UWORLD stuff Flashcards
(132 cards)
1
Q
Fetal hydrantoin vs fetal EtOH syndrome
A
Hydrantoin from anti convulsants (esp. phenytoin and carbamazepine) has the same sx as EtOH but ALSO has hirsutism and cleft palate
2
Q
Duchenne, Becker, Myotonic muscular dystrophies
Age of onset and inheritance?
A
2-3 yo Duchennne (XR)
5-15 Becker (XR)
12-30 Myotonic (AD)
3
Q
Trihexyphenidyl (class of drug?)
A
anti-cholinergic
4
Q
Common comorbidity with absence seizures?
A
ADHD
5
Q
Femoral nerve innervates?
Sensation:
Motor:
A
Sensation to anterior thigh and medial leg (via saphenous)
Knee EXTENSION, hip FLEXION
6
Q
Positive arm drop means?
A
Rotator cuff tear
7
Q
Drug of choice for trigeminal neuralgia?
A
Carbamazepine
8
Q
Parkinson’s gait typically narrow or wide based?
A
Narrow, and hypokinetic/festinating
If broad then consider other syndromes, eg MSA
9
Q
Parkinsonism with autonomic dysfunction and widespread neuro dysfxn (eg LMN signs)?
(postural hypotension, impotence, incontinence)
A
MSA, aka Shy-Drager
10
Q
Guillain Barre CSF findings?
A
High protein (45-1000), normal glucose and WBC
11
Q
Cerebellar dysfunction symptoms? (5)
Common among what population?
A
Common among EtOH abusers
- gait instability
- truncal ataxia
- hyptotonia
- intention tremor
- difficulty with rapid alternating movements
12
Q
What are Lewy Bodies?
A
eosinophlic intracytoplasmic inclusions representing accumulations of alpha-synuclein protein
13
Q
Treatment of Lewy Body hallucinations and motor sx?
2nd line for LB hallucinations?
A
ACh-esterase inhibitors (eg rivastigmine)
If hallucination refractory then atypical anti-psychotics
14
Q
Lewy Body Dementia vs Parkinsons?
A
In Lewy Body you get dementia first then motor, in PD you get motor first then dementia. Both have Lewy Bodies
15
Q
Affected leg extended and swinging outwards while patient walks, with affected arm adducted?
A
Hemiparesis
16
Q
Wide gait with high lift and foot slapping?
A
Tabes dorsalis
17
Q
Muscular dystrophy gait?
A
Waddling (due to gluteal weakness)
18
Q
Give abortive meds if (febrile) seizure lasts longer than?
A
5 min
19
Q
Guillain Barre complications and how to test for them?
A
Flaccid paralysis progressing to respiratory failure due to respiratory and bulbar involvement
20
Q
Pure sensory stroke, with allodynia weeks to months later - location of stroke?
A
Posterolateral Thalamus - (contralateral side)
21
Q
Friedrich’s Ataxia inheritance pattern?
A
AR
22
Q
Lesch-Nyhan syndrome enzyme deficiency?
A
Hypo-xanthine guanine phosphoribosyl transferase
23
Q
CN most suscpetible to ICP?
A
Abducens
24
Q
CN most susceptible herniation?
A
Oculomotor
25
Cushing's reflex (3)? Indicates?
HTN, bradycardia, resp depression
| Indicated incr ICP
26
Slow onset confusion etc. in Alzheimer's pt?
Amyloid angiopathy ---> lobar hemorrhage
27
Painless proximal muscle weakness with normal CK and ESR. Think?
Corticosteroid use - drug induced myopathy
28
DA antagonism effect in:
Mesolimbic pathway?
Nigrostriatal pathway?
Tuberoinfundibular pathway?
- Antipsychotic efficacy
- EPS (dystonia, akathisia, Parkinsonism)
- Hyperprolactinemia
29
Extra-axial, well circumscribed, DURAL-BASED partially calcified mass?
And what do you do about it?
Meningioma
which is benign
If symptomatic (HA, seizure, focal deficits etc.) due to mass effect then surgically resect
30
Appearance of brain mets?
Multiple ring-enhancing lesions at the grey-white junction (intra-axial)
31
Bleeding in germinal matrix of newborn?
Presents with?
Most at risk?
IVH (intraventricular hemorrhage)
Hypotension, seizure, pallor, bulging fontanel etc. BUT can be asymptomatic
Premature or LBW kids
32
Minute punctuate hemorrhages on CT with grey white blurrings?
Which often follows?
Diffuse axonal injury (DAI)
| Often follows TBI
33
Ataxia, nausea, vomiting - lesion location?
Cerebellum
34
Ataxia - lesion location?
Posterior column
35
Absent sensation from umbilicus down - lesion location?
