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Medicine > step 3 2 > Flashcards

step 3 2 Flashcards

1
Q

absolute contraindications to lytics

A
  • history of hemorrhagic stroke
  • presence of intracranial neoplasm/mass
  • active bleeding or surgery within 6 weeks
  • presence of bleeding disorder
  • CPR within 3 weeks that was traumatic
  • suspicion of aortic dissection
  • stroke within 1 year
  • cerebral trauma or brain surgery within 6 months
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2
Q

timing of stroke interventions

A

lytics within 3 hours, catheter retrieval within 8 hours

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3
Q

afib treatment options

A

Dabigatran (pradaxa)

Rivaroxaban (xarelto)

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4
Q

how to manage status epilepticus

A

Ativan → if persisting for 10 minutes, add fosphenytoin → if persistent for another 10 minutes, add phenobarbital → if persistent another 10 minutes, general anesthesia with pentobarbital, thiopental, midazolam, or propofol.

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5
Q

Indications for starting antiepileptic after first seizure

A

FH of seizures
Abnormal EEG
Status
Non-correctable precipitating cause

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6
Q

first line seizure meds

A

valproic acid, carbamazepine, phenytoin, levetiracetam (keppra)

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7
Q

other SE to be aware with anticholinergics

A

can worsen memory

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8
Q

how to differentiate tremor on clinical features

A

1) resting and not action –> PD
2) both resting and action –> ET
3) action only –> cerebellar disease

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9
Q

how to differentiate tremor on exam

A

1) Have them hold their arms out in the air

2) Have them point towards your finger

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10
Q

best test for MS

A

MRI, if nondiagnostic then get lumbar tap.

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11
Q

major thing to be concerned about with iodinated contrast in patients with renal insufficiency

A

nephrogenic systemic fibrosis – systemic overreaction to contrast leading to increased collagen deposition in soft tissues.

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12
Q

antispasmodics to treat spasticity in MS

A

baclofen

tizanidine

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13
Q

how to treat fatigue in MS

A

amantadine

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14
Q

disease-modifying drugs in MS

A 
Beta interferon
Glatiramer
Mitoxantrone
Natalizumab
Fingolimod
Dalfampridine
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15
Q

memory loss differential

A

FTD vs. CJD vs. DLB vs. NPH vs. thyroid dysfunction vs. B12 deficiency vs. syphilis

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16
Q

CJD workup

A

brain biopsy
MRI
L-tap with CSF showing 14-3-3

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17
Q

NPH workup on CCS

A

head CT

LP, showing normal pressure.

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18
Q

NPH treatment

A

shunt

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19
Q

HA red flags

A

sudden/severe + onset after 40 + focal deficits

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20
Q

cluster HA management

A

sumatriptan to abort

verapamil to prophylaxe

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21
Q

headache differential

A

dehydration vs. migraine vs. cluster vs. tension vs. temporal arteritis vs. pseudotumor cerebri

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22
Q

temporal arteritis workup

A

sed rate + temporal artery biopsy

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23
Q

temporal arteritis management

A

steroids FAST

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24
Q

pseudotumor cerebri management

A
  • weight loss
  • acetazolamide
  • surgery if above fail (VP shunt, optic nerve sheath fenestration)
25
Q

BPV treatment

A

meclizine

26
Q

labyrinthitis treatmetn

A

meclizine, steroids

27
Q

meniere’s disease

A

salt restriction

diuretics

28
Q

acoustic neuroma presentation

A

ataxia + hearing loss + tinnitus + vertigo

- you differentiate it from meniere’s based on presence of ATAXIA

29
Q

vertigo differential

A

BPV vs. vestibular neuritis vs. post-CVA vs. meniere’s disease vs. acoustic neuroma vs. Wernicke-Korsakoff syndrome
also, post-stroke vs. labyrinthitis vs. perilymph fistula.

30
Q

wernicke’s presentation

A 
heavy alcohol use
confusion with confabulation
ataxia
memory loss
gaze palsy/otphalmoplegia
nystagmus
31
Q

indications for CT before LP

A 
history of CNS disease
focal deficits
presence of papilledema
seizures
altered
delay in ability to perfrom an LP
32
Q

cryptococcal meningitis general features

A

more indolent and less severe meningeal signs + CD4 less than 100

33
Q

best initial test for cryptococcus

A

india ink

34
Q

most accurate test for cryptococcus

A

cryptococcal antigen

35
Q

TB meningitis general features

A

indolent (over weeks to months) + very high CSF protein

36
Q

most accurate test for TB meningitis

A

CSF PCR

37
Q

how do you treat TB meningitis

A

4 drug treatment (but use quinolone instead of ethambutol which has poor CNS penetration), same as regular TB, but add steroids + extend length of therapy

38
Q

fungal meningitis lab profile

A

LYMPHOCYTOSIS, similar to viral, not neutrophilia.

39
Q

treatment for amoebic meningitis

A

miltefosine

40
Q

brain abscess management

A

CT w/ CONTRAST
Determine HIV status:
If HIV-positive → treat for toxo w/ pyrimethamine + sulfadiazine x 2 weeks then repeat CT head
If HIV-negative → brain biopsy

41
Q

neurocysticercosis classic case

A
  • mexican with seizure+ multiple calcified lesions on CT
42
Q

neurocysticercosis treatment

A
  • if lesions still uncalcified treat with albendazole + steroids to prevent reaction to dying parasites
  • if calcified– only use antiepileptic
43
Q

PRES stands for

A

posterior reversible encephalopathy syndrome

44
Q

PRES presentation

A

HA/LOC/visual dysfunction/seizures in setting of HTN crisis/preeclampsia/cytotoxic meds (cyclosporine)

45
Q

PRES management

A

MRI, self-resolving

46
Q

large brain bleed mgmt

A

Intubate + hyperventilate, target pCO2 to 28032
Mannitol
Surgical evacuation

47
Q

SAH management

A

STAT non-con CT head → if positive, no LP, if inconclusive, get LP. → CT-angio to determine site → embolize site (better than clipping) → insert VP shunt if hydrocephalus develops → prescribe nimodipine for stroke prophylaxis.

48
Q

ASA infarction

A

loss in sensation in everything except position and vibratory sense (posterior column)

49
Q

brown-sequard presentation

A

ipsilateral position/vibratory sense, contralateral pain/temperature

50
Q

UMN signs

A

hyperreflexia
upgoing toes on plantar reflex
spasticity
weakness

51
Q

LMN signs

A

wasting
fasciculations
weakness

52
Q

other name for chronic regional pain syndrome

A

reflex sympathetic dystrophy

53
Q

reflex sympathetic dystrophy treatment

A

NSAIDs, gabapentin, nerve block, surgical sympathectomy if refractory

54
Q

Bell’s palsy presentation

A

hemifacial paralysis + loss of taste in anterior two thirds of tongue + hyperacusis

55
Q

myasthenia gravis management

A

Start neostigimine or pyridostigmine → if inadequate response, thymectomy AND consider prednisone

56
Q

normocytic anemia differential

A

ARF (anemia of chronic renal disease) vs. dilutional vs. hospital acquired anemia (new since hospitalization) vs. ACD

57
Q

HSP treatment

A

none, self-resolving

58
Q

A-Line indications

A

1) labile BP
2) hemodynamic therapy is being titrated (pressors)
3) when non-invasive is inaccurate (arrhythmia or morbid obesity)

59
Q

unstable angina definition

A

ischemic symptoms suggestive of an ACS and no elevation in troponins, with or without electrocardiogram changes indicative of ischemia (eg, ST segment depression or transient elevation or new T wave inversion)

Medicine (71 decks)

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