Usmle Step 2: Neuro Qbank

Front 1

Metoclopromide can cause what kind of change in neuro exam?

Back 1

drug-induced extrapyramidal sx

Front 2

cauda equina syndrome

Back 2

serious neurologic disorder characterized by saddle anesthesia, bowel and bladder dysfunction, low back pain, and a variety of lower extremity findings.

Etiology, trauma, lumbar disk disease, malignancy, abscesses

Front 3

Damage to lateral spinothalamic tracts will cause loss of pain and temp sensation to what level of lesion?

Back 3

Beginning at two levels below the level of the lesion

Front 4

pronator drift

Back 4

sensitive and specific for UMN dz.
UMN lesions cause a weakness in supination that results in the pronator muscles becoming dominant. As a result, when these pts close their eyes and extend their arms with the palms up, the affected arm will tend to pronate.

Front 5

amaurosis fugax

Back 5

painloss loss of vision from emboli -> warning sign for an impending stroke. Most emboli occur from a carotid bifurcation; hence, a duplex U/S of the neck should be performed

Front 6

trigeminal neuralgia

Back 6

pain in the distribution of the branches of the fifth nerve: severe, intense, burning or electric shock-like

use carbamazepine

Front 7

Migraine with N/V tx?

Back 7

IV antiemetics (chlorpromazine, prochlorperazine or metoclopramide) can be used as monotherapy for acute migraine attacks, particularly in patients with accompanying N/V

Front 8

torticollis

Back 8

focal dystonia of SCM

dystonia defined as sustained muscle contraction resulting in twisting, repetitive movements, or abnormal postures.

medications commonly responsible include the typical antipsychotics, metoclopramide, and prochlorperazine

Front 9

lacunar stroke

Back 9

principal cause is hypertension, which induces lipohyalinotic thickening of the small vessels. Lacunae are formed as a result of thrombotic occlusion of penetrating vessels, which are usually 0.5-0.8mm in diameter.

Front 10

heat stroke cause?

Back 10

occurs in otherwise healthy individuals undergoing conditioning in extreme heat and humidity due to thermoregulation failure.

look for altered mental status, high temp, hypotension, tachycardia, tachypnea

Front 11

DLB

Back 11

dementia with lewy bodies: causes alterations in alertness, visual hallucinations, and extrapyramidal symptoms

Front 12

First line therapy for idiopathic benign intracranial hypertension (causing pseudotumor cerebri)

Back 12

acetazolamide

corticosteroids and repeated lumbar punctures may also be performed

Front 13

Heat stroke definition

Back 13

core temp > 40C, altered mental status, tachycardia, and coagulaopathic bleeding after heavy work under direct sunlight (think epistaxis)

Front 14

How to distinguish between dementia and normal changes of aging?

Back 14

impairment of daily functioning essential in dementia

Front 15

Ulnar nerve syndrome

Back 15

decreased sensations over the 4th and 5th fingers and weak grip due to involvement of the interosseous muscles of the hand are characteristic.

Most common site of ulnar nerve entrapment is the elbow where the ulnar nerve lies at the medial epicondylar groove.

Prolonged, inadvertent compression of the nerve by leaning on the elbows while working at a desk or table is the typical scenario.

Front 16

areflexic weakness in the upper extremities and dissociated anesthesia in a cape distribution. Presence of cord cacvity is most characteristic feature

Back 16

syringomyelia

Front 17

ipsilateral ataxia, nystagmus, intention tremor, and loss of coordination

Back 17

cerebellar tumors

Front 18

myasthenia gravis patients have a 15% chance of having what?

Back 18

coexisting thymoma

Front 19

Hypokalemia manifestations of neurologic condition

Back 19

hypokalemia is a common electrolyte abnormality that causes weakness, fatigue, and muscle cramps. When severe, it can lead to paralysis and arrhythmia. ECG may show U waves, flat and broad T waves, and PVCs

Front 20

Huntington's dz pathophysiology

Back 20

atrophy of the caudate nucleus

Front 21

foot drop

Back 21

most commonly caused by peripheral neuropathy

also from trauma to common peroneal nerve or radiculopathy to any of the spinal roots that contribute to the common peroneal nerve (L4-S2)

congenital: carcot marie tooth dz

Front 22

distinguishing btw ruptured berry aneurysm and intracranial hemorrhage

Back 22

ICH: commonly involved sites include basal ganglia, thalamus, pons, cerebellum, and lobar (less common) cerebral lesions usually cause MOTOR DEFICITS OPPOSITE THE SITE OF THE LESION BUT GAZE DEVIATION TOWARD THE SITE OF THE LESION

focal eye and motor deficits not commonly observed in SAH

Front 23

treatment of essential tremor if beta blockers contraindicated

Back 23

can also use anticonvulsants such as topiramate and primidone.

PRImidone CAN PRECIPITATE ACUTE INTERMITTENT PORPHYRIA, manifested as abdominal pain, neuro and psych anomalies (confusion, ha, hallucinations, and dizziness)

alprazolam, but potential for dependence

Front 24

diabetic mononeuropathy

Back 24

often involves CNIII -> down and out + ptosis

nerve damage is ischemic, and only somatic nerve fibers are affected.

Front 25

most common hypertensive hemorrhages occur where?

