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?
X-LINKED
A hyperextension lesion of the shoulder resulting in weakness of abduction, internal rotation, flexion, and adduction of the extended arm most likely includes which nerve roots?
C5, C6
5 y/o cannot maintain eyes open, attempts to look at person/object results in tonic eyelid closure. Can watch television w/o difficulty. Extraocular movements NML. Dx?
BLEPHAROSPASM
Electrophysiologic signs of denervation:
FIBRILLATION AND POSITIVE SHARP WAVES
Pt s/p surgery develops weakness and wasting of small muscles of the hand and sensory loss of the ulnar border of the hand and inner forearm. Dx?
LOWER BRACHIAL PLEXUS PARALYSIS
3 month progressive limb weakness L>R, problems swallowing. Normal CN, weakness in neck extensor muscles, in distal and proximal muscles (quadriceps, feet dorsal flexors, extensor pollicis longus) and in wrist/finger flexors. DTRs normal. Motor tone/coordination/gait normal. Elevated CK.
INCLUSION BODY MYOSITIS
Spinal fluid of patient w/ acute inflammatory polyneuropathy shows:
HIGH PROTEIN, NORMAL CELL COUNT
Pt with double vision when looking to the left shows her eyes on primary gaze. On left gaze the right eye fails to adduct and there is nystagmus in the left eye. On right gaze and vertical gaze the eyes move normally. Dx?
INTERNUCLEAR OPHTHALMOPLEGIA
Right shoulder weakness on initial abduction and external rotation of the arm at the shoulder joint, after carrying sand bags. Affect nerve:
SUPRASCAPULAR
Acute onset of left facial weakness involving the forehead & perioral musculature. Onset of facial weakness was preceded by pain in left ear and mastoid, and by sensation of discomfort in the left ear w/ loud noises or low pitch sounds. Dx?
BELL’S PALSY
Orbital pain with L eye paralysis of adduction and elevation of the eye but normal pupil function. Dx?
DIABETIC 3RD NERVE PALSY
25 y/o pt with pain in L periorbital region, followed by blurring then loss of vision in left eye. Exam normal but no reaction when light shone on L eye. This is consistent with:
DEMYELINATING LESION OF LEFT OPTIC NERVE
Involuntary set of flowing jerky movements in multiple joints describe:
CHOREA
49 y/o w/ DM2 presents with severe burning of soles of feet and insomnia b/c the touch of the sheet against the feet is painful. Exam shows decreased sensation to pin and touch up to ankle, 50% reduction in vibratory sense at ankle and impaired proprioception at toes. Ankle jerks are absent, but knee jerks present. Dx?
PERIPHERAL NEUROPATHY
Resting, non-intentional tremor
PARKINSON’S DISEASE
25 y/o F with L eye pain which increases with moving the eye. Diminished acuity in L eye, pupils constrict well with light on R eye, but only constrict weakly with light on L eye. Dx?
OPTIC NEURITIS
Recurrent deafness, tinnitus then vertigo:
MENIERE’S DISEASE
49 y/o with gradual hearing loss. A tuning fork used during the Weber test reveals a failure to lateralize, and the woman’s perception of air conduction is better than that of bone conduction. She has trouble discriminating words “fat” “cat” “mat”. Dx?
BILATERAL SENSORINEURAL HEARING LOSS
Viral agents frequently associated with idiopathic unilateral facial nerve palsy:
HERPES SIMPLEX
Tremor decreasing with volitional movements and appears primarily in an attitude of repose:
RESTING TREMOR
Mucosal lesion that heals and then pt has pain in trigeminal nerve area
POST-HERPETIC NEURALGIA
Unilateral foot drop with steppage gait indicates:
PERONEAL NERVE COMPRESSION
Severe jabbing pain, lasts few seconds, triggered by light touch on face
TIC DOULOUREUX
Irregular, unequal, small pupils nonreactive, do not dilate, but do constrict to accommodation:
SYPHILIS
Pt was hit from behind while driving & awoke w/ pain radiating into his left ankle. Weakness of plantar flexion and decreased ankle jerk. Straight leg raising reveals pain beyond 45 degrees on left. Dx?
S-1 RADICULOPATHY
Myasthenia gravis pt with mild respiratory infection develops severe respiratory fatigue, restlessness, and diaphoresis. Pt appears anxious and tremulous. Tx?
MECHANICAL VENTILATION
Pt c/o left foot slapping floor when he walks. He has to step high to avoid tripping. Weakness of dorsiflexion of left foot, w/ small area of numbness in the dorsum of the left foot. Normal ankle and knee jerks, and hamstring reflexes. Dx?
PERONEAL NERVE PALSY
Hyperkalemic periodic paralysis is characterized by episodes of generalized weakness of fairly rapid onset. It is also associated with a rise in serum K, with weakness typically appearing after a period of rest following exercise. Which of the following molecular deficits underlies this disease?
SODIUM CHANNEL INACTIVATION
Weakness of opponens of thumb and adduction of 4th, 5th digit, decreased sensation in 4th, 5th digits extending into palm and ending at crease of wrist, caused by:
ULNAR NERVE LESION
Severely sensitive, lancinating pain on the cheek
TRIGEMINAL NEURALGIA
52 y/o w recurrent stabbing pain over right cheek and jaw forcing him to frown. Stopped shaving or brushing teeth d/t fear of pain. Episodes last less than 1 minute. Only exam abnormality is pain upon repeated touching of pt’s face. Most likely explanation of symptoms?
TRIGEMINAL NEURALGIA
23 y/o develops tingling paresthesias in the lower extremities, followed several days later by progressive weakness, R>L. PE shows sensory level at T10 to pinprick, +3/5 weakness of LE, slightly weaker on R. Knee and ankle jerks are hyperactive, b/l congenit. Pt has difficulty walking with broad-based, stiff-legged gait. Dx?
