Only $35.99/year

PRITE 2021

Terms in this set (730)

30 yo with intermittent HAs, each attack lasting approx 1 hour. Attacks w/ sharp, stabbing pain around eye, tearing, and nasal congestion. Most effective abortive treatment? (2x)

OXYGEN

60 yo R-handed M, getting lost, only writes on right half of paper. Left sided hemi-neglect. Where is the lesion (8x)

Right Parietal lobe

66 yo with HTN develops vertigo, diplopia, nausea, vomiting, hiccups, L face numbness, nystagmus, hoarseness, ataxia of limbs, staggering gait, and tendency to fall to the left. Dx? (8x)

Lateral Medullary Stroke

26 yo w/HA and R-hand clumsiness for weeks. Exam shows difficulty w/rapid alternating movements of hand, overt intention tremor on finger-to-nose, and mildly dysmetric finger tamping. CNS intact and no papilledema. Where will damage show on MRI? (5x)

Cerebellum

78 yo pt had an ischemic stroke that left him with a residual mild hemiplegia. Pt appeared to be unaware that there was a problem of weakness on one side of this body. When asked to raise the weak arm, the patient raised his normal arm. When the failure to raise the paralyzed arm was pointed out to pt, he admitted that the arm was slightly weak. He also neglects the side of the body when dressing and grooming. Pt did not shave one side of his face, had difficulty putting a shirt on when it was turned inside out. Area of the brain likely affected by stroke? (4x)

RIGHT PARIETAL LOBE

Adult neurogenesis in which area of the brain? (4x)

HIPPOCAMPUS

MRI scan of head reveals an infarct in distribution of left anterior cerebral artery. Pt most likely exhibits: (3x)

WEAKNESS OF CONTRALATERAL FOOT AND LEG, SPARING OF FACE AND ARM, WITH ABULIA

Previously pleasant mom becomes profane and irresponsible over 6 months. Most likely a pathology in: (2x)

FRONTAL LOBE

Rapid onset of right facial weakness, left limb weakness, diplopia: (2x)

BRAIN STEM INFARCTION

In addiction, dopaminergic neurons project to nucleus accumbens. Cell bodies of these neurons reside in which area of the brain? (2x)

VENTRAL TEGMENTAL AREA

Orexin is made in what part of the brain? (2x)

LATERAL HYPOTHALAMIC NUCLEI

Brain area activated by subliminal presentations of emotional faces (2x)

AMYGDALA

Where does histamine synthesis happen? (2x)

HYPOTHALAMUS

Which dopaminergic pathway includes the nucleus accumbens and mediates addiction and associated behaviors/ reinforcing? (2x)

MESOLIMBIC

Which cell types secretes innate pro-inflammatory cytokines TNF - alpha and Il -1 B in pts with inflammatory conditions that affect the brain? (2x)

MICROGLIA

Three major epigenetic mechanisms? (2x)

DNA METHYLATION, HISTONE MODIFICATION, micro-RNAs

Effect of histone acetylation leads to? (2x)

ACTIVATES TRANSCRIPTION

The cortical synaptic remodeling characteristic of normal adolescence is also believed to be associated with what neurobiological change? (2x)

PREFERENTIAL LOSS OF EXCITATORY SYNAPSES

DA release in what structure represents common final event assoc w reinforcing effects of opiates, cocaine, amphetamines, nicotine, PCP, and alcohol? (5x)

NUCLEUS ACCUMBENS

In addiction, dopaminergic neurons project to nucleus accumbens. Cell bodies of these neurons reside in which area of the brain? (3x)

VENTRAL TEGMENTAL AREA

Role of glycine at NMDA receptor (2x)

OBLIGATE COAGONIST

Which neurotransmitter system is the last to mature in the CNS of children and adolescents? (2x)

CHOLINERGIC

A compound that increases muscle mass by increasing episodic secretion of GH (2x):

GAMMA HYDROXYBUTYRATE

Which neurotransmitter is predominantly inhibitory? (2x)

GLYCINE

Neurochemical that reinforces effects of drugs of abuse acutely? (2x)

DOPAMINE

Decreased level of what NT is most associated with depressed mood, poor sleep, and poor impulse control, and affective aggression? (2x)

SEROTONIN

Name the rate-limiting enzyme in the synthesis of norepinephrine and dopamine (2x)

TYROSINE HYDROXYLASE

Neurohormone for social bonding (2x)

