FULLY RANDOMIZED PART I Flashcards
1
Q
Carbidopa-levodopa is the drug of choice in treating Parkinson’s disease. What does the carbidopa portion do? What about the levodopa?
A
Levodopa is a dopamine precursor that is able to cross the blood-brain-barrier. Carbidopa protect l-dopa from being converted to dopamine before it crosses the BBB.
2
Q
What are the medical risk factors for gastric cancer?
A
H. Pylori infection, prior gastric surgery, adenomatous polyps, and gastric atrophy and gastritis
3
Q
What is the treatment for Barret’s esophagus that does NOT involve high-grade dysplasia?
A
Proton pump inhibitors and/or laproscopic fundoplication; may also need to have a biopsy done with some frequency depending on the level of metaplasia/dysplasia.
4
Q
In terms of classifying weight severity in anorexia, what BMI is considered mild?
A
> 17 kg/m2
5
Q
Where in the US is toxocariasis more common?
A
South central and southeastern; due to poor soil conditions.
6
Q
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat shizotypal disorder?
A
Pharmacotherapy
7
Q
Drugs for depression include MAOis, tricyclic antidepressants, atypical antidepressants, SSRIs, NDRIs, and SNRIs. Which class is the most commonly prescribed in the US?
A
SSRIs
8
Q
Comparing subdural vs epidural hematomas, which is located between the skull and the dura?
A
Epidural
9
Q
Separation anxiety disorder is defined as a developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached. How long does this anxiety need to last for diagnosis in children? In adults?
A
4 weeks for children, 6 months for adults
10
Q
There are four categories of histoplasmosis. Which is usually found in the very young, very old, or immunosuppressed patients? What symptoms can occur in this category? What is the prognosis for a patient in this category?
A
Disseminated histoplasmosis. Poor T-cell immune response has allowed the fungi to disseminate (spread). Many symptoms are nonspecific (fever, chills, cough, etc.). Hypersplenism can occur and pulmonary infiltrates may be seen on x-rays. Adrenal glands will be involved and may yield Addison disease. If not treated, up to 80% mortality within 4-10 months. If treated, this drops to less than 25%.
11
Q
To be diagnosed as migraine with aura, the aura symptom(s) must be fully reversible. Two of what four characteristics must be present?
A
At least one aura symptoms spreading gradually over more than 5 minutes (and/or two or more symptoms occurring in succession); individual aura symptoms last 5 to 60 minutes; at least one aura symptom is unilateral; aura accompanied by or followed within 60 minutes by a headache
12
Q
In terms of electrodiagnostic testing for MG, repeated nerve stimulation in a patient with MG shows reduced amplitude. This is positive in more than 75% of patients with generalized MG. Single fiber stimulation is even better at 80-95% and is better for ocular MG.
A
Free card.
13
Q
What non-pharmaceutical options are available for a patient with emphysema?
A
Bullectomy (removal of bullae)/volume reduction surgery to reduce the pressure on healthy lung tissue; bronchoscopy (metal coils inserted which compress unhealthy tissue).
14
Q
Which medication for asthma is useful in children and pregnant women, and why?
A
Cromolyn is a mast cell stabilizer that is used for prophylaxis and is poorly absorbed, leading to few side effects.
15
Q
What is the name for a gastrin-secreting non-beta islet cell tumor? What effect does it have on gastric acid?
A
Gastrinoma, aka Zollinger-Ellison Syndrome. It causes increased gastric acid secretion that leads to ulceration in the stomach and small intestine.
16
Q
How is HDV diagnosed?
A
Detection of IgM HBV antibody; detection of HDV RNA by RT-PCR
17
Q
Is there a vaccine for Hepatitis C?
A
Yes, but not available in the US
18
Q
What are the symptoms of a giant cell arteritis headache?
A
New headache, scalp tenderness, jaw claudication, sudden vision loss in one eye.
19
Q
Treatment for tension headaches can include analgesics (ibuprofen, naproxen, aspirin) and acetaminophen. Which of these (analgesics vs acetaminophen) is more effective and should be limited to 15 days/month?
A
Analgesics
20
Q
The liver releases certain proteins when there is acute damage. Which four proteins can you test for, as discussed in class? Which two of these are most commonly done?
A
Aspartate amino transferase (AST)Alanine Transaminase (ALT)Alkaline Phosphatase (ALP)Gamma-glutamyltranspeptidase (GGT).AST and ALT are the most commonly done.
21
Q
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the N stand for?
A
Neurologic symptoms–confusion, impaired consciousness, bilateral optic disc swelling, seizures
22
Q
What is a major concern of gonorrheal conjunctivitis?
A
Possible corneal perforation and blindness.
23
Q
What is the chronic treatment for SUNCT?
A
Lamotrigine, occipital nerve stimulation
24
Q
What surgical treatment options are there for a patient with sleep apnea?
A
Tonsillectomy (for kids), uvulopalatopharyngoplasty (UPPP; upper airway surgery), Inspire Device (“pacemaker” to move tongue forward), jaw surgery, trachestomy
25
What genetic factor is associated with multiple sclerosis?
HLA-DRB1
26
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. What are a few things that can damage the mucosa?
Aspirin, iron salts, TCAs, quinidine, potassium chloride tablets
27
Briefly outline the pathophysiology of infiltrative lung disease.
Something infiltrates the lungs, causing diffuse injury and inflammation. The alveoli become scarred and the septa thicken and stiffen. The reduced stretch of the lungs makes it harder to breathe, and gas exchange is decreased due to thicker walls.
28
One of the esophageal conditions discussed in class has a higher prevalence in women. Which condition is it?
Scleroderma esophagus. (Scleroderma is more common in women, and since the esophagus is involved in 75-85% of patients with scleroderma, I assume scleroderma esophagus is also skewed toward women.)
29
Comparing subdural vs epidural hematomas, which has a more acute onset?
Epidural
30
Is there a vaccine for Hepatitis B?
Yes
31
Cluster headaches can occur like clockwork* and are common during ________ (sleep/waking).
Sleep*
32
The symptoms of choledocholithiasis are similar to those of cholelithiasis, with the addition of?
Jaundice, dark urine, pale stools, rapid heartbeat and decreased BP.
