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250 Cards in this Set
- Front
- Back
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What are the three most common causes of peripheral neuropathy?
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Diabetes
Alcoholism Connective tissue disease |
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How do you get diabetic neuropathy?
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damage to nerves via small vessel ischemia and hyperglycemia
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What is carpal tunnel syndrome?
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most common entrapment neuropathy
pressure causes ischemia results in demylination then axonal degeneration |
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What are the symptoms of Capal tunnel syndrome?
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paraesthesiasa, dysestheia in palmar aspect of hands and fingers
may awaken pt. progresses to weakness of ABP, FDP, FDS |
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What part of the hand gets sensory from the median N?
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thumb, index, middle, and 1/2 of ring fingers
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what is the main cause of carpal tunnel syndrome?
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idiopathic
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does the electrodiagnostic study of in carpal tunnel always come up positive?
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no it does not- especially early
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What are the treatments for carpel tunnel?
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cock-up night splint
omm CT release, but dont wait too long |
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What is the distribution of distal sensory neruopathy?
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stocking glove distribution
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What is the presentation of diabetic distal sensory neruopathy?
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intermittent pain and tingling in the feet
later becomes constant, intense, then painless eventually. NO motor changes |
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What are the keys to treating distal sensory neruopahy?
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blood sugar control in type 2 Dm
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What is mononeuritis?
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painful sensory and motor neuropathy involving 1 peripheral nerve
quick onset/ progression |
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what is mononeuritis multiplex?
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painful sensory and motor neruopathy involving at least two separate nerve areas
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What is diabetic thoracic radiculopathy?
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burning, stabbing, belt like pain- usualy unilateral
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What are some of the neuropathologic findings in parkinsons disease?
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loss of pigmented dopaminergic neurons of substantia nigra compacta
lewy bodies and lewy neurites |
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What is the average age of onset for parkinsons? when is it rare before?**
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average age of onset is 60
but rare before 40* |
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What are the cardinal signs of parkinsons?
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Resting tremor
rigidity bradykinesia postural instability |
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What is the most common initial symptom of parkinsons?
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pill rolling tremor, on one side
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What is the progression of parkinsons tremor like?
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starts unilateral, pill rolling
then spreads to the opposite side a Resting tremor |
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What is an essential tremor?
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most common tremor
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What are the features of an essential tremor?
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usually symmetric, and intention based**
isolated head tremor familial relationship |
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What is the gait of parkinsons like?
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shuffling gait
fenestrated gait with en bloc movement |
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On physical exam, what is it like trying to move a pts limbs with parkinsons?
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you'll see cogwheeling or lead pipe motion
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Other than motion problems, what are the other signs of parkinsons disease?
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Mood disorders (depression)
Sleep disturbances pain |
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What are the common complications of parkinsons?
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dementia, starting years later
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How long is levodopa good for in parkinsons?
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good control for 4-6 years, but disability often progresses from then on
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What is peripheral diabetic neuropathy most often related to?
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poor glycemic control
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What is multiple sclerosis?
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a chronic inflammatory demyelinating disease of the CNS
(Lesions that skip in time and space) |
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What is the microscopic morphology of multiple sclerosis?
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perivascular infiltrates of lymphocytes and monocytes
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What HLA is related to multiple sclerosis?
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HLA DRB1-1501
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How does multiple sclerosis happen?
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humoral component, increased levels of IgG demonstrated by oligoclonal banding on CSF electrophoresis
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What are the common manifestations of multiple sclerosis?
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Optic Neuritis- orbital pain, and variable visual loss- made worse by heat*
Ataxia Hemiparesis facial nerve palsies nystagmus, opthalplegia Vertigo myelopathy-incontinence |
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What is the most common disease course in multiple sclerosis?
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relapsins remitting
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How do you diagnose multiple sclerosis?
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history
oligoclonal banding in CSF IgG index |
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What is the gold standard DX of multiple sclerosis?
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MRI with Gadolinium
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How does Gadolinium enhance on MRI with multiple sclerosis?
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active lesions
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How do you treat multiple sclerosis?
