Associations 1 Flashcards Preview

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Flashcards in Associations 1 Deck (190):
1

Meningitis + petechiae/purpura

Neisseria meningitis

2

Temporal lobe encephalitis + skin lesions

Herpes simplex virus

3

Meningitis + AMS

Encephalitis

4

WNV animals

Birds are reservoir, mosquitoes are vector

5

Virus + ASA

Reye syndrome (brain + liver)

6

Ring enhancing lesion on MRI

Brain abscess

7

Poliomyelitis

Destroys motor neurons (flaccid paralysis)

8

Negri bodies (eosinophilic inclusions in neurons)

Rabies

9

HA made worse by foods w/ tyramine

Migraine

10

HA in obese woman w/ papilledema

Pseudotumor cerebri

11

Jaw muscle pain when chewing

Temporal (giant cell) arteritis

12

Periorbital pain w/ ptosis and miosis

Cluster HA

13

Horner's syndrome - 2 causes

Ptosis, miosis, anhydrosis
Pancoast tumor (apex of lung), Cluster HA (partial)

14

HA w/ photophobia and/or phonophobia

Migraine

15

HA w/ b/l frontal/occipital pressure

Tension

16

HA w/ lacrimation and/or rhinorrhea

Cluster

17

HA w/ elevated ESR

Temporal (giant cell) arteritis

18

"Worst HA of my life"

SAH

19

HA + extraocular muscle palsies

Cavernous sinus thrombosis

20

Scintillating scotomas prior to HA

Migraine w/ aura

21

HA associated with sex (before/after orgasm)

Post coital cephalgia

22

HA responsive to 100% O2

Cluster

23

Frontal HA made worse by bending over

Sinus

24

Trauma to head leading to HA that begins days later, persists for over a week and doesn't go away

Subdural hematoma

25

Trigeminal neuralgia first line Rx

Carbamazepine

26

UMN s/sx

Spasticity, increased DTR, positive Babinski sign
Slowed rapid alternating movements, gait disorder
Movement stiffness, slowness, incoordination

27

LMN s/sx

Flaccid paralysis, decreased DTR, fasciculations, muscle atrophy
Weakness, gait disorder

28

Bulbar UMN s/sx

Dysphagia, dysarthria
Pseudobulbar: inappropriate laughing, crying, yawning

29

Two symptoms = MS

Unilateral optic neuritis
Internuclear ophthalmoplegia

30

Eye pain worse with movement, central vision loss, afferent pupillary defect

Optic neuritis --> MS

31

Ipsilateral loss of adduction on lateral gaze + contralateral nystagmus + intact convergence

Internuclear ophthalmoplegia --> MS

32

Marcus Gunn pupil

Optic nerve injury or retinal detachment
Fail swinging flashlight test
Afferent pupillary defect

33

Dementia with Parkinsonian features

Lewy body dementia

34

Dementia with visual hallucinations

Lewy body dementia

35

Dementia with syncope / repeated falls

Lewy body dementia

36

Dementia with behavior or personality changes

Frontotemporal dementia (Pick disease)

37

Dementia with progressive aphasia

Frontotemporal dementia (Pick disease)

38

Dementia work-up

MMSE
Electrolytes, BUN/Cr, LFT, Ca, CBC, UA, RPR, HIV, TSH, B12
MRI of brain

39

Bilateral facial weakness

Guillain-Barre syndrome
Lyme disease (b/l Bell's palsy)

40

Upper and lower facial weakness

Bell's palsy

41

Causes of Bell's palsy

Lyme disease
Herpes Zoster, AIDS, sarcoid, tumors
Diabetes

42

Muscle weakness worse w/ use, what is next step?

Myasthenia gravis; CT chest for thymoma

43

Muscle weakness better w/ use, associated?

Lambert-Eaton; small cell lung cancer

44

Ptosis and Diplopia, young woman

Myasthenia gravis

45

Ascending bilateral weakness post recent viral illness

Guillain-Barre syndrome

46

Guillain-Barre associated viral illnesses

Campylobacter jejuni diarrhea (20%)
HIV, CMV, EBV, Mycoplasma, other viruses, immunizations (rare)

47

Chorea

Hyperthyroidism
Huntington
SLE
Rheumatic fever
Levodopa use

48

Athetosis

Cerebral palsy
Encephalopathy, Huntington, Wilson

49

Dystonia

Parkinson
Neuroleptic use
Wilson, Huntington, encephalitis

50

Hemiballismus

Stroke (subthalamic nucleus)

51

Tics

Tourette syndrome
OCD, ADHD

52

MC brain tumors in adults

MGM Studios
Metastases
Glioblastoma (prognosis = 6 months)
Meningtioma
Schwannoma

53

MC brain tumors in children

Animal Kingdom, Magic Kingdom, Epcot
Astrocytoma (benign)
Medulloblastoma (malignant)
Ependymoma (may be malignant)

54

Metastatic CNS neoplasms - from where

Lots of Bad Stuff Kills Glia
Lung
Breast
Skin (melanoma)
Kidney (RCC)
GI (CRC)

55

Neurofibromatosis Type I - S/Sx

AD on chromosome 17
COFFINS
Cafe-au-lait spots
Optic glioma
Freckling (axillary/inguinal)
Family hx
Iris hamartomas (Lisch nodules)
Neurofibromas
Skeletal lesions

56

Neurofibromatosis Type II

AD on chromosome 22
Bilateral acoustic neuromas (schwannomas) - hearing loss

57

Syncope causes

Reflex (vasovagal, situational)
Carotid-sinus hypersensitivity
Cardiogenic
Orthostatic
Cerebrovascular
Idiopathic (>20%)

58

Syncope work-up

Tilt test
R/o seizure by H&P
Cbc, electrolytes, BUN/Cr, glucose
Assess volume statis
Pulse ox and EKG
Evaluate medications
Carotid sinus massage (patients >40 w/o carotid disease or bruit)
Also consider: serial cardiac enzymes/EKG x3, echocardiogram, cardiac stress test, bilateral carotid duplex, 24 hr Holter monitor, CT head and EEG

59

Seizure vs syncope vs nonspecific

Prodrome of deja-vu, aura; postictal confusion, tongue lacerations vs Prodrome of sweating, lightheadedness; hx prolonged standing
Nonspecific: brief limb jerking, urinary incontinence

60

Diff Dx in ER for LOC

AEIOU TIPS
Alcohol
Epilepsy/environmental (hypothermia)
Insulin (+/-)
OD/opioids
Uremia
Trauma
Infection
Psychogenic
Stroke

61

Arnold Chiari malformation associated abnormalities

Hydrocephalus
Syringomyelia
Myelomeningocele

62

RB gene

Retinoblastoma
Osteosarcoma

63

Cherry red spots on retina

Tay Sachs
Niemann-Pick
Central retinal artery occlusion

64

Hydrocephalus in children

Arnold Chiari type II
Dandy Walker malformation

65

Tay Sach's disease

Ashkenazi Jews
Cherry red spot on retina

66

Blown/dilated pupil

CNIII lesion (parasympathetic fibers)

67

MLF syndrome (maintains conjugate gaze when one eye abducts)

Bilateral - MS
Unilateral - stroke

68

Bitemporal hemianopia

Optic chiasm lesion (pituitary adenoma)

69

Argyll Robertson pupil

Accommodates to near objects, nonreactive to light
Syphilis (prostitute's eye)
SLE, DM

70

Adie pupil

Minimally reactive dilated pupil
Abnormal innervation of iris (usu inflammation from former infection)

71

Uveitis - associated diseases

Seronegative spondyloarthropathies (-RF): psoriatic arthritis, ankylosing spondylitis, inflammatory bowel diseases (esp UC), reactive arthritis
Juvenile idiopathic arthritis
Behcet's disease, Sarcoidosis, Kawasaki disease

72

MCC blindness over age 55

Macular degeneration

73

MCC blindness under age 55

Diabetes mellitus

74

MCC blindness in blacks

Glaucoma

75

Bacterial conjunctivitis

Purulent, copious discharge 24 hrs/day
S. aureus, S. pneumo, N. gonorrhea, Chlamydia

76

Viral conjunctivitis

Watery discharge, eyelid may be sealed shut in AM
May also have fever, URI, lymphadenopathy, pharyngitis
Adenovirus

77

Conjunctivitis +/- diarrhea +/- URI

Adenovirus

78

Allergic conjunctivitis

Bilateral watery discharge, eyelids may be sealed shut in AM
May also have pruritis, other allergy symptoms

79

Red eye + may indicate collagen vascular disorder

Uveitis (or scleritis)

80

Red eye w/ potential serious complication of corneal ulceration

Herpes simplex keratitis

81

Red eye + colored halos

Acute angle-closure glaucoma

82

Red eye + itching

Allergic conjunctivitis

83

Red eye + preauricular LN enlargement

Viral conjunctivitis

84

Red eye + "dry eyes"

Keratoconjunctivitis sicca (feature of Sjogren's syndrome)

85

Red eye + shallow anterior chamber

Acute angle-closure glaucoma

86

Afferent defect

Optic nerve damage prior to pretectal nucleus
No constriction of either pupil w/ light in affected eye
Constriction of both pupils w/ light in non-affected eye

87

Efferent defect

Oculomotor nerve damage
Affected pupil will not contract w/ light in either eye
Non-affected pupil contracts w/ light in either eye

88

Diff dx for lens dislocation

Marfan syndrome (dislocates upward)
Homocystinuria (dislocates downward)
Alport syndrome

89

Vitamin A deficiency

Night blindness (or complete)
Xerophthalmia
Bitot spots (areas of abnl squamous cell proliferation and keratinization of conjunctiva)

90

Cotton wool spots

Retinal vein occlusion
Diabetes
HTN
HIV

91

Diabetic retinopathy

Cotton wool spots
Lipid exudates
Proliferative or non-proliferative (blood vessels)

92

Cupping of optic disc (>50%)

Open angle glaucoma

93

MCC conductive hearing loss in adults

Otosclerosis

94

MCC sensorineural hearing loss in adults

Presbycusis (high frequency bilateral)

95

Meniere's disease

Vertigo, tinnitus, low frequency hearing loss

96

Ramsay Hunt syndrome

Herpes zoster oticus
Ipsilateral facial paralysis, ear pain, vesicles in auditory canal/auricle
Also abnl taste perception, tinnitus, vertigo, abnl lacrimation

97

Otitis media organisms

S. pneumo
H. influenzae
Moraxella catarrhalis
S. pyogenes, viruses

98

Otitis externa organisms

S. aureus
Pseudomonas
S. epidermis

99

Subconsciously pushing memories out of conscious mind

Repression

100

Consciously pushing memories out of conscious mind

Suppression

101

Taking out frustrations on another target in socially inacceptable way

Displacement

102

Taking out frustrations on another target in socially acceptable way

Sublimation

103

Splitting and self-mutilation/suicide attempts

Borderline personality disorder

104

Wants to be alone vs wants to be with others but is afraid

Schizoid vs Avoidant personality disorder

105

CAGE questions

Cut down
Annoyance w/ others
Guilt
Eye-opener

106

Wernicke-Korsakoff

Encephalopathy, eye problems, ataxia
Anterograde and retrograde amnesia, confabulations, hallucinations

107

Aspiration pneumonia w/ alcoholics, organisms?

Anaerobes
Klebsiella

108

Drug use - red eyes

Marijuana

109

Drug use - horizontal and vertical nystagmus

PCP (some nystagmus w/ alcohol OD)

110

Drug use - mydriasis (dilated pupils)

Cocaine
Amphetamines
LSD

111

Drug use - miosis (pinpoint pupils)

Opioids (heroin, morphine, methadone)
Organophosphates

112

Albuminiocytologic dissociation (increased protein w/ normal WBC in CSF)

Guillain-Barre syndrome

113

MCC delirium in elderly

UTI
Meds (anticholinergics and benzos)

114

MCC delirium, drugs

Corticosteroids
Benzodiazepines
Anticholinergics
Antihistamines

115

DOC in delirium, dementia-related agitation

Haloperidol, low dose
NO benzos or anticholinergics (diphenhydramine) b/c they can worsen symptoms

116

Atrophy of mammillary bodies

Wernicke encephalopathy

117

Nausea and vomiting with NO diarrhea

NOT gastroenteritis
DKA in differential

118

Leading cause of death in diabetes

Cardiac disease (esp from atherosclerosis)

119

Causes of hypoglycemia

Medications (in diabetics)
Fasting + underlying liver/hormone disorder/malnutrition
Alcohol abuse
Pituitary/adrenal insufficiency
Insulinoma
Factitious (medications)
Reactive (gastric bypass)

120

Diagnostic criteria for DM

Random glucose >200 + symptoms
Fasting glucose >126 on 2 separate occasions
Glucose tolerance test >200 (2 hrs after 75 g oral glucose)
Hemoglobin A1C >6.5

121

Acanthosis nigricans

Insulin resistance
(or occult malignancies)

122

Metabolic syndrome criteria

Three of five:
Abdominal obesity
TG >150
HDL 130/85
Fasting glucose >100 (or >140 GTT)

