LAST SEM CONCEPTS Flashcards
(131 cards)
1
Q
What NT is responsible for the negative effects of Benzos?
A
GABA
2
Q
What is the first line pharmacotherapy for anxiety disorders?
A
SSRIs– fluoxetine, paroxetine, ec___, sertraline
3
Q
What melatonin agonist can be used safely in the elderly?
A
Ramelteon (for elderly & jetlag)
4
Q
What is the MOA and TU of Mirtazapine?
A
a2 blocker –> increase 5HT & NE… adjunct anti-depressant. Decr sexual AE and blocks nausea
5
Q
Pt is taking MAO-I, but it’s not working. Switch him to a transdermal MAOI. What is the benefit?
A
Selegiline– doesn’t cause HTN crisis with tyramines (bypasses GI)
6
Q
Anxious and depressed. How do you tx?
A
SSRI. If already on SSRI, give SNRI
7
Q
Partial generalized seizures. What first gen, narroow spec drug?
A
Phenytoin. AE = gingival hyperplasia,, hirsutism
8
Q
Pt is on Valproate. What second gen drug would you add to increase efficacy?
A
Lamotrigine– increased half-life because valproate will inhibit CYP450
9
Q
What are the effects of Carbamazapine on P450s and what clinical effects will this have?
A
Induces P450s, therefore induces its own metabolism.
10
Q
Patient has tics…. What is the MOA of the drug that you prescribe?
A
Guanfacine— a2 agonist
11
Q
Vascular headache with gradual onset, photophobia. History of HTN and family hx of vascular problems. What kind of headache?
A
Migraine
12
Q
Regular episodic severe unilateral headache in male. Eye-watering. Short in length.
A
Cluster headaches
13
Q
Limbic signs, deja vu. Where is the seizure?
A
Medial temporal lobe
14
Q
Transient loss of vision.
A
Retinal artery occlusion due to microthrombi in the common carotid.
15
Q
Pic of woman with 2 lights shining into eyes from side. Shadow indicates?
A
Shallow anterior chamber– acute angle closure glaucoma
16
Q
Crescent shaped hematoma. Pre-existing cortical atrophy.
A
Subdural hematoma
17
Q
Glasgow Coma scale. Midpoint pupils. what level?
A
Midbrain.
18
Q
What is an optional test used to determine brain death?
A
Cerebral Angiography
19
Q
Weakness Face & Arm > Leg
A
MCA
20
Q
Timeline of nervous tissue reaction to injury
A
2 days only - red neuron.
2-3 days- PMNs
3-10 days- foamy macrophages & gemistocytes
11-4w- liquefaction, fibrillary astrocytes
21
Q
Infection of brain with ring-like lesions. Patient dies after seeming like she was recovering.
A
Abscess– rupture into ventricles. (s.pneumo)
22
Q
HIstology of Alzheimers
A
Neurofibrillary triangles (PHFs, Tau), Senile Neuritic Plaques w/amyloid core
23
Q
Person hits head. Seems fine, but dies.
A
Epidural hematoma–lucid phase
24
Q
45 year old man running on treadmill. Gets headache. Rests against wall. Passes out 3 mins later and dies.
A
Berry aneurysm. (marfan, polycystic kidney, HTN)
25
Pallisading tumor.
Glioblastoma (large darker pink cirlcle-ish)
26
Homer Wright Rosettes
Medulloblastoma (purple rosette with pinkish stuff inside)
27
Proliferative retinopathy
VEGF
28
Fixed, mid-sized pupil. increased SNS. asian.
Acute angle closure glaucoma
29
Person any age over 10y and still walking, family history of dystrophy. Pseudoatrophy of calves.
Beckers
30
S/S Major Depressive Disorder
SIGECAPS
31
Bipolar I vs II
I- manic; II - major dep + hypomania
32
Straight A med student sleeps 4h a day
Hypomania
33
Paranoid that in-law or friend is poisoning him
paranoid schizophrenia
34
Sinusitis --> abscess- causitive agent
s.pneumo
35
Dx ketosis in hypoglycemic infant
urine strip for ketonuria, ketone breath
36
Prostprandial physiologic changes in glucose metabolism.
decrease GH, increased glycogenolysis, decreased guconeogenesis
37
During thyroid surgery, mess up ligation of nerves @ right inferior thyroid artery. Woman wakes up with hoarse voice. What did you hit?
Right recurrent larygeal
38
Overuse of somatotroph cells- what will you see (in terms of glucose levels?)
Hyperglycemia (somatotroph increases GH which increases glucose)
39
Diabetic Ketoacidosis. Treatment?
Saline. Check potassium first. If normo- or hyperkalemic, give insulin.