TRANSVERSE MYELITIS
Unilateral distal weakness in one limb, often associated w/ muscle wasting in the same distribution, the most common Dx:
AMYOTROPHIC LATERAL SCLEROSIS (ALS)
Which neurological disorder has the highest prevalence of pathological laughing and crying
AMYOTROPHIC LATERAL SCLEROSIS (ALS)
A dislocation of shoulder joint resulting in weakness of abduction of arm, wasting of deltoid muscle and slight impairment of sensation on the lateral aspect of shoulder, involves which nerves:
AXILLARY
A 57 yo pt develops drooping of the R eyelid following mild neck trauma. The patient’s neurological exam is remarkable for asymmetric pupils, smaller on the R, mild eyelid ptosis and decreased sweating over the R face. These findings are consistent with which of the following?
HORNER’S SYNDROME
38 y/o F with muscle spasm of the proximal limbs and trunk, lumbar lordosis while walking, w/o EMG abnormality and with serum antiglutamic acid antibodies is suffering from:
STIFF-PERSON SYNDROME
DM pt with creeping paresthesias and burning pain in L anterolateral thigh. DTRs normal, no weakness. Dx?
MERALGIA PARESTHETICA
45 y/o reports lower back pain along w/ pain and numbness in R leg and foot w/ difficulty walking x 4 wks. Exam: limited due to back pain, foot drop on right side. Nerve conduction studies: normal motor and sensory in leg. EMG: decreased recruitment and spontaneous activity in right tibialis anterior and tibialis posterior muscles. Otherwise normal. Dx:
L-5 RADICULOPATHY
A 54yo pt complains of intermittent double vision that has worsened over the last 3wks. The pt’s coworker also noted that at times the patient had a “droopiness” of the eyelids as if sleepy. Examination reveals bilateral ptosis, mild esotropia, and double vision only after the pt is asked to maintain an upward gaze for 2 minutes. There is no dysarthria, but a mild 4/5 weakness is found in the proximal arm muscles bilaterally. What is most appropriate test to perform next to establish the diagnosis?
EDROPHONIUM TEST
Which of the following antibiotics is most likely to cause or precipitate acute myasthenia?
CIPROFLOXACIN
Polyneuropathy can be caused by either deficiency or extreme excess of which of the following B vitamins?
VITAMIN B6
45yo pw gradual progressive weakness for 3-4mo in LUE, atrophy in RUE intrinsic mm, and brisk reflexes and extensor plantar responses. EMG with widespread fasciculations, fibrillations, and +sharp waves. Dx?
ALS
57 y/o office worker w numbness in 4th/5th digit of right hand, which wakes patient in middle of night. Nerve conduction study finding most likely to explain syndrome?
SLOWED CONDUCTION VELOCITY ACROSS THE ELBOW IN THE ULNAR NERVE
Conduction block in NCS indicates what?
FOCAL DEMYELINATION
Female with vertigo and diplopia, when looks left has isolated L eye nystagmus, and cannot adduct R eye. Dx?
MULTIPLE SCLEROSIS
20 y/o occasional double vision when looking to R and normal acuity in each eye alone. L ptosis and difficulty keeping L eye adducted. Pupils round and reactive. Speech nasal and neck flexors weak. No paresis or reflex abnormalities in extremities. Dx?
MYASTHENIA GRAVIS
55 y/o w/ DM and HTN develops R periorbital pain and diplopia. Exam: paralysis of abduction of R eye.
DIABETIC 6TH NERVE PALSY
Shaking hands, increased when using hands/writing/volitional activities. Stress worsens, wine improves. Is familial. DX:
ESSENTIAL TREMOR
55 yo pt complains of numbness in 4th/5th digit R hand. Sxs worse when pt speaks on phone, awakens w paresthesias in same fingers. Test to confirm the dx?
NERVE CONDUCTION STUDIES
55 y/o pt w/ hx of weakness and clumsiness x several months. Difficulty w/ fine motor tasks. Arm muscles twitch and cramp easily, weakening, atrophy. Sensory, coordination, cranial nerve exams wnl. Underlying illness affects neuronal bodies where?
ANTERIOR HORN OF SPINAL CORD, MEDIAL BRAINSTEM AND CORTEX
Prognosis of acute inflammatory demyelinating polyneuropathy is poorest if the disease process involves which of the following?
PROXIMAL AXON
Pt with HTN develops painless vision loss in the left eye. Exam: blindness in L eye and afferent pupillary defect on the left. MRI: several T2 hyperintensities in the white matter periventricularly. No corpus callosum lesions. No enhancement with gadolinium. Dx?
ISCHEMIC OPTIC NEUROPATHY
Chronic peripheral neuropathy of insidious onset, symmetric, more prominent distally in limbs, legs more than arms affected, slowly progressive, with greater sensory than motor involvement, with involvement of peripheral sympathetic nerves, and variable loss of DTR, is most likely caused by agent:
ALCOHOL
The usual target for Deep Brain Stimulation in Essential Tremor:
VENTRAL INTERMEDIATE THALAMUS
72-year-old pt presents with subacute onset of progressive ataxia of gait and limbs. Lab testing reveals the presence of an anti-Yo antibody in serum. Which of the following tests should be ordered next?
CT SCAN OF THE CHEST, ABDOMEN, AND PELVIS
Young pt recovering from flu-like illness w/ progressive weakness and numbness of legs and feet. Weakness and numbness below middle of thorax. Increased LE DTR’s, extensor plantar reflexes. Urinary incontinence. LP 23 mononuclear cells, protein level 37, nml glucose
ACUTE TRANSVERSE MYELITIS
25 y/o pt reports double vision and some difficulty with balance. On right lateral gaze, there is weakness of the left medial rectus, with nystagmus of the right eye. On left lateral gaze, there is weakness of the right medial rectus, with nystagmus of the left eye. There is also mild finger to nose ataxia on the right. Dx:
MULTIPLE SCLEROSIS
50 y/o man w a cut onset of neck pain radiating down left arm, progressing gait difficulty, urinary incontinence. Which test should be administered immediately?
