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Neurology > Part 2 > Flashcards

Part 2 Flashcards

1
Q

20y Marine, headache, confusion, purpuric rash, 103 degree fever? Dx?

A

= Bacterial Meningitis: PMN predominance, increased protein, low glucose

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2
Q

42y Secretary with headache. Now stiff and unresponsive? Dx?

A

= Subarachnoid Hemorrhage: Stiff and Unresponsive

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3
Q

31y M from haiti. Feels tired, dull headache. Taking Isoniazid? Dx?

A

= Tuberculosis: Lymphocyte predominance, increased protein, low glucose

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4
Q

50y M hospitalized with 3 days of progressive painless weakness in the lower limbs with areflexia? Dx

A

= Guillain Barre: Increased Protein, Lymphocyte predominance, Normal glucose

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5
Q

27y Female. Overweight. 1 wk diffuse headache. Bilaterally blurred optic discs and flame hemorrhage. MRI normal? Dx

A

= Pseudotumor Cerebri: MASSIVELY INCREASED Opening pressure, normal protein and glucose

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6
Q

70y policeman. Blindness for 20 minutes in the right eye last night that lasted for 20 minutes. History of DM, HTN. On presentation, neuro exam and visual exam normal? Dx?

A

= TIA of R internal carotid artery

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7
Q

Elderly man. Unresponsive. Taken to ER. BP 200/110. Normal vitals otherwise. Shallow breaths. Pupils 2mm reactive. Moans, no response to noxious stimuli. CT “Shown”. ? Dx?

A

= Hypertensive Cerebral Hemorrhage

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8
Q

65y M with 1 wk lower back pain that radiates to foot. Painful vesicles over R shin, dorsal foot, great toe. Pain prevented sensory exam. ⅘ dorsiflexion of the right foot. ? Location?

A

= Lesion in L5 root

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9
Q

24y M in a head on collision and pulled out of car. Unable to move hands/lower limbs. Smoker. BP 100/65. Upper limbs 5/5 strength. 0/5 strength in lower limbs. Reflexes 2+ in upper limbs, Reflexes absent in lower limbs. Pain and temp not present below neck? Location?

A

= Spinal cord trauma C8/T1

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10
Q

28y F aimlessly turning knob on dishwasher. She is awake-appearing. Does not answer/follow commands. After 5 minutes, leaves to nap in her room. Upon waking, she is alert but cannot remember the event? Dx?

A

= Complex partial seizure

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11
Q

22y F with brief, severe mandible pain provoked by talking? Dx?

A

= Trigeminal neuralgia

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12
Q

75y F in the ER with slurred speech and clumsy left arm. MI 5 years ago. No cardiac symptoms. On aspirin, digoxin, potassium, and furosemide. BP 180/85, Pulse 88. Temp 37.2. L palate does not elevate. Voice hoarse. L dysmetria. L face pain/temp decreased. Proprioception/vibration intact. R body pain/temp decreased. ? Location?

A

= Left lateral medulla lesion (Wallenberg)

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13
Q

52y M. Trouble opening jars w/ right hand for 3 weeks. History of rheumatoid arthritis and on 10mg Prednisone. BP 135/78. R dorsal interossei are weak. 5/5 strength everywhere else? Location?

A

= R C8 root lesion

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14
Q

55y Businessman. 3 months progressive trouble finding words/reading. MRI shows L perisylvian mass. Pathology report is poorly differentiated carcinoma?

A

= Metastasis from lung most likely

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15
Q

18y F. Generalized tonic-clonic seizures since 6 months old. On 300mg phenytoin. Good seizure control but experiences clumsiness/slurred speech for past 2 days. Falls when walking straight line. Dysarthric. Mild nystagmus in all directions. Strength/sensation intact. What test do you order?

A

= Order serum phenytoin levels

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16
Q

52y F waitress. Worsening frontal headache over the past few weeks. Transitions from silly to depressed often. Taking Ibuprofen PRN. Vitals normal. Intermittently giggles. MRI is “shown”. What kind of lesion is this?

A

= Astrocytoma (not meningioma because of acute onset)

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17
Q

16 y student presents with weak legs after a diving accident. Has trouble walking. Lower limb strength ⅘. Difficult to move lower legs. Stiff/spasm of legs. Clonus at the knee and ankle. Bilateral babinski signs. Upper limbs are normal. How do we treat this?

A

= Baclofen

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18
Q

47y M poorly controlled diabetic. Wakens with L limb paralysis. BP 165/85, Pulse 76, Temp 37. Left upper and lower limbs ⅘ strength, increased Left reflexes, Left babinski. Cannot raise R eyebrow. R facial droop. Eye maneuvers are normal. Where is the lesion?