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treat depression associated with it
acute flares are treated with glucocorticoids |
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How does Glatriamer work?
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this is a mix of 4 amino acids, which mimics myelin basic protein
binds up the angry T cells- also induces T helper 2 type suppressor cells |
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How do interferons work to treat multiple sclerosis?
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modulates immune responsiveness
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What is ALS?
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a neurodegenerative disorder or unknown etiology- characterized by progressive muscular paralysis, due to degeneration of motor neurons
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What neurons are affected by ALS?
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lower motor neurons in anterior horn of cord and brain stem
upper motor neurons in precentral gryus and prefrontal motor neurons |
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How do most people get ALS?
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spontaneous mutation in TDP-43 gene
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What are the major risk factor for ALS?
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Smoking
eating food products made from Cycad |
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What are the four regions of ALS?
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Bulbar- face/mouth.throad
Cervical- neck, shoulder, upper extremities Thoracic- chest/abdomen Lumbosacral- groin/lower back/ extremities |
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What is the most common symptom onset of ALS?
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progressive weakness in a single region
lack of pain, sensory sxs Incontinence** |
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What is on the physical exam for ALS?
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hyperreflexia (UMS)
atrophy fasciulations weakness spastic |
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How do you extend life in ALS?
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noninvasive ventlation
PEG tube |
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What is Riluzole?
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this is a Glutamate pathway antagonist to treat ALS
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What is the progression os MS?
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frequently seen with periods of relapses and remission
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What is the prognosis with ALS?
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usually follow a downhill course over 3-5 years
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What is the leading cause of disability in the US?
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strokes
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What three things can cause an ischemic stroke?
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Thrombosis
Embolism Hypoperfusion |
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What are the neruologic signs for an ischemic stroke usually like?
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usually present Bilaterally
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What is the most common type of stroke?
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ischemic stroke
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What part of the brain does the ACA cover?
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superior and anterior strip of the cortex
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Where does the MCA cover?
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deep central structures
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What three arteries contribute to the circle of willis?
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ICA
MCA Basilar artery |
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What are the symptoms of a MCA occlusion?
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Contralateral**
hemiplegia, Hemianesthesia, homonymous hemianopia gaze preference TO the stroke side** |
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What are the major signs of an ACA stroke?
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abulia- delay in verbal and motor response
paraparesis urinary incontinence Visual field deficits** |
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What is the most common sign of PCA stroke?
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occipital cortex is affected- so contralateral hemianopia, with MACULAR SPARING*
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What are the symptoms of a PICA stroke?
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vertigo, vomiting, nystagmus
numbness of ipsilateral face, contrlateral limbs- ataxia, hoarseness, dysarthria ipsilateral horners syndrome (affect ipsi up high, contra down low) |
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What does a Basilar artery stroke result in?
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Lock in syndrome
preserved consiciousness with quadraplegia |
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What does an AICA stroke result in?
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ipsilateral deafness
facial weakness vertigo N/V nystagmus tinnitus ataxia CN III palsy |
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What does a lacunar stroke of the posterior limb of internal capsule cause?
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pure motor hemiparesis
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What does a lacunar stroke of the ventrolateral thalamus cause?
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pure sensory stroke
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What does a lacunar stroke of the pons cause?
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ataxic hemiparesis
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What does a lacunar stroke of the internal capsule cause?
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dysarthria
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What should be the initial assessment in a CVA?
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ABC's
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How can having a stroke affect breathing?
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with a stroke, a pt can have increased ICP
this can decrease the respiratory drive |
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How is MAP affected in a stroke?
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MAP usually goes up
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What are the blood pressure guide lines for ischemic strokes?
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dont treat unless greater then 220/120
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What are the BP guidelines for hemorrhagic strokes?
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keep BP below 160/90
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What is very important to find out about a stroke?
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when did symptoms begin
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What is the first diagnostic test in a stroke?****
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Non contrast CT scan of brain
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How can an ischemia CVA present on CT initially?
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this can be normal initally
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What is the ONLY drug that shows to be effective for early treatment of ischemic stroke (the msot common kind)
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Aspirin! yay!
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How do you treat a hemorrhagic stroke?