33
True or false: the neurologic effects of neuroinvasive WNV are usually short-lived.
False; they can be permanent, or last a very long time.
34
5-15% of heavy drinkers have __________.
Cirrhosis
35
True or false: smoking increases the risk of Parkinson's disease.
False; it may actually decrease the risk.
36
What is Uhthoff's sign?
Symptoms of MS get worse with heat.
37
What are the adverse effects of ethambutol?
Most importantly is optic neuritis; also macular edema and pigment changes.
38
What imaging is used to screen individuals who are at high risk for pancreatic cancer?
CT, MRI, EUS
39
List the treatment for primary, secondary, or early latent syphilis. (No neurological involvement.)
Penicillin G benzathine, 2.4 million U IM one timeORIf allergic to penicillin and not pregnant-Doxy 100 mg po bid for 14 days-Tetracycline 500 mg po qid for 14 days
40
Which type of seizure is most common?
Complex partial.
41
Crohn's Disease is pharmaceutically treated with what kinds of drugs?
Corticosteroids and Mesalazine
42
What are the risk factors for gallstones?
Pregnancy, diabetes, obesity, sickle cell disease, and cirrhosis.
43
In terms of classifying weight severity in anorexia, what BMI is considered moderate?
16-16.99 kg/m2
44
It is estimated that only 50% of individuals get recommended screening for STIs. What is the screening recommendation for pregnant women?
Syphilis/HIV/Chlamydia/HBV screening if:-PregnantGonorrhea screening at first prenatal visit if:-At-risk and pregnant
45
For men under the age of 65, what is the number of standard drinks that would indicate an increase in health risks?
14/week, or 4/day
46
True or false: in an acute Hepatitis B infection, 70% of adults are clinical, 30% are subclinical.
False; 70% are subclinical, and 30% are clinical.
47
True or false: a retinal migraine is associated with a severe headache and can lead to permanent vision loss.
False; it can indeed lead to permanent vision loss, but the associated headach is mild*
48
True or false: Barret's esophagus is a cancerous condition.
False; it is a precancerous condition. 1/200 Barret's esophagus patients develop cancer per year.
49
______________ consists of non-peristaltic esophageal contractions and impaired relaxation of the LES.
Achalasia
50
In what area of the brain are embolytic strokes common?
Basal ganglia.
51
What are the ocular signs and symptoms of secondary syphilis?
Madarosis, iris nodules, disc edema, exudative RD, plus just about any type of "itis" you can think of.
52
The crisis or final stage of HIV infection features a decreased CD4 cell count, increased viral load, and includes what S/S?
Constitutional symptoms, CNS involvement (dementia, memory loss, depression, seizures, social withdrawal), opportunistic infections.
53
For focal seizures, surgical removal of the area causing the seizure is a treatment option, leaving 65-75% of patients seizure free. What is the most common site of the surgery?
Temporal lobe.
54
Which gender has a higher prevalence of multiple sclerosis?
Female
55
Histoplasmosis is a fungal infection. For adults, the primary site of involvement is the lungs. For children, it's the liver.
Free card.
56
The mutations that cause cystic fibrosis affect what type of ion channel? How does this affect the airways?
Chloride. If it can't leave cells, sodium can't leave cells, and water is pulled into the cells. This causes the viscosity of the mucous in the airways to increase. This causes obstruction of the airways and sets the stage for infection from even the normal lung flora. Persistent infection and inflammation causes damage to airway walls and destroys small airways.
57
When can a bipolar disorder be defined as cyclothymic?
When it doesn't meet the criteria for a manic, hypomanic, or major depression.
58
What do you do for a patient that is experiencing angina or a myocardial infarction?
Call 911 and administer a single chewed 325 mg dose of aspirin (and 0.4 mg sublingual nitroglycerin if the patient uses it for angina). Monitor their vitals.
59
How long must the binge eating of bulimia have been going on to meet the diagnostic criteria?
3 months (of binge eating at least once a week)
60
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat avoidant disorder?
Psycotherapy
61
Avoidant/restrictive food intake disorder contrasts with anorexia nervosa and bulimia nervosa in that _____________ is not a factor in avoidant/restrictive food intake disorder.
Self-image
62
What ocular effects might a patient with chronic bronchitis experience?
Decreased (night) VA, decreased color vision, decreased retinal function, swollen ONH, transient visual obscurations.
63
True or false: in an acute Hepatitis B infection, newborns are typically subclinical.
True.
64
In drug sensitivity testing for TB, what is the advantage of gene based vs. culture based?
Gene based is rapid and accurate; culture based is slow and accurate. Gene based is expensive, though, whereas culture based is inexpensive.
65
What percentage of non-HIV+ patients with TB have ocular signs? What about HIV+ patients?
1-2% of non-HIV+ patients, 18% of HIV+ patients. The ocular symptoms can be in the anterior segment or the posterior segment, and is basically a lot of inflammation (lots of "itis"es).
66
Briefly outline the molecular cause of the plaques that occur in early onset Alzheimer's (age 30-60).
Amyloid precursor protein is improperly cut, releasing beta amyloid (beta amyloid 42 in particular), which clumps up creating the senile plaques. These tend to accumulate in the hippocampus and amygdala.
67
It is estimated that only 50% of individuals get recommended screening for STIs. What is the gonorrhea screening recommendation for non-pregnant women?
Annual gonorrhea screening if:-Sexually active AND-New or multiple sex partners/Those living in communities with high burden of disease
68
Comparing Crohn's Disease and Ulcerative Colitis, which features lower right abdominal pain?
Crohn's Disease
69
There are different types of delusional disorder. Briefly describe the grandiose subtype.
Belief that they've made some great discovery or have some great talent.
70
Find the one false statement about toxoplasmosis:-60 million infected in US-2 billion infected worldwide-organism completes life cycle in dogs-leading cause of foodborne illness
False--Organism does not complete its life cycle in dogs; it completes it in cats.
71
True or false: 50% of patients with chronic pancreatitis die within 5 years.
False; 50% die within 10 years.
72
True or false: histoplasmosis is extremely contagious from person to person.
False; it cannot be passed from one human to another.
73
What symptoms are possible with congenital toxoplasmosis?