40
What is the mechanism of Atomoxetine?
Non-stimulant treatment of ADD-- Norepi reuptake inhibitor
41
Treatment of Huntington's Chorea?
Tetrabenazine- controls chorea by inhibiting VMAT --> dec. DA.
A/E include depression & prolonged QT
42
What is an adverse effect of Sumatriptan
Coronary Vasospasm-- angina
43
How would you treat ALCOHOL WITHDRAWAL SX in the ELDERLY & those with LIVER DAMAGE?
INTERMEDIATE-acting benzo (elderly)-- oxazepam, lorazepam, t----pam.
44
What MAO-I works in Parkinson's and how?
Selegilin- transdermal patch. Low doses selectively inhibit MAO-B, thereby increasing levels of DA
45
What si the role of Carbidopa in combination with L-DOPA?
Blocks AADC in the periphery, preventing the metabolism of L-DOPA in the periphery, allowing more to reach the CNS
46
What is the MOA of Donepazil?
Cholinesterase inhibitor (2nd gen)
47
What is the MOA and TU of Memantine?
NMDA receptor antagonist. For moderate-severe Alz
48
What is an abnormal movment side-effect that occurs with chronic L-DOPA and carbidopa?
Dyskinesias--- treat by reducing dose and adding AMANTADINE
49
Schizophrenic. Has been taking a first generation drug for 30 years and has odd movements such as tongue flicking and jerking. Why? What is the drug?
TARDIVE DYSKINESIA!! From Haloperidol or Chlorapromazine
50
Anti-psychotic. D2 and 5-HT1a partial agonist. No weight gain.
Aripiprazole. No muscarinic, 5HT2C or His antag--> lowest weight gain. Approved for teens. Also approved to treat irritability in autism.
51
What is the most significant modifiable risk factor for stroke?
HTN
52
Girl's father has a stroke in front of her. Before she calls the ambulance, what should she give him?
Baby aspirin.
53
What are the CNS vascular complications of poorly controlled HTN?
Lacunar strokes --> internal capsule L = A = F
54
S/S of acute confusional state
aka ICU/Toxic Psychosis aka Encephalopathy aka Delirium. NO CLEAR SENSORIUM.
55
Patient comes in dehydrated and extremely confused. Tx?
Treat the underlying problem (rehydrate) and WAIT.
56
65 year old man has 1 year onset of serious erratic behavior. What kind?
Pick's. Same as frontotemporal except RAPID PROGRESSION (<2y)
57
Pt has cogwheeling and shuffling gait. dx?
Parkinson's
58
Man comes in with serious behavior issues and jerky movements. dx?
Huntington's
59
Woman has problems blow-drying her hair and has ptosis. dx?
Myasthenia Gravis
60
What is the pathogenesis of myasthenia gravis?
Autoantibodies against the ACh receptor
61
What would you see clinically and in an MRI of Multiple Sclerosis?
MRI/gross: Focal demyelinated regions
S/S: UNILATERAL probs.
Dx: IgG oligoclonal bands @ spinal tap
62
Nervous tissue damage. What would you see after 4 days?
>12h-1day: Red neurons
Day 2: PMNs
Day 3-10: Macrophages, reactive astrocytes
Day 11-Week4: Macrophages, gemcistocytic & fibrillary astrocytes
63
Arnold-Chiary II S/S
```
Downward displacement of cerebellar vermis, tonsils, & medulla
Caused by shallow post. fossa
Causes Syringohydromyelia
Obstructive Hydrocephalus
Meningomyelocele
Brainstem beaking
```
64
CNS infections in immunocompromised pts?
LISTERIA, or s. pneumoniae. Higher risk of sepsis.
65
Alcohol is ruining this guy's life. HE'S TRIED QUITTING, but failed. What is this?
DEPENDENCE.
66
Tremors and hallucinations WITHIN 3 days of hospitalization.
DELERIUM TREMENS-- coarse tremors of hands, tongue, N/V, hTN, disorientation.
Tx with Lorazepam or chlordiazepoxide with thiamine. DON'T GIVE ANTI-PSYCH OR DEXTROSE.
NOTE: alcohol hallucinosis w/in 2 days, withdrawal seizure w/in 3 days.
67
What are the symptoms of PTSD?
Exposure to a traumatic experience. RE-EXPERIENCE. Avoidance of associated situations/Numbness. Increased arousal (cortisol- vigilance, startle, irritability).
>1mo
68
Child has von Gierke. Mom wants to give juice to child, but wanted to ask first.
Intake of carbohydrates which must be converted to G6P to be utilized (e.g., galactose and fructose) should be minimized.
69
Woman gave birth. Now has amenorrhea and inability to lactate. You find that TSH is low. What else should be low?
