Podcast
Questions and Answers
What is the next best step in diagnosis for a patient with 32F and paresthesias in the thenar region of the hand?
What is the next best step in diagnosis for a patient with 32F and paresthesias in the thenar region of the hand?
- Electrophysiological testing (correct)
- Tinel sign
- Phalen maneuver
- Flick test
What is the first treatment for carpal tunnel syndrome in a patient who cannot stop the offending activity?
What is the first treatment for carpal tunnel syndrome in a patient who cannot stop the offending activity?
- Triamcinolone injection
- NSAIDs
- Wrist splint (correct)
- Surgery
What is the treatment for cubital tunnel syndrome?
What is the treatment for cubital tunnel syndrome?
Elbow splint
What is cubital tunnel syndrome?
What is cubital tunnel syndrome?
What is Guyon canal syndrome?
What is Guyon canal syndrome?
In a midshaft fracture of the humerus, which nerve is injured?
In a midshaft fracture of the humerus, which nerve is injured?
In a supracondylar fracture of the humerus, which nerve is injured?
In a supracondylar fracture of the humerus, which nerve is injured?
In a medial epicondylar fracture, which nerve is injured?
In a medial epicondylar fracture, which nerve is injured?
In a surgical neck of humerus fracture, which nerve is injured?
In a surgical neck of humerus fracture, which nerve is injured?
What nerve injury is caused by a mastectomy leading to a post-operative winged scapula?
What nerve injury is caused by a mastectomy leading to a post-operative winged scapula?
Which muscle is innervated by the long thoracic nerve?
Which muscle is innervated by the long thoracic nerve?
What is the diagnosis for a 6-year-old with ECG showing miscellaneous arrhythmia and seizure-like episodes?
What is the diagnosis for a 6-year-old with ECG showing miscellaneous arrhythmia and seizure-like episodes?
In a 75-year-old patient with episodes of loss of consciousness and a history of MI, what is the diagnosis?
In a 75-year-old patient with episodes of loss of consciousness and a history of MI, what is the diagnosis?
What is the diagnosis for a patient with 33F + 1-week history of right-sided weakness + left-sided inability to feel temperature/pain + diminished vibratory sensation over right foot + brisk right-sided reflexes + right-sided Babinski sign?
What is the diagnosis for a patient with 33F + 1-week history of right-sided weakness + left-sided inability to feel temperature/pain + diminished vibratory sensation over right foot + brisk right-sided reflexes + right-sided Babinski sign?
What is the most likely reason for a 59F patient with metastatic cancer who expresses wanting to die?
What is the most likely reason for a 59F patient with metastatic cancer who expresses wanting to die?
What is the next best step in management for a 42F patient with a 3-month history of insomnia and discomfort while lying in bed?
What is the next best step in management for a 42F patient with a 3-month history of insomnia and discomfort while lying in bed?
What is the next best step in management for a 42F with insomnia and normal serum iron and ferritin?
What is the next best step in management for a 42F with insomnia and normal serum iron and ferritin?
What disease is a patient with restless leg syndrome at increased risk for later in life?
What disease is a patient with restless leg syndrome at increased risk for later in life?
What is the diagnosis for a 58M who loses consciousness while shaving and has a tilt-table test showing no abnormalities?
What is the diagnosis for a 58M who loses consciousness while shaving and has a tilt-table test showing no abnormalities?
What is the diagnosis for a 45F with hard exudates, cotton wool spots, and scattered hemorrhages seen on fundoscopy?
What is the diagnosis for a 45F with hard exudates, cotton wool spots, and scattered hemorrhages seen on fundoscopy?
What medication can cause tardive dyskinesia that is not an antipsychotic?
What medication can cause tardive dyskinesia that is not an antipsychotic?
Which anti-depressant medication can cause seizures?
Which anti-depressant medication can cause seizures?
What is the most likely cognitive deficit after a frontal lobe injury in a car accident?
What is the most likely cognitive deficit after a frontal lobe injury in a car accident?
