Which of the following is not a sx of Meniere's syndrome?
Sensorineural hearing loss
All of the above are sx
Pt comes to the ED due to recurrent bouts of dizziness which generally last around 30 minutes but has lasted as long as 18 hrs. Pt notes that it usually starts with a severe HA but at times will occur without it or last longer than the headache does. During these episodes the patient is incredibly sensitive to sounds and lights and just wants to lay down. Pt notes that they are worse when she has had a stressful day at work or when her noisy neighbors keep her up all night. The current episode occurred right after she ate some chocolate w/ her afternoon coffee. Pt denies tinnitus and weber and rinne tests are normal). Which of the following would be your leading ddx?
Vertigo secondary to MS
Vertigo secondary to MS is often described as gradual, mild intensity vertigo with N/V, neuro deficits, mild nystagmus (vertical OR multidirectional), change position has effect, can repeat with tilt test and positive every time. NO TINNITUS or HEARING LOSS.
Which of the following is NOT a sx of frontal lobe lesions
Intellectual decline (progressive), slowing of mental activity, personality chagnes
Contralateral grasp reflex
Anosmia (Loss of smell)
Expressive aphasia (Broca's aphasia) when on L side
If located centrally, focal motor seizures on the contralateral side
Crossed homonymous hemianopsia or partial field defect and visual hallucinations
Your next patient of the day is a 38 y/o obese woman who comes to your office c/o HA that are worse in the morning and no other sx. Of course, you automatically assume she has a brain tumor. On the MRI you do not see any space occupying lesions but do note enlarged ventricles. Which of the following is your likely dx?
Frontal lobe lesion
Occipital lobe lesion
Cortical blindness, a condition in which the patient is unaware that they are not actually seeing a realistic view of their surroundings, is due to a unilateral occipital lobe lesion
Select which of the following are not a/w brainstem lesions
Ataxia and incoordination
Nystagmus, extrapyramidal, and sensory deficits in the limbs
Increase in ICP in late stages
You are on a medical mission trip somewhere in africa and you come across a young boy who is brought into your clinic due to asymmetric muscle weakness in his left leg. Pt's mother reports that the other members of the family have been mildly ill with a stomach bug but that no one else had developed the weakness. On exam you note that there is flaccid paralysis and muscle atrophy in the LLE. Pt's DTR are also absent in that extremity but the sensation is intact. What is the cause of this pt's disease?
A 30 y/o male is brought into the clinic by the ambulance after being found altered at his apartment. His mother states she got worried after he had not picked up her call for a few days in a row. Upon talking to the Pt's best friend that had gone to check on him and found him unable to get out of bed and saw what he thought was a seizure you note that the Pt is currently sexually active with several different partners. Pt's best friend is unaware of his HIV status but states that he doesn't believe he uses protective measures.
On exam you note negative budzinski and kernig's signs. On fundoscopic exam you not papilledema so you do a STAT CT w/ contrast. On CT you see a space occupying non vascularized lesion. You also did a CBC and cultures which elevated WBC and a left shift. The cultures came back showing toxoplasma gondii. What does this pt have?
Early Bacterial Meningitis
Pt is a 60 y/o man who is brought to the ED by ambulance due to increasing imbalance. Pt's daughter is worried about him having had a stroke. On exam you note pupils that are unreactive to light but accommodating enabling the Pt to read his consent papers. On exam you note that he has impared vibratory senses and there is muscular hypotonia and hyporeflexia with LE DTR of 2/5. Once the Pt's daughter left the room the pt admits to having some sores on his genital area 20 years ago after his divorce with his ex-wife but states it went away on it's own so he didn't seek medical attention. What is your top ddx?
Tertiary Syphilis (neurosyphilis)
Pt is a 35 y/o male brought to the ED by their spouse who states that over the last 24 hrs they have become increasingly confused and disoriented and she believes he has been having hallucinations. Pt states that prior to the last day he had returned home from a cabrewing trip with his buddies and had a headache, muscle aches, and a general crappy feeling which he attributed to having a few too many beers on the trip. On exam you note that he has several big welts that appear to be mosquito bites. You are waiting for MRI results to come back. What do you think this pt has?
Which of the following is not part of the classic sx of parkinsonism
Resting "pill rolling" tremor
Postural Instability (stooped posture, impaired righting reflexes, freezing, falls.
Bradykinesia (slow movements and difficulty initiating movements)
Anticholinergic drugs (trihexyphenidyl, benztropine, orphenadrine, procyclidine, and biperiden) are good to decrease the overall "positive" movement sx of parkinson's
Levodopa/Carbidopa is a combo therapy that is the mainstay treatment of Parkinson's.
Levodopa is a dopamine precursor that can cross the BBB.
Carbidopa Blocks the peripheral conversion of levodopa to prevent the side effects of levodopa (nausea and vomiting).
This combo medication often called "Sinemet" should be started at initial onset of parkinson's sx.
Selegiline is a MAO-B inhibitor that may be neuroprotective and decrease need for levodopa.
Entacopone and Tolcanpone are not given alone but can increase the availability of levodopa to the brain and may decrease motor fluctuations. These drugs work by inhibiting MAO-B
Amantadine should be used early in the disease for mild antiparkinsonian activity such as akinesia, rigidity and tremor. This drug CANNOT be used as a monotherapy
Surgical pallidotomy or deep brain stimulators may produce clinical benefit in the treatment of Alzheimers.
Which of the following is not a normal finding on lumbar puncture
80 mg/dL glucose
65 mg/dL protein
70-180 mm H2O Opening pressure
The following CSF analysis describes what condition?
