Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
225 Cards in this Set
- Front
- Back
Sx/Mnemonic for SLE
|
Discoid Lupus
Oral Ulcers Photosensitivity ANA Malar rash Immunologic Neuro changes ESR Renal Dz Arthritis Serositis Hematologic changes |
|
What sx differentiate drug-induced SLE from non-drug induced form?
|
renal and cns involvement
|
|
pulmonary findings in SLE
|
pleuritis
pneumonitis pleural effusion pHTN |
|
joint involvement in SLE
|
symmetric, small joint involvment
non-erosive / non-deforming |
|
Behcet's syndrome
|
arthralgias, fatigue, oral/genital ulcers (painful)
|
|
Felty's syndrome
|
cytopenia in setting of RF+ nodular RA
|
|
rx that can cause DI-SLE
|
HIPP
quinidine etanercept methyldopa |
|
skin manifestations in systemic sclerosis
|
thickening
pigmentation changes digital pitting ulceration telangiectasia |
|
Pathophysiology of digital pitting in systemic sclerosis
|
2/2 vascular injury --> raynaud's
vascular injury is 2/2 proliferation of the intimal layer |
|
course of skin thickening in systemic sclerosis
|
thickens for 2 yrs before atrophy occurs
|
|
tx of raynaud's
|
DCCBs (nifedipine, amlodipine)
dipyridamole nitrates |
|
3 gi manifestations of systemic sclerosis
|
dysmotility --> dysphagia
decreased pressure in LES --> GERD dysmotility --> pseudo-obx |
|
tx of gi dysmotility sx in systemic sclerosis
|
nitroglycerine/nitrates
pain control |
|
tx of ILD in systemic sclerosis
|
cyclophosphamide
|
|
tx of PAH in systemic sclerosis
|
coumadin
O2 bosentan epoprostenol, iloprostenol sildenafil |
|
if a pt is + anti-Scl70, what are they at increased risk for?
|
difffuse cutaneous systemic sclerosis
ILD |
|
what malignancy are systemic sclerosis pts with at an increased risk of?
|
lung ca
|
|
cardiac complications in systemic sclerosis
|
restrictive CMP
pericarditis arrhythmia 2/2 myocardial fibrosis |
|
renal complications in systemic sclerosis
|
hyperreninemic renal crisis that resembles malignant HTN
|
|
tx for renal crisis in systemic sclerosis?
why is this tx effective? |
ACEi - captopril is fast-acting and is the mainstay (keep using even if cr worsens, and continue even if pt is on HD 2/2 renal crisis)
effective b/c the crisis is caused by hyperreninism |
|
describe use of steroids in systemic sclerosis
|
NOT often used b/c process is NOT inflammatory
* steroids can INDUCE renal crisis in scleroderma * |
|
pathophys of takayasu's arteritis
|
granulomatous
|
|
exam findings in takayasu's arteritis
|
bruits
tenderness when palpating large arteries decreased pulses aortic insufficiency |
|
normal presentation of pt with takayasu's
|
constitutional sx
arterial insuff |
|
SCA increases risk of what type of arthritis?
|
gout
b/c high rbc turnover and renal dz --> hyperuricemia |
|
s/sx PMR
|
* PAIN *
morning stiffness in axial joints / prox muscles (limb girdle involvement) NO weakness NO joint swelling |
|
which lab is usually elevated in pts with PMR?
|
CK
|
|
which dz is associated with PMR
what are the incidences of each in each? |
40-50% pts with GCA have PMR
10-15% pts with PMR have GCA |
|
tx of PMR
|
steroids
|
|
when to tx for GCA if bx of temp art has NOT been done
|
if there are NO visual sx, then it is OK to start steroids AFTER bx is taken; do not have to wait for results
if there ARE visual sx, tx IMMEDIATELY, should not affect the bx results (up to 2 wks) |
|
which rheumatologic condition can be associated with subclavian steal?
|
takayasu's arteritis
|
|
potential GI complication in systemic sclerosis
tx? |
bacterial overgrowth -> malabsorption
abx - cover anaerobes, GNRs, B. frag. (CIPRO) |
|
SE of an elevated ESR in GCA?
|
75-90% (NOT all cases!)
|
|
malignancies associated with RA?
