Prite 2016 - Neurology Questions

Front 1

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What characterizes the memory loss in patients with dissociative amnesia?

Back 1

Episodic

Front 2

Amnesia preceded by epigastric sensation/fear are associated with electrical abnormalities where?

Back 2

Temporal Lobe

Front 3

Memory loss pattern in dissociative amnesia.

Back 3

Occurs for a discrete period of time.

Front 4

Amnesia characterized by loss of memory of events that occur after onset of etiologic condition/agent

Back 4

Anterograde

Front 5

This psychoactive drug produces amnesia.

Back 5

Alcohol

Front 6

Patient with strange behavior answers appropriately with fluent speech but no ability to retain new info. Episode lasts 6 hours then back to normal without recollection of events.

Back 6

Transient Global Amnesia

Front 7

Patient reports hearing voices of someone not present. Patient stops moving, stares blankly, repetitively picks at clothing, does not respond to questions/commands for several minutes. Resolves after 15 minutes and patient can't recall events.

Back 7

Complex Partial Seizure

Front 8

55yo brought in by family after episode of amnesia/bewilderment lasting hours. CVA ruled out. Patient keeps asking what is happening. Which medication?

Back 8

Observation with no pharmacological intervention

Front 9

Sense of loss of identity often following a traumatic experience and associated with inability to recall one's past.

Back 9

Dissociative Fugue

Front 10

Contralateral leg weakness with sparing of face and arms. Urinary incontinence and abulia. Where is the lesion?

Back 10

Anterior Cerebral Artery

Front 11

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Visual problem in pituitary tumor compressing optic chiasm.

Back 11

Bitemporal hemianopsia

Front 12

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60yo right-handed M gets lost frequently, only writes on right half of paper. Left-sided hemi-neglect. Where is the lesion?

Back 12

R Parietal

Front 13

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66yo with frequent falls, months of anxiety, unwilling to leave home. Mild impairment of vertical gaze on smooth pursuit/saccades. Mild axial rigidity, mild upper extremity rigidity, mild slowness of movement with normal posture. Dx ?

Back 13

Progressive Supranuclear Palsy

Front 14

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65yo patient fell several times in the past 6 months. MSE wnl, smooth pursuit and saccades impaired and worse with vertical gaze. Full ROM on head, mild symmetric rigidity, no tremor. MRI/CSF/labs unremarkable. Dx?

Back 14

Progressive Supranuclear Palsy

Front 15

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26yo with headache, clumsiness of R hand for weeks. Struggles with rapid alternating movements of R hand, overt intention tremor with finger-to-nose. CNs wnl, no papilledema. Lesion?

Back 15

Cerebellum

Front 16

9yoF has a 3 months history of unprovoked laughter. Worse when not sleeping well. Patient is not happy during laughing episodes. Started menstruating 6 months ago. Tanner 4. Dx?

Back 16

Hypothalamic Hamartoma/Gelastic Seizure

Front 17

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5yo with 4 month h/o morning HA, emesis, ataxia, falls, diplopia. Lesion?

Back 17

Medulloblastoma

Front 18

75yo evaluated for progressive ataxia, urine incontinence, cognitive decline. After removal of CSF, there is improvement in gait and balance. What would the CT show?

Back 18

Enlargement of the frontal horns

Front 19

70yo develops confusion, lethargy, generalized tonic-clonic seizure. Lab reveals serum sodium of 95. Most likely complication of excessively rapid correction?

Back 19

Central Pontine Myelinolysis

Front 20

Where is the lesion that causes bilateral coarse nystagmus worsening with visual fixation and is present with horizontal and vertical gaze?

Back 20

Brainstem

Front 21

32yo with 1 month h/o worsening HA, episodic mood swings, and occasional hallucinations. Hallucinations are visual, tactile, and auditory. CT head reveals tumor where?

Back 21

Temporal Lobe

Front 22

Fluent speech, preserved comprehension, inability to repeat speech. No associated signs. Where is the lesion?

Back 22

Supramarginal Gyrus or Insula

Front 23

Acute onset of hemiballismus of LUE & LLE. MRI shows lesion where?

Back 23

Subthalamic Nucleus

Front 24

43yo with newly dx AIDS has increasing social withdrawal and irritability over weeks. Can't remember phone number, unable to do chores, seems distracted. R hemiparesis, L limb ataxia, bilateral visual field defects. LP normal. Dx?

Back 24

Progressive Multifocal Leukoencephalitis

Front 25

Unconsciousness can be induced by a small area of damage where?

Back 25

Reticular Formation

Front 26

Patient admitted to ED after MVA. Receives D5. Later experiences confusion, oculomotor paralysis, and dysarthria. Sx caused by?

Back 26

Wernicke's Encephalopathy

Front 27

Patient reports HA and loss of peripheral vision. Visual field defects of both temporal fields of oth eyes. MRI shows?

Back 27

Mass in Sella Turcica

Front 28

37yoF w/ discoid lupus controlled on stable dose of PO prednisone. Abrupt development of fatigue, inflamed joints, diffuse myalgia. Depressed mood + cognitive impairment. No prior psych history or focal neuro signs. Dx?

Back 28

Disease-Induced Cerebritis

Front 29

25yo with diplopia and difficulty balancing. R lateral gaze shows weakness of L medial rectus w/ nystagmus of R eye. L lateral gaze shows weakness of R medial rectus w/ nystagmus of L eye. Mild finger-nose ataxia on R. Dx?

Back 29

Multiple Sclerosis

Front 30

52yo with gait difficulty. Mild dysarthria, mild finger-nose ataxia, minimal heel-shin ataxia. Romberg negative but unsteady while walking. Broad-based lurching gait. Plantar reflexes are flexor. Imaging demonstrates?

Back 30

Cerebellar vermis atropy

Front 31

Syndrome associated with occlusion of the cortical branch of the posterior cerebral artery.

Back 31

Homonymous Hemianopia with alexia without agraphia.

Front 32

34yoM for psych eval 5y after TBI @ work. Since accident, overly talkative/restless. Divorced because he was acting irresponsible and lost job. Psychometrics show avg intelligence, no memory deficits. Lesion is where?

Back 32

Frontal Lobe

Front 33

Child starts kindergarten, is more emotionally reactive and regresses at home. Teacher says child is normal at school. What accounts for the change noticed by parents?

Back 33

Normative response to stress 2/2 school transition

Front 34

Which cancer has the highest chance of going to the brain?

Back 34

Lung

Front 35

Which hormone is secreted in a functional pituitary adenoma?

Back 35

Prolactin

Front 36

CT + MRI shows ventriculomegaly out of proportion to sulcal atrophy. Dx?

Back 36

Normal Pressure Hydrocephalus

Front 37

20yo with 1y h/o bitemporal HA, polydipsia, polyuria, and bulimia with 2mo h/o emotional outbursts, aggression, and transient confusion. Neuro exam normal. MRI shows?

Back 37

Hypothalamic Tumor

Front 38

Previously pleasant mom becomes profane and irresponsible over 6 months. Lesion is where?