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stop all anticoagulants, or reverse them
lower ICP |
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What is a transient ischemic attach?
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transient episode of neurologic dysfunction- due to ischemia without infarction
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What should you do after a transient ischemic attack?
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prevent the impending stroke
aspirin therapy ekg antihypertensive meds |
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What is the presentation of a subarachnoid hemorrhage?
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thunderclap onset, described as the worst headache of my life
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What is the preventable risk for subarachnoid hemorrhage?
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cigarette smoking
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What is the common complication that makes subarachnoid hemorrhages worse?
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vasospasm
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How do you diagnose a subarachnoid hemorrhage?***
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Lumbar puncture-
LOOK for: Xanthochromia (pink/yellow tint of CSF) this is THE most sensitive test |
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How do you manage a subarachnoid hemorrhage?
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admit to ICU
analgeisa prevents hemodynamic spikes- which cause re bleeding |
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What is the classic triad of meningitis?
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fever
nuchal rigidity change in mental status headache is usually severe and generalized |
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What is Brudzinski's sign?
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spontaneous flexion of the hips during passive flexion of the neck
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What is Kernigs sign?
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inability to allow full extions of the knee when the hips is flexed to 90*
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What should every pt with suspected meningitis have done?
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a lumbar puncture
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What are the CSF findings in bacterial meningitis?
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high WBC/Protein
Low glucose |
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Meningitis with G+ diplococci is...
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strep pneumoniae
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Meningitis with G- diplococci is....
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neissera meningitidis
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What is the most common cause of aseptic meningitis?
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enterovirus
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How does aseptic meningitis play out?
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typically self limited in course
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What does CSF look like for aseptic meningitis?
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some WBCs (<500)
some protein (<100) normal glucose negative G stain |
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What are the treatments for Meningitis?
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ABC's
supportive Antibiotics |
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What are the four phases of a migraine?
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premonitory symptoms
aura headache postdrome |
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What is the most common type of migraine?
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migraine without aura
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What are the frequent prodrome symptoms of a migraine?
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euphoria, depression
cravings, stiff neck, yawing |
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What is the aura of a migraine like?
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visual loss, bright spots
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what is the headache of a migraine like?
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unilateral, throbbing, pulsatile, lasts for a long time- can have N/V
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What are the symptoms of a tension headache?
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bilateral, rubber band feeling
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What are cluster headaches?
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short lasting, unilatearl severe attacks
severe orbital, supraorbital, or temporal pain that must be unilateral |
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What are some of the symptoms for cluster headaches?
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unilateral autonomic symptoms, ptosis, miosis, lacrimation, and such.
ipsilateral with the attack |
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How do you treat cluster headaches?
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oxygen
and regular headache treatments |
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Where does a subdural hematoma form?
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between the dura, and arachnoid membranes
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What causes a subdural hematoma?
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head trauma- tearing the bridging veins
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How do you treat a subdural hematoma?
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ABC's
supportive sometimes neuro emergency |
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Where do epidural hematoms form?
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in the potential space between the dura and the skull?
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What usually causes an epidural hematoma?**
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tearing of the middle meningeal artery
these are LENS SHAPED** |
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what shape are subdural hematomas?
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crescent shaped
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What are the symptoms of Anterior cord syndrome?
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injury to the anterior spinal artery.
produces weakness and reflex changes bilateral loss of pain and temp urinary incontinence |
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What are the symptoms of posterior cord syndrome?
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gait ataxia, and paresthesias,
weakness |
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What are the symptoms of Brown sequard syndrome? (hemicordectomy)
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Ipsilateral- weakness, loss of vibration/proprioception
Loss of pain/temp on opposite side. no bladder symptoms |
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What are the symptoms of central cord syndrome?
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loss of pain and temperature in one or several adjacent dermatomes .
this is a "suspended sensory level" Bladdy dysfunction. upper motor problems |
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what usually causes central cord syndrome?
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hyperextension injuries
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What is a SCIWORA?
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spinal cord injury with out radiographic abnormalities
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Who gets SCIWORAs?
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usually kids
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What is neurogenic shock?
