FINAL Flashcards
what are meningitis signs?
HA photophobia neck stiffness Brudzinski’s sign Kernig’s sign
what are signs of intra cranial pressure signs?
- CUSHING TRIAD (hypertension + bradycardia + abnormal respiration)
-projectile vomiting
-unilatral change of sensation a/o muscle weakness
-severe HA, uneven pupils
as mental status is declined
neurological examination includes?
- identification of mental status
- cranial nerves
- muscle strength
- gait
- stance
- coordination
- dermatomes
- spinal reflexes
- comparison of pulses (central and peripheral
pupillary and accommodation reflex
sensory CN 2 / optic
motor CN 3 / oculomotor - constrict pupil and lense accommodation for near vision (consensual reflex)
corneal reflex
sensory CN 5 /trigeminal - feeling that cornea is being touched
motor CN 7 / facial - blinking
gag reflex
sensory CN 9 / glossopharagneal
motor CN 10 / vagus - gagging
what are two major arteries, as the branches of the brachia-cephalic aortic trunk on both sides, that serves as origin of circle of willis?
vertebral and common carotid
which part of circle of willis supply blood to occipital lobes of cerebrum, brain stem, cerebellum? and what are these areas of brain responsible for?
posterior cerebral arteries
for vision, vital centers, and maintenance of equilibrium (respectively)
which part of circle of willis is responsible for supplying lateral parts of cerebrum?
what are these areas of brain responsible for?
*middle cerebral arteries
brain cortex are responsible for functioning of upper part of trunk and upper extremities + speech
what is most commonly affected arteries in stroke (CVA)?
middle cerebral arteries
why does fracture or other types of injuries to the face (eye, nose) may compromise brain circulation?
because internal carotid arteries, which are origin of middle cerebral arteries, climb to the circle of willis via the cavernous sinuses
which part of circle of willis is responsible for supplying blood to superior parts of the brain and the diencephalon? and injury to this reflects?
anterior cerebral arteries
reflected on dysfunction of lower trunk/lower extremities and diencephalon
what are 2 types of stroke or cerebra-vascular accident (CVA)? what percentages do they make up?
ischemic (embolic) - 90%
hemorrhagic
major etiology of ischemic stroke is?
systemic arterial hypertension + atherosclerosis and thrombosis
*usually from heart –> brain
[different from DVT, leg –> Lung]
major etiology of hemorrhagic stroke
malignant arterial hypertensions associated with aneurysm within circle of willis (for ex ADPKD) or trauma
in which neuron injury, will you see exaggerated spinal reflexes? what other signs will you see in this injury?
upper motor nuron (bc brain damage, spinal loop…)
- Baginski’s reflex present
- spastic muscle on affected (central-lateral) side
- muscle fasciculation (isolated muscle contraction)
in lower motor neuron injury, you will see?
- spinal reflex diminished or absent
- weakness of muscle on contra-lateral side of body
upper motor neurons are presented by what?
motor area neurons of brain and cortico-spinal (pyramidal) tract, composed of their axons before they synapse with LMN, situated in ventral horns of spinal cord.
which is the “Talk or Die” hemorrhage? why is it called this?
-where is it an injury to?
epidural (extra-dura) hemorrhage/hematoma
- trauma to meningeal arteries, which are superficially locked in grooves of skull above dura
- person will lose consciousness briefly due to shaking of reticular formation of brain stem, then gain consciousness for a short while and again lose consciousness due to accumulation of hematoma and herniation of brain as result of blood clot gravity
injured veins of brain within subdural space (also called the bridging veins) causes, what type of hemorrhage?
what are red flags for this condition
subdural hemorrhage
bridging veins have low pressure, the hemorrhage, originated from them could be acute, sub-acute, or even chronic.
