Pages 495-499, 465-469

Question 1

A 35 yr old female is induced into labor. The patient is in agony due to labor induced pains and the patient is requesting to be put on pain medication. As her keen primary OB/GYN physician, you notice that the patient has a Hx of COPD. Which drug do you prescribe this patient and what is the MOA that allows for this drug to be favorable?

Answer 1

Butarphonal

K opioid receptor agonist/ Mu opioid receptor partial ag

Causes less respiratory depression and shouldn’t compromise her breathing compared to morphine

Question 2

A 5 year old child is sent to the nurse’s office because of decreased attention by his teacher. She says that when asked to answer a quiz question, he looked up with blank stare and didn’t answer back. Other kids have mentioned that he also stands in a corner in gym class without moving for a short periods, and find to be very weird. When the nurse asks the kid why he isn’t paying any attention, the child doesn’t know what she’s talking about. What is Dx, and which drug is the DOC and MOA?

Answer 2

The child has an absent seizure.

Ethosuximide- T type Ca Ch blocker

Question 3

A 30 year old man comes in the ER with severe pain and bizarre presentation on his skin. He literally felt that his skin is peeling off when he was in the shower. When asked if he had any other symptoms, he said that last week he developed a rash/sunburn on his face but he surprised because he hasn’t been out in the sun. He has also been feeling tired throughout the week As a keen physician, you are worried when you fin out that the patient has a 6 yr Hx of recurrent seizures. What is the Dx and the reason of your concern?

Answer 3

Th pt has phenytoin toxicity and is having SJ syndrome with a Hx of drug induced SLE

Question 4

A 30 yr old primagravida female patient is requesting for an ultrasound since she is concerned about the health of firstborn. As her keen primary OB/GYN physician, you notice that the patient has a Hx of seizures, and says that her neurologist has prescribed her a syrup which has helped her through her episodes. As a caring physician, what do you recommend to your patient? Why?

Answer 4

1) Immediately stop her medication (Valproic acid). CI in pregnancy b/c it cause NT defects
2) Also check her LFT for any signs of hepatic damage

Question 5

A 40 year old man comes in the ER with severe flank pain. He literally falls on the floor and curls up groaning with agony. When asked if he had any other symptoms, he said that he has been fine. He also remembers that 2 weeks ago he was prescribed a new drug for his episodes of seizures. What is the Dx and the reason of concern?

Answer 5

The patient is having kidney stones because of taking Topiramate (blocks Na Ch)

Question 6

A 20 year old female has been very depressed after her boyfriend broke up with her. She has been binge drinking all of last week, and to her keen judgement she finds a bottle of pills and decides to use them to her benefit. 6 hrs later she is presented in the ER with very shallow breathing. Lab results shows pH 7.30, CO2 levels of 60mm, and HCO3=30. As her PCP what is you Dx and reason for concern. What Tx can be done?

Answer 6

The patient has barbiturate toxicity, and only supportive Tx can be given. As a physician you can as for a gastric lavage as a Hail Mary theory.

Question 7

A 25 year old male has been very depressed after getting fired from his job. He has been binge drinking all of last week, and to his keen judgement she finds a bottle of pills and decides to use them to his benefit. 4 hrs later she is presented in the ER with mildly depressed breathing. Lab results show pH=7.40, PCO2= 38mm, HCO3= 30. As her PCP what is you Dx and reason for concern. What Tx can be done in this case?

Answer 7

This patient has overdoses on BZs. The patient should be given flumazenil in order to reverse the toxicity

Question 8

How doe s minimal alveolar concentration of an anesthetic compare to its solubility?

Answer 8

increased MAC = decreased solubility = decreased potency

Question 9

A 21 yr old male presents to the ER and doesn’t respond to verbal commands. He stars muttering incantations in a jibberish language that can’t be translated. Lab results show increased HR. The pt is sent to a neurologist. The neurologist identifies that the pt has increased blood supply to the brain. What is the Dx, and which unique phenomenon is associated with this patient?

Answer 9

The patient has taken Ketamine (NMDA receptor blocker). The patient is hallucinating and uttering jibbersh. Pt should be given rest and possibly given a long acting BZ to calm him down. When he wakes up he will reassure the doctors that he felt that he was having a out of body experience (dissociative fugue)

Question 10

A 65 year old man gets severe abdominal pain and faints.. When taken to the ER, the physicians diagnose AAA and get him prepped for surgery as soon as possible. The anesthesiologist gives the patient an inhaled anesthetic. 4 hrs after surgery, the patient is burning up and has muscle rigidity. WHat is the Dx and Tx

Answer 10

The patient is having malignant hyperthermia —>

Tx= Dantrolene

Question 11

A 40 yr old patient comes in complaining of diplopia. When the neurologist sees the patient he notices an external strabismus in the right eye. When asked to move look left, his right eye remains down and out. The physician orders an MRA to confirm his diagnosis when finds out that the patient has long history of HTN?.

