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UWORLD stuff Flashcards

1
Q

Fetal hydrantoin vs fetal EtOH syndrome

A

Hydrantoin from anti convulsants (esp. phenytoin and carbamazepine) has the same sx as EtOH but ALSO has hirsutism and cleft palate

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2
Q

Duchenne, Becker, Myotonic muscular dystrophies

Age of onset and inheritance?

A

2-3 yo Duchennne (XR)
5-15 Becker (XR)
12-30 Myotonic (AD)

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3
Q

Trihexyphenidyl (class of drug?)

A

anti-cholinergic

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4
Q

Common comorbidity with absence seizures?

A

ADHD

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5
Q

Femoral nerve innervates?
Sensation:
Motor:

A

Sensation to anterior thigh and medial leg (via saphenous)

Knee EXTENSION, hip FLEXION

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6
Q

Positive arm drop means?

A

Rotator cuff tear

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7
Q

Drug of choice for trigeminal neuralgia?

A

Carbamazepine

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8
Q

Parkinson’s gait typically narrow or wide based?

A

Narrow, and hypokinetic/festinating

If broad then consider other syndromes, eg MSA

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9
Q

Parkinsonism with autonomic dysfunction and widespread neuro dysfxn (eg LMN signs)?
(postural hypotension, impotence, incontinence)

A

MSA, aka Shy-Drager

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10
Q

Guillain Barre CSF findings?

A

High protein (45-1000), normal glucose and WBC

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11
Q

Cerebellar dysfunction symptoms? (5)

Common among what population?

A

Common among EtOH abusers

  • gait instability
  • truncal ataxia
  • hyptotonia
  • intention tremor
  • difficulty with rapid alternating movements
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12
Q

What are Lewy Bodies?

A

eosinophlic intracytoplasmic inclusions representing accumulations of alpha-synuclein protein

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13
Q

Treatment of Lewy Body hallucinations and motor sx?

2nd line for LB hallucinations?

A

ACh-esterase inhibitors (eg rivastigmine)

If hallucination refractory then atypical anti-psychotics

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14
Q

Lewy Body Dementia vs Parkinsons?

A

In Lewy Body you get dementia first then motor, in PD you get motor first then dementia. Both have Lewy Bodies

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15
Q

Affected leg extended and swinging outwards while patient walks, with affected arm adducted?

A

Hemiparesis

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16
Q

Wide gait with high lift and foot slapping?

A

Tabes dorsalis

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17
Q

Muscular dystrophy gait?

A

Waddling (due to gluteal weakness)

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18
Q

Give abortive meds if (febrile) seizure lasts longer than?

A

5 min

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19
Q

Guillain Barre complications and how to test for them?

A

Flaccid paralysis progressing to respiratory failure due to respiratory and bulbar involvement

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20
Q

Pure sensory stroke, with allodynia weeks to months later - location of stroke?

A

Posterolateral Thalamus - (contralateral side)

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21
Q

Friedrich’s Ataxia inheritance pattern?

A

AR

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22
Q

Lesch-Nyhan syndrome enzyme deficiency?

A

Hypo-xanthine guanine phosphoribosyl transferase

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23
Q

CN most suscpetible to ICP?

A

Abducens

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24
Q

CN most susceptible herniation?

A

Oculomotor

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25
Q

Cushing’s reflex (3)? Indicates?

A

HTN, bradycardia, resp depression

Indicated incr ICP

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26
Q

Slow onset confusion etc. in Alzheimer’s pt?

A

Amyloid angiopathy —> lobar hemorrhage

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27
Q

Painless proximal muscle weakness with normal CK and ESR. Think?

A

Corticosteroid use - drug induced myopathy

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28
Q

DA antagonism effect in:
Mesolimbic pathway?
Nigrostriatal pathway?
Tuberoinfundibular pathway?

A
  • Antipsychotic efficacy
  • EPS (dystonia, akathisia, Parkinsonism)
  • Hyperprolactinemia
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29
Q

Extra-axial, well circumscribed, DURAL-BASED partially calcified mass?
And what do you do about it?

