UWorld - Step 2 CK "Nervous System"

Question 1

When is plasmapheresis indicated in the treatment of MS?

Answer 1

When a patient with MS has disabling symptoms, you first treat with corticosteroids. If the steroids fail, then you administer plasmapheresis.

Question 2

Trigeminal neuralgia is caused by ______________.

Answer 2

demyelination secondary to compression of the nerve

Question 3

The ____________ nerve arises from the posterior cord and travels posterior to the humerus.

Answer 3

axillary

It is the unique pathway behind the humerus that makes it susceptible to injury in anterior dislocations.

Question 4

Epidural hematoma is treated with _______________.

Answer 4

emergent craniotomy

Question 5

A single brain abscess is most likely one of two organisms: ______________.

Answer 5

Staphylococcus aureus or Streptococcus viridans

Note: this usually results from infection of adjacent structures (teeth or sinuses).

Question 6

Charcot-Bouchard aneurysms are the product of _________________.

Answer 6

hypertensive vasculopathy (typically bleeding into the basal ganglia or internal capsule)

Question 7

To qualify as a febrile seizure, there needs to be no _____________.

Answer 7

identifiable cause of the seizure (such as meningitis, encephalitis, electrolyte abnormality, or mass)

Question 8

What percent of those who’ve had one febrile seizure will develop epilepsy?

Answer 8

Less than 5%

Question 9

What two studies would you order to help diagnose Guillain-Barré?

Answer 9

• LP (which will show high protein content with all other values normal)
• NCS (which will show decreased NCV)

Question 10

What unique vital sign abnormality might those with Guillain-Barré have?

Answer 10

Orthostatic hypotension

Question 11

List the triad of symptoms that suggest Wernicke encephalopathy.

Answer 11

• Gait disturbances
• Nystagmus
• Encephalopathy

Question 12

For severe pain from cancer, give _____________.

Answer 12

short-acting opioids; for moderate pain, however, NSAIDs are more appropriate

Question 13

What gait problems are associated with NPH?

Answer 13

Slow, broad-based, shuffling gait

Question 14

Once again, what is the frequency of a Parkinsonian tremor?

Answer 14

4 to 6 Hz

Question 15

How could you differentiate between an ACA stroke and a lacunar stroke that selected for the lower limb?

Answer 15

Lacunar strokes are so small that they generally are either pure motor or pure sensory, whereas ACA strokes are more often sensory and motor. Also, ACA strokes are more likely to induce urinary incontinence.

Question 16

What is the first line treatment for IIH?

Answer 16

Acetazolamide +/- furosemide

Serial lumbar punctures can provide relief, but they are not preferred due to their risk of complications.

Question 17

List the two big differences in the physical exams of cauda equina syndrome and conus medullaris syndrome?

Answer 17

• Conus medullaris syndrome affects the spinal cord and thus presents with upper motor neuron signs (hyperreflexia), while cauda equina syndrome affects the lower motor neurons and thus causes LMN signs (hyporeflexia, fasciculations).
• CES is asymmetric while CMS is symmetric.

Question 18

Those with ____________ are more likely to develop ADHD.

Answer 18

absence seizures

Question 19

NPH is thought to be caused by ________________.

Answer 19

the decreased absorption of CSF

Question 20

Explain breath holding spells (BHS).

Answer 20

BHS occur in children ages 6 months to 2 years. They are episodes of breath holding after crying (often in response to an emotional stressor) during which the child passes out and turns blue. They are benign.

Question 21

Cerebellar signs and T-wave inversions?

Answer 21

Friedrich’s ataxia

Question 22

In uncal herniation, compression of the _____________ produces depression in consciousness.

Answer 22

reticular formation

Question 23

Seizures are more typical of ________-tentorial masses, while clummsiness is more typical of _________-tentorial masses.

Answer 23

supra; infra

Question 24

What kind of imaging might you do for a patient with café-au-lait spots?

Answer 24

Optic/orbital MRI (to evaluate for optic gliomas in NF-1)

Question 25

If a patient with Parkinson's presents with autonomic symptoms, then ___________ is a likely diagnosis.

Answer 25

Shy-Drager, also called multi-system atrophy | "Mouth is DRY? Think SHY!"

Question 26

Describe the most common type of cerebral palsy.

Answer 26

Caused by prematurity, the most common form of cerebral palsy presents with bilateral equinovarus feet with spasticity.

Question 27

A man presents with paralysis after a hike. What is the likely cause?

Answer 27

Tick-borne paralysis In this disorder, ticks release a neurotoxin after feeding for 4-7 days. It causes paralysis without autonomic dysfunction (which does occur in Guillain-Barré syndrome). Importantly, this occurs without a prodromal or concomitant illness.

Question 28

The most common side effects of Sinemet are _____________.

Answer 28

hallucinations, confusion, and dizziness – all CNS manifestations

Question 29

How is botulism treated?

