neuro shelf

Question 1

surgical evacuation of subdural hematoma if there is evidence of moderate to severe cognitive impairment, if the subdural hematoma is ≥ ?? mm, or if there is midline shift ≥ ?? mm on brain scan.

Answer 1

there is evidence of moderate to severe cognitive impairment, if the subdural hematoma is ≥ 10 mm, or if there is midline shift ≥ 5 mm on brain scan.

Question 2

Focal deficits involving the contralateral lower limbs indicate involvement of the superior segment of the motor cortex

which herniation?

Answer 2

Subfalcine herniation is the most common cerebral herniation syndrome and is usually due to cingulate gyrus herniation under the falx cerebri, causing compression of the foramen of Monro (leading to hydrocephalus and consequent headache) and branches of the anterior cerebral artery (causing infarction in the ACA territory and consequent contralateral lower limb weakness).

Question 3

Degeneration of the ???? is the most common cause of subacute or chronic ataxia in patients with alcohol use disorder (seen in 1% of cases). Cerebellar degeneration in this patient group occurs due to the direct toxic effects of alcohol or as a result of thiamine deficiency.

Answer 3

superior cerebellar vermis

Question 4

This patient presents with periorbital edema, chemosis, high fever, and dysfunction of CN III (bilateral ptosis) and CN VI (impaired lateral gaze) 2 days after the onset of sinusitis.

Answer 4

septic cavernous sinus thrombosis

Intravenous vancomycin, ceftriaxone, and metronidazole

Antibiotic therapy is the mainstay of treatment

Question 5

This patient has regained normal mental status after her first simple febrile seizure, what to do next?

Answer 5

discharge

Simple febrile seizure

The most common type of febrile seizure. Typically occurs among children 6 months to 5 years of age and is generalized, lasts less than 15 minutes, and does not recur within 24 hours. Usually followed by a quick return to a normal state without focal neurologic deficits, but confusion may be present for a short period of time.

Question 6

is the most common cause of death in patients with Friedreich ataxia (FA).

Answer 6

heart failure

Question 7

girl presents with progressive bilateral limb ataxia and weakness, loss of deep tendon reflexes, pallhypesthesia, dysarthria, and skeletal deformities

Inverted feet, hammer toes, and kyphoscoliosis are all typical skeletal deformities

Answer 7

Friedreich ataxia (FA)

Question 8

The development of focal weakness after a seizure, which typically resolves within 48 hours. Thought to result from exhaustion of the primary motor cortex.`

Answer 8

Todd’s paralysis

Question 9

darkening of the red reflex, obscuration of the ocular fundus indicate ???

Answer 9

cataracts

Question 10

form of sensorineural hearing loss, which is identified by a bilateral positive Rinne test and no lateralization on Weber test. It is a multifactorial process caused by the degeneration of the organ of Corti that gradually develops over the course of years, often identified first by difficulty hearing in crowded spaces

Answer 10

Presbycusis

Question 11

Alcoholic cerebellar degeneration is caused by the degeneration of Purkinje cells in the cortex of the ????

patients present with signs and symptoms of a midline cerebellar lesion, such as gait ataxia (especially on tandem gait), truncal ataxia, dysmetria predominantly affecting the lower extremities (elicited by the heel-knee-shin test), and gaze-evoked nystagmus

Answer 11

cerebellar vermis

Question 12

Repeated exposure to sounds above a threshold of 85 dB (e.g., motorcycle) or a single exposure to sounds above 120–155 dB (e.g., gunshots, jet takeoffs) can lead to noise-induced hearing loss

Such hearing loss is slowly progressive and affects ?? frequencies (3–4 kHz) first

Answer 12

high

Question 13

??? test should be performed in all patients with ALS to screen for >>

Answer 13

bedside swallowing test for dysphagia

ALS is characterized by concomitant upper motor neuron and lower motor neuron dysfunction and can manifest with pseudobulbar palsy and bulbar palsy, both of which result in dysphagia.

Question 14

movement disorder that is associated with rheumatic fever and manifests with speech disorders, neuropsychiatric symptoms (e.g., agitation, anxiety), and involuntary choreiform movements

Answer 14

Sydenham chorea

Question 15

symptoms of Sydenham chorea typically occur within 6 months after an infection with ??

Answer 15

S. pyogenes (most commonly pharyngitis)

Question 16

Sudden, painless, transient monocular loss of vision with discoloration along the retinal arterial supply on fundoscopy is highly suggestive of ???

Answer 16

retinal artery occlusion

Question 17

The best next step in management for a patient with retinal artery occlusion secondary to atherosclerotic emboli is ??

Answer 17

carotid duplex ultrasonography

Question 18

?? disturbances are common in the later stages of Alzheimer disease and can result in anxiety and further disruption of patients’ cognitive status

Answer 18

Sleep disturbances

Behavioral and environmental regulation, such as adhering to a regular sleep schedule, maintaining a familiar environment, and removing ambient noise, should always be attempted for patients who are agitated or anxious before resorting to pharmacological treatment

Question 19

?? tremors worsens under direct observation and diminishes with distraction (e.g., while working on the computer). The condition is often associated with psychiatric disorders (e.g., conversion disorder, anxiety disorder, depression).

quick progression to severe symptoms, significant functional disability, and changing of amplitude, frequency, and/or distribution of movement over time.

Answer 19

functional tremors

Question 20

a postural tremor that typically affects the hands and head, worsens with voluntary movement and/or an anxious state, and is associated with an otherwise normal neurological examination.

Postural tremor = Tremor that appears when the body part is held in a fixed position against gravity

Answer 20

essential tremor

Question 21

a coarse hand tremor that is aggravated by goal-directed movements (i.e., increases in frequency during a finger-to-nose tes

Answer 21

intention tremor

Question 22

which pathogen?? cause nonpurulent conjunctivitis, which manifests with photophobia, pruritus on the periocular area, crusts over the eyelashes, conjunctival injection, redness, and watery discharge from the eye

usually unilateral and often manifests with a vesicular rash and corneal involvement (dendritic keratitis). Additionally, patients with a history of atopic dermatitis are particularly susceptible

Answer 22

Herpes simplex virus (HSV)

Question 23

?? toxicity manifests with neurological symptoms (altered mental status, dysarthria, decreased muscle strength, coarse tremor).

and gastrointestinal symptoms (nausea, vomiting, diarrhea)

Answer 23

lithium toxicity

can be caused by dehydration (due to severe vomiting and diarrhea for the past 2 days), which predisposes him to acute lithium toxicity.

Question 24

tx for lithium toxicity

lithium toxicity in patients with an altered mental status, seizures, and/or life-threatening arrhythmias

Answer 24

Hemodialysis

Question 25

Painless and intermittent otorrhea, hearing loss, and a visible defect of the tympanic membrane in a patient who did not complete antibiotic treatment for acute otitis media (AOM) suggest chronic suppurative otitis media (CSOM) which TX?

Answer 25

Topical fluoroquinolones, such as **ofloxacin**, in combination with aural toileting, are the preferred treatment for CSOM

Question 26

The patient presents with a 5-day history fever and headache followed by the acute onset of altered mental status and focal neurological deficits. In combination with the MRI findings of a temporal hyperintense area (cMRT in T2), these signs and symptoms are highly suggestive of ????

Answer 26

herpes simplex encephalitis (HSE)

Question 27

an acute or subacute inflammatory myelopathy that results in motor, sensory, and autonomic symptoms below the level of the affected segment

Answer 27

Transverse myelitis

Question 28

Intermetatarsal neuroma (also called Morton neuroma) is caused by entrapment or enlargement of one of the plantar digital nerves typically manifests with neuropathic pain in the plantar aspect of the foot that is exacerbated by palpation which manuever?

Answer 28

Mulder sign Pain is elicited when pressure is applied to the sole of the foot between the metatarsal heads

Question 29

first-line abortive treatment for children with migraine.

Answer 29

NSAIDs or acetaminophen A headache calendar should also be recommended to elucidate environmental triggers of headache (e.g., strenuous exercise, stress, certain food).

Question 30

While there is no definitive treatment for patients with ALS, ??? can be used to slow down the deterioration of motor function and increase life expectancy by 3–4 months

Answer 30

riluzole

Question 31

spontaneous, nonbullous subconjunctival hemorrhage (SCH) without other symptoms (e.g., changes in visual acuity, photophobia, eye pain, foreign body sensation) work-up???

Answer 31

reassurance and follow-up

Question 32

Irritability, poor feeding, vomiting, delayed gross motor milestones, upper motor neuron signs (increased muscle tone and hyperreflexia), macrocephaly, a bulging anterior fontanelle, and an MRI showing symmetrical enlargement of all 4 ventricles indicate a symptomatic ?????

Answer 32

communicating hydrocephalus

Question 33

tx for symptomatic communicating hydrocephalus in children

Answer 33

A ventriculoperitoneal shunt, which diverts excess CSF from the ventricles to the peritoneal cavity, is the standard of care to decrease intracranial pressure in children with a communicating hydrocephalus

Question 34

?? is indicated for patients with neurologic deficits from spinal cord compression neurologic symptoms (decreased leg strength and sensation, hyperreflexia, positive Babinski sign) are concerning for cord compression

Answer 34

IV glucocorticoids (dexamethasone) Glucocorticoids reduce pain, inflammation, and edema, preventing further neurologic damage until definitive treatment is available (e.g., urgent decompression surgery).

Question 35

If any alarm symptoms or features (immunocompromise, focal neurological deficits, abnormal level of consciousness, seizure at initial presentation, history of CNS disease) are present for meningitis what to do?

Answer 35

dminister empiric antibiotic therapy until LP can be performed \*\*also do CT head first to make sure there is no herniation

Question 36

a crescent-shaped, concave hematoma that crosses suture lines would be seen on CT scan.

Answer 36

subdural hematoma

Question 37

which hematoma

Answer 37

epidural hematoma

Question 38

apidly progressive dementia and myoclonus with associated aphasia and agnosia are suggestive of ??

Answer 38

Creutzfeldt-Jakob disease

Question 39

???? are usually the first-line drugs for long-term prophylaxis of migraine headaches

Answer 39

Beta-blockers (e.g., propranolol) Other drugs that may be used for migraine prophylaxis include antiepileptic drugs such as topiramate, sodium valproate, and sodium divalproate, tricyclic antidepressants (e.g., amitriptyline), and calcium channel blockers.

Question 40

?? is recommended for all patients with a TIA as secondary stroke prevention.

Answer 40

Antiplatelet therapy with aspirin or clopidogrel A noncontrast CT should be performed beforehand to rule out intracranial hemorrhage. Additional strategies for preventing recurrent TIA or stroke in this patient include lifestyle modifications (e.g., exercise, dietary interventions, and weight loss), optimizing blood pressure control, and initiation of statin therapy.

Question 41

Symptoms include a cape-like distribution of decreased sensitivity to pain and temperature and flaccid atrophic paralysis in the upper extremities.

Answer 41

syringomyelia (central cord syndrome, can be secondary to whiplash)

Question 42

risk of expansion of syringomelia

Answer 42

expansion of the syrinx can damage descending hypothalamic fibers in the T1 to T4 segments, which carry sympathetic fibers from the hypothalamus to the intermediate horn, resulting in central Horner syndrome.

Question 43

??? autoantibodies are seen in 10–25% of patients with CIDP Progressive ascending motor and sensory deficits for greater than 2 months are characteristic of chronic inflammatory demyelinating polyneuropathy (CIDP).

Answer 43

Anti-GM1

Question 44

??? indicated for severe or refractory post lumbar puncture headaches from cerebrospinal fluid (CSF) leak syndrome

Answer 44

epidural blood patch: autologous blood injected at the site of the lumbar puncture seals the hole in the dura and resolves the CSF leak that causes the postural headache.

Question 45

The risk of hemorrhagic transformation is significantly increased in patients who have received thrombolytic medications (e.g., alteplase), antiplatelet therapy (e.g., aspirin, clopidogrel), and/or thrombosis prophylaxis (e.g., heparin, enoxaparin). Other risk factors for HT include hyperglycemia, hypertension, advanced age, delayed initiation of reperfusion therapy, and ??? infarct size.

Answer 45

large

Question 46

Hemorrhagic transformation (HT) is a common complication of ischemic stroke and typically manifests with neurologic deterioration (e.g., new confusion, worsening neurological deficits) within ?? hours of the inciting ischemic event.

Answer 46

24–48

Question 47

typically present with symptoms of hydrocephalus/increased ICP and involvement of the cerebellar vermis such as vomiting, morning headaches, ataxia, and cranial nerve dysfunction. tumor in children

Answer 47

medulloblastoma is most common malignant in children Ependymomas are often located in the posterior fossa and may also manifest with signs of hydrocephalus, as well as ataxia and cranial nerve dysfunction. However, these tumors are less common than medulloblastomas, accounting for ∼ 10% of pediatric brain tumors.

Question 48

asymptomatic patients with relatively small (\< 3 mm) linear, nondepressed skull fractures workup?

Answer 48

sent home

Question 49

which patients require further observation for small linear, non-compressed skull fracture? (4)

Answer 49

- signs of potentially elevated ICP require further inpatient observation - evidence of traumatic brain injury on imaging (e.g., intracranial hemorrhage) - signs of physical abuse - caregivers who are unreliable or unable to return if neurological deficits develop within 24 hours after release.

Question 50

2 most important risk factors for cerebral palsy

Answer 50

Preterm birth and low birth weight

Question 51

child has signs of UMN injury (positive ankle clonus, extensor plantar response), persistent Moro reflex, feeding difficulties, and developmental delays (all milestones are delayed except for rolling over, a sign of spasticity), as well as an MRI of the head showing periventricular leukomalacia. These features are all consistent with ???

Answer 51

cerebral palsy

Question 52

Moro reflex?

Answer 52

Question 53

Recurrent headaches and visual changes in a young woman with obesity and a history of vitamin A use raise concern for ???? Papilledema and an empty sella on MRI support the diagnosis.

Answer 53

idiopathic intracranial hypertension (IIH)

Question 54

?? can be caused by axonal disorders (e.g., diabetes, alcohol use disorder, HIV, Charcot-Marie-Tooth disease) or demyelinating diseases (e.g., Guillain-Barré syndrome).

Answer 54

Polyneuropathy

Question 55

??? is required in patients with myasthenic crisis and signs of impending respiratory failure (e.g., pallor, anxiety, tachycardia, tachypnea, cyanosis)

Answer 55

Early endotracheal intubation The exacerbation of myasthenic symptoms is commonly triggered by infections (evidenced in this patient by the history of a sore throat, runny nose, and fever), surgery, anesthesia, pregnancy, or certain medications.