A

= Right Pons

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19
Q

56y M with sensation of burning feet when trying to sleep at night. Feet are sensitive to light touch. Pain and temp decreased in lower extremities. Position and strength are intact. Reflexes 2+ in upper limbs and 1+ in lower limbs. CBC and blood labs are normal. How do we treat this?

A

= Carbamazepine

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20
Q

4y M constantly falls when running. He must hang on to furniture to rise. Enlarged calves? Dx?

A

= Duchenne Muscular Dystrophy

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21
Q

59y carpenter. Ache behind L ear. Can’t taste breakfast well. Drools when drinking coffee. Vitals normal. Facial/forehead paralysis? Dx?

A

= Bell’s palsy

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22
Q

63y F with episodes for minutes of R hand clumsiness. No pain/tingling. 60 pack year smoking history. Diabetic. Soft systolic murmur. Normal neuro exam. Normal brain MRI, carotid duplex, echo, CBC. Abnormal EKG. What medicine should we prescribe for this patient to prevent these episodes?

A

= Warfarin with target INR of 2.5

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23
Q

60yM with HTN. Has L hemiplegia, L visual field deficit. MRI shows R fronto parietal temporal infarct. Suddenly he becomes difficult to arouse but is breathing normally. What medication do we start immediately??

A

= Mannitol

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24
Q

73y M is unresponsive. Temperature is 33 degrees celsius. No vestibulo ocular reflex. No pupillary reflex. On mechanical ventilation. Failed apnea test. What do we do??

A

= Warm the body before pronouncing dead. (MUST BE WARM AND DEAD)

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25
Q

62y/o smoker, 10lb weight loss, cant walk farther than 50ft; reflexes elicitable only after 5s of strong isometric contraction? Dx? Path?

A

= Lambert eaton syndrome- impaired release of Ach

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26
Q

30y/o female with a droopy left eyelid, double vision after reading for 30min? Dx, Rx?

A

= myasthenia gravis- loss of Ach receptors

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27
Q

16 y/o nausea/vomiting, speech slurred, trouble swallowing, post family picnic? dx Rx?

A

= Botulism- Impaired release of Ach

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28
Q

Patient had a stroke of 12 hours duration? TPA?

A

= Can’t give TPA, but still within the timeframe for a thrombectomy (24hrs), so you need to do emergent angiography or stenting

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29
Q

Right inferior quadrantanopia? Location?

A

= Left parietal lobe lesion

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30
Q

In the OR s/p CABG, woman gets stiff, clenches teeth, has vigorous flexion-extension movements of all limbs- movements continue for 30 minutes; therapy?

A

= lorazepam 2-4mgIV push over 5 minutes

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31
Q

Pt right handed, confused and wandering through the woods, cannot follow written commands? Lesion, location?

A

= Language deficits with poor comprehension= lesion in the left superior temporal lobe

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32
Q

40 y/o woman, continuous involuntary scratching, grasping, and turning movements for the last year- Huntington’s disease. The most specific diagnostic test?

A

= Inc trinucleotide repeats on a specific chromosome

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33
Q

42 y/o woman with involuntary turning of her head to the right throughout the day, which can be suppressed temporarily by resting her chin on her hand? Dx rx?

A

= cervical dystonia; treat with Botox

34
Q

Woman with history of breast cancer post chemo, now in remission for 3 years, and presenting with generalized tonic-clonic seizures; MRI shows 3 ring enhancing lesions= Complication of Chemotherapy?

A

= immunosuppression

35
Q

8 y/o boy kept after school for not paying attention in class- teacher always observes him staring into space? Dx rx?

A

= Absence seizures- Treat with Ethosuximide, Valproate

36
Q

30 yr old man, 3 yr history of numbness and weakness in the right or left lower limb every 4-6 months. Symptoms resolve without treatment in 7-10 days. Electrical sensation down his back whenever he flexes his necn. On exam, limbs are strong with normal sensation except decreased vibration at both ankles. He has ankle clonus and babinski sign bilaterally; nystagmus only on left gaze? Dx, Rx?

A

= Probable MS- Treat with parenteral beta interferon

37
Q

8 y/o becomes unresponsive after MVA. Right pupil is blown and unreactive to light? Dx?

A

= Right optic nerve lesion

38
Q

35 y/o man post trauma–>generalized tonic-clonic seizures controlled with phenytoin (300mg/day) for 1 month. Serum phenytoin is 15mg/dL (normal is 10-20)? Rx?