MRI OF HEAD TO EXCLUDE DX OF ACUTE HYDROCEPHALUS
Transcutaneous electrical nerve stimulation (TENS)
FOR PERIPHERAL NEURALGIA
Electrodiagnostic test finding most indicative of a demyelinating neuropathic process?
CONDUCTION BLOCK
Term for burning dysesthesia with shock-like paroxysms:
NEUROPATHIC
Pt displays spastic gait in which legs are stiff, feet scrape against floor, and legs circumduct which each step. Reflexes are increased and plantar responses are extensor bilaterally. Dx?
CERVICAL SPONDYLOSIS
Term for sudden, irrepressible shock-like contraction of a muscle triggered by an event in CNS?
MYOCLONUS
28 y/o with acute urinary incontinence and unsteady gait. Also reports 1 week h/o numbness progressing from both feet up to abdomen. Light touch, temperature, and pinprick are reduced below the mid-thoracic region. Vibration and position sensation in both feet are absent. Muscle bulk and tone are normal. Strength in BLE are reduced, R>L. Brisk DTRs in BLE with + Babinski’s. What’s the Dx?
ACUTE TRANSVERSE MYELITIS
Pt present with progressive weakness of left upper extremity, followed by the right upper extremity. + Muscle wasting of bilateral arms. Upper and lower ext reflexes increased, and plantar response are extensor. Normal nerve conduction studies. EMG: fibrillations in arm and leg muscles. Dx?
AMYOTROPHIC LATERAL SCLEROSIS
The most frequent cause of simultaneous, bilateral facial nerve palsies
BORRELIA BURGDORFERI
Gait pattern in which one side of pelvis is dropped is associated with which neurological condition?
MUSCULAR DYSTROPHY
A 63 y/o pt with insidious onset of neck pain, progressive limb weakness, falls, and urinary incontinence. On exam, pt has decreased neck ROM, mild distal and proximal limb weakness, brisk DTRs with ankle clonus, and upgoing plantar reflexes. Increase muscle tone in legs. Rest of exam is normal. What is most likely dx?
CERVICAL MYELOPATHY
55 y/o pt c/o of mild muscular aches and stiffness for which steroid treatment was previously given. Hx of hypercholesterolemia and hypertriglyceridemia, and was treated with atorvastatin and gemfibrozil with a positive response. Serum creatine kinase level is slightly elevated. Which of the following is the most likely diagnosis?
STATIN-INDUCED MYELOPATHY
45 y/o pt w/weakness of hips and thighs, and lesser extent the shoulder and neck. Also extremely difficult to rise from a squatting or kneeling position, No muscle pain. No tender. DTR: normal. Dx:
POLYMYOSITIS
A lesion in what structure is associated with ptosis, lack of sweating on same side of the face, and conjunctival injection?
SUPERIOR CERVICAL GANGLION
50 y/o otherwise healthy pt who is a secretary notices cramping and stiffening of hands only while writing, stiffness ceases when pt stops writing. Occasionally hands will tremor. Which of the following Is most effective therapy
BOTULINUM TOXIN
R neck pain, usually rotating neck to left. Corrected by touching chin. Spasm of R SCM on PE. Treatment?
BOTOX
70 Y/O pt with confusion, lethargy, fever. Dx of encephalitis is made after CSF analysis. What clinical feature suggests West Nile virus?
MONOPARESIS
60 y/o pt w/ progressive proximal arm and leg weakness, elevated creatine kinase level. MD suspects a myopathy and orders EMG. Which findings on EMG:
SMALL, SHORT DURING MOTOR UNIT ON NEEDLE EXAM
Which finding would you expect if someone is diagnosed with ulnar neuropathy at the elbow?
LOSS OF SENSATION IN THE FOURTH AND FIFTH DIGIT AND WEAKNESS OF INTRINSIC HAND MUSCLES
Pt c/o hearing loss on right side. When tuning fork held at vertex of skull, pt hears sound better on the right. When fork is held in front of the pt’s ears, pt reports hearing it better on the left. Dx?
CONDUCTIVE HEARING LOSS ON THE RIGHT
Progressive LE stiffness & hyperreflexia (ankle clonus) with extensor plantar responses and decreased light-touch & vibration/proprioception in b/l stocking pattern?
COBALAMIN DEFICIENCY
Pt is evaluated for unilateral lower extremity weakness with no apparent physiologic explanation.
THERE IS A RISK THAT RELEVANT NEUROLOGIC ILLNESS WILL BE IDENTIFIED IN THE FUTURE.
24 y/o pt w/ sudden onset stumbling and pain in legs, negative neuro workup – saw a counselor previously for protracted grief after father’s death – increased conflict with husband. Dx?
CONVERSION D/O
27 year old normal patient with intermittent muscle twitching. EMG findings showing spontaneous discharges, fairly constant, representing motor unit firing are typical of?
FASCICULATIONS
54 y/o wakes up with weakness or R hand. he has been drinking at a bar and fell asleep on right arm over the armrest of chair. exam shows weakness of wrist and finger extension with normal grip strength. Which nerve is affected?
RADIAL NERVE
The new onset of pathological gambling, increased libido, and hypersexuality in a patient with Parkinson disease is likely to be secondary to: (3x)
PRAMIPEXOLE
First line treatment of vocal tics in Tourette syndrome: (2x)
ALPHA 2 ADRENERGIC AGONIST
Which drug for the Tx of parkinsonism has been associated with sudden sleep attacks? (2x)
ROPINIROLE
2nd generation with the lowest D2 affinity
QUETIAPINE
What medicine interferes with efficacy of Donepezil?
OXYBUTYNIN
A condition with increased frequency in pts with HIV on long term HAART:
HEPATOTOXICITY
Inhibitors of enzyme catechol-O-methyl transferase are used in Parkinson disease to address which disease-associate problem?
WEARING OFF OF LEVODOPA EFFECT
33 y/o with insomnia, fatigue, nervousness, irritability, and depressed mood. Has scaly dermatitis in sun-exposed areas, apathy, and mild memory impairment. Which vitamin is pt deficient in?
