NBME Shelf Review (Part 10) – Miscellaneous

Stroke

* Most appropriate initial tests * Blood Glucose* Hypoglycemia is a common stroke mimic* CT Head without contrast* Rules out HEMORRHAGIC strokes

Subarachnoid Hemorrhage

* Classic description* “Worst headache of life”* “Sudden and maximal in onset”* “Thunderclap”* Testing* CT Head without contrast* (If negative CT) Lumbar puncture* Xanthochromia (yellowish fluid)* Treatment* Nimodipine (Given orally)* Prevents vasospasm

Causes of Stroke in Young People

* Cervical artery dissection* Vasospasm* Vasculitis* Sickle Cell Disease

Meningitis

* Treatment* Vancomycin, Ceftriaxone* Add ampicillin (covers listeria) in very young/old* Rifampin prophylaxis for close contacts (if patient has petechial rash)* Neisseria Meningitidis

HSV Encephalitis

* Classic symptoms* Fevers* Headache* Altered Mental Status* Seizures* Treat with acyclovir

Altered Mental Status

* The two most common causes on your test* Hypoglycemia* Infections (Especially in elderly)* Aka Delirium

Fat embolism

* Trauma PLUS petechial rash * Common with long bone fracture

Schaphoid Fracture

* Exam shows tenderness over anatomic “snuffbox”* Notorious for being missed on X-ray * High risk of osteonecrosis* If suspicious, place patient in thumb spica splint regardless of X-ray findings* Outpatient followup 1-2 weeks for repeat xray

Pericarditis

* Patient complains of chest pain that is… * Sharp* Positional* Worse when laying flat* Friction rub on exam* EKG Findings* Diffuse ST segment elevation* Diffuse PR depression* Treat with NSAIDS

Kawasaki’s Disease

* Mnemonic: CRASH and Burn* Conjunctivitis* Rash* Adenopathy* Strawberry Tongue* Hands/Feet Swelling* Burn = Fever for 5 days* Treat with aspirin

Burns

* Parkland formula* Weight (kg) x BSA (%) x 4 = Volume of fluid needed in first 24 hours* Give half over first 8 hours* Rule of 9s* Estimates % Body surface area burned

Vascular Injury

* Hard Signs * If present patient needs OR* Mnemonic: ABCDE* Active pulsatile hemorrhage* Bruit* Cerebral ischemia* Diminished Distal pulses* Expanding Hematoma

Infectious Disease Pearls

* Gram positive cocci in CLUSTERS* Staphylococcus Aureus* Gram positive cocci in CHAINS* Streptococcus Pneumoniae

Additional Reading

* Basic approach to altered mental status (EM Clerkship)* Basic approach to neck trauma (EM Clerkship)