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EOR- ER > Neuro + Random > Flashcards

Neuro + Random Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Ischemic stoke: frontal lobe dysfunction, apraxia, contralateral paralysis (LEG WEAKNESS) (lower > upper)

A

Anterior cerebral artery (Ants go under your foot)

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2
Q

Ischemic stroke: contralateral paralysis (upper > lower), aphasia

A

Middle cerebral artery

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3
Q

Ischemic stroke: LOC, nausea or vomiting, CN dysfunction, ataxia, visual agnosia

A

Posterior

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4
Q

What artery is typically involved in strokes causing homonymous hemianopsia?

A

Posterior

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5
Q

What is Todd paralysis?

A

Postictal paralysis that follows a generalized or complex partial seizure and is a focal motor deficit that may persist up to 24 hours.

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6
Q

PE will show ≥ 5 minutes of continuous seizure activity or more than one seizure without recovery from the postictal state between episodes

A

Status Epilepticus

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7
Q

Status Epilepticus tx

A
  • Treatment
    • First-line: benzodiazepines (e.g., lorazepam)
    • Second-line: phenytoin or fosphenytoin, valproic acid, levetiracetam
    • Third-line: pentobarbital, propofol, phenobarbital
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8
Q

What kind of incontinence do patients with spinal cord compression syndromes develop?

A

Overflow incontinence

Urinary incontinence seen with Cauda Equina

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9
Q

Study of choice for AAA

A

CT abdomen/pelvis WITH contrast

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10
Q

AAA triad

A

Hypotension

Abdominal Pain

Pulsatile abdominal mass

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11
Q

The USPSTF recommends one-time screening for AAA by ultrasonography in men aged ___?____ who have ever smoked

A

65–75

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12
Q

What is the clinical presentation of anterior cord syndrome?

A

Bilateral loss of pain, temperature, and motor with preservation of vibration and proprioception below level of cord involvement.

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13
Q

Which etiologic organism is commonly seen in patients with sickle cell disease with osteomyelitis?

A

Sickle cell: Salmonella, S. aureus

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14
Q

Sx of spontaneous pneumothroax

A

acute dyspnea and pleuritic chest pain

Spontaneous Pneumothorax

  • Risk factors: tall, thin, male, ages 10–30, Marfan syndrome, cigarette smoking, COPD, TB, CF, ILD, PCP pneumonia
  • Sx: acute dyspnea and pleuritic chest pain
  • PE: decreased breath sounds, decreased fremitus, hyperresonance to percussion
  • Dx:
    • Upright CXR: absence of lung markings along lung periphery
    • Pleural U/S: absence of lung sliding
  • Tx:
    • < small ≤3 cm in a healthy patient: observation with oxygen administration
    • > large >3 cm: needle aspiration or chest tube thoracostomy
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15
Q

What are the traumatic causes of obstructive shock?

A

Cardiac tamponade and tension pneumothorax.

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16
Q

Neurogenic shock causes (type of distributive shock)

A

Neurogenic Shock

  • Spinal cord injury above T5
  • Unopposed vagal tone
  • Hypotension, poikilothermia, bradycardia
  • Airway support, fluids, atropine, vasopressors
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17
Q

2 types of distributive shock

A

Septic = Gram positive, gram-negative, fungal, viral, parasitic, mycobacterium

Nonseptic = inflammatory shock (SIRS), burns, pancreatitis MI

+

  • Neurogenic = TBI, spinal cord
  • Anaphylactic
  • Other - liver failure, transfusions, vasoplegia, toxic shock, beriberi
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18
Q

What is the most common pathogen that causes erysipelas?

A

Strep. pyogenes.

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19
Q

Erysipelas tx

A

Treatment

  • Infections with systemic compromise: parenteral cefazolin, ceftriaxone, or flucloxacillin
  • Mild infections: oral amoxicillin or cephalexin
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20
Q

What is the most common bone disease that occurs as a result of hyperparathyroidism?

A

Osteitis fibrosa cystica.

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21
Q

What is the most common bone disease that occurs as a result of hyperparathyroidism?

A

Osteitis fibrosa cystica.

