Master the board step 3

Master the Boards: USMLE Step 3
Huntington’s Disease/Chorea
Huntington’s presents in a young patient (30s) far below the age for Alzheimer’s
disease. The question likely will mention family history. Symptoms are the
following:
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Dementia
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Psychiatric disturbance with personality changes
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Chorea/movement disorder
Diagnostic Testing
Diagnose with specific genetic testing. Inheritance is autosomal dominant.
Treatment
Give tetrabenazine for movement disorder, antipsychotics for symptomatic
control.
Dementia Syndromes
All patients have memory loss and should have a head CT/MRI, VDRL, B12,
and T4. Conditions vary as follows:
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Alzheimer’s: No focal deficits. Treatment is with anticholinesterases and
memantine.
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Pick’s/frontotemporal: Personality and behavior are affected first.
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Lewy body: Parkinsonian symptoms and sometimes hallucinations accompany
dementia.
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Huntington’s: Presents with movement (chorea) and personality disorders.
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Normal pressure hydrocephalus: Remember WWW: Wet, weird, wobbly.
Headache
Migraine
Of migraines, 60 percent are unilateral, and 40 percent are bilateral.
Triggers include the following:
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Cheese
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Caffeine
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Menstruation
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Oral contraceptive
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