Back 38

Frontal Lobe

Front 39

Unilateral hearing loss, vertigo, unsteadiness/falls, HA, mild facial weakness, ipsilateral limb ataxia. Lesion is where?

Back 39

Cerebellopontine Angle

Front 40

38yoF with muscle spasm of proximal limbs and trunk, lumbar lordosis while walking. EMG abnormal. Serum antiglutamic acid antibodies.

Back 40

Stiff-Person Syndrome

Front 41

Pituitary tumor that protrudes though the diaphragmatic sella is most likely to cause?

Back 41

Bitemporal hemianopsia

Front 42

Conduction aphasia often 2/2 damage to what?

Back 42

Arcuate Fasciculus

Front 43

70yo develops flaccid paralysis following severe H2O intoxication. Dysphagia + dysarthria w/o other cranial nerve involvement. Sensory exam limited but grossly normal. DTR symmetric. Cognition intact. Dx?

Back 43

Central Pontine Myelinolysis

Front 44

MRI finding for woman with memory decline, urinary incontinence, and trouble walking

Back 44

Dilation of Ventricles

Front 45

Patient draws clock with hemiagnosia. Lesion?

Back 45

Parietal Lobe

Front 46

Effortful nonfluent speech with decreased speech output. Lesion?

Back 46

Anterior Frontal Gyrus

Front 47

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Which term describes a state of immobility that is constantly maintained?

Back 47

Catalepsy

Front 48

52yo with h/o unipolar depression brought to ED with first episode catatonia. No meds, UDS negative. Workup should focus on what?

Back 48

Metabolic disorders

Front 49

Among inpatients, catatonia occurs most frequently in the context of what illness?

Back 49

MDD

Front 50

21yo recently diagnosed with schizophrenia becomes mute, occasionally parrots words. What subtype of schizophrenia is this?

Back 50

Catatonic

Front 51

Symptoms that dominate mood disorder with catatonia.

Back 51

Purposeless motor activity not influenced by external stimuli.

Front 52

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62yoM with DM is not making sense saying "thar szing is phrumper zu stalking." Normal intonation but no one in the family can understand it. He verbally responds to questions with similar phrases but fails to execute any instruction. Dx?

Back 52

Wernicke's Aphasia

Front 53

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66yo with HTN develops vertigo, diplopia, n/v, hiccups, L face numbness, nystagmus, hoarseness, ataxia of limbs, staggering gait, tendency to fall to the left. Dx?

Back 53

Lateral Medullary Stroke

Front 54

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Patient with chronic Afib develops aphasia and R hemiparesis at noon. ER exam notes weakness of R extremities and severe dysfluent aphasia, but CT at 1330 has no acute lesion. Most appropriate TX?

Back 54

TPA

Front 55

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Rapid onset of R facial weakness, left limb weakness, diplopia. Dx?

Back 55

Brain Stem Infarct

Front 56

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A life threatening complication of cerebellar hemorrhage.

Back 56

Acute hydrocephalus

Front 57

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72yo with embolic infarct in MCA. Cardiac US shows no structural abnormalities. Carotid Doppler shows <50% occlusion of either side. EKG reveals AFib. Which strategy has the best likelihood of reducing strokes in this patient?

Back 57

Warfarin

Front 58

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Young adult gained 70lbs in last year and complains of daily severe HA sometimes associated with grayed out vision. Papilledema present. CT + MRI show ventricles smaller than usual. Goal of tx?

Back 58

Prevent blindness

Front 59

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68yo with HTN develops rapidly progressing RUE + RLE weakness w/ deviation of eyes to left. W/in 30 min of onset, pt becomes sleepy. 2h after onset patient is unresponsive. Dense R hemiplegia, eyes deviated to left. PERRL. R facial weakness to grimace. Cough and gag present. CT finds?

Back 59

L Putaminal Hemorrhage

Front 60

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Superior homonymous quadrantic defects in visual fields result from lesions to which structure?

Back 60

Temporal Optic Radiations

Front 61

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78yo h/o ischemic stroke w/ residual mild hemiplegia. Unaware that there's a problem of weakness. When asked to raise the weak arm, patient raises normal arm. Neglects weak side of the body. Where is the lesion?

Back 61

Parietal Lobe

Front 62

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Patient has multiple stroke-like sx of short duration over several days. New-onset sx for last 90 min. CT is negative for hemorrhage. Appropriate tx?

Back 62

IV Thrombolytics

Front 63

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MRI scan of head reveals an infarct in distribution of L ACA. Patient most likely exhibits?

Back 63

Contralateral LE weakness

Front 64

Pure sensory deficit extending to midline and involving face, arm, trunk, and leg. Where is the lacunar infarct?

Back 64

Lateral Thalamus

Front 65

Head CT w/ lens-shaped hyperdensity

Back 65

Epidural Hematoma

Front 66

50yo patient has VH of children playing. VH are fully formed, colorful, vivid, without sound. Patient is amused rather than scared. Normal language, memory, cranial nerves. No weakness or involuntary movement. No sensory deficit. DTR symmetric. CSF/UDS wnl. Dx?

Back 66

PCA ischemia

Front 67

R palsy with equal involvement of face, arm, leg combined with CN3 palsy. Most likely an occlusion of a branch of what?

Back 67

PCA

Front 68

Hemisensory loss followed by pain and hyperpathia involving all modalities. Reaches midline of trunk and head. Which artery is ischemic?

Back 68

PCA

Front 69

Most common manifestation of acute neurosyphillis

Back 69

Stroke

Front 70

65yo wakes with R hemiparesis and motor aphasia. Eval completed w/in 1h. Neuro exam has no other abnormalities. Head CT w/o contrast negative. Next step?

Back 70

ASA

Front 71

65yo falls 2/2 stroke. Weak RLE, minor weakness in RUE. No face weakness, no sensory deficit. Speech unaffected. Unusually quiet and passive. Where is the stroke?

Back 71

L ACA

Front 72

58yoM with w/o HTN, smoking, sudden inability to speak. Face droop and leg drag on R side. Seen in ER w/in 40 min of onset. Aphasic, cannot understand or repeat. Unintelligible sounds for speech. Alert but frustrated. Arm and face weaker than leg. CT Head neg for hemorrhage. Pathology and location?

Back 72

Thromboembolic Stroke of L MCA

Front 73

Abulia is an impairment in?

Back 73

Spontaneous movement and speech.

Front 74

Sudden onset vertigo, nausea, hoarseness/dysphagia, R sided face numbness, diminished R gag, decreased pinprick and temperature sensation on L. Lesion?

Back 74

R Medullary Infarct

Front 75

65yo DM patient presents w/ acute L sided weakness, deviation of gaze to R, L hemipelgia and hemisensory deficit, L homonymous hemianopsia. 12h later, patient is unconscious, L pupil enlarged and unreactive. CT shows?

Back 75

R MCA infarct, Edema, Uncal Herniation

Front 76

Patient with acute onset vertigo, what will suggest R lateral medullary infarct?

Back 76

R facial loss of touch and temperature sensation

Front 77

46yoM with diplopia and R eye pain. Ptosis of R eyelid, inability to elevate or adduct R eye + R pupillary dilation. Cause?

