Neurology - Part 2 of 2 Flashcards
Which of the following is the most effective treatment of spasmodic torticollis? (x2)
BOTULINUM TOXIN
72 yo with profound sensory ataxia with loss of vibratory sensation and cognitive issues with irritability and somnolence. Nutritional deficiency?
COBALAMIN
Source of pain that is primarily central (non-nocioceptive)?
FIBROMYALGIA
Exam findings suggests L5 radiculopathy in pt with back pain and foot drop?
WEAKNESS OF ANKLE INVERSION
35yo gets blurry vision, drooping eyelids, and difficulty swallowing. Weakness of bulbar muscles. What caused this?
BOTULINUM
Which of the following is most likely to reduce pain in postherpetic neuralgia
CAPSAICIN
53 y/o w/ insidious onset of blurred vision, diplopia x1 day, ptosis, CN6 palsy, unreactive pupils, hoarse voice, dysarthria, weak neck muscles. EMG - inc amp with repetitive nerve stimulation. Dx?
BOTULISM
Dx for 45yo woman w/ pins & needles feeling in hand at night and upon awakening
CARPAL TUNNEL SYNDROME
Pt with chronic muscle wasting in both UE, loss of light touch, pain, and temperature sensation in shoulders, upper arms, and back, and painful paresthesias over the same distribution, diagnosis?
SYRINGOMYELIA
23 y/o Caucasian F in office for f/u after an ER visit 2 days earlier for sudden diplopia, R leg weakness and shaking, difficulty w/ speech which resolved after a few hours. Pt had fever 103.1 F and was tx for UTI. Current exam: normal CN & sensory, minimal R leg weakness, brisk DTR and musculocutaneous reflexes throughout, and equivocal plantar reflex on L. R toe is downgoing. Hx of several episodes of transient neurological deficits that resolved spontaneously after a few days. Her spinal fluid is most likely to show what?
PROTEIN: 50MG, + OLIGOCLONAL BANDS, NUCLEATED CELLS: 10
68 y/o w/ pain in buttocks while walking, shooting down legs, w/ weakness and numbness. Relieved by sitting, pain persists with standing. Dx?
LUMBAR SPINAL STENOSIS
Where is the lesion when a picture of a female patient with ptosis is shown?
SUPERIOR CERVICAL GANGLION
T2 MRI figure in pt with cervical myelopathy. Most consistent with what dx?
DEGENERATIVE CERVICAL SPONDYLOSIS
New-onset back pain after shoveling – left paraspinal muscle spasm, negative straight leg raise, reflexes symmetric, no weakness, no sensory deficit. Management?
CONSERVATIVE (BED REST) WITH NSAIDS
50 y/o M w/ acute neck pain radiating down L arm, gait problems, urinary incontinence. What test should be ordered?
MRI OF C SPINE TO R/O CORD COMPRESSION
Horner’s syndrome is characterized by?
MIOSIS, PTOSIS, AND ANHIDROSIS OF FOREHEAD
First step in the management of acute myasthenic crisis:
MECHANICAL VENTILATION
Pt c/o pain when walking that radiates from lower back and is severe in the calves. Pain relieved by stopping for a couple of minutes, then resuming. No sensory or motor deficits. Test most likely to yield Dx?
VASCULAR EVALUATION OF LOWER EXTREMITIES
Fall from a ladder with persistent back pain and inability to void. B/l leg weakness, decreased pinprick in sacral and perianal area. Dx?
CAUDA EQUINA COMPRESSION
35-year old pt with new onset of numbness and tingling in the legs. The pt complains of a band-like sensation around the mid chest and reports episodes of urinary incontinence. Which of the following tests should be ordered next?
MRI OF THE SPINE
Fluctuating aching pain in lower back, buttocks, and sciatic distribution elicited by standing or walking, and relieved by sitting with numbness in a similar distribution, loss of ankle reflexes: what dx?
SPINAL STENOSIS
A young pt w/ a few days of progressive weakness and numbness of both legs and feet after recovering from a flu-like illness. Exam: weakness and loss of sensation to all sensory modalities below the middle of the thorax. DTR: brisker on the lower extremities, plantar reflexes are extensor. Pt has had several episodes of urinary incontinence. Other neuro exam and vital: normal. LP: 23 mononuclear cells, protein level: 37mg/dl, and normal glucose. Dx:
ACUTE TRANSVERSE MYELITIS
55 y/o M presents w/ hx of weakness and clumsiness. Symptoms began several months earlier with difficulty buttoning his clothes, getting the car keys in the ignition, and performing other fine motor tasks. He noticed that the muscles in his arm and forearm twitched under the surface, and cramped easily. Over the past few months his arms have continued to weaken and lose muscle mass. On exam, he has diffuse wasting and weakness of BUE, fasciculations, slight spasticity on arms and legs, and hyperreflexia with extensor plantar responses. Sensory, coordination, and CN exams are normal. The underlying pathological process affects neuronal bodies in which of the following structures?
ANTERIOR HORN OF THE SPINAL CORD, MEDIAL BRAINSTEM, AND PREROLANDIC CORTEX
13 y/o M w trouble keeping up w P.E. class. On exam: symmetric weakness in legs/ arms, worse in proximal muscles, most prominent in quadriceps/hamstrings. Both calves enlarged, painful w exercise. Serum creatine kinase level is 13,000. Muscle bx reveals abnormalities in dystrophin protein staining. Pattern of inheritance is?
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