Clinical Medicine Flashcards
(83 cards)
1
Q
- Neonate assessment - ventricle size and hemorrhage
- No significant use in adults
A
Ultrasound
2
Q
- Head trauma
- Acute hemorrhage
- Sinusitis
- Orbital trauma
- Spinal trauma (NO cord symptoms)
A
CT
3
Q
- Spinal trauma (cord symptoms)
- Specific
- Soft tissue
- Nerve pinches
- Cord contusions
A
MRI
4
Q
To image a pt that has metal in his or her head, use:
A
Plain film
5
Q
Gold standard imaging modality for tumors and aneurysms
A
Angiography
6
Q
- Fastest exam (less than 5 min)
- Most accurate
- Most info
A
CT
7
Q
TQ: MRI takes (shorter/longer) than CT, but gets more info
A
MRI takes LONGER than CT, but gets more info
-Pt can be in any position
8
Q
Imaging modality for stenosis and calcification:
A
CT angiography
9
Q
Pituitary adenoma < 10 mm is classified as a:
A
Microadenoma
10
Q
Imaging modality for pituitary adenoma:
-What planes are best? (2)
A
MRI
-Coronal and sagittal planes
11
Q
Intensely _______ MRI for acoustic neuroma.
A
Enhance
12
Q
A hemosiderin ring means that the tumor is:
A
Bleeding
13
Q
Imaging modality for Multiple Sclerosis:
A
MRI
14
Q
Imaging modality for Metastatic Disease:
A
CT
smaller mets only seen in MRI
15
Q
Coup is from:
A
Direct impact on stationary brain.
16
Q
Angiography is gold standard for: (2)
A
- Tumors
- Aneurysms
17
Q
Unless pt cannot take the contrast (kidney failure), use __ over ___.
A
Unless pt cannot take the contrast (kidney failure), use CT over MRI.
18
Q
Imaging modality for:
- Soft tissue
- Cord contusion
- Nerve pinches
- Specificity
A
MRI
19
Q
Cavernous angioma requires __ first, form differential dx, then nail down with ___.
A
Cavernous angioma requires CT first, form differential dx, then nail down with MRI.
20
Q
Imaging modality for choroid plexus CA:
A
MRI
see it within ventricle
21
Q
Contracoup is from:
A
Impact of moving brain on stationary calvarium.
22
Q
MC lesion in severe head trauma:
A
Diffuse axonal injury
- White matter (axons) shearing injury caused by indirect trauma with rotational forces
- Causes severe impairment of consciousness
23
Q
- MC in falls and direct trauma to head with sudden force
- 5% of head trauma pts
- No relationship to skull fracture
- Tearing of subdural (bridging) veins
- Freely cross suture lines and limited only by the interhemispheric fissure and tentorium
- Concave (crescent) shape
A
Subdural hematoma
24
Q
- Skull fracture in approx 85%
- Caused by laceration of the MMA
- Transient loss of consciousness, lucent interval, somnolence
- Neurosurgical emergency due to mass effect
- Lens-shaped
A
Epidural hematoma
25
- 72% caused by ruptured aneurysms (spontaneous)
- May also occur with cerebral contusion (trauma)
- Injury to leptomeningeal vessels at vertex
- Rupture of major intracerebral vessels
Subarachnoid hemorrhage
26
TQ: *Worrisome Signs*
| Signs which may indicate HA of pathological origin (Secondary HA): (10)
- "Worst HA"*
- Onset of HA after age 50*
- Atypical HA for pt*
- HA with fever*
- Abrupt onset (max. intensity in sec to min)
- Subacute HA with progressive worsening over time
- Drowsiness, confusion, memory impairment*
- Weakness, ataxia, loss of coordination*
- Paresthesias / sensory loss / paralysis
- Abnormal medical or neurological exam
27
Primary HA disorders: (4)
- Common migraine (w/o aura)
- Classic migraine (with aura)
- Tension-type HA
- Cluster HA
28
As a general rule, many physicians believe that any person with HA should have a one-time, thorough:
Neuroimaging study - CT or MRI
29
Any patient with a "worrisome history" or abnormal examination needs an urgent imaging study and perhaps even an __.
-Lumbar puncture (LP)
30
Remember: CT can miss 5-10% of subarachnoid hemorrhages and a ______ ________ may be needed if the CT is normal!
