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76 Cards in this Set
- Front
- Back
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where is the dysfunction with a coma?
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both hemispheres of brain or reticular activating system
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what all should be done in the management of a comA?
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ABCs then
DONT Forget = Dextrose, oyxgen, naloxone, thiamine before dextrose, flumazenil |
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what should be done in management of brain herniation?
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ABCs- intubate
then force into respiratory alkalosis to pco2 of 25, give mannitol, dexamethasone. NO LP! |
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1. if pt has HSV encephalitis what will EEG show?
2. Where is the brain destruction localized to? 3 what is treatment? |
PLEDS (periodic lateralized epileptiform discharges) and seizures are common
2. temporal lobe destruction 3. acyclovir but poor prognosis |
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elderly pt presents with delirium? what should be first lab checked?
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urine for UTI
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what is drug of choice for acute delirium and what is a side effect that must be monitored?
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haldol and watch QT
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if pt has cheyne stokes breathing pattern what could be possible diagnosis?
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CHF or brain lesions
(rhythmic breathing patter like torsades on an EKG- crescendo decrescendo) |
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what is apneustic breathing and what does it indicate?
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breathing with pauses after inspiration. indicated brain stem injury, impending respiratory distress adn death
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if pt presents with cluster breathing (short bursts of respirations) or ataxic breathing (no pattern) what doe that indicate?
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death within 72 hours
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pt presents with unequal pupil sizes. what is this called and What could be the cause?
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called anisocoria and due to uncal herniation or eye drops
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a lesion in what part of your brain would cause pinpoint pupils?
what drug causes pinpoint pupils? |
- lesion in pontine
-narcotics |
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where is problem in brain if pt presents with midposition fixed pupils?
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midbrain, transtentorial herniation
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anoxia, scopolamine, and methanol can all do what do your pupils?
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bilaterally fixed and dilated
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in the dolls eye test what indicates an intact brain stem?
- if test is negative what does it indicate? |
moving head side to side causes eyes to move opposite of head movement.
if absent indicates bilateral pontine lesions or drug induced |
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if brainstem function is intact which was should eyes move in the cold caloric test?
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toward the ear canal with the cold water
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if pt has dysconjugate gaze where is the lesion?
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brainstem
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gaze preference
1. which way will eyes go after a stroke? 2. after a seizure? |
1. eyes look toward affected stroke side
2. eyes look away from irritative lesion like in a seizure |
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pt presents with n/v/ HA, bradycardia, and papiledema and is dx with increased CSF pressure. What nerve palsy is associated with increased CSF and how does it present?
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6th nerve palsy and eyes will look down and inward
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it is a clinical dx to be considered brain dead, but what will EEG and brain blood-flow study show?
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EEG shows no electrical activity and blood-flow study shows no cerebral blood flow
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what is management for pt is status epilepticus?
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ABC- oxygen
thiamine, dextrose, lorazepam, phenytoin or general anesthesia. |
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pt presents with ptosis, miosis, and anhidrosis. what is this syndrome called and what is it associated with?
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horners syndrome
associated with pancoast lung tumor or internal carotid dissection |
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treatment of CVA?
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ASA, rt-PA?
keep BP above 160/90 for first 24 hours. Heparin and coumadin do nothing |
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what is treatment for cardiogenic embolus?
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heparins or warfarin
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1.what are causes of SAH?
2. how to dx it? 3. treatment? |
1. hydrocephalus, aneurysm, cocaine, meth,
2. CT and then if neg LP to look for xanthochromia or blood 3. nimodipine or neurosurgery for clip or coil |
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what are classic findings with basilar skull fracture?
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Battle sign (postauricular hematoma)
raccoon eyes (periorbital edema) CSF rhinorrhea/otorrhea |
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1. what artery is most commonly involved in an epidural hematoma?
2. how is timing/presentation of this different than other hematomas? 3. what is seen on CT? |
1. middle meningeal
2. pts have a lucid interval 3. lenticular hematoma |
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what antibody is found in a pt with peripheral neuropathy and small cell lung cancer?
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ANNA-A (anit-hu antibody)
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what antibody causes a paraneoplastic syndrome on small cell lung cancer?
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anti-yo antibody
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pt presents with back pain and urinary retention and sensory deficits? what is dx and what could be causing it?
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spinal cord compression caused by tumor, disc herniation, epidural abscess, hematoma
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pt has unilateral cord lesions with contralateral pain and temperature loss, ipsilateral weakness and loss of proprioception. what is dx?
