7/28/16 Flashcards
what is the normal RBC to WBC ratio in CSF?
1 WBC to each 500-1000 RBCs
loss of all function (flaccid paralysis) except for position and vibratory sensation below a spinal cord level, loss of deep tendon reflexes
anterior spinal artery occlusion
ddx: position and vibratory sensation are lost, motor pain and temperature intact
subacute combined degeneration of the cord (B12 deficiency or neurosyphilis)
loss of pain and temperature on one side and loss of position and vibratory sense on the other side below a spinal cord level
brown-sequard syndrome (unilateral hemisection of sp cd)
presentation of tuberous sclerosis
RETINAL LESIONS, NEUROLOGICAL ABNORMALITIES (seizures, mental retardation), SKIN (leathery plaques on trunk, hypopigmented patches, reddened facial nodules), RENAL ANGIOMYOLIPOMAS, cardiac rhabdomyomas
port-wine stain on the face, seizures
sturge-weber syndrome
tx of mild vs severe parkinson disease
mild: ANTICHOLINERGICS (benztropine, trihexyphenidyl), AMANTADINE (in older pts intolerant of anticholinergics)
severe: DOPAMINE AGONISTS (pramipexole, ropinirole), LEVODOPA/CARBIDOPA, COMT INHIBITORS (extend duration of levodopa/carbidopa), MAO INHIBITORS (slow progression of disease)
what are the important side effects of the anticholinergic medications given to mild parkinson disease pts?
benzytropine and trihecyphenidyl cause dry mouth, WORSENING of PROSTATE HYPERTROPHY, and constipation
what are the important side effects of the medications given to severe parkinson disease pts?
levodopa/carbidopa are associated with “ON/OFF” phenomena, where insufficient dopamine can cause BRADYKINESIA (off), or too much dopamine can cause DYSKINESIA (on)
MAO inhibitors can cause hypertensive crisis if taken with tyramine-rich foods
pt with parkinson syndrome symptoms PLUS autonomic problems such as orthostatic hypotension, impotence, incontinence, dry mouth, dry skin
multiple system atrophy (Shy-Drager syndrome)
tx for dyskinesia of huntington disease
tetrabenazine
what should you consider in a pt with multiple sclerosis on chronic suppressive medication has worsening neurological deficits and MRI shows new, multiple white matter hypodense lesions
NATALIZUMAB is associated with development of PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML)
what are the best drugs to prevent relapse in multiple sclerosis?
glatiramer and beta-interferon
tx for amyotrophic lateral sclerosis (ALS)
RILUZOLE (prevent progression), BACLOFEN (for spasticity)
what nerve affected: wasting of hypothenar eminence, pain in 4th and 5th fingers
ulnar nerve
what nerve affected: wrist drop
radial nerve (saturday night palsy = pressure on inner, upper arm; crutches)
what nerve affected: pain/numbness in ankle and sole of foot that worsens with walking
Tibial nerve (Tarsal Tunnel syndrome)
what nerve affected: weak foot with decreased dorsiflexion and eversion
peroneal (high boots, pressure on back of knee)
tx for guillain barre syndrome
IVIG OR plasmapheresis (NOT STEROIDS and NOT BOTH)
pathogenesis of myasthenia gravis and presentation
autoantibodies against acetylcholine receptors at the neuromuscular junction, presents in YOUNG WOMEN OR OLD MEN with ptosis, difficulty chewing, slurred speech, diplopia, weakness of limb muscles EXACERBATED BY CONTINUOUS USE
what imaging should be done in pts with confirmed myasthenia gravis?
chest CT with contrast to look for thymoma
tx for myasthenia gravis
neostigmine or pyridostigmine (acetylcholinesterase inhibitors)
distinguishing features of myasthenia gravis vs lambert-eaton syndrome
myasthenia gravis sx WORSEN with repeated muscle stimulation, whereas lambert-eaton syndrome (small cell lung cancer antibodies against presynaptic calcium channels) causes weakness that IMPROVES with repeated stimulation
management of myasthenia gravis pts that are refractory to medications
under 60 = thymectomy
over 60 = prednisone
tx for acute myasthenic crisis
IVIG or plasmapheresis
tx for lewy body dementia
tx alzheimers and parkisons features with levodopa/carbidopa
what is BRCA associated with?
