Clin Med - Exam 1 PQ Flashcards Preview

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Flashcards in Clin Med - Exam 1 PQ Deck (68):
1

A patient has a tremor with motion in his hands. What medication might you prescribe?

This patient has an active tremor therefore a BB - Propranolol is a good start.

2

A patient complains of muscle weakness and fatigability that improves with rest. What diagnosis should you be thinking of?

Myasthenia Gravies

3

A patient complains of an aching headache which feels like a band around his head. What diagnosis should you be thinking of?

Tension headache

4

An EEG showing FOCAL RHYTHMIC discharges at the onset of the seizure should make you think of what diagnosis?

Simple partial seizure

5

A middle age male presents with unilateral periorbital headaches occurring daily for SEVERAL WKS. These headaches are extremely PAINFUL. Which type of headache is the most likely cause?

Cluster headache

6

Name one abortive drug for migraines.

Triptans (sumatriptan, zolmitriptan), ergotamine

7

What is the MCC of dementia?

Alzheimer's dz, it may be as high as 80%.

8

Duchenne's & Becker's muscular dystrophy have what genetic characteristic?
What is the age range for Duchenne's muscular dystrophy?

- X-linked recessive
- 3-5 years old

9

A patient presents with lateralized THROBBING HA. He is also complaining of N/V & PHOTOPHOBIA. What type of headache is most likely?

Migraine

10

If CT is negative and you still believe there is a stroke what is the next best test to order?

LP

11

A pt presents with a painful ipsilateral 3rd N. palsy. What diagnosis should you be thinking of?

Posterior communicating artery aneurysm (PComA)

12

Describe Kernig's sign?

Pt lies supine, flex hip while keeping knee straight.

- Back pain is positive.

13

A patient presents following a seizure. Just before the siezure she remembers seeing flashing lights all around her. What diagnosis should be at the top of your differential?

Complex partial

14

A patient presents to your office complaining of a tremor in his right hand. He states after a beer it goes away completely. What diagnosis should you be thinking of?

Benign essential tremor or familial tremor

15

Which nerve root is responsible for the knee jerk reflex?

L3-L4

16

What cranial nerve is affected with Bell's palsy?

CN VII

17

What is the medical treatment for a stroke in which the CT has shown no evidence of a hemorrhage?

Thrombolytics w/in 4 hrs & w/ no contraindications

18

Alcohol may be a major factor in which encephalopathy?

Wernicke's

19

Under what conditions would aspirin or clopidogrel be used following a TIA as prophylaxis?

These are antiplatelet medications. They would be used unless there is a known cardiac etiology for the embolism. Patients with a cardiac cause should use heparin or Coumadin.

20

An EEG showing generalized spikes and associated slow waves should make you think of what diagnosis?

Generalized or absence seizure

21

What is the medication of choice for a patient with Tourette's syndrome?

Haloperidol

22

What are the most MC primary cancer sites for metastasis to the brain?

- Lung,
- Breast,
- Kidney

23

A patient presents with what appears to be an inability to understand speech. Which aphasia should be at the top of your differential?

Wernicke's aphasia

24

At what age do symptoms of Huntington's disease appear?

~ 30yo

25

Wilson's disease is associated with a build up of what mineral?

Copper

- d/t def of copper binding protein

26

A patient is brought in following a seizure in which she did not lose consciousness. What diagnosis should you be thinking of?

Simple partial seizure

27

Which is the most commonly herniated vertebral disc?

L4-L5 followed by L5-S1

28

A patient presents with signs of a stroke to the ER what is the most important test to get?

CT

29

A patient presents complaining of the worst headache of his life. What might you expect their blood pressure to be?

Elevated

- d/t Subarachnoid Hemorrhage.

30

A sudden thunderclap headache should make you think of what diagnosis?

Subarachnoid hematoma

31

Lead pipe or cogwheel rigidity should make you think of what diagnosis?

Parkinson's disease

32

A 35 yo pt comes to your office because his wife made him. He has been increasingly IRRITABLE & MOODY. She has also noticed that he is very RESTLESS. You order a CT scan which shows CEREBRAL ATROPHY as well as ATROPHY of the CAUDATE NUCLEUS. What diagnosis should you be thinking of?

