Rapid Review Flashcards
Unilateral, severe periorbital headache with tearing and conjunctival erythema
Cluster headaches
Prophylactic treatment for migraine
- Antihypertensives
- Antidepressants
- Anticonvulsants
- Dietary changes
Most common pituitary tumor. Treatment?
Prolactinoma
-dopamine agonists (e.g. bromocriptine)
55 y/o patient presents with acute “broken speech”. What type of aphasia? What lobe and vascular distribution?
Broca’s aphasia
- frontal lobe (left MCA distribution)
Most common cause of subarachnoid hemorrhage
Trauma
- the second most common cause is berry aneurysm
Crescent shaped hyperdensity on CT that does not cross the midline
Subdural hematoma - bridging veins torn
Hx significant for initial AMS w/ an intervening lucid interval. Most likely source? Treatment?
Epidural hematoma
- middle meningeal artery torn
- Neurosurgical evacuation
CSF findings with subarachnoid hemorrhage
- Elevated ICP, RBCs, xanthochromia
Albuminocytologic disassociation
Guillain-Barre syndrome
- increased protein in CSF w/o a significant increased in cell count
Cold water is flushed into a patient’s ear and the fast phase of the nystagmus toward the opposite side. Normal or pathologic?
Normal
Most common primary source of metastases to the brain
Lung breast skin (melanoma) Kidney GI tract
May be seen in children who are accused of inattention in class and confused with ADHD
Absence seizures
Most frequent presentation of intracranial neoplasm
Headache
- primary neoplasm are much less common than brain metastases
Most common cause of seizures in children (2 - 10 years)
Infection
Febrile seizures
Trauma
Idiopathic
Most common cause of seizures in young adults (18 - 35 years old)
Trauma
Alcohol withdrawal
Brain tumor
First line medication for status epilepticus
IV benzodiazepines
Confusion, confabulation, ophthalmoplegia, ataxia
Wernicke’s encephalopathy due to deficiency of thiamine
What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic
The most common causes of dementia
Alzheimer’s and multi-infarct
A combined UMN and LMN disorder
ALS
Rigidity and stiffness with unilateral resting tremor and masked facies
Parkinson’s disease
Mainstay of Parkinson’s therapy
Levodopa/carbidopa
Treatment of Guillain-Barre syndrome
IVIG or plasmapheresis. Avoid steroids
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.
Huntington’s disorder
A 6 year old girl presents with a port-wine stain in the V1 distribution as well as with mental retardation, seizures, and ipsilateral leptomeningeal angioma
Sturge-Weber syndrome
- treat symptomatically.
- possible focal cerebral resection of the affected lobe
Multiple cafe au late spots on skin
Neurofibromatosis type 1
Hyperphagia, hypersexuality, hyperorality, and hyperdocility
Kluver-Bucy syndrome (amygdala)
May be administered to a symptomatic patient to diagnose myasthenia gravis
Edrophonium
Classic ECG finding in atrial flutter
“Sawtooth” P waves
Definition of unstable angina
Angina that is new, is worsening, or occurs at rest
Antihypertensive for a diabetic patient with proteinuria
ACE inhibitors
Beck’s triad for cardiac tamponade
Hypotension
Distant heart sounds
JVD
Drugs that slow heart rate
B-blockers
Calcium channel blockers (CCBs)
Digoxin
Amiodorone
Hypercholesterolemia treatment that leads to flushing and pruritis
Niacin
Murmur - hypertrophic obstructive cardiomyopathy (HOCM)
Systolic ejection murmur heard along the lateral sternal border that increased with decreased preload (Valsalva maneuver)
Murmur - aortic insufficiency
Austin Flint murmur
- diastolic, decrescendo, low-pitched, blowing murmur that is best heard sitting up
- increased with increased afterload (handgrip maneuver)
Murmur - aortic stenosis
Systolic crescendo/descrendo murmur that radiates to the neck with increased with increased preload (squatting maneuver)
Murmur - mitral regurgitation
Holosystolic murmur that radiates to axilla
- increases with increased afterload (handgrip maneuver)
Murmur - mitral stenosis
Diastolic, mid-to late, low pitched murmur preceded by opening snap
Treatment for atrial fibrillation and atrial flutter
If unstable, cardiovert. If stable or chronic, rate control with CCBs or B-blockers
Treatment for ventricular fibrillation
Immediate cardioversion
Dressler’s syndrome
autoimmune reaction with fever, pericarditis and increased ESR occurring 2-4 weeks post MI
IV drug abuse with JVD and holosystolic murmur at the LSB (increases with inspiration). Treatment?
Tricuspid regurgitation
- treat existing heart failure and replace the tricuspid valve
Diagnostic test for hypertrophic cardiomyopathy
Echocardiogram
- showing a thickened LV wall and outflow obstruction
Pulsus paradoxus
a decrease in systolic BP > 10 mm Hg with inspiration
- seen in cardiac tamponade
Classic ECG findings in pericarditis
Low-voltage, diffuse ST segment elevation
Definition of hypertension
BP > 140/90 mm Hg on 3 separate occasions 2 weeks apart
Eight surgically correctable causes of hypertension
- Renal artery stenosis
- Coarctation of aorta
- Pheochromocytoma
- Conn’s syndrome
- Cushing’s syndrome
- Unilateral renal parenchymal disease
- Hyperthyroidism
- Hyperparathyroidism
Evaluation of a pulsatile abdominal mass and bruit
Abdominal ultrasound and CT
Indications for surgical repair of abdominal aortic aneurysm
> 5.5 cm, rapidly enlarging, symptomatic or ruptured
Treatment for acute coronary syndrome
- ASA, heparin, clopidogrel, morphine, oxygen, sublingual nitrogen, IV B-blockers
Metabolic syndrome
- abdominal obesity
- high triglycerides
- low HDL
- hypertension
- insulin resistance
- prothrombotic or proinflammatory states
50 year old man with stable angina can exercise to 85% of maximum predicted heart rate. Appropriate diagnostic test?
Exercise stress treadmill with ECG
65 year old woman with left bundle branch block and severe osteoarthritis has unstable angina. Appropriate diagnostic test?
Pharmacological stress test (e.g dobutamine echo)
Target LDL in a patient with diabetes
< 70 mg/dL
Signs of active ischemia during stress testing
Angina
ST segment changes on ECG
Decreased BP
ECG findings suggesting MI
ST segment elevation (depression means ischemia)
Flattened T waves
Q waves
Where’s the occlusion? Anterior wall MI
LAD / diagonal
- ST elevations in V1 - V4
Where’s the occlusion? Inferior wall MI
PDA
- ST elevations in leads II, III, avF
Where’s the occlusion? Posterior wall MI
LCX / RCA
Where’s the occlusion? Septal wall MI
LAD / diagonal
Young patient with angina with rest and ST-segment elevation with normal cardiac enzymes
Prinzmental’s angina
- treat with CCBs (e.g. diltiazem)
Common symptoms associated with silent MIs
CHF
shock
AMS
Diagnostic test for pulmonary embolism
Spiral CT with contrast
Protamine
reverse effects of heparin
Prothrombin time
coagulation parameter affected by warfarin
Young patient with a family hx of sudden death and collapses while exercising
Hypertrophic cardiomyopathy
- decreased murmur with increased preload (squatting, Valsava maneuver)
- increased preload
Endocarditis prophylaxis regimens
Oral surgery - amoxicillin for certain situations
GI or GU procedures - not recommended
Virchow’s triad
Stasis
hypercoaguability
endothelial damage
Most common cause of hypertension in young women
OCPs
Most common cause of hypertension in young men
Excessive EtOH
Figure 3 sign
Coarctation of aorta
Water bottle shaped heart
Pericardial effusion
- look for pulsus paradoxus
Pt presents with sudden onset of severe, diffuse abdominal pain. Examination reveals peritoneal signs, and AXR reveals of free air under the diaphragm. Management?
Emergent laparotomy to repair perforated viscus
Most likely cause of acute lower GI bleed > 40 years of age
Diverticulosis
Diagnostic modality used when ultrasound is equivocal for cholecystitis
HIDA scan
Risk factors for cholelithiasis
Fat
Female
Fertile
Forty
Inspiratory arrest during palpation of RUQ
Murphy’s sign
- seen in acute cholecystitis
Most common cause of small bowel obstruction SBO in patients with no history of abdominal surgery
Hernia
Most common cause of SBO in patients with a hx of abdominal surgery
Adhesions
Most common organism in diarrhea
Campylobacter
Most common cause of diarrhea: recent antibiotic use
Clostridium difficile
Most common cause of diarrhea: camping
Giardia
Most common cause of diarrhea: Traveler’s diarrhea
ETEC
Diarrhea organism at church picnics/mayonnaise
S. aureus
Diarrhea organism causing uncooked hamburgers
E. coli 0157:H7
Diarrhea organism associated with poultry/eggs
Salmonella
Diarrhea organism associated with Fried Rice
Bacillus cereus
Diarrhea organism associated with raw seafood
Vibrio, HAV
Diarrhea organism associated with AIDS
Isospora
Cryptosporidium
Mycobacterium
Diarrhea organism associated with pseudoappendicitis
Yersinia
25 year old Jewish man presents with pain and watery diarrhea after meals. Examination shows fistula between the bowel and skin and nodular lesions on his tibia
Crohn’s disease
Inflammatory bowel disease of colon with an increased risk of colon cancer
Ulcerative colitis (greater risk than Crohn’s)
Extraintestinal manifestations of IBD
Uveitis
Ankylosing spondylitis
Pyoderma gangrenosum
Primary sclerosing cholangitis
Medical treatment for IBD
5-ASA agents and steroids during acute exacerbations
Difference between Mallory-Weiss and Boerhaave tears
Mallory Weiss: superficial tear in the esophageal mucosa
Boerhaave: full-thickness esophageal rupture
Charcot’s triad
Fever
RUQ pain
Jaundice
** signs of ascending cholangitis**
Reynold’s pentaus
Fever, RUQ pain, jaundice PLUS shock and mental status changes
– signs of suppurative ascending cholangitis
Medical treatment for hepatic encephalopathy
Decreased protein intake
Lactulose
Rifaximin
First step in the management of a patien with an acute GI bleed
Manage ABCs
4 year old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Hemolytic-uremic syndrome (HUS) due to E.coli 0157:H7
Post-HBV exposure treatment
HBV immunoglobulin
Classic causes of drug induced hepatitis
TB medications (isoniazid, rifampin, pyrazinamide)
Acetaminophen
Tetracycline
40 year old obese woman with elevated alkaline phosphotase, elevated bilirubin, pruritis, dark urine, and clay stools.
Biliary tract obstruction
Hernia with highest risk of incarceration – indirect, direct or femoral?
Femoral hernia
50 year old man with a history of EtOH abuse presents with boring epigastric pain that radiates to the back and is relieved sitting forward. Management?
Confirm diagnosis of acute pancreatitis with elevated amylase and lipase.
- Make the patient NPO and IV fluids, oxygen, analgesia, and “tincture of time”
Four cases of microcytic anemia
TICS Thalassemia Iron deficiency anemia of Chronic disease Sideroblastic anemia
Elderly man w/ hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?
Fecal occult blood test and sigmoidoscopy
- suspect colorectal cancer
Precipitants of hemolytic crisis in patients with G6PD deficiency
Sulfonamides
Antimalarial drugs
Fava beans
Most common inherited cause of hypercoagulability
Factor V Leiden mutation
Most common inherited bleeding disorder
von Willebrand’s disease
Most common inherited hemolytic anemia
Hereditary spherocytosis
Diagnostic test for hereditary spherocytosis
Osmotic fragility test
Pure RBC aplasia
Diamond-Blackfan anemia
Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe au late spots, microcephaly, and pancytopenia
Fanconi’s anemia
Medications and virus that lead to aplastic anemia
Chloramphenicol Sulfonamides Radiation HIV Chemotherapeutic agents Hepatitis Parvovirus B19 EBV
How to distinguish polycythemia vera from secondary polycythemia
Both have increased hematocrit and RBC mass but polycythemia cera should have normal oxygen saturation and low erythropoietin levels
Thrombotic thrombocytopenic purpura (TTP) pentad?
FAT RN:
- Fever
- Anemia
- Thrombocytopenia
- Renal dysfunction
- Neurologic abnormalities
HUS triad?
Anemia
Thrombocytopenia
Acute renal failure
Treatment for TTP
Emergent large volume plasmapheresis
Corticosteroids
Antiplatelet drugs
** Platelet transfusion is contraindicated!!
Treatment for idiopathic thrombocytopenic purpura (ITP) in children
Usually resolves spontaneously,
may require IVIG and/or corticosteroids
Which of the following are increased in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit
Fibrin split products and D-dimer are elevated;
platelets, fibrinogen and hematocrit are decreased
8 year old boy presents with hemarthrosis and increased PTT with normal PT and bleeding time. Diagnosis? Treatment?
Hemophilia A or B
- consider desmopressin (for hemophilia A) or factor VIII or factor IX supplements
Nontender abdominal mass associated with elevated VMA and HVA
Neuroblastoma
Most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Not contraindications to vaccination
Mild illness and/or low grade fever, current antibiotic therapy, and prematurity
Tests to rule out shaken baby syndrome
Ophthalmologic exam, CT, and MRI
A neonate has meconium ileus
Cystic fibrosis (Hirschsprung’s disease is associated with failure to pass meconium for 48 hrs)
Bilious emesis within hours after the first feeding
Duodenal atresia
- associated with Down’s syndrome
A 2 month old baby presents with nonbilious projectile emesis. Diagnosis? What are the appropriate steps in management?
Pyloric stenosis
- correct metabolic abnormalities; then correct pyloric stenosis with pyloromyotomy
The most common primary immunodeficiency
Selective IgA deficiency
An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Febrile seizures (due to roseola infantum)
What is the immunodeficiency? A boy has chronic respiratory infections. Nitroblue tetrazolium test is negative>
Chronic granulomatous disease
What is the immunodeficiency? A child has eczema, thrombocytopenia, and high levels of IgA.
Wiskott-Aldrich syndrome
What is the immunodeficiency? A 4 month old boy has life threatening Pseudomonas infection.
Bruton’s X-linked aggamaglobulinemia
Acute phase treatment for Kawasaki disease
High dose ASA for inflammation and fever
IVIG to prevent coronary artery aneurysms
Treatment for mild and severe conjugated hyperbilirubinemia
Phototherapy (mild) or exchange transfusion (severe)
- Do not use phototherapy for conjugated hyperbilirubinemia
Sudden onset of mental status changes, emesis, and liver dysfunction after ASA intake.
Reye’s syndrome
- do not give aspirin to children < 15 years for viral infxns
- bx shows microvascular steatosis in liver, brain,
Child has loss right light reflex (white pupil). Diagnosis? The child has an increased risk of what cancer?
Suspect retinoblastoma
- Osteosarcoma
Vaccinations at 6 month well child visit.
HBV DTaP Hib IPV PCV Rotavirus
Tanner stage 3 in a 6 year old girl
Precocious puberty
Injection of small airways with epidemics in winter and spring
RSV bronchiolitis
Cause of neontal RDS
Surfactant deficiency
A condition associated with red “currant-jelly” stools, colicky abdominal pain, bilious vomiting, and sausage-shaped mass in the RUQ
Intussusception
Congenital heart disease that causes secondary hypertension. What would you find on physical examination?
Coarcation of the aorta
- decreased femoral pulses
First line treatment of otitis media
Amoxicillin x 10 days
Most common pathogen causing croup
Parainfluenza virus type I
Homeless child is small for his age and has peeling skin and a swollen bell
Kwashiokor (protein malnutrition)
Defect in a X-linked syndrome with mental retardation, gout, self-mutilation and choreoathetosis
Lesch-Nyhan syndrome (purine salvage problem with HGPRTase deficiency)
Newborn girl has a continuous “machinery murmur”. What drug would you give?
Patent ductus arteriosus (PDA)
- indomethacin is given to close the PDA
Newborn with a posterior neck mass and swelling of the hands.
Turner’s syndrome
First line pharmacotherapy for depression
SSRIs
Antidepressants associated with hypertensive crisis
MAO inhibitors
Galactorrhea, impotence, menstrual dysfunction, and decreased libido
Dopamine antagonists
