Flashcards in Random2 Deck (176):
Scleroderma renal crisis findings? (5)
- Acute renal crisis (w/o previous renal disease)
- Malignant HTN (ie headache, n/, blurry vision)
- U/A mild proteinuria
- Microangiopathic hemolytic anemia w/ fragmented RBCs (schistocytes)
- spiculated appearing RBCs
- seen in liver disease and end-stage renal disease
Burr cell is?
Spiculated appearing RBCs w/ serrated edges seen in liver disease and end stage renal disease
Howell-jolly body is?
Basophilic remnants of the nucleus that appear as small, black pellets in RBCs
- seen in pts w/ hx of spelnectomy or functional asplenia
When do you see howell-jolly bodies?
- Pts w/ hx of spelnectomy
- Functional asplenic pts
Another name for acanthocyte?
Another name for echinocyte?
Burr cells other name?
Spur cell other name?
What is a spur cell?
RBCs w/ irregularly sized and spaced projections
- seen in liver disease
WHen are spur cells seen?
In liver disease
Spiculated RBC - think?
- liver and endstage renal disease
Target cells are?
RBCs w/ central density surrounded by pallor (bull's eye)
Target cell seen w/?
- Hemoglobinopathies (ie thalassemia)
- Chronic liver disease (esp obstructive liver disease)
Thalassemia has what type of abnl RBCs?
Main CXR finding on aortic injury?
Initial screening study for aortic injury?
main causes of aortic traumatic injury?
MVAs and falls from >10 feet
what is often associated finding on CXR w/ myocardial contusion?
How do glucocorticoids effect lymphocytes, eosinophils, and neutrophils?
- Inc Neutrophils (left shift)
- Dec lymphocytes and eosinophils
recent cardiac cath + heparin in prep of CABG, now w/ hypotension, tachycardia, flat neck veins and back pain -- think?
- due to bleeding from the arterial access site
recent cath + hemodynamic instability + flank/back pain think?
how to confirm dx of retroperitoneal hematoma?
NON-contrast CT scan of abdomen and pelvis
treatment of retroperitoneal hematoma
- intense monitoring
- bed rest
- IV fluids
- bld transfusions as needed
*Rarely needs surgery
First line treatment for specific phobia?
Behavioral therapy (assuming enough time)
Treatment of specific phobia if not enough time (ie flight next week?)?
eye movement desensitization useful in what disorder?
industrial worker + pleural calcifications - think?
good way to distinguish b/t restrictive lung disease causes?
look at diffusion capacity (DLco)
- wall issue (ie obesity, ankylosing spondylitis) --> normal diffusion capacity
- Interstitial lung disease --> low DLco
Way to distinguish b/t obstructive lung diseases?
- If FEV1 improves - think asthma
- if no change, think COPD
first line mood stabilizers for bipolar maintenance?
- Lithium (renal and thyroid toxic)
- valproate (hepatotoxic, thrombocytopenia)
associated adverse effects of Lithium?
- adverse effects on kidneys and thyroids
kidneys: nephrogenic DI or chronic tubulointerstitial nephropathy
Valproate adverse effects?
- rare hepatotoxicity
what is bupropion?
- NE and dopamine reuptake inhibitor (NDRI)
antidepressants w/ bipolar patients can cause what?
inducing mania (so don't use)
drugs that may be useful for long term maintenance of pts w/ bipolar?
- Valproate (1stline)
- Quetiapine (antipsychotic 2nd gen)
- Lamotrigine (anticonvulsant)
What is topiramate
main pharmacologic target for treatment of OCD?
First line treatment of OCD?
(fluoxetine, fluvoxamine, paroxetine, citalopram, escitalopram, sertraline)
- Cognitive-behavioral therappy
2nd line treatment of OCD?
clomipramine (tricyclic antidepressant, less well tolerated than SSRI - 1st line)
antipsychotics target what?
primary target of benzodiazepines?
post MI few days + new pain that hurts more supine and improved on sitting up and leaning forwards - think?
ECG findings for acute pericarditis?
- Diffuse ST elevations
- PR depressions
post MI 3-7 dys, now w/ new onset systolic murmur - think (2)?
- interventricular free wall rupture
- Papillary muscle rupture (MR)
major depressive episode should last how long for dx?
Atypical depression symptoms (4)?
- Increased appetite
- Rejection sensitivity
- Leaden Paralysis (heavy feeling limbs)
timing for adjustment disorder?
symp dev w/in 3 mo of stressor and last no more than 6 mo after stressor ends
Low mood lasting most of the day on more days than not for at least 2 years?
Persistent depressive disorder (dysthymia)
timing for persistent depressive disorder (dysthymia)
- low mood lasting most of the day on more days than not
- At least 2 years
first line treatment for absence seizure?
EEG w/ classic 3 Hz spike wave pattern - think?
1st and second line treatments for absence seizure?
2) Valproic acid (side fx)
stimulant used to treat ADHD
Nonstimulant med used to treat ADHD
Lorazepam used for?
Benzo used for anxiety and acute managment of prolonged seizures (ie status epilepticus)
Phenytoin used for as 1st line for what?
Generalized tonic-clonic seizures or focal seizures
Side fx of phenytoin? (3)
- Gingival hyperplasia
- Stevens Johnson syndrome
- Toxic epidermal necrolysis
where is lesion that causes hemi-neglect syndrome
Lesion on non-dominant (usually R) PARIETAL lobe
What part of brain hurt --> hemi-neglect?
Parietal lobe (non dominant side, usually R)
- in charge of spatial organization
lesion on frontal cortex would cause?
- w/ motor aphasia if dominant lobe involved (Broca's, expressive aphasia)
- maintained comprehension, but speech is stilted and effortful
Left temporal lobe damage -->?
Receptive aphasia (Wernike's)
- cannot comprehend written or spoken language
- expresses fluently, although incoherently
occipital lobe damage results in?
pt unaware of deficit (ie unaware of hemineglect)
comb only R side, clock only on R side - this is?
pulsus paradoxus associated w/?
systolic murmur that increases w/ standing is?
Hypertrophic obstructive cardiomyopathy (HOCM)
good way to tell syncope vs seizure in non-witnessed pt?
syncope would immediately return to neurological baseline, while seizures would be delayed, sleepy, confused
bilious vomiting + contrast from upper GI series in corkscrew appearance - think?
small bowel volvulus
Ligamentz of Treitz on R side of abdomen on upper GI series - think?
stable neonate w/ bilious vomiting + xray finding no free air or double bubble, next step?
Upper GI series to look for malrotation (-> volvulus)
bilious vomiting neonate - diff dx (4)?
- Malrotation (-> volvulus)
- Duodenal atresia
- Hirschsprung disease
- Meconium ileus
What procedure done to fix malrotation and prevent volvulus?
bilious vomiting stable neonate + dilated loops of bowel on xray --> next step to dx b/t?
Next step: Contrast Enema
- Microcolon --> Meconium ileus
- Rectosigmoid transition zone (b/c tonically contracted distal to) --> Hirschsprung disease
lesion in the brain + personality changes and strange behavior localize it to what area of brain?
brain lesion w/ butterfly appearance w/ central necrosis - think?
brain metastasis usually look and are found?
Found in gray-white junctions or at watershed zones
a high grade astrocytoma may also be known as?
Glioblastoma multiforme (grade 4 astrocytoma)
heterogenous, serpiginous contrast enhancement can be found w/ what brain lesion?
High-grade astrocytoma (incl GBM)
Liver disease w/ acute onset of kidney issues --> think?
liver disease + inc creatinine + failure to respond to IV fluids + absence of shock, proteinuria, specific reason for renal disease --> think?
Treatment of hepatorenal syndrome?
Pulsus paradoxus - diff dx (6)?
- Cardiac tamponade
- Chronic COPD
Pulsus parvus et tardus - think?
Inspiration causes what?
inc systemic venous return to heart
Tic douloureux is?
etiology of trigeminal neuralgia (tic douloureux)?
compression of the trigeminal nerve (pain along 2 & 3rd branches)
tongue palsy results from damage to what nerve?
facial nerve does what?
- muscles of facial expression
- Taste: ant. 2/3 tongue
jaw asymmetry can result from what nerve damage?
Mandibular division of the trigeminal nerve (V3) --> paralysis of muscles of mastication
winged scapula - what nerve hurt?
long thoracic nerve
MS does what to nerves?
autoimmune disease --> inflammatory demyelination of axons in CNS
ocular issues + fatigable chewing + dysphagia w/ nasopharyngeal regurge + dysarthria - think
tall R wave in aVL + Deep S wave in V3 + repolarization changes in anterolateral leads (I, aVL, V4-6) - think?
- tall and deep waves indicate LVH
violent behavior + hallucinations + nystagmus - what drug?
Visual hallucinations + tachy/HTN - what drug?
Chest pain + seizures + agitation + Mydriasis + tachy/HTN --> what drug?
tooth decay + choreiform movements + sweating + psychosis/violence - what drug?
increased appetite + conjunctival injection + impaired time perception - what drug?
Depressed mental status + Miosis + respiratory depression - what drug?
resp depression, pinpoint pupils, CNS depression, hypotension - think?
subperiosteal hemorrhage newborn?
newborn head swelling few hours later that does NOT cross suture lines - think?
swelling of newborn head seen right after birth - think?
diffuse swelling of newborn scalp that crosses suturelines and midline - think?
good indications of cranial meningocele
- increased pressure upon crying
- bony defects
small-vessel hyalinosis - aka?
kussmaul's sign is?
increase in JVD w/ inspiration
increase in JVD w/ inspiration is known as?
wallenberg syndrome due to?
lateral medullary infarction likely due to an occluded intracranial vertebral artery
Vestibulocerebellar symptoms in wallenberg syndrome
- nystagmus (horz and rotational)
- vertigo w/ falling to side of lesion
- difficulty sitting upright w/o support
- Ipsilateral limb ataxia
wallenberg syndrome findings? (6)
- vertigo (fall to side of lesion)
- ipsilateral loss of pain and temp on face
- contralateral loss of pain and temp on trunk and limbs
- Horner's syndrome
weakness of muscles of mastication, diminished jaw jerk reflex, and impaired tactile and position sensation over face - where is lesion?
- effects ipsilateral trigeminal nerve
Lateral mid-pons lesion would effect what nerve?
Ipsilateral trigeminal nerve
lateral medullary infarct effects what nerves?
IX and X
--> hoarseness, dysphagia, diminished gag reflex
paralysis of the arm and leg w/ loss of tactile and position sense + tongue deviation -- think?
Medial medullary syndrome
lesion on medullary pyramid causes?
lesion on medial lemniscus causes?
contralateral loss of tactile, vibratory, and position sense
medial medullary lesion effects what cranial nerve?
--> ipsilateral tongue paralysis w/ deviation to side of lesion
Alternating hypoglossal hemiplegia is also known as ?
medial medulary syndrome
- contralateral hemiparesis
- tongue deviation to ipsilateral side of lesion
contralateral ataxia + hemiparesis of the face, trunk, and limbs - think?
medial mid pontine infarction
lateral medullary infarct occurs due to?
- occlusion of the post. inf cerebellar or vertebral artery
neutrophilic cryptitis in GI - think?
IBD (Crohn's or UC)
epithelial ecrosis in GI - think?
conversion disorder is?
sudden onset of neurological symptom that is incompatible w/ nL neuro exam brought on by a stressor
somatic symptom disorder is?
1 or more persistent physical symptoms that causes disproportionate and excessive anxiety and energy devoted to it.
