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128 Cards in this Set
- Front
- Back
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Clinical features of blow-out fractures?
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-entrapment: inability to look in one direction
-double vision -subcu emphysema -exopthalmus |
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Tx for corneal abrasions?
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antibiotic drops (bacitracin/polymyxin)
eye patch only for large abrasions (leave on for <24 hrs) |
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Dx: acute onset of floaters/flashes that progresses to blurred vision and eventual monocular blindness?
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retinal detachment
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Dx: gradual central vision loss
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macular degeneration
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What drugs can cause macular degeneration?
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chloroquine
phenothiazine |
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Fundoscopic findings wit macular degeneration?
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Drusen
hemorrhages |
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Types of macular degeneration?
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Dry: atrophy and loss of central photoreceptors
Wet: neovascularization causing bleeding and protein leak under retina |
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Dx: sudden, painless unilateral vision loss
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retinal artery occlusion
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Fundoscopic findings in retinal artery occlusion?
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-arteriolar narrowing
-retinal edema -cherry red spot -pale retina |
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Dx: "blood and thunder" retina on fundoscopy
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retinal vein occlusion
(dilated veins, hemorrhages, edema, exudates) |
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Fundoscopic findings in diabetic retinopathy?
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cotton wool spots
exudates splinter hemorrhages |
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Dx: gradual increase in vision loss, blurred vision, glare intolerance, double vision
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cataracts
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Dx: painful monocular vision loss, fixed mid-dilated pupil, injection, n/v
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angle-closure glaucoma
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Dx: gradual peripheral vision loss
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open angle glaucoma
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Tx for acute angle closure glaucoma?
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Acetezolamide
+ topical beta blocker (timolol) pilocarpine (opens angle) after 1 hr |
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Dx: inflammation of lid margins
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blepharitis
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Dx: painful nodule/pustule within a gland in eyelid
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hordeolum (sty)
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Dx: cyst caused by blockage of meibomian gland
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chlazion
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Common virus causing conjunctivitis?
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adenovirus
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Dx: slow growing triangular thickening of bulbar conjunctiva
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pterygium
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Vision change with lesion across left sided optic nerve?
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total blindness of left eye
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Vision change with lesion to optic chiasm?
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bitemporal heteronymous hemianopsia
(lateral vision loss of both eyes) |
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Vision change with lesion to right optic tract?
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left hemonymous hemianopsia
(lateral left and nasal right vision loss) |
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Tx of temporal arteritis
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prednisone
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Binocular fixation is not present?
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strabismus
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PE exams used to diagnose strabismus?
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corneal light reflex test
cover-uncover test |
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Weber test findings in conductive hearing loss?
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lateralization to the affected ear
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Rinne test will show what conductive hearing loss?
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bone conduction greater than air conduction on affected side
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Rinne test findings in sensorineural hearing loss?
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impariment of both air and bone conduction
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Most common cause of sensorineural hearing loss?
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presbycusis
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Dx: progressive hearing loss, tinnitus, vertigo
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menieres disease
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Tx of menieres disease
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Diuretics
prednisone |
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Dx: unilateral hearing loss, tinnitus, vertigo, ataxia
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acoustic neuroma
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What drugs may cause hearing loss?
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Macrolides
chloramphenicol ethacrynic acid |
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Common organisms causing otitis media?
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Strep pneumoniae
H. influenzae Moraxella catarrhalis |
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Tx for otitis media?
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Amoxicillin 80-90mg/kg/day divided q8-12hrs
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Tx for otitis media if pt has pen allergy?
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azithromycin
clarithromycin |
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Common pathogens in otitis externa?
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pseudomonas
enterobacter proteus |
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Dx: acute vertigo, hearing loss and tinnitus following URI or otitis media
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labyrinthitis
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Phenylephrine or oxmetazoline (affrin) nose drops may cause what?
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rhinitis medicamentosa (rebound congestion if used > 3 days)
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What is the centor criteria?
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-fever > 38C
-tender anterior cervical adenopathy -lack of cough -tonsillar exudates |
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Thrombolytic therapy for a stroke is most effective when?
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within 3 hrs
but can be given up to 12 hrs |
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Time frame difference between TIA and stroke?
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TIA sx last less than 24 hrs (usually seconds)
Stroke sx last >24 hrs |
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Sx associated with carotid TIA?
