mg
Warfarin/NOAC if Afib with CHADS2 score 2+
High-potency statins
HTN control and DM management if needed

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

Patient wih Hx of epilepsy who comes to the ER with Lost of consciousness, Limb jerking, Bowel/bladder incontinence, tongue biting.

Next step?

A

Check level of antiepilpectic medications
Increase Drug dose
Add a Drug
Change Drug .

….VITAMINS?

  • Vascular
  • Infxn
  • Trauma
  • Autoimmune
  • Metabolic
  • Idiopathic/withdrawal
  • Neoplasm
  • Sychiatric
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Patient wihout Hx of epilepsy who comes to the ER with Lost of consciousness, Limb jerking, Bowel/bladder incontinence, tongue biting. He is currently in seizure, which lasts more than 5 minutes.

Dx, tx?

A

Status (medical emergency!)

Tx:

  1. IV Benzo
  2. Phenytoin
  3. Midazolam + Propofol
  4. Phenobarbital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Patient wihout Hx of epilepsy who comes to the ER with Lost of consciousness, Limb jerking, Bowel/bladder incontinence, tongue biting. He is not currently in seizure. The seizure lasted less than 5 minutes.

Next step?

A 
CT
EEG 
Look for cause (VITAMINS)
- Vascular
- Infxn
- Trauma
- Autoimmune
- Metabolic
- Idiopathic/withdrawal
- Neoplasm
- Sychiatric
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Secondary causes of seizure

A

VITAMINS

  • Vascular: stroke
  • Infxn: encephalitis, meningitis
  • Trauma: brain bleeds
  • Autoimmune: cerebritis (lupus), vasculitis
  • Metabolic: glucose, perfusion, oxygenation, Na, Ca
  • Idiopathic/withdrawal: BDZ, alcohol
  • Neoplasm
  • Sychiatric
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Definition of seizure status

A

seizure > 5 min; > 20 mins of post-ictal

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

First-line tx to prevent seizures

A

valproate, lamotrigine, levetiracetam

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

Child with recurrent episodes of loss of tone without LOC. Dx and tx?

A

Atonic epilepsy

Tx: Valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Boy with LOC without loss of tone. Dx and tx?

A

Absence

Tx: Ethosuximide

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

Tx of Myoclonic epilepsy?

A

Valproate

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

Patient with recurrent episodes of lancinating pain in face. Dx and tx?

A

Trigeminal neuralgia

Carbamazepine

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

Patient < 70 y-o functional patient with Bradykinesia, mask-like facies, trouble gatting started, Cogwheel rigidity, Resting pill-rolling tremor, Gait/postral instability (no postural correction–> falls).

Dx and tx?

A

Parkinson’s

Tx:

  • Levodopa + carbidopa
  • Dopamine agonists: ropinirole, pramipexole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Patient > 70 y-o non-functional patient with Bradykinesia, mask-like facies, trouble gatting started, Cogwheel rigidity, Resting pill-rolling tremor, Gait/postral instability (no postural correction–> falls).

Dx and tx?

A

Parkinson’s

Tx: Levodopa + carbidopa
• Carbidopa prevents conversion of levodopa in the periphery

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

Patient > 70 y-o non-functional patient with Parkinson’s. Is currently treated with Levodopa + carbidopa. Sx keep worsening.

Next step?

A

Add MAO-B-i: Selegeline, then COMT inhibitors: –capones

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

Young patient with mild Parkinson’s. Tx?

A

Ach antagonist: Benztropine

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

Middle-aged man Tremor with movement. No tremor at rest. The treamor doesn’t worsens when closer to the objective.
Dx and Tx?

A

Essential tremor

Tx: propranolol

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

Tremor with movement, no tremor at rest, worsens in amplitude the closer to the target. Dx and tx?

A

Intention tremor (Cereberal disfuntion caused by stroke or alcohol)

No tx :(

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

Purposeless ballistic uncontrolled movements.

What’s the path of Core of Huntington’s?

A
  • Autosomal dominant genetic disease
  • Caused by trinucleotide repeats (the more repeats, the younger the disease starts)
  • Anticipation: occurring earlier in subsequent generations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Red flags headache?

A 
o	Fever
o	Focal neurological deficit
o	New onset headache in a > 50 patient
o	Thunderclap headache
o	Progressive nausea and vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Patient with a headache that described bilateral vice-like pain that radiates from the front to the back/neck.

Dx and tx?

A

Tension headache

NSAIDs, acetaminophen

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

Patient who takes chronic analgesics (opiates, ergots, triptans, OTC, taken 2-3 times/week) who suffers from frequent headaches (10x/month).

