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3, 4, 5 Star topics Flashcards

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1
Q

Anterior cerebral artery stroke (3.5)

A

Leg/foot/trunk motor and sensory

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2
Q

Middle cerebral artery stroke (3.5)

A

Hand/arm motor and sensory

Broca and Wernicke areas (speech)

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3
Q

Posterior cerebral artery stroke (3.5)

A

Vision

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4
Q

CSF findings bacterial meningitis (4)

A

++ WBC (NEUTROPHILS)
++ CSF pressure
- Glucose
+ Protein

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5
Q

CSF findings fungal/TB meningitis (4)

A

+ WBC (LYMPHOCYTES)
++ CSF pressure
- Glucose
+ Protein

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6
Q

CSF findings viral meningitis (4)

A

May be normal
+ WBC (lymphocytes)
+ CSF pressure
Usu glucose/protein normal

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7
Q

MC HA in adults (5)

A

Tension HA

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8
Q

Sudden, very severe HA w/ FND - next step? (5)

A

CT w/o contrast / MRI to r/o hemorrhage

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9
Q

Migraine HA presentation, causes (5)

A

Young adult women.
Unilateral throbbing, N/V, photo/phonophobia, visual auras (scintillating scotomas)
Stress, OCP, menstruation, exertion, foods w/ tyramine/nitrates (aged/rotting, chocolate, meat, alcohol, caffeine, etc).

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10
Q

Cluster HA presentation (5)

A

Young men.
Clustered in time (same time every day for weeks, then disappear for months)
Severe unilateral, around one eye, with conjunctival injection, eye redness, lacrimation, nasal congestion, nasal discharge, Horner’s
Exacerbated by alcohol

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11
Q

Tension HA presentation (5)

A

MC HA in adults
B/L band-like tightness in occiput and/or neck
Exacerbated by stress, fatigue

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12
Q

Tension HA treatment (5)

A

NSAIDs (first line), can try triptans, dihydroergotamine

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13
Q

Cluster HA treatment (5)

A

100% O2 (6+ L/min on non-rebreather for 20+ minutes), can try triptans, dihydroergotamine

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14
Q

Migraine HA treatment (5)

A

Sumatriptan (triptans), dihydroergotamine (DHE 45); NSAIDs; antiemetics (chlorpromazine, prochlorperazine, metoclopramide); some combination of drugs (don’t mix vasoconstrictors)

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15
Q

Migraine prophylaxis (5)

A

CCB (verapamil often first-line), BB (comorbid HTN), TCA anti-depressants (comorbid depression, insomnia, pain syndromes), NSAIDs (comorbid pain, menstrual), anticonvulsants (comorbid bipolar - valproate)

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16
Q

SAH cause, presentation and Dx (4)

A 
Aneurysm rupture (usu berry aneurysm, associated w/ ADPKD, Ehlers-Danlos)
Worse headache of my life, sentinal headaches
CT scan shows blood in CSF, if negative LP to r/o (blood or xanthochromia; r/o traumatic tap by counting RBC in first and last tube); then do MRA/CTA to localize
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17
Q

Any hemorrhage - diagnosis study of choice

A

CT w/o contrast

LP C/I if any suspected mass effect

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18
Q

Epidural hematoma cause, presentation, Dx, Rx (4)

A

Middle meningeal artery rupture
Lucid interval, pupil abnormalities, HA, FND, nausea, seizure
Biconvex (lens shaped), can cross midline
Surgical drainage/burr hole

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19
Q

Subdural hematoma cause, presentation, Dx, Rx

A

Bridging veins rupture after trauma (elderly w/ falls)
Slowly progressive HA, AMS, contralateral hemiparesis, increased DTR
Crescent shaped, doesn’t cross midline
Surgical drainage, supportive monitoring

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20
Q

Aphasia types (3)

A

Broca - good comprehension, poor speech
Wernicke - good speech, poor comprehension
Conduction - good speech/comprehension, poor repetition
Global - poor speech, comprehension and repetition

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21
Q

Normal pressure hydrocephalus presentation, Dx, Rx (4)

A

Wacky (cognitive impairment/dementia), Wet (urinary incontinence), Wobbly (gain abnormality w/ poor foot height and stride length)
CT/MRI shows dilation/enlarged ventricles w/ normal ICP
Ventricoperitoneal shunt

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22
Q

Cs of Huntington disease (3)

A 
CAG repeat disorder on chromosome cuatro
Caudate and putamen atrophy on MRI
Cognitive decline
Chorea
Cuarenta (40) age of onset
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23
Q

