The End Flashcards
Stroke of small vessels (penetrating branches)
Lacunar
CM lacunar stroke
- Pure motor (MC)
- Ataxic hemiparesis (leg > arm)
- Dysarthria (clumsy hand syndrome)
- Pure sensory loss
Tx lacunar stroke
ASA
Middle cerebral stroke CM
- contralateral sensory/motor loss/hemiparesis greater in face, arm > leg/foot
- Contralateral homonymous heminopsia, gaze preference toward lesion
- D: broca (expressive), wernicke (sensory), math comprehension, agraphia
- ND: spatial deficits, dysarrthria, left sided neglect, anosognois, aprexia
Anterior cerebral artery storke CM
- contralateral sensory/motor loss/hemiparesis greater in leg/foot
- face spared, speech preservation
- Personality changes, confusion
- Urinary incontince
- Gaze preference toward lesion
Posterior cerebral stroke CM
- Visual hallucinations
- Contralateral homonymous hemianopsia
- Ipsilateral CN deficts + contralatteral muscle weakness
Basillar stroke CM
cerebellar dysfunction
vertebral stroke CM
vertigo, nystagmus, N/V, diplopia
Ischemic stroke dx
non-con CT to r/o hemorrhage
Tx ischemic stroke
thrombolytics within 3 horus of onset
- Alteplase only tpa effective in ischemic stroke
- antiplatelet therapy: ASA after 3 hours and TPA not give; or at least 24 hours after thrombolytics
- only lower BP if >185/110 for thrombo or >220/120 with no thrombo
Berry aneurysm MC location
circle of willis
Spinal injury MC after blowout vertebral body burst fracture
anterior cord
Anterior cord mneumonic
ANT couldn’t walk to the bathroom in the TeePee so he peeds his pants when his bladder busted into flex
(LE >UE)
Spinal injury MC after hyperextension injuries
central cord
MC incomplete cord syndrome
central cord
central cord mneumonic
because maleficicent developed frost bite when she extended her hand to touch the cold window pane, she couldn’t put her shawl on with her weak hands
-UE>LE
sensory “shaw distribution”
Posterior cord
loss of proprioception and vibratiory sense only
MC cord syndrome after penetrating trauma
Brown-Sequard
Brown sequard mneumonic
the MVP (motor, vib, prop) on the winning side was oblivious 2 (levels) the stabbing heat of pain (temp and pain) of defeat from the losing side
- Ipsilateral motor, vibration, proprioception
- Contralateral: pain, temp
optic neuritis tx
IV methylprednisolone followed by oral steroids
Most important step in chemical eye burns
irrigation
irrigate eye for how long?
30 minutes or >2 L until pH 7.0 - 7.3
Orbital cellulitis is most commonly secondary to
sinus infection (ethmoid)
Orbital cellulitis abx
vanco, clinda
erysipelas tx
IV PCN, vanco
cellulitis tx
cephalexin, dicloxacillin
MRSA: Iv vanc or linezolid
folliculiits tx
topical mupirocin, clinda, eryth
6th disease =
roseola
Only childhood exanthem that starts on trunk and spreads to face
Roseola
MC viral cause of pericarditis/ myocarditis
coxsackie
MCC of pancreatitis in children
mumps
Measles =
rubeola
Koplik spots
Rubeola
Koplik spots def
buccal mucosa
Rubeola CM
URI prodrome (cough, coryza, conjunctiviits) –> koplik spots –> morbilliform rash (bright red) at hairline –> extremities
vitamin that reduces mortality in rubeola
A
Rubella AKA
3 day rash
Rubella CM
low grade fever/cough/anorexia/LN –> pink maculopapular rash on face –> extremities
Forcheimer spots def:
soft palate
Forcheimer spots
Rubella, Scarlet fever
Fifth dz
Erythema infectuosum
Slapped check rash
Erythema infectuosum
Can cause aplastic crises in those with SCD or G6PD
erythema infectiuosom
Childhood rash that spares palms/ soles
erythema infectuosom
Posterior pituitary releases?
oxytocin and ADH
SIADH is d/t
increased ADH (inappropriate)
MC of SIADH
stroke
Type of cancer that secrets ectopic ADH (resulting in SIADH)
SCLC
patient usually only becomes symptomatic with SIADH when
increase oral free water intake
Dx of SIADH
isovolemic hypotonic hyponatremia
Tx SIADH
water restriction; demeclocycline in severe cases
-severe hyponatremia or intracranial bleed –> IV hypertonic saline with furosemide
Diabetes insipidus d/t
1) ADH deficiency (central DI)
2) Insensitivity to ADH (nephrogenic) –> large amounts of dilute urine
Nephrogenic DI often caused by what drug
lithium
dx DI:
- fluid deprivation test: continued production of dilute urine
- desmopressin (ADH) stimulation test: differentiates nephrogenic from central
- Central: reduction in urine output
- nephrogenic: continued production of dilute urine
Tx: central DI
desmopressin; carbamazepine
Tx: nephrogenic DI
na/protein restriction –> HCTZ, indomethacin
autonomic symptoms of hypoglyemica:
sweating, tremors, palpitations, nervousness, tachy
CNS symptoms of hypoglycemia:
HA, lightheadedness, slurred pseech, confusion, dizziness
Symptomatic hypoglycemic?
<60
If <60 bs tx?
fast acting carb
If <40 bs or LOC tx?
IV bolus D50 or inject glucagon SQ
Gold standard for diagnosis DM
fasting >126 (at least 8 hours, two occasions)
2 hr GTT =
> 200
Gold standard for gestational DM testing
2 hr GTT
HBA1c
6.5+
random glucose
200+
breathing associated with DKA?
kussmaul’s
what type of acid/base is DKA?
high anion gap metabolic acidosis
MCC of DKA/HSS?
infection
Tx DKA/HSS?
IV fluids: isotonic 0.9% NS until hypotension resolves –> 0.45% NS
- When glucose reaches 250, switch to DS 0.45 (1/2) NS to prevent hypoglycmia
- Insulin
- K+ correction –> 20-40 me1/L if <5.5
Anion gap calculation
Na - (Cl + HC03)
High anion gap if >
12
pH of HHS
> 7.30
pH of DKA
<7.30
MC type of hyperparathyroidism?
primary
MCC of primary hyperparathyroidism?
parathyroid adenoma
Primary hyperparathryoidism is d/t
excess PTH production
Hyperparathyroidism is common in people taking?
lithium
MEN I:
HPT, pituitary tumors, pancreatic tumors
MEN 2A:
HPT, pheo, medullary thyroid cancer
Secondary hyperparathyroidism is d/t
increase PTH d/t hypocalcemia or vitamin D deficiency
MCC of secondary hyperparathyroidism?
Chronic kidney failure
Triad of hyperparathyroidism:
hypercalcemia, increased PTH, decrease phosphate
Tx: primary hyperparathyroidism
parahtyroidectomy
Tx: secondary hyperparathyroidism
vitamin D/calcium supplements
Trousseu’s associte dwith
hypocalcemia
Chvostek’s associated with
hypocalcemia