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IM EOR > Neuro (8%) and Uro/Renal (8%) > Flashcards

Neuro (8%) and Uro/Renal (8%) Flashcards

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1
Q

Pt presents with unilateral facial drooping and inability to wrinkle forehead on one side. What is the treatment?

A

Prednisone UNLESS in an area where Lyme is endemic; can add acyclovir

Eye patch at night to prevent corneal abrasion

If paralysis persists >10 days, consider EMG; if progresses, consider surgical decompression

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2
Q

What is the nerve affected in Bells Palsy?

A

CN VII

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3
Q

What is the transmission pattern of Huntington Dz and what is the causative mutation?

A

Autosomal dominant

Expanded tri-nucleotide (GAG) repeats in the HTT gene

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4
Q

How can penetrance of Huntington Dz be predicted?

A 
# of GAG repeats in HTT gene:
<28 = WNL
28-35 = asymptomatic carrier
36-39 = incomplete penetrance
40+ = completely penetrant; will develop HD
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5
Q

What part of the brain is affected in Huntington Dz?

A

GAG repeats in the HTT gene cause atrophy of the caudate nucleus and putamen

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6
Q

CVA vessel identification: aphasia, gaze preference, and half-sided vision

A

MCA

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7
Q

CVA vessel identification: Leg paresis, hemiplegia, incontinence

A

ACA

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8
Q

CVA vessel identification: half-sided vision with lots of dizziness

A

PCA

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9
Q

CVA vessel identification: coma, cranial nerve palsies, apnea, vertigo

A

Basilar artery

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10
Q

CVA vessel identification: “Clumsy hand syndrome”, ataxis hemiparesis, pure motor OR pure sensory stroke

A

Lacunar infarcts

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11
Q

25 YO female with refractory HTN presents to ED with “worst HA of my life”. What is the likely underlying etiology?

A

Polycystic kidney disease is RF for subarachnoid hemorrhage, 2/2 rupture of berry aneurysms

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12
Q

What area is affected in pt who cannot process language but can still form and speak words?

A

Wenicke’s area

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13
Q

What area is affected in patient who cannot physically speak but can process language?

A

Broca’s area

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14
Q

What is the time frame in which tPA should be administered?

A

W/in 3 hours from last known normal

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15
Q

What is the treatment for a patient who presents with unilateral HA with lacrimation, recurrent at night?

A

Likely cluster HA

Treat acute with 100% O2 6-12 L/min via NRB (preferred); +/- triptan subQ

Prophylaxis with verapamil

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16
Q

What are 4 characteristics that help describe delirium?

A
  • Reversibility
  • Fluctuating levels of disorientation
  • Hallucinations likely
  • Secondary to underlying medical condition
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17
Q

What is the MC cause of AMS in the inpatient setting?

A

Delirium

  • EtOH is MC cause
  • Heightened risk after surgery, esp in patients with CVD or DM
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18
Q

What are two key features that help distinguish delirium from dementia?

A

Delirium is more likely to present with hallucinations; dementia rarely does

Delirium is reversible

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19
Q

How is the treatment of vascular dementia different from that of AZD?

A

AZD is treated with cholinesterase inhibitors (donepezil)

Vascular dementia treated with BP control

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20
Q

Patient with rapid onset of fever, HA, seizures, focal neuro deficits, and impaired consciousness is sus for what condition?

A

Encephilitis – more likely to present with AMS than meningitis

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21
Q

What’s the difference between a Parkinsonian tremor and a hereditary tremor?

A

Parkinsonian: Tremor at rest

Essential tremor: Intention tremor

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22
Q

Describe LP findings in Guillain Barre

A

Normal glucose
Normal WBC
Elevated protein

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23
Q

Pt presents with fever, HA, stiff neck and LP shows elevated lymphocytes with normal glucose and protein <200. What is the likely dx?