Stillbirth, miscarriage, hydroencephaly, microcephaly, endocrine disorders, cerebral calcifications, rash, fever, psychomotor retardation, jaundice, enlarged spleen, CSF abnormalities.Ocular: chorioretinitis, potentially leading to macular scarring, strabismus, and optic nerve problems.
74
What two classes of drugs are available to treat Alzheimer's disease?
Acetylcholinesterase inhibitors (Donepezil in particular) and NMDA receptor antagonists (Memantidine)
75
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do parietal cells secrete?
Hydrochloric acid and intrinsic factor
76
Huntington's disease is inherited in an autosomal dominant pattern. The mutant protein responsible, huntingtin, is encoded on chromosome 4. What trinucleotide pattern is found repeating many more times in patients with Huntington's as compared to normal patients?
CAG
77
1/3 of patients with IBD have manifestations in the eyes, skin, or joints. What skin manifestations are there?
Erythema nodosum, pyoderma gangrenosum, psoriasis, dermatitis, erthematous rash, uticaria
78
A defect in which gene leads to Wilson Disease? Transport of what substance is decreased in this condition?
ATP7B gene; copper transport is decreased.
79
There are five classes of HIV medications (plus pharmacokinetic enhancers). Describe what NRTIs (nukes) do, as well as any specific points made during class about this class of medication.
They provide faulty versions of viral DNA nucleotides/nucleosides, stopping reverse transcriptase.
80
What is the treatment for an anaphylactic shock?
Administer subcutaneous epinephrine, call 911, give them benadryl if they can swallow it. Also have them lie flat, raise feet about 12 inches, and cover with a blanket to prevent shock.
81
True or false: patients with cluster headaches act restless and agitated.
True*
82
There are different types of delusional disorder. Briefly describe the mixed subtype.
Involves a mix of the other categories, with none predominating.
83
In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. One of them is there must be no nausea or vomiting* AND no more than one of photophobia or phonophobia*.
Free card.
84
Though expiration is mainly achieved through relaxation of the diaphragm, what inherent tendency of the lung tissue helps?
Elastic recoil acts to help the lungs snap back to their original shape.
85
Describe the age and gender of the typical MG patient.
There is a bimodal distribution: younger females (teens-20s) and older males (50-70)
86
Which lung volumes/capacities can be measured directly?
Expiratory reserve volume, tidal volume, and inspiratory reserve volume
87
Chronic daily headaches (aka "chronic migraines") are characterized by headaches occurring at least _____ days per month for at least _______ months.
At least 15 days/month for at least 3 months*
88
True or false: the symptoms of HEV are similar to those of HAV but are less severe.
False; the symptoms of HEV are much more severe than those of HAV.
89
How would you diagnose primary sclerosing cholangitis?
ERCP, magnetic resonance cholangiography (MRC), percutaneous cholangiogram, possibly liver biopsy.
90
True or false: a thymectomy is recommended in almost all patients who are positive for autoantibodies against the acetylcholine receptor, and makes the chances of a medication-free remission twice as likely.
True.
91
True or false: Bipolar II disorder typically begins with a hypomanic episode.
False; it typically begins with a major depressive episode.
92
Pica is the eating of non-nutritive, non-food substances over a period of at least 1 month. At what age does it most commonly onset, and what comorbidities accompany it?
Onset during childhood; comorbid with autism spectrum disorder or intellectual disability.
93
Treatment for a gastrinoma involves surgical removal and then medication for long term therapy. What medications can be used?
Proton pump inhibitor and somatostatin analog
94
What percentage of patients with Hepatitis D have a Hepatitis B coinfection?
5%
95
Trigeminal autonomic cephalgias are thought to be due to abnormal hypothalamus and trigeminal activity.
Free card.
96
What is the ocular finding that occurs in less than 1% of patients with acquired toxoplasmosis but more than 80% of patients with congenital toxoplasmosis?
Chorioretinitis (inflammation from the tachyzoite in retinal cells; tends to occur in the macula but can be in the periphery; can cause optic nerve problems and strabismus; also tends to be unilateral in acquired and congenital but bilateral in immunocompromised).FYI: toxoplasmosis is the most common cause of human retinochoroiditis.
97
The three types of clinical syndromes caused by chlamydia trachomatis are local, complications and sequelae. What are the findings of local infection for men, women, and children?
Men: conjunctivitis, urethritis, prostatitisWomen: conjunctivitis, urethritis, cervicitis, proctitisChildren: conjunctivitis, pneumonitis, pharyngitis, rhinitis
98
A patient with ptosis due to myasthenia gravis, when looking into primary gaze from a downgaze position, might experience which phenomenon?
Cogan's lid twich
99
What is the name of the anxiety disorder in which a person may use nonspoken means to communicate when encountering other people in social situations?
Selective mutism
100
How is gastic cancer diagnosed?
Endoscopy with biopsy. Endoscopic ultrasonography can be used to see the extent of the cancer.
101
Avoidant/restrictive food intake disorder is manifested by persistent failure to meet appropriate nutritional and/or energy needs, associated with at least one of the following: significant weight loss, significant nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, marked interference with psychosocial functioning. It is comorbid with anxiety disorders, OCD, autism spectrum disorders, and ADHD.
Free card.
102
What are the symptoms of esophageal dysphagia?
Coughing/choking at night (unrelated to swallowing), symptoms of GERD, associated chest pain and regurgitation, feeling that swallowed bolus is "stuck" on the way down. Dsyphagia occurs with solids and liquids.
103
There were three types of migraine headaches discussed in class: without aura, with aura, and aura without headache (acephalgic). Which of these is the most common type?
Migraine without aura.
104
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the P stand for?
Previous headache with history of progression--change in frequency, duration, intensity
105
Loss of consciousness with syncope lasts about how long?
5-20 seconds
106
Comparing tension headaches to migraines, which is typically associated with nausea or vomiting?
Migraine
107
What are some of the risk factors for IBS?
Anxiety depression, personality disorders, history of childhood sexual abuse, and domestic abuse in women.
108
How do the symptoms of variant CJD compare with those of CJD?
They include the rapid deterioration of mental status and myoclonus, as well as psychiatric symptoms and paresthesia.
109
True or false: the pain of a brain tumor headache comes and goes, is deep and dull, and is worse in the evening.
False; the pain is constant* and is worse upon waking. (But yes, the pain is deep and dull.)
110
Briefly outline the pathophysiology of asthma.
Asthmatics have 10x more mast cells than normal, so initiating factors cause a huge response in inflammatory response. Histamines, prostaglandins, tryptase, and leukotrienes cause bronchospasm, mucosal edema, and hypersecretion of mucous. Eosinophils releases proteins toxic to epithelial cells, which undergo metaplasia and become goblet cells and secrete more mucous. Proteins and collagens deposit in basement membranes, which thickens walls and narrows airways. Smooth muscle undergoes hyperplasia and has less beta receptors, which leads to increased bronchoconstriction.
111
Bipolar I is the classic manic-depressive disorder. How does Bipolar II differ?
It requires at least one major depressive episode and at least one hypomanic episode.
112
Which Cluster C personality disorder is characterized by viewing self as socially inept, a fear of being shamed or ridiculed, and feelings of inadequacy?
Avoidant
113
Lhermitte's sign, which is one of the symptoms of multiple sclerosis, involves a a radiating pain down the spine due to movement of what body part?
Neck
114
____________________ is the perception of pain due to normally non-painful stimuli and can occur with a migraine.
Cutaneous allodynia
115
True or false: although there is a higher rate of syphilis among men as compared to women, the difference is minimal.
False; the rate of syphilis among men is more than 10x that in females.
116
What are the advantages of non-treponemal serological testing for syphilis?
Rapid and inexpensive, easy to perform, quantitative and qualitative, can be used to monitor success of treatment, as well as evaluate for possible reinfection.
117
What is the overall fatality rate for patients who develop neuroinvasive WNV? Is it higher or lower in meningitis as compared to encephalitis?
10% is the overall, and it is higher in encephalitis than in meningitis.
118
True or false: having severe asthma as a child slightly increases your risk of developing COPD as an adult.
Falase; it greatly increases the risk (32X)
119
True or false: when asked to localize the pain, a patient with a basilar migraine will point to their entire forehead, just above the eyes.
False; they will more likely point to the back of their head (occipital area).
120
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. What lifestyle habits can predispose to GERD?
Weight gain, obesity, smoking, and eating prior to reclining.
121
What are the treatment options for Barret's esophagus that DOES involve high-grade dysplasia?
Endoscopic mucosal resection (EMR)*, photodynamic therapy (PDT)*, radiofrequency ablation, focal thermal ablation, and cryoablation.
122
True or false: the upper 2/3 of the esophagus has skeletal muscle while the lower 1/3 has smooth muscle.
False; the upper 1/3 of the esophagus has skeletal muscle while the lower 2/3 has smooth muscle.
123
Tonic-clonic (grand mal) is a type of generalized seizure. It includes a tonic phase, a clonic phase, and a postictal recovery phase. About how long does each of these phases last?
Tonic = 10-20 seconds; clonic = 30-90 seconds, and postictal = 5-30 minutes
124
What respiratory symptoms may be found in a patient with sarcoidosis?
Dry cough and dyspnea most commonly. Paratracheal and hilar adenopathy are also possible, as are infiltrates and fibrosis.
125
Which test is the gold standard to differentiate active vs latent TB?
Sputum evaluation; use an acid fast stain and perform nucleic acid amplification.
126
In acute pancreatitis, pancreatic enzymes are inappropriately released, damaging pancreatic tissue. What are some causes of this condition?
Toxi exposure (such as with alcohol) and pancreatic duct obstruction (such as from biliary tract disease) are the two main causes.
127
Since primary sclerosing cholangitis can cause cirrhosis, the median survival time of symptomatic patients is 10-18 years after initial diagnosis.
Free card.
128
What are the clinical features of Lewy Body dementia?
Fluctuations or "blanking out"Recurrent, detailed visual hallucinations (67%)Parkinsonism featuresREM sleep behavior disorderRecurrent falls, fainting
129
Death in a patient with kuru occurs within how long after diagnosis?
9 to 24 months
130
There are neurologic, iatrogenic, structural, muscular, infectious, and metabolic causes of oropharyngeal dysphagia. What neurologic causes are possible?
Cardiovascular accident, Parkinson's, ALS
131
Which of the liver conditions discussed in class are more common in men?
Hepatocellular carcinoma
132
Toxoplasmosis in the immunosuppressed features the same types of symptoms as acquired toxoplasmosis (but more severe), plus confusion, seizures, nausea, poor coordination, encephalitis, pneumonitis, myocarditis, retinochoroiditis.
Free card.
133
What is the most common first symptom of COPD?
Dyspnea on exertion.
134
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form involves minimal progression, at the beginning?
RRMS
135
_____________ is a surgical treatment for GERD that involves wrapping the stomach around the lower esophagus to strengthen the LES. In how many patients does this surgery lead to symptom resolution?
Laproscopic fundoplication; symptom resolution in more than 90%.
136
What is the treatment for gastric cancer?
Gastrectomy with regional lymphadenectomy, chemotherapy, radiotherapy
137
Celiac disease is a chronic autoimmune disease characterized by malabsorption and diarrhea precipitated by ingestion of food products containing gluten. CD is more common in people with what other conditions?
Type I diabetes and thyroid disorder.
138
Besides SNOOP, what are the two headache danger signs mentioned in class?
"First or worst" headache*, headaches not reponding to treatment
139
Binge-eating differs from bulimia in that binge-eating involves no ____________.
Compensatory actions (to reduce weight gain)
140
What two factors are important in the development of fibrosis due to asbestosis?
Dose of asbestos and fiber dimension (shape, length, diameter).
141
Describe the chancre found in primary syphilis.
It starts 2-6 weeks after exposure, as a red painless papule (0.5-1.5 cm in size). It ulcerates "cleanly" in 1-2 days, then heals in 3-6 weeks.
142
Short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT) last anywhere between 1 to 240 seconds. How often do they occur per day, on average?
60/day, though can be up to 200/day.
143
True or false: though most untreated individuals with primary syphilis will progress to secondary, there are a few whose genetic make up seem to protect them from progression to secondary.
