Muscle/Nerves
65 yo w/ progressive weakness, worse when squatting and standing from a chair. C/o decreased strength in the R hand. On exam, prominent weakness of quadriceps b/l and on opposition of R thumb. Atrophy of foreman muscles with normal DTRs. No other weakness on exam. Sensory exam normal. ROS negative. Normal CK, negative for anti-transfer RNA synthase antibodies (Jo1). Dx? (2x)
Myotonic Dystrophy
2 years afer rear-end collision MVA pt develops BUE weakness w/ some muscle wasting, loss of DTRs in arms, loss of sensation to pain and temp in neck/arms/shoulders, intact sensation to touch. Most likely cause? (2x)
SYRINGOMYELIA
55M c/ o weakness and clumsiness. Sx began several months earlier w/ difficulty buttoning his clothes, getng car keys in the ignition and other fine motor tasks. Noticed that muscles in arm and forearm twitched under the surface and cramped easily. Over the past few months his arms have continued to weaken and lose muscle mass. On exam, he has diffuse wasting and weakness of BUE, fasciculations, slight spasticity on arms and legs, and hyperreflexia with extensor plantar responses. Sensory, coordination, and CN exams are normal. The underlying pathological process affects neuronal bodies in which of the following structures? (2x)
ANTERIOR HORN OF THE SPINAL CORD, MEDIAL BRAINSTEM, AND PERIROLANDIC CORTEX
New onset of pathological gambling, increased libido, and hypersexuality in a Parkinson’s pt is likely to be secondary to (3x)
Pramipexole
Neuroimaging modality that relies on concentration of deoxyhemoglobin in blood flow as its most common technique and can measure change in cerebral blood flow: (3x)
fMRI
One month afer MVA, a 21 yo c/o persistent pain in the L shoulder and arm, with sharp pain radiating into L thumb. Exam shows weakness ot biceps. The biceps reflex on L is absent. Likely dx? (2x)
C-6 Radiculopathy
50M w/ acute neck pain radiating down L arm, gait problems, urinary incontinence. What test should be ordered? (2x)
MRI OF C SPINE TO R/O CORD COMPRESSION
Conduction block in nerve conduction studies indicates what? (2x)
Focal demyelination
First-line tx of vocal tics in Tourette’s: (2x)
alpha-2 adrenergic agonist
Neuroimaging that measures neuronal glucose metabolism: (3x)
PET scan
Pt c/o unpleasant aching and drawing sensations in calves and thighs associated w/ a crawling feeling, forcing him to move legs, bringing transient relief. Sxs worsened by fatigue. Exam normal. Best med tx? (2x)
Pergolide (for Restless Leg Syndrome)
Polyneuropathy can be caused by either deficiency or extreme excess of what B vitamin? (2x)
Vitamin B6
Which drug for the tx of parkinsonism has been associated w/ sudden sleep attacks? (2x)
Ropinirole
Med that interferes with the efficacy of donepezil in elderly patient: (2x)
Oxybutynin
MRI finding for woman with memory decline, urinary incontinence, and trouble walking: (2x)
Enlarged dilation of ventricles
Severe spasms and rigidity of limbs intermittently and later more persistent/continuous: (2x)
ANTIGLUTAMIC AND ANTI DECARBOXYLASE ANTIBODIES (ANTI-GAD) ANTIBODIES
Middle age man w/ b/l shaking hands, increased when using hands, writing, volitional activities. Stress worsens, wine improves. Is familial. Dx? (2x)
Essential tremor
Most effective tx for 25 yo w/ daytime sleepiness, needs several short naps, fell asleep while driving once, decreased REM latency: (2x)
Modafinil
What drug can reduce psychotic symptoms in Parkinson’s w/o worsening motor symptoms? (2x)
Pimavanserin
MRI technique detecting mild TBI: (2x)
Diffusor tension imaging
Weakness in limbs 2 weeks after viral gastroenteritis. Weakness in UE/LE, absent DTRs. Spinal fluid shows no cells and elevated protein. EMG shows slow conduction velocity, prolonged distal motor latency, and conduction block. Dx? (2x)
Acute Inflammatory Polyneuropathy
Fluctuating aching pain in lower back, buttocks, and sciatic distribution elicited by standing or walking, and relieved by sitting with numbness in a similar distribution, loss of ankle reflexes. Dx? (2x)
Spinal stenosis
An elderly pt w/ confusion, fever, temporal lobe hemorrhage. CSF shows increased lymphocyte and protein. Most appropriate medication? (2x)
Acyclovir
Memantine’s cognitive preservation effect has which mechanism? (2x)
GLUTAMATE NMDA RECEPTOR ANTAGONIST
10 yo w/ frequent episodes of brief lapses of consciousness w/o premonitory sxs. Lasts 2-10 seconds, followed by immediate and full resumption of consciousness without awareness of what happened. These ictal episodes are most likely caused by what kind of seizures? (4x)
Absence