-Lumbar puncture (LP)
31
-Moderate to severe intensity*
-Pain aggravated by activity
-Prevalence peaks between 35-40yo*
-Females predominate (3 : 1)*
-More unilateral*
-Throbbing/sharp/pressure*
-Prodrome: mood changes, myalgias, food cravings, sluggishness, excessive yawning
Postdrome: fatigue, irritability, "fog"
-Behavior: Retreat to dark, quiet room*
-NO aura* (85-90% migraine sufferers do not experience an aura)
Common migraine
32
-Aura present (15-30 min, sometimes longer ... commonly visual symptoms*- e.g., scintillations, scotoma - often hemianopic)*
Classic migraine
33
- Mild to moderate intensity*
- Does not prohibit daily activities*
- Females 3:2 Males
- Location: Bifrontal, bioccipital*
- Dull, aching, squeezing, pressure*
- NO prodrome or aura
Tension-type HA
34
- Severe, excruciating intensity*
- 20-50yo
- Males predominate (6 : 1)*
- Assoc with sleep apnea** (may cure with a CPAP)
- Seasonal
- Duration: 30min to 2hr
- Location: 100% unilateral; generally orbitotemporal**
- NO aura
- Behavior: Frenetic, pacing, rocking, grabbing head
- Assoc sx: Ipsilateral ptosis, miosis, conjunctival injection, lacrimation, stuffed or runny nose
Cluster HA
- Tx with 8L of 100% O2 face mask
- Verapamil
35
Contraindications to Triptan usage: (7)
- Ischemic heart disease
- Atherosclerosis/vascular disease
- Raynaud's syndrome
- Uncontrolled HTN
- Hemiplegic or basilar migraine
- Severe renal or hepatic impairment
- Within 24 hrs of ergotamines, MAOIs, or other 5-HT1 agonists
36
How is the DHE protocol and the Triptan protocol similar?
Same general contraindications
37
Subtypes of stroke: (2)
- Hemorrhagic (20%)
| - Ischemic (80%)
38
Risk factors for stroke: (multiple)
- Increasing age
- Previous TIA or stroke
- Atherosclerosis (HTN, smoking, diabetes, hyperlipidemia)
- Cardiac disorders (valvular dz, endocarditis, patent ductus/septal abnormalities)
- Drug abuse
- Oral contraceptives
- Pregnancy / postpartum period
- Fibromuscular dysplasia (hereditary)
- Hypercoagulable states
- Inflammatory (Syphilis, HIV)*
- Migraine
39
Emergent Dx and Tx: (5)
- ABCs (Airway, Breathing, Circulation) ... always the 1st thing
- BP, pulse, cardiac monitor, EKG, O2 saturation
- IV access
- Neuro exam and rapid transport to CT scan
- Labs
40
T/F: Acute HTN is common in acute ischemic stroke and in most cases should NOT be treated. (170/100 should be left alone.)
TRUE
-The area of infarction may have lost autoregulatory function, so that "normal" BP may be relatively hypotensive in the brain
41
T/F: IVFs should NOT include glucose as hyperglycemia is assoc with worse neurologic outcomes.
TRUE
42
NIH Stroke Scale: 0-42 (coma)
- Score < 10 =
- Score > 10 =
- Score < 10 = 2-3% risk of hemorrhage
| - Score > 10 = 17% risk of hemorrhage
43
IV Thrombolytic Therapy
| Tx of acute ischemic stroke:
t-PA
| Tissue Plasminogen Activator
44
Antiplatelet agents for Tx of stroke: (3)
- ASA
- Aggrenox
- Plavix
45
TQ: Percent (+) findings for epilepsy on a SINGLE EEG:
- All types:
- Generalized Tonic/Clonic:
- Petit mal (with HV)*:
- Partial:
- All types: 40% (60% MISS)**
- Generalized Tonic/Clonic: 20%
- Petit mal (with HV): 90% **
- Partial: 30%
46
TQ: Percent (+) for epilepsy (all types) when doing 3 sleep-deprived EEGs:
85%
| (Value in repeating the test)***
47
Although the EEG is an impt tool in the Dx of epilepsy, the single most impt information is _______ of the event - preferably by witnesses.
History
48
Seizure classification: (2)
- Partial seizures
| - Generalized seizures
49
Partial seizure subtypes: (3)
- Simple partial
- Complex partial
- Secondarily generalized (Partial onset)*
50
Generalized seizure subtypes: (7)
- Absence (Petit mal)
- Tonic-clonic
- Myoclonic
- Tonic
- Clonic
- Atonic
- Clonic-tonic-clonic
51
What area of the brain is surgically treated for Partial ("focal") onset seizures?
