Neurological & Psychiatric Disorders Flashcards
7 cards from real ABEM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Neurological & Psychiatric Disorders flashcards as text
A 50-year-old presents with acute onset severe headache after intercourse. CT and LP are negative for subarachnoid hemorrhage. What is the most likely diagnosis?
Answer: Primary thunderclap headache / coital cephalgia
Primary thunderclap headache (coital or exertional cephalgia) can mimic SAH and must be a diagnosis of exclusion after negative workup.
A 65-year-old diabetic presents with painful ophthalmoplegia, ptosis, and normal pupillary response. What is the most likely etiology?
Answer: Microvascular ischemic CN III palsy
Diabetic microvascular ischemia causes pupil-sparing CN III palsy because the pupillomotor fibers travel on the outside of the nerve and are spared by ischemia that affects the inner fibers.
A patient with known myasthenia gravis presents with worsening dyspnea and inability to swallow after starting ciprofloxacin for a UTI. What is the most likely explanation?
Answer: Fluoroquinolone-induced myasthenic crisis
Fluoroquinolones, aminoglycosides, and other antibiotics can worsen neuromuscular junction blockade and precipitate myasthenic crisis.
A 32-year-old presents with visual disturbances, bilateral internuclear ophthalmoplegia, and an episode of transverse myelitis 6 months ago. MRI shows periventricular white matter lesions. What is the most likely diagnosis?
Answer: Multiple sclerosis
Multiple sclerosis presents with relapsing-remitting neurological episodes, periventricular demyelinating lesions, and internuclear ophthalmoplegia due to MLF involvement.
A comatose patient has pinpoint pupils, bradycardia, and respiratory depression after being found with empty prescription bottles. What is the antidote?
Answer: Naloxone 0.4–2 mg IV
The opioid toxidrome (CNS depression, miosis, respiratory depression) is reversed with naloxone, an opioid receptor antagonist.
A 22-year-old college student presents with fever, severe headache, photophobia, and a non-blanching petechial rash. Which action is most critical and time-sensitive?
Answer: Administer IV ceftriaxone immediately without waiting for LP
Bacterial meningitis with petechial rash (suggesting meningococcemia) requires immediate IV antibiotics; any delay for cultures or CT is unacceptable given mortality risk.
A patient with a known seizure disorder is brought in seizing. He received 4 mg of lorazepam IV and continues to seize at 10 minutes. What is the next intervention?
Answer: Load with fosphenytoin or levetiracetam IV
After benzodiazepine failure, the next step in status epilepticus management per guidelines is a second-line antiepileptic such as fosphenytoin, valproate, or levetiracetam.