What does B1 administration decrease most significantly in a 56M with alcoholism and acute intoxication?
What does B1 administration decrease most significantly in a 56M with alcoholism and acute intoxication?
What is the treatment for a 56M with a 3-day history of alcohol withdrawal who develops tremulousness?
What is the treatment for a 56M with a 3-day history of alcohol withdrawal who develops tremulousness?
What is the diagnosis for a 50F with high ESR, creatine kinase (CK), and proximal muscle weakness?
What is the diagnosis for a 50F with high ESR, creatine kinase (CK), and proximal muscle weakness?
What is the diagnosis for a 50F with high ESR, muscle pain, and stiffness but no mention of high CK or weakness?
What is the diagnosis for a 50F with high ESR, muscle pain, and stiffness but no mention of high CK or weakness?
What is the main difference between PMR and polymyositis?
What is the main difference between PMR and polymyositis?
What is the next best step in diagnosing polymyositis?
What is the next best step in diagnosing polymyositis?
What is the diagnosis for a 59F with temporal headache, muscle pain, stiffness, and high ESR?
What is the diagnosis for a 59F with temporal headache, muscle pain, stiffness, and high ESR?
What is the next best step in diagnosing a 68M with a history of prostate cancer now presenting with neurologic findings?
What is the next best step in diagnosing a 68M with a history of prostate cancer now presenting with neurologic findings?
What is the next best step for a 65F with breast cancer and neurologic findings?
What is the next best step for a 65F with breast cancer and neurologic findings?
What is the diagnosis for a 72M with prostate cancer presenting with neurologic findings?
What is the diagnosis for a 72M with prostate cancer presenting with neurologic findings?
What is the next best step for a patient with brain cancer?
What is the next best step for a patient with brain cancer?
What is the gold standard for diagnosing brain cancer?
What is the gold standard for diagnosing brain cancer?
What is the best method to diagnose a brain bleed?
What is the best method to diagnose a brain bleed?
What is the next best step after a CT confirms an epidural hematoma?
What is the next best step after a CT confirms an epidural hematoma?
What is the next best step after a CT confirms a subdural hematoma?
What is the next best step after a CT confirms a subdural hematoma?
What differentiates an epidural hematoma from a subdural hematoma on CT imaging?
What differentiates an epidural hematoma from a subdural hematoma on CT imaging?
What is the diagnosis and treatment for a patient with blood pressure of 220/120 and confusion?
What is the diagnosis and treatment for a patient with blood pressure of 220/120 and confusion?
What is the diagnosis for a patient with BP of 220/120 after sodium nitroprusside is administered who experiences confusion?
What is the diagnosis for a patient with BP of 220/120 after sodium nitroprusside is administered who experiences confusion?
What drug can be given to prevent vasospasm after subarachnoid hemorrhage (SAH)?
What drug can be given to prevent vasospasm after subarachnoid hemorrhage (SAH)?
What is the diagnosis for severe headache and stiff neck?
What is the diagnosis for severe headache and stiff neck?
What is the diagnosis for a brain bleed in a patient with Alzheimer’s?
What is the diagnosis for a brain bleed in a patient with Alzheimer’s?
What is the next best step for an 87F with Alzheimer’s, low-grade fever, and delirium?
What is the next best step for an 87F with Alzheimer’s, low-grade fever, and delirium?
What is the diagnosis for a viral infection with tinnitus, vertigo, and possible neurosensory hearing loss?
What is the diagnosis for a viral infection with tinnitus, vertigo, and possible neurosensory hearing loss?
What is the diagnosis for a viral infection accompanied by vertigo?
What is the diagnosis for a viral infection accompanied by vertigo?
What is the treatment for an acute flare of multiple sclerosis (MS)?
What is the treatment for an acute flare of multiple sclerosis (MS)?
What is the treatment between flares of MS when the patient is asymptomatic?
What is the treatment between flares of MS when the patient is asymptomatic?
