NINJA PRITE EXAM PREP STUDY GUIDE
QUESTIONS ANSWERS COMPLETE
SOLUTION BUNDLE
●● Unsteady gait, appendicular ataxia in lower-extremity only and
normal eye movement. Walks with lurching broad-based gait. (8x)
Answer: CEREBELLAR DEGENERATION (ALCOHOLIC)
●● 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)
Answer: PSEUDOTUMOR CEREBRI
●● 66 y/o 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: (7x)
Answer: progressive supranuclear palsy
,●● 79 y/o 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)
Answer: 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)
Answer: NORMAL PRESSURE HYDROCEPHALUS
●● 65 y/o 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)
Answer: PROGRESSIVE SUPRANUCLEAR PALS
●● 28y/o with emotional lability and impulsivity. LFT's elevated. Close
relative had similar sx and died at 30y/o from hepatic failure. Which
blood level would be diagnostic? (3x)
Answer: CERULOPLASMIN
●● 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: (3x)
, Answer: MULTIPLE SCLEROSIS
●● 9 y/o 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)
Answer: HYPOTHALAMIC HAMARTOMA
●● 5 yo w/ 4 month history of morning HA, vomiting, and recent
problems with gait, falls, and diplopia: (2x)
Answer: MEDULLOBLASTOMA
●● 70 y/o 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)
Answer: 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)
Answer: PREVENT BLINDNESS
QUESTIONS ANSWERS COMPLETE
SOLUTION BUNDLE
●● Unsteady gait, appendicular ataxia in lower-extremity only and
normal eye movement. Walks with lurching broad-based gait. (8x)
Answer: CEREBELLAR DEGENERATION (ALCOHOLIC)
●● 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)
Answer: PSEUDOTUMOR CEREBRI
●● 66 y/o 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: (7x)
Answer: progressive supranuclear palsy
,●● 79 y/o 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)
Answer: 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)
Answer: NORMAL PRESSURE HYDROCEPHALUS
●● 65 y/o 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)
Answer: PROGRESSIVE SUPRANUCLEAR PALS
●● 28y/o with emotional lability and impulsivity. LFT's elevated. Close
relative had similar sx and died at 30y/o from hepatic failure. Which
blood level would be diagnostic? (3x)
Answer: CERULOPLASMIN
●● 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: (3x)
, Answer: MULTIPLE SCLEROSIS
●● 9 y/o 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)
Answer: HYPOTHALAMIC HAMARTOMA
●● 5 yo w/ 4 month history of morning HA, vomiting, and recent
problems with gait, falls, and diplopia: (2x)
Answer: MEDULLOBLASTOMA
●● 70 y/o 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)
Answer: 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)
Answer: PREVENT BLINDNESS
