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Flashcards in USMLE Neurology Deck (160)
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1

The diaphragm receives motor innervation from which nerve?

Phrenic nerve (?C3, 4, 5 keep the diaphragm alive?).

2

A 40 year old with sharp pain radiating from buttocks down leg that began after lifting a heavy container; positive straight leg raise test. What is the diagnosis?

Sciatica caused by herniation of a lumbar disc.

3

52 year old with polycystic kidney disease presents with ?worst headache ever;? photophobia, nausea, left eye deviation down and to left; CSF yellow. What is the diagnosis?

Subarachnoid hemorrhage caused by a ruptured berry aneurysm.

4

72 year old alcoholic on warfarin for atrial fibrillation presents with lethargy, headache, papilledema; CT of head shows crescent shaped, hypodense 2.5 cm fluid collection along convexity of skull. What is the diagnosis?

Chronic subdural hematoma

5

53 year old male with lower extremity weakness, muscle atrophy; positive Babinski's sign, fasciculations, hyperreflexia and spasticity in the arms. What is the diagnosis?

Amyotrophic lateral sclerosis

6

68 year old with gradual onset of decreased memory and inability to carry out activities of daily living; head CT: enlargement of ventricles, diffuse cortical atrophy. What is the diagnosis?

Alzheimer's disease

7

65 year old male with carotid atherosclerosis presents with aphasia and weakness on right–side; positive Babinski's on right side. What is the diagnosis?

Left middle cerebral artery infarction.

8

17 year old with headache, nausea, vomiting 2 hours after being hit in the temple; initial loss of consciousness; head CT: lens–shaped, right–side hyperdense mass adjacent to temporal bone. What is the diagnosis?

Epidural hematoma

9

39 year old with history of Campylobacter enteritis one week ago; ascending symmetric weakness; absent reflexes; CSF: elevated protein, normal cellular. What is the diagnosis?

Gillian–Bare syndrome

10

40 year old male with poor memory, depression; spontaneous writhing movements , hypotonia; his father died at 48 with tremors dementia; MRI: marked atrophy of caudate nucleus. What is the diagnosis?

Huntington's disease with choreiform movements.

11

32 year old female with diplopia, scanning speech, paresthesias, numbness in right hand, urinary incontinence; CSF: oligoclonal bands; MRI: periventricular demyelination. What is the diagnosis?

Multiple sclerosis

12

55 year old with lung cancer, nausea, vomiting, headache, diplopia; papilledema, left oculomotor palsy, right pronator drift; MRI: multiple round, ring–enhancing hyperintense cortical cerebellar lesions Diagnosis?

Metastases to brain

13

28 year old female with unilateral throbbing headaches, nausea, photophobia, scotoma; headaches occur during menstrual periods each month. What is the diagnosis?

Menstrual migraine

14

65 year old with urinary incontinence, loss of short–term memory, dementia; wide–based gait; head CT: dilated ventricular system. What is the diagnosis?

Normal pressure hydrocephalus

15

65 year old with gradual onset of pill–rolling tremor; masked face, stooped posture, shuffling gait; cogwheel rigidity. What is the diagnosis?

Parkinson's disease

16

32 year old with loss of libido, galactorrhea, irregular menses; bitemporal hemianopia; negative beta–hCG. What is the diagnosis?

Prolactinoma

17

What is angle closure glaucoma?

Sudden onset of blurred vision, eye pain; hard, red, painful eye; nonreactive pupil and increased intraocular pressure.

18

What is the most common cause of permanent bilateral visual loss in the US?

Macular degeneration

19

What is open angle glaucoma?

Gradual increase intraocular pressure with progressive eye pain, colored halos, peripheral vision loss.

20

What is the treatment of angle closure glaucoma?

Emergent lowering of the intraocular pressure with acetazolamide. Pilocarpine may be used after intraocular pressure is reduced.

21

What are the symptoms and signs of macular degeneration?

Loss of night and central vision; retinal epithelial elevation, hemorrhagic changes.

22

What type of vertigo is associated with a popping sensation in the middle ear after sneezing, coughing, or straining?

Perilymphatic fistula, which is an abnormal communication between the inner ear fluids and the middle ear, often occurring after sneezing.

23

What type of vertigo is triggered by sudden changes in position, and may sometimes be associated with trauma?

Benign positional vertigo

24

What type of vertigo is associated with progressive hearing loss, episodic vertigo, nausea, vomiting, and a sense of fullness in the ear?

Ménière's disease

25

What type of disorder is characterized by self–limited vertigo associated with nausea, vomiting?

Vestibular neuronitis

26

What are the symptoms of amyotrophic lateral sclerosis?

Asymmetric, slowly progressive limb, bulbar weakness with fasciculations (weakness of the jaw, face, palate, pharynx, larynx and tongue, difficulty swallowing).

27

Multiple sclerosis is associated with what findings on MRI?

Periventricular white matter lesions.

28

Multiple sclerosis is associated with what CSF findings?

Oligoclonal bands and mononuclear pleocytosis

29

What class of medications can be used during exacerbations of multiple sclerosis?

Steroids

30

What medications can be used to prolong periods of remission in multiple sclerosis?

Immunosuppressants, such as cyclophosphamide, azathioprine, methotrexate, and immunomodulators, such as beta interferon and Copaxone.