Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Adult Clinical Medicine > Rheum and Neuro > Flashcards

Rheum and Neuro Flashcards

1
Q

3-step screening tool for inflammatory arthritis (RA)

A
  1. discomfort with squeezing the MCP and MTP joints
  2. 3 or more swollen joints
  3. More than 1 hour of morning stiffness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

key labs for RA

A

RF: may be pos or neg - but positive = more severe dz

Anti-CCP: confirmatory test for RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RA: poor prognostic indicators

A
  • Functional limitations
  • RF + or Anti-CCP +
  • Erosions on x-rays
  • Extra-articular disease: Interstitial lung disease, vasculitis, scleritis, rheumatoid nodules
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Guidelines for bone densitometry - who should get a DEXA scan

A

Women > 65 years and men > age 70 - ALL
Younger postmenopausal women and men aged 50-69 years with a risk factor (must document):
• Prior fragility fracture (before age 50)
• Use of a high risk medication
• Family history of osteoporosis
• Rheumatoid arthritis or condition associated with increased bone loss
• Glucocorticoids > 5mg daily for > 3 months
• Current smoker
• Low body weight (<127 lbs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Guidelines for using pharmacotherapy for osteoporosis

A

Applicable population: postmenopausal women and men age 50+
• Previous hip or vertebral fx
• T-score -2.5 or less at femoral neck, total hip, or spine
• T-score b/t -1.0 and -2.5 at femoral neck, total hip or spine and 10yr FRAX of >3% at hip or >20% for major osteoporosis-related fxs (humerus, forearm, hip, clinical vertebral fx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Central findings - indicates lesion in CNS (brain and spinal cord - upper motor neurons)

A

Horizontal axis:

  • Hyper-reflexia
  • Spasticity: velocity-dependent “catch” with rapid passive extension of joint
  • Sensory changes: often harder to localize
  • Weakness (flexor posturing in UE; extensor posturing in LE)

Vertical Axis:

  • if unilateral, think cortex / brainstem
  • if bilateral, think subcortical, brainstem, or spinal cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Peripheral Findings

A

Horizontal axis:

  • Hypo-reflexia
  • Atrophy/Fasciculation
  • Sensory changes: dermatomal, sensory-nerve dist, glove/stocking (polyneuropathy)

Vertical Axis:

  • reflexes: biceps: C5/6, triceps: C7/8, patella: L3/4, achilles: S1/2
  • dermatomes
  • muscle innervation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

aphasia - definition and likely location pf lesion

A

language disorder
Brocas: impaired production
Wernickes: impaired comprehension

lesion: left side – frontal and temporal regions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

agnosia - definition and likely location pf lesion

A

inability to process sensory information despite adequate sensory input
• Tactile agnosia
• Prosopagnosia (“face blindness”)

lesion: occipital/parietal lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

apraxia - definition and likely location of lesion

A

disorder of planning motor tasks, perform learned motor tasks

lesion: posterior parietal lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

amnesia - definition and likely location pf lesion

A

deficit in memory

lesion: medial temporal lobe, hippocampus, dienceohalon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Headache - red flag sxs that suggest secondary cause

A 
SSNOOP
Systemic symptoms (fever, weight loss, vomiting, vision loss)

Secondary risk factors (HIV, cancer, immuno-supressive drugs)

Neurologic symptoms (confusion, impaired alertness)

Onset: sudden, abrupt, pain induced by exertion, wakes from sleep, subsides w/ emesis

Older: new onset and progressive (worsening) HA, esp age > 50 (or < 5yr)

Previous HA history or HA progression: pattern change, first HA, or different (change in quality, frequency or severity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Headache - red flag signs that suggest secondary cause

A

Abnormal neurologic exam: focal signs

Neck stiffness and especially meningismus

Papilledema (inc. ICP)

Temporal artery palpation

AMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

common HA triggers (tension and migraine)

A 
Diet / EtOH
Hormones
Sensory stimuli: light/odor
Stress
Change of environment/habit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

migraine HA treatment

A

mild: anti-inflammatory
- acetaminophen/aspirin/caffeine (Excedrin Migraine)
- NSAIDs (Ibuprofen/Naproxen)

Failed analgesics: 5-HT recepto agonists (ergotamines and triptans) - no CV dz

Dopamine receptor antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

migraine HA prophylaxis - indications

A
  • HA > 2 times weekly
  • Contraindications or intolerance to abortive meds
  • HA that severely limits quality of life despite abortive therapy
  • Presence of uncommon migraine conditions: hemiplegic or basilar migraine, or migraine with prolonged aura
17
Q

migraine prophylaxis - medications

A

beta-blockers (propranolol, timolol)

tricyclics (amitriptyline, nortriptyline)

anti-convulsants (topirimate, valproate, gabapentin)

18
Q

tension HA - treatment

A

Simple analgesics (acetaminophen, Aspirin, NSAIDs)

Behavioral approaches: relaxation techniques

19
Q

cluster HA - treatment

A

First line abortive therapy is oxygen (10-12L via nasal cannula for 15 min)

Follow with same tx as migraine HA

20
Q

medication OD headache - dx and tx

A

Hx of analgesic use averaging more than 2 - 3 days per wk in association with chronic daily HA supports the diagnosis of MOH

Treatment:

  • stop all the overused med
  • bridge therapy: long acting NSAID (Naproxen 550 mg BID) or prednisone
  • preventative med and revisit triggers (diary)
21
Q

stroke - modifiable risk factors

A
  • HTN (most important risk)
  • CV dz - CHF, previous MI, aortic valve disease and atrial fibrillation
  • Cigarette smoking
  • Carotid Artery Disease: can limit blood flow to the brain, act as a potential source for cerebral emboli
  • Diabetes
    Dyslipidemia
    Obesity
    Lack of Exercise
    Use of OCP, Hormone Therapy
22
Q

stroke - non-modifiable risk factors

A
  1. Family History: stroke or CAD
  2. Age: risk doubles every 10 yrs after age 55
  3. Gender: <55 (men more likely to have stroke); >55 risk same for males and females
  4. History of Prior Stroke, TIA or Heart Attack
  5. Race: African Americans - higher incidence and risk of death from stroke; Asian Americans – high risk of hemorrhagic stroke
23
Q

symptoms not likely to be a stroke or TIA (non-focal)

A

Generalized weakness or numbness (bilateral)

Faintness or syncope

Incontinence

Isolated symptoms (occurring alone)

  • Vertigo or loss of balance
  • Double vision
  • Slurred speech or difficulty swallowing

Confusion / reduced LOC
- reduced conscious level is more important predictor of non stroke pathology

24
Q

ABSD2 score

A

Helps to determine disposition following TIA:

Age [A]: >60 (1 pt)
Blood pressure [B]: >140/90 (1 pt)
Clinical features [C]
 - Unilateral weakness (2 pts)
 - Dysphasia (difficult swallow) w/out weakness (1 pt)
Duration of symptoms [D]
 - >60 min (2 pts)
 - 10-59 min (1 pt)
Diabetes [D]: 1 pt
25
Q

TIA - indications for hospital admit

A 
o	Crescendo symptoms
o	Symptom duration > 1 hour
o	Internal carotid stenosis > 50%
o	Known Afib or other cardiac source
o	Known hypercoagulable state
o	ABCD2 Score >3
26
Q

stroke - imaging

A

CT (non contrast): fast, available, cheap

  • R/O hemorrhage
  • verify cerebrovascular cause to sxs
  • identify abnormal findings that contradict tPA
  • goal: door to CT 25 min; 45 min interpretate

MRI: higher sensitivity for ischemic stroke (also detects hemorrahage)

27
Q

4 proven interventions for acute ischemic stroke (aka tx for acute ischemic stroke)

A

SCUs: stroke care units

Thrombolysis (tPA): IV alteplase w/ in 3 hrs

Aspirin (ASA): 300 mg QD for 14 days (initiate after 24 hrs if using thrombolytics)

Decompressive hemicraniectomy

  • reduces mortality in pts < 55 years with malignant brain swelling after large infarction
  • make decision w/ neurosurgeon
28
Q

acute tx for hemorrhagic stroke

A

Management in SCU
Regulate BP (not yet found to improve outcome)
Control brain edema (not yet found to improve outcome)

Neurosurgical consultation: pts at risk for obstructive hydrocephalus

29
Q

acute tx fort TIA

A

Note: usually not admitted

confirm not stroke (imagine - CT/MRI)
pt education and good RTC precautions: 10.5 % have stroke w/in 3 mo)

Primary prevention measures:

  • anticoagulants
  • antiplatelets
  • carotid endarterectomy
30
Q

thrombolysis alteplase)

A

can improve recovery following ischemic stroke, but also carries a risk of a brain bleed (so there are several contraindications)

  • > 3 hrs since stroke onset
  • bleeding or bleeding risks
  • meds that cause bleeding / reduced clotting
  • blood glucose < 50 mg/dl
  • seizure w/ post-ictal neural impairment
31
Q

Primary Prevention for Stroke or TIA (never had one before)

A

Anti-coagulation (Warfarin): for patients with atrial fibrillation (CHA2DS2-VASc score)

Antihypertensives: for the tx of hypertension

Lipid reduction with statins: pts w/ pre-existing ischaemic heart disease

Aspirin in women 45 years or older (but not men)

Modification of risk factors such as diabetes, moderation of EtOH, reduction in smoking

32
Q

Secondary Prevention for Stroke or TIA (had one before)

A

Anticoagulants (Warfarin): for pts w/ atrial fibrillation reduces RR of recurrent stroke by about 70% (CHA2DS2-VASc Score)

Antiplatelet agents: ASA and extended-release dipyridamole (Persantine)

Carotid endarterectomy: pets who have at least 70% stenosis of the symptomatic carotid artery

33
Q

CHA2DS2-VASc Score

A

used to determine whether to recommend anticoagulants to patients with Atrial Fibrillation
- estimate risk of pt having a thromboembolic event if no anti-coagulation medication is used

O = low risk: possibly DO NOT use Warfarin / Coumadin

1 or greater = moderate to high risk: recommended to use Warfarin / Coumadin

Adult Clinical Medicine (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions