Term
| What are the 4 major clinical signs of a posterior circulation stroke? |
|
Definition
4 Deadly "Ds"
1) Diplopia
2) Dizziness
3) Dysphagia
4) Dysarthria |
|
|
Term
| What part of the spinal chord is affected in Poliomyositis and how does it present? |
|
Definition
| LMN lesions leading to destruction of anterior horn cells and producing flaccid paralysis below lesion. |
|
|
Term
| What are the differentiating features of ALS from other paralytic diseases? |
|
Definition
Combination of UMN and LMN.
There are no sensory or oculomotor deficits
Riluzole (anti-glutamate) will delay progression |
|
|
Term
| What are you most concerned about in an elderly patient with absent DTRs, ataxia and a positive romberg sign? |
|
Definition
Sounds like degeneration of dorsal columns with areflexia.
This is typical of Tabes dorsals in tertiary syphillis. Also consider B12. |
|
|
Term
| What conditions can produce an UMN lesion of facial nerve? |
|
Definition
Will lose lower division on contralateral side.
ALexander Bell with STD: AIDS, Lyme, Sarcoid, Tumors, Diabetes |
|
|
Term
| in an MCA stroke, in which direction will eyes deviate? Why? |
|
Definition
| Toward side of lesion because of loss of FEF, which drives contralateral movement |
|
|
Term
What is the nerve root and nerve of the following reflexes?
1) Triceps
2) Biceps
3) BR
4) Patellar
5) Achilles
6) Babinski |
|
Definition
1) Radial, C7
2) Musculocutaneous, C5
3) Radial, C5
4) Femoral, L2-4
5) S1
6) Normal in 1st year of life, then sign of UMN lesion |
|
|
Term
| What are absolute contraindications to TPA therapy? |
|
Definition
SAMPLE STAGES
1) Stroke or trauma within 3 months
2) Anticoagulation with INR > 1.7 or prolonged PTT
3) MI in past 3 months
4) Prior ICH
5) Low platelet count (<100k)
6) Surgery in past 14 days
7) TIA within 6 months
8) GI or urinary bleeding in past 21 days or Glucose < 50
9) Elevated (> 400) or decreased (< 50) Glucose
10) Seizures present with stroke. |
|
|
Term
| What are the appropriate medical treatment measures in a patient with an ischemic stroke > 3 hours ago? |
|
Definition
Can't use TPA
- ASA, or if patient on ASA, consider Clopidogrel
- Treat fever and hyperglycemia
- If increased ICP, use mannitol and hyperventilation |
|
|
Term
| How would a PCA stroke present? |
|
Definition
| Vertigo and homonymous hemianopsia |
|
|
Term
| How would a Lacunar infarct present? |
|
Definition
| Pure motor, pure sensory, ataxic hemiparesis or dysarthria |
|
|
Term
| What are the major risks after SAH? How are they prevented? |
|
Definition
1) Re-bleed: Keep BP < 150
2) Obstructive hydrocephalus: Raise head and hyperventilate, place drain
3) Vasospasm: use Nimodipine |
|
|
Term
| Describe your workup in a suspected SAH |
|
Definition
1) Non-con CT first
2) If negative, get LP and look for Xanthocrhomia and increased protein/opening pressure
3) Get Angiography once SAH confirmed |
|
|
Term
| Which conditions are associated with berry aneurysms? |
|
Definition
1) Marfan
2) Aortic coarcation
3) Kidney disease (ADPKD)
4) Ehlers-Danlos
5) Sicke cell, tobacco
6) Atherosclerosis
7) History/HTN/Hyperlipidemia |
|
|
Term
| What is the diagnostic study of choice for Cavernous Sinus Thrombosis? How is it treated? |
|
Definition
1) MRI
2) IV Empiric antibiotics for 3-4w: Nafcillin/Vancomycin + Ceftriaxone + MTZ +/- anti-fungal |
|
|
Term
| Which neurotransmitter systems are associated with Migraine? What are typical triggers? |
|
Definition
1) 5-HT and Dopamine
2) Foods, fasting, stress, menses, OCPs, bright light, sleep disturbance |
|
|
Term
| What is the prophylactic treatment for Migraine and Cluster headaches? |
|
Definition
1) Migrane
- ADEs, TCA, Beta blockers
2) Cluster
- Verapimil |
|
|
Term
| What are the risk factors for IIH? How is it treated? |
|
Definition
Give acetazolamide or possibly consider shunt
1) Obesity
2) Tetracycline use
3) Growth hormone
4) Excess vitamin A |
|
|
Term
| What are the typical features of a tonic-clonic seizure? |
|
Definition
1) Incontinence and Tongue biting
2) Cyanotic appearance during octal period
3) Post-ictal confusion |
|
|
Term
What are the classic EEG findings for the following seizures?
1) Absence
2) Tonic-clonic
3) Partial |
|
Definition
1) 3-per-second spike-and-wave. Often triggered by hyperventilation
2) 10 Hz activity in tonic phase and slow waves in clonic phase
3) Epileptogenic focus |
|
|
Term
| What is the first-line anticonvulsant for seizure control in children? |
|
Definition
| Phenobarbital. Except Absence, which uses Ethosuxamide (T type CCB) or Valproic acid second line |
|
|
Term
| What is the management of status epileptics? |
|
Definition
1) ABCs, give thiamine, followed by glucose and naloxone
2) IV lorazepam 0.1 mg/kg. Repeat after 5-10 min
3) Phenytoin or Fosphenytoin after 20 minutes |
|
|
Term
| Withdrawal from which agents can cause seizures? |
|
Definition
ABBA
1) Alcohol
2) Benzos
3) Barbs
4) ADEs |
|
|
Term
| What is the classic presentation of BPPV? |
|
Definition
1) Transient, episodic vertigo (< 1min)
2) Nystagmus triggered by changes in head position
3) Perform Dix-Hallpike |
|
|
Term
| What is on your differential for Peripheral Vertigo? |
|
Definition
1) BPPV: episodic lasting < 1 min with nystagmus on position change
2) Vestibular Neuritis/Labrynthitis: acute onset vertigo with gait unsteadiness, N/V and nystagmus.
- VN lacks auditory or aural symptoms (looks like PICA infarction)
- Labrynthitis has Auditory or aural symptoms (looks like AICA infarction)
3) Meniere Disease: Vertigo, tinnitus and low-frequency SNHL with sensation or ear fullness. |
|
|
Term
| What is the treatment for Vestibular neuritis? |
|
Definition
| Steroids given < 72 after onset and anti-vertigo agents (Meclizine) |
|
|
Term
| What is the treatment for Menierre Disease? |
|
Definition
1) Acute: Meclizine or bentos and anti-emetics
2) Chronic: Salt restriction, Diuretics Intra-tympanic gentamicin injection for severe unilateral cases |
|
|
Term
| What is the first step in management for a patient with new-onset syncope? |
|
Definition
| Rule out cardiac by 1) placing on telemetry or Holder monitor and 2) ECG and troponins |
|
|
Term
| What are the confirmatory diagnostic tests for a patient with diplopia, bulbar dysfunction and proximal muscle weakness? |
|
Definition
Sounds like M. gravis
1) Antibodies (ACh-R, MUSK, LRP-4)
2) Tension test
3) Single fiber EMG
4) Repetitive Nerve stimulation (decremental response) |
|
|
Term
| Which drugs should be avoided in patients with M. gravis? How is an acute attack treated? |
|
Definition
Treat acutely with IVIG or Plasma exchange
- Avoid antibiotics (FQ and ahminoglycosides) and Beta blockers because of effects on NMJ |
|
|
Term
| What is the workup for suspected LES? How is it treated? |
|
Definition
1) Repetitive nerve stimulation test and chest imaging (lung cancer ro)
2) Tumor resection, 3, 4 diaminopyridine or Guanidine
3) If no tumor identified, can use steroids and azathioprine for immunosupression. |
|
|
Term
Which type of MS has the best prognosis?
How is it treated acutely? |
|
Definition
1) Relapse-remitting (also most common)
2) IV steroids with oral taper |
|
|
Term
| What agents are involved in symptomatic management of MS? |
|
Definition
1) Baclofen for spasticity
2) Anti-cholinergics (Oxybutinin) for Urge incontinence
3) TCA or ADE for painful paresthesias
4) SSRI for depression |
|
|
Term
1) What is the classic CSF finding for GBS?
2) How is it treated? |
|
Definition
1) Elevated protein (> 55) with normal cell count (Albuminocytologic dissociation)
2) Monitor respiratory status. IVIG or Plasmapheresis |
|
|
Term
What are the classic imaging findings for the following forms of Dementia?