-Cells/ mcL: 200 PMNs
-Glucose: 20 mg/dL
-Protein: 60 mg/dL
-Opening pressure: 200 mm H2O
All of the following are found in fungal meningitis CSF analysis except
low glucose (<45)
High Protein (>50)
Moderately Elevated Opening pressure
Which type of cells would you find in Aseptic meningitis
Markedly elevated opening pressure
Normal or low glucose
High protein (>50)
Select which age, microorganism, treatment profile is incorrect.
18-50 y/o-S. Pneumo, N. meningitidis-vanco + cefotaxime/ceftriaxone
>50 - S. pneumo, N. meningitidis, Listeria monocytogenes, gram (-) bacilli- vanco + cefotaxime/ceftriaxone
Impaired cellular immunity-listeria monocytogenes, gram (-) bacilli, S. Pneumo- Vanco + ampicillin + cefepime
Postsurgical or posttraumatic - S. aureus, S. pneumo, gram (-) bacilli- vanco + cefepime
Dexamethasone should be added as an adjunctive tx along with the abx for adults with N. Meningitidis meningitis
Corticosteroids should be added for HIV negative pts with gram-positive organisms (S. Pneumo)
Drainage (excission or aspiration) and systemic abx are indicated in brain abscess
If a patient comes in with a red petechial rash and neck stiffness you should treat them empirically with cefotaxime (3rd generaltion cephalosporin) because the bacterial etiology of their disease is probably S. Pneumo
The most common intracerebral neoplasm is:
Which of the following is not indicated for tx for HTN in an acute stroke situation
Keep BP below 185/110 for tPA but don't lower much beyond 170/100
Use PO metoprolol as the first line tx
Within 2 weeks of stroke - avoid lowering BP because of loss of cerebral autoregulation, > 200 mmHg can be lowered to 170-200 with continuous monitoring
AFTER 2 weeks, can lower it to < 140/90 mm Hg
If lowered too fast you worry about hypoperfusion to the brain
Which of the following is NOT a sx of Wernicke's encephalopathy
Wernicke's encephalopathy is often seen in alcoholics or people with thiamine (Vit B1) deficient diets. First line tx should be to supplement their thiamine and ensure they take a multivitamin and correct their diet.
Glossodynia is a painful swelling of the tongue which can be attributed to DM, tobacco, candidiasis, diuretic use. Which of the following is a suitable tx for this condition.
Removing offending medication and switching to alternative
All answers are correct.
Which is incorrect concerning normal pressure hydrocephalus?
CT will show shrunken vesicles, sulci widening, and overall brain atrophy
Sx generally fit into the mnemonic of "Wet (incontinent), Wacky (dementia), and Wobbly (gait disturbances)
Gait disturbances are often 1st sign and may include brady kinetic, shuffling, or broad-based gaits
Urinary signs can include urinary frequency or urgency to frank incontinence
Select the correct nerve root compression for the following s/s:
Radiation: L1 lesion causes pain in the groin while a L2 lesion causes pain in antero-medial aspect of thigh,
S&S: weak hip flexion, weak knee extension, and impaired quadriceps tendon reflex, sensory deficit in the anteromedial aspect of the thigh, pain may be relieved w/external hip rotation, decrease patellar reflex
Select which nerve root compression is responsible for the following s/s:
Radiation: pain that radiates along anterior thigh into the anterior leg
S&S: weakness of the muscles on the front of the thigh and/or the inability to bring the ankle upwards, also reduced patellar reflex, with weakness the knee may feel like it’s going to give out, with difficulty getting out of a chair, or you might fall
All of the following are causes or pathophysiology for myasthenia gravis except:
A/w thymic tumors, especially in older men, thyrotoxicosis, rheumatoid arthritis, SLE in those w/ genetic predisposition, triggered by coincidental infection
HLA-DL3 is a genetic condition which could cause thymomas in young women and lead to MG development
S/S include ptosis and easy fatigue with chewing or talking. Diplopia but normally pupillary response (not CN III). No change in sensation and reflexes
Cellular immunity against acetylcholine receptors
All answers are true
Which of the following is false about the management of carotid stenosis with bruits
Asymptomatic stenosis > 60%: endarterectomy can be done but many will medically manage asymptomatic pts until stenosis ≥ 80%
If previous TIA/CVA (symptomatic) w/ 40% occlusion: endarterectomy
ASA, 325 mg qd or other antiplatelet therapy (if at risk of cardiac emboli (Afib, etc.) use warfarin or Plavix)
Risk factors include DM, HTN, smoking, hyperlipidemia, and obesity
Pt is a 2 year old male who is rushed to the ED due to seizure activity. Pt's parents state that he has had recurrent ear infections but that he hasn't had one in a few months and that he was asymptomatic before going to bed. On exam Pt is an ill appearing toddler that is crying but in no other distress. Pt's L TM appears bulging and is hypomobile. His current temp is 103 F. Which of the following is not warrented in this case
EEG and start the Pt on valproic acid
Antipyretics s/a ibuprofen or tylenol
Abx tx for AOM s/a amoxicillin
Monitor Pt until fever has been broken.
Which is not a prophylactic tx of migraine headaches?
Which of the following is not an etiology of a cluster headache
Ingestion of specific foods
A common etiology of a lumbar disc herniation is bending or heavy lifting with the back in flexion causing extrusion of disk content.
Upper motor neuron disease sx include weakness, paralysis, spasticity, hyperreflexia, and primative reflexes such as babinski's sign
Which of the following is a/w nerve root disease.
Shooting radiating pain, weakness, paresthesia, paralysis, tingling.
Not associated with a dermatomal pattern
Sensory function is never affected
Will not have a sensory level.
Primary muscle disorders (s/a Muscular dystrophy, ALS, or polymyositis) will show asymmetrical changes in muscles.