OXYTOCIN

Visual problem in pituitary tumor compressing optic chiasm (10x)

BITEMPORAL HEMIANOPSIA

Unsteady gait, appendicular ataxia in LE only and normal eye movement. Walks with lurching broad-based gait. (8x)

CEREBELLAR DEGENERATION (ALCOHOLIC)

66 yo c/o frequent falls, several-month hx of anxiety, unwillingness to leave home. On exam, mild impairment of vertical gaze on smooth pursuit/ saccades, mild axial rigidity & minimal rigidity of upper extremities, along w mild slowness of movement on finger tapping, hand opening & wrist opposition. Posture nml. Gait tentative/awkward, but w/o shuffling, ataxia, tremor. Pt is slow in arising from a chair. Most likely dx: (8x)

PROGRESSIVE SUPRANUCLEAR PALSY

Severe occipital HA, BL papilledema and no other abnormalities. Chronic acne treated with isotretinoin. Lumbar puncture elevated opening pressure with no cells, 62 mg/dl glucose, and 22mg/dl protein. CT is normal. (7x)

PSEUDOTUMOR CEREBRI

79 yo pt with a deteriorating mental state over a 3-week period has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the pt. Myoclonic jerks are also seen. Diagnosis: (5x)

SPONGIFORM ENCEPHALOPATHY

Pt presents with a slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilledema or headaches are reported. Likely diagnosis? (4x)

NORMAL PRESSURE HYDROCEPHALUS

65 yo pt fell several times past 6 mos. MSE nml. Smooth pursuit, saccadic movements impaired. Worse w vertical gaze. Full ROM w doll head maneuver. Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/labs unremarkable. Dx? (4x)

PROGRESSIVE SUPRANUCLEAR PALSY

Pt w/ acute onset of pain and decreased vision in the R eye. Colors look faded when viewed through the R eye. On exam, has a R afferent pupillary defect and a swollen right optic disc. Pt spontaneously recovers over the next 6 wks. Likely to develop later: (4x)

MULTIPLE SCLEROSIS

28yo with emotional lability and impulsivity. LFT's elevated. Close relative had similar sx and died at 30yo from hepatic failure. Which blood level would be diagnostic? (3x)

CERULOPLASMIN

9 yo F has 3 month h/o seemingly unprovoked bouts of laughter. Worse when not sleeping well. Pt does not feel happy during these episodes. Started menstruating 6 months ago, and at Tanner stage 4. Dx? (2x)

HYPOTHALAMIC HAMARTOMA

5 yo with 4 month history of morning HA, vomiting, and recent problems with gait, falls, and diplopia: (2x)

MEDULLOBLASTOMA

70 yo develops flaccid paralysis following severe water intoxication. He develops dysphagia and dysarthria without other cranial nerve involvement. Sensory exam is limited but grossly normal, DTR's are symmetric, and cognition is intact. Likely dx: (2x)

CENTRAL PONTINE MYELINOLYSIS

Young adult gained 70 lbs in last year c/o daily severe headaches sometimes associated with graying out of vision. Papilledema present. CT and MRI brain no abnormalities but ventricles smaller than usual. Goal of treatment in this case: (2x)

PREVENT BLINDNESS

Superior homonymous quadrantic defects in the visual fields result from lesions to which of the following structures? (2x)

TEMPORAL OPTIC RADIATIONS

Tremor with a frequency of around 3 Hz, irregular amplitude, most evident towards the end of reaching movements: (2x)

CEREBELLAR TUMOR

Pt with several days of fever and severe headaches presents to ED b/o generalized seizure. Pt is confused and somnolent. Also reported to have been irritable and has c/o foul smells. T2 MRI displayed (hyperintensity of left temporal): (2x)

HERPES ENCEPHALITIS

Acute onset of fever, sore throat, diplopia, & dysarthria. Exam reveals an inflamed throat, left adductor nerve palsy w/ impairment of vertical pursuit, diffuse hyperreflexia w/ bilateral clonus, lower ext spasticity, & mild right hemiparesis. CT is uninformative. Spinal fluid has protein of 24, 10 mononuclear cells, and glucose of 70. Dx? (2x)

MULTIPLE SCLEROSIS

Which is the most reliable finding from CSF analysis for a pt with multiple sclerosis in the chronic progressive phase of the dz? (2x)

PRESENCE OF OLIGOCLONAL BANDS

Benign intracranial HTN etiology: (2x)