NIACIN
Which medication reduces accumulation of plaques and disability in pt’s with relapsing remitting MS?
INTERFERON BETA-1 A
What cognitive enhancer is an NMDA receptor antagonist?
MEMANTINE
Medication helpful in early HIV dementia but is potentially toxic later in the disease?
METHYLPHENIDATE
Acamprosate works through which neurotransmitter system?
GLUTAMATE
Neuronal enzyme that is the target of drugs to treat Alzheimer’s i.e. galantamine and rivastigmine
ACETYLCHOLINESTERASE
Pharmacologic mechanisms of topiramate include: inhibition of firing of voltage- dependent sodium channels, antagonism of kainite binding to the alpha-amino-3- hydroxy-5-methyl-4- isoxazole propionic acid (AMPA) receptor & potentiation at which receptor?
GABA-A
A medication to treat MS is an integrin antagonist that primarily acts by blocking lymphocytes and monocytes adhesion to the endothelial cells:
NATALIZUMAB
Medication for restless leg syndrome:
BROMOCRIPTINE
A 73 yo M pt is seen for follow up treatment for a seizure disorder. On examination the pt is found to have gum hypertrophy, cerebellar ataxia and hirsutism. Which of the following medication is the pt taking (most likely)?
PHENYTOIN/DILANTIN
Restless Legs syndrome 2/2 medication
ANTIDEPRESSANTS
62 y/o pt evaluated for frequent falls w/o loss of consciousness. Pt w rigidity, hallucinations. Three episodes of hallucinations resolved w/o sequelae. Cause?
RISPERIDONE
Safest heterocyclic antidepressant for 78 y/o w depression, agitation & dementia is:
NORTRIPTYLINE
Neuronal damage from excitotoxicity secondary to glutamate sensitivity. Treat with:
MEMANTINE
Which medication for insomnia is most likely to cause amnestic cognitive impairment?
TEMAZEPAM
Sx most likely related to excessive use of vitamin B12
BURNING SENSATIONS
60 y/o F with 10 month hx of apathy and depression has hyperchromic macrocytic anemia. Best test to order next:
VITAMIN B12 LEVEL
A pt with EtOH-dependence present to ED with confusion, ataxia, nystagmus and ophthalmologist. High doses of which of the following vitamins could have prevented this syndrome?
VITAMIN B1
A derivative of which of the following vitamins is a necessary cofactor for the function of the enzyme glutamic acid decarboxylase?
PYRIDOXINE
Which of the following neurohormones is known to modulate immune function, has analgesic properties, is derived from the serotonin molecule, and is a potent antioxidant and free-radical scavenger?
MELATONIN
Mirtazapine mediates increased release of NE and and serotonin through what mechanism?
ALPHA-2 ADRENERGIC BLOCKADE
Reduces Sxs during acute exacerbation of MS:
METHYLPREDNISONE
What occurs when the central nervous system responds to an acute cortical insult?
Microglia processes retract, and the cell body enlarges
What drug can reduce psychotic symptoms in parkinson’s disease w/out worsening motor symptoms
Pimavanserin
Which medication class exacerbates physiology tremor? Barbiturates, corticosteroids, benzos, CCB’s, Beta blockers
Corticosteroids
Neuroimaging that measures neuronal glucose metabolism (2x)
PET SCAN
Pt in ED with sudden HA and collapsing, some lethargy. Exam shows rigid neck, no papilledema, no focal CN or motor signs. The initial test should be?
CT HEAD
Which is an advantage for CT head vs MRI?
DIAGNOSING ACUTE EPIDURAL HEMORRHAGE
Gadolinium contrast in MRI scans is most specifically useful for diagnosing patients with diseases affecting which of the following structures?
BLOOD BRAIN BARRIER
CT is preferable over MRI in which situation?
70 Y/O FEMALE WHO FELL AT HOME AND NOW HAS DEPRESSED LEVEL OF CONSCIOUSNESS
CT scan is better than MRI for what?
DIFFERENTIATING HEMORRHAGING FROM EDEMA
65 y/o has first generalized tonic-clonic Sz seen by spouse and they have been confused and lethargic since. Episode began w/ repetitive shaking of right arm. Blood tests unremarkable and no hx of other recent symptoms, trauma, or metabolic disorders. What study will likely reveal cause?
BRAIN MRI
What does functional MRI measure?
DETECTS BLOOD FLOW
Purpose of CT scan when patient suspected of having stroke?
EXCLUDE HEMORRHAGE
Which MRI technique most likely reveals early signs of ischemic stroke?
