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  #1  
Old 07-04-2015
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Default any insight, mastery series neuro 1 and 2 questions

some questions from neuro 1/2 forms. any insight would help thank you!
1.
72 year old man comes to the physician bc he has had several 4 min episodes of twithcing of the left arm since discharge frm the hospital 3 weeks ago, following a right cerebral hemisphere infarction. exam shows no abnormalities except mild left hemiparesis. which is the most likely cause of pts symptoms?

absence seizure
atonic seizure
complex partial
myoclonic -- put this, was not correct.
psyhogenic seizure
simple partial

2. an 82 year old woman with mild dementia, alzheimer is admitte for txt of pyelonephritis, she has been living at home under care of her husband. she has been receiving IV abx for 1 day, her pulse is 90/min and resp are 16/min bp is 152/70. PE shows CVA tenderness. MSE she is alrt , oriented to person , place but not time. she is calm. her husband is concerned bc she has become more confused and agitated, when she is away from home, esp at night. which is the most appropriate to prevent agitation while she is hospitlized. ?

bright illumination of room at all times
dec ambient nose and interruptions at night
hourly orientaiton by nurses to her situation
low dose haloperidol - i put this not correct.
use of restraints as needed

3. 77 year old woman is bought to the ED 5 hours after onset of dizziness, blurred vision numbness of the right side of her face, slurred speech. she has 3 similar 30-40 min episodes during the past week. she feels well in between episodes. she has tinnutius in her left ear caused by chronic mastoiditis and neck pain caused by OA. she undergoes cervical manipulation by chiropractor 4x/monthly. she underwent CABG 4 yrs ago. meds include: clopidogrel, isosorbide. her pulse is 85 resp 20 and bP 140/104 . EXAM including neuro is normal except well healed midline sternal scar, ct head and MRi are Normal. MRA shows dissection of right vertebral artery. what is the most appropriate txt

iv hep
iv TPA
iv urokinase
oral dipyridamole- not correct
oral warfarin

4
an 18 year old man comes to the phys bc of difficly walking x 1 week exam shows visual fields that are equally constrict in both eyes on closeand distant testing. he has collapsing effort on muscle strength testing in left extremities. he staggers from side to side when walking but doesnt fall. on romberg he falls to the left. there is hemisensory loss to light touch, prinpick, vibration and proprioception on the left that stops exactly midline. dx>

cerebrellar degene. -not correct
cervical SC compression
conversion disordder
GBS
MS
sensory neuropathy
Tabes dorsalis
VIT b12 def.

5
70 year old man is broguht to the EF 1 hour after sudden onset of incoordination and clumliness. he has fallen seeveral x PE shows broad-based unsteady gait and resting tremor. left eye doesnt move past midlie. he is oriented to person but not to place or time. and is vague and rambling in his hx. dx?

freidreich ataxia
wilsons
spinocerebellar ataxia, type 1 -not correct.
wernicke

6
47 yo W comes tot he physc bc of a 4 month hx of difficulty walking, constant headache, urinary incontience. her symptoms have worsened over the past month. txt with acetaminiophen and ibupro. have not helped. mild memory impiarment since MVA 5 years ago which she lost conciosuness. she has two generalized tonic clonic seizures / 1 year. her sister has MS. vital signs normal. exam shows normal strength in Upper and lower Exteme. and inc muslce tone in LE. DTR are normal in UE and brisk in LE. babinski is present BL. her gait is broad based and spatic. sensation is intact. where is her lesion

cauda equina
cervical SC
parasaggital cerebral cortex
pons
thoraic SC -not correct

thank you whoever decides to take time out and answer.
i hope this helps others too!
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  #2  
Old 07-08-2015
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Quote:
Originally Posted by alittlebitmore View Post
some questions from neuro 1/2 forms. any insight would help thank you!
1.
72 year old man comes to the physician bc he has had several 4 min episodes of twithcing of the left arm since discharge frm the hospital 3 weeks ago, following a right cerebral hemisphere infarction. exam shows no abnormalities except mild left hemiparesis. which is the most likely cause of pts symptoms?

