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Shelf Exams/USMLE Step 2 CK ❄️ > UW-Med/Neuro > Flashcards

UW-Med/Neuro Flashcards

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USMLE® Step 1 flashcards
1
Q

What sort of lesion does pronator drift represent and why?

A

UMN lesion -> Cause weakness in supination, pronator muscles become dominant

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2
Q

What major functions is the parietal lobe responsible for?

A

Sensation, perception, integration of sensory inputs

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3
Q

What cranial nerve is primarily affected in diabetic peripheral neuropathy and how? What results?

A

Ischemic injury of CN III –> Somatic fibers affected (parasympathetic left intact) –> Ptosis and down/out gaze

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4
Q

What results from compression of CN III?

A

Ptosis, down and out gaze, a fixed dilated pupil, and no accommodation reflex

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5
Q

What are the clinical features consist with stroke + intracerebral hemorrhage?

A

History of uncontrolled HTN, caogulopathy, illicit drug use (meth, cocaine)

Symptoms progress over minutes to hours

Early focal neuro sx –> followed by sx of increased ICP (vomit, bradycardia, headache)

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6
Q

What are the characteristics of an ischemic thalamic stroke (Dejerine-Roussy Syndrome)?

A

Contralateral hemianesthesia, transient hemiparesis, athetosis or ballistic movements, and Dysesthesia (thalamic pain phenomenon)

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7
Q

What is progressive ascending paralysis over hours to days indicative of? What are some characteristics of this type of paralysis?

A

Tick-borne paralysis (check body thoroughly for tick and remove)

Localized or more pronounced in 1 leg/arm

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8
Q

What are characteristic features of the paralysis in GBS and how do you treat this?

A
  1. Ascending symmetrical paralysis over DAYS/WEEKS
  2. Autonomic dysfxn (tachycardia, urinary retention, arrhythmia)
  3. High protein and few cells in CSF

Tx: IVIG or plasmapheresis

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9
Q

What are the characteristic features of Central Cord syndrome and which populations are primarily affected?

A

Occurs with hyperextension injuries in elderly patients with pre-existing degenerative changes (OA, spondylosis etc.)

Pronounced weakness and sensation loss in UE (selective loss of pain/temp possible)

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10
Q

What are the features of anterior cord syndrome, and who is at risk of this?

A

bilateral spastic motor paresis distal to lesion and pain/temp loss

Occlusion of anterior spinal arteries (aortic repair surgery, Ao aneurysm etc.)

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11
Q

A patient with extensive history of opioid abuse presents to ED with severe injuries after being hit by a car. He has excruciating pain, how should you treat?

A

IV morphine (greater chance of relapse if pain not treated adequately)

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12
Q

What are the features of Lewy body dementia? How can you treat?

A

Alterations in consciousness, disorganized speech, visual hallucinations, extra-pyramidal symptoms, early compromise of executive functions

Tx: Acetylcholinesterase inhibitors (Rivastigmine)

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13
Q

What are the clinical features of multiple lacunar strokes?

A

Vascular dementia - Dementia with patchy focal neurological findings (depending on infarct location). Numerous old infarcts on MRI

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14
Q

What over the counter Rx can potentiate the effects of Warfarin and what could result from this?

A

Acetaminophen –> Warfarin associated intracerebral hemorrhage

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15
Q

What is the MoA and use of Riluzole?

A

Glutamate inhibitor used in Tx of ALS

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16
Q

What is a major cause of nonexertional heatstroke? Exertional?

A

NE: Patients with chronic medical conditions (from medication/underlying illness)

Ex: Inadequate/failure of thermoregulation (in otherwise healthy ppl undergoing condition in extreme heat/humidity)

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17
Q

What is a typical presentation for cerebellar tumor?

A

Ipsilateral ataxia (difficulty maintaining balance), patient falls toward side of lesion, Nystagmus, intention tremor, difficulty coordinating movement, headache, nausea, progressive/chronic onset

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18
Q

What is a characteristic movement of someone with hemiparesis?