Back 77

Posterior Communicating Artery Aneurysm

Front 78

Aphasia with effortful, fragmented, non-fluent, telegraphic speech. Lesion is where?

Back 78

Posterior Frontal Lobe

Front 79

39yo patient with h/o multiple miscarriages develops an acute L sideded hemiparesis. Work-up reveals elevated anticardiolipin titers and no other risk factors for stroke.
Next step?

Back 79

Plasmapheresis

Front 80

Abnormal elevated metabolic findings associated with increased risk of stroke in patients under 50.

Back 80

Plasma Homocysteine

Front 81

70yo patient hospitalized because of MCA stroke. Psych eval shows non-fluent aphasia. What most likely characterized the patient's interaction with the psychiatrist?

Back 81

The patient was able to follow the verbal request "close your eyes".

Front 82

Acute onset dense sensorimotor deficit in contralateral face/arm, mild involvement of LE. Associated with gaze deviation towards opposite side of deficit. Occlusion?

Back 82

Superior Division of MCA

Front 83

Weakness of extension at knee involves a lesion of which nerve?

Back 83

Femoral

Front 84

CT scan w/ occipital and intraventricular hyperintensities.

Back 84

Parenchymal Hemorrhage

Front 85

Which med has secondary prevention against embolic stroke in patients with Afib?

Back 85

Warfarin

Front 86

As opposed to strokes caused by arterial embolism or thrombosis, those cause by cerebral vein or venous sinus thrombosis are?

Back 86

Associated with seizures at onset

Front 87

Atrophy of R temporal lobe on cross section associated with occlusion of?

Back 87

MCA

Front 88

Loss of ability to execute previously learned motor activities (not due to weakness/ataxia/sensory loss) is associated with lesions of what?

Back 88

L Parietal Cortex

Front 89

58yo s/p CABG has anomia for fingers and body parts, errors involving left/right, inability to write thoughts/take notes/make calculations. Fluent speech and excellent comprehension. Etiology?

Back 89

L Medial Temporal Stroke

Front 90

Visual disturbances associated with occlusion of R PCA?

Back 90

L Homonymous Hemianopsia

Front 91

65yo with HTN collapsed. Stuporous, R hemiparesis + hemisensory deficit. Eyes deviate to L. CT would show intraparenchymal hemorrhage in what?

Back 91

L Basal Ganglia

Front 92

Lower facial weakness with relative sparing of forehead. Stroke occurred where?

Back 92

Internal Capsule

Front 93

Which location for stroke has a high frequency and greater severity of depression?

Back 93

L Anterior Frontal

Front 94

68yo patient is depressed following hip surgery. Withdrawn, looks blank, shows dysarthria, weakness, PMR, hyperreflexia, trouble swallowing. MRI shows?

Back 94

Periventricular White Matter Demyelination

Front 95

Prognosis of acute inflammatory demyelinating polyneuropathy is poorest if the disease process involves which of the following?

Back 95

Proximal Axon

Front 96

Patient with HTN. Painless blindness in L eye with afferent pupillary defect. MRI shows several T2 hyperintensities in white matter periventricularly. No corpus callosum lesions. No enhancement with gadolinium. Diagnosis?

Back 96

Ischemic Optic Neuropathy

Front 97

63yo with new-onset aphasia and R hemiparesis. 2 day ago had milder/similar sx that resolved in 30 minutes. Yesterday had one for 45 minutes. Current sx started 1.5h ago CT neg for stroke and hemorrhage. TX?

Back 97

IV Thrombolytics

Front 98

Prosopagnosis is?

Back 98

The inability to recognize faces

Front 99

57 year old diabetic w/ HTN has episodes of vision loss like a "curtain falling" over L eye. Transient speech + language disturbance, mild R hemiparesis that lasts 2 hours. Presence of what?

Back 99

Extracranial L Internal Carotid Stenosis

Front 100

Head Injury w/ LOC. Hours long lucid interval leads to rapidly progressing coma. Hemorrhage?

Back 100

Epidural

Front 101

Pt in ED with sudden HA and collapsing, some lethargy. Rigid neck, no papilledema, no focal CN/motor signs. Initial test?

Back 101

CT head

Front 102

Post-stroke depression in 80yo R handed patient is associated with cognitive impairments that:

Back 102

Correlate with L hemispheric involvement

Front 103

Fluent speech with preserved comprehension and inability to repeat statements

Back 103

Conduction aphasia

Front 104

Normal romberg w/ eyes open but loses balance with eyes closed. Location?

Back 104

Cerebellar Vermis

Front 105

65yo w/ HTN, Meniere's. N/V worse w/ head movement. R beating nystagmus on lateral gaze, finger-nose is ataxic, poor balance, dysarthria. Dx?

Back 105

Cerebellar infarct

Front 106

66yoM w/ sudden occipital HA, vertigo, slurred speech. Eyes: small reactive pupil, R gaze, nystagmus, blobbing. CN: R facial weakness, poor R corneal reflex Motor: truncal ataxia, b/l hyperreflexia + Babinski. Dx?

Back 106

Cerebellar hemorrhage

Front 107

Motor speech paradigm activation task on fMRI. Hyperactivity in R temporal. Damage is where?

Back 107

Calcarine Fissure

Front 108

Inability to recognize object by touch.

Back 108

Astereognosis

Front 109

In managing acute ischemic stroke, administer this w/in 48h of onset to reduce risk of recurrent stroke, disability, death.

Back 109

ASA

Front 110

70yo w/ attacks of "whirling sensation", w/n/v, diplopia, dysarthria, tingling of lips. 1 minute, multiple times a day. Patient collapses, is immobilized. No residual s/s, tinnitus, hearing loss, ALOC, or association w/ specific activity. Dx?

Back 110

Vertebrobasilar insufficiency

Front 111

Component of type A behavior most reliable as a risk factor for CAD

Back 111

Hostility

Front 112

Vascular lesion most characteristic of sudden severe HA, emesis, collapse, preservation of consciousness, few lateralizing signs, neck stiffness.

Back 112

Subarachnoid Hemorrhage

Front 113

Patient with sudden onset of L hemiparesis, L homonymous hemianopsia, R gaze, L side neglect. Occlusion of what?

Back 113

R MCA

Front 114

70yoF sudden paralysis RLE. RUE slightly affected. No aphasia or visual field deficit. Slower onset of bladder incontinence, abulia, lack of spontaneity. Which vascular area?

Back 114

L ACA

Front 115

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72yo w/ recent behavior/memory problems. Disrobing, not sleeping, irritable. Waxing/waning consciousness. Dx?

Back 115

Delirium

Front 116

*****

79yo with decreasing mental state over 3 weeks has an exaggerated startle w/ violent myoclonus. Myoclonic jerks occur spontaneously, ataxia. EEG shows sharp waves. Dx?

Back 116

Subacute Spongiform Encephalopathy

Front 117

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52yo with h/o depression, HTN. Severe HA, "has not been himself" for 10d. Poor eye contact, inattentive, muttering, picking at clothes, occasionally dozes off even at mid-day. Dx?

