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nms

nms question-answer

NMS QuestionNMS Answer
M/C location of a peripheral a. aneurysm popliteal
Cause of progressive worsening HA, papilledema, vomiting, convulsions and focal neurological deficits w/out fever: intracranial masses
Sign of papilledema bulging fundus on fundoscopic exam
Is MS inflammatory? No
What clinical findings are found with arterial ds? shiny thin skin, leading to loss of hair; marked edema leading to venous insufficiency
At which site is the post tib pulse palpable? Post to the medial malleolus
What ds is m/c in males, manifests as m. weakness, atrophy and irregular twitching of involved mm., but is not accompanied by sensory or mental deficits? amyotrophic lateral sclerosis (Lou Gerhig's ds)
What motor neuron's are involved w/ ALS? LMN-upper ext, UMN-lower ext w/ no sensory deficit
Sx of myasthenia gravis? fatigue of CN sm. mm. leading to feeling fine in the morning and gets worse at night
Sx of Parkinson's ds mental deficits and resting tremor (tremor when at rest)
Sx of MS: triad of sin (scanning speech, intention tremor, nystagmus); Charcot's triad-generally female(young adult), intentional tremor (tremor w/ motion)
Which system is implicated when pt. presents w/ altered gait and difficulty performing the finger to the nose test or rapid alternating mvmt? cerebellar-ataxia, dysmetria, dysdiadochokinesia
What is not a characteristic of Parkinson's ds? Intention tremor
What is a constant tinnitus which begins faintly and becomes progressively louder most characteristic of? otosclerosis (NOT positional if it is constant)
What ds has tinnitus present w/ vertigo? Mennier's ds
Pt presents with diplopia, ptosis, dysphagia, dysarthria, limb weakness and an expressionless face all of which become worse in the evening. What is the ds process? Myasthenia gravis
What ds is characterized by m. dysfunction following injury or ds of UMN at the level of the cortex or throughout the course of their fibers within the brain? cerebral palsy (caused by birth injury)
Arnold Chiari Syndrome protrusion of brain out thru the foramen magnum
Brown Sequard Syndrome contra spinal problem, sensory problem on one side and motor on the other side
What does damage to the radial n. often lead to/ wrist drop
What does DR CUMA represent? Regarding wrist drop: drop-radial, claw-ulna, ape-median
What does a pt who exhibits dysdiadochokinesia most likely have? ataxia
Leriche's syndrome is characterized by occlusion of what? aortic bifurcation
What is the process of occlusion in Leriche's syndrome? prob w/ ab aorta, where it bifurcates, decreases arterial supply to the legs. Not enough blood to the femoral a. BUT the occlusion is in the ab aorta
What ds is characterized by chronic progressive sm vessel ds? polycythemia
What n. is most likely entrapped in the lower ext in a pt w/ sx of nocturnal burning foot m. weakness which is confirmed by electromyography? post tibial
What syndrome involves post tibial n.? tarsal tunnel
What is ds when pt sx are severe R sided throat px which radiates into the R ear. Talking, swallowing and eating elicit px. Exam of the pharynx is normal. glossopharyngeal neuralgia
What are DDx of glossopharyngeal neuralgia? trigeminal neuralgia (Tic Delereau) and Bell's Palsy (involves CN 7)
Describe the pattern of neuro sign and sx secondary to an intervertebral formaina lesion: dermatomal-n. root to IVF; (soma pattern is m., tendon, ligament then myofascia)
What area is an intracranial mass located in the presence of R side ataxia, dysmetria, dysarthria, intention tremor and general hypertonia? R. cerebellar hemisphere (NO crossing over of cerebellum-crossing occurs in the cortex)
What is dx if pt presents with bilateral leg px during walking. Continued walking produces paresthesia, numbness and foot drop? central spinal stenosis (n. root problem)
What is a myoneural junction disorder? m. to nerve problem as in myasthenia gravis
DDx for central spinal stenosis? m. weakness (d/t n. compression), paresthesia, n. or arterial problem causing numbness, myasthenia gravis, cerebrovascular disorder (stroke)
What is dx for bilateral soft pitting edema following prolonged sitting or standing w/ no associated cutaneous changes? orthostatic edema (change in symptoms with change in posture)
A hyperabduction syndrome results from compression of the neurovascular bundle between the rib cage and the [blank] muscle. pectoralis minor
Pectoralis minor syndrome aka Wright's syndrome
What is the peripheral and cerebellar neuropahty caused by alcohol abuse called? Wernieke Korsakoff syndrome
Sign of Charcot Marie Tooth ds toothpick legs in children (little girls)
Sign of Guillian Barre syndrome paralysis progressing upward from ft
What is the cause of Guillian Barre syndrome flue shot
Sx in pt with Duchenne's muscular dystrophy: absence of dystrophin (chem agent responsible for Ca uptake in m. causing enlargement), dec m. px and deep tendon reflexes, abn high CPK, waddling gait, Becker's muscular dystrophy
One difference betw Becker's muscular dystrophy and Duchenne's muscular dystrophy Becker's affects the 18 yoa, and Duchenne's affects the 8 yoa
What results from severed lateral bands or the avulsion of the distal insertion of the ext digitorum tendon? mallet finger
What is mallet finger? in ext fingers dip down at the tips
What is swan neck's deformity? hyperext of the prox and flex of the distal
What is Boutonniere's deformity? flex of the prox and ext of the dist
Where is Boutonniere's and Swan Neck seen (what ds)? RA
What is location of Heberden's nodes? DIP
What ds has Heberden's nodes? OA
Where are Haygarth nodes located? PIP
What ds has Haygarth nodes? RA
What ds has stenosing tenosynovitis of the abductor pollicus longus and extensor pollicus brevis? Dequervain's ds
What is Keinbock's? avascular necrosis of the lunate
What is Dupuytren's contracture? thickening of the palmar tendon causing flexion of the 4th and 5th digits
What is Sever's ds? avulsion fx of the calcaneous, seen in children
What type of HA is characterized by general head px and tenderness over the occiput and cervical trapezial musculature? tension
What characterizes chorea? fine, rapid, rhythmic involuntary mvmts.
A 30 yoa obese male presents with a history of gradually progressive difficulty climbing stairs. Exam reveals hyperlordosis, quadriceps atrophy, large calves, sluggish deep tendon reflexex and elevated serum creatinine kinase levels. What is the dx? Becker's dystrophy (MD in men)
What m. is most apt to atrophy during prolonged, post operative immobilization of the knee? vastus medialis
What is Kohler's ds? osteochondrosis of the tarsal navicular
Bending deformity and long thin tubular bones which appear osteoporotic and poorly trabeculated is characteristic of what ds? rickets (bone softening)
DDx for rickets: osteogenesis imperfecta and hypoparathyroidism
What is osteogenesis imperfecta? genetic disorder passed from father to son (blue sclera)
hypoparathyroidism aka pseudogout (more Ca in bone)
A 72 yoa female presents w/ shoulder px which occurs when she combs her hair or dresses herself. She has a restricted shoulder ROM in all directions and marked hyperkyphosis. X-rays are normal. What is the dx? adhesive capsulitis
DDx for adhesive capsulitis: AC separation
aka for adhesive capsulitis frozen shoulder
Why does pt w/ adhesive capsulitis have the appearance of hyperkyphosis? d/t lat scap
A sign of AC separation? step deformity
A 50 yoa male presents w/ a 6 mo hx of gradually progressive fatigue, low back px and dec appetite. He relates a 15 lb wt loss in the last 3 months. One month ago he had a normal prostate exam. Lumbar x-rays reveal generalized osteopenia. What is the dx? early multiple myeloma
What jt is most often affected by hemophilia? knee
Subcutaneous calcification may occur as a sequelae of [blank]. dermatomyositis
What commonly manifests as flexion deformities at the prox phalangeal and metacarpal jts and causes ulnar deviation at the wrist? RA
What is the m/c initial complaint of the pt w/ progressive systemic sclerosis? Raynaud's phenomenon
What condition is most likely to cause avascular necrosis of the femoral head? sickle cell anemia-only one to affect jts.
