Uw April 10, 2012 Neu

Front 1

1934:

Neuromuscular junction.

Which must happen for vesicle to release ACh into synaptic space.

Back 1

1934:

Calcium Ca++ influx.

Front 2

17:

PC: 65yo female: poor memory, urinary incontinence, gait abnormality.

1. What is likely found on MRI?
2. What causes the above finding?

Back 2

17:

1. MRI shows normal-pressure hydrocephalus, occurred in elderly PT's.

2. Symptoms caused by STRETCHING of descending cortical fibers.

Front 3

633:

PC: 42yo male Dx with depression. Now have involuntary grimacing, strange arm and leg movement. Grandfather died at 65, father died at 58. How is this explained?

Back 3

633:

Anticipation

Front 4

496:

PC. Infant with mass overlying spine and tuft of hair. Pregnancy complicated by pre-eclampsia and UTI and treated with Cefazolin.

1. What does the child have?
2. What causes the child's symptoms?

Back 4

496:

1. Child has neural tube defect.
2. Caused by deficient in Folate.

Front 5

1460:

PC: 42yo man with daytime sleepiness and sleep while doing everything. Denies hallucination. BMI of 31.3. What is Diagnosis?

Back 5

1460:

Obstructive Sleep Apnea.

Front 6

1060:

PC: 59yo male in ER diplopia, Hx of DM, osteoarthritis, and peptic ulcer. Exam shows right-sided ptosis with right eye looking down and out. Eye are PEARLS.

What is causing the PT's symptoms?

Back 6

1060:

Nerve ischemia (due to diabetic neuropathy) -- most commonly CN-3.

:: Somatic ischemia - down and out gaze, accomodation, light response.
:: Parasympathetic - down and out, no accom, dilated pupil.

Front 7

673:

PC: 4yo boy with difficulty walking. Hx of frequent resp infection. Cell shows high rate of radiation induced genetic mutation.

1. What is DX?
2. What is associated?

Back 7

673:

1. Ataxia telangiectasia (AR) leading to Oculocutaneous telangiectasia.

2. Associated with Cerebellar Atrophy.

Front 8

840:

Huntington with with expression of huntingtin gene and suppression of other genes.

What is the mechanism of this suppression?

Back 8

840:

Hyper-methylation of histones on the 4th chromosome, which prevent transcription of other genes.

Front 9

907:

PC: 23yo in ER with Hx of fever, headache, confusion. Autopsy shows bilat temporal necrosis.

What is DX?

Back 9

907:

HSV-1 is the most common cause of sporadic encephalitis in young healthy adults.

Temporal Lobe involvement is characteristic.

Front 10

660:

New inhaled anesthetic has very high AV concentration.

Describe property of anesthetic.

Back 10

660:

Inhaled air -- lungs -- blood -- brain.

1. High soluble = high AV = slow onset
2. Low soluble = low AV = rapid onset

Front 11

969:

PC: 25yo male with Tetanus.

What is the best way to diagnose Tetanus?

Back 11

969:

1. PT Hx and physical.

2. Culture is not very reliable.

Front 12

737:

PC: 21yo male with headache has BEAN-SHAPE GRAM-NEG COCCI in PAIR. what is the route of meningeal contamination?

Back 12

737:

Neisseria meningitidis

Pharynx -- blood -- choroid plexus -- meninges

Front 13

510:

23yo female in ER with restlessness in legs and can't sit or lie still. Hx of schizo and Tx helps. BP 140/90 and HR 90. She's alert, awake, and oriented.

What is most likely Dx?

Back 13

510:

Akathisia = well known complication of neuroleptic therapy, ranges from mild anxiety to intense physical restlessness.

Front 14

1299:

How is the confidence interval (CI) for the mean is calculated?

Back 14

1299:

95% confidence:
Mean +/- 1.96*SD/root(n)

99% confidence:
Mean +/- 2.58*SD/root(n)

Front 15

1428:

Which part of the tRNA is responsible for amino acid binding?

Back 15

1428:

3'-end

Front 16

671:

16yo male has gait instability and dysarthria. MRI shows degeneration of DC and SC tract.

What does PT have?
What other disease mimic this presentation?

Back 16

671:

PT have Friedreich's Ataxia

DDX = Vitamin-E deficiency

Front 17

497:

43yo female in ER with sudden severe headache. BP of 160/90 and HR 90. Eyes are PEARL with normal power extremities. Brain CT shows diminished ventricles.

What is most likely cause of condition?

Back 17

497:

Rupture of saccular (berry) aneurysm from Subarachoid hemorrhage (SAH)

Front 18

1318:

23yo female with MS has diplopia due to small ara of demyelination. What is decreased?

Back 18

1318:

Space constant = a measure of how far along an axon an electrical impulse can travel.

Front 19

1920:

53yo male has difficulty walking and R.L extremity weakness. Stroking sole of R-foot elicits toe extension. Which is another additional finding?

Back 19

1920:

HYPER-reflexia

PT shows positive Babinksi reflex caused by an UMN lesion.