Lower thoracic spinal cord
36
Absent sensation from nipples down, paraplegia, rectal and bladder incontinence - lesion location?
Upper thoracic spinal cord
37
Partial or complete hemiparesis - lesion location?
Supratentorial
38
Multiple ring enhancing lesions in basal ganglia?
Toxoplasmosis
39
Solitary weakly ring-enhancing periventricular mass on MRI with EBV DNA in the CSF?
CNS lymphoma
40
Sellar masses (3)
pituitary adenoma, craniopharyngoma (benign), meningioma (benign)
41
Unprovoked first seizure studies?
CT w/o contrast THEN EEG
42
Established myasthenia gravis diagnosis - then check for what?
Thymoma with CT or MR of chest
43
Three cholinesteras inhibitors? (D, R, G)
donepezil, rivastigmine, galantamine
44
Early vs late sinemet side effects?
Early: hallucination, dizziness, HA, agitation
| Late (several years): involuntary movement
45
Nerve at risk during repeated parotid surgery?
Facial (so can lead to facial droop)
46
Treatment for idiopathic intracrnail HTN (pseudotumor cerebri)?
acetazolamide +/- furosemide
47
Typical length of absence seizures?
| Often accompanied by?
<20 seconds
| Eyelid fluttering or lip smacking
48
Risks of benzo use in elderly?
cognitive impairment, falls, PARADOXICAL AGITATION
49
Resection vs whole brain radiation in brain mets?
Resection if single met and stable dz
| Whole brain radiation if multiple mets
50
Trigeminal nerve hemangioma suggests Sturge-Weber - what is the intracranial finding?
tramline calcifications
51
Hyperextension injuries - resulting in UE weakness with LE mostly spared, sometimes with pain/temp probs?
Most at risk?
```
Central cord syndrome
Those with (cervical) spondylosis
```
52
Elevated MMA means?
B12 defic, more sensitive than serum B12 level
53
Respiratory muscle weakness with generalized weakness and bulbar involvement following infx/surgery/and some meds (eg FQs) - THINK?
myasthenic crisis in setting of myasthenia graivs
54
Tx for Hemorrhagic stoke due to excess anti-coag (wararin and heparin)?
If warfarin: Reverse with Vit K and PROTHROMBIN COMPLEX CONCENTRATE
If heparin: protamine suflate
55
Most common site for hypertensive hemorrhage?
basal ganglia
56
Signs of cerebellar hemorrhage?
Occipital AH, neck stiffness, n/v, nystagmus
57
Left hemi-neglect involves what lobe?
Right (nondominant) parietal
58
Butterfly with central necrosis on MRI?
Glioblastoma
59
Heterogeneous, serpiginous enhancement with contrast?
High grade astrocytoma
60
Fair hair and eyes, developmental delays, donward lens displacement, stroke (or CVA) and Marfanoid body habitus? Likley diagnosis and inheritance pattern?
Homocystinuria (AR)
61
Treatment for homocystinuria?
B6, folate, B12 PLUS anti-PLT or anti-COAG
62
Kid with intellectual disability, fair complexion, musty urine odor, eczema? Likely diagnosis?
Phenylketonuria (phenylalanine hydroxylase defic)
63
To diagnose Wilson's dz?
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Urine copper (incr), serum ceruloplasmin (<20), slit lamp eye exam for Kayser-Fleisher rings
WITH hepatic or neuropsychiatric sx
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64
Young child with NONPROGRESSIVE MOTOR DYSFUNCTION (hypertonia, hyperreflexia, equinovarus deformity - feet pointing down and inward, ressitance to passvie movement) and INTELLECTUAL DISABILITY?
Diagnosis and biggest risk?
Cerebral palsy, prematurity
65
Infant with bulbar palsies, constipation, hypotonia? Likely diagnosis?
Botulism SPORE ingestion (California, Pennsylvania, Utah)
| Foodborne ingestion would be with preformed toxin (canned food, cured fish, honey)
66
Deep intracerebral hemorrhage - presentation and most common cause? Most common area of brain?
```
Presents with sudden onset focal deficits that gets worse over minutes to hours
Hypertensive vasculopathy involving small penetrating branches (of major cerebral arteries)
Basal ganglia (putamen)
```
67
Hyperventilation decreases ICP by?
Washing out CO2 and thus causing cerebral vasoconstriction and thus decreasing cerebral blood flow
68
Abortive tx for acute cluster headache?
| Prophylaxis?
100% O2
| Verapamil for prophylaxis
69
Tx for acute MS exacerbation?
| First line, then if refractory, then long term?
```
IV steroids (methylprednisone)
PLEX if refractory
Interferon for long term (if relapse/remit or progressive)
```
70
Rapidly progressive ascending paralysis, no fever or sensory probs, normal CSF? Likely diagnosis and next steps?
