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116 Cards in this Set
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- 3rd side (hint)
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What is the cardiac anomaly associated with Turner's Syndrome? and what symptom will be seen with this?
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Coarctation of the Aorta. Will see Associated Hypertension in the UE and lower pressure in the LE
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What is the most common cardiac anomaly associated with Marfan Syndrome?
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Aortic Regurg
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Is Levothyroxine okay to use in Pregnancy?
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Yes, in fact some may even need an increase in their levothyroxine dosage after 5 weeks into the 1st trimester.
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When you see a mass protruding from an infant girls vagina and it has a "cluster of grapes" appearance, what do you think of?
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Sarcoma Botryoides
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Sarcoma botryoides is a subtype of embryonal rhabdomyosarcoma, which is the leading malignant tumor of the lower genitourinary tract in infant girls. The majority of cases present within the first two years of life. Sarcoma botryoides commonly presents with vaginal bleeding and has a gross appearance that resembles a cluster of grapes as in the above case
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What Congenital abnormalities can be present born to a mother with uncontrolled DM?
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Macrosomia, Heart defects including transposition of the great vessels, and caudal regression syndrome.
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What are the symptoms of you have occlusion of the AICA?
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1. Facial Paralysis
2. Deafness/Tinnitus (vestibular/cochlear nerve) 3. Nystagmus and vertigo 4. Will not have loss of motor/light touch. |
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What are symptoms of PICA occlusion?
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You get Wallenberg's syndrome
1. Loss of Pain and Temp on contralateral body 2. Loss of Pain and Temp on IpsilateralFace 3. Ipsilateral cerebellar defects such as ataxia and past pointing. |
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What two viruses effect the motor neurons of the anterior horn and what symptom does this cause?
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Polio and West Nile. This can cause a flaccid paralysis.
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What are the most common causes of bacterial meningitis in a patient less than one month of age?
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GBS and E. Coli. Listeria is also included in there.
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What are the preferred empiric Abx for bacterial meningitis in a patient less than 1 month of age?
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Ampicililn + Cefotaxime or Gentamycin.
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What are the most common causative organisms of bacterial meningitis in patients 1 month to 60 years of age?
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1. Strep Pneumo
2. Nisseria Meningitidis |
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What empiric Abx would ou start for suspected meningitis in patients 1 month to age 60?
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1. Cefotaxime or Ceftriaxone
2. Vancomycin 3. Dexamethasone IV q6hrs x 4 days if over 6 weeks of age. |
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What are the most common causes of bacterial meningitis in patients greater than 60 years of age?
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1. Strep pneumo
2. Listeria 3. Nisseria 4. Gram - bacilli (eg pseudomonas and e.coli) |
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What empiric abx do you give to a patient with bacterial meningitis greater than 60 years of age?
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1. Ampicillin (Listeria coverage)
2. Cefotaxime of ceftriaxone 3. Vancomycin 4. Dexamethasone IV q6 hrs x 4 days. |
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What two drugs can be given for Nisseria Meningitis prophylaxis to close contacts?
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1. Rifampin
2. Ciprofloxacin |
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What are the 4 main long term complications children can get from bacterial meningitis?
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1. Hearing loss
2. Long Term Seizure Disorder 3. Mental Retardation 4. Spastic Paralysis |
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What are the three most common causes of viral meningitis?
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1. Coxackie
2. Echovirus 3. Human Enterovirus |
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What is the most common presentation of someone with Pseudotumor Cerebri?
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Look for this diagnosis in an obese female of child-bearing age who presents with morning headaches that are recurrent along with nausea and vomiting. Excess vitamin A may be a cause. It can be effectively treated with carbonic andhyrase inhibitor diuretics such as acetazolamide or CSF shunting. Patient may also have papilledema and a pulsatile posterior eye pain.
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What are the treatments for Pseudotumor Cerebri?
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Weight Loss as well as Medical Management with Acetazolamide.
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What is the most worrisome sequela of Pseudoturmor Cerebri?
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Vision Loss
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What are the three most common causes of orbital cellulitis?
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1. Staph Aureus
2. Streop pneumo 3. Beta hemolytic strep |
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What do you think of when you hear Anti-microsomal antibodies?
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Hashimotos Thyroiditis
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What is Pernicious Anemia?
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an autoimmune attack against the parietal cells in the stomach leading to vitamin B12 deficiency, megaloblastic anemia and achlorohydria (low gastric acid production).
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What type of medication is contraindicated in women who have Migranes WITH Aura?
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OCP's!!!!! they are more likely to have clots and die from stroke from those clots.
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What are some precipitating factors of Migranes?
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Stress, OCPs, Menstruation, exertion, foods containing tyramine or nitrates (chocolate, cheese, processed meats).
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What are two precipitating factors of Cluster headaches?
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Alcohol and Vasodilators
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What is the characteristic pattern of cluster headaches?
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Young men with severe, unilateral periorbital headaches with lacrimation and nasal congestion. Can cause hornet's syndrome (ptosis, mitosis, and anhidrosis).
These headaches usually occur at the same time every day for a certain amount of time. They usually last 30 mins to about 3 hours. |
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Are tension headaches usually bilateral or unilateral?
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Bilateral, with tightness at the occipital region and possibly neck pain.
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What is the tx of choice for tension headaches?
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NSAIDS is definitely first line but can also possibly use ergots or triptans.
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What is the tx of choice for cluster headaches?
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100% Oxygen and can use sumatriptan or dihydroergotamine.
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What is the treatment of choice for Migrane headaches?
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sumatriptan (or other triptan) dihydroergotamine (DHE 45), NSAID's, and/or anti emetics (chlorpromazine, prochlorperazine, metoclopramide).
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When do you want to avoid giving vasoconstrictors (ergots and triptans?)
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In patients with CAD, Prinzmetals Angina (due to coronary artery vasospasm) or in pregnancy because you can have serious complications.
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What agents can be used for prophylaxis of migraine headaches?
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1. CCB's (verapamil is often first line)
2. Beta Blockers (propranolol, metoprolol, good choice if comorbid HTN). 3. Antidepressants 4. NSAIDS (naproxen, good choice if menstrual migraine or comorbid osteoarthritis or other pain that could benefit from NSAID's). 5. Anticonvulsants |
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What is the first line treatment for Trigeminal neuralgia?
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Carbamazepine!!!!!!
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What are some inciting agents of Pseudotumor Cerebri?
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Vitamin A excess, Acutane, long term tetracycline, and withdrawal from corticosteroids.
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What ist he HTN goal for someone with carotid artery stenosis?
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<140/90
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What is the ideal lipid profile for a patient with carotid artery stenosis? and what is the best way to achieve these numbers?
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LDL < 100 mg/dL
HDL > 35 mg/dL triglycerides < 200 mg/dL Lipid control with statins will reduce stroke while other lipid lowering drugs will not. Niacin reduces carotid artery intima thickness and can help increase HDL levels. AHA diet |
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What should the glucose be in patients with carotid artery stenosis?
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<126 Fasting with an
HbAIC < 7%. |
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What are the three most common locations for an atherosclerotic chromatic ischemic stroke?
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1. Carotid
2. Basilar Artery 3. Vertebral Artery |
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Stroke effacing the lacunar arteries will present with which type of symptoms?
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Focal motor or sensory deficitis, loss of coordination, difficulty speaking
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What are the signs and symptoms of a basilar artery stroke?
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Cranial nerve abnormalities, contralateral full body weakness (corticospinal tract) and decreased sensation (medial lemniscus) vertigo, loss of coordination, difficulty speaking, visual abnormalities, and coma.
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What are the three most common locations for an atherosclerotic chromatic ischemic stroke?
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1. Carotid
2. Basilar Artery 3. Vertebral Artery |
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Stroke effacing the lacunar arteries will present with which type of symptoms?
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Focal motor or sensory deficitis, loss of coordination, difficulty speaking
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What are the signs and symptoms of a basilar artery stroke?
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Cranial nerve abnormalities, contralateral full body weakness (corticospinal tract) and decreased sensation (medial lemniscus) vertigo, loss of coordination, difficulty speaking, visual abnormalities, and coma.
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What happens to Thyroid binding globulin with PCOS?
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Levels increase
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What Primary tumors metastasize to the Brain?
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lung, breast, skin, kidney, GI; remember that 50% of brain tumors are from metastases.
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What primary tumors metastasize to the Liver?
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colon, stomach, pancreas, breast, lung
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What primary tumors metastasize to Bone?
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prostate, thyroid, testes, breast, lung, kidney
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what is the treatment of choice to control blood pressure in a patients with subarachnoid hemorrhage?
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Labetalol is first line but will also give Nimodipine which is a CCB to prevent Vasospasm.
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What vitamine Deficiency can cause seizures?
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B6 deficiency because it is an important factor in the production of GABA which is the main inhibitory neurotransmitter. Therefore if you have no GABA there will be no inhibition leading to seizures.
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What is the medication of choice to treat Grand mal (tonic-clonic) seizures?
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Valproate first then carbamazepinge, phenytoin, lamotrigine, and topiramate.
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What sit he treatment of choice for partial seizures?
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Carbamazepine is first then Lamotrigine, phenytoin
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What is the treatment of choice for Absence Seizures?
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Ethosuximide
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Which drugs are known for causing Stevens-Johnson Syndrome?
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Anticonvulsants include Lamotrigine (which is the most common) and Phenytoin, Ethosuximide, Phenobarbital, and carbamazepine.