A

Viral meningitis

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24
Q

Describe/differentiate Kernig vs Brudzinksi signs

A

Kernig - can’t extend Knee w/o hip flexion

Brudzinski - neck flexion results in hip and knee flexion

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25
Describe the LP findings in bacterial meningitis
Decreased glucose Increased neutrophils Increased protein Increased pressure
26
Pt presents with fever, HA, and stiff neck. What is the next diagnostic step?
``` LP for CSF examination UNLESS: - papilledema - seizures - confusion - focal neuro effcs are present, in which case get a CT first to r/o mass effect ```
27
What are some acute treatment options for migraine HA?
Toradol, reglen, benadryl combo vs Sumatriptan
28
What is the treatment for status migrainosus?
(72+ hours) - IVF - Parenteral kertoralac - Dopamine receptor blocker (antiemetics, including metoclopramide, prochlorperazine, chlorpromazine) Often parenteral dexamethasone is also added to help prevent attack relapse
29
What are some CIx for commonly used migraine medications?
Don't use triptans in ischemic heart disease, smokers, or >60 YO. Don't use ergotamine in pregnancy Don't use propranolol in pregnancy
30
What is the pathophys involved in a patient who presents with ptosis which varies in severity throughout the day?
Likely myasthenia gravis Antibody-mediated, T-cell dependent immunologic attack on proteins of the postsynaptic membrane of the ACh receptors in the neuromuscular junction Antibodies = AChR-Ab
31
How is myasthenia gravis diagnosed?
Single-fiber electromyography (EMG) Immunologic assay showing ACh-R-Ab
32
What is the MOA of the drug of choice for a patient who presents with bradykinesia, resting tremor, and shuffling gait?
Sinemet (carbidopa-levadopa) is the 1st line treatment for Parkinson disease Levodopa gets converted to dopamine after carbidopa helps it cross BBB and inhibits breakdown in the plasma
33
What is the pathophys involved in Parkinson Dz?
Loss of dopaminergic neurons in the substantia nigra
34
What are some important AE's ass'd with the first line treatment for Parkinson's?
Carbidopa-levodopa * Impulse control disorders - LE edema - Orthostatic hypotension - Drowsiness - N/V
35
EEG shows interictal spikes in frontotemporal region of brain
Complex focal seizure
36
EEG shows slow waves in temporal region of brain
Complex focal seizure
37
EEG shows bilateral, symmetric, 3 Hz spike and waves
Generalized seizure
38
What is the 1st and 2nd line treatments for status epilepticus?
1st line = benzos - IV Lorazapam is 1st line - IM midazolam if IV cannot be established 2nd line = phenytoin/fosphenytoin
39
What kind of acid/base imbalance and electrolyte abnormality is expected in a patient who has been having excessive vomiting?
Hypochloremic Hypokalemic Metabolic alkalosis
40
What is the best indicator of presence of chronic renal failure?
Proteinurea | - Spot urine albumin:Cr is preferable
41
What is nephrotic range proteinurea?
>3gm in 24 hours
42
What is the MC cause of CKD?
Uncontrolled DM, HTN
43
What is the MC cause of CKD ass'd with malignancy?
Membranous nephropathy
44
What are the labs associated with and treatment for renal osteodystrophy?
Low Ca2+ High Phosphate -- Give calcitriol and phosphate binders Also watch out for signs of osteomalacia: replace vitamin D and Ca2+
45
Which drugs are most commonly associated with acute interstitial nephritis?
5 P's: - Pee (diuretics) - Pain (NSAIDs) - PPIs - PCN - rifamPin
46
What are some s/sx of acute interstitial nephritis?
Hematuria Rash Possible fever - Likely recent drug use (diuretics, NSAIDs, PPI, PCN, or rifampin)
47
What is the #1 RF for bladder cancer?
Smoking
48
Painless hematuria in a smoker on a test is almost certainly ...
Bladder cancer
49
What are the s/s of glomerulonephritis?
- Hematuria - HTN - Azotemia (elevated BUN) - Proteinurea May also see fever, peripheral edema, malaise. Will likely have recently recovered from GAS infection, URI or GI infection.
50
What is the gold standard diagnosis for glomerulonephritis?
Renal biopsy- not generally done or needed
51
Describe the pathogenesis of glomerulonephritis
Post GAS immunologic inflammation of glomeruli causing protein and RBC leakage into urine
52
How is a hydrocele diagnosed?
Testicular US to r/o mass
53
MC cause of acute scrotal pain?
Epididymitis
54
