New Deck

Question 1

55-y/o male presents with lower extremity weakness and muscle atrophy; physical examination (PE): ⊕ Babinski’s sign, fasciculations, upper extremity hyperreflexia, and spasticity

Answer 1

Amyotrophic lateral sclerosis

Question 2

65-y/o presents with a gradual decline in memory and inability to complete activities of daily living; head CT: marked enlargement of ventricles and diffuse cortical atrophy

Answer 2

Alzheimer disease

Question 3

65-y/o female with h/o spinal metastases presents with pain radiating down the back of leg, saddle anesthesia, urinary retention; PE: absent ankle jerk reflexes; lumbar CT: vertebral fracture with large bony fragment in lumbar spinal canal

Answer 3

Cauda equina syndrome

Question 4

63-y/o male with h/o cartoid atherosclerosis presents with aphasia and right-sided weakness; PE: dense right hemiparesis, ⊕ Babinski’s on right side

Answer 4

Left MCA cerebrovascular accident

Question 5

20-y/o presents with nausea, vomiting, and headache 2 h after being hit in the temple with a baseball; patient lost consciousness initially but soon recovered; head CT: lens-shaped, right-sided hyperdense mass adjacent to temporal bone

Answer 5

Epidural hematoma

Question 6

40-y/o with h/o Campylobacter enteritis 1 week ago presents with ascending symmetric muscle weakness; PE: absent reflexes; w/u: CSF shows ↑ protein, normal cellular (albuminocytologic dissociation)

Answer 6

Guillain-Barré syndrome

Question 7

37-y/o male presents with poor memory, depression, choreiform movements, and hypotonia; FH of a father who died at 45 after worsening tremors and dementia; brain MRI: marked atrophy of the caudate nucleus

Answer 7

Huntington disease

Question 8

25-y/o with h/o bilateral temporal lobe contusions 1 week ago presents with a sudden increase in appetite, sexual desire, and hyperorality.

Answer 8

Klüver-Bucy syndrome

Question 9

30-y/o female with insidious onset of diplopia, scanning speech, paresthesias, numbness of right upper extremity, and urinary incontinence; w/u: CSF analysis is ⊕ for oligoclonal bands; MRI shows discrete areas of periventricular demyelination.

Answer 9

MS

Question 10

65-y/o female with h/o neurofibromatosis type 2 presents with headache, right-sided leg jerking, and worsening mental status; PE: papilledema and right-sided pronator drift; head CT: dural-based, enhancing left-sided baseball-sized tumor

Answer 10

Meningioma

Question 11

50-y/o with a h/o squamous cell carcinoma of the lung presents with N/V, headache, and diplopia; PE: papilledema, left oculomotor palsy, right pronator drift; brain MRI: multiple round, ring-enhancing, hyperintense cortical, and cerebellar lesions

Answer 11

Metastases to brain

Question 12

30-y/o female presents with unilateral throbbing headache, nausea, photophobia, and scotoma. Similar symptoms occur monthly at the same time of her menstrual cycle.

Answer 12

Migraine headache

Question 13

62-y/o with urinary incontinence, loss of short-term memory, and dementia; PE: wide-based gate; head CT: massively dilated ventricular system

Answer 13

Normal pressure hydrocephalus

Question 14

60-y/o presents with gradual onset of pill-rolling tremor; PE: masked facies, stooped posture, shuffling gait, cogwheel muscle rigidity

Answer 14

Parkinson disease

Question 15

31-y/o presents with loss of libido, galactorrhea, and irregular menses; PE: bitemporal hemianopia; w/u: negative β-hCG

Answer 15

Prolactinoma (Prolactin-secreting pituitary adenoma)

Question 16

45-y/o presents with the gradual onset of sharp pain radiating from his buttocks down his leg that began 2 weeks ago while lifting a heavy box; PE: positive straight leg raise

Answer 16

Sciatica (2° to acute herniation of a lumbar disc)

Question 17

50-y/o with h/o polycystic kidney disease presents with “worst headache of life,” photophobia, nausea; PE: meningismus, impaired consciousness, right eye deviates down and out; w/u: CSF is xanthochromic.

