Retinoblastomas are the most common pediatric intraocular tumor and classically present

with leukocoria or a white reflection in place of the standard red reflex.

Pulmonary hypertension and polycythemia commonly co-exist. First, polycythemia can cause
pulmonary hypertension by increasing blood viscosity within the pulmonary vasculature.
Additionally, in patients with chronic hypoxemia, both pulmonary hypertension and
polycythemia can result

Polycystic kidney disease Is associated with an increased risk of berry

aneurysms that can rupture and cause subarachnoid hemorrhage (SAH). However, SAH usually presents with severe headache
and impaired level of consciousness. Focal neurologic findings are uncommon with SAH
Korsakoff syndrome (KS) is described as an acute onset of severe memory impairment that occurs in the setting of thiamine
(vitamin B1) deficiency and is commonly seen in alcoholic patients. KS may occur concurrently with or following the
development of Wernicke encephalopathy (late phase), which is also caused by thiamine deficiency
(early phase) and characterized by the presence of ocular disturbances, alteration of consciousness, and ataxia.

Acute stress disorder develops following exposure to threatened death, serious injury, or sexual violation and is characterized
by intrusive memories, nightmares, flashbacks, avoidance, and arousal symptoms (eg, hypervigilance, insomnia, irritability,
poor concentration). Symptoms last 3 days to 1 month. Although acute stress disorder symptoms overlap with those of TBI, the
type of trauma, prominent physical symptoms, and lack of nightmares or flashbacks in this patient make TBI more likely.

Cerebral venous thrombosis typically occurs in patients with hypercoagulable conditions (eg, contraceptive use, malignancy) and
can present with headache, altered mentation. seizures. and focal neurologic deficits. The diagnosis is confirmed using MRI of the
brain with venography as head CT scan often shows no abnormalities.

Atrophy of the lenticular nucleus is most marked in patients with Wilson's disease.
Hyperglycemic nonketotic state can present in type 2 diabetics with altered mental status and/or neurologic deficits. However,
symptoms usually do not start until blood glucose >600 mg/dL (more often >1000 mg/dL).

Treatment of attention-deficit hyperactivity disorder (ADHD) includes stimulant (eg, methylphenidate) and nonstimulant (eg, atomoxetine) medications.
Patients with the inattentive subtype of ADHD often present with staring spells. However, these spells, in comparison to absence seizures,
tend to occur with boredom or during sedentary activities and are typically responsive to vocal or tactile stimulation

The Edinger-Westphal nucleus provides preganglionic parasympathetic

outflow to the eye. Damage to this structure would result in an ipsilateral fixed and
dilated pupil that is nonreactive to light or accommodation
 Ohhhh shit save this

Some forms of vitamin A (eg, beta carotene) in

excess may increase the risk of lung cancer in
smokers
Several drugs, including many cancer chemotherapy
agents, cause peripheral neuropathy. The most
commonly implicated agents are vincristine,
cisplatin, and the taxanes (docetaxel and paclitaxel).
Other drugs that cause peripheral neuropathy
include phenytoin, isoniazid, amiodarone, and
hydralazine.
Direct antiglobulin test can help diagnose autoimmune hemolytic
anemias.

Cervical spine x-ray may be considered when there is concern for cervical spine disease (eg, spinal or
neuroforaminal stenosis). Patients generally present with neck pain and can have bilateral hand/arm numbness and
weakness; however

IV heparin can be used to treat dural sinus thrombosis, which typically

occurs in patients with hypercoagulable conditions (eg, contraceptive use, pregnancy, malignancy) and presents
with headache and signs/symptoms of elevated intracranial pressure (eg, papilledema, impaired consciousness,
nausea/vomiting).
Spinal cord Myelopathy can present with back pain, loss of motor and sensory function below
the level of lesion and incontinence,

Cervical spondylotlc myelopathy may present in older adults with progressive neck pain, and various
symptoms/signs of radiculopathy and myelopathy. This patient's younger age, Isolated upper extremity
findings, and lack of neck pain make the diagnosis unlikely. Cervical spondylosis results from disc degeneration in
patients over age 40. Neck pain and stiffness are the most common symptoms. Patients may develop spinal stenosis,
resulting in neurologic deficits.

Hodgkin lymphoma is a 8-cell neoplasm with characteristic Reed-Sternberg cells that usually manifests with a mediastinal mass or
a painless, enlarged lymph node (often cervical). Hodgkin lymphoma often presents with painless lymphadenopathy and B symptoms
(night sweats, fevers) in the setting of a normal peripheral blood smear and complete blood count.

Erythromycin is primarily used as an antibiotic, but it also functions as a motilin receptor agonist and can help treat nausea
secondary to gastroparesis.
 The rapid plasma reagin test is a nontreponemal antigen test used to
screen for syphilis. Congenital syphilis can be associated with stillbirth,
anemia, and thrombocytopenia. However, syphilis in adults is usually not
associated with thrombocytopenia.
\Polycystic kidney disease Is associated with an increased risk of berry
aneurysms that can rupture and cause subarachnoid hemorrhage (SAH). However, SAH usually presents with severe headache
and impaired level of consciousness. Focal neurologic findings are uncommon with SAH

Cerebral venous thrombosis typically occurs in patients with

hypercoagulable conditions (eg, contraceptive use, malignancy) and can present with headache, altered mentation. seizures. and
focal neurologic deficits. The diagnosis is confirmed using MRI of the brain with venography as head CT scan often shows no
abnormalities.

