Podcast
Questions and Answers
A patient presents with right-sided weakness, left-sided loss of temperature and pain sensation, diminished vibration sense on the right foot, brisk right-sided reflexes, and a positive Babinski sign on the right. Which of the following is the most likely diagnosis?
A patient presents with right-sided weakness, left-sided loss of temperature and pain sensation, diminished vibration sense on the right foot, brisk right-sided reflexes, and a positive Babinski sign on the right. Which of the following is the most likely diagnosis?
A 59-year-old female with metastatic cancer is crying, expressing a desire to die, and reports severe pain. What is the most likely underlying cause of her desire to die?
A 59-year-old female with metastatic cancer is crying, expressing a desire to die, and reports severe pain. What is the most likely underlying cause of her desire to die?
A 42-year-old female reports 3 months of insomnia and discomfort while lying in bed. What is the next best step in management?
A 42-year-old female reports 3 months of insomnia and discomfort while lying in bed. What is the next best step in management?
A 58-year-old male loses consciousness while shaving, a tilt-table test reveals no abnormalities. What is the most likely diagnosis?
A 58-year-old male loses consciousness while shaving, a tilt-table test reveals no abnormalities. What is the most likely diagnosis?
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A 45-year-old female with diabetes presents with fundoscopic findings including hard exudates, cotton wool spots, and scattered hemorrhages. What is most likely diagnosis?
A 45-year-old female with diabetes presents with fundoscopic findings including hard exudates, cotton wool spots, and scattered hemorrhages. What is most likely diagnosis?
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Which of the following medications, not typically classified as an antipsychotic, can cause tardive dyskinesia?
Which of the following medications, not typically classified as an antipsychotic, can cause tardive dyskinesia?
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A 56-year-old male with a history of alcoholism is admitted acutely intoxicated and is given thiamine. This intervention is most likely to decrease which of the following?
A 56-year-old male with a history of alcoholism is admitted acutely intoxicated and is given thiamine. This intervention is most likely to decrease which of the following?
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A 50-year-old female presents with muscle pain, fatigue, an elevated erythrocyte sedimentation rate (ESR), and elevated creatine kinase (CK) . Which of the following is the most likely diagnosis?
A 50-year-old female presents with muscle pain, fatigue, an elevated erythrocyte sedimentation rate (ESR), and elevated creatine kinase (CK) . Which of the following is the most likely diagnosis?
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What is the main distinguishing feature of polymyositis compared to PMR?
What is the main distinguishing feature of polymyositis compared to PMR?
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In a patient presenting with proximal muscle weakness and elevated creatine kinase, what is the next best diagnostic step for polymyositis?
In a patient presenting with proximal muscle weakness and elevated creatine kinase, what is the next best diagnostic step for polymyositis?
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What is the appropriate initial treatment for a patient diagnosed with temporal arteritis?
What is the appropriate initial treatment for a patient diagnosed with temporal arteritis?
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What condition is likely if a 72-year-old male with prostate cancer presents with neurologic findings?
What condition is likely if a 72-year-old male with prostate cancer presents with neurologic findings?
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What is the next best step in management for a patient suspected of having spinal cord compression due to cancer?
What is the next best step in management for a patient suspected of having spinal cord compression due to cancer?
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Study Notes
Neurological Diagnoses and Management
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Brown-Sequard Syndrome: Caused by viral infection, presents with right-sided weakness, left-sided temperature/pain loss, diminished vibration in right foot, brisk reflexes and Babinski sign on right side.
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Pain Management in Cancer Patients: Inadequate pain control is a leading reason for patients with metastatic cancer wanting to die. Addressing pain management is crucial.
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Restless Leg Syndrome: Often caused by iron deficiency. Initial management step is checking serum iron and ferritin levels. If levels are normal, dopamine agonists (e.g., pramipexole, ropinirole) are the next step.
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Restless Legs Syndrome and Parkinson's Disease: Patients with restless legs syndrome have an increased risk of developing Parkinson's disease later in life, potentially due to dopamine transmission issues.
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Carotid Sinus Hypersensitivity: Loss of consciousness during shaving, with a negative tilt-table test, suggests this condition. A positive tilt-table test would point to vasovagal syncope.
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Diabetic Retinopathy: Hard exudates, cotton wool spots, and scattered hemorrhages in fundoscopic examination indicate diabetic retinopathy.
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Tardive Dyskinesia and Metoclopramide: Metoclopramide, a D2 antagonist, can cause tardive dyskinesia, prolong the QT interval, and lead to hyperprolactinemia. This is important to differentiate from antipsychotic drugs.
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Bupropion and Seizures: Bupropion, an antidepressant, can cause seizures. This is important to note.
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Frontal Lobe Injury - Conceptual Planning: Frontal lobe injury, (e.g. from a car accident), can lead to deficits in conceptual planning.
Vitamin B1 Deficiency (Wernicke's Encephalopathy)
- Acute Alcoholism and Wernicke's Encephalopathy: Administering B1 (thiamine) in acutely intoxicated alcoholics is crucial. B1 administration significantly reduces the risk of anterograde amnesia. (Wernicke's triad mnemonic is helpful here; A COW → Ataxia, Confusion, Ophthalmoplegia, Wernicke).
Alcohol Withdrawal Symptoms
- Alcohol Withdrawal Tremors: Sudden reduction in alcohol intake (from 12 beers a day to 4 beers a day) can cause tremulousness leading to possible delirium tremens or alcoholic hallucinosis. Administering chlordiazepoxide (anxiety med) can help prevent or treat these symptoms.
Inflammatory Muscle Conditions
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Polymyositis: Characterized by high ESR and CK (creatine kinase) levels, and proximal muscle weakness. Diagnosis can involve anti-Jo1/-Mi2 antibodies, or electromyography/nerve conduction studies. Muscle biopsy provides definitive diagnosis.
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Polymyalgia Rheumatica (PMR): High ESR, muscle pain and stiffness but usually no muscle weakness or high CK. No specific blood tests are commonly used to definitively diagnose PMR.
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Difference Between PMR and Polymyositis: The key differentiating factor is the presence or absence of muscle weakness and elevated CK levels.
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Temporal Arteritis: Temporal headaches, muscle pain, and stiffness with elevated ESR may indicate temporal arteritis. Crucial next step is giving intravenous methylprednisolone immediately, followed by a biopsy of the temporal artery.
Neurological Findings from Cancer
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Spinal Cord Compression from Cancer: Suspect spinal cord compression (from cancer or trauma) if a patient with cancer presents with neurologic findings. If a corticosteroid is listed, administer it first, before considering an MRI.
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Breast Cancer/Prostate Cancer and Neurologic Finding: Neurologic findings in patients with either breast or prostate cancer may be due to metastasis. Administer high-dose intravenous dexamethasone or steroids if listed before an MRI to assess and mitigate the potential for spinal compression.
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Description
Test your knowledge on various neurological disorders and their management strategies. This quiz covers conditions like Brown-Sequard Syndrome, Restless Leg Syndrome, and pain management in cancer patients. Evaluate your understanding of diagnosis and treatment approaches in neurology.