Huntington's disease

33

What percentage of strokes are ischemic? What percentage are hemorrhagic?

80%, 20%

34

Name three medications used to break a seizure?

- Diazepam,
- Lorazepam,
- Phenytoin or fosphenytoin

35

At what percentage of blockage is an endarterectomy indicated?

- Asymptomatic >70%,

- Symptomatic >60%

36

Elevated circulating acetylcholine receptor antibodies should make you think of what diagnosis?

Myasthenia gravis

37

A patient presents with inability to speak and right sided weakness. He seems to understand speech and follows commands well. What type of aphasia should you be thinking of?

Broca's aphasia

38

What are the genetic characteristics of Wilson's disease?

- Autosomal recessive,

- Chromosome 13

39

What four chromosomes have been linked to dementia?

1,14,19,21

40

Decreased GABA and substance P should make you think of what diagnosis?

Huntington's

41

What is the defining symptom of Alzheimer's?

Progressive memory impairment

42

List three medications used to "treat" multiple sclerosis?

- Steroids,
- Interferon beta,
- Copolymer 1

43

A lumbar puncture for a patient with bacterial
meningitis will show elevated or decreased WBCs? Protein? Glucose?

- Elevated WBCs,

- Elevated Protein

- Decreased Glucose

44

Weakness and numbness in the left hand might be a blockage in which carotid artery?

Right (Contralateral)

45

A resting or pill-rolling tremor should make you think of what diagnosis?

Parkinson's disease

46

A patient has an intracranial neoplasm causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in?

Temporal

47

A study result comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What diagnosis should you be thinking of?

Alzheimer's disease

48

Is the ankle jerk reflex of lumbar or sacral origin?

Sacral

49

What is the most common cause of subarachnoid hemorrhage aside from trauma?

Ruptured cerebral aneurysm

50

List six medications that can be used for migraine prophylaxis?

- Beta blockers,
- Tricyclics,
- CCBs,
- NSAIDs
- VPA

51

There is an MRI result of multiple foci of demyelination in the white matter. What diagnosis should you be thinking of?

Multiple sclerosis

52

List three drugs that treat cluster headaches.

- Oxygen,
- Sumatriptan,
- Butorphanol

53

A patient presents with weakness that he has felt in his lower legs and now feels in his knees and hips bilaterally. He has decreased deep tendon reflexes. This has been getting progressively worse. What diagnosis should you be thinking of?

Guillain-Barre

54

What three symptoms are classic for a normal
pressure hydrocephalus?

Gait disturbance, dementia and urinary incontinence

55

What is the most common primary intracranial neoplasm?

Glioma

56

A 34 year old presents with symptoms which are relapsing and remitting over the past few weeks. These include visual problems and weakness in her right arm. What is the most likely diagnosis?

Multiple sclerosis

57

List two medications you might use to treat an essential tremor.

- BB (propranolol)

- Primidone

58

Give two classes of drug therapy for treating parkinson's.

- Dopaminergic (LD),
- Anticholinergics - 2nd line.

59

A shuffling gait should make you think of what diagnosis?

Parkinson's disease

60

You believe a patient has had a stroke. He presents with aphasia, loss of hearing in one ear and loss of vision in his left eye. Is the blockage likely in the anterior or posterior circulation?

Posterior

61

What is the single most important thing to be concerned about with a patient in status epilepticus?

Airway,

- Followed by management of hyperthermia.

62

Is Huntington's autosomal dominant or recessive?

Dominant

63

What symptom is associated with a classic migraine?

Having an aura

64

An EEG showing interictal spikes should make you think of what diagnosis?

Complex partial seizure

65

Describe Brudzinski's sign

When you lift the patient's head the patient bends his hips.

66

A slit lamp shows Kayser-Fleischer rings. What
diagnosis should you be thinking of?

Wilson's disease

67

What siezure medication may cause overgrowth of the gums?

Phenytoin

68

You are looking for lesions associated with multiple sclerosis. When you order an MRI do you order it with gadolinium or without?

With gadolinium