ALS pathophysiology (4)

A

Progressive loss of UMN (corticospinal tract) and LMN (anterior horn cells)

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24
Q

ALS S/Sx (4)

A

Weakness but normal sensation
80% initial symptom: asymmetric limb weakness
20% dysarthria and dysphagia (bulbar dysfxn)
UMN, Bulbar UMN, LMN signs and symptoms, cognitive defects
Respiratory failure 3-5 years on average after dx

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25
ALS labs, radiology, tests, treatment (4)
Labs/radiology to r/o other pathology (B12, HIV, syphilis, CT/MRI) Electromyogram demonstrates widespread muscular denervation and motor block Riluzole = only FDA approved treatment
26
MS path, presentation (3)
AI progressive demyelinating disease of brain and spinal cord Variable initial presentation w/ multiple neurologic complaints, may have remissions, worse w/ stress
27
MS labs, radiology, treatment (3)
CSF w/ increased protein, mildly increased WBC, oligoclonal bands (IgG) MRI brain, spine shows multiple asymmetric white matter lesions Corticosteroids for acute attacks, IFN-B for maintenance; also methotrexate, glatiramer
28
Syringomyelia path, presentation, treatment (3)
Post-traumatic cystic degeneration of spinal cord from unknown mechanism Channel compresses anterior white commissure (loss of pain and temperature 1-3 levels below lesion), anterior horns if big enough (LMN signs) Surgical decompression, may need shunting if recurrent
29
Coma work-up (3.5)
History Pupils Ocular motility Motor function
30
Febrile seizures - presentation (4)
6 months - 6 years w/ no CNS infx, lesion, abnl, hx of afebrile seizures. Fever >102 (39) w/ rapid rise in temperature Tonic-clonic seizures <15 min (atypical seizures can occur at lower temps and last longer)
31
Febrile seizures - labs/imaging (4)
LP if meningitis suspected or age <12 months | EEG, CMP usu normal
32
Febrile seizures - treatment (4)
``` Respiratory stability Acetaminophen/ibuprofen as antipyretic Atypical seizures need more in-depth workup Reassure parents No anti-epileptics unless cause ```
33
Febrile seizures - complications (4)
35% recurrence Very little increase in lifetime risk of epilepsy Atypical - more likely to recur, occur over longer periods of time, increased risk of epilepsy
34
Neural tube disorders - types (3.5)
Spina bifida occulta (defect in closure of dorsal vertebral arches, usu at lumbosacral junction) Meningocele (herniation of meninges) Myelomeningtocele (herniation of spinal cord and meninges) Anencephaly (failure to close of cranial NT; absence of forebrain, meninges, portions of skull; death w/i days)
35
Neural tube disorders - risk factor, prevention (3.5)
Poor folate intake Child-bearing age women = 0.4 mg (400 ug) folate/day Women w/ prior child w/ NTD or taking anticonvulsants = 4 mg folate/day
36
Neural tube disorders - prenatal labs/imaging (3.5)
Increased AFP on quad screen Increased ACHase during gestation May see on US
37
Neural tube disorders - complications (3.5)
Increased risk of UTI and CNS infx Severe: bowel and bladder incontinence, flaccid paralysis, poor sensation, LMN signs, hydrocephalus Anencephaly: death within a few days
38
Cerebral palsy - risk factors (3)
Usu from perinatal complications, or during development Prematurity**, IUGR, birth trauma, neonatal seizures or cerebral hemorrhage, perinatal asphyxia, multiple births, intrauterine infx (esp chorioamnionitis)
39
Cerebral palsy - types, S/Sx (3)
Spastic (damage of pyramidal tracts) - spastic paresis, frequent MR, gait abnl Dyskinetic (extrapyramidal pathology) - choreoathetoid, dystonic, ataxic movements, dysarthria Both - hyperactivity, seizures, limb disorders
40
Cerebral palsy - treatment (3)
Pharmacology: reduce spasms (botulinum toxin, dantrolene, baclofen, benzos) PT, bracing, surgery Speech therapy, special education, social and psychological support
41
Metformin (4)
