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Block 3 > Clin Med 3 > Flashcards

Clin Med 3 Flashcards

1
Q

failure to thrive def vs causes vs PE vs dx criteria vs tx

A

inadeq growth or fail to maintain growth vs child can’t use calories, malabsorption, inc metab demands vs dysmorph, subq fat stores, adenopathy vs wt/ht <5th percentile; wt dec 2 percentile, wt for ht = <5th percentile; inadeq wt for ht/age/BMI vs involve parents, support, inpt eval

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2
Q

Fail to thrive from insufficient calories: inadeq food vs emesis vs child not taking enough food

A

Poor knowledge, Food insecurity, Formula dil, BF difficulties vs pyloric stenosis, esophagitis vs oromotor dysfxn, behavior feeding problem, anorexia from systemic illness

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3
Q

fail to thrive from malabsorption d/t:

A

CF, celiac dz, hepatobiliary dz, short gut syndrome

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4
Q

fail to thrive from inc metab demand d/t:

A

endo/metab d/o, congen infxn like TORCHES/HIV, genetics, immunodef/autoimmune

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5
Q

developmental delay def vs causes vs screening examples

A

child not meeting milestones in >1 area of development vs genetic, environ, metab, vision/hearing, autism vs newborn screen, hgb, Pb, vision/hearing, MCHAT-R, lipid, depression

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6
Q

why is hgb impt to screen? when is it screened?

A

anemia = cause of DD d/t lack of Fe, hgbnopathy, chronic dz, too much cow’s milk. birth, 12mo, 24mo

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7
Q

why is Pb impt to screen? when to do it?

A

sig cause of DD. 12 & 24mo by blood, 6mo by risk assessment

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8
Q

what’s MCHAT-R? when to do it?

A

modifed checklist for autism in toddlers-revised. risk assessment for autism spectrum d/o at 18 & 24mo

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9
Q

when/why do lipid screen

A

9-11yo, 17-21yo; see if high risk for CVD

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10
Q

OMAS = assoc w/ neuroblastoma which are found in where? what do they express?

A

adrenal glands, chest, neck of children <5yo. neurofilament protein Hu –> plasma cells make antiHu igG to attack neuroblastoma but also brain –> autoimmune

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11
Q

how to dx vs tx OMAS?

A

those 3 sxs, CSF w/ high protein w/o inc in cells => albuminocytologic dissociation, blood test w/ EBV & VZV vs dexamethasone, azathioprine, ACTH; IV igG; benzodiazepines, antiepi, rehab

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12
Q

MS pathology vs sxs vs dx vs tx

A

inc Th17 inflamm, myelin lost & oligodendocytes destroyed –> astrocytes activated, lymphocytes invade brain parenchyma b/c BBB broken vs paresthesias, muscle cramps, optic neuritis vs space/time, CSF oligoclonal bands, EEG vs immunomodulary therapy, dimethyl/diroximel fumerate, PT/OT; INFB, IVIG, antiCD20

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13
Q

Guillain Barre syndrome. dx vs tx

A

molec mimicry b/w C. jejuni/CMV/EBV ab w/ GM1/2, GD1b along a dermatome –> ascending symmetrical weakness/dec reflexes/flaccid paralysis, tachy/bradycardia, hypo/pertension. LP w/ albumonicyto dissoc, CT/MRI show cauda equina nerve root enhancement, nerve condux show nerve root demyelin vs resp therapy, cardiac monitor, analgesia, IVIG/plasma exchange

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14
Q

MG genetics. comorbidities?

A

HLA-B, HLA-DRB1, thymic abnlity –> postsynaptic Ach receptor autoab –> affects skel muscles, transplacental transfer –> neonatal MG lasting 2-3mo. autoimmune DM, RA, Hashimoto’s

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15
Q

how to dx vs tx MG?

A

immunofluorescence, EMG, edrophonium, chest rads vs AchEI, IVIG/plasma, immunosuppressants, thymectomy

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16
Q

Lambert-Eaton syndrome. risk factors? dx vs tx

A

autoimmune against voltage gated Ca2+ channels –> presynaptic d/o –> can’t release Ach –> muscle weakness, dec reflexes. SCLC, smoking. sxs, inc reflex after ctx muscle, ab, repetitive nerve stim studies vs corticosteroids, IVIG, plasmaphoresis, chemo if ca

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17
Q

stage 1 vs 2 vs 3 sleep characteristics

A

together make 75-80% of sleep time. slower alpha waves w/ sharp waves at the end of stage, dec EMG, slow eye movements vs delta waves, sleep spindles, K complexes vs more delta waves

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18
Q

REM sleep

A

20-25% of sleep time, aroused EEG, sexual arousal, saccadic eyes, dream, assoc w/ pons

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19
Q

tonic vs phasic phase of REM sleep

A

desynch EEG, a/hypotonia, monosynpatic depression, polysynaptic reflexes vs rapid eye movements, inc HR/bp, irreg resp, mid ear activity, tongue movements

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20
Q

which parts of brain generate wake vs NREM vs REM sleep?

