Random2 Flashcards
1
Q
Scleroderma renal crisis findings? (5)
A
- Acute renal crisis (w/o previous renal disease)
- Malignant HTN (ie headache, n/, blurry vision)
- U/A mild proteinuria
- Microangiopathic hemolytic anemia w/ fragmented RBCs (schistocytes)
- Thrombocytopenia
2
Q
Schistocyte?
A
Fragmented RBC
3
Q
Fragmented RBC?
A
Schistocyte
4
Q
Echinocyte is?
A
Burr cell
- spiculated appearing RBCs
- seen in liver disease and end-stage renal disease
5
Q
Burr cell is?
A
Spiculated appearing RBCs w/ serrated edges seen in liver disease and end stage renal disease
6
Q
Howell-jolly body is?
A
Basophilic remnants of the nucleus that appear as small, black pellets in RBCs
- seen in pts w/ hx of spelnectomy or functional asplenia
7
Q
When do you see howell-jolly bodies?
A
- Pts w/ hx of spelnectomy
- Functional asplenic pts
8
Q
Another name for acanthocyte?
A
Spur cell
9
Q
Another name for echinocyte?
A
Burr cell
10
Q
Burr cells other name?
A
echinocyte
11
Q
Spur cell other name?
A
acanthocyte
12
Q
What is a spur cell?
A
RBCs w/ irregularly sized and spaced projections
- seen in liver disease
13
Q
WHen are spur cells seen?
A
In liver disease
14
Q
Spiculated RBC - think?
A
Burr cell
- liver and endstage renal disease
15
Q
Target cells are?
A
RBCs w/ central density surrounded by pallor (bull’s eye)
16
Q
Target cell seen w/?
A
- Hemoglobinopathies (ie thalassemia)
- Chronic liver disease (esp obstructive liver disease)
17
Q
Thalassemia has what type of abnl RBCs?
A
Target cells
18
Q
Main CXR finding on aortic injury?
A
Mediastinal widening
19
Q
Initial screening study for aortic injury?
A
CXR
20
Q
main causes of aortic traumatic injury?
A
MVAs and falls from >10 feet
21
Q
what is often associated finding on CXR w/ myocardial contusion?
A
rib fractures
22
Q
How do glucocorticoids effect lymphocytes, eosinophils, and neutrophils?
A
- Inc Neutrophils (left shift)
- Dec lymphocytes and eosinophils
23
Q
recent cardiac cath + heparin in prep of CABG, now w/ hypotension, tachycardia, flat neck veins and back pain – think?
A
Retroperitoneal hematoma
- due to bleeding from the arterial access site
24
Q
recent cath + hemodynamic instability + flank/back pain think?
A
retroperitoneal hematoma
25
how to confirm dx of retroperitoneal hematoma?
NON-contrast CT scan of abdomen and pelvis
or
abdominal u/s
26
treatment of retroperitoneal hematoma
supportive
- intense monitoring
- bed rest
- IV fluids
- bld transfusions as needed
*Rarely needs surgery
27
First line treatment for specific phobia?
Behavioral therapy (assuming enough time)
28
Treatment of specific phobia if not enough time (ie flight next week?)?
Benzodiazepines
29
eye movement desensitization useful in what disorder?
PTSD
30
industrial worker + pleural calcifications - think?
asbestos exposure
31
good way to distinguish b/t restrictive lung disease causes?
look at diffusion capacity (DLco)
- wall issue (ie obesity, ankylosing spondylitis) --> normal diffusion capacity
- Interstitial lung disease --> low DLco
32
Way to distinguish b/t obstructive lung diseases?
Bronchodilator challenge
- If FEV1 improves - think asthma
- if no change, think COPD
33
first line mood stabilizers for bipolar maintenance?
- Lithium (renal and thyroid toxic)
| - valproate (hepatotoxic, thrombocytopenia)
34
associated adverse effects of Lithium?