DIFFUSION WEIGHTED MRI
16 y/o pt brought to psychiatrist’s attn after having single grand mal sz. Pt’s parents have noted on occasion pt has sudden jerks of entire body, resulting in dropping objects. EEG: rare 4-6 HZ irregular polyspike/wave bursts. Diagnosis? (9x)
JUVENILE MYOCLONIC EPILEPSY
Fever, HA, seizures, confusion, stupor, and coma, evolving over several days. EEG with lateralized high-voltage sharp waves arising in the L temporal region w slow wave repeating at 2-3 sec intervals. CT low-density lesion in L temporal lobe. (8x)
HERPES SIMPLEX ENCEPHALITIS
8y/o has episodes of staring into space and then blinking for a few seconds. EEG will show? (7x)
3 CYCLES PER SECOND SPIKE AND WAVE ACTIVITY
40y/o has episodes of flailing of the arms and tonic postures described as “fencing.” EEG confirms seizure. Which seizure type? (4x)
FRONTAL LOBE
10 y/o child freq episodes brief lapses of consciousness without premonitory sxs. Lasts 2-10 seconds, followed by immediate and full resumption of consciousness without awareness of what has happened. These ictal episodes most likely caused by what kind szs? (4x)
ABSENCE
EEG that reveals posterior alpha and anterior beta activity is most likely to have been obtained from whom? (4x)
A RELAXED ADULT WITH EYES CLOSED
What is the diagnostic value of transient paresis or aphasia after a seizure? (3x)
LOCALIZES THE FOCUS OF SEIZURE
28 y/o female referred to psych d/t recent onset episodes of altered behavior lasting 1 to 2 minutes. Husband notes if occurs when cooking pt will place the clean silverware back in dishwasher. Also notes she does drawing movements he is unable to interrupt. Pt has no recollection of the events. MRI scan is normal. Diagnosis? (x2)
COMPLEX PARTIAL SEIZURES
1st seizure with focal onset and secondary generalization in a 58 y/o pt is likely the consequence of what? (2x)
GLIOBLASTOMA MULTIFORME
The EEG finding of 4-6 hz irregular polyspike activity in a patient with generalized seizures is characteristic of which of the following forms of epilepsy? (2x)
JUVENILE MYOCLONIC
Which of the following surgical procedures can be used in the treatment of epilepsy refractory to meds? (2x)
ELECTRICAL STIMULATION OF THE VAGUS NERVE
What EEG findings are expected in a comatose pt with hepatic encephalopathy? (2x)
TRIPHASIC WAVES
3 days s/p cardiac arrest and CPR, 73 y/o man is comatose. His eyes are open but he does not fix and follow with his eyes. Doll’s eyes elicits full horizontal eye movements. His spontaneous limb movements are symmetrical. Reflexes: mildly hyperactive. The EEG shows? (2x)
BURST SUPPRESSION PATTERN
Pt with seizure has flailing arms and tonic postures of “fencing.” What seizure type?
FRONTAL LOBE
Absence seizure EEG?
THREE CYCLE PER SECOND SPIKE-AND- WAVE
Seizures get controlled, then has paranoid delusions, what type of seizure
COMPLEX PARTIAL
Dx for pt w/ new-onset sz, multiple subQ nodules, freckling of axilla?
NF TYPE I
40 yo new-onset sz b/l thrashing movement. What suggests non-epileptic cause?
FOLLOWING COMMANDS
Which of the following best describes the characteristics of the normal adult alpha rhythm seen on an EEG recording?
INTERMITTENT AND POSTERIOR DOMINANT
EEG-biofeedback training is efficacious for what d/o?
GAD
49 y/o pt develops seizure disorder that is difficult to control. CSF shows lymphocytic pleocytosis and many RBC’s. MRI: T2 hyperintensity in the Left temporal lobe, with gadolinium enhancement in this area in T1 weighted image. EEG: periodic discharges. Dx?
HERPES SIMPLEX ENCEPHALITIS
Typical feature of epileptic activity in alcoholic pt with seizure 12h after EtOH cessation
MULTIPLE EPISODES
Distinguishing absence seizures from partial complex seizures:
LACK OF POSTICTAL MANIFESTATIONS
Which procedure confirms the diagnosis of non-epileptic seizures? Video telemetry or EEG between episodes?
EEG VIDEO TELEMETRY
Antiepileptic for juvenile myoclonic epilepsy:
VALPROIC ACID
Complex partial seizures are differentiated from simple partial seizures by:
SIMPLE SEIZURES HAVE NO LOSS OF CONSCIOUSNESS BUT HAVE ALTERED RESPONSIVENESS TO OUTSIDE STIMULI.
24 y/o pt w/ hx of epilepsy since childhood has several seizures in rapid succession. Following Szs, pt developed paranoia and hallucination, but resolved over a matter of days. Dx:
INTERICTAL PSYCHOSIS
Convulsive episode with leftward eye deviation, tonic contracture of left side. Postictally, eyes deviate to right w/ hemiparesis of left side
SEIZURE FOCUS RIGHT FRONTAL REGION
28 y/o F w/ HA, hyperventilates, asynchronous tonic-clonic sz, no LOC during Sz:
PSYCHOGENIC SEIZURE
In young pt w/ epilepsy, Tx depression w/:
PROZAC
Why is there a relatively high rate of suicide in epileptics?
COMORBID PSYCHIATRIC DISORDERS
Lack of prolactin elevation after szs suggests what kind of szs:
NON-EPILEPTIC
Drug-addicted healthcare professional experiences seizure that is not a withdrawal phenomenon. Cause?
MEPERIDINE
Complex partial epilepsy aura has what symptom?
LIP SMACKING
Head & eyes deviate to right and right arm extends immediately before a generalized tonic- clonic seizure. Seizure focus:
LEFT CEREBRAL HEMISPHERE
Gustatory special sensory seizures (auras) localize where?
INSULAR CORTEX
Pt w/ episodes of altered behavior lasting 1-2 minutes. During episodes pt makes chewing movements. Pt has no recollection. MRI is normal. Dx?
COMPLEX PARTIAL SEIZURES
32 Pt reports AH of someone not present, then stops moving, stares blankly, repetitively picks clothing, and does not respond for several minutes. Symptoms resolve after 15min but pt has no recollection of events. This represents what type of seizure?
COMPLEX PARTIAL
16 y/o pt w/ new onset tonic clonic seizures. Pt reports having jerky movements which cause him to drop objects. EEG shows polyspike pattern. Which antiepileptic medication?
VALPROIC ACID
15 y/o has hx of seizures beginning at the age of 9years, followed by prolonged motor or sensory deficits lasting days to weeks. The pattern of the seizures and the focal deficits has changed over time. The pt also has hemicranial headaches. No family hx of similar symptoms. Most likely diagnosis?
MITOCHONDRIAL ENCEPHALOMYOPATHY, LACTIC ACIDOSIS AND STROKE.
What is the medication for adequate initial treatment of absence seizures in children?
VALPROIC ACID
Gelastic seizures are a/w which brain foci?
HYPOTHALAMUS
An increase in beta frequency during an awake EEG is caused by what type of medication?
SEDATIVES
Most common EEG finding in metabolic encephalopathy? (question requires assigning diagnosis to EEG)
GENERALIZED SLOWING
15 y/o pt w/ partial complex seizures w/ secondary generalization, mental retardation, and adenoma sebaceum. Dx?
