Neuro NBME questions

WOman with intermittent numbness of left shin and foot + decreased sensation to pinprick over dorsal left foot and left lateral shin + weakened dorsiflexion What is likely Dx and cause

Peroneal nerve damage ==> common in females from leg crossing

W just had baby Now droswy, right pupil reacts sluggishly to light + meningismus + mild papillepdema + bitemporal hemianopia + trouble breast feeding vitals stable likely cause?

Pituary Apoplexy: ===> Mass effect, same reason that causes the bitemporal hemianopsia. The pituitary lies adjacent to the cavernous sinus, which contains the EOM cranial nerves, and as such apoplexy can cause compression of CNs 3, 4, or 6, leading to the associated EOM deficits

64 yo W WEAKNESS and tenderness of proximal arm and leg muscles + 6 weeks of achins in shoulders, thighs, hard to climb stairs

Polymyositis -

How do you diagnose REM Sleep Disorder?

Polysomnography = Presence of REM sleep without atonia on polysomnography.

Chiari type II malformation

Posterior fossa malformation: = *2* structures herniate in type II ---> *cerebellar vermis & tonsillar herniation* thru the foramen magnum w/ aqueductal stenosis ===> hydrocephaly. - often w/ lumbosacral meningomyelocele (may present as paralysis/sensory loss at and below level of lesion)

What cancer is associated with multiple osteoblastic lesions?

Prostate Cancer - Check the PSA - biopsy will show adenocarcinoma

What occurs/diseases associated with pseudobulbar palsy

Pseudobulbar palsy: - common in stroke patients and those with neurological disorders such as amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). ===> these disorders are characterized by the degeneration of motor neurons in the cerebral cortex, spinal cord, brain stem, and pyramidal tracts

hx of rheumatic fever, SOB, rumbling diastolic murmur + Now presenting with acute onset of Left-sided weakness involving leg, face, arm Likely Cause?

RF during childhood, heart murmur MR at that time, MS in long run(now), ===> MS leads to atrial dilation that leads to AFib, statis-clots. Then embolic stroke cerebral artery

What provides sensory innervation to the dorsal side of hand over thumb, index finger and 1/2 middle finger

Radial N C6, C7

HIV Patient w/ brain tumor + Hyponatremia (Na= 128) + urine osmolality is 500 (elevated) Likely Dx?

SIADH - hyponatremia + concentrated urine = shows that ADH isnt being turned off BC if low serum sodium, should compensate by making urine dilute and saving all the sodium - in HIV, SIADH is usually due to pneumonia (PCP or others), malignancy, or occult or symptomatic infection of the central nervous system

37 M with 10 days of increasingly severe headaches, severe and ounding. Exam shows face/neck to be mildly swollen w/ dusky red-purple skin color w/ venous distenstion over head and neck + papilledema Likely Dx?

SVC syndrome = increased ICP from obstruction of venous return to the heart

Most common locations of saccular aneurysm

Saccular aneurysms are most common in the anterior communicating artery (ACoA) or anterior cerebral artery (ACA) in men, whereas the junction of the ICA with the posterior communicating artery (PCoA) is the most common site for saccular aneurysms in women".

decreased temp sensation on left body + weakness of right arm and leg + sensation to pinprick and temp decreased over left trunk and left arm/leg + sensatin tovibration decreased over right foot + reflexes on Right more brisk than left Babinkski on Right Likely location of patietns lesion?

Spinal cord = Brown Sequard Syndrome - "hemisection" of the cord - can occur in MS, epidural hematoma, intramedullar spinal cord tumor, infectious causes, stab wound

Urinary incontinence and paraplegia after falling 35 feet. What is cause of the incontinence

Spinal shock = occurs within 24 hrs of spinal cord injury results in loss of all reflexes and autonomic dysreflexia.

80 yo W with insidious onset of gait disturbance, sensory loss, and weakness and muscle atrophy in hand, , along with neck and arm pain, + spasticity and increased reflexes in legs

Spondylotic cervical myelopathy - progressive degenerative process affecting the cervical vertebral bodies and intervertebral discs. This process can lead to narrowing (stenosis) of the central spinal canal, compressing the cervical spinal cord

20 yo man had severe headache onset - then loses consciousness -moderate nuchal rigidity - temp 100, BP 180/90 non-con CT: characteristic star shaped hyperdensity on head CT

Subarachnoid Hemorrhage = ruptured berry aneurysm - "star of death," affectionately named for what happens when a subarachnoid hemorrhage is allowed to bleed into the cranium.

