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Step III
Step III - Neuro 2
| Question | Answer |
|---|---|
| Resting tremor, >50yo, Small handwriting. Dx | Parkinson |
| Tremor ↑ w/ activity but improves w/ EtOH, Difficult handwriting. Dx | Essential tremor |
| Parkinson sx + Autonomic insufficiency. Dx | Shy Drager syndrome |
| Parkinson like sx, Renal + liver + CNS dz, Yellow rings in cornea. Dx | Wilson’s dz |
| Dance mvts, Dementia, Pysch c/o, 30-50yo. Dx | Huntington chorea |
| Transmission of Huntington chorea | AD |
| Neuro signs separated by space and time ie parasthesia in LE, 1 yr later visual . Hot shower worsens sx | MS |
| Initial Diagnostic study for MS | MRI brain + SC |
| MC 1⁰ sx of MS | LE parasthesia |
| What is the classic pt CC in dr office for MS | pt c/o visual change |
| Demylx white matter, Muscle weakness w/ continued use | MG |
| Diagnostic study for MG | EMG |
| What Abs are made in MG | Nicotinic Ach-R |
| Rapidly ascending BILAT muscle weakness x4 ext | GB |
| Diagnostic study for GB | EMG |
| Progressive muscle weakness, UMN + LMN, Impaired speech, Fasciculations (denervation) | ALS |
| Diagnostic study for ALS | EMG |
| Lip smacking, Rapid eye blinking, Depersonalization (consciousness impaired) | Absence seizure |
| Tx for absence seizure | Ethosux only |
| Diagnostic study for absence and what does it show | EEG: 3 second spike and generalized wave D/C |
| Impaired consciousness, Involuntary mvts, Postictal confusion + Temporal lobe c/o eg: Olfactory, auditory, visual hallucinations | Complex partial seizure |
| Tensing/rigid + Repetitive mvts + Postictal + Tongue biting, Loss of urine/bowel | Tonic clonic |
| What is the difference b/t tonic clonic and syncope presentation | does NOT show loss of bladder control |
| Hemangiomas in brain, sp, retina | Von-Hippel-Lindau |
| ↑phosphokinase, Absent DTRs, Atrophy muscle | Poliomyelitis |
| Trauma causing hemi-section S.C. is called | Brown Sequard |
| What are the IPSILAT findings in Brown Sequard | Hemiparesis (corticospinal tract), Loss vibration, Loss positional sense (dorsal columns) |
| What are the CONTRALAT findings in Brown Sequard | Pain + temp (spinothalamic) |
| “cape like”, UE areflexia, B/L loss pain + temp | Syringomyelia |
| Tx for Syringomyelia | Decompression, Drainage, Shunt placement |
| Diagnostic study for Syringomyelia | MRI |
| What type of herniation is Syringomyelia a/w | ARNOLD CHIARI herniation |
| reflexes, Unsteady gait, Formication, proprioception, B/L Argyl pupil (no constrictx, + accom) | Tabes dorsalis |
| What disease is a/w tabes dorsalis | 3⁰ syphilis |
| Pt immigrant w/ no vaccx hx, Sudden asymmetric weakness, Flaccid paralysis, NO DTRs | Poliomyelitis |
| Chorea, Dementia, Pysch | Huntington |
| What DNA abnL found in Huntington dz | DNA CAG repeats |
| What is the time frame that distinguishes TIA from strokes | TIA <24hr |
| What the two causes of TIAs | Emboli OR thrombosis (not hemorrhage) |
| Aphasia, neglect/apraxia, and profound UE weakness is linked to what aa | MCA |
| Eyes deviate toward or away from lesion in MCA stroke | TOWARD |
| What does prosopagnosia mean | Can’t recognize faces |
| Contralat homo hemianopsia w/ macular sparing + can’t recognize faces liked to what aa | PCA |
| Vertigo, N/V, labile BP, vertical nystagmus, ataxia, dysarthria, sensory change in scalp and face, “drop attack” linked t what aa | vertebrobasilar aa |
| Absence of cortical (motor) deficits, hemiparesis (face), ataxia, parkinsonian signs | Lacunar infract |
| Transient loss of vision in one eye is called what and linked to what aa | Amaurosis fugax; ophthalmic aa |
| What is the best initial Diagnostic study for TIA/stroke | CT w/o contrast |