TUBEROUS SCLEROSIS
Pt w/ h/o Depression and well–controlled epilepsy responded to bupropion after failing on several antidepressants. Pt had not tried imipramine, nortriptyline, duloxetine, and selegiline. No Sz have occurred on bupropion 100mg BID. Insurance recommends changing med due to reduced sz threshold with bupropion. What is appropriate response from psychiatrist?
CONTINUE BUPROPION
54 y/o pt with gastric ulcer undergoes emergent surgery and 30 hrs post-op becomes confused, agitated and responds to internal stimuli and suffers a generalized tonic-clonic seizure: Dx:
DELIRIUM TREMENS
A child with intellectual disability is free of seizures but develops epilepsy in adolescence. Pattern of onset is often seen with?
AUTISM SPECTRUM DISORDER
Test for psychogenic tremor by:
TLL PATIENT TO TAP HAND AND SEE IF TREMOR CHANGES
Pt p/w limb-shaking episodes lasting >3min. Pt is conscious, talking, and is briefly able to suppress movements during these episodes. Which is a risk factor for poor prognosis?
INSIDIOUS ONSET OF SYMPTOMS
5 y/o with screaming/crying for no reason about 1 hour after falling asleep. Sits up in bed with eyes open, trembling, sweating, mother cannot gain his attention for 5 minutes. No new stressors. Boy has no memory of the event. PE normal. Dx? (4x)
SLEEP TERROR
Paralysis when awakening, lasts several minutes. Can see/hear but cannot move during episodes. Disappears spontaneously or when called by his wife. No hallucinations, nightmares, daytime sleepiness or h/o falls. Neuro exam normal (4x)
SLEEP PARALYSIS
REM sleep is first evident at which stage of development? (x3)
IN UTERO
What sleep stage is the most important in restoring the altered functions that result from prolonged sleep deprivation? (3x)
STAGE 4, NON-RAPID EYE MOVEMENT
Insomnia secondary to depression will more consistently affect REM sleep in which of the following ways? (3x)
REDUCED LATENCY TO REM SLEEP
Which of the following is a characteristics change on polysomnogram associated with major depression? (x3)
SHORT REM LATENCY
A pt presents with a hx of irresistible episodic sleepiness that is accompanied by a vivid, dreamlike state at the onset of an episode. Which of the following additional sleep symptoms are likely to be present? (x2)
SLEEP PARALYSIS
8 y/o with persistent delayed sleep onset despite good sleep hygiene, given no indication of broader psychopathology, which med has best evidence to treat this problem and restore normal circadian rhythm? (2x)
MELATONIN
REM sleep behavior disorder is commonly associated with abnormal inclusions containing which of the following proteins? (2x)
SYNUCLEIN
Medical student asks for something to help w/o attention and alertness. Taking a 2-week board review course and struggles to keep up w/ the pace. Sleeping 4hrs/night. Usually sleeps 8hr/night. Dx? (2x)
DYSSOMNIA NOS
Age-related sleep pattern change (2x)
GREATER WAKEFULNESS INTERMIXED WITH SLEEP
What aspect of sleep is increased in older adults? (2x)
DURATION OF AWAKENINGS
What medication is best for decreasing nightmares in PTSD pts? (2x)
PRAZOSIN
Pt reports insomnia, frequent nighttime awakenings, and excessive daytime sleepiness. Sleep study reveals brief lower external jerks with brief repeated arousals. Pt is unaware of these movements. Which dx is most consistent with pt presentation? (2x)
PERIODIC LIMB MOVEMENT DISORDER
HPA axis cortisol production is less active in?
SLEEP ONSET
Neuropeptides decreased in hypothalamus in narcolepsy
OREXIN A
In Narcolepsy weakness in the arms and legs with laughter would respond to which med
VENLAFAXINE
What finding on a multiple sleep latency test (MSLT) confirms the diagnosis of narcolepsy?
DECREASED REM LATENCY
Physiologic changes during REM sleep
INCREASED HEART RATE, INCREASED EYE MOVEMENTS, DECREASED MUSCLE TONE
Brief episodes of sudden loss of muscle tone, with intense emotion are characteristic of:
NARCOLEPSY
65 y/o M trouble falling asleep 2/2 unpleasant aching and drawing sensations in calves and thighs. Also creeping and crawling sensations in legs. Urge to move legs can be suppressed voluntarily for short while but is ultimately irresistible. Most likely Dx is:
RESTLESS LEG SYNDROME
Most common symptom in narcoleptics:
SLEEP ATTACKS
A patient with day time sleepiness, frequent naps. Sleep studies shows that pt enters REM within 5 minutes and wakes frequently at night. Which treatment is appropriate?
MODAFINIL GIVEN DOSE IN THE MORNING
Changes w/ sleep associated with aging:
DELTA WAVE AMPLITUDE DECREASES AND PROPORTIONALLY LESS TIME IS SPENT IN STAGE 3 AND 4
High voltage delta activity with slow eye-rolling on polysomnogram characterizes which stage of sleep?
N3
What is the first step to manage restless leg syndrome?
CHECK FOR IRON DEFICIENCY
Pts over 65 y/o who experience chronic insomnia are most likely to have what comorbid psych conditions
ALCOHOL ABUSE
EEG findings in Stage II (N2) sleep
K-COMPLEXES AND SLEEP SPINDLES
65yo p/w pillow-punching (x several months) in his sleep with sudden awakening from dreams involving pursuit by assailants. Dx?
REM BEHAVIOR DISORDER
The evidence suggests that after completing treatment for insomnia, long term outcomes are better among patients with which medication/therapy?
CBT
EEG biofeedback more effective than progressive muscle relaxation in treating?
INSOMNIA
17 yo with increased sleep duration to 18 hours, lethargy and cognitive slowing. Sleep EEG is normal.
KLINE-LEVIN SYNDROME
Pt p/w complaints of excessive daytime sleepiness, morning headaches, and excessive nighttime sweating. Symptoms are consistent with which sleep disorder?