absence seizure
atonic seizure
complex partial
myoclonic -- put this, was not correct.
psyhogenic seizure
simple partial

2. an 82 year old woman with mild dementia, alzheimer is admitte for txt of pyelonephritis, she has been living at home under care of her husband. she has been receiving IV abx for 1 day, her pulse is 90/min and resp are 16/min bp is 152/70. PE shows CVA tenderness. MSE she is alrt , oriented to person , place but not time. she is calm. her husband is concerned bc she has become more confused and agitated, when she is away from home, esp at night. which is the most appropriate to prevent agitation while she is hospitlized. ?

bright illumination of room at all times
dec ambient nose and interruptions at night
hourly orientaiton by nurses to her situation
low dose haloperidol - i put this not correct.
use of restraints as needed

3. 77 year old woman is bought to the ED 5 hours after onset of dizziness, blurred vision numbness of the right side of her face, slurred speech. she has 3 similar 30-40 min episodes during the past week. she feels well in between episodes. she has tinnutius in her left ear caused by chronic mastoiditis and neck pain caused by OA. she undergoes cervical manipulation by chiropractor 4x/monthly. she underwent CABG 4 yrs ago. meds include: clopidogrel, isosorbide. her pulse is 85 resp 20 and bP 140/104 . EXAM including neuro is normal except well healed midline sternal scar, ct head and MRi are Normal. MRA shows dissection of right vertebral artery. what is the most appropriate txt

iv hep
iv TPA
iv urokinase
oral dipyridamole- not correct
oral warfarin

4
an 18 year old man comes to the phys bc of difficly walking x 1 week exam shows visual fields that are equally constrict in both eyes on closeand distant testing. he has collapsing effort on muscle strength testing in left extremities. he staggers from side to side when walking but doesnt fall. on romberg he falls to the left. there is hemisensory loss to light touch, prinpick, vibration and proprioception on the left that stops exactly midline. dx>

cerebrellar degene. -not correct
cervical SC compression
conversion disordder
GBS
MS
sensory neuropathy
Tabes dorsalis
VIT b12 def.

5
70 year old man is broguht to the EF 1 hour after sudden onset of incoordination and clumliness. he has fallen seeveral x PE shows broad-based unsteady gait and resting tremor. left eye doesnt move past midlie. he is oriented to person but not to place or time. and is vague and rambling in his hx. dx?

freidreich ataxia
wilsons
spinocerebellar ataxia, type 1 -not correct.
wernicke

6
47 yo W comes tot he physc bc of a 4 month hx of difficulty walking, constant headache, urinary incontience. her symptoms have worsened over the past month. txt with acetaminiophen and ibupro. have not helped. mild memory impiarment since MVA 5 years ago which she lost conciosuness. she has two generalized tonic clonic seizures / 1 year. her sister has MS. vital signs normal. exam shows normal strength in Upper and lower Exteme. and inc muslce tone in LE. DTR are normal in UE and brisk in LE. babinski is present BL. her gait is broad based and spatic. sensation is intact. where is her lesion

cauda equina
cervical SC
parasaggital cerebral cortex
pons
thoraic SC -not correct

thank you whoever decides to take time out and answer.
i hope this helps others too!
1. I think the answer here is simple partial. It could have been complete partial but there was no loss of consciousness. I am not quite sure of Myoclonic seizure can happen unilateral, as far as I know it's usually general. Paresis after seizure is called Todd's paralysis.

2. I think the correct answer is to minimize stimulation but providing a conducive environment. So the answer could be B, or decrease ambient noise.

