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step 2 disease treatment > randoms part 4 > Flashcards

randoms part 4 Flashcards

1
Q

where does copper deposit in wilsons disease?

A

liver (also has mallory hyaline)
basal ganglia
cornea

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2
Q

pure motor hemiparesis stroke?

A

lacunar infarction - posterior limb

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3
Q

pure sensory stroke?

A

thalamus - VPL

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4
Q

ataxic hemiparesis stroke?

-lower extremities

A

lacurnar - anterior limb of internal capsule

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5
Q

dysarthia, clumsy hand syndrome stroke

A

lacurnar stroke - basis pontis

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6
Q

what are trihexyphenidyl and benzotropine?

A

anticholinergics used for parkinsons

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7
Q

anticholinergic quote

A

red as a beet, dry as a bone, hot as a hare, blind as a bat, mad as a hatter, full as a flask

-dry, urinary retension, constipation etc.

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8
Q

cavernous sinus thrombosis

A
  • bilateral periorbital edema, headache

- CN III, IV,V-1 V-2, VI

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9
Q

pronator drift signifies

A

UMN lesion

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10
Q

what is selegiline?

A

MAOB inhibitor

side effects are insomnia and confusion

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11
Q

what is entacopone tolcapone?

A

COMT inhibitor

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12
Q

Name some DA agonists?

A

bromocriptine, pramipexole, ropinirole, apomorphine

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13
Q

what is the bradykinesia of parkinsons

A

difficulty initiating movement, soft speech, festinating gait, small hand writing, decreased facial expression

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14
Q

what is cushing reflex?

A

HTN, bradycardia, decreased RR

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15
Q

BPPV

A
  • crystalline deposits in the semicircular canals that disrupt the normal flow of fluid in the vestibular system
  • recurrent brief episodes brought on by predictable head movements or position change.
  • dix-hall-pike maneuver will cause nystagmus
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16
Q

menieres

A

recurrent episodes of vertigo, preceeded by ear fullness and pain, unilateral hearing loss and tinnutus (rining)

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17
Q

ACA vs MCA stroke

A

ACA - leg more than arm weakness

MCA - arm, face, aphasia of dominant hemisphere

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18
Q

you had a stroke, now what med gets added

A

statin

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19
Q

carotid stenosis

A

70% endarterectomy

100% why bother

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20
Q

migraine ppx

A

propanolol or valproic acid

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21
Q

cluster ppx

A

verapamil, prednisone, valproate, ergotamine

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22
Q

aboritive therapy for a migraine?

A

triptan or ergotamine

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23
Q

tuberous sclerosis

A

sz, progressive psychomotor retatrdation, slowly progressive mental deterioration.

  • adenoma sebaceum, shagreen pathces, ash leaf (hypopigmented spots)
  • retinal lesions
  • cardiac rhabdomyomas
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24
Q

neurofibromatosis

A
  • neurofibromas
  • 8th cranial nerve tumors
  • cafe au lait
  • meningioma and glioma
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25
Q

sturge-weber syndrome

A

port-wine stain
sz
homonymous hemianopsia, hemiparesis, mental subnormality.

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26
Q

treat essential tremor with

A

propanolol

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27
Q

how to treat restless leg syndrome

A

DA agonists - pramipexole

28
Q

pericarditis EKG

A

PR segment depression

ST segment elevation in all leads

29
Q

DHEA vs DHEAS

A

DHEA - ovaries and adrenals

DHEAS - adrenals only

30
Q

FSH works on what cell

A

granulosa cell to promote aromatase to make estrogen

31
Q

LH works on what cell

A

thecal cell to promote desmolase to convert cholesterol to androstenedione

32
Q

verapamil side effect

A

constipation

33
Q

hydralazine side effect

A

orthostatic hypotension

drug induced lupus

34
Q

hydrochlorathiazide and glucose tolerance

A

deccreased glucose tolerance, increases TG and LDL

35
Q

aortic stenosis can disrupt VWF multimers

A

this can cause AVM to bleed more, so angiodysplasia especially in the GI tract. painless bleeding, anemia

36
Q

how to reduced HTN in order

A
  • weight loss
  • DASH diet
  • exercise
  • sodium
  • alcohol
37
Q

consolidate areas act as a?

A

physiologic shunt as v/q ratio is 0.
ventilation ~ 0
perfusion remains intact

38
Q

deadspace

A

volume of inhaled air not available for gas exchange

  • wasted ventilation
  • examples are a PE –> no perfusion, but ventilation is working, so waste
39
Q

squamous cell a non-small cell lung cancer

A

PTHrP

40
Q

small cell cancer

A

ACTH, ADH

41
Q

what drugs lower mortality for a patient with chronic angina?

A

aspirin, beta blockers and nitroglycerin

42
Q

do not give calcium channel blocker in CAD

A

do not lower mortality, they risk reflex tach
- you could use verapamil or diltiazem as they dont affect , use for pts with severe asthma, or prinzmetal variant angine

43
Q

beta blockers when not to use

A

severe asthma cant tolerate, causes bronchoconstriction

44
Q

treatment of stable angina

A

aspirin, beta blockers and nitrates

45
Q

treatment of unstable angina/non-st elevation MI

A

heparin, GPIIb/IIIa - to prevent a thrombus from forming
as well as
aspirin, beta blockers and nitrates

46
Q

treatment of st elevation MI

A

PCI!! thrombolytics if you cant PCI

aspirin, beta blockers and nitrates, you can do heparin too, but after thrombolytics

47
Q

contraindications to thrombolytics?

A

major bleeding, recent surgery

48
Q

cannon A waves

A

third degree heart block

-atrial systole against a closed TV because the atrium and ventricles are completely out of sink

49
Q

right ventricule infarction

A

st elevation in RV4, tachy because the RCA supplies the AV node

50
Q

cause of systolic dysfunction

A

HTN –> heart dilates –> systolic dysfunction and low ejection fraction—> regurgitation

51
Q

low CO in CHF will do what?

A

decreases perfusion pressure turning on the RAAS –> hy[onatremia, also increase sympathetic tone so SVR tries to clamp down

52
Q

S4`

A

stiffened ventricle

53
Q

S3

A

ventricle with turbulent blood flow while filling

54
Q

what drugs to use for systolic dysfunction CHF?

A 
ACE, ARB
betablockers
spirinolactone
diuretics
digoxin (controls symptoms but does not lower mortality)
55
Q

mortality benefit in systolic dysfunction? what drugs what to do?

A

ACEI/ARBs, beta blockers, spirinolactone, eplerenone, hydralazine, nitrates, implantable defibrillator

56
Q

drugs that benefit diastolic dysfuction CHF

A

beta blockers and diuretics

57
Q

MS presentation

A

dysphagia and hoarsness from enlarged LA pressing on esophagus and laryngeal nerve
AF from dilated LA
hemoptysis
-diastole
-louder with increased preload (squating, leg raise)
-softer with standing, valsalva
-nitrates and handgrip have no effect

58
Q

AS presentation

A
  • congenital bicuspid valve or with age
  • systolic murmer
  • softer with standing or valsalva
  • louder with increased preload so squating or leg raise
  • hand grip increases afterload, decreases ejection of blood, so makes it softer
59
Q

handgrip

A

handgrop increases afterload and delays emptying of the ventricle. the ventricle is more full and dilated

60
Q

amyl nitratre

A

emptier ventricle, increases forward flow of blood

61
Q

MR presentation

A
  • dilation leads to MR
  • pansystolic murmur
  • hand grip will make it louder
  • amyl nitrate will make it softer
  • increasing preload with make it louder
  • decreasing preload will make it softer
62
Q

AR presentation

A
  • wide pulse presure
  • water hammer bounding pulses that you feel
  • pulsations in nail bed
  • head bobbing
  • diastolic decreasendo murmur
  • handgrip increases afterload make it louder/worse
  • valsalva and standing, decrease preload making it better
63
Q

MVP

A
  • usually aysmptomatic
  • assoc with ehrlos danlos, marfans
  • atypical chest pain, panic attacks, palpitations
  • dilate the ventricle less murmer, make ventricle smaller more murmer
  • handgrip will improve the mumur
  • standing or valsava will worse, since less preload
  • amyl nitrate will worsen
  • sqwuating or lef raise will improve
64
Q

restrictive cardiomyopathy examples

A

sarcoid
amyloid
hemochromatosis (reversible)
scleroderma

65
Q

pt non compliant on anticoagulation, has hx of DVT, young? try?

A

rivaroxiban! direct factor 10a inhibitor

66
Q

selective IgA deficiency is common in?

A

celiac

-so they may test negative for antibodies

67
Q

patient with migraines

A

you can give an antiemetic as well such as prochlorpezine or metoclopramide

step 2 disease treatment (12 decks)

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