What is the treatment for spasticity in MS?
What is the treatment for spasticity in MS?
What type of incontinence is most common in MS?
What type of incontinence is most common in MS?
What is the mechanism of multiple sclerosis?
What is the mechanism of multiple sclerosis?
How is multiple sclerosis diagnosed?
How is multiple sclerosis diagnosed?
What is the diagnosis for a 27F with intermittent headaches and blurry vision?
What is the diagnosis for a 27F with intermittent headaches and blurry vision?
What is the most specific eye finding in MS?
What is the most specific eye finding in MS?
How can you differentiate a cranial nerve III lesion from internuclear ophthalmoplegia (INO)?
How can you differentiate a cranial nerve III lesion from internuclear ophthalmoplegia (INO)?
What is the diagnosis for a 20F with stiffness of hands, frontal balding, and impaired relaxation of hypothenar muscles?
What is the diagnosis for a 20F with stiffness of hands, frontal balding, and impaired relaxation of hypothenar muscles?
What is the diagnosis for a cancer patient on cisplatin or vincristine who develops neuropathy?
What is the diagnosis for a cancer patient on cisplatin or vincristine who develops neuropathy?
What electrolyte disturbances can cause confusion and/or seizures?
What electrolyte disturbances can cause confusion and/or seizures?
What is the diagnosis for confusion in the setting of high BUN and creatinine?
What is the diagnosis for confusion in the setting of high BUN and creatinine?
What is the diagnosis for floppy baby syndrome and the location of affected CNS/PNS?
What is the diagnosis for floppy baby syndrome and the location of affected CNS/PNS?
What occurs after antipsychotic medication is started and the patient experiences muscle rigidity but no fever?
What occurs after antipsychotic medication is started and the patient experiences muscle rigidity but no fever?
What occurs after antipsychotic medication is started and the patient presents with abnormal eye movements and a stiff neck?
What occurs after antipsychotic medication is started and the patient presents with abnormal eye movements and a stiff neck?
What occurs after antipsychotic medication is initiated with muscle rigidity and fever?
What occurs after antipsychotic medication is initiated with muscle rigidity and fever?
What diagnosis occurs after the administration of an antipsychotic med and the patient experiences restlessness?
What diagnosis occurs after the administration of an antipsychotic med and the patient experiences restlessness?
What is the diagnosis for an antipsychotic medication that causes bradykinesia?
What is the diagnosis for an antipsychotic medication that causes bradykinesia?
What occurs after antipsychotic medication causes abnormal tongue movements?
What occurs after antipsychotic medication causes abnormal tongue movements?
What is the treatment for diabetic neuropathic pain?
What is the treatment for diabetic neuropathic pain?
What is the treatment for herpetic/post-herpetic neuralgia?
What is the treatment for herpetic/post-herpetic neuralgia?
What is the next best step for an 82M diabetic with neuropathic pain already taking carbamazepine and gabapentin?
What is the next best step for an 82M diabetic with neuropathic pain already taking carbamazepine and gabapentin?
How do you differentiate a cluster headache from trigeminal neuralgia?
How do you differentiate a cluster headache from trigeminal neuralgia?
What is the treatment and prophylaxis for cluster headaches?
What is the treatment and prophylaxis for cluster headaches?
What is the treatment and prophylaxis for trigeminal neuralgia?
What is the treatment and prophylaxis for trigeminal neuralgia?
What is the treatment and prophylaxis for migraines?
What is the treatment and prophylaxis for migraines?
What is the diagnosis for a 32M with a diffuse headache relieved by acetaminophen and sleep?
What is the diagnosis for a 32M with a diffuse headache relieved by acetaminophen and sleep?
What are the other high-yield uses for propranolol?
What are the other high-yield uses for propranolol?
What is the most likely tumor in a 47M with bitemporal hemianopsia?
What is the most likely tumor in a 47M with bitemporal hemianopsia?
What is the most likely tumor in an 8M with bitemporal hemianopsia?
