PHM BOARD PREP
QUESTIONS &
ANSWERS SOLVED
100% CORRECT!!
PHM
Evatee 10/31/24 PHM
,PHM BOARD PREP QUESTIONS & ANSWERS
SOLVED 100% CORRECT!!
Opsoclonus-myoclonus syndrome Answer - non-rhythmic conjugate eye
movement
involuntary limb jerking
associated with neuroblastoma in kids (paraneoplastic)
acute cerebellar ataxia Answer - childhood condition characterized by an
unsteady gait, most likely secondary to an autoimmune of postinfectious cause,
drug induced or paraneoplastic. Most common virus causing acute cerebellar
ataxia are Chickenpox virus and Epstein Barr Virus
Anti-NMDA receptor encephalitis Answer - Psych disturbance, memory
deficits, seizures, (orofacial) dyskinesia, autonomic instability, language
dysfunction
viral syndrome
MRI normal; EEG with diffuse slowing
which neuroimaging study? Answer - tumor --> MRI (can't see posterior fossa
on CT)
?NAT, hydrocephalus, calcifications, bone fractures, foreign body --> non-
contrast head CT
abscess/tumor --> CT with contrast
stroke --> MRI with DWI
shunt issue --> FAST MRI
* don't get MRI if c/f foreign body (could be metal)
,Acute Flaccid Myelitis Answer - acute onset focal limb weakness
5 days after viral symptoms
MRI: spinal cord lesion in grey matter
Miller-Fischer variant Answer - ophthalmoplegia, ataxia, hyporeflexia
rapidly progressive
GQ1b antibodies in deep cerebellar nuclei
ddx hypotonia Answer - SMA, Prader Willi, congenital myotonic dystrophy
Spinal Muscular Atrophy (SMA) Answer - most common genetic cause of death
1 = most severe (never sit up), 80% of all cases
test SMA 1/2 in any hypotonic infant with FTT or recurrent respiratory infection
prenatal: decreased FM, polyhydramnios (not swallowing)
ddx acute weakness Answer - central: ADEM, transverse myelitis, acute flaccid
myelitis
peripheral: GBS, ticks, botulism, myasthenia gravis, metabolic derangement
antiepileptics Answer - LEV - wide dosing range, no respiratory compromise or
toxicity
VPA - no respiratory compromise, good for many types NOT mito. liver, platelet
toxicity
oxcarbazepine - focal seizures. not avail IV
onfi - well-tolerated excpet somnolence. no IV
topiramate - metabolic acidosis. no IV
, migraine dx and tx Answer - 2/4: unilateral, pulsating, mod-severe, worse with
activity
+1: n/v, photophobia, phonophobia
acute tx: early triptan and analgesia for abortive therapy
toradol, prochlorperazine for status migrainosus (>72h)
meningitis Answer - Give IV dex for Hib - reduces hearing loss
no empiric AEDs
repeat imaging if increased ventricle size or hydrocephalus
monitor Na, UOP (SIADH/DI)
1/3 develop subdural effusions, can progress to empyema - repeat LP if no
improvement after 48 hours
if abscess, IV steroids decrease antibiotic penetration of BBB, decrease capsule
formation - don't give unless Cushing's triad
encephalitis findings Answer - paraechovirus - white matter/corpus callosum
HSV - temporal lobes
oligoarticular JIA Answer - <= 4 joints
young (<7), white, female
+ANA
prone to uveitis --> get slip lamp exam
polyarticular JIA Answer - 5+ joints
looks like adults with RA
+RF
QUESTIONS &
ANSWERS SOLVED
100% CORRECT!!
PHM
Evatee 10/31/24 PHM
,PHM BOARD PREP QUESTIONS & ANSWERS
SOLVED 100% CORRECT!!
Opsoclonus-myoclonus syndrome Answer - non-rhythmic conjugate eye
movement
involuntary limb jerking
associated with neuroblastoma in kids (paraneoplastic)
acute cerebellar ataxia Answer - childhood condition characterized by an
unsteady gait, most likely secondary to an autoimmune of postinfectious cause,
drug induced or paraneoplastic. Most common virus causing acute cerebellar
ataxia are Chickenpox virus and Epstein Barr Virus
Anti-NMDA receptor encephalitis Answer - Psych disturbance, memory
deficits, seizures, (orofacial) dyskinesia, autonomic instability, language
dysfunction
viral syndrome
MRI normal; EEG with diffuse slowing
which neuroimaging study? Answer - tumor --> MRI (can't see posterior fossa
on CT)
?NAT, hydrocephalus, calcifications, bone fractures, foreign body --> non-
contrast head CT
abscess/tumor --> CT with contrast
stroke --> MRI with DWI
shunt issue --> FAST MRI
* don't get MRI if c/f foreign body (could be metal)
,Acute Flaccid Myelitis Answer - acute onset focal limb weakness
5 days after viral symptoms
MRI: spinal cord lesion in grey matter
Miller-Fischer variant Answer - ophthalmoplegia, ataxia, hyporeflexia
rapidly progressive
GQ1b antibodies in deep cerebellar nuclei
ddx hypotonia Answer - SMA, Prader Willi, congenital myotonic dystrophy
Spinal Muscular Atrophy (SMA) Answer - most common genetic cause of death
1 = most severe (never sit up), 80% of all cases
test SMA 1/2 in any hypotonic infant with FTT or recurrent respiratory infection
prenatal: decreased FM, polyhydramnios (not swallowing)
ddx acute weakness Answer - central: ADEM, transverse myelitis, acute flaccid
myelitis
peripheral: GBS, ticks, botulism, myasthenia gravis, metabolic derangement
antiepileptics Answer - LEV - wide dosing range, no respiratory compromise or
toxicity
VPA - no respiratory compromise, good for many types NOT mito. liver, platelet
toxicity
oxcarbazepine - focal seizures. not avail IV
onfi - well-tolerated excpet somnolence. no IV
topiramate - metabolic acidosis. no IV
, migraine dx and tx Answer - 2/4: unilateral, pulsating, mod-severe, worse with
activity
+1: n/v, photophobia, phonophobia
acute tx: early triptan and analgesia for abortive therapy
toradol, prochlorperazine for status migrainosus (>72h)
meningitis Answer - Give IV dex for Hib - reduces hearing loss
no empiric AEDs
repeat imaging if increased ventricle size or hydrocephalus
monitor Na, UOP (SIADH/DI)
1/3 develop subdural effusions, can progress to empyema - repeat LP if no
improvement after 48 hours
if abscess, IV steroids decrease antibiotic penetration of BBB, decrease capsule
formation - don't give unless Cushing's triad
encephalitis findings Answer - paraechovirus - white matter/corpus callosum
HSV - temporal lobes
oligoarticular JIA Answer - <= 4 joints
young (<7), white, female
+ANA
prone to uveitis --> get slip lamp exam
polyarticular JIA Answer - 5+ joints
looks like adults with RA
+RF
