Test 52 - Created Aug 14

Question 1

Wallenberg syndrome (some characteristic features)

Answer 1

vertigo, nystagmus, ipsi limb ataxia, loss of pain/temp in ipsi face and contra trunk/limbs, dysphagia, dysarthria, dysphonia, ipsi Horner’s, bad hiccups, lack of automatic respiration

Question 2

location of lesion in Wallenberg syndrome

Answer 2

lateral medulla

Question 3

general rules for localizing brain lesions

Answer 3

1. thalamus/cortex - sensory loss in contra face/body
2. cortex - aphasia, neglect, or agraphesthesia
3. brainstem - CN’s; impaired sensory over ipsi face and contra body
4. cerebellum - ataxia, discoordination

Question 4

cranial nerves in each of the following: midbrain, pons, medulla

Answer 4

midbrain: 3, 4
pons: 5, 6, 7, 8
medulla: 9, 10, 11, 12

Question 5

correlation of increases in specificity or sensitivity and (+) and (-) predictive values

Answer 5

increased sPecificity, increases PPV

increased seNsitivity, increases NPV

Question 6

presentation of adjustment disorder

Answer 6

stressor within the last 3 months, sxs started after it, having mixed sxs of MDD/anxiety/adhd

Question 7

tx of adjustment disorder

Answer 7

short-term psychotherapy; zolpidem to help w/ sleep

Question 8

presentation of stress-induced (takotsubo) CMP

Answer 8

postmenopausal F with recent physical or emotional stressor -> CP, decompensated HF, moderated troponin elev., some ischemic changes

Question 9

diagnosis of stress-induced (takotsubo) CMP

Answer 9

cath: no obstr. CAD
echo: LV apical hypokinesis, basilar hyperkinesis

Question 10

GI bleeding from angiodysplasias are associated with what diseases

Answer 10

end-stage renal disease, aortic stenosis, and von Willebrand disease

Question 11

presentation of G6PD def. in newborn

Answer 11

unconjugated hyperbili and anemia on D.O.L. 2-3

Question 12

when Rhogam is given in pregnant Rh(D) neg pt

Answer 12

1. once at 28-32 wks GA
2. once postpartum
3. any time mom’s and baby’s blood may mix (abortion, mole, villi sampling, trauma, etc.)

Question 13

definition of severe aortic stenosis

Answer 13

aortic jet velocity >4.0 m/sec or mean transvalvular gradient >40 mmHg

Question 14

indications for aortic valve replacement in aortic stenosis pt

Answer 14

severe AS plus 1/+ of:

1. sxs
2. LVEF <50%
3. undergoing other cardiac surgery

Question 15

what to suspect when thrombocytopenia found on labs in HIV pt? treatment?

Answer 15

if isolated -> HIV-associated thrombocytopenia; tx = HAART

Question 16

drop of viral load in HIV pt on HAART

Answer 16

(logarithmic drop)
4 wks: <5000 copies
8-16 wks: <500
16-24 wks: <50

should be <50 by 6 mo. mark

Question 17

1st line meds for Raynaud phenomenon

Answer 17

“-dipine” (nifedipine, amlodipine)

Raynaud people have cold hands, which are used to “dip” ice cream.

Question 18

when is further evaluation indicated for Raynaud phenomenon pt

Answer 18

when there are sxs suggestive of systemic disease

Question 19

signs of adrenal failure

Answer 19

weight loss, weak/lacks energy, eosinophilia, borderline sodium levels, hyperkalemia, mild anion gap acidosis, prerenal azotemia, low blood glucose

Question 20

diagnosis of adrenal failure

Answer 20

cosyntropin stimulation test

Question 21

protective factors against suicide

Answer 21

social support/family connectedness, pregnancy, parenthood, religion and participation in religious activities

Question 22

presentation of bowel injury and what to do next

Answer 22

fever, leukocytosis, abdominal pain/guarding, N, ileus; do abd. CT w/ oral contrast to find site of leakage

Question 23

tx of Mobitz type II 2* AV block

Answer 23

unstable - IV atropine

stable - pacemaker

Question 24

tx of central venous sinus thrombosis

Answer 24

heparin or LMWH

Question 25

fetal postmaturity syndrome

Answer 25

SGA, wrinkled/peeling skin, long/thin body, decr. fat, long fingernails, sparse lanugo hair but increased scalp hair, meconium-stained (green/black) placenta (and possibly meconium covered baby too)

Question 26

tx of epistaxis refractory to pinching for 10 minutes

listed in order of when to do it

Answer 26

1. oxymetazoline on cotton
2. chemical or electrical cautery
3. bacitracin-covered sponge

Question 27

who is most at risk of postop pulmonary complications; what to do about these prior to surgery

Answer 27

COPD, cig smoking, sleep apnea, heart failure

stop smoking 4 wks prior; optimize COPD and HF

Question 28

1st line tx of cocaine-related CP

Answer 28

1. BONA (benzo, O2, nitrates, aspirin)
2. phentolamine for resistant HTN
3. morphine for resistant CP
4. PCI if all else fails

Question 29

next step when pt who ingested cocaine has persistent CP despite medicines and new neuro findings

Answer 29

do imaging to look for dissection of ascending aorta

CTA, MRA, or TEE