A

reticular activating system but diffusely localized vs basal forebrain, medulla vs basal forebrain, pons

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21
Q

polysomnography

A

diag test to record brain electrical activity/EEG, eye/jaw/leg muscle movement/EMG, airflow/resp, EKG, O2 sat

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22
Q

mult sleep latency test

A

5 20min naps 2 hrs apart –> document obj excessive sleepiness & lseep onset. mean sleep latency <5min –> pathologic sleepiness

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23
Q

Epworth sleepiness scale: 0 vs 1 vs 2 vs 3

A

never doze off vs slight chance dozing vs mod chance dosing vs high chance dozing. score >10 –> abnl

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24
Q

Mallampati classification of OSA: 1 vs 2 vs 3 vs 4

A

soft palate, uvula, fauces, ant/post pillars vs soft palate, uvula, fauces vs soft palate, base of uvula vs no soft palate

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25
Q

sx (day & nocturnal) vs PE vs dx vs tx vs prevent OSA?

A

excess somnolence, forgetfulness, personality change, dry mouth when wakening, morning HA, impotence; snoring/choking in sleep, fighting for breath, acid reflux, insomnia vs obesity, large uvula/low hanging soft palate, retro/micrognathia, HTN, cardiac arrhythmia vs PSG, apnea hypoapnea index/resp disturbance index (<5 = nml, 15-30 = mod, >30 = severe OSA) vs C/BPAP, tongue retaining devices, uvulopalatopharyngoplasty, tonsillectomy/adenoidectomy, tracheostomy vs avoid alc, sed, hypnotics, lose wt/exer

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26
Q

narcolepsy sx vs genetics

A

tetrad of excess daytime sleepiness, cataplex (loss of skel muscle tone), sleep paralysis, hypnagogic halluc vs HLA-DQB1-0602, dec CSF hypocretin in post and lat hypothal, fhx

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27
Q

dx vs tx narcolepsy

A

excess daytime sleepiness & cataplex; MSLT vs behavior therapy; ritalin, pemoline, ar/modafinil

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28
Q

insomnia. assoc vs dx vs tx

A

a sx not a dx; difficulty falling/maintaining sleep, waking too early, nonrefreshing sleep. assoc w/ EDS, fatigue, difficult conc, irritability vs when other conditions = ruled out, PSG/MSLT not required vs sleep hygiene, short acting hypnotics

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29
Q

parasomnia

A

violent or subtle motor activity, autonomic or behavioral phenomena in sleep or sleep-wake transition

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30
Q

parasomnia classifications: sleep wake transition vs arousal d/o vs REM vs others

A

rhythmic movements, nocturnal leg cramps, sleep talking vs confusional arousals, sleep terrors, sleep walking vs behavior d/o, nightmares, sleep paralysis vs sleep bruxism, sleep enuresis

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31
Q

sleep terrors/Pavor nocturns

A

terrified screaming w/ autonomic component (tachycardia/apnea, diaphoresis, mydriasis), disorient/confusion when waking; occurs in 1st half of sleeping period N3

32
Q

nightmares. when do they occur in sleep?

A

vivid dreams in REM causing person to wake up b/c emotions in dream threaten sense of security while resting; occurs in 2nd half of sleep during REM

33
Q

REM sleep behavior d/o. assoc w/? PSG shows? tx?

A

skel muscle atonia in REM –> complex motor activity in REM –> talk/laugh, punch/kick. assoc w/ Parkinsons, mult system atrophy, lewy body dementia. high EMG activity during REM. clonzepam 0.5-2mg

34
Q

what part of the brain = master of circadian clock? how do circadian rhythm sleep d/o occur?

A

suprachiasmatic nuclei. physcial environ = altered relative to internal circadian time

35
Q

delayed sleep phase syndrome. tx?

A

sleep = delayed in relation to desired sleep time –> insomnia, difficulty waking at desired time. chronotherapy: intentionally delay sleep onset by 2-3h on successive days until desired bedtime achieved; phototherapy: exposing bright light to stay awake

36
Q

advanced sleep phase syndrome. dx vs tx?

A

sleep early to wake up early; more common in elderly. clincally vs chronotherapy: shift sleeping schedule 2-3h backwards; phototherapy: bright light in evening

37
Q

what are neurocut/Phakamatoses d/o?

A

CNS d/o resulting in lesions on skin, eye, other organs of ectodermal region

38
Q

tuberous sclerosis. tx?