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22
Q

high PTH, high calcium, low phosphorus

A

Hyperparathyroidism

  • Labs will show high PTH, high calcium, low phosphorus
  • Most commonly caused by an adenoma with unregulated overproduction of PTH
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23
Q

intrauterine fetal death prior to 20 weeks gestation in a patient with a closed cervical os and retention of the pregnancy

A

Missed abortion

24
Q

Which of the following is most sensitive for a urinary tract infection on urine dipstick testing?

A
25
Q

What is most sensitive for a urinary tract infection on urine dipstick testing?

A

Leukocyte esterase is an enzyme found in neutrophils which are not normally present in urine unless an infection is present. It has a sensitivity of 75-96% in detecting pyuria associated with a urinary tract infection.

Leukocytes = More sensitive

Nitrites = More specific

26
Q

CSF findings → increased red blood cells, lymphocytic pleocytosis, elevated protein, and a normal or mildly decreased glucose

A

HSV Encephalitis

Lymphocytic pleocytosis = Increased count of lymphocytes

27
Q

Corneal ulcer on PE

A

oval ulcer with ragged edges, severe conjunctival inflammation

Patient will have a history of trauma, incomplete closure, or extended contact lens use

28
Q

Pyelonephritis tx

A

Cipro → uncomplicated

Ceftriaxone → septic patients

Treatment depends on infection severity and community/host risk factors for resistant pathogens, options include fluoroquinolones, 3rd/4th gen cephalosporins, TMP-SMX. Critical illness or risk for multidrug resistant organisms: consider coverage for MRSA, VRE

29
Q

What is the treatment for heparin-induced thrombocytopenia (HIT)?

A

Discontinue heparin and start a direct thrombin inhibitor

30
Q

What fluoroquinolone antibiotics are appropriate for covering hospital-acquired pneumonia?

A

Levofloxacin or Ciprofloxacin

31
Q

What emergent procedure needs to be performed in a patient with paraphimosis when all reduction techniques have failed and ongoing ischemia is clearly evident?

A

Superficial dorsal slit incision of the constricting band

32
Q

thrombotic thrombocytopenic purpura PENTAD

A

Anemia, fever, neurologic findings, thrombocytopenia, kidney injury

Thrombotic Thrombocytopenic Purpura (TTP)

  • Risk factors: female sex, age < 50, pregnancy
  • Sx: fever, confusion, difficulty speaking, headache, seizure, nausea, vomiting, diarrhea
  • Labs: elevated LDH, elevated indirect bilirubin, normal coagulation studies, microangiopathic hemolytic anemia, and thrombocytopenia
  • Caused by autoantibody against ADAMTS13 leading to severe deficiency of the enzyme
  • Treatment is plasma exchange with intravenous corticosteroids
33
Q

The mainstay of treatment for TTP is

A

plasmapheresis (plasma exchange), which can achieve remission of disease in 80% of patients. If plasmapheresis cannot be immediately performed, fresh frozen plasma (FFP) should be administered until plasmapheresis can be performed.

34
Q

How does lithium affect kidneys?

A

Lithium toxicity is associated with several different forms of renal injury, but nephrogenic diabetes insipidus is by far the most common

35
Q

Classic symptoms include explosive diarrhea, colicky abdominal pain, and pale, loose, foul-smelling stools, which bacteria is this?

A

Giardiasis

  • History of camping and drinking lake water
  • Sudden onset of explosive, foul-smelling, and non-bloody diarrhea
  • Labs will show flagellated protozoan
  • Most commonly caused by Giardia lamblia
  • Management includes supportive care and antibiotics for symptomatic individuals
  • Choosing an antibiotic:
    • Individuals ≥3 years old — tinidazole
    • Individuals between 1 and 3 years old — nitazoxanide
    • Individuals <12 months old —metronidazole
36
Q

Inspiratory arrest with right upper quadrant palpation

A

Murphys sign

37
Q

Tx of mastitis

A

Mastitis

  • Patient will be a breastfeeding mother
  • Breast erythema, tenderness, fever
  • Most commonly caused by Staph**. **aureus
  • Management includes cool compresses and analgesics between feedings
  • Antibiotics: dicloxacillin, cephalexin, TMP-SMX (MRSA), clindamycin (PCN allergy)
  • Continue breast feeding to avoid progression to abscess
38
Q

What are the empiric antibiotics of choice for septic arthritis?