A

Meningioma
which is benign
If symptomatic (HA, seizure, focal deficits etc.) due to mass effect then surgically resect

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30
Q

Appearance of brain mets?

A

Multiple ring-enhancing lesions at the grey-white junction (intra-axial)

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31
Q

Bleeding in germinal matrix of newborn?
Presents with?
Most at risk?

A

IVH (intraventricular hemorrhage)
Hypotension, seizure, pallor, bulging fontanel etc. BUT can be asymptomatic
Premature or LBW kids

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32
Q

Minute punctuate hemorrhages on CT with grey white blurrings?
Which often follows?

A

Diffuse axonal injury (DAI)

Often follows TBI

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33
Q

Ataxia, nausea, vomiting - lesion location?

A

Cerebellum

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34
Q

Ataxia - lesion location?

A

Posterior column

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35
Q

Absent sensation from umbilicus down - lesion location?

A

Lower thoracic spinal cord

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36
Q

Absent sensation from nipples down, paraplegia, rectal and bladder incontinence - lesion location?

A

Upper thoracic spinal cord

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37
Q

Partial or complete hemiparesis - lesion location?

A

Supratentorial

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38
Q

Multiple ring enhancing lesions in basal ganglia?

A

Toxoplasmosis

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39
Q

Solitary weakly ring-enhancing periventricular mass on MRI with EBV DNA in the CSF?

A

CNS lymphoma

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40
Q

Sellar masses (3)

A

pituitary adenoma, craniopharyngoma (benign), meningioma (benign)

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41
Q

Unprovoked first seizure studies?

A

CT w/o contrast THEN EEG

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42
Q

Established myasthenia gravis diagnosis - then check for what?

A

Thymoma with CT or MR of chest

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43
Q

Three cholinesteras inhibitors? (D, R, G)

A

donepezil, rivastigmine, galantamine

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44
Q

Early vs late sinemet side effects?

A

Early: hallucination, dizziness, HA, agitation

Late (several years): involuntary movement

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45
Q

Nerve at risk during repeated parotid surgery?

A

Facial (so can lead to facial droop)

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46
Q

Treatment for idiopathic intracrnail HTN (pseudotumor cerebri)?

A

acetazolamide +/- furosemide

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47
Q

Typical length of absence seizures?

Often accompanied by?

A

<20 seconds

Eyelid fluttering or lip smacking

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48
Q

Risks of benzo use in elderly?

A

cognitive impairment, falls, PARADOXICAL AGITATION

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49
Q

Resection vs whole brain radiation in brain mets?

A

Resection if single met and stable dz

Whole brain radiation if multiple mets

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50
Q

Trigeminal nerve hemangioma suggests Sturge-Weber - what is the intracranial finding?

A

tramline calcifications

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51
Q

Hyperextension injuries - resulting in UE weakness with LE mostly spared, sometimes with pain/temp probs?
Most at risk?

A 
Central cord syndrome
Those with (cervical) spondylosis
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52
Q

Elevated MMA means?

A

B12 defic, more sensitive than serum B12 level

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53
Q

Respiratory muscle weakness with generalized weakness and bulbar involvement following infx/surgery/and some meds (eg FQs) - THINK?

A

myasthenic crisis in setting of myasthenia graivs

54
Q

Tx for Hemorrhagic stoke due to excess anti-coag (wararin and heparin)?

A

If warfarin: Reverse with Vit K and PROTHROMBIN COMPLEX CONCENTRATE
If heparin: protamine suflate

55
Q

Most common site for hypertensive hemorrhage?

A

basal ganglia

56
Q

Signs of cerebellar hemorrhage?

A

Occipital AH, neck stiffness, n/v, nystagmus

57
Q

Left hemi-neglect involves what lobe?

A

Right (nondominant) parietal

58
Q

Butterfly with central necrosis on MRI?

A

Glioblastoma

59
Q

Heterogeneous, serpiginous enhancement with contrast?

A

High grade astrocytoma

60
Q

Fair hair and eyes, developmental delays, donward lens displacement, stroke (or CVA) and Marfanoid body habitus? Likley diagnosis and inheritance pattern?