1) AD
2) Vascular
3) FTD
4) NPH
5) CJD
6) LBD |
|
Definition
1) Diffuse cortical atrophy in temporal and parietal lobes
2) Old infarctions and deep white-matter changes
3) FT atrophy on MRI. Pick bodies (round intraneuronal inclusions) on pathology
4) Ventricular enlargement
5) Increased T2 in putamen and head of caudate. EEG shows sharp wave complexes
6) Lewy bodies on pathology |
|
|
Term
| What chromosome is involved in HD? What available treatments are there? |
|
Definition
1) AD TNR disorder on chromosome 4
2) CT/MRI shows atrophy of caudate and putamen
3) Reserpine or Tetrabenazine can help with chorea and SSRIs for depression |
|
|
Term
| What are the useful drugs in treating PD and what are their SE? |
|
Definition
1) Amantadine for mild symptoms: Ankle edema is SE
2) Carvidopa/Levodopa: Hallucinations, dizziness, agitation
3) Dopamine agonists: Confusion, compulsive gambling, hallucinations
4) Selegiline: Confusion and insomnia
5) COMT inhibitors (entacapone) can increase availability of levodopa to brain
6) Anticholinergics for younger patients with tremor: Dry mouth, blurred vision, constipation, nausea
7) DBS |
|
|
Term
| What are the major primary sites of brain metastasis |
|
Definition
| Lung> Breast, Melanoma, Colon |
|
|
Term
| What are the most common CNS tumors in children and adults, respectively? |
|
Definition
1) Adults get meningioma and GBM
2) Kids get Medulloblastoma and Astrocytoma |
|
|
Term
| What type of pediatric brain tumor is GFAP positive? |
|
Definition
Pilocytic atrocytoma: posterior-fossa/infratentorial mass.
Usually has a protracted course |
|
|
Term
| What type of cell gives rise to medulloblastoma in kids? |
|
Definition
| Neuroectomdermal. Arises from fourth ventricle or cerebellar vermis and causes increased ICP |
|
|
Term
| Why give steroids in patients with brain tumors? |
|
Definition
|
|
Term
| What are the defining features of NF-1 and NF-2 |
|
Definition
Both autosomal dominant neurocutaneous disorders
Get MRI for both. No cure, but surgery can help.
1) NF-1 (chromosome 17): optic nerve gliomas, ash leaf spots, cafe-aut-lait spots, litchi nodules on eye, ependymomas
2) NF-2 (chromosome 22): bilateral acoustic schwanommas |
|
|
Term
Infant presents with seizures, hypo pigmented lesions on trunk and mental disabilities.
What other findings are characteristic of this disorder? |
|
Definition
Sounds like Tuberous Sclerosis. AD disorder affecting skin, brain, kidneys and heart
1) Sebaceous adenomas (red nodules on nose and cheeks)
2) Shagreen patch (rough papule in lumbosacral region)
Get MRI to evaluate for subenpendymal giant cell astrocytoma or calcified tubers. Also get Echo, MRI of abdomen and EEG. |
|
|
Term
| What type of injury leads to coma in high-acceleration traumas (such as MVA) |
|
Definition
| Diffuse axonal injury: punctate lesions on MRI |
|
|
Term
| How can you distinguish a persistent vegetative state from "locked in syndrome"? |
|
Definition
1) PVS: wakefulness without awareness with normal sleep-wake cycles and no voluntary motor ability
2) Locked in: Wakeful and alert with retained cognitive abilities and voluntary movement of eyes. CPM and brainstem stroke are common causes |
|
|
Term
| What is a headache worsened by darkness troubling for? |
|
Definition
| Angle-closure glaucoma (pupillary dilation worsens obstruction of flow) |
|
|
Term
What is the injury and potential nerve involved? How do you treat?
- Holding arm in slight abduction and external rotation |
|
Definition
Anterior shoulder dislocation: Axillary nerve injury
Reduction with sling and swath. Eventually surgery. |
|
|
Term
What is the injury? How do you treat?
- Hold arm in adduction and internal rotation in patient recently suffered seizure |
|
Definition
| Posterior shoulder dislocation. Reduction with sling and swatch |
|
|
Term
What is the injury and potential nerve involved? How do you treat?
Direct trauma to arm leading to wrist drop and loss of thumb sensation |
|
Definition
Humerus fracture: Radial nerve
Hanging arm case vs. coaptation splint and sling. Functional bracing |
|
|
Term
| How is an ulnar shaft fracture managed in a patient struck with a night stick? |
|
Definition
|
|
Term
| What kind of upper extremity injury occurs after fall on outstretched hand? What nerve is typically involved? |
|
Definition
Colles fracture of distal radius. Also possible scaphoid
Dorsally displaced and orally angulated fracture seen in children and elderly with osteoporosis.
Usually involves median nerve damage and managed with closed reduction |
|
|
Term
| What is the major concern with a scaphoid fracture? |
|
Definition
| Avascular necrosis can occur |
|
|
Term
| Which nerve is typically injured in anterior vs. posterior hip dislocation? Which is more common? How are they managed? |
|
Definition
1) Posterior is most common "dashboard injury": Risk of sciatic injury (extension) and AVN.
2) Anterior can damage obturator nerve (adduction, L3)
3) Closed reduction followed by CT |
|
|
Term
| What injury presents as a shortened and externally rotated leg? What is the management? |
|
Definition
1) Hip fracture
2) ORIF with anticoagulation to prevent DVT |
|
|
Term
| What is a major potential complication of femoral fracture? How is it managed? |
|
Definition
Fat emboli: look out for fever, AMS, dyspnea, hypoxia, petechiae and low platelets
Treat with intra-medullary nailing. Irrigate and debride open fractures. |
|
|
Term
| How does management of ACL and PCL injuries differ? |
|
Definition
ACL needs surgical, whereas PCL surgery is only for athletes
Both need MRI for diagnosis |
|
|
Term
| What types of knee injuries occur with twisting and present with "clicking" or "locking"? How are they managed? |
|
Definition
Meniscal tears
- MCL: valgus stress
- LCL: varus stress
Management is operative in young patients with reparable tears or older patients with mechanical symptoms |
|
|
Term
| What is management of Achilles tendon rupture? |
|
Definition
| Surgery followed by 6w long-leg cast |
|
|
Term
Which nerve is associated with each of the following motor/sensory deficits? What are common causes?
1) Wrist drop with sensory loss of dorsal forearm
2) Claw hand, with impaired finger abduction and loss of sensation of palmar and dorsal surface of last 2 fingers
3) Weak wrist flexion and flat thenar eminence with impaired forearm pronation.
4) Loss of arm abduction
5) Loss of foot dorsiflexion/eversion (foot drop) |
|
Definition
1) Radial (C7-8): Humeral fracture, prolonged compression (Saturday night)
2) Ulnar (C8-T1): Elbow dislocation
3) Median (C6-7): Carpal tunnel
4) Axillary: Anterior shoulder dislocation
5) Peroneal: Knee dislocation, fibular trauma |
|
|
Term
What type of hip injury is associated with:
1) shortened, internally rotated leg
2) shortened, externally rotated leg
3) lengthened, externally rotated leg |
|
Definition
1) Posterior dislocation
2) Fracture
3) Anterior dislocation |
|
|
Term
| What is the appropriate management of carpal tunnel syndrome? |
|
Definition
1) Night splints
2) CS injections into canal
3) Surgical release for refractory |
|
|
Term
| How is bursitis generally managed? |
|
Definition
Conservative is RICE and NSAIDs
CS injections can be considered, but NOT in infection (needs 7-10d antibiotics) |
|
|
Term
| What MSK complication is associated with FQ use? |
|
Definition
| Risk of tendon rupture and tendonitis |
|
|
Term
| What is management of patient with presumed human bite injury? |
|
Definition
| Surgical irrigation and debridement and IV ABX to cover Eikinella |
|
|
Term
What type of back pain occurs suddenly, is exacerbated by intra-abdominal pressure and shows straight-leg raise pain?
What is the next step in management? |
|
Definition
Herniated disc (usually L5-S1)
1) Order ESR and radiograph. Get MRI stat is CES is considered or if symptoms are refractory to conservative management.
2) Management is NSAIDs and PT. May use epidural injection. |
|
|
Term
What type of back pain is associated with radiation to arms or buttocks and legs, and is worse with standing and walking?
What is the next step in management? |
|
Definition
1) Spinal stenosis
2) Radiographs +/- CT/MRI.
- Mild to moderate gets NSAIDs and abdominal strengthening
- Advanced gets CS injections
- Refractory needs surgical laminectomy |
|
|
Term
Which nerve root is affected in the following cases?