Dx and tx?

A

Analgesic rebound

Withdraw offending medications despite initial worsening of sx

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

Patient with who was ASx for months but then has many headache 8-10 times/day, Unilateral eye pain and autonomic symptoms: rhinorrhea, lacrimation, conjunctival injection, Horner’s (facial anhidrosis, ptosis, myosis).

Dx and tx?

A

Cluster headache

Acute attack:
• 1st: Oxygen
• 2nd: SC Sumatriptan
Ppx: CCB like verapamile

F/U: Brain MRI

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

Patient with Unilateral pulsatile headache, Photophobia/phonophobia, Nausea/vomiting, Trigger (nitrites, caffeine, chocolate, menstrual cycle, stress, etc), Sleep may abort it, but hangover the next day.

Dx and tx?

A

Migraine

Tx:
Acute
• Mild: NSAIDs
• Severe or refractory: triptans, ergot (careful if CAD)
Ppx: propranolol, valproic acid, topiramate

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

Woman on oral contraceptive pill, consults with headache, Nausea/vomiting, and Focal neurological deficit. On physical she has Papilledema

Negative CT

Dx, next step and tx?

A

Idiopathic intracranial hypertension/pseudotumor cerebi (secondary headache)

Next step: Lumbar puncture with pressure opening > 25 H2O cm

Tx: Acetazolamide
- If refractory: serial lumbar puncture or ventricularperitoneal shunt

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

Idiopathic intracranial hypertension/pseudotumor cerebi is associated with?

A

OCPs (oral contraceptive pill)
Vitamin A
Isotretinoin
Glucocorticoid withdrawal.

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

lancinating pain of the face.

Dx, tx and F/U?

A

Trigeminal neuralgia

Tx: carbamazepine
F/U: MRI to r/o compressions

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

Alarm sx in back pain, next steps and tx?

A

Alarm sx
o Bladder/bowel incontinence
o Saddle anesthesia: restricted to the area of the buttocks, perineum and inner surfaces of the thighs
o New/rapidly progressive focal neurological deficit
o History of cancer
o Sexual dysfunction
o Fever

Next steps:

  1. Dexamethasone
  2. X Ray/MRI

Tx:

  • Drain hematoma
  • Incision and drainage
  • Abx for abscess
  • Radiation for cancer
  • Surgery for facture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Male, young, heavy lifting with a belt-like back pain. Dx, tx?

A

Musculoskeletal pain

Tx: Exercise and NSAIDs

F/U: Reasses in 4-6 month. If tx fails–> X Ray, MRI

42
Q

30-50-y-o male doing heavy lifting, back pain, lightning or shooting pain down the leg. On physical: (+) Straight leg raise test. Dx, next step and tx?

A

Disk herniation

Next step:
• X Ray
• MRI

Tx: NeuroSurgery vs conservative tx depending on severity and lifestyle of patient

43
Q

Old male, back pain, no heavy lifting, lightning or shooting pain down the leg. On physical: (+) Straight leg raise test. Dx, next step and tx?

A

Osteophyte

Next step:
• X ray
• MRI

Tx: Surgery

44
Q

Old woman, back pain, she had fell on coccyx. On physical: Vertebral step off and Point tenderness. Dx, next step and tx?

A

Compression fracture

Next step:
• X Ray
• MRI

Tx: Surgery
F/U: Dexa scan and treat osteoporosis

45
Q

Old patient, with leg and butt pain when upright and with exercise. No sx when hunched over. Dx, next step and tx?

A

Spinal stenosis

Next step:
• X Ray
• MRI

Tx: Laminectomy

46
Q

Patient with Chronic, Insidious, and Permanent Cognitive impairment and Memory loss. Next step?

A

R/O reversible cause. Order:

  • TSH, T4
  • BMP
  • Vit B12
  • LFTs
  • RPR
  • Depression
  • CT
  • MRI(?)
47
Q

Alzheimer associated with what genetic disease?

A

Down syndrome

48
Q

Patient with Memory loss (first short term, then long term). Social graces are normal.

CT: diffuse cortical atrophy

Dx and tx?

A

Alzheimer’s disease

Tx: Supportive care and family education
• Mild AD = ACh-Esterase-i (Donepezil, Rivastigmine, Galantamine)
• Severe AD = Memantine

49
Q

Old patient, normal before, the family has noted progressively that he has no filter, is violent and hypersexual. No memory loss yet.

• CT: frontotemporal degeneration

Dx?