A

Homocystinuria (AR)

61
Q

Treatment for homocystinuria?

A

B6, folate, B12 PLUS anti-PLT or anti-COAG

62
Q

Kid with intellectual disability, fair complexion, musty urine odor, eczema? Likely diagnosis?

A

Phenylketonuria (phenylalanine hydroxylase defic)

63
Q

To diagnose Wilson’s dz?

A 
Urine copper (incr), serum ceruloplasmin (<20), slit lamp eye exam for Kayser-Fleisher rings
WITH hepatic or neuropsychiatric sx
64
Q

Young child with NONPROGRESSIVE MOTOR DYSFUNCTION (hypertonia, hyperreflexia, equinovarus deformity - feet pointing down and inward, ressitance to passvie movement) and INTELLECTUAL DISABILITY?
Diagnosis and biggest risk?

A

Cerebral palsy, prematurity

65
Q

Infant with bulbar palsies, constipation, hypotonia? Likely diagnosis?

A

Botulism SPORE ingestion (California, Pennsylvania, Utah)

Foodborne ingestion would be with preformed toxin (canned food, cured fish, honey)

66
Q

Deep intracerebral hemorrhage - presentation and most common cause? Most common area of brain?

A 
Presents with sudden onset focal deficits that gets worse over minutes to hours
Hypertensive vasculopathy involving small penetrating branches (of major cerebral arteries)
Basal ganglia (putamen)
67
Q

Hyperventilation decreases ICP by?

A

Washing out CO2 and thus causing cerebral vasoconstriction and thus decreasing cerebral blood flow

68
Q

Abortive tx for acute cluster headache?

Prophylaxis?

A

100% O2

Verapamil for prophylaxis

69
Q

Tx for acute MS exacerbation?

First line, then if refractory, then long term?

A 
IV steroids (methylprednisone)
PLEX if refractory
Interferon for long term (if relapse/remit or progressive)
70
Q

Rapidly progressive ascending paralysis, no fever or sensory probs, normal CSF? Likely diagnosis and next steps?

A

Tick borne paralysis, find the tick (as it needs to feed for 4-7 days) and patient should then improve

71
Q

Approved drug for ALS? Mech? Side effects?

A

Riluzole, glutamate inhib, elevated LFTS (plus nausea, dizziness, weight loss, skeletal weakness)

72
Q

Guillain Barre tx? LP result?

A

PLEX or IVIG

Elevated protein on LP, normal WBC on LP

73
Q

Optic neuritis sx?

Common pres of what?

A

Acute vision loss, pain, APD

MS

74
Q

Unilateral HA with dilated pupil and poor light response and nausea/vomiting? Likely diagnosis?
Can it cause vision loss?

A

Acute angle closed glaucoma

Vision loss in 2-5 hours

75
Q

Seizure or syncope - which has prodrome?

A

Syncope has PROdrome, seizures have POSTictal state

76
Q

What is the only antiPLT agent effective reducing risk of ischemic stroke?

A

Aspirin
Give within 24 hours
Add dypyridamole OR clopidogrel is still stroking on ASA

77
Q

RLS tx?

A 
iron supplementation
DA agonists (eg pramiprexole) or gabapentin
78
Q

Post whiplash condition - months to years later?
Affects what part of spinal cord to cause what?
Diagnose with?

A

syringomyelia
affects cental canal and causes diminished strength and diminished pain/temp in upper extremities
Diagnose with MRI - CSF retention in spinal cord

79
Q

Cluster HA doesn’t have to present with lacrimation/runny nose, it can also present with?

A

ipsilateral Horner’s syndrome

80
Q

Myasthenic crisis tx?

A

Intubate for respiraoty probs

Then PLEX, IVIG, or corticosteroids

81
Q

If pseudotumor cerebri is untreated - leads to ?

A

Blindness

82
Q

ICH in a young obese female suspicious of tumor but imaging is normal. Incr CSF pressure, papiledema, poss visual field defects or 6th nerve palsy - likely diagnx and treatment?

