7/28/16

Question 1

what is the normal RBC to WBC ratio in CSF?

Answer 1

1 WBC to each 500-1000 RBCs

Question 2

loss of all function (flaccid paralysis) except for position and vibratory sensation below a spinal cord level, loss of deep tendon reflexes

Answer 2

anterior spinal artery occlusion

Question 3

ddx: position and vibratory sensation are lost, motor pain and temperature intact

Answer 3

subacute combined degeneration of the cord (B12 deficiency or neurosyphilis)

Question 4

loss of pain and temperature on one side and loss of position and vibratory sense on the other side below a spinal cord level

Answer 4

brown-sequard syndrome (unilateral hemisection of sp cd)

Question 5

presentation of tuberous sclerosis

Answer 5

RETINAL LESIONS, NEUROLOGICAL ABNORMALITIES (seizures, mental retardation), SKIN (leathery plaques on trunk, hypopigmented patches, reddened facial nodules), RENAL ANGIOMYOLIPOMAS, cardiac rhabdomyomas

Question 6

port-wine stain on the face, seizures

Answer 6

sturge-weber syndrome

Question 7

tx of mild vs severe parkinson disease

Answer 7

mild: ANTICHOLINERGICS (benztropine, trihexyphenidyl), AMANTADINE (in older pts intolerant of anticholinergics)
severe: DOPAMINE AGONISTS (pramipexole, ropinirole), LEVODOPA/CARBIDOPA, COMT INHIBITORS (extend duration of levodopa/carbidopa), MAO INHIBITORS (slow progression of disease)

Question 8

what are the important side effects of the anticholinergic medications given to mild parkinson disease pts?

Answer 8

benzytropine and trihecyphenidyl cause dry mouth, WORSENING of PROSTATE HYPERTROPHY, and constipation

Question 9

what are the important side effects of the medications given to severe parkinson disease pts?

Answer 9

levodopa/carbidopa are associated with “ON/OFF” phenomena, where insufficient dopamine can cause BRADYKINESIA (off), or too much dopamine can cause DYSKINESIA (on)
MAO inhibitors can cause hypertensive crisis if taken with tyramine-rich foods

Question 10

pt with parkinson syndrome symptoms PLUS autonomic problems such as orthostatic hypotension, impotence, incontinence, dry mouth, dry skin

Answer 10

multiple system atrophy (Shy-Drager syndrome)

Question 11

tx for dyskinesia of huntington disease

Answer 11

tetrabenazine

Question 12

what should you consider in a pt with multiple sclerosis on chronic suppressive medication has worsening neurological deficits and MRI shows new, multiple white matter hypodense lesions

Answer 12

NATALIZUMAB is associated with development of PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML)

Question 13

what are the best drugs to prevent relapse in multiple sclerosis?

Answer 13

glatiramer and beta-interferon

Question 14

tx for amyotrophic lateral sclerosis (ALS)

Answer 14

RILUZOLE (prevent progression), BACLOFEN (for spasticity)

Question 15

what nerve affected: wasting of hypothenar eminence, pain in 4th and 5th fingers

Answer 15

ulnar nerve

Question 16

what nerve affected: wrist drop

Answer 16

radial nerve (saturday night palsy = pressure on inner, upper arm; crutches)

Question 17

what nerve affected: pain/numbness in ankle and sole of foot that worsens with walking

Answer 17

Tibial nerve (Tarsal Tunnel syndrome)

Question 18

what nerve affected: weak foot with decreased dorsiflexion and eversion

Answer 18

peroneal (high boots, pressure on back of knee)

Question 19

tx for guillain barre syndrome

Answer 19

IVIG OR plasmapheresis (NOT STEROIDS and NOT BOTH)

Question 20

pathogenesis of myasthenia gravis and presentation

Answer 20

autoantibodies against acetylcholine receptors at the neuromuscular junction, presents in YOUNG WOMEN OR OLD MEN with ptosis, difficulty chewing, slurred speech, diplopia, weakness of limb muscles EXACERBATED BY CONTINUOUS USE

Question 21

what imaging should be done in pts with confirmed myasthenia gravis?

Answer 21

chest CT with contrast to look for thymoma

Question 22

tx for myasthenia gravis

Answer 22

neostigmine or pyridostigmine (acetylcholinesterase inhibitors)

Question 23

distinguishing features of myasthenia gravis vs lambert-eaton syndrome

Answer 23

myasthenia gravis sx WORSEN with repeated muscle stimulation, whereas lambert-eaton syndrome (small cell lung cancer antibodies against presynaptic calcium channels) causes weakness that IMPROVES with repeated stimulation

Question 24

management of myasthenia gravis pts that are refractory to medications

Answer 24

under 60 = thymectomy

over 60 = prednisone

Question 25

tx for acute myasthenic crisis

Answer 25

IVIG or plasmapheresis

Question 26

tx for lewy body dementia

Answer 26

tx alzheimers and parkisons features with levodopa/carbidopa

Question 27

what is BRCA associated with?

Answer 27

THE BRCA BOP! Breast, Ovarian, and Pancreatic cancer

Question 28

what are the side effects of the ER/PR positive breast cancer drugs?

