Neuro/Derm

Question 1

transient loss of consciousness from an injury, then lucid period followed by increasing drowsiness, headache, and unilateral (contralateral) weakness

Answer 1

Epidural hematoma

Question 2

elderly patient with a history of multiple falls who is now presenting with neurological symptoms

Answer 2

Subdural hematoma

Question 3

explosive “thunderclap” headache described as “the worst headache ever”

Answer 3

Subarachnoid headache

Question 4

an abrupt onset of a focal neurologic deficit that worsens steadily over 30 to 90 minutes, altered level of consciousness, stupor, or coma. Headache, vomiting, and signs of increased ICP

Answer 4

Intracerebral hemorrhage

Question 5

• The Middle meningeal artery at the temple is most commonly involved in what type of brain hemorrhage

Answer 5

Epidural hematoma

Question 6

• Transient loss of consciousness from injury, then lucid period followed by increasing drowsiness, headache, and unilateral (contralateral) weakness.

Answer 6

Epidural hematoma

Question 7

Epidural hematoma, convex or concave

Answer 7

• Diagnosis: CT brain - classic CT finding is lenticular, unilateral convexity, usually in the temporal region. (lens-shaped, biconvex)

Question 8

• Most common intracranial pathology due to head trauma (rupture of veins in the cerebral cortex)

Answer 8

Subdural hematoma

Question 9

Crescent shape hematoma

Answer 9

Subdural

Question 10

Ruptured saccular (berry) aneurysm accounts for approximately 75% of nontraumatic cases of

Answer 10

Subarachnoid hemorrhage

Question 11

Subarachnoid hemorrhage

Answer 11

• Altered mental status – may have neck stiffness and nuchal rigidity

Question 12

Aphasia causes

Answer 12

• Postoperative cerebral vascular accident (stroke)- trouble speaking, along with having a numb or drooping face and feeling weak in one arm, is one of the three major signs of stroke
• Multiple sclerosis - lesions in areas of the brain responsible for speech can have speech issues that range from mild to severe
• Intracerebral hemorrhage
• Migraine headache may cause transient aphasia
• Carotid disease - see general surgery vascular disorders
• Recurrent laryngeal nerve injury 0.77% of thyroidectomies resulting in hoarseness and aphonia

Question 13

• The most common cause of postoperative ocular injury is , which may or may not be associated with visual loss

Answer 13

corneal abrasion

Question 14

• Loss of pain and temperature below the level with preserved joint position/vibration sense

Answer 14

Anterior cord syndrome

Question 15

• Loss of pain and temperature sensation at the level of the lesion, where the spinothalamic fibers cross the cord, with other modalities preserved (dissociated sensory loss)

Answer 15

Central cord syndrome

Question 16

Brown Sequard syndrome is what?

Answer 16

• Loss of joint position sense and vibration sense on the same side as lesion and pain and temperature on the opposite side a few levels below the lesion
• Lesion of half-ipsilateral cervical cord lesion
• Contralateral sensory findings: pain and temperature loss

Question 17

Distal sensory polyneuropathy

Answer 17

• Stocking-glove sensory loss is a term used to describe sensory loss affecting the distal lower and upper extremities that is most commonly seen in length-dependent axonal neuropathies

Question 18

What are the 4 stages of ulcers

Answer 18

• Stage 1: erythema of localized area, usually non-blanching over the bony surface
• Stage 2: partial loss of dermal layer, resulting in pink ulceration
• Stage 3: full dermal loss often exposing subcutaneous tissue and fat
• Stage 4: full thickness ulceration exposing bone, tendon, or muscle. Osteomyelitis may be present

Question 19

Which stage ulcer does this describe “full thickness ulceration exposing bone, tendon, or muscle. Osteomyelitis may be present”

Answer 19

Stage 4

Question 20

What is the wound mangement for ulcers stage 1-4

Answer 20

• Stage I: aggressive preventive measures, thin film dressings for protection
• Stage II: occlusive dressing to maintain healing, transparent films, hydrocolloids
• Stages III-IV: Débridement of necrotic tissue. Exudative ulcers will benefit from absorptive dressings such as calcium alginates, foams, hydrofibers. Dry ulcers require occlusive dressing to maintain moisture, including hydrocolloids, and hydrogels.

Question 21

What is pruritis ani

Answer 21

is a rare condition characterized by an intraepithelial adenocarcinoma of the perianal skin. The most common presenting complaint is intolerable pruritus and examination typically reveals a well-demarcated, erythematous, eczematous rash

Question 22

Fat emoboli in long bones would present how?

Answer 22

cause a syndrome characterized by respiratory insufficiency, coagulopathy, encephalopathy, and an upper body petechial rash

Question 23

What is Dariers sign

Answer 23

localized urticaria appearing where the skin is rubbed (histamine release)

Question 24

What is Clarks classification for staging of melanoma

Answer 24

Clark Classification System of Microstaging

• Level I: Confined to the epidermis (in situ)
• Level II: Invasion into the papillary dermis
• Level III: Penetration to the papillary-reticular interface
• Level IV: Invasion into the reticular dermis
• Level V: Penetration into the subcutaneous fat

Question 25

What is the tx for postop drug eruption?

Answer 25

• STOP DRUG then → Intravenous immunoglobulin (IVIG)
• Steroids used to be the treatment of choice are now thought to be an increased risk for sepsisIntravenous immunoglobulin (IVIG)
• Steroids used to be the treatment of choice are now thought to be an increased risk for sepsis

Question 26

nipple discharge, sexual dysfunction, reduced sex drive should make you think of what?

Answer 26

Hypogonadism

Question 27

How is cellulitis treated

Answer 27

Treat methicillin-resistant Staphylococcus aureus infection (MRSA) with

• Trimethoprim-sulfamethoxazole (TMP-SMZ) 1 DS tab PO BID
• Clindamycin 300–450 mg PO
• Doxycycline 100 mg PO BID
• Intravenous Vancomycin or Linezolid