Man gets pale and sweaty than collapses to floor + jerking/twitching movements of the extremities and trunk + recovers after and not confused likely dx?

Sycope - can have convulsions - no post ictal state

12 yo w/ uncontrollable, sudden movements of face, arms legs + dont occur when sleeping + hx of sore throat 2 weeks ago Likely Dx?

Sydenham Chorea

Prophylaxis of Toxoplasmosis

TMP-SMX

Why must you give Vit B1 before admin of GLucose?

Thiamine deficiency can cause Wernicke encephalopathy, oculomotor dysfunction, and gait ataxia. This is generally seen in malnourished patients (eg, anorexia, chronic alcohol use) or hyperemesis gravidarum and may be induced iatrogenically by the administration of glucose without thiamine. Thiamine administration will prevent anterograde amnesia/Wernicke's

60 yo woman on cis[platin, etoposide for ovarian cancer Absent DTRs, sensation to vibration is decreased in hands and below the knees. ROmberg sign is present, wide based gait. Most likely cause?

Toxic NEuropathy - peripheral neuropathy due to Chemotherapy. highly associated with Vincristine, Pilitaxil and cis-platin. - Present with Stocking- glove pattern

Ring enhancing lesion seen via CT in parietal cortex In HIV patient with CD count of 78. + Febrile, and left arm weakness

Toxoplasma encephalitis (TE) - represents reactivation disease from prior infection. - Affected patients present with fever, headache, altered mental status, and focal neurologic complaints or seizures. = Supporting laboratory findings include the presence of Toxoplasma antibodies, which is consistent with past exposure, and advanced immunosuppression with CD4 counts <100 cells/microL.

Sudden onset of memory loss, verified by a witness Retention of personal identity despite memory loss Normal cognition, such as the ability to recognize and name familiar objects and follow simple directions Absence of signs indicating damage to a particular area of the brain, such as limb paralysis, involuntary movement or impaired word recognition Likely dx?

Transient Global Amnesia

Treatment of Toxoplasma encephalitis (TE)

Treatment: = *pyrimethamine plus sulfadiazine plus leucovorin*. ---> Pyrimethamine penetrates the brain parenchyma efficiently even in the absence of inflammation. Use of leucovorin reduces the likelihood of the hematologic toxicities associated with pyrimethamine therapy. The preferred alternative regimen for patients with TE who are unable to tolerate or who fail to respond to first-line therapy is pyrimethamine plus clindamycin plus leucovorin.

57 F with 3 month hx of Progressive Slurred speech & gait unsteadiness + mild occipital headache each morning for 3 weeks + atrophy and fasciculation of right side of tongue, deviates to right on protrusion - deep tendon reflexes are 3+ - Babinski sign present bilaterally - sensation is normal What is most likely dx?

Tumor of the Foramen Magnum - CN 12 (hypoglossal) palsy (LMN signs) + ataxia = cerebellum, occipital headache + UMN signs since entire cord getting compressed

Pt w/ pancreatic cancer has rapid weight loss Now presenting with muscle strength decreased (3/5) in right interosseous and hypothenar muscles, flexor digitorum profundus of small and ring gingers - Sensation to pinprick, temp dereased over ulnar part of pulm and dorsum of hand, right, small fingers Likely cause?

Ulnar nerve compression: =Rapid weight loss can lead to nerve compression b/c of less cushion --> Ulnar nerve provides sensory innervation to the fifth digit and the medial half of the fourth digit. Neuropathy causes weakness in flexion of the hand at the wrist, loss of flexion of ulnar half of digits, or the 4th and 5th digits, loss of ability to cross the digits of the hand (inteross..). vs. if C8 neuropathy, will show median and radial involvement.

Treatment of psychosis/hallucinations from higher dose levidopa therapy in a parkinsons patient

Use low potency antipsychotics with minimal D2 antagonism: Quetiapine, Clozapine, Pimavanserin. vs, not Haloperidol BC can make the Parkinson's worse

TIAs resolve how quickly?

Usually last minutes - hours, done within 24 hours

Pt w/ atrophic gastritis + paresthesias of hands and feet + unsteady gait, worse in dark + sen sation to vibration & position in hands and feet decreased Likely Cause?