What is the treatment for a patient who presents with localized testicular pain and tenderness with palpation of the posterior testis?
NSAIDs + antibiotics: <35 YO/higher risk of STIs: - cover gonorrhea, chlamydia - Ceftriaxone - Doxy (can sub AZ) >35 YO & low risk of STIs: - Cover enteric apathogens - Levofloxacin 500 mg PO x 10 days Any patient practicing anal intercourse: - Cover gonorrhea, chlamydia, and enteric pathogens - Ceftriaxone - Levofloxacin
55
What are two clinical signs that are suggestive of testicular torsion?
Absence of Phren sign (no relief with elevation) Absence of cremesteric reflex
56
What are some s/sx associated with hydronephrosis?
Often asx, discomfort associated with bladder distention, obstructive stones, or secondary infections. If chronic, labs may show hyperkalemia If bilateral or underlying kidney disease, Cr may be elevated
57
Pt presents with painful hematuria and is restless during exam. What is the diagnostic test of choice for the likely diagnosis?
Helical CT / non-con CT "stone protocol"
58
What are the size parameters that dictate treatment of a kidney stone?
<5 mm, likely to pass spontaneously >8 mm, unlikely to pass, consider lithotripsy
59
What is the MC site of obstruction in nephrolithiasis?
Ureterovesical junction
60
What is the MC type of kidney stone?
Ca oxalate
61
What dietary advice should be given to patients with frequent kidney stones of ANY type?
All types of stones: - Enough fluid to produce 2 L urine per day - Limit sodium intake <2300 mg/day (low sodium increased proximal Ca2+ reabsorption = less Ca2+ excretion) - Increase fruit, vegetable intake (esp K+ rich) - Weight loss
62
What are some dietary adjustment that should be suggested to patients with recurrent kidney stones of the MC variety?
Ca+ Oxalate stones are MC - INCREASE dietary (not supplementary) Ca2+ at meals - - Ca2+ binds to oxalate in intestine, reducing oxalate absorption - Reduce nondairy animal protein intake - Don't take Ca2+ supplements - Avoid vitamin C supplements
63
What is the most clinically important inhibitor of Ca2+ oxalate stone formation?
Citrate - chelates Ca2+ in the urine = decreased free Ca2+ available to bind with oxalate or phosphorus
64
Pt with very high intake of animal protein develops nephrolithiasis and urine pH is excessively low - what is suspected type of stone and what is the treatment?
Uric acid stone Increase fruit/vegetable intake Potassium citrate supplementation
65
What kind of large kidney stones form in the setting of UTI?
Struvite "staghorn calculus"
66
What kind of stones are ass'd with familial history and huge numbers of stones?
Cystine stones
67
In what case would a patient with kidney stones be advised to AVOID fruits and greens?
Patients with Ca phosphate stones (rare) ass'd with increased (alkaline) urine pH
68
Patients with FHx of refractory HTN should be screened for what condition?
Polycystic kidney disease
69
How is polycystic kidney disease treated?
- ACEi/ARB for BP control - Dietary sodium restriction - Increased fluid intake (>3 L per day) - Pts with GFR 25+: Tolvaptan (vasopressin receptor blocker) Also screen family via US
70
What is a lab abnormality on CBC that might be associated with renal cell carcinoma?
High Hg/Hct 2/2 increased epo production
71
What are parameters for prostate cancer screening?
- 55-69 and life expectancy >10 years or - Starting at 40 if there is FHx or pt is Black
72
Pt has PSA of 60 on 2 separate occasions 6 months apart. What is the next step in diagnosis?
CT or MRI pelvis Consider MRI-US fusion to direct biopsy
73
What is the MC type and location of prostate cancer?
Adenocarcinoma of the peripheral zone
74
What are some s/sx of prostatitis?
Fever Pain in the perineal, sacral, or suprapubic regions Possible urinary retention *Exquisitely tender, warm, boggy prostate
75
How is acute prostatitis diagnosed and treated?
UA with micro, C&S Blood culture (NO PSA) Tx with doxycycline 100mg BID 2-6 weeks
76
What are alarm signs associated with varicocele, and what is the concern?
- R-sided or bilateral - Doesn't disappear when laying supine Concern for IVC obstruction
77
What is the inpatient treatment for pyelonephritis?
IV amp + gent | --> transition to PO cipro
78
What is the outpatient treatment for pyelonephritis?
Cipro BID x7-14 days
79
What are the tx for uncomplicated UTI?
Nitrofurantoin 1st line TMP-SMX next Cipro/levoflox reserved

IM EOR (8 decks)

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