- adverse effects on kidneys and thyroids
| kidneys: nephrogenic DI or chronic tubulointerstitial nephropathy
35
Valproate adverse effects?
- rare hepatotoxicity
| - thrombocytopenia
36
what is bupropion?
Antidepressant
| - NE and dopamine reuptake inhibitor (NDRI)
37
antidepressants w/ bipolar patients can cause what?
inducing mania (so don't use)
38
drugs that may be useful for long term maintenance of pts w/ bipolar?
- Lithium (1stline)
- Valproate (1stline)
- Quetiapine (antipsychotic 2nd gen)
- Lamotrigine (anticonvulsant)
39
What is topiramate
anticonvulsant
40
main pharmacologic target for treatment of OCD?
serotonin
41
First line treatment of OCD?
- SSRI
(fluoxetine, fluvoxamine, paroxetine, citalopram, escitalopram, sertraline)
- Cognitive-behavioral therappy
42
2nd line treatment of OCD?
clomipramine (tricyclic antidepressant, less well tolerated than SSRI - 1st line)
43
antipsychotics target what?
dopamine
44
primary target of benzodiazepines?
Gamma-aminobutyric acid
45
post MI few days + new pain that hurts more supine and improved on sitting up and leaning forwards - think?
acute pericarditis
46
ECG findings for acute pericarditis?
- Diffuse ST elevations
| - PR depressions
47
post MI 3-7 dys, now w/ new onset systolic murmur - think (2)?
- interventricular free wall rupture
| - Papillary muscle rupture (MR)
48
major depressive episode should last how long for dx?
>2wks
49
Atypical depression symptoms (4)?
- Hypersomnia
- Increased appetite
- Rejection sensitivity
- Leaden Paralysis (heavy feeling limbs)
50
timing for adjustment disorder?
symp dev w/in 3 mo of stressor and last no more than 6 mo after stressor ends
51
Low mood lasting most of the day on more days than not for at least 2 years?
Persistent depressive disorder (dysthymia)
52
timing for persistent depressive disorder (dysthymia)
- low mood lasting most of the day on more days than not
| - At least 2 years
53
first line treatment for absence seizure?
Ethosuximide
54
EEG w/ classic 3 Hz spike wave pattern - think?
Absence seizure
55
1st and second line treatments for absence seizure?
1) Ethosuximide
| 2) Valproic acid (side fx)
56
Methylphenidate is?
stimulant used to treat ADHD
57
Atomoxetine is?
Nonstimulant med used to treat ADHD
58
Lorazepam is?
Benzodiazepine
59
Lorazepam used for?
Benzo used for anxiety and acute managment of prolonged seizures (ie status epilepticus)
60
Phenytoin used for as 1st line for what?
Generalized tonic-clonic seizures or focal seizures
61
Side fx of phenytoin? (3)
- Gingival hyperplasia
- Stevens Johnson syndrome
- Toxic epidermal necrolysis
62
where is lesion that causes hemi-neglect syndrome
Lesion on non-dominant (usually R) PARIETAL lobe
63
What part of brain hurt --> hemi-neglect?
```
Parietal lobe (non dominant side, usually R)
- in charge of spatial organization
```
64
lesion on frontal cortex would cause?
Hemiparesis
- w/ motor aphasia if dominant lobe involved (Broca's, expressive aphasia)
- maintained comprehension, but speech is stilted and effortful
65
Left temporal lobe damage -->?
Receptive aphasia (Wernike's)
- cannot comprehend written or spoken language
- expresses fluently, although incoherently
66
occipital lobe damage results in?
visual distrubances
67
ansognosia?
pt unaware of deficit (ie unaware of hemineglect)
68
comb only R side, clock only on R side - this is?
hemi neglect
69
pulsus paradoxus associated w/?
cardiac tamponade
70
systolic murmur that increases w/ standing is?
