Friday, November 9, 2012

Answer for Question 23, Neurology











Eccentric topic of the Week, Neurology
Question 23:

A. Above the elbow, 3.0 mm/day


B. Between the elbow/wrist and the knee/ankle, 1.5 mm/day

C. Distal to the wrist/ankle, 0.5 mm/day

   1. Average: 1 mm/day
   2. Axonal regrowth is faster in the proximal limbs than in the distal limb. 

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Answer for Question 22, Neuropharmacology













Eccentric topic of the Week, Neuropharmacology
Question 22:

The correct answer is D, cabergoline

Cabergoline is less effective than octreotide but it is available in an oral preparation. Octreotide suspension must be injected intramuscularly.

   A.   Octreotide -> Somatostatin analogue -> More than 90% of patients show a reduction in growth hormone levels, only approximately 50-60% achieve levels of less than 2 ng/ml
   B.  Nimodipine -> Calcium channel blocker -> No role in treating acromegaly
   C.  Pegvisomant -> Growth hormone receptor blocker -> growth hormone levels cannot be measured in routine assays because the drug itself interferes with growth hormone assays but pituitary-derived growth hormone increases by a third, serum IGF-I levels are normalized in over 90% of patients
   D.  Cabergoline -> Dopamine agonist -> approximately 60% of patients will show a reduction in growth hormone levels, only about 10-15% achieve a mean level of less than 2 ng/ml.

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Wednesday, November 7, 2012

Question 23, Neurology













Eccentric topic of the Week, Neurology
Question 23:

What is the approximate rate (in millimeters per day) of axonal growth in each of the following anatomic areas?

A. Above the elbow.
B. Between the elbow/wrist and the knee/ankle.
C. Distal to the wrist/ankle.


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Monday, November 5, 2012

Question 22, Neuropharmacology












Eccentric topic of the Week, Neuropharmacology
Question 22:

The first line ORAL medication used to treat acromegaly is:


A. Octreotide
B. Nimodipine
C. Pegvisomant
D. Cabergoline

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Friday, November 2, 2012

Answer for Question 21, Neurocritical Care











Eccentric topic of the Week, Neurocritical Care
Question 21:

The correct answer is C, lung hyperinflation.

Assisted-control ventilation (ACV) assists each spontaneous breath regardless of the respiratory rate, leading to hyperinflation, respiratory alkalosis and increased work of breathing in patients with tachypnea. 


Colen Publishing looking for Drupal Web Developer












Colen Publishing is looking for a energetic and self-motivated Drupal Web Developer! 

Anyone who are: 
1. Proficiency in Drupal web language 
2. Proficiency in overall web design and computer programming 
3. Positive Demeanor 
4. Self-Motivated 
5. Great group Work Ethic 
6. Punctuality Professionalism 
7. Lives in Metro-Detroit Area 

Please forward this to anyone who may be eligible. If you have any question, please send an e-mail to frank@doctorpal.net Have a great day everyone!

Monday, October 29, 2012

Question 21, Neurocritical Care










Eccentric topic of the Week, Neurocritical Care
Question 21:

Which of the following is expected to occur in patients on assisted-control ventilation (ACV) who are tachypneic?
:

A. Respiratory acidosis
B. Decreased work load of the respiratory muscles
C. Lung hyperinflation
D. None of the above

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Friday, October 26, 2012

Answer for Question 20, Neuroradiology











Eccentric topic of the Week, Neuroradiology
Question 20:

The correct answer is A, administrator of 100% oxygen.

A burr hole might be necessary, but there should be no delay in initiation of 100% oxygenation.

When the clinical and imaging findings are correctly identified, treatment consists of emergent decompression to alleviate pressure on the brain parenchyma. Treatment options for tension pneumocephalus including drilling of burr holes, craniotomy, needle aspiration, ventriculostomy placement, administration of 100% oxygen, and closure of dural defects. Careful monitoring for clinical signs of deterioration  as well as serial CT scanning of the brain, is recommended. In patients who are treated for tension pneumocephalus, resolution of the subdural air collection is expected. 

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Answer for Question 19, Neurobiology











Source: www.andrewkelsall.com

Eccentric topic of the Week, Neurobiology
Question 19:

The correct answer is D, 78%

Brain water content is usually between 70 - 80%. This is clinically important because the total brain water content changes in cerebral disease states. 

The measurement of brain water content might be important in determining which therapeutic strategies need to be considered.