Question 56

?? can cause nonpurulent conjunctivitis, which manifests with photophobia, pruritus on the periocular area, crusts over the eyelashes, conjunctival injection, redness, and watery discharge from the eye usually unilateral and often manifests with a vesicular rash and corneal involvement (e.g., dendritic keratitis). Additionally, patients with a history of atopic dermatitis are particularly susceptible

Answer 56

Herpes simplex virus (HSV)

Question 57

??? in combination with aural toileting, are the preferred treatment for chronic suppurative otitis media (CSOM Painless and intermittent otorrhea, hearing loss, and a visible defect of the tympanic membrane in a patient who did not complete antibiotic treatment for acute otitis media (AOM)

Answer 57

Topical fluoroquinolones, such as ofloxacin,

Question 58

5-day history fever and headache followed by the acute onset of altered mental status and focal neurological deficits. In combination with the MRI findings of a temporal hyperintense area (cMRT in T2), these signs and symptoms are highly suggestive of ???

Answer 58

herpes simplex encephalitis (HSE).

Question 59

spontaneous, nonbullous subconjunctival hemorrhage (SCH) without other symptoms (e.g., changes in visual acuity, photophobia, eye pain, foreign body sensation), require what diagnostic workup or treatment?? Spontaneous SCH typically occurs as a result of maneuvers that increase venous pressure in the eyeball (e.g., coughing, straining, heavy lifting, vomiting, Valsalva maneuver).

Answer 59

NONE

Question 60

Irritability, poor feeding, vomiting, delayed gross motor milestones, upper motor neuron signs (increased muscle tone and hyperreflexia), macrocephaly, a bulging anterior fontanelle, and an MRI showing symmetrical enlargement of all 4 ventricles indicate a symptomatic

Answer 60

communicating hydrocephalus

Question 61

tx for communicating hydrocephalus

Answer 61

A ventriculoperitoneal shunt, which diverts excess CSF from the ventricles to the peritoneal cavity

Question 62

Emergent administration of ??? is indicated for patients with neurologic deficits from spinal cord compression

Answer 62

glucocorticoids

Question 63

?? are usually the first-line drugs for long-term prophylaxis of migraine headaches.

Answer 63

Beta-blockers (e.g., propranolol)

Question 64

?? is recommended for all patients with a TIA as secondary stroke prevention.

Answer 64

Antiplatelet therapy with aspirin or clopidogrel, lifestyle modifications (e.g., exercise, dietary interventions, and weight loss), optimizing blood pressure control, and initiation of statin therapy.

Question 65

?? is indicated for severe or refractory post lumbar puncture headaches from cerebrospinal fluid (CSF) leak syndrome

Answer 65

An epidural blood patch Autologous blood injected at the site of the lumbar puncture seals the hole in the dura and resolves the CSF leak that causes the postural headache. Additional management includes sufficient fluid intake, oral analgesics, and bed rest.

Question 66

patient's dilated pupils, labored breathing, speech and swallowing difficulties, and flaccidity suggest a descending paralysis, likely due to ??

Answer 66

botulism irreversibly inhibiting ACh release from motor endplates in the neuromuscular junction Botulinum toxins are most often found in home-canned foods and packed meats

Question 67

Medulloblastoma is the most common malignant brain tumor in children, with a peak incidence between 3–5 years of age. The mass is characteristically located in the ??

Answer 67

cerebellum

Question 68

The metastasis of a primary central nervous system (CNS) neoplasm inferiorly, typically via cerebrospinal fluid (CSF). Typically presents as nodules along the spine and cauda equina that can cause back pain with neurologic symptoms (e.g., limb weakness). Can be detected by lumbar puncture

Answer 68

spinal drop metastases

Question 69

A 3-week history of headaches, difficulty sleeping, difficulty concentrating, irritability, and fatigue after a mild traumatic brain injury (mTBI) is consistent with ??

Answer 69

postconcussion syndrome (PCS) Reassurance and symptomatic therapy are the most appropriate management for patients with PCS

Question 70

Contact lens use is an important risk factor for bacterial keratitis and is most commonly associated with what pathogen ??

Answer 70

Pseudomonas aeruginosa

Question 71

A ??? should be performed on all patients following a syncopal episode to rule out cardiac syncope

Answer 71

electrocardiogram (ECG)

Question 72

Lower extremity radiculopathy that worsens with standing or walking downhill is consistent with ??

Answer 72

lumbar spinal stenosis In spinal stenosis, different postural changes can widen or narrow the spinal canal and thereby alleviate or worsen symptoms. By leaning forward, the spinal canal is widened and compression of the spinal cord is reduced

Question 73

Status epilepticus can cause potentially irreversible tissue damage of the CNS, resulting in ??

Answer 73

cortical laminar necrosis (CLN) seems to be associated with repeated seizures, hypoxia, and hypoglycemia

Question 74

Following a grand mal seizure, a patient has what acid-base disorder??

Answer 74

postictal lactic acidosis, an anion gap metabolic acidosis that leads to a consequential decrease in serum bicarbonate. A grand mal seizure is a highly exertional event, during which muscles utilize anaerobic respiration due to inadequate oxygen delivery

Question 75

chronic ?? deficiency typically present with sensory peripheral neuropathy and hypochromic, microcytic anemia (sideroblastic anemia) can be result of isoniazid toxicity

Answer 75

pyridoxine (vitamin B6)

Question 76

?? are the most common cause of acquired hypopituitarism among children.

Answer 76

Craniopharyngiomas

Question 77

Orbital cellulitis can be distinguished from preseptal cellulitis by the presence of

Answer 77

pain with ocular movements and vision changes

Question 78

tricyclic antidepressants are generally considered a first-line treatment for postherpetic neuralgia they are contraindicated in which patients? (give gabapentin instead)

Answer 78

caution in a patient with pre-existing heart disease because they may prolong the QRS and/or QT interval, and thus may lead to arrhythmias.

Question 79

?? is characterized by sudden, painless loss of vision and an afferent pupillary defect, which manifests with no perception of light in the affected eye and an abnormal swinging flashlight test

Answer 79

Central retinal artery occlusion

Question 80

The most common organism causing bacterial conjunctivitis in adults is

Answer 80

Staphylococcus aureus, followed by Streptococcal pneumoniae and Haemophilus influenzae. **Erythromycin** is effective against gram-positive and some gram-negative organisms, making it the empirical antibiotic of choice in patients with bacterial conjunctivitis.

Question 81

Chronic inflammation and scaling at the eyelid margins associated with eye irritation and visual abnormalities is consistent with a diagnosis of

Answer 81

blepharitis Warm compresses, lid massage, and gentle lid cleansing are the cornerstones of therapy

Question 82

Typical symptoms caused by ?? tumors include gait ataxia, truncal ataxia, dysarthria, nystagmus, dysmetria, dysdiadochokinesia, and pronator drift

Answer 82

cerebellar

Question 83

a rare inherited disorder characterized by the combination of primary brain tumors and colorectal cancer or polyposis.

Answer 83

Turcot syndrome Mismatch repair cancer syndrome, Turcot syndrome A rare inherited disorder characterized by the combination of primary brain tumors and colorectal cancer or polyposis. Associated with familial adenomatous polyposis (mostly medulloblastomas) and Lynch syndrome (mostly gliomas).

Question 84

Once-monthly episodes of nonpulsating, pressing, band-like headache accompanied by a singular autonomic symptom (e.g., phonophobia) and pericranial muscle tenderness lasting 30 minutes to 7 days in conjunction with a normal neurologic examination are characteristic of episodic ????

Answer 84

tension-type headaches (TTHs)

Question 85

typically starts with a prodrome (fever, headache, malaise) followed by unilateral painful impaired vision with reduced corneal sensation and vesicular skin lesions in the area innervated by the ophthalmic nerve (forehead, bridge, and tip of the nose)

Answer 85

Herpes zoster keratitis

Question 86

Treatment with ??? is indicated for extracranial carotid artery dissection once a thrombus has been identified and intracranial hemorrhage has been ruled out by CT scan

Answer 86

antithrombotic agents (either anticoagulants such as heparin or antiplatelet drugs)

Question 87

The presence of severe ipsilateral head and neck pain and partial Horner syndrome (ptosis and miosis) in combination with duplex ultrasonography of the neck showing absent flow in the left internal carotid artery, indicates a ???

Answer 87

carotid artery dissection

Question 88

type of parasomnia characterized by short (\< 60 seconds) dream enactments (e.g., yelling, moving limbs, walking, punching) due to loss of REM sleep atonia, which may lead to injury to self or others Affected individuals are typically alert and orientated after awakening and remember their dreams.

Answer 88

REM sleep behavior disorder (RBD)

Question 89

The gradual development of asymmetric lower limb weakness, reduced reflexes in both the knees and ankles, saddle anesthesia, bladder dysfunction, decreased anal tone, and severe back pain with radiation to the lower limb is the classic clinical picture of ??

Answer 89

cauda equina syndrome

Question 90

what is characteristic of symptoms of Conus medullaris??

Answer 90

Symptoms occur symmetrically

Question 91

??? in the thoracic spinal cord segments would produce symmetrical lower limb weakness, as well as loss of pain and temperature sensation Sensation around the buttocks, inner thighs, and genitalia, as well as anal sphincter tone, are classically spared

Answer 91

Central cord syndrome

Question 92

manifests with symmetrical lower limb weakness and loss of pain and temperature sensations in all areas below the level of the lesion

Answer 92

Anterior spinal cord syndrome

Question 93

Stroke in this area most commonly manifests with contralateral homonymous hemianopia with macular sparing

Answer 93

The posterior cerebral artery

Question 94

If the PCA of the nondominant (usually the right) hemisphere is affected, patients may present with

Answer 94

prosopagnosia

Question 95

because the ??? also supplies the lateral parts of the thalamus, patients with lesions may also report contralateral hemisensory abnormalities such as numbness or paresthesia in the limbs, trunk, and/or chest. Further manifestations include memory deficits, vertigo, and nausea.

Answer 95

posterior cerebral artery (PCA)

Question 96

If the PCA of the dominant (usually the left) hemisphere is affected, patients may also present with ???

Answer 96

alexia without agraphia, anomic aphasia, and/or visual agnosia due to ischemic damage to the splenium of the corpus callosum, which carries visual information from the visual cortex to the Broca area and Wernicke area

Question 97

vision loss in the right halves of the visual field (nasal field on the left and temporal field on the right), which is consistent with right-sided ??? This finding suggests the involvement of the visual pathways behind the optical chiasma.

Answer 97

homonymous hemianopia

Question 98

Bilateral periorbital ecchymosis (“raccoon eyes”) is a classic sign of which fracture?

Answer 98

basilar skull fracture involving the anterior cranial fossa

Question 99

This man has blood-tinged fluid draining from his nose after trauma that shows a halo sign (rapidly expanding clear ring of fluid surrounding blood), indicating ?? the most likely explanation is a basilar skull fracture of the anterior cranial fossa.

Answer 99

CSF rhinorrhea

Question 100

The presence of soft drusen near the macula is consistent with

Answer 100

age-related macular degeneration (AMD)

Question 101

Wet vs nonexudative age-related macular degeneration

Answer 101

Exudative AMD (wet AMD) makes up 10% of cases and is associated with retinal neovascularization, retinal hemorrhage, and/or loss of vision that progresses more rapidly Nonexudative AMD (dry AMD) is the most common type of AMD and leads to a slowly progressive central or pericentral loss of vision.

Question 102

Timely drainage of a larger (≥ 2 cm) auricular hematomas \< 7 days prevents the formation of a ???

Answer 102

cauliflower ear

Question 103

which medication for essential tremors can cause acute intermittent porphyria: elevated urinary levels of aminolevulinic acid and porphobilinogen and 5 P's of AIP: Painful abdomen, Polyneuropathy, Psychologic disturbances, Purple pee, Precipitated by triggers (like drugs).

Answer 103

Barbiturates (like primidone) trigger acute intermittent porphyria by inducing synthesis of cytochrome P-450 enzymes that contain heme components, thereby reducing heme levels and leading to stimulation of δ-aminolevulinate synthase, which leads to increased levels and accumulation of δ-aminolevulinate and porphobilinogen

Question 104

folate vs. Vit B12

Answer 104

folate: increased homocysteine levels, and normal methylmalonic acid levels nystagmus is not typically seen in vitamin B12 deficiency, and levels of both homocysteine and methylmalonic acid would be increased

Question 105

Headache that worsens when leaning forward, engorged veins over the anterior chest, and swelling limited to the head, neck, and upper extremities are consistent with

Answer 105

superior vena cava (SVC) syndrome

Question 106

SVC syndrome is most commonly caused by

Answer 106

lung cancer (usually small cell lung cancer or squamous cell carcinoma) or non-Hodgkin lymphoma (particularly in younger patients)

Question 107

which antipsych meds cause metabolic syndrome?

Answer 107

olanzapine and clozapine

Question 108

donepezil and galantamine considered first line for?

Answer 108

Alzheimer disease Also rivastigmine Acetylcholinesterase inhibitors promote an increase of acetylcholine concentration on the synaptic gap and have been shown to improve cognition and the ability to perform everyday activities.

Question 109

?? is appropriate additional therapy for patients with moderate to severe AD, which is defined as an MMSE score ≤ 18/30.

Answer 109

Memantine An NMDA receptor antagonist used to treat moderate to severe dementia. Although the mechanism of action is unclear, memantine is thought to be neuroprotective. Glutamate agonizes NMDA receptors in certain neurons linked to memory in the hippocampus; excessive stimulation of these neurons may lead to damage (i.e., excitotoxicity). By blocking NMDA receptors, memantine may prevent excitotoxicity.

Question 110

33-year-old female patient presents with acute, unilateral color blindness, a decrease in visual acuity, and pain with eye movements, all of which are consistent with ???

Answer 110

optic neuritis, which is often the first manifestation of multiple sclerosis (MS)

Question 111

bilateral buttock pain with walking that is relieved by sitting and leaning forward suggests ??

Answer 111

spinal stenosis

Question 112

tx for phantom limb pain?

Answer 112

gabapentin multimodal approach is typically recommended, including mirror therapy, transcutaneous electrical nerve stimulation, NMDA receptor antagonists

Question 113

combination of acute nausea, imbalance, and vertigo is concerning for acute vestibular syndrome (AVS) The Head Impulse, Nystagmus, and Test of Skew (HINTS) exam is used to differentiate between central and peripheral causes of AVS. This patient's negative head impulse test and vertical nystagmus are consistent with a ?? cause of AVS.

Answer 113

central can be caused by cerebrovascular accident, a stroke affecting the cerebellum or brainstem or demyelinating diseases of the CNS

Question 114

common peroneal neuropathy presents with a foot drop (high stepping gait, weakness of foot dorsiflexion) and numbness in the distribution of both the superficial and deep peroneal nerves (dorsum of the foot and first web space, respectively) foot eversion or inversion?

