Neuro + Random Flashcards
Ischemic stoke: frontal lobe dysfunction, apraxia, contralateral paralysis (LEG WEAKNESS) (lower > upper)
Anterior cerebral artery (Ants go under your foot)
Ischemic stroke: contralateral paralysis (upper > lower), aphasia
Middle cerebral artery
Ischemic stroke: LOC, nausea or vomiting, CN dysfunction, ataxia, visual agnosia
Posterior
What artery is typically involved in strokes causing homonymous hemianopsia?
Posterior
What is Todd paralysis?
Postictal paralysis that follows a generalized or complex partial seizure and is a focal motor deficit that may persist up to 24 hours.
PE will show ≥ 5 minutes of continuous seizure activity or more than one seizure without recovery from the postictal state between episodes
Status Epilepticus
Status Epilepticus tx
- Treatment
- First-line: benzodiazepines (e.g., lorazepam)
- Second-line: phenytoin or fosphenytoin, valproic acid, levetiracetam
- Third-line: pentobarbital, propofol, phenobarbital
What kind of incontinence do patients with spinal cord compression syndromes develop?
Overflow incontinence
Urinary incontinence seen with Cauda Equina
Study of choice for AAA
CT abdomen/pelvis WITH contrast
AAA triad
Hypotension
Abdominal Pain
Pulsatile abdominal mass
The USPSTF recommends one-time screening for AAA by ultrasonography in men aged ___?____ who have ever smoked
65–75
What is the clinical presentation of anterior cord syndrome?
Bilateral loss of pain, temperature, and motor with preservation of vibration and proprioception below level of cord involvement.
Which etiologic organism is commonly seen in patients with sickle cell disease with osteomyelitis?
Sickle cell: Salmonella, S. aureus
Sx of spontaneous pneumothroax
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
What are the traumatic causes of obstructive shock?
Cardiac tamponade and tension pneumothorax.
Neurogenic shock causes (type of distributive shock)
Neurogenic Shock
- Spinal cord injury above T5
- Unopposed vagal tone
- Hypotension, poikilothermia, bradycardia
- Airway support, fluids, atropine, vasopressors
2 types of distributive shock
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
What is the most common pathogen that causes erysipelas?
Strep. pyogenes.
Erysipelas tx
Treatment
- Infections with systemic compromise: parenteral cefazolin, ceftriaxone, or flucloxacillin
- Mild infections: oral amoxicillin or cephalexin
What is the most common bone disease that occurs as a result of hyperparathyroidism?
Osteitis fibrosa cystica.
What is the most common bone disease that occurs as a result of hyperparathyroidism?
Osteitis fibrosa cystica.
high PTH, high calcium, low phosphorus
Hyperparathyroidism
- Labs will show high PTH, high calcium, low phosphorus
- Most commonly caused by an adenoma with unregulated overproduction of PTH
intrauterine fetal death prior to 20 weeks gestation in a patient with a closed cervical os and retention of the pregnancy
Missed abortion
Which of the following is most sensitive for a urinary tract infection on urine dipstick testing?
What is most sensitive for a urinary tract infection on urine dipstick testing?
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
CSF findings → increased red blood cells, lymphocytic pleocytosis, elevated protein, and a normal or mildly decreased glucose
HSV Encephalitis
Lymphocytic pleocytosis = Increased count of lymphocytes
Corneal ulcer on PE
oval ulcer with ragged edges, severe conjunctival inflammation
Patient will have a history of trauma, incomplete closure, or extended contact lens use
Pyelonephritis tx
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
What is the treatment for heparin-induced thrombocytopenia (HIT)?
Discontinue heparin and start a direct thrombin inhibitor
What fluoroquinolone antibiotics are appropriate for covering hospital-acquired pneumonia?
Levofloxacin or Ciprofloxacin
What emergent procedure needs to be performed in a patient with paraphimosis when all reduction techniques have failed and ongoing ischemia is clearly evident?
Superficial dorsal slit incision of the constricting band
thrombotic thrombocytopenic purpura PENTAD
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
The mainstay of treatment for TTP is
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.
How does lithium affect kidneys?
Lithium toxicity is associated with several different forms of renal injury, but nephrogenic diabetes insipidus is by far the most common
Classic symptoms include explosive diarrhea, colicky abdominal pain, and pale, loose, foul-smelling stools, which bacteria is this?
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
Inspiratory arrest with right upper quadrant palpation
Murphys sign
Tx of mastitis
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
What are the empiric antibiotics of choice for septic arthritis?
Vanc + ceftriaxone
- Most common cause overall: S**. **aureus
- N. gonorrhoeae is a common cause in young, sexually active individuals
acute unilateral pain and vision loss, headache, vomiting, and seeing halos around lights
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
What environmental disorder is acetazolamide used to treat?
Acute mountain sickness
Patient presents with sudden unilateral electric shock-like pains in gums, cheek, chin, temporal forehead
Trigeminal Neuralgia (Tic Douloureux)
- PE will show pain in V2 and V3 distributions, not V1
- Treatment is carbamazepine
MC artery ruptured in epidural hematoma
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
Most common organisms associated with guillain-barre
The most common organisms associated with GBS are Campylobacter jejuni, Cytomegalovirus (CMV), Epstein Barr virus (EBV), and Mycoplasma pneumoniae.
Guillain-Barre risk factors
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
Labs: normal pH < 4.5, wet prep: budding yeast, pseudohyphae, hyphae
Vulvovaginal candidiasis
Retinal vein vs retinal artery occlusion PE findings
Retinal artery = red cherry spot → Sudden painless, complete loss of vision
Retinal vein → Blood and thunder appearance (retinal hemorrhages and cotton wool spots)
What systemic neurologic disorder is associated with optic neuritis?
Multiple sclerosis
Tx of pertussis
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
severe hypothyroidism resulting in a decompensated metabolic state and mental status change
Myxedema coma
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
Rovsing sign
tense and firm blisters that do not extend with lateral pressure (Nikolsky sign negative)
Pemphigus vulgaris
Which virus can cause a transient aplastic crisis in sickle cell?
Erythema infectiosum → Parvovirus B19
- Hydroxyurea to reduce pain and vaso-occlusive crises
- Antibiotic prophylaxis until age 5 years, pediatric vaccinations (extra PCV)
antibody-mediated destruction of platelets
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
In a pt with pancreatitis which lab value is the greatest predictor of mortality?
Glucose
Impetigo is associated with which condition
Acute poststreptococcal glomerulonephritis results from an antecedent infection of the skin or throat caused by nephritogenic strains of group A beta-hemolytic streptococci.
