Thursday, July 17, 2014

1. Risperidone is most likely to cause tardive dyskinesia, clozapine is the least likely (but may cause myocarditis, agranulocytosis, seizures...)
2. Blood cancers & smears
- Lymphoblastic leukemia: blasts in smears
- CLL: smudge cells, "overmatured" cells (hypercondensed nuclear chromatin). LAD + splenomegaly, then anemia and thrombocytopenia
- Early Hodgkins: normal periperipheral smears - reed-sternberg cells on LN biopsy
- CML - leukocytosis + left shift (myelomonocytes, neutrophils, basophilia) + marked splenomegaly
2. Types of aphasia: 
- Broca's: non fluent speech, impaired repetition, intact comprehension; may be associated with hemiparesis, eye deviation to affected side (i.e. MCA infarct)
- Wernicke's: fluent speech, impaired repetition, impaired comprehension; may be associated with contralateral superior quadrantanopia (meyer's loop)
- Conduction: fluent speech with some errors, impaired repetition, intact comprehension
3. Nondominant hemisphere strokes: 
- Temporal: can lead to sensory aprosodia (inability to comprehend emotional gestures), contralateral quadrantanospia (meyer's loop)
- Parietal: can lead to anosognosia - denial of one's disabilities, contralateral apraxia (can't carry out learned movements), contralateral inferior quadrantanopia (superior optic radiation).
- Frontal: can lead to motor aprosodia (inability to convey emotion through speech), contralateral weaknesss (motor strip), apraxia (pre-motor).
4. Dominant hemisphere strokes: 
- Temporal: wernicke's aphasia, may affect ability to speak nouns (anomic aphasia), may affect broca's if you take superior temporal gyrus, may affect arcuate fasciculus, meyer's loop.
- Parietal: may cause contralateral hemineglect, sensory losses (pain, vibration, agraphesthesia- can't recognize letter written on hand, asterognosis- can't ID object by touching it), contralateral inferior quandrantanopia.
- Frontal: Broca's, pre-motor, motor, frontal eye fields (eyes move towards side of lesion due to unopposed contralateral frontal eye field)
5. Cardiac drugs that interact with Digoxin: 
- Amio (D'oh! decreased dig by 25-50%)
- Verapamil
- Quinidine
- Propafenone (class Ic - also has beta-blockade activity)
6. Femoral head has 2 blood supply sources - ascending arteries and foveal artery (inside ligamentum teres) which is patent early in life but may become obliterated in older patients - this is why aseptic femoral head necrosis is rare in kids.
7. Complete spinal block is a complication of spinal/epidural anesthesia - when the anesthetic migrates all the way up to the cervical spine/medulla - hypotension, bradycardia, respiratory difficulty/apnea, may even lead to cardiopulmonary arrest, loss of consciousness.
8. Inheritance of bipolar disease
- General public: 1%
- First degree relative: 5-10%
- Both parents: 60%
- Monozygotic twin: 70%
9. TCA overdose.  
- Sodium bicarbonate can narrow the QRS, as well as facilitate clearance and correct acidosis.
- Manage seizures with benzos, and not dilantin, as it can increase frequency of ventricular arrhythmias
10. Trauma to the soft palate - may cause ICA dissection or compression of ICA that dislodges a thrombus and causes embolic stroke.

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