A

Pick’s disease

50
Q

Patient with Bradykinesia: mask-like facies, trouble gatting started, Cogwheel rigidity, Resting pill-rolling tremor, who in addition has memory loss and visual hallucinations.

MRI: loss of substantia nigra

Dx?

A

Lewy-body’s dementia

51
Q

Patient who has had a few strokes. The family has noted stepwise functional decline with each stroke.

• CT: many brain infracts

Dx?

A

Vascular dementia

52
Q

Young with dementia, rapid funcitonal decline and myoclonus.

Dx and next step?

A

Creutzfeldt-Jakob Disease (CJD)

Next step:

  • MRI
  • Palliative care
53
Q

Patient with Urinary incontinence, Gate ataxia, and Dementia.

CT with hydrocephalous

Dx and tx?

A

Normal Pressure Hydrocephalus

Tx:

  • LP improves condition
  • VP shunt
54
Q

Patient with dizziness, no tinnitus, no hearing loss. On physical exam cerebellar signs. Next step?

A

MRI (MS, stroke, tumor, abscess, migraines, seizures)

55
Q

Patient with recurrent vertigo that lasts < 1 min and is reproducible with movement. Dx, next step and tx?

A

Benign paroxysmal positional vertigo

Next step: Dix Hallpike

Tx: Epley maneuver

56
Q

Patient with vertigo that lasts 1-10 min, + hearing loss, Nausea/vomiting. 4 weeks ago the patient had an upper respiratory infection (URI).

Dx and tx?

A

Labyrinthitis/vestibular neuritis

Tx:
• Steroids
• Anti-vertigo meds like meclizine

57
Q

Patient with episodes that last between 30-60 min of Hearing loss, Tinnitus and Vertigo without movement.

Dx and tx?

A

Menière’s Disease

Tx:
• Salt restriction
• Thiazides diuretics
• Meclizine

58
Q

Young woman with pain with eye movements and blurry vision who now has tingling of the arm.

MRI: Periventricular plaques

Dx and tx?

A

Multiple sclerosis

Tx:
Flare: steroids and r/o infection
Chronic
o	Interferon
o	Glatiramer
o	Fingolimod
59
Q

Tx of Urinary retention in multiple sclerosis?

A

Bethanechol

60
Q

Tx of Incontinence in multiple sclerosis?

A

Amitriptyline

61
Q

Tx of Spasms in multiple sclerosis?

A

Baclofen

62
Q

Tx of Neuropathic pain in multiple sclerosis?

A

gabapentin

63
Q

Patient with Ascending paralysis and Hyporeflexia. A few days agos he had watery diarrhea caused by campylobacter or flu vaccine.

Dx, next step and tx?

A

Guillaim-Barré

Next step: Lumbar puncture: ↑proteins with few cells

Tx:
• Intubation?
• IV Ig or plasmapheresis
• DON’T give steroids

64
Q

Patient of 55 years of age with Blurry vision, dysphagia, lack of hand coordination that are worse in the evening.

Dx, next steps, and tx?

A

Myasthenia Gravis

Next step:
• Anti-Ach receptor
• EMR
• CT scan of chest looking for thymoma

Tx:
• Cholinesterase inhibitors: Pyridostigmine
• Steroids
• In crisis (trouble breathing or swalling): IV Ig or plasmapheresis
• Thymectomy

65
Q

Myasthenia Gravis is associated with what tumor?

A

Thymoma

66
Q

Patient of 55 years of age with Trouble raising from a chair and Difficulty combing that improves over the day.

Dx, next steps, and tx?

A

Lambert-Eaton

Next steps:
• Antibody
• EMR
• CT looking for small cell carcinoma

Tx: Treat lung cancer

67
Q

Patient with a combination of upper and lower motor neuro lesions
• Upper: hyperreflexia, with weakness and hypertonicity
• Lower: Areflexia, weakness, hypotonicity and fasciculation

Dx, next step and tx?

A

Amyotrophic Lateral Sclerosis (ALS)

Next steps:

  • CT/MRI to r/o spinal lesion
  • Confirm dx with EMR

Tx: Riluzole and supportive

68
Q

Patient with depressed EEG, positive corneal reflex, you irrigate cold water on ear canal and eyes towards the ipsilateral side, no nystagmus, you move their head and his eyes move. Normal ECG, normal motor reflexes.
Dx, causes and management?

A

Coma

Causes: Toxins (EtOH, Benzos, Opiates), Electrolytes, Hypothyroid, Thiamine, hypoxic/ischemic encephalopathy, trauma (diffuse axonal injury) or brainstem path (hemorrhage or infarction)

Management: CMP, CT scan, LP, EEG
 Coma cocktail (Thiamine, D50, Oxygen, Naloxone),
69
Q

Cold water caloric reflex?