Answer 114

normal foot inversion because the primary muscle responsible for foot inversion (tibialis posterior) is not innervated by the peroneal nerve superficial branch of the peroneal nerve controls foot eversion

Question 115

A tremor that worsens as the hand reaches for an object (intention tremor) and overshooting of the target (hypermetria) indicate a lesion where?

Answer 115

cerebellar dysfunction most likely cause of cerebellar dysfunction in a woman in her 40s is multiple sclerosis

Question 116

sudden onset of flaccid paralysis and respiratory failure in a logger from Washington is highly suggestive of

Answer 116

tick paralysis a neurotoxin produced in the tick's salivary gland prevents acetylcholine release at the neuromuscular junction. Symptoms typically occur within 2–7 days. Patients present with very rapid ascending paralysis (over 24–48 hours) and ataxia, though mental status remains intact. The **treatment** simply consists of **removing the tick** and administering supportive measures (e.g., assisted breathing).

Question 117

palpitations, dizziness, chest pain, dyspnea, syncopes, and urinary urgency together with the ECG findings (narrow QRS complex with no discernible P waves) suggest ?

Answer 117

paroxysmal supraventricular tachycardia (PSVT) most commonly caused by atrioventricular nodal reentrant tachycardia (AVNRT) - AV node with slow and fast pathway

Question 118

management of cervical fracture that is complicated by altered mental status with respiratory insufficiency (respiratory rate of 8/min) ??

Answer 118

Rapid sequence intubation Cervical fractures may lead to immediate or delayed cervical spinal cord compression and/or phrenic nerve paralysis and subsequent respiratory failure

Question 119

High doses of dexamethasone in pituitary vs. ectopic source of increased ACTH

Answer 119

dexamethasone sends a negative feedback response to the brain to decrease ACTH production. Since the pituitary is receptive to negative feedback loops but ectopic foci are resistant to negative feedback, cortisol levels will decrease to \< 50% of baseline following high doses of dexamethasone if the patient has Cushing disease, but will be relatively unchanged in ectopic ACTH production.

Question 120

Approx. 25% of patients on lithium develop which neuro sx?

Answer 120

symmetric, nonprogressive, fine (approx. 10 Hz) postural tremor in the distal ends of the upper extremities

Question 121

Patient with Down syndrome presents with ataxia, quadriparesis, hyperreflexia, and vertebrobasilar symptoms (vertigo, diplopia). These symptoms suggest ??

Answer 121

atlantoaxial instability tx: Surgical fusion of C1 (atlas) and C2 (axis) stabilizes the upper vertebrae

Question 122

which drugs increase lithium toxicity?

Answer 122

ACE inhibitors, such as enalapril, cause vasodilation of the efferent arterioles and a subsequent decrease in GFR, which can lead to renal impairment. Lithium has a narrow therapeutic window, and any cause of renal impairment (e.g., chronic kidney disease, NSAID use) or volume depletion (e.g., due to diuretic therapy, cardiovascular disease) can precipitate lithium toxicity.

Question 123

what are features of lithium toxicity? (4)

Answer 123

myoclonic seizures, altered mental status, coarse tremors, and neuromuscular excitability.

Question 124

In older patients with MDD, cognitive deficits may resemble ??

Answer 124

dementia (i.e., pseudodementia)

Question 125

teratogenic effects of valproic acid?

Answer 125

Inhibition of folate absorption in the mother due to valproic acid intake leads to an increased risk of neural tube defects such as spina bifida in the embryo, which may require lower spinal surgery after birth

Question 126

Critically ill patients with an intact gastrointestinal tract can receive what kind of nutrition??

Answer 126

short-term enteral feeding via nasogastric tube (e.g., less than 3 weeks) if there are no contraindications. Enteral feeding is preferred over parenteral nutrition because it stimulates intestinal motility and prevents atrophy of the GI tract

Question 127

first-line treatments for all prolactinomas

Answer 127

Dopamine receptor agonists such as cabergoline or bromocriptine Dopamine agonists usually also induce regression of tumor size, thereby improving symptoms due to mass effect such as headaches or bitemporal hemianopsia.

Question 128

how does hyperglycemia effevt vision?

Answer 128

. Hyperglycemia with subsequent osmotic diuresis affects visual acuity, most probably due to swelling of the lens.

Question 129

Diarrhea, Urination, Miosis/Muscle weakness, Bronchospasm, Bradycardia, Emesis, Lacrimation, Lethargy, Salivation, and Sweating should raise concern for ??

Answer 129

cholinergic crisis (DUMBBELLSS) organophosphate poisoning tx: atropine; anticholinergic agent that competitively blocks muscarinic acetylcholine receptors

Question 130

preferred imaging modality for TIA bc it shows even small ischemic changes within 30 minutes after onset (while a CT scan shows changes only after 6–24 hours) and can differentiate acute from chronic lesions

Answer 130

Diffusion-weighted MRI of the brain

Question 131

neurologic abnormalities (likely TIA or stroke, confusion), fever, impaired renal function (increased BUN and creatinine), microangiopathic hemolytic anemia (decreased hemoglobin, elevated LDH and indirect bilirubin, schistocytes), and thrombocytopenia (platelets \< 150,000/mm3)

Answer 131

thrombotic thrombocytopenic purpura (TTP)

Question 132

A CD4 count \< 200 cells/mm3 indicates AIDS. The MRI shows a confluent, hyperintense area of asymmetrical shape that mainly involves the right frontoparietal white matter without any mass effect. In conjunction with the progressive onset of focal neurological deficits, these findings suggest ???

Answer 132

Progressive multifocal leukoencephalopathy PML is a demyelinating disease of the CNS caused by the reactivation of JC virus and is mainly seen in patients with severe immunosuppression (e.g., AIDS)

Question 133

Rupture of small penetrating artery vs. saccular aneurysm

Answer 133

A noncontrast CT scan of the head characteristically shows a **solitary hyperdense lesion surrounded by hypodense edema** (most commonly within the basal ganglia or internal capsule) for small artery saccular: a noncontrast CT scan of the head would characteristically show focal or diffuse hyperdensity within the subarachnoid space.

Question 134

Cushing's triad (hypertension, bradycardia, and irregular respiration) as a result of ??? due to traumatic brain injury (TBI).

Answer 134

increased intracranial pressure (ICP)

Question 135

response to Cushing's triad and increased intracranial pressure (ICP)

Answer 135

Elevated ICP leads to a decrease in cerebral perfusion pressure (CPP). The sympathetic nervous system is activated in this situation to increase mean arterial pressure to maintain CPP

Question 136

spinal shock includes flaccid, areflexic paralysis, bradycardia, and absent ??reflex.

Answer 136

bulbocavernosus

Question 137

Management of spinal cord injuries in an emergency setting involves obtaining vital signs, airway stabilization, immobilization of the neck and body, a thorough neurological examination, and ???

Answer 137

insertion of a urinary catheter To prevent bladder distension, acute urinary retention (AUR), and eventual bladder rupture

Question 138

Although ALS is primarily diagnosed clinically, patients with progressively worsening features of UMN and LMN degeneration should undergo ??? to confirm the diagnosis.

Answer 138

electromyography (EMG) EMG findings in ALS include spontaneous fasciculation potentials, which reflect the random firing of denervated motor units, and fibrillations and positive sharp wave potentials, which reflect the activity of denervated muscle fibers at rest.

Question 139

Livedo reticularis and peripheral edema occur as adverse effects in up to 5% of patients who take this medication for Parkinson's levido retic = reddish-blue discoloration of the skin in a reticular (net-like) pattern

Answer 139

amantadine

Question 140

which test first when suspecting acute meningitis??

Answer 140

**CT scan of the head before lumbar puncture (LP)** is indicated in patients presenting with typical signs of acute meningitis accompanied by signs of increased intracranial pressure or a mass lesion (e.g., altered mental status). The primary goal of obtaining neuroimaging before LP is to mitigate the risk of brain herniation, which can be precipitated by the transient decrease in intracranial pressure caused by LP.

Question 141

indications for performing a head CT prior to LP in patients with suspected meningitis are summarized in the mnemonic ???

Answer 141

“FAILS:” Focal neurological deficit, Altered mental status, Immunocompromised/ICP elevated, Lesion in the brain or skin near LP site, new-onset Seizures.

Question 142

Ear pain, otorrhea, hearing loss, and granulation tissue in the external auditory canal are consistent with ??

Answer 142

malignant otitis externa

Question 143

?? patients are at the greatest risk for developing malignant otitis externa.

Answer 143

Elderly diabetic

Question 144

??? is a complication of TBI that is thought to be caused by the loss of inhibition of the sympathetic nervous system due to cortical injury. It usually manifests about one week after the inciting event with recurrent episodes of hypertension, tachycardia, tachypnea, fever, diaphoresis, muscle spasms, and possibly dystonia with posturing.

Answer 144

Paroxysmal sympathetic hyperactivity (PSH)

Question 145

Nieman Picks vs. Tay-Sachs main sx difference

Answer 145

NP has hePATomegaly

Question 146

next step for suspected brain abscess (Headache, vomiting, and a focal neurologic deficit (abducens nerve palsy), increased intracranial pressure (ICP)

Answer 146

MRI brain intraparenchymal lesion with a central hypointense (T1-weighted) or hyperintense (T2-weighted), purulent center and a peripheral ring will be visible

Question 147

This patient's presentation with apparent inattentiveness and difficulty following directions when directly spoken to, delayed language development (at 4 years, he should be able to speak in at least 4-word sentences), mispronunciation of words (due to poor speech discrimination), and symptoms of frustration (apparently unprovoked episodes of crying and screaming) warrants a thorough evaluation for ???

Answer 147

hearing impairment: in children can cause delays in speech, language, and cognitive development

Question 148

Episodes of proximal muscle weakness and hyporeflexia with concomitant ECG findings of hypokalemia are consistent with ??

Answer 148

hypokalemic periodic paralysis (hypoKPP) ECG: T wave flattening and inversion, prominent U waves, a prolonged PR interval, and ST segment depress

Question 149

excessive daytime sleepiness, cataplexy (tilting of the head and jaw dropping), hypnagogic hallucinations, and sleep paralysis which condition? tx?

Answer 149

narcolepsy modafinil

Question 150

? is used to differentiate neuropathic (e.g., carpal tunnel syndrome, Guillain-Barré syndrome) from myopathic muscle weakness (e.g., polyomyositis (PM), muscular dystrophy); results are abnormal in approx. 90% of patients with PM. If

Answer 150

Electromyography (EMG)

Question 151

repeated episodes of painful neck stiffness after administration of haloperidol are suggestive of ??

Answer 151

acute dystonia tx: benzotropine

Question 152

focal seizure with impaired awareness is the main presenting feature of which epilepsy?

Answer 152

temporal lobe epilepsy Focal seizures are caused by structural changes or damage to the brain (e.g., encephalitis, developmental disorders) and originate in the temporal lobe of one brain hemisphere

Question 153

?? is the strongest predisposing factor for both ischemic and hemorrhagic stroke.

Answer 153

Hypertension

Question 154

first-line disease-modifying drugs for ??? include glatiramer acetate, dimethyl fumarate, teriflunomide, and fingolimod.

Answer 154

relapsing-remitting MS \*also interferon-beta is one of the drugs

Question 155

??? has been shown to improve both survival and quality of life in patients with a single brain metastasis.

Answer 155

Surgical resection

Question 156

delayed development, autistic behavior, long and narrow face with a prominent chin, protruding ears, and above average head circumference indicate

Answer 156

fragile X syndrome \*commonly have mitral valve prolapse

Question 157

Chest pain, diaphoresis, agitation, elevated temperature, tachycardia, hypertension, and mydriasis suggest the use of stimulants (e.g., amphetamine, cocaine) tx ??

Answer 157

benzodiazepines such as lorazepam

Question 158

Neuroleptic malignant syndrome (NMS) is a condition most commonly associated with which drug use?? It presents with altered mental status, fever (often \> 39°C/102.2°F), diaphoresis, muscle rigidity, and tachycardia

Answer 158

antipsychotics like haloperidol

Question 159

first line therapy for restless leg syndrome

Answer 159

**gabapentin**: alpha-2-delta calcium channel ligands (e.g., gabapentin) are considered first-line pharmacotherapy for RLS Pharmacotherapy is reserved for severe cases of primary RLS (i.e., symptoms result in functional impairment and sleep disturbance) and patients who do not respond to behavioral interventions (e.g., sleep hygiene, leg massage) or the attempted correction of any iron deficiency (in the case of secondary RLS)

Question 160

??? and ??? are used as a first-line treatment for painful diabetic neuropathy. The SNRIs duloxetine and venlafaxine can also be used as first-line treatment but are relatively contraindicated for patients already taking a serotonergic agent, such as tramadol, because of the associated risk of serotonin syndrome.

Answer 160

gabapentin and pregabalin

Question 161

?? is the first-line treatment for the acute management of severe migraine in pregnant patients

Answer 161

Acetaminophen triptans have vasoconstrictive effect on uteroplacental vessels and increased uterotonic activity, both of which can contribute to fetal growth retardation and intrauterine fetal demise.

Question 162

Lateral cerebral ventricle enlargement (in addition to decreased cortical volume) is one of the most consistent MRI findings in which patients???

Answer 162

schizophrenic patients The specific reason for ventricular enlargement is not known, but it seems to stem from diffusely decreased cortical volume and shrinkage of the thalamus and putamen. Frequent use of cannabis is a risk factor for psychosis.

Question 163

The combination of vertical gaze palsy, nystagmus, eyelid retraction on looking upwards, and pupils that do not react to light, but do accommodate, suggests Parinaud syndrome which raises concern for???

Answer 163

Pinealoma, a tumor of the pineal gland most common type of pinealoma in children is a germinoma = precocious puberty

Question 164

Brain dead = cause + demonstrate via examination that the patient is comatose, does not have brain-mediated motor responses (e.g., decorticate or decerebrate posturing, facial grimacing) to noxious stimuli applied above and below the neck, has brainstem areflexia, and has a positive ?? test.

Answer 164

apnea test After preoxygenation with 100% oxygen, the patient is disconnected from the ventilator and observed for evidence of respiratory drive (such as gasps or chest movement). After 8–10 minutes, an arterial blood gas reading is obtained. If the PCO2 is elevated above normal levels, this signifies an absence of respiratory drive, and the apnea test is considered positive.

Question 165

A history of palpable purpura, increased fatigue, **progressive sensorimotor neuropathy**, mildly decreased C3 levels, and nearly undetectable C4 levels in a patient with hepatitis C (hepatitis C antibody and HCV RNA positive) is suggestive of ???

Answer 165

mixed cryoglobulinemia

Question 166

??? should be the initial step in the treatment of patients with severe HCV-associated mixed cryoglobulinemia to reduce inflammation and prevent organ damage.