Tick borne paralysis, find the tick (as it needs to feed for 4-7 days) and patient should then improve
71
Approved drug for ALS? Mech? Side effects?
Riluzole, glutamate inhib, elevated LFTS (plus nausea, dizziness, weight loss, skeletal weakness)
72
Guillain Barre tx? LP result?
PLEX or IVIG
| Elevated protein on LP, normal WBC on LP
73
Optic neuritis sx?
| Common pres of what?
Acute vision loss, pain, APD
| MS
74
Unilateral HA with dilated pupil and poor light response and nausea/vomiting? Likely diagnosis?
Can it cause vision loss?
Acute angle closed glaucoma
| Vision loss in 2-5 hours
75
Seizure or syncope - which has prodrome?
Syncope has PROdrome, seizures have POSTictal state
76
What is the only antiPLT agent effective reducing risk of ischemic stroke?
Aspirin
Give within 24 hours
Add dypyridamole OR clopidogrel is still stroking on ASA
77
RLS tx?
```
iron supplementation
DA agonists (eg pramiprexole) or gabapentin
```
78
Post whiplash condition - months to years later?
Affects what part of spinal cord to cause what?
Diagnose with?
syringomyelia
affects cental canal and causes diminished strength and diminished pain/temp in upper extremities
Diagnose with MRI - CSF retention in spinal cord
79
Cluster HA doesn't have to present with lacrimation/runny nose, it can also present with?
ipsilateral Horner's syndrome
80
Myasthenic crisis tx?
Intubate for respiraoty probs
| Then PLEX, IVIG, or corticosteroids
81
If pseudotumor cerebri is untreated - leads to ?
Blindness
82
ICH in a young obese female suspicious of tumor but imaging is normal. Incr CSF pressure, papiledema, poss visual field defects or 6th nerve palsy - likely diagnx and treatment?
Pseudotumor cerebri
Treat: acetazolamide, weight loss, CSF shunt
Optic nerve sheath fenestration to prevent blindness
83
Dix Halpike - what is it and what does it diagnose?
vertigo and nystagmus going quickly supine with head 45 degrees - diagnoses BPPV (benign paroxsymal positional vertigo)
84
Periobrital cellulits vs infectious cavernous sinus thrombosis: Which is mild and which is nasty?
Mild - periorbital cellulits
| Nasty - cavernous sinus thrombosis
85
Which NF is which?
Bilateral acoustic neuromas and cataracts?
Cafe au lait, macrocephaly, feeding probs, short stature, learning probs?
Neuromas and cats - NF2
| Cafe au lait etc. - NF1
86
Acute motor deficits WITHOUT sensory or higher cortical dysfunction - suggests? Risk factor?
Lacunar stroke
| Hypertension
87
Timeline for gait impairment in NPH and Alzheimer?
EARLY in NPH, LATE in alzheimer
88
Internuclear opthalmaplegia - conugation/nystagmus probs (seen often in MS) is a problem in what nucleus?
The MLF (medial longitudinal fasciculus)
89
Spinal cord compression - presentaion and diagnosis?
Presents with UMN signs distal to compression (i.e form lifting injury)
Diagnose with MRI of spine
90
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Cushing reflex (triad)?
Worryign sx of?
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Hypertension, bradycardia, respiratory depression
| Brainstem compression
91
Sharp, triphasic, synchronous dishcharge on EEG, with dementia and myoclonus - diagnoisis?
CJD
92
Meds associated with idiopathic intracranial HTN? (IIH)
Growth hormone
TCNs
Vit A (including retinoic acid)
OCPs
93
Niemann PIck vs Tay Sachs? (reflexes)
Niemann PIck has areflexia and hepatomegaly
| Tay Sachs does not but doe shave hyperreflexia (no hepatomegaly)
94
BILATERAL trigeminal neuralgia - think? (as it's usually unilateral)
MS
95
Sensory ataxia, pain, reduced deep tendon reflexes, with pupils that cannot accomodate with light but otherwise constrict normally? Think?
Tabes dorsalis, late syphilis
| Treat with penicillin
96
Young child, extracranial mass, calficfications and hemorrhages on XR and CT, urine catecholimines elevated and metabolites (HVA, VMA). What tumor and from which cells?
Neuroblastoma from neural crest cells
97
Flat and broad t-waves (or U waves) with PVCs, plus sever muscle weakness? Think?
Hypokalemia!
| Especially if taking a K-wasting diuretic
98
What is Todd paralysis?
Hemiparesis that occurs after a seizure and resolves within hours in postictal period
Can also have visual probs or aphasia
99
Meds for excructiating trauma pain with hx of opioid abuse?