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-contralateral hand/arm weakness
with sensory loss -ipsilateral visual sx, aphasia, amaurosis fugax |
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Most common cause of non-traumatic subarachnoid bleed?
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ruptured saccular berrry aneurysm
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Bleed causing "worst headache of my life"?
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sub arachnoid hemorrhage
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Definition of status epilepticus?
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-seizures do not cease spontaneously
-full consciousness is not restored between seizures |
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Difference between generalized and partial seizures?
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no loss of consciousness in partial seizure
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Drug of choice for status epilepticus?
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Lorazepam
or Diazepam until seizures stop |
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Cause of multiple sclerosis?
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demyelination in CNS white matter
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Sx associated with anterior cerebral artery stroke?
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hemiplegia (leg>arm)
confusion, incontinence, primitive reflexes |
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Sx associated with middle cerebral artery stroke?
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hemiplegia (arm/face > leg)
homonymous hemianopia aphasia apraxia |
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Sx associated with posterior cerebral artery stroke?
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contralateral sensory disturbnce
aphasia homonymous hemianopia |
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Sx associated with vertebral artery stroke?
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wallenberg syndrome
(numbness of ipsilateral face and contralateral limbs, diplopia, dysarthria, ipsilateral horners) |
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Sx associated with basilar artery stroke?
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pinpoint pupils
quadriplegia, sensory loss cerebellar dysfunction Cranial nerve dysfunction |
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Sx of cerebelar stroke?
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vertigo
n/v diplopia nystagmus ipsilateral limb ataxia |
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Imaging of choice in acute stroke?
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non contrast head CT to r/o hemorrhage
if negative for hemorrhage then do CT angiogram |
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What is ABCD2 risk factors for progression of TIA to stroke?
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Age >60y
BP >140/90 Clinical features (weakness, speech impairment) Duration >60 min Diabetes |
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Carotid endarterectomy is indicated with what degree of carotid stenosis?
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>70%
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Gastroenteritis bacteria associated with guillain-barre syndrome?
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campylobacter
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Dx: ascending symmetric paralysis,
hypoactive then absent reflexes |
guillain-barre syndrome
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CSF findings in GBS?
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increased protein
< 20 lymphs |
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Tx of GBS?
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Plasma exchange
or IVIG |
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Dx: Fluctuating weakness with fatigability
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myasthenia gravis
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Cause of myasthenia gravis?
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antibody against acetylcholine receptor
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What is ice pack test?
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used in dx of nyasthenia gravis
ptosis after >30 sec of upward gaze, improved with ice pack |
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Medication used to temporarily increase strength in myasthenia gravis?
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neostigmine
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Medication for chronic myasthenia gravis?
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pyridostigmine
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Medications used to improve memory function in alzheimers?
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Galantamine
Donepezil ribastigmine tacrine |
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Type of dementia associated with HTN?
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vascular
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Difference in progression between alzheimers and vascular dementia?
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alzheimers has steady decline
vascular has stepwise decline |
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Frontotemporal dementia is associated with what conditions?
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Pick's disease
(progressive destruction of nerve cells, build up of tau proteins) ALS |
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Treatment which relieves most cluster headaches?
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100% O2
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Dx: rhythmic to and fro tremor of upper extremities, brought on by stress and relieved by alcohol?
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benign essential tremor
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Cause of parkinsons disease?
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degeneration of cells in substantia nigra, causes a deficiency of dopamine
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4 common features of parkinsons?
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resting tremor
bradykinesia rigidity postural instability |
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Tremor associated with parkinsons?
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pill-rolling
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Physical problems associated with bradykinesia in parkinsons?
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slow shuffling gait
slowed rapid alternating movements masklike facies |
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Medications used to reduce parkinsons tremor?
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anticholinergics: benztropine, trihexyphenidyl
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Medication which improves all sx of parkinsons?
What med improves its efficacy? |
Levodopa (dopamine precursor)
Carbidopa |
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What dopamine agonist is used in parkinsons pts refractory to levodopa?
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bromocriptine
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What drug inhibits breakdown of dopamine?
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selegiline (monoamine oxidase B inhibitor)
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What drugs reduce the metabolism of levodopa?
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tolcapone
entacapone (COMT inhibitors) |
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Dx: genetic disease with progressive chorea and dementia,
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huntingtons disease
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Dx: impairment of muscle tone, strength and coordination resulting in spasticity, ataxia, seizures, and mental retardation?