A

Pseudotumor cerebri
Treat: acetazolamide, weight loss, CSF shunt
Optic nerve sheath fenestration to prevent blindness

83
Q

Dix Halpike - what is it and what does it diagnose?

A

vertigo and nystagmus going quickly supine with head 45 degrees - diagnoses BPPV (benign paroxsymal positional vertigo)

84
Q

Periobrital cellulits vs infectious cavernous sinus thrombosis: Which is mild and which is nasty?

A

Mild - periorbital cellulits

Nasty - cavernous sinus thrombosis

85
Q

Which NF is which?
Bilateral acoustic neuromas and cataracts?
Cafe au lait, macrocephaly, feeding probs, short stature, learning probs?

A

Neuromas and cats - NF2

Cafe au lait etc. - NF1

86
Q

Acute motor deficits WITHOUT sensory or higher cortical dysfunction - suggests? Risk factor?

A

Lacunar stroke

Hypertension

87
Q

Timeline for gait impairment in NPH and Alzheimer?

A

EARLY in NPH, LATE in alzheimer

88
Q

Internuclear opthalmaplegia - conugation/nystagmus probs (seen often in MS) is a problem in what nucleus?

A

The MLF (medial longitudinal fasciculus)

89
Q

Spinal cord compression - presentaion and diagnosis?

A

Presents with UMN signs distal to compression (i.e form lifting injury)
Diagnose with MRI of spine

90
Q 
Cushing reflex (triad)?
Worryign sx of?
A

Hypertension, bradycardia, respiratory depression

Brainstem compression

91
Q

Sharp, triphasic, synchronous dishcharge on EEG, with dementia and myoclonus - diagnoisis?

A

CJD

92
Q

Meds associated with idiopathic intracranial HTN? (IIH)

A

Growth hormone
TCNs
Vit A (including retinoic acid)
OCPs

93
Q

Niemann PIck vs Tay Sachs? (reflexes)

A

Niemann PIck has areflexia and hepatomegaly

Tay Sachs does not but doe shave hyperreflexia (no hepatomegaly)

94
Q

BILATERAL trigeminal neuralgia - think? (as it’s usually unilateral)

A

MS

95
Q

Sensory ataxia, pain, reduced deep tendon reflexes, with pupils that cannot accomodate with light but otherwise constrict normally? Think?

A

Tabes dorsalis, late syphilis

Treat with penicillin

96
Q

Young child, extracranial mass, calficfications and hemorrhages on XR and CT, urine catecholimines elevated and metabolites (HVA, VMA). What tumor and from which cells?

A

Neuroblastoma from neural crest cells

97
Q

Flat and broad t-waves (or U waves) with PVCs, plus sever muscle weakness? Think?

A

Hypokalemia!

Especially if taking a K-wasting diuretic

98
Q

What is Todd paralysis?

A

Hemiparesis that occurs after a seizure and resolves within hours in postictal period
Can also have visual probs or aphasia

99
Q

Meds for excructiating trauma pain with hx of opioid abuse?

A

IV morphine

100
Q

Swelling of scalp limited to one cranial bone? No pulsing

A

NOT intracranial hemorrhage - but CEPHALOHEMATOMA, will likely resolve without treatment in 2 weeks to 3 months

101
Q

Muscle weakness that comes on for first time after surgery, meds, infection etc. and responds to ice pack test? Think?

A

myasthenia gravis

102
Q

Face, arm AND leg equally effected with NO corticular features (ie no incontinence)? What kind of stroke?

A

lacunar (posterior limb of internal capsule)

103
Q

Contralateral sensory and motor deficits, more in LE, urinary incontience, lack of will? Stroke location?

A

ACA

104
Q

Fluorescein exam showing corneal staining defect - suggests?

And if no pain?

A

Corneal abrasion

Trigeminal (opthalmic branch) dysfunction

105
Q

Steppage gait indicative of?

A

Motor neuropathy

106
Q

Ataxic, staggering, wide based gait, indicitive of?

A

cerebellar lesion, booze, B12 defic

107
Q

Magnetic gait (freezing, start and turn hesitation) indicative of?

