Sept '21 Flashcards
Which muscles do the motor fibers of the trigeminal nerve innervate?
muscles of mastication
What is the most frequent cause of stroke in patients <45 yo?
carotid artery dissection
carotid artery dissection symptoms
unilateral neck pain, or headache around the eye or frontal area. abrupt in onset.
partial ipsilateral horner syndrome without anhidrosis
vertebral artery dissection symptoms
marked occipital or posterior neck pain and may have FND, including facial numbness and CL pain and temp sensory loss
treatment of a pt with a brain abscess and signs of increased ICP?
surgical drainage
which type of vertigo is vertical nystagmus always associated with?
central vertigo
periph is associated with horizontal or horizontal rotatry nystagmus
afferent pupillary defect and loss of monocular partial or complete vision
optic neuritis
concern for MS, infection, autoimmune, methanol poisoning, B12 deficiency, diabetes
bilateral internuclear ophthalmoplegia is pathognomonic for
MS
what class of medications used to treat peripheral vertigo?
antihistamines
meclizine 25
abx for neonatal sepsis
ampicillin plus either gentamicin or cefotaxime
MC congenital heart defect
VSD
classic VSD murmur
holosystolic and best heard at left lower sternal border
fixed split S2 and a loud S1
ASD
when is vasospasm most common after a subarachnoid hemorrhage?
2 to 21 days
Marcus Gunn pupil
afferent pupillary defect
bilateral pupil constriction when shining light in the unaffected eye but pupil dilation when light shines in the affected eye
How will a pt with MG respond to edrophonium chloride testing if she is having a cholinergic crisis?
muscle fasciculations, cholinergic symptoms, and respiratory depression will occur within a few minutes
acute spinal cord disorder characterized by paraplegia, a transverse level of sensory impairment, and sphincter disturbance
transverse myelitis
sometimes noted to follow a viral infection, aka post infectious myelitis
Where does syringomyelia most often occur?
cervical spine
causes of transverse myelitis
viral, autoimmune, idopathic
fluctuating headache with seizure activity should prompt clinician to consider
cerebral venous thrombosis
How are migraine headaches affected by pregnancy
vastly improve in most women
first line treatment for chemoprophylaxis for exposure to bacterial meningitis?
rifampin, with cipro as alternative
what is the name of the toxin associated with tick paralysis?
ixobotoxin
What is the Miller fisher variant of GBS?
affects eye muscles and presents with triad of ophthalmoplegia, ataxia, and areflexia
which anatomical location does ALS involve?
anterior horn cells
MCC of chronic stridor in infants?
vocal cord paralysis
torus fracture
buckle fx
Triangular metaphyseal fragment in the mataphysis from a salter harris type II fx
Thurstan Holland sign
which anatomical regions of the brain does infectious encephalitis have a predilection for?
gray matter of the temporal lobes and inferior frontal lobe
how long until the onset of action of penobarbital?
onset is 15-30 min
What is the MC aura associated with migraines?
visual - scintillating scotomas or flashing lights
meningitis suspected, AMS, what is the order of tx?
dexamethasone, empiric abx, CT head, LP
most reliable physical exam finding in patients with meningitis?
jolt accentuation - baseline headache increases when the patient turns the head horizontally two or three rotations per second
MC location for pediatric pseudosubluxation?
C2 on C3
how do you correct for pseudosubluxation during radiography?
pt placed in cervical extension
How long do you monitor a pt with TCA overdose?
until ECG normal for 12-24 hours
kid with status asthmaticus, not responding to initial therapies, next line?
IV mag sulfate
smooth muscle relaxant, acting on Ca channels to competitively block calcium influx and promote bronchodilation
CSF findings suggestive of MS?
pleocytosis, elevated gamma globulin, oligoclonal banding
How many g/dL of deoxygenated blood is classically required before cyanosis is apparent?
5g/dL
classic EKG findings in tetralogy of Fallot?
RV hypertrophy (dominant R wave in the right precordium) and right axis deviation
AMS, cerebral edema, hepatic dysfunction in a kid that has had a viral syndrome
Reye Syndrome from aspirin
progressive encephalopathty with hepatic dysfunction
What are three substances that contain salicylates?
aspirin, bismuth subsalicylate, and oil of wintergreen (methyl salicylate)
URI prodrome, then high fever, inspiratory and expiratory stridor in kid
bacterial tracheitis
test for exogenous v endogenous insulin
c- peptide level
low in patients taking exogenous insulin
encephalitis v meningitits
AMS and FND is more likely encephalitis
in kids under 8 what is the most common fx of the elbow?
supracondylar fx, usually due to a FOOSH
What division of the median nerve is damaged in supracondylar elbow fx and how do you test for it?
anterior interosseous
make the OK sign/strength
what happens with instillation of cold water into ear of comatose pt?
tonic deviation toward the ear with cold water inserted
clusters of myoclonic seizures, hypsarrhythmia on EEG, and developmental delay, onset 4-8 months old
West syndroma/infantile spasms
less than 5 yo and painless rectal bleeding
meckels diverticulum
abx for brain abscess from sinus or oral source?
IV metronidazole + ceftriaxone or cefotaxime, +/- vanc
what renal disorder puts patient at higher risk of cerebral aneurysm/SAH?
autosomal dominant polycystic kidney disease
BP goal for SAH
140-160
MC tumor of cerebellopontine angle?
vestibular schwannoma
MC tumor of the CNS
meningioma
how long should facial sutures in children be left in place?
3-5 days
MCC of congenital hydrocephalus?
aqueductal stenosis
pt with fatigue, diplopia, and asymmetric paresthesias and weakness after heat exposure
Multiple sclerosis
correct formula to calculate systolic hypotension in children?
70 + (age x2) is the lower limit of normal BP for children aged 1 to 10 years
What CSF opening pressure is diagnostic for idiopathic intracranial HTN?
250 mm H2O or 25 cm H2O
Most sensitive lab test for spinal epidural abscess?
ESR
combination of acute HTN and endothelial dysfunction resulting in bilateral symmetric vasogenic edema
posterior reversible encephalopathy syndrome (PRES)
which antihypertensivese agents are recommended in the treatment of PRES
labetalol or nicardipine
MC sign of a CNS tumor in infants and young children?
macrocephaly
type of tracheoesophageal fistula that usually presents after the newborn period
an H type tracheoesophageal fistula
when should children with umbilical hernia be referred to a pediatric surgeon
at 2 yo or sooner if symptomatic
at what blood pressure should antihypertensives be given prior to the administration of tPA?
185/110 mmHg
VP shunt overdraining and associated headaches
slit ventricle syndrome
symptoms most sensitive for VP shunt failure?
nausea, vomiting, and decreased LOC
high RDW is common in what type of anemia
fe deficiency
what diseases should be considered when a patient has thrombocytopenia associated with anemia?
HUS and TTP
IV lorazepam or diazepam for seizure and why?
lorazepam, shorter time to peak effect and significantly longer effective duration of action
best benzo for seizure if no IV access?
IM midazolam
tx of akathisia?
antihistamine, like benadryl
tx for transverse myelitis?
IV glucocorticoids