What is the most likely tumor in an 8M with bitemporal hemianopsia?
What is the most common primary brain cancer in children?
What is the most common primary brain cancer in children?
What is the diagnosis for a 3F with morning vomiting and truncal ataxia?
What is the diagnosis for a 3F with morning vomiting and truncal ataxia?
What is the most common primary brain cancer in adults?
What is the most common primary brain cancer in adults?
What is the diagnosis for a 44F with lupus presenting with irregular ring-enhancing lesions on head CT?
What is the diagnosis for a 44F with lupus presenting with irregular ring-enhancing lesions on head CT?
What is the treatment for Toxoplasmosis?
What is the treatment for Toxoplasmosis?
What is the diagnosis for a neonate with intracranial calcifications, chorioretinitis, and hydrocephalus?
What is the diagnosis for a neonate with intracranial calcifications, chorioretinitis, and hydrocephalus?
What is the diagnosis for a neonate with intracranial calcifications, deafness, hepatomegaly, and rash?
What is the diagnosis for a neonate with intracranial calcifications, deafness, hepatomegaly, and rash?
What is the diagnosis for a neonate with bilateral deafness due to maternal infection and no other information given?
What is the diagnosis for a neonate with bilateral deafness due to maternal infection and no other information given?
What CNS tumors are seen in neurofibromatosis?
What CNS tumors are seen in neurofibromatosis?
What is the diagnosis for a 50F with jaw pain, headaches, and normal ESR?
What is the diagnosis for a 50F with jaw pain, headaches, and normal ESR?
What diagnosis is suggested by a 40F being treated for TB and having neurologic findings in extremities with possible seizure?
What diagnosis is suggested by a 40F being treated for TB and having neurologic findings in extremities with possible seizure?
What is the diagnosis for a 65F with metastatic breast cancer presenting with a suprapubic mass and decreased sphincter tone?
What is the diagnosis for a 65F with metastatic breast cancer presenting with a suprapubic mass and decreased sphincter tone?
What is the diagnosis for a 44M with saddle anesthesia and late urinary incontinence?
What is the diagnosis for a 44M with saddle anesthesia and late urinary incontinence?
What is the diagnosis for a 44M with perianal anesthesia and early urinary and fecal incontinence?
What is the diagnosis for a 44M with perianal anesthesia and early urinary and fecal incontinence?
What dermatome senses pain when a 48M burns his thumb?
What dermatome senses pain when a 48M burns his thumb?
What does CSF show in Guillain-Barre syndrome?
What does CSF show in Guillain-Barre syndrome?
What is the diagnosis for a 24M with weakness proximally and distally in lower limbs?
What is the diagnosis for a 24M with weakness proximally and distally in lower limbs?
What is the diagnosis for GBS?
What is the diagnosis for GBS?
What is the mechanism of Guillain-Barre syndrome?
What is the mechanism of Guillain-Barre syndrome?
What is the treatment for Guillain-Barre syndrome?
What is the treatment for Guillain-Barre syndrome?
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Study Notes
Brown-Sequard Syndrome
- Presentation includes right-sided weakness, left-sided loss of temperature and pain sensation, diminished vibratory sensation in right foot, brisk right-sided reflexes, and a right-sided Babinski sign.
- Diagnosis is Brown-Sequard syndrome secondary to viral infection.
Pain Management in Cancer Patients
- A 59-year-old female with metastatic cancer and severe pain expressing desires to die likely indicates inadequate pain control, not major depression.
- Importance of managing pain effectively in cancer patients.
Insomnia and Restless Leg Syndrome
- A 42-year-old female with a 3-month history of insomnia and discomfort in bed should have serum iron and ferritin levels checked; iron deficiency is a common cause of restless leg syndrome.
- If iron levels are normal, consider D2 agonists like pramipexole or ropinirole for treatment.
Risk Factors and Neurological Symptoms
- Patients with restless leg syndrome have an increased risk of developing Parkinson’s disease due to the possible underlying dopamine transmission issues.