Answer 17

Subarachnoid hemorrhage (2° to ruptured berry aneurysm of posterior communicating artery)

Question 18

32-y/o male with h/o Arnold-Chiari malformation presents with bilateral upper extremity muscle weakness; PE: loss of pain and temperature sensation, ↓ DTR in upper extremities, and scoliosis; spine MRI: central cavitation of the thoracic spinal cord

Answer 18

Syringomyelia

Question 19

75-y/o alcoholic male on warfarin for h/o atrial fibrillation presents with declining mental status, headache, and papilledema; head CT: crescenteric, hypodense 2-cm fluid collection along convexity of skull

Answer 19

Chronic subdural hematoma

Question 20

30-y/o female with ⊕ FH for renal cell carcinoma presents with gait disturbance and blurred vision; PE: retinal hemangiomas, nystagmus, cerebellar ataxia, and dysdiadokinesia; brain MRI: two cerebellar cystic lesions

Answer 20

von Hippel-Lindau disease

Question 21

50-y/o with h/o alcoholism presents with psychosis, bilateral CN VI palsy, and ataxia; brain MRI: mamillary body atrophy, periventricular hyperintensity on T2, and diffuse cortical atrophy

Answer 21

Wernicke’s encephalopathy

Question 22

5-y/o boy born 5 weeks premature by spontaneous vaginal delivery is found to have an IQ of 60. Developmentally, he initially sat at 10 months, said his first word at 18 months and walked at 20 months. On physical examination, he currently walks on his tiptoes with a scissoring gait; his legs are hypertonicbilaterally w/ brisk patellar reflexes and upgoing toes.

Answer 22

Cerebral palsy

Question 23

50-y/o man w/ history of polycystic kidney disease presents to the ED with a progressively worsening headache, which began acutely while working out at the gym. While in the ED he has had a decrease in level of consciousness.

Answer 23

Subarachnoid hemorrhage (secondary to berry aneurysm)

Question 24

12-mo/o girl with normal development until about the age of 5 months. Since that age, she has regressed in both coordination and language, as she can no longer walk and is not speaking her first words any longer. Her parents have also noticed that she has developed a peculiar behavior of wringing her hands for long periods of time.

Answer 24

Rett syndrome

Question 25

55-y/o female presenting with headaches and progressive visual loss. Physical exam reveals optic atrophy in the right eye and papilledema in the left.

Answer 25

Foster-Kennedy syndrome (commonly caused by a frontal meningioma causing elevated intracranial pressure and mass effect on a single optic nerve)

Question 26

52-y/o man who is 10 days s/p embolization of an anterior communicating aneurysm (following subarachnoid bleed) 10 days ago, now presents to the ED with an acute decline in mental status.

Answer 26

Vasospasm

Question 27

27-y/o man who is asymptomatic is found to have pigmented hamartomas of the iris and pigmented macules on his torso and upper back. Upon questioning, he mentions that father and brother also have these “dark spots” on their skin.

Answer 27

Neurofibromatosis type I

Question 28

63-y/o man recently diagnosed with lung cancer presents to the ED with acute onset of seizure activity. His family states that he has been more confused and fatigued lately. Hct is obtained and is normal.

Answer 28

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

Question 29

4-mo/o boy of Ashkenazi descent is brought in to see the pediatrician as his mom is concerned about his development. He no longer lifts his head, is less alert, and startles very easily. Upon physical examination, his doctor notices a bright red macula surrounded by a whitish ring.

Answer 29

Tay-Sachs

Question 30

2-mo/o boy w/ a 2-day history of fever, nasal discharge, and decreased oral intake. Upon physical examination, he is ill appearing, unresponsive to stimulation, and his anterior fontanelle is open and bulging. Fluid from lumbar puncture reveals increased WBC and protein levels and decreased glucose.

Answer 30

Acute bacterial meningitis (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae)

Question 31

65-y/o woman with a 4-month history of progressively worse headache presents for evaluation. A subsequent MRI reveals a mass involving the corpus callosum and both frontal lobes. Biopsy shows a poorly differentiated tumor with pleomorphic cells and nuclear atypia.

Answer 31

Glioblastoma multiforme

Question 32

61-y/o man presents with a broad-based unsteady gait. He denies vertigo. On physical examination, upper limb coordination is within normal limits, and without tremor. However, he is unable to walk in a straight line, and has nystagmus.

Answer 32

Cerebellar vermis lesion