NBME CMS forms 1‐4 NEURO
NEURO FORM 1 Boy has hyperfeflexia nad papilledema from falling from tree 2 weeks ago SE of metoclopramide Unconscious, laying in vomitous, obtunded, HTN First step in unconscious pt w/ possible intracerebral bleed (fell over) Unkempt, icteric w occult blood “irregular lapses of postural tone when arms extended” Difference btwn lambert eaton and polymyositis
Tx of vertebral artery dissection Vegetation + regurge (two major dukes criteria) Baby w/ sunken anterior fontanelle, sunken eyes, dry mucous membrane + seizure Aerosolized bio weapon
Bilateral weakness that started w/ “shooting pains” in both legs and weakness in bilateral hands later. Child awakens from sleep w/ leg pain Schober test Kid has heel pain, can’t bend over, fam hx Function of inferior oblizue Man can’t look up after being hit in face w/ ball Past hx of l acoustic neuroma, pt has what dz. Years later, her other year has hearing loss. Abdominal pain, diarrhea, lacrimation, salivating Tx of organiphosphate Acute onset back pain w/ positive straight leg test in construction worker
NMS neurotransmitter that’s responsible NEURO FORM 2 Ipsliat blindness due to central retinal artery occlusion Double vision, droopy eyelid, tired looking up, dx and tx? Riskfactor for temporal arteritis
Subdural hematoma Looks like parkinsons! Brain bleed, high ICP Intubate intubate intubate intubate intubate intubate intubate intubate. Hepatic encephalopathy Hepatic encephalopathy (astrexis) Lambert: lung cancer, improve w/ stimulation polymyositis: develops over 6 weeks or so, no lung issues. Oral warfarin ENDOCARDITIS GIVE ABX ASAP (pt can stroke out) Dehydration seizure; dx dehydration by measuring serum sodium Botulism (flaccid motor paralysis starting at neck and shoulders downward) Guillain barre syndrome.
Growing pains Decreased spine flexion seen in ankylosing spondylitis Ankylosing spondylitis ( high ESR) Look up Entrapment of inferior oblique Neurofibromatosis (bilateral acoustic neuromas, but not at the same time) Organophosphate INCREASED cholinergic activity 2/2 blockage of acetylcholinesterase Atrophine + pralidoxime Slipped disk, no further testing needed (get MRI or xray if pt has red flags ‐ >50, malignancy, neuro deficit) Massive glutamate release
Temporal arteritis Myasthenia pyridostigmine Polymyalgia rheumatica
NBME CMS forms 1‐4 NEURO
Tibia fracture after MVA/painw/ cast PAIN W/ EXTENSION OF TOES Back pain + pain w/ passive straight leg+ bowel/bladder incontinence PT JUST HAS BACK PAIN and + SLT, SHOULD U GET MRI? What anatomical location damaged in horners Child not saying intelligible words, bables, screams, next step? Heacache relieved by acetaminophine, physical exam is normal Abrupt Romberg, “constricted “visual fields on close and far testing (tunnel vision), “collapsing effort” on strength, loss of vibration exactly at midline. “left eye doesn’t move past midline” Triad of wernickes encephalopathy Diagnostic test in pt w/ rheumatoid arthritis Vertigo, hearing loss tinnitus, occours over and over again How to get a endolymphatic fistula
“irrigularly irregular” heart + stroke symtoms Right shoulder injury w/ anterior dislocation.
FORM 3 NEURO conus medullaris compression LEAD posioning Teeth grinding Cerebral edema (papilledema) caused by htn Papiledema + hemorrhages Optic glioma Hearing loss + facial droop South america + seizure + cysts in brain Difficulty moving hand, hand weakness, next step BEST TEST FOR CARPAL TUNNEL 10Yo boy w/ involuntary movements
Compartment syndrome measure compartment pressure emergency fasciotomy. Pulses are normal. Cauda equina syndrome get MRI ASAP. NO Lower neck (above T1), stellate ganglion (dissection), spinal cord (pancost), Test hearing, audiometry Tension headache All signs of Conversion disorder.
Lateral rectus palsy, seen in wernicke’s encephalopathy (B1 dif) Encephalopathy, opthalmoplegia, ataxia. MRI of cervical spine to check for cervical subluxation deformity Meniere disease Trauma then meinere symtoms Neurocystercercosis (contaminated food w/ feces, seizure, ring enhancing/swiss cheese brain)
Afib embolic stroke. Axillary nerve damage.
Cauda equina syndrome (urinary incontinence ). Foot drop (CHECK FOR HOME WHISKY DISTILLERY) ecstasy overdose Hypertensive encephalopathy Hypertensive encephalopathy Neurofibromatosis type 1 Acustic neroma affecting VIII and VII Neurocystercercosis Electrophysiologic studies (EMG) EMG Shndhams corea (autioimmne basal gangla).
NBME CMS forms 1‐4 NEURO
Pain in thumb Homeless person having seizure Fever, can’t move lower extremities, painful leg infection, not obtunded Tx of long term prevention of afib Tx of acte afib Decreased pinprick in upper extremities, atrophy of forearms and hands bilaterally
NBME NEURO FORM 4 Why give thiamine before glucose Pt has breast cancer, bilateral numbness in feet, positive babinski Mcardle disease? Bell’s palsy Kicking wife while asleep CT shows Ring enhancing lesion in AIDS pt, nest step in management? Anticholinergics improove Anticholinergics worsen How to prevent transmission of shingles Cause of amaurosis fugax Tx of lacunar (htn) infarct? “small infarction in thalamus” breast cancer says she needs more morphine small cell carcinoma ‐‐> SIADH ‐‐> what lab value? High RBC in baby’s CSF! DX? Man faints ONLY when he shaves neck CSF of enterovirus meningitis Jerking movements in old man, facial grimicing, leg spasm Old M fever stiff neck, what dx and organsim Best preventitive tx for migraine Best predisposing factor for MS Tx for toxo Right enhancing lesion in right parietal lboe Renal failure, Cr 5, what brain problem? Worst headache of life, pupil affected, what location
C6 radiculopathy Is always etoh withdrawl lorazepam Infection resulted in Epidural abscess (can even have nucal rigidity). Warfarin Heparin Syringomyelia
Prevents Wernicke encephalopathy (anteriograde amnesia) Epidural spinal cord compression (metastatic disease). Destruction of nerve? REM sleep disorder polysomnography LP to distinguish between primary cns lymphoma vs. toxo Parkinsons Alzheimers Avoid contact with pt until rash resolved Ulcerative plaque in internal carotid Antihypertensives ONLY (no warfarin, heparin, enoxaparin or anhthing else). Htn lucanar infarct! Give her more. HYPONATREMIA (too much ADH) HERPES simplex meningitis give acyclovir asap Carotid sinus hypersensitivity. Prodromal + Low WBC, high protein, normal glucose Atrophy of caudate (this is huntingtons) Step pneumo meningitis (MCC of meningitis). Betablocker (propranolol) White ppl (ancestry) Sulfadiazine pyrimethamine (not trim sulfa) toxoplasmosis Uremic encephalopathy PCOM artery HERNEATED NUCLEOUS PULPOSIS!
Pt jerks after door slams (loud noises)
Crutzfeldt Jakob disease
NBME CMS forms 1‐4 NEURO