aka for sickle cell anemia Thalassemia major
Common sx of Paget's ds: thickening of bone
What condition may result in multiple levels of thoracic boney fusion? ankylosing spondylitis
Radiographic term for x-ray findings of spine in AS: bamboo spine
What is the most likely cause of pxful scoliosis in an adolescent? osteoid osteoma
Sx of osteoid osteoma: px at night relieved by aspirin
Characteristics of Levi Lorain dwarf: normal body proportions and ROM, as well as mental development
Characteristics of Achondroplastic dwarf abnormal body proportions, abn ROM and normal mental development
Where does degenerative spondylolisthesis occur at? L4
Where does traumatic spondylolisthesis occur at? L5
Blood analysis of 65 yoa male reveals normochromic, normocytic anemia, normal serum alkaline phosphatase, increased serum Ca, elevated ESR, hyperglobulinemia and rouleaux formation. What is the dx? multiple myeloma (d/t reversal of albuminglobulin ratio)
What is rouleaux formation? stacking of the RBC
What is the grade for transient clonus elicited during a m. stretch? 4+
What is a normal grade for reflex? 2+
A lesion of which n. causes inability to extend the thumb? radial
What ortho test is performed in the cervical spine that is used to check for max dec in the IVF? Spurling's test
Rust's sign pt holding back of head-indicates C1 fx
A 65 yoa male presents w/ deep bone px in the spine and ribs precipitated by mvmt. Lab indicates a mild normocytic, normochromic anemia, inc ESR, inc IgG, dec IgA an IgM and free lambda light chains detected by a 24 hr urine electrophoresis. What dx? multiple myeloma
What event is not part of the stance phase of gait? leg advancement
Order of gait mvmt? advancement, then stance, then push off
Difficulty during ambulationin dimly lit rooms is most suggestive of dysfunction in which part of the CNS? posterior columns
A 26 yoa female presents with episodic px, numbness and tingling at the parietal occipital scalp which usually occurs on the same side of the head. Px radiates from the suboccipital area to the vertex and periorbital area. What is the dx? greater occipital neuralgia
Sign of syringomyelia shawl like distribution of the shoulder
What ds shows as progressive m. atrophy of the ant. tibial mm.? charcot marie tooth
What m. is injured when tenderness occurs over the lesser tubercle, rotator cuff? subscapularis
What m. is affected w/ tenderness on the rotator cuff over the greater tubercle of the humerus? supraspinatus
32 yoa F, urinary incont, staggering gait, intermittent fog in R visual field, 3 episodes of neurologic deficits in last several mths. Shock like sensations down her back when she flexes her head. What is the dx? MS
What ds shows as aching or burning px w/ great disparity betw the severity of the inciting injury and the degree of symptoms? reflex sympathetic dystrophy (old injury)
25 yoa F presents w/ severe unilateral HA w/ accompanied nausea and photophobia. She has been under a great deal of pressure lately. Dx? migraine HA
Pt experiences attacks which are characteriezed by abrupt cessation of activities, incoherent mumbling, picking of the clothing and subsequent confusion. Dx? complex partial seizure (out of it but still with it)
What does the forward bending test attempt to differentiate between? lumbar lesions and SI lesions (belt test aka supported Adam's)
What does the presence of px and swelling over the area of the olecrannon process indicate? bursitis (tenosynovitis occurs at the wrist and ankle)
What lumbar ROM is most restricted in the late stages of AS? extension (loss of lumbar lordosis)
Kayser Fleisher rings are pathognomonic of what ds? Wilson's
A 78 yoa pt presents w/ difficulty walking, stooped posture, unsteady gait which improves when pt holds examiner's arm. All neuro tests normal. What is the dx? normal aging
Pt presents w/ neck px. No radiating px upon testing. Pxless passive cervical ROM tests. Strength tests ellicit grade 3 m. strength and px. What is the dx? m. strain
What test does not assist in determining if a lat ankle sprain includes injury to the ant talofib lig? eversion w/ plantar flex
Ds in which there is an infection of the post ganglion of a n. root? herpes zoster (the ONLY one that is dormant in the post ganglion)
Sign present if tapping the area anterior to the ear w/ a neuro hammer causes ipsi twitching of the mm. above the mouth: Chvostek's
Which n. is involved w/ hiccups? phrenic n.
What is the difference betw. Volkmann's and Dupuytren's? both have a flexed 4th and 5th digit, Volkmann's is post-traumatic, Dupuytren's is hereditary w/ red ropy fascia
Created by: pcelvfrdm