Medical Quiz: Dizziness and Cardiovascular Issues

Questions and Answers

Given the Romberg test result, pathology in which of the following systems is most likely?

Cerebellar

Visual

Cardiovascular

Vestibular (correct)

What is a common cause of imbalance due to peripheral disease in the US?

Diabetic distal peripheral polyneuropathy

Which of the following tests should first be performed during the evaluation of positional dizziness?

Chest radiograph

Transesophageal echocardiography

Orthostatic vital signs (correct)

Head-up tilt-table testing

List some medications whose side effects can cause symptoms of orthostasis.

Antiparkinsonian drugs, antiadrenergics, anticholinergics, antidepressants, antiarrhythmics, antipsychotics, diuretics, narcotics and sedatives. Signup and view all the answers

Orthostatic hypotension diagnostic criteria include a decrease in systolic blood pressure of ___ or more.

20 Signup and view all the answers

Orthostatic hypotension diagnostic criteria include a decrease in diastolic blood pressure of ___ or more.

10 Signup and view all the answers

Which of the following vagal maneuvers is the most effective to treat the rhythm seen above?

Apply ice to the face Signup and view all the answers

What is the treatment for a hemodynamically unstable child with supraventricular tachycardia?

Cardioversion at 0.5 to 1 J/kg. Signup and view all the answers

Which of the following is appropriate management for a 26-year-old woman with a positive home pregnancy test and abdominal cramping?

Discharge home with repeat beta hCG in 48 hours Signup and view all the answers

What is the success rate of methotrexate in the management of early ectopic pregnancy?

85-93% Signup and view all the answers

Which of the following is the most appropriate next step in the evaluation and management of a patient with blood in the eye?

Reassure the patient and discharge her home Signup and view all the answers

What injury can occur if Hemoccult drops are instilled in the eye?

Severe alkali burns can occur. Signup and view all the answers

Describe a typical presentation of subconjunctival hemorrhage.

Patient will be complaining of blood in the eye, PE will show blood under conjunctiva and stops at limbus. Signup and view all the answers

Which of the following is prominently visualized in the abdominal x-ray image above?

Haustra Signup and view all the answers

What is a haustra?

Pouches of the colon Signup and view all the answers

What is the upper limit of normal diameter for the different segments of bowel?

Small bowel (3 cm), colon (6 cm), cecum (9 cm)—the 3/6/9 rule. Signup and view all the answers

What are common signs of large bowel obstruction?

High-pitched bowel sounds, abdominal distension. Signup and view all the answers

What variabilities are seen in subdural hematoma presentation?

Diminished level of consciousness, headache, and focal neurologic deficits. Signup and view all the answers

Describe the characteristic presentation of subdural hematoma on head CT.

Collection of hyperdense blood in a crescent-shaped pattern conforming to the convexity of the hemisphere. Signup and view all the answers

What causes a subdural hematoma?

Tear in bridging veins. Signup and view all the answers

What is the shape and location of an epidural hematoma?

Biconvex (lens) shaped blood collection between dura and skull. Signup and view all the answers

What does subarachnoid hemorrhage indicate?

Blood in circle of Willis, cisterns, and fissures. Signup and view all the answers

What causes intracerebral hemorrhage?

Blood in parenchyma and ventricles due to hypertensive vasculopathy. Signup and view all the answers

What is a subdural hygroma?

A collection of clear, xanthochromic blood-tinged fluid in the dural space. Signup and view all the answers

Which of the following is true regarding osteosarcoma?

Ionizing radiation for childhood cancer is a risk factor for osteosarcoma Signup and view all the answers

What are the most common sites of involvement for osteosarcoma?

Distal femur, proximal tibia, proximal humerus, middle and proximal femur. Signup and view all the answers

What are the clinical presentations of osteosarcoma?

Localized pain, pain after injury, systemic symptoms generally absent, soft tissue mass. Signup and view all the answers

What lab abnormalities are associated with osteosarcoma?

Elevated alkaline phosphatase, lactate dehydrogenase (LDH), and erythrocyte sedimentation rate (ESR). Signup and view all the answers

What are the x-ray findings for osteosarcoma?

Codman's triangle and sunburst pattern. Signup and view all the answers

What is the most appropriate next step in a patient presenting with hyperkalemia?

Calcium gluconate Signup and view all the answers

What is the approximate duration of action of calcium on cardiac membrane stabilization?

30 to 60 minutes. Signup and view all the answers

What are the symptoms of hyperkalemia?

