Neuro + Random

Question 1

Ischemic stoke: frontal lobe dysfunction, apraxia, contralateral paralysis (LEG WEAKNESS) (lower > upper)

Answer 1

Anterior cerebral artery (Ants go under your foot)

Question 2

Ischemic stroke: contralateral paralysis (upper > lower), aphasia

Answer 2

Middle cerebral artery

Question 3

Ischemic stroke: LOC, nausea or vomiting, CN dysfunction, ataxia, visual agnosia

Answer 3

Posterior

Question 4

What artery is typically involved in strokes causing homonymous hemianopsia?

Answer 4

Posterior

Question 5

What is Todd paralysis?

Answer 5

Postictal paralysis that follows a generalized or complex partial seizure and is a focal motor deficit that may persist up to 24 hours.

Question 6

PE will show ≥ 5 minutes of continuous seizure activity or more than one seizure without recovery from the postictal state between episodes

Answer 6

Status Epilepticus

Question 7

Status Epilepticus tx

Answer 7

• Treatment
  
  • First-line: benzodiazepines (e.g., lorazepam)
  • Second-line: phenytoin or fosphenytoin, valproic acid, levetiracetam
  • Third-line: pentobarbital, propofol, phenobarbital

Question 8

What kind of incontinence do patients with spinal cord compression syndromes develop?

Answer 8

Overflow incontinence

Urinary incontinence seen with Cauda Equina

Question 9

Study of choice for AAA

Answer 9

CT abdomen/pelvis WITH contrast

Question 10

AAA triad

Answer 10

Hypotension

Abdominal Pain

Pulsatile abdominal mass

Question 11

The USPSTF recommends one-time screening for AAA by ultrasonography in men aged ___?____ who have ever smoked

Answer 11

65–75

Question 12

What is the clinical presentation of anterior cord syndrome?

Answer 12

Bilateral loss of pain, temperature, and motor with preservation of vibration and proprioception below level of cord involvement.

Question 13

Which etiologic organism is commonly seen in patients with sickle cell disease with osteomyelitis?

Answer 13

Sickle cell: Salmonella, S. aureus

Question 14

Sx of spontaneous pneumothroax

Answer 14

acute dyspnea and pleuritic chest pain

Spontaneous Pneumothorax

• Risk factors: tall, thin, male, ages 10–30, Marfan syndrome, cigarette smoking, COPD, TB, CF, ILD, PCP pneumonia
• Sx: acute dyspnea and pleuritic chest pain
• PE: decreased breath sounds, decreased fremitus, hyperresonance to percussion
• Dx:
  
  • Upright CXR: absence of lung markings along lung periphery
  • Pleural U/S: absence of lung sliding
• Tx:
  
  • < small ≤3 cm in a healthy patient: observation with oxygen administration
  • > large >3 cm: needle aspiration or chest tube thoracostomy

Question 15

What are the traumatic causes of obstructive shock?

Answer 15

Cardiac tamponade and tension pneumothorax.

Question 16

Neurogenic shock causes (type of distributive shock)

Answer 16

Neurogenic Shock

• Spinal cord injury above T5
• Unopposed vagal tone
• Hypotension, poikilothermia, bradycardia
• Airway support, fluids, atropine, vasopressors

Question 17

2 types of distributive shock

Answer 17

Septic = Gram positive, gram-negative, fungal, viral, parasitic, mycobacterium

Nonseptic = inflammatory shock (SIRS), burns, pancreatitis MI

+

• Neurogenic = TBI, spinal cord
• Anaphylactic
• Other - liver failure, transfusions, vasoplegia, toxic shock, beriberi

Question 18

What is the most common pathogen that causes erysipelas?

Answer 18

Strep. pyogenes.

Question 19

Erysipelas tx

Answer 19

Treatment

• Infections with systemic compromise: parenteral cefazolin, ceftriaxone, or flucloxacillin
• Mild infections: oral amoxicillin or cephalexin

Question 20

What is the most common bone disease that occurs as a result of hyperparathyroidism?

Answer 20

Osteitis fibrosa cystica.

Question 21

What is the most common bone disease that occurs as a result of hyperparathyroidism?

Answer 21

Osteitis fibrosa cystica.

Question 22

high PTH, high calcium, low phosphorus

Answer 22

Hyperparathyroidism

• Labs will show high PTH, high calcium, low phosphorus
• Most commonly caused by an adenoma with unregulated overproduction of PTH

Question 23

intrauterine fetal death prior to 20 weeks gestation in a patient with a closed cervical os and retention of the pregnancy

Answer 23

Missed abortion

Question 24

Which of the following is most sensitive for a urinary tract infection on urine dipstick testing?