A

auto dom TSC1 on 9q34 + TSC2 on 16q13 –> no hamartin + tuberin –> triad of mental retard, epi, skin lesion (benign hamartoma, adenoma sebaceous, hypomelanin, cardiac/renal tumors, subependymal giant cell tumors). correct hydrocephalus, ctrl epi, monitor other organs

39
Q

NF1

A

auto dom NF1 –> no neurofibromin –> 6+ cafe au lait, 2+/1plexi neurofibroma, axilla freckles, 2+ Lisch nodules, optic glioma, sphenoid dysplasia, 1st relative w/ NF1

40
Q

NF2

A

auto dom NF2 –> no merlin –> vestibular schwannoma, hearing loss, tinnitus, bal probs

41
Q

sturge-Weber syndrome. tx?

A

facial capillary venous malformation/port white stain affecting brain & eye, sz, glaucoma, mental retard/learning disability, hemiplegia/atrophy, behav/emotional probs. laser therapy for wine stains, anticonvulsant/surg for sz, eye drops/surg for glaucoma, PT for paralysis

42
Q

VHL. type 1 vs 2. tx?

A

auto dom VHL tumor suppressor gene –> no VHL protein –> non/cancerous tumors or fluid-filled cysts. low risk pheochromocytoma vs high risk 2A/B/C –> pheochromocytoma, renal cell ca; hemangioblastoma in brain & spinal cord –> HA, emesis, atax; retinal angioma –> vision loss, pancreas tumors. surg, rads therapy, better to tx when small

43
Q

2005 def of sz vs epi. 2014 def of epi?

A

transient abnl/excessive or synchronous neuronal brain activity vs brain d/o w/ predeposition to epi sz & by bio/cog/psych/social conseq of the condition. 2 unprovoked szs >24h apart, 1 sz w/ higher chance of another sz, 2 szs w/ reflex epi

44
Q

simple vs complex partial sz

A

pt = aware of event; can progress to dyscognitive or tonic clonic sz vs pt w/ impaired awareness during sz –> confused, amnesia; 30s-3min

45
Q

absence sz

A

sudden onset w/o aura, prompt offset, momentarily LOC, eye flutter; 3-15s

46
Q

tonic vs atonic sz

A

sudden stiff, max arm extension, extratemporal origin, refractory to therapy, assoc w/ fall/injury; few seconds vs sudden onset, sudden loss in tone, head drop/fall/injury; 1-2s

47
Q

myclonic sz vs tonic-clonic sz

A

sudden jerks, max arm extension, photic/sensory triggered; 1s vs focal/generalized onset, tonic extension of limbs, rhythmic clonic jerking, cess breathing/tongue biting/incont, LOC, post ictal sleep

48
Q

Jacksonian march. area it affectS?

A

focal sz w/ clonic or tonic movements usually face/hands; primary motor cortex –> precentral gyrus

49
Q

how does a sz occur?

A

excitation (gluE, asp NT; Na+/Ca2+ ions), inhibition (GABA; Cl- entering, K+ leaving)

50
Q

what is stroke?

A

vasc event –> focal brain injury; in old def: sxs lasting <24h, in new def: +dmg seen in (diffusion) MRI w/in min or CT w/in 6h

51
Q

what is TIA?

A

pathologically same as stroke but sxs last for less time & not seen in img; have same eval & risk factors

52
Q

ABCD2 interpretation stroke risk: 0-3 vs 4-5 vs 6-7pts. NIH stroke interpretation: 0 vs 1-4 vs 5-15 vs 16-20 vs 21-42

A

low risk vs mod risk vs high risk. no stroke sxs vs minor stroke vs mod stroke vs mod to severe stroke vs severe stroke

53
Q

atherosclerosis vs thrombus vs embolism

A

plaque w/ irreg surfaces building up in blood vessels, usually chol –> block vessel –> stroke vs clot/plaque building up & block vessel in situ vs clot/plaque breaks off –> travels thru till it blocks vessel –> stroke

54
Q

stroke risk factors vs protective factors

A

prev stroke, >65yo, female, black; HTN (tx if >140/90 <60yo or >150/90 >60), high chol (tx if LDL <100 or <70 if concomitant risk); DM/metab syndrome, tobacco esp smoking; soda, high salt, obese, sleep apnea vs cruciferous & green leafy veggies, citrus fruits, juice, coffee, Mediterranean diet, exer

55
Q

rapid stroke eval

A

last seen nml = rtPA clock starts: sudden or gradual onset (grad = stroke mimics like migraines), vasc risk factors, eligibility for rTPA, triage in EMS or ER, labs/head CT

56
Q

yes vs no for rTPA candidate

A

stroke onset w/in 4.5h, >18yo, <185/110, INR <1.7, PLT >100000, blood glu >50
vs
severe head trauma, intracranial/spinal surgery, ischemic stroke past 3mo, heparin w/ 48h, prev or current intracranial blee, aneurysm, tumor, AVM

