Evens Flashcards
Ddx for an elderly person with altered mental status?
Delirium vs Dementia
Describe a patient with delirium
acute onset of altered mental state with fluctuating course; patient is inattentive/ psychotic.
(in contrast to dementia, which generally involves impoverished thought)
What are some common causes of delirium in the elderly?
D-drugs (benzos, etc.) E-Electolytes L-lack of something (i.e. EtOH) I-infection R-recent surgery I-intracranial lesion U-urinary/ fecal retention M- major organ system failure
What is Lissaeur’s Tract?
- Located just next to fasiculus cuneatus in the spinal cord
- Site of entry for lateral spinothalamic tract, where tract ascends a couple of levels before decussating.
Fasiculus cuneatus and gracilis:
which is located medially? laterally?
From which parts of the body do they carry sensory information?
- Fasiculus gracilis- medial, lower limbs
- Feet touch the GRASS, legs are more medial than arms on the body.*
- Fasiculus cuneatus- lateral, upper limbs
- Sites of entry for dorsal column/medial lemniscal tract, carry fine touch and vibration
Basic pathogenesis Myasthenia Gravis:
antibodies against Ach receptors
Four DIRECT Ach agonists and their uses
- bethanecol (gut motility post op/ urinary retention)
- carbachol (glaucoma)
- pilocarpine (stimulates tears, sweat, saliva)
- methacholine (asthma dx)
How do indirect Ach agonists work?
-inhibit AchE
List five indirect Ach agonists and their uses
- neostigmine (gut motility, NMJ block reverse, MG Tx)
- pyridostigmine (MG Tx)
- edrophonium (MG Dx- “tenselon test”)
- echothiopate (glaucoma)
- donepezile (Alzheimers)
Three fetal vasculature shunts?
- Ductus venosus: in liver, mixes deoxy blood from LE and oxy blood from umbilical vein
- Foramen Ovale: shunts blood from right atrium to left atrium (remember: R –> L because ^^ pulm resistance)
- Ductus arteriosus: shunts blood from pulmonary artery to the aorta (R –> L for the same reason FO is R –> L)
Vessel in the fetus with the highest O2 content? Lowest? Which is often missing in the fetus/ doesn’t cause a problem?
- Highest O2: umbilical VEIN
- Lowest O2: umbilical artery
- Infants are often with only ONE instead of two umbilical arteries, not symptomatic in and of itself but can be a sign of other underlying pathologies.
Bullous Pemphigoid vs. Pemphigus vulgaris:
- What is the pathology of each?
- What is the prognosis for each?
Pemphigoid Vulgaris = Ab to desmosomes (connection between two cells) ** More severe, need IV steroids.
Bullous Pemphigoid= Ab to hemidesmosomes (connection between 1 cell and basement membrane)
less serious, can treat topically
Describe the blisters of Bullous pemphigoid vs pemphigus vulgarus:
- Bullous: tense blisters with negative nikolsky
- NOT IN MOUTH*
- Pemphigus V: acantholysis, painful thin walled blisters with positive nikolsky OFTEN IN MOUTH
Ataxia Telangiectasia:
- gene defect
- missing immune key players
- symptoms
DNA repair gene defect Missing: IgA and T cells (A&T = ataxia Telangiectasia) A-ataxia T- Telangiectasia X-Xray sensitive I- IgA related Infections A- increased AFP
What is the genetic defect in Brutons agammaglobulinemia?
What is missing?
X linked: Bruton is a little Boy.
Tyrosine kinase is mutated
IgG is missing