A
  • Normal: Irrigate cold water–> eyes towards the ipsilateral side, then opposite nystagmus
  • Coma: Irrigate cold water–> eyes towards the ipsilateral side, no nystagmus
  • Brain dead: Irrigate cold water–> no eye movement
70
Q

Patient with flat EEG, positive corneal reflex, you irrigate cold wateron ear cannal and eyes towards ipsilateral side, no nystagmus, you move their head and his eyes move. Normal ECG, normal motor reflexes.
Dx?

A

Persistent vegetative state

71
Q

Patient with flat EEG, negative corneal reflex, you irrigate cold water on ear cannal and there’s no response from eyes, you move their head and his eyes don’t move. Normal ECG, no motor reflexes.
Dx and next step?

A

Brain dead

Get a coleage to confirm the dx

72
Q

Patient with arroused EEG, positive corneal reflex, you irrigate cold wateron ear cannal and eyes towards the ipsilateral side, then opposite nystagmus; you move their head and his eyes move. Normal ECG, but not motor.
Dx?

A

Locked-in syndorme

73
Q

Unilateral, severe periorbital headache with tearing and conjunctival erythema.

A

Cluster headache.

74
Q

Prophylactic treatment for migraine.

A

Antihypertensives, antidepressants, anticonvulsants.

75
Q

The most common pituitary tumor. Treatment?

A

Prolactinoma. Dopamine agonists (e.g., bromocriptine).

76
Q

A 55-year-old patient presents with acute “broken speech.” What type of aphasia? What lobe and vascular distribution?

A

Broca’s aphasia. Frontal lobe, left MCA distribution.

77
Q

The most common cause of subarachnoid hemorrhage (SAH).

A

Trauma; the second most common is berry aneurysm.

78
Q

A crescent-shaped hyperdensity on CT that does not cross the midline.

A

Subdural hematoma—bridging veins torn.

79
Q

A history significant for initial altered mental status with an intervening lucid interval.

Diagnosis? Most likely source? Treatment?

A

Epidural hematoma.

Middle meningeal artery. Neurosurgical evacuation.

80
Q

CSF fi ndings with SAH.

A

Elevated ICP, RBCs, xanthochromia.

81
Q

Albuminocytologic dissociation.

A

Guillain-Barré syndrome (↑ protein in CSF without a

signifi cant ↑ in cell count).

82
Q

Cold water is flushed into a patient’s ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathologic?

A

Normal.

83
Q

The most common 1° sources of metastases to the brain.

A

Lung, breast, skin (melanoma), kidney, GI tract.

84
Q

May be seen in children who are accused of inattention in class and confused with ADHD.

A

Absence seizures.

85
Q

The most frequent presentation of intracranial neoplasm.

A

Headache.

86
Q

The most common cause of seizures in children (2–10

years).

A

Infection, febrile seizures, trauma, idiopathic.

87
Q

The most common cause of seizures in young adults (18–35 years).

A

Trauma, alcohol withdrawal, brain tumor.

88
Q

First-line medication for status epilepticus.

A

IV benzodiazepine.

89
Q

Confusion, confabulation, ophthalmoplegia, ataxia.

A

Wernicke’s encephalopathy due to a defi ciency of thiamine.

90
Q

What % lesion is an indication for carotid endarterectomy?

A

Seventy percent if the stenosis is symptomatic.

91
Q

The most common causes of dementia.

A

Alzheimer’s and multi-infarct.

92
Q

Combined UMN and LMN disorder.

A

ALS.

93
Q

Rigidity and stiffness with resting tremor and masked facies.

A

Parkinson’s disease.

94
Q

The mainstay of Parkinson’s therapy.

A

Levodopa/carbidopa.

95
Q

Treatment for Guillain-Barré syndrome.

A

IVIg or plasmapheresis.

96
Q

Rigidity and stiffness that progress to choreiform
movements, accompanied by moodiness and altered
behavior.

A

Huntington’s disease.

97
Q

A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation, seizures, and ipsilateral leptomeningeal angioma.

A

Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of the affected lobe.

98
Q

Café au lait spots on skin.

Associated dx?

A

Neurofibromatosis type 1.

99
Q

Hyperphagia, hypersexuality, hyperorality, and hyperdocility.

Dx?

A

Klüver-Bucy syndrome (amygdala).

100
Q

May be administered to a symptomatic patient to diagnose myasthenia gravis.

A

Edrophonium.

MCCQE1 (19 decks)

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