Found 4 PC Flashcards
(116 cards)
1
Q
What is the most frequent HA?
A
Tension HA
2
Q
What is the MC HA leading to a PCP visit?
A
Migraine
3
Q
What are the 4 primary HA?
A
Migraine, Tension, Trigeminal (cluster), New Daily
4
Q
Which headache’s ADE include Photophobia, Phonophobia, and Nausea?
A
Migraine (mc in Women)
- triggers = emotional stress, hormones
5
Q
What HA is associated with trigeminal system dysfunction/ Pain
A
Migraines
6
Q
whats more common, a migraine w or w/o aura?
A
W/o
Aura = feeling, sxs before a migraine
7
Q
Are auras common in Menstrual migraines
A
No
8
Q
What is abortive Tx for Migraines
A
NEAT- Ass
NSAID, Ergotamins, Acetaminophen, Tripans,
AntiemeticSS
9
Q
Tx for mild -mod Migraines? NAA
A
1st line = NSAID
2nd line = Acetaminophen
3rd line = ASA/Caffiene
10
Q
Tx for mod - severe Migraines? Try eating opioids -
A
1st line = Triptan
2nd line = ergots
3rd line = opioids
11
Q
What does botulism block?
A
Substance P
“flip the b to a P”
12
Q
What is associated with Tension HA?
A
Vice-grip, pericranial myofascial pain
“hands around the head” Bilateral,
13
Q
Acute Tension HA treatment? NAA
A
1st line: NSAID, Acetaminophen, ASA
* No opioids, butalbital, muscle relaxant*
14
Q
Chronic Tension HA treatment? T AD AC TLB
TCA (North America)
AD (Mexico Venezuela)
AC (Togo)
These countries all have tension!!
A
TCA (amitriptyline, Nortiptyline) Antidepressant (Mitra + Ven) Anticonvulsants (Topiramate, Gabapentin)
Tizanidine, Lidocane, Botulism
15
Q
Cluster HA = Many times a day (8), mostly Episodic, Chronic.
What else is Popcorn to Cluster?
A
Cluster: conjuctival injection, lacrimation, Nasal conjection, Rhinorrhea (nose crap)
16
Q
Cluster tx? “100% Sumatran Coffee,”
A
1st line = 100% O2, for 15 mins, Sumatripan, Corticosteroids.
Prophylatic = Verapamil
17
Q
Popcorn New Daily headache?
A
1986, Self-limiting, bilateral, (like Migraine = Nausea, photophobia, phonophobia)
18
Q
Red Flags Headache
A
New onset, (thunderclap = worst HA ever), Preg or post-partum severe HA, wakes patient from sleep, Weight loss, persistent morning headaches
19
Q
Red Flags Headache
A
AMS, Confusion, Fever, Nuchal rigidity, Papilledema, Tender temporal artery, Severe HTN
20
Q
Popcorn Pseudotumor Cerebri
A
Chronically ICP, Growth Hormones, Tetracyclines, Abducens palsu, Photopsia, backpain, retrobulbar pain
21
Q
Pseudotumor Cerebri PE?
“ Obese patients vomit alot”
A
Obesity, Papilledema, Visual fields, Abducens palsy
22
Q
Pseudotumor Cerebri TX?
“Fast weight loss, No salt or carbs
A
Furosimide, Weight lose, Stop Na, Carbonic anhydrase.
23
Q
What are overused meds that lead to headache? “Buy others alcohol”
A
Butalbital, Opioids, ASA
24
Q
SXS of med overdoes HA? “Megan Never Drinks Iced Amoretto”
A
Memory, Nausea, Diff conc., Irritable, Asthenia
25
Popcorn for Temporalis Arteritis. "Giant Elephants Crunches my Head"
Giant, High ESR (100), High dose Corticosterioids (only Tx) inflamed temporal arteries. Old men can't wear hats
26
What is Tic Douloureux?
Compressed Trigeminal , any normal stim (shaving) causes pain. Sharp electrical pain
27
How do you dx and tx trigeminal neuraglia?