Vit b12 deficiency - Subacute combined degeneration

High dose of what can cause symptoms of increased intracranial pressure? = Papilledema, N/V, headaches

Vitamin A Toxicity = disk swelling on fundoploscopic exam

Newborn child w/ with congenital weakness, hypotonia, and muscle atrophy may have

Werdnig-Hoffmann disease, a congenital motor neuron disease. - lethal form of motor neuron disease and may limit the child's life expectancy to weeks or months

10 yo girl with increased headaches, irritability + anxiety, OCD + Chorea

diagnosis of PANDAS included: 1) the presence of OCD and/or a tic disorder; 2) a pediatric onset; 3) an episodic course of symptom severity; 4) an association with streptococcal infections; 5) an association with neurological abnormalities, including piano-playing choreiform movements

Consequence of orbital floor fracture

entrapment of inferior rectus M ==> impaired upward gaze in affected eye

Treatment of Sciatica w/o Red Flag signs

for non urgent backpain: = start with conservative treatment (NSAIDs + exercise) for 4 weeks. If things don't improve, do imaging (XR/MRI)

What is a common neurologic symptom seen in CKD

peripheral neuropathy = symmetric, distal, mixed sensorimotor neuropathy. - The legs are generally affected first and most severely. Men are more commonly affected than women. Most of the peripheral neuropathies in patients with chronic renal failure involve axonal degeneration. - usually improves with dialysis

Treatment of Restless Leg syndrome

pramipexole or ropinirole = Dopamine agonists

Multiple ring-enhancing lesions on brain CT or MRI in HIV pt

toxplasma gondii

DDx for bilateral spastic paraparesis:

(1) Thoracic spinal cord lesion -> Sensory level. (2) ALS -> will show combined UMNL and LMNL (wasting) and AHC damage (fasciculations) and bulbar palsy. Sensations are intact. (3) RARE. Bilateral parasagittal lesion of the brain, classically a meningioma. Sensations are intact. ==> may be associated w/ headache, seizures from Increased ICP

Hyperpigmented spots are associated with what neurologic dz

*Café au lait spots* in patients with neurofibromatosis = Hyperpigmented patches = usually larger than a few centimeters and occur in several locations in individual patients. - can have ragged edges and are called coast of Maine spots. - occur with both type 1 and type 2 neurofibromatosis, but are much more common with type 1.

Treatment of Carpal Tunnel

1. wrist splint 2. anti-inflammatory meds (NSAIDs) 3. local corticosteroid injection 4. surgical release

Treatment of Acute Angle Closure GLaucoma

= emergency use of topical ophthalmic medications to reduce IOP ===> drugs may include a beta-blocker, an alpha agonist, and an agent to produce miosis. - suggest systemic medication to decrease IOP, which may include oral or intravenous (IV) acetazolamide or IV mannitol Once the acute attack is controlled, definitive treatment for angle-closure glaucoma is a laser peripheral iridotomy to provide a small drainage hole through the iris.

Features of Serotonin Syndrome

= tremor, extreme aggressiveness, akathisia, or clonus (spontaneous, inducible and ocular). Physical examination - assessment of deep-tendon reflexes and muscle rigidity. - Spontaneous clonus, or Inducible clonus plus agitation or diaphoresis, or - Ocular clonus plus agitation or diaphoresis, or - Tremor plus hyperreflexia, or - Hypertonism plus temperature > 38 °C (100 °F) plus ocular clonus or inducible clonus

Treatment of infantile spasms

ACTH

First line treatment in Alzheimers

AD is a problem of low ACh = Cholinesterase inhibitors (Donepezil-Cholinesterase inhibitor) is first line. ===> (Memantine-NMDA antagonist) is second line.

2 yo boy has repetitive ear infections + speech hard to understand + no clear words Look in ear and see retracted tympanic membranes w/ poor movement on otoscopy? NExt step in management? - Audiometry? - CT of head? - insertion of tympanostomy tubes

AUdiometry

2 yo girl has *sudden onset unsteady gait* following chicken pox + unable to sit, stand unsupported + bilateral horizontal nystagmus + CSF shows elevated leukocytes, no gram stain Likely Dx?

Acute Cerebellar Ataxia: = clinical syndrome characterized by the sudden onset of ataxia, usually manifested as gait disturbance. - Most cases occur in toddlers or school-aged children, in many cases the symptoms develop a few days or weeks after a viral illness, particularly varicella. + Fever, meningismus, and seizures are ABSENT + CSF analysis in acute cerebellar ataxia is typically normal or shows a mild lymphocytic pleocytosis, with or without elevations in protein.

acute onset eye pain & headache + blurred vision + diffuse redness of conjunctiva w/ circumcorneal prominence + pupil is midrange and nonreactive to lgiht Likely dx

Acute angle closure gluacoma - tonemetry is next step in magement

WHat type of medication should you give in a person with acute dystonic reaction after administration of haloperidol?

Anti-cholinergic drug (ie: benztropine)

Treatment of septic emboli to brain causing stroke

Antibiotic therapy. (weird nbme question)

Symptoms of Arsenic poisoning

Arsenic poisoning: Commonly found in pesticides. - Symptoms include headaches, diarrhea, vomiting, and later develop changes to the pigmentation of nails (leukonchychia striata) + hyp[erpigmentation, skin cancer

Stroke prophylaxis for everyone after stroke?

Aspirin - unless Afibb and CHADSVASC > 2 = Warfarin *if allergic or CI aspirin, use clopidogrel * if have another stroke on aspirin, add dipyromile

Pt with TIA incident Bilateral carotid bruits, both with 40% stenosis Best way to prevent stroke?

Aspirin - only do endarterectomy if > 70% or - if 50-70% with symptoms and male *women, only if 70% stenosis asx and symptomatic

Weakness of deltoid muscle = weak abduction + Numbness over proximal lateral arm after football game right shoulder injury. What nerve injured?

Axillary N

Features of Carotid Sinus Hypersensitivity

CArotid sinus hypersensitivity it has the same pathophysiology to vasovagal attack and the same presentation. = the difference is the triigering factor. In CSH we have attacks with neck movements. while vasovagal attacks are triggered by prolonged standing, warm environment, painful stimuli.

CSF with increased *14-3-3* protein concentrations + 6 week rapidly progressing cognitive changes/dementia + twitching movements of arms/legs (frequent irregular jerks of UE & LE) likely dx?

CJD - CSF: 14-3-3 protein concentrations - myoclonus - rapidly progressing dementia, often in younger person

Bilateral hearing loss in 6 month old infant MOst likely cause?

CMV

Diabetic presents with double vision Severe weakness of abduction with conjugate gaze to the left + left eye has some adduction when staring straight ahead (on primary gaze)

CN VI palsy = Mild adduction of left eye on primary gaze (looking straight ahead)" suggests left eye abductors are weak. + "weak abduction on conjugate gaze to left side" also supports the left lateral rectus weakness

18 yo M with difficulty walking for 1 week + Visiual fields that are constricted equally in both eyes on close and distant testing + collapsing effort on muscle strength testing in left extremtiies Hemisensory loss to all modalities on the left and stop exactly on midline Likely dx?

COnversion Disorder

What can CSF be like in SAH

CSF WBC count increases in SAH and thus mimics meningitis therefore always look at CSF WBC:RBC ratio; normal is 1:500-1000; this is close to that with 1:400. + You also typically get bloody or xanthochromic spinal taps (color was pink and lots of RBCs).

TREATMENT? Trigeminal neuralgia (tic douloureux)

Carbamazepine

Exam shows proptosis + opthalmoplegia + partial vision loss on right = double vision, + headache in setting os sinus infection...

Cavernous Sinus Thrombosis

5 yo with cerebral palsy + developmental delay + bilateral sensorineural hearing loss + CT shows punctate hyperintensities along the ventricula margins Most likely cause of this kids abnormalities?

Congenital CMV infection

Infarct in the territory of the Right PCA would lead to what symptoms?

Contralateral (left) hemianomous heminopia w/ macular sparing ie: only reads on right side of page - but not same as hemineglect (

11 yo girl with headache, blurred vision, + bitemporal visual field defects and papilledema CT shows large suprasellar mass with calcifications dx>

Craniopharyngioma

What is DRESS syndrome and what causes it

DRESS: Drug reaction w/ eosinophila & Systemic symptoms: - increased eosinophils, thrombocytopenia, atypical lymphocytosis + lymphadenopathy + fever - can involve organs - maculopapular rash on trunk - body aches Causes: - phenytoin, Carbamazepine

tx of narcolepsy

Daytime sleepiness with sudden episodes where muscles go limp. Tx = Modafinil or methyfenidate. Diagnosis: polysomnography.

Fever, HTN, Tachycardia, Tachypnea after 4 days in hospital in pt for femur fracture + diaphorectic, agitated, high BP (180) Likely cause?

Delirium Tremens - Treat with benzos vs. fat embolism = tachypnea, tachycardia, chest pain, SOB<

Name a few drugs can cause a macrocytic anemia: Why?

Drug induced Folic acid deficiency: (1) Trimethoprim-sulphasalazine (2) Anticonvulsants (3) *Phenytoin* (4) Methotrexate. + chronic alcoholism

Woman w/ weakness of shoulders, deltoids/bicepts/triceps/psoas, gluts/quads + high CK > 2,500 and high ESR What is best step in diagnosis?

EMG and nerve conduction studies = Pathologic process in myopathies results in dysfunction and dropout of individual muscle fibers located randomly within the motor unit. + Motor neurons and motor axons are not affected. ==> As a result, each MUAP is generated by fewer motor fibers. *MUAPs become polyphasic, short in duration, and low in amplitude*

Hyponatremia, really thirty 19 yo girl + temp of 103 + grinding teeth, restless Collapsed and had seizure Pupils 5mm bilaterally What drug?

Ecstasy

CHiari type I malformation

Ectopia of cerebellar tonsils - usually asymptomatic in childhood - manifests in adulthood w/ headaches and cerebellar symptoms - associated w/ syrinogmyelia

2 years of episodes of veritgo w/ N & V last 1 hour triggered by sneezing, elevators, going up in planes Hx: concussion after a fall 2 years ago Likely cause?

Endolymphatic fistula - trigger with sneezing/change in pressure causing leakage of endolymphatic fluid. - associated w/ trauma - surgery to fix

Pt w/ cellulitis of leg. Now has development of fever, nuchal rigidity + lower extremity weakness + DTR's brisk + babinski present Sensation to pinprick decreased below C7 Likely Dx?

Epidural ABscess of the spine

27 M presents with a *history of fever, back pain and neurologic deficits* + Hx of IV drug use + decreased sesntation to pinprick below the belly button + decreased pinprick, touch, proprioception and hyperreflexia & weakness in the lower extremities

Epidural abscess: - fever, back pain and neurologic deficits -Spinothalamic effect is seen 2 segments below the corticospinal effect: umbilicus level is T10, so lesion in thoracic cord around T8

Treatment of Restless leg syndrome

Exercise before going to bed may alleviate much of the discomfort. Agents that may be effective in alleviating symptoms include clonazepam, gabapentin, L-dopa, dopamine agonists (eg, pramipexole or ropinirole), and opiates. = DOPAMINE AGONISTS

Prior to undergoing surgery, what should be checked in rheumatoid arthritis patients? (Ie: 60 yo with rheum arthritis getting hip replacement)?

Flexion and extension x-rays of the cervical spine - In RA patients are at risk for atlantoaxial subluxation and spinal cord damage with intubation, so do x-ray of c-spine prior and possibly use fiberoptic intubation

Syringomyelia symptoms

Fluid collection w/in center of spinal cord ==> expands - causes weakness, muscle atrophy of hands, + loss of pain and temp sensation (cape-like distriution) + stiffness and leg spasticity (UMN signs), increased reflexes

Megaloblastic anemia in an alcoholic w/o focal neuro deficits Likely cause?

Folic acid deficiency vs. B12 deficiency - takes longer - neurologic symptoms (sensation) - elevated MMA

LP with elevated RBCs and WBCs (mostly lymphocytes) + elevated temperature + FND + normal CT EEG shows repetitive complexes over the right temporal region

HSV encephalitis - confirm dx via PCR of CSF for HSV

Alcoholic presents with positive blood in stool + irregular lapses of postural tone + confused and lethargic + sclera are jaundiced Likely cause?

Hepatic Encephalopathy: - GI bleed due to varices - increased urea absorption from breakdown of blood products - increased ammonia (think urea cycle pushed back) which alcohol-damaged liver can't handle leads to HE

47 M drooping of right eyelid + right pupil 3mm (Vs. 5mm in Left) + anhidrosis over R face - both pupils reactive What is Dx?

Horner's Syndrome: - MRI Of lower neck would find the reason (ie: pancoast tumor)

Bilateral atrophy of Caudate On CT, see "Hydrocephalus ex-vacuo" Dx? What neurons are being lost?

Huntington's Disease: - degeneration of striatal gamma-aminobutyric acid neurons

When do you treat shingles with IV (Vs. oral) acyclovir?

IV Acyclovir is also indicated for shingles that affects dermatomes in the face involving the eye (V1) - there is a risk of blindness as a complication of disease affecting this dermatome, so treatment may need to be more aggressive.

11 y/o female with 2-day history of increasing weakness and prickling sensation in her legs. + had a mild flu-like illness during the past week. + Legs are strength 1/5 bilaterally and decreased sensation to pinprick. + Achilles and Patellar reflexes decreased. No other abnormalities. LP shows total protein of 80mg/dL and leuks of 4/mm3. What is the best pharmacotherapy - antibiotics, anticonvulsants, antivirals, corticosteroids, immune globulins?

IV IG = Gullian Barre syndrome

Treatment of stroke associated with vertebral artery dissection

IV heparin

Treatment of MS flare?

IV steroids

Patient with high Cr and BUN PResents with 3 weeks of lethargy, confusion, sleepyness + occasional myoclonic jerks

In acute renal failure, clouding of the sensorium is practically always associated with a variety of motor phenomena. Every level of the spinal cord is affected in uremia from the spinal cord to the cerebrum. This patient's myoclonic-twitch-convulsive syndrome helps identify uremic encephalopathy as the cause this patient's lethargy. As the uremia worsens, this patient could lapse into a quiet coma. Unless the accompanying metabolic acidosis is corrected, Kussmaul breathing appears and gives way to Cheyne-Stokes breathing and death

Features of Uncal Herniation

In uncal herniation, 4 things occur: 1) Compression on the *contralateral crus cerebri causing ipsilateral hemiparesis* 2) Compression on the ipsilateral CN III resulting loss of PSNS innervation and *dilation of the eye + mild ptosis* 3) compression on the ipsilateral PCA resulting in contralateral hemonomous hemaniosopia with macular sparing 4) compression of reticular fibers = coma/decreased consciousness *may be hyperventilating = trying to decrease the increased ICP

EEG shows *multifocal, high-amplitude spikes* "hypsarrythmia" and slowing In a 1 yo with developmental delay,+ "sit-up" like spasms

Infantile spasms - ie: see in tuberous sclerosis

What is the blood flow to the retina?

Internal carotid A ===> ==> Ophthalmic A ==> Central retinal A (also ophthalmic A ==> Supraorbital A) Ie: patient w/ amaurosis fugax = get Carotid U/S

EYes move OK to Left Wehn looking right, left eye does not fully adduct, nystagmus in abducting right eye

Internulcar opthalmoplegia = lesion in Medial Longtitudinal fasciculus

Symptoms of a stroke in territory of Posterior Inferior Cerebellar artery

Involvement of nucleus ambiguus = CN IX, X, XI = dysphagia, decreased gag reflex, hoarseness + loss of pain / temp on side of face, opposite side of body affected (ie: L PICA = Left face loses pain/temp, R Body loses pain & temp)

57 yo with fatigeue and AMS - hx of vokda pints per day - Liver LFTs are WNL - BUN is normal Large ascieties Likely dx and treatment

Lactulose = Hepatic Encephalopathy - INR >1.5 is indicator of late stage liver dz (not LFTs) - lactulose binds ammonium

man has 2 weeks of progressive weakness + is constipated, + has microcytic anemia, + hyperuricemia Has been drinking homemade whisky Atrophy of muscles in hands and feet. Senosry exam normal Likely cause?

Lead poisoning: - can contaminate home distilled whiskey? + microyctic anemia = sideroblastic anemia + hyperuricemia from lead nephropathy (kidneys cant excrete uric acid)

immigrant + numb hands + mildy coarsened features - loss of pinprick and light touch sesnation, esp. over tip of nose and ears - common peroneal nerves feel thickened Likely Dx

Leprosy --> treat with rifampin + dapsone add colfazamine

82 yo woman after picnic where she had hot dogs and unpastreurized cheese. ON oral prednisone. She has rigid neck and CSF from LP shows high protein and WBCs (Monocytes 40%, neutro 60%) + Gram positive Bacilli Dx? Treatment?