OBSTRUCTIVE SLEEP APNEA
Which of the following is characteristic of sleep in individuals over the age of 65, as compared to that of young adults?
INCREASED FRAGMENTATION
Which medication is most effective in the treatment of cataplexy?
CLOMIPRAMINE (TCAs 2/2 TO INC NE)
51y/o pt w/ dysthymic disorder has responded well to citalopram. However, the pt continues to complain of morning headaches, anxiety and daytime fatigue. The psychiatrist prescribes clonazepam and the pt immediately reports profound daytime sedation. The differential dx, in addition to a direct sedative effect of the drug, should include:
SLEEP APNEA
Somnambulism during childhood is associated with which of the following stages of sleep measured by an EEG?
STAGE IV
Night terrors typically appear when in life?
CHILDHOOD
42 y/o anesthesiologist with repeated episodes of falling asleep in the OR, mild depression, irritability and mild cognitive troubles. UDS is negative. He gained substantial weight in 18 months, which he attributes to poor eating habits. Most likely Dx:
BREATHING-RELATED SLEEP D/O
A characteristic of non-REM sleep?
DECREASED RECALL OF DREAM ACTIVITY
According to DSM 5, Length of time of sleep difficulty for diagnosis of insomnia
3 MONTHS
Most common explanation given by individuals >65 years for difficulty maintaining sleep?
NOCTURIA
67 y/o with MDD doing well on SSRI but continues to have insomnia and sleepiness during day. Snores loudly, morning headaches, and night sweats. Dx?
BREATHING-RELATED SLEEP DISORDER
Which of the following measures of rapid eye movement (REM) is typically reduced in MDD?
SLEEP ONSET TO REM ONSET
MDD has what sleep abnormality?
SHORTENED REM LATENCY, DECREASED STAGE 4 SLEEP, INCREASED AWAKENINGS IN THE SECOND HALF OF THE NIGHT
REM sleep behavior disorder associated with which pathology:
PARKINSON’S DISEASE
Involuntary jerking of legs while falling asleep, not uncomfortable, stops with falling asleep
NORMAL PHENOMENON, NONPATHOLOGICAL
Predominantly non-REM sleep problem:
ENURESIS
Sinusoidal waves at 9-11 Hz on EEG is:
DEEP SLEEP
Pt working overtime develops frightening nocturnal episodes characterized by semi- wakefulness and inability to move, accompanied by the sense that an intruder is present. The pt denies daytime sleep attacks or sudden loss of motor control. Best initial tx?
GETTING SUFFICIENT SLEEP
A patient reports feeling “irritable” with inability to sleep more than an hour at night one week after receiving 80 mg prednisone daily for a poison ivy rash.
BEGIN TO GRADUALLY TAPER THE PATIENT OFF OF THE PREDNISONE
Most effective treatment for REM sleep behavior disorders.
CLONAZEPAM
Which of the following aspects of sleep is increased in older adults?
SUBJECTIVE QUALITY
A 35 yo recurrent episodes of awakening during sleep waking up with a panicked scream and sweating, racing HR. can’t remember, daytime drowsiness affecting functioning, EEG normal. What is the diagnosis?
SLEEP TERRORS
Most effective treatment for OSA
POSITIVE PRESSURE THERAPY
32 yo with episodes of severe sleepiness and falls asleep while driving, reporting episodes of paralysis and hallucinations while awakening. Symptoms are best explained by a deficiency of what?
OREXIN
Which sleep disorder is associated w/ mild neurocognitive disorder w/ Lewy bodies?
REM SLEEP BEHAVIOR DISORDER
Maximium sleepiness in humans occurs when melatonin reaches its highest point and when what reaches lowest point
BODY TEMPERATURE
This is characteristic of sleep in individuals over the age of 65 compared to young adults
INCREASED SLEEP FRAGMENTATION
42 y/o M with a gradually progressive cognitive deficit also develops jerking movements of the extremities, head, and trunk. Imaging shows atrophy of the caudate nuclei bilaterally. Pt’s father had a similar illness that started at age 50. Which of the following tests is most likely to confirm the diagnosis? (6x)
DNA ANALYSIS FOR CAG REPEATS
79 y/o pt w/ decreasing mental state over 3 weeks has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the patient. Myoclonic jerks occur spontaneously, ataxia, EEG: sharp waves. Dx: (5x)
SUBACUTE SPONGIFORM ENCEPHALOPATHY
Parkinson’s Disease treated w/ levodopa. Visual hallucinations. Recommendations? (5x)
REDUCE DOSE OF LEVODOPA
What MRI finding would most specifically indicate a diagnosis of Huntington’s Disease? (5x)
CAUDATE HEAD ATROPHY
65y/o w/ h/o asthma presents for treatment of essential tremor. Which for first-line? (4x)
PRIMIDONE
Medication useful in management of orthostatic hypotension in Parkinson’s (4x)
FLUDROCORTISONE
98 y/o M in ER, unconscious after choking, had progressive neuro condition presented in his early 30’s w involuntary irregular movements of all extremities & face but after 15 yr course evolved into rigid, akinetic condition w diff swallowing, speaking. Also progressive dementia & full time care. After obstruction was relieved pt remained unconscious, had cardiac arrest & died. PM exam showed generalized brain atrophy. (Pathology picture showing brain atrophy). Dx: (3x)
HUNTINGTON’S DISEASE
Treatment of Huntington’s chorea (3x)
HALOPERIDOL
Gait consisting of: postural instability, festination, & truncal rigidity. Lewy bodies visualized. Also with involuntary acceleration is seen in what condition? (3x)
PARKINSON’S DISEASE
35 y/o pt w/ 2 yr hx of cognitive deterioration, difficulty at work, and irritability. Exam: restless w/ slow, writhing movements in most muscle groups and frequent blinking. Pt’s father and paternal grandpa had similar sx and died in their 50s. Dx: (2x)
HUNTINGTON’S DISEASE
Pt w/ depression, 3 yr hx of change in personality, irritability, impulsive outbursts, & eccentric or inappropriate social interactions. He subsequently lost his job & is now withdrawn & fidgety. Pt has increased eye blinking, marked tongue impersistence, mild bradykinesia, akinesia & mild hyperreflexia w/o clonus. The pt’s dad died of severe dementia at 55. Dx? (2x)
HUNTINGTON’S DISEASE
Typical of Idiopathic Parkinson’s disease, rather than another Parkinsonian syndrome: (2x)
ASYMMETRICAL ONSET AND PROGRESSION OF MOTOR SYMPTOMS.