1) Absent foot dorsiflexion
2) Loss of foot eversion and big toe dorsiflexion
3) Loss of plantar flexion or hip extension |
|
Definition
1) L4. Deep perineal nerve. Also may see loss of Patellar reflex and loss of sensation on medial lower leg
2) L5: Superficial peroneal. Loss of sensation on foot and lethal lower leg
3) S1: Loss of achilles reflex, loss of tibial nerve and/or sciatic nerve. Loss of sensation on lateral foot. |
|
|
Term
| What is the most common primary bone malignancy in children? How is it diagnosed and where does it metastasize? |
|
Definition
1) Osteosarcoma
2) Progressive, night pain with constitutional symptoms, "sunburst" appearance
3) Lungs |
|
|
Term
| Which type of primary bone tumor appears as "sunburst," "onion skinning" and "soap bubble" respectively? |
|
Definition
1) Osteosarcoma: goes to lungs
2) Ewing's sarcoma
3) Giant cell |
|
|
Term
What is the first step is diagnosis of a suspected septic joint?
What is the treatment? |
|
Definition
1) Aspiration: WBC > 80k, + gram stain or fluid culture
- Staph, strep or gram - rods
2) Empirically with IV Cefriaxone and Vancomycin
- If confirmed, surgical debridement necessary |
|
|
Term
| What is on the differential for hyperuricemia? |
|
Definition
1) Increased cell turnover
2) Cyclosporine use
3) Dehydration
4) Diabetes
5) LN syndrome
6) Lead poisoning
7) Salicylates
8) Starvation |
|
|
Term
| What do you think of when you hear "punched out" erosions with overhanging cortical bone? How is this condition managed? |
|
Definition
1) Gout
2) Acutely: NSAIDs, Colchicine (watch out for neutropenia and diarrhea), Steroids 2nd line
3) Chronic: Probenecid (increase elimination), Allopurinol (decrease production) |
|
|
Term
| What medical history might clue you into Psuedogout? |
|
Definition
Hemochromatosis or Hyperparathyroidism
Positively birerefringent, rhomboid shaped crystals affecting wrists and knees |
|
|
Term
| What are the seronegative spondyloarthropathies? |
|
Definition
1) Ankylosing spondylitis
- HLA-B27
- LBP worsens with inactivity and in mornings
- Uveitis and heart block
- Treat with NSAIDs for pain and TNF inhibitors if refractory
2) Reactive (Reiter syndrome)
- Can't see, pee or climb tree
- Arthritis, uveitis, urethritis after infection with chlamydia or others
3) Psoriatic
- Oligoarthritis involving DIPs and sausage-shaped digits (dactylics). Pencil in cup on XR
4) Enteropathic spondylitis
- Sacroiliitis that is asymmetric and associated with IBD. |
|
|
Term
| What type of toxicity is worrisome with Hydroxychloroquine use? |
|
Definition
|
|
Term
|
Definition
Systemic Sclerosis: Anti Scl-70, Anti-Topo
CREST: anti-centromere
1) Calcinosis
2) Raynaud's
3) Esophogeal dysmotility
4) Sclerodactyly
5) Telangiectasia |
|
|
Term
| What are the major organ system complications of Systemic Sclerosis? |
|
Definition
1) Pulmonary Fibrosis
2) Renal failure
3) GI motility issues
4) Malignant hypertension |
|
|
Term
Match the disease to the antibody.
1) Anti-dsDNA
2) Anti-centromere
3) Anti-histone
4) Antimitochondrial
5) Anti-Sm
6) Anti-smooth muscle
7) Anti-topoisomerase
8) p-ANCA
9) U1RNP antibody |
|
Definition
1) SLE
2) CREST syndrome
3) DI Lupus
4) PBC
5) SLE
6) Autoimmune hepatitis
7) Systemic Sclerosis
8) Microscopic polyangiitis
9) Mixed connective tissue disease |
|
|
Term
How are each of the following managed in Systemic Sclerosis?
1) Raynaud's
2) Acute flares
3) Renal disease |
|
Definition
1) CCB
2) Steroids (watch out for renal)
3) ACE inhibitors |
|
|
Term
| What disease is associated with Anti-Ro antibodies? |
|
Definition
|
|
Term
|
Definition
1) NSAIDs for mild joint symptoms
2) CS for exacerbations
3) Hydroxychloroquine for isolated skin/joint involvement (watch out for Retinitis)
4) Cyclophosphamide: severe cases of nephritis |
|
|
Term
| What are the major RF for Giant Cell Arteritis? |
|
Definition
1) Polymyalgia Rheumatica
2) Age > 50
3) Female gender |
|
|
Term
| How can you differentiate SLE arthritis from RA? |
|
Definition
| Both affect MCP and PIP, but SLE is NON-deforming |
|
|
Term
| How is fibromyalgia treated? |
|
Definition
| Anti-depressants (SNRIs) and PT. |
|
|
