Opioids
Anaesthetics
FNA-cases
Psychiatry
Analgesia/Pain
100
A patient with an incurable cancer is suffering from pain that is gradually increasing in intensity and levorphanol ( a strong u-receptor agonist) is prescribed. With chronic use of the drug, tolerance is not likely to develop to constipation or to
What is pupillary constriction?
100
A 20 year old male patient scheduled for hernia surgery was anaesthetised with halothane and nitrous oxide; tubocurane was provided for skeletal muscle relaxation. The patient rapidly developed tachycardia and became hypertensive. Generalised skeletal muscle rigidity was accompanied by marker hyperthermia. Laboratory values revealed hyperkalemia and acidosis.
What is malignant hyperthermia?
100
A 68 year old woman with acute onset of left sided weakness. The patient awoke unable to get out of bed. She smokes three cigarettes a day for 40 years. Moderate alcohol consumption. Plays tennis fives times a week. Vital signs remarkable for BP= 190/100. For CNS exam: Motor- 0/5 strength left arm and leg with increased tone. Right sided strength 5/5 with normal tone. Reflexes: 3+ left arm and leg, 2+ right and leg. Babinski sign present on the left.
What is right sided stroke- UMN signs?
100
A32-year-old man is brought to the psychiatric emergency department by the police after having been arrested for public nudity. Laboratory tests show a negative drug screen and alcohol levels. On MSE, you find that the patient cannot sit down and is only partly cooperative. He interrupts the interview several times demanding to be allowed to contact his lawyer “because my rights given to me by God and ordained by the Jeffersonians and Washingtonians and Lincolnians have been infringed...and you, sir, are committing illegalities of the highest order.” His speech is pressured. Examination of the patient’s psychiatric records indicate that he has a history of a major depressive episode treated successfully with an SSRI for 1 year when he was age 23. The patient’s parents arrive in the emergency department and tell you that the patient is a college graduate and a computer programmer. Lately, his job has been rather stressful as he has been overlooked for promotion, and his girlfriend left him 1 month ago. He is also in a great deal of credit card debt.
What is bipolar type I?
100
A 17-year-old boy presents to the ED with severe RLQ abdominal pain. The pain is well localised and sharp and severe in intensity. The pain started as dull poorly localised abdominal pain around the umbilical region.
What is somatic pain?
200
They are located in peripheral tissues (activated by inflammation), in the Spinal Cord Dorsal Horn, in the Thalamus, Limbic and Somatosensory cortex (ascending pathway) and the midbrain Periaqueductal Gray, the Nucleus Raphe Magnus and Rostral Ventral Medulla (descending pathway)?
What is MOR (mu opioid receptors)?
200
The mechanism of action includes the blockade of voltage dependent sodium channels and an increase in membrane refractory period with resting channels having LOW affinity.
What is local anaesthetics?
200
A 50 year old patient has a spinal cord injury due to trauma. As a result of the injury the patient presents with the following signs spastic paralysis on the right side of the body from the level from the umbilicus, right side loss of vibration and proprioception from the level of the umbilicus, loss of pain and temperature sensation on the left side 2 levels below the level of the umbilicus. At the right side, there is loss of all sensory modalities as well as flaccid paralysis.
What is spinal cord hemi-section on the right side at the level of T10?
200
A 24-year-old woman presents to her primary care physician for a regular checkup. During the examination, her doctor notes a 15-pound weight gain. The patient complains that she always feels tired during the day despite sleeping from 8 PM to 9 AM daily. On further questioning, the physician learns that the patient feels sad and empty, often thinks about death, cannot concentrate at work, and lacks the energy to care for her two children. However, her mood picks up when her physician questions her about her children.
What is atypical depression?
200
Jane is a 20-year-old prostitute who has been using cocaine regularly for greater than 3 years. Over the past 12 months, she finds that she has had to use increasing amounts of cocaine in order to obtain the same level of “high.” Which of the following terms best describes this effect?
What is tolerance?
300
An active component in many over the counter cough suppressant and has no appreciable analgesic activity. Compared with codeine, also an effective antitussive, and causes less constipation. When properly and used in small amounts, it can be used safely as a cough suppressant. Overdose toxicity in toddlers has raised concern, and abuse of the drug in powdered form has caused disorientation, hallucinations, seizures, and death.
What is dextromethorphan?
300
This is a molecular target for a certain type of parenteral anaesthetic that acts on NMDA receptors as an antagononist.
What is Ketamine?
