Mix4

Question 1

Best way to treat uric acid stones?

Answer 1

High fluid intake, low purine diet, alkalinization of urine (with potassium citrate). Give allopurinol if recurrent sx.

Question 2

Encephalopathy, oculomotor dysfunction (horizontal nystagmus/bilateral abducens palsy), and postural/gait ataxia in malnutrition. What’s the cause?

Answer 2

Wernicke’s encephalopathy = thiamine B1 deficiency.

Question 3

MCC of spontaneous lobar hemorrhage in Pt > 60yo

Answer 3

Cerebral amyloid angiopathy

B-amyloid deposits in walls of small-med sized cerebral arteries&raquo_space; vessel wall weakening&raquo_space; rupture

Question 4

Nephrotic syndrome diagnosed then treated with diuretics and salt restriction then Pt develops severe R sided abdominal pain, hematuria, and fever. What happened?

Answer 4

Renal vein thrombosis (due to loss of AT III). Potential for all nephrotic syndromes but happens most in Membranous Nephropathy

Question 5

Why does low Mg prevent K repletion?

Answer 5

Intracellular Mg prevents K+ secretion by ROMK (renal outer medullary K+) channels in collecting ducts of the kidney. Low Mg&raquo_space; excessive K+ renal wasting.

Question 6

Rapidly progressive dementia with myoclonus, akinetic mutism, cerebellar/visual disturbance, and EPS with periodic sharp wave complexes on EEG and normal non-con CT:

Answer 6

Creutzfield Jakob. Need 2 of the 4 Sx. Confirm with 14-3-3 CSF assay

Question 7

First-line treatments for Alzheimer’s:

Answer 7

Anticholinesterase inhibitors (donepezil, rivastigmine, galantamine, tacrine). Memantine (NMDA antag) is approved for moderate-severe dementia

Question 8

Lateral medullary infarction develops due to occlusion of the:

Answer 8

PICA. Pt develops loss of pain/temp sensation over the ipsilateral face and contralateral body (due to spinal trigeminal and spinothalamic injury), ipsilateral bulbar weakness (nucleus ambiguus), vertigo (vestibular nuclei) and horner syndrome (ascending sympathetic fiber)

Question 9

Area of the brain affected in ipsilateral oculomotor nerve palsy, ataxia, and contralateral hemiparesis.

Answer 9

Midbrain. Ataxia = superior cerebellar peduncle. Hemiparesis due to cerebral peduncle.

Question 10

Best way to reverse warfarin assoc intracerebral hemorrhage?

Answer 10

Prothrombin complex concentrate (has II, VII, IX, and X) and is good for rapid short term reversal. Can give FFP if PCC is unavailable, but FFP takes longer to prepare. IV Vit K takes 12-24 hrs to be effective.

Question 11

First line drugs for uncomplicated cystitis in nonpregnant woman:

Answer 11

Nitrofurantion for 5 days, or TMP-SMX for 3 days, or single dose Fosfomycin

Question 12

Fever, Anemia, decreased platelet #, renal failure:

Answer 12

TTP. “ FAT-RN” . Small vessel thrombi in microvasculature consume platelets, shear RBC, and cause end organ damage. Due to deficiency of plasma protease ADAMTS13. Requires emergent plasma exchange.

Question 13

Electrolyte disturbance in HIV Pt treated with TMP-SMX

Answer 13

Can cause hyperkalemia. TMP blocks ENaC in collecting tubule (similar to amiloride - K sparring)&raquo_space; hyperkalemia. TMP also causes competitive inhibition of creatinine secretion.

Question 14

Focal dystonia of the SCM

Answer 14

Torticollis. Lots of causes (idiopathic, congenital, drug, trauma, inflammation). Drug induced due to typical antipsychotics, metoclopramide, and prochlorperazine.