Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro 1 Final > Clinical Medicine > Flashcards

Clinical Medicine Flashcards

1
Q
  • Neonate assessment - ventricle size and hemorrhage

- No significant use in adults

A

Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  • Head trauma
  • Acute hemorrhage
  • Sinusitis
  • Orbital trauma
  • Spinal trauma (NO cord symptoms)
A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  • Spinal trauma (cord symptoms)
  • Specific
  • Soft tissue
  • Nerve pinches
  • Cord contusions
A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

To image a pt that has metal in his or her head, use:

A

Plain film

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gold standard imaging modality for tumors and aneurysms

A

Angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  • Fastest exam (less than 5 min)
  • Most accurate
  • Most info
A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Imaging modality for stenosis and calcification:

A

CT angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pituitary adenoma < 10 mm is classified as a:

A

Microadenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Imaging modality for pituitary adenoma:

-What planes are best? (2)

A

MRI

-Coronal and sagittal planes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Intensely _______ MRI for acoustic neuroma.

A

Enhance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A hemosiderin ring means that the tumor is:

A

Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Imaging modality for Multiple Sclerosis:

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Imaging modality for Metastatic Disease:

A

CT

smaller mets only seen in MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Coup is from:

A

Direct impact on stationary brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Angiography is gold standard for: (2)

A
  • Tumors

- Aneurysms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Imaging modality for:

  • Soft tissue
  • Cord contusion
  • Nerve pinches
  • Specificity
A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Imaging modality for choroid plexus CA:

A

MRI

see it within ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Contracoup is from:

A

Impact of moving brain on stationary calvarium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q
  • 72% caused by ruptured aneurysms (spontaneous)
  • May also occur with cerebral contusion (trauma)
  • Injury to leptomeningeal vessels at vertex
  • Rupture of major intracerebral vessels
A

Subarachnoid hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

TQ: Worrisome Signs

Signs which may indicate HA of pathological origin (Secondary HA): (10)

A
  • “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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Primary HA disorders: (4)

A
  • Common migraine (w/o aura)
  • Classic migraine (with aura)
  • Tension-type HA
  • Cluster HA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

As a general rule, many physicians believe that any person with HA should have a one-time, thorough:

A

Neuroimaging study - CT or MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Any patient with a “worrisome history” or abnormal examination needs an urgent imaging study and perhaps even an __.

A

-Lumbar puncture (LP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Remember: CT can miss 5-10% of subarachnoid hemorrhages and a ______ ________ may be needed if the CT is normal!

A

-Lumbar puncture (LP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

-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)

A

Common migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

-Aura present (15-30 min, sometimes longer … commonly visual symptoms- e.g., scintillations, scotoma - often hemianopic)

A

Classic migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q
  • Mild to moderate intensity*
  • Does not prohibit daily activities*
  • Females 3:2 Males
  • Location: Bifrontal, bioccipital*
  • Dull, aching, squeezing, pressure*
  • NO prodrome or aura
A

Tension-type HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q
  • 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
A

Cluster HA

  • Tx with 8L of 100% O2 face mask
  • Verapamil
35
Q

Contraindications to Triptan usage: (7)

A
  • 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
Q

How is the DHE protocol and the Triptan protocol similar?

A

Same general contraindications

37
Q

Subtypes of stroke: (2)

A
  • Hemorrhagic (20%)

- Ischemic (80%)

38
Q

Risk factors for stroke: (multiple)

A
  • 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
Q

Emergent Dx and Tx: (5)

A
  • 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
Q

T/F: Acute HTN is common in acute ischemic stroke and in most cases should NOT be treated. (170/100 should be left alone.)

A

TRUE
-The area of infarction may have lost autoregulatory function, so that “normal” BP may be relatively hypotensive in the brain

41
Q

T/F: IVFs should NOT include glucose as hyperglycemia is assoc with worse neurologic outcomes.

A

TRUE

42
Q

NIH Stroke Scale: 0-42 (coma)

  • Score < 10 =
  • Score > 10 =
A
  • Score < 10 = 2-3% risk of hemorrhage

- Score > 10 = 17% risk of hemorrhage

43
Q

IV Thrombolytic Therapy

Tx of acute ischemic stroke:

A

t-PA

Tissue Plasminogen Activator

44
Q

Antiplatelet agents for Tx of stroke: (3)

A
  • ASA
  • Aggrenox
  • Plavix
45
Q

TQ: Percent (+) findings for epilepsy on a SINGLE EEG:

  • All types:
  • Generalized Tonic/Clonic:
  • Petit mal (with HV)*:
  • Partial:
A
  • All types: 40% (60% MISS)**
  • Generalized Tonic/Clonic: 20%
  • Petit mal (with HV): 90% **
  • Partial: 30%
46
Q

TQ: Percent (+) for epilepsy (all types) when doing 3 sleep-deprived EEGs:

A

85%

(Value in repeating the test)***

47
Q

Although the EEG is an impt tool in the Dx of epilepsy, the single most impt information is _______ of the event - preferably by witnesses.

