SOLUTIONS RATED A+
✔✔Guillaine Barre Syndrome - ✔✔Monophysite immune mediated polyradiculopathy
that causes ascending paralysis. It is often post-infectious and associated with
Campylobacter infection. Spinal fluid will reveal elevated protein without pleocytosis
(presence of cells). Rx with IV gamma globulin
✔✔Myasthenia gravis - ✔✔Autoimmune disorder that affects more women than men,
peak age of 31-40 or men after 60. Causes fatigue and weakness. Eye movements and
speech are commonly affected. Test for presence of autoantibodies against
acetylcholine. Treat with IV IG, plasmapheresis, and anticholinesterace inhibitors.
Check for thymoma as a thymectomy can be curative.
✔✔Multiple sclerosis - ✔✔Demyelination disease that is debilitataing. Can be
relapsing/remitting, primary progressive or secondary progressive. Most commonly
diagnosed between 20-50. Demyelination leads to plaques. Patient will complain of
weakness of legs and bladder,bowel. Optic neuritis can occur, transverse myelitis
(spinal cord inflammation).
Mainstay treatment are glucocorticoids,
✔✔Alzheimer's disease - ✔✔Progressive neurodegenerative disorder and is the most
common form of dementia (60-80%). Characterized by insidious onset, slow
progression, and array of emotional and behavioral problems. Manifests as declines in
memory and learning with at least one additional cognitive domain- language (aphasia),
executive function, learned motor function (apraxia), visual spatial, and complex
attention.
Changes occur in the hippocampus, the amygdala, the temporal comple, the olfactory
system and the inter cortical connections.
Patient will have elevated levels of TAU.
✔✔Functional Activities Questionnaire - ✔✔Information based measure of functional
abilities that is completed by the family. Areas measured include ability to maintain
financial record, shop for necessities, heat water and turn off stove, cooks. Healthy
meal, knowledge about what is going on in the world. Arrange for transportation and
remember medications and significant dates.
✔✔Montreal Cognitive Assessment (MoCO) - ✔✔Cognitive test done by patient that
asks the to follow instructions of matching linear concepts, draw a clock at a specific
time, identify animals, spell. Word, recall and item, count backwards from serial 7s.
Scored on a 30 point max and 25/30 indicates the presence of cognitive impairment,
22/30 is significant.
✔✔Mini mental status exam (MMSE) - ✔✔Used to screen for cognitive impairment
30 point scale. Score less than 23 is significant.
, ✔✔CAM (confusion assessment method tool) - ✔✔Tool that can be used by clinicians
to integrate observations and identify delirium. Must have presence of features of 1
(acute onset and fluctuation course) and 2 (Inattention) and either 3 (disorganized
thinking) or 4 (altered level of consciousness).
✔✔Aortic stenosis murmur - ✔✔Mid to late systolic, murmur softer with valsalva
✔✔Mitral stenosis murmur - ✔✔Diastolic RUMBLE with opening snap. LOW frequency=
Rumble; heard at apex in left lateral position.
✔✔Stills murmur - ✔✔Innocent murmur in children, systolic murmur with vibratory or
miscible quality, max intensity at the left lower sternal boarder and apex
✔✔Aortic regurgitation - ✔✔Blowing diastolic murmur with widened pulse pressure.
✔✔Mild regurgitation - ✔✔Holosystolic soft, S3 may be present, heard at apex
✔✔Mitral valve prolapse murmur - ✔✔Mid-systolic click with/without a systolic murmur
heard at the apex and radiates to axilla
✔✔Normal PR interval duration - ✔✔0.12-0.20 seconds (3-5 small boxes)
✔✔Normal QRS complex - ✔✔0.08-0.12 seconds
✔✔First Degree AV Heart Block - ✔✔PR interval is longer than 0.20 sec
-can be caused by CCB or beta-blockers, sometimes in athletes, diseased AV node
✔✔Second Degree AV Block Type 1 - ✔✔Wenckeback (progressive lengthening of the
PR followed by a dropped beat.
✔✔Second Degree AV Block Type II - ✔✔Occurs in the bundle of HIS with constant or
normal PR interval and a periodic drop of a QRS.
✔✔Thirds Degree AV Block - ✔✔The Atria beat regularly at a normal rate but no
electrical transmission to the ventricles. The atria and ventricles beat at their own rate.
✔✔Wolfe-Parkinson-White Syndrome - ✔✔A tachycardia that occurs from an accessory
Re entry. Delta wave will be seen on the EKG with WPW.
✔✔Normal axis on EKG - ✔✔Positive complexes in leads I and AVF
✔✔Left axis deviation - ✔✔Positive complex in lead I and negative complex in AVf