Neurological & Psychiatric Disorders Flashcards

A 28-year-old presents with acute psychosis, severe agitation, hyperthermia, rigidity, and elevated CK after starting haloperidol 3 days ago. What is the most likely diagnosis?

Answer: Neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) presents with hyperthermia, lead-pipe rigidity, altered mental status, and autonomic instability following antipsychotic use.

Which feature best differentiates Todd's paralysis from an acute ischemic stroke in a patient with post-ictal focal weakness?

Answer: Gradual resolution of weakness over minutes to hours

Todd's paralysis (post-ictal paresis) typically resolves within minutes to hours after a seizure, whereas stroke deficits are persistent.

A 35-year-old with HIV presents with headache, fever, and altered mental status. CSF shows lymphocytic pleocytosis and India ink staining is positive. What is the treatment?

Answer: Amphotericin B plus flucytosine

Cryptococcal meningitis in HIV patients is treated with amphotericin B plus flucytosine for induction therapy.

A 60-year-old woman presents with painless diplopia, ptosis, and a dilated pupil. She has a known posterior communicating artery aneurysm. What is the most urgent next step?

Answer: Emergent neurosurgical or interventional neuroradiology consultation

Third nerve palsy with pupil involvement from a PComm aneurysm represents a surgical emergency due to risk of rupture and subarachnoid hemorrhage.

A patient presents with tetanus following a puncture wound. Which medication directly addresses the pathophysiology of muscle spasms in tetanus?

Answer: Benzodiazepines

Tetanus toxin blocks inhibitory neurotransmitter release (glycine and GABA), causing muscle spasms best managed with benzodiazepines that enhance GABA activity.

A 40-year-old presents with sudden unilateral vision loss, described as a 'shade coming down' over the eye that resolved in 10 minutes. What is this phenomenon called and what does it indicate?

Answer: Amaurosis fugax — indicates carotid artery disease

Amaurosis fugax (transient monocular blindness) is caused by emboli from ipsilateral carotid stenosis temporarily occluding retinal blood flow.

An 18-year-old male presents with his third episode of sudden bilateral leg weakness with preserved consciousness, triggered by emotional laughter. EEG is normal during an episode. What is the most likely diagnosis?

Answer: Cataplexy associated with narcolepsy

Cataplexy is characterized by sudden bilateral muscle weakness triggered by strong emotions (especially laughter), associated with narcolepsy, with preserved consciousness and normal EEG.