Mech: decreases hepatic gluconeogenesis, increases insulin activity peripherally Use: usu first line in DM II AE: GI (esp diarrhea), rare lactic acidosis, decreased B12, C/I in hepatic and renal insufficiency (stop if transient increase in Cr; metabolized in kidneys) Other: decreases LDL, TG, raises HDL; no weight gain, no hypoglycemia
42
Sulfonureas (4)
Glyburide, Glimepiride, Glipizide Mech: stimulate insulin release from B-cells Use: frequently second line after metformin AE: hypoglycemia, weight gain, C/I in hepatic or esp renal insufficiency (greater risk of hypoglycemia) Other: inexpensive, requires fxn pancreas
43
Thiazolidinediones (TZDs) (4)
Pioglitazone, Rosiglitazone Mech: Increases tissue uptake of glucose, somewhat decreases hepatic gluconeogenesis AE: weight gain and fluid retention (C/I in CHF, stop if peripheral edema develops) Other: no hypoglycemia
44
Glyburide (4)
Sulfonurea Mech: stimulate insulin release from B-cells Use: frequently second line after metformin AE: hypoglycemia, weight gain, C/I in hepatic or esp renal insufficiency (greater risk of hypoglycemia) Other: inexpensive, requires fxn pancreas
45
Glimepiride (4)
Sulfonurea Mech: stimulate insulin release from B-cells Use: frequently second line after metformin AE: hypoglycemia, weight gain, C/I in hepatic or esp renal insufficiency (greater risk of hypoglycemia) Other: inexpensive, requires fxn pancreas
46
Glipizide (4)
Sulfonurea Mech: stimulate insulin release from B-cells Use: frequently second line after metformin AE: hypoglycemia, weight gain, C/I in hepatic or esp renal insufficiency (greater risk of hypoglycemia) Other: inexpensive, requires fxn pancreas
47
Pioglitazone (4)
Thiazolidinedione (TZD) Mech: Increases tissue uptake of glucose, somewhat decreases hepatic gluconeogenesis AE: weight gain and fluid retention (C/I in CHF, stop if peripheral edema develops) Other: no hypoglycemia
48
Rosiglitazone (4)
Thiazolidinedione (TZD) Mech: Increases tissue uptake of glucose, somewhat decreases hepatic gluconeogenesis AE: weight gain and fluid retention (C/I in CHF, stop if peripheral edema develops) Other: no hypoglycemia; recent study showed no association w/ ischemic MI
49
CAD risk factors (5)
Tobacco use HTN (BP >140/90 or treatment) HDL 45, F >55) HDL >60 cancels 1 risk factor
50
CAD equivalents (5)
DM AAA PVD Symptomatic carotid artery disease
51
When to treat cholesterol w/ medication (5)
LDL >160 (0-1 risk factors) LDL >130 (2+ risk factors) LDL >100 (CAD or equivalent)
52
Systolic ejection murmurs (crescendo-decrescendo) (5)
``` Aortic stenosis (2nd right interspace to neck, may radiate more widely, much MC) Pulmonic stenosis (2-3rd left interspace) ```
53
Holosystolic murmurs (5)
``` Mitral regurgitation (apex -> axilla) Tricuspid regurgitation (LLSB -> RLSB) VSD ```
54
Late systolic murmurs (5)
Mitral valve prolapse (apex -> axilla)
55
Early diastolic murmurs (5)
``` Aortic regurgitation (L side of sternum) Pulmonic regurgitation (upper L side of sternum) ```
56
Mid/late diastolic murmurs (5)
Mitral stenosis (apex)
57
Benign murmurs, need no workup (5)
``` Asymptomatic Split S1 Split S2 on inspiration S3 < 40 yo Early, quiet systolic murmur ```
58
Murmurs heard best in left lateral decubitus (5)
Mitral | L sided S3, S4
59
Murmurs louder with inspiration (5)
Tricuspid regurgitation Tricuspid stenosis Maybe VSD?`
60
Murmurs louder with Valsalva (5)
Hypertrophic cardiomyopathy????
61
Murmurs softer with Valsalva (5)
Aortic stenosis
62
Aortic stenosis - causes (5)
Congenital defect RHD Calcification in elderly patients (usu >60) Tertiary syphilis (tree-barking aortitis) (rare) MCC: congenital bicuspid valve (usu around age 40)
63
Aortic stenosis - symptoms (5)
Chest pain Dyspnea on exertion Syncope
64
Aortic stenosis - exam (5)
Weak, prolonged pulse (parvus et tardus) Crescendo-decrescendo systolic murmur radiating from R upper sternal border to carotids Valsalva decreases
65
Aortic stenosis - treatment (5)