Answer 166

Immunosuppressive therapy (e.g., rituximab and high-dose prednisone) Pneumocystis pneumonia prophylaxis (trimethoprim-sulfamethoxazole) is also recommended in all patients with mixed cryoglobulinemia who receive immunosuppression

Question 167

n a child with a recent history of a sore throat, rapid onset of involuntary purposeless movements, emotional lability, hypotonia, inability to sustain contraction (“milkmaid grip”), and flexion of the wrist and extension of the digits when the arms are extended most likely indicate

Answer 167

Sydenham chorea \*\*\*\*feature of rheumatic fever inflammation within the basal ganglia and cortical structures leads to Sydenham chorea Treatment with penicillin V is indicated to completely eradicate S. pyogenes and address the underlying cause of this cross-reaction.

Question 168

??? is the most common brain tumor in children and is usually located within the posterior fossa. Imaging typically shows a well-circumscribed, enhancing cystic mass within one of the cerebellar hemispheres, but it can also occur in the cerebral hemispheres.

Answer 168

Pilocytic astrocytoma

Question 169

typical (fluphenazine) vs atypical antipsychotics (risperidone)

Answer 169

atypical antipsychotics have weaker interactions with D2 dopamine receptors, resulting in less dopamine antagonism and lower rates of extrapyramidal symptoms than typical antipsychotics.

Question 170

infant c. botulinum vs c. tetani

Answer 170

tetani: **muscle spasms**, **myoclonus**, irritability, and poor feeding botulism: **hypotony**, **weakness**, poor feeding, and irritability

Question 171

what is hypercalcemia of malignancy?

Answer 171

metastatic lytic bone lesions cause hypercalcemia Patients with mild to moderate hypercalcemia are typically asymptomatic or develop symptoms such as constipation, fatigue, and polyuria. Severe hypercalcemia (hypercalcemic crisis), which is seen here, is a life-threatening condition that manifests with oliguria/anuria, dehydration, gastrointestinal symptoms, and an **altered level of consciousness**

Question 172

?? antibodies are specific to both dermatomyositis and polymyositis.

Answer 172

Anti-Jo-1 The presence of anti-Jo-1 antibodies is associated with a more aggressive disease course and an increased risk for interstitial lung disease.

Question 173

?? antibodies may be present with dermatomyositis or polymyositis and are typically associated with a more favorable prognosis

Answer 173

Anti-Mi-2

Question 174

patients with meningiomas at the ?? present with sensory and motor deficits typically start in one extremity and spread to the others. Late presentation is characterized by spastic quadriparesis (hyperreflexia, positive Babinski's sign), gait disturbances, and lower cranial nerve palsies (CN IX–XII)

Answer 174

foramen magnum

Question 175

Hypotonia (floppy infant syndrome), bulbar palsy symptoms (e.g., tongue fasciculations, difficulty feeding), and hyporeflexia are characteristic of ???? Children can also present with **recurrent hip dislocation** (differences in leg length with external rotation of the affected leg)

Answer 175

Spinal muscular atrophy (SMA) is an autosomal recessive condition caused by apoptosis of lower motor neurons

Question 176

Leg pain associated with sensory, motor, and vasomotor symptoms following a femur fracture is consistent with usually develop within 4–6 weeks of the event

Answer 176

complex regional pain syndrome (CRPS) Physical and occupational therapy is the recommended first-line therapy for CRPS

Question 177

An acute neurological syndrome caused by thiamine deficiency that is characterized by a triad of **confusion**, **ophthalmoplegia**, and **ataxia**. Requires emergency treatment with thiamine repletion. Typically occurs in alcoholics.

Answer 177

Wernicke encephalopathy

Question 178

Chronic neurologic condition characterized by selective anterograde and retrograde amnesia with relative preservation of long-term memory. Occurs as a consequence of long-term thiamine deficiency

Answer 178

Korsakoff syndrome

Question 179

A combination of ???? and ???? are used for empiric treatment of community-acquired meningitis to cover the most likely pathogens in patients between 1 month and 50 years of age, including S. pneumoniae, N. meningitidis, and H. influenza. Meningococcal meningitis has a high case fatality rate (up to 13%). **Rifampin** is indicated for post-exposure prophylaxis in all close contacts

Answer 179

vancomycin and a third-generation cephalosporin (ceftriaxone, cefotaxime)

Question 180

In a high-pressure environment (e.g., during scuba diving), a large amount of gas (primarily nitrogen) is dissolved in blood and tissue fluid. With a sudden subsequent decrease in pressure (e.g., during rapid ascent), air bubbles form because the gas is no longer dissolved (Henry's law) and they begin to expand (Boyle's law). These bubbles cause local tissue damage and are primarily responsible for the multisystem manifestations of **decompression sickness**, which can also include chest pain, dyspnea, myalgia, arthralgia, pruritus, painful lymphadenopathy, and lymphedema. what is the treatment?

Answer 180

hyperbaric oxygen therapy

Question 181

vitamin B12 deficiency can manifest with symmetrical peripheral sensorimotor neuropathy, it causes ? type of paresis

Answer 181

\*\*spastic not flaccid

Question 182

Progressive symmetric loss of sensation, dysesthesia, decreased muscle strength, and hyporeflexia in the distal lower extremities are consistent with

Answer 182

polyneuropathy

Question 183

?? is the first step of care in patients with conversion disorder

Answer 183

Patient education symptoms may resolve after an explanation of the diagnosis and its causes. Strategies for presenting the diagnosis to patients include asking about their perspective of the problem, taking their symptoms seriously, explaining clinical features that are inconsistent with neurologic disease, and emphasizing that symptoms are potentially reversible.

Question 184

PCP vs stimulants (cocaine/meth) physical sx

Answer 184

PCP leads to miosis cocaine or methamphetamine commonly present with dilated pupils

Question 185

initial step in diagnosis of Duchenne muscular dystrophy (DMD)

Answer 185

**serum CK concentration** should be obtained as the **first step** in diagnosis and **genetic analysis** for DMD gene mutations should then be performed **to confirm the diagnosis**

Question 186

how does hypothyroidism cause nipple discharge?

Answer 186

in primary hypothyroidism secretion of thyrotropin-releasing hormone (TRH) by the hypothalamus stimulates the lactotroph cells of the anterior pituitary to release prolactin = nipple discharge + vaginal atrophy in women

Question 187

As a general rule, patients with a GCS score of ??? or below as a result of traumatic brain injury require intubation and mechanical ventilation to protect the airway and ensure adequate ventilation.

Answer 187

8

Question 188

High-dose ??? is the treatment of choice in patients with confirmed primary CNS lymphoma.

Answer 188

methotrexate

Question 189

??? nerve damage, therefore, causes hypertropia (one eye is deviated upward) and vertical diplopia

Answer 189

Trochlear nerve superior oblique muscle (SOM) is a depressor and intortor of the eyeball.

Question 190

Abduction of the thumb followed by slow relaxation upon percussion indicates

Answer 190

myotonia: a very slow relaxation of the muscle after cessation of contraction. Occurs as a result of prolonged depolarization of muscle fibers due to instability of the sarcolemmal membrane.

Question 191

diabetic mononeuropathy causes ptosis or dilated pupils and why?

Answer 191

**Ptosis** occurs in patients with oculomotor nerve palsy because the **levator palpebrae superioris muscle** is **innervated** by the **oculomotor nerve CN3** Whereas patients with **oculomotor nerve palsy due to compression usually** **show dilated pupils**, those with diabetic mononeuropathy normally do not have pupillary involvement because the microangiopathy typically involves the vasa nervorum within the oculomotor nerve, while the pial blood vessels (which supply the superficial parasympathetic fibers) are usually spared.

Question 192

Ring-enhancing lesions seen on MRI, neurologic symptoms (e.g., headache, seizures), and eosinophils in cerebrospinal fluid should raise concern for ??

Answer 192

neurocysticercosis Cerebral Taenia soleum infection

Question 193

What test confirms suspected carpal tunnel syndrome (CTS)?

Answer 193

Nerve conduction studies

Question 194

prolonged altered mental status, headache, Todd paralysis, and aphasia for minutes-to-hours after onset of sx what happened?

Answer 194

postictal seizure state remember chronic alcoholics are at increased rx of seizures from alcohol withdrawal

Question 195

sharp, burning, and radiating pain that worsens with prosthesis use (i.e., when pressure is applied to the stump)

Answer 195

Traumatic neuromas arise from the disorganized proliferation of nerve fibers or their myelin sheath and usually develop within the first year following amputation.

Question 196

an indolent type of non-Hodgkin lymphoma that is caused by abnormal production of **IgM antibodies** by monoclonal plasma cells. This condition usually manifests in older patients with impaired platelet function (nosebleeds), anemia, and mild thrombocytopenia, p**rogressive neuropathy (history of pain and numbness in the feet, muscle weakness)**, and **hyperviscosity syndrome (vision and hearing loss)**

Answer 196

Waldenstrom macroglobulinemia

Question 197

Rapidly deteriorating vision, hearing, motor abilities, and cognition alongside spastic tetraplegia, sensory loss, and adrenal insufficiency (suggested by hyperpigmented skin, fatigue, nausea) in a young boy are characteristic of ???

Answer 197

adrenoleukodystrophy rare X-linked recessive neurological disease caused by a d**ysfunctional peroxisomal ATP-binding cassette transporter** protein due to a mutation in the ABCD1 gene main **distinguishing factor** is the presence of **adrenal insufficiency** (usually manifesting with hyperpigmented skin but also fatigue, nausea, vomiting, hypotension, etc.

Question 198

what is the use of **trihexyphenidyl and biperiden**

Answer 198

Initial monotherapy with an **anticholinergic (e.g., trihexyphenidyl, benztropine, biperiden)** can be considered in patients with PD who are ≤ 65 years of age if the main symptom is resting tremor and there is no evidence of cognitive impairment, significant bradykinesia, or gait disturbance.

Question 199

Treatment with natalizumab increases the risk of developing About 80% of the general population has this latent infection

Answer 199

progressive multifocal leukoencephalopathy (PML), a demyelinating disease of the CNS caused by the **reactivation of the JC virus (JCV).**

Question 200

??? is the most appropriate next step in management in patients with an unprovoked first seizure if an intracranial process (e.g., hemorrhage) is suspected = altered mental status, continued disorientation, headache

Answer 200

neuroimaging most likley CT noncon of head

Question 201

3 sx of HIV encephalopathy (CD4 count \< 200/mm3).

Answer 201

**subacute** onset of memory impairment, depressive symptoms, and movement disorders (ataxia, dysdiadochokinesia)

Question 202

is the most common cause of viral encephalitis.

Answer 202

Herpes simplex virus (HSV)

Question 203

1st, 2nd, 3rd steps for spinal epidural abscess

Answer 203

1. MRI of spine 2. blood cultures 3. empiric antibiotics 4. surgical drainage & decompression

Question 204

which condition? Hamartomas may manifest in the skin as shagreen patches, angiofibromas, and ash-leaf spots; in the CNS, with secondary seizures, hydrocephalus, and/or intellectual disability; in the kidney, as angiomyolipomas (which may cause pain and impairment of renal function), benign cysts, or renal cell carcinoma

Answer 204

Tuberous sclerosis

Question 205

initial management of **delirium** with or without agitation is nonpharmacological and includes measures such as **verbal redirection, reorientation, and physical restraints.** If patient continues to be violent and destructive, and verbal redirection has been unsuccessful, first-line pharmacotherapy is???

Answer 205

**Haloperidol** is the drug of choice for refractory agitation in patients with delirium

Question 206

corneal haziness with neovascularization is called pannus and is a classic presentation of active ??? initially manifests as follicular conjunctivitis and then progresses to a mixed papillary and follicular conjunctivitis

Answer 206

**Trachoma** is caused by Chlamydia trachomatis serotypes A–C.

Question 207

which brachial plexus injuries can be seen from shoulder dystocia from birth trauma?

Answer 207

neonatal Horner syndrome (damages cervical sympathetic nerve fibers) and **Klumpke palsy** can also result from brachial plexus injury (due to damage of C8 and T1 nerve fibers that supply the ipsilateral intrinsic hand muscles), causing an **absent grasp reflex**

Question 208

appearance of **gram-negative coccobacilli** in cerebrospinal fluid (**CSF**) in an unvaccinated child w/meng sx indicates

Answer 208

Haemophilus influenzae rx of transient or permanent sensorineural hearing loss as a result of the spread of infection from the meninges to the cochlea via the cochlear aqueduct

Question 209

weight gain, bradycardia, and cognitive symptoms that can mimic Alzehimer's disease/dementia indicate?

Answer 209

elderly patients with **hypothyroidism**

Question 210

in a patient history of polysubstance use disorder, after administration of antagonists, which drug can cause seizure?

Answer 210

**Benzodiazepine withdrawal** due to administration of its antagonist, flumazenil, **may precipitate withdrawal seizur**e, especially in patients with high tolerance to benzodiazepines from chronic use. If benzodiazepine dependence is suspected, an **anticonvulsant (e.g., carbamazepine) is indicated as seizure prophylaxis**

Question 211

where is inflammation in polyomyositis?

Answer 211

Intrafascicular infiltration on muscle biopsy Inflammatory cellular infiltrates of cytotoxic T cells within muscle fascicle

Question 212

lab findings for polymyositis?

Answer 212

mildly elevated levels of inflammatory markers: **CRP, ESR**; and muscle enzymes: **creatine kinase, lactate dehydrogenase, AST, and ALT**

Question 213

child has multiple pigmented iris nodules (Lisch nodules), ≥ 6 hyperpigmented macules (café au lait spots), and numerous soft, pedunculated skin nodules (neurofibromas). These findings fulfill the diagnostic criteria for ??

Answer 213

neurofibromatosis type 1 (NF1)

Question 214

tests for neurofibromatosis type 1 (NF1)

Answer 214

All patients with NF1 and visual symptoms should undergo **MRI of the brain with contrast** for further evaluation. In addition, all children with NF1 should undergo an **annual ophthalmologic examination** to screen for **optic glioma**.

Question 215

most common CNS tumor associated with NF1

Answer 215

optic glioma

Question 216

4 brainstem reflexes that must be checked prior to declaring brain death If all these reflexes are negative, an apnea test is performed, which can confirm the diagnosis

Answer 216

corneal reflex, the gag reflex, cough reflex, and pupillary light reflex

Question 217

patient presents with symptomatic thrombocytopenia (platelet count \< 150,000/mm3, epistaxis, petechiae), microangiopathic hemolytic anemia (schistocytes, elevated LDH, elevated indirect bilirubin, decreased hemoglobin), neurologic abnormalities (seizure, confusion), and renal insufficiency (elevated creatinine). These findings are consistent with ???