False; 100% of untreated individuals with primary will progress to secondary.
144
Which of the psychotic disorders has a 20% attempted suicide rate?
Schizophrenia
145
There are five classes of HIV medications (plus pharmacokinetic enhancers). Describe what INSTIs (integrase strand transfer inhibitors; integrase inhibitors) do, as well as any specific points made during class about this class of medication.
They block integrase, keeping the viral DNA from being inserted into the host cell DNA. This class has been associated with SJS.
146
Comparing subdural vs epidural hematomas, which involves the venous blood supply?
Subdural
147
What ocular symptoms may be found in a patient with sarcoidosis?
Anterior uveitis most commonly. Can also have granulomas, conjunctivitis, lacrimal gland inflammation, retinal vasculitis, ONH edema, and cranial neuropathies.
148
Tension headaches are divided into infrequent/episodic, frequent, and chronic. Which is most common?
Infrequent/episodic*
149
True or false: COPD consists of emphysema, chronic bronchitis, and asthma.
False; asthma is not considered part of COPD.
150
Diabetic ketoacidosis is when the body does not produce enough glucose, so it breaks down fat, with ketones as a byproduct. What level of blood sugar would indicate to check the patient's urine for ketones?
Over 240 mg/dL
151
Comparing angina and myocardial infarction, which involves a decreased (but not completely stopped) blood flow to the heart?
Angina
152
What clinical feature is found in 97% of patients with a subarachnoid hemorrhage?
A sudden, severe headache.
153
What happened in 1986 in relation to TB? What caused this to happen?
There was a resurgence of TB incidence. It was due to the HIV epidemic, immigration of individuals from TB prevalent countries, rise of multidrug-resistant mycobacterial organisms, and decline of TB control programs.
154
In what percent of hepatic manifestations of Wilson Disease will the patient also have a Kayser-Fleisher Ring?
50%
155
How would you treat disseminated and chronic pulmonary histoplasmosis?
Anti-fungals for 3m-1 year-IV amphotericin B-Oral itraconazoleSystemic corticosteroids-To treat Addison and decrease damage from inflammation
156
What two categories of symptoms occur in tertiary syphilis? How long after initial infection does each occur?
Benign (10-15 years post infection): gummas (localized soft granulomas), chronic inflammation, fibrosis of tissue/destruction of cartilage.Cardiovascular (20-30 years post infection): aortic aneurysm, aortic valve insufficiency/regurgitation, CAD, MI, HF, strokes, seizures.
157
Which disease in the US is the leading vector borne disease?
Lyme disease
158
What is the main complication of chlamydia?
Reactive arthritis (urethritis, arthritis, conjunctivitis, rash)
159
Ambulatory pH monitoring, barium swllow, esophageal manometry, and endoscopy are all tests that can be used to evaluate GERD. Which test is the most diagnostic test, with a sensitivity and specificity of 92%?
Ambulatory pH monitoring.
160
Primary sclerosing cholangitis is associated with what bowel condition?
Inflammatory Bowel Disease
161
Of the four features of Parkinson's disease, which occurs later in the disease and is not a diagnostic criteria?
Postural instability.
162
How would you treat a moderate to severe acute migraine?
Triptans or a combination of triptans and NSAIDs
163
Though 50% of patients with primary sclerosing cholangitis are asymptomatic, symptoms can include what?
Fatigue, pruritis, jaundice, hepatomegaly, splenomegaly.
164
The biliary system is a collection of vessels that direct the secretions from the liver, gallbladder, and pancreas into which part of the small intestine?
Duodenum.
165
Give a one-sentence description of a tonic seizure.
Sudden muscle stiffness with or without impaired consciousness.
166
Jeopardy style: 95% of cases of Lyme disease in the US come from these geographic regions.
What are the Northeast, Wisconsin, and Minnesota?
167
What is the common clinical manifestation of gonorrhea?
Conjunctivitis.
168
Testing for serum bilirubin (both conjugated and unconjugated) is one way to test for liver function. Which, conjugated or unconjugated, is not found in the serum of healthy patients?
Conjugated
169
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat paranoid disorder?
Possibly pharmacotherapy
170
True or false: there are an estimates 20 million new STIs each year in the US, with about half of them occurring in the age range of 20-30
Half true--there are indeed 20 million new STIs each year in the US, but half of them occur in the 15-24 age range.
171
Name the features of Wernicke encephalopathy.
Permanent damage to memory areas of brain, loss of muscle coordination, confusion and loss of mental activity, alcohol withdrawal, nystagmus, ptosis.
172
Comparing sigmoidoscopy and colonoscopy, which requires that the patient be sedated?
Colonoscopy
173
What is the name for the "shivering disease" or "laughing sickness"?
Kuru
174
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the S stand for?
Systemic symptoms--fever, weight loss, cancer, immunocompromised, pregnant
175
Which of the personality disorders are more common in men? Which are more common in women?
Men: schizoid, narcissistic, antisocial. Women: borderline, histrionic, avoidant, dependent
176
True or false: the biggest concern of asbestosis is outside of the U.S.
False; biggest concern is in the U.S.
177
Alteplase is a tissue plasminogen activator that is sometimes used to break down clots. It must be used within 4.5 hours of the onset of symptoms. What are two scenarios that would contraindicate the use of alteplase?
If there is evidence of hemorrhage, or if the patient is an anticoagulants (warfarin, coumadin, heparin).
178
What are possible side effects of anticholinergics?
Blurry vision, dry mouth, HA, dizziness, cough, mydriasis, conjunctival hyperemia, angle closure glaucoma.
179
For whom does the CDC recommend 2 step testing for initial TB screening?
For anybody needing to have periodic testing.
180
What are the potential complications of choledocholithiasis?
Gallstone pancreatitis and acute cholangitis.
181
Stress gastritis is characterized by superficial erosions in the stomach that occur after what types of events?
Physical trauma, shock, sepsis*, or respiratory failure.
182
Parkinson's disease (aka "the shaking palsy") is more common in which gender?
Male
183
What ocular or case history findings might make you suspect that your adult patient's conjunctivitis was caused by chlamydia (adult inclusion conjunctivitis)?
