Neuro

Question 1

what is acute colonic pseudoobstruction?

Answer 1

Autonomic disruption of the colon causes painful abdominal distension, the inability to poop, and vomiting

Question 2

what causes acute colonic psuedoobstruction

Answer 2

1. electrolyte imbalances
2. trauma, recent surgery, infections
3. medications
4. Neurological disorders

Question 3

imaging for acute colonic psuedoobstruction shows what

Answer 3

X-Ray will show colonic dilation, normal haustra, and a non dilated small bowel

CT scan will sow colonic dilation and NO anatomic obstruction

Question 4

what are the symptoms of acute colonic pseduoobstruction

Answer 4

abdominal distension, vomiting, inability to poop, decreased bowel sounds, tympanic to percussion

Question 5

complications of acute colonic psuedoobstruction

Answer 5

bowel perforation (gaurding, rigidity, reboudn tenderness)

Question 6

management of acute colonic psuedoobstruction

Answer 6

NPO (bowel rest), nasogastric decompression and IV neostigmine if there is no improvement within 2 days

Question 7

after an MI what interventions are aimed at achieving the most improvement for a patient’s long term prognosis?

Answer 7

time it takes to restore coronary blood flow - this will limit myocardial damage and improve cardiovascular mortality

*this is done by PCI or fibrinolysis

Question 8

SIADH serum osmolality and urine osmolality levels

Answer 8

serum <275 mOsm/kg H20

urine <100 mOsm/kg H20

Question 9

a patient with a hilar mass in the setting of weight loss, cough, and a significant smoking history is concerning for?

Answer 9

small cell lung cancer

Question 10

small cell lung cancers can cause what paraneoplastic syndrome

Answer 10

SIADH

Question 11

types of SIADH

Answer 11

mild hyponatremia: nausea and forgetfulness
severe hyponatremia: seizures and coma
Euvolemia: most mucus membranes, no edema

Question 12

managemtn of SIADH

Answer 12

fluid restriction with salt tablets

for severe Na<120 - hypertonic saline

Question 13

when adminsitering hypertonic saline you want to correct the sodium levels slowly with a rate of <8 mEq/L over the first 24 hours to prevent what complication

Answer 13

osmotic demyelination syndrome

Question 14

what are the two most important risk factors for stroke on USMLE

Answer 14

hypertension and AFIB

Question 15

ACA stroke signs

Answer 15

motor and sensory abnormalities of the contralateral leg

Question 16

MCA stroke signs

Answer 16

motor and sensory abnormalities of the contralteral arm and face

Question 17

dominant MCA strokes are usually on which side

Answer 17

left sided

Question 18

dominant MCA stroke can lead to?

Answer 18

Wernicke or Broca Aphasia

Question 19

nondominant MCA stroke can cause?

Answer 19

hemispatial neglect

Question 20

what is hemispatial neglect

Answer 20

the inability to draw clockface

Question 21

PCA stroke signs

Answer 21

prospagnosia ( inability to recognize faces)

contralateral homonymous hemianopsia with macular sparing

Question 22

lateral medullary syndrome is caused by?

Answer 22

posterior inferior cerebellar artery (PICA) or vertebral artery ischemia

Question 23

lateral medullary syndrome is also known as?

Answer 23

wallenberg syndrome

Question 24

what are the symptoms of lateral medullary syndrome

Answer 24

dysphagia and ipsilateral horner syndrome

Question 25

what is horner syndrome

Answer 25

ipsilateral miosis, partial ptosis, and anhidrosis

Question 26

horner syndrome can be caused by what two things?

Answer 26

pancoast tumor, or lateral medullary syndrome

Question 27

what is the artery involved in medial medullary syndrome

Answer 27

anterior spinal artery

Question 28

what are the signs of medial medullary syndrome

Answer 28

ipsilateral tongue deviation

Question 29

what is the artery involved in lateral pontine syndrome

Answer 29

anterior inferior cerebellar artery (AICA)

Question 30

signs of lateral pontine syndrome

Answer 30

ipsilateral Bells Palsy (facial droop, ptosis)- cranial nerve 7

Question 31

weber syndrome is a stroke in what location

Answer 31

the midbrain

Question 32

what are the symtoms of weber syndrome

Answer 32

ipsilateral CN III palsy (down and out eye) with contralateral spastic hemiparesis (weakness)

Question 33

locked in syndrome is a stroke of what artery

Answer 33

Basilar artery

Question 34

signs of locked in syndrome

Answer 34

inability to move enitre body expect for the eyes

Question 35

gerstmann syndrome is a stroke of?