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Brown-Sequard syndrome
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pt presents with saddle anesthesia, flaccid lower extremities and bowel and bladder incontinence. what is first step and what is tx?
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cauda equina syndrome so get MRI or CT and then given dexamethasone and neurosurgery
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if pt has bladder or rectal distention then develops HA, tachycardia, and diaphoresis. what is the underlying cause of tachy, Ha, diaphoresis.
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autonomic dysreflexia
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pt presents with rapid ascending paralysis with decreased DTRs after Gastroenteritis.
1. what is dx 2. what is bug on boards? 3. what will CSF look like? 4. how to dx it? 5. what is treatment? 6. what is biggest risk? |
1. guillain-barre
2. campylobacter 3. high protein with no pleocytosis 4. EMG 5. IVIG or plasmapheresis 6. respiratory mm paralysis so resp failure. |
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female pt presents with wekaness after exercise, ptosis, diplopia, dysphagia.
1. what is diagnosis 2. what is underlying cause 3. what is best test? 4. what is next step after diagnosis and why? 5. what is treatment? |
1. myasthenia gravis
2. antibody against post synaptic ach receptors at neuromuscular junction 3. acetylcholine receptor antibody test 4. CT chest to look for thymoma 5. anticholinesterase pyridostigmine (mestinon); plasmapheresis adn IVIG for acute flare |
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pt presents with blurred vision, dry mouth, cranial nerve palsies, and weakness after eating canned foods.
1. what is dx 2. what is mechanism? 3. tx? |
1. botulism
2. exotoxin from c. botulinum causes no relesase of ach from presynaptic terminals. 3. antitoxin and supportive care |
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pt with psych pmhx preesnts with fever, rigidity, high CPK. what is dx?
tx? |
neuroleptic malignancy syndrome
treat with dantrolene |
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pt presents with Ha, confusions, seizures, and visual loss. MRI shows classic hyperintense findings. what is dx?
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PRES (posterior reversible encephalopathy syndrome
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pt presents with tinnitus, sensory hearing loss and episodic vertigo. what is dx and treatmetn?
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meniere disease
tx with diuretics and surgery |
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in parkinsons, prior to surgery how long should selegeline be stopped and why?
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2 weeks prior because of interaction of MAO-I with anesthesia can cause serotonin syndrome
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pt presents with dementia, hallucinations, parkinsonism, falls and sleep problems. what is most likely diagnosis?
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lewy body dementia
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pt has hearing loss, dizziness, tinnitus, and abnormal caloric test with marked vestibular hypoactivity
dx? |
acoustic neuroma
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pemphigus vulgaris- with classic Nikolsky sign of skill pulling off like a sheet
1. what antibody found? 2. take skin bx to look for what? 3 what is treatment? |
1. anti-desmoglein 3 ab
2. IgG and C3 3. steroids |
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Pt with history of hep C and alcohol abuse presents with several sun exposed non-healing blisters and hyperpigmentation. Urine shows porphyrins. what is dx?
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porphyria cutanea tarda
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pt presents with tinea versicolor.
1. how to dx it? 2. what is classic finding seen on micro 3. what is bug? 4. what is treatment? |
1. KOH prep
2. spaghetti and meatball pattern 3. Malassezia furfur 4. terbinafine |
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what are common bugs for necrotizing fasciitis?
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group A strep or clostridium
pt wil have high cpk and air on xray |
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what is treatment for pityriasis rosea and what are the 2 common things they will say on boards for clinical findings?
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treat with topical steroids but will resolve in 2 months
"herald patch" and christmas tree pattern |
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what is the bug in hot tub folliculitis or in hot-foot syndrome?
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psuedomonas
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pt presents with "saucer shaped ulcers"
what is dx, tx, and bug? |
ecthyma
tx with penicillin bug is usually strep |
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female pt with pmhx of inflammatory bowel disease presents following a URI with tender "red nodules with juicy center" and is febrile.
what is dx and what is treatment |
sweet syndrome (aka acute febrile neutrophilic dermatosis)
tx with prednisone |
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pt presents with rash and itching after staying in a hotel . Dx? and what is bug called?
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bed bugs.
cimex leticularis |
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pt presents with abscesses in apocrine sweat glands in axilla and groin. what is dx and tx?
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hidradenitis suppurativa
tx with abx, cyclosporine, or TNF agents |
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for most toxins if pt overdoses pick what to treat on boards?
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charcoal- not in alcohol, heavy metals, cyanide or tylenol
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what two drugs cause alkaline diuresis with bicarb?