A

Frontal lobe degeneration or NPH

108
Q

Falling to one side gait (vestibular gait) indicative of - 2 things?

A

Labyrythitits

Meniere dz

109
Q

Indication for emergent surgery in epidural hematoma?

A

Any intercranial HTN sx

Smaller hematomas could be observed with frequent CT

110
Q

Head turning with hypertrophied SCM muscle?

A

Torricollis, a DYSTONIA

111
Q 
Lacunar stroke causes by?
Seen on CT shortly after event?
Risk factors (4)?
A

Occlusion of deep pentrating arteries of brain (microatheroma, lipohyalinosis)
Often not seen on CT shortly after
HTN, HLD, DM, smoking

112
Q

Temp >104 with CNS dysfunction (seizure, irritability, confusion etc.)? Diagnosis and treatment?

A

Exertional heat stroke, rapid cooling

113
Q

Myasthenia gravis age of onset for women, and men?

A

W: second to third decade
M: sixth to eight decade

114
Q

Increasing head circumference, and signs of ICH in infant? Next steps?

A

CT head to check for hydropcephalus (enlarged ventricles)

If so: ventricular shunt

115
Q

Galactosemia enzyme defic?

Pres?

A

galactose-1-phospahte uridyl transferase
Cataracts, FtoT, hyperglycemia, jaundice
TREAT EARLY

116
Q

Cancer hx with LE neuro sx? Think?

A

Epidural spinal cord compression from mets

117
Q

SAH sx that come with thunderclap HA?

A

nausea, vomiting, photophobia, nuchal rigidity

ie sx of meningeal irritation

118
Q

Syringomyelia assoc with what malformation?

A

Arnold Chiari type 1

119
Q

What is syringomyelia?

A

Fluid filled cavity in cervial and thoracic spinal cord that presents with areflexic weariness in UE, and “cape” patterned sensory loss

120
Q

“curtain descending over one eye”? diagnosis, cause, and next steps?

A

amaurosis fugax, retinal artery occlusion due to emboli from ipsilateral CA leading to retinal ischemia, do a carotid doppler (duplex US)

121
Q

ulnar nerve problems in hand - location of pathology?

A

at elbow, in medial epicondylar groove

122
Q 
Pyridostigmine, the intial tx for myasthenia gravis is what class of drug?
Next steps in tx if refractory would be?
A 
acetylcholinesterase inhibitor 
(LONG ACTING)
whereas edrophonium is SHORT ACTING
Next steps: immunosuppression with steroids, azathioprine, mofetil etc.)
IVIG or PLEX for crisis
123
Q

MS LP findings?

A

Normal pressure, protein, cell count but with oligoclonal bands

124
Q

Pronator drift indicates?

A

UMN or pyramidal tract dz (possibly due to MS)

125
Q

Ring enhancements - single vs multiple?

A

Single would be brain abscess (or possibly neoplasm)

Multiple would be toxoplasmosis

126
Q

Organisms in brain abscess?

A

Staph aureus
Strep viridans
GNegs

127
Q

Chemotherapy related peripheral neuropathy - presentation and 3 classes responsible?

A

symmetric, distal, sensory stocking-glove

  • platinum based (cisplatin)
  • vinca alkaloirds (vincristine)
  • taxanes (paclitaxel)
128
Q

Total loss of motor function, pain & temp but intact propprioception, assoc. with burst fracture of the vertebra?

A

Anterior cord syndrome

129
Q 
Other than NSAIDs and triptans, what class of drugs can be used to abort migraines?
3 examples?
A

IV anti-emetics, especially with n/v, and if you don’t catch the HA early
chlorpromazine, prochlorperazine, metoclopramide)

130
Q

small fiber neuropathy complaints?

A

pain and temp loss so burning pain and parathesias

131
Q

deep tendon areflexia suggests what type of nerve involvement?

A

large nerve fibers

132
Q

prosopagnosia - inability to recognize familiar faces - what part of brain lesion?

A

bilateral inferior occipitemporal cortex (fusiform gyrus)

Neuro Shelf (3 decks)

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