MRA (artery) and vascular decompression
28
Trigeminal neuraglia red flags? "2,3,4"
Bilateral, trigeminal sensory lose, under 40
29
Charcot - Marie - Tooth disease popcorn
| "Country Music TV 1"
MC hereditary peripheral neuropathy. CMT1 = Dance (footdrop, pes cavus, hammer toe) No DTRs
30
Porphyria popcorn
| "Aut dominates many harum, Sara, Angela, and Holly are very painful"
Autosomal Dom. Metabolic Heme dysorder, HAV porphoria, Sharp pain, agitation, hallucination, extreme pain
31
DM peripheral neuropathy popcorn.
Most common peripheral neuropathy in western world.
| Distal, symmetry, neuro cachexia, Painless, Overactive sweat, Ataxia, bad gait, Syncope
32
DM peripheral Tx?
| Dont overthink it
Glucose, Foot care, education
33
Hypothyroidism peripheral popcorn
Proximal myopathy = MC is Carpal tunnel
| Tx = correct hypothyroidism
34
GI peripheral popcorn
No gluten, need more B12 and Vit E
35
infectious peripheral popcorn
Borrelia (lyme), Deer tick (ixodes dammini)
| Facial neuropathy
36
Vit B12 (cobalamin) peripheral popcorn
Pernicious Anemia, Glossitis, absent achiles reflex.
| Tx = Vit B12 supplement
37
Vit B1 (thiamine) peripheral popcorn
Beri beri disease
Chronic alcohol abuser, recurrent vomitter
Tx = parenteral thiamine replacement
38
Carpal Tunnel Synd popcorn
Compressed Medial nerve
Office worker, female, obesity, small space risk, Shake out & flick sign,
Thenar Atrophy
TX = NSAID, Surgery
39
(Ulnar neuropathy) Cubital Tunnel Synd popcorn
Pass btw the medial epicondyle and olecrenan. Tinel elbow sign. 5th and half of 4th finger sensory and motor.
40
(Ulnar neuropathy) Cubital Tunnel Synd Tx?
Use elbow pads
| Surgical decompression
41
Radial neuropathy popcorn
Wrist drop, weak finger extension, Keep triceps reflex, heal spontaneously.
Tx: Cock-Up wrist or splint: No Surgery
42
Meralgia Paresthetica (lateral cutaneous femoralneuropathy) Popcorn
Numb lateral quad,
| Tx: no tight belts, lose wt, NSAIDs
43
Peroneal neuropathy popcorn
Foot drop, L5 radiculopathy.
| No leg crossing, heals spontaneously
44
Bells Palsy Popcorn
CN 7 & LMN, associated with HSV, DM, & 3rd trimester.
Unilateral face paralysis (Whole Face)
No corneal light reflex
45
Bells Palsy vs Stroke
"Stroke Spares" the forehead = wrinkles/ bilateral
46
How can you test for Bells Palsy?
" Garima & Megan love Chololate Blue Bell ice-cream"
Godalimuim MRI, Burreli, CT - Bells palsy
47
How can you tx Bells Palsy? "Eat Vanilla Pudding"
Eye protection, Valacyclovir, Prednisone
48
CRPS popcorn
Triad: Burning, auto dysfunc, trophic changes = after surgery.
Trauma = trigger
Hot ashy hands
49
CRPS diagnosis & Tx?
| "Budapest Bones Need proper and neat sorting"
Budapest - clinical diag
Bone density scan
Tx: NSAID, Prednisone, Anticonvulsants, Nortriptylline, SNRIs
50
Tourette's popcorn
Men, ADHD, OCD, Motor and phonic tic,
Echopraxia (mimic), Copropraxia (dirty gesture)
Echolalia, Palilalia (repreat phrase faster and faster)
51
How can you TX Tourette's? "cartman cant genuinly treat Hankey (christmas poop) better"
1st Line = CIBT, Clonidine, Guanfacine.
| Tetrabenazine, Haloperidol, Botulinum
52
What time of sleep is regenerative?
N3
53
Can you move when your dreaming? When are you dreaming
No way, Rem sleep
54
What is the Mallampati scoring? "mallampati is a mouth full"
Measures airway . 1 = tonsils, uvula, ext are visable, 4 = only hard palate is visible
55
In general what tests can diag sleep disorders? "Pa Students Hardly Ever"
Polysomnography, surface electromyogram, Home sleep test, Epworth Sleepiness scale.
56
Who gets insomnia?
| "WOULD" how do you diag?
Women, older, un-employeed, Low SES, divorced.
| Diag with 3 sxs per week.
57
Sleep tx? "Hey Bitch, Ambien and lunesta makes dolly sleepy!"
Hygiene, Benzo, Ambien and lunesta, Melatonin, Doxepin, Suvorexant
58
OSA popcorn
Obese, Male, Old, High Mallampati score
59
OSA Diag and Tx? "Polly wants a cracker"
Polysomnography
| Weight loss, avoid alcohol, CPAP
60
Narcolepsy popcorn
| Narcos: killed Orexin, Emptied 15 clips, murdered 8 other
Narcos: killed Orexin, Epworth 15+ score, MSLT under 8 mins
61
Tx Narcolepsy? "Pablo murdered many anxious cops fleeing the southern villa"
Provigil, modafinil, methyphenidates, amphetamines. Cataplexy = fluoxetine, tricyclics, Sodium oxybate, venlafaxine.
62
Circadian = think shitty schedule
Shift workers, grave yard shift
63
Parasomnia = N3
| "paranatural phenom"
NREM = menses, sleep deprivation, emotional, Sleep terrors: tachy, sweaty, fear!
64
what are the 3 patheways of CNS infection?
Blood, retrograde up a neuronal path, direct contiguous
65
What does an LP measure? CC GG VP
Cell, Culture, glucose, gram, protein, viral
66
When should you not do an LP?
Cushings triad (repsiratory depression, Brady, HTN)
Mass, skin infection, severe coag
67
Is a little blood in vial 1 of 4 ok?
Yes, if theres blood in all 4 = subarachnoid hemorrhage, intracranial hemorrage, cerebral infacrt.
68
Encephalopathy popcorn
VIRAL>>Bacterial, Paraneoplastic.
| No sign of meningial irritation (photophobia, nuchal rigidity)
69
What can you see in a the PE for Encephalopathy?
Fundoscope: Papilledema, Retinitis
| Skin = alot of shit
70
How to diag Encephalopathy?
| "Look sick? Cancel the STEPS
1st = MRI, then CT.
| If patient looks sick, do a CT and Serum electrolytes, Thoat swab, sputum EEG, Peripheral smear, & Sputum culture.
71
Encephalopathy hyponatremia is caused by
Ricketssia and SIADH
| * on the test*
72
How can you stablize an encephalitis patient? VENMO
Ventilate,
ET tube
n'
MOnitor electrolites
73
Empiric Encephalopathy treatment?
* on the test*
A! Da Bitch Got Incarcerated:
Acyclovire 10 mg for 8 hours.
DVT, Bacterial, GI, Increased ICP
74
Meningitis Popcorn.
| "Fondling Noren produces nasty favors"
Fever, photophobia, HA/N/V, neck stiffness,
75
Bacterial meningities POPCORN
```
Adults = penetrating injury
Kids = brith canal/placenta
Rapid bact growth!!
Neonate = S. agalactiaa (lactating)
Babies = S. penumo
Teens = n. meningitides
Adults = s. penumo
```
76
How can you diag Bact Meningities?
| "Big ass lips can cause chaos"
Blood culture x2
Antibiotics
LP
CBC, CMP, COags
77
Bacterial meningitis empiric tx?
| "Another 50 Cent Victim"
Cetf/cefo + Vanco+ Amp (50)
| + acyclovir
78
```
Meningitis tx for
S. pneumo
N. meningitides
Listeria
H. Flu
```
S. pneumo - Vanco + Cephalo
N. meningitides - cephalo
Listeria - Amp/ Pen G
H. Flu - Cephalo
79
Is Bact meningitis bad?
Emergency, untreated = 100% fatal
80
Can you prevent Bact Meningitis?
| * on the test*
Yes!
<1 month = Rif or Cirpo
>15 year = Ceftriaxone
```
Neonates (S. pneumo) = Quad meningitis A vax
- Menactra (9months to 55yo)
- Menveo (2 months to 55Yo)
Meningitis B vas
- Trumenba
-Bexsero
```
81
Whats Aseptic Meningtitis
| TX (Install the NBA)
meningitis w/o infection - cancer, meds, SLE
| -TX = Bactrim, NSAIDs, Chemo (Azathioprine, Infliximab
82
What is drug resistant epilepsy?
seizure occur with 2 medications (15% of pts)
83
How does epilepsy kill you?
