Week 1 Flashcards
What is associated with von hippel lindau and where is the mutation
pheochromocytomas, retinal and cerebellar hemangioblastomas, and RCC. Mut is on chromosome 3 of VHL gene
what is indicative of a postictal state vs. syncope
confusion lasting for several minutes after a seizure. In syncope you return almost immediately to baseline
after a carotid endarterectomy what is the more immediate risk and what is a risk in a couple months
immidiate - plaque embolism months- intimal hyperplasia
distinguish between early and late findings of alzheimers
early-forgetfullness, trouble driving places that were once commonplace, language difficulties, etc. LATE: urinary incontinence, dyspraxia, noncognitive deficits, urinary incontinence
describe idiopathic intracranial HTN
typically an obese woman, likely because of outlet syndrome. You will see papilledema, negative imaging, elevated opening pressure
normal pregnancy urine findings
trace protein is normal
Sturge-Weber syndrome findings
port wine stain on the face into eye, risk of glaucoma
Phenytoin toxicity signs
cerebellar dysfunction, ataxia, altered mental status, hyperrflexia
How can an AV fistula in the arm for dialysis affect the median nerve
multifactorial, main thing to know is that it is carpal tunnel syndrome that is the main thing that happens
how do you manage traumatic brain injury
maintain central pressure, administer a antifibrinolytic (tranexamic acid), prevent seizures, control blood glucose, etc.
what is the likely etiology of a 20yo with new onset hearing loss with family hx of similar hearing loss at 20yo
NF2 bc of bilateral acoustic neuromas
what is the likely cause of a intracranial hemorrhage in a 40yo without any PMH
cocaine
what do you give to a pregnant patient for migraine prophylaxis
a beta blocker, the other prophylaxis drugs are topiramate/valproate (toxic) or an antidepressant TCA or venlafaxine which also cannot be given
Hallmarks of tuberous sclerosis
ash leaf spots, angiofibromas, and shagreen patches (papules in lumbosacral region), CNS tumors, autism, renal angiomyolipomas, cardiovascular rhabdomyomas
non pharmacological management of delirum
night sitter to reassure them that they are okay and tell them where they are at, helps get a full nights rest, avoid benzos
symptoms of a parasagittal meningioma
bilateral leg weakness, urinary incontinence (frontal lobe dysfunction) and UMN signs in the lower limbs with preserved reflexes in the upper limbs
CSF in bacterial vs. fungal vs. viral meningitis
bacterial: low glucose high protein and PMNs // Fungal: low glucose, high protein but lymphocytes // viral: normal glucose, normal to high protein and lymphocytes
what is amaurosis fugax
this is transient occlusion of the retinal artery causing vision loss without pain. in an older individual it is often due to carotid emboli so a ultrasound of the neck should be done
difference between adult vs. neonate meningitis presentation
adults: neck rigidity, fever, nausea/vomitting // infants: poor feeding, fever, jaundice, irritability, lethargy
signs of DRESS syndrome and drugs that cause it
delayed reaction to mostly antiepileptics or antimicrobials // sx: facial edema, lymphadenopathy, eosinophilia, rash, fever // drugs: carbamazapine, phenytoin, lamotragine, dapsone, TMP/SMX, vanc
signs and treatment of organophosphate poisoning
signs: DUMBELS // treatment: atropine (blocks the AChR itself) and then also pralidoxine
what antibiotics do you give to neonates for meningitis
ampicillin, gentamicin, and cefotaxime
which mutations mean early onset vs. late onset alzheimers
presenilin 1 for early and ApoE4 for late
what is the main cause of death of acromegaly
congestive heart failure leading to reduced cardiac output
what is transient global amnesia
this is where you have sudden onset impairment of short term memory and ability to retain new information. no longer than 24 hours
signs of cocaine use
decreased appetite, weight loss, nervousness, conflict with family, dilated pupils, tachycardia, high BP, tremor, NORMAL refelxes
essential vs pill rolling tremor
essential: increases with a task, not seen at rest, gets better with alcohol // pill rolling: at rest, asymmetric, and parkinsons
how do you treat essential tremor
propanolol
what is the first line treatment for spinal mets from prostate cancer
high dose steroids to decrease inflammation and pain before surgery
describe cerebral amyloid angiopathy
this is when the beta amyloid plaques infiltrate into the brain and then they cause ICH in a lobar fashion. signs ans sx will be confusion and things related to the specific lobe
what are the signs of a lacunar stroke vs. larger ischemic strokes
lacunar: leg or arm weakness, NO focal signs, absence of cortical signs (aphasia, dysarthria, etc) NO mental status changes, often dont see them on imaging bc they are so small. Larger ones: focal signs, LOC etc.
signs of retinal detachment
curtain in front of vision, floaters, specific areas of vision loss, often in one eye not bilateral
describe the path of infection if a bug bites your face and say the signs and symptoms
travels from the facial vein or sinuses to the cavernous sinus causing a thrombosis // signs and sx: headache, periorbital edema, fever, vomiting etc .
first line diagnostics for a carotid bruit heard on physical exam
doppler ultrasound
first line diagnostics for an INFANT with full anterior fontanelles
ultrasound, dont want to CT bc of radiation exposure
signs of amantadine toxicity
livedo reticularis, orthostatic hypotension, peripheral edema, ataxia
how do you treat status epilipticus
IV benzo (lorazepam) –> phenytoin –> phenobarbital –> propofol
how do you diagnose ALS
electromyography
differentiate between peripheral and central facial nerve palsys
peripheral: forehead also affected // central: ipsilateral forehead is okay because of dual innervation peripherally
what are the signs of idiopathic intracranial hypertension
blurry vision, papilledema, diffuse headache,
differentiate between menieres and benign paroxysmal positional vertigo
Menieres: failure to absorb endolymph, tinitus, hearing loss // BPPV: crystals are displaced, do dix-halpike maneuver, vertigo
when should you not do a lumbar puncture?
if there are signs of increased intracranial pressure (such as confusion, somnolence, etc) bc of risk of herniation
what is the lesion type in prostate mets vs. multiple myeloma
prostate mets: sclerotic // multiple myeloma: lytic
