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MS3 > Step studying 1 > Flashcards

Step studying 1 Flashcards

1
Q

What is the cause of Meniere disease

A

Increased pressure and volume of endolymph

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2
Q

Triad presentation or Meniere

A
  • Episodic vertigo, commonly associated with light-headedness, nausea, and vomiting
  • Tinnitus, often accompanied by a feeling of fullness
  • Sensorineural hearing loss
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3
Q

Pharmacologic treatment of cancer-related anorexia/cachexia

A

Progesterone analogs

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4
Q

Describe Light’s criteria for pleural effusions

A

♣ 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
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5
Q

What part of the spine is often affected in rheumatoid arthritis

A

Cervical spine

vs. seronegative spondyloarthropathies which affect the sacroiliac joints

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6
Q

What disorder presents initially with loss of peripheral vision

A

Glaucoma

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7
Q

Describe presentation of macular degeneration

A

Affects central vision

vs. glaucoma which affects peripheral vision

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8
Q

Primary intervention to slow the progression of diabetic nephropathy

A

Aggressive BP control (ACEi and ARBs are recommended)

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9
Q

What lab values can you use to determine if AKI is pre-renal

A

BUN/Cr > 20

- BUN is reabsorbed, creatinine is not

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10
Q

What is Wilson disease

A

♣ 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

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11
Q

Presentation of Wilson disease

A

♣ Hepatic (acute liver failure, chronic hepatitis, cirrhosis)
♣ Neurologic (parkinsonism, gait disturbance, dysarthria)
♣ Renal disease (Fanconi syndrome)
♣ Psychiatric (depression, personality changes, psychosis)
♣ Kayser-Fleischer rings

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12
Q

What medication is used post-MI to prevent myocardial remodelling

A

ACEi

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13
Q

What is the cause of neuropathy with the use of Isoniazid

A

• 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)

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14
Q

Diagnose: blood pressure discrepancy between R and L arm with supraclavicular bruit in 20 y/o Asian woman

A

Takayasu arteritis

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15
Q

Describe presentation of Takayasu

A

• 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

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16
Q

Tx of Takayasu

A

Steroids

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17
Q

What part of the body will be affected in a stroke of anterior cerebral artery

A

Foot and leg (think of homunculus)

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18
Q

What part of the body will be affected in a stroke of middle cerebral artery

A

Face, arms, and speech

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19
Q

What part of the body will be affected in a stroke of posterior cerebral artery

A

Visual cortex

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20
Q

What is the window time limit in which tPA can be given after a stroke

A

<3 hours

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21
Q

What BP is allowed after a stroke

A

Permissive hypertension (220/120)

22
Q

What tests must be done in a person after a stroke

A
  • Immediately = Non-con CT to determine if hemorrhagic or not
  • Later work-up = ECG, Echo, carotid US
23
Q

Tx of status epilepticus

A
  • Benzos (first line)
  • Phenytoin
  • Phenobarb
24
Q

Describe pathogenesis behind parkinsons

A

♣ 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

25
Q

Symptoms of parkinsons

A 
♣	TRAPS + mask-like facies
•	Tremor (resting)
•	Rigidity (cogwheel)
•	Akinesia (or bradykinesia)
•	Postural instability
•	Staggering gait
26
Q

Describe go-to meds and MOA for tx of Parkinsons

A

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
27
Q

Describe MOA of COMT inhibitors in tx of Parkinsons

A

Drugs: Entacapone, Tolcapone

Prevent conversion of L-dopa into inactive metabolite. Must be given with L-dopa

28
Q

MOA of Selegiline in tx of Parkinsons

A

MAO-B inhibitor

Prevents metabolization of Dopamine

29
Q

MOA of Ropinirole

A

D2 receptor agonist

30
Q

MOA of Pramipexole

A

D3 receptor agonist

31
Q

Tx of essential tremor

A
  • Beta-blockers (Propranolol)
  • Primidone (barbiturate/anticonvulsant)
  • Self-medicated with alcohol
  • Benzodiasepines (clonazepam)
32
Q

Describe presentation of tension HA

A
  • 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
33
Q

Tx of tension HA

A

NSAIDs, Acetaminophen

34
Q

Tx of cluster HA

A

100% O2, Triptans

35
Q

Tx of pseudotumor cerebri (aka idiopathic intracranial HTN)

A
  • Acetazolamide
  • Serial LP
  • Intracranial shunt
36
Q

Describe presentation of frontotemporal dementia

A

Picks disease

Early = behavior/personality changes
Late = dementia
37
Q

Diagnose: dementia with visual hallucinations

A

Lewy body dementia

38
Q

Compare Lewy body dementia and Parkinsons

A

Lewy body = early onset dementia with Parkinson sx

Parkinson = Parkinson sx with late onset dementia

39
Q

Diagnose: young onset dementia with myoclonus

A

Creutzfeld Jakob Disease (CJD)

40
Q

Presentation of normal pressure hydrocephalus

A

Wet, wacky, wobbly

41
Q

Diagnosis of NPH

A

♣ CT scan shows hydrocephalus

♣ LP causes improvement of symptoms

42
Q

Tx of NPH

A

LP shunt

43
Q

Describe BPPV

  • Length of symptoms
  • Associated ear sx
A

o Brief episodes brought on by head movement
o Episodes usually last for less than 1 minute
o No auditory symptoms

44
Q

Tx of BPPV

A

Epley maneuver

45
Q

Describe vestibular neuritis

  • Length of sx
  • Associated sx
A

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

46
Q

Tx of vestibular neuritis

A

o Usually self-resolves
o Symptomatic (Meclizine)
o Steroids can decrease duration of symptoms

47
Q

Describe Meniere disease pathogenesis

A

• Increased pressure and volume of endolymph

48
Q

Describe presentation of Meniere

  • Length of sx
  • Associated sx
A

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

49
Q

Tx of Meniere

A

o Salt restriction
o Thiazide diuretics
o Symptomatic treatment (Meclizine)

50
Q

Describe presentation of multiple sclerosis

A

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

51
Q

How do you diagnose MS

A

♣ MRI = gold standard
• Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)

♣ Lumbar puncture
• Increased protein
• Oligoclonal IgG bands

52
Q

Tx of MS

A

♣ Steroids for acute flares

♣ Interferon beta slows progression

MS3 (88 decks)

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