A

Vanc + ceftriaxone

  • Most common cause overall: S**. **aureus
  • N. gonorrhoeae is a common cause in young, sexually active individuals
39
Q

acute unilateral pain and vision loss, headache, vomiting, and seeing halos around lights

A

Acute angle glaucoma

Acute Angle-Closure Glaucoma

  • Sx: acute unilateral pain and vision loss, headache, vomiting, and seeing halos around lights
  • PE: cloudy cornea and fixed mid-dilated pupil
  • Dx: increased IOP
  • Tx: emergent ophthalmology evaluation, topical beta-blockers (timolol), topical alpha-agonists (apraclonidine), miotics (pilocarpine), carbonic anhydrase inhibitors (acetazolamide), iridotomy
40
Q

What environmental disorder is acetazolamide used to treat?

A

Acute mountain sickness

41
Q

Patient presents with sudden unilateral electric shock-like pains in gums, cheek, chin, temporal forehead

A

Trigeminal Neuralgia (Tic Douloureux)

  • PE will show pain in V2 and V3 distributions, not V1
  • Treatment is carbamazepine
42
Q

MC artery ruptured in epidural hematoma

A

Most common artery ruptured is the middle meningeal artery

Epidural Hematoma

  • History of a head injury with a loss of consciousness followed by a lucid interval
  • CT will show a biconvex opacity
  • Most common artery ruptured is the middle meningeal artery
  • Treatment is emergent evacuation
43
Q

Most common organisms associated with guillain-barre

A

The most common organisms associated with GBS are Campylobacter jejuni, Cytomegalovirus (CMV), Epstein Barr virus (EBV), and Mycoplasma pneumoniae.

44
Q

Guillain-Barre risk factors

A

Guillain-Barré Syndrome

  • Risk Factors: recent minor respiratory or GI illness
  • Sx: Symmetric, progressive ascending muscle weakness, can lead to respiratory failure
  • PE: lack of deep tendon reflexes, symmetric weakness
  • Lumbar puncture: increased CSF protein but a normal cell count
  • Most commonly caused by Campylobacter jejuni
  • Treatment is supportive, plasmapheresis, or IVIG
45
Q

Labs: normal pH < 4.5, wet prep: budding yeast, pseudohyphae, hyphae

A

Vulvovaginal candidiasis

46
Q

Retinal vein vs retinal artery occlusion PE findings

A

Retinal artery = red cherry spot → Sudden painless, complete loss of vision

Retinal vein → Blood and thunder appearance (retinal hemorrhages and cotton wool spots)

47
Q

What systemic neurologic disorder is associated with optic neuritis?

A

Multiple sclerosis

48
Q

Tx of pertussis

A

Azithromycin

Pertussis (Whooping Cough)

  • History of nasal congestion, cough, and low-grade fever
  • Rapid-fire repetitive coughing followed by an inspiratory whoop and post-tussive emesis
  • Most commonly caused by Bordetella pertussis
  • Treatment is a macrolide: azithromycin
49
Q

severe hypothyroidism resulting in a decompensated metabolic state and mental status change

A

Myxedema coma

50
Q

positive when palpation of the left lower quadrant causes pain in the right lower quadrant, by pushing bowel contents towards the ileocecal valve and thus increasing pressure around the appendix

A

Rovsing sign

51
Q

tense and firm blisters that do not extend with lateral pressure (Nikolsky sign negative)

A

Pemphigus vulgaris

52
Q

Which virus can cause a transient aplastic crisis in sickle cell?

A

Erythema infectiosum → Parvovirus B19

  • Hydroxyurea to reduce pain and vaso-occlusive crises
  • Antibiotic prophylaxis until age 5 years, pediatric vaccinations (extra PCV)
53
Q

antibody-mediated destruction of platelets

A

Primary immune thrombocytopenia

Primary Immune Thrombocytopenia

  • Patient will be a child 2–6 years old
  • History of recent viral infection
  • Red spots on skin or easy bleeding
  • PE will show petechiae, purpura, and gingival bleeding
  • Labs will show platelets < 100,000/µL
  • Most commonly caused by antiplatelet antibodies
  • Treatment is observation, steroids, IVIG
54
Q

In a pt with pancreatitis which lab value is the greatest predictor of mortality?

A

Glucose

55
Q

Impetigo is associated with which condition

A

Acute poststreptococcal glomerulonephritis results from an antecedent infection of the skin or throat caused by nephritogenic strains of group A beta-hemolytic streptococci.

EOR- ER (4 decks)

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