A

History

48
Q

Seizure classification: (2)

A
  • Partial seizures

- Generalized seizures

49
Q

Partial seizure subtypes: (3)

A
  • Simple partial
  • Complex partial
  • Secondarily generalized (Partial onset)*
50
Q

Generalized seizure subtypes: (7)

A
  • Absence (Petit mal)
  • Tonic-clonic
  • Myoclonic
  • Tonic
  • Clonic
  • Atonic
  • Clonic-tonic-clonic
51
Q

What area of the brain is surgically treated for Partial (“focal”) onset seizures?

A

Hippocampus

52
Q

TQ: Drug used for absence seizure ONLY:

A

Ethosuxamide

53
Q

Drug used for absence or primary tonic-clonic:

A 
Valproic acid (esp. males)
-Teratogenic! Avoid in pregnant women.
54
Q

Other drugs which may be effective for primary generalized sz: (4)

-Use for women!

A
  • Lamotrigine
  • Levetiracetam
  • Topiramate
  • Zonisamide
55
Q

Carbamazepine (CBZ) has drug interaction with:

A

Oral contraceptives

56
Q

CBZ or phenytoin has long term side effects, such as:

A

Bone loss

57
Q

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:

A

Best controls her seizures

58
Q

TQ:

  • Pale (pallor)
  • Sweating (diaphoresis)
  • Abnormal head position
  • Lightheadedness
  • Positionally related (usually stand and then go down)
  • Slow onset
  • Brief unconsciousness
A

Syncope

59
Q

TQ:

  • Urinary or bowel incontinence
  • Tongue injury
  • Tonic/Clonic movements
  • Blue or red in color
  • Postictal state (takes longer to become aware of surroundings)
A

Seizure

60
Q

Hyperreflexia graded as:

Characteristic of what type of lesion?

A

3/4 or 4/4

-UMN lesion

61
Q

Babinski sign (aka extensors of plantar reflex):

A

UMN lesions

62
Q

Pt has L5 rediculopathy. What might you expect to find on exam?

A

Weakness of big toe extension

63
Q

Patellar tendon reflex:

A

L4

64
Q

Achilles reflex:

A

S1

65
Q

Brachioradialis reflex:

A

C6

66
Q

Triceps reflex:

A

C7

67
Q

T/F: You expect to see a “sensory level” in a pt with a spinal cord abnormality.

A

TRUE

68
Q

Typical triggers for migraine: (4)

A
  • Stress
  • Weather change
  • Hormonal
  • Strong odors/lights
69
Q

Can a migraine be U/L, B/L, or either?

A

Either U/L OR B/L.

70
Q

Why is having a U/L migraine a good thing when compared to tension headaches?

A

Tension headaches are generally B/L.

71
Q

TQ: What’s the MC cause of breakthrough seizure?

What are a few other causes for breakthrough seizure? (2)

A 
TQ: Noncompliance 
(Not taking meds)
-Infection
-Sleep deprivation
-Quinolones (GABA inhibitors... glutamate increases)
72
Q

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)

A
  • BC = Levetiracetam (Keppra)
  • Depressed = Lamotrigine (Lamictal)
  • Japan = Zonisamide
73
Q

TQ: What is Todd’s (“Postictal”) paralysis? How long does it last? What parts of the body are usually affected?

A

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
Q

TQ: Difference between simple partial and complex partial seizures:

A
  • 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
Q

TQ: What are some things that can mimic stroke? (4)

A
  • Blood glucose abnormalities (hyper- or hypo-)
  • Migraine
  • Hepatic abnormalities
  • Postictal (“Todd’s”) paralysis
76
Q

Treatment of stroke (meds):

-Long-term maintenance to prevent another from occurring: (6)

A

-Aspirin, Agrinox, Plavix, Pradaxa, warfarin/coumadin, Xarelto

77
Q

TQ:
Long-term maintenance of stroke.
FULL anti-coagulants: (3)

A
  • Warfarin
  • Pradaxa
  • Xarelto
78
Q

Indications for full anti-cogaulation: (5)

A
  • Atrial fibrillation
  • Artificial heart valves
  • Hypercoagulable states (Antiphospholipid syndrome, etc.)
  • Atrial septal defect
  • Low ejection fraction (15-20%)
79
Q

If no reason to put pt on full anti-coagulants, what can you put them on? (3)

A

Anti-platelet agents:

  • Aspirin
  • Plavix
  • Agrinox (combo med)
80
Q

What do you expect to see on the CT of a patient with acute stroke?

A

Usually normal!

81
Q

TQ: How will a stroke appear on CT that has been forming over a longer period of time (hours to days)?

A

Hypodensity* or darkness in the area where the stroke is

82
Q

In ER, someone is brought in with acute stroke, what do you do? (Start to finish)

A
  • ABCs
  • IV access
  • Order labs
  • PT/PTT
  • Urinalysis
  • CT
  • EKG/Echo
  • Do NOT give hypertension meds**
83
Q

Decreased ejection fraction of heart. Think:

A

Cardiomyopathy

Neuro 1 Final (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions