Neurological & Psychiatric Disorders Flashcards

A 45-year-old presents with sudden facial drooping involving the forehead, inability to close the eye, and loss of taste on the anterior two-thirds of the tongue. What is the most likely diagnosis?

Answer: Bell's palsy (idiopathic peripheral CN VII palsy)

Peripheral CN VII palsy (Bell's palsy) involves upper and lower face including forehead, distinguishing it from central lesions which spare the forehead due to bilateral cortical representation.

A 19-year-old presents with sudden-onset psychosis, orofacial dyskinesias, autonomic instability, and decreased consciousness following a viral illness. Which antibody is most likely responsible?

Answer: Anti-NMDA receptor antibody

Anti-NMDA receptor encephalitis presents with psychiatric symptoms, movement disorders, autonomic dysfunction, and decreased consciousness, often following herpes encephalitis or in young women with ovarian teratoma.

A patient presents with locked-in syndrome after a pontine stroke. Which finding would you expect on examination?

Answer: Preserved vertical gaze and blinking with quadriplegia

Locked-in syndrome from ventral pontine lesions spares the midbrain, preserving vertical eye movements and blinking (controlled by CN III/IV and superior colliculus) while causing quadriplegia.

Which feature most reliably distinguishes hypertensive encephalopathy from hypertensive urgency without end-organ damage?

Answer: Presence of papilledema, encephalopathy, or focal neurological deficits

Hypertensive emergency is defined by end-organ damage (encephalopathy, papilledema, focal deficits, AKI, heart failure) rather than a specific blood pressure threshold.

A 70-year-old presents with sudden loss of pain and temperature sensation over his right arm and leg, with left-sided face numbness, and left-sided Horner syndrome. Which vessel is most likely occluded?

Answer: Left posterior inferior cerebellar artery

Left PICA occlusion causes lateral medullary (Wallenberg) syndrome with left-sided Horner and facial sensory loss, and crossed (right-sided) body pain/temperature loss via spinothalamic tract.

A patient presents after a tonic-clonic seizure. Which finding on history or exam would most urgently warrant a CT head before lumbar puncture?

Answer: New focal neurological deficit with GCS 12

New focal neurological deficits after seizure may indicate an intracranial mass or hemorrhage; CT must precede LP to rule out herniation risk.

A 38-year-old female presents with episodic severe unilateral headache with nausea, photophobia, and a preceding visual aura of a scintillating scotoma. Which medication is most appropriate for acute treatment of a moderate-to-severe attack?

Answer: Sumatriptan 6 mg SC

Triptans (serotonin 5-HT1B/1D agonists) are first-line for moderate-to-severe migraine attacks; sumatriptan SC has the fastest onset.