Case history indicates new sexual partner1-2 weeks post infectious opportunity (i.e., sex with new partner)Conjunctivitis is prolonged and unresponsive to topical antibioticsPossibly unilateralPapillae and follicles
184
Though HIV was first brought into the US in the 1970s, AIDS wasn't first recognized as a disease until what year? When was HIV first isolated?
Recognized in 1981Isolated in 1983
185
Huntington's disease is usually diagnosed in what age range? Which gender has a higher predilection?
Usually diagnosed in middle ages (30-50), and there is no gender predilection.
186
What ocular findings NOT directly related to an infection might a patient with HIV have?
KCV sicca, immune recovery uveitis/vitritis, kaposi sarcoma, HIV retinopathy, and neuro-ophthalmic abnormalities.
187
Comparing angina and myocardial infarction, which involves a completely stoppage of blood flow to the heart?
Myocardial infarction.
188
True or false: bulimia tends to be more chronic and resistant to treatment compared to anorexia.
False; anorexia is more chronic and resistant to treatment compared to bulimia.
189
In Bipolar I and II, a manic episode is a distinct period of abnormal and persistant elevation or irritation of mood and increased energy lasting for at least one week. A manic episode can include features such as decreased need for sleep, being easily distracted, being more talkative and feeling pressure to keep talking, among others. How many of these criteria does a person need to meet before it can be termed "manic episode"?
Three to four
190
True or false: acute Hepatitis C is usually subclinical
True.
191
Define: inspiratory reserve volume
The extra volume of air that can be brought into the lungs with effort.
192
Cirrhosis results from chronic liver disease, most commonly ___________ and ____________.
Alcoholic liver disease and hepatitis B/C (also from fatty liver)
193
The most common sign of the early/localized Lyme disease infection is erythema migrans (average of 7 days post bite). Which of the following descriptors usually apply to EM?PainfulItchyWarmFor bonus points, what is the CDC definition of EM?
EM can feel warm, but typically involves no pain and no itch.BonusCDC definition of erythema migrans-at least 5 cm in size-expanding->1 week in duration
194
Some medical conditions are associated with sleep apnea. Which are they?
HTN, obesity, MS, DM, CV disease.
195
True or false: in HCV, chronic cases are more common than acute.
True.
196
Tension headaches are divided into infrequent/episodic, frequent, and chronic. On average, how often do infrequent/episodic headaches occur?
Less than 1 day per month on average
197
What protein, encoded by a gene on chromosome 17, is involved in the production of neurofibrillary tangles? What is this protein's normal function?
Tau protein. It normally acts to stabilize microtubules, but in Alzheimer's becomes hyperphosphorylated and can no longer perform this function.
198
True or false: although spraying clothes with permethrine and >20% DEET are among some of the most effective things you can do to reduce your chances of being bitten by a tick, the overall best thing you can do is sit down with the ticks, make friends, and sing kumbaya.
False (well, the last part at least).
199
Tension-type headaches are ___________ (bilateral/unilateral) and ___________ (throbbing/non-throbbing).
Bilateral*, non-throbbing
200
What are the two forms of chlamydia trachomatis? Which is the infectious form, and which is the duplicating form?
The elementary body is the infectious form.The reticulate body is the duplicating form.
201
If a patient has a danger sign for a headache, imaging should be done, and typically an MRI is preferred over a CT (though CT is preferred in emergencies). Lumbar puncture should be performe
Free card.
202
Which of the features of Parkinson's is the most common? Which is most commonly the presenting symptom?
Bradykinesia is the most common feature, but tremor is the most common presenting symptom.
203
The cortical spreading depression (CSD) theory of migraine pathophysiology states that aura are caused by a wave of excitation in parts of the brain. The permeability of the blood-brain-barr
COX-2, TNF-alpha, MMPs
204
What ocular symptoms might a patient with cystic fibrosis have?
Aqueous deficient dry eye, reduced endothelial density, increased corneal thickness, PSC cataract, reduced contrast sensitivity, diabetic reinopathy, decreased macular pigmentation, xerophthalmia.
205
Which class of drugs for Parkinson's disease works well for patients under 65 years?
Doapmine receptor agonists (bromocriptine, pramipexole, ropinirole, apomorphine)
206
Which gender has a higher predilection for Alzheimer's?
Females
207
What is the typical transmission of Hepatitis B?
Percutaneous, sexual, or perinatal.
208
What are the symptoms of alcoholic hepatitis (alcoholic steatohepatitis)?
Jaundice, fever, anorexia, ascites (causing abdominal distention), muscle wasting, abdominal pain
209
What percentage of gastrinomas are malignant?
60-95%
210
If you could choose two words to describe the typical emphysema patient, what would they be? What do these two words imply about the condition?
Pink puffer; pink implies they have enough oxygen, and puffer implies to their tachypnea, which helps keep the airways from collapsing.
211
What are the risk factors for postherpetic neuralgia?
Older age, severity of initial rash and pain, and immunocompromised
212
One of the esophageal conditions discussed in class has a higher prevalence in men. Which condition is it?
Barret's esophagus
213
When a TBI occurs, there is axonal rupture from shear forces. What ypes of neurotransmitters are released in response?
Excitatory (glutamate, acetylcholine). This also leads to the generation of free radicals.
214
What are the main features of Huntington's disease?
Chorea (dance-like unpatterened movement, dystonia), psychiatric problems, and dementia.
215
What is the most common cause of death for patients with cystic fibrosis?
Pulmonary failure secondary to infection.
216
Stooped posture and _______________ (increased/decreased) arm swing when walking are two of the ways in which Parkinsonian rigidity can manifest.
Decreased
217
Migraine headaches affect activities of daily living, are ___________ (unilateral/bilateral) and typically occur how many times per month?
Unilateral, 1-4 times per month or less.
218
Define: residual volume
The volume of air remaining in the lungs even after forceful expiration.
219
There are three preferred regimens of ART. List them.
#NAME?
220
Jacksonian march is associated with what type of seizure?
Simple partial.
221
What are some antiviral therapies specific to HCV?
Ribavirin, pegylated interferons, sofosbuvir, simeprevir, telaprevir, boceprevir.
222
How would sarcoidosis be diagnosed?