SUDEP
| sudden unexpected death in Epilepsy
84
FOCAL siezures popcorn
Motor (shake), Aware, Hemisphere that spreads
85
GENERAL siezures
From both sides of the brain
86
Associations
Temporal lobe
Frontal lobe
Juvenial myoclonic
Lennox-Gastaut
Temporal lobe - MC, good outcome
Frontal lobe - less favorable
Juvenial myoclonic - lifelong, genetics
Lennox-Gastaut - drug resistant, behavioral decline
87
MC causes of Epilepsy?
Structural (stroke, head trauma/tumor)
| Infection - encephalitis
88
When do you do an MRI
What about CTs
MRI = any new onset
CT = if MRI isn't available
89
What do you look for in an EEG?
Epileptiform btw seizures
90
When do you treat Seizures?
| "USE NOS"
Unprovoked seizures,
Sig brain abnormality,
Epileptiform on EEG
Nocturnal seizures
Old
Social factors (driving, work)
91
```
ADE of drugs
Wt gain
Wt lose
Kidney stones
Hyponatremia
Ostepenia
Cognition
Mood
```
```
Wt gain - Valproate
Wt lose - topiramate, zonisamide
Kidney stones - topiramate, zonisamide
Hyponatremia - Carba, oxcarba, zonisamide
Ostepenia - Valproate
Cognition - All
Mood - All
```
92
What drugs increase the risk of seizures in epileptic patients?
"Better make a clean dermal cut"
Buproprion, maprotile, ampxapine, clomipramine, demerol, cipro
93
Seizures: enzyme inducers cause
Birth control to fail
| *valproate = never use in pregs*
94
When is surgery needed for epileptic pts?
Drug resistant, MC is a temporal lobe resection
95
What are the three Epileptic diets? (LAKE)
Keto, low glycemic, Atkins
96
What is status epilepticus
cont. seizure > 5 mins w/o return to baseline
97
status epilepticus tx?
| Ben loves valleries Pu, but denies rectal
Benzo, Levetiracetam, valproate, phenytoin, diacetam PR
98
If a stroke occurs on the left side of the brain what side of the body is affected?
Right (cross over)
99
CN 7 vs stroke on facial paralysis?
Stroke spares forehead,
| CN 7 paralizes all (seven continents)
100
85% of strokes are
Ischemic
101
What does the Cincinnati Pre-hospital stroke scale measure?
Face droop
Arm drift
Slurred speech
102
What can mimic a stroke
Hypoglycemia (<50)
103
What is an ischemic stroke?
Blockage (Thrombotic = atherosclerosis - large vessels) (Embolic = Left side or Artery to Artery stroke - Lacunar = smaller vessels)
104
AIS vs TIA
AIS
- sudden, stop blood perfusion, > 24 hrs, permanent damage
TIA (no acure infarct)
- Sudden, transient lack of blood, <24 hrs, < 1 hr, No permanent damage
105
How can you risk stratify stroke risk
| ABCD2 - 2 day risk
Age, BP >140/90, Clin sxs, Duration >60, DM
106
What is the penumbra
zone of reversible tissue ischemia with a necrotic core
107
Window to give tPA for stroke
3-4.5 hours
108
FAST score for stroke
90% sensative if you all cincinnati shit
109
```
AIS ED stroke triage steps?
triage
Medical care
CT and labs
Tx
```
triage - tPA
Medical care - O2, BP, Wt, EKG CT
CT and labs- CT, ED
Tx - tPA, HTN, H/N/V
110
What is MERCI
Cork-screw app that removes clots
111
What is the main cause of Hemorrhagic Stroke
HTN >> ICP, rupture blood vessel
112
Arteriovenous malformations tx
Coil embolization, clip
113
Glasgow coma scale
```
3 = worst
15 = normal
```
114
CNS herniation
- subfalcine
- Transtentorial
- tonsillar
- subfalcine - contra leg weakness
- Transtentorial - CN III shit
- tonsillar - obtundation
115
Subarachnoid Hemorrhage Tx
Stool softener, cough suppressants
116
Tx fore post stroke depression
SSRI
