Uworld6 Flashcards
Difference between peripheral and central bell’s palsy
peripheral: inability to raise eyebrow or close eye
central: preserved eyebrow and eye movement
Next step for central bell’s palsy
brain imaging
treatment for solitary brain metastasis in patients with good performance status and stable extracranial disease
surgical resection
whole brain mets treatment
radiation therapy is typically used
when do you refer carotid endarterectomy
TIA, stroke past 6 months
70-99% stenosis
Cauda equina syndrome
radicular pain
asymmetric motor weakness
hyporeflexia/areflexia
Conus medullaris syndrome
symmetric motor weakness
hyperreflexia
What can cause central cord syndrome
hyperextension injuries
What type of headache awakens you from sleep
cluster headache
ptosis
“down-and-out” gaze
Diplopia
normal pupillary response
Ischemic oculomotor palsy
poorly controlled diabetes
Damage to inner somatic nerve fibers
Spare peripheral parasympathetic fibers
Lambert Eaton is associated with what malignancy
small cell lung cancer
Clinical feature of Eaton Lambert syndrome
symmetric proximal muscle weakness with depressed deep tendon reflexes
lab value for epidural abscess
ESR always elevated
equine antitoxin treats
botulism
What type of tremor is essential tremor
action tremor
Treatment for exertional heat stroke
ice water immersion
Atrophy of what part of the brain is Huntington’s disease
caudate nucleus
CSF for HSV encephalitis
lymphocytic pleocytosis
increased erythrocytes
elevated protein
normal glucose
Difference between Sensorineural and conductive hearing loss
Sensorineural: disorder involving inner ear, cochlea, or auditory nerve
Conductive: any cause that limits sound from gaining access to the inner ear
what type of hemorrhagic stroke has rapidly worsening global neurologic symptoms (vomiting, stupor, bradycardia)
Intercerebral
Not lacunar strokes
Clinical picture of putaminal hemorrhage
contralateral hemiparesis
contralateral sensory loss
What is the cushing reflex and what does it mean
hypertension
bradycardia
respiratory depression
Brainstem compression
First line treatment for idiopathic intracranial hypertension
acetazolamide +/- furosemide
location of broca
dominant frontal lobe
location of wernicke
temporal lobe
location of wallenberg syndrome
lateral medullary infarct
Patient outstretched the arms with palms up and eyes closed. Affected arm drifts downward and palm turn (pronates) toward the floor
Pronator drift
sign of upper motor neuron or pyramidal tract disease
Stand with feet together, arms to the side and eye closed. May loose balance
romberg test
what drug is effective in reducing the risk of early recurrence of ischemic stroke?
aspirin, give within 24 hours
what drug would you give for recurrent stroke on aspirin therapy
aspirin plus dipyridamole OR clopidogrel
Contralateral and motor deficit (face, arm, leg)
Homonymous hemianopia
conjugate eye deviation toward side of infarct
type of stroke?
middle cerebral artery occlusion
Contralateral somatosensory and motor deficit
urinary incontinence
type of stroke?
Anterior cerebral artery occlusion
Hemi-neglect syndrome occurs where in the brain
right (non-dominant) Parietal lob
what is the biggestest risk factor for stroke
hypertension
nerve for facial movement
VII 7
nerve for facial sensation
V 5
side effect of cisplatin
Nephrotoxicity
ototoxicity
neurotoxocity
psuedodementia
elderly patient with depression present with cognitive impairment
oligoclonal IgG bands
multiple sclerosis
Uhthoff phenomenon? what is it associated with
symptoms worsen during exposure to high temperatures
such as moving to Arizona in June
If MS patient does not respond to steroids, next drug?