- A 58-year-old male losing consciousness without abnormalities on tilt-table testing is diagnosed with carotid sinus hypersensitivity.
Ocular Findings and Associated Conditions
- Fundoscopy showing hard exudates, cotton wool spots, and scattered hemorrhages suggests diabetic retinopathy.
- Tardive dyskinesia can occur from medications like metoclopramide, which is a D2 antagonist.
Neurological Drug Effects
- Bupropion is known for inducing seizures as a side effect.
- Frontal lobe injury after an accident may result in deficits in conceptual planning.
Alcohol and Thiamine Deficiency
- Administering B1 (thiamine) to an acutely intoxicated 56-year-old male reduces the risk of anterograde amnesia, primarily associated with Wernicke's encephalopathy.
Alcohol Withdrawal and Treatment
- A 56-year-old male reducing alcohol intake from 12 to 4 beers daily may experience tremors; treatment should include chlordiazepoxide for delirium tremens.
Muscle Weakness and Inflammatory Myopathies
- A 50-year-old female with high ESR and creatine kinase levels presenting with proximal muscle weakness is diagnosed with polymyositis.
- Polymyalgia rheumatica (PMR) presents with high ESR but no CK elevation or muscle weakness.
Differential Diagnosis in Muscle Disorders
- The key difference between polymyositis and PMR is that PMR does not involve proximal muscle weakness and typically has normal CK levels.
- Diagnosis of polymyositis can involve tests for anti-Jo1 or -Mi2 antibodies and electromyography.
Temporal Arteritis and Associated Conditions
- Temporal arteritis presentation includes temporal headaches, muscle pain, stiffness, and elevated ESR; immediate treatment should involve IV methylprednisolone followed by biopsy.
Neurological Findings and Cancer
- In patients with a history of cancer, neurological findings necessitate MRI of the spine to check for metastases, with steroids administered first if indicated.
Brain Tumors and Diagnostic Imaging
- Contrast head CT is crucial to diagnose brain cancers, while non-contrast CT is used for detecting brain bleeds.
- In cases of epidural hematoma, intubation and hyperventilation are prioritized post-CT confirmation.
Managing Headaches
- Subdural hematomas typically require craniotomy following CT confirmation.
- Cluster headaches are treated with 100% oxygen, and prophylaxis involves verapamil.
Types of Headaches and Their Treatments
- Migraine treatment includes NSAIDs followed by triptans for acute attacks, and prophylaxis with propranolol.
- Tension-type headaches are addressed with rest and potential caffeine tapering.
Tumor Types and Characteristics
- Prolactinomas are the most common pituitary tumors in adults, while craniopharyngiomas are most common in children.
- Glioblastoma multiforme is the most common primary brain cancer in adults, presenting as a large, irregular mass on imaging.
Congenital Infections and CNS Tumors
- Congenital toxoplasmosis presents with intracranial calcifications, chorioretinitis, and hydrocephalus, while congenital CMV presents with deafness and rash.
- Neurofibromatosis types I and II are associated with specific CNS tumors like optic nerve gliomas and meningiomas.
Nerve Injuries and Related Conditions
- Ulnar nerve entrapment at the elbow leads to cubital tunnel syndrome; wrist injuries commonly lead to carpal tunnel syndrome.
- Midshaft humeral fractures typically injure the radial nerve, leading to wrist drop.
Guillain-Barré Syndrome
- GBS features include ascending muscle weakness and albuminocytologic dissociation in CSF.
- Treatment includes IVIG and plasmapheresis; steroids are ineffective.
Peripheral Nerve Entrapments
- The first step in treating carpal tunnel syndrome is wrist splinting, followed by steroid injections if necessary.
- Cubital tunnel syndrome treatment focuses on elbow splinting.
Seizures and Cardiac Arrhythmias
- Adam-Stokes attacks result from arrhythmias leading to hypoxia of the brainstem, presenting with seizure-like episodes.
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