THE BRCA BOP! Breast, Ovarian, and Pancreatic cancer
what are the side effects of the ER/PR positive breast cancer drugs?
tamoxifen: endometrial cancer, clots aromatase inhibitors (anastrazole, letrozole, exemestane): osteoporosis (inhibit estrogen effect everywhere, even the good effects, like on bone density)
how do you decide what medications to give to a ER/PR positive breast cancer pt?
aromatase inhibitors (anastrozole, letrozole, exemestane) are better for POSTmenopausal pts, whereas tamoxifen is better for PREmenopausal pts
what is the tx for her2/neu positive breast cancer pts?
trastuzumab
how is gleason grading used in prostate cancer?
measures aggressiveness of prostate cancer; range from 2-10, high score = get it out before it metastasizes!
alpha fetoprotein is secreted only by ______ testicular cancers. _____ is up in all of them.
nonseminomatous; hCG
tx of seminoma vs non-seminoma testicular cancers
seminoma: radiation for local disease and chemotherapy for widespread disease
non-seminoma: chemotherapy only
management of low-grade or high-grade dysplasia on pap smear vs atypical squamous cells of undetermined significance (ASCUS)
low-grade or high-grade dysplasia = colposcopy
ASCUS = HPV testing; if HPV is positive, get colposcopy. if HPV is negative, repeat pap at 6 MONTHS
what is an important risk factor for squamous cell cancer of the skin other than sunlight?
organ transplant pts, secondary to LONG-TERM USE OF IMMUNOSUPPRESSIVE DRUGS
thick, scaly, crusty patches on sun-exposed skin
actinic keratosis (premalignant, must remove due to risk of squamous cell cancer)
hyperpigmented lesions with “stuck-on” appearance
seborrheic keratoses (no premalignant potential)
what agents are used in atopic dermatitis to help pts get off steroids?
tacrolimus and pimecrolimus (T cell-inhibiting agents; rarely associated with development of lymphoma)
tx of extensive psoriasis
UV light, anti-TNF inhibitors (infliximab, etanercept, adalimumab)
what class of medication is associated with pemphigus vulgaris?
ACE inhibitors
what drugs are used to wean pts with pemphigus vulgaris off of steroids?
azathioprine, mycophenolate
what is porphyria cutanea tarda and what diseases is it associated with?
blistering skin disease of sun-exposed areas; HEPATITIS C and HEMOCHROMATOSIS
most accurate diagnostic test for porphyria cutanea tarda
increased uroporphyrins in a 24-hour urine collection
if pt has penicillin allergy with anaphylaxis, what are the alternate medications for a mild infection?
macrolides, clindamycin, doxycycline, or TMP/SMX
if pt has penicillin allergy with anaphylaxis, what are the alternate medications for a severe infection?
vancomycin, linezolid
tx for tinea in hair or nails
ORAL TERBINAFINE (itraconazole is close in efficacy)
what is the tx for steven-johnsons syndrome or toxic epidermal necrolysis?
IVIG (NOT STEROIDS!)
side effects of isotretinoin (vitamin A)
hyperlipidemia, pseudotumor cerebri, teratogen (get a pregnancy test)
blood gas in aspirin overdose
respiratory alkalosis progressing to metabolic acidosis (both, not a compensation, pH should be alkalotic)
cyanosis with normal pO2
methemoglobinemia
most effective therapy for methemoglobinemia
methylene blue (decreases half-life of methemoglobin)
tx for pt with nerve gas or organophosphate poisoning with ACTIVE sx
atropine (blocks effects of acetylcholine already increased in body)
when is pralidoxime used?
organophosphate poisoning (reactivates acetylcholinesterase) without current threatening symptoms (i.e., respiratory arrest)
yellow halos around objects, arrhythmias, nausea, vomiting, hyperkalemia
digoxin toxicity
what are the sx of a black widow spider bite? what is the tx?
abdominal pain, muscle pain, hypocalcemia; tx with calcium and antivenin
management of human cat dog bite with no suspicion for rabies
AMOX/CLAV
what type of intracranial hematoma is associated with skull fracture?
epidural hematoma
why is hyperventiatlion used in a brain bleed?
it decreases pCO2 which causes cerebral vasoconstriction, which decreases pressure. normally, cerebral circulation constricts when the pCO2 is low and dilates when pO2 is high
what are the indications for stress ulcer prophylaxis with a PPI?
head trauma, burns, endotracheal intubation, coagulopathy with respiratory failure
how to calculate volume replacement in burns
4 mL x %BSA burned x weight in kg. head is 9, arms are 9 each, legs are 18 each, chest and back are 18 each. one hand width is 1.
painless proximal muscle weakness with normal ESR and CK
glucocorticoid-induced myopathy
what is normal pH and glucose for pleural fluid?
pH = 7.2, glucose = 60
what are the sx of acute intermittent porphyria?
5 P’s: Painful abdomen, Port wine-colored urine, Polyneuropathy, Psychological disturbances, Precipitated by drugs, alcohol, starvation
