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IM EOR > Neuro (8%) and Uro/Renal (8%) > Flashcards

Neuro (8%) and Uro/Renal (8%) Flashcards

1
Q

Pt presents with unilateral facial drooping and inability to wrinkle forehead on one side. What is the treatment?

A

Prednisone UNLESS in an area where Lyme is endemic; can add acyclovir

Eye patch at night to prevent corneal abrasion

If paralysis persists >10 days, consider EMG; if progresses, consider surgical decompression

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2
Q

What is the nerve affected in Bells Palsy?

A

CN VII

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3
Q

What is the transmission pattern of Huntington Dz and what is the causative mutation?

A

Autosomal dominant

Expanded tri-nucleotide (GAG) repeats in the HTT gene

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4
Q

How can penetrance of Huntington Dz be predicted?

A 
# of GAG repeats in HTT gene:
<28 = WNL
28-35 = asymptomatic carrier
36-39 = incomplete penetrance
40+ = completely penetrant; will develop HD
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5
Q

What part of the brain is affected in Huntington Dz?

A

GAG repeats in the HTT gene cause atrophy of the caudate nucleus and putamen

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6
Q

CVA vessel identification: aphasia, gaze preference, and half-sided vision

A

MCA

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7
Q

CVA vessel identification: Leg paresis, hemiplegia, incontinence

A

ACA

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8
Q

CVA vessel identification: half-sided vision with lots of dizziness

A

PCA

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9
Q

CVA vessel identification: coma, cranial nerve palsies, apnea, vertigo

A

Basilar artery

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10
Q

CVA vessel identification: “Clumsy hand syndrome”, ataxis hemiparesis, pure motor OR pure sensory stroke

A

Lacunar infarcts

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11
Q

25 YO female with refractory HTN presents to ED with “worst HA of my life”. What is the likely underlying etiology?

A

Polycystic kidney disease is RF for subarachnoid hemorrhage, 2/2 rupture of berry aneurysms

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12
Q

What area is affected in pt who cannot process language but can still form and speak words?

A

Wenicke’s area

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13
Q

What area is affected in patient who cannot physically speak but can process language?

A

Broca’s area

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14
Q

What is the time frame in which tPA should be administered?

A

W/in 3 hours from last known normal

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15
Q

What is the treatment for a patient who presents with unilateral HA with lacrimation, recurrent at night?

A

Likely cluster HA

Treat acute with 100% O2 6-12 L/min via NRB (preferred); +/- triptan subQ

Prophylaxis with verapamil

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16
Q

What are 4 characteristics that help describe delirium?

A
  • Reversibility
  • Fluctuating levels of disorientation
  • Hallucinations likely
  • Secondary to underlying medical condition
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17
Q

What is the MC cause of AMS in the inpatient setting?

A

Delirium

  • EtOH is MC cause
  • Heightened risk after surgery, esp in patients with CVD or DM
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18
Q

What are two key features that help distinguish delirium from dementia?

A

Delirium is more likely to present with hallucinations; dementia rarely does

Delirium is reversible

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19
Q

How is the treatment of vascular dementia different from that of AZD?

A

AZD is treated with cholinesterase inhibitors (donepezil)

Vascular dementia treated with BP control

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20
Q

Patient with rapid onset of fever, HA, seizures, focal neuro deficits, and impaired consciousness is sus for what condition?

A

Encephilitis – more likely to present with AMS than meningitis

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21
Q

What’s the difference between a Parkinsonian tremor and a hereditary tremor?

A

Parkinsonian: Tremor at rest

Essential tremor: Intention tremor

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22
Q

Describe LP findings in Guillain Barre

A

Normal glucose
Normal WBC
Elevated protein

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23
Q

Pt presents with fever, HA, stiff neck and LP shows elevated lymphocytes with normal glucose and protein <200. What is the likely dx?

A

Viral meningitis

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24
Q

Describe/differentiate Kernig vs Brudzinksi signs

A

Kernig - can’t extend Knee w/o hip flexion

Brudzinski - neck flexion results in hip and knee flexion

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25
Q

Describe the LP findings in bacterial meningitis

A

Decreased glucose
Increased neutrophils
Increased protein

Increased pressure

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26
Q

Pt presents with fever, HA, and stiff neck. What is the next diagnostic step?

A 
LP for CSF examination UNLESS:
- papilledema
- seizures
- confusion
- focal neuro effcs
are present, in which case get a CT first to r/o mass effect
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27
Q

What are some acute treatment options for migraine HA?

A

Toradol, reglen, benadryl combo
vs
Sumatriptan

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28
Q

What is the treatment for status migrainosus?

