Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
19 Cards in this Set
- Front
- Back
78 y/o lady is brought in from her nursing home for altered mental status. She sleeps more during the day and becomes agitated at night-reporting seeing green men in the corner. She also complains of pain upon urination. - First step? - Biggest risk factor? - Other common causes? - EEG findings? - Treatment? |
First step: - In her case, UA and culture - Work up also includes glucose, Na, blood cultures, B12, RPR - Make sure to look at med list- benadryl, opiates, benzos. Biggest risk factor: - Age. Underlying dementia is the second biggest. Other common causes: - Acute substance withdrawal. - Look for it on the 2nd or 3rd post-op day in alcoholic. EEG Findings: - Diffuse background slowing of background rhythm. - Psychosis has normal EEG Treatment: - Reduce excessive stimuli, calendar and clock to orient patient. Stop unnecessary meds. Give haloperidol if agitated. |
|
A 78 y/o F presents w/ memory loss, aphasia, apraxia, and gets lost while driving.. - Diagnosis? - Pathology? - Genes? - Treatment? |
Diagnosis: - Alzheimer's Dementia. MC type. - On MMSE, prompting does not increase recall. Pathology: - Global brain atrophy. - B-amyloid plaques or tau tangles. Genes: - APP (on chromosome 21), ApoE E2 Treatment: - Donepezil, rivastigmine, galantamine (diarrhea) - Memantine. |
|
A 78 y/o F presents w/ memory loss and becomes more sexually explicit, apathy. - Diagnosis? - Pathology? - Treatment? |
Diagnosis: - Frontotemporal Dementia (Pick's disease) Pathology: - Lobar atrophy - Intra-neuronal silver staining inclusions Treatment: - Olanzepine for severe disinhibition. |
|
A 78 y/o F presents w/ memory loss, and fluctuations in consciousness, visual hallucinations and shuffling gait. - Diagnosis? - Pathology? - Treatment? |
Diagnosis: - Lewy body dementia Pathology: - Intra cytoplasmic alpha-synuclein inclusions in neocortex Treatment: - Give Ach-Ease inhibitors. NOT L-dopa. Avoid neuroleptics. |
|
A 78 y/o F presents w/ memory loss and sudden, step-wise decrease in memory/cognitions. - Diagnosis? |
Vascular Dementia. |
|
A 78 y/o F presents w/ memory loss, plus loss of vibration sense, labile affect. Pupil that accommodates but doesn't react. - Diagnosis? - Dx how? - Tx? |
Diagnosis: - Tertiary syphilis Diagnose how? - +RPR, VDRL. Do spinal tap to look for spirochetes. Tx: - IV PNC. If PNC-allergic, must desensitize. |
|
A 78 y/o F presents w/ memory loss, plus myoclonus, startle response, seizures. Recently had a corneal transplant. - Diagnosis - Pathology? - EEG findings? |
Diagnosis: - Creutzfeldt Jakob Pathology: - Spongiform encephalopathy EEG Findings: - Triphasic bursts |
|
A 78 y/o F presents w/ memory loss, plus incontinence, gait disturbance/frequency falls, and rapidly developing dementia: - Diagnosis? - Diagnose how? - Tx? |
Diagnosis: - Normal pressure hydrocephalus Diagnose how: - CT/MRI shows hydrocephalus, spinal tap shows normal opening pressure Treatment: - Ventriculoperitoneal shunt improves cognitive function in 50-67% of patients. |
|
A 50 y/o known alcoholic presents to the ER with tonic clonic seizures. BP 180/110, HR 118, T 100.1. - How long since his last drink? - How long till he develops confusion, fluctuations in consciousness and the feeling of ants crawling on him? |
- Around 12-24 hours. (bimodal peak at 8 hours and 48 hours) - 48-72 hours since last drink is when delirium tremens usually start. |
|
His blood alcohol level is 225mg/mL. How long till its out of his system? |
Around 9 hours. Alcohol is metabolized by zero order kinetics (same amount/unit time = 25 mg/hr). |
|
If an alcoholic, and meds include propranolol, lactulose, and allopurinol, what would be the best sign to monitor for his withdrawals? |
Beta-blockers mask the signs of autonomic hyperactivity, but you can follow hyperreflexia to dose the benzos during w/drawal. |
|
Alcoholic: - Best initial treatment of our patient? - What if he's a Child's class C cirrhotic? |
Best initial treatment: - Diazepam or chlordiazepoxide b/c they have 80 & 120hr ½-lives respectively. What if he's a Child's class C cirrhotic? - Lorazepam, oxazepam or temazepam because they are glucuronidated prior to elimination |
|
What is the most specific test for ETOH consumption in the past 10 days? |
Carbohydrate-deficient transferrin. Less specific-elevated GGT and AST more than twice ALT. |
|
A patient comes in with confusion, ataxia, and crossed eyes on PE. - Diagnosis? - Cause? - Complication? |
Diagnosis: - Wernicke Encephalopathy Cause: - Thiamine deficiency. Give thiamine first, then glucose containing fluids. Complication: - Can progress to Korsakoff's syndrome (irreversible damage to maxillary bodies, etc.)- apathy, anter/retrograde amnesia and confabulation. Can see MB atrophy on MRI. |
|
A patient is brought into the ER in a non-responsive state. His BP is 100/60, HR is 50, RR is 6. He has multiple track marks on his arms. - Best first step? - You realize his pupils are dilated. Does that change your diagnosis? - What sxs do you expect as he starts to withdrawal? - Treatment? |
Best first step: - Intubate the patient. Then give IV or IM naloxone(full mu-opiate antagonist) Dilated pupils...: - No. The hypoxia 2/2 respiratory depression can cause hypoxia What sxs to expect w/ withdrawal: - hypoxiaJoint and muscle pain, photophobia, goosebumps, diarrhea, tachycardia, HTN, GI cramps, dilated pupils, anxiety/depression Treatment: - Clonidine for autonomic sxs, ibuprofen for muscle cramps, loperimide for diarrhea. - Methadone, buprenorphrine or Naltrexone can be used for long-term dependence. |
|
Pt presents w/ horizontal nystagmus, dilated pupils, ataxia, and acute psychosis... - Diagnosis? - Tx? |
Hallucinogen (PCP) intoxication. Can use haloperidol for acute psychosis. |
|
Pt presents s/p MVC with injected conjunctiva, sedation and is asking for Doritos (cool ranch plz). - Diagnosis? |
Cannabis intoxication. |
|
Pt presents with SI, hypersomnia, depression and anergia. - Diagnosis? |
Cocaine/Amphetamine withdrawal |
|
Pt presents with dilated pupils, seizure, tachycardia and HTN. - Likely diagnosis? - Best first test? - Tx of HTN and tachycardia? |
Diagnosis: - Cocaine/Amphetamine intoxication Best first test: - EKG then urine tox screen. Treat seizure with lorazepam. Treatment of HTN and tachycardia: - CCB. BB are CONTRAINDICATED! |