A

Tx= Inc phenytoin to 350mg/day

39
Q

Trigeminal neuralgia Rx?

A

= Carbamazepine

40
Q

2 y/o man, receiving CPR and on ventilator= sudden jerks of the limb or whole body what is this?

A

= Myoclonus (poor prognostic indicator)

41
Q

Retired teacher, tremor of the right hand and chin that only occur when quietly seated and watching TV? Lesion, location?

A

= Parkinson’s- substantia nigra problem

42
Q

Cook with postural Bilateral hand tremor? Lesion, location?

A

= Essential tremor- unknown anatomic site lesion

43
Q

Woman in cardiac rehab with involuntary flinging movements of right upper limb? Lesion, location?

A

= hemiballismus- contralateral subthalamic nucleus lesion

44
Q

Receptionist, undershooting target when she picks up the phone in her right hand? Lesion, location?

A

= Dysmetria= Ipsilateral cerebellar hemisphere lesion

45
Q

Professional pianist with involuntary spasms of his right fingers which curl into a fist? Lesion, location?

A

= Focal dystonia= substantia nigra lesion

46
Q

“Sense of motion” w/ activity such as bending over. Takes B12. when head is lowered on exam table gets nystagmus when head is turned to the right. But no nystagmus when head is turned to the left?

A

benign vestibular dysfx

47
Q

3 YO with 3 months of periodic diplopia. Weak chewing/arms/ SOB that required mechanical ventilation in ER. bilateral ptosis. IV tensilon test improves symptoms. How to regain strength quickly?

A

plasmapheresis

48
Q

73YO with gait ataxia, h/o stroke. Takes diltiazem, glyburide and HTN meds. In hospital develops diplopia, dysarthria. MRI shows increased signal on FLAIR. Where is the infarction?

A

pons

49
Q

Patient kicks spouse at night. (very obvious RLS patient. How to you relieve symptoms?

A

levodopa

50
Q

TBI, generalized tonic clonic seizures that have been repetitive for the past hour. Glucose and electrolytes are normal. IV meds in ER do not help. What other meds can you give?

A

20 meq of fosphenytoin

51
Q

60YOM confusion over the past month. Multiple car wrecks recently and over drawn his bank account. 50 pack year smoking history. Ataxia for 1 week. Distal weakness in lower extremity, no ankle reflexes, 2+ reflexes everywhere else with decreased pin and temp in feet. Patien is positive for anti-HU antibodies. What caused these symptoms?

A

SCcarcinoma

52
Q

Know the indications for carotid endarterectomy or stenting?

A

cervical internal carotid at 80%…. 100% stenosis is inoperable,

53
Q

Patient with frontal HA, aphasia, generalized tonic clonic seizures. Unresponsive, 40 degree celsius fever. Given anti convulsive. What else should you do for patient?

A

give acyclovir.. (implied that this is herpes encephalitis)

54
Q

20 YO found down. Sleepy agitated. In ER he is fully awake with no recollection and is fully cooperative. What likely happened?

A

generalized seizure

55
Q

22 year old wakes up blind in R eye.. Was partially blind in L eye last year which resolved w/o treatment. How to treat??

A

methylprednisone 25mg IV Q6

56
Q

Occipital HA, clumsy Rarm and Rleg, chronic abd pain. 10 lb weight low. CT shows cerebellar mass. In hospital patient had slurred speech and unarousable w/ O2 92%. What therapy do you give?

A

Lactulose, naloxone, thiamine, dexamethasone or methylphenidate… i think the answer is dexa not sure

57
Q

Cant climb stairs, progresses to the point where cant get out of bed or wiggle toes, weak lower extremities and weak finger flexion. Upper arms have no deficits. Decreased vibration/positions in feet.? Dx?

A

GBS

58
Q

65 with memory impairment for 6 months, gets lost alot, making poor decisions. No neuro PMH. what would you find? Rx?

A

amyloid plaques in hippocampus

- donepezil

59
Q

30 yo with wrist drop, tricep weakness, 2+ reflexes everywhere except tricep is +1. What part of arm is injured?

A

Radial neuropathy from mid humerus.. (cant remember if this is correct)

60
Q

50 M 2 weeks weakness in deltoids, biceps, and brachioradialis. Also neck pain radiating to right shoulder. Tingling numbness in right thumb. Which nerve involved?

A

C8

61
Q

77M, neck pain, decreased pain/tmep clavicles to belly button. Normal strength and sensation in limbs.

A

syringomyelia

62
Q

52W, falls d/t weak left leg. Ankle clonus and babinski in L ankle. Decreased proprioception in left toes. Right leg strong, with decreased pain/temp?

A

Brown Sequard,

63
Q

70M acute back pain and paraplegia w/ decreased pin/temp with proprioception intact?

A

Anterior Spinal Artery Syndrome

64
Q

5W, spastic lower limbs and babinski with +3 reflexes. Upper limbs normal. Low proprioception in feet?

A

Sub acute combined degeneration,

65
Q 
0W obese, numb tingling feet w/ some trips and falls. Increased urination. Diminished dorsiflexion and toe extension in left foot. Which lab would be abnormal?
AIC
ESR
CK
Serum Protein
TSH
A

A1C

66
Q 
59W, 1 month trouble combing hair and achy on climbing stairs. ⅗ weakness in neck, delts, tris, bis, hips, and quads. Diagnosis?
Spinal stenosis
Cervical myelopathy
Myotonic Dystrophy
Polymyositis 
Dermatomyositis
A

Myotonic Dystrophy

67
Q

Drowning victim with seizure not responding to benzos? . Drug target??

A

Na Channels

68
Q
  1. 24W with migraines?. Drug target??
A

Serotonin

69
Q
  1. 35M with command auditory hallucinations and delusions?. Drug target??
A

Dopamine

70
Q
  1. 20W with ptosis and slurring of speech after lecturing 6 hours?. Drug target??
A

Ach

71
Q
  1. 75M with alzheimer’s. Drug target??
A

Ach

72
Q 
32M 1 week progressive painless weakness in lower limbs, hands, face. Mildly numb both feet. 0/5 strength in legs, ⅗ arms. Dyspnea, slurred speech, chokes on food. No reflexes. How to feed?
TPN central catheter
Liquid Diet NG Tube
PEG, liquid diet
PO, with aspiration precautions
A

TPN central catheter

NG?

73
Q 
80M hard time walking and 2 falls x 1 month. No dizziness or LOC. Says loses control of legs. Bent over and stooped walking with small steps to turn. Staggers when lightly pushed. Rigid arms and legs. How to Diagnose?
CT
MRI
EEG
LP
No Test
A

NO TEST

74
Q 
72W 2 weeks choking on food 15 lb weights loss. Weak arms with legs spasms. Normal sensory. Vertebral compression fracture year ago. Slurred speech, slow tongue movement. Tongue and limb fasciculation. Babinski. Diagnosis?\
ALS 
Botulism
GBD
Epidural cord compression
Polymyositis
A

ALS

75
Q 
35M, shaky hands and trouble writing, father same issue. Shaky hands when arms extended. Rx?
L Dopa
Propranolol
Trihexyphenidyl
Haloperidol
B. toxin
A

Propranolol

76
Q 
46M falls asleep while talking. When started, falls limp to floor. Vivid dreams. Diagnosis.
REM Disorder
OSA
Central sleep apnea
Narcolepsy
Complex partial narcolepsy
A

Narcolepsy

77
Q 
73W shaking right hand. Slow shuffling gait. Rocks to stand up from chair. Given med now hallucinating. Upper arms twisting and turning. What was given?
L dopa
Haloperidol 
Propranolol
Diazepam
Donezepil
A

L dopa

78
Q 
1 month URI symptoms. 47M with weakness. Legs ⅗, feet 0, Arms normal, no reflexes. Speech slurred, falling out of bed. Rx?
Methylprednisolone
Beta interferon
Pyridostigmine
IVIG
Azathioprine
A

IVIG

79
Q 
32W, diplopia. Left eye cannot adduct to look right Right fully abducts with nystagmus. Normal left up and down movement. Pupils react normal. Lesions?
CN III
CN VI
MLF
Tectal midbrain
Left frontal eye field
A

MLF

80
Q 
8W 2 weeks dull HA and nausea on OCPS, febrile. 20/25 vision. Normal disks and lifght reflex. Bitemporal hemianopsia. Problem?
Pinealoma
Pituitary adenoma
Pontine tumor
Bilateral occipital lobe tumor
MS
A

Pituitary adenoma

81
Q 
Same patient now has tingling in legs and feet and ataxia a week later. Brain scan with normal findings. Which CSF studies to order?
Oligoclonal bands
VDRL 
Cytology
Viral culture
PcR HSV
A

Oligoclonal bands

82
Q 
32M entering detox confused and unsteady gait. Nystagmus with limited eye movement. Falls when walking on straight line. Rx?
Diazepam
Haloperidol
Thiamine
B12
Steroid
A

Thiamine

Neurology (37 decks)

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