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Wednesday, October 24, 2012

Question 20, Neuroradiology










Eccentric topic of the Week, Neuroradiology
Question 20:

A 57 year-old male underwent transnasal/transfacial ethmoidectomy for metastatic squamous cell carcinoma. Post-operatively he developed clear rhinorrhea. Lumbar puncture was performe



d daily for three days, draining 20cc each time. He became confused and lethargic on the third day, On examination he was non-verbal and localized to painful stimulus. Head CT is shown. What is the most appropriate initial step in management?:



A. Administer 100% oxygen
B. No treatment at this time
C. Craniotomy
D. None of the above

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Question 19, Neurobiology










Eccentric topic of the Week, Neurobiology
Question 19:

The average total brain H2O content is:

A. 50%
B. 55%
C. 60%
D. 78%
E. 90%

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Friday, October 19, 2012

Medical Field! Multivitamin Use May Be Linked To Reduced Cancer Risk‏


Multivitamin use may be linked to reduced cancer risk.

Research linking multivitamin use to reduced cancer risks received extensive coverage, particularly online. The news was also featured on two of last night's national news broadcasts. The CBS Evening News (10/17, story 7, 0:15, Pelley) reported that "a largestudy of multivitamins found that they may slightly lower a healthy man's risk of developing cancer."
        On NBC Nightly News (10/17, story 5, 1:50, Williams), NBC's Chief Science Correspondent Robert Bazell said that for the study, "researchers gave almost 15,000 male physicians 50 years or over either a multivitamin or a placebo."
        The New York Times (10/18, A23, Rabin, Subscription Publication) reports that after following the participants "for more than a decade," the researchers "found that those taking a daily multivitamin experienced 8 percent fewer cancers than the subjects taking dummy pills." The investigators reported that "multivitamin use had no effect on the incidence of prostate cancer, which was the most common cancer diagnosed in the study participants." When the investigators "looked at the effect of vitamin use on all other cancers, they found a 12 percent reduction in occurrence."
        The Washington Post (10/18, Huget) "The Checkup" blog reports, "The study didn't detect reductions in risk for any single form of cancer, just the total risk of a cancer diagnosis overall."
        The Los Angeles Times (10/18, Bardin) "Booster Shots" blog reports that "the researchers...pointed out that prostate cancer is often benign - and that the results suggest that multivitamins may prevent more serious types of cancer better than the study's overall 8% mark."
        Bloomberg News (10/18, Flinn) reports, "The study's authors couldn't pinpoint any single reason for the reduction in cancer among those who took the supplements, though they speculated it may be due to the combination of several low-dose vitamins and minerals, where previous studies looked at the effect of high levels of individual nutrients."
        The CNN (10/18) "The Chart" blog reports that the researchers "are also not sure that the results will be seen in other groups of people such as women or smokers. The men in this study were generally healthy physicians, not overweight or obese and most were non-smokers."
        NBC News (10/18, Aleccia) reports, "The new study suggests that boosting nutrition, even with the modest nudge of a daily vitamin, could have far-reaching health benefits, said Dr. Demetrius Albanes, a senior investigator and expert in nutritional epidemiology with the National Cancer Institute." According to Albanes, "It's exciting. It's encouraging."
        The Boston Globe (10/18, Kotz) "Daily Dose" blog reports, however, that according Dr. Albanes, "These are very encouraging results, but women weren't included in this study, nor were younger men, nor those from a range of ethnicities." Dr. Albanes added, "It's one trial, and we've seen many cases where one trial doesn't always give the final answer."
        CQ (10/18, McGlade, Subscription Publication) reports, "A number of studies in the past have come up with negligible evidence that multivitamins could prevent chronic illness, leading an NIH-sponsored conference to conclude that it could not recommend for or against the use of multivitamins to prevent such illness." Although "Albanes said he didn't think the NIH would automatically reverse its position...he said the National Cancer Institute is looking closely at the trial and might do future clinical trials to include a more diverse population sample."
        The Wall Street Journal (10/18, Winslow, Subscription Publication) reports that the study received funding from the National Institutes of Health. The research was published online in the Journal of the American Medical Association and presented at an American Association for Cancer Research meeting.
        Forbes (10/18, Herper) quotes George Sledge, a past-president of the American Society for Clinical Oncology, as saying, "This is a case of a statistically significant but not particularly impactful result." Sledge adds, "The reduction in cancer incidence is small but real, but at the end of the day no one lived any longer."
        The AP (10/18, Marchione, Writer) reports that Dr. Ernest Hawk, formerly of the National Cancer Institute, said that "it's a very mild effect and personally I'm not sure it's significant enough to recommend to anyone," but "at least this doesn't suggest a harm."
        HealthDay (10/18, Gardner) reports, "The authors also collected information on multivitamin use and heart disease, eye disease and cognitive function, which will be presented at later dates." Also covering the story are The Boston Herald (10/18, Mcconville), theHuffington Post (10/18), ABC News (10/18), MedPage Today (10/18, Bankhead), Reuters (10/18, Beasley), Medscape (10/18), andWebMD (10/18, Doheny).


Wednesday, October 17, 2012

Question 18, Neurocritical Care











Eccentric topic of the Week, Neurocritical Care
Question 18:

A 25 year-old male is brought to the emergency room after suffering blunt trauma to his back and right leg. Vital signs: Tmax: 37 ºC, BP:130/80, HR: 92, R:19. Current GCS is 15. The patient has lower extremity paraplegia, decreased rectal sphincter tone, and a T12 sensory level. Hemoglobin repeated twice over one hour shows 14.4 and 14.3 gm/dL respectively. Standard of care for diagnosing an intraperitoneal bleed would be:

A. Emergent laparotomy
B. Abdominal Ultrasonography
C. Diagnostic peritoneal lavage
D. Upright abdominal X-ray

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Monday, October 15, 2012

Question 17, Neurocritical Care












Eccentric topic of the Week, Neurocritical Care
Question 17:

In comparison to assist-control ventilation (ACV), what is the advantage of using pressure controlled ventilation (PCV)?

A. Has a better effect in patients with decreased lung c
ompliance
B. Decrease the risk of lung over-inflation
C. Can be used to assist spontaneous breathing
D. None of the above

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Question 16, Neuropharmacology












Eccentric topic of the Week, Neuropharmacology
Question 16:

What is the medicine of choice for treating prolactinomas during pregnancy?

A. Caberoline
B. Tricyclic antidepressants
C. Reserpine
D. Metaclopramide
E. Bromocriptine

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Question 15 Answer, Neurobiology












Answer

Eccentric topic of the Week, Neurobiology
Question 15:
The correct answer is A, Epithelial.

In the choroid plexus, the blood-brain barrier is primarily epithelial. This is in contrast to the endothelial blood-brain barrier that exists elsewhere.

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Question 14 Answer, Neuroradiology













Eccentric topic of the Week, Neuroradiology
Question 14:

The correct answer is B, primary CNS lymphoma lesions will enhance on MRI.

Before the introduction and widespread use of combination antiretroviral therapy, the incidence of Primary CNS lymphoma (PCNSL), which is strongly associated with Epstein-Barr virus (some strudies also suggest human herpesvirus 8 [HHV-8]), was increasing in patients with AIDS. One study found that the median CD4+ cell count at which AIDS related-PCNSL was diagnosed was 30/mL, but the CD4+ cell range in these patients was 0 to 279/mL. This finding is important because the CD4+ count at the high end of this range far exceeds the threshold CD4+ level at which clinicians routinely suspect AIDS related-PCNSL.

Stateme t A is false because single legions are typically seen at first, and statement C is incorrect because although Magnetic Resonance Spectroscopy is a valuable tool, brain biopsy remains the gold standard.

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Question 15, Neurobiology













Eccentric topic of the Week, Neurobiology
Question 15:

The difference between the blodd-brain barrier in the choroid plexus and other areas in the brain is that in the choroid plexus it is primarily:

A. Epithelial
B. Endothelial
C. Fenestrated
D. Absent

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Question 14, Neuroradiology













Eccentric topic of the Week, Neuroradiology
Question 14:

Regarding primary CNS lymphoma in HIV, which of the following is a CORRECT statement:

A. It is more likely to see multiple MRI lesions initially.
B. Primary CNS lymphoma lesions will enhance on MRI.
C. Magnetic Resonance Spectroscopy (MRS) is the diagnostic gold standard.
D. All of the above are correct.

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Friday, October 5, 2012

Question 13 Answer, Neurosurgery Board Exam Favorite!










Board Exam Favorite!

Eccentric topic of the Week, Neurosurgery
Question 13 Answer:

The correct answer is A, true.

Coupling is important in the lumbar spine (also cervical and thoracic regions). Coupling is the 3-dimensional movement (vertebral rotations and translations in three dimensions) by the spine to maintain alignment.

Abnormal coupling patterns in the lumbar spine can be an indicator of low-back problems. 

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Question 12 Answer, Neurosurgery

 
 
Eccentric topic of the Week, Neurosurgery
Question 12 Answer:

The correct answer is B, 2mm.

Up to 2 mm of translation is considered normal in the lumbar spine. 

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Question 11 Answer, Neuropathology










Eccentric topic of the Week, Neuropathology
Question 11 Answer:

The correct answer is C, fever.

The most common type of seizure in children is the febrile seizure, which occurs when an infection associated with a high fever develops.

Other common causes of seizures in the pediatric population are cortical malformations and low grade supratentorial tumors. Cerebral tumors present with seizures, generalized and focal, in 25% to 50% of all patients.

Slow growing tumors are more prone to present with seizures than rapidly growing tumors and is the most common presentation of low grade glioma.

Cortical malformations cause aberrant signaling and are common foci for seizures.

Temporal lobe epilepsy is common cause for epilepsy in adults, and presents usually as a complex partial seizure.

Malignant tumors in children (medulloblastoma being the most common) are located in the infratentorial compartment and do not cause seizures from this site. 

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