Three elements are required for diagnosis: consistent clinic history and x-ray; exclusion of other disease; and biopsy for granuloma.
223
Choledocholithiasis can be diagnosed with transabdominal ultrasound, CT, magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), or endoscopic ultrasonography. Which of these imaging techniques includes the ability to perform surgical procedures as treatment for choledocholithiasis?
ERCP
224
How often should patients being treated for TB have eye exams? What should these eye exams include?
Monthly; should include VAs, EOMs, Amsler grid, VF, pupil exam, R/G color vision, SLEx, DFE.
225
True or false: the accessory muscles of inspiration usually contribute only little to inspiration.
True; though some disease processes cause these to be more important.
226
Fill in the blank: _____________, an anticholinesterase agent used to treat acute MG, is usually dosed at qid due to its duration of 3-4 hours.
Pyridostigmine
227
Diagnosis for IBD is based on endoscopy and imaging (CT with contrast*, MRI)
Free card.
228
There are four categories of histoplasmosis. Which occurs when already-diseased lung tissue (COPD, emphysema, etc.) is infected by the fungi? What symptoms can occur in this category?
Chronic pulmonary. Histoplasmomas can form, and bronchiectasia can occur (small airway collapse). Chest pain can also occur in this category. Could resolve in 1-3 months or be a chronic condition.
229
What two main categories of restrictive lung diseases were discussed in class?
Infiltrative (pneumonconiosis, collagen vascular diseases, and sasrcoidosis) and chest wall abnormalities (kyphoscoliosis, obesity, and respiratory muscle fatigue).
230
True or false: tension-type headaches are the most common type of headache worldwide.
True.
231
QuantiFERON is an interferon gamma release assay (IGRA) that is an alternative to the TST. What are the benefits of IGRAs over TST?
Blood is drawn, so only one patient vision.Results available in 24 hours.Test does not cause booster phenomenon.BCG vacinnation doesn't cause a false positive.
232
List the two facts about the microbiology of chlamydia trachomatis that makes it 1) more likely to infect women2) more likely to cause infertility in women
It infect columnar epithelial cells, which are more common in the vagina than in the penis.It is an obligate intracellular organism that destroys the host cell when it dies, resulting in scarring that could lead to infertility (and since it preferentially infects columnar epithelial cells, scarring is more common in women)
233
Some medications can induce IIH. Name some of them.
Oral contraceptives, tetracyclines, and retinoids.
234
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What do the O's stand for?
Onset is new (especially if over age 40*); Other associated features--head trauma, drug use, pain worse with posture changes
235
What are some parasitic causes of aspectic meningitis?
Lyme
236
TST results are made by measuring the induration of the resulting reaction, not the redness. In which individuals would an induration of 5 mm be considered posittive?
#NAME?
237
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat histrionic disorder?
Psychotherapy
238
Name the age prevalence, if any, for the following diseases, as discussed in class:-Lyme-West Nile Virus-Syphilis-Chlamydia-Gonorrhea-HIV/AIDS-Toxoplasmosis-Toxocariasis
-Lyme: bimodal; 5-19 and 45-50-West Nile Virus: none-Syphilis: 20-30 for male and female-Chlamydia: 20-30 for male, 15-25 for female-Gonorrhea: 20-30 for male, 15-25 for female-HIV/AIDS: 13-24? (26% of new HIV infections)-Toxoplasmosis: none-Toxocariasis:
239
In terms of classifying the severity of bulimia, how many episodes per week is considered severe?
Eight to thirteen
240
Which Cluster B personality disorder is characterized by a sense of self-importance, fantasies of power, needing excessive attention, lack of empathy, etc?
Narcissistic
241
What are the most common primary intracranial tumors?
Meningiomas, gliomas, pituitary adenomas
242
Treatment for stress gastritis involves keeping the stomach pH greater than 5.0, and 80% of patients stop bleeding with supportive care. An indication for surgery would be if bleeding recurs or persists and requires more than how many units of blood?
Six.
243
Define: tidal volume
The volume of air expired and inspired with normal breathing.
244
Your patient is experiencing a seizure. What do you do during the seizure?
Move dangerous items away from the individuals, but don't try to hold them down or put anything in their mouth. Record the length of the seizure.
245
Which of the personality disorders has a 10% suicide rate?
Borderline
246
What kind of geographic climate is likely to have a higher prevalence of toxoplasmosis?
Warm, moist, and lower altitude
247
In 12% of patients with reflux documented by pH monitoring, what complication is found?
Barret's esophagus
248
Jeopardy style: This is the rate at which chlamydia occurs in females as compared to males.
What is 2.5 times more?
249
Which type of dysphagia arises from the esophagus or LES?
Esophageal dysphagia.
250
Trigeminal neuralgia involves extreme pain. Does it occur bilaterally or unilaterally?
Unilaterally*
251
Comparing subdural vs epidural hematomas, which has the worse prognosis?
Subdural
252
How would you treat an extremely severe acute migraine?
Subcutaneous sumatriptan, IV/I antiemetic with diphenhydramine or dihydroergotamine, IV/IM ketorolac or dexamethasone
253
What are the symptoms of oropharyngeal dysphagia?
Inability to form a bolus, difficulty initiating a swallow, coughing/choking, aspiration/regurgitations, food sticking at the level of throat. Liquids are more problematic.
254
How is HBV diagnosed?
By detecting HBV antigens or IgM and IgG HBV antibodies.
255
Inability to digest complex foods, such as can occur with chronic pancreatitis, occurs when what percentage of pancreatic function is lost?
More than 90%
256
True or false: TB kills more people worldwide than AIDS.
False; but TB does come in second after AIDS.
257
Unfortunately, there is no specific treatment for WNV, there are only supportive therapies. What can you do to help the patient?
Pain control, IV fluids (due to N&V), respiratory support (from the flaccid paralysis), antibiotics (prevent secondary infections), anti-inflammatory meds, osmotic agents (decrease ICP caused by brain swelling).
258
Diverticula is an acquired herniation of the small weak areas of the colon's muscular wall. It is a common occurrence with age except in patients with what kind of diet?
Vegetarian
259
What sort of imaging can be done for chronic pancreatitis?