RED FLAG - patient present with chronic increasing in severity HA
the “worse HA of one’s life” can result from which brain hemorrhage?
causes?
subarachnoid hemorrhage
can be trauma or spontaneous bleeding from circle of willis arteries and their branches (stroke, aneurysm rupture)
what is hydrocephalus, it can result in?
accumulation of cerebra-spinal fluid within system of circulation
regardless of etiology, can result in motor, sensory deficit, demential in adults, and neurological/mental retardation in newborn
what is non-communicating hydrocephalus?\most common in?
due to obstruction as per blockages such as adhesions, malformation of CSF system
- congenital malformation (rebulla during pregnancy, fetal irradiation), or adhesion due to meningitis or menage-encepalitis
what is communicating hydrocephalus?
most common in?
atrophy of arachnoid granulations (villi) of arachnoid membrane (meninx)
-geriatrics
arachnoid villa returns CSF to venous sinus
dementia is defined as?
profound loss of CONTENT of consciousness
most common type of dementia is ?
alzheimer’s disease
what is pathogenesis of Alzheimer’s
abnormal deposition of AMYLOID, tau proteins, creating neurofibrillary tangles and amyloid plaques, that disrupt normal communications of neurons within system of basal ganglia and limbic system
which dementia is due to systemic arterial hypertension and ischemic heart disease / atherosclerosis
vascular dementia
name different types of dementia?
alzheimer vascular dementia post stroke dementia parkinson's dementia hydrocephalic dementia brain trauma dementia drug related dementia
parkinson’s always includes?
muscular spasticity rigidity hypokinesia bradykinesia mask-like face resting tremor
what is Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis)?
what famous scientist has it?
degenerative disease of UMN and LMN of unclear etiology
-gradual atrophy of motor neurons and corresponding muscles, but SENSORY is all preserved
Stephan Hawkings
what is meningitis? it result in?
inflammation of meninges
result in malfx of brain, high potential of systemic complications as septicemia, Disseminated Intravascular Coagulation, shock, failure of vital organs, including hemorrhage into adrenal gland (Waterhouse-Friderichsen Syndrome) and death
what is most dangerous type of meningitis?
Bacterial
- infants can be affected by E. Coli, Listeria, Homophiles influenza, Strep pneumonia
- teens affected by Neisseria meningitides
- elderly affected by S. pneumonia
immune compromised people are prone to what type of meningitis?
fungal
what will you see in bacterial meningitis that you won’t see with other types?
glucose content of CSF will be decreased, bc bacteria is interested in glucose
what labs will you see in fungal meningitis?
in viral?
fungal meningitis - monocytosis
viral meningitis - lymphocytosis
in Left-side stroke, what will you see?
functional loss or motor skill impairment of Right side of body,
+
maybe loss of speech
what will you see in Right side stroke?
functional loss or motor skill impairment of LEFT side of body,
+
*impairment of normal attention to left side of body and surroundings (bc right brain is responsible for space orientation)
stroke affecting cerebellum may cause?
dizziness, nausea, balance and coordination problems
stroke affecting brain stem causes?
malfx of breathing, and heartbeat
also, may have double vision, nausea, loss of coordination
gene coding for cerebral amyloid (Alzheimer’s), is on chromosome 21, how does this relate to Down Syndrome
persons with trisomy 21 (down syndrome) usually develop Alzheimer by 40 years of age
what will you see in CSF analysis in Bacterial meningitis?
-turbidity
-increased protein CSF level
-decreased glucose
-neutrophils in blood and CSF
bacteria in CSF
-increased pressure upon CSF -withdrawal - penetrate dura with syringe
what is brudzinski’s sign
severe neck stiffness causes patient’s hips and knees to flex when neck is flexed
what is kerning’s sign
severe stiffness of hamstring causes an inability to straighten leg when hip is flexed to 90 degrees
when is spinal tap contraindicated?
with increased intra-cranial pressure
definition of sinus HA
pain usually behind forehead and/or cheekbones
definition of cluster HA
pain is in and around one eye
definition of tension HA
pain is like a band squeeing head
definition of migraine HA
pain, nausea and visual changes are typical of classic form
what is generalized seizures?
produced by electrical impulses from throughout entire brain
what is partial seizures?
produced (initially) by electrical impulses in relatively small part of brain
what are 6 types of generalized seizures?
1) grand-mal *most common - collapse, loose consciousness, body stiffening (tonic), violent jerking(clonic)
2) absence (petit-mal) - short loss of consciousness
3) myoclonic - sporadic jerks
4) clonic - repetitive, rhythmic jerks
5) tonic - stiffening of muscles
6) atonic - sudden loss of muscle tone (arm and legs usually)
what are febrile seizures?
occurs most often in otherwise healthy child between 9 months to 5 years
- toddler most commonly affected, runs in family
- most febrile seizures occur in first 24hrs of an illness, and may not occur when fever is highest
- can be triggered by ear infection, or any cold or viral illness
name the 12 cranial nerves and whether they are motor, sensory of both?
Oh, Oh, Oh, To, Touch, And, Feel, Very, Green, Vegetables, A H
Some Say Marry Money But My Brother Says Bigger Boos Matter More
testing reflex biceps brachi
C5 - C6
testing reflex triceps brachii
C6-C8
testing reflex quadriceps femoris (knee jerk)
L2-L4
testing reflex gastrocnemius (ankle jerk)
SI-S2
dermatome testing for shoulder?
C4 - C6
dermatome for index fingers
C6
dermatome for middle finger
C7
dermatome for ring and little finger
C8
dermatome for nipple
T4
dermatome for umbilicus
T10
dermatome for knee
L3
dermatome for ball of foot, great toe
L5
dermatome for rest of sole
S1
Alert, normale leve lof consciousness means?
orient to self, time, and place + perceives and responds/remember to new/current stimuli
disturbed level of consciousness with impaired ability to think clearly, and to perceive, respond to, remember current stimuli, somewhat disoriented means?
confusion
disturbed state of consciousness with motor restlessness, hallucinations, severe disorientation, sometimes, delusions mean?
delirium
decreased alertness with psychomotor retardation is?
obtundation
little spontaneous activity, mostly to painful stimuli means?
stupor
what are the content of consciousness?
short and long term memory abstract thinking intellectual fx judgement speech content of thought mood and affect
perception of non-existing stimulus is?
hallucination
wrong/abnormal identification of existing stimulus is?
illusion
abnormal thought process, which can not be corrected by judgment is
delusion
which disease is also called Waterhouse-Fridrichesen’s syndrome?
Meningococcemia - a fulminant disease caused by several groups of Neisseria meningitides - cause of death is adrenal necrosis with vascular collapse
- type of bacterial meningitis
what are distributive septic shock signs?
tachycardia
hypotension
cold + clammy hands
*above are signs for all shock, this with rash and fever will be sepsis
what is digoxin
cardiac glycoside - this drug increases force of contraction and gives more stamina to heart, used to control Atrial Fabulation
-can be used in tx of Cerebrovascular accident (stroke)
abnormal pupil indicates damage to which cranial nerve and which part of brain?
CN III, and always in midbrain (so can happen in midbrain hemorrhage)
laceration of bridging veins can result in?
displacement of brain and possible cerebral herniations
can happen in Subdural hematoma (accumulation of blood bt dura and arachnoid)
congenital berry aneurysms are associated with what disease?
polycystic kidney disease and arteriovenous malformation - they may rupture during straining (sex, wight lifting, etc) and cause subarachnoid hemorrhage
what are most common ruptures sites of artery? in order
- circle of willis
- abdominal aorta
- thoracic aorta
what is Guillain-Barre syndrome?
demylineation on perisperhal neuronal sites, going toward brain
-very rapid progression, within 48-72 hrs of infection
-it tis common cause of polyneuropathy in adults that is usually proceeded by GI or respiratory infection or by specific illness such as Epstein-Barr, Campylobacter enteritis, and cytomegalovirus infections. respiratory paralysis may occur, necessitating mechanical ventilation
how do you differentiate bt parkinson and alzhemiers?
usually in parkinson, demential is last step of disease progression. first you will have mostly motor neuron deficit, with muscle rigidity
what is colposcopy?
“colpos” means cervix, examination of cervix, vagina, vulva; if your pap smear is abnormal
vaginal bleeding, vague abdominal/pelvic discomfort, esp. in combination with amenorrhea in female of reproductive age is Red Flag for?
cervical cancer
what is infection that affects all or most of reproductive organs?
(cervix, tubes, uterus, ovaries)
PID
what signs suggest PID?
adnexal and cervical tenderness
pain with menses is? what is primary and secondary condition of this?
dysmenorrhea
primary - pain occurs at beginning of menses cycle or during
secondary - pain with menses due to underlying pathological cause such as fibroids, endometriosis
infrequent, light menses is called?
oligomemorrhea
heavy menses is called?
menorrhagia
irregular uterine bleeding, particularly between expected menses is?
metorrhagia
examples of bacterial infections of FRS are?