Hippocampus
52
TQ: Drug used for absence seizure ONLY:
Ethosuxamide
53
Drug used for absence or primary tonic-clonic:
```
Valproic acid (esp. males)
-Teratogenic! Avoid in pregnant women.
```
54
Other drugs which may be effective for primary generalized sz: (4)
-Use for women!
- Lamotrigine
- Levetiracetam
- Topiramate
- Zonisamide
55
Carbamazepine (CBZ) has drug interaction with:
Oral contraceptives
56
CBZ or phenytoin has long term side effects, such as:
Bone loss
57
In general, the newer AEDs (e.g., Lamotrigine) are probably safer in pregnancy than the older ones (e.g., phenytoin or valproic acid), but the drug of choice for a woman with epilepsy is the drug which:
Best controls her seizures
58
TQ:
- Pale (pallor)
- Sweating (diaphoresis)
- Abnormal head position
- Lightheadedness
- Positionally related (usually stand and then go down)
- Slow onset
- Brief unconsciousness
Syncope
59
TQ:
- Urinary or bowel incontinence
- Tongue injury
- Tonic/Clonic movements
- Blue or red in color
- Postictal state (takes longer to become aware of surroundings)
Seizure
60
Hyperreflexia graded as:
| Characteristic of what type of lesion?
3/4 or 4/4
| -UMN lesion
61
Babinski sign (aka extensors of plantar reflex):
UMN lesions
62
Pt has L5 rediculopathy. What might you expect to find on exam?
Weakness of big toe extension
63
Patellar tendon reflex:
L4
64
Achilles reflex:
S1
65
Brachioradialis reflex:
C6
66
Triceps reflex:
C7
67
T/F: You expect to see a "sensory level" in a pt with a spinal cord abnormality.
TRUE
68
Typical triggers for migraine: (4)
- Stress
- Weather change
- Hormonal
- Strong odors/lights
69
Can a migraine be U/L, B/L, or either?
Either U/L OR B/L.
70
Why is having a U/L migraine a good thing when compared to tension headaches?
Tension headaches are generally B/L.
71
TQ: What's the MC cause of breakthrough seizure?
| What are a few other causes for breakthrough seizure? (2)
```
TQ: Noncompliance
(Not taking meds)
-Infection
-Sleep deprivation
-Quinolones (GABA inhibitors... glutamate increases)
```
72
TQ: 21 yo female, newly married, on birth control pills.
What are you going to prescribe? (1)
What if pt is depressed? (1)
In Japan, what are we going to do? (1)
- BC = Levetiracetam (Keppra)
- Depressed = Lamotrigine (Lamictal)
- Japan = Zonisamide
73
TQ: What is Todd's ("Postictal") paralysis? How long does it last? What parts of the body are usually affected?
Focal weakness in a part of the body after a seizure.
- Subsides within a few days
- Localized to either L or R side
- Usually affects appendages, speech, and vision (these are the last to come back)
74
TQ: Difference between simple partial and complex partial seizures:
- Simple partial: seizure on one side of brain, pt remains conscious
- Complex partial: seizure on one side of brain, pt undergoes LOSS OF CONSCIOUSNESS (C and C)
75
TQ: What are some things that can mimic stroke? (4)
- Blood glucose abnormalities (hyper- or hypo-)
- Migraine
- Hepatic abnormalities
- Postictal ("Todd's") paralysis
76
Treatment of stroke (meds):
| -Long-term maintenance to prevent another from occurring: (6)
-Aspirin, Agrinox, Plavix, Pradaxa, warfarin/coumadin, Xarelto
77
TQ:
Long-term maintenance of stroke.
FULL anti-coagulants: (3)
- Warfarin
- Pradaxa
- Xarelto
78
Indications for full anti-cogaulation: (5)
- Atrial fibrillation
- Artificial heart valves
- Hypercoagulable states (Antiphospholipid syndrome, etc.)
- Atrial septal defect
- Low ejection fraction (15-20%)
79
If no reason to put pt on full anti-coagulants, what can you put them on? (3)
Anti-platelet agents:
- Aspirin
- Plavix
- Agrinox (combo med)
80
What do you expect to see on the CT of a patient with acute stroke?
Usually normal!
81
TQ: How will a stroke appear on CT that has been forming over a longer period of time (hours to days)?
Hypodensity* or darkness in the area where the stroke is
82
In ER, someone is brought in with acute stroke, what do you do? (Start to finish)
- ABCs
- IV access
- Order labs
- PT/PTT
- Urinalysis
- CT
- EKG/Echo
- Do NOT give hypertension meds**
83
Decreased ejection fraction of heart. Think:
Cardiomyopathy