Back 25

putamen -> the internal capsule that lies adjacent to the putamen is almost always involved, leading to contralateral dense hemiparesis

Front 26

most common organisms in brain abscess

Back 26

aerobic and anaerobic streptococci and bacteroides species (anaerobes)

Front 27

wallenberg syndrome

Back 27

occurs due to occlusiono f hte posterior inferior cerebellar or vertebral artery.

pts develop loss of pain and temp over the ipsilateral face and contralateral body, ipsilateral bulbar muscle weakness, vestibulocerebellar impairment (vertigo, nystagmus), and horner's syndrome.

motor funciton of the face and body is typically spared

due to LATERAL MEDULLARY INFARCT

Front 28

bell's palsy vs stroke

Back 28

bell's: sudden onset unilateral facial paralysis. inability to raise eyebrow or close the eye, drooping of mouth corner, and disappearance of the nasolabial fold. may also have decreased tearing, hyperacusis, and/or loss of taste sensation over the anterior 2/3 of the tongue.

Lesions in CNS occuring above the facial nucleus will typically cause a contralateral lower facial weakness that spares the forehead.

Front 29

multiple system atrophy

Back 29

always consider this when a pt with Parkinsonism experiences orthostatic hypotension, impotence, incontinence, or other autonomic sx

qid 4130

Front 30

tPa therapy indications

Back 30

recommended in pts with acute ischemic stroke if it is initiated within 3-4.5 hours of sx onset (unless contraindicated)

Front 31

restless leg syndrome tx

Back 31

dopamine agonists (pramiprexole) OR alpha 2 delta ca channel ligands (gabapentin)

Front 32

CJD

Back 32

rapidly progressive dementia, myoclonus and sharp, triphasic, synchronous discharges on EEG!!!! know all of these

spongiform encephalopathy caused by prion.

most pts die within one year of sx onset.

Front 33

alzheimer's dementia: histopathologic findings

Back 33

amyloid plaques, neurofibrillary tanles, and selectivel oss of cholinergic neurons

Front 34

craniopharyngiomas

Back 34

signs of hypopituitarism, headaches, and bitemporal blindness

extremely high yield!

benign tumor of rathke's pouch
bimodal age distribution -> children and 55-65yo

in children, retarded growth is more prominent whereas sexual dysfunction more prominent in adults

Front 35

GBS: how to adequately monitor respiratory function

Back 35

serial measurements of bedside vital capacity

Front 36

pt develops serious bleeding (eg ICH) due to excess anticoagulation with warfarin. next step in mgmt?

Back 36

ffp!

Front 37

pseudotumor cerebri complications

Back 37

shunting or optic nerve sheath fenestration may be performed to prevent BLINDNESS

most significant complication of otherwise benign disorder

Front 38

antipsychotics vs bzd for agitation of older adults

Back 38

better to use antipsychotics. bzd typiocally not recommended bc older pts tend to metabolize these drugs slowly, making their effects verrry long lasting.

plus, in elderly, bzd often worsen confusion. finally elderly at increased risk for all adverse events a/w bzd including withdrawal, dependence, and motor impairment

Front 39

causes of idiopathic intracranial hypertension

Back 39

most common in obese young women.

growth hormone, tetracyclines (minocycline, doxy), and excessive vitA and its derivatives (isotretinoin, all trans retinoic acid) can cause IIH.

withdrawal of these meds lead to sx resolution

Front 40

hemi-neglect syndrome

Back 40

characterized by ignoring the left side of a space, and involves the right (nondominant) parietal lobe

Front 41

three treatment options for myasthenia gravis

Back 41

acetylcholinerase inhibitors (anticholinesterases), immunosuppressive agents and thymectomy

immunosuppressives (prednisone, azathioprine and cyclosporine which are used with poor response to anticholesterases) and thymectomy may induce remission

Front 42

ALS

Back 42

characterized by preence of both upper (spasticity, bulbar sx, hyperreflexia) and lower (fasciculations) motor neuron lesions

Front 43

bulbar

Back 43

muscles of mouth and throat responsible for speech and swallowing

Front 44

eaton lambert syndrome

Back 44

a/w small cell carcinoma of hte lung, results from autoantibodies against voltage gated ca channels in the presynaptic motor nerve terminal

electrophysiological studies show muscle response to motor nerve stimulation should increase with repetitive stimulation!

treatment consists of plasmapharesis and immunosuppressive drug therapy

Front 45

cerebral salt wasting syndrome

Back 45

may occur in pts with SAH

pathology involves 1) inappropriate secretion of vasopressin, and 2) increased secretion of atrial/brain natriuretic peptide, which causes cerebral salt wasting.

Front 46

brain death criteria

Back 46

total loss of brain fxn and is a legally acceptable definition of death

criteria include: absent CN reflexes, fixed and dilated pupils, no spontaneous breaths, and agreement of two physicians

Front 47

approved tx for ALS

Back 47

riluzole (gluamate inhibitor)

Front 48

cerebellar hemorrhage sx

Back 48

ataxia, vomiting, occipital HA, gaze palsy, and facial weakness

no hemiparesis

Front 49

BPPV

Back 49

triggered by changes in head position, dx confirmed with Dix Hallpike maneuver

pathophys: semicircular canal dysfunction!

Front 50

hallmark of prolonged seizures

Back 50

cortical laminar necrosis! -> can lead to persistent neuro deficits and recurrent seizures

lasting greater than 5min

Front 51

NPH: pathophys

Back 51

decreased CSF absorption or transient increases in ICP that cause permanent ventricular enlargement w/o chronically increasing ICP

characterized by gait disturbance, urinary incontinence, and dementia

treated with serial LP and if successful ventriculoperitoneal shunt