HYPERVITAMINOSIS A

Gait abnormality, slow movement, asymmetric UE rigidity. Difficulty in voluntary vertical upward/downward gaze. Slowness/rigidity improved slightly with levodopa. Later has problems with horizontal & vertical gaze. Oculocephalic reflexes normal. Involuntary saccades. (2x)

PROGRESSIVE SUPRANUCLEAR PALSY

HERPES ENCEPHALITIS

Pt presents with personality changes, cognitive difficulties, affective lability, and olfactory and gustatory hallucinations. The most likely medical cause of this presentation is: (2x)

HERPES SIMPLEX VIRUS (HSV) INFECTION

What condition is a forerunner of MS? (2x)

TRANSVERSE MYELITIS

Location of characteristic lesions seen in CT scans of pt with carbon monoxide poisoning associated comas? (2x)

GLOBUS PALLIDUS

43 yo newly AIDS pt has increasing social withdrawal and irritability over several weeks. Can't remember phone number, unable to do chores, appears distracted. Mild right hemiparesis, left limb ataxia, and bilateral visual field defects. LP: normal cell counts, protein, and glucose. T2 Scan is shown. What is the diagnosis: (2x)

PROGRESSIVE MULTIFOCAL LEUKOENCEPHALITIS

62 yo M w/ DM is not making sense, saying "thar szing is phrumper zu stalking". Normal intonation but no one in the family can understand it. He verbally responds to Qs w similar utterances but fails to successfully execute any instruction. (8x)

WERNICKE'S APHASIA

Chronic A-fib develops aphasia and R hemiparesis at noon. ER exam notes weakness of R extremities and severe dysfluent aphasia, but CT at 1:30 PM has no acute lesion. Most appropriate treatment: (4x)

TPA

70 yo pt was hospitalized because of a middle cerebral artery stroke. The psychiatrist was asked to evaluate the pt. The pt has non-fluent aphasia. Which most likely characterized the pt's interaction with the psychiatrist? (3x)

THE PT WAS ABLE TO FOLLOW THE VERBAL REQUEST, "CLOSE YOUR EYES."

Head CT w/ lens-shaped hyper density (2x)

EPIDURAL HEMATOMA

A life-threatening complication of cerebellar hemorrhage is: (2x)

ACUTE HYDROCEPHALUS

A 72 yo patient had an embolic infarct in the middle cerebral artery territory. ECG shows no structural abnormalities. Doppler studies of the neck arteries reveal less than 50% occlusion on both carotid arteries. An EKG reveals A Fib. Which of the following strategies has the best likelihood of reducing recurrent strokes in this patient? (2x)

ANTICOAGULATION WITH WARFARIN

68 yo pt w/ hypertension develops rapidly progressing right arm and leg weakness, with deviation of the eyes to the left. Within 30 minutes of the onset of this deficit, pt became increasingly sleepy. Two hours after the onset, the patient became unresponsive. On exam: dense right hemiplegia, eyes deviated to the left, pupils: equal and reactive, a right facial weakness to grimace elicited by noxious stimuli. Cough and gag reflexes: present. Which CT finding is most likely? (2x)

LEFT PUTAMINAL HEMORRHAGE

A pt has multiple stroke-like symptoms of short duration over several days. And has new onset symptoms for the last 90 minutes. CT scan shows no evidence of stroke or hemorrhage. What is the appropriate treatment? (2x)

INTRAVENOUS THROMBOLYTIC AGENTS

Most common psychiatric presentation following a stroke? (2x)

DEPRESSION

Chiropractic adjustments are a known precipitant for which of the following acute conditions? (2x)

VERTEBRAL ARTERY DISSECTION

The most common complication of temporal arteritis is caused by occlusion of the: (2x

OPHTHALMIC ARTERY

The most common possible cause of a posterior cerebral artery infarct in 36 yo F with hx of migraine: (2x)

ORAL CONTRACEPTIVES

Abnormal elevated metabolic findings associated with increased risk of stroke in patients under 50 (2x)

PLASMA HOMOCYSTEINE

L MCA stroke resulting in R hemiparesis, gait abnormality (2x)

CIRCUMDUCTION

Why would brains >65 years old or a history of alcoholism more susceptible to chronic subdural hematoma? (2x)

CORTICAL ATROPHY (LONGER DISTANCE FOR BRIDGING VEINS TO BE DAMAGED)

65 yo M with 6 mo h/o confusion episodes, disorientation, VHs of children playing in his room. Hallucinated images are fully formed, colorful, vivid and pt has little insight into their nature. No AH. Wife says he is normal between episodes. Exam: Normal language, memory, mod diff with trails test, mild diff with serial subtractions, mild symmetric rigidity and bradykinesia. Brain MRI unremarkable. CSF, routine labs and UDS normal. Diagnosis: (7x)

LEWY BODY DEMENTIA

When combined with functional neuroimaging, which of the following biomarkers is most likely to identify those geriatric pts with mild cognitive impairment most at risk for developing Alzheimer's disease? (7x)

E-4 APOLIPOPROTEIN E ALLELE

80 yo with VH and worsening gait, episodic confusion, disturbed sleep, fighting in sleep, bilateral rigidity, masked facies. Levodopa/carbidopa improved movement temporarily. Diagnosis? (4x)

DEMENTIA WITH LEWY BODIES

80 yo pt with Alzheimer's is brought in for increasingly combative behavior. Daughter would like to keep the pt at home if possible. What interventions would be most helpful in this situation? (3x)

ASSESSING FOR CAREGIVER BURNOUT

91 yo hospice pt w/ cachexia, end stage dementia, and renal impairment has stopped eating and drinking. What comfort measure would be most appropriate? (3x)

FREQUENT SMALL SIPS OF WATER

Which of the following is the most specific factor for distinguishing delirium from dementia of the Alzheimer type? (2x)

FLUCTUATING AROUSAL

Neurocognitive functions most likely to show decline in people over 65 years of age? (x2)

INFORMATION PROCESSING SPEED

Over the course of several months, a 46 yo pt w no past psych hx becomes emotionally labile/irritable. Pt undergoes personality changes, is observed to laugh inappropriately when neighbor kids taunt stray cat. Within 2 yrs pt is convinced all food has germs. Memory is preserved. Pt is no longer able to work/live independently. Neuropsych testing shows impaired language/attn. (2x)

FRONTOTEMPORAL DEMENTIA

35 yo M awakens frequently in the middle of night with severe HAs, which sometimes occurs nightly and lasts approx 1-2 hrs, so severe that pt is afraid to go to sleep, located around L eye and assoc with lacrimation, ptosis, & miosis. Likely dx is: (12x)

CLUSTER HEADACHES

Abortive treatment of common migraines is best achieved w/ which medication? (8x)

RIZATRIPTAN

Young pt with new onset severe HAs associated with periods of visual obscuration. Neuro exam is normal except for papilledema. MRI: normal and shows no mass effect. Next test? (8x)

LUMBAR PUNCTURE TO MEASURE PRESSURE

Which of the following is characteristic of post lumbar puncture HA? (4x)

HA WORSE W/ SITTING UPRIGHT

35 yo reports episodes of flashing lights traveling slowly from L to R in the left visual field, symptoms persisting for about 30 minutes, followed by difficulty expressing self and concentrating. After about 30 minutes, these neurologic symptoms seem to subside, and pt develops a pounding headache associated with nausea. Both physical exam and MRI are normal. (3x)

MIGRAINE WITH AURA

25 yo has HA and vomiting. Pain is dull and in the occipital region, worse when lying down. +severe papilledema b/l. LP shows opening pressure of 80 w/ normal CSF chemistry, and 120 RBCs in last tube. D-dimer, FDP in blood are elevated. CT normal. (3x)

SAGITTAL SINUS THROMBOSIS

25 yo w/ VH - similar to the wavy distortions produced by heat rising from asphalt - affecting the whole of both visual fields, + vertigo, dysarthria, tingling in both hands and feet and around both sides of mouth followed by occipital headache. Most likely dx: (2x)

BASILAR MIGRAINE

24 yo m with nocturnal HA resulting in early am waking. ROS +rhinorrhea, nostril blocking and ipsilateral eye tearing and facial swelling. HA persists 45-60 min. Likely dx: (2x)

CLUSTER HA

The effective treatment for acute migraine: (2x)

SUMATRIPTAN

28 yo F reports episodes of severe HAs w nausea/vomiting. HAs can be incapacitating, often preceded by flashes of light in the right visual field. During headache, pt sometimes has difficulty expressing herself. Which med would be the appropriate to prevent these episodes? (2x)