Answer 217

thrombotic thrombocytopenic purpura (TTP)

Question 218

tx for thrombotic thrombocytopenic purpura (TTP).

Answer 218

Plasma exchange therapy + glucocorticoid (e.g., prednisone)

Question 219

1st vs 2nd gen antipsychotics

Answer 219

second-generation antipsychotics (e.g., quetiapine, ziprasidone) exhibit a**ntagonistic activity at 5-HT2A receptors**, and, to a lesser degree, **D3, α-adrenergic, and H1 receptors** and **weaker D2 receptor antagonists** than first-generation antipsychotics

Question 220

Impaired adduction of the ipsilateral eye and abduction nystagmus of the contralateral eye (i.e., dissociated nystagmus) on lateral horizontal gaze should raise concern for

Answer 220

internuclear ophthalmoplegia (INO) often caused by MS, demyelination of the medial longitudinal fasciculus (MLF)

Question 221

??? is used to treat symptomatic exacerbations in acute intermittent porphyria (AIP). Five P's” of acute intermittent porphyria (AIP): Painful abdomen, Polyneuropathy, Psychologic disturbances, Precipitated by drugs/alcohol, and Purple pee

Answer 221

Hemin It functions as an inhibitor of δ-aminolevulinate synthase which in return leads to decreased heme synthesis and decreased production of intermediates that are thought to cause symptoms in AIP.

Question 222

exposure to what?? distal sensorimotor polyneuropathy, white bands across the nails (Mees lines), and hyperkeratosis. Workers in battery factories have an increased risk of being exposed

Answer 222

arsenic

Question 223

cause of death in acromegaly

Answer 223

\*\*cardiomyopathy Cardiovascular complications such as hypertension, concentric ventricular hypertrophy, and arrhythmias are the most common complications and the cause of death in ∼ 60% of patients with acromegaly.

Question 224

initial treatment of choice for cryptococcal meningitis India ink stain showings a prominent capsule = infection with Cryptococcus neoformans.

Answer 224

i**ntravenous amphotericin B and oral flucytosine** for at least **2 weeks** **Oral fluconazole** is then administered for at least **8 weeks** (consolidation therapy) followed by maintenance therapy with lo**wer dose fluconazole** for at least **12 months.**

Question 225

what work-up is needed for clinically suspected Bell's palsy? tx?

Answer 225

NONE for routine, idiopathic Bell's palsy Imaging studies and blood tests are appropriate for atypical presentations, such as a slowly progressive palsy (which may be caused by mass effect from a tumor) or bilateral involvement (which may be caused by Lyme disease) Tx: oral glucocorticoids

Question 226

?? are the first-line treatment for primary open-angle glaucoma (POAG)

Answer 226

Topical prostaglandins such as **latanoprost**

Question 227

Children with a history of seizure disorder are at increased risk of having a seizure with the administration of the ?? vaccine. vaccine is contraindicated for children with uncontrolled seizures

Answer 227

pertussis

Question 228

Watery diarrhea, crampy abdominal pain, episodic cutaneous flushing triggered by eating or emotional events, asthma-like attacks, and a murmur indicative of tricuspid regurgitation are highly suggestive of ??

Answer 228

carcinoid syndrome serotonin secretion from extraintestinal neuroendocrine tumors

Question 229

deficiency caused by carcinoid tumors

Answer 229

Pellagra, or niacin deficiency = Dementia, dermatitis, diarrhea, and glossitis

Question 230

Slowed and reduced amplitude of repetitive movements (e.g., foot tapping, opening and closing the hand, or tapping thumb and index fingers) is a sign of ????? , which is a hallmark feature of PD

Answer 230

bradykinesia

Question 231

New-onset seizure and CT scan results showing ring-enhancing lesions in a patient with HIV infection are highly suggestive of a diagnosis of ???

Answer 231

cerebral toxoplasmosis

Question 232

Treatment of cerebral toxoplasmosis consists of (3)

Answer 232

pyrimethamine, sulfadiazine, and leucovorin (folinic acid) Pyrimethamine and sulfadiazine inhibit folic acid metabolism in T. gondii, while folinic acid is administered to alleviate myelotoxic side effects

Question 233

caused by narrowing of the central spinal canal due to degenerative changes of the spine. This condition most commonly affects older adults (\> 50 years of age) and usually manifests with **neck pain** (which can radiate to the arms due to concomitant nerve root compression), paresthesias, findings of **lower motor neuron injury at the level of the lesion** (e.g., hyporeflexia), and findings of **upper motor neuron injury below the level of the lesion** (e.g., hyperreflexia, Babinski sign)

Answer 233

cervical spondylotic myelopathy (CSM)

Question 234

Parkinson-plus syndromes should be considered if parkinsonism does not ??

Answer 234

respond to levodopa treatment

Question 235

??? is a neurodegenerative disease that belongs to the Parkinson-plus syndromes. It is characterized by motor abnormalities (tremor and rigidity), autonomic dysfunction (orthostatic hypotension and urinary incontinence), and cerebellar symptoms (dysdiadochokinesia, gait disturbances, dysarthria).

Answer 235

Multiple system atrophy

Question 236

??? is the screening test of choice for Lyme disease Patient presents w/ peripheral facial nerve paralysis

Answer 236

Enzyme-linked immunosorbent assay (ELISA) If ELISA is positive, Western blot should be performed to confirm the diagnosis

Question 237

Patients with neurosarcoidosis most commonly present with ??? ; some may have meningitis, peripheral neuropathy, myopathy, and neuroendocrine dysfunction, such as hypopituitarism or central diabetes insipidus Chest x-ray is the most appropriate initial test

Answer 237

facial nerve palsy

Question 238

???? radiculopathy typically manifests with ipsilateral pain or paresthesia extending from the dorsal medial forearm up to the fingers II–IV and in palmar fingers II–IV (ulnar half of II, III entirely, radial half of IV). Damage to the root leads to impaired function of the triceps, wrist flexor, and finger extensor muscles as well as a reduction in triceps reflex.

Answer 238

C7

Question 239

???? radiculopathy typically manifests with ipsilateral pain and paresthesia extending from the radial aspect of the forearm to the thumb and radial side of the index finger damage to the nerve root leads to impaired function of the biceps and wrist extensor muscles as well as a reduction in biceps and brachioradialis reflexes, none of which is seen here.

Answer 239

C6

Question 240

??? radiculopathy typically manifests with ipsilateral pain and paresthesia over the anterior shoulder damage to the nerve root leads to impaired function of the biceps and deltoid muscles as well as a reduction in biceps reflex

Answer 240

C5

Question 241

cupped optic discs (a cup-to-disc ratio \> 0.6), optic disc pallor, and decreased visual acuity == ??

Answer 241

Open-angle glaucoma Chronically increased intraocular pressure in patients with open-angle glaucoma causes slowly progressive optic nerve atrophy

Question 242

unvaccinated patient has a 3-day history of coryza, cough, conjunctivitis (the “3 Cs”), fever, and multiple bluish-gray lesions on an erythematous background, all of which suggest an active ???? infection

Answer 242

measles \*blue-grayish spots are koplik spots

Question 243

??? is a rare NEURO complication of measles infection usually develops at least 7 years after the initial infection and is characterized by dementia, myoclonus, and epilepsy, leading to coma and death

Answer 243

Subacute sclerosing panencephalitis (SSPE)

Question 244

Broca aphasia is caused by damage where?

Answer 244

inferior frontal gyrus of the dominant (typically left) hemisphere MCA

Question 245

first-line treatment for trigeminal neuralgia ??

Answer 245

Carbamazepine

Question 246

??? cancer is also the single most common source of brain metastases

Answer 246

Lung

Question 247

several round lesions at the border of the gray and white matter of the brain suggest ??

Answer 247

brain metastases

Question 248

Intravenous or intramuscular antiemetics such as prochlorperazine or chlorpromazine can be used as monotherapy for ???? , especially if sx are associated with vomiting

Answer 248

acute migraine attacks

Question 249

Forceps-assisted delivery increases the risk of developing which neuropathy?

Answer 249

peripheral facial nerve palsy as the forceps compress the facial nerve against the mandible or parts of the skull

Question 250

In neonates (age \< 1 month), empiric treatment for bacterial meningitis consists of ??

Answer 250

ampicillin plus an aminoglycoside (e.g., gentamicin) and/or a third-generation cephalosporin (e.g., cefotaxime).

Question 251

pathogens responsible for neonatal meningitis

Answer 251

Typically caused by group B Streptococcus, E. coli, or L. monocytogenes.

Question 252

female patient is \> 50 years old and presents with amaurosis fugax, jaw claudication, headaches, constitutional symptoms (night sweats, weight loss, fatigue), and a markedly elevated ESR what diagnosis??

Answer 252

giant cell arteritis (GCA)

Question 253

??? typically manifests with both upper and lower motor neuron signs. Bladder and bowel dysfunction within hours of the injury, hyperreflexia of the ankles, symmetric lower extremity weakness, and back pain are all consistent with this diagnosis.

Answer 253

Conus medullaris syndrome

Question 254

??? are the most common cause of viral meningitis

Answer 254

Enteroviruses (e.g., coxsackieviruses)

Question 255

first-line treatment for patients with suspected giant cell arteritis (GCA)

Answer 255

**Medium doses** of oral glucocorticoids, such as **prednisone**, are indicated in patients without signs of acute ischemic organ damage (e.g., impaired vision and/or neurologic deficits) \*\*also temporal artery biopsy

Question 256

2 signs of neurosyphilis

Answer 256

positive Romberg test suggesting tabes dorsalis and Argyll Robertson pupil: Bilateral miosis and light-near dissociation as a result of a dorsal midbrain lesion, which selectively damages the fibers that control the pupillary reflex but spares the more ventral fibres that control the accommodation reflex

Question 257

A patient with a tibial fracture, pale, cool skin, weak peripheral pulses, as well as increased capillary refill time and a positive stretch test (pain in the calf muscle on passively dorsiflexing the foot) all suggest ???

Answer 257

**compartment syndrome** and impending critical limb ischemia tx: Fasciotomy

Question 258

??? is the prophylactic treatment of choice for chronic tension headache, which is defined as episodes occurring at least 15 days per month for more than 3 months

Answer 258

Amitriptyline

Question 259

chronic tension headache is defined as ??? episodes occurring at least per month for more than 3 months

Answer 259

\>15 days

Question 260

Mastoiditis is a severe complication of acute otitis media that usually manifests with persistent or recurrent symptoms of otitis media after initial improvement, profuse ear discharge, a tender and edematous mastoid, and anterolateral protrusion of the auricle. Mastoiditis should usually be confirmed via what imaging??

Answer 260

CT scan of the temporal bone

Question 261

gold standard test for diagnosis of angle-closure glaucoma

Answer 261

**Gonioscopy** allows for direct visualization of the anterior chamber angle of the eye

Question 262

recommendation for mild TBI

Answer 262

Observe for 6 hours in the ED and refrain from contact sports for one week

Question 263

progressive worsening headache, chemosis, cranial nerve VI palsy (impaired right-sided lateral gaze), increased intracranial pressure (evident by headache and bilateral papilledema), and the occlusive lesion in a cerebral sinus on imaging indicates ????

Answer 263

cerebral venous thrombosis (CVT)

Question 264

tx for cerebral venous thrombosis (CVT)

Answer 264

low molecular weight heparin (LMWH), such as dalteparin

Question 265

what is a favorable prognistic factor for schizophrenia??

Answer 265

acute onset of symptoms

Question 266

adverse effect of cyclophosphamide (often given to patients with polyarteritis nodosa)

Answer 266

SIADH

Question 267

shaken baby syndrome is associated with what type of hematoma??

Answer 267

subdural hematoma \*\*shearing of briding veins also diffuse axonal injury is seen

Question 268

Reye syndrome presents with features of ????? such as profuse vomiting, lethargy, altered mental status, headache, and papilledema (due to increased intracranial pressure).

Answer 268

hepatic encephalopathy

Question 269

compression of adjacent white matter and/or a rim of cerebrospinal fluid (CSF) around the tumor (**hyperintense appearance of CSF on T2-weighted imaging**) indicate which tumor

Answer 269

meningioma

Question 270

occupations that involve hammering and lifting heavy objects, such as carpentry, the ulnar nerve can be compressed proximally within the ???? as a result of repetitive elbow flexion, which decreases the volume of the cubital tunnel. Decreased pinch strength occurs as a result of weakness of the adductor pollicis muscle, which appears as the Froment sign.

Answer 270

cubital tunnel (cubital tunnel syndrome)

Question 271

headaches, vision abnormalities (e.g., blurry vision, diplopia, photopsia), and bilateral papilledema most commonly seen in women with obesity aged 15–44 years

Answer 271

Idiopathic intracranial hypertension

Question 272

Mixed lytic and sclerotic lesions are typical radiological findings in

Answer 272

Paget disease of bone (PDB)

Question 273

Carbamazepine can cause what systemic syndrome as a side effect?

Answer 273

drug-induced hypersensitivity syndrome (HSS): fever, lymphadenopathy and a diffuse morbilliform rash that progresses to confluent erythema with accentuation of the hair follicles, as well as facial edema. HSS usually develops 2–8 weeks after initiating treatment and is also referred to as **drug reaction with eosinophilia and systemic symptoms** (DRESS) as further symptoms include **hematologic abnormalities (e.g., leukocytosis with eosinophilia), and internal organ involvement (e.g., hepatitis, pneumonitis, nephritis)**

Question 274

hemiparesis, hemisensory deficits, miotic and nonreactive pupils, and gaze deviation downward and toward the affected side of the body (i.e., away from the side of the brain lesion) is a phenomenon known as “wrong way eyes” and characteristically occurs in hemorrhage where??

Answer 274

thalamus

Question 275

ataxia, ophthalmoplegia, and areflexia a few weeks after an infection

Answer 275

Miller-Fisher syndrome (MFS) Detection on serological testing of anti-GQ1b antibodies, which are specific to MFS, confirms the diagnosis

Question 276

MRI classically appear as ring-enhancing masses with perifocal edema. These tumors are typically located in the supratentorial white matter of the cerebral hemispheres (e.g., left temporal lobe), and may cross the midline (i.e., butterfly ??)

Answer 276

astrocytomas (gliobastoma)

Question 277

One of the first signs of magnesium sulfate toxicity is ???? If left untreated, the toxicity can progress to respiratory depression and even cardiac arrest.

Answer 277

depressed or absent deep tendon reflexes.

Question 278

simple febrile seizure (a generalized seizure lasting \< 15 minutes) due to herpangina what is the treatment?

Answer 278

Antipyretic therapy (NSAIDs such as ibuprofen, or acetaminophen)

Question 279

Symptomatic management of neuropathic pain from diabetic peripheral neuropathy can be achieved with SNRIs such as ????