STD –> gonorrhea, chlamydia, syphills, strep, stap
examples of viral infections of FRS are
herpes genitalis, HPV
examples of fungal infections of FRS are
candida albicans
examples of protozoal infections of FRS are
trichomonad vaginalis
what are risk factors of PID?
young age of sexual activity STD multiple sex parters intra-uterine contraceptive device IUD neglecting GYN checkup
leading cause of ectopic pregnancy and infertility is what disease?
PID
post-coital bleeding is red flag for what disease ?
genital cancer (ex cervical cancer)
exposure to STD, esp HPV infection sex at early age multiple partners smoking are risk factors for?
cervical cancer
S&S
found during middle and later reproductive years
mostly asymptomatic, they can grow and cause heavy and painful menses
painful sexual intercourse
urinary frequency and urgency
these are s&s of Uterine Fibroids
vaginal bleeding in postmenopausal women is red flag for?
Uterine cancer
Ovarian Cancer
which disease has following risk factors? obesity diabetes hypertension family history un-opposed estrogen polycystic ovary syndrome nulliparity late menopause
uterine / endometrial cancer
what are triad clinical symptoms of endometriosis?
dysmenorrhea
dyspareunia (painful intercourse)
infertility
if endometrial tissues are imbed in pleural what happens?
when this sheds according to menstrual cycle, it will cause catamenial pneumothorax
pouch of douglas is significant for?
endometriosis, when endometrial tissues imbed in posterior-cul-de-sac (between rectum and posterior wall of uterus)
what FRS condition has following S&S and risk factors?
painful and heavy menses
women bt 35-50
multiparous female
adenomyosis
acute abdominal pain in woman of childbearing age is red flag for?
ectopic pregnancy
in which FRS cancer, risks increases with age and decreases with pregnancy? and is affected by mutation in BRAC 1 and 2 gene?
Ovarian cancer
what is most common endocrine disorder of FRS?
polycystic ovary syndrome
the triad of symptoms and other S&S occur in which FRS disorder?
1) obesity (although 45% are not obese)
2) anovulation infertility
3) oligomenorrhea or amenorrhea
other S&S
hirsutism
acne
string of pearls in ultrasound of pelvis
polycystic ovary syndrome
the rotterdam criteria (endocrine abnormalities) of the following is need to dx which FRS condition?
high level of androgens (free testosterone)
absence of mid-cycle peak of LH and FSH
excessive secretion of LH
glucose intolerance
polycystic ovary syndrome
which FRS disorder does metformin help treat as symptomatic treatment?
polycystic ovary syndrome, metformin is used for diabetes mellitus type 2 glucose intolerance
preeclampsia can lead to eclampsia, which is characterized by what type of seizures
Tonic-clonic
condition in which placenta is shallowly implanted and thus the placenta becomes hypoxic, and there is immune reaction, which is characterized by secretion of unregulated inflammatory mediators from placenta and acts on vascular endothelium -
preeclampsia
what is definitive diagnose of preeclampsia
1) pregnant women with high blood pressure ( 2 separate takes at least 4 hrs apart of of 140/90 or more)
2) more than 200-300 mg of pretin in 24 hrs urine sample
HTN in pregnancy is?
RED FLAG
these are risk factors of which FRS cancer?
sex, age, childbearing, hormones, high fat diet, alcohol intake, obesity, environment, tobacco use, radiation, endocrine disruptors and shift work, mutation of BRAC 1 and 2 genes
Breast cancer
fetal age from first day of last menstrual period (LMP) is ?
gestational age
fetal age from last assumed fertilization?
developmental age
2 weeks less than GA
history of giving birth is called?
parity / para
history of being pregnant is called?
gravidity / gravida
what are sign and symptoms of pregnancy?
chadwick’s signs (blueish discoloration of vagina and cervix)
goodell’s sign: softening and cyanosis of cervix at or after 4 weeks
ladin’s sign: softening of uterus after 6 weeks
linea nigra
telangiectasis
palmar erythema
what is quickening?
fetal movement with maternal awareness of it after 16 weeks of gestation
in pregnancy test what are you looking for?