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cerebral palsy
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Drugs of choice for restless leg syndrome?
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Dopamine agonists:
bromocriptine ropinirole |
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Treatment for bells palsy?
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prednisone +/- acyclovir
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PE findings in diabetic neuropathy?
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reduced DTRs
impaired vibratory sense impaired proprioception |
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Tumor that is associated with myasthenia gravis?
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thymoma
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Most common bacterial causes of meningitis?
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strep pneumoniae
neisseria meningitidis group B strep |
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Meningitis with a petechial rash is associated wit what bacteria?
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neisseria meningitidis
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CSF findings in bacterial meningitis?
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elevated opening pressure
elevated WBC decreased glucose |
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Tx of meningitis in newborns?
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ampicillin
+ cefotaxime |
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Tx of meningitis in adults <55 y?
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cefotaxime or ceftriaxone
+ vancomycin |
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Tx of hospital acquired or post neurosurgery meningitis?
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ampicillin
+ ceftazidime + vancomycin |
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Criteria of glascow coma scale?
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eye opening (4 pts)
verbal response (5 points) motor response (6 points) |
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Sx with frontal lobe lesions?
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slowing of mental activity
personality changes aphasia |
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Sx of temporal lobe lesions?
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seizures
olfactory, gustatory, visual, and auditory hallucinations |
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Sx of parietal lobe lesions?
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contralateral disturbance in sensation
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Sx of occipital lobe lesions?
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crossed homonymous hemianopia
visual defects and hallucinations |
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Tx of narcolepsy?
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stimulants: dextroamphetamine
modafinil |
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What are the stages of schizophrenia?
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prodromal
psychotic residual |
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Difference between brief psychotic disorder, schizophreniform, and schizophrenia?
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brief psychotic: sx >1 day, but < 1 month
schizophreniform: >1 month, <6 months schizophrenia: >6 months |
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Antipsychotic which causes agranulocytosis?
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clozapine
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Medications preferred for tx of negative sx in schizophrenia?
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atypicals
(seratonin and dopamine antagonist activity) |
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Side effects of antipsychotics?
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parkinsonian like syndrome
neuroleptic malignant syndrome tardive dyskinesia extrapyrimidal sx |
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What are extrapyrimidal sx?
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parkinsonism
akathesia dystonia tardive dyskinesia |
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Dx: vague physical complaints that cant be explained by medical condition
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somatization disorder
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Dx: preoccupation with an imagined defect in physical appearance
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body dysmorphic disorder
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Dx: neurologic complaints that cant be explained medically
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conversion disorder
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Dx: faked signs and symptoms in order to assume a sick role
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munchausen syndrome
(factitious disorder) |
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Common medications associated with serotonin syndrome?
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MAOI + SSRI
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Which psych meds require a tyramine free diet?
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MAOIs
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Side effects of SSRIs?
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GI upset
headache sexual dysfunction |
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Side effects of Lithium?
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weight gain
nausea tremor hypothyroidism arrhythmias seizure |
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Timetable of development of adjustment disorder?
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sx develop within 3 mo after a stressful life event and end within 6 months of event
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Personality disorder: pervasive distrust and suspicion of others, holds grudges
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paranoid
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Personality disorder: voluntary social withdrawal, eccentric and reclusive, no desire for relationships
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schizoid
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Personality disorder: eccentric behavior, ideas of reference, magical thinking and fantasies
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schizotypal
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Personality disorder: inability to conform to social norms, disregard for feelings of others, lacking empathy
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antisocial
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Personality disorder: unstable moods and behavior, paranoid ideations, splitting
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borderline
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Personality disorder: overly emotional, dramatic and seductive, flamboyant, extroverted
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histrionic
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Personality disorder:inflated self image, grandiosity, need for admiration, lack of empathy
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narcissistic
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Personality disorder: extreme sensitivity to rejection, social anxiety, inadequacy
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avoidant
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Personality disorder: clinging, submissive behavior, cant make own decisions, lack self confidence
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dependent
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Personality disorder: orderliness, perfectionism, inflexibility, change in routine leads to anxiety
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obsessive-compulsive
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Anorexic pts are usually what percentage of expected weight?
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<85%
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What psch med lowers the seizure threshold?
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bupropion
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