A

Usually in patients following stroke -> affected arm is adducted and leg extended, leg is swung in outward semicircles as patient walks

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19
Q

What are dystonias? Akathisia? Athetosis?

A

Dystonia = Sustained muscle contraction resulting in twisting, repetitive movements, or abnormal postures

Akathisia = sensation of restlessness causing patient to move frequently

Athetosis = slow writhing movements, typically affecting hands/feet

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20
Q

A patient presents with migraine headaches associated with nausea/vomit and photophobia. What is the best initial step in management?

A

IV antiemetic (Prochlorperazine, chlorpromazine, or metoclopramide) as monotx or with NSAIDs/Triptans

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21
Q

What are the symptoms of hypothyroidism?

A

Weight gain, fatigue, constipation, hoarseness, and memory changes

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22
Q

What are the clinical features and risk factors for multi-infarct dementia?

A

Stepwise deterioration with psych disturbances like depression/agitation

Risks = vascular disease, history of cerebrovascular disease, evidence of strokes on imaging

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23
Q

What region is most commonly involved in ulnar nerve syndrome? How may this arise?

A

Ulnar nerve entrapment in elbow at medial epicondylar groove; like from prolonged inadvertent compression of nerve by leaning elbows on desk for long time

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24
Q

What are the clinical features and infarct location in Wallenberg syndrome?

A
  1. Vestibulocerebellar - vertigo, falling to side of lesion, diplopia/nystagmus
  2. Sensory sx - Loss of pain/temp on ipsilateral face and contra trunks/limbs
  3. Ipsilateral bulbar muscle weakness - Dysphagia/aspiration, dysarthria, dysphonia, HOARSENESS
  4. Autonomic dysfunction - Ipsilateral Horner’s, lack of automatic respiration, hiccups

Loc = Lateral Medullary from infarction of intracranial vertebral artery

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25
Q

How can you differentiate lateral/mid pontine lesions from those in the medulla?

A

Pattern of cranial nerve involvement:
Lateral pons = motor/principal sensory nuclei of CNV (weak chewing, impaired facial sense),

Lateral medullary = dysphagia, hoarseness and diminished gag (CN IX, X)

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26
Q

What are the signs of a medial medullary syndrome (from stroke), which vessels are affected?

A

Branch occlusion of vertebral/anterior spinal arteries –> Alternating hypoglossal hemiplegia; contralateral paralysis of arm/leg, tongue deviation to side of lesion, contra loss of tactile/position sense (with dorsal extending infarcts)

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27
Q

What are the signs of medial mid-pontine lesions?

A

Contralateral ataxia, hemiparesis of face, trunks, limbs (i.e. ataxic hemiparesis) and variable loss of contra tactile/position sense

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28
Q

What are the clinical signs of severe hypokalemia? What can predispose patients to this?

A

Motor: Weakness/cramps, flaccid paralysis, hyporeflexia, tetany, rhabdomyolysis
CV: Arrhythmia, broad flat T waves, U waves, ST depression, premature ventricular beats (a-fib, v-fib, torsades possible)

Look out for Potassium wasting diuretics, hydrochlorothiazide!!!

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29
Q

What are the clinical signs of ALS?

A

UMN/LMN affected with sparing of sensation/cognition –> Weakness, difficulty chewing, swallowing, coughing, breathing

Hyperreflexia, spasticity, fasciculations

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30
Q

What are the clinical features of lumbar spinal stenosis?

A

Back pain radiating to butt/thighs that interfere with walking/lumbar extension

Lumbar flex improves symptoms

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31
Q

What should you consider if a patient has weakness with no UMN/LMN signs?

A

Neuromuscular junction disorder (MG, Eaton-lambert) or muscle fiber itself (polymyositis)

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32
Q

What are the cardinal signs of Myasthenia gravis?