57
Q

post stroke early vs late complications

A

allergy to rTPA, reperfusion bleed/edema; malig cerebral edema, recurrent stroke, DVT, dysphagia/aspiration –> PNA, infxn vs fall, sz, sleep d/o breathing, depression

58
Q

stroke tx goal for 72h vs long term

A

avoid stroke extension, protect ischemic penumbra: nml saline/no dextrose, >92% satO2, glu >150, temp <99, ASA 325mg 24h post rTPA, don’t lower bp unless >210/100; OT/PT, speech/swallow eval –> bed up 30degrees vs ASA/extended, clopidogrel if allergic to ASA, anticoag

59
Q

what happens if there is hypovolemia/hypoTN?

A

dec cardiac output or hypovolemia –> low bp to maintain perfusion. if systemic hypoTN –> focal artery stenosis –> brain distal to stenosis –> prone to ischemia

60
Q

watershed infarcts. risk factors?

A

systemic hypoTN w/o focal vessel stenosis in watershed regions (b/w ACA/MCA or PCA/MCA). orthostat hypoTN, perioperative, MI, cardiac dysrhythmia, severe lg vessel stenosis

61
Q

intracerebral hemorrhage sxs

A

focal cerebral sxs & deficits, sudden onset severe HA, sz, altered consc, WORSENING in short period of time, ICP

62
Q

intracerebral hemorrhage causes

A

trauma, hem stroke, ishcemic stroke turning to hem stroke, aneurysm rupture/Charcot Bouch pseudoaneurysm/Berry, arterial dissection, amyloid angiography, vasc malformations, tumor

63
Q

hem stroke sxs vs eval vs tx

A

sudden onset neuro deficit, HA, but hard to tell diff b/w ischemic stroke –> vs neuro eval, noncontrast head CT, LP, bp b/c major risk factor vs no anticoag, keep bp <160/80, neurosurg decompression

64
Q

intracerebral aneurysm sxs vs eval vs tx

A

loss of consc w/ focal findings, thunderclap HA, subarach hem, ICP –> irreg breathing, dil pupil, abnl extraocular vs noncontrast head CT, LP if CT neg, cerebral angiography/CTA/MRA vs clip/coil, prevent sz & arterial spasm, supportive

65
Q

berry vs Charc-Bouch aneurysms

A

mult, sac, 2-25mm, in circle of Willis; rupture –> subarach hem or ICH w/o SAH vs chronic HTN, BG/thal/brainstem, <1mm; sm arterioles rupture –> hem stroke

66
Q

arterial dissection features vs eval vs tx

A

carotid = most common but can affect any vessel; pain, HA, focal neuro deficits for wks; assoc w/ SAH vs angiogram, CTA/MRA, LP vs ASA 325mg; if persistent embol –> anticoag, bypass, vein graft; if vertebrobasilr & intracranial dissections –> clip, balloon/graft, reverse flow

67
Q

vascular malformation features vs eval vs tx

A

v/v –> cavernous hemangioma, venous angioma; a/v –> a/v malformations –> more likely to bleed b/ higher pressure –> sz, HA, ICH; smaller = worse than lg vs angio, CTA/MRA, noncontrast CT/MRI vs no tx/monitor for v/v; embolization, radiation, resection for a/v

68
Q

amyloid angiopathy features vs eval vs tx

A

recurrent or petchial lobar hem (seen on gradient echo MRI) vs cerebral bx for amyloid vs no tx, avoid anticoag & anti PLT

69
Q

most common hem brain tumors

A

glioblastoma, primary CNS lymphoma, melanoma, choriocarcinoma, renal cell ca, bronchogenic ca

70
Q

brain abscess forms in which order of lobes? by what bacteria and what can they lead to?

A

front/temp > front-par > par > cerebellar > occ. strep anginosus –> dental plaque, oral abscess

71
Q

direct vs indirect brain abscess. sxs?

A

single abscess –> mid ear, mastoid, sinuses, front lobe vs mult abscesses –> MCA, GW jxn, par lobe. ipsi HA, intracranial HTN, papilledema, meningism

72
Q

eval vs tx of brain abscess

A

high serum CRP & WBC, CT/MRI: ring enhance vs metronidazole to prevent anaerobe DNA synthesis (disulfram rxn if w/ alc)

73
Q

nonop vs op tx for closed head injury

A

hypertonic saline, mannitol/diuresis, hypervent vs EVD w/ CSF drain, surgical decompression

74
Q

spinal vs neurogenic shock

A

temporary, in/complete, contused phenomenon vs loss sympathetic/preserved parasympathetic, hemodynamic phenomenon

75
Q

when to do surg for SDH vs EDH?

A

> 5mm MLs, >1cm thick vs >30cm cubed, GCS <9

Block 3 (23 decks)

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