6/16 UWorld Flashcards
What is the difference between simple focal and complex focal seizures
- Simple
- No LOC or postictal state
- Motor, sensory, autonomic, or psychic symptoms
- Complex
- LOC and postictal state
- May have automatisms (e.g. lip smacking)
Describe presentation of tonic-clonic vs. myoclonic seizure
- Tonic-clonic
- LOC and postictal state
- Diffuse muscle contraction of limbs (tonic) followed by rhythmic jerkin (clonic)
- Myoclonic
- No LOC or postictal state
- Brief jerking movements
What are the broad spectrum anti-epileptics that can be used to treat focal, tonic-clonic, and absence seizures
Valproic acid
Lamotrigine
Recall festival and Llamas outside of Ethosuximide classroom
First line therapy for absence seizures
Ethosuximide
First line treatment for focal seizures
Carbamazepine
First line treatment for tonic-clonic seizures
Phenytoin, Valproic acid
First line treatment for status epilepticus
Phenytoin - 1st line prophylaxis
Benzos - 1st line for acute
MOA and uses of Gabapentin
- SKetchy = Grab a pint ice cream truck
- Mechanism of action:
- Narrow spectrum anti-epileptic
- Bind and block voltage-gated calcium channels, stopping inward calcium current, stopping NT release
- Does NOT bind to GABA receptors
- Uses:
- Anti-seizure
- Neuropathic pain (e.g. diabetic neuropathy)
- Fibromyalgia
- Post-herpetic neuralgia (VZV)
MOA and uses of Vigabatrin
- Sketchy = V cab
- Narrow spectrum antiepileptics
- Mechanism of action:
- Irreversible inhibitor of GABA-transaminase, enzyme responsible for degradation of GABA
- = raised CAB
- = V cab “transmission”
- This produces and increase of GABA in the CNS, producing tonic inhibition
- Irreversible inhibitor of GABA-transaminase, enzyme responsible for degradation of GABA
- Uses:
- Adjunctive treatment for partial seizures
MOA and uses of Tiagabine
- Sketchy = tied up cab driver
- Narrow spectrum antiepileptics
- Mechanism of action:
- Inhibits GABA reuptake, increasing GABA concentration in CNS
- Uses:
- Adjunctive treatment for partial seizures
Cause and presentation of Hyper IgE syndrome
o Deficiency in IFN-y lead to impaired neutrophil recruitment
o Presentation à FATED
§ F – coarse Facies
§ A – Abscesses
§ T – retained primary Teeth
§ E – increased IgE (all other immunoglobulins are normal)
§ D – dermatologic problems (eczema)
Release and function of TNF-a
§ Secreted by activated macrophages
§ Mediates septic shock
§ Causes neutrophil and lymphocyte recruitment
§ Responsible for fever, anorexia, corticotrophin releasing hormone, septic shock, and cachexia
MOA and uses of Infliximab
- THINK: TNF = The NetFLIX Friday
- TNF-a inhibitor
- Recall: TNF-a is an acute phase reactant produced by activated macrophages to mediate inflammation by accelerating neutrophil migration, and facilitate lymphocyte proliferation; TNF-a is responsible for fever, anorexia, corticotropin releasing hormone, septic shot, and cachexia
- Mechanism of action:
- Is a monoclonal antibody to TNF-a
- Uses:
- Used for autoimmune conditions due to anti-inflammatory effect
- Rheumatoid arthritis, psoriasis, ankylosing spondylitis
What are the 2 drugs that inhibit IL-2 transcription
Cyclosporine and Tacrolimus
- THINK: you use a toilet paper roll (Tacrolimus) to make yourself look like a cyclops (Cyclosporine) instead of having 2 eyes (IL-2)
What 2 drugs prevent IL-2 response
Sirolumus and Dacluzimab
What is the use of drugs that inhibit IL-2
Transplant rejection prophylaxis, psoriasis, rheumatoid arthritis
Describe the defect and presentation fo Wiskott Aldrich syndrome
o X-linked recessive immunodeficiency due to mutation in WASp gene
o Leukocytes and platelets unable to reorganize actin skeleton = defective antigen presentation
o WATER - Wiskott Aldrich, Thrombocytopenia, Eczema (especially truncal), Recurrent infections
Antibody associated with mixed connective tissue disease
Anti-U1 RNP (ribonucleoprotein)
What are the different defects that cause homonymous hemianopia with macular involvment vs homonymous hemianopia with macular sparing
E: homonymous hemianopia with macular involvement is consistent with involvement of the temporal lobe (e.g. occlusion of the middle cerebral artery)
H: homonymous hemianopia with macular sparing is consistent with occlusion of the posterior cerebral
When after fertilization will b-hCG become positive in materal serum vs. urin
8 days = serum
14 days = urine
What murmur is associated with an opening snap vs. an ejection click
Opening snap = mitral stenosis
Ejection click = aortic stenosis
What is the most common location of patients infected with Babesia
NE United States (NE on maltese cross on floor)
Presentation of carcinoid syndrome
- Symptoms = BFDR
- Bronchospasm
- Flushing
- Diarrhea
- Right-sided heart disease/murmur
Where is the inflammation and with what T-cell (CD4+ or CD8+) is inflammation caused by in Dermatomyositis vs. Polymyositis
- Dermatomyositis
- Perimysial (THINK: periphery b/c of muscle + skin involvement) inflammation with CD4+ T cells
- Polymyositis
- Endomysial inflammation with CD8+ T cells
- Think of the 8 as multiple bulging muscles