A

Extraocular muscle weakness (diplopia,ptosis), symmetrical proximal weakness of extremities (upper > lower), neck muscle weakness, bulbar muscle weakness ( dysarthria/dysphagia)

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33
Q

What are the symptoms of fibromyalgia?

A

Multiple well defined, localized tender muscle points. May have proximal pain-limited weakness (but not ptosis, diplopia, dysphagia as in MG)

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34
Q

What triad is associated with Wernicke’s syndrome?

A

Encephalopathy, oculomotor dysfunction, gait ataxia

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35
Q

What are the key features of Multiple System Atrophy (Shy-Drager Syndrome)?

A
  1. Parkinsonism
  2. Autonomic dysfunction (postural hypotension, abnormal sweating, disturbance of bowel/bladder, abnormal salivation, lacrimation, impotence, gastroparesis etc.)
  3. Widespread neuro signs (cerebellar, pyramidal, or LMN)
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36
Q

What is the most common cause of non-trauma SAH? Top 2 causes of intracerebral hemorrhage?

A

SAH - saccular “berry” aneurysm

ICH - 1. HTN 2. Amyloid angiopathy

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37
Q

What is the most appropriate management step for a patient who has severe myasthenia crisis, with weak respiratory effort?

A

Intubation (do not increase pyridostigmine dose as this will increase risk of aspiration from excess secretions)

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38
Q

What are the first, second and third line treatments for Myasthenia gravis?

A
  1. Pyridostigmine
  2. Add immunotherapy (glucocorticoids, azathioprine, mycophenolate mofetil & cyclosporin)
  3. Crisis => Plasmapharesis/IVIG + Glucocorticoids
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39
Q

What is a good way to differentiate pseudodementia from Alzheimer’s?

A

With Pseudo, patients are overly concerned of their memory loss and will seek help

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40
Q

What type of drug is Trihexyphenidyl and what will result from toxic levels?

A

Antimuscarinic drug used in the treatment of Parkinson’s in Younger patients with pronounced tremor

Toxicity = Anticholinergic excess (Red as a beet, dry as a bone, hot as hare, blind as a bat, mad as a hatter, and full as a flask) and it can precipitate acute glaucoma causing retro-orbital pain

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41
Q

What are the key features of serotonin syndrome?

A

Agitation, confusion, tachycardia, muscle rigidity, sometimes seizures

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42
Q

What type of drug is bromocriptine and what are it’s toxic effects?

A

Dop agonist

Toxic = Hypotension, nausea, constipation, headache and dizziness

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43
Q

What spine lesion is common among diabetic patients?

A

Epidural Abcess

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44
Q

What are the clinical features and findings in a patient with idopathic intracranial HTN (pseudotumor cerebri)?

A

Young obese women, transient vision loss, pulsatile tinnitus, diplopia

Papilledema, peripheral vision defect, CN VI palsy (empty Sella in ~70%)

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45
Q

How do you treat idipathic intracranial HTN?

A

medical cause -> stop offending medication (e.g. glucocorticoids, vitamin A, OCP)

Idiopathic -> weight loss and acetazolamide if that doesn’t work

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46
Q

What is the most serious complication in idiopathic intracranial HTN and how can it be avoided?

A

Visual defects can progress to blindness

VP Shunting or optic nerve fenestration can prevent

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47
Q

What are the treatment options for essential tremor?

A

Propranalol (beta blocker) and Primidone (anticonvulsant that converts into phenobarbital)

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48
Q

What is a risk factor associated with using Primidone?

A

May precipitate acute intermittent porphyria -> abdominal pain, confusion, headaches, hallucination, dizziness (neuropsych abnormalities)

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49
Q

What type of drug is Clozapine and when is it used?

A

Atypical antipsychotic used for schizophrenia and rarely for essential tremor (if refractory to propranalol and Primidone)

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50
Q

What are the clinical features associated with CJD?