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hypotension, bradycardia. usually due to traumatic spinal injury
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What is Entropion?
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inward turning of eyelid- tx surgery
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what is extropion?
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outward turning of eyelid. tx surgery
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How do you treat inflamed pinguecula and pterygiums?
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artifical tears, vasoconstrictors
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How do you treat belpharitis?
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warm compress
bacitracin minocycline keflex |
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How do you treat a hordeolum/chalazion?
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G+ coverage!
topical Warm compress |
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What must you apply to the eye after foreign body removal?
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pressure patch
antibiotics |
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How do you treat herpies simplex infection of the eye?
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Viroptic 5X daily
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What are the signs of viral conjunctivitis?
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preauricular lymphadenopathy is the sign*
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What are the signs of pre septal cellulitis?
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vision, pupils, and motility are all normal
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What are the signs of orbital cellulitis?
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pain, fever, blurred vision, diplopia, limited motility
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What is the treatment of pre-septal cellulitis?
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oral antibiotics
warm compresses |
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what is the treatment of orbital cellulitis?
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CT
ENT consult eye referral |
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What X ray view do you want for a blow out fracture?
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orbital X ray, Waters view
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What should be in your evaluation of a pediatric injury?
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ABC's
5P's of compartment syndrome |
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When is an Ankle X ray series required?
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if there is any pain in the malleolar zone, AND there are bone tenderness in a couple regions. (posterior edge of lateral maleolus or medial maleolus)
AND cant bear weight right away and in the ER |
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What is a foot x ray required?
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pain in the malleolar zone, AND tenderness at two points (base of 5th metatarsal/navicular)
AND cant bear weight right away AND in the ER |
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What is a salter type 1
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separation of physeal plate
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what is a salter type 2
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through physeal plate and into metaepiphysis (long part of bone)
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What is a salter type 3
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through physeal plate and epiphysis (the tip o fthe bone)
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What is a salter type 4?
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through metaphysis and epiphysis
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What is a salter type 5?
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crushes physis
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What is the mnemonic for the ossification of bones in the elbow?
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come-capitulum 2 yrs
rub- radial head - 4 yrs my- medial epicondyle- 6yrs tree-troclea - 8 of- olecranon-10 life- lateral epicondyle-12 |
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What is a sprained wrist often considered?
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this is often considered a fractured wirst
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What is Diarrhea?
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loose and or water stools for at least 3 days, or increase in volume and fluidity
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What is noninflammatory diarrhea?
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watery, non bloody diarreha
-from small intestine associated with cramps/bloating/ N/V |
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What is inflammatory diarrhea?
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due to colonic tissue damage by invasion of bugs.
fever, dysentery |
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Is there a fever with the dysentery of E coli O157:H7?
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no there is not
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What is tenesmus
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sensation of incomplete rectal evacuation, and painful urgency to evacuate the stool
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What is travelers diarrhea
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3 movements in 24 hours, with one or more of these: N/V/Cramp/ fever
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what is the most common cause of acute diarrhea?
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viral diarrhea
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What bugs can cause inflammatory diarrhea?
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salmonella
shigella campylobacter EIEC yersnia enterocolitica (mimics appendicitis) |
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What bugs create inflammatory diarrhea via cytotoxin production?
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EHEC (O157:H7)
Virbio C- DIff |
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What is the presentation of staph A diarrhea?
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1-6 hours, projectile vomiting
food is toxin. self limited due to-salads, cream/custard/mayo |
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What is the presentation of B cereus diarrhea?
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vomiting in 1-6 hours, diarrhea in 8-14 hours.
found with fried rice |
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What is the presentation of C. perfringens diarrhea?
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diarrhea/cramps
due to meat/gravey thats allowed to cool |
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When does enterotoxigenic E coli produce toxin?
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After ingestion
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What does weight loss with diarrhea suggest?
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CA
hyperthyroidism malabsoprtion |
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What does constipation alternating with diarrhea suggest?
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IBS
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What does arthritis, iritis, uveitis, and erythema nodosum implies
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inflammatory bowel disease
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Goiter, tremor, and tachycardia make you think of
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hyperthyroidism
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What conditions can cause WBC's in the stool- but are not infectious?