Hypertrophic obstructive cardiomyopathy (HOCM)
71
good way to tell syncope vs seizure in non-witnessed pt?
syncope would immediately return to neurological baseline, while seizures would be delayed, sleepy, confused
72
bilious vomiting + contrast from upper GI series in corkscrew appearance - think?
small bowel volvulus
73
Ligamentz of Treitz on R side of abdomen on upper GI series - think?
Malrotation
74
stable neonate w/ bilious vomiting + xray finding no free air or double bubble, next step?
Upper GI series to look for malrotation (-> volvulus)
75
bilious vomiting neonate - diff dx (4)?
- Malrotation (-> volvulus)
- Duodenal atresia
- Hirschsprung disease
- Meconium ileus
76
What procedure done to fix malrotation and prevent volvulus?
Ladd procedure
77
bilious vomiting stable neonate + dilated loops of bowel on xray --> next step to dx b/t?
Next step: Contrast Enema
- Microcolon --> Meconium ileus
- Rectosigmoid transition zone (b/c tonically contracted distal to) --> Hirschsprung disease
78
lesion in the brain + personality changes and strange behavior localize it to what area of brain?
frontal lobe
79
brain lesion w/ butterfly appearance w/ central necrosis - think?
Glioblastoma multiforme
80
brain metastasis usually look and are found?
Look:
| Found in gray-white junctions or at watershed zones
81
a high grade astrocytoma may also be known as?
Glioblastoma multiforme (grade 4 astrocytoma)
82
heterogenous, serpiginous contrast enhancement can be found w/ what brain lesion?
High-grade astrocytoma (incl GBM)
83
Liver disease w/ acute onset of kidney issues --> think?
Hepatorenal syndrome
84
liver disease + inc creatinine + failure to respond to IV fluids + absence of shock, proteinuria, specific reason for renal disease --> think?
Hepatorenal syndrome
85
Treatment of hepatorenal syndrome?
Liver transplant
86
Pulsus paradoxus - diff dx (6)?
- Cardiac tamponade
- Asthma
- Chronic COPD
- OSA
- Pericarditis
- Croup
87
Pulsus parvus et tardus - think?
aortic stenosis
88
Inspiration causes what?
inc systemic venous return to heart
89
Tic douloureux is?
Trigeminal neuralgia
90
etiology of trigeminal neuralgia (tic douloureux)?
compression of the trigeminal nerve (pain along 2 & 3rd branches)
91
tongue palsy results from damage to what nerve?
hypoglossal nerve
92
facial nerve does what?
- muscles of facial expression
| - Taste: ant. 2/3 tongue
93
jaw asymmetry can result from what nerve damage?
Mandibular division of the trigeminal nerve (V3) --> paralysis of muscles of mastication
94
winged scapula - what nerve hurt?
long thoracic nerve
95
MS does what to nerves?
autoimmune disease --> inflammatory demyelination of axons in CNS
96
ocular issues + fatigable chewing + dysphagia w/ nasopharyngeal regurge + dysarthria - think
Myasthenia Gravis
97
tall R wave in aVL + Deep S wave in V3 + repolarization changes in anterolateral leads (I, aVL, V4-6) - think?
Hypertrophic cardiomyopathy
| - tall and deep waves indicate LVH
98
violent behavior + hallucinations + nystagmus - what drug?
PCP intox
99
Visual hallucinations + tachy/HTN - what drug?
LSD intox
100
Chest pain + seizures + agitation + Mydriasis + tachy/HTN --> what drug?
Cocaine intox
101
tooth decay + choreiform movements + sweating + psychosis/violence - what drug?
Meth intox
102
increased appetite + conjunctival injection + impaired time perception - what drug?
marijuana intox
103
Depressed mental status + Miosis + respiratory depression - what drug?
Heroin intox
104
resp depression, pinpoint pupils, CNS depression, hypotension - think?
