UWorld Question Analysis Flashcards
Alzheimer dementia clinical features ?
- Anterograde memory loss
- Immediate recall affected
- Distant memories preserved
- Language difficulties
- Visospatial defictis
- Lost in own neighborhood
- Cognitive impairment with progressive decline
- Urinary incontinence
- Hallucination s
- Wandering
- Dyspraxia
- Difficulty performing learned motor tasks 4
- Non cognitive neurologic deficits
- Pyramidal and extra pyramidal motor
- Myoclonus
- Seizures
- Occipital headache
- Neck stiffness
- Vomiting
- Nausea
- Nystagmus
- Ipsilateral hemiataxia
Dx ?
Intraparenchymal hemorrhage in the right cerebellar hemispheres
Intraparenchymal hemorrhage patient have risk of—-
- Brain embolism
- Subarachnoid hemorrhage
Cerebellar hemorrhage site ?
- Basal ganglia
- Thalamus
- Pons
- Cerebellar nuclei
- Cerebral cortex
Cerebellar hemorrhage patient -which findings is most ;likely to be seen in this patient ?
Right cerebellar hemispheres =Right hemiataxia
- Patient neglect one side of body in which disease ?
Hemineglect syndrome
Hemineglect syndrome which lobe ?
Non dominant parietal lobe - spatial organization
- Patient comb left side head
- Shave left side of face
- Left handed writing ?
Hemineglect syndrome
Occipital lobe disturbance results in —
Visual disturbance
A frontal cortex lesion leads to —
Hemiparesis
Left temporal lobe involvement leads to –
Receptive aphasia
- Autoantibodies against nicotinic acetylcholine receptor
- Fluctuating
- Fatigable proximal muscle weakness
- Ocular-Diplopia Ptosis
- Bulbar -Dysphagia Dysarthria
- Resolves with rest
Dx ?
Myasthenia gravis
Diagnosis of myasthenia gravis ?
CT Scan of chest
THYMOMA
Treatment of myasthenia gravis ?
Thyrectomy
Causes of exacerbatrions of Myasthenia gravis ?
- Beta blocker
- MgSO4
- Penicillamine
- Infection
5.Aminoglycosides
6.Fluroquinolones
CSF analysis & MRI of brain is doen in which disease ?
Multiple sclerosis
Cervical spine imaging is done in which disease ?
Cervical spondylosis
Myasthenia gravis site ?
Motor end plate in NMJ
- Difficulty in holding up head
- Difficulty combing hair
- Muscle weakness
Dx ?
Myasthenia gravis
Motor cortex lesion example ?
Stroke
Motor neuron axon lesion-Demyelination ?
Guillain barre syndrome
Autoimmune demyelination of the white matter tracts in the CNS ?
Multiple sclerosis
- Past multiplee sclerosis
- Neuroimaging -new area of demyelination
- Urinary urgency & incontinence ?
Dx ?
Acute MS exacerbation
Acute MS exacerbation management ?
Glucocorticoid
Methyl prednislone
MS + Spasticity
Treatment ?
Baclofen
If in acute MS exacerbation patient is refractory to corticosteroid therapy then what ?
Plasmapheresis
Progressive form of MS / Secondary form of MS -Managment ?
Interferon beta
- Right leg pain & numbness
- Burning pain= Lateral aspect = Right thigh
- Obese
- Tight belts and clothing
Dx ?
Meralgia paresthetica
Meralgia paresthetica which nerve ?
Lateral femoral cutaneous nerve
If sensory symptoms arise in Medial thigh which nerve ?
Obturator nerve
Sensory symptoms arise in posterolateral leg ans dorsolateral foot -
which nerve ?
Common peroneal nerve
- Double vision=Diplopia
- numbness
- ataxia
- dizziness + vertigo
Dx ?
Multiple sclerosis
- Affected eye (Ipsilateral to lesion ) in unable to adduct
- Contraletaral eye abduct with nystagmus
Dx ?
Internuclear opthalmoplegia
Internuclear opthalmoplegia damage which site ?
Medial longitudinal fasciculus
Ipsilateral fixed and dilated pupil + Nonreactive to light or accommodation ?
Edinger westphal nucleus damage
Optic nerve lesion ?
Monocular vision loss
Optic chiasm lesion ?
Bitemporal hemianopsia
Trochlear nerve plasy lesion ?
Vertical diplopia
+ Affected eye looks down and toward the nose (Walking downstairs,Reading books )
- Shaking of hands
- Disappears with purposeful activity
- Occurs during rest
Dx ?
Early stage of parkinson disease
Parkinson disease Tx ?
Anticholinergic agent-Trihexyphenidyl
Adult-Amantadine
During rest-No tremor
Activity-Tremor start
Dx ?
Essential tremor
Essential tremor Tx ?
Beta blocker-Propanolol + Primidone
Limb tremor + ET = Clonazepam
- Visual hallucination - A lion in the room
- Spontaneous parkinsonism
- Fluctuating cognition
- Dopamine antagonists=Risperidone =Aggravtes stiffness
Dementia with lewy bodies
Examination-Asked to close eyes - Strwtch out arms with the palms facing up = Then left arm involuntarily drifts downward and the palm turns towrds the floor
Dx ?
Pyramidal tract lesion
Pyramidal tract lesion Dx exam ?
Pronation > Supination
Prnotor drift
Arms to the sides
Eyes closed
Stand with there feet together
Which test ?
Romberg test
Romberg test for which disease ?
Propioception evaluation
- Patient-Valproic acid using
- Encephalopathy
- Confusion
- Lehtargy
- Bradykinesia
- Asterixis
Dx ?
Drug induced hyperammonemia
Ischemic stroke Drug ?
Aspirine
Stroke + Atrial fibrillation = Tx ?
Long term anticoagulation
Dabigatran warfarin
- Fallen down in several occasion = Initial injury
- Headache
- Somnolence
- Confusion ‘Focal neurologic defictis
Dx >?
Subdural hematoma
Subdural hematoma Dx ?
Head CT -Crescent shaped hyperdensity acute or hypodensity chronic crossing suture lines
AIDS defining malignancy ?
- Kaposi sarcoma=Human herpes virus 8
- Invasive cervical Ca = Human papilloma Virus
- Non hodgkin lymphoma = Epstein Bar Virus
- Primary CNS lymphoma = Epstein Bar Virus
- Untreated AIDS
- Ring enhancing lesion on brain on Brain MRI
- CSF PCR is + for EPV
- Seizure
Dx ?
Primary CNS lymphoma