A

(72+ hours)

  • IVF
  • Parenteral kertoralac
  • Dopamine receptor blocker (antiemetics, including metoclopramide, prochlorperazine, chlorpromazine)

Often parenteral dexamethasone is also added to help prevent attack relapse

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29
Q

What are some CIx for commonly used migraine medications?

A

Don’t use triptans in ischemic heart disease, smokers, or >60 YO.

Don’t use ergotamine in pregnancy

Don’t use propranolol in pregnancy

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30
Q

What is the pathophys involved in a patient who presents with ptosis which varies in severity throughout the day?

A

Likely myasthenia gravis

Antibody-mediated, T-cell dependent immunologic attack on proteins of the postsynaptic membrane of the ACh receptors in the neuromuscular junction

Antibodies = AChR-Ab

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31
Q

How is myasthenia gravis diagnosed?

A

Single-fiber electromyography (EMG)

Immunologic assay showing ACh-R-Ab

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32
Q

What is the MOA of the drug of choice for a patient who presents with bradykinesia, resting tremor, and shuffling gait?

A

Sinemet (carbidopa-levadopa) is the 1st line treatment for Parkinson disease

Levodopa gets converted to dopamine after carbidopa helps it cross BBB and inhibits breakdown in the plasma

33
Q

What is the pathophys involved in Parkinson Dz?

A

Loss of dopaminergic neurons in the substantia nigra

34
Q

What are some important AE’s ass’d with the first line treatment for Parkinson’s?

A

Carbidopa-levodopa

  • Impulse control disorders
  • LE edema
  • Orthostatic hypotension
  • Drowsiness
  • N/V
35
Q

EEG shows interictal spikes in frontotemporal region of brain

A

Complex focal seizure

36
Q

EEG shows slow waves in temporal region of brain

A

Complex focal seizure

37
Q

EEG shows bilateral, symmetric, 3 Hz spike and waves

A

Generalized seizure

38
Q

What is the 1st and 2nd line treatments for status epilepticus?

A

1st line = benzos

  • IV Lorazapam is 1st line
  • IM midazolam if IV cannot be established

2nd line = phenytoin/fosphenytoin

39
Q

What kind of acid/base imbalance and electrolyte abnormality is expected in a patient who has been having excessive vomiting?

A

Hypochloremic
Hypokalemic
Metabolic alkalosis

40
Q

What is the best indicator of presence of chronic renal failure?

A

Proteinurea

- Spot urine albumin:Cr is preferable

41
Q

What is nephrotic range proteinurea?

A

> 3gm in 24 hours

42
Q

What is the MC cause of CKD?

A

Uncontrolled DM, HTN

43
Q

What is the MC cause of CKD ass’d with malignancy?

A

Membranous nephropathy

44
Q

What are the labs associated with and treatment for renal osteodystrophy?

A

Low Ca2+
High Phosphate
– Give calcitriol and phosphate binders

Also watch out for signs of osteomalacia: replace vitamin D and Ca2+

45
Q

Which drugs are most commonly associated with acute interstitial nephritis?

A

5 P’s:

  • Pee (diuretics)
  • Pain (NSAIDs)
  • PPIs
  • PCN
  • rifamPin
46
Q

What are some s/sx of acute interstitial nephritis?

A

Hematuria
Rash
Possible fever
- Likely recent drug use (diuretics, NSAIDs, PPI, PCN, or rifampin)

47
Q

What is the #1 RF for bladder cancer?

A

Smoking

48
Q

Painless hematuria in a smoker on a test is almost certainly …

A

Bladder cancer

49
Q

What are the s/s of glomerulonephritis?

A
  • Hematuria
  • HTN
  • Azotemia (elevated BUN)
  • Proteinurea

May also see fever, peripheral edema, malaise. Will likely have recently recovered from GAS infection, URI or GI infection.

50
Q

What is the gold standard diagnosis for glomerulonephritis?

A

Renal biopsy- not generally done or needed

51
Q

Describe the pathogenesis of glomerulonephritis

A

Post GAS immunologic inflammation of glomeruli causing protein and RBC leakage into urine

52
Q

How is a hydrocele diagnosed?

A

Testicular US to r/o mass

53
Q

MC cause of acute scrotal pain?

A

Epididymitis

54
Q

What is the treatment for a patient who presents with localized testicular pain and tenderness with palpation of the posterior testis?

A

NSAIDs + antibiotics:

<35 YO/higher risk of STIs:

  • cover gonorrhea, chlamydia
  • Ceftriaxone
  • Doxy (can sub AZ)

> 35 YO & low risk of STIs:

  • Cover enteric apathogens
  • Levofloxacin 500 mg PO x 10 days

Any patient practicing anal intercourse:

  • Cover gonorrhea, chlamydia, and enteric pathogens
  • Ceftriaxone
  • Levofloxacin
55
Q

What are two clinical signs that are suggestive of testicular torsion?