serum beta-hCG - this will appear shortly after conception, rise exponentially, doubling in value every 48 hrs until 12 weeks of GA, or 10 weeks of DA, after which it will level off until time of delivery
what is Nagele’s rule for EDC (estimated date of confinement)
(LMP - 3 months) + 7 days
why do you have nausea and vomiting (morning sickness) un pregnancy? what other GI changes?
elevated estrogen, progesterone, hCG
stomach will increased gastric emptying times
LES will have decreased tone –> may lead to GE reflux and spitting due to ptyalism (exuberant saliva)
LI decreased motility –> constipation
what hormone is produced by placenta?
human placental lactogen (hPL) or also called Human Chorionic Somatomammotropin
what are some endocrine changes in pregnancy?
- hyperestrogen state
- estrogen produced mostly by placenta and less production by ovaries
- hCG - alph and beta
antibodies to cyclic citrulinated peptides (anti-CCP) is
new definitive dx for ?
rheumatoid arthritis
morning stiffness of joints greater than 1 hour in morning
-swan neck deformity of hand joints
-ulnar deviation of hand joint
classical presentation of ?
rheumatoid arthritis
2/5 of following CREST signs indicate? Calcium deposits Raynaud's phenomen Esophageal dysfunction Sclerodactyle Telangiectasis
Systemic Sclerosis (scleroderma)
bamboo spine
tenderness in sacroiliac joint
nocturnal back pain
accentuated kyphosis
indicates?
ankylosing spondylosis
positive cellular marker HLA-B27 indicates?
ankylosing spondylosis
positive HLA-DR4 and rheumatoid factor may indicate?
rheumatoid arthritis, but not def dx
transient monoarticular arthritis or severe multisystem disorder, generally asymmetric and polyarticular arthritis primary in large joints. inflammation at tendinous insertions of bone (painter fascitis, tendinitis), lesions (ulcers in oral mucosa), puss vessels on palm or soles…
+ symptoms of GI or GU ingestion
reactive arthritis
2 forms sexually transmitted (chlamydia) and dysenteric
cellular marker HLA-B27
rat tail in Lung imaging indicates?
achalasia, which can happen in systemic sclerosis
butterfly rash over cheeks
positive for antinuclear antibodies, anti-dsDNA, anti-smiths, antiphospholipid antibodies, false positive syphills test indicates?
systemic lupus erythematosus
episodic muscle weakness, fatigue, symptoms worsen with activity and better with rest.
ptosis
diplopia
Ache antibody levels
autoimmune attack on polysynaptic acetylcholine receptors which disrupt neurotransmission, and associated with thymus disorders
myasthenia gravis
autosomal recensisce trait on chromosome 7 that affects protein called cystic fibrosis transmembrane conductance regulator (CFTR) … glands become obstructed by viscid or solid eosinophilic material and produce excessive secretion
dx with sweat test with elevated sweat CL on > 2 occasions
cystic fibrosis
brain damage and LV function problems of unknown cause, sometimes associated with use of salicylate (aspiring) to treat fever in children.
usually follows upper respiratory infection or chickenpox
happens in children 4-12 yrs old
vomiting for hours, irritable, aggressive behavior, lethargy, seizures, decerebrated posture
Reyes syndrome
painful swelling of salivary glands (classically parotid gland), orchitis, oophoritis, pancreatitis
in post-pubeteral man, can lead to infertility
mumps
kopek’s spot on buccal mucosa
infect eyes, upper respiratory tract, then spread to regional lymph nodes
in brain can cause meningitis, in lungs pneumonia
S&S barking cough initial HA photophobia foul smelling discharge (coryza)
measles (rubeola)
related to fetal malformations if pregnant female in 1st trimester gets it
muffin top rash in children
german measles (rubella)
neuropathic cough (coughing bc of brain, large inspiration w/o re-inspiring) , whooping cough, can be fetal for kids bc they can suffocate and hypoxia to brain is dangerous in kids
pertussis
toxin released into blood stream, can create necrosis in throat, which is thick and adherent to underlying tissues
diptheria
skin condition that has
yellow crust as an aftermath of previously pussy blisters and drying oozing fluid
very contagious
strep or stap infection of skin
highly likely following an autoimmune glomerulonephritis as nephritic syndrome
impetigo
acute inflammation of connective tissues of skin
strep or stap infection of skin usually
localized skin redness, warmth along with edema, glossy stretched skin etc.
