Abner Stainer
Name parts A, B, C, and D of Medicare
A: Hospitals
B: Physician services
C: Medicare advantage
D: Rx
The most important controllable risk factor for stroke
What is the largest layer in the somatosensory cortex (layers I-VI)
Layer IV
This physiologic effect explains how rib raising improves lymphatic drainage in addition to rib motion.
What is the modulation of sympathetic chain activity?
Function of the central sulcus
Separates the motor cortex from the sensory cortex
This vascular finding on physical exam suggests turbulent blood flow and supports atherosclerotic disease as an underlying etiology.
What is a Bruit
You are an EMT, and you are called out to pick up a 60 y/o male with facial droop and loss of strength in his left arm. According to his wife, his last known well time was 4 hours ago.
Your options are an acute stroke-ready hospital 10 minutes away or a comprehensive stroke center 40 minutes away. Where do you take him?
An acute stroke-ready hospital, even though the comprehensive stroke center has the best resources
Thrombolytics can only be administered within 4.5 hrs and time is brain
This cranial nerve exam finding that helps distinguish an upper motor neuron lesion from a lower motor neuron lesion.
Include both ways to find this in the face and in the limbs?
Forehead Sparing in the face
UMN: Hyperreflexia
LMN: Areflexia
Why do we pull our hands away from the patient's chest at the end of the Miller Thoracic Pump Technique
To accentuate negative intrathoracic pressure
This increases lymphatic return, loosens mucus plugs via the vibratory component, and potentially stimulates the immune system.
8675309/Jenny (yes, that's her name) is currently on diazepam to control her status epillepticus. She just has been married for 2 years and wants so have children soon. She wants to know if she needs her medication changed and, if so, why?
Yes, she needs to change medications
Benzodiazepines can cross the placental barrier during pregnancy and are detectable in breast milk
-can contribute to the depression of neonatal and nursling infants' vital functions
-normally avoided in pregnancy and nursing mothers
A good alternative would be lorazepam
This neurological pattern—right face and arm weakness with leg sparing—localizes the lesion to this region of the brain. (and which artery supplies it)
What is the left frontal cerebral cortex (MCA territory)?
The blood pressures needed to start and maintain thrombolytics.
What is:
Need <185/110 to start thrombolytics (tPA)
Need to maintain <180/105 after starting thrombolytics
What parts of the motor homonculus are supplied by the ACA
contralateral leg, foot, and genital area
In counterstrain for the medial pterygoid, the mandible is moved in this direction relative to the tender point.
What is away from the tenderpoint
A man walked in with head pain and a clearly bulging temporal artery. He has an elevated erythrocyte sedimentation rate as well and you suspect Giant Cell Arteriosis. What should you do in order to confirm your diagnosis and what is the best treatment for this condition?
Biopsy the artery and look for multinuclated giant cells.
The best treatment is high-dose corticosteroids, so you want to be absolutely sure of your diagnosis before subjecting patients to their many side effects.
Jeremy "Robert" Johnson comes into the ED with his wife after he woke up unable to communicate with her. He nods along with what you are saying but when he responds to your questions he doen't make any sense. He is clearly frusterated that you nor his wife seems to understand him. What consition does he have and what is the underlying pathology?
He is suffering from wernicke's aphasia
This is caused by an ischemic stroke of the PCA
What four tests and/or history pieces should be taken in order to determine which treatment should be used for a stroke patient?
1. Vitals
2. Noncontrast Head CT
3. ABCs
4. Blood Glucose
5. You should know their last known well time
John Palsy suffers a blockage of a anterior spinal artery which causes an infarct the right anterior corticospinal tract. What type of deficit would he suffer from?
None. ACST ends bilaterally so if one side suffers an infarct, the other side still innervates both the contralateral side and the ipsilateral side
The correct order for venous sinus drainage
1. Occipital Sinus
2. Transverse Sinus
3. Sigmoid Sinus
4. Superior Sagittal Sinus
Rick Richardson comes into your office complaining of weakness in his arms and legs. He says that the more he moves them, the better they get. On examination, he was found to have greatly decreased deep tendon reflexes. When testing his blood to confirm your diagnosis, what type of antibody would you expect to find in his blood?
Lambert-Eaton Syndrome
Antibody against voltage-gated calcium channel
John Lastname was rushed to the hospital this evening with an inability to coordinate the movements of his limbs and torso. He had a +0/5 for sensation in his right arm and leg, as well as a +0/5 for muscle strength in his Right upper and lower limbs. He was able to feel a cotton swab on his right arm and leg, and has a +5/5 for motor sensation on the left as well. Additionally, he is only able to use the left side of his face. What type of artery was blocked and which side of the body was the block on?
Medial and Lateral lenticulostriate arteries
These are symptoms of a lacunar stroke
The criteria for a patient to be considered for mechanical thrombectomy (there are 3)
1. Occlusion of large major vessels like the M1 section of the MCA or the internal carotid artery
2. Optimum time frame is under 6 hours, but can be performed in under 24 hrs from onset (just need one)
3. Systolic BP under 185
A man tripped on a toy car and in an unexplainable turn of events, he severed a white matter tract in the right anterior part of the medulla oblongata in the lateral right portion of the medial lemniscus. What deficit would this man face?
He would be missing fine, discriminative touch, vibration, and conscious proprioception from the lower trunk and lower limbs on the contralateral side.
This would cut the nucleus gracilis AFTER it has decusated
In a technique that uses the fifth digit of a gloved hand. We stimulated a ganglion located in the patient's mandible in order to relieve congestion. Which ganglion was this, is it sympathetic or parasympathetic and what does this do to the oral secretions?
1. pterygopalatine ganglion
2. Parasympathetic
3. Makes the secretions more watery
LeBronette comes into your office complaining of pulsating right-sided headaches and the inability to see what is going on in her WNBA games due to zig-zagging lines across her vision. What is the mechanism of action of the first-line actute treatment for her condition?
Sumatriptan is a 5-HT1B/1D agonist
5-HT1B is a serotonin receptor
This causes vasoconstriction of painfully distended arteries in the brain