plasma exchange
name 2 causes of oculomotor nerve palsy
nerve compression (posterior communicating aneurysm) diabetes mellitus - microvascular nerve ischemia
Triad of oculomotor nerve palsy
mydriasis
ptosis
“down and out” deviation
when multiple sclerosis is suspected but clinical examination or MRI is not classic, next step
lumbar puncture
Riley-Day syndrome
autonomic nervous system dysfunction with severe orthostatic hypotension
For myasthenia gravis, if acetylcholine receptor antibody is present, what is the next step
CT of chest to rule out thymoma
problem in motor neuron cell body
ALS
Damage to white matter tracts
multiple sclerosis
Decreased acetylcholine release from motor neurons
botulism
Degeneration of myenteric plexus neurons
achalaisa
Fibrous tissue replacement of smooth muscles
systemic sclerosis
Worsens with repetitive motions of the same muscle groups and improves with rest
myasthenia gravis
Treatment for myasthenia gravis crisis
plasmapheresis (or IVIG) and steroids
What causes neuroleptic malignant syndrome
drug reaction to dopamine antagonist
3 cardinal signs of parkinson disease
resting tremor
rigidity
bradykinesia
2/3 for clinical diagnosis
What parkinson drug induce acute closure glaucoma
trihexyphenidyl/benztropine
anything anti-cholinergic
14-3-3 proteins in cerebrospinal fluid sample
Creutzfeldt-Jakob disease
what muscle is responsible for initiating the 1st degress of abduction
supraspinatus
What the hallmark of prolonged seizures and can lead to persistent neurologic deficits and recurrent seizures
cortical laminar necrosis
What is a complication 3 days after subarachnoid hemorrahge? treatment
vasospasm
CT angiogram
Nimodipine
Upper extremity ischemia (pain, fatigue, paresthesias)
Vertebrobasilar insufficiency (dizziness, ataxia, dysequilirbrium)
Worsened by upper extremity exercise
subclavian steal syndrome
rupture of bridging veins
subdural
Syringomyelia is associated with?
Arnold Chiari malformation type 1
Toxin-medited neurotranmission blockage
tetanus
T-lymphocyte mediated skeletal muscle injury
polymyositits
what molecules do tetanus block
glycine and GABA
What is the difference between guillan barrie and tick-borne paralysis
GBS: symmetric paralysis over days to weeks
tick: asymmetrical paralysis within hours
Initial treatment for TIA
aspirin and statin
difference between MS episodes and TIA
TIA <24 hours
MS episodes last for days to weeks
MOA of sumatriptan
vascular serotonin agonist
Location of ulnar nerve entrapment
elbow
Methylmalonic acid deviation
B12 deficiency
Unfavorable metabolic side effects of thiazide diuretics
hyperglycemia
increased LDL cholesterol
increaed plasma triglycerides
hyperuricemia
most comm on form of glomerulopathy with HIV
focal and segmental glomerulosclerosis
what causes the pain in PE
pulmonary infarction not pulmonary arterial dilation
what type of heart block does digitalis induce
atrial tachycardia with AV block
What are respiratory concerns for Granulomatosis with polyangiitis
URI: most common
Lower respiratory tract: narrowing with ulceration
chest x-ray: multiple lung nodules with cavitation
does TB have kidney and upperairway invovlement
no
Psychogenic polydipsia ? sodium levels
excessive free water intake by patient
hyponatremic
diabetes insipidus sodium level?
hypernatremic
pneumothorax on x-ray
radiolucent black region
COPD and acute-onset shortness of breath, hypoxia and unulaterally decreased breath sounds
secondary spontaneous pneumothorax
-large alveolar blebs which rupture
fluid accumulation in the avleolar spaces
pulmonary edema
liver transplant: hyperacute rejection
less than 1 week
difference between acute cellular rejection and bacterial infection in liver transplant
bacterial infection: rapid-onset hemodynamic instability
significant leukocytosis
high fever
what type of diarrhea is CMV
bloody
when do you give Tdap or Td
tdap –> single dose age 11-18 and pregnancy
td –> every 10 years
what vitamin causes thyroid dysfunction, cardiomyopathy,immune dysfunction
selenium
what decreases the risk of septic embolic events in patients with native valve infective endocarditis (even if they have right sided weakness)
IV abs
no need for heparin or antiplatelet
what will cause severe headache and impaired level of consciousness. focal neurologic findings are uncommon
subarachnoid hemorrhage
isoniazid interferes with what vitamin
niacin
anti-histone abs
drug-induced lupus
cyclic cirtullinated paptide anbs
rheumatoid arthritis
which has a greater impact on respiratory acidosis: chloride shift or kidney compensation
kidney compensation
what makes tick-borne paralysis different from GBS
absence of fever
absence of sensory abnormalities
normal CSF examination
Treatment for acute hyponatremic encephalopathy
hypertonic (3%) saline with close monitoring of electrolytes
Auer rods
AML
characterize acute promeylocytic leukemia
life-threatening coagulopathy due to DIC
Lupus anticoagulant (anti-phospholipid antibody) changes what lab value
prolongs PTT
treatment for autoimmune hemolytic anemia
steroids
