Step studying 1 Flashcards
What is the cause of Meniere disease
Increased pressure and volume of endolymph
Triad presentation or Meniere
- Episodic vertigo, commonly associated with light-headedness, nausea, and vomiting
- Tinnitus, often accompanied by a feeling of fullness
- Sensorineural hearing loss
Pharmacologic treatment of cancer-related anorexia/cachexia
Progesterone analogs
Describe Light’s criteria for pleural effusions
♣ If at least one of the following 3 criteria is true, the fluid is an exudate:
- Pleural fluid protein/serum protein ratio > 0.5
- Pleural fluid LDH/serum LDH ratio > 0.6
- Pleural fluid LDH > 2/3 the upper limit of laboratory’s normal serum LDH
What part of the spine is often affected in rheumatoid arthritis
Cervical spine
vs. seronegative spondyloarthropathies which affect the sacroiliac joints
What disorder presents initially with loss of peripheral vision
Glaucoma
Describe presentation of macular degeneration
Affects central vision
vs. glaucoma which affects peripheral vision
Primary intervention to slow the progression of diabetic nephropathy
Aggressive BP control (ACEi and ARBs are recommended)
What lab values can you use to determine if AKI is pre-renal
BUN/Cr > 20
- BUN is reabsorbed, creatinine is not
What is Wilson disease
♣ Mutation in hepatocyte copper-transporting ATPase (ATP7B gene)
♣ Inadequate copper excretion into bile and blood
• Decreased serum ceruloplasmin (copper-binding protein)
• Increased urine copper
• Copper accumulation in: liver, brain, cornea, kidney, joints
Presentation of Wilson disease
♣ Hepatic (acute liver failure, chronic hepatitis, cirrhosis)
♣ Neurologic (parkinsonism, gait disturbance, dysarthria)
♣ Renal disease (Fanconi syndrome)
♣ Psychiatric (depression, personality changes, psychosis)
♣ Kayser-Fleischer rings
What medication is used post-MI to prevent myocardial remodelling
ACEi
What is the cause of neuropathy with the use of Isoniazid
• Neuropathy is caused by a Vit B6 (pyridoxine) deficiency because INH promotes the excretion of Vit B6
(THINK: pair of dice flipped to 6’s = Pyridoxine/B6)
Diagnose: blood pressure discrepancy between R and L arm with supraclavicular bruit in 20 y/o Asian woman
Takayasu arteritis
Describe presentation of Takayasu
• Affects branches of aortic arch
• Symptoms:
o Constitutional (e.g. fever, weight loss)
o Arterio-occlusive (e.g. claudication, ulcers) in upper extremities
o Arthalgias/myalgias
o Visual and neuro symptoms
Tx of Takayasu
Steroids
What part of the body will be affected in a stroke of anterior cerebral artery
Foot and leg (think of homunculus)
What part of the body will be affected in a stroke of middle cerebral artery
Face, arms, and speech
What part of the body will be affected in a stroke of posterior cerebral artery
Visual cortex
What is the window time limit in which tPA can be given after a stroke
<3 hours
What BP is allowed after a stroke
Permissive hypertension (220/120)
What tests must be done in a person after a stroke
- Immediately = Non-con CT to determine if hemorrhagic or not
- Later work-up = ECG, Echo, carotid US
Tx of status epilepticus
- Benzos (first line)
- Phenytoin
- Phenobarb
Describe pathogenesis behind parkinsons
♣ Due to loss of dopaminergic neurons in the substantia nigra
• Dopamine usually promotes movement via inhibition of gaba, which usually inhibits movement
• So in parkinsons, there is no dopamine = no inhibition of gaba = gaba inhibits movement patient is akinetic/bradykinetic
Symptoms of parkinsons
♣ TRAPS + mask-like facies • Tremor (resting) • Rigidity (cogwheel) • Akinesia (or bradykinesia) • Postural instability • Staggering gait
Describe go-to meds and MOA for tx of Parkinsons
Levadopa + Carbidopa
OR
Dopamine receptors agonists (Ropinirole, Pramipexole)
- Levadopa is precursor of dopamine
- Carbidopa prevents peripheral conversion of L-dopa to Dopa, so that more L-dopa will cross BBB before conversion
Describe MOA of COMT inhibitors in tx of Parkinsons
Drugs: Entacapone, Tolcapone
Prevent conversion of L-dopa into inactive metabolite. Must be given with L-dopa
MOA of Selegiline in tx of Parkinsons
MAO-B inhibitor
Prevents metabolization of Dopamine
MOA of Ropinirole
D2 receptor agonist
MOA of Pramipexole
D3 receptor agonist
Tx of essential tremor
- Beta-blockers (Propranolol)
- Primidone (barbiturate/anticonvulsant)
- Self-medicated with alcohol
- Benzodiasepines (clonazepam)
Describe presentation of tension HA
- Usually 4 – 6 hours
- Bilateral headache with constant, steady pain (non-throbbing)
- Usually in frontal or occipital lobe (band-like)
- No throbbing, no photophobia, no phonophobia, no aura
Tx of tension HA
NSAIDs, Acetaminophen
Tx of cluster HA
100% O2, Triptans
Tx of pseudotumor cerebri (aka idiopathic intracranial HTN)
- Acetazolamide
- Serial LP
- Intracranial shunt
Describe presentation of frontotemporal dementia
Picks disease
Early = behavior/personality changes Late = dementia
Diagnose: dementia with visual hallucinations
Lewy body dementia
Compare Lewy body dementia and Parkinsons
Lewy body = early onset dementia with Parkinson sx
Parkinson = Parkinson sx with late onset dementia
Diagnose: young onset dementia with myoclonus
Creutzfeld Jakob Disease (CJD)
Presentation of normal pressure hydrocephalus
Wet, wacky, wobbly
Diagnosis of NPH
♣ CT scan shows hydrocephalus
♣ LP causes improvement of symptoms
Tx of NPH
LP shunt
Describe BPPV
- Length of symptoms
- Associated ear sx
o Brief episodes brought on by head movement
o Episodes usually last for less than 1 minute
o No auditory symptoms
Tx of BPPV
Epley maneuver
Describe vestibular neuritis
- Length of sx
- Associated sx
o Sudden onset episode of vertigo that can last 1-10 min (longer than BPPV)
o Often follows viral syndrome
o Associated with nausea and vomiting
o May or may not have hearing loss
Tx of vestibular neuritis
o Usually self-resolves
o Symptomatic (Meclizine)
o Steroids can decrease duration of symptoms
Describe Meniere disease pathogenesis
• Increased pressure and volume of endolymph
Describe presentation of Meniere
- Length of sx
- Associated sx
o Episodic vertigo with nausea and vomiting
o Recurrent episodes lasting 20 min to several hours
o Ear fullness/pain
o Unilateral sensorineural hearing loss
o Tinnitus
Tx of Meniere
o Salt restriction
o Thiazide diuretics
o Symptomatic treatment (Meclizine)
Describe presentation of multiple sclerosis
o Most often affects women in 20s-30s
o Presentation:
♣ Any neuro symptoms separated by time that cannot be traced back to one single structure
♣ Charcot triad of symptoms SIN:
• Scanning speech
• Intention tremor, Incontinence, Internuclear ophthalmoplegia
• Nystagmus
♣ Optic neuritis – blurry vision with painful movement
♣ Hemiparesis, hemisensory symptoms
How do you diagnose MS
♣ MRI = gold standard
• Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)
♣ Lumbar puncture
• Increased protein
• Oligoclonal IgG bands
Tx of MS
♣ Steroids for acute flares
♣ Interferon beta slows progression