Back 117

Delirium

Front 118

**

Mild confusion, lethargy, thirst, polydipsia

Back 118

Hyponatremia

Front 119

**

Multifocal myoclonus in a comatose patient indicates?

Back 119

Metabolic encephalopathy

Front 120

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70yo with mild Alzheimer's lives with family, prescribed an SSRI for MDD. H/O HTN, DM, RA. Acute confusion w/o other med/psych sx. What do you order first?

Back 120

Electrolytes

Front 121

What test is most helpful to distinguish dementia vs delirium?

Back 121

EEG

Front 122

Alcoholic patient w/ 2 days of confusion, AVH, disorientation, distractibility, fever, tachycardia, tremor. EEG is low voltage fast waves on slow waves. On olanzapine for schizoaffective d/o. Dx?

Back 122

Delirium, EtOH Withdrawal

Front 123

Most common EEG finding in metabolic encephalopathy?

Back 123

Generalized slowing

Front 124

2d after bowel surgery, 53yo is delirious. Draws a square when asked, but continues to draw a square when asked to draw other things. MSE reveals?

Back 124

Perseveration

Front 125

Patient with ICU psychosis most likely has what condition?

Back 125

Delirium

Front 126

Best recommendation for patient with delirium?

Back 126

Maximize Staff Continuity assigned to patient

Front 127

Delirium in HIV patients is treated with what parenteral agent?

Back 127

Low dose high-potency antipsychotic

Front 128

34yo tx for malaria with h/o schizoaffective d/o controlled with risperdal and lithium. Given a single dose of mefloquine. 1 week later, reports anxiety. Escalates to PMA and persecutory delusions. Most likely cause of psychotic sx?

Back 128

Uncommon SE of new medication

Front 129

Cancer patient on chemo is disoriented and agitated. Afebrile and VSS. Neuro exam neg. Poor attention, some cognitive impairment. CT ned, EEG shows diffuse slowing.

Back 129

Haldol

Front 130

70yo HIV+ IV drug abuser w/ MDD tx with lopinavir, ritonavir, fluoxetine. HepC was dx and treated 2 months ago. Since then patient is irritable, has insomnia and diarrhea. Why?

Back 130

Drug-Drug interaction

Front 131

Patient delirious, agitated, hallucinating. Flushed and hot w/ dry skin, mydriasis, tachycardia, diminished bowel sounds. First recommendation?

Back 131

D/C Anticholinergic Drugs

Front 132

This major symptom of delirium may require that the patient receive pharmalogical treatment.

Back 132

Insomnia

Front 133

***** **

65yoM with 6mo h/o confusion episodes, disorientation, VH of children playing in his room. VH are fully formed, colorful, vivid. Pt has little insight into VH. Normal between episodes. Mild difficulty with serial subtraction, mild symmetric rigidity, bradykinesia. MRI, CSF, labs, UDS neg. Dx?

Back 133

Lewy Body Dementia

Front 134

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A limitation of the MMSE

Back 134

May fail to detect very mild cognitive impairment

Front 135

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When combined with functional neuroimaging, this biomarker identifies geriatric pt with mild impairment most at risk for Alzheimer's.

Back 135

E4 APO E allele

Front 136

**

The most specific factor for distinguishing delirium from dementia of Alzheimer type

Back 136

Fluctuating Arousal

Front 137

72yo w/ early dementia. Paranoid + VH. Lightheaded and socially inappropriate. Risperal 0.25mg for 2d leads to confusion, sedation, rigidity. Dx?

Back 137

Lewy Body Dementia

Front 138

In addition to orientation, attention, calculation, language, and registration, what other cognitive domain does the MMSE test?

Back 138

Recall

Front 139

Tau staining with progressive dementia. Dx?

Back 139

Alzheimer's Dementia

Front 140

80yo w/ VH and worsening gate, episodic confusion, disturbed sleep, b/l rigidity, masked facies. Levodopa improved movement temporarily. Dx?

Back 140

Lewy Body Dementia

Front 141

Medicine that interferes with the efficacy of Donepezil?

Back 141

Oxybutinin

Front 142

A dialysis patient becomes more disoriented and has memory loss. Physical exam normal. Reported that patient has had seizures. Labs and neurodiagnostics negative. Dx?

Back 142

Dialysis Dementia

Front 143

Which test correlates most strongly with pre-morbid functioning in early dementia

Back 143

WAIS-IV Vocabulary Test

Front 144

71yo with Parkinsonian gait, prominent delusions, fluctuating attention, VH, sensitivity to EPS. Dx?

Back 144

Lewy Body Dementia

Front 145

FTD with mutation in Chr17 is associated with abnormal intraneuronal deposition of which protein?

Back 145

Tau

Front 146

Neuropsychological test most useful in the early diagnosis of Alzheimer's disease.

Back 146

10 item world list learning task

Front 147

Best initial tx of patient with mild Alzheimer's

Back 147

Cholinesterase Inhibitor

Front 148

74yo R handed patient with significant memory loss, expressive aphasia. L plantar extensor response. Dx?

Back 148

Vascular Dementia

Front 149

Sx most likely related to excessive VitB12

Back 149

Burning Sensation

Front 150

60yoF w/ 10 month h/o apathy and depression. Hyperchromic macrocytic anemia. Best test to order next?

Back 150

VitB12 Level

Front 151

Earliest evidence of cell loss in patients with Alzheimer's typically occurs in this area of the brain

Back 151

Entorhinal Cortex

Front 152

EtOH dependent patient with confusion, ataxia, nystagmus, ophthalmoplegia. High doses of what could prevent this syndrome?

Back 152

VitB1

Front 153

Medication helpful in early HIV dementia but is toxic later in the disease

Back 153

Methylphenidate

Front 154

74yoF w/ personality change, poor ADLs. Dx?

Back 154

Pick's Disease

Front 155

80yo, no prior psych hx. More forgetful, worse ADLs. Can conduct routine social activities. Acquaintances don't notice abnormalities. Dx?

Back 155

Alzheimer's Dementia

Front 156

Safest heterocyclic antidepressant for 78yo with depression, agitation, dementia.

Back 156

Nortriptyline

Front 157

This cognitive enhancer is an NMDA receptor antagonist

Back 157

Memantine

Front 158

Neuronal damage from glutamate excitotoxicity is treated with this.

Back 158

Memantine

Front 159

Acamprosate works through this neurotransmitter.

Back 159

Glutamate

Front 160

Neurofibrillary tangles in Alzheimer's Dementia are composed of this.

Back 160

Hyperphosphorylated Tau Proteins

Front 161

80yo Alzheimer's Dementia patient w/ increasingly combative behavior. Family wants to keep at home. Give which med?

Back 161

Haldol

Front 162

Dementia characterized by personality change, attention deficit, impulsivity, affect lability, indifference, perseveration, and loss of executive function. Dysfunction is where?

Back 162

Frontal Lobe

Front 163

Binswanger disease has pseudobulbar state, gait disturbance, and this.

Back 163

Dementia

Front 164

80yo Alzheimer's pt is brought home for increasingly combative behavior. Daughter would like to keep pt at home if possible. Helpful intervention?

Back 164

Assessing for caregiver burnout

Front 165

Early stage HIV type 1 associated dementia has this feature that early onset dementia does not.

Back 165

Decreased processing speed

Front 166

Best treatment for agitation in dementia?

Back 166

Antipsychotics

Front 167

Clock drawing test is sensitive for this d/o.

Back 167

Alzheimer's

Front 168

An amyloid precursor protein is found in this d/o.

Back 168

Alzheimer's

Front 169

Most common cause of dementia >65yo.

Back 169

Alzheimer's

Front 170

Down's syndrome pt >40yo get this d/o.

Back 170

Alzheimer's

Front 171

Characteristic MRI finding in Alzheimer's.

Back 171

Reduced Hippocampal Volumes

Front 172

Known risk factors for dementia.

Back 172

Age

Family Hx

Female

Down's Syndrome

Front 173

Target of Alzheimer's drugs.

Back 173

Acetylcholinesterase

Front 174

Vascular dementia has changes in this structure.

Back 174

Basal Ganglia

Front 175

83yo w/ mild HTN, new HA, L hemiparesis. MRI shows R parietal and small occipital hemorrhage. Old R temporal and L parietal hemorrhage. Etiology?

Back 175

Amyloid Angiopathy

Front 176

65yo disoriented, mild agitation, VH of children playing. 2 episodes in past, normal between episodes. Mild symmetric rigidity and bradykinesia. MRI, UDS, CSF normal. Etiology?

Back 176

Lewy Body Dementia

Front 177

Med most likely to slow progression of vascular dementia.

Back 177

ASA

Front 178

Best rationale for cholinesterase inhibitors in Alzheimer's pt.

Back 178

Reduce neuropsych sx

Front 179

Pt w/ HIV. Memory loss, inattention, amotivation, poor coordination. Normal LP, atrophy on CT. MRI shows diffuse & confluent white matter changes on T2 w/o enhancement. Dx?

Back 179

HIV-associated Dementia

Front 180

Most important tool for eval of early-mod dementia.

Back 180

MMSE

Front 181

60yo w/ memory problems (losing things, forgetting names). No other neurocognitive sx. Gradual over years. Former history professor who enjoys intellectual activities. MMSE would be insensitive in this case because of this.

Back 181

It has a ceiling for the well-educated.

Front 182

65yo gradual/slow progression of confusion. Anomia, mental slowness, self-neglect, apathy, altered personality, impaired gait, prominent grasp & suck reflexes. Ddx?

Back 182

Frontotemporal Dementia or Alzheimer's

Front 183

65yo high school grad w/ MMSE of 23. Score suggests these.

Back 183

Dementia or Mild Cognitive Impairment

Front 184

46yo w/o past psych hx over several months becomes labile and irritable. Personality changes w/ inappropriate laughter. In 2 years is convinced all food has germs. Memory intact. Neuropsych testing shows impaired language and attention. Dx?

Back 184

Frontotemporal Dementia

Front 185

In regards to memory, dementia rather than depression has this.

Back 185

Naming Deficits

Front 186

Bilateral loss of neurons in CA1 (Hippocampus) is the most common histology finding in this.

Back 186

Alzheimer Dementia

Front 187

65yo lives alone, increasingly forgetful, difficulty making phone calls and remembering appointments. Lifelong difficulty recalling names. Lives independently. MSE has delayed recall of 4 words. Sx consistent with?

Back 187

Amnestic mild cognitive impairment

Front 188

Most common genetic cause of intellectual disability.

Back 188

Down's Syndrome

Front 189

Alzheimer's patient in clinic. Daughter is frustrated with caring for her, wants to remover her from her church group. Best initial response?

Back 189

Tell her to continue going to group.

Front 190

***** ****

16yo with 1x grand mal. Occasionally has jerks of entire body where they drop things. EEG shows rare 4-6Hz irregular polyspike/wave bursts. Dx?

Back 190

Juvenile Myoclonic Epilepsy

Front 191

***** **

8yo w/ staring spells. EEG shows this.

Back 191

3Hz spike and wave

Front 192

****

40yo w/ episodes of flailing arm and tonic "fencing" postures. EEG confirms this seizure.

Back 192

Frontal Lobe

Front 193

****

10yo with 2-10s lapses of consciousness w/o premonitory sxs. Immediate and full resumption of consciousness. No memory of event. Dx?

Back 193

Absence Seizure

Front 194

1st seizure w/ focal onset and secondary generalization in 58yo pt is likely 2/2 this.

Back 194

Glioblastoma Multiforme

Front 195

The diagnostic value of transient paresis or aphasia after seizure.

Back 195

Localization of lesion

Front 196

6yo w/ brief staring and blinking spells. Best treatment(s).

Back 196

VPA

Ethosuximide

Front 197

40yo new onset seizure w/ bilateral thrashing movement. This suggests non-epileptic cause.

Back 197

Following commands.

Front 198

Characteristics of normal adult alpha rhythm seen on EEG.

Back 198

Intermittent and posterior dominant.

Front 199

Surgical treatment of medication refractory epilepsy.

Back 199

Vagal stimulation

Front 200

19yoF has bouts of motor agitation followed by intense meaningless writing. Mood lability, tactile and olfactory hallucinations. Abruptly stops interview to pace the room. Next step is this.

Back 200

Wait 15min then obtain a prolactin level.

Front 201

73yoM, routine f/u for seizure d/o. Gum hypertrophy, cerebellar ataxia, hirsutism. The patient is taking this medication.

Back 201

Phenytoin (Dilantin)

Front 202

Pt with h/o MDD and well controlled epilepsy seizure free on Wellbutrin 100mg BID. Insurance wants med change to reduce seizure threshold. Has not tried imipramine, nortryptyline, duloxetine, or selegiline. Appropriate response?

Back 202

Continue Bupropion

Front 203

Most serious s/e of rTMS.

Back 203

Seizure

Front 204

This procedure confirms dx of nonepileptiform seizure.

Back 204

EEG video telemetry

Front 205

Tx for juvenile myoclonic epilepsy.

Back 205

VPA

Front 206

Complex partial seizures are differentiated from simple partials by this.

Back 206

Altered Consciousness

Front 207

Convulsive episode w/ leftward eye deviation, tonic contracture of L side. Post-ictally, eyes deviate to R w/ L side hemiparesis. Focus?

Back 207

R frontal

Front 208

28yoF w/ HA. Hyperventilates. Asynchronous tonic-clonic w/o LOC. Dx?

Back 208

Psychogenic Seizure

Front 209

In young pt w/ epilepsy, tx depression with this.

Back 209

Prozac

Front 210

Why is there a high suicide rate in epileptics?

Back 210

Comorbid Psychiatric D/O

Front 211

Lack of prolactin elevation after SZs suggests this etiology.

Back 211

Psychogenic Seizure

Front 212

32yo w/ tx refractory complex partials. MRI shows.

Back 212

Mesial Temporal Sclerosis

Front 213

Drug-addicted healthcare professional has SZ that isn't withdrawal. Cause?

Back 213

Meperidine

Front 214

Complex partial epilepsy aura has this symptom.

Back 214

Lip Smacking

Front 215

Head and eyes deviate R and R arm extends immediately before generalized tonic-clonic SZ. Focus?

Back 215

L cerebral hemisphere

Front 216

Gustatory special sensory SZ/auras are localized here.

Back 216

Insular Cortex

Front 217

This surgery can be used to tx refractory epilepsy.

Back 217

Stimulation of Vagus Nerve

Front 218

Pt w/ 1-2 min episodes of altered behavior w/ chewing movements. Pt has no recollection. MRI neg. Dx?

Back 218

Complex Partial Seizure

Front 219

28yoF recent onset 1-2 min episodes of altered behavior. Puts clean silverware back in dishwasher, uninterruptible drawing movements. Pt doesn't recall episodes. MRI neg. Dx?

Back 219

Complex Partial Seizure

Front 220

16yo w/ new onset tonic clonic. Jerky movements that cause him to drop objects. EEG shows polyspikes. Tx?

Back 220

Valproic Acid

Front 221

15yo patient w/ partial complex and secondary generalization, MR, and adenoma sebaceum. Dx?

Back 221

Tuberous Sclerosis

Front 222

Adequate initial tx of absence sz in children.

Back 222

Valproic Acid

Front 223

***

EEG revealing posterior alpha and anterior beta is obtained in this situation.

Back 223

Relaxed adult with eyes closed

Front 224

**

4-6 Hz irregular polyspike in pt with generalized sz is characteristic of this epileptic syndrome.

Back 224

Juvenile Myoclonic Epilepsy

Front 225

**

3d s/p cardiac arrest and CPR, 73yoM is comatose. Eyes open, no movement. Doll's eyes elicits full horizontal eye movements. Spontaneous limb movements are symmetrical. Mildly hyperactive reflexes. EEG shows this.

Back 225

Burst Suppression Pattern

Front 226

***

28yo with emotional lability and impulsivity. LFT elevated. Close relative has similar sx, died at 30yo from hepatic failure. Diagnostic lab?

Back 226

Ceruloplasmin

Front 227

25yo w/ several years of cognitive decline, dysarthria, dysphagia, and slow movement. Hand tremor that increases in amplitude on arm extension. Hepatic disease of unknown etiology. Ocular exam reveals golden brown ring around cornea. Diagnostic lab?

Back 227

Ceruloplasmin

Front 228

73yoM w/ onset of fatigue, weight gain, constipation, cold intolerance, depressed mood. R/O this organic cause.

Back 228

Thyroid

Front 229

Neuro finding associated with hypothyroidism.

Back 229

Slow relaxation of DTR

Front 230

Which patient is indicated for ceruloplasmin titer?

Back 230

Young adult M w/ new onset emotional lability and movement d/o

Front 231

Pt with bipolar d/o on lithium for 2y develops rapid cycling. Order this lab.

Back 231

Thyroid Function

Front 232

32yo s/p thyroidectomy presents c/o frequent panic attacks, progressive cognitive inefficiency, perceptual disturbances, severe muscle cramps, and carpopedal spasm. Alopecia and absent DTR on exam.

Back 232

Hypoparathyroidism

Front 233

***** ***** **

35yoM awakens frequently in the night w/ severe HA, lasts 1-2h, pt is afraid to go to sleep. HA is at L eye, assoc w/ lacrimation, ptosis, miosis. Dx?

Back 233

Cluster HA

Front 234

***** **
Young pt w/ new onset severe HA assoc w/ periods of visual obscuration. Neuro exam is normal except for papilledema. MRI neg. Next test?

Back 234

LP to measure pressure

Front 235

*****

Abortive tx of common migraines is best achieved w/ this medication.

Back 235

Rizatriptan

Front 236

****

Characteristic of post-LP HA.

Back 236

HA worse w/ sitting upright

Front 237

***

25yo has HA and emesis. Pain dull, in occiput. Worse when lying down. Severe papilledema b/l. LP shows opening pressure of 80 w/ normal CSF and 120 RBCs in last tube. D-dimer, FDP in blood are elevated. CT normal. Dx?

Back 237

Sagittal Sinus Thrombosis

Front 238

**

24yoM w/ nocturnal HA and early waking. Rhinorrhea, nostril blocking, ipsi eye tearing, facial swelling. HA persists 45-60 min. Dx?

Back 238

Cluster HA

Front 239

**

35yo w/ episodes of flashing lights traveling L->R in L visual field lasting 30 min followed by difficulty speaking and concentrating. Sx subside but pounding HA and nausea starts. PE and MRI neg. Dx?

Back 239

Migraine w/ Aura

Front 240

**

30yo w/ intermittent HAs lasting 1h. Attacks w/ sharp, stabbing pain around eye, tearing, congestion. Most effective abortive?

Back 240

Oxygen

Front 241

**

Most effective treatment for acute acute migraine.

Back 241

Sumatriptan

Front 242

25yo w/ VH in both visual fields similar to wavy distortions produced by head rising from asphalt. Vertigo, dysarthria, b/l tingling in limbs and mouth followed by occipital HA. Dx?

Back 242

Basilar Migraine

Front 243

MOA of Topiramate includes these.

Back 243

Inhibiting voltage-gated Na channels;

Antagonizing Kainate + AMPA receptors;

Potentiation of GABA-A receptor

Front 244

28yoF reports severe HAs with n/v. HAs can be incapacitating, preceded by flashes of light in R visual field. During HA can have difficulty expressing herself. Most effective prevention is this.

Back 244

Topiramate

Front 245

26yoF with 3d h/o severe continuous non-throbbing HA not improved on NSAID. Mild b/l papilledema. Head CT w/wo contrast shows this.

Back 245

Sagittal Sinus Thrombosis

Front 246

Pt c/o severe dull and constant HA not assoc with N/V. Vision loss in L eye, pain and stiffness of limbs. MRI shows periventricular white matter hyperintensities of T2. Elevated sed rate. Next step is this.

Back 246

High Dose Prednisone

Front 247

35yo pt w/ 5 min paroxysms of sharp pain around eyes and side of head. 10 times/day. HA with rhinorrhea and conjunctival erythema. This med is most likely to give relief.

Back 247

Propranolol

Front 248

***** *

42yoM w/ progressive cognitive deficit develops jerking movements. Imaging shows b/l atrophy of caudate. Pt father had similar illness starting at 50yo. This test confirms dx.

Back 248

DNA analysis for CAG repeats

Front 249

*****

This MRI finding most specifically indicates Huntington's.

Back 249

Caudate Head Atrophy

Front 250

***

Tx of Huntington's Chorea.

Back 250

Haloperidol

Front 251

***

98yoM in ER, unconscious after choking. Progressive neuro d/o presented in early 30s w/ involuntary irregular movements. Evolved into rigid akinesis. Progressive dementia and full time care. Pathology showed generalized atrophy. Dx?

Back 251

Huntington's Disease

Front 252

**

35yo pt w/ 2y h/o cognitive decline, difficulty at work, irritability. Restless w/ slow writhing movements in most muscle groups and frequent blinking. Pt's father and paternal grandpa had similar sx and died in their 50s. Dx?

Back 252

Huntington's Disease

Front 253

**

Pt w/ depression, 3y h/o change in personality, irritability, impulsive outbursts, and eccentric social interactions. Withdrawn and fidgety. Increased blinking, marked tongue impersistence, mild bradykinesia. Father died of severe dementia at 55yo. Dx?

Back 253

Huntington's Disease

Front 254

Disease with trinucleotide repeat expansion

Back 254

Huntington's Disease

Front 255

Huntington's Disease etiogene is classified as a polymorphism due to this quality.

Back 255

Region has many alleles differing in the number of CAG repeats.

Front 256

****

Role of the hippocampus and parahippocampal gyrus.

Back 256

Declarative Memory (Facts)

Front 257

**

Example of declarative memory.

Back 257

Retention and recall of facts.

Front 258

Unconscious filling in of memory gap

Back 258

Confabulation

Front 259

45yo w/ nystagmus, ataxia, and short term memory loss. Believes wife is possessed by demons. Tx?

Back 259

Thiamine

Front 260

A conscious memory that covers for another memory that is too painful to hold in consciousness.

Back 260

Screen memory

Front 261

In pt with pronounced deficits in recent memory, remote memory is often...

Back 261

Deficient on close examination even when it seems well preserved.

Front 262

"My father was very involved in my life. I remember going to football games in the snow with him" is an example of memory associated with this part of the brain.

Back 262

Medial Temporal Lobe

Front 263

Working memory requires prefrontal cortex, dorsal thalamus, and this area of the brain.

Back 263

Hippocampus

Front 264

Asking a patient what they ate for breakfast tests for this.

Back 264

Recent memory

Front 265

This question evaluates immediate recall.

Back 265

Can you repeat these six numbers?

Front 266

Asking patient to remember 3 things and repeat them in a few minutes tests this.

Back 266

Short term memory

Front 267

**

This is the most reliable finding from CSF in MS during chronic progressive phase.

Back 267

Oligoclonal Bands

Front 268

**

This condition is the forerunner of MS

Back 268

Transverse Myelitis

Front 269

**

Acute onset of fever, sore throat, diplopia, dysarthria. Inflamed throat, left adductor palsy, impaired vertical pursuit, diffuse hyperreflexia w/ b/l clonus, LE spasticity, mild R hemiparesis. CT uninformative. CSF protein is 24, 10 mononuclear cells, glucose 70. Dx?

Back 269

Multiple Sclerosis

Front 270

**

Acute onset of pain and decreased vision in R eye. Colors look faded in R eye. On exam, R afferent pupillary defect and swollen R optic disc. Spontaneous recovery in 6 weeks. Pt likely to develop this later.

Back 270

Multiple Sclerosis

Front 271

**

25yo w/ diplopia, balance problems. On R lateral gaze, weakness of L medial rectus w/ nystagmus of R eye. On L lateral gaze, weakness of R medial rectus w/ nystagmus of L eye. Mild finger-nose ataxia. Dx?

Back 271

Multiple Sclerosis

Front 272

32yoF w/ vertigo and INO. Dx?

Back 272

Multiple Sclerosis

Front 273

***** *

Myasthenia gravis is associated with this EMG finding.

Back 273

Decreased amplitude with repetitive motor nerve stimulation.

Front 274

***** *

37yo truck driver w/ numbness of L hand increasing in severity over 2y. Reduced pinprick sensation on ring and pinky fingers. Atrophy of hypothenar muscle. Dx?

Back 274

Ulnar Nerve Lesion

Front 275

***

This is seen in electrophysiologic testing of patients with myasthenia gravis.

Back 275

Decremental response to repetitive stimulation.

Front 276

***

MOA of botulinum toxin at NMJ.

Back 276

Inh of ACh release from presynaptic terminals

Front 277

***

Myasthenia gravis can be dx in 80-90% of cases by identification of this serum Ab.

Back 277

AChR

Front 278

***

38yoF, pregnant Tri2, b/l hand numbness in thumb, forefinger, middle finger. Arms ache in morning from shoulders to hands. Dx?

Back 278

Median Neuropathy at wrist

Front 279

**
30yo develops pain behind L ear. Later complains of L face numbness, tearing, and discomfort w/ low frequencies. L weakness w/o sensory deficit. Dx?

Back 279

Idiopathic Bell's Palsy

Front 280

**
1mo s/p MVA, 21yo c/o persistent L shoulder/arm pain radiating to thumb. Weakness and decreased reflex of biceps. Dx?

Back 280

C6 radiculopathy

Front 281

**

Pt c/o progressive weakness for days. Exam shows generalized weakness and absent reflexes. Nerve conduction shows slowed velocities. Dx?

Back 281

Acute polyneuropathy

Front 282

**

65yo pt with progressive weakness worse w/ squatting and standing from chair. C/o decreased strength in R hand. Weak b/l quads and R thumb. Atrophy forearms w/ normal DTRs. Sensation intact, ROS neg. Normal CK, Jo1 Ab neg. Dx?

Back 282

Myotonic Dystrophy

Front 283

**

This chemo agent is most commonly associated with distal sensory polyneuropathy.

Back 283

Cisplatin

Front 284

**

Pt presents w/ personality changes, cognitive difficulty, affective lability, and olfactory and gustatory hallucinations. Most likely medical cause is this.

Back 284

HSV Infection

Front 285

Conduction block in NCS indicates this.

Back 285

Focal demyelination

Front 286

Polyneuropathy can be caused by deficiency or extreme excess of this B vitamin.

Back 286

VitB6

Front 287

57yo office worker w/ numbness in 4th/5th digit of R hand which wakes patient in middle of night. NCS will most likely find this.

Back 287

Slowed conduction velocity across elbow in ulnar nerve.

Front 288

45yo w/ LBP and R leg pain and numbness. Difficulty walking x4wk. R foot drop. NCS neg. EMG shows reduced recruitment and spontaneous activity in R tibialis anterior and posterior. Dx?

Back 288

L5 radiculopathy

Front 289

54yo c/o intermittent diplopia worsening over 3wk. Bilateral ptosis, mild esotropia, diplopia after maintaining upward gaze for 2 minutes. No dysarthria, 4/5 weakness in b/l proximal arm muscles. Most appropriate test?

Back 289

Edrophonium

Front 290

Which antibiotic is most likely to cause/precipitate acute myasthenia?

Back 290

Ciprofloxacin

Front 291

15yo h/o seizures starting @ 9yo followed by prolonged motor/sensory deficits lasting days to weeks. Pattern of deficits has changed over time. Hemicranial HA. No FamHx. Dxs?

Back 291

Mitochondrial Encephalomyopathy,

Lactic Acidosis,

Stroke

Front 292

Hyperextension lesion of shoulder results in weakness of abduction, internal rotation, flexion, and adduction of the extended arm. Nerve roots involved?