Antibiotics: Sulfa drugs and penicillins specifically. Allopurinol |
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What Neurotransmitter changes do you see with Anxiety disorders?
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Increased NE
Decreased Serotonin Decreased GABA |
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What Neurotransmitter changes do you see with Depression
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Decreased Serotonin
Decreased NE Decreased Dopamine |
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What Neurotransmitter changes do you see with Mania?
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Increased NE
Increased Serotonin |
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What Neurotransmitter changes do you see with Alzheimer disease?
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Decreased Acetylcholine
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What Neurotransmitter changes do you see with Huntington disease
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Decreased acetylcholine and decreased GABA
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What Neurotransmitter changes do you see with Schizophrenia?
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Increased Dopamine
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What Neurotransmitter changes do you see with Parkinson Disease?
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Decreased Dopamine
Increased Acetylcholine |
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What is a common side effect of SNRI's?
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HTN, but don't forget about the sexual side effects as well.
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What types of side effects do TCA's cause?
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Anticholinergic side effects:
Dry Mouth Constipation Urinary retention Delirium in elderly |
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What are the symptoms of TCA OD?
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Cardiotoxicity (tachycardia, hypotension, conduction abnormalities)
CNS Toxicity (Sedation, obtunation, coma seizures) Anticholinergic Symptoms (mydriasis, xerostomia, ileus, urinary retention). |
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What drug do you give to ap patient who has a QRS > 100 msec who ODed on TCA's?
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Sodium Bicarbonate
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What are the Side effects of Lithium?
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Hypothyroidism/hyperthyroidism
Nephrogenic Diabetes Insipidus Tremor Weight Gain Renal Insufficiency Teratogenesis Confusion Need to monitor thyroid and renal function while on lithium |
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What si the treatment for nephrogenic diabetes insipidus caused by lithium toxicity?
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HCTZ and Amiloride.
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What is the drug of choice in the treatment of bipolar disorder in a patient with renal failure?
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Carbamazapine or Valporic acid
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What GI disease should you think of with a constellation of Malabsorption, joint pain and visual disturbances?
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Whipple Disease
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What are the two low potency traditional antipsychotics? And What types of side effects do they cause?
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Thioridazine, and chlorpromazine. They tend to cause more anticholinergic side effects.
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What is the most common side effect of olanzapine?
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Remember Weight gain, diabetes and dyslipidemia.
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What should you monitor in a patient who is taking clozapine?
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Monitor a CBC because they are at an increased risk of developing agranulocytosis. So will check a CBC before starting and periodically as they are taking the medication.
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What medications are used to treat Alzheimer's disease?
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Donepezil, rivastigmine, galantamine. All are cholinesterase inhibitors and prevent the breakdown of acetylcholine. Memantine which is an NMDA receptor blocker is also used.
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What is one of the first presenting symptoms of MS?
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Vision abnormalities
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When you think of eye pain that is worse with eye movement, central vision loss, in a younger woman what should you think of?
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MS. This is classic for optic neuritis and is usually Unilateral in MS,
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What is internuclear opthalmoplegia?
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loss of adduction on lateral gaze and nystagmus of the contralateral eye (the eye that is abducting).
Convergence will be normal |
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What will an LP show on a patient with MS?
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CSF will have increased protein, mildly increased WBCs and Oligoclonal bands, as well as increased IgG
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What will MRI of the head show in a patent with MS?
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WIll show multiple asymmetric white matter lesions.
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What is the mainstay treatment for someone with MS?
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High Dose corticosteroids, can also add methotrexate. Also avoid stress.
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What medication decreases the frequency of relapses in patines with MS?
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IFN-Beta
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What are the most common Mets to the brain?
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1. Lung
2. Brease 3. Kidney 4. GI 5. Melanoma |
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What causes Lambert Eaton Syndrome?
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It is a paraneoplastic syndrome caused by small cell lung CA.
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What is the pathophysiology of Lambert Eaton Syndrome?
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Antibodies to presynaptic Ca2+ channels.
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What si the treatment of Lambert eaton syndrome
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Immunosuppressive agents and plasmapharesis.
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Does muscle weakness improve or get worse with use in patients with Lambert Eaton syndrome?
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Weakness improves with use, which is contrasted with Myasthenia Gravis in which weakness will get worse with use.
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Does weakness improve or get worse with use in patients with myasthenia gravis?
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It gets progressively worse throughout the day.
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What is the pathophysiology of Myasthenia gravis?
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Autoimmune disorder characterized by antibodies that bind to acetylcholine receptors at neuromuscular junctions and block normal neuromuscular transmission resulting in easy fatigability.
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What are some conditions associated with myasthenia gravis?
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Thymoma and thyrotoxicosis. So if MG is suspected, it may not be a bad idea to look at a chest CT to look for thymoma or to check thyroid function.
