Key facts

Question 1

recurrent episodes of severe vertigo, hearing loss, tinnitus, ear fullness, lasting hours to days. Nausea and vomiting.

Answer 1

Ménière’s disease.

** diff from BPPV due to time that episode lasts. BPPV=

Question 2

female w recurrent vertigo, with no auditory or aural symptoms that lasts minutes to days.

Answer 2

vestibular migraine

Question 3

decremental response when nerve is stimulated. which cancer is associated w/ ddx.

Answer 3

thymoma

myasthenia gravis ddx test: edrophonium, ice test, EMG

Question 4

repetitive nerve stimulation shows incremental response, autoanttibody to presynaptic calcium channels. what cancer is associated w/ ddx.

Answer 4

small cell lung carcinoma

Question 5

Charcot’s triad

Answer 5

For MS:

1. Scanning speech
2. Intranuclear ophthalmoplegia
3. Nystagmus

Question 6

limb weakness, optic neuritis, paresthesia, diplopia, vertigo, nystagmus, gait unsteadiness, urinary retension, sexual and bowel dysfunction, etc. treatment?

Answer 6

MS treatment:

1. Corticosteroids for acute exacerbation (IV for optic neuritis)
2. immunomodulators
3. Natalizumab (risk of JC virus mediated PML)
4. IVIG, cyclophosphamide, plasmapheresis
5. symptomatic treatment! baclofen etc

Question 7

pt with vertigo, vomiting for 1 week after being diagnosed w/ viral infx.

Answer 7

acute vestibular neuritis

Question 8

The 5 As of GBS

Answer 8

Acute inflammatory demyelinating polyradiculopathy
Ascending paralysis
Autonomic neuropathy
Arrhythmias
Albuminocytologic dissociation (CSF protein >55mg/dL w/ no pleocytosis)

tx: plasmapheresis, IVIG, NOT corticosteroids

Question 9

55 y/o M w/ slowly progressive weakness in LUE and later R, assoc w/ fasciculations and atrophy, but w/o bladder disturbance and normal cervical MRI. emotional lability. DDX?

Answer 9

ALS

** “bulbar onset” ALS; difficulty swallowing, loss of tongue motility, difficulty speaking (slurred/nasal speech)

Question 10

59 yo F concerned about worsening memory, difficulty participating in daily activity, restlessness, difficulty sleeping for last 3 months. DDX?

Answer 10

pseudodementia

** diff b/w AD= pseudodementia pt aware of losing memory.

Question 11

85 yo M w/ h/o diabetes, stroke, and hypertension presents w/ abrupt memory loss, language impairment, impairment of motor activity, inability of recognizing familiar faces.

Answer 11

vascular dementia

Question 12

43 yo M sudden onset of chorea, irritability, antisocial behavior, with father who had similar experiences. DDX? TX?

Answer 12

Huntingtons. AD. CAG repeats. Anticipation.
Caudate and putamen atrophy
tx with reserpine or tetrabenazine.

Question 13

70 yo male with unstable gait without arm swinging, unilateral resting tremors, rigidity. ddx?

Answer 13

parkinson’s–> dopamine deficiency

Question 14

encephalopathy, ophthalmoplegia, ataxia, alcoholic, renal dialysis. Received high-dose glucose administration. tx?

Answer 14

dx: wernicke’s encephalopathy (thiamine deficiency).
tx: always give thiamine before glucose.