Day 3 - radiology, neurology Flashcards
1
Q
cavitary lesion in upper lobe = think?
A
TB
2
Q
intubation then sudden white out on L afterwards indicates?
A
Tube in R main bronchus –> airway obstruction of L
3
Q
Next step after intubation?
A
Xray to make sure in right place
OR
Listen to lung to ensure it is in right place
4
Q
Numerous eosinophilic cells n bronchioalveolar lavage = think?
A
Eosinophilic pneumonia
5
Q
What medications decrease mortality in CHF pts?
A
- ACE
- Beta blockers
- Spirinolactone
6
Q
What decreases mortality for COPD pt?
A
- Oxygen
- Stop Smoking
7
Q
What disease has kidney issues + cerebral aneurysm + cardiac valve issues?
A
polycystic kidney disease
8
Q
polycystic kidney disease associated w/?
A
- aortic aneurysm –> AR, sometimes MVP
- berry aneurysm
- liver cyst
- Kidney issues
9
Q
What 3 diseases associated w/ aortic aneurysm, cardiac valve issues, and berry aneurysm?
A
- Polycystic kidney disease
- Marfans
- Erhlos Danlos
10
Q
tumor starts outside of the brain but next to it = think?
A
meningioma
11
Q
tumor starts outside of the brain but next to it + pressing on temporal lobe = think?
A
meningioma
12
Q
alcoholics w/ bloody cough = think?
A
Klebsilla or at least gram neg rods
13
Q
pulm issue after being in CAVES = think?
A
Histoplasmosis
14
Q
brain tumors 2 most common types?
A
- metastasizes
- glioblastoma
15
Q
workup of valve disease -?
A
initial - Transthoracic echo
2) Transesophageal echo
Confirmatory/gold standard - Catheterization and angiography
16
Q
Work up for ejection fraction issues –?
A
initial - Transthoracic echo
cofirmatory/gold standard - MUGA scan
17
Q
L sided colon CA most common presenting symptom =?
A
Obstruction
18
Q
R sided colon CA most common presenting symptom =?
A
Microcytic Anemia/bleeding
19
Q
60 yo w/ iron deficiency anemia most likely cause?
A
Colon cancer (likely R sided)
20
Q
tubular, “finger like” consolidation in lung = think?
A
Allergic bronchopulmonary aspergilosis
21
Q
Central mass (closer to trachea) get biopsy how?
A
Bronchoscopy (needle through bronchus)
22
Q
Peripheral mass (closer to outside of lung) get biopsy sample how?
A
CT-guided lung biopsy
23
Q
Lung Nodule dx pathway?
A
1) Xray
2) CT
3) Biopsy
4) PET scan
24
Q
multiple ring enhancing lesions in HIV pts = think?
A
Toxo
25
1 ring enhancing lesion in HIV pt = think (2)?
- Toxo
| - Primary CNS lymphoma
26
Treatment of toxo = ?
Pyrimethamine and sulfadiazine
27
HIV pt w/ single solitary ring enhancing lesion on imaging, what is next step?
Brain biopsy to determine proper treatment
28
ankylosing spondylitis treatment?
- NSAIDs (indomethacin)
- if above doesn't work, then start intense autoimmune meds that are not steroids (DMARDs - Disease-modifying antirheumatic drug)
29
Ankylosing spondylitis give steroids or not?
NO
- doesn't work well
- may predispose to spinal fracture b/c it predisposes to ostepenia
30
Subfalcine herniation would present with what on imaging?
Midline shift
31
image of cerebellar head asking about herniation = think?
Cerebellar tonsillar herniation
32
Transtentorial herniation presents how on imaging?
Roof of cerrebellum (tentori), brain can push through tentori --> see tentori and brain appears to be squishing brainstem (uncal may appear similar)
33
Transcalvarial herniation presents how on imaging?
Brain pushes through skull (ie through fracture)
34
polycystic kidney disease caused by what?
Defect in epithelial cell differentiation
35
Mutation Transmembrane Conductance Regulator Protein = think?
Cystic Fibrosis
36
Mutation of a connective tissue protein think?(2)
Marfans (fibrillin) or Erlos Danlos
37
Treatment for breast cancer = ?
1) Surgery - lumpectomy v mastectomy (size determines)
1a) w/ lumpectomy ALWAYS do radiation too (regardless of nodes)
2) Add Chemo for cases w/ CA in nodes/metastases
3) Add Tamoxifin - only for those that are estrogen receptor +
38
Reasons to admit to ICU ()?
- Need to intubated
- Renal failure (pre, post, ATN)
- VS severely abnl (esp RR >30)
39
Fine tremor at rest = think?
Parkinsonism
40
tinnitus, hearing loss, vertigo = think?
Meniere's Disease
41
Positional vertigo = think?
Benign positional vertigo
42
Vertigo due to medication/toxin is?
Toxic labyrinthitis
43
Toxic labyrinthitis can be cause by what family of meds?
Aminoglycoside
44
Vertigo non-positional, not due to meds, w/o hearing loss = think?
Vestibular neuronitis (Benign recurrent vertigo)
45
Teenage boy w/ bleeding nasal mass is?
Juvenile nasopharyngeal angiofibroma
46
treat juvenile naopharyngeal angiofibroma how?
Embolization
47
opthalmoplegia + alcoholic = think?
Wernike encephalopathy b/c thiamine deficiency
48
Wernike encephalopathy treat how and in what order?
Give thiamine BEFORE glucose
49
best initial test for dx of guillane barre in non-emergent case?
CSF studies
50
Confirmatory/gold standard test for dx of guillane barre in non-emergent case?
Motor nerve conduction test
51
fasciculations are a what type of motor neuron problem?
LMN
52
Deep tendon reflex are brisk indicate what type of motor neuron problem?
UMN
53
UMN and LMN problems = think?
ALS
54
MVA and clear discharge from ear --> concerned for? Dx by?
CSF leak
| Test w/ Beta 2 transferrin
55
Test for CSF fluid with?
Beta 2 transferrin level
56
lambert eaton pathophys?
Ab-mediated detruction of presynaptic calcium channels
57
Muscle weakness improved with activity = think?
Lambert Eaton
58
Muscle weakness worse with activity = think?
Myasthinia Gravis
59
What is associated w/ Lambert Eaton?
Lung CA
60
Myasthinia Gravis pathophys?
Immune-mediated nicotinic acetylcholine receptor blockade
61
Lambert Eaton pre or post synaptic?
PRE-synaptic
62
Myasthinia Gravis pre or post synaptic?
POST-synaptic
63
Dandy Walker is?
Absence of the posterior cerebellar vermis
64
Chiari malformation type 1 = ?
Type I involves the extension of the cerebellar tonsils (the lower part of the cerebellum) into the foramen magnum, without involving the brain stem. Normally, only the spinal cord passes through this opening.
65
Chiari malformation type 2 = ?
"Arnold Chiari" involves the extension of both cerebellar and brain stem tissue into the foramen magnum. Also, the cerebellar vermis (the nerve tissue that connects the two halves of the cerebellum) may be only partially complete or absent.
66
Chiari malformation type 2 associated w/?
myelomeningocele
67
Chiari malformation type 1 associated w/?
syringomyelia/spinal cavitations
68
tongue deviated to one side = ?
Hypoglossal nerve damage
69
Tongue deviated towards the lesion or away?
TOWARDS -- "Lick the Lesion"
| hypoglossal nerve
70
issue in caudate = think?
Huntington's disease
71
Winged scapula = what nerve damaged?
Long thoracic nerve
72
morning headaches = think?
Inc ICP
73
morning headaches --> think Inc ICP + worry about what types of masses (2)?
1) Astrocytoma
| 2) Medulla blastoma
74
Trigeminal neuralgia treatment?
Carbamazipine
2nd line gabapentin
75
MRI shows what for Trigemnial neuralgia
NOTHING!
76
nuchal rigidity + severe headache = dx pathway?
CT head w/o contrast
| LP if CT head non-diagnostic
77
Nuchal rigidity happens when?
meniges are irritated
1) Meningitis
2) Subarachnoid Hemorrhage
78
In SIADH what is the vol status and urine sodium?
Euvolemic or hypervolemic (chronic v acute)
Urine Na HIGH bc water being sucked out
79
Reasons to give contrast w/ CT?
If worried about:
- infx
- tumor
- something in a vessel (embolism, mass, etc)
80
nL lab values (esp CK) + muscle weakness + on steroids = ?
Steroid induced muscle weakness --> taper
81
Hearing Loss diff dx (5)?
- Meniere disease (+tinnitus, vertigo)
- Acoustic neuroma (+tinnitus, vertigo, mass on imaging)
- Presbycusis (sensory-neural hearing loss, old ppl)
- Chronic otitis media (hx, TM scarred/bulging/dull)
- Otosclerosis (conductive hearing loss, genetic)
82
Pain in the eye/around eye + watery eye = think?
Cluster headache
83
Treat cluster headache (2)?
Step 1) Oxygen
| Step 2) Sumatriptan
84
Trigeminal Neuralgia treat?
Carbamazepine
85
Treatable causes of dementia
- Pseudodementia (depression)
- Hypothyroid
- Syphillis
- NPH (get CT/MRI)
- B12 deficiency
86
IV drug user + back pain = think?