123

Oral diabetic medication w/ rare lactic acidosis

Metformin

124

Oral diabetic medication w/ hypoglycemia

Sulfonureas, Meglitinides

125

Oral diabetic medication also helps lower TG/LDL

Metformin

126

Oral diabetic medication not safe in CHF

TZDs (-glitazones)

127

Oral diabetic medication shouldn't be used in with elevated serum creatinine

Metformin

128

Oral diabetic medication shouldn't be used in IBD

alpha-Glucosidase inhibitors (acarbose)
Also metformin, incretin analogs (not oral)

129

Oral diabetic medication should monitor LFTs

Metformin (safe in mild liver disease)

130

Oral diabetic medication w/ no weight gain

Metformin
Incretin mimetics, DPP-4 inhibitors, SGLT-2 inhibitors

131

Oral diabetic medication metabolized by liver (excellent choice in renal insufficiency)

TZDs, DPP-4 inhibitors (-gliptins)

132

DKA vs HHNS, workup

Glucose 300-800 vs >800 (often >1,000)
+AG met acidosis vs no acidosis
Type I or II DM vs Type II DM
ABG, check serum/urine ketones

133

Causes (workup) of DKA or HHNS

Usu excess glucagon, catecholamines, corticosteroids
Infection (PNA, gastroenteritis, UTI, pancreatitis)
Medication reduction/omission
Severe medical illness (MI, CVA, trauma)
Undiagnosed DM (esp kids)
Dehydration
Alcohol or drug abuse
Corticosteroids
Blood/urine cx, UA, CXR, Tox screen, amylase/lipase, EKG, serial cardiac enzymes

134

Charcot joint (chronic progressive arthropathy - severe foot deformity and joint destruction)

Diabetic neuropathy
(Syphilis - tabes dorsalis - much less common)

135

MCC hyperthyroidism

Graves disease

136

Graves disease pathology

Autoimmune TSI antibodies that bind TSH receptors and stimulate thyroid hormone production

137

Increases TBG levels

(Increased total T4, normal free T4)
Pregnancy
OCPs

138

Decreases TBG levels

(Increased free T3/T4)
Hepatic failure, cirrhosis

139

Causes of hyperthyroidism

Graves disease
Toxic adenoma
Toxic multinodular goiter
Subacute thyroiditis (de Quervain thyroiditis)
Silent thyroiditis
Factitious thyroiditis
Amiodarone
Iodine ingestion (eg radiocontrast dye)

140

Painful goiter

Subacute (deQuervain's) thyroiditis

141

Painless goiter

Hashimoto's
graves disease
Silent thyroiditis

142

MCC hypothyroidism

Hashimoto's

143

Pathology of Hashimoto's thyroiditis

Anti-TPO (thyroid peroxidase) and antithyroglobulin antibodies (cell and Ab mediated attacks)

144

Hypothyroidism labs

High TSH
Low T3 and T4
High LDL and total cholesterol

145

Thyroid cancer forms

Papillary (MC, 78%) [Follicular MC variant, 17%]
Medullary
Anaplastic (worst prognosis)

146

Papillary thyroid cancer

MC (78%), Follicular variant MC (17%)
Good prognosis
Usu younger patients

147

Medullary thyroid cancer

Parafollicular C cells
Produces calcitonin
Associated w/ MEN IIa and IIb

148

Anaplastic thyroid cancer

MC in older patients
Rock hard thyroid
Very aggressive, poor prognosis

149

Common complications of thyroid surgery

Hoarseness (recurrent laryngeal n. damage)
Hypocalcemia (secondary hypoparathyroidism from surgical damage)

150

Hypercalcemia

Stones, Bones, (Abdominal) Groans, Psychic overtones
Kidney stones
Osteitis fibrosis cystica, osteoporosis, osteomalacia, OA
Constipation, N/V, peptic ulcers, pancreatitis
Lethargy, fatigue, depression, memory loss, psychosis, personality changes confusion, stupor, coma
Other: proximal muscle weakness, keratitis, conjunctivitis, HTN, itching

151

Medical conditions causing depression

Hypothyroidism
Hyperparathyroidism (hypercalcemia)
Parkinson's
Stroke (esp ACA)
CNS neoplasms
Pancreatic cancer
Celiac disease

152

Acute pancreatitis causes

Gallstones & alcohol
Hypercalcemia
Increased TGs

153

Hypocalcemia

Tingling in lips and fingers, dry skin, weakness, abdominal pain, tetany, dyspnea, possible tachycardia, seizures, movement disorders, cataracts, dental hypoplasia
Chvostek sign (facial nerve spasm), Trousseau sign (carpal spasm w/ BP cuff)

154

Albright hereditary osteodystrophy

Shortening of 4th and 5th digits
Pseudohypoparathyroidism (no tissue response to PTH)

155

MCC hypoparathyroidism

Surgical removal of PTH
AI gland degenration (uncommon)

156

MCC primary hyperparathyroidism

Single adenoma
Hyperplasia of all 4 glands (less common)
PTH cancer (rare)

157

Wacky, wet and wobbly

NPH

158

Causes of hyperprolactinemia

Pregnancy
Prolactinoma (MC adenoma)
DA synthesis blocking drugs
Thyroid

159

Progression of hormone deficiency in hypopituitarism

1) GH
2) LH, FSH
3) TSH
4) Prolactin
5) ACTH, MSH

160

GH deficiency

Short stature/growth failure in children

161

LH/FSH deficiency

Infertility, decreased libido, decreased pubic hair, amenorrhea (women), genital atrophy)

162

TSH deficiency

Hypothyroidism w/ no goiter

163

Prolactin deficiency

No pp lactation

164

ACTH deficiency

Adrenal insufficiency - fatigue, weight loss, decreased appetite, poor response to stress

165

MSH deficiency

Decreased skin pigment

166

MC pituitary tumor

Prolactinoma

167

Mineralocorticoid

Aldosterone

168

Glucocorticoid

Cortisol

169

MCC Cushing syndrome (top 3)

Excess corticosteroid administration
Ectopic ACTH (usu SCLC)
Pituitary adenoma ACTH production

170

Cushing syndrome symptoms

Acne, hirsuitism, buffalo hump, moon facies;
Weakness, depression, menstrual irregularities, polydipsia, polyuria, increased libido, impotence;
Central obesity, purple striae on abdomen, cataracts

171

Cushing syndrome labs

Hyperglycemia, glycosuria, hypokalemia

172

HTN + Hypokalemia + Metabolic alkalosis

Hyperaldosteronism

173

Cushing syndrome vs Conn syndrome

Excess cortisol

174

Conn syndrome

Excess aldosterone secretion by unilateral adrenal adenoma (primary hyperaldosteronism)

175

Addison disease

Adrenal cortical destruction caused by AI, infx, hemorrhage (primary adrenal insufficiency)

176

Addison disease labs

Decreased Na, increased K
Eosinophilia
Decreased cortisol
ACTH increased (Addison) or decreased (2 or 3 insufficiency)

177

Cosyntropin stimulation test

ACTH analog - decreased cortisol in 2 or 3 adrenal insufficiency, no response in Addison disease

178

Addison / adrenal crisis

Severe weakness, fever, AMS, vascular collapse or shock

179

17 alpha hydroxylase deficiency

(no aldosterone, +cortisol, +androgens)
Amenorrhea/ambiguous genitalia, HTN
Increased Na, decreased K, decreased androgens

180

21 alpha hydroxylase deficiency

(no aldosterone or cortisol, + androgens)
Ambiguous genitalia (female), virilization (female), precocious puberty (male), hypotension
Decreased Na, increased K, increased androgens

181

11 beta hydroxylase deficiency

(no aldosterone or cortisol, +precursors, + androgen)
Ambiguous genitalia (female), virilization (female), precocious puberty (male), HTN
Increased deoxycorticosterone, increased deoxycortisol, increased androgens

182

Congenital adrenal hyperplasia symptoms

First 1 = HTN
Second 1 = virilization/ambiguous genitalia (female), precocious puberty (male) = +androgens

183

MC form CAH

21 alpha hydroxylase deficiency

184

Pheochromocytoma symptoms

Intermittent HTN, diaphoresis, HA; tachycardia, palpitations, CP, anxiety

185

RET proto-oncogene mutation

MEN IIa and IIb

186

MEN type I

3 Ps
Parathyroid adenoma
Pancreas tumors (endocrine)
Pituitary

187

Hypercalcemia + peptic ulcer disease

Common presentation of MEN I

188

MEN type IIa

2 Ps, 1 M
Parathyroid hyperplasia
Pheochromocytoma
Medullary thyroid cancer

189

MEN type IIb

1 P, 2 Ms
Pheochromocytoma
Medullary thyroid cancer
Mucosal neuromas

190

Eosinophilia causes

DNA AACP
Drugs
Neoplasms
Allergic (allergies, asthma, Churg-Strauss)
Addison disease
AIN (acute interstitial nephritis)
CVD (collagen vascular disease)
Parasites (eg Loefflers, ascaris lumbricoides)