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UC
Chrons Ischemic colitis |
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What are the treatments for diarrhea?
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fluids! like carbonated drinks. gatorade (but it needs more sodium/potassium)
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What are the indications of IV rehydration due to diarrhea?
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severe dehydration, shock, altered consciousness, cant keep fluids down
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how do you prevent most kinds of diarrhea?
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frequent hand washing
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When do you give empiric antibiotic therapy for diarrhea?
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moderate to severe travelers diarrhea
-bacterial sxs- fever/bloody diarrhea/pain/ leukocytes dehydration |
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What is empiric therapy for travelers diarrhea?
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fluoroquinolones
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What is the complication of ecoli O157:H7 diarrhea?
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hemolytic uremic syndrome
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where do you get O157:H7 from?
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undercooked hamburger and apple cider
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What should you avoid drinking with acute NONinflammatory diarrhea?
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avoid colas, caffeinate drinks
milk booze |
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Do you need to report diarrhea?
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yes if its food handler OR a health care worker
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What is the most important mode of cooling under heat stress?
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evaporation
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What are Heat cramps?
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heavy work load in heat stressed enviorment.
muscles being used cramp occurs in athelets |
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how do you treat heat cramps?
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this is caused by dilutional hyponatermia, so treat it accordingly
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What are the symptoms of heat exhaustion?
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dizziness, N/V, fever, weaknes and syncope
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What causes heat exhaustion?
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heat stress and profuse sweating plus symptoms= heat exhaustion
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How does heat exhaustion develop?
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depletion of body water and salt sotres over afew days. due to drinking only water
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Who often gets heat exhaustion?
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nursing home pts
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what causes heat syncopy?
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depleted volume
vasodilation |
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What are the symptoms of heat stroke?
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fever, neruo dysfunction
altered mental status focal deficits seziure coma |
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When do you get heat stroke?
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develops over days, dehydration over time
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What lab tests do you run in heat stroke? findings?
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CBC- wbc's high
electrolyes- low ABG- acidosis LFT- elevated Glucose- ok clotting- DIC ECG- SVT |
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How do you treat heat stoke?
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cool enviroments
evaporation is best can use invasive stuff- cold internal lavages |
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How do you treat shivering during heat stroke tx?
|
chlorpromazine IV
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How do you treat hypotension in heatstroke
|
fluids- duh
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how do you reat rhabdomyolysis in heat stroke?
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mannitol- osmotic diuresis, alkalinze urine (bicarb)
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What is continuous data?
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this is measured data, where intervals are useful
height, BP, cholesterol |
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What can you calculate from continuous data?
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means and standard deviations'
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What is Ordinal data? (ranked)
|
numbers are arbitrary, but rank stuff
pain scale, apgar score |
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What are the appropriate was to calculate ordinal data?
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medians and percentiles are best
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What is counted data?
|
categorical stuff, like gender or cancer grade
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How can you characterize counted data?
|
my mode (most frequently occuring data point)
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What does the upper edge of the box in the middle of a box plot mean?
|
75th percentile
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what does the lower edge of the box in the middle of a box plot mean?
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25th percentile
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what does the midde line of the box in the middle of a box plot mean?
|
50th percentile
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What do the whiskers of a box plot mean?
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extreme values, less than 1.5X box heigh away from box edges
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What type of data is the mean used for?
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measured data thats not skewed
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what is the median used for?
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ranked data or skewed measured data
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what is the mode used for?
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counted data
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How do you measure dispersion in ranked data?
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percentiles
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how do you measure variance in measured data?
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the standard deviation
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which way does the tail skew?
|
mean moves direction of the skew (the way of the tail)
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What do you do with small p-value?
|
reject the null hypothesis
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What is a confidence interval?
|
mean+/_ (constant)* measure of variability
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what type of test paring removes variability between groups?
|
a paired design is best
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what is a type 1 error?
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false positive
-here you reject the null hypothesis, but the null is actually true |
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what is a type 2 error?
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accept null hypothesis, but null is not true
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How do you compare two unpaired comparisons?