Answer 28

``` tamoxifen: endometrial cancer, clots aromatase inhibitors (anastrazole, letrozole, exemestane): osteoporosis (inhibit estrogen effect everywhere, even the good effects, like on bone density) ```

Question 29

how do you decide what medications to give to a ER/PR positive breast cancer pt?

Answer 29

aromatase inhibitors (anastrozole, letrozole, exemestane) are better for POSTmenopausal pts, whereas tamoxifen is better for PREmenopausal pts

Question 30

what is the tx for her2/neu positive breast cancer pts?

Answer 30

trastuzumab

Question 31

how is gleason grading used in prostate cancer?

Answer 31

measures aggressiveness of prostate cancer; range from 2-10, high score = get it out before it metastasizes!

Question 32

alpha fetoprotein is secreted only by ______ testicular cancers. _____ is up in all of them.

Answer 32

nonseminomatous; hCG

Question 33

tx of seminoma vs non-seminoma testicular cancers

Answer 33

seminoma: radiation for local disease and chemotherapy for widespread disease non-seminoma: chemotherapy only

Question 34

management of low-grade or high-grade dysplasia on pap smear vs atypical squamous cells of undetermined significance (ASCUS)

Answer 34

low-grade or high-grade dysplasia = colposcopy | ASCUS = HPV testing; if HPV is positive, get colposcopy. if HPV is negative, repeat pap at 6 MONTHS

Question 35

what is an important risk factor for squamous cell cancer of the skin other than sunlight?

Answer 35

organ transplant pts, secondary to LONG-TERM USE OF IMMUNOSUPPRESSIVE DRUGS

Question 36

thick, scaly, crusty patches on sun-exposed skin

Answer 36

actinic keratosis (premalignant, must remove due to risk of squamous cell cancer)

Question 37

hyperpigmented lesions with "stuck-on" appearance

Answer 37

seborrheic keratoses (no premalignant potential)

Question 38

what agents are used in atopic dermatitis to help pts get off steroids?

Answer 38

tacrolimus and pimecrolimus (T cell-inhibiting agents; rarely associated with development of lymphoma)

Question 39

tx of extensive psoriasis

Answer 39

UV light, anti-TNF inhibitors (infliximab, etanercept, adalimumab)

Question 40

what class of medication is associated with pemphigus vulgaris?

Answer 40

ACE inhibitors

Question 41

what drugs are used to wean pts with pemphigus vulgaris off of steroids?

Answer 41

azathioprine, mycophenolate

Question 42

what is porphyria cutanea tarda and what diseases is it associated with?

Answer 42

blistering skin disease of sun-exposed areas; HEPATITIS C and HEMOCHROMATOSIS

Question 43

most accurate diagnostic test for porphyria cutanea tarda

Answer 43

increased uroporphyrins in a 24-hour urine collection

Question 44

if pt has penicillin allergy with anaphylaxis, what are the alternate medications for a mild infection?

Answer 44

macrolides, clindamycin, doxycycline, or TMP/SMX

Question 45

if pt has penicillin allergy with anaphylaxis, what are the alternate medications for a severe infection?

Answer 45

vancomycin, linezolid

Question 46

tx for tinea in hair or nails

Answer 46

ORAL TERBINAFINE (itraconazole is close in efficacy)

Question 47

what is the tx for steven-johnsons syndrome or toxic epidermal necrolysis?

Answer 47

IVIG (NOT STEROIDS!)

Question 48

side effects of isotretinoin (vitamin A)

Answer 48

hyperlipidemia, pseudotumor cerebri, teratogen (get a pregnancy test)

Question 49

blood gas in aspirin overdose

Answer 49

respiratory alkalosis progressing to metabolic acidosis (both, not a compensation, pH should be alkalotic)

Question 50

cyanosis with normal pO2

Answer 50

methemoglobinemia

Question 51

most effective therapy for methemoglobinemia

Answer 51

methylene blue (decreases half-life of methemoglobin)

Question 52

tx for pt with nerve gas or organophosphate poisoning with ACTIVE sx

Answer 52

atropine (blocks effects of acetylcholine already increased in body)

Question 53

when is pralidoxime used?

Answer 53

organophosphate poisoning (reactivates acetylcholinesterase) without current threatening symptoms (i.e., respiratory arrest)

Question 54

yellow halos around objects, arrhythmias, nausea, vomiting, hyperkalemia

Answer 54

digoxin toxicity

Question 55

what are the sx of a black widow spider bite? what is the tx?

Answer 55

abdominal pain, muscle pain, hypocalcemia; tx with calcium and antivenin

Question 56

management of human cat dog bite with no suspicion for rabies

Answer 56

AMOX/CLAV

Question 57

what type of intracranial hematoma is associated with skull fracture?

Answer 57

epidural hematoma

Question 58

why is hyperventiatlion used in a brain bleed?

Answer 58

it decreases pCO2 which causes cerebral vasoconstriction, which decreases pressure. normally, cerebral circulation constricts when the pCO2 is low and dilates when pO2 is high

Question 59

what are the indications for stress ulcer prophylaxis with a PPI?

Answer 59

head trauma, burns, endotracheal intubation, coagulopathy with respiratory failure

Question 60

how to calculate volume replacement in burns

Answer 60

4 mL x %BSA burned x weight in kg. head is 9, arms are 9 each, legs are 18 each, chest and back are 18 each. one hand width is 1.

Question 61

painless proximal muscle weakness with normal ESR and CK

Answer 61

glucocorticoid-induced myopathy

Question 62

what is normal pH and glucose for pleural fluid?

Answer 62

pH = 7.2, glucose = 60

Question 63

what are the sx of acute intermittent porphyria?

Answer 63

5 P's: Painful abdomen, Port wine-colored urine, Polyneuropathy, Psychological disturbances, Precipitated by drugs, alcohol, starvation