UWORLD

Question 1

contralateral somatosensory and motor deficit, predominantly in lower extremity
abulia (lack of will)
dyspraxia (clumsiness)
urinary incontinence

Answer 1

ACA stroke

Question 2

contralateral somatosensory and motor deficit in FACE, ARM, AND LEG)
homonymous hemianopia
aphasia (dominant hemisphere)
hemineglect (non dominant hemisphere)
conjigate eye deviation toward side of infarct

Answer 2

MCA stroke

Question 3

unilateral motor impairment
no sensory/cortical deficit
no visual field abnormalities

Answer 3

lacunar infarct (posterior limb of internal capsule)

Question 4

headache worse at night
n/v
mental status changes
focal neurologic deficit/vision changes

Answer 4

intracranial HTN

Question 5

symmetric proximal limb muscle weakness (standing up, combing hair, putting stuff in cabinets)
reduced/absent DTRs
autonomic dysfunction
lung mass

Answer 5

lambert eaton

Question 6

treatment for agitation from delirium in ELDERLY and young

Answer 6

elderly - haloperidol (less adverse effects/addiction vs lorazepam)
young - lorazepam

Question 7

what kind of gait is associated with Parkinsonism

Answer 7

NARROW BASED
shuffling
hypokinetic gait

Question 8

MVA; CT shows minute punctate hemorrhages with blurring of gre-white interface

Answer 8

diffuse axonal injury

can lead to persistent vegetative state; major cause morbidity from TBI

Question 9

loss of pain/temp ipsilateral face and contralateral body, ipsilateral bulbar muscle weakness, vestibulocerebellar impairment, horner’s syndrome…motor function face and body spared

Answer 9

wallenberg syndrome (LATERAL MEDULLARY INFARCT usu due to occlusion of PICA or vertebral artery)

Question 10

patient with giant cell arteritis develops PAINLESS proximal muscle weakness (lower extremity); normal CK and ESR

Answer 10

glucocorticoid induced myopathy

different from polymyalgia rheumatica which is painful and has no muscle weakness

Question 11

asymmetris resting tremor assocaited with rigidiy; gets better with activity
dx and treatment for tremor

Answer 11

parkinsonian tremor

anticholinergics like TRIHEXYPHENIDYL

Question 12

patient hx of HTN presents with sudden onset hemisensory loss, hemiparesis, homonymous hemianopsia, gaze palsy

Answer 12

basal ganglia bleed

Question 13

prolonged seizures increases risk of what brain structural abnormality

Answer 13

cortical laminar necrosis (hallmark of prolonged seizures; due to excitotoxicity)
leads to persistent neurologic deficits and recurrent seizures

Question 14

NMS is due to blockade of which neurotransmitter in what pathway

Answer 14

dopamine (d2 receptor blocking)

in nigrostriatal pathway

Question 15

seizures, diaphoresis, tremulousness, tachycardia, HTN afterone day in hospital…dx and treatment

Answer 15

alcohol withdrawal

lorazepam

Question 16

acute confusion, hyperthermia (greater than 105F), tachhy cardia, persistent bleeding (i.e. epistaxis) after direct work under sunlight

Answer 16

heat stroke

Question 17

risk of benzos in elderly

Answer 17

increased risk of cognitive impairment, paradoxical agitation, and falls

Question 18

initial work up for first time seizure in adult

Answer 18

electrolytes
glucose
Ca/Mg
CBC
renal and LFTs

URINE TOXICOLOGY SCREEEEEEEEEEN

Question 19

pathogenesis NPH

Answer 19

transient increase in ICP which causes ventricular enlargement, which will then normalize. Increase in ventricular size due to diminished CSF absorption at arachnoid villi or obstructive hydrocephalus

Question 20

what kind of gait is typically seen in NPH

Answer 20

slow BROAD BASED shuffling gait

Question 21

how do parkinsonian tremors worsen?

Answer 21

distractibility (mental tasks)

goes away with movement and re-emerges when ovement is stopped

Question 22

how is physiologic tremor worsened

Answer 22

worsened - anxiety, caffeine, hyperthyroidism, drugs

Question 23

symptoms of cerebellar dysfunction

Answer 23

gait instability
truncal ataxa
difficulty with rapid altermating movements
hypotonia
INTENTION TREMOR