The answer is B. Transient ischemic attack

The patient had a transient ischemic attack (TIA), which is characterized by transient neurological symptoms without objective evidence of acute infarction. Symptoms vary, but patients may have hemiparesis, hemiplegia, aphasia, or vision loss. Risk factors include alcohol, hypertension, smoking, diabetes, illicit drug use, and atrial fibrillation.

Urgent evaluation is needed in patients with symptoms of TIA (e.g., coagulation studies, TTE, EKG, CT or MRI head, imaging of the cervicocephalic vasculature via carotid US, CTA, or MRA). Treatment for high-risk patients includes dual antiplatelet therapy (ASA + clopidogrel) for 21 days and risk factor management (statin, exercise, etc). Remember the risk of an actual stroke is high after a TIA.

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Covered under ⇒ PANCE Blueprint Neurology ⇒ Vascular Disorder ⇒ Transient ischemic attack

Also covered as part of the Internal Medicine EOR, Family Medicine EOR, and Emergency Medicine EOR topic list

The answer is D. Warfarin

Antiphospholipid syndrome (APS) is an autoimmune disease defined by venous thromboembolism, arterial thrombosis, and obstetric morbidity in the presence of circulating antiphospholipid antibodies (aPLs). It is the most common form of acquired thrombophilia.

aPLs include lupus anticoagulant, anticardiolipin, anti-b2-glycoprotein I antibodies. Clinical features include DVTs (32%), thrombocytopenia (22%), livedo reticularis (20%), stroke (13%), PEs (9%), and fetal loss (8%). The mainstay of treatment is warfarin. Other anticoagulants have been found to be less effective than warfarin so far.

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Covered under ⇒ PANCE Blueprint Hematology ⇒ Coagulation Disorders ⇒ Hypercoagulable states

Also covered as part of the Internal Medicine EOR and Emergency Medicine EOR topic list

The answer is A. Virus

Acute bronchitis is characterized by a cough due to inflammation of the large airways and trachea with no evidence of pneumonia. Acute bronchitis often follows an upper respiratory infection. The most common cause of acute bronchitis is viral. Symptoms include cough (10-20 days), headache, shortness of breath, and wheezing. The presence of fever should make you consider pneumonia or influenza.

Diagnosis is clinical. A chest radiograph should be given if it is hard to clinically distinguish between pneumonia and bronchitis. Treatment is mainly supportive care (rest, hydration) and symptomatic management (antitussives for cough, bronchodilators for wheezing, etc). Antibiotics should NOT be given for acute bronchitis.

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