Week 1

Question 1

What is associated with von hippel lindau and where is the mutation

Answer 1

pheochromocytomas, retinal and cerebellar hemangioblastomas, and RCC. Mut is on chromosome 3 of VHL gene

Question 2

what is indicative of a postictal state vs. syncope

Answer 2

confusion lasting for several minutes after a seizure. In syncope you return almost immediately to baseline

Question 3

after a carotid endarterectomy what is the more immediate risk and what is a risk in a couple months

Answer 3

immidiate - plaque embolism months- intimal hyperplasia

Question 4

distinguish between early and late findings of alzheimers

Answer 4

early-forgetfullness, trouble driving places that were once commonplace, language difficulties, etc. LATE: urinary incontinence, dyspraxia, noncognitive deficits, urinary incontinence

Question 5

describe idiopathic intracranial HTN

Answer 5

typically an obese woman, likely because of outlet syndrome. You will see papilledema, negative imaging, elevated opening pressure

Question 6

normal pregnancy urine findings

Answer 6

trace protein is normal

Question 7

Sturge-Weber syndrome findings

Answer 7

port wine stain on the face into eye, risk of glaucoma

Question 8

Phenytoin toxicity signs

Answer 8

cerebellar dysfunction, ataxia, altered mental status, hyperrflexia

Question 9

How can an AV fistula in the arm for dialysis affect the median nerve

Answer 9

multifactorial, main thing to know is that it is carpal tunnel syndrome that is the main thing that happens

Question 10

how do you manage traumatic brain injury

Answer 10

maintain central pressure, administer a antifibrinolytic (tranexamic acid), prevent seizures, control blood glucose, etc.

Question 11

what is the likely etiology of a 20yo with new onset hearing loss with family hx of similar hearing loss at 20yo

Answer 11

NF2 bc of bilateral acoustic neuromas

Question 12

what is the likely cause of a intracranial hemorrhage in a 40yo without any PMH

Answer 12

cocaine

Question 13

what do you give to a pregnant patient for migraine prophylaxis

Answer 13

a beta blocker, the other prophylaxis drugs are topiramate/valproate (toxic) or an antidepressant TCA or venlafaxine which also cannot be given

Question 14

Hallmarks of tuberous sclerosis

Answer 14

ash leaf spots, angiofibromas, and shagreen patches (papules in lumbosacral region), CNS tumors, autism, renal angiomyolipomas, cardiovascular rhabdomyomas

Question 15

non pharmacological management of delirum

Answer 15

night sitter to reassure them that they are okay and tell them where they are at, helps get a full nights rest, avoid benzos

Question 16

symptoms of a parasagittal meningioma

Answer 16

bilateral leg weakness, urinary incontinence (frontal lobe dysfunction) and UMN signs in the lower limbs with preserved reflexes in the upper limbs

Question 17

CSF in bacterial vs. fungal vs. viral meningitis

Answer 17

bacterial: low glucose high protein and PMNs // Fungal: low glucose, high protein but lymphocytes // viral: normal glucose, normal to high protein and lymphocytes

Question 18

what is amaurosis fugax

Answer 18

this is transient occlusion of the retinal artery causing vision loss without pain. in an older individual it is often due to carotid emboli so a ultrasound of the neck should be done

Question 19

difference between adult vs. neonate meningitis presentation

Answer 19

adults: neck rigidity, fever, nausea/vomitting // infants: poor feeding, fever, jaundice, irritability, lethargy

Question 20

signs of DRESS syndrome and drugs that cause it

Answer 20

delayed reaction to mostly antiepileptics or antimicrobials // sx: facial edema, lymphadenopathy, eosinophilia, rash, fever // drugs: carbamazapine, phenytoin, lamotragine, dapsone, TMP/SMX, vanc

Question 21

signs and treatment of organophosphate poisoning

Answer 21

signs: DUMBELS // treatment: atropine (blocks the AChR itself) and then also pralidoxine

Question 22

what antibiotics do you give to neonates for meningitis

Answer 22

ampicillin, gentamicin, and cefotaxime

Question 23

which mutations mean early onset vs. late onset alzheimers

Answer 23

presenilin 1 for early and ApoE4 for late

Question 24

what is the main cause of death of acromegaly

Answer 24

congestive heart failure leading to reduced cardiac output

Question 25

what is transient global amnesia

Answer 25

this is where you have sudden onset impairment of short term memory and ability to retain new information. no longer than 24 hours

Question 26

signs of cocaine use

Answer 26

decreased appetite, weight loss, nervousness, conflict with family, dilated pupils, tachycardia, high BP, tremor, NORMAL refelxes

Question 27

essential vs pill rolling tremor

Answer 27

essential: increases with a task, not seen at rest, gets better with alcohol // pill rolling: at rest, asymmetric, and parkinsons

Question 28

how do you treat essential tremor

Answer 28

propanolol

Question 29

what is the first line treatment for spinal mets from prostate cancer

Answer 29

high dose steroids to decrease inflammation and pain before surgery

Question 30

describe cerebral amyloid angiopathy

Answer 30

this is when the beta amyloid plaques infiltrate into the brain and then they cause ICH in a lobar fashion. signs ans sx will be confusion and things related to the specific lobe

Question 31

what are the signs of a lacunar stroke vs. larger ischemic strokes

Answer 31

lacunar: leg or arm weakness, NO focal signs, absence of cortical signs (aphasia, dysarthria, etc) NO mental status changes, often dont see them on imaging bc they are so small. Larger ones: focal signs, LOC etc.

Question 32

signs of retinal detachment

Answer 32

curtain in front of vision, floaters, specific areas of vision loss, often in one eye not bilateral

Question 33

describe the path of infection if a bug bites your face and say the signs and symptoms

Answer 33

travels from the facial vein or sinuses to the cavernous sinus causing a thrombosis // signs and sx: headache, periorbital edema, fever, vomiting etc .

Question 34

first line diagnostics for a carotid bruit heard on physical exam

Answer 34

doppler ultrasound

Question 35

first line diagnostics for an INFANT with full anterior fontanelles

Answer 35

ultrasound, dont want to CT bc of radiation exposure

Question 36

signs of amantadine toxicity

Answer 36

livedo reticularis, orthostatic hypotension, peripheral edema, ataxia

Question 37

how do you treat status epilipticus

Answer 37

IV benzo (lorazepam) –> phenytoin –> phenobarbital –> propofol

Question 38

how do you diagnose ALS

Answer 38

electromyography

Question 39

differentiate between peripheral and central facial nerve palsys

Answer 39

peripheral: forehead also affected // central: ipsilateral forehead is okay because of dual innervation peripherally

Question 40

what are the signs of idiopathic intracranial hypertension

Answer 40

blurry vision, papilledema, diffuse headache,

Question 41

differentiate between menieres and benign paroxysmal positional vertigo

Answer 41

Menieres: failure to absorb endolymph, tinitus, hearing loss // BPPV: crystals are displaced, do dix-halpike maneuver, vertigo

Question 42

when should you not do a lumbar puncture?

Answer 42

if there are signs of increased intracranial pressure (such as confusion, somnolence, etc) bc of risk of herniation

Question 43

what is the lesion type in prostate mets vs. multiple myeloma

Answer 43

prostate mets: sclerotic // multiple myeloma: lytic