TOPIRAMATE

26-year-old obese pt presents to ER with severe headache. Pt is otherwise healthy and does not take any meds. Head CT and brain MRI are unrevealing. The only finding on exam is shown in the fundoscopic images below (blurred optic disk). What is diagnosis? (2x)

IDIOPATHIC INTRACRANIAL HYPERTENSION

Role of the hippocampus and parahippocampal gyrus? (4x)

DECLARATIVE MEMORY (FACTS)

On the way to the airport for vacation, 58 yo F begins to behave in a very strange way. Husband notices when he talks to her she answers appropriately w fluent speech but seems to have no ability to retain any new information. She repeatedly asks where they are going, even after he has told her many times. The episode lasts for about 6 hours. The following day she is back to normal but has no recollection of the prior day events. This episode is most consist with a diagnosis of: (3x)

TRANSIENT GLOBAL AMNESIA

Characteristic of alcohol-induced blackouts (2x)

ANTEROGRADE AMNESIA FOR A TIME WHILE HEAVILY INTOXICATED BUT AWAKE

What characterizes the memory loss in patients with dissociative amnesia? (2x)

EPISODIC

Example of declarative memory (2x)

RETENTION AND RECALL OF FACTS

Pt with hx of herpes simplex and seizure d/o undergoing EEG monitoring that recorded no epileptic activity during, after and before a confused state wherein pt suddenly awoke frightened. The next day pt with baseline demeanor has no memory about that episode. (2x)

AMNESTIC DISORDER

61 yo pt presents to ED with family who report that the pt is unable to remember recent events. Memory problems started 2 hours prior; cognitively intact before the episode. Pt is alert, anxious, frustrated: "Why am I in the hospital?" Dx: (2x)

TRANSIENT GLOBAL AMNESIA

54 yo pt has several days of low grade fever, malaise and severe pain in the right side of the ribcage. Examination reveals an erythematous rash with clusters of tense vesicles, with clear content, on a belt distribution from the front of the chest to the back under the nipple, limited to the right side. Likely causal viral agent? (4x)

VARICELLA ZOSTER VIRUS

17 yo pt has an insidious onset of unusual behavior and argumentativeness. Exam, the mouth is held slightly open. Pt has mild dysarthria and hoarseness, generalized slowness, rigidity, and a mild resting tremor of the left arm and head. rule out drug and/or alcohol abuse. Liver function tests show elevated transaminases. An increase in which laboratory test is most likely to confirm Dx? (4x)

URINARY COPPER EXCRETION

45 yo M, with recurrent episodes of LOC while wearing a shirt with a tight collar, has a feeling of faintness accompanied by pallor, followed by collapse and LOC, and several seconds later by a few bilateral jerks of the arms and legs. Entire episode lasted less than one minute. Most likely explanation? (2x)

CAROTID SINUS SYNCOPE

Myasthenia gravis associated w/ which EMG finding? (10x)

DECREASED AMPLITUDE WITH REPETITIVE MOTOR NERVE STIMULATION

36 yo pt w pain behind L ear progressing to numbness of L side of face, tearing of L eye, discomfort w low frequency sounds, left facial weakness on exam. Dx? (9x)

IDIOPATHIC BELL'S PALSY

Treatment of Trigeminal Neuralgia: (7x)

GABAPENTIN (BUT MOST EFFECTIVE IS CARBAMAZEPINE)

37 yo truck driver w numbness of L hand, inc severity in past 2 yrs. Reduced pinprick sensation on L little/ring fingers, atrophy of hypothenar muscle. (6x)

ULNAR NERVE LESION

22 yo with pain in the right hand that radiates into the forearm and bicep muscle. Paresthesia in the palm of the hand, thumb, index, middle ring finger. Sensory systems in the ring finger split the ringer finger longitudinally. Dx? (6x)

MEDIAN NERVE ENTRAPMENT AT THE WRIST

Atrophy of the intrinsic muscles of the right arm and forearm. Reflexes are generally brisk, plantar reflexes are extensor. Electrophysiology shows widespread fasciculations, fibrillation and sharp waves, normal sensation, muscle spasticity. Positive sharp waves on EMG. (5x)

AMYOTROPHIC LATERAL SCLEROSIS

Stiffness of legs while walking and spasms of LE while sleeping. Stifflegged gait, adducts legs while walking. Increased LE tone/spastic catch, hyperactive knee jerks, ankle jerk clonus. Increased Romberg sway. (5x)

CERVICAL SPONDYLOSIS