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unpaired T test
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how do you compare two paired comparisons?
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paired T Test
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how do you compare more than two "unpaired" comparisons
|
independent ANOVA
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how do you compared more than two "paired" comparisons?
|
repeated ANOVA
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What does the chi-squared test do?
|
this test the frequency comparisons
typically used in 2X2 charts |
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What does the t-test compare?
|
compares two means.
used to compare means of two normally distributed samples |
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What does the H0 null hypothesis of the t-test mean?
|
any differences between the means of your two data sets is due to sampling error
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What does Ha research/alternative hypothesis of the t-test man?
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this means the difference between the means of the data sets is due to the effect your studying
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how do you determine if your t-test is statically significant ?
|
if your p value is below .05
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What is ANOVA used to compare?
|
comparing several different means (more than two)
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What is correlation and regression used to look for?
|
the relationship between two continuous variables
(smoking and lung cancer) |
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What does the pearson product moment correlation coefficent measure?
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measures direction and degree of LINEAR correlation between two variables
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what do the values for R (the pearson product moment correlation coefficient) mean?
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+r = positive linear
-r = negative correlation |
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What does the chi squared test look for?
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analyzing categorical data- like a 2x2 square
used to see if it is statistically significant in aid |
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what is exanthem?
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skin rash associated with viral infection
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what is enanthem?
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rash on mucosal surface assocaited with viral infection
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What is exanthem subitum due to?
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HHV 6/7
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What is the presentation of exanthem subitum?
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high fever followed by erythematous macular rash
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What is the presentation of rubella?
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mild URI
rash on face and spreads down to trunk clears by 3rd day |
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What is the causative agent of rubella?
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RNA virus in the togaviridae class
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What is the presentation of rubeola?
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Prodome- cough, coryza, conjunctivitis
Koplick spots** rash comes a couple days AFTER the fever |
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What causes ruebola?
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parmyxovirus
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What is the presentation of scarlet fever?
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sandpaper rash
desquamatoin of face, hands, feet |
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What causes scarlet fever?
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GABHS
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What is the presntation of tinea versicolor?
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macules on chest or back, hypopigmented, pink, or brown with fine scale
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What causes tinea versicolor?
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malassezia globosa
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What is nummular eczema?
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sharply demarcated scaly coin lesion.
happens in dry winter climates in people with atopy |
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Does chronic irritant contact dermatitis usually have vesciles?
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nope- just dry and chapped
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What type of allergic reaction is latex allergy?
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Type 4 rxn- T cell over time, BUT if you have a true anaphylatic reaction, it is type 1 IgE mediated
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What does atopic dermatiis look like?
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the itch that rashes
on cheeks, antecubital and popliteal areas |
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what is the #1 casue of urticaria?
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idopathic
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how deep in the tissues does erythema nodosum extend?
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into subQ and nodular in nature
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What is dermatomyositis?
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a systemic disease.
changes of eyelids, erythema of face neck and upper trunk, papules over knuckles (gottrons papules) pilateral proximal muscle weakness |
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What is dermatomyositis associated with?
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underlying malignancies
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How is icthyosis vulgaris transmitted?
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autosomal dominant
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waht type of ichtyosis only affects males?
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x linked ichthyosis
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What is the presentation of an epidermoid cyst?
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growth of cells over a pore, can squeeze out foul smelling crap
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what is actinic keratosis?
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erythemaous scaly papules on sun exposed areas
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how is most HIV transmitted?
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hetero sex (in africa)
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how fast is HIV transported to regional lymph nodes?
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48-72 hours
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What is the most common symptom of HIV infection?
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fever
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with HIV, what does a +ELISA and - Western blot mean?
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false positive
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With HIV, what does a + ELISA and indeterminate western blot mean?
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HIV status unkowns
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With HIV, what does a + ELISA, indeterminate western blot, and + HIV RNA mean?
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acute HIV
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With HIV, what does -ELISA, - Western blot, HIV RNA +100,000
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acute HIV
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what is the HIV rash?
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maculopapular and symmetrical, over the face and trunk
2-3 days after onset of fever |