A

Absence of Phren sign (no relief with elevation)

Absence of cremesteric reflex

56
Q

What are some s/sx associated with hydronephrosis?

A

Often asx, discomfort associated with bladder distention, obstructive stones, or secondary infections.

If chronic, labs may show hyperkalemia

If bilateral or underlying kidney disease, Cr may be elevated

57
Q

Pt presents with painful hematuria and is restless during exam. What is the diagnostic test of choice for the likely diagnosis?

A

Helical CT / non-con CT “stone protocol”

58
Q

What are the size parameters that dictate treatment of a kidney stone?

A

<5 mm, likely to pass spontaneously

> 8 mm, unlikely to pass, consider lithotripsy

59
Q

What is the MC site of obstruction in nephrolithiasis?

A

Ureterovesical junction

60
Q

What is the MC type of kidney stone?

A

Ca oxalate

61
Q

What dietary advice should be given to patients with frequent kidney stones of ANY type?

A

All types of stones:

  • Enough fluid to produce 2 L urine per day
  • Limit sodium intake <2300 mg/day (low sodium increased proximal Ca2+ reabsorption = less Ca2+ excretion)
  • Increase fruit, vegetable intake (esp K+ rich)
  • Weight loss
62
Q

What are some dietary adjustment that should be suggested to patients with recurrent kidney stones of the MC variety?

A

Ca+ Oxalate stones are MC

  • INCREASE dietary (not supplementary) Ca2+ at meals
      • Ca2+ binds to oxalate in intestine, reducing oxalate absorption
  • Reduce nondairy animal protein intake
  • Don’t take Ca2+ supplements
  • Avoid vitamin C supplements
63
Q

What is the most clinically important inhibitor of Ca2+ oxalate stone formation?

A

Citrate - chelates Ca2+ in the urine = decreased free Ca2+ available to bind with oxalate or phosphorus

64
Q

Pt with very high intake of animal protein develops nephrolithiasis and urine pH is excessively low - what is suspected type of stone and what is the treatment?

A

Uric acid stone
Increase fruit/vegetable intake
Potassium citrate supplementation

65
Q

What kind of large kidney stones form in the setting of UTI?

A

Struvite “staghorn calculus”

66
Q

What kind of stones are ass’d with familial history and huge numbers of stones?

A

Cystine stones

67
Q

In what case would a patient with kidney stones be advised to AVOID fruits and greens?

A

Patients with Ca phosphate stones (rare) ass’d with increased (alkaline) urine pH

68
Q

Patients with FHx of refractory HTN should be screened for what condition?

A

Polycystic kidney disease

69
Q

How is polycystic kidney disease treated?

A
  • ACEi/ARB for BP control
  • Dietary sodium restriction
  • Increased fluid intake (>3 L per day)
  • Pts with GFR 25+: Tolvaptan (vasopressin receptor blocker)

Also screen family via US

70
Q

What is a lab abnormality on CBC that might be associated with renal cell carcinoma?

A

High Hg/Hct 2/2 increased epo production

71
Q

What are parameters for prostate cancer screening?

A
  • 55-69 and life expectancy >10 years
    or
  • Starting at 40 if there is FHx or pt is Black
72
Q

Pt has PSA of 60 on 2 separate occasions 6 months apart. What is the next step in diagnosis?

A

CT or MRI pelvis

Consider MRI-US fusion to direct biopsy

73
Q

What is the MC type and location of prostate cancer?

A

Adenocarcinoma of the peripheral zone

74
Q

What are some s/sx of prostatitis?

A

Fever
Pain in the perineal, sacral, or suprapubic regions
Possible urinary retention
*Exquisitely tender, warm, boggy prostate

75
Q

How is acute prostatitis diagnosed and treated?

A

UA with micro, C&S
Blood culture

(NO PSA)

Tx with doxycycline 100mg BID 2-6 weeks

76
Q

What are alarm signs associated with varicocele, and what is the concern?

A
  • R-sided or bilateral
  • Doesn’t disappear when laying supine

Concern for IVC obstruction

77
Q

What is the inpatient treatment for pyelonephritis?

A

IV amp + gent

–> transition to PO cipro

78
Q

What is the outpatient treatment for pyelonephritis?

A

Cipro BID x7-14 days

79
Q

What are the tx for uncomplicated UTI?

A

Nitrofurantoin 1st line
TMP-SMX next

Cipro/levoflox reserved

IM EOR (8 decks)

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