300
A 70-year old semi-retired janitor with a history of hypertension went to work one morning and at 7:00 AM had a sudden onset of nausea, vomiting, and unsteadiness. He was taken to the emergency room, where his exam was notable for mildly slurred speech, with slowed tongue movements, dysmetria on finger-to-nose testing on the left, dysmetria on heel-to-shin testing on the left, and left dysdiadochokinesia. Upon attempting to stand, he fell to the left, even when he kept his eyes open.
What is appendicular ataxia/ spinocerebellum (intermediate zone)?
300
A 50-year-old white atheist woman with a history of schizophrenia presents to your office after divorce with her husband. She is unemployed and has been staying home taking care of the couple’s children. She notes feeling sad and reports thoughts of killing herself. She has a past history of an overdose attempt with aspirin.
What is high risk suicide patient?
300
At 2 years and 6 months after the initial surgery she reports that the increasing pain in her abdomen and right leg is no longer controlled by the oral analgesic regimen and she reports increasing adverse effects including increasing sedation, nausea and multifocal myoclonus. Since the patient is experiencing limiting side effects you can no longer increase the dose of morphine to provide additional pain relief.
What is opioid rotation?
400
A 25-year-old man is brought into the emergency department lethargic and stuporous. He responds only to painful stimuli, wakes up briefly and yells, then goes back to sleep. Ambulance personnel report that they found him near a house known for drug trafficking. There is no evidence of physical injury but pinpoint pupils are noted on P/E.
What is opioid toxicity?
400
It is the least potent of the inhaled anaesthetics. It has not been implicated in malignant hyperthermia. More than 98% of the drug is eliminated by exhalation.
What is nitrous oxide?
400
A 76-year old man with a history of cigarette smoking developed progressive difficulty walking over the course of one month. He noticed that when he stood up he felt 'woozy,' and he described his gait as feeling like he was drunk, saying 'my legs go one way, and I go the other.' His family said he frequently lost his balance, with staggering and unsteadiness. He also had frequent mild headaches that occurred at any time of the day or night and seemed to be getting worse. His exam was unremarkable except for a wide-based, unsteady gait and tendancy to fall to the left, especially during tandem walking. Of note, there was no ataxia on the finger-to-nose or heel-to-shin testing and rapid alternating movements were normal. There was no history of alcohol intake.
What is truncal ataxia/ spinocerebellum (vermis)?
400
I don’t even need to make money. Money makes the world go ’round, ’round the mulberry bush the monkey chased the weasel. Weasels make good politicians you know.
What is flight of ideas?
400
An anti-pyretic analgesic; very weak cyclooxygenase inhibitor, not an anti-inflammatory. It causes less GI distress than aspirin but is dangerous in overdose. It causes hepatic necrosis in overdose.
What is acetaminophen?
500
A young male patient is brought to the ED in an anxious and agitated state. He informs the attending physician that he uses street drugs and that he gave himself an IV fix 12 hours ago. He now has chills and muscle aches and has also been vomiting. His symptoms include hyperventilation and hyperthermia. The attending physician notes that his pupil size is larger than normal.
What is opioid withdrawal syndrome?
500
A patient is to undergo surgery, and a short-acting anesthetic with a fast onset will be used. Recovery, unhampered by postoperative nausea, will be rapid because the clearance of the drug is greater than hepatic blood flow.
What is propofol?
500
A 31 year old woman developed left face, arm, and leg weakness. The keys symptoms and signs in this case are: left face, arm, and leg weakness, clumsiness, slowness, increased tone, hyperreflexia, and equivocal Babinski sign, dysarthria, unsteady gait, falling to the left, with decreased arm swing. Clinical localisation:
What is right corticobulbar and corticospinal tracts in the posterior limb of internal capsule or ventral pons?
500
A 33-year-old woman is brought to the emergency department by her husband, who tells you that in the last week his wife has been increasingly tearful and easily upset. Over the last few months, she has been increasingly irritable and has a hard time sitting still. Additionally, she had told him she was having some difficulty doing her usual tasks like paying her bills and balancing her checkbook. She has occasional “hot flashes.” On examination, she is alert and oriented, but continuously changes position in her seat and gets up frequently. Her speech is normal for rate, volume, and production. She has difficulty with simple arithmetic and short-term memory. Her deep tendon reflexes are brisk symmetrically throughout. She has a fine resting tremor of her hands and has difficulty rising from a seated position. This lab test is done to rule out medical etiology.
What is TSH?
500
A partial opioid agonists that has lower affinity to u receptors. It is used for mild to moderate pain and sometimes for acute debilitating cough. It is an analgesic that is used in combinations with NSAIDS and acetaminophen.
What is codeine?
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