3

Question 1

TIAs in the carotid system can cause ?

Answer 1

temporary loss of speech, paralysis/paresthesias of C/L extremity, clumsiness of 1 limb, amaurosis fugax: transient loss of sight in I/L eye due to micro emboli to retina

Question 2

TIAs in the vertebrobasilar system can cause ?

Answer 2

decreased perfusion to posterior fossa, dizziness, double vision, vertigo, numbness of I/L face and C/L limbs, dysarthria, horsiness, dysphagia, projectile vomiting, HA, drop attacks

Question 3

subclavian steal syndrome

Answer 3

stenosis of subclavian artery proximal to vertebral artery origin such that when working out left arm, distal subclavian artery “steals” blood from vertebral artery resulting in decreased cerebral blood flow resulting in symptoms in previous card

Question 4

if block in MCA

Answer 4

C/L hemiparesis, sensory loss, hyperreflexia (UE more than LE)
aphasia (if dom hemisphere) apraxia (if nondom)

Question 5

lacunar stroke symptoms based on location

Answer 5

internal capsule -motor
thalamus -sensory
pons -dysarthria, clumsy hand

Question 6

tests to order if pt presents with possible acute stroke

Answer 6

noncontrast CT brain, EKG CXR, CBC, plts, PT/PTT, serum e-lytes, glucose, b/l carotid US, Echo

Question 7

anticoagulants given in acute ischemic stroke?

Answer 7

no, not unless caused by emboli

ASA indicated unless tPA given, if CI to ASA give clopidogrel (Plavix) then ticlopidine

Question 8

carotid endarterectomy is indicated when ?

Answer 8

carotid stenosis +70% + symptoms

Question 9

causes of intracerebral hemorrhage (ICH)

Answer 9

HTN*, amyloid angiopathy, anticoag/tPA use, brain tumors, AVM
basal ganglia most common site, then pons, cerebellum

Question 10

cocaine use is associated with what types of stroke

Answer 10

ICH, SAH, ischemic

Question 11

goal BP in ICH

vs goal in ischemic stroke

Answer 11

less than 160-180/105

less than 220/120 in order to preserve the penumbra

Question 12

when to perform LP in stroke

Answer 12

when CT scan is unremarkable and clinical suspicion for SAH is high and papilledema is NOT present (may cause herniation)
-xanthrochromia +/- blood in SCF (non traumatic tap) +/- is diagnostic

Question 13

once SAH diagnosed, next steps

Answer 13

cerebral angiogram: locate site of bleeding and clip site

Question 14

goal in Parkinson’s treatment

Answer 14

enhance deficient dopaminergic system: carbidopa-levodopa (Sinemet), bromocriptine, pramipexole, selegeline (MAOB-i)
or inhibit uninhibited cholinergic system: trihexyphenidyle, benztropine, amitriptyline (not in old ppl)
others: amantidine-antiviral (not anymore?), deep brain stimulation if refractory

Question 15

treatment of Tourette’s

Answer 15

clonidine, pimozide, haloperidol

Question 16

tests when considering dementia

Answer 16

CBC with diff, CMP, TSH/T4, B12, folate, VDRL, HIV, CT/MRI of head

Question 17

tx for Meniere’s

Answer 17

salt restriction, thiazide diuretics

meclizine for symptoms

Question 18

diagnosis of Guillain Barre

treatment?

Answer 18

LP shows lots of protein and few cells
IVIG = plasmaphoresis
NEVER steroids!

Question 19

myasthenia gravis crisis tx

management tx

Answer 19

plasmaphoresis = IVIG, + steroids

management: Acetylcholinesterase inhibitor (pyridostigmine) then steroids, azathioprine, or mycophenolate mofetil

Question 20

MS treatment
exacerbation
management

Answer 20

acute attack: steroids, if cannot tolerate use plasmapheresis
management: INF-B or glatiramer

Question 21

if suspect SLE, get what Ab test first?

Answer 21

ANA (most sensitive and cheap)

if positive THEN anti-double stranded DNA (more specific) to confirm

Question 22

older pt with unilateral weakness in UE more than LE after car accident +/- pain/temp deficit think?

Answer 22

central cord syndrome (hyperextension injury)

Question 23

apraxia (expressive aphasia) is seen in infarct to what area?

Answer 23

dominant frontal lobe (Broca’s area)

i.e. left MCA lesion will result in right hemiparesis and aphasia

Question 24

Brown-Sequard presentation

Answer 24

same side of lesion: hemiparesis (lateral corticospinal) and loss of proprioception, vibration and light touch (dorsal columns) at level of lesion and below
contralateral loss of pain/temp 1-2 levels below lesion (lateral SpTT, decussates 1-2 levels above entrance into SC)

Question 25

Delivery of O2 equation

Answer 25

DLO2 = CO x Hgb x %Sat

Question 26

labs that can ddx hemolysis from hemorrhage in normocytic anemia (but will actually just see the bleeding if hemorrhage)

Answer 26

hemolysis will have ^LDH, ^T. Bili/D. Bili, decreased haptoglobin next step if hemolysis: blood smear

Question 27

normocytic anemia not caused by destruction (hemorrhage/hemolysis)

Answer 27

marrow malignancy: leukemia, myelodysplasia | CKD, BM fibrosis, tumor, aplastic anemia, anemia of chronic disease (poss. microcytic)