Listeria Meningitis - gram positive bacilli Tx: Ampicillin

Patient w. slow slurred speeech + coarse tremor of arms + increased DTRs + sleepy, unresponding Litiium level > 4 Dx and Treatment?

Lithium Toxicity - hydrate the patient and if Lithium level > 4 then directly do haemodialysis regardless of the symptoms. - But if the lithium level is >2.5 also haemodialysis IF the patient is having severe symptoms such as seizure or depressed mode like our patient her.

3 month old with diarrhea and vomiting and low fever over past 3 days. No formula, but had glucose and water. Now having a tonic-clonic seizure. He has dry mucous membranes and a sunken fontanelle What electrolyte abnormal?

Low Sodium - avoid dilute solutions in babies less than 6 mos old - You're not supposed to give a child < 6mo water because of hyponatremia. Seizures and coma are late findings and imply a large sodium deficit!

Recurrent vertigo episodes - last hours + hearing loss unilateral + tinnitus unilateral Likely Dx?

MEnieres Dz Tx: salt restriction, diuretics

In patient w/ suspected vascular/other dementia, after doing mental status exam & get labs Whats next step in Dx?

MRI

60 F with Rheumatoid arthritis - has 2 month progressive weakness of hands + tingling in hands, esp. with buttoning, writing + been on corticosteroids for 10 years + Weakness of Finger extensors and wrist flexors bilaterally - Deep tendon reflexes are 3+ (hyperreflexia) NExt step in Diagnosis?

MRI Of cervical spine = to rule out atlanto-axial dislocation seen with rheumatoid arthritis

27 yo man with 2 years of severe muscle cramping and weakness immediatrly after exercise. + Pain resolves in 24 hours + Also has dark urine during this time. Most likely dx?

Mcardle disease is glycogen storage disease type V. = present with exercise intolerance due to muscle pain and myoglobinuria.

Man with headache, adominal pain, dizzy + decreased vision _ generalized weakness + Optic disc pallor, pupils react slowly to bright light + consumes his own homemade liquor

Methanol poisoning

30 yo F patient with "tight band-like sensation around her mid-abdominal region" + ascending sensory deficit + diffuse hyperreflexia + imapired left eye adduction

Multiple Sclerosis - "tight band" around abdomen = hints at Transvere myelitis aka "MS hug" -

30 yo man + Arrhythmias, cataracts, balding, testicular atrophy/infertility + intrinsic hand muscles atrophy, weakness + percussion of hypothenar muscles results in slow relaxation Dx?

Myotonic Dystrophy: - autosomal dominant disease due to CTG repeats with mutation on DMPK gene. muscle contraction with slow relaxation is highly suggestive.

Boy with episodes of falling asleep during day + acute weakness of neck and knee muscles randomly likely dx

Narcolespy = Daytime sleepiness, Cataplexy - cataplexy usually affects a group of muscles (ie: Knees buckling) - Cataplexy is a sudden and transient episode of muscle weakness accompanied by full conscious awareness, typically triggered by emotions such as laughing, crying, or terror

Blebs inside ventricles on MRI in 40 yo Mexican guy who had 1st generalized tonic-clonic seizure Likely Dx? transmission?

Neurocystercosis = fecal contamination of food + intraventricular cysts on MRI or multiple small calcifications

Central American immigrant + new onset seizures + CT w/ contrast shows multiple little bright spots (calcifications0

Neurocysticercosis TX: antiepileptics, albendazole and corticosteroids to reduce brain inflammation

77 yo man comes in for routine physical Has BP 140/70. Neuro exam normal except absent ankle reflex bilaterally Next step?

No additional management needed - can have absent ankle reflexes in elderly

What tests must you do in a patient with Bell's palsy suspected?

No further testing indicated (clinical dx)

hypokinetic gait disorder in which the older adult's feet look as though they are glued to the floor = "magnetic" + mild dementia and + Bladder and bowel incontinence."

Normal Pressure Hydrocephalus

Man gets hit in eye by a softball When asked to look up, the affected eye doesnt. OTherwise normal Dx>?

Orbital floor fracture ===> entrapment of inferior oblique m Inferior rectus and inferior oblique can BOTH become entrapped OR transected from inferior orbital fracture If IO or IR alone is entrapped --> can't gaze up If IO or IR alone is transected --> can't gaze down