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salicylates and phenobarb
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tylenol OD
1. how does tylenol cause liver necrosis? 2. how much would pt need to ingest? 3. what is the first thing you should do? 4. what is the reversal agent and when should it be given? |
1. depletion of hepatic glutathione
2. 7-10 grams 3. check the level on nomogram 4. NAC (mucomyst) |
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pt presents with mydriasis, urinary retention, hyperthermia, rash, and SVT or other ventricular arrhythmias and hypotension because of alpha-1 blockade.
what is most likely OD cause? what to look for on EKG? |
TCAs- cholinergic blockade
watch for QT prolongation |
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pt with hx of treatment for depression presents with agitation, confusion, diaphoresis, fever, and diarrhea.
what is most likely casue and what is treatment? |
Serotonin syndrome
tx with cyproheptadine |
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in BB OD what is first tx?
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glucagon
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what is tx for CCB OD?
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calcium choloride or gluconate or glucagon
atropine and may need pacemaker |
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what drug commonly causes wenckebach?
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digoxin
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pt presents with hx of etoh abuse wtih hypotension, nausea, and vomiting. Ketosis and osmolar gap are present.
what is likely cause and tx? why does this cause ketones? |
isopropyl alcohol and tx with charcoal and/or hemodialysis
is metabolized to acetone |
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pt has n/v/ convulsions, severe anion gap met acidosis and an osmolar gap and vision changes due to damage to the optic nerve. what is cause?
what is treatment? what is substance converted to? |
methyl alcohol
folinic acid to metabolize the formic acid that methyl alcohol is converted to and the give fomepizole |
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pt presents with renal failure and oxalate crystal in urine and increased anion gap met acidosis and and osmolar gap. +urine fluorescence ( can check woods lamp of urine)
what is cause? tx? |
ethylene glycol
tx with dialysis and fomepizole |
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what is first step when someone presents with hydrocarbon ingestion like gasoline or kerosene?
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remove soaked clothes then watch for aspiration
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in lithium toxicity with confusion, seizures, and posturing. what should be done?
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gastric lavage, give normal saline, DIALYSIS
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what are common causes of methemoglobinuria ?
what will abg show? what will pulse ox show what is treatment? |
nitrates, sulfa, antimalarials, topical benzocaine, dapsone
ABG= normal o2 pulse ox= low and cyanotic tx with methylene blue, oxygen and charcoal |
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pt presents with respiratory depression, miosis, and delirium.
dx? tx? |
opioid OD
give naloxone |
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pt presents with miosis, lacrimation/salivation, blurry vision, diaphoresis, N/V/D.
what is the cause? what labs will be low? what is the treatment? |
organophosphates like insecticides or anticholineterases.
2. RBC cholinesterase and plasma pseudocholinesterase will be low 3. tx with atropine and pralidoxime |
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phenothiazines can causes NMS with delirium, hyperthermia, and hypotension, and dystonic reactions. what should treatment be?
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benztropine or diphenhydramine for torticollis/ dystonia
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pt presents with tinnitus, pulm edema, respiratory alkalosis and then metabolic acidosis, hypoglycemia.
what is cause? tx? |
ASA OD
give gastric lavage and alkalinize urine with bicarb and possible dialysis if levels >20-30 |
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kid presents wtih coma and ventilator assitance, has normal ph on blood gas. dx?
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ASA
#18 on absolutes of emergencies and antidotes |
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what is key feature of barbiturate OD and what is treatment?
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respiratory depression. give charcoal, alkalinize urine
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what is reversal for benzo od?
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flumazenil
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pt presents with cocaine OD and has MI. what drug commonly used in ACS protocol should be avoided.
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beta blockers because it leads to unopposed alpha constriction
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what are causes of cyanide poisoning?
what is the classic odor associated? what is mechanism? tx? |
cause= synthetic or plastics fire like burning upholstery
almond odor mechanism is converting hgb to metHgb to bind cyanide tx with amyl nitrite, o2, bicarb, thiosulfate |
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how to treat hydrogen sulfide toxicity?
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same as cyanide
"rotten egg odor" |
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match the symptom with what artery caused the CVA.
1. painless monocular blindness (amaurosis fugax) 2. hemiparesis with sensory sx, aphasia, hemianesthesia, homonymous hemianopsia 3. weakness and sensory loss with diplopia, loss of facial sensation, ataxia 4. |
1. internal carotid artery
2. middle cerebral artery 3. midbasilar artery |
