Weakness

Question 1

the main difference between GBS and CIDP is

Answer 1

time course

CIDP lasts greater than 8 weeks
GBS peaks in severity at 8 weeks

Question 2

Guillain-Barre causes […] paralysis

Answer 2

ascending

Question 3

proximal and distal bilateral diffuse neuropathies are categorized as [2]

Answer 3

time course

GBS (acute)
CIDP (chronic)

Question 4

[…] is the most common pathogen associated with GBS.

Answer 4

C. jejuni

Question 5

most common demyelinating disease affecting the central nervous system

Answer 5

multiple sclerosis

Question 6

what kind of deficit pattern does MS cause?

Answer 6

multifocal

discrete areas of transient inflammatory deyelination

Question 7

signs and symptoms of MS are dependent on […] of the lesion

Answer 7

location

Question 8

diagnostic criteria for MS

Answer 8

two or more lesion of the CNS separated in space and time without other explanation

Question 9

free radicals damage cells via membrane lipid […]

Answer 9

peroxidation

Question 10

what would you expect to see on biopsy 0-4 hrs post MI?

Answer 10

wavy fibers

Question 11

what would you expect to see on biopsy 4-24 hrs post MI?

Answer 11

early coagulative necrosis: edema, lysed cells
reperfusion injury –> hypercontraction of myofibrils (dark eosinophilic stripes)

Question 12

what would you expect to see on biopsy 1-3 days post MI?

Answer 12

extensive coagulative necrosis
surrounding tissue with acute inflammation and neutrophils
more edema

Question 13

what would you expect to see on biopsy 3-14 days post MI?

Answer 13

macrophages
granulation tissue at margins

Question 14

what would you expect to see on biopsy 2+ weeks post MI?

Answer 14

contracted scar tissue

(white is scar tissue)

Question 15

Collagen is deposited by […] starting at around seven days post MI then continues in a linear pattern for months

Answer 15

fibroblasts

“graph this out from 7 days to 6 months” (not really sure what is meant by that)

Question 16

activation of clopidogrel is dependent on […]

Answer 16

CYP enzymes

(Not effective in individuals with genetic polymorphisms of CYP enzymes or drug-induced inhibition of CYP enzymes)

Question 17

MOA of clopidogrel

Answer 17

Inhibition of P2Y12 receptor on platelets (ADP receptor) → ↓ expression of Gp IIb/IIIa receptors on platelets → inhibition of platelet aggregation

Question 18

Name three complications that can be seen in the first two weeks after a myocardial infarction and explain why they occur

Answer 18

arrhythmia: due to myocardial death and scarring

papillary muscle rupture: more often posteromedial papillary muscle because it is only supplied by the PDA. The anterolateral has dual supply

interventricular septum rupture: macrophage mediated degradation causes VSD

pericarditis: neutrophilic infiltrate 1-3 days post MI can cause pericarditis

Question 19

MOA of nitroglycerin/isosorbide

Answer 19

Exogenous supply of nitric oxide (NO) through nitrate → activation of guanylyl cyclase → ↑ cyclic guanosine monophosphate (cGMP) → activation of protein kinase G

Increases SERCA activity → ↓ intracellular calcium → ↓ recruitment of contractile units → vasodilation

Increases myosin light chain phosphatase activity → ↓ phosphorylated myosin → smooth muscle relaxation → vasodilation

Question 20

how to prevent tolerance in people using nitrates

Answer 20

nitrate free intervals of at least 8 hrs

Question 21

pain/temperature loss in a cape-like distribution

Answer 21

syringomelia

Question 22

why is the anterior white commissure significant in syringomelia?

Answer 22

the 2nd order neuron of the spinothalamic tract decussates here
often the first structure compressed as the syrinx expands

Question 23

Look for progressive pain-sensation-loss, and temperature-sensation-loss in the […] as an initial complaint to differentiate syringomyelia from other common foils

Answer 23

hands

Question 24

spinal cord lesion presenting with combined UMN and LMN degeneration
no sensory or bowel/bladder defects

Answer 24

ALS

Question 25

spinal cord lesion presenting with UMN signs below the lesion and LMN signs at the level of the lesion and loss of pain/temperature below the lesion dorsal columns intact

Answer 25

anterior spinal artery occlusion

Question 26

spinal cord lesion presenting with progressive sensory ataxia and absent DTRs

Answer 26

tabes dorsalis

Question 27

spinal cord lesion presenting with ataxic gait, paresthesias, impaired proprioception, UMN signs

Answer 27

subacute combined degeneration loss of Spinocerebellar tracts Corticospinal tracts Dorsal columns

Question 28

what would you expect to find on physical exam in Brown-Sequard syndrome?

Answer 28

at level of lesion: ipsilateral loss of all sensation ipsilateral LMN below level of lesion: ipsilateral UMN signs below level of lesion ipsilateral loss of proprioception, fine touch, vibration contralateral loss of pain temperature

Question 29

[MG vs LE] fatigable weakness spared reflexes worsens with use

Answer 29

MG

Question 30

[MG vs LE] proximal muscle weakness autonomic symptoms hyporeflexia improves with use

Answer 30

LE

Question 31

[MG vs LE] associated with thymoma

Answer 31

MG

Question 32

[MG vs LE] associated with SCLC

Answer 32

LE

Question 33

[MG vs LE] antibodies to the postsynaptic ACh-R

Answer 33

MG

Question 34

[MG vs LE] antibodies to the presynaptic Ca2+ channel

Answer 34

LE

Question 35

humoral hypercalcemia of malignancy causes [...]calcemia and [...]phosphatemia

Answer 35

humoral hypercalcemia of malignancy causes [hyper]calcemia and [hypo]phosphatemia (hypercalcemia suppresses PTH --> low PTH)

Question 36

Occlusion of which artery is most likely to cause papillary muscle rupture and acute mitral regurgitation?

Answer 36

posterior descending artery

Question 37

Rupture of the left ventricular free wall will most likely result in [...]

Answer 37

cardiac tamponade (beck's triad: hypotension, muffled heart sounds, and jugular venous distention)

Question 38

Infarction affecting the inferior heart is most likely to show changes in which ECG leads?

Answer 38

leads II, III, and aVF RCA

Question 39

Abnormalities found in leads I, aVL, and V5-V6 suggest dysfunction of the [...] portion of the heart

Answer 39

lateral LCX

Question 40

An infarction in the anterior heart would show abnormalities in leads [...]

Answer 40

V1-V4 LAD

Question 41

An infarction affecting the [...] heart would show abnormalities in leads I, aVL, and leads V1-V6.

Answer 41

anterolateral (occlusion of left main, so would affect LCX and LAD)