|
Large B-cell NHL
NHL (44x greater than general public) |
|
what is the imaging study of choice to dx RA
|
XR
(earlier joint damage can be seen on MRI) |
|
what is anti-CCP AB?
|
IgG rxn to altered synovial membrane peptides
indicates an increased SEVERITY in RA "Citrulline indicates Severity" |
|
what is the association btw RA and heart dz
|
premature atherosclerosis
(esp. in pts with poorly-controlled dz for > 6 wks) 100% increased risk of MI 70% increased risk of stroke |
|
DMARDs used in mild RA
|
hydroxychloroquine
sulfasalazine MTX +folate etanercept/infliximab/adalimumab |
|
what defines mild RA
|
5-10 joints involved + mild impairment
|
|
how to treat SEVERE RA
|
DMARDS (MTX is best) + anti-TNFa
|
|
s/sx of adult-onset Still's Dz
|
Arthritis, arthlagias and myalgias (100% of pts)
Daily high fevers Salmon-colored rash pharyngitis serositis splenomegaly elevated ferritin, LFTs, LDH |
|
tx of adult-onset Still's Dz
|
NSAIDs (usually work)
Steroids and DMARDs if Sx are life-long |
|
Dz course of adult-onset Still's dz
|
self-limited, chronic, or intermittent
Chronic dz - assoc with severe reactive arthritis |
|
Sx of Parvovirus B19 infx in an otherwse healthy adults
mimics what other adult disease? |
(mimics RA):
symmetric polyarthritis of wrist, MCP, PIP, and similar joints in feet rash possible (not common) |
|
course of adult Parvovirus B19 infection
|
sx resolve in 1-2 mos, helped w/ NSAIDS
if last > 3 mos, then dx of RA |
|
what should be prescribed to pts who are on steroids long-term
|
any pt who is on prednisone for >3 mos:
- Ca, vit D, and bisphosphonate - PPI - +/- TMP/SMX for PCP ppx _____? |
|
teriparatide
indications? contraind? |
severe osteoporosis tx; limit use <2 yrs
contraind: Paget's hypercalcemia, h/o bone malignancy or XRT |
|
upper limit of urate that will cause precipitate (gout)
|
6.7 mg/dl
|
|
side effects of colchicine
|
neuropathy
myopathy (esp in pts with liver or kidney dz) |
|
is colchicine used to treat or prevent gout
|
both!
|
|
allopurinol
SE? |
Steven-Johnson syndrome (if rash develops, STOP!)
|
|
what is livedo reticularis?
when do you see it? |
painless, net-like rash on extremities
seen in SLE |
|
Jaccoud's arthropathy
|
hand deformity that is similar to RA...
...BUT it is reversible and NON-erosive :) |
|
other than arthritis and arthropathy, what other joint or MSK complaints might a pt wth SLE have?
|
avascular necrosis (5-10%)
fibromyalgia |
|
Most common renal manifestations in SLE
|
Glomerulonephritis (--> casts, dysmorphic RBC in UA)
Interstitial nephritis Renal vein thrombosis |
|
Neuro/psych manifestations of SLE
|
Sz
encephalitis CVA Transverse myelitis Psychosis Aseptic meningitis Demyelinating dz HA and cognitive dysfxn |
|
what is shrinking lung syndrome?
findings on CXR? when do you see it? |
diaphragmatic dysfxn --> restrictive lung dz
CXR: lungs fields normal but elevated hemidiaphragm seen in SLE |
|
Libman-Sacks Endocarditis
complication? |
STERILE vegetations on valve margin (usually mitral or tricuspid)
Cx: can --> infx endocarditis |
|
Heme findings in SLE
|
mild cytopenias
Coomb's + AIHA (15%) |
|
complement levels during SLE flare
|
LOW C3 and C4
|
|
which lab test has + prognostic value for lupus nephritis
|
ds-DNA
|
|
Tx of SLE
|
NSAIDs
low-dose steroids hydroxychloroquine |
|
what are the benefits of hydroxychloroquine
|
steroid-sparing
lowers cholesterol anti-thrombotic |
|
SE of hydroxychloroquine
|
IRREVERSIBLE retinopathy (pts must have annual eye exams!)
|
|
when can MTX be used in SLE
|
if there is joint involvement
"Mobility problems? Give MTX!" |
|
What rx can be added to tx SEVERE SLE
|
high-dose (pulse) steroids
cyclophosphamide AZA mycophenolate |
|
how is neonatal lupus syndrome prevented
|
hydroxychloroquine during pregnancy
|
|
what are the major causes of death in SLE
|
CKD
CAD infx |
|
lab findings of TB infiltration in liver
|
isolated elevated AP
nl AST, ALT |
|
elevated AP + unexplained pruritis
|
primary biliary cirrhosis
|
|
pathophsy of pbc
prognosis/time course? |
autoimmune destruction of small- and medium-sized bile ducts --> fibrosis
ESLD within 5-10 yrs |
|
tx of pbc
|
ursodeoxycholic acid (slows progression)
transplant is definitive tx |
|
sx of pbc
|
jaundice, pruritis
steatorrhea HLD, xanthomas ADEK deficiencies |
|
what add'l labs to order if HBcAb is elevated
|
repeat test
If repeat is +, get anti-HBc IgM titer, LFTs |
|
how long can HBc IgM titers be elevated
|
up to 2 yrs after infx
|
|
when to treat Asx, subclinical hypothyroidism
|
if anti thyroid ab present (b/c will likely become overt)
abnl lipid profile AUB/anovulation TSH >10 (?) |
|
DKA: what is the timing to switch a pt to subQ insulin once blood sugar has normalized?
|
30-60 mintues BEFORE insulin drip is stopped.
otherwise, DKA can occur again! |
|
best way to manage DM during elective c/s?
|
nl dose of insulin the night before surgery
then start insulin gtt + D5/NS keep glucose < 160 |
|
when should incidental thyroid nodules have FNA?
|
if > 1cm, FNA
if < 1cm, follow with annual U/S |
|
which of these is the most common cx of hypothyroidism?
HLD HTN Myxedema Glossitis Angina |
HLD
|
|
Schmidt syndrome
|
polyglandular autoimmune failure type II
= addison's, type I DM, autoimmune thyroid dz |
|
clinical picture of MODY
|
modest hyperglycemia
no DKA +FHx |
|
what happens to blood sugar in delayed gastric emptying
|
post-prandial hypoglycemia
(b/c the peak insulin level does not correspond with the the food absorption) |
|
methimazole in pregnancy
cx? |
teratogenic (aplasia cutis)
|
|
cx of hyperthyroidism during pregnancy
|
thyroid storm
(if thyroid dz is not controlled. added stress of labor is a trigger) |
|
what triglyceride level warrants tx
|
>200
|
|
tegaserod
moa? uses? |
serotonin agonist
used to tx constipation in IBS |
|
clinical presentation of subacute lymphocytic thyroiditis
|
painless nodule/goiter, sx <2 mo
transient hyperthyroidism b/c T4 is released from inflamed gland if severe, tx: propranolol |
|
who gets subacute lymphocytic thyroiditis
|
pts on IFN, amiodarone, or IL-2
|
|
causes of subclinical thyrotoxicosis
|
#1 = Rx-induced (levothryoxine)
nodular thyroid dz Graves thyrotoxicosis |
|
how to manage Asx subclinical thyrotoxicosis
|
if pts are Asx: recheck TSH (b/c they have a high chance of normalization)
DON'T Tx unless Sx |
|
Conn's syndrome
lab findings? |
primary hyperaldo
aldo:renin ratio >30 (also, aldo must be >15) |
|
tx of graves dz
contraindication to this tx |
radioactive iodine ablation
CI: large retrosternal goiter --> inflammation from tx --> airway obstruction! |
|
mgmt of orbital myxedema / proptosis in graves dz
|
steroids (+ radioactive iodine)
to prevent ophthalmoplegia 2/2 CN III, IV, VI inflamm |
|
what rx inhibit T4 -----> T3 conversion?
