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
Common mutation in SCID
Signs?
Adenosine deaminase in purine synthesis is missing
See infections, diarrhea, failure to thrive and thymic Aplasia
Possible genetic effect in DiGeorge? What is missing?
Possible assc cardiac defect?
22q11 mutation Lose branchial arches 3,4 Lose thymus and PT gland Lose calcium and T cells May see truncus arteriosus
Describe the FEV1/FVC in obstructive disease?
Decreased because, although both factors lower, FEV1 lowers MORE than FVC
*Note: these people also have increased lung volumes and trapping.
FEV1/FVC in restrictive diseases?
Normal. Because both terms decrease an even amount
Describe Benzo/Barb effects and withdraw symptoms?
What is the Benzo antidote?
Fatigue & respiratory depression
Anxiety + seizures
Flumazenil
Opioid effects and withdraw symptoms?
Antidote?
Miosis and constipation
Agitation and runny nose
Naloxone = antidote
Cocaine and amphetamines:
Intoxication symptoms
Withdraw symptoms
OD treatment?
Euphoria and appetite
Agitation and weight gain
Can give BDZ/haloperidol but NOT NOT NOT BBers.
LSD intoxication symptoms
Withdraw symptoms
OD treatment
Hallucinations and delusions
Flashback/ none
Can give benzos/ haloperidol
Most common cause of congenital adrenal hyperplasia
95% = 21ahydroxylase
Trick for remembering effects of CAH enzyme deficiencies
“1” in first position = HTN
“1” in second position = masculinization.
So:
21 = masculinization and HYPOtension
11: HTN & masculinization
17= HTN
Why does an enzyme deficiency in the adrenal glands cause HYPERplasia?
Low cortisol causes the pituitary to release a bunch of ACTH = ^^ growth of adrenals
Four causes of cushings
#1 glucocorticoids = syndrome -also: small cell lung cancer Pituitary & adrenal adenomas = disease
Describe the symptoms of SiADH
What cancer causes this? Hyponatremia Confusion Poor gate. (Reminds me of NPH) Can be caused by small cell lung cancer
Lung cancer that may cause hypercalcemia?
How might it do this?
Squamous cell –> secretes PTHRP
Symptoms of multiple myeloma
Increased hematocrit
Decreased Ca
Increased creatinine
Lytic lesions
How does a pheochromocytoma effect HCT/EPO?
Increases them!
Four causes of polycythemia
Potentially Really High Hematocrit
- pheo
- renal cell carcinoma
- hepatocellular carcinoma
- hemangioblastoma