Answer 11

Posterior Communicating artery lesion due to a Berry aneurysm rupture

Question 12

Normally what is the common lesion of a rupture of aBerry aneurysm?

Answer 12

ACom artery can lead to visual field defects

Question 13

A 45-year-old, previously healthy man has developed headaches over the past month. There are no remarkable
findings on physical examination. The patient does report a Hx of HTN. This time around the patient complains of a severe headache and pain isn’t going away from pain medication. On an MRA, what pathology will be found?

Answer 13

Berry aneurysm a the MCA arteries leading to SAH

Question 14

Name two conditions that are associated with rupture of lenticulostriate arteries

Answer 14

1) Subarachanoid Hemorrhage

2) Charcot Bouchard microaneurysm

Question 15

A 72-year-old woman trips on a toy truck left at the top of a flight of stairs by her grandchild and falls down the stairs. She does not lose consciousness. About 36 hours later, she develops a headache and confusion and is taken to the emergency department. On physical examination, she is conscious and has a scalp contusion. What is the
most likely location of the pathology in this patient?

Answer 15

Bridging veins rupture leding to subdural hematoma

Question 16

A 2 year old baby is brought in by his mother into the ER department crying of pain and vomitting. The baby seems irritated, and blood work is sent out for the lab. As a keen physician, you notice bruises on the skin. What should be the primary concern and Dx

Answer 16

The kid has shaken baby syndrome leading to a subdural hematoma. The physician should call social services and the police in order to inquire further about the situation. CT scan will show a crescent shaped collection of blood.

Question 17

A 20 year old man is boxing in the gym with his buddy. Though asked to take it easy, he gets a right jab to the forehead and falls unconscious. 6 Hours after taken to the ER he wakes up, and says that he wants to be discharged.. He has dealt with pain symptoms before and he needs to go back to work. What is your concern after getting a Head XR and Tx as a physician?

Answer 17

The pt should be monitored and and shouldn’t be discharged. He probably has a pteryion fracture with a lenticulate lemon shaped collection of blood due to a rupture of the MMA. The pt is in a lucid state and can develop transtentorial herniation if discharged later which can be fatal.

Question 18

What are differences on CTscan b/w a sub dural and epidural hematoma

Answer 18

epidural crosses the falx, subdural doesn’t cross the falx

Question 19

A 73 year old man with a history of BPH presents to the emergency room complaining of repeated falls. His wife admits that during the past 3 weeks he has had unsteady gait and memory disturbances, and urinary incontinence. His medical, surgical and family histories are unremarkable. He has never smoked or taken any recreational drugs. He drinks alcohol socially. His laboratory tests are all normal. A CT scan of the head shows slightly enlarged ventricles and slightly compressed gyri. What is the most likely diagnosis of this patient’s condition?

Answer 19

Normal pressure hydrocephalus

Question 20

What pathology is associated with hypoxia of neurons? What is seen in acute and chronic presentations?

Answer 20

Hypoxia leads to liquefactive necrosis

Acute presentation can have red neurons

Chronic presentation has reactive gliosis and eventually a glial scar with internal liquefied contents

Question 21

Focal ischia is often the causative agent for this pathology? How can this last for?

Answer 21

TIA up to 15 mins

Question 22

A 2 year old baby is brought in by his mother into the ER department crying of pain and vomiting. The baby seems irritated, and blood work is sent out for the lab. It is determined that ICP is increased As a keen physician, you order an MRI and see enlarged lateral ventricles . What should be the primary concern and Dx/Tx?

Answer 22

The pt has obstructive hydrocephalus due to obstruction of the aq of Sylvius. The patient should be given mannitol in order to reduce the ICP

Question 23

A 20 yr old man presents with papilledema, and blown out pupils. He is unconscious when arriving to the ER. Blood work is positive for Abs against gram negative diplococci and history of having a meningitis. What is the diagnosis and emergency Tx for this pathology?

Answer 23

The patient has communicating hydrocephalus due to arachnoid scarring post meningitis. The pt needs to be given mannitol and possibly surgery to relieve the increased ICP

Question 24

In the patient in the previous question a LP is ordered. Where should the needle be placed

Answer 24

b/w L3- L4 since he is an adult

Question 25

A 75 year old man with a history of forgetfullness presents to the emergency room disoriented . His wife admits that during the past 3 weeks he has had memory disturbances, and has misplaced his keys. He also forgot to turn the stove off after boiling water for pasta. His medical, surgical and family histories are unremarkable. He has never smoked or taken any recreational drugs. He drinks alcohol socially. His laboratory tests are all normal. A CT scan of the head shows slightly enlarged ventricles. What is the most likely diagnosis of this patient’s condition?

Answer 25

Hydrocephalus ex vacuo caused by Alzheimers disease