Prolactin. (Sheehan synd)
70
Blood supply of adrenal gland.
aorta --> inf. phrenic --> sup. suprarenal aa.
aorta --> middle suprarenal aa
aorta --> renal aa --> inf. suprarenal aa.
R suprarenal v -> IVC
L suprarenal v -> L renal v. -> IVC
71
Structure involved in hormone synthesis
Primary capillary plexus??
Hormones synth in pituitary, stored in unmyel. axons in HERRING BODIES containing secretory granules. Release into PCP @ median eminence
72
What are Kussmaul respirations?
rapid, deep respirations characteristic of DKA, due to respiratory compensation for metabolic acidosis
73
Patient on anti-psychotic. Must be have blood tests weekly. What drug & why?
CLOZAPINE is the most efficacious but causes AGRANULOCYTOSIS.
74
Woman with schizophrenia has gained a lot of weight after starting treatment and wants to switch to a drug that won't cause this AE.
Aripiprazole.
75
What is the TU and AE of Lithium?
Bipolar disorder, esp with MANIA. Very narrow TI. Cannot be taken with NSAIDs (incr. Li+ levels), Diuretics (incr. Li+ levels), or ACE Inhibitors (Na+ depletion)
76
Patient wants to quit smoking. You give them Nicotinic partial agonist.
Varenicline.
77
What Z-Drug can be given on demand, in the middle of the night. Why?
Zaleplon-- short half life
78
Opioid abuser-- you give them partial agonist with low abuse liability.
Buprenorphine. [partial ag @ mu, full @ K & d)
79
What dopamine agonist is used as a rescue for freezing in late-stage Parkinson's?
Apomorphine.
80
Patient is diagnosed with Parkinson's at age 67. tx?
Since he is >65, give L-DOPA +/- DA agonist. If he was <65, give DA agonist
81
Patient has respiratory failure, pinpoint pupils, hTN. Dx & Tx
Opioid overdose. Give IV NALOXONE (for emergency use).
| Naltrexone & Buprenorphine are used for quitting
82
Patient is tense and irritable, high energy, low-appetite, agitated, mydriasis, cardiac arrythmias, whatever. Dx?
Cocaine overdose. (w/drawal would have depression, fatigue, inc appetite).
83
Woman in 30s with blurred vision, difficulty walking (weakness & incoordination), parasthesias, fatigue, malaise, depression.
Multiple Sclerosis
84
Patient is on corticosteroids. Get an infection. What do you do to prevent Acute Adrenal Crisis?
Decrease dose.
85
S/S Conn syndrome
```
Primary hyperaldosteronism:
+ Chvotsek's sign
+ Trusseau sign
HTN
Glycosuria
Edema
DECREASED RENIN
```
86
S/S Hyperthyroidism in ELDERLY
APATHETIC HYPERTHYROIDISM: fatigue and weight loss mask symptoms of thyrotoxicosis
87
What are the features of CONGENITAL hypothyroidism?
Thyroid agenesis/hypoplasia; TSH-R mutation, Dyshormonogenesis (Pendred synd).
S/S: Normal at birth, neonatal jaundice for >1mo, umbilical hernia, hoarse cry, poor feeding, hypotonia
88
What are the features of Sheehan syndromE?
During pregnancy, pit doubles in size but doesn't get double blood supply, so sensitive to ischemia. Any complication with birth (hemorrhage) will cause necrosis of the pituitary.
S/S: Amenorrhea, problem with lactation, weight loss, decreased pigmentation, hypogonadism
89
What are the features of Acromegaly?
Prominent jaw, increased shoe size, secondary diabetes, arthritis.
*skeletal changes are permanent
Tx with Octreotide, Pegvisomant
90
Management of diabetes- good range for HbA1c?
Keep close to 6, no more than 9.
6.5-7.5 = "Intensive montioring"
8-9 = "less intensive monitoring"
91
What are the features of HONKS/HHS (Hyperosmolar hyperglycemic state)
confused, DRY mucus membranes, decreased skin turgor (dehydration), NO KETONES.
92
What is the main issue behind diabetic foot complications?
Suppresion of Immune response
- -PMNs and macrophage function is impaired
- -T lymphocyte function depressed
Blood supply impaired due to vasculopathy
93
Patient pale, HTN, raccoon eyes. What would show on Histo if good prognosis?
Pseudorosettes
Bad prognosis: >18mo, NSE, VMA-HVA low, N-myc
94
Hashimoto Thyroiditis: Histo, Dx
Anti-thyroperoxidase antibodies --> hyperthyroidism.
| Sheets of lymphocytes
95
Histo of Medullary Carcinoma
Amyloid due to agg of pro-calcitonin B-pleated sheets.