Answer 29

Equine antitoxin

Question 30

The big worry about falling with an object in your mouth is ________________.

Answer 30

carotid dissection, which can result from oropharyngeal trauma

Question 31

Remember, the oculomotor nerve has ____________ on the outside.

Answer 31

parasympathetics; this is why diabetic ischemic neuropathy can cause disrupted motor function (in the middle of the nerve, far from the arteries) without parasympathetic disruption (on the periphery, close to the arteries)

Question 32

Headache, nausea, and eye pain are suggestive of _______________.

Answer 32

acute angle-closure glaucoma

Question 33

Which is the more complicated presentation, galactokinase deficiency or galactose-1-phosphate uritdyl transferase deficiency?

Answer 33

G1PUTD Galactokinase presents with only cataracts.

Question 34

Remember, hypertensive vasculopathy presents with __________________.

Answer 34

isolated pure weakness or pure sensory loss Hypertensive vasculopathy is also called lacunar stroke.

Question 35

Hyporeflexia, weakness, and arrhythmia in an older person on a diuretic might indicate ____________.

Answer 35

hypokalemia

Question 36

Bloodstream infection with lower-extremity paralysis might indicate _______________.

Answer 36

spinal epidural abscess

Question 37

What is the mechanism of action of the only drug approved to treat ALS?

Answer 37

Riluzole is a glutamate antagonist.

Question 38

What is the "classic triad" of brain abscesses?

Answer 38

* Fever *  Focal neurologic deficit *  Nocturnal headache

Question 39

One of the best ways to prevent SIDS is _______________.

Answer 39

to have babies sleep on their backs (like the "Back to Sleep" campaign)

Question 40

Remember that Guillain-Barré presents with ________-reflexia.

Answer 40

hypo Hyperreflexia indicates UMN disorder.

Question 41

What is athetosis?

Answer 41

Slow, writhing movements characteristic of Huntington's

Question 42

Describe the typical course of subarachnoid hemorrhage.

Answer 42

Initially, the person develops focal neurologic deficits over the area of bleeding. As time progresses, the intracranial pressure increases and causes signs of intracranial hypertension (vomiting, decreased alertness).

Question 43

The best test for evaluating GBS is _________________.

Answer 43

spirometry (more accurate than peak flow meter)

Question 44

How is cold therapy managed in heat stroke?

Answer 44

Immersion in cold water is preferred.

Question 45

What can precipitate myasthenic crisis?

Answer 45

*  Infection *  Surgery *  Pregnancy *  Medication changes

Question 46

Which common OTC medication can potentiate the effects of warfarin?

Answer 46

Acetaminophen

Question 47

What malignancy often presents with anti-NMDA encephalitis?

Answer 47

Ovarian teratoma

Question 48

Once a patient with myasthenic crisis has been intubated, you should decrease __________________.

Answer 48

their cholinesterase inhibitors (to reduce secretions that might complicate their airway); at this point, plasma exchange and corticosteroids are indicated

Question 49

What anticoagulation therapy is recommended for the treatment of septic emboli strokes?

Answer 49

Nothing Antibiotics and observation are all that are needed.

Question 50

Describe the causes and presentation of central cord syndrome.

Answer 50

*  Caused by hyperextension of the neck (car crash) | *  Presents with arm weakness

Question 51

The most rapid-acting treatment of cluster headache is ______________.

Answer 51

oxygen therapy

Question 52

Those with presbycusis will often complain of ____________.

Answer 52

difficulty hearing others when competing noises are present

Question 53

___________ should be discontinued slowly.

Answer 53

Phenytoin

Question 54

Rapid, transient vision loss can be caused by _________________.

Answer 54

atherosclerosis of the carotid arteries causing recurrent clots

Question 55

The scariest complication of pseudotumor is ______________.

Answer 55

blindness due to optic nerve ischemia

Question 56

Retinal detachment causes what visual disturbances?

Answer 56

Floaters or darkening vision from the periphery

Question 57

Describe the presentation of cephalohematoma.

Answer 57

Occurring in neonates, cephalohematomas are periosteal bleeds that are limited to one bone. They present with swelling of just that bone.

Question 58

Pronator drift is suggestive of what type of neurologic injury?

Answer 58

UMN weakness

Question 59

In addition to focal neurologic deficits, what symptoms suggest brain tumor?

Answer 59

Nausea and headache that worsen at night

Question 60

Why would you do a CT in a case of suspected meningitis?

Answer 60

If the patient also has vomiting or recent ear/sinus infection, then brain abscess is a possibility and LP could cause herniation.

Question 61

If a person has hemisensory loss at about T10 from a stab wound, then they were likely stabbed at ______________.

Answer 61

T8 The fibers descend before exiting the spinal cord.

Question 62

The most common site of ulnar entrapment is _____________.