cellulitis
hypersensitivity inflammatory relations to variety of antigens and allergens
mediated by T-CD8 lymphocytes mainly as delayed type of hypersensitivity reaction
pruritic, red, papulo-vesicular… crusting
eczema (atopic dermatitis)
normally, keratinocytes develop from epidermal stem cells and mature within 28 days.
but in this condition, due to autoimmune inflammation, the cycle of keratinocytes matures is shorter, (about 2 weeks, 1/2 the normal amount). eventually all layers of skin affected and skin appears scaling as per inability to discard all mature cells, ready for exfoliation
skin may have:
guttae (drop-like papule)
plaque, pustules
Auspitz points of hemorrhaging skin
yellow and pitting nails
psoriasis
what is most common skin cancer?
basal cell carcinoma
second most common skin cancer>
squamous cell carcinoma
what is most aggressive skin cancer, that metastasize to eye (or might be originated from pigment layer of retina), liver, and brain before spreading to other organs and tissues
melanoma
what is ABCDE system of surveillance for skin malignancies?
Asymmetry Borders Color Diameter ( >5-6 mm) Extension (growing in size or depth)
in which degree burn do you have blisters?
second degree
veins of the brain return blood into where?
dural sinuses
dural sinus return venous blood into where?
jugular veins then to heart
what extension of dura mater separates two hemispheres of cerebrum?
falx cerebri
what extension of dura mater separates two hemispheres of cerebellum
falx cerebelli
what extension of dura mater separates cerebrum from cerebellum?
tentorium cerebelli
the bridging veins are where? what happens if they rupture?
in the subdural space, they carry venous blood to dural sinuses
when rupture - subdural hemorrhage
injury to inner arteries of brain due to stroke or trauma is ?
subarachnoid hemorrhage
where does CSF normally circulate?
around the brain and spend cord within subarachnoid space (space bt arachnoid and pia)
why does subarachnoid hemorrhage produce the “worse HA of one’s life”?
bc subarachnoid hemorrhage from a ruptured aneurysm is more of an irritant producing vasospasm than a mass lesion
CSF is produced by?
plasma filtration through ependymal cell layer of ventricular choroid plexus, which is situated within in both later 3rd ventricles
toxic appearance, drooling, sitting up on both arms, muffled voice,
caused by bacteria infection, staph, strep, influenza,
happens in kids
abrupt onset
why is this disease dangerous?
acute epiglottis,
dangerous bc edema of epiglottis - small childcare have small airway
rough, red rash that feels like sandpaper
rash in skin folds, esp groins, armpit, elbow creases
strep throat + rash
scarlet fever
humoral immunity carried out by?
B lymphocytes and their manufactured antibodies
cellular immunity carried out by?
T lymphocyte
what is plasma cells, how are they produced?
activated B cell
TCD 4 activates B lymphocytes, when activated they become plasma cells, plasma cells secrete immunoglobulin - antibodies, class IgM (initial humoral response to new pathogen)
which immunoglobulin is memory response?
IgG
which immunoglobulin is most abundant in blood? and crosses placenta barrier as passive immunity for fetus?
IgG
immunoglobulin A is found where?
mucous, specific defense
what are two types of natural killer lymphocytes?
1) cytotoxic cells - TCD 8 (specific killers)
2) natural killers - T lymphocytes
which hep is a DNA virus, and its transmitted 90% of time via sex?
Hep B
which hep is RNA virus, and called disease of nurses bc commonly transmitted by needle stick?
Hep C
which hep is asymptomatic until late stage?
hep c
major cells of allergic reaction type 1 sensitivity are?
mast cells and basophils
which Hep B indicates chronic carrier, convalescent, incubation period, ?
HBsAg
also called Austrian antigen
or surface antigen
which Hep B indicates successful immunization and recovery?
HBsAb
Austrian antibodies, or surface antibodies
which Hep B indicates acute stage of disease?
HBcAg + HBsAg
Hep B core antigen + surface antigen
which Hep B indicates highly infectious stage, with high viral load and activity of virus?
HBeAg
Hep B envelope antigen