A

Rapidly progressive dementia, myoclonus, and sharp triphasic synchronous discharges on EEG

51
Q

What abnormality results in Huntington’s disease?

A

Autosomal dominant mutation on chrom 4 in huntingtin gene (increased CAG repeats)

52
Q

What is the best therapy and management in a patient with a solitary brain metastases from NSSLC?

A

Surgical rsxn of mass followed by Stereotactic radiosurgery or whole brain radiation therapy (Start with SRS for nonsurgical candidates)

53
Q

What is Brachytherapy?

A

Implant of radioactive source directly into intracerebral mass or surgical cavity –> delivers higher radiation dose to the brain region without affecting other organs

54
Q

What are key signs of cerebellar dysfxn as in alcoholic cerebellar degeneration?

A

Progressive gait dysfunction, Truncal ataxia, Nystagmus, Intention tremor/dysmetria, Impaired rapid alternating movements, muscle hypotonia which leads to pendular knee reflex

55
Q

Is Babinski sign present with cerebellar disease?

A

Not likely if pathology is confined to cerebellum

56
Q

What are the key features of Normal pressure hydrocephalus?

A

Ataxia early in disease, Urinary incontinence, Dilated ventricles on neuroimaging

57
Q

What is steppage gait and how does it arise?

A

Footdrop with excessive hip/knee flexion while walking, slapping quality, frequent falls

Motor neuropathy (#1 of L5 radiculopathy and #2 of common peroneal nerve)

58
Q

What may result from sensory neuropathy in the leg/foot?

A

Loss of proprioception leads to postural/gait instability and wide based gait, and a “SLAP” gait as patient stomps foot down to identify their location

59
Q

How do you differentiate cauda equina syndrome and conus medullaris?

A

Cona Medullaris -> Hyperreflexia, Symmetric weakness, early onset bowel/bladder sx

Cauda Equina -> Hyporeflexia, asymmetric, late onset bowel/bladder sx

60
Q

What is the most common cause of brain abscesses?

A

50% - Head/neck infection (sinusitis) from Viridans strep and other anaerobes

25% - Staph Aureus (lung/heart infection hematogenous spread)

61
Q

What can cause acute angle closure glaucoma?

A

Pupillary dilation from meds (anticholinergic, sympathomimetics) or dim light

62
Q

What is the best choice of treatment for elderly patients with delirium (from infection/metabolic derangements)? Younger patients?

A

Low-dose Haloperidol - elderly

Lorazepam/benzos - young

63
Q

What is the most characteristic sign of dementia in elderly?

A

Impaired daily functioning

64
Q

What are the characteristic features of Creutzfeld Jakob disease?

A

Rapidly progressing dementia and myoclonus, insomnia, apathy, behavioral changes, and impaired vision (eventually lose ability to move/speak -> comatose)

65
Q

What are the signs of intracranial HTN?

A
  1. Headache (worse at night), N/V, AMS
  2. Focal neuro signs: Vision changes, unsteady gait, seizure
  3. Sx worsen w/ leaning forward, Valsalva, cough
  4. Papilledema and focal neuro defects
66
Q

What are the clinical features of acute angle closure glaucoma?

A

age >60, conjuctival erythema, mild dilated pupil poorly reactive to light, frontal HA/eye pain, blurry vision

67
Q

What are the 4 most common lacunar syndromes? Location? Presentation?

A
  1. Pure motor hemiparesis of ipsi face/arm/leg; Post limb of internal capsule
  2. Pure sensory stroke; VPL of thalamus; unilateral paresthesias & hemisensory deficit
  3. Ataxic-hemiparesis; Anterior limb of internal capsule; Prominent LE weak & ipsilateral leg/arm incoordination
  4. Dysarthria/clumsy hand syndrome; basis pontis; Hand weak, mild motor aphasia, NO sensory problems
68
Q

A patient w/ severe N/V is given Metoclopramide, and 2 hrs later develops neck pain and stiffness. How do you treat?

A

Discontinue anti-emetic, administer benztropine or diphenhydramine

69
Q

What are key signs of lumbar spinal stenosis, and what are the main causes of this? How can you confirm the diagnosis?

A

Low back pain, exacerbated by spine extension (walking downhill or standing), improved by spine flexion (walk uphill or sitting), weak, sensory loss, numb/tingle

Causes = Degenerative joint disease (disc herniation, facet osteophytes)

Spine MRI to confirm

70
Q

How does ankylosing spondylitis usually present?

A

Young males (15-30) low back pain, limited spinal mobility, sx better w/ exercise, HLA B27

71
Q

What are major causes of idiopathic intracranial HTN (pseudotumor cerebri)?

A

Overweight female of childbearing age, Links to certain medication (growth hormone, tetracyclines -mino/doxycycline), Hypervitaminosis A

72
Q

What is the first thing that should be done when considering a Dx of Myasthenia Gravis?

A

CT scan of chest to rule out Thymoma (present in 15% of patients)

73
Q

What are the clinical features of infectious cavernous sinus thrombosis?

A

HA –> Intolerable HA, Low grade fever, periorbital edema, binocular palsies, vomit and papilledema from increased ICP, and sx can quickly spread bilaterally.

74
Q

What is the source of most emboli causing strokes/TIA (e.g. isolated vision loss), and what study should be done to confirm?

A

Carotid bifurcation –> conduct duplex ultrasound of neck to confirm

75
Q

What are the features of benign paroxysmal positional vertigo (BPPV)? How does this dz arise?

A

Recurrent brief episodes of vertigo brought on by predictable head movement/position change, No neuro/auditory symptoms, Dix-Hallpike maneuver causes nystagmus

Cause= Semicircular canal dysfxn, from dislodged crystalline deposits (canaliths)

76
Q

What cardiovascular dysfxn can lead to dizziness and what are common symptoms?

A

Causes = Aortic Stenosis, Arrhythmia, hypovolemia

Global cerebral hypoperfusion -> lightheaded/presyncope (not vertigo)

77
Q

What are the main early SEs of levodopa/carbidopa and other Dop agonists? Amantadine?

A
  1. Somnolence, confusion, hallucinations (dyskinesia later on for levo/carbi)
  2. Ankle edema, livedo reticularis
78
Q

What are the clinical signs of cluster headaches?

A
  1. Intense, unilateral, retro-orbital pain, starts suddenly (common at night), peaks rapidly and lasts for 2 hrs
  2. Greater in men,
  3. Redness in ipsilateral eye, tearing, stuffed/runny nose, and ipsilateral Horner’s can accompany
79
Q

What is the best treatment for an acute attack of cluster HAs? Ppx?

A
  1. 100% O2 and subQ sumatriptan

2. Verapamil, Lithium, Ergotamine

80
Q

What should be the first diagnostic step in a patient who presents with unprovoked first seizure?

A

MRI or non-con CT of head (especially if associated with trauma/fall)

81
Q

What type of tremor is associated with action/intention?

A

Essential tremor

82
Q

What are deep intracranial hemorrhages and lobar hemorrhages most associated with?

A 
Deep =  HTN vasculopathy
Lobar = Amyloid angiopathy (esp in elderly)
83
Q

What are the features associated with basal ganglia hemorrhage?

A

Contralateral hemiparesis & hemisensory loss, homonymous hemianopsia, gaze palsy

84
Q

What features are associated with thalamic hemorrhage?

A

Contra hemiparesis/hemisensory loss, nonreactive miotic pupils, upgaze palsy, eyes deviate towards hemiparesis

85
Q

What should you consider in a patient with broad-based gait and Sx of Parkinsonism? Other causes of wide based gait?

A

Multiple system atrophy, spinocerebellar atrophy, multi-infarct disorders

Sensory ataxia, cerebellar disorders, muscular dystrophy

86
Q

What is carotidynia?

