Test 52 - Created Aug 14 Flashcards
Wallenberg syndrome (some characteristic features)
vertigo, nystagmus, ipsi limb ataxia, loss of pain/temp in ipsi face and contra trunk/limbs, dysphagia, dysarthria, dysphonia, ipsi Horner’s, bad hiccups, lack of automatic respiration
location of lesion in Wallenberg syndrome
lateral medulla
general rules for localizing brain lesions
- thalamus/cortex - sensory loss in contra face/body
- cortex - aphasia, neglect, or agraphesthesia
- brainstem - CN’s; impaired sensory over ipsi face and contra body
- cerebellum - ataxia, discoordination
cranial nerves in each of the following: midbrain, pons, medulla
midbrain: 3, 4
pons: 5, 6, 7, 8
medulla: 9, 10, 11, 12
correlation of increases in specificity or sensitivity and (+) and (-) predictive values
increased sPecificity, increases PPV
increased seNsitivity, increases NPV
presentation of adjustment disorder
stressor within the last 3 months, sxs started after it, having mixed sxs of MDD/anxiety/adhd
tx of adjustment disorder
short-term psychotherapy; zolpidem to help w/ sleep
presentation of stress-induced (takotsubo) CMP
postmenopausal F with recent physical or emotional stressor -> CP, decompensated HF, moderated troponin elev., some ischemic changes
diagnosis of stress-induced (takotsubo) CMP
cath: no obstr. CAD
echo: LV apical hypokinesis, basilar hyperkinesis
GI bleeding from angiodysplasias are associated with what diseases
end-stage renal disease, aortic stenosis, and von Willebrand disease
presentation of G6PD def. in newborn
unconjugated hyperbili and anemia on D.O.L. 2-3
when Rhogam is given in pregnant Rh(D) neg pt
- once at 28-32 wks GA
- once postpartum
- any time mom’s and baby’s blood may mix (abortion, mole, villi sampling, trauma, etc.)
definition of severe aortic stenosis
aortic jet velocity >4.0 m/sec or mean transvalvular gradient >40 mmHg
indications for aortic valve replacement in aortic stenosis pt
severe AS plus 1/+ of:
- sxs
- LVEF <50%
- undergoing other cardiac surgery
what to suspect when thrombocytopenia found on labs in HIV pt? treatment?
if isolated -> HIV-associated thrombocytopenia; tx = HAART
drop of viral load in HIV pt on HAART
(logarithmic drop)
4 wks: <5000 copies
8-16 wks: <500
16-24 wks: <50
should be <50 by 6 mo. mark
1st line meds for Raynaud phenomenon
“-dipine” (nifedipine, amlodipine)
Raynaud people have cold hands, which are used to “dip” ice cream.
when is further evaluation indicated for Raynaud phenomenon pt
when there are sxs suggestive of systemic disease
signs of adrenal failure
weight loss, weak/lacks energy, eosinophilia, borderline sodium levels, hyperkalemia, mild anion gap acidosis, prerenal azotemia, low blood glucose
diagnosis of adrenal failure
cosyntropin stimulation test
protective factors against suicide
social support/family connectedness, pregnancy, parenthood, religion and participation in religious activities
presentation of bowel injury and what to do next
fever, leukocytosis, abdominal pain/guarding, N, ileus; do abd. CT w/ oral contrast to find site of leakage
tx of Mobitz type II 2* AV block
unstable - IV atropine
stable - pacemaker
tx of central venous sinus thrombosis
heparin or LMWH
fetal postmaturity syndrome
SGA, wrinkled/peeling skin, long/thin body, decr. fat, long fingernails, sparse lanugo hair but increased scalp hair, meconium-stained (green/black) placenta (and possibly meconium covered baby too)
tx of epistaxis refractory to pinching for 10 minutes
listed in order of when to do it
- oxymetazoline on cotton
- chemical or electrical cautery
- bacitracin-covered sponge
who is most at risk of postop pulmonary complications; what to do about these prior to surgery
COPD, cig smoking, sleep apnea, heart failure
stop smoking 4 wks prior; optimize COPD and HF
1st line tx of cocaine-related CP
- BONA (benzo, O2, nitrates, aspirin)
- phentolamine for resistant HTN
- morphine for resistant CP
- PCI if all else fails
next step when pt who ingested cocaine has persistent CP despite medicines and new neuro findings
do imaging to look for dissection of ascending aorta
CTA, MRA, or TEE
