Questions1 Flashcards
What is Heyde’s syndrome?
Aortic stenosis + GIB 2/2 angiodysplasia
Preferred form of hormonal contraception for lactating mothers:
progestin-only
Forgetfulness and dissociation assoc w travel:
dissociative fugue
Treatment for simple or partial seizure:
carbamazepine (first line), lamotrigine, oxcarbazepine, levetiracetam
Treatment for complex partial seizures:
carbamazepine (1st line), valproate, lamotrigine, levetiracetam
Treatment for absence seizure:
ethosuximide (first line), valproate
Treatment for tonic-clonic seizure:
phenytoin (first line), carbamazepine (1st line), valproate (1st line), lamotrigine, levetiracetam
Children are more likely to have a febrile seizure in the future if…
1) less than 18 months at first seizure
2) FH of febrile convulsions in first-degree relatives
3) short time before fever and seizure
4) low degree fever before seizure
5) seizure history of abnormal neuro signs or developmental delay
In children with cerebellar findings, consider which diseases?
1) cerebellar astrocytoma, medulloblastoma
2) hydrocephalus (arnold-chiari or dandy-walker malformations)
3) Friedreich ataxia (AR, areflexia, loss of bivration/position sense, cardiomyopathy=HCM)
4) ataxia-telangiectasia (progressive cerebelalr ataxia, oculocutaneous telangiectasias, immune deficiency)
What are the two classic causes of “floppy” baby?
Wernig-Hoffmann disease (FH–autosomal recessive, congenital degeneration of anterior horns of spinal cord (LMN lesion) long slowly progressive disease; all affected by 6 months)
Botulism: sudden onset, honey or home-canned foods; spontaneous recovery within 1 week
What can ethambutol cause?
optic neuritis
Polio is caused by destruction cells where?
anterior horn of spinal cord (LMN death)
Toxicities of carbamazepine:
blood dyscrasias (agranulocytosis/aplastic anemia), liver toxicitiy
P450 inducers:
Momma Barb Steals Phen-phen and refuses greasy carbs chronically
Modafinil Barbiturates St. John's wort Phenytoin Rifampin Griseofulvin Carbamazepine Chronic alcohol abuse
P450 inhibitors
MAGIC RACKS in GQ
Macrolides Amiodarone Grapefruit juice Isoniazid Carbamazepine
Ritonavir Acute alcohol Ciprofloxacin Ketoconazole Sulfa
Gemfibrozil
Quinidine
Which muscls are spared in Lambert-Eaton but almost always involved in MG?
extraocular
How do you treat organophosphate poisoning?
atropine, pralidoxime (antidote to organophosphate)
Which antibiotics given in high doses can cause MG-like muscular weakness or prolong effects of muscular blockade after anesthesia?
aminoglycosides
Inability to relax grip or release a handshake, mental retardation, baldness, ovarian/testicular dystrophy:
myotonic dystrophy. Autosomal dominant
Both Duchenne and Becker muscular dystrophy show what kind of inheritance?
XLR
What glycogen storage disease (autosomal recessive) can cause muscular weakness that may resemble muscular dystrophy?
McArdle disease (deficiency in glycogen phosphorylase)
What is the MOA of memantine?
acts on the glutamatergic system by blocking NMDA receptors
What are acetylcholinesterase inhibitors used to treat dementia?
donepezil, rivastigmine, galantamine, tacrine
What is ropinirole/pramiprexole?
dopamine agonists used to treat PD
RMSF spreads from head to palms/soles or from palms/soles to center of body?
spreads centripedally from palms/soles to center of body. THrombocytopenia, increased LFTs
What is the BP threshold for those eligible for thrombolysis?
185/110
T/F: Triptans are contraindicated in patients with stroke and uncontrolled hypertension.
True
After exposure to varicella, patients only need the vaccine (and not the IG) if…
they are older than 1 and immunocompetent (and asymptomatic)
The most serious side effect of hydroxychloroquine is
retinopathy
Antibiotic tx needed in salmonella diarrhea when
severe disease or immunocompromised patients
Which diarrheal pathogens cause bloody diarrhea?
e coli, shigella (travel), campylobacter (raw/under cooked meats)
Persistent ST-segment elevation after a recent MI and deep Q waves in the same leads might suggest
ventricular aneursym
Indications for oxygen therapy in COPD:
PaO2 55%, evidence of cor pulmonale
Which blood test should you order for necrotizing vasclitis with GRANULOMAs in the lung and necrotizing glomeruloneprhitis?
c-ANCA for Wegners. Treat with cyclophosphamide and steroids.
**no granulomas with the same clinical picture would be p-Anca for microscopic polyangiitis. But if there are granulomas AND eosinophilia, consider Churg-Strauss, esp if also peripheral neuropathy = that is pANCA, too
A stroke in the putamen or the cerebellum will have eyes FACING the lesion?
cerebellum! FEF usually pushes eyes to opposite side.
putamen stroke will have eyes facing opposite since PPRF pulls eyes
Diffuse proliferative glomerulonephritis is due to
SLE or membranoproliferative glomerulonephritis
Which testicular tumor results in an increase in AFP?
Yolk sac (note that all of the germ cell, except seminoma which is the most common, produce increased hCG)
What is the pregnancy quad screen for Downs?
What is it for Edwards syndrome?
Increased Bhcg and inhibin. Decreased estriol and AFP
Edwards: normal Inhibin. Decreased everything else
Rockerbottom feet, polydactyly w/ flexed fingers, congenital heart disease, holoprosencephaly
Patau’s (chromosome 13)
Index finger overlapping third and fourth fingers, prominent occiput, rocker bottom feet, congenital heart problems, micrognathia
Edwards (chromosome 18)
GI sx, splinter hemorrhages, conjunctival hemorrhages, PERIORBITAL EDEMA, MYOSITIS, EOSINOPHILIA:
trichinellosis
How can you distinguish between Tay-Sachs and Niemann Pick? Which enzyme is deficient in each?
Niemann Pick = sphingomyelinase. Cherry red spot AND HEPATOSPLENOMEGALY
Tay-Sachs = hexosaminidase. No hsm.
Both interventricular wall rupture and papillary muscle rupture occur 3-5 days after infarction and cause new holosystolic murmurs. How do you tell them apart?
Interventricular wall rupture: murmur best heard at LLSB
Papillary muscle rupture: murmur best heard at apex
A buccal smear in Turner Syndrome will show (absent/numerous) Barr bodies.
ABSENT
Describe the clinical findings of tuberous sclerosis:
AD, hypopigmented skin macules (“ash leaf spots”), seizures, CNS hamartomas (tubers) and increased risk of cardiac rhabdomyomas and renal tumors=angiomyolipomas, adenoma sebaceum, thick leathery skin at nape of neck/back (“shagreens patches”)