A

Inflammation of carotids and vagus causing a sharp localized pain over the carotid artery distribution of neck

87
Q

What are the clinical features on presentation of undiagnosed/advanced HIV infection?

A

Anorexia, weight loss, fatigue, mild/borderline cognitive impairment. Associated with dementia.

Check history for IV drug abuse, other social factors

88
Q

What radiographic finding may be associated with schizophrenia?

A

Enlargement of cerebral ventricles

89
Q

What is a good initial treatment for the management of psychosis?

A

Second generation anti-psychotic -> Quetiapine, Risperidone, Olanzapine, Ziprasidone, Aripiprazole

90
Q

What are the two most common associations with syringomyelia?

A

Arnold chiari malformations and prior spinal cord injuries

91
Q

What is a physical sign consistent with complete rotator cuff tear?

A

Arm drops rapidly from the 90 degree position

92
Q

What clinical features are consistent with epidural hematoma?

A

Unconsciousness followed by a lucid interval, leading to gradual deterioration of consciousness and sx of elevated ICP (N/V, HA, seizure), dilation of pupil on side of lesion (CN III compress), contralateral hemiparesis, biconvex hematoma on CT

93
Q

What are 5 main interventions for lowering ICP?

A
  1. Head elevation -> increased venous outflow
  2. Sedation -> decreased metabolic demand & control HTN
  3. IV mannitol -> extraction of free water from brain tissue (osmotic diuresis)
  4. Hyperventilation -> CO2 washout -> cerebral vasoconstriction
  5. Removal of CSF
94
Q

What lab screening should be done to rule out other (non-alzheimers) causes of dementia?

A

Thyroid, LFTs, B12/folate, infections (HIV, syphilis)

95
Q

What is the CSF profile in a patient with MS?

A

Pleocytosis rarely w/ PMNs - WBC 20, PMN 5%

Normal glucose, and mildly elevated proteins (glucose 75, prot 80)

IgG and oligoclonal band elevation

96
Q

What condition other than MS can cause mononuclear visual loss, urinary urgency, and tingling? What factor is involved in this disease?

A

Neuromyelitis optica - more prominent inflammatory response (more aggressive therapy needed)

Antibodies to aquaporin-4-channel

97
Q

What is the best AED for a female patient of child bearing age with generalized seizures and why?

A

Lamotrigine - b/c least risk of birth defects and low freq of cognitive side effects (Valproic acid and phenytoin have high birth defects, topiramate causes cognitive abnormalities)

98
Q

What are the features of temporal epilepsy? How do you best treat this?

A

Episodes of Deja vu, unpleasant olfactory aura, staring, confusion, unresponsiveness; followed by staring confusion and unresponsiveness

Tx = Lamotrigine

99
Q

A young teen male presents with previous generalized tonic-clonic seizure (after a night of having a few beers with friends). He denies recent falls, trauma, or fever/illness. What is the most important test to have before leaving ER?

A

Urine drug screen (MRI and EEG should be done but not emergently)

100
Q

What disc level is involved in a patient has pain in the lateral border of the right arm that radiates down to thumb and index finger. Pt also has weak right bicep and absent bicep jerk?

A

C5 - C6 disc herniation

101
Q

What is a possible presentation for a migraine without aura?

A

35F w/ 3-4 bad HAs per month, each lasting 2 days, pain behind eyes bifrontally, nasal congestion, increased tears and snot, throbbing quality with nausea, HA triggered by weather changes

102
Q

What are the 3 major causes of paroxysmal focal symptoms? How do you differentiate?

A
  1. TIAs - Abrupt onset & loss of fxn with no residual deficits
  2. Seizures - 2-3 minutes
  3. Migraine auras - 15-30 minutes most commonly involving visual disturbance or tingling which spread slowly
103
Q

What is the most important first diagnostic step in a patient with signs consist with idiopathic intracranial HTN?

