Quizzes Missed Topics Flashcards
Why is CT without contrast generally preferred in settings of acute trauma?
Imaging done to detect acute traumatic lesions (i.e. hematomas) does not enhance with contrast
What is the purpose of inducing hyperventilation in patients with elevated ICP such as in acute head trauma?
To reduce ICP
What effect does elevated CO2 have on intracranial pressure?
Increased serum CO2 raises PCO2 and causes a decrease in the pH of the CSF.
Decreased pH of CSF can act as a cerebral vasodilator, and cause an increase in cerebral blood flow and subsequently in ICP
A patient with a 15 month history of progressive head intolerance, 15lb unintentional weight loss, xerostoma, xeropthalmia, and hypohidrosis as well as orthostatic hypotension would most likely have what disorder? Explain the etiology of each symptom (can use grouped bullets).
Dysautonomia (both sympathetic and parasympathetic)
Parasympathetic Sx
-Gastroparesis
-Dry mouth
-Dry eyes
-22-lb unintentional weight loss
Sympathetic Sx
-Heat intolerance
-Anhidrosis
-Orthostatic hypotension
Antibodies against what receptor type would be able to cause a dysautonomia affecting both divisions of the autonomic nervous system?
Nicotinic acetylcholine receptors
They are found in both preganglionic and postganglionic ANS synapses, making them a possible culprit for dysautonomia
If bacterial meningitis causes the accumulation of pus and subsequent scarring of the leptomeninges, what clinical effect would this be expected to have on the ventricles of the brain?
Communicating hydrocephalus
There is a barrier in the pressure gradient that normally allows CSF to drain into the venous system, which causes a buildup of CSF despite there being no obstruction between the ventricles.
When in doubt, what is the best kind of opening remark to make to a patient in a difficult situation?
It is always best to rely on open-ended questions. This is the least confrontational way to begin the patient interaction and get their understanding of events.
For a patient with history of substance abuse, what type of medication (stimulant/non-stimulant) would be preferred first line treatment for a diagnosis of ADHD? What medication would be preferred?
A non-stimulant medication would be preferred.
Atomoxetine is the only FDA approved monotherapy nonstimulant medication for treatment of ADHD.
T/F: The left facial nucleus receives UMNs from the left corticobulbar tract
FALSE, it is the opposite
The left facial nucleus receives UMNs from the right corticobulbar tract, with the exception of the region of the facial nucleus responsible for the temporal motor divison which also receives UMN input from the left PMC.
Where does the UMN in the corticospinal tract synapse with the LMN?
In the ventral horn of the spinal cord at the level of exit.
Through what structure does CSF pass through to get from the lateral ventricles to the third ventricle?
The inerventricular foramen
In questions where Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome are both given as answer choices, a fatigueable weakness, such as beginning the day normally and ending the day with muscle fatigue would be most consistant with which disorder?
Myasthenia Gravis
What type of cancer is the most commonly associated with Dermatomyositis?
Ovarian cancer, where dermatomyositis is often the presenting complaint.
Note that it is associated with many cancers, but ovarian cancer is unquestionably the most common.
What is the difference between a manic and a hypomanic episode?
Hypomanic episodes follow the same criteria as Manic episodes, DIGFAST, with 3 exceptions.
1) Only needs to last 4 days
2) Cannot involve psychosis
3) Does not result in social/occupational impairment, or require hospitalization
What is one of the ways to differentiate serotonin syndrome from anticholinergic syndrome if both are considered possible?
Anticholinergic syndrome will present with mydriasis that may not be reactive to light, where as serotonin syndrome will not have this finding.
Additionally, if the drug in question that is causing the syndrome is a TCA, it may be best to err on the side of anticholinergic syndrome.
What is important to assess at baseline as well as periodically during treatment with Lithium?
Lithium has known nephrotoxic and thyrotoxic effects. Therefore it would be expected to test BUN and Creatinine at baseline and periodically.
What area of the brain would be lesioned in a patient with both eyes deviated to the right as well as left UE and LE weakness?
Eye deviation to the right implies a left frontal eye field. frontal lobe cortex lesion.
Left-sided hemiparesis implies a right hemisphere lesion, leading to a conclusion of right cerebral hemisphere lesion.
What can best differentiate a chronic closed angle glaucoma from a chronic open angle glaucoma?
A chronic closed angle glaucoma will be more likely in a patient with a narrow anterior chamber on penlight exam, as well as predisposing factors such as
-older age
-female
-history of hyperopia
What is another name for the common peroneal nerve?
The common fibular nerve.
A 70 year old woman who presents with a red, painful right eye with a history of hyperopia would be at risk for what pathology? What testing could be done to confirm this?
Acute angle closure glaucoma. Confirmatory testing would most likely be tonometry to measure IOP.
What are notable physical exam findings in Myotonic dystrophy? What genetic mutation is responsible for this disease? Is it heritable?
Trinucleotide repeat expansion is repsonsible for myotonic distrophy, and can be heritable in an autosomal dominant manner.
What is the point of a funnel plot?
To assess for publication bias
Which extraocular movements will be affected by knocking out the right Paramedian pontine reticular formation?
The right eye CN VI (abducens) and the left eye CN III *in the horizontal plane (medial rectus will be affected)
In other words, knocking out the right PPRF:
Right eye cannot abduct (lateral gaze to right is lost)- right abducens
Left eye cannot adduct (medial gaze to right is lost)- left MLF