Question 25

What is most sensitive for a urinary tract infection on urine dipstick testing?

Answer 25

**Leukocyte esterase** is an enzyme found in neutrophils which are not normally present in urine unless an infection is present. It has a sensitivity of 75-96% in detecting pyuria associated with a urinary tract infection. ## Footnote **Leukocytes = More sensitive** **Nitrites = More specific**

Question 26

CSF findings → increased red blood cells, lymphocytic pleocytosis, elevated protein, and a normal or mildly decreased glucose

Answer 26

HSV Encephalitis Lymphocytic pleocytosis = Increased count of lymphocytes

Question 27

Corneal ulcer on PE

Answer 27

**oval ulcer with ragged edges**, **severe conjunctival inflammation** ## Footnote Patient will have a history of **trauma**, **incomplete closure**, or **extended contact lens use**

Question 28

Pyelonephritis tx

Answer 28

**Cipro → uncomplicated** **Ceftriaxone → septic patients** Treatment depends on infection severity and community/host risk factors for resistant pathogens, options include fluoroquinolones, 3rd/4th gen cephalosporins, TMP-SMX. Critical illness or risk for multidrug resistant organisms: consider coverage for MRSA, VRE

Question 29

What is the treatment for heparin-induced thrombocytopenia (HIT)?

Answer 29

Discontinue heparin and start a direct thrombin inhibitor

Question 30

What fluoroquinolone antibiotics are appropriate for covering hospital-acquired pneumonia?

Answer 30

Levofloxacin or Ciprofloxacin

Question 31

What emergent procedure needs to be performed in a patient with paraphimosis when all reduction techniques have failed and ongoing ischemia is clearly evident?

Answer 31

Superficial dorsal slit incision of the constricting band

Question 32

**thrombotic thrombocytopenic purpura PENTAD**

Answer 32

Anemia, fever, neurologic findings, thrombocytopenia, kidney injury **_Thrombotic Thrombocytopenic Purpura (TTP)_** * Risk factors: female sex, age \< 50, pregnancy * Sx: fever, **confusion**, difficulty speaking, **headache**, seizure, nausea, **vomiting**, diarrhea * Labs: **elevated LDH**, **elevated indirect bilirubin**, normal coagulation studies, microangiopathic hemolytic anemia, and **thrombocytopenia** * Caused by autoantibody against **ADAMTS13** leading to severe deficiency of the enzyme * Treatment is plasma exchange with intravenous corticosteroids

Question 33

**The mainstay of treatment for TTP is**

Answer 33

**plasmapheresis (plasma exchange)**, which can achieve remission of disease in 80% of patients. If plasmapheresis cannot be immediately performed, fresh frozen plasma (FFP) should be administered until plasmapheresis can be performed.

Question 34

How does lithium affect kidneys?

Answer 34

Lithium toxicity is associated with several different forms of renal injury, but **nephrogenic diabetes insipidus is by far the most common**

Question 35

Classic symptoms include **explosive diarrhea**, **colicky abdominal pain**, and **pale**, **loose**, **foul-smelling stools, which bacteria is this?**

Answer 35

**_Giardiasis_** * History of **camping** and drinking lake water * Sudden onset of **explosive**, **foul-smelling**, and **non-bloody diarrhea** * Labs will show **flagellated protozoan** * Most commonly caused by *Giardia lamblia* * Management includes **supportive care** and **antibiotics** for **symptomatic** individuals * Choosing an antibiotic: * Individuals ≥3 years old — **tinidazole** * Individuals between 1 and 3 years old — **nitazoxanide** * Individuals \<12 months old —**metronidazole**

Question 36

Inspiratory arrest with right upper quadrant palpation

Answer 36

**Murphys sign**

Question 37

Tx of mastitis

Answer 37

**_Mastitis_** * Patient will be a breastfeeding mother * Breast **erythema**, **tenderness**, **fever** * Most commonly caused by ***Staph**. **aureus*** * Management includes **cool compresses** and **analgesics** between feedings * Antibiotics: **dicloxacillin**, cephalexin, TMP-SMX (MRSA), clindamycin (PCN allergy) * **Continue breast feeding** to avoid progression to abscess

Question 38

What are the empiric antibiotics of choice for septic arthritis?