X-ray, CT, and endoscopic untrasonography with or without fine needle aspiration.
260
What does the typical patient with Barret's syndrome look like, in terms of gender, race, and age?
Middle-aged Caucasian male
261
Basilar migraines need two or more of what symptoms for diagnosis? (FYI: these symptoms last 5-60 minutes)
DysarthriaVertigo/difficulty walkingTinnitus and/or hearing impairmentDiplopiaBilateral visual symptoms*Bilateral paresthesiaDecreased consciousness
262
Name the gender prevalence, if any, for the following diseases, as discussed in class:-Lyme-West Nile Virus-Syphilis-Chlamydia-Gonorrhea-HIV/AIDS-Toxoplasmosis-Toxocariasis
-Lyme: none-West Nile Virus: none-Syphilis: male-Chlamydia: female-Gonorrhea: none-HIV/AIDS: male? (63% of new HIV infections is MSM)-Toxoplasmosis: none-Toxocariasis: none
263
In which areas of the U.S. is histoplasmosis most commonly found?
Ohio and Mississippi river valleys (60-90% exposure)
264
The average stomach can hold how much food/liquid, at maximum?
1.5 gallons
265
What are the major risk factors for idiopathic intracranial hypertension?
Female of childbearing age, obesity
266
Esophageal dysphagia has issues with solids or liquids?
Both.
267
Some medical conditions have an increased incidence in a patient with sleep apnea. Which are they?
Cognitive decline, emotional problems, impotence, oxteoporosis, glaucoma (especially normal tension), anterior ischemic optic neuropathy.
268
What is the most common autonomic finding of SUNCT?
Conjunctival injection and lacrimation.
269
Headache is the initial complaint in 20% of patients with what condition?
Brain tumor.
270
Which Cluster A personality disorder is characterized by participation in solitary activities, lack of emotions, and appearing cold or detached?
Schizoid
271
Briefly describe ambulatory pH monitoring.
An acid-sensitive catheter is placed in the esophagus for a prolonged period of time to measure the pattern of pH changes. Diet and exercise are unrestricted, and the patient should have stopped acid-suppressing medications 3-14 days prior to the study.
272
What is the drug of choice to treat focal seizures?
Lamotrigine
273
1/3 of patients with IBD have manifestations in the eyes, skin, or joints. What eye manifestations are there?
Episcleritis and anterior uveitis
274
Injected cocaine can cause what kind of retinopathy?
Talc.
275
What gender, age, and race is more likely to develop asthma? Least likely?
Female, child, black are more likely to develop asthma. Male, adult, Hispanic are less likely to develop asthma.
276
Comparing Crohn's Disease and Ulcerative Colitis, which tends to include the ileum?
Crohn's Disease
277
If a patient with severe chronic bronchitis were to be in your waiting room, how might he look?
Obese, large chest, chronic coughing, and cyanotic/happy (due to CO2 narcosis).
278
What are the nutritional risk factors for gastric cancer?
Salted meats/fish, high nitrate consumption, smoking, and alcohol.
279
Prevention of migraines can be done with anticonvulsants like valproate (also used for ________ seizures), lamotrigine (also used for __________), and topiramate (which has what side effects?).
Valproate: general seizures; lamotrigine: focal seizures; topiramate: causes angle closure and myopic shift
280
What are the treatment options for hepatocellular carcinoma?
Liver resection or transplantation, tumor ablation by radiofrequency, transarterial chemoembolization.
281
What drug can be used to treat trigeminal neuralgia?
Carbamazepine*
282
What might neuroimaging show in a patient with Alzheimer's?
Cortical/hippocampal atrophy, white matter lesions, enlarged ventricles.
283
A myasthenic crisis is respiratory failure due to weakness of the respiratory muscles, and can occur after thymectomy. At what point during the course of the disease does this usually occur? How many MG patients experience it?
Usually occurs in the first years after diagnosis; 10-20% of patients experience it at some point.
284
Thunderclap headaches reach maximal intensity even faster than cluster headaches, in a few seconds to less than a minute. How long do thunderclap headaches last?
At least 5 minutes, up to 10 days.
285
What test quantifies the amount of liver fibrosis?
Transient elastography
286
Cholelithiasis is another name for gallstones. 80% of gallstones are made of what?
Cholesterol
287
Which triptan is available as a patch?
Sumatriptan*
288
In the early 1900s, 1 in 5 people in the U.S. had active TB, and 1 in 7 people in the U.S. died from active TB. Has the incidence of TB increased or decreased since then?
Overall, decreased, but there was a resurgence in 1986.
289
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Patients with which form usually progress to SPMS?
RRMS
290
Fill in the blanks: in ________% of patients with multiple sclerosis, optic neuritis is the most common symptom; in __________%, it is the first symptom.
40-50% = most common symptom; 15-20% = first symptom
291
Injection therapy for MS is safer than infusion therapy, but less effective. Name a few injectable MS medications.
Interferon beta (Avonex, Rebif, Betaseron, Plegrity), Glatiramer
292
What symptoms can occur in ocular larva migrans?
The larva enters the eye through choroidal circulation and can cause a granuloma, potentially leading to a retinal detachment; also chorioretinitis, uveitis, endophthalmitis, optic neuritis. This is usually unilateral.
293
If a person has experienced a thunderclap headache, you must use CT* and lumbar puncture to rule out what possible underlying causes?
Subarachnoid hemorrhage or ruptured aneurysm.
294
In terms of classifying weight severity in anorexia, what BMI is considered extreme?
Below 15 kg/m2
295
True or false: bilirubin in the urine may be an indicator of liver damage or disease.
True.
296
Who should get pre-exposure prophylaxis for HIV?
MSM, heterosexuals with risky behaviors, partners with one HIV+, injectable drug users.
297
Nearly 90% of headaches fall into one of these categories: migraine, tension-type, chronic daily, and cluster. Which of these types of the most frequent?
Tension-type
298
The headaches that occur in recurrent painful ophthalmoplegic neuropathy can develop up to how many weeks prior to the eye muscle weakness? Does the eye muscle weakness ever resolve?
2 weeks; the muscle weakness does recover completely between attacks.
299
Does Hepatitis E have a chronic form?
No.