Valve replacement if symptomatic
66
Mitral regurgitation - causes (5)
``` RHD (MC murmur in RHD) MVP Papillary muscle dysfunction (post MI) Endocarditis LV dilation ```
67
Mitral regurgitation - exam (5)
Harsh holosystolic murmur radiating from apex to axilla, louder in LLD
68
Aortic regurgitation - causes (5)
Endocarditis (classic) RHD Tertiary syphilis
69
Aortic regurgitation - exam (5)
Bounding pulses Widened pulse pressure Diastolic decrescendo murmur at R 2nd intercostal space or down L sternum Capillary pulsations in nail bed, more visible with applied pressure (Quincke sign) Rhythmic head bobbing (deMusset sign)
70
Mitral stenosis - causes (5)
RHD
71
Mitral stenosis - exam (5)
Opening snap after S2 Diastolic rumble at apex LA enlargement
72
Acute pericarditis - causes (4)
Viral infection TB, SLE Uremia, neoplasm, drug toxicity (isoniazid, hydralazine) Post-MI, radiation, recent heart surgery
73
Acute pericarditis - exam (4)
``` Pleuritic chest pain, dyspnea, cough Pain worse supine, lessens w/ leaning forward Friction rub Pulsus paradoxus Global ST elevation/PR depression on EKG ```
74
Acute pericarditis - treatment (4)
Treat underlying cause NSAIDs for pain, inflammation Pericardiocentesis for large effusions
75
Acute pericarditis - complication (4)
Chronic constrictive pericarditis
76
Cardiac tamponade - causes (4)
Chest trauma | Progressive acute pericarditis, LV rupture following MI, dissecting aortic aneurysm
77
Cardiac tamponade - exam (4)
Dyspnea, tachycardia, tachypnea, JVD, pulsus paradoxus Beck triad (hypotension, distant heart sounds, JVD) Enlarged heart shadow on CXR Large effusion seen on echo (dx) Global low voltage on EKG (or electrical alternans)
78
Cardiac tamponade - treatment (4)
Immediate pericardiocentesis (high mortality)
79
Cardiogenic shock treatment (5)
``` Dobutamine (first line), dopamine No IVF (risk of pulm edema) (intra-aortic balloon pump, PCTA for MI) ```
80
Septic shock treatment (5)
Treat underlying infection IVF Norepinephrine if needed
81
Hypovolemic shock treatment (5)
IVF (Transfusions, surgery if needed to stop bleeding) (Dressings, skin grafts maybe for burns)
82
Anaphylactic shock treatment (5)
Maintain airway Epinephrine (IV diphenhydramine) (IVF)
83
Neurogenic shock treatment (5)
IVF Pressors Atropine for bradycardia
84
Cause of cardiogenic shock (5)
Heart muscle failure
85
Cause of extracardiogenic shock (5)
Compression of heart
86
Cause of hypovolemic shock (5)
Not enough fluid to pump
87
Cause of anaphylactic shock (5)
Vasodilation (histamine release)
88
Cause of neurogenic shock (5)
Vasodilation, bradycardia (autonomic dysfxn)
89
Cause of septic shock (5)
Vasodilation (inflammatory proteins)
90
Shock caused by pump failure (5)
Cardiogenic
91
Shock caused by pump compression (5)
Extracardiogenic (tension pneumo, massive hemothorax, cardiac tamponade)
92
Shock caused by lack of fluid to pump (5)
Hypovolemic
93
Shock caused by vasodilation from histamine release (5)
Anaphylactic
94
Shock caused by vasodilation from autonomic dysfxn (5)
Neurogenic
95
Shock caused by vasodilation from inflammation (5)
Septic
96
Kawasaki disease - diagnostic criteria (3.5)
Fever >40/104 for at least 5 days + 4/5 (CRASH): Conjunctivitis (bilateral, non-exudative, painless) Rash (on trunk) Adenopathy (cervical LN) Strawberry tongue (and diffuse mucositis) Hands and feet (desquamation, erythema or edema)
97
Kawasaki disease - biggest complication (3.5)
Coronary vasculitis in 25% can lead to aneurysm, MI, sudden death
98
Kawasaki disease - treatment (3.5)
Frequently self-limited IVIG (w/i 10 days of onset if possible) High dose ASA until 48 hrs post fever Low dose ASA until inflammatory markers recover (ESR, platelets) (usu about 6 wks) Echo during acute phase and 6-8 wks later NO steroids
99
Tetralogy of Fallot - characteristics (4)
VSD Overriding aorta RV outflow obstruction w/ pulmonary stenosis RVH

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