Lethargy, weakness, paralysis. Signup and view all the answers

Which of the following statements is correct regarding a black widow spider bite?

Envenomation causes the release of acetylcholine and norepinephrine at nerve terminals leading to severe muscle cramping and systemic effects Signup and view all the answers

What are the symptoms of a black widow bite?

Dizziness, restlessness, profuse sweating, difficulty speaking, ptosis, hypertension, and tachycardia. Signup and view all the answers

What is the management of a patient with sigmoid volvulus?

Sigmoidoscopy Signup and view all the answers

What is the most common cause of bowel obstruction in pregnancy?

Cecal volvulus. Signup and view all the answers

Describe the typical presentation of a patient with an inferior shoulder dislocation.

Arm raised, inability to adduct arm, rotator cuff detachment. Signup and view all the answers

Which of the following indicates the need for imaging of the ankle?

Tenderness over the posterior edge of the distal lateral malleolus Signup and view all the answers

What are the Ottawa Ankle Rules for determining a need for a radiograph in ankle injuries?

Tenderness at the posterior edge of the distal 6 cm or the tip of the lateral malleolus, tenderness at the posterior edge of the distal 6 cm or the tip of the medial malleolus, inability to bear weight for at least four steps both immediately after the injury and at the time of evaluation. Signup and view all the answers

What types of fractures are associated with medial ankle disruptions?

Maisonneuve fracture. Signup and view all the answers

Which type of cerebral herniation is associated with a dilated pupil?

Uncal Signup and view all the answers

What is Babinski's sign?

Dorsiflexion of the great toe and fanning of the other toes when the sole is stimulated. Signup and view all the answers

Study Notes

Dizziness and Balance Disorders

Normal Romberg test with eyes open and swaying with eyes closed suggests vestibular pathology.
Common cause of imbalance in peripheral disease in the US: diabetic distal peripheral polyneuropathy.
Initial test for positional dizziness in the elderly: orthostatic vital signs.

Orthostatic Hypotension

Diagnostic criteria:
- Systolic BP decrease ≥ 20 mmHg
- Diastolic BP decrease ≥ 10 mmHg
Medications causing orthostatic symptoms: antiparkinsonian drugs, antiadrenergics, anticholinergics, antidepressants, antiarrhythmics, antipsychotics, diuretics, narcotics, sedatives.

Supraventricular Tachycardia (SVT) in Pediatric Patients

Most effective vagal maneuver for a 1-year-old with SVT: applying ice to the face.
For unstable children with SVT: cardioversion at 0.5 to 1 J/kg, increasing to 2 J/kg if needed.

Early Pregnancy Complications

In cases of suspected early pregnancy complications, management may include discharge with repeat beta hCG for monitoring.
Success rate of methotrexate for early ectopic pregnancy: 85-93%.

Eye Conditions

Subconjunctival hemorrhage characterized by blood under the conjunctiva, often resulting from coughing or minor trauma; treatment involves reassurance.
Hemoccult drops may cause severe alkali burns if introduced into the eye.

Gastrointestinal Imaging and Conditions

Large bowel imaging commonly shows haustra.
Most common cause of bowel obstruction in pregnancy: cecal volvulus.
Sigmoidoscopy is a key management step for sigmoid volvulus.

Neurological Trauma

Presentation of subdural hematoma: crescent-shaped blood collection seen on CT, often due to tearing of bridging veins.
Epidural hematoma: biconvex shape caused by tearing of the middle meningeal artery, prevalent in young trauma patients.
Subarachnoid hemorrhage associated with ruptured berry aneurysms.

Fractures and Injuries

Maisonneuve fracture of the fibula indicates potential medial ankle disruption.
Ottawa Ankle Rules: imaging indicated by tenderness in specific areas or inability to bear weight.
Scaphoid fractures can cause avascular necrosis; recommended splint: thumb spica.

Hyperkalemia Management

In hyperkalemia, management includes calcium gluconate, with a duration of action of 30-60 minutes.

Spider Bites

Black widow spider envenomation leads to the release of neurotransmitters causing systemic effects including muscle cramping.

Shoulder Dislocation

Inferior shoulder dislocation leads to the arm being locked in abduction with potential axillary nerve injury causing motor deficits.

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Description

Test your understanding of dizziness, balance disorders, orthostatic hypotension, and supraventricular tachycardia in pediatric patients. This quiz covers important diagnostic criteria and management strategies related to early pregnancy complications and cardiovascular health. Enhance your medical knowledge with these essential concepts.