MUSCULOSKELETAL/NEURO

Question 1

What is Creatinine Kinase an indicator of?

Answer 1

CK is an indicator of muscle breakdown
Causes of elevated CK:
-Rhabdomyolysis (causes AKI sec to myoglobin disposition)
-MI
-seizures
-severe infection
- prolonged shivering

Question 2

S/S and Risk factors of idiopathic intracranial Hypertension

Answer 2

-Headache
-Visual changes and distubances

Risk factors:
-Female of childbearing age
-obesity
-Hypothyroidism
-Recent treatment of Doxycycline

MRI will come back with without any changes or abnormalities

Question 3

What is increased ICP with no obvious cause treated with?

Answer 3

Analgesics such as Fentanyl are used to treat subclinical pain or agitation

ICP is treated when its over 20 mm Hg

Question 4

What is the treatment for symptomatic cerebral salt washing?

Answer 4

A hypertonic saline solution of 3% sodium chloride because it rapidly increases serum sodium

Question 5

What deficits will you see with a embolism of the anterior, middle and posterior cerebral artery

Answer 5

-Anterior ( voluntary movements - hemiplegia)
- Middle ( Aphasia)
- Posterior (sensory and visual loss)

Question 6

What are the hallmark s/s of Normal Pressure Hydrocephalus ?

Answer 6

• increase urinary incontinence
  -cognitive decline with disinhibition and aphasia
  -Gait disturbances with falls
  -ataxia
  -Restrictive eye movement with no enlargement of ventricles on imaging

Question 7

S/S of Central Cord Syndrome?

Answer 7

Weakness more prominent in the upper extremities than the lower extremities

Question 8

S/S of Horner Syndrome and diagnostic tool?

Answer 8

-Miosis
-Ptosis
-Anhidrosis
-MRA of the head and neck is most urgent to r/o Carotid artery dissection

Question 9

Treatment for delirium not caused by ETOH or benzodiazepines withdrawal?

Answer 9

Dexmedetomidine Hydrochloride (Precedex) infusion

Question 10

Management for patients with severe TBI with a GCS 3-8 and abnormal head CT

Answer 10

Intubation and ICP monitoring
High priority concern for TBI is cerebral edema (increased intracranial volume)

Question 11

What test confirms Rhabdomyolosis and treatment?

Answer 11

CK level greater that 1000 U/L or at least 5x the upper limit of normal
- Prompt crystalloid resuscitation

Question 12

Management of acute Subluxation of the acromioclavicular joint

Answer 12

-Sling to immobilize joint
-Ice to reduce swelling at the site
-NSAIDs to reduce inflammation and contribute to pain control

Question 13

Why is Acute Respiratory Failure a complication of Guillian-Barre Syndrome?

Answer 13

-GB is a autoimmune attack of the peripheral myelin.
-Demyelintion of the nerves that innervate the diaphragm and intercostal muscles results in respiratory failure

Question 14

Diagnostic standard to evaluate intracranial lesion

Answer 14

MRI with contrast/gadolinium

Question 15

S/S of Brown-Sequard (hemicord) Syndrome

Answer 15

-Weakness, loss of vibration and proprioception ipsilateral to the site of injury
-Loss of pain and temperature on the opposite side

Question 16

First-line agent for increased ICP

Answer 16

Mannitol 1gm/kg over 20 mins

Question 17

S/S of Giant Cell Arteritis

Answer 17

-Common in women who are 50 years and patient of Scandinavian descent
-Headaches
-Fevers
-Fatigue
- Muscle aches that started with stiffness and Pain in neck, shoulders, lower back, hips and thighs
-Elevated ESR and CRP

Question 18

S/S of Lewy Body Dementia

Answer 18

• Fluctuating cognitive impairment
• Rigidity
  -Bradykinesia

Question 19

S/S of Parkinson’s Disease

Answer 19

• Resting Tremor
  -Rigidity
  -Bradykinesia
• Hypomimia or mask-like face
• Sleep disorders
  -Micrograhia
• Microphonia

Question 20

S/S Myasthenia Gravis

Answer 20

• Affect women in their early 20-30s and men in their 50-60s
• Weakness later in the day or with repeated usage
• facial and cranial weakness including eyelids, extraocular muscles with diplopia, ptosis and chewing and swallowing
  Symptoms improve after sleeping or rest

Question 21

Classic sign of Epidural Hematoma

Answer 21

• Lucid interval between the head trauma and decline in consciousness

Question 22

Precursor of Guillian-Barre Syndrome and presentation

Answer 22

-Precursor: recent viral infections or immunization
Presentation:
- Neuropathic pain in the neck and back
-Ascending paralysis with loss of deep tendon reflexes
patient often require ventilator support including tracheostomy so measurement PF vital capacity is a priority.

Question 23

Cocaine s/s

Answer 23

-Seizures

Question 24

S/S of Cushing’s Triad

Answer 24

-Severe Hypertension
- Bradycardia
- Respiratory irregularity due to medullary dysfunction

Question 25

S/S of Multiple sclerosis

Answer 25

-Sensory loss
- Optic neuritis
-Weakness
-Paresthesia

Question 26

S/S of Physiologic Anisocira

Answer 26

• One pupil slightly larger than the other
• the size difference does not change in different lighting

Question 27

Treatment for non-displaced fractured coccyx

Answer 27

-Discharge home on Analgesics
-Bed rest for 3-4 weeks
-Follow up with orthopedics in 2-3 weeks of pain continues
Fracture generally heal on their own

Question 28

Treatment for type 2 amiodarone induced thyrotoxicosis

Answer 28

-Glucocorticosteroids

Question 29

Treatment for type 1 amiodarone induced thyrotoxicosis

Answer 29

Thionamide

Question 30

Rapidly progressing Cellulitis treatment

Answer 30

Penicillin
OR
Ceftriaxone
Clindamycin

Question 31

CAMRSA skin infections treatment

Answer 31

Bactrim
Doxycycline
Clindamycin

Question 32

Adverse effect of Nicardipine infusion

Answer 32

Reflex tachycardia
Add a Beta blocker (example Esmolol) to prevent