Answer 35

the angular gyrus of the parietal lobe

Question 36

what is the tetrad of syndrome from gerstmann syndrome

Answer 36

1. agraphia (inability to write) 2. acalculia (inability to do math) 3. finger agnosia (cant identify fingers) 4. left-right dissociation (cannot differentiate between left and right sides of the body)

Question 37

Hemiballismus is a stroke of what location?

Answer 37

subthalamic nucleus

Question 38

signs of a hemiballistic stroke

Answer 38

ballistic flailing of contralateral arm or leg

Question 39

what is the mechanism of lacular infarcts?

Answer 39

hypertension causes liphyalinosis which is atheromas in the small lenticulostriate (deep) arteries in the brain this plaques cause ischemia in the brain which can lead to necrosis and reabsorption of tissue and forms tiny cavities called lacunae

Question 40

symptoms of a lacunar infarct

Answer 40

specific syndromes based on their location pure motor hemiparesis, purse sensory stroke, ataxic hemmiparesis

Question 41

cortical stroke symptoms

Answer 41

aphasia, neglect, visual field losses

Question 42

what is wenicke aphasia

Answer 42

fluent aphasia where the patient can speak with a normal pace and use lots of words but it doesnt make any sense "WORD SALAD" comprehension is impaired, repition is impaired

Question 43

where is wernickes area located what causes it

Answer 43

temporal lobe; caused by a L sided MCA infarct

Question 44

what is brocas aphasia

Answer 44

non-fluent aphasia there is frustration in not being able to make sense comprehension is NORMAL repetition is impaired

Question 45

brocas area is located where and caused by what infarct

Answer 45

frontal lobe caused by a L sided MCA infarct

Question 46

Conductive aphasia

Answer 46

stroke of the arcuate fasciulus which connects wernicke and brocas areas repetition is impaired only

Question 47

global aphapsia

Answer 47

bascially brocas, acrcuate fasciculus and wenickes at the same time no repetition, no comprehension, no word salad

Question 48

transcortical sensory aphasia

Answer 48

same presentation as wernicke but repeittion is intact

Question 49

transcorticol motor apahsia

Answer 49

same presentation as broca but repeptition intact

Question 50

what imaging is done to look for a stroke

Answer 50

non-contrast CT

Question 51

how does blood appear on a non contrast CT

Answer 51

hyperdense (bright)

Question 52

for an ischemic stoke what is given if symptom onsent has been within the past 4.5 hours ?

Answer 52

tPA (tissue plasminogin)

Question 53

what does the 4.5 hour window refer to

Answer 53

when the patient was last observed as normal

Question 54

if the 4.5 hour window has elapsed what do you do for an ischemia stroke

Answer 54

give aspirin

Question 55

ischemia strokes bp should be rapidly be broght down below the threshold of what? After meeting this threshold slower blood pressure control is done. AN increase in blood pressure can actually help perfusion of penumbric areas on ischemia

Answer 55

185/110

Question 56

what is the treatment of a hemorrhagic stroke (hyperdense CT)

Answer 56

do NOT give tpa 1. lower the blood pressure rapidly so that systolic is less than 140mmhg 2. reverse anticoagulation if the patient is on it (FFP for patients on warfarin)

Question 57

correction of hypernatremia too quickly with hypotonic aline can cause

Answer 57

cerebral edema

Question 58

correcting hyponatemia too quickly with hypertonic saline can cause

Answer 58

central pontine myelinolysis aka osmotic demyelination causes locked in syndrome

Question 59

what is a hypercalcemic crisis

Answer 59

a deliruium like state caused by SEVERE hypercalcemia usually caused by malignancy or primary hyperparathyroidism

Question 60

treatment of hypercalcemia

Answer 60

normal saline bisphophonates

Question 61

what is psuedotumor cerebri

Answer 61

increased intracranial pressure with no structural cause causes: obesity, idopathic intracranial hypertension, OCP, isotretinonin, danazol

Question 62

reye syndrome

Answer 62

cerebral edema and hepatotoxicity from giving aspirin to children during a viral infection

Question 63

diffuse aconal injury

Answer 63

acceletation, deceleration, contact brain injury that causes axonal shearing and tearing and subsequent brain swelling can have severe cognitive defects, motor or sensory dysfunction