Answer 38

**Vanc + ceftriaxone** * Most common cause overall: ***S**. **aureus*** * ***N. gonorrhoeae*** is a common cause in young, sexually active individuals

Question 39

**acute unilateral pain and vision loss**, headache, vomiting, and **seeing halos around lights**

Answer 39

Acute angle glaucoma **_Acute Angle-Closure Glaucoma_** * Sx: **acute unilateral pain and vision loss**, headache, vomiting, and **seeing halos around lights** * PE: **cloudy cornea** and **fixed mid-dilated pupil** * Dx: increased IOP * Tx: emergent ophthalmology evaluation, topical beta-blockers (timolol), topical alpha-agonists (apraclonidine), miotics (pilocarpine), carbonic anhydrase inhibitors (acetazolamide), **iridotomy**

Question 40

What environmental disorder is acetazolamide used to treat?

Answer 40

Acute mountain sickness

Question 41

Patient presents with sudden **unilateral electric shock-like pains** in gums, cheek, chin, temporal forehead

Answer 41

**_Trigeminal Neuralgia (Tic Douloureux)_** * PE will show pain in V2 and V3 distributions, not V1 * Treatment is **_carbamazepine_**

Question 42

MC artery ruptured in epidural hematoma

Answer 42

Most common artery ruptured is the **middle meningeal artery** **_Epidural Hematoma_** * History of a head injury with a loss of consciousness followed by a **lucid interval** * CT will show a **biconvex opacity** * Most common artery ruptured is the **middle meningeal artery** * Treatment is emergent evacuation

Question 43

Most common organisms associated with guillain-barre

Answer 43

The most common organisms associated with GBS are ***Campylobacter jejuni*****,** Cytomegalovirus (CMV), Epstein Barr virus (EBV), and *Mycoplasma pneumoniae*.

Question 44

Guillain-Barre risk factors

Answer 44

**_Guillain-Barré Syndrome_** * Risk Factors: recent minor respiratory or GI illness * Sx: **Symmetric**, progressive **ascending** muscle weakness, can lead to respiratory failure * PE: **lack of deep tendon reflexes,** symmetric weakness * Lumbar puncture: **increased CSF protein** but a normal cell count * Most commonly caused by ***Campylobacter jejuni*** * Treatment is supportive, plasmapheresis, or IVIG

Question 45

Labs: **normal pH** \< **4**.**5**, wet prep: budding yeast, pseudohyphae, hyphae

Answer 45

Vulvovaginal candidiasis

Question 46

Retinal vein vs retinal artery occlusion PE findings

Answer 46

Retinal artery = red cherry spot → Sudden painless, complete loss of vision Retinal vein → Blood and thunder appearance (retinal hemorrhages and cotton wool spots)

Question 47

What systemic neurologic disorder is associated with optic neuritis?

Answer 47

Multiple sclerosis

Question 48

Tx of pertussis

Answer 48

Azithromycin **_Pertussis (Whooping Cough)_** * History of nasal congestion, cough, and low-grade fever * **Rapid-fire repetitive coughing followed by an inspiratory whoop and post-tussive emesis** * Most commonly caused by ***Bordetella pertussis*** * Treatment is a **macrolide**: **azithromycin**

Question 49

severe hypothyroidism resulting in a **decompensated metabolic state** and **mental status change**

Answer 49

Myxedema coma

Question 50

positive when **palpation of the left lower quadrant causes pain in the right lower quadrant**, by pushing bowel contents towards the ileocecal valve and thus increasing pressure around the appendix

Answer 50

Rovsing sign

Question 51

**tense** and **firm** blisters that **do not extend with lateral pressure** (**Nikolsky sign negative**)

Answer 51

Pemphigus vulgaris

Question 52

Which virus can cause a transient aplastic crisis in sickle cell?

Answer 52

Erythema infectiosum → Parvovirus B19 * **Hydroxyurea** to reduce pain and vaso-occlusive crises * Antibiotic prophylaxis until age 5 years, pediatric vaccinations (extra PCV)

Question 53

**antibody**-**mediated destruction of platelets**

Answer 53

Primary immune thrombocytopenia **_Primary Immune Thrombocytopenia_** * Patient will be a **child 2**–**6 years old** * History of recent viral infection * Red spots on skin or easy bleeding * PE will show **petechiae**, **purpura**, and **gingival bleeding** * Labs will show platelets \< **100**,**000**/**µL** * Most commonly caused by antiplatelet antibodies * Treatment is observation, steroids, IVIG

Question 54

In a pt with pancreatitis which lab value is the greatest predictor of mortality?

Answer 54

Glucose

Question 55

Impetigo is associated with which condition

Answer 55

Acute poststreptococcal glomerulonephritis results from an **antecedent infection of the skin** or **throat caused by nephritogenic strains of group A beta-hemolytic streptococci**.