A

MRI of the brain

-Follow up with LP if no mass lesion etc. (not safe to do LP in setting of papilledema)

104
Q

What are the first line treatments for migraine prevention therapy? What would preclude the use of each of these drugs?

A
  1. Topiramate - can cause renal stones and cog defects
  2. Propranolol - exacerbate asthma, bradycardia
  3. Valproic Acid - hepatotox, birth defects
  4. Amitriptyline - Convulsions, coma, cardiotox

Verapamil is 2nd line

105
Q

What are the classifications necessary to Dx migraine without aura?

A

At least 5 episodes of HAs lasting 4-72 hrs and associated with:

  1. Two of following sx: moderate to severe, worse w/ moving, throbbing
  2. one of following: light and noise sensitivity, or N/V
106
Q

What are signs of depression in someone with MS and predisposing factors?

A

Complaints of worsening physical impairment despite stable findings, uncharacteristic irritability, sleep disturbances

Chronic illness, beta interferon Tx, and recent losses put pt at risk

107
Q

What brain region is responsible for differentiating objects and their features? Which patients are at risk for loss of this function (semantic problem)?

A

Dominant lateral temporal lobe

Alzheimer disease

108
Q

Which brain region is responsible for recognition of faces?

A

Inferior occipitotemporal cortex (Fusiform gyrus)

109
Q

Which spinal tract is responsible for descending cerebellar projections?

A

Rubrospinal

110
Q

What features are characteristic of pineal gland tumors?

A

Parinaud syndrome - vertical gaze, loss of pupillary light reflex, lid retraction, convergence-refraction nystagmus from upward gaze

111
Q

What are the cardinal features of Parkinson disease?

A

Resting tremor, radykinesia, rigidity and postural instability (2/4 required to diagnose)

112
Q

What drug is best for a patient with Parkinson who has nausea?

A

Ondansetron

113
Q

What are the features of Wernicke encephalopathy?

A

Mental status change, opthalmoplegia, ataxia, nystagmus (THIAMINE DEFiCIENCY)

114
Q

What signs are consistent with dysfunction of the muscles?

A

Proximal symmetrical weakness with normal tendon reflexes

115
Q

What is the best initial step in managing carpal tunnel syndrome?

A

Wrist splinting

116
Q

What is the genetic cause of Duchenne and Becker muscular dystrophy? What is the difference?

A

X-linked

BMD progresses at a much slower slower rate. Corticosteroids can help with DMD

117
Q

What are the symptoms and features associated with hyper/hypokalemic periodic paralysis?

A

Profound generalized weakness following waking up in the morning or precipitated by rest following exercise

Hypo - defect in calcium channel, high carb meal can cause attack
Hyper - sodium channel defect

both autosomal dominant defect

118
Q

What distinct physical feature is associated with B12 deficiency?

A

Beefy red tongue

119
Q

What positional arrangement can lead to common peroneal nerve injury?

A

Crossing legs at the knee -> compression at fibular head

120
Q

How do you differentiate median nerve damage at carpal tunnel vs. forearm?

A

In CTS weakness is in thumb adduction not flexion, and thenar sensation intact

Forearm - sensory loss at thenar eminence and weakness in thumb flexion (flexor pollicus longus innervated before nerve enters carpal tunnel)

121
Q

What are possible signs that could indicate a high grade primary brain tumor in the posterior frontal and parietal lobes?

A

Right pronator drift, aphasia, seizures with right sided posturing

122
Q

What is the presentation for spinal dural AV fistulas?

A

Present with gradual onset over months, most commonly localizing to cervical or upper thoracic spinal cord

123
Q

What malignancy is most likely to present with epidural spinal metastasis?

A

Lung cancer

124
Q

What is the best treatment for isolated back pain unrelated to radiculopathy, malignancy, infection or trauma?

A

NSAIDs

Shelf Exams/USMLE Step 2 CK ❄️ (21 decks)

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