Integration I

Question 1

Broca’s vs Wernicke’s vs Conduction Aphasia

Answer 1

Broca’s: Can’t get the words out. Every word you want to say is always on the tip of your tongue. Nouns and verbs are easier, but prepositions are very hard.

Wernicke’s: Speech is totally fluent, but does not have intact meaning. The speech produced is incomprehensible.

Conduction: Can read, write, speak, and understand normally. However, when asked to repeat a phrase, it is as though they have Broca’s aphasia: Every word of the phrase is on the tip of their tongue.

Question 2

Patient is in a skiing injury and loses consciousness. They come to for a while and are lucid, but then lose consciousness again. Where is the bleed?

Answer 2

This is likely an epidural bleed due to the pattern of consciousness. The initial injury knocked the patient out. They then came to, but had an epidural bleed which became a hematoma. The mass effect of the hematoma then causes the second loss of consciousness.

The artery that is most often involved is the middle meningeal artery, a branch of the external carotid.

Diagnose with a CT to look for a hematoma that follows suture lines.

Question 3

Three causes of loss of consciousness

Answer 3

• Both hemispheres have been affected
• Both thalami have been affected
• There is injury to the brainstem

Question 4

Hoffman’s sign

Answer 4

Pinch the patient’s middle finger nail.

If the thumb transiently abducts, the Hoffman sign is present.

This is a sign of upper motor neuron pathology.

Question 5

The posterior limb of the internal capsule contains. . .

Answer 5

. . . descending motor fibers and ascending sensory fibers

Question 6

___ is the only viral meningitis/encephalitis that presents with elevated xanthochromic RBCs on lumbar puncture.

Answer 6

HSV is the only viral meningitis/encephalitis that presents with elevated xanthochromic RBCs on lumbar puncture.

Question 7

CMV meningitis is exclusively seen in patients who are ___.

Answer 7

CMV meningitis is exclusively seen in patients who are immunodeficient.

Question 8

___ is the most common cause of viral meningitis.

Answer 8

Enterovirus is the most common cause of viral meningitis.

Question 9

ToRCHES

Answer 9

Mnemonic for diseases which may cross the placenta and cause congenital infection

• Toxoplasmosis
• Rubella
• Cytomegalovirus
• HErpes/HIV
• Syphilis

Question 10

Subgroups of enteroviruses

Answer 10

• Poliovirus
• Coxsackie A
• Coxsackie B
• Echovirus
• New Enteroviruses

Question 11

Coxsackie A

Answer 11

• May cause herpangina: Fever, sore throat, small red-based vesicles over the back of the throat
• Hand, foot, and mouth syndrome: Common acute illness, usually pediatric, with fever, oral vesicles, and tender lesions on hands/feet/buttocks. This may be any enterovirus, but is most commonly Coxsackie A.
• As well as the syndromes common to enteroviridae

Question 12

All enteroviridae may cause:

Answer 12

• Aseptic meningitis (most common cause)
• Respiratory symptoms (“cold”)
• Rashes
• Asymptomatic or mild febrile infections
• Hand, foot, and mouth syndrome

Question 13

What is going on in this picture?

Answer 13

Herpangina, Coxsackie A

Appears as part of a syndrome with fever and sore throat

Self limited

Question 14

What is going on in this patient?

Answer 14

Hand foot and mouth syndrome.

Occur with fever as acute illness, usually in children. May be caused by any enterovirus.

Question 15

Coxsackie B

Answer 15

• May cause Pleurodynia: Syndrome of fever, headache, and severe pleuritic pain. Respiratory Coxsackie B infection.
• May cause myocarditis or pericarditis. Coxsackie B is the cause of 50% of all cases of myocarditis/pericarditis.
• As well as the syndromes common to enteroviridae

Question 16

Benzodiazepines

Answer 16

• Most common anxiolytics
• Bind adjacent to GABA receptors and enhance GABA receptor affinity for GABA, resulting in more frequent opening of a downstream chloride channel. This enhances chloride conductance and causes hyperpolarization and thus inhibition of neuronal firing.
• Treat anxiety at low doses
• Produce sedation or hypnosis at high doses
• Some anticonvulsant activity and may be used to treat epilepsy
• Skeletal muscle relaxant, acting via increasing presynaptic inhibition in the spinal cord

Question 17

Nomenclature of benzodiazepines

Answer 17

Almost all end in -pam or -lam

Lorazepam is the prototypical benzodiazepine

Question 18

Flumazenil

Answer 18

Benzodiazepine antagonist

Really acts as a GABA receptor antagonist. May be necessary to reverse long-acting benzodiazepines.

Question 19

Adverse effects of benzodiazepines

Answer 19

• Ataxia at high doses
• Cognitive impairment
• Must be used cautiously in patients with liver disease, as they are metabolized in the liver
• Should not be taken with other central depressants, including ethanol

Question 20

The Listeria List

Answer 20

• Pregnant women
• Neonates
• Meningitis
• Elderly (~>50 years of age)
• Immunocompromised

Question 21

Stages of Syphilis

Answer 21

Question 22

Syphilis Rule of Sixes

Answer 22

1. 6 Week Incubation
2. 6 Weeks for the ulcer to heal
3. 6 weeks after the ulcer heals to develop secondary syphilis
4. 6 weeks for secondary syphilis to resolve
5. 66% of latent patients have resolution
6. 6 years for the other 33% to develop tertiary hyphilis

Question 23

Scientific name of syphilis

Answer 23

Treponema pallidum

Question 24

Jarisch-Herxheimer phenomenon

Answer 24

Acute worsening of syphilis symptoms immediately after antibiotics are administered.

This is because Treponema pallidum (and related spirochetes) releases pyrogens when killed.

Question 25

What is the correct way to assess for relative afferent pupillary defect?

Answer 25

Shine a light in one eye, hold for ~2 seconds, then bring the light **DOWN, beneath the nose ridge, and back up to the other eye**, ensuring that the central light **only ever illuminates one eye at a time.** **DO NOT** swing the light back and forther over the nose bridge. This is how you get false positives.

Question 26

What is going on in this individual?

Answer 26

Annular syphilis