IV morphine
100
Swelling of scalp limited to one cranial bone? No pulsing
NOT intracranial hemorrhage - but CEPHALOHEMATOMA, will likely resolve without treatment in 2 weeks to 3 months
101
Muscle weakness that comes on for first time after surgery, meds, infection etc. and responds to ice pack test? Think?
myasthenia gravis
102
Face, arm AND leg equally effected with NO corticular features (ie no incontinence)? What kind of stroke?
lacunar (posterior limb of internal capsule)
103
Contralateral sensory and motor deficits, more in LE, urinary incontience, lack of will? Stroke location?
ACA
104
Fluorescein exam showing corneal staining defect - suggests?
| And if no pain?
Corneal abrasion
| Trigeminal (opthalmic branch) dysfunction
105
Steppage gait indicative of?
Motor neuropathy
106
Ataxic, staggering, wide based gait, indicitive of?
cerebellar lesion, booze, B12 defic
107
Magnetic gait (freezing, start and turn hesitation) indicative of?
Frontal lobe degeneration or NPH
108
Falling to one side gait (vestibular gait) indicative of - 2 things?
Labyrythitits
| Meniere dz
109
Indication for emergent surgery in epidural hematoma?
Any intercranial HTN sx
| Smaller hematomas could be observed with frequent CT
110
Head turning with hypertrophied SCM muscle?
Torricollis, a DYSTONIA
111
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Lacunar stroke causes by?
Seen on CT shortly after event?
Risk factors (4)?
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Occlusion of deep pentrating arteries of brain (microatheroma, lipohyalinosis)
Often not seen on CT shortly after
HTN, HLD, DM, smoking
112
Temp >104 with CNS dysfunction (seizure, irritability, confusion etc.)? Diagnosis and treatment?
Exertional heat stroke, rapid cooling
113
Myasthenia gravis age of onset for women, and men?
W: second to third decade
M: sixth to eight decade
114
Increasing head circumference, and signs of ICH in infant? Next steps?
CT head to check for hydropcephalus (enlarged ventricles)
| If so: ventricular shunt
115
Galactosemia enzyme defic?
| Pres?
galactose-1-phospahte uridyl transferase
Cataracts, FtoT, hyperglycemia, jaundice
TREAT EARLY
116
Cancer hx with LE neuro sx? Think?
Epidural spinal cord compression from mets
117
SAH sx that come with thunderclap HA?
nausea, vomiting, photophobia, nuchal rigidity
| ie sx of meningeal irritation
118
Syringomyelia assoc with what malformation?
Arnold Chiari type 1
119
What is syringomyelia?
Fluid filled cavity in cervial and thoracic spinal cord that presents with areflexic weariness in UE, and "cape" patterned sensory loss
120
"curtain descending over one eye"? diagnosis, cause, and next steps?
amaurosis fugax, retinal artery occlusion due to emboli from ipsilateral CA leading to retinal ischemia, do a carotid doppler (duplex US)
121
ulnar nerve problems in hand - location of pathology?
at elbow, in medial epicondylar groove
122
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Pyridostigmine, the intial tx for myasthenia gravis is what class of drug?
Next steps in tx if refractory would be?
```
```
acetylcholinesterase inhibitor
(LONG ACTING)
whereas edrophonium is SHORT ACTING
Next steps: immunosuppression with steroids, azathioprine, mofetil etc.)
IVIG or PLEX for crisis
```
123
MS LP findings?
Normal pressure, protein, cell count but with oligoclonal bands
124
Pronator drift indicates?
UMN or pyramidal tract dz (possibly due to MS)
125
Ring enhancements - single vs multiple?
Single would be brain abscess (or possibly neoplasm)
| Multiple would be toxoplasmosis
126
Organisms in brain abscess?
Staph aureus
Strep viridans
GNegs
127
Chemotherapy related peripheral neuropathy - presentation and 3 classes responsible?
symmetric, distal, sensory stocking-glove
- platinum based (cisplatin)
- vinca alkaloirds (vincristine)
- taxanes (paclitaxel)
128
Total loss of motor function, pain & temp but intact propprioception, assoc. with burst fracture of the vertebra?
Anterior cord syndrome
129
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Other than NSAIDs and triptans, what class of drugs can be used to abort migraines?
3 examples?
```
IV anti-emetics, especially with n/v, and if you don't catch the HA early
chlorpromazine, prochlorperazine, metoclopramide)
130
small fiber neuropathy complaints?
pain and temp loss so burning pain and parathesias
131
deep tendon areflexia suggests what type of nerve involvement?
large nerve fibers
132
prosopagnosia - inability to recognize familiar faces - what part of brain lesion?
bilateral inferior occipitemporal cortex (fusiform gyrus)