Back 292

C5 and C6

Front 293

55yoM h/o weakness and clumsiness. Sx began months ago w/ difficulty on fine motor tasks. Fasciculations of forearms w/ increased cramping. Diffuse wasting and weakness of BUE, fasciculations, slight spasticity on arms and legs, and hyperreflexia w/ extensor plantar responses. Senses, coordination, and CN exams wnl. Pathological process is occuring in these locations.

Back 293

Ant Horn of SC,

Medial Brainstem,

Prerolandic cortex

Front 294

13yoM w/ trouble in PE class. Symmetric weakness of BUE/BLE, worse in proximal muscles. Most prominent in quads/hams. Calves enlarged, painful w/ exercise. Serum CK is 13,000. Muscle bx shows abn dystrophin protein staining. Pathology has this pattern of inheritance.

Back 294

X-Linked

Front 295

Neoplasms of the thymus are associated with this.

Back 295

Myasthenia Gravis

Front 296

Hyperkalemic periodic paralysis is characterized by episodes of generalized weakness of fairly rapid onset. Also assoc w/ rise in K. Weakness typically appears after a period of rest after excercise. Disease is due to molecular deficits in this.

Back 296

Na Channel Inactivation

Front 297

PT was hit from behind while driving, woke w/ pain radiating into L ankle. Weakness of plantarflexion and decreased ankle jerk. Straight leg raising painful >45 degrees on L. Dx?

Back 297

S1 Radiculopathy

Front 298

Myasthenia gravis pt w/ mild respiratory infection develops severe respiratory fatigue, restlessness, and diaphoresis. Pt. appears anxious and tremulous. Tx?

Back 298

Mechanical Ventilation

Front 299

Pt w/ L foot drop. Weakness of dorsiflexion of L foot w/ small area of numbness in dorsum of L foot. Normal ankle, knee jerks, hamstring reflexes. Dx?

Back 299

Peroneal Nerve Palsy

Front 300

Ptosis, ipsilateral anhidrosis, conjunctival injection. Lesion is here.

Back 300

Superior Cervical Ganglion

Front 301

Most effective tx for spasmodic torticollis.

Back 301

Botulinum Toxin

Front 302

50yo secretary w/ cramping/stiffening of hands. Only while writing. Occasional hand tremor. Most effective therapy is this.

Back 302

Botulinum Toxin

Front 303

R neck pain, usually rotating neck to L. Corrected by touching chin. Spasm of R SCM on PE. Tx?

Back 303

Botulinum Toxin

Front 304

70yo w/ confusion, lethargy, fever. Dx of encephalitis is made after CSF. This clinical feature suggests West Nile.

Back 304

Monoparesis

Front 305

55yo c/o mild muscle ache and stiffness for which steroids were given. Hx of hyperlipidemia tx w/ atorvastatin and gemfibrozil w/ positive response. Serum CK is elevated. Dx?

Back 305

Statin-Induced Myelopathy

Front 306

63yo w/ insidious onset of neck pain, progressive limb weakness, falls, urinary incontinence. Decreased neck ROM, mild distal and prox limb weakness. Brisk DTRs with ankle clonus and upgoing plantar reflex. Increased muscle tone in legs. Dx?

Back 306

Cervical Myelopathy

Front 307

*****

Parkinson's Disease tx w/ levodopa. VH+. Recommend this.

Back 307

Reduce dose of levodopa

Front 308

***

Medication for orthostatic hypotension in Parkinson's.

Back 308

Fludrocortisone

Front 309

***

Postural instability, festination, truncal regidity. Lewy bodies visualized. Involuntary acceleration. Dx?

Back 309

Parkinson's Disease

Front 310

***

Picture showing substantia nigra changes. Dx?

Back 310

Parkinson's Disease

Front 311

***

New onset of pathological gambling, increased libido, hypersexuality in PD pt. Cause?

Back 311

Pramipexole

Front 312

80yoM w/ gait imbalance and falls. Kicks and screams while sleeping, dreams of being chased. Patient likely will develop this disease.

Back 312

Parkinson's Disease

Front 313

67yo w/ Parkinson's takes pramipexole for years w/o cognitive decline. Started gambling excessively, isn't drinking or using drugs. Likely cause?

Back 313

Pramipexole

Front 314

Most appropriate initial tx for idiopathic Parkinson's in an 81yo

Back 314

Carbidopa/Levodopa

Front 315

66yo c/o frequent falls, mild axial and LUE regidity. Mild slowness of finger tapping, hand opening, and wrist opposition (all worse on left). Normal posture. Slow gait w/ short steps, doesn't swing L arm. Slow rising from chair. Dx?

Back 315

Parkinson's Disease

Front 316

Implantation of deep brain stimulation electrodes is an effective tx for Parkinson's. This is the optimal location for electrodes.

Back 316

Subthalamic Nucleus

Front 317

DBS proble placement for primary generalized dystonia.

Back 317

Globus Pallidus

Front 318

Motor dysfunction in Parkinson's is due to this.

Back 318

Increased activity in Subthalamic Nucleus and pars interna of Globus Pallidus

Front 319

Characteristic of Parkinson's tremor.

Back 319

Being inhibited with volitional movement.

Front 320

Clinical syndrome that is most commonly comorbid with Parkinson's Disease.

Back 320

Depression

Front 321

This is typical of idiopathic Parkinson's disease rather than another parkinsonian syndrome.

Back 321

Asymmetrical onset and progression of motor symptoms.

Front 322

Patient with Parkinson's disease experiences visual hallucinations on levodopa/carbidopa therapy. This is the most appropriate intervention.

Back 322

Quetiapine

Front 323

***

26yo w/ sudden onset back pain. Spasms in R paraspinal muscles in lumbar region. Straight leg test is positive. Ankle jerk on L is diminished. No muscle weakness or sensory deficit. Next step.

Back 323

MRI of lumbar spine

Front 324

**

Contralateral loss of pain and temp sensation w/ motor paralysis and proprioception loss on the other. Dx?

Back 324

Brown-Sequard Syndrome (Hemisection)

Front 325

**

Subacute combined degeneration of posterior column of the spinal cord is 2/2 this deficiency.

Back 325

Vitamin B12

Front 326

T2 MRI in pt w/ cervical myelopathy. Dx?

Back 326

Degenerative Cervical Spondylosis

Front 327

New onset back pain after shoveling. L paraspinal muscle spasm, negative straight leg raise, reflexes symmetric. No weakness or sensory deficit. Management?

Back 327

Conservative w/ NSAIDS

Front 328

50yoM w/ acute neck pain radiating down L arm, gait problems, urinary incontinence. Which test?

Back 328

MRI of C-Spine to r/o cord compression

Front 329

23yoF f/u ER visit of sudden diplopia, R leg weakness and shaking, difficulty w/ speech resolving after hours. Had fever of 103.1 and was tx for UTI. Now has minimal R leg weakness, brisk DTR, and equivocal plantar reflex on R w/o other sx. Hx of multiple episodes like ER. CSF shows this.

Back 329

Increase protein, Oligoclonal bands, increased nucleated cells