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and Answers A+ Guide Exam
Unilateral facial muscle weakness is due to swelling of CN VII - correct answers✅✅ Bell's Palsy Bell's palsy has strong associated with what illness - correct answers✅✅ HSV Bell's Palsy tx - correct answers✅✅ prednisone gradual onset of chorea and restlessness, progressing to choreiform movements - correct answers✅✅ Huntington Disease Huntington Disease initial imaging study - correct answers✅✅ MRI Huntington Disease confirmatory dx - correct answers✅✅ DNA testing Huntington Disease tx (3) - correct answers✅✅ a. There is no cure. b. dopamine blockers for the chorea & psychosis c. Anxiolytic & antidepressant therapy A 48 year-old male presents with a mild tremor that seems to increase with stressful situations and subsides when he has a glass of wine with dinner. The patient does not demonstrate the tremor at rest but it reappears when he reaches for a pen. Which of the following is most likely the cause of this patient's symptoms? A. Parkinson disease B. Essential tremor
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C. Huntington disease D. Focal torsion dystonia - correct answers✅✅ (u) A. Parkinsonism is characterized by combination of tremor, rigidity, bradykinesia, and postural instability. (c) B. Essential tremor can be familial and cause action related hand tremor, head tremor, or voice tremor. The lower extremities are spared and generally no further neurologic findings are present. (u) C. Huntington disease is characterized by gradual onset of chorea and restlessness, progressing to choreiform movements. (u) D. Focal torsion dystonia causes involuntary spasmodic movements including torsion of neck, oromandibular dystonia, or uncontrolled eye blinking. Essential tremor tx - correct answers✅✅ propranolol Bradykinesia, slow shuffling gait, reduced arm swing, slowed rapid alternating movements, infrequent blinking, masklike facies, micrographia, monotonous speech - correct answers✅✅ Parkinson's Disease Parkinson's tx - correct answers✅✅ Levodopa / Carbidopa (Sinemet) Complaining of motor or vocal tics
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progressive weakness that starts peripherally and proceeds centrally over a brief period of time - correct answers✅✅ GBS GBS dx test - correct answers✅✅ CSF analysis A 30 year-old female presents to the office complaining of generalized weakness and reduced exercise tolerance that improves with rest. On physical examination you note the presence of bilateral eyelid ptosis, proximal muscle weakness and NORMAL reflexes. What is the most likely diagnosis? A. Lambert-Eaton syndrome B. Organophosphate intoxication C. Multiple sclerosis D. Myasthenia gravis - correct answers✅✅ EXPLANATIONS: (u) A. Common symptoms of Lambert-Eaton syndrome are proximal muscle weakness of lower limbs, cranial nerve findings, and depressed or absent reflexes. Patients commonly have a malignancy. (u) B. Patients with organophosphate intoxication have seizures, excessive secretions, wheezing and diaphoresis. (u) C. Patients with multiple sclerosis have multiple lesions in time and space. (c) D. Common symptoms of myasthenia gravis are fatigable weakness, ptosis, diplopia, and proximal muscle weakness. The disease is more common in women in the 2nd and 3rd decade and in men older than 60.
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Episodic diplopia progressing to proximal weakness worsened by repetition and lacking sensory deficits - correct answers✅✅ Myasthenia Gravis Myasthenia Gravis tx - correct answers✅✅ Pyridostigmine / Neostigmine Myasthenia Gravis initial dx - correct answers✅✅ edrophonium (tensilon) test most specific test for Myasthenia Gravis - correct answers✅✅ (+) Ach- receptor Antibodies relapsing weakness of the limbs sensory loss, paresthesias visual changes. Diagnosis is based on history and either abnormal brain or spinal cord MRI, or visual, auditory, or somatosensory evoked electrical response. - correct answers✅✅ MS Degeneration of white matter, optic nerve, and spinal cord - correct answers✅✅ MS MS test of choice - correct answers✅✅ Gadolinium uptake MRI MS tx for acute attacks - correct answers✅✅ steroids
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cluster headache tx - correct answers✅✅ O cluster HA ppx - correct answers✅✅ verapamil migraine ppx (5) - correct answers✅✅ topiramate, propranolol, amitriptyline, valproic acid, and botulinum toxin type A migraine 1st line tx - correct answers✅✅ NSAIDs + acetaminophen migraine 2nd line tx - correct answers✅✅ Sumatriptan (5-HT receptor agonists) Patient with hx of migraines with CAD. What med is contraindicated? - correct answers✅✅ Sumatriptan tension headache 1st line tx - correct answers✅✅ NSAIDs, acetaminophen, aspirin A 50 year-old female has a history of severe, stabbing pains, lasting only seconds, over the cheek and chin areas. She also experiences intense pain in these areas with chewing, washing her face and even with smiling. Examination reveals no sensory or motor deficits. Head computer tomography (CT) and erythrocyte sedimentation rate (ESR) are normal. She has been unresponsive to maximum doses of carbamazepine. What is the next best option for this patient? A. Combination simvastatin (Zocor) and sertraline (Zoloft) B. Bilateral deep brain stimulation C. Stereotactic (Gamma knife) radiosurgery
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D. High dose corticosteroid therapy - correct answers✅✅ Explanations (u) A. See C for explanation. (u) B. See C for explanation. (c) C. Trigeminal neuralgia is generally responsive to Carbamazepine however, for those who fail to respond to medicinal therapy surgery is the next valid option. Though there are various procedures, Stereotactic (Gamma knife) radiosurgery has provided the best results. (u) D. See C for explanation. Trigeminal neuralgia 1st line tx - correct answers✅✅ carbamazepine Epidural hematoma are (venous/arterial) bleeds - correct answers✅✅ arterial how will epidural hematoma show on CT - correct answers✅✅ convex / lens shaped epidural hematoma tx - correct answers✅✅ surgery subdural hematoma are (venous/arterial) bleeds - correct answers✅✅ venous how will subdural hematoma show on CT - correct answers✅✅ concave / crescent shaped crosses suture lines
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D. Internal carotid artery - correct answers✅✅ Explanations (u) A. Patients with anterior cerebral artery stroke will have findings greater in the legs than hands. (c) B. This case is a description of a middle cerebral artery stroke. (u) C. Posterior cerebral artery stroke patients will have midbrain and thalamic or sensory findings. (u) D. Internal carotid artery stroke patients will have amaurosis fugax, visual disturbances and crossed symptoms Where is the location of the stroke? findings greater in the legs than hands - correct answers✅✅ ACA Where is the location of the stroke? midbrain and thalamic or sensory findings - correct answers✅✅ PCA Where is the location of the stroke? amaurosis fugax, visual disturbances and crossed symptoms - correct answers✅✅ internal carotid artery Where is the location of the stroke?
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coma cranial nerve palsies apnea drop attack vertigo - correct answers✅✅ basilar artery Where is the location of the stroke? clumsy hand syndrome ataxic hemiparesis (usually leg/foot weakness on ipsilateral side) - correct answers✅✅ lacunar stroke C/I to tPA (4) - correct answers✅✅ 1. >3hrs
- Head trauma / CVA <6mo ago
- BP >185/110mmHg
- Hemorrhagic stroke stroke imaging study - correct answers✅✅ CT #1 RF for TIA - correct answers✅✅ HTN meningitis tx 2/2 to listeria monocytogenes - correct answers✅✅ ampicillin
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high neutrophils high protein low glucose - correct answers✅✅ bacterial what type of meningitis? increased CSF mononuclear cells - correct answers✅✅ viral A 2 month-old infant has had a single, generalized tonic-clonic convulsion lasting 4 to 5 minutes. There is no history of trauma and the infant had been well previously. Physical findings include a temperature of 39.6 degrees C (103.2 degrees F), a bulging tympanic membrane on the right, and an inflamed pharynx. The next most appropriate step is to A. perform a lumbar puncture. B. order x-ray studies of the skull. C. obtain an electroencephalogram. D. send home with antibiotics and an anticonvulsant. - correct answers✅✅ Explanations (c) A. Febrile convulsions are uncommon under the age of 3 months. The physical findings suggest the possibility of meningitis, so lumbar puncture with CSF analysis is indicated. (u) B. See A for explanation. (u) C. See A for explanation. (h) D. See A for explanation. In addition, anticonvulsant therapy is not indicated for febrile seizures.
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Household contacts of a patient with bacterial meningitis are best treated with.... - correct answers✅✅ CIPRO (c) B. Rifampin, Cipro, Levaquin, Zithromax and Rocephin are the drugs of choice. meningitis tx for infants (2) - correct answers✅✅ ampicillin + cefotaxime C/I to performing LP in suspected meningitis (5) - correct answers✅✅ focal neurologic signs (papilledema) hx cancer/immunocompromised seizures AMS space occupying lesions with elevation of ICP MCC of encephalitis - correct answers✅✅ HSV encephalitis dx - correct answers✅✅ CT + LP what will LP show in encephalitis (3) - correct answers✅✅ lymphocytosis normal glucose
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A patient describes a history of intermittent and uncontrollable twitching of his right hand that spreads to involve the entire arm after a few minutes. Afterward, the arm is extremely weak. There are no other areas of involvement, sensory deficit or altered consciousness. What is the most likely seizure diagnosis? - correct answers✅✅ simple partial The lack of altered consciousness and focal motor symptoms are strongly indicative of this type of seizure. generalized complex seizure tx - correct answers✅✅ phenytoin or carbamazepine partial seizure tx - correct answers✅✅ phenobarbital absence seizure tx - correct answers✅✅ ethosuximide or valproic acid What is the appropriate initial intravenous drug therapy for a patient in status epilepticus? Answers A. Midazolam (Versed) B. Lorazepam (Ativan) C. Fosphenytoin (Mesantoin) D. Phenobarbital - correct answers✅✅ Explanations (u) A. See B for explanation. (c) B. A benzodiazepine (lorazepam) is first line in the treatment of status epilepticus, followed by phenytoin or fosphenytoin. (h) C. See B for explanation.
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(h) D. This answer is potentially harmful because the patient is currently seizing and lorazepam is indicated. numbness and tingling, primarily on the medial surface of the arm and into the ulnar side of the hand into the fourth and fifth digits which nerve root? - correct answers✅✅ C neck and upper shoulder numbness and pain which nerve root? - correct answers✅✅ C deltoid and shoulder numbness and pain, and biceps and brachioradialis tendon reflexes may be diminished. Numbness, if it occurs, is in the lateral arm - correct answers✅✅ C numbness and tingling down the arm into the thumb, with weakness in the bicep muscle and diminished brachioradialis tendon reflex in the affected extremity - correct answers✅✅ C numbness and pain down the affected arm but into the middle finger, and the triceps reflex may be diminished on exam - correct answers✅✅ C normal pressure hydrocephalus triad - correct answers✅✅ slowly progressive gait disorder followed by impairment of mental function
