Neurology Form 1 Help please?

[Delacroix22]

1.) 62 yo Female with Rheumatoid Arthritis. Well controlled on methotrexate. No steroid therapy for more than 2 weeks during past year. Vitals normal. Cardiopulmonary exam normal. MCP swelling and PIP swelling. Ulnar deviation of hands, nodules on UE. Knees show degenerative changes. Rectal exam shows decreased sphincter tone but otherwise normal. Which of the follow is most appropriate before surgery?
A. Serum RF assay
B. Overnight dexamethasone suppression test
C. Cortisol concentration measurements before, 30 min, 60min, post cosyntropin injection
D. Flextion and extension x-rays of spine
E. Pulmonary function testing (not correct)




2. 82 yo F. Mild Alzheimers. Admitted for pyelonephritis. CVS tenderness. Husband concerned she beccomes agitated when away from home especially at night. Which of the follow should be done to prevent agitation in this patient?
A. Bright illumination of room constantly
B. Decrease noise and interruptions at night
C. Hourly orientation by nurses
D. Low dose haloperidol (not correct)
E. Use of restraints as needed




3. Previously healthy 32 yo F has abrupt onset of severe bifrontal HA/N/V and diplopia 24hr after uncompllicated delivery of 7lb newborn. Also has difficulty breast feeding. Drowsy. Opens eyes and moves on command. Vitals normal. Bitemporal hemianopia and weakness of lateral rectus BL. Right pupil 5mm reacts directly and consensually. Left pupil 3mm reactive. Mild papilledema, no meningismus. Oriented to person and place but not time. Diagnosis?
A. Brain stem infarct
B. Migrane
C. Pituitary apoplexy
D. Sagittal sinus thrombosis
E. SAH (not correct)




4. 62yo M sudden onset numbness/weakness right arma nd face with difficulty in speech. Resolves in 30 minutes. 15year Hx of HTN. BP is 150/85. BL carotid bruits. EKG and Echo normal. BL carotid angiography show 40% stenoses BL. Most effective prevention for cerebral infarct?
A. Aspirin
B. LMWH
C. Warfarin (not correct)
D. Left carotid endartectomy
E. BL carotid endartectomy




5. Previously healthy 62 yo M brought in by wife for confusion x 3 hours. During breakfast he stopped eating and asked his wife the same question 6 times despite her answering. Now he is oriented and clear thinking. Doesn't remember anything since breakfast. Physical and mental exams are normal. Diagnosis?
A. Communicating hydrocephalu
B. Concussion
C. Alzheimers
D. HSV encephalitis
E. Hypoxic-ischemic cencephalopathy (not correct)
F. Hysterical amnesia
G. Transient global amnesia
H. Wernicke-Korsakoff





6. Unkempt 49yo M comes to ED confused and lethargic. Icteric sclera. Arms held extended has irreegular lapses of postural tone. FOBT positive. Diagnosis?
A. Acute alcohol intoxication
B. Epidural hematoma
C. Hepatic encephalopathy
D. Uremic encephalopathy (not correct)
E. Wernicke encephaloptahy

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[suarad32]

Just my opinion here, correct me if I'm wrong:
1. Flex/Ext Xrays - RA patients are at risk for cervical spine subluxation - caution while intubating prior to surgery.
2. Not sure, but I think reduce noises and light at night since delirium (likely in an elderly patient with dementia) is precipitated by messing up the circadian rhythm, especially if it's an ICU.
3. Apoplexy. CN palsies localize to sella with cavernous sinus involvement. Also headache. IIRC, pituitary tumors grow in pregnancy and after delivery they suddenly lose hormonal stimulus and become ischemic. You can get a cerebral venous thrombosis in pregnancy due to the hypercoag state, but bitemporal hemianopia is unlikely in that case.
4. Aspirin prevents emboli from an atherosclerotic plaque. Warfarin is for DVT/PE and AFib. CEA for stenosis >70-80%
5. Not sure, but by eliminating the others I think I would go with transient global amnesia.
6. Hepatic encephalopathy. Unkempt, icteric= homeless alcoholic, FOBT = occult upper GI bleeding from varices. Uremic encephalopathy = CKD, no indication of that here.

Hope that helps

 

[Delacroix22]

Thanks for the help!

I had seen something like question number 2 before, I think you are correct

And number 5 is Transient Global Amnesia like you said. The characteristic "buzz word" situation here is the man repeating his question. Apparently people during a TGA attack sound like they are stuck on repeat and will say the same thing over and over for a bit. And have no recollection of it and return to baseline mental status with no residual ramifications.

Much appreciated