Show:
He's got some nerve!
What are you gonna do about it?
Take two aspirin and call me in the morning
Its all in your head
Random other stuff!
100
A patient presents with unilateral hearing loss, tinnitus and deterioration in discrimination of speech. MRI shows a lesion in the internal auditory canal. What is your diagnosis?
What is an acoustic neuroma (Vestibular schwannoma); Their typical auditory symptoms are unilateral hearing loss with a deterioration of speech discrimination exceeding that predicted by the degree of pure tone loss. Diagnosis is made by enhanced MRI.
100
Recovery from acute relapses of multiple sclerosis may be hastened by treatment with what?
Corticosteroids [but the extent of recovery is unchanged and alternatives are plasma exchange and IVIG]
100
What is the most common type of primary headache disorder?
Tension headache
100
What area of the brain is destroyed in the neurodegenerative disease Parkinson’s?
substantia nigra
100
A patient presents to the emergency department after falling from a ladder, hitting his head and losing consciousness for an undetermined amount of time. What is the first diagnostic test you would perform on this patient?
A CT scan of the head [CT scanning has an important role in demonstrating intracranial hemorrhage and may also provide evidence of cerebral edema and displacement of midline structures.]
200
How would you test to see if a patient had a psychogenic tremor?
Have them do a complex activity with their opposite hand
200
A patient presents with fever, HA, AMS, meningismus and gram-positive diplococci on gram stain of cerebrospinal fluid. What is your diagnosis, and what is the empirical treatment for this diagnosis?
Pneumococcal meningitis; ceftriaxone, dexamethasone and vancomycin [S pneumoniae is the most common cause of meningitis in adults. The patient should be treated empirically for presumed meningitis with ceftriaxone, vancomycin, and dexamethasone]
200
This type of headache is known as the “executive” headache, is more common in men, and commonly presents with unilateral pain centered around one eye
Cluster headache
200
What would the dementia of “multiple infarcts” of the brain (strokes) be called? What is a characteristic of this dementia?
Vascular dementia; a stepwise decline in function
200
A gentleman presents with a history of falling unexpectedly over the last several months. He also tell you that he is unable to “look down at the newspaper,” which he enjoys reading every morning before work. What disorder is now at the top of your differential diagnosis?
Progressive supranuclear palsy (PSP); falling is a classic early sign
300
A patient presents with dysphagia, dysarthria, drooling, food getting stuck in their throat, and coughing/choking while eating. You have localized the problem to the posterior aspect of the tongue and the pharynx. What nerve is most likely involved?
What is the glossopharyngeal nerve (CN IX)
300
A benign essential tremor may improve after administration of?
Alcohol (temporarily) and propranolol; however, treatment is often unnecessary. When it is required because of disability, propranolol may be helpful but will need to be continued indefinitely in doses of 60–240 mg daily orally.
300
What emergency should be considered if a patient complains of the “worst headache of my life”?
Subarachnoid hemorrhage
300
What primary intracranial tumor presents commonly with nonspecific complaints and increased intracranial pressure. As it grows, focal deficits develop? What is the prognosis?
Glioblastoma multiforme; poor prognosis because of rapidly progressive course (~1 year)
300
What autosomal dominant disorder involves gradual onset and progression of chorea and dementia or behavioral change and is seen around the world in all ethnic groups?
Huntington disease [The initial symptoms may consist of either abnormal movements or intellectual changes, but ultimately both occur. The earliest mental changes are often behavioral, with irritability, moodiness, antisocial behavior, or a psychiatric disturbance, but a more obvious dementia subsequently develops.]
400
A patient presents with loss of sensation on the dorsal aspect of their distal second and third digits. What nerve is mostly likely involved?
What is the median nerve
400
Treatment for a lacunar ischemic stroke involves?
ASA and long-term management of risk factors, such as HTN and DM [ASA has been shown to decrease mortality]
400
A 79 year old patient presents to your primary care office complaining of a new onset throbbing, severe, unilateral headache in the right temporal region. The patient also notes some changes in vision and has an elevated ESR. What is your diagnosis, and why is this considered an emergency?
Temporal arteritis (Giant Cell arteritis); increased risk for blindness
400
Spontaneous, nontraumatic intracerebral hemorrhage in patients with no angiographic evidence of an associated vascular anomaly (eg, aneurysm or angioma) is usually due to what?
Hypertension
400
A genetic defect on the short arm of the X chromosome that codes for the protein dystrophin has been identified in this disorder
Duchenne’s muscular dystrophy
500
This is a condition involving lower motor neurons in the brainstem that are needed for swallowing, speaking, and chewing. Symptoms include pharyngeal muscle weakness, progressive loss of speech, tongue muscle atrophy, and emotional lability (outbursts of crying/laughing). Typically, this condition also involves limb weakness with both upper and lower motor neuron symptoms.
What is progressive bulbar palsy (involing CN IX, X, and XII)
500
How would you treat clinically severe or rapidly progressing Guillian-Barré Syndrome?
Plasmapheresis; it is best performed within the first few days of illness and is particularly useful for clinically severe or rapidly progressive cases or those with ventilatory impairment. IVIG is equally helpful and imposes less stress on the cardiovascular system than plasmapheresis.
500
A patient with a spinal cord injury presents with a severe headache, nasal stuffiness, and blurred vision. He also reports that he has not had a bowel movement in 5 days. On physical exam you note that he is hypertensive (BP is normally well controlled), and is sweating on his arms and chest, but his legs show increasing pallor. What is your most likely diagnosis?
Autonomic dysreflexia
500
Benign intracranial hypertension is also known as
Pseudotumor cerebri
500
The following characteristics describe what condition: fluctuating muscle weakness, diplopia, ptosis, and difficulty swallowing, symptoms are worse with increased activity, symptoms are due to a blockade of neuromuscular transmission involving the neurotransmitter acetylcholine.
Myasthenia gravis