Muscle/Nerve
36 yo w/ pain behind L ear progressing to numbness on L side of face, tearing of L eye, discomfort w/ low frequency sounds, L facial weakness on exam. Dx? (12x)
Idiopathic Bell's palsy
Stiffness of legs while walking and spasms of LE while sleeping. Stiff-legged gait, adducts legs while walking. Increased LE tone/spastic catch, hyperactive knee jerks, ankle jerk clonus. Increased Romberg sway. Dx? (6x)
Cervical Spondylosis
Most effective treatment for a patient with involuntary eye blinking? Neuro exam shows symmetric, involuntary contraction of the orbicularis oculi muscles but otherwise unremarkable. (4x)
Botulinum toxin
Myasthenia gravis can be diagnosed in 80-90% of cases by identification of serum antibodies against what? (3x)
Acetylcholine receptors
IV meth user develops severe back pain, followed afer several days by BLE weakness/sensory loss, bladder incontinence, low grade fever, tenderness to percussion over the 2nd and 3rd lumbar vertebrae, paraparesis and loss of sensation to light touch and pinprick in both legs, buttocks & sacral region. Dx? (3x)
Spinal epidural abscess
Myasthenia gravis associated w/ what EMG finding: (10x)
DECREASED AMPLITUDE WITH REPETITIVE MOTOR NERVE STIMULATION
Atrophy of the intrinsic muscles of the R arm and forearm. Reflexes are generally brisk, plantar reflexes are extensor. Electrophysiology shows widespread fasciculations, fibrillation and sharp waves, normal sensation, muscle spasticity. Positive sharp waves on EMG. Dx? (6x)
Amyotrophic Lateral Sclerosis
54 yo had a viral upper respiratory infection 2 weeks ago and now presents w/ 3 day episode of progressive, symmetric weakness in the legs, and tingling in the toes and fingers. On exam, Achilles and patellar DTRs diminished. Nerve conduction studies demonstrate decreased conduction velocity and decreased amplitude of action potentials. Likely dx? (4x)
ACUTE INFLAMMATORY DEMYELINATING POLYNEUROPATHY
Mechanism of action of botulinum toxin at neuromuscular junction. (3x)
INHIBITION OF ACETYLCHOLINE FROM PRESYNAPTIC TERMINALS
What chemo agent is most commonly associated w/ distal sensory polyneuropathy? (3x)
Cisplatin
Tx for trigeminal neuralgia: (7x)
Gabapentin (but most effective is Carbamazepine)
R neck pain, tends to rotate neck to L – touching the chin prevents deviation – prominent R SCM spasm. Tx? (5x)
Botulinum toxin
Young pt w/ a few days of progressive weakness and numbness of both legs and feet after recovering from a flu-like illness. Exam: weakness and loss of sensation to all sensory modalities below middle of the thorax. DTR: brisker on the lower extremities, plantar reflexes are extensor. Pt has had several episodes of urinary incontinence. Other neuro exam and vitals: normal. LP: 23 mononuclear cells, protein 37 mg/dl, and normal glucose. Dx? (4x)
Acute transverse myelitis
During 2nd trimester, a pregnant 38F has numbness in both hands, particularly the thumb, forefinger, middle finger bilaterally. Dorsal part of hand unaffected. Arms ache in the morning from shoulders to hands. Dx? (3x)
Median neuropathy of the wrist
Effective tx for spasmodic torticollis. (2x)
botox
37 yo truck driver w/ numbness of L hand, increased severity in past 2 yrs. Reduced pinprick sensation on L little/ring fingers, atrophy of hypothenar muscle. Dx? (6x)
Ulnar nerve lesion
Persistent numbness in L hand, decreased sensation in 4th/5th digits (palmar/dorsal), weak finger abduction/adduction especially 5th digit. Likely dx? (4x)
Ulnar nerve entrapment at the elbow
14 yo afer a demanding physical test becomes extremely weak and unable to stand. PE is positive for depressed DTR’s. Labs: K 2.8. Hx of similar episodes afer strenuous exercises. EKG: minimally prolonged PR, QRS, QT interval. Father and grandfather had similar episodes. Dx? (3x)
Periodic paralysis
Contralateral loss of pain and temp sensation with motor paralysis and proprioception loss on the other. Dx? (2x)
Brown-Sequard syndrome (hemisection)
Pt w/ episodes of severe, intermittent, lancinating pain involving the posterior tongue and pharynx, w/ radiation to deep ear structures. Triggered by swallowing cold liquids and talking. Workup: normal. Dx? (2x)
Glossopharyngeal neuralgia
22 yo w/ pain in R hand that radiates into the forearm and bicep. Paresthesia in the palm of the hand, thumb, index, middle ring finger. Sensory systems in the ring finger split the ring finger longitudinally. Dx? (6x)
MEDIAN NERVE ENTRAPMENT AT THE WRIST
Subacute combined degeneration of the posterior column of the spinal cord is associated with a deficiency of what? (2x)
Vitamin B12 deficiency
26 yo w/ sudden onset back pain. Spasms in R paraspinal muscles in the lumbar region. Straight leg raising on the R limited by sharp pain at 45 degrees. Ankle jerk on L is diminished. No muscle weakness, no sensory deficit. Next step? (3x)
Order MRI scan of the lumbar spine
An effective tx for blepharospasm? (2x)
Botox
Pt c/o progressive weakness of several days. Exam shows generalized weakness and absent reflexes. Nerve conduction studies show slowing of velocities. Dx? (2x)
Acute Polyneuropathy