Answer 279

duloxetine

Question 280

One of the major complications of long-standing undertreated diabetes mellitus is ????, which typically arises 5–10 years after disease onset and may manifest as diabetic nephropathy, retinopathy, or neuropathy

Answer 280

microvascular damage

Question 281

??? is commonly seen in patients with multiple sclerosis or spinal cord injury. involuntary contractions of the detrusor muscle press small amounts of urine against the contracted sphincter muscle = irregular, small volume loss of urine and the lack of an urge to urinate

Answer 281

Detrusor sphincter dyssynergia (DSD)

Question 282

sudden, monocular loss of vision; does not resolve spontaneously manifests with massive retinal hemorrhages, dilated tortuous retinal veins, macular edema, and papilledema on fundoscopic examination

Answer 282

Thrombotic occlusion of the retinal vein \*\*\*flame shaped hemorrhages

Question 283

fundoscopic examination shows microaneurysms, increased tortuosity of the retinal arterioles, and “Hollenhorst plaques” (bright, yellow, refractile bodies at the bifurcations of the retinal arterioles), which are indicative of cholesterol crystal embolizations

Answer 283

hypertensive retinopathy

Question 284

?? is a clinical syndrome that manifests with seizures, headache, visual disturbances, and altered mental status and is characterized by radiographic findings consistent with bilateral vasogenic edema in the subcortical white matter of the posterior cerebral hemispheres, particularly in the parieto-occipital regions. Diagnosis is based on neuroimaging

Answer 284

Posterior reversible encephalopathy syndrome (PRES) \*\*often caused by immunosuppressive medications

Question 285

can occur following injury to the CNS and should be high on the differential diagnosis for any neurosurgery patient presenting with hyponatremia.

Answer 285

euvolemic, hypotonic hyponatremia Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Question 286

most common side effects of ECT include ???, tension headaches, nausea, and transient muscle pain

Answer 286

reversible amnesia (retrograde more often than anterograde amnesia)

Question 287

Relative contraindications for ECT include increased intracranial pressure, ?????, severe arterial hypertension, and ??? (2)

Answer 287

recent myocardial infarction (within the last 3 months) and acute glaucoma

Question 288

is it safe for elderly and pregnant women to use ECT

Answer 288

yes

Question 289

Pronator drift is a sensitive test for ??? lesions and can reveal subtle weakness that may be undetectable on traditional confrontation strength testing.

Answer 289

upper motor neuron (UMN) deficits

Question 290

Sudden onset of paraparesis and autonomic dysfunction immediately after an ??? surgery, especially in the setting of intraoperative hypotension, is highly suggestive of anterior spinal artery (ASA) syndrome

Answer 290

aortic srugery artery that contributes to spinal cord perfusion (artery of Adamkiewicz) can be injured during aortic surgery.

Question 291

?? often present with position-dependent symptoms of obstructed blood flow through the atrioventricular valves Additionally, patients may present with constitutional findings (e.g., weight loss, fever, or anemia) typical auscultatory finding (also present in this patient) is an early diastolic “plop” followed by a mid-diastolic rumbling murmur best heard at the apex that results from the obstructed blood flow through the mitral valve, and mimics the murmur of mitral stenosis

Answer 291

cardiac myxoma

Question 292

Early-morning neck pain in a patient with rheumatoid arthritis should raise suspicion for ???

Answer 292

atlantoaxial subluxation loss of ligamentous stability between the atlas (C1) and axis (C2), which can result in compression of the spinal cord, medulla, and/or vertebral arteries by the odontoid process, especially upon neck flexion

Question 293

?? is the initial diagnostic test of choice to evaluate patients for atlantoaxial instability.

Answer 293

Extension and flexion x-ray of the cervical spine Diagnosis is established if the distance between the anterior arch of the atlas and the dens axis (i.e., the atlantodental interval) is increased to \> 3 mm in a fully flexed position.

Question 294

??? are contraindicated in stroke patients with likely septic cardioembolism from IE because the rate of postthrombolytic intracerebral hemorrhage is significantly higher in these patients than in those with other etiologies of ischemic stroke

Answer 294

thrombolytics

Question 295

management of ischemic stroke in patients with IE includes intravenous antibiotics and ???

Answer 295

evaluation for cardiac surgery ​​​​​​​

Question 296

Where does blood pool on CT for a subarachnoid hemorrhage?

Answer 296

brainstem and basal cisterns

Question 297

which syndrome? Classic examination findings include limitation of upward gaze (ie, downward gaze preference), light-near dissociation (ie, pupils reactive to accommodation but not to light), and bilateral eyelid retraction (ie, Collier sign), resulting in visible sclera above the superior corneal limbus

Answer 297

Parinaud syndrome (or dorsal midbrain syndrome) results from pressure on the pretectal region of the midbrain near the superior colliculus and the oculomotor nerve (CN III) \*\*typically caused by pinealoma\*\*

Question 298

choroid plexus papilloma (CPP) is a highly vascular, neuroepithelial tissue found within the ventricles. Most common in infants, CPP is a rare, slow-growing, benign overgrowth of the choroid plexus that produces?

Answer 298

increased CSF

Question 299

features of locked-in syndrome include: preserved consciousness because the midbrain reticular formation is spared, Preserved sensation because sensory pathways are not affected and preserved brainstem and preserved spinal reflexes because they do not require cortical input. which gaze is preserved?

Answer 299

absent horizontal eye movements because coordinated conjugate gaze is controlled in the pons; however, **vertical eye movements and eyelid elevation are preserved** because they are controlled in the rostral midbrain.

Question 300

The ??? nerve innervates the muscles of the anterior compartment of the thigh (ie, quadriceps femoris, sartorius, pectineus) and is responsible for knee extension and hip flexion. It also provides sensation to the anterior thigh and medial leg (via the saphenous branch). Patients with this nerve injury also have decreased patellar reflex, as the reflex involves the quadriceps muscle ​​​​​​​

Answer 300

femoral

Question 301

20% of patients using SSRIs develop a ??? tremor, possibly due to serotonergic stimulation of the cortical and thalamic nuclei. The following characteristics support a diagnosis of a medication-enhanced tremor: Temporal relationship to initiation of the medication Dose-response relationship Lack of tremor progression Symmetry of the affected limbs

Answer 301

enhanced physiologic tremor,

Question 302

diabetic neuropathy typically presents how??

Answer 302

symmetric sensory polyneuropathy in a glove and stocking pattern \*\*not typically weakness

Question 303

alternative therapy for essential tremor (not propanolol)

Answer 303

primidone - anticonvulsant \*used for pt's with reactive airway disease, nonselective beta blockers are contraindicated

Question 304

T2 hyperintensity of the spinal cord and no compressive lesion is most consistent with ??? hyperintensity on spinal MRI is characteristic because the inflammatory infiltrate leads to an increase in water content in the spinal cord

Answer 304

transverse myelitis (TM)

Question 305

?? first-line management for Idiopathic transverse myelitis

Answer 305

high-dose intravenous glucocorticoids

Question 306

patient's seizure behavior associated with forceful eye closure and absence of self-injury, incontinence, or postictal confusion is suggestive of ??

Answer 306

psychogenic nonepileptic seizure (PNES)

Question 307

​​​​​​​ Patients with dementia with Lewy bodies (DLB) are extremely sensitive to ???, and use of this class of medication may be associated with worsening confusion, parkinsonism, and autonomic dysfunction

Answer 307

antipsychotics

Question 308

a degenerative condition associated with spinal canal narrowing due to the formation of osteophytes in the lateral vertebral bodies and ossification of the posterior longitudinal ligament/ligamentum flavum

Answer 308

cervical spondylosis

Question 309

insidious, progressive neurologic deficits in older patient lower motor neuron findings in upper extremeties and upper motor neuron findings in lower extremeties

Answer 309

cervical spondylotic myelopathy from cervical spondylosis Damage to the cervical spine nerve roots (peripheral nervous system), which leads to neck pain that radiates to the shoulders/arms and lower motor neuron findings (eg, weakness, atrophy, reduced reflexes) in a myotome/dermatome distribution in the upper extremities Damage to the spinal cord descending tracts (central nervous system), which leads to unsteady gait (spastic, scissoring walk), a sensation of leg weakness/stiffness, and upper motor neuron signs (eg, increased reflexes, increased tone, upgoing Babinski sign) in the lower extremities

Question 310

tingling, numbness, and burning of the bilateral hands that worsen during hemodialysis suggests?

Answer 310

carpal tunnel syndrome (CTS)

Question 311

Bell palsy presents with acute, progressive, unilateral facial weakness. what work-up is needed?

Answer 311

none for classic presentation

Question 312

what kind of tremor is associated with alcoholic cerebellar degeneration

Answer 312

postural tremor

Question 313

imaging modality and hallmark for diffuse axonal injury

Answer 313

MRI shows numerous minute punctate hemorrhages in the white matter (ie, axons) and blurring of the gray-white interface (due to edema).

Question 314

Guillain-Barré syndrome is caused by demyelination of which nerves?

Answer 314

peripheral nerve fibers

Question 315

psychiatric symptoms (eg, anxiety, psychosis, insomnia), autonomic instability (eg, hyperthermia, hypertension, tachycardia), cognitive impairment, rigidity, hyperreflexia, dystonia, and focal seizure after a flu-like prodrome in the setting of known **ovarian teratoma** strongly suggest ??

Answer 315

anti-NMDA receptor (anti-NMDAR) encephalitis tx = immunosuppresive + removal of tumors diagnosis = GluN1 antibodies in CSF

Question 316

Treatment of stroke in sickle cell disease patients is ??

Answer 316

**exchange transfusion** (ie, slowly removing the patient's blood and replacing it with allogeneic blood), which lowers the relative percentage of sickled cells compared to healthy red blood cells. By decreasing RBC sickling, exchange transfusion increases the oxygen-carrying capacity of the blood and improves hyperviscosity, limiting further occlusion.

Question 317

Unilateral foot drop, Numbness/tingling over the dorsal foot and lateral shin. Impaired ankle dorsiflexion (walking on heels) and great toe extension, Preserved plantar flexion (walking on toes) and reflexes which neuroapathy?

Answer 317

common fibular/peroneal nerve compression

Question 318

common fibular neuropathy has which impairment of flexion?

Answer 318

Impaired ankle dorsiflexion (walking on heels) and great toe extension ​​​​​​​

Question 319

first-line therapy for ALS patients with respiratory insufficiency

Answer 319

Noninvasive positive-pressure ventilation (NIPPV) improves respiratory function by opening the upper airway and providing positive end-expiratory pressure to improve atelectasis

Question 320

3 step management of hemorrhagic stroke

Answer 320

Blood pressure control: Reversible and titratable antihypertensive medications such as intravenous nicardipine or labetalol are used, with a systolic blood pressure goal of 140-160 mm Hg. Reversal of anticoagulation: Targeted reversal of any anticoagulation; vitamin K is typically given to patients on warfarin, and protamine sulfate to patients on heparin. Regulation of ICP: Increased ICP is treated with interventions such as head-of-the-bed elevation, sedation, and osmotic therapy (eg, mannitol).

Question 321

warning signs for headaches that should lead to MRI: Neurologic findings: Seizure, changes in consciousness, specific deficits Other: New at age \>40, sudden onset, trauma, present on awakening one more???

Answer 321

Differences compared to prior headaches: Change in frequency, intensity, characteristics

Question 322

at what point is therapy advised for tourrette's syndrome? Behavioral therapy consists of habit reversal training in which the patient learns to substitute a voluntary movement that is incompatible with the tic. Pharmacological options include vesicular monoamine transporter 2 (VMAT2) inhibitors (eg, tetrabenazine), which are increasingly preferred as initial treatment; antipsychotic medications (eg, risperidone), which are associated with a risk of parkinsonism, tardive dyskinesia, and metabolic effects; and alpha-adrenergic agonists (eg, guanfacine, clonidine), which are helpful when comorbid attention deficit hyperactivity disorder or behavioral issues are present

Answer 322

when tics are severe, disabling, or distressing

Question 323

3 types of pharm for tourette's syndrome

Answer 323

vesicular monoamine transporter 2 (VMAT2) inhibitors (eg, **tetrabenazine**); antipsychotic medications (eg, **risperidone**), which are associated with a risk of parkinsonism, tardive dyskinesia, and metabolic effects; and a**lpha-adrenergic agonists (eg, guanfacine, clonidine)**, which are helpful when comorbid attention deficit hyperactivity disorder or behavioral issues are present

Question 324

mainstay of therapy for Bell's palsy

Answer 324

high-dose oral glucocorticoids (eg, prednisone) within 72 hours of symptom onset

Question 325

anterior cord syndrome and other severe spinal cord injuries can disrupt the ??? tracts involved in bladder control, leading to acute urinary retention. Therefore, ???? should be performed to prevent bladder distension and possible injury.

Answer 325

autonomic tracts catherization

Question 326

abnormal huntingtin protein is particularly toxic to the caudate nucleus and putamen (ie, neostriatum). The neostriatum is rich in ???-producing neurons that are preferentially destroyed due to HD

Answer 326

GABA

Question 327

which brain infection?? CT scan of the brain with intravenous contrast reveals several asymmetric, hypodense, nonenhancing white matter lesions with no edema

Answer 327

progressive, multifocal leukoencephalopathy (PML), a life-threatening neurologic disease caused by the reactivation of JC virus ​​​​​

Question 328

Cerebellar & retinal hemangioblastomas Pheochromocytoma Renal cell carcinoma (clear cell subtype) which syndrome??

Answer 328

Von Hippel Landau

Question 329

The most common cause of spontaneous intraparenchymal hemorrhage impacting the basal ganglia is ??

Answer 329

hypertensive vasculopathy involving the small penetrating branches of the major cerebral arteries

Question 330

common areas for hypertensive vasculopathy leading to intraparenchymal hemorrhage (4)

Answer 330

basal ganglia, cerebellum, thalamus, pons

Question 331

rapid eye movement (REM) sleep behavior disorder has a very strong association with the future development of

Answer 331

alpha-synuclein neurodegenerative disorders; ie Parkinsons

Question 332

3 physical exam findings of brain herniation

Answer 332

**Unconsciousness** due to dysfunction of the ascending reticular activating system responsible for arousal **Midsized, fixed pupils** due to impairment of both parasympathetic and sympathetic nerve fibers innervating the pupil **Abnormal limb posturing** due to disruption of descending tracts (eg, rubrospinal, vestibulospinal) typically involved in reflexive and postural movements. This commonly begins with decorticate (flexor) posturing with damage above the level of the midbrain (ie, red nucleus) but often changes to decerebrate (extensor) posturing as brainstem injury progresses caudally.

Question 333

decorticate vs. decerebrate posturing

Answer 333

Abnormal limb posturing due to disruption of descending tracts (eg, rubrospinal, vestibulospinal) typically involved in reflexive and postural movements. This commonly begins with decorticate (flexor) posturing with damage above the level of the midbrain (ie, red nucleus) but often changes to decerebrate (extensor) posturing as brainstem injury progresses caudally.