First-line treatment for restless leg syndrome (2x)
PRAMIPEXOLE
Multifocal myoclonus in a comatose patient indicates: (2x)
METABOLIC ENCEPHALOPATHY
Most effective tx for “writer’s cramp” (focal dystonia assoc w/ writing) (2x)
BOTULINUM TOXIN
Essential tremor improves with
REACHING FOR OBJECTS
Most prevalent movement d/o in those over 70 y/o?
ESSENTIAL TREMOR
6 y/o w/ 4 wk intense eye-blinking and lip pursing. Wax and wane, increase with stress. Family Hx of tic d/o. First step:
EXPLAIN TO FAMILY MAY BE TRANSIENT
Dz w/ trinucleotide repeat expansion
HUNTINGTON’S
Treatment for Huntington’s disease:
HIGH POTENCY ANTIPSYCHOTICS
25 yo pt w several year cognitive decline, dysarthria, dysphagia, and slow movements. Has hand tremor which increases in amplitude on arm extension. Also has hepatic disease of unknown etiology. Ocular exam reveals golden brown ring around cornea. Can confirm diagnosis w blood test for?
CERULOPLASMIN
For which patient would ordering a serum ceruloplasmin be indicated?
A YOUNG ADULT MALE WITH NEW ONSET EMOTIONAL LABILITY AND MOVEMENT DISORDER
Huntington’s disease etiology is classified as a polymorphism due to what property?
THE REGION HAS MANY ALLELES DIFFERING IN THE NUMBER OF GAC REPEATS
68 y/o pt w/ hx of schizophrenia since early adulthood and maintained for yrs on thioridazine. On exam: pt’s tongue frequently retracts on its longitudinal axis and moves in lateral directions. No other findings. When tongue movements are pointed out, pt reports being unaware of making them. What recommendation for best Tx:
GRADUALLY D/C THIORIDAZINE AND START LOW DOSE RISPERIDONE
What is the treatment of acute dystonia?
BENZTROPINE
What symptoms are most commonly associated with Tourette’s syndrome?
OBSESSIONS AND COMPULSIONS
Pathologic findings in brain of Tourette’s?
NO ABNORMALITY
One of the earliest sx of Tourette’s:
EYE-BLINKING AND HEAD JERKING
Tic severity begins to decrease during which age period?
ADOLESCENCE
Common cause of acute cerebellar ataxia in adults:
INTOXICATION WITH ANTIEPILEPTICS
Initial approach for child with new-onset tic disorder
CLINICAL MONITORING
Comorbid condition w/ Tourette’s in kids:
ADHD
Motor dysfunction in Parkinson’s associated with:
INCREASED ACTIVITY IN SUBTHALAMIC NUCLEUS AND PARS INTERNA OF GLOBUS PALLIDUS
Characteristics of Parkinson’s tremor
BEING INHIBITED WITH VOLITIONAL MOVEMENT
80 yo male evaluated for gait imbalance and falls. wife explains that he kicks and screams while sleeping, he reports dreams of being chased. Pt likely has/will develop?
PARKINSON’S DISEASE
67 y/o recently retired pt with Parkinsons, no other psych hx, has taken Pramipexole for several years without cognitive decline. Pt has since started gambling excessively. Pt does not drink or use illicit substances. What is the most likely cause?
USE OF DOPAMINERGIC AGENTS
Most appropriate initial tx for idiopathic Parkinson dz in an 81 y/o pt
CARBIDOPA/LEVODOPA
66 y/o c/o frequent falls, mild axial and L UE rigidity, mild slowness of finger tapping, hand opening, and wrist opposition (all worse on left), normal posture, slow gait with short steps, does not swing left arm, slow rising from chair. What is the dx?
PARKINSON’S DISEASE
Picture showing substantia nigra changes, what neurological disease would be expected?
PARKINSON’S DISEASE
Clinical syndrome that is most commonly comorbid with Parkinson’s disease:
DEPRESSION
Pt w/ Parkinson’s disease experiences visual hallucinations on levodopa/carbidopa therapy. Which med would be the most appropriate intervention:
QUETIAPINE
Pt has severe postural tremor of upper extremities and dystonic posturing of the hands. Pt voice is mildly dysarthric. Eyes have a golden brown limbic ring. Deep tendon reflexes are markedly increased. Elevated LFT’s. Dx?
WILSON’S DISEASE
Pt c/o inability to sit still and describes feeling an inner tension. Exam notes pt is constantly shifting body and legs. Paced hall continuously. Received a course of neuroleptics until recently. Dx?
AKATHISIA
The single most consistently documented and significant risk factor in the epidemiology of tardive dyskinesia is?
ADVANCED AGE
Risk factor for TD
PRESENCE OF MOOD DISORDER
TD in 63 y/o w/ end stage renal failure. Culprit:
METOCLOPRAMIDE
Which gender has a higher risk for tardive dyskinesia (TD)?
FEMALE
75 y/o with hx of extensive tobacco smoking presents with subacute progressive ataxic d/o over several months. MRI brain is unremarkable. CSF shows mild pleocytosis. Found positive for anti-Yo antibody. What test should be ordered next?
CT CHEST
Adult onset opsoclonus-myoclonus-ataxia is associated with which form of cancer?
BREAST CARCINOMA
Next test to order after anti-Yo antibody found in serum in 72 year old patient with subacute onset of progressive ataxia of gait and limbs
CT of chest (also CT of abdomen and pelvis)