Epidural abscess
87
Test for epidural abscess w/?
MRI (sensitive + specific)
88
things for child abuse
- CBC
- coag studies
- Chem panel
- Fundoscopic exam
- CT head
- skeletal scan
89
Most common pituitary tumor in kids =?
craniopharyngioma
90
Craniopharyngioma looks like
cystic
91
Cause of Lambert Eaton?
Lung CA
92
degenerative joint disease + back pain + neurological claudication = indicates?
spinal nerve compression (spinal stenosis)
93
DJD + back pain + neurological claudication + MRI show compression of nerve roots, next step?
Treat spinal stenosis w/ surgical decompression
94
ant spinal a. occlusion --> what nerve findings?
Sudden pain + temp loss
Sensory intact
95
Dry mouth, dry eyes, = think?
Sjogren Syndrome
96
What Ab found in Sjogren?
Anti-SS, Anti-Rho
97
Sjogren syndrome effect fetus how?
Congenital AV block
98
Sjogren syndrome pathophys =?
Lymphocytc infiltration of salivary and lacrimal glands
99
Essential tremor treated w/?
Beta Blocker
100
Pseudoclaudication -?
Neurologic claudication, can result from spinal stenosis --> compression of nerves
101
Huntington's treat?
Anti-psychotic (ie haloperidol)
102
Gold standard confirmatory test for Myasthenia Gravis?
EMG under repetitive stimulation
103
Prevent migraines/headaches - ?
Beta blockers
104
Abort meds for migraines?
Sumatriptan
105
brain death gives you what type of pupils --> ?
Dilated
106
Opiate overdose type of pupil?
Constricted (pinpoint)
107
Anticholinergic agent overdose type of pupil?
Dilated
108
Brainstem hemorrhage type of pupil?
Dilated
109
low back pain + fever = think?
Epidural abscess
110
itchy rash + asthma + excoriation + papules + other family member w/ = think?
Eczema
111
Treat Eczema ?
Regular use of over the counter bland emollients
112
Acne treatment (mild, mod, severe) ?
mild - topical drug (esp benzoyl peroxide)
mod - oral doxy +/- topical retinoid
severe - isotretinoin
113
scaly, keratotic, erythematous macules and papules on the anterior scap, arms, and dorsal hands = t
Actinic keratosis
114
Actinic keratosis puts at risk for ?
squamous cell CA
115
Erythema nodosum details?
PAINFUL on shins, many autoimmune diseases associated w/
116
Pyoderma gangerenosum details?
Associated w/ Ulcerated Colitis, NOT painful
117
Ulcerated colitis associated w/ what type of cutaneous disease?
Pyoderma gangerenosum
118
Crohn's associated ssociated w/ what type of cutaneous disease?
Erythema nodosum
119
Actinic keratosis caused by?
Excessive Sun exposure
120
Squamous cell CA can be caused by?
- Excessive sun exposure
| - Arsenic
121
Silica predisposes to?
TB bc weakens upper lungs
122
Arsenic exposure predisposes for?
Squamous Cell CA
123
Vitiligo caused by?
Autoimmune destruction of melanocytes
124
3 categories of drugs often associated w/ allergies?
- Abx: Penicillin or Cephalosporin
- Sulfa drugs
- NSAIDs
125
Pitarysis rosea clinical findings?
1) heralding patch (1 patch)
| 2) Christmas tree distribution (2nd rash comes in that is more diffuse)
126
Compound nevus found ?
Multiple layers of epidermis + dermis
127
Intradermal nevus found?
Dermis
128
Lentigo is?
benign pigmented macules that result from increased activity of epidermal melanocytes
129
Junctional nevus found?
Dermoepidermal junction
130
Halo nevus?
a mole that is surrounded by a depigmented ring or 'halo' associated with vitiligo
131
Vermilion border lower lip
Squamous cell CA
132
Upper lip
Basal cell CA
133
pearly papule = think?
Basal cell CA
134
greasy mole = think?
Seborrheic keratosis
135
Most imp pronostic factor in melanoma?
Depth
136
hypopigmented patches = think?
Tinea Versicolor (caused by malassezia fungi)
137
Treat Tinea Versicolor?
Selsin blue shampoo
138
Tinea Versicolor cause by?
malassezia fungi
139
Dermitis herpetiformis associated w/?
Celiac disease
140
Anti-tissue transglutaminase Ab associated w/?
Celiac disease
141
vesicles w/ erythematous base w/ excoriations on extensor surfaces (elbows knees) = think?
Dermititis herpetiformis
142
Treatment for CMV
Ganciclovir
143
Treatment of Shingles?
Valcyclovir
144
Vascular raised papule w/ thin collarette of scale = think?
Pyogenic granuloma (misnomer)
