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Medicine > step 3 2 > Flashcards

step 3 2 Flashcards

1
Q

absolute contraindications to lytics

A
  • history of hemorrhagic stroke
  • presence of intracranial neoplasm/mass
  • active bleeding or surgery within 6 weeks
  • presence of bleeding disorder
  • CPR within 3 weeks that was traumatic
  • suspicion of aortic dissection
  • stroke within 1 year
  • cerebral trauma or brain surgery within 6 months
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2
Q

timing of stroke interventions

A

lytics within 3 hours, catheter retrieval within 8 hours

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3
Q

afib treatment options

A

Dabigatran (pradaxa)

Rivaroxaban (xarelto)

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4
Q

how to manage status epilepticus

A

Ativan → if persisting for 10 minutes, add fosphenytoin → if persistent for another 10 minutes, add phenobarbital → if persistent another 10 minutes, general anesthesia with pentobarbital, thiopental, midazolam, or propofol.

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5
Q

Indications for starting antiepileptic after first seizure

A

FH of seizures
Abnormal EEG
Status
Non-correctable precipitating cause

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6
Q

first line seizure meds

A

valproic acid, carbamazepine, phenytoin, levetiracetam (keppra)

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7
Q

other SE to be aware with anticholinergics

A

can worsen memory

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8
Q

how to differentiate tremor on clinical features

A

1) resting and not action –> PD
2) both resting and action –> ET
3) action only –> cerebellar disease

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9
Q

how to differentiate tremor on exam

A

1) Have them hold their arms out in the air

2) Have them point towards your finger

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10
Q

best test for MS

A

MRI, if nondiagnostic then get lumbar tap.

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11
Q

major thing to be concerned about with iodinated contrast in patients with renal insufficiency

A

nephrogenic systemic fibrosis – systemic overreaction to contrast leading to increased collagen deposition in soft tissues.

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12
Q

antispasmodics to treat spasticity in MS

A

baclofen

tizanidine

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13
Q

how to treat fatigue in MS

A

amantadine

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14
Q

disease-modifying drugs in MS

A 
Beta interferon
Glatiramer
Mitoxantrone
Natalizumab
Fingolimod
Dalfampridine
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15
Q

memory loss differential

A

FTD vs. CJD vs. DLB vs. NPH vs. thyroid dysfunction vs. B12 deficiency vs. syphilis

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16
Q

CJD workup

A

brain biopsy
MRI
L-tap with CSF showing 14-3-3

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17
Q

NPH workup on CCS

A

head CT

LP, showing normal pressure.

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18
Q

NPH treatment

A

shunt

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19
Q

HA red flags

A

sudden/severe + onset after 40 + focal deficits

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20
Q

cluster HA management

A

sumatriptan to abort

verapamil to prophylaxe

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21
Q

headache differential

A

dehydration vs. migraine vs. cluster vs. tension vs. temporal arteritis vs. pseudotumor cerebri

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22
Q

temporal arteritis workup

A

sed rate + temporal artery biopsy

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23
Q

temporal arteritis management

A

steroids FAST

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24
Q

pseudotumor cerebri management

A
  • weight loss
  • acetazolamide
  • surgery if above fail (VP shunt, optic nerve sheath fenestration)
25
BPV treatment
meclizine
26
labyrinthitis treatmetn
meclizine, steroids
27
meniere's disease
salt restriction | diuretics
28
acoustic neuroma presentation
ataxia + hearing loss + tinnitus + vertigo | - you differentiate it from meniere's based on presence of ATAXIA
29
vertigo differential
BPV vs. vestibular neuritis vs. post-CVA vs. meniere’s disease vs. acoustic neuroma vs. Wernicke-Korsakoff syndrome also, post-stroke vs. labyrinthitis vs. perilymph fistula.
30
wernicke's presentation
``` heavy alcohol use confusion with confabulation ataxia memory loss gaze palsy/otphalmoplegia nystagmus ```
31
indications for CT before LP
``` history of CNS disease focal deficits presence of papilledema seizures altered delay in ability to perfrom an LP ```
32
cryptococcal meningitis general features
more indolent and less severe meningeal signs + CD4 less than 100
33
best initial test for cryptococcus
india ink
34
most accurate test for cryptococcus
cryptococcal antigen
35
TB meningitis general features
indolent (over weeks to months) + very high CSF protein
36
most accurate test for TB meningitis
CSF PCR
37
how do you treat TB meningitis
4 drug treatment (but use quinolone instead of ethambutol which has poor CNS penetration), same as regular TB, but add steroids + extend length of therapy
38
fungal meningitis lab profile
LYMPHOCYTOSIS, similar to viral, not neutrophilia.
39
treatment for amoebic meningitis
miltefosine
40
brain abscess management
CT w/ CONTRAST Determine HIV status: If HIV-positive → treat for toxo w/ pyrimethamine + sulfadiazine x 2 weeks then repeat CT head If HIV-negative → brain biopsy
41
neurocysticercosis classic case
- mexican with seizure+ multiple calcified lesions on CT
42
neurocysticercosis treatment
- if lesions still uncalcified treat with albendazole + steroids to prevent reaction to dying parasites - if calcified-- only use antiepileptic
43
PRES stands for
posterior reversible encephalopathy syndrome
44
PRES presentation
HA/LOC/visual dysfunction/seizures in setting of HTN crisis/preeclampsia/cytotoxic meds (cyclosporine)
45
PRES management
MRI, self-resolving
46
large brain bleed mgmt
Intubate + hyperventilate, target pCO2 to 28032 Mannitol Surgical evacuation
47
SAH management
STAT non-con CT head → if positive, no LP, if inconclusive, get LP. → CT-angio to determine site → embolize site (better than clipping) → insert VP shunt if hydrocephalus develops → prescribe nimodipine for stroke prophylaxis.
48
ASA infarction
loss in sensation in everything except position and vibratory sense (posterior column)
49
brown-sequard presentation
ipsilateral position/vibratory sense, contralateral pain/temperature
50
UMN signs
hyperreflexia upgoing toes on plantar reflex spasticity weakness
51
LMN signs
wasting fasciculations weakness
52
other name for chronic regional pain syndrome
reflex sympathetic dystrophy
53
reflex sympathetic dystrophy treatment
NSAIDs, gabapentin, nerve block, surgical sympathectomy if refractory
54
Bell's palsy presentation
hemifacial paralysis + loss of taste in anterior two thirds of tongue + hyperacusis
55
myasthenia gravis management
Start neostigimine or pyridostigmine → if inadequate response, thymectomy AND consider prednisone
56
normocytic anemia differential
ARF (anemia of chronic renal disease) vs. dilutional vs. hospital acquired anemia (new since hospitalization) vs. ACD
57
HSP treatment
none, self-resolving
58
A-Line indications
1) labile BP 2) hemodynamic therapy is being titrated (pressors) 3) when non-invasive is inaccurate (arrhythmia or morbid obesity)
59
unstable angina definition
ischemic symptoms suggestive of an ACS and no elevation in troponins, with or without electrocardiogram changes indicative of ischemia (eg, ST segment depression or transient elevation or new T wave inversion)

Medicine (71 decks)

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