Step 3 Usmle - Neurology

Front 1

Dorsal column function tests

Back 1

Romberg and joint position sense

Front 2

myasthenia gravis tests

Back 2

Tensilson and edrophonium

Front 3

edrophonium

Back 3

anticholinesterase drug acts by inhibiting breakdown of Ach and increases the concentration of Ach at the neuromuscular junction

Front 4

Botulsim presentation

Back 4

weakness, ptosis, pupillary changes (dilated and react slowly), decreased deep tendon reflexes

Front 5

infant botulism

Back 5

poor feeding, drooling, obstructive apnea

Front 6

Meniere's disease

Back 6

tinnitis, roaring sound, pressure sensation in ear, hearing loss; episodes occur at regular intervals for years with periods of remission; due to increased endolymph volume

Front 7

Acute unilateral vestibulopathy

Back 7

acute onset vertigo, N/V lasting for several days preceded by URI

Front 8

reversal of warfarin

Back 8

for immediate reversal FFP, longer term vit K

Front 9

Chloral hydrate effect on warfarin

Back 9

highly protein bound, so increases warfarin by displacing it from protein binding sites

Front 10

chloral hydrate use and SEs

Back 10

mild sleep problem-doesn't have unwanted anticholinergic effects (delirium, ileus) common to antipsychotics and tricyclic agents; SE=sedation and GI irritation

Front 11

hordeolum

Back 11

acute infection of one or more glands of eyelid; painful nodule w/core of pus; Rx antibiotic ointment and warm compress-generally erupts, drains, and clears on own

Front 12

chalazion

Back 12

firm nodule in eyelid caused by chrinic inflammation and build-up of material from mebomian gland; dvlps over months and usually not painful. Incision and drainage often necessary

Front 13

small vessel (locunar) strokes associated with

Back 13

long-standing hypertension and DM

Front 14

herpes encephalitis EEG

Back 14

nonspecific temporal lobe EEG abnormalities

Front 15

left frontal lobe lesion

Back 15

indistinguishable from depressive symptoms (except sudden onset)

Front 16

L parietal lesion

Back 16

language and speech dificulties

Front 17

R parietal lesion

Back 17

visuospacial integration problems and neglect syndromes

Front 18

Pontine lesions

Back 18

CN signs and multiple motor/sensory deficiencies

Front 19

cerebellar lesions

Back 19

coordination difficulties and likely have accompanying CN signs

Front 20

Guillian Barre

Back 20

follows URI or gastroenteritis (campylobacter species) by ~10 days; weakness/paralysis ascending gradual over days/weeks

Front 21

myasthenia gravis common presentation

Back 21

difficulty chewing, proximal muscle weakness, ptosis, nasal voice

Front 22

Transverse myelitis

Back 22

often postviral; root and back pain with sensory loss below level of lesion; rapidly dvlping paralysis

Front 23

pseudotumor cerebri

Back 23

idiopathic intracranial hypertension; common in obese females; pulsitile tinnitus and transient visual obscurations secondary to increased ICP; diplopia secondary to transient 6th nerve palsies; bilateral optic disk edema

Front 24

RX pseudotumor

Back 24

acetazolamide; should have serial visual field testing with any visual complaints

Front 25

Parkinson's common findings

Back 25

asymmetric at onset, resting tremor, rigidity, bradykinesia, postural instability

Front 26

what can enhance physiologic tremor

Back 26

hyperthyroid disease and medications like valproate and lithium

Front 27

Neurofibromatosis type 1 (aka von Recklinghausen disease)

Back 27

cafe-au-lait macules, neurofibromas, Lisch nodules, optic gliomas, bony dysplasia, intertriginous freckling (Crow's sign), autosomal dominant with 50% spontaneous mutations

Front 28

McCune Albright syndrome

Back 28

polyostotic fibrous dysplasia, irregular skin pigmentation, and sexual precocity

Front 29

Neurofibromatosis type 2

Back 29

bilateral acoustic neuromas, neurofibromas and schwannomas (no cafe-au-lait or freckling)

Front 30

Watson syndrome

Back 30

cafe-au-lait macules, dull intelligence, and pulmonary stenosis

Front 31

Rx narcolepsy

Back 31

methylphenidate and amphetamine as well as some antidepressants when cataplexy present (sudden loss muscular tone)

Front 32

Sumatriptan MOA

Back 32

serotonin receptor agonist that selectively activates 1A, 1D subpopulation of serotonin receptors

Front 33

benztropine

Back 33

anticholinergic agent used for adjunctive parkinson treatment and drug-induced extrapyrimidal symtpoms

Front 34

bromocriptine

Back 34

dopamine agonist used in parkinsons; SE involuntary movements and hallucinations

Front 35

Donepezil

Back 35

reversible acetylcholinesterase inhibitor used in Alzheimers

Front 36

Cimetidine MOA and SE

Back 36

H2 blocker; can cause CNS disturbances and somnolence, diarrhea, arrhythmias, arthralgia, myalgia, nephritis, pancreatitis

Front 37

nitroglycerin patch SE

Back 37

postural hypotension, headache, flushing, nausea

Front 38

vitamen E in alzheimers

Back 38

may protect nerve membranes from oxidative damage

Front 39

Migraines Rx

Back 39

First line NSAIDs, then sumatriptan (or other triptan) or ergotamine

Front 40

Criteria for temporal arteritis

Back 40

3 of the 5: age over 50, new onset headache, temporal artery abnormality (tenderness or reduced pusation), ESR>50, positive temporal artery biopsy; symptoms=headache, jaw claudication, and viasual loss

Front 41

oxybutynin MOA anda use

Back 41

inhibits muscarinic action of acetylcholine on smooth muscle; incontenence

Front 42

GI upset of alzheimers

Back 42

rivastigmine>galantamine>donepezil

Front 43

why is tacrine rarely pescribed for alzheimers now

Back 43

potential for serious hepatotoxicity; regular LFT warranted if used

Front 44

posterior circulation transient ischemic attacks

Back 44

dizziness on standing up, relief when sitting; vascular disease

Front 45

spinal cord vs peripheral nerve pathology in neck

Back 45

spinal cord=increased reflexes and weakness of primarily extensor muscles in UE (biceps relatively spared)

Front 46

pramipexole

Back 46

dopamine agonist used to treat parkinsons

Front 47

Rx reduce frequency of MS

Back 47

interferon beta-1B and glatiramer

Front 48

Rx acute angle glaucoma

Back 48

IV acetazolamide and topical timolol (B-blocker)=decrease intraocular P; Pilocarpine eye drops cause vasoconstriction and decrease outflow obstruction

Front 49

tetracaine

Back 49

local anesthetic used when examining patient w/corneal abrasion

Front 50

tropicamide

Back 50

anticholinergic agent that will dilate the pupil

Front 51

phenytoin MOA and SE

Back 51

sodium channel antagonist; if infused too fast=profound hypotension (max 50 mg/min); fosphenytoin is often used now and doesn't cause significant hypotension

Front 52

tuberculosis meningitis CSF findings

Back 52

increased P, decreased glucose, lymphocytosis

Front 53

subdural hematoma cause

Back 53

rupture of veins transversinf subdural space or arterial bleeding from parenchymal lacteration

Front 54

vertebral-basilar strokes

Back 54

affect posterior circulation of brainstem/brain; often produce bilateral sensory/motor deficits and may be accompanied by CN and brainstem signs (vertigo, difficulty w/balance); speech rarely affected

Front 55

tuberous sclerosis

Back 55

autosomal dominant neurocutaneous disorder; associated w/seizures, mental retardation, incracranial calcifications, and cutaneous findings; ash leaf macules (hypopigmented areas w/irregular borders)=most have visible spots by 2 yo

Front 56

Sturge-Weber syndrome

Back 56

neurocutaneous syndrome associated w/seizures and port wine stain (vascular nevus found along trigeminal nerve distribution)

Front 57

essential tremor

Back 57

postural tremor with onset 2nd-6th decades of life with increasing prevalence as age and slowly progressive; frequency 5 Hz; affects hands, head, voice, tongue, legs

Front 58

cerebellar tremor

Back 58

intention or goal-directed tremor that increases in severity as extremity approaches target

Front 59

psychogenic tremor

Back 59

abrupt onset, static course, spontaneous remission, and unclassified tremors; often increase in frequency and amplitude with attention and decrease with distraction

Front 60

vasovagal syncope

Back 60

prodrome of N/V/diaphoresis/pallor/lightheadedness before LOC, quick recovery; provide reassurance

Front 61

Drug most common to cause peripheral neuropathy

Back 61

alcoholism (in outpatient setting); cisplatin, isoniazid, ethambutol, vincristine, metronidazole

Front 62

chronic neuropathy rx

Back 62

treatment of underlying disease (vitB12), supportive measures; TCAs (amitriptyline) or anticonvulsants (carbamazepine, phenytoin), sometimes in conjunction w/phenothiazines (Fluphenazine);

Front 63

amiloride use and SE

Back 63

diuretic; hyperkalemia and muscle cramps

Front 64

Amiodarone

Back 64

class 3 antiarrhythmic used for life-threatening v-fib; SE=lungs (pulmonary fibrosis), liver (toxic), heart (heart block or failure); may potentiate peripheral neuropathy

Front 65

Amlodipine

Back 65

Ca channel blocker; SE=peripheral edema and headache

Front 66

difference btwn simple/complex partial seizure

Back 66

loss of awareness

Front 67

amaurosis fugax

Back 67

acute non-painful monocular visual loss; embolus to central retinal artery usually from carotid or L atrial thrombus

Front 68

cervical myelopathy

Back 68

intrinsic or extrinsic spinal-cord lesions; LMN signs at level of lesion, a sensory level, and UMN signs below level of lesion

Front 69

Neurofibomatosis type 1 CNS neoplasms

Back 69

plexiform neurofibromas, optic gliomas, ependymomas, meningiomas, astrocytomas, pheochromocytomas; neurofibromas may undergo secondary malignant degeneration and become sarcomas

Front 70

Netherton syndrome

Back 70

Bamboo hair (trichorrhexis invaginata), ichthyosiform dermatitis and atopic diathesis; autosomal recessive; usually severily ill and may die in childhood

Front 71

Von Hippel-Lindau syndrome

Back 71

autosomal dominant; retinal angiomas, cerebellar medullary angioblastic tumors, pancreatic cysts, and renal tumors/cysts; usually no skin involvement, but occasional angiomas in occipitocervical region

Front 72

incontinentia pigmenti

Back 72

x-linked domainant lethal in utero in boys; appears in girls during first weeks of life and evolves through vesicular (inflammatory), verrucous, and pigmentary stage; subtle, faint, hypochromic or atrophic Blaschko-linear lesions on extremities in 4th stage

Front 73

Horner syndrome

Back 73

ipsilateral ptosis, miosis, and decreased facial sweating (anhydrosis); due to decreased sympathetic innervation by innvolement of stellage ganglion (Pancoast's tumor of lung)=chest x-ray

Front 74

narcolepsy sleep latency test findings

Back 74

onset of sleep with REM phase and decreased sleep latency