Question 334

pregnant patient with an uncomfortable feeling in her legs temporarily alleviated by movement most likely has

Answer 334

restless legs syndrome (RLS) typically worse during gestation, improves after delivery \*\*typically caused by iron deficiency in all types of patients

Question 335

A positive CSF real-time quaking-induced conversion test (RT-QuIC) confirms a diagnosis of ???

Answer 335

Creutzfeldt-Jakob disease

Question 336

patients with ? deficiency are at increased risk of MS development other risk factors (eg, geographic location, colder climates, reduced sunlight exposure) are likely related to this. Epstein-Barr virus infection and smoking are also associated

Answer 336

vitamin D

Question 337

young woman with hand stiffness and muscle atrophy associated with a flat affect, ptosis, and dysarthria has findings suggestive of ???

Answer 337

myotonic dystrophy (MD)

Question 338

myotonic dystrophy (MD) is a multisystem autosomal dominant disorder most commonly caused by which mutation?

Answer 338

expansion of cytosine-thymine-guanine (CTG) trinucleotides in the dystrophia myotonica protein kinase (DMPK) genemyotonic dystrophy (MD)

Question 339

??? is characterized by delayed muscle relaxation after contraction with progressive muscle atrophy and weakness. Involvement of the muscles of the face can lead to **ptosis**, **flat affect** (likely due to prolonged weakness), and **lid lag** after closing the eyes tightly. Oropharyngeal muscle weakness (eg, **dysarthria**) may also occur. Involvement of the distal musculature (eg, intrinsic muscles of the hands, ankle dorsiflexors) explains the **classic grip myotonia** (inability to quickly release the hand grip). Other common associated features, reflecting involvement of systems other than muscular system, include **cataracts, testicular atrophy, and sleep disturbances (eg, hypersomnia, excessive daytime sleepiness)**. Genetic testing confirms the diagnosis

Answer 339

myotonic dystrophy (MD)

Question 340

Non–pupil-sparing CN III palsies are frequently caused by ??

Answer 340

mass effect and should be considered due to an intracranial aneurysm until proved otherwise. Patients should undergo immediate **MR or CT angiography of the head for evaluation**.

Question 341

Pupil-sparing CN III palsies are typically caused by ??

Answer 341

microvascular ischemia and are associated with diabetes, hypertension, hyperlipidemia, and advanced age. Observation and supportive care may be appropriate in patients with vasculopathic risk factors (eg, diabetes, hypertension).

Question 342

Severe carbon monoxide poisoning can cause myocardial ischemia, ????, coma, and death

Answer 342

seizure (evidenced by urinary incontinence and lateral tongue biting)

Question 343

??? are the most common presenting feature of tuberous sclerosis complex (TSC), with typical onset in infancy or early childhood.

Answer 343

Seizures (eg, infantile spasms, tonic-clonic) Intellectual disability and developmental delay are particularly prominent in patients with refractory epilepsy.

Question 344

cause/pathophysiology of trigeminal neuralgia is??

Answer 344

compression of the trigeminal nerve root as it enters the pons, leading to demyelination and atrophy of the nerve

Question 345

serotonin and norepinephrine inhibitor (SNRI), ???? , has demonstrated efficacy in treating painful diabetic neuropathy. It can also be used as a first line treatment for depression ​​​​​​​

Answer 345

duloxetine

Question 346

partial Horner syndrome characterized by ptosis and miosis and NO anhidrosis is a feature of??

Answer 346

internal carotid artery dissection sympathetic fibers responsible for facial diaphoresis travel along the external carotid artery)

Question 347

history of severe bipolar disorder and acute immobility and mutism are suggestive of ??

Answer 347

catatonia catatonia is a syndrome (not a specific disorder) of marked psychomotor disturbance that occurs in severely ill patients with mood disorders with psychotic features, psychotic disorders, autism spectrum disorder, and medical conditions (infectious, metabolic, neurologic, rheumatologic). Common features include decreased motor activity, lack of responsiveness during interview, posturing, and waxy flexibility (initial resistance to repositioning by the examiner, followed by maintenance of new repositioned posture)

Question 348

Treatment of catatonia includes ??? and/or electroconvulsive therapy (ECT).

Answer 348

benzodiazepines (most commonly lorazepam)

Question 349

hemorrhage where? contralateral hemiparesis and hemianesthesia and conjugate gaze deviation toward the side of the lesion

Answer 349

hemianesthesia due to disruption of the corticospinal and somatosensory fibers in the posterior limb and conjugate gaze deviation toward the side of the lesion due to damage of frontal eye field efferents in the anterior limb

Question 350

for organophosphate poisoning, what should be given after atropine?

Answer 350

pralidoxime, a cholinesterase-reactivating agent that has both nicotinic and muscarinic activity, should be given to treat neurotoxicity \*\*atropine is only a muscaranic antagonist Pralidoxime should be given only after atropine, because pralidoxime can cause transient acetylcholinesterase inhibition, which can momentarily worsen symptoms

Question 351

\*\*in a young patient (children) jerky, irregular, involuntary contractions of the limbs and face that cannot be suppressed Poor execution of motor tasks due to hypotonia and intrusion of choreic movements, which can result in intermittently **weakened hand grip** (ie, **milkmaid grip**) **Tics** (eg, repetitive throat clearing) Behavioral changes: emotional lability, anxiety, irritability, **obsessive-compulsive behaviors**

Answer 351

Sydenham chorea 2/2 to GAS infection

Question 352

Always consider ??? when a patient with Parkinsonism experiences orthostatic hypotension, impotence, incontinence, or other autonomic symptoms

Answer 352

Shy-Drager syndrome multiple system atrophy (Shy-Drager syndrome) = **Parkinsonism** + **Autonomic dysfunction** (postural hypotension, abnormal sweating, disturbance of bowel or bladder control, abnormal salivation or lacrimation, impotence, gastroparesis, etc) + **Widespread neurological signs** (cerebellar, pyramidal or lower motor neuron)

Question 353

patient with untreated HIV (inconsistent antiretroviral use) has headaches, nausea/vomiting, confusion, **abducens nerve palsy**, and scattered, **umbilicated skin papules**, raising strong suspicion for infection with ???

Answer 353

Cryptococcus neoformans

Question 354

?? infection usually presents with subacute (eg, 2 weeks in this patient) meningeal manifestations (eg, headache, nausea/vomiting, neck stiffness, dizziness) followed by signs of ischemic stroke (eg, sudden-onset unilateral weakness, hyperreflexia). \*\*prececed by constitutional symptoms and a rash that is typically symmetric, maculopapular, and involving the extremities (including palms and soles) and the trunk

Answer 354

Meningovascular syphilis

Question 355

typical features of cerebellar hemorrhage include ??? headache (may radiate to neck/shoulders), neck stiffness (due to extension of blood into the 4th ventricle), nausea/vomiting, and nystagmus.

Answer 355

occipital headache

Question 356

acute monocular vision loss following 2 months of headache and associated lateral scalp tenderness to palpation in a patient age ≥50 suggests??

Answer 356

giant cell arteritis

Question 357

??? is the most dreaded complication of GCA

Answer 357

Vision loss most patients experience transient monocular vision loss (ie, amaurosis fugax) prior to developing permanent vision loss. Anterior ischemic optic neuropathy (AION), the most common ocular manifestation, occurs due to partial or complete occlusion of the posterior ciliary artery and is characterized by a pale, edematous disc with blurred margins

Question 358

Threatened (eg, vision change) or confirmed vision loss in GCA requires what treatment??

Answer 358

high-dose intravenous glucocorticoids (eg, methylprednisolone 500-1,000 mg daily

Question 359

When tremor is the dominant symptom of PD (ie, without significant bradykinesia/rigidity), **???** therapy is often effective. Treatment is typically limited to younger patients (ie, ≤65), such as in this case, due to the risk of adverse effects in older patients.

Answer 359

anticholinergic therapy (eg, trihexyphenidyl)

Question 360

full or partial CN ?? palsy suggests an enlarging or ruptured aneurysm of the adjacent posterior communicating artery.

Answer 360

CN 3, oculomotor defecits

Question 361

?? is a common adverse effect of lithium, possibly due to increased iron accumulation in the substantia nigra.

Answer 361

Tremor Lithium-induced enhanced physiologic tremor is typically symmetric, limited to the hands and upper limbs, and occurs when the medication is started or the dose is increased (eg, after a manic episode). It is nonprogressive and often decreases over time, even with no dosage reduction.

Question 362

For patients with recurrent vasovagal syncope, management consists of advice to avoid triggers and ??

Answer 362

Physical counterpressure maneuvers assume a supine position with leg raising at the onset of symptoms. Also leg crossing with tensing of muscles, handgrip and tensing of arm muscles with clenched fists during the prodromal phase can improve venous return and cardiac output, sometimes aborting syncopal episodes.

Question 363

tramadol is an analgesic medication with ??? activity.

Answer 363

serotonergic can cause Serotonin Syndrome when combined with SSRIs

Question 364

thunderclap headache (TCH), bilateral visual field defects (suggesting involvement of the optic chiasm) and ophthalmoplegia (eg, impaired right eye adduction consistent with oculomotor nerve [CN III] compromise) localize the lesion to the region of the ???

Answer 364

pituitary and sella turcica often secondary to pituitary adenoma (prolactinoma)

Question 365

what type of gain in PD?

Answer 365

narrow-based and shuffling

Question 366

bulbar symptoms of PD (3)

Answer 366

Hypophonia (a soft voice) Aspiration of liquids (coughing when drinking) Loss of olfactory function (often perceived by patients as change in taste)

Question 367

??? % stenosis: Revascularization with carotid endarterectomy (CEA) is generally recommended.

Answer 367

70%-99%

Question 368

??? is the most common inherited form of intellectual disability Affected boys classically have a long face, prominent chin and forehead, protruding ears, and macroorchidism; infants and young children are more likely to have hypotonia and macrocephaly, and joint hypermobility can also occur

Answer 368

Fragile X syndrome (FXS)

Question 369

Patients classically have a brief loss of consciousness, followed by a lucid interval of minutes to hours.

Answer 369

epidural hematoma

Question 370

Sensorineural hearing loss, most commonly seen following ??? meningitis, is due to inflammation of the cochlea and/or labyrinth and may not be immediately apparent

Answer 370

Streptococcus pneumoniae

Question 371

all patients with bacterial meningitis should undergo ??? testing as soon as possible (ideally, before hospital discharge).

Answer 371

audiologic

Question 372

Acute toxicity of this drug???? initially manifests with signs of cerebellar dysfunction: horizontal nystagmus (ie, nystagmus on lateral gaze), ataxia (eg, wide-based gait), dysmetria (eg, on finger-nose testing), slurred speech, and nausea/vomiting are common, and hyperreflexia may occur.

Answer 372

phenytoin

Question 373

??? meningitis is typically marked by **subacute** symptoms of meningeal irritation (eg, vomiting, headache, nuchal rigidity) and imaging findings of basilar meningeal enhancement, hydrocephalus, and stroke due to vasculitis.

Answer 373

Tuberculous

Question 374

motor sx of cauda equina vs. conus medullaris

Answer 374

Lesions in the brain, spinal cord, and conus medullaris (tapered end of the spinal cord) generally cause **upper motor neuron findings such as hypertonia,** spasticity, hyperreflexia, and positive Babinski sign. In contrast, **lesions at the level of the spinal roots (conus medullaris) usually cause lower motor neuron** findings such as decreased/absent reflexes and decreased muscle tone.

Question 375

initial lab work-up for dementia (4) Evaluation als involves neuropsychological testing (eg, Montreal Cognitive) and neuroimaging.

Answer 375

complete blood count, vitamin B12, TSH, complete metabolic panel

Question 376

patient's cranial nerve (CN) palsy (ptosis, dilated pupil), acute hypoxemic respiratory failure, muscle weakness (eg, inability to hold the head up), and cutaneous abscesses raise strong suspicion for ??

Answer 376

wound botulism

Question 377

his patient's increasing forgetfulness, low energy and motivation, sleep disturbance, and psychomotor retardation (eg, slowed speech, thinking, movements) are consistent with ?

Answer 377

major depressive disorder (MDD).

Question 378

the pathophysiology of tardive dyskinesia is thought to involve what change in dopamine D2 receptor?

Answer 378

upregulation and supersensitivity resulting from chronic blockade of dopamine receptors

Question 379

young patient has Horner syndrome in the setting of a cervical paravertebral mass, findings suspicious for ??

Answer 379

neuroblastoma. Neuroblastoma is the most common extracranial solid tumor of childhood, with a median age \<2. The tumor arises from neural crest cells, which are precursors to the sympathetic ganglia and adrenal medulla. Tumor involvement of the cervical paravertebral sympathetic chain can lead to ipsilateral Horner syndrome (ie, ptosis, miosis, anhidrosis).

Question 380

lab tests for neuroblastoma

Answer 380

Urine and serum catecholamines (vanillylmandelic acid and homovanillic acid) are elevated in the majority of patients; tissue biopsy is required for definitive diagnosis.

Question 381

High-risk features of head trauma in children age ≥2 include: Altered mental status ???? Severe mechanism of injury (eg, fall \>1.5 m [5 ft], high-impact hit, serious motor vehicle collision) Vomiting or severe headache Signs of basilar skull fracture

Answer 381

Loss of consciousness (LOC)

Question 382

Shoulder abduction reduces tension on the impinged nerve root, and improvement of symptoms when the hand is placed on the top of the head (ie, shoulder abduction relief test) is both diagnostic and therapeutic for ???

Answer 382

cervical radiculopathy

Question 383

if CT scan results are negative, ?? should be performed in all patients with a high level of concern for SAH

Answer 383

lumbar puncture (LP)

Question 384

Profound hemineglect is usually due to a lesion impacting the ???, which is responsible for spatial organization

Answer 384

nondominant parietal lobe usually right side

Question 385

Cyanotic ???: Triggered by vigorous crying, leading to cyanosis, and loss of consciousness (LOC) with rapid return to baseline. Pallid ??? (less common): Typically occurs after minor trauma and without crying, as seen in this patient. Pain or fear causes the heart rate to slow and the child become pale, diaphoretic, and limp. Brief LOC follows, and patients are sometimes sleepy or confused for a short period after.

Answer 385

breath-holding spell (BHS)

Question 386

stroke 4 weeks ago; as numbness improved, patient developed allodynia (burning pain exacerbated by touch) and hyperesthesia in areas impacted by the stroke (right arm and leg). These findings are likely due to the development of

Answer 386

**thalamic pain syndrome,** a central neuropathic pain syndrome that can develop after a stroke impacting the thalamus (most likely a lacunar stroke); the adjacent basal ganglia can also be impacted, resulting in athetosis (writhing movements) or ballistic movements The thalamus relays sensory information between various subcortical areas and the somatosensory cortex.