3. I think the correct answer is TPA, since the patient seems to be having an ischemic stroke/transient ischemic attack (TIA)

4. This is a hard question. It seems that his lesion doesn't fit a specific pattern. He should have cross-deficit owing to the level of motor and sensory involved. But he doesn't. It looks like he has Brown-Sequard on a very high spinal level, which is not possible. So i think the patient has conversion disorder. Not sure though.
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  #3  
Old 08-05-2015
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Default answers

Quote:
Originally Posted by alittlebitmore View Post
some questions from neuro 1/2 forms. any insight would help thank you!
1.
72 year old man comes to the physician bc he has had several 4 min episodes of twithcing of the left arm since discharge frm the hospital 3 weeks ago, following a right cerebral hemisphere infarction. exam shows no abnormalities except mild left hemiparesis. which is the most likely cause of pts symptoms?

absence seizure
atonic seizure
complex partial
myoclonic -- put this, was not correct.
psyhogenic seizure
simple partial

2. an 82 year old woman with mild dementia, alzheimer is admitte for txt of pyelonephritis, she has been living at home under care of her husband. she has been receiving IV abx for 1 day, her pulse is 90/min and resp are 16/min bp is 152/70. PE shows CVA tenderness. MSE she is alrt , oriented to person , place but not time. she is calm. her husband is concerned bc she has become more confused and agitated, when she is away from home, esp at night. which is the most appropriate to prevent agitation while she is hospitlized. ?

bright illumination of room at all times
dec ambient nose and interruptions at night
hourly orientaiton by nurses to her situation
low dose haloperidol - i put this not correct.
use of restraints as needed

3. 77 year old woman is bought to the ED 5 hours after onset of dizziness, blurred vision numbness of the right side of her face, slurred speech. she has 3 similar 30-40 min episodes during the past week. she feels well in between episodes. she has tinnutius in her left ear caused by chronic mastoiditis and neck pain caused by OA. she undergoes cervical manipulation by chiropractor 4x/monthly. she underwent CABG 4 yrs ago. meds include: clopidogrel, isosorbide. her pulse is 85 resp 20 and bP 140/104 . EXAM including neuro is normal except well healed midline sternal scar, ct head and MRi are Normal. MRA shows dissection of right vertebral artery. what is the most appropriate txt

iv hep
iv TPA
iv urokinase
oral dipyridamole- not correct
oral warfarin

4
an 18 year old man comes to the phys bc of difficly walking x 1 week exam shows visual fields that are equally constrict in both eyes on closeand distant testing. he has collapsing effort on muscle strength testing in left extremities. he staggers from side to side when walking but doesnt fall. on romberg he falls to the left. there is hemisensory loss to light touch, prinpick, vibration and proprioception on the left that stops exactly midline. dx>

cerebrellar degene. -not correct
cervical SC compression
conversion disordder
GBS
MS
sensory neuropathy
Tabes dorsalis
VIT b12 def.

5
70 year old man is broguht to the EF 1 hour after sudden onset of incoordination and clumliness. he has fallen seeveral x PE shows broad-based unsteady gait and resting tremor. left eye doesnt move past midlie. he is oriented to person but not to place or time. and is vague and rambling in his hx. dx?

freidreich ataxia
wilsons
spinocerebellar ataxia, type 1 -not correct.
wernicke

6
47 yo W comes tot he physc bc of a 4 month hx of difficulty walking, constant headache, urinary incontience. her symptoms have worsened over the past month. txt with acetaminiophen and ibupro. have not helped. mild memory impiarment since MVA 5 years ago which she lost conciosuness. she has two generalized tonic clonic seizures / 1 year. her sister has MS. vital signs normal. exam shows normal strength in Upper and lower Exteme. and inc muslce tone in LE. DTR are normal in UE and brisk in LE. babinski is present BL. her gait is broad based and spatic. sensation is intact. where is her lesion

cauda equina
cervical SC
parasaggital cerebral cortex
pons
thoraic SC -not correct

thank you whoever decides to take time out and answer.
i hope this helps others too!
I have chosen them and got em right. I hope it helps
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The above post was thanked by:
mynar (08-05-2015)



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