- generally symp is minor but anxiety is big
phosphodiesterase 5 inhibitor
sildenafil has cross reaction w/ what drugs (2)?
- alpha blockers (-zosins)
can cause hypOtension
sildanefil first line for?
erectile dysfunction treatment
IV drug user --> endocarditis think what valve?
IV drug user + endocarditis murmur effected how w/ inspiration?
Increased murmur w/ inspiration (TR)
IV drug user + endocarditis + round alverolar infiltrates on CXR - think?
septic emboli to lungs
mumur best heard while sitting up -- think?
Paradoxical splitting -- think?
LV outflow obstruction
- R ventricular paced rhythm
Tricuspid endocarditis --> what murmur?
pleural plaques - think?
unilateral pleural abnormality w/ large pleural effusion in plumber - think?
AST ALT levels in alcoholic liver disease?
AST:ALT --> 2:1
AST & ALT
Marked elevations in AST and ALT (>25x) -- think? (3)
- toxin induced
- viral hepatitis
What location in brain usually has NO hemiparesis if there is a lesion?
Facial weakness + ataxia + nystagmus + headache + neck stiffness + n/v -- think where is lesion?
- note: NO hemiparesis
contralateral hemiparesis + hemianesthesia + conjugate gaze deviation toward lesion - think where is lesion (2)?
1) putamen + internal capsule (Basal ganglia)
2) occlusion of proximal middle cerebral artery (more acute onset)
eyes react how when there is a hemorrhage at the thalamus?
eyes deviate Towards hemiparesis (contralateral to bleed)
contralateral hemiparesis + hemisensory loss + nonreactive miotic pupils + upgaze palsy + eyes deviate towards hemiparesis - where is hemorrhage?
Deep coma and total paralysis w/in minutes + pinpoint reactive pupils - where is hemorrhage?
cerebral lobe bleed w/ contralateral hemiparesis + eyes deviate away from hemiparesis - location?
cerebral lobe bleed w/ contralteral hemisensory loss - location?
cerebral lobe bleed w/ homonymous hemianopsia - location?
Lead poisoning risk next step?
venous lead level
Treatment of lead poisoning? (mild, mod, severe)
- mild (5-44): no meds, repeat venous lead level in =70): Dimercaprol (BAL) + calcium disodium edtate (EDTA)
Dimercaprol (BAL) + EDTA can treat what?
severe lead poisoning
Dimercaprol + calcium disodium edetate can treat?
severe lead poisoning
"BAL + EDTA"
Meso - 2,3 -Dimercaptosuccinic acid can treat?
moderate lead poisoning
infant w/ hypertonia and hyperreflexia in lower extremities w/ equinovarus deformity - think?
Deficiency of niacin (B3) --> 3 D's
watery diarrhea + tender rash similar to sunburn + beefy tongue + poor concentration - think?
Pellagra due to niacin (B3) deficiency
niacin deficiency can cause?
vit B3 is?
vit B6 is?
vit B2 is?
vit B1 is?
G6PD deficiency will have what findings on peripheral smear?
Heinz bodies and Bite cells
maternal estrogen effects on newborns?
- breast hypertrophy
- swollen labia
- white vaginal discharge (leukorrhea)
- uterine withdrawal bleeding
treatment of transplacental maternal estrogen exposure in newborns?
Observation and routine w/ reassurance
Mammary gland enlargement + non-purulent vaginal discharge + mild uterine bleeding in newborn -- think?
transplacental maternal estrogen exposure
drug for antidepressant effect and smoking cessation?
indications for urgent dialysis?
pericarditis in a pt w/ renal failure - treat how and why?
- urgent dialysis
- Uremic pericarditis
typical paricarditis ECG findings?
- Diffuse concave upwards ST segment elevation
- PR segment depression
most common site of ulnar nerve entrapment?
at elbow (medial epicondylar groove)
dec sensations at 4th and 5th fingers w/ weak grip think?
ulnar nerve syndrome (compression of nerve)