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What is the most common initial prevention of a patient with Myasthenia Gravis?
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Ptosis and Diplopia (drooping of the eye lid and double vision)
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What significant lab findings will you have in a patient with myasthenia gravis?
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positive ACh receptor antibodies. WIll also have a positive Tensilon test which is where you give edrophonium and symptoms improve. Edrophonium is a short acting anticholinesterase agent.
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What are the treatment options for Myasthenia Gravis?
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Anticholinesterase agent like Neostigmine or pyridostigmine. Can also use immunosuppressants, and in refractory cases can use IVIG.
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Other than symmetric muscle weakness that starts in the sitar legs and works its way up progressively over a few days to weeks what other symptoms will you see with Guillain-Barre Syndrome?
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1. Respiratory paralysis in 30% of cases
2. Facial muscle weakness in 50% of cases 3. Autonomic Dysfunction (tachycardia) 4. Absent or depressed DTR's!!!!!!! 5. NO change in Sensation 6. NO fever at onset of symptoms |
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What infection can precede Guillain-Barre syndrome?
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Campylobacter jejuni is popular. But HIV, CMV or EBV or Mycoplasma infections can also cause it.
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What is the treatment of Guilain-Barre syndrome?
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HUGE is Plasmapherisis or IVIG. Do NOT give steroids. They are not recommended. They just don't work.
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What diseases are associated with Bell's Palsy?
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Think of the mnemonic Larry Had An STD
L = Lyme disease H = Herpes Zoster A = AIDS S = Sarcoidosis T = Tumors D = Diabetes |
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What chromosome abnormality is seen with CML?
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Philadelphia chromosome [t(9;22)]
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What is a key laboratory finding in CML?
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Increased WBCs usually > 100,000
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What age group do you usually see CML in?
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Middle aged adults.
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What are the 4 components of Tetralogy of Fallot?
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Right ventricular hypertrophy, pulmonic stenosis, overriding aorta and ventricular septal defect (VSD).
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Is Tetralogy of Fallot a R to L shunt or L to R shunt?
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R to L shunt which is why they present with cyanosis.
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If you hear Machine like Murmur what do you think of?
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Patent Ductus Arteriosus
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What is the difference between caput succedaneum and cehpalohematoma?
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Caput succedaneum - Diffuse swelling or edema of the scalp, the scalp edema CROSSES the suture lines and resolves within a few days.
Cehphalohematoma - subperiosteal hemorrhage, Edema does NOT cross suture lines, will resolve in weeks to months. It is more common with vacuum deliveries. |
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What are the characteristic features of anterior uveitis?
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Pain and photophobia, and slit lamp exam will show inflammation of eye and keratin deposits on cornea
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What are the characteristic features of posterior uveitis?
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Mild vision abnormalities; slit lamp exam shows eye inflammation and retinal lesions.
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What are the risk factors for cataracts?
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Trauma (caustic substances), DM, corticosteroid use, age, alcohol use, tobacco use, and long term sunlight use.
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What is the classic H/P in someone with cataracts?
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painless, progressive decrease in vision manifested with difficulty driving at night, reading road signs, or reading fine-print. It is usually bilateral but is still often unilateral. Possible disabling glare in bright sunlight or from oncoming headlights (more likely with steroid induced cataracts).
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What is Glaucoma?
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It is increased intraoccular pressure leading to loss of vision.
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What is the pattern of vision loss in a patient with glaucoma?
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IT is loss of vision from periphery to central.
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what should you suspect in a patient who requires frequent changes of lens prescriptions?
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Glaucoma
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If you see cupping of the optic disc on fundoscopic exam what do you think of?
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Open Angle Glaucoma.
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What ist he most common cause of conjunctivitis appearing in the first 24 hours of life?
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Chemical conjunctivitis.
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What ist he treatment for acute angle closure glaucoma?
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Pressure lowering eye drops (timolol which is a topical Beta Blocker , apraclonidine, and pilocarpine.
Acetazolamide If refractory then can use mannitol given IV Can do a laser peripheral iridotomy. |
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What is Closed angle or acute angle glaucoma?
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an Acute increase in IOP secondary to narrowing of the anterior chamber angle and obstructed drainage of aqueous humor from eye. It is usually Unilateral
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What are some risk factors of closed angle glaucoma?
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Increased age, asian, hyperopia, dilated pupils (e.g. low-light environments), eye exam dilation
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What is the classic H/P of someone with closed angle glaucoma?
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Severe eye pain, blurred vision, halos seen around lights, nausea and vomiting, eye is inflamed and HARD with a DILATED and nonreactive pupil
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What ist he treatment of close angle glaucoma?
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Acetazolamide first then can use pilocarpine to reduce obstruction. can also use timolol and mannitol.
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