Step studying 1 Flashcards by Giselle McIntyre

What is the cause of Meniere disease

Increased pressure and volume of endolymph

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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

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Pharmacologic treatment of cancer-related anorexia/cachexia

Progesterone analogs

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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

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What part of the spine is often affected in rheumatoid arthritis

Cervical spine

vs. seronegative spondyloarthropathies which affect the sacroiliac joints

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What disorder presents initially with loss of peripheral vision

Glaucoma

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Describe presentation of macular degeneration

Affects central vision

vs. glaucoma which affects peripheral vision

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Primary intervention to slow the progression of diabetic nephropathy

Aggressive BP control (ACEi and ARBs are recommended)

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

BUN/Cr > 20

- BUN is reabsorbed, creatinine is not

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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

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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

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What medication is used post-MI to prevent myocardial remodelling

ACEi

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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)

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

Takayasu arteritis

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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

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Tx of Takayasu

Steroids

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

Foot and leg (think of homunculus)

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

Face, arms, and speech

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

Visual cortex

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

<3 hours

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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