FYI: 5HT inc -> panic, flushing
RET mutation
96
Tumor with machine-like fluid inside. Where did it originate?
Rathke's pouch remnant. (oral ectoderm)
97
Clinicopathology of SIADH?
SMALL cell carcinoma
98
Baby is born without PTH glands. What else would be missing?
Thymus (DiGeorge)
99
Etiopathogenesis of Diabetic Retinopathy
non-enzyme glycosylation of collagen
100
Pt with neurologic damage, but tests show nothing (no known cause)
Conversion disorder
101
Schizoid Personality Disorder
Doesn't care. indifferent to criticism & praise. Doesn't want friends.
102
D.nozzzzle comes in late to appt, demands to be seen immediately. Finally gets to see doctor, says employees are incompetent and he should fire them. "I hope you're a good doctor since you're going to be treating me".
Narcissistic Personality.
103
Woman with sprained ankle. "how bad does it hurt?" "It's not that bad. If you have other patients to see, you can see them instead".
Willingness to volunteer for unpleasant tasks to gain approval-- Dependent PErsonality.
104
What are the stages of Readiness for Change?
Precontemplation-- don't currr-- educate them
Contemplation-- no plan -- ID barriers
Preparation-- plan -- realistic goals
Action --- positive reinforcement
Maintenance-- relapse prevention -- encouragement
105
How would you dx a virus that's causing encephalitis?
PCR
106
Immunocompromised. Pigeons.
Cryptococcal meningitis.
107
Precocious puberty in boy. Increased 17a, normal salt levels
11a (11-DOC is functioning--- makes mineralcorticoids)
108
Gastroduodenal a and Inferior pancreaticoduodenal a supply what part of the pancreas?
Head
109
Patient has cardiac arrhythmia. What opioid should you NOT give.
Meperidine (prolonged QT)
110
What opiod is a partial mu agonist and full K antagonist?
| Partial mu agonist and full K agonist?
Buprenorphine; Pentazocine
111
What MS drug binds S1P-Receptor?
Fingolimod (oral)
112
Higher MAC means what for a drug?
Higher MAC = lower potency.
113
NHomeless person inhales something on the streets to get a high. Comes in with serious analgesia. What drug?
Nitrous Oxide
114
Patient comes in with ischemic stroke. Temp is, say, 104. Tx?
Acetaminophen
115
Drugs for SAIDH?
Conivaptin. V2-R, cAMP
116
"My shoes are too smalllll!" Give PEgvisomant. MOA?
GH-R antagonist--- competitive antagonist--> decr. IGF-1, GH remains high.
117
Woman with hypothyroidism takes levothyroxine. becomes preg. what to do?
increase dose (pregnancy increases TBG)
118
How to manage cardiac symptoms during thyroid storm.
Beta blocker: esmolol. (use PTU also, in general)
119
Secondary obesity vs. primary
Secondary: Endocrine or pharm effects. Usually --> RAPID gain
120
What is age-related cochlear degeneration called?
Presbycusis
121
How to prevent osteoporosis in elderly?
Calcium, vit D
122
Interviewing styles acronym
```
OARS
Open-ended Qs
Affirmations
Reflective statements
Summarizing
```
123
Boy goes swimming. Eyes start watering like crazy. blah blah pink eye. Causative agent?
Adenovirus
124
Baby is born with meningitis. What is the most likely cause?
Strep agalactiae (B)
125
Muscle glucose uptake during exercise
Insulin-independent.
| Contraction incr Ca2+, incr GLUT4, Glucose moves in
126
What is the role of glucocorticoid therapy in the treatment of CAH?
negative feedback on pituitary
127
What drug binds PO4 to control Ca-P homeostasis in chronic renal disease?
Sevelamer. A/e: G/I probs
128
Short-acting insuiin. When is it useful and what makes it effective?
Insulin lispro, aspart, glulisine
Short t1/2
Rapid absorption. 5-15min before meal.
129
Patient knows how to recognize when he is hypoglycemic based on sx. What drug might a person be on that would mask these sx?
Esmolol (b-blockers blunt hypoglycemic sx)
130
Girl is 18 and has arthritis, so she takes chronic glucocorticoids. Gets and infection-- taking antibiotics. What should you do?
Lower dose of glucocorticoids, but DONT remove completely.
131
Tx of hypercalcemia of malignancy
```
First rehydrate with saline to restore renal fx.
Give Bisphosphonates (Zoledronic acid, Pamidronate) - ih GTPases imp in signaling cascades/osteoclast fx.
```
Give glucocorticoids to pt with myeloma, lymphoma, sarcoidosis.