This is known as pyramidal signs

Front 20

1059:

62yo female with Hx of DM, HTN, and Gout. Now has numbness and tingling in her feet.

What are the 2 causes of neuropathy in DM?

Back 20

1059:

1. Non-enzymatic glycosylation -- increased thickness, hyalinization, and narrowing of arterial wall.

2. Intracellular hyperglycemia occurs in peripheral nerves -- excess sugar converted to sorbitol and fructose by aldose reductase -- osmotic damage.

Front 21

1692:

43yo female with back pain after dragging heavy box. Pain in R.posterior thigh and posterior calf shooting down to foot. Exam shows symmetric knee reflex but dimished ankle jerk reflex on right.

What is DX and what nerve-root level is affected?

Back 21

1692:

DX = sciatic neuropathy (sciatica)

S1

Front 22

675:

White male with severe neurological disease dies of respiratory infection. Autopsy show atrophic precentral gurys and thin anterior root of spinal cord.

What is PT suffering from?

Back 22

675:

ALS (Lou-Gerrig Disease

Front 23

498:

6yo male develops L-sided weakness and numbness. BP is 190/100 and PR is 78. Exam shows loss of power on L-side and upward plantar reflex. Brain CT shows mass pushing against midline.

What is likely cause of PT's condition?

Back 23

498:

Charcot-Bouchard pseudo-aneurysm

- caused by HTN and usually intracerebral.

Front 24

1261:

4yo Asian boy with facial hair growth, enlarged genitalia, pubic hair, and impaired upward gaze.

1. What is DX?
2. What is likely abnormal on brain CT?

Back 24

1261:

1. DX = Parinaud's

2. Pineal gland Germinomas.

Front 25

1922:

KINESIN and DYNEIN are associated with what cell structure?

Back 25

1922:

Microtubules

Kinesin = forward
Dynein = backward

Front 26

1690:

Where is the caudate nucleus (CN) in the brain cutout?

Back 26

1690:

Front 27

1853:

18yo freshman in ER with fever, confusion, headache. Exams show nuchal rigidity and purpuric rash.

What is used for vaccine against this organism?

Back 27

1853:

Organism = N. Meningitidis

Vaccine = capsular polysaccharide

Front 28

1306:

34yo female with hearing loss. Complain of noise in right ear. Exams show right-sided heading loss, asymmetric smile, and decrease corneal reflex in right eye.

Intracranial mass should be found where?

Back 28

1306:

DX = intracranial schwannoma.

Commonly found at cerebello-pontine angle, which is between cerebellum and lateral pons.

Front 29

1369:

PT consumes radioactive ALANINE, which is taken up by the liver and detected in blood glucose later. Before conversion into glucose, where did ALANINE give up its extra amino-group to?

Back 29

1369:

alpha-ketoglutarate

Front 30

1339:

22yo female in ER with abdo pain, nausea, confusion, and urine that turns dark upon standing.

What is DX?
How does high-dose glucose infusion help?

Back 30

1339:

DX = AIP (acute intermitten porphyria)

Glucose administration affects PORPHYRIN SYNTHESIS.

Front 31

353:

21yo male in ER with seizure.

What are 1st, 2nd, and 3rd line Tx for status epilepticus?

Back 31

353:

1st line = Benzo's (LORAZEPAM)

2nd line = PHENYTOIN (decrease Na current in cortical neurons)

3rd line = phenobarbital

4th line = general anesthesia

Front 32

1573:

42yo male with RING-ENHANCING LESION.

What are possible causes?

Back 32

1573:

Pg 218:

- Toxo
- Lymphoma
- Abscess
- Metastatis

Front 33

1458:

23yo male constantly tired and falls asleep at inappropriate time. Falls to ground if startled or excited. Each episode lasted 1-2min. Denies confusion or lost of consciousness.

What is DX?

Back 33

1458:

Narcolepsy (enter REM very quickly)

Front 34

1335:

Infant develops vomiting and lethargy after birth. Exam shows hypertonicity, rigidity, and smell of burnt sugar in diaper.

Which AA should be restricted?

Back 34

1335:

DX = maple syrup urine disease

Should restrict LEUCINE in diet.

Front 35

1340:

New born with lethargy, vomiting, and HYPOtonia after birth. Exam shows metabolic acidosis with large anion gap, ketosis, hypoglycemia, and increased PROPIONIC ACID in plasma and urine.

Which AA contributes to this condition?

Back 35

1340:

Catabolism of... lead of Propionic acid.

- Isoleucine
- Valine
- Threonine
- Cholesterol
- Odd-chain FA

Front 36

2088:

32yo woman feels sad, fragmented sleep, decreased appetite, and everything else is normal. After treatment, she comes back with agitation and confusion, tremors, abdo cramp, diarrhea, high temp, BP 210/120, HR 120. Pupil dilated, hyper-reflexia, and ankle clonus

What is original DX and TX?
What is present DX?
The CNS symptoms is associated with which AA?

Back 36

2088:

1. Depression, treated with SSRI to increase NE and 5HT.

2. DX = serotonin syndrome

3. serotonin derived from tryptophan.

TX = cyproheptadine