randoms part 4 Flashcards
where does copper deposit in wilsons disease?
liver (also has mallory hyaline)
basal ganglia
cornea
pure motor hemiparesis stroke?
lacunar infarction - posterior limb
pure sensory stroke?
thalamus - VPL
ataxic hemiparesis stroke?
-lower extremities
lacurnar - anterior limb of internal capsule
dysarthia, clumsy hand syndrome stroke
lacurnar stroke - basis pontis
what are trihexyphenidyl and benzotropine?
anticholinergics used for parkinsons
anticholinergic quote
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.
cavernous sinus thrombosis
- bilateral periorbital edema, headache
- CN III, IV,V-1 V-2, VI
pronator drift signifies
UMN lesion
what is selegiline?
MAOB inhibitor
side effects are insomnia and confusion
what is entacopone tolcapone?
COMT inhibitor
Name some DA agonists?
bromocriptine, pramipexole, ropinirole, apomorphine
what is the bradykinesia of parkinsons
difficulty initiating movement, soft speech, festinating gait, small hand writing, decreased facial expression
what is cushing reflex?
HTN, bradycardia, decreased RR
BPPV
- 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
menieres
recurrent episodes of vertigo, preceeded by ear fullness and pain, unilateral hearing loss and tinnutus (rining)
ACA vs MCA stroke
ACA - leg more than arm weakness
MCA - arm, face, aphasia of dominant hemisphere
you had a stroke, now what med gets added
statin
carotid stenosis
70% endarterectomy
100% why bother
migraine ppx
propanolol or valproic acid
cluster ppx
verapamil, prednisone, valproate, ergotamine
aboritive therapy for a migraine?
triptan or ergotamine
tuberous sclerosis
sz, progressive psychomotor retatrdation, slowly progressive mental deterioration.
- adenoma sebaceum, shagreen pathces, ash leaf (hypopigmented spots)
- retinal lesions
- cardiac rhabdomyomas
neurofibromatosis
- neurofibromas
- 8th cranial nerve tumors
- cafe au lait
- meningioma and glioma
sturge-weber syndrome
port-wine stain
sz
homonymous hemianopsia, hemiparesis, mental subnormality.
treat essential tremor with
propanolol
how to treat restless leg syndrome
DA agonists - pramipexole
pericarditis EKG
PR segment depression
ST segment elevation in all leads
DHEA vs DHEAS
DHEA - ovaries and adrenals
DHEAS - adrenals only
FSH works on what cell
granulosa cell to promote aromatase to make estrogen
LH works on what cell
thecal cell to promote desmolase to convert cholesterol to androstenedione
verapamil side effect
constipation
hydralazine side effect
orthostatic hypotension
drug induced lupus
hydrochlorathiazide and glucose tolerance
deccreased glucose tolerance, increases TG and LDL
aortic stenosis can disrupt VWF multimers
this can cause AVM to bleed more, so angiodysplasia especially in the GI tract. painless bleeding, anemia
how to reduced HTN in order
- weight loss
- DASH diet
- exercise
- sodium
- alcohol
consolidate areas act as a?
physiologic shunt as v/q ratio is 0.
ventilation ~ 0
perfusion remains intact
deadspace
volume of inhaled air not available for gas exchange
- wasted ventilation
- examples are a PE –> no perfusion, but ventilation is working, so waste
squamous cell a non-small cell lung cancer
PTHrP
small cell cancer
ACTH, ADH
what drugs lower mortality for a patient with chronic angina?
aspirin, beta blockers and nitroglycerin
do not give calcium channel blocker in CAD
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
beta blockers when not to use
severe asthma cant tolerate, causes bronchoconstriction
treatment of stable angina
aspirin, beta blockers and nitrates
treatment of unstable angina/non-st elevation MI
heparin, GPIIb/IIIa - to prevent a thrombus from forming
as well as
aspirin, beta blockers and nitrates
treatment of st elevation MI
PCI!! thrombolytics if you cant PCI
aspirin, beta blockers and nitrates, you can do heparin too, but after thrombolytics
contraindications to thrombolytics?
major bleeding, recent surgery
cannon A waves
third degree heart block
-atrial systole against a closed TV because the atrium and ventricles are completely out of sink
right ventricule infarction
st elevation in RV4, tachy because the RCA supplies the AV node
cause of systolic dysfunction
HTN –> heart dilates –> systolic dysfunction and low ejection fraction—> regurgitation
low CO in CHF will do what?
decreases perfusion pressure turning on the RAAS –> hy[onatremia, also increase sympathetic tone so SVR tries to clamp down
S4`
stiffened ventricle
S3
ventricle with turbulent blood flow while filling
what drugs to use for systolic dysfunction CHF?
ACE, ARB betablockers spirinolactone diuretics digoxin (controls symptoms but does not lower mortality)
mortality benefit in systolic dysfunction? what drugs what to do?
ACEI/ARBs, beta blockers, spirinolactone, eplerenone, hydralazine, nitrates, implantable defibrillator
drugs that benefit diastolic dysfuction CHF
beta blockers and diuretics
MS presentation
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
AS presentation
- 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
handgrip
handgrop increases afterload and delays emptying of the ventricle. the ventricle is more full and dilated
amyl nitratre
emptier ventricle, increases forward flow of blood
MR presentation
- 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
AR presentation
- 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
MVP
- 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
restrictive cardiomyopathy examples
sarcoid
amyloid
hemochromatosis (reversible)
scleroderma
pt non compliant on anticoagulation, has hx of DVT, young? try?
rivaroxiban! direct factor 10a inhibitor
selective IgA deficiency is common in?
celiac
-so they may test negative for antibodies
patient with migraines
you can give an antiemetic as well such as prochlorpezine or metoclopramide