Question 28

common triggers of G6PD deficiency

Answer 28

``` dapsone TMPSMX nitrofurantoin primaquine dimercaprol (fava beans- Greek variant) infection ```

Question 29

dx and tx of paroxysmal nocturnal hemoglobinuria (PNH)

Answer 29

flow cytometry shows CD55- cells | tx: eculizumab

Question 30

causes of nonmegaloblastic macrocytic anemia

Answer 30

cirrhosis, alcoholism, drugs (5-FU, AZT), metabolic disease (Lesch-Nyhan, Hereditary Orotic Aciduria)

Question 31

TTP vs DIC

Answer 31

both have low platelets and schistocytes TTP will have normal PT/PTT, INR, fibrinogen, D-dimer DIC will have ^PT/PTT, ^INR, decreased fibrinogen, ^D-dimer also, just use plasmapheresis in TTP, platelets are contraindicated platelet transfusion recommended in DIC if plts drop below 30,000

Question 32

TTP presentation (acronym)

Answer 32

``` FAT RN Fever Anemia (MIHA) Thrombocytopenia Renal failure Neuro symptoms ```

Question 33

Therapy for non-Hodgkin Lymphoma

Answer 33

``` R-CHOP Rituximab Cyclyphosphomide Hydroxydaunomycin (doxorubicin) Oncovin (vincristine) Prednisone ```

Question 34

MM vs Waldenstrom vs MGUS

Answer 34

MM: +10% plasma cells (HSCT, Melphagan chemo) Waldenstrom: +10% lymphoma cells (Ritux chemo) MGUS: no increase (W/W)

Question 35

MM dx

Answer 35

10%+ plasma cells, +SPEP, +UPEP, +bone survey (lytic lesions)

Question 36

headaches, dizziness, nausea, polycythemia (^HCT) think?

Answer 36

``` CO poisoning (carboxyhgb) dx with ABG (pulse ox can't ddx) ```

Question 37

tumor lysis syndrome electrolyte abnormalities? adverse effects? how to prevent?

Answer 37

^uric acid, ^K+, ^phos, low Ca2+ (phis binds/precipitates Ca2+) cardiac arrhythmias, n/v/d, cramps, seizures, tetany, AKI IVF, allopurinol, rasburicase

Question 38

findings in MM

Answer 38

^Ca2+, normocytic anemia, renal insufficiency, protein gap (T. protein- albumin 4+)

Question 39

polycythemia vera treatment

Answer 39

phlebotomy, hydroxyurea if high risk thrombosis (BM suppression)

Question 40

why are asplenic pts more likely to have infections from encapsulated organisms?

Answer 40

deficient in antibody mediated phagocytosis (opsonization) and antibody-mediated complement activation S. pneumo, Hib, N. menigitis

Question 41

what is hyposthenuria?

Answer 41

impaired ability of kidney to concentrate urine, found in SCD pts and those with trait RBC sickling in vasa rectae of inner medulla, impairing countercurrent exchange and free water reabsorption

Question 42

normocytic anemia, splenomegaly, reticulocytosis, jaundice with ^I.Bili, ^LDH, decreased haptoglobin, think ?

Answer 42

AIHA | tx with glucocorticoids

Question 43

how to dx CLL

Answer 43

flow cytometry

Question 44

osteoid osteoma on imaging

Answer 44

sclerotic, cortical lesion with central nidus of lucency pain worse at night and unrelated to activity relieved by NSAIDs

Question 45

giant cell tumor of bone presentation (GCTB)

Answer 45

"soap-bubble" appearance in epiphyseal regions commonly femur and tibia around knee y. adult with decreased ROM, pain and swelling tx: surgery is first-line

Question 46

lab derangements in hereditary spherocytosis

Answer 46

low MCV, ^RWD, osmotic fragiligy test, eosin-5-maleimide binding test, ^MCHC (Hgb concentration) dx: tx: splenectomy increased risk of bilirubin gallstones and Parvo B19 infection-->aplastic anemia

Question 47

PT/PTT in von Willebrand

Answer 47

^PTT, ^bleeding time, normal PT

Question 48

acute hemolytic transfusion reaction

Answer 48

fever, flank pain, hgburia, renal failure, DIC w.in 1 hr of transfusion dx with direct Coombs test, pink plasma caused by ABO incompatibility

Question 49

medications that can induce methemoglubinemia

Answer 49

topical anesthetics (benzocaine), dapsone, nitrates (in infants) cause iron component of Hgb to be oxidized forming methemoglobin which cannot bind O2 pulse Ox commonly at 85%, ABG may be falsely elevated (doesn't base on true Hgb-O2 binding)-->large O2 saturation gap tx: methylene blue

Question 50

thyroid storm tx

Answer 50

IVF, cooling blankets propranol (reduce sympathetic symptoms) PTU, methimazole (thionamides- inhibit thyroid synthesis) steroids (reduce peripheral T4-->T3)

Question 51

surgery vs radioactive ablation for hyperthyroidism

Answer 51

surgery for Graves as pretibial myxedema and exopthalmos will persia radioactive ablation for other causes

Question 52

SIADH tx

Answer 52

water restriction tx underlying cause demeclocycine, lithium

Question 53

diabetes insipidus tx

Answer 53

central DI: DDAVP | nephrogenic: gentle diurese with HCTZ, amilioride

Question 54

metformin is contraindicated in..

Answer 54

CKD, CHF, liver disease