Answer 62

the elbow (particularly in those who work at desks)

Question 63

Hyperesthesia and athetosis can be a symptom of an infarction to what artery?

Answer 63

Posterior cerebral artery

Question 64

Periorbital cellulitis and cavernous sinus thrombosis both present with swelling of the orbit. What physical exam finding can differentiate the two?

Answer 64

Cavernous sinus thrombosis presents with ophthalmoplegia due to impairment of the EOM nerves.

Question 65

Those with impingement of the common peroneal nerve can walk on their ___________ but not their _____________.

Answer 65

toes; heel (because they can't dorsiflex)

Question 66

Tramtrack intracranial calcifications and ________________ are components of Sturge-Weber syndrome.

Answer 66

cavernous hemangiomas along the trigeminal distribution | Imagine Spider-Man – the "webber" – trying to stop a train made of calcium from crashing into a giant hemangioma.

Question 67

The two neurologic signs of syphilis are ______________.

Answer 67

(1) pupils that don't constrict to light but do to accommodation and (2) loss of vibratory and position sensation

Question 68

What symptoms can help distinguish thrombotic from embolic causes of ischemic stroke?

Answer 68

Embolic strokes usually happen all at once (because the clot gets dislodged and stuck there), while thrombotic strokes fluctuate in symptoms and have precursor events (because of the narrowed carotid arteries).

Question 69

Diabetic neuropathy can present with motor involvement. When might you be concerned about motor symptoms in ruling out other causes?

Answer 69

Motor symptoms are generally a later manifestation of diabetic neuropathy, so if a patient presents with early motor symptoms then you need to rule out other sources (like spinal compression).

Question 70

Myotonic dystrophy has what inheritance pattern?

Answer 70

Autosomal dominant

Question 71

What two labs can help you diagnose myopathies?

Answer 71

ESR and CK: *  ESR normal / CK normal: steroid-induced myopathy * ESR normal / CK elevated: statin-induced myopathy or hypothyroid myopathy *  ESR elevated / CK elevated: autoimmune myositis *  ESR elevated / CK normal: polymyalgia rheumatica

Question 72

_______________ is the most common complication of bacterial meningitis.

Answer 72

Hearing loss

Question 73

What is the strongest risk factor associated with ischemic stroke?

Answer 73

Hypertension

Question 74

Absence seizures typically last less than _______________.

Answer 74

20 seconds

Question 75

The ________________ test is specific for myasthenia gravis.

Answer 75

ice pack Cold helps slow the breakdown of acetylcholine. Classically, the ice pack is placed on the eyes of a person with ptosis for a couple minutes.

Question 76

How should acute, severe pain in a former opioid addict be treated?

Answer 76

With IV morphine Treatment in the acute setting is the same regardless of past substance abuse.

Question 77

While _______________ is a common test for spinal stenosis, only about 10% of patients with spinal stenosis have a positive test.

Answer 77

the straight leg raise

Question 78

Cluster headaches classically occur during __________.

Answer 78

sleep

Question 79

What features make a brain cancer resectable?

Answer 79

*  Single lesion *  Well-circumscribed *  On the periphery of the brain at the gray-white junction

Question 80

At what age does myasthenia gravis typically occur?

Answer 80

Trick question! Women: teens to 20s Men: 50s to 70s

Question 81

The basal ganglia controls the _____-lateral side of the body.

Answer 81

contra

Question 82

In terms of the presentation of symptoms, how can you differentiate between intraparenchymal hemorrhage and subarachnoid hemorrhage?

Answer 82

Intraparenchymal hemorrhage slowly worsens, while SAH presents suddenly and stabilizes or improves.

Question 83

Hemiparesis and hemisensory loss with gaze palsy are suggestive of _______________.

Answer 83

hemorrhage in the basal ganglia

Question 84

If the stem talks about weakness and they show you a chest CT then the answer is ________________.

Answer 84

myasthenia gravis

Question 85

The most common cause of lobar hemorrhage in adults over age 60 is _________________.

Answer 85

amyloid angiography

Question 86

Optic neuritis causes _____________ of the optic nerve.

Answer 86

demyelination

Question 87

What visual symptoms does optic neuritis cause?

Answer 87

"Washed-out" colors with an initial smudge in the visual field

Question 88

The presence of _______________ in CSF is specific for CNS lymphoma.

Answer 88

EBV DNA

Question 89

Why don't patients with aminoglycoside toxicity experience vertigo?

Answer 89

Both vestibular organs are damaged equally.

Question 90

____________ is first-line treatment for myasthenia gravis.

Answer 90

Cholinesterase inhibitors Immune therapy is second-line.

Question 91

Berry aneurysm rupture will show what on CT?

Answer 91

Bleeding into the basal cistern and insula

Question 92

The arcuate fasciculus is in what two lobes?

Answer 92

Dominant frontal and parietal