Associations 1 Flashcards
1
Q
Meningitis + petechiae/purpura
A
Neisseria meningitis
2
Q
Temporal lobe encephalitis + skin lesions
A
Herpes simplex virus
3
Q
Meningitis + AMS
A
Encephalitis
4
Q
WNV animals
A
Birds are reservoir, mosquitoes are vector
5
Q
Virus + ASA
A
Reye syndrome (brain + liver)
6
Q
Ring enhancing lesion on MRI
A
Brain abscess
7
Q
Poliomyelitis
A
Destroys motor neurons (flaccid paralysis)
8
Q
Negri bodies (eosinophilic inclusions in neurons)
A
Rabies
9
Q
HA made worse by foods w/ tyramine
A
Migraine
10
Q
HA in obese woman w/ papilledema
A
Pseudotumor cerebri
11
Q
Jaw muscle pain when chewing
A
Temporal (giant cell) arteritis
12
Q
Periorbital pain w/ ptosis and miosis
A
Cluster HA
13
Q
Horner’s syndrome - 2 causes
A
Ptosis, miosis, anhydrosis Pancoast tumor (apex of lung), Cluster HA (partial)
14
Q
HA w/ photophobia and/or phonophobia
A
Migraine
15
Q
HA w/ b/l frontal/occipital pressure
A
Tension
16
Q
HA w/ lacrimation and/or rhinorrhea
A
Cluster
17
Q
HA w/ elevated ESR
A
Temporal (giant cell) arteritis
18
Q
“Worst HA of my life”
A
SAH
19
Q
HA + extraocular muscle palsies
A
Cavernous sinus thrombosis
20
Q
Scintillating scotomas prior to HA
A
Migraine w/ aura
21
Q
HA associated with sex (before/after orgasm)
A
Post coital cephalgia
22
Q
HA responsive to 100% O2
A
Cluster
23
Q
Frontal HA made worse by bending over
A
Sinus
24
Q
Trauma to head leading to HA that begins days later, persists for over a week and doesn’t go away
A
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)
```