|
propranolol (B-blockers)
PTU steroids amiodarone |
|
what dz is risk factor for thyroid lymphoma
|
hashimoto's thyroiditis
|
|
tx of thyroid lymphoma
|
XRT + chemo
|
|
are oral medications effective in preventing diabetic retinopathy
|
no
|
|
PROVOKED (underlying risk factor), 1st DVT
how long to tx? |
3 months
|
|
toxic thyroid nodule
s/sx? dx test of choice? |
s/sx hyperthyroidism
focal uptake on scan |
|
3 GI cx of somatostatinoma?
|
gallstones (ST inhibits gallbladder contraction)
malabsorption (ST inhibits motility) DM (ST inhibits pancreatic secretions) |
|
Glucagonoma
how do pts present? |
Pts present with mild DM + rash
necrolytic migratory erythema, rash that clears from center |
|
thryoid nodule
w/u algorithm? |
+ --> FNA
TSH - --> thyroid scan --> +hot --> OBSERVE --> -cold --> surgery |
|
electrolyte abnormalities in rhabdo
|
hyperkalemia
hypocalcemia hyperphosphatemia hyper-CK |
|
causes of rhabdo
|
cocaine use
EtOH use trauma/exertion Rx-induced |
|
how to manage rhabdo
|
IVF
alkalinize urine |
|
how to manage hyperkalemia with rhabdo
|
monitor EKG
K will likely correct as renal fxn improves +/- kayexylate / no tx if no arrhythmias |
|
appearance of Paget's dz of bone on ct
|
"cotton wool" appearance on ct
|
|
tx of Paget's dz of bone
|
calcitonin + bisphosphonates
|
|
t or f:
ergonomic keyboards are useful in management of carpal tunnel syndrome |
false
|
|
SLE
DOC DMARD? 2nd line if that fails? |
MTX
if fails --> anti-TNFa |
|
#1 cause of MI in SLE
|
premature atherosclerosis / CAD
|
|
how do steroids lead to osteopenia?
|
decreased intestinal absorption of Ca
increased Ca excretion in urine |
|
screening procedure for bone health in pts on steroids
|
if on steroids >3 mo
DEXA: baseline at initiation, then annually |
|
how to dx spinal stenosis
study of choice? |
MRI
|
|
best screening test for SLE
|
ANA
(ds-DNA only 70% SE, good SP) |
|
definition of mixed connective tissue dz (MCTD)
|
+anti-RNP + 3 clinical features of SLE, PM or scleroderma
|
|
clinical features of hemochromatosis
|
central hypogonadism
DM arthropathy skin pigmentation liver disease |
|
how to dx Sjogrens
Screening? Confirmation? |
anti-Ro/La
Bx minor salivary glands: focal collection of lymphocytes |
|
tx for renal failure in SLE... by WHO Type 1-5
|
WHO types 1 or 2: no tx
WHO types 3, 4, 5: steroids; if fail, cyclophosphamide |
|
t or f:
levels of anti-dsDNA and C' correlate with severity of SLE |
true
|
|
first line tx for acute gout flares?
|
indomethacin
|
|
clinical presentation of ankylosing spondylitis
|
LBP, morning stiffness -> improves with exercise
sx > 3 mo decreased flexion in L-spine |
|
how to dx ankylosing spondylitis
test of choice? |
XR of SI joints
If XR - but suspicion HI --> CT |
|
associated lung problems in ankylosing spondylitis
|
pulmonary fibrosis
restrictive lung dz 2/2 decreased costo-vertebral joint movement |
|
t or f:
there is decreased life expectancy in ankylosing spondylitis |
false
|
|
best way to dx osteonecrosis of hips
test of choice? |
MRI
|
|
carpal tunnel syndrome has increased association with what other things
|
trauma
DM RA hypothyroidism acromegaly pregnancy menopause ESRD fibromyalgia obesity |
|
tx of papillary ca of thyroid
|
near-total thyroidectomy --> then radioactive therapy
|
|
blood sugar cx in chronic pancreatitis
|
"Brittle DM"
(increased risk of hypoglycemia b/c loss of a-cells too) |
|
contraindications to metformin
|
renal failure
CHF EtOH-ism |
|
contraindications to thiazoladinadiones (glitazones)
|
CHF (class III/IV)
|
|
contraindications to exercise in dm
|
bs >250
no weightlifting if retinopathy present |
|
endocrine cx of angiography
|
thyrotoxicosis
(b/c high IODINE load can act as a substrate) |
|
tx for sulfonylurea overdose
|
D5
If fails... octerotide (inhibits insulin release) |
|
Ca/Phos cx s/p gastric bypass surgery
|
malabsorption --> Vit D def --> Hi PTH --> phosphate wasting (in urine)
LOW phosphate BEFORE Low Ca |
|
what BP rx increase the risk of DM (with prolonged use)
|
B-blockers
HCTZ |
|
tx of choice for a non-secreting pituitary tumor
|
trans-