Medical Pearls Intern Year

Question 1

ACA supplies what area of the body (in terms of stroke)

Answer 1

legs and feet

Question 2

MCA supplies what area of the body (in terms of stroke)

Answer 2

hands, arms, face, and speech

Question 3

PCA stroke affects what bodily function

Answer 3

vision

Question 4

Things to consider before giving TPA for an ischemic stroke

Answer 4

Any recent bleeds, Surgery, or Intracranial hemorrhage

Needs to be within 3-4 hrs of last well known

BP controlled to 180/110

Give ASA for antiplatelet benefit

Question 5

What risk factors are associated with an ischemic stroke

Answer 5

HTN, DM, smoking, hyperlipidemia, older age

Question 6

What is included in the workup of the etiology of an ischemic stroke?

Answer 6

Echo (looking for structural or valvular causes), carotid U/S (looking for stenosis- greater than 70/80% you need a surgical intervention like the placement of a stent or endarterectomy), and an ECG to assess for an arrhythmia like A fib

Question 7

When would an MRI be helpful in a potential stroke patient

Answer 7

If you are unsure and want to rule out the possibility, DWI are really good for identifying acute strokes

Question 8

What key clinical finding is suggestive of a stroke

Answer 8

focal neurological deficit

Question 9

What is a hemorrhagic transformation

Answer 9

when an ischemic stroke becomes hemorrhagic, usually is a complication after giving TPA

Question 10

What is the main deficit in Parkinson’s disease

Answer 10

low dopamine levels because of the degeneration of dopamine producing neurons in the substantia nigra and locus cerulus

Question 11

Common symptoms in Parkinson’s patients

Answer 11

tremor @ rest/pill rolling
postural instability 
akinesia/bradykinesia
rigidity, lead-pipe
personality changes (stress and depression can worsen the other symptoms)
Masked facies

Their disability tends to get worse over the 5-10 years

Question 12

Management for mild Parkinson’s disease (where they can still function)

Answer 12

anticholinergic like benztropine

Question 13

Role of DA and ACH in movement disorders

Answer 13

DA helps to encourage movement by blocking the release of gaba
Ach inhibits movement by stimulating the release of Gaba

At baseline, Gaba is inhibiting movements

Question 14

Management of more severe Parkinson’s disease where they are less funtional

Answer 14

Levodopa carbidopa (wait as long as you can to start sinemet because it looses efficacy after a while )

OR

DA agonist life bromocriptine/pramipexole/roniprole

OR

other options like MAO B inhibitors like seligine or COMT inhibitors like entacopone (both of these enzymes will help increase the amount of dopamine by blocking their breakdown)

Question 15

Metabolic causes for seizures

Answer 15

Withdrawal from alcohol or benzo

Hyponatremia, hypoglycemia, hypomagnesmia, hypocalcemia, hyperglycemia

Question 16

Features of subdural hemorrhage vs epidural vs intraparenchumal hemorrhage

Answer 16

Subdural- crescent shape, usually associated with trauma and is insidous. Related to shearing of bridging veins. Can lead to midline shift

Epidural- lentiform shape and usually associated with trauma and a fractured skull

Intraparenchymal- usually associated with high bop, trauma, av malformation, tumor and is typically rounded p

Question 17

Genetics and clinical presentation of Huntington’s disease

Answer 17

Autosomal dominant, CAG repeats. A neuro degenerative disorder that leads to atrophy of the caudate nucleus

Will see purposeless movements (chorea) and dementia/cognitive decline

Can manage some symptoms with antipsychotics