Question 387

which are alpha-2-delta calcium channel ligands ?

Answer 387

gabapentin, pregabalin

Question 388

Approximately 30% of patients on metformin develop clinically significant ??? deficiency after ≥5 years of treatment neuropsychiatric manifestations (eg, irritability, crying spells), sensory ataxia (swaying when standing with eyes closed), and positive Babinski sign

Answer 388

vitamin B12

Question 389

Left CN III palsy with contralateral weakness of the lower face (corticobulbar tract), arm, and leg (corticospinal tract) is most likely caused by a left ???infarction due to occlusion of mesencephalic branches of the posterior cerebral artery (ie, Weber syndrome)

Answer 389

midbrain

Question 390

??? often presents within 4-6 weeks following trauma (eg, fracture, sprain) or surgery; characterized by burning or tingling pain out of proportion to the inciting event. The pain does not follow a dermatomal distribution and is typically worsened by movement or light contact (allodynia) sensory changes (allodynia, hyperesthesia), edema/sudomotor changes (eg, sweating) and vasomotor changes (eg, erythema, altered skin temperature). X-ray often shows patchy demineralization, and bone scintigraphy may show increased uptake in the affected limb.

Answer 390

complex regional pain syndrome (CRPS)

Question 391

subependymal nodules, periungual fibromas which disease?

Answer 391

tuberous sclerosis

Question 392

Rett syndrome is an X-linked genetic disorder that occurs mainly in girls and is characterized by neurodevelopmental regression at age 6-18 months after a period of normal development. In addition to loss of purposeful hand movements (eg, inability to feed herself, stereotypical movements such as hair-pulling) and gait disturbances (eg, lurching gait), other findings can include ????

Answer 392

seizures

Question 393

ptoms of intracranial hypertension include headache (worse at ???), nausea/vomiting, and mental status changes.

Answer 393

night

Question 394

downward pronator drift is sensitive and specific for lesion where

Answer 394

UMN lesion in pyramidal/corticospinal tract

Question 395

Hoffman sign (flexion and adduction of the thumb when flicking the nail of the middle finger) suggests a lesion where??

Answer 395

corticospinal tract

Question 396

patient developed weakness, paresthesias, and hyperreflexia after intubation; in the setting of her known rheumatoid arthritis (RA), this presentation suggests spinal cord compression due to

Answer 396

atlantoaxial joint instability

Question 397

sensory loss: Lateral shin, Dorsum of the foot Weakness: Foot dorsiflexion & inversion (tibialis anterior), Foot eversion (peroneus), Toe extension (extensor hallucis & digitorum) which injury?

Answer 397

L5

Question 398

loss of achilles reflex sensory loss to posterior calf and sole + lateral foot wekaness of hip extension, knee felxion, and foot plantarflexion

Answer 398

S1 injury

Question 399

Alzheimer disease initially presents with memory impairment. Neuroimaging generally demonstrates atrophy in which lobe of the brain?

Answer 399

temporal lobe atrophy, which is most prominent in the hippocampi and surrounding medial temporal lobes.

Question 400

??? commonly presents with an acute, painless, monocular vision disturbance accompanied by flashes of light and/or floaters. may be a complication (acute or delayed) of intraocular surgery; other common risk factors include advanced age, myopia, and ocular trauma.

Answer 400

Retinal detachment

Question 401

Antibodies directed at ???, a ganglioside found in peripheral nerves, are thought to contribute to the rapid-onset ophthalmoplegia present in Miller Fisher syndome ; these antibodies are high sensitive for MFS

Answer 401

GQ1b

Question 402

Clinical features include multiple café-au-lait macules, axillary and inguinal freckling, Lisch nodules (iris hamartomas), and ????.

Answer 402

neurofibromas neurofibromatosis type 1 (NF1). NF1 is an autosomal dominant neurocutaneous disorder caused by mutations in the NF1 gene

Question 403

?? poisoning can cause permanent hypoxic brain injury, as evidenced in this patient's MRI showing bilateral hyperintensity of the globus pallidus, an area highly sensitive to hypoxic conditions.

Answer 403

carbon monoxide

Question 404

??? is characterized by rapidly progressive ascending paralysis \*\*within hours (which may be asymmetrical), absence of fever and sensory abnormalities, and normal CSF examination.

Answer 404

Tick-borne paralysis Removal of the tick results in spontaneous improvement in most patients.

Question 405

Patients with dementia have an increased risk of developing agitated delirium in the hospital. ??? are useful for treating acute agitation in elderly patients with dementia.

Answer 405

Typical and atypical antipsychotics Benzodiazepines are typically not recommended in this setting.

Question 406

A single brain abscess usually results from direct extension of an adjacent infection (eg, otitis media, sinusitis, dental infection). ???? are the 2 most commonly isolated organisms. Headache, fever, focal neurologic deficits, and seizure may be present. Brain imaging (CT scan, MRI) typically reveals a single ring-enhancing lesion with central necrosis.

Answer 406

Viridans streptococcus and Staphylococcus aureus

Question 407

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

Answer 407

Hypokalemia

Question 408

reduced renal clearance of uremic toxins leads to high levels of blood urea nitrogen (BUN) and symptoms of lethargy and somnolence. The diagnosis of uremia is based on clinical symptoms/signs and not on an absolute BUN level. Symptoms typically appear at a BUN level of \>100 mg/dL but can develop at lower levels. Uremic encephalopathy is an indication for ???

Answer 408

urgent hemodialysis

Question 409

Patients who develop serious bleeding (eg, intracerebral hemorrhage) due to excess anticoagulation with warfarin should have their anticoagulation immediately reversed with ??? (2) to reduce the risk of death and permanent disability.

Answer 409

intravenous vitamin K and prothrombin complex concentrate

Question 410

CSF analysis generally shows lymphocytosis with a leukocyte count of 100-500/mm3, mild protein elevation, low glucose, and elevated adenosine deaminase

Answer 410

Tuberculous meningitis is generally marked by subacute symptoms of meningeal irritation with or without cranial nerve palsy and stroke

Question 411

This patient with fever, muscle stiffness, trismus/lockjaw (inability to open his mouth completely), and painful muscle spasms triggered by physical stimuli likely has ???

Answer 411

tetanus

Question 412

c. tetani bacterium secretes a toxin that binds to the peripheral nerve terminals and, using retrograde axonal transport, arrives at a central nervous system synapse, where it blocks the release of ???? across the synaptic cleft.

Answer 412

inhibitory neurotransmitters glycine and GABA

Question 413

patient with confusion and fever has multiloculated, rim-enhancing fluid lesions in the temporal lobe, indicating likely

Answer 413

**Brain abscess** usually occurs due to direct spread from adjacent infection (eg, sinusitis) or hematogenous spread from distant infection. In this case, the presence of subacute nonspecific symptoms, subconjunctival hemorrhage (petechiae), and signs of mitral valve insufficiency (holosystolic murmur at cardiac apex) raises suspicion for left-sided infective endocarditis (IE) with septic emboli to the eye and brain.

Question 414

The diagnosis of ?? can be supported with the bedside ice pack test, in which an ice pack is applied over the eyelids for several minutes, leading to an improvement in ptosis

Answer 414

myasthenia gravis the cold temperature improves muscle strength by inhibiting the breakdown of acetylcholine at the neuromuscular junction, thereby increasing acetylcholine availability to the nicotinic receptor.

Question 415

Infectious keratitis causes eye pain/redness, photophobia, and blurred vision. Slit-lamp examination revealing branching dendritic corneal ulcerations is diagnostic of ????; patients with HIV are at increased risk.

Answer 415

herpes simplex virus keratitis

Question 416

One of the earliest findings in ??? is distortion of straight lines such that they appear wavy it is the most common cause of blindness in industrialized nations. Activities that require fine visual acuity are usually the first affected, and patients with this condition may report that straight grid lines appear curved.

Answer 416

Macular degeneration

Question 417

??? often presents with sudden-onset hazy vision or vision loss. Proliferative diabetic retinopathy is a common risk factor. Examination frequently shows red blood cells or floating debris and a dark red glow with loss of fundal details on fundoscopy.

Answer 417

Vitreous hemorrhage

Question 418

anterior uveitis is most often idiopathic or traumatic but can be associated with systemic inflammatory diseases such as certain infections, sarcoidosis, spondyloarthritis, and ???

Answer 418

inflammatory bowel disease

Question 419

Examination findings include ciliary flush, pupillary constriction, a hazy "flare" in the aqueous humor, and hypopyon.

Answer 419

anterior uveitis

Question 420

patient with apparent ear pain (eg, clutching her ear while crying), facial nerve weakness, and granulation tissue in the external auditory canal (EAC) likely has ???, an osteomyelitis of the skull base.

Answer 420

necrotizing (malignant) otitis externa (NOE)

Question 421

Necrotizing (malignant) otitis externa represents osteomyelitis of the skull base and is most commonly caused by ????. The characteristic presentation consists of severe ear pain and ear drainage; granulation tissue may be seen in the ear canal. Progression of the infection may lead to cranial neuropathies

Answer 421

Pseudomonas aeruginosa

Question 422

Temporomandibular joint disorder can result in referred pain to the ear that is worse with chewing. Patients typically have a history of ??

Answer 422

nocturnal teeth grinding

Question 423

Otitis media with effusion may be a cause of ear pain and fullness in adults. The pain is typically less than that of otitis externa, the external canal is clear, and fluid is seen where??

Answer 423

behind the tympanic membrane

Question 424

patient has acute, persistent vertigo consistent with ?? it is a self-limited disorder that sometimes follows a viral upper respiratory infection. can be associated with significant nausea and vomiting as well as impaired gait, with the patient falling toward the affected side.

Answer 424

vestibular neuritis (VN)

Question 425

Carpal tunnel syndrome is common in patients with ??? and is frequently bilateral. This disease causes soft tissue thickening and mucinous infiltration, which can lead to compression of the median nerve within the carpal tunnel.

Answer 425

hypothyroidism

Question 426

presence of an extra-axial well-circumscribed or round homogenously enhancing dural-based mass on MRI is strongly suggestive of a ????. These tumors usually undergo calcification and can appear hyperdense on non-contrast head CT scan

Answer 426

meningioma

Question 427

perioral cyanosis can be a sign of ?

Answer 427

seizure often seen in the post-ictal state due to lack of breathing during seizure

Question 428

Examination shows diffuse, fluctuant scalp swelling that extends beyond the suture lines and potentially beyond the skull to the neck. The swelling shifts with movement and expands over 2-3 days. Prompt diagnosis is critical because progressive bleeding can lead to hypovolemic shock, disseminated intravascular coagulation, and death. Treatment is generally supportive (eg, volume resuscitation, correction of coagulopathy).

Answer 428

Subgaleal hemorrhage: caused by the shearing of veins between the dural sinuses and scalp due to scalp traction during delivery. \*\* Cephalohematoma does not cross suture lines or lead to significant blood loss.

Question 429

National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria. According to these criteria, cervical spinal imaging is necessary if any of the following is present: Neurologic deficit Spinal tenderness Altered mental status Intoxication Distracting injury what is the preferred screening test to evaluate for CS injury???

Answer 429

A CT scan of the CS without contrast

Question 430

??? deficiency typically occurs in patients with a history of gastric surgery (eg, bariatric), chronic malabsorption (eg, inflammatory bowel disease), or excessive zinc ingestion. Symptoms include slowly progressive myeloneuropathy similar to that of vitamin B12 deficiency (eg, distal extremity paresthesia, numbness, sensory ataxia), anemia, hair fragility, skin depigmentation, hepatosplenomegaly, edema, and osteoporosis.

Answer 430

Copper

Question 431

Multiple sclerosis may result in disabling spasticity. Baclofen, an agonist at the GABA-B receptor, and ????, an alpha-2 adrenergic agonist, are the most commonly used medications for reducing muscle tone and painful muscle spasms.

Answer 431

tizanidine Tizanidine, an alpha-2 adrenergic agonist, improves spasticity, perhaps by decreasing alpha motor neuron excitability

Question 432

Chronic lead toxicity presents in adults with neuropsychiatric, gastrointestinal, and general symptoms, including peripheral sensorimotor neuropathy, fatigue, abdominal pain, and constipation. It can lead to hypertension, nephropathy, hyperuricemia, and microcytic anemia with basophilic stippling seen on peripheral smear. Treatment for symptomatic patients involves chelation therapy with an agent such as ????

Answer 432

calcium disodium EDTA

Question 433

this imaging finding and difficulty swallowing means ??

Answer 433

Myasthenia gravis is caused by autoantibody-mediated degradation of acetylcholine receptors at the neuromuscular junction, which often leads to fatigable ocular and bulbar muscle weakness. Most patients with acetylcholine receptor antibodies have thymic abnormalities (eg, thymoma), which appear as an anterior mediastinal mass on chest imaging.

Question 434

?? should be supplemented to all women at child-bearing age who are prescribed valproic acid

Answer 434

folate

Question 435

TIA is a transiet neurologic deficit that lasts \<24 hours It is most commonly caused by ? CT scan can be negative

Answer 435

cerebal emboli

Question 436

polymyalgia rheumatica vs. fibromyalgia vs. polymyositis

Answer 436

polymyalgia rheumatica: symmetric pain; usually women \>50; fever/weight loss/fatigue fibromyalgia: \*\*point tenderness; women \<40 polymyositis: muscle weakness only, no pain

Question 437

subdural hematoma sx (acute vs. chronic)

Answer 437

Acutely symptomatic SDH typically manifests with altered mental status, focal neurological signs, and signs of increased ICP, and it can progress to brain herniation and death if not treated. Chronic SDH manifests gradually with cognitive deficits, impaired memory, personality changes, and focal neurological signs. Subacute SDH can manifest with features of acute and/or chronic SDH.

Question 438

temporal arteritis vs. tempomandibular joint disorder vs. trigeminal neuralgia

Answer 438

for GCA: glucocorticoids should be administered immediately, even prior to diagnostic workup if needed, to reduce the risk of permanent vision loss and cerebral ischemia. constitutional sx, temporary blindesss, unilateral headache vs. tempomandibular joint disorder: Constant, dull, and unilateral w/intervals of sharp pain; tx is nsaids vs. trigeminal neuralgia: shooting pain many times a day; tx is IV lidocaine and start regular anticonvulsant therapy

Question 439

dry beri-beri vs. wernicke encephalopathy

Answer 439

both due to thiamine def dry beri-beri: \*\*peripheral neuropathies wernicke enceph: confusion, nystagmus/diplopia, ataxic gait (korsakoff when confabulation, personality change, and amnesia occur)