| What are the CI to thrombolytic tx for stroke | Surgery or active bleeding <6wks, Aortic dissection, Active internal bleeding, Pericarditis, h/o hemorrhagic stroke, ischemic stroke <3mos, BP > 180/110, Recent traumatic CPR <3wks, presence neoplasm/mass, brain trauma or brain surgery <6mos |
| In what time frame can thrombolytics be given to stroke pts w/o CI | 3 hrs from onset of S/S |
| What will the CT show in first several days for NON-hemorrhagic stroke | NORMAL CT |
| How many days does it take for MRI and CT to approach 95% sensitivity in detecting NON-hemorrhaghic stroke | CT: 3-5 days; MRI: 24hrs |
| What is the best initial tx for stroke pts past the thrombolytic time frame | ASA |
| If stroke pt is already on ASA and presents after thrombolytic time frame what can be used | Dipyridamole OR clopidogrel |
| Once imaging and thrombolytics are given to pt what is the next goal of tx | Find the cause of the stroke |
| What studies are indicated for ALL stroke/TIA pts to determine the etio | Echo, EKG +/- Holter, carotid dopplers |
| If you find clots on ECHO for stroke pt what is the tx | Warfarin +/- surgery of valve vegetation |
| When do you order a Holter monitor in stroke pt | when EKG is nL |
| When would you do an endarterectomy for carotid stenosis in stroke pt | >70% stenosis |
| When would you NOT do an endarterectomy for carotid stenosis in stroke pt | 100% stenosis |
| Young pts who have stroke are caused by | Vasculitis or hypercoag state |
| What is the BP goal for HTN stroke pt | <130/80 |
| What is the LDL goal for stroke pts | <100 |
| What is the stepwise tx plan for status epilepticus | 1st: lorazepam, if seizures persists 10-20 mins later add fosphenytoin > Phenobarbital > gen anesthesia/pentobarbital |
| What initial tests are indicated in pt w/ seizure | O2, Na, Ca, glucose, creatinine, Mg, CT head, UDS |
| If initial testing for seizures reveals nothing then what is the next test | EEG |
| Generally first time seizures are not managed with chr anti-seizure meds. In what cases would this be different | Strong FHx, use of BDZ to stop seizure, abnL EEG |
| What are the first line chronic tx for status epilepticus | Valproate, carbamazepine, lamotrigine, levetiracetam, phenytoin |
| Which 1st line chronic tx for status epilepticus cause skin conditions and SJS | Lamotrigine |
| What are the 2nd line chronic tx for status epilepticus | Phenobarbital, gabapentin |
| What is the chronic tx for absence seizures | Ethosuximide |
| Orthostasis + festinating gait = | Parkinson’s dz |
| What does hypomimia mean | Mask face |
| What is still intact w/ Parkinson’s dz | Cognition and memory |
| What is the tx for mild sx of Parkinson’s dz in pt <60 | Anti-cholinergics eg hydroxyzine, benztropine |
| What is the tx for mild sx of Parkinson’s dz in pt >60 | Amantadine |
| Which tx for severe Parkinson’s dz has the greatest efficacy | Levodopa, carbidopa |
| Which tx for severe Parkinson’s dz has the least AE | Dopa agonist (pramipexole, ropinerole, cabergoline) |
| If initial tx for severe PD does not control sx then what can be added | COMT (-) eg tolcapone, entacapone OR MAOIs eg selegiline, resegiline |
| What is the tx for essential tremor | Propranolol |
| What is the tx for PD tremor | Amantadine |
| What should be ordered for all pts w/ memory loss | B12 level, CT, T4/TSH, RPR or VDRL |
| Slowly progressive loss of memory exclusively in older pt >65yo w/ apathy. Years later imprecise speech. No motor or sensory focal deficits | ALZ |
| What does CT show in ALZ | Diffuse symmetrical cortical atrophy |
| What is the standard of care for tx ALZ | Anticholinesterase meds eg donepezil, rivastigmine, galantamine >> memantine |
| Tx for Pick’s disease and response | Same as ALZ (anticholinesterase) but less response |
| Pt <65 w/ rapidly progressive dementia and myoclonus | CJD |
| Most accurate test for CJD | Brain bx |
Created by:
DrINFJ
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