Atrophy of the lenticular nucleus is most marked in patients with Wilson's

disease.
Spinal cord compression is associated with muscle weakness and
hyperactive deep tendon reflexes
Hyperglycemic nonketotic state can present in type 2 diabetics with altered
mental status and/or neurologic deficits. However, symptoms usually do not start until
 blood glucose >600 mg/dL (more often >1000 mg/dL).

(Choice A) Cerebral contusion is a bruise of brain tissue resulting from

coup/contre-coup injuries. These are less likely to cause uncal herniation with focal neurologic deficits and typically heal without
medical intervention.
.

Cerebellar atrophy can be caused by chronic use of certain antiepileptic drugs (eg, phenytoin) and
Psuedotumor cerebri have shrukken ventricles
Treatment of attention-deficit hyperactivity disorder (ADHD) includes stimulant (eg, methylphenidate) and nonstimulant (eg, atomoxetine) medications.
Patients with the inattentive subtype of ADHD often present with staring spells. However, these spells, in comparison to absence seizures,
tend to occur with boredom or during sedentary activities and are typically responsive to vocal or tactile stimulation

Orbital massage can be useful in central retinal artery occlusion (unilateralacute painless vision loss), as a way to remove an embolism by increasing outflow
ofaqueous humor as well as perfusion to the eye

Neurosyphilis appears in 15-20% of late syphilis cases. There are fourtypes. In the general paresis type, there is general involvement of cerebral cortex.
Thereis usually decreased concentration, memory loss, dysarthria, tremors of finger and lipsirritability and mild headaches. A positive RPR test
with a history of untreated sexually transmitted diseases is suggestive of the diagnosis Neurosyphilis appears in 15%-20% of late syphilis cases
and can presentwith forgetfulness, personality change, dysarthria, and intention tremor. This patient'sfamily history and lack of physical
findings associated with neurosyphilis make FTD amore likely diagnosis Neurosyphilis appears in 15-20% of late syphilis cases. There are four
types. In general paresis type, there is general involvement of the cerebral cortex. Thereis usually a decrease in concentrating power, memory loss,
dysarthria, tremors of fingersand lips, irritability, and mild headaches. In addition, there are alsocharacteristic personality changes, with the
patient becoming slovenly, irresponsible,confused and psychotic.

Amyotrophic lateral sclerosis is a progressive, incurable neurodegenerativedisorder that causes muscle atrophy and eventual death. Clinical signs include
hyperreflexia, fasciculations, spasticity, and weakness; myoclonus is not typically seen Subtle cognitive changes may occur, but physical symptoms are
most prominent.

Intravenous acyclovir is used to treat herpes simplex encephalitis, which presents with fever, altered mental status, focal neurologic deficits, and seizures.
Cerebrospinal fluid usually shows lymphocytic pleocytosis. This patient's presentation I not suggestive of herpes simplex virus encephalitis Viral
meningitis typically has elevated WBC count, and normal RBC and glucose counts. Protein level can be normal to slightly elevated. The exception is
herpes meningoencephalitis, which can have high RBC and protein levels reflecting temporal lobe hemorrhage.
 Illnesses that involve the anterior horn cells include spinal muscular atrophy
(typically a flaccid paralysis in infancy), poliomyelitis (unlikely in a vaccinated patient),
and amyotrophic lateral sclerosis (upper and lower motor neuron disease in adults
Tumors in the cerebral cortex can cause upper motor neuron symptoms (eg,
hyperreflexia, hypertonia) but would also be expected to cause a severe headache that
worsens when supine.
Diseases of the neuromuscular junction include botulism (descending flaccid
paralysis), myasthenia gravis (weakness worsens with use and improves with rest),
Lambert-Eaton syndrome (progressive proximal muscle weakness), and
organophosphate poisoning (weakness accompanied by multisystem cholinergic
symptoms).
Vitamin 8, deficiency can occur in vegetarians. The subacute degeneration
of the dorsal and lateral spinal columns (upper motor neurons) can cause ataxia, bilateral
paresthesias, and loss of vibration and position sense. Neurologic symptoms are
typically accompanied by megaloblastic anemia (pallor, fatigue, syncope, shortness of
breath). Manifestations of severe deficiency are usually seen in adults and rarely in
children.
The Edinger-Westphal nucleus provides preganglionic parasympathetic
outflow to the eye. Damage to this structure would result in an ipsilateral fixed and
dilated pupil that is nonreactive to light or accommodation
This patient's paranoid delusions, tactile hallucinations (bugs crawling under the skin), aggressive behavior, severe insomnia, and
physical findings of poor dentition and skin sores are suggestive of chronic methamphetamine abuse. Methamphetamine is a highly
addictive and very potent central nervous stimulant also known as "meth," "crystal meth," "ice," and "glass." Heavy use frequently
causes marked weight loss, psychotic symptoms, and excoriations due to chronic skin picking.
Severe dental problems ("meth mouth") can include brown discoloration, tooth decay, and cracked teeth due to severe clenching.
Other features of intoxication include mood disturbances, anxiety, irritability, confusion, violent behavior, and signs of sympathetic
over-activity (eg, elevated pulse and blood pressure, hyperthermia, sweating, pupillary dilation).
Some chronic methamphetamine users can develop persistent psychosis that may be difficult to distinguish from primary psychiatric
disorders. Visual and tactile hallucinations tend to be more common in substance-induced psychotic disorders. Long-term
management includes both cognitive-behavioral treatment to prevent relapse and antipsychotic medication.

Structural abnormalities in the orbitofrontal cortex and basal ganglia are

associated with obsessive-compulsive disorder.

Most children learn to tie their shoelaces at 5