Opioid overdose
105
subperiosteal hemorrhage newborn?
cephalohematoma
106
newborn head swelling few hours later that does NOT cross suture lines - think?
cephalohematoma
107
swelling of newborn head seen right after birth - think?
caput succedaneum
108
diffuse swelling of newborn scalp that crosses suturelines and midline - think?
caput succedaneum
109
good indications of cranial meningocele
- pulsations
- increased pressure upon crying
- bony defects
110
small-vessel hyalinosis - aka?
lacunar stroke
111
kussmaul's sign is?
increase in JVD w/ inspiration
112
increase in JVD w/ inspiration is known as?
kussmaul sign
113
wallenberg syndrome due to?
lateral medullary infarction likely due to an occluded intracranial vertebral artery
114
Vestibulocerebellar symptoms in wallenberg syndrome
- nystagmus (horz and rotational)
- diplopia
- vertigo w/ falling to side of lesion
- difficulty sitting upright w/o support
- Ipsilateral limb ataxia
115
wallenberg syndrome findings? (6)
- vertigo (fall to side of lesion)
- nystagmus
- ipsilateral loss of pain and temp on face
- contralateral loss of pain and temp on trunk and limbs
- Horner's syndrome
- Hoarseness
116
weakness of muscles of mastication, diminished jaw jerk reflex, and impaired tactile and position sensation over face - where is lesion?
Lateral mid-pons
| - effects ipsilateral trigeminal nerve
117
Lateral mid-pons lesion would effect what nerve?
Ipsilateral trigeminal nerve
118
lateral medullary infarct effects what nerves?
IX and X
| --> hoarseness, dysphagia, diminished gag reflex
119
paralysis of the arm and leg w/ loss of tactile and position sense + tongue deviation -- think?
Medial medullary syndrome
120
lesion on medullary pyramid causes?
contralateral hemiparesis
121
lesion on medial lemniscus causes?
contralateral loss of tactile, vibratory, and position sense
122
medial medullary lesion effects what cranial nerve?
Hypoglossal (XII)
| --> ipsilateral tongue paralysis w/ deviation to side of lesion
123
Alternating hypoglossal hemiplegia is also known as ?
medial medulary syndrome
- contralateral hemiparesis
- tongue deviation to ipsilateral side of lesion
124
contralateral ataxia + hemiparesis of the face, trunk, and limbs - think?
medial mid pontine infarction
125
lateral medullary infarct occurs due to?
- occlusion of the post. inf cerebellar or vertebral artery
"wallenberg syndrome"
126
neutrophilic cryptitis in GI - think?
IBD (Crohn's or UC)
127
epithelial ecrosis in GI - think?
Ischemic colitis
128
conversion disorder is?
sudden onset of neurological symptom that is incompatible w/ nL neuro exam brought on by a stressor
129
somatic symptom disorder is?
1 or more persistent physical symptoms that causes disproportionate and excessive anxiety and energy devoted to it.
- generally symp is minor but anxiety is big
130
sildenafil is?
phosphodiesterase 5 inhibitor
131
sildenafil has cross reaction w/ what drugs (2)?
- alpha blockers (-zosins)
- nitrates
can cause hypOtension
132
sildanefil first line for?
erectile dysfunction treatment
133
IV drug user --> endocarditis think what valve?
Tricuspid
134
IV drug user + endocarditis murmur effected how w/ inspiration?
Increased murmur w/ inspiration (TR)
135
IV drug user + endocarditis + round alverolar infiltrates on CXR - think?
septic emboli to lungs
136
mumur best heard while sitting up -- think?
AR
137
Paradoxical splitting -- think?
LV outflow obstruction
- AS
- LBBB
- R ventricular paced rhythm
138
Tricuspid endocarditis --> what murmur?
TR
139
pleural plaques - think?
Asbestosis
140
unilateral pleural abnormality w/ large pleural effusion in plumber - think?
pleural mesothelioma
141
AST ALT levels in alcoholic liver disease?
AST:ALT --> 2:1
| AST & ALT
142
Marked elevations in AST and ALT (>25x) -- think? (3)
- toxin induced
- ischemia
- viral hepatitis
143
What location in brain usually has NO hemiparesis if there is a lesion?
Cerebellum
144
Facial weakness + ataxia + nystagmus + headache + neck stiffness + n/v -- think where is lesion?
Cerebellum
| - note: NO hemiparesis
145
contralateral hemiparesis + hemianesthesia + conjugate gaze deviation toward lesion - think where is lesion (2)?
1) putamen + internal capsule (Basal ganglia)
| 2) occlusion of proximal middle cerebral artery (more acute onset)
146
eyes react how when there is a hemorrhage at the thalamus?
eyes deviate Towards hemiparesis (contralateral to bleed)
147
contralateral hemiparesis + hemisensory loss + nonreactive miotic pupils + upgaze palsy + eyes deviate towards hemiparesis - where is hemorrhage?
Thalamus
148
Deep coma and total paralysis w/in minutes + pinpoint reactive pupils - where is hemorrhage?
Pons
149
cerebral lobe bleed w/ contralateral hemiparesis + eyes deviate away from hemiparesis - location?
frontal lobe
150
cerebral lobe bleed w/ contralteral hemisensory loss - location?
parietal lobe
151
cerebral lobe bleed w/ homonymous hemianopsia - location?
occipital lobe
152
Lead poisoning risk next step?
venous lead level
153
Treatment of lead poisoning? (mild, mod, severe)
- mild (5-44): no meds, repeat venous lead level in =70): Dimercaprol (BAL) + calcium disodium edtate (EDTA)
154
Dimercaprol (BAL) + EDTA can treat what?
severe lead poisoning
155
Dimercaprol + calcium disodium edetate can treat?
severe lead poisoning
| "BAL + EDTA"
156
Meso - 2,3 -Dimercaptosuccinic acid can treat?
moderate lead poisoning
| "DMSA"
157
infant w/ hypertonia and hyperreflexia in lower extremities w/ equinovarus deformity - think?
cerebral palsy
158
pellagra?
Deficiency of niacin (B3) --> 3 D's
- Diarrhea
- Dermatitis
- Dementia
159
watery diarrhea + tender rash similar to sunburn + beefy tongue + poor concentration - think?
Pellagra due to niacin (B3) deficiency
160
niacin deficiency can cause?
Pellagra
161
cyanocobalamin is?
vit B12
162
vit B3 is?
niacin
163
vit B6 is?
Pyridoxine
164
vit B2 is?
riboflavin
165
vit B1 is?
Thiamine
166
G6PD deficiency will have what findings on peripheral smear?
Heinz bodies and Bite cells
167
maternal estrogen effects on newborns?
- breast hypertrophy
- swollen labia
- white vaginal discharge (leukorrhea)
- uterine withdrawal bleeding
168
treatment of transplacental maternal estrogen exposure in newborns?
Observation and routine w/ reassurance
169
Mammary gland enlargement + non-purulent vaginal discharge + mild uterine bleeding in newborn -- think?
transplacental maternal estrogen exposure
170
drug for antidepressant effect and smoking cessation?
Bupropion
171
indications for urgent dialysis?
```
"AEIOU"
Acidosis
Electrolyte abnl
Ingestion
Overload
Uremia
```
172
pericarditis in a pt w/ renal failure - treat how and why?
- urgent dialysis
| - Uremic pericarditis
173
typical paricarditis ECG findings?
- Diffuse concave upwards ST segment elevation
| - PR segment depression
174
most common site of ulnar nerve entrapment?
at elbow (medial epicondylar groove)
175
dec sensations at 4th and 5th fingers w/ weak grip think?
ulnar nerve syndrome (compression of nerve)
176
papillary muscle rupture --> what murmur most commonly?
MR
