QBank, Pretest Flashcards by jon wilson

Name that tremor: suppressed at rest and exacerbated toward the end of goal-directed movement

Essential tremor

IF RESTING TREMOR THINK PARKINSONS

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A patient comes in with severe episodic headache with sharp, stabbing unilateral eye pain, watering of the eyes and nose. No nausea or visual disturbances- diagnosis and treatment?

Cluster headaches

Treat with 100% O2

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What is the most common complication of psuedotumor cerebri?

Blindness

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A patient presents with unilateral motor deficit (face or arm), mild dysarthria, but NO higher cortical dysfunction- diagnosis?

Lacunar stroke in posterior limb of internal capsule causing pur motor hemiparesis

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A patient presents with unilateral numbness, parasthesias, and hemisensory deficit involving face, arms, legs, and trunk- diagnosis?

Lacunar stroke in VPL of thalamus cause pure sensory stroke

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A patient presents with weakness worse in lower extremities and incoordination- diagnosis?

Lacunar stroke in anterior limb of internal capsule causing ataxia and hemiparesis

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A patient presents with hand weakness and mild motor aphasia but NORMAL sensation- diagnosis?

Lacunar stroke at basis pontis

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A patient presents with sudden lower extremity weakness, loss of sensation in perianal area, loss of rectal tone, and urinary retention- treatment?

Emergent surgery, patient has spinal cord compression, possible cauda equina syndrome

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A patient with an essential tremor returns with new complaints of abdominal pain, hallucinations, dizziness, and headaches- what drug was he treated with?

Primidone- metabolized to phenobarbital caused acute intermittent porphyria

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Can you give opioids for severe acute pain in recovered addict?

Yes, but close follow up is necessary

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A patient presents with acute severe unilateral headache surrounding her eye associated with photphobia, vomiting, and seeing halos around light. Exam shows dilated, nonreactive pupil. Diagnosis?

Acute angle glaucoma- all other acute problems- headache- migraine or cluster, keratoconjunctivitis, temporal arteritis- would not have dilated and fixed pupil

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A patient presents with sudden worsening right sided weakness with headache and vomiting- where is the hemorrhage?

Putamen or internal capsule

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What does a positive pronator drift signify?

Upper motor neuron lesion

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What is trihexyphenidyl?

Anti-cholinergic used in younger patients with PD who have tremor as predominant symptom

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What electrolyte abnormality is associated with Subarachnoid hemorrhage?

Hyponatremia

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Name the tremor: present at rest and improves with goal oriented movement?

Parkinson’s tremor

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A patient comes in because she is concerned with her worsening memory- why is this a clue towards diagnosis? Treatment?

Patients with dementia rarely come in on their own and are brought in by family members. PSEUDODEMENTIA is the likely diagnosis as the patient herself is concerned with memory loss.
Tx is SSRI

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What is the hallmark cytotoxic injury associated with prolonged seizures?

Cortical laminar necrosis

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What part of the nervous system is affected by schistosoma mansoni?

Spinal cord

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What cranial nerve is most likely to be affected by sarcoid?

VII

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What parasite causes a large brain cyst with numerous daughter cysts?

Taenia echinococcus

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What is a common cause of recurrent meningitis?

CSF leak

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Treatment for JC virus/ PML?

HAART

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Herpes encephalitis can cause what changes to EEG?

Bilateral epileptiform activity

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Treatment for CNS lyme disease?

IV ceftriaxone

What tumor has hyperostosis?

Meningiomas

What cells are most likely to cause primary brain tumors?

Glial cells

A migraine patient presents with acute headache, photophobia and nausea. Besides NSIADs, what other class of drug can be used as monotherapy?

Anti-emetics such as prochlorperazine, metoclopramide

What is the first radiologic test for stroke work up?

CT without contrast- differentiates hemorrhagic vs other cause of stroke

How to differentiate pontine, cerebellar, and putamen hemorrhage?

Pontine- almost immediate paraplegia and deep coma Cerebellar- ataxia, gaze palsy, facial weakness Putamen- hemiparesis

Compare/contrast conus medullaris syndrome vs cauda equina symdrome?

Conus medullaris- sudden severe backpain with symmetric motor weakness and hyperreflexia Cauda equina- sudden bilateral radicular pain with asymmetric motor weakness and hyporeflexia Treatment is steroids and surgery eval

First line test for spinal cord compression?

MRI

What is a complication of subarachnoid hemorrhage in the first 24 hours? 3 days? Treatment for complication in 3 days?

24 hours- rebleeding is major cause of death | 3 days- vasospasm...treat with nifedipine

What disease causes diffuse cortical and subcortical atrophy more prominent in temporal and parietal lobes as seen on CT?

Alzheimer's

A HIV patient on TMP-SMX has multiple hypodense non-enhancing lesions in cerebral white matter on CT- diagnosis?

PML | If on TMP-SMX very unlikely to be toxo

A patient with facial muscle weakness has her forehead muscles spared- localize?

Lesion in CNS above the pons - would warrant brain imaging | This occurs due to bilateral UMN innervaton to the forehead

What is the most important stroke risk factor?

HTN, always

A Parkinson's patient presents with blurred vision, constipation, vomiting, and severe headache 2/2 medication- which calss?

Anti-cholinergic syndrome | Look for benztropine or trihexyphenidyl

Wallenberg syndrome- localize, artery, symptoms

Lateral medulla Vertebral artery Vestibulocerebellar (nystagmus, difficulty sitting up), sensory (abnormal facial sensation, loss of pain/temp in ipsilateral face and contralateral body), ipsilateral bulbar weakness (hoarseness, dysphagia), and autonomic dysfunction (ipsilateral horner's)

Lateral medullary lesion vs lateral pontine lesion?

Thinks cranial nerves! Medulla- IX and X causing hoarseness and decreased gag reflex Pons- V causing decreased facial sensation, weakness during chewing

Alternating hypoglossal hemiplegia- localize, artery, symptoms

Medial medulla Anterior spinal artery Contralateral paralysis of arm and leg, deviation of tongue toward the lesion

Patient presents with tinnitus, hearing loss, and cafe-au-lait spots. Diagnosis and best test?

NF II | Get MRI to show acoustic neuromas

CSF profile- normal glucose, normal protein, increased RBC and WBC

Herpes encephalitis | Viral meningitis has high protein

What is the description of a Parkinson patient's gait?

Hypokinetic- general slowing of activity

What nevre controls corneal sensation- as in damage to what nerve would result in patient unable to feel corneal abrasions?

V1 branch of trigeminal

A patient presents with cape like distribution of decreased pain/temp sensation- diagnosis and cause?

Syringomyelia via cord cavitation

An immobile patient from a nursing home has a partial thickness ulcer on her right heel over the bony prominence without any drainage or erythema- diagnosis?

pressure ulcer! nursing home, bony prominence, immobile are all clues

A patient presents with nausea and vomiting, receives medication, then develops neck stiffness- what medication did she receive?

Metoclopramide induced dystonia

What should be ruled out first when a patient presents with weakness and EKG changes?

Hypokalemia!

A patient has a ring enhancing lesion on CT, is immunocompetent and has sinusitis- what bug?

Streptococci or bacteroides are most common

A patient comes in disoriented and unable to give history. Pupils are reactive, movements are symmetric, vitals are stable. Next step?

Give thiamine, dextrose, and oxygen | If signs of heroin OD, add naloxone

What is the most likely early side effect of levodopa?

Hallucinations, confusion, somnolence | Takes 5-10 years to develop movement problems

A patient on warfarin comes in with intracranial bleed- what do you give first, vitamin K or FFP?

FFP is immediate | Vitamin K takes 8-12 hours

Atrophy in the caudate nucleus with Huntington's increases the size of what structure?

Lateral ventricle

Neurons in the substantia nigra of a Parkinson's patient display what?

Intracytoplasmic inclusion bodies- Lewy bodies

A 35 year old man with cerebellar dysfunction, erythrocytosis, and hepatosplenomegaly- diagnosis? What will be seen on retinal exam? What carcinoma is commonly associated with this disease?

von-Hippel Lindau disease Telangiectasias on the fundus Renal carcinoma which can spread to spinal cord

What disorder is associated with adenoma sebaceum of the face? What can be seen on X ray or CT of the skull?

Tuberous Sclerosis | Calcifications showing subependymal glial nodules

How does alcohol affect the fetal CNS?

Impairs neuronal migration leading to many effects

What blood test is elevated in Duchenne's?

CPK

What is the most common site for chronic alcoholism to affect the brain and what cells are affected?

Cerebellar vermis and purkinje cells

What disease causes retinal microaneurysms- DM or HTN

DM | HTN causes narrowing of retinal arterioles

A patient has double vision that disappears when one eye is covered- diagnosis?

6th nerve palsy

What nerve that affects vision is most likely to be injured with trauma to the face?

CN IV

Amaurosis fugax is typically associated with which aretery?

Internal carotid

What is the artery of adamkiewicz/ great anterior medullary artery?

arises from aorta at T10-L1 and supplies thoracic vertebrae- implicated in ischemic spinal disease

Name a class of medications used for prophylaxis of migraines?

beta blockers

An Alzheimer's patient on donepezil is worsening, what is another medication that can be offered?

Memantine, NMDA receptor antagonist

A patient comes in with a significant headache and no other symptoms. CT scan is normal- next step?

Get LP and rule out subarachnoid hemorrhage

What disease strips myelin from axons via macrophages in a patchy fashion throughout the peripheral nervous system?

GBS

What autosomal dominant disorder presents with ptosis, temporal atrophy, atrophy of the SCM, frontal baldness, testicular atrophy, and inability to relax a firm hand grip?

Myotonic dystrophy

A patient presents for pre op clearance and says her father died during an operation after developing a high fever- what test should you do before surgery?

Caffeine-halothane contraction test

What electrolye abnormality is associated with periodic paralysis following meals, exercise or stress?

Potassium- both hyper and hypokalemia

What medication improves outcome for intracranial hemorrhage?

Ca channel blockers

A young otherwise healthy adult presents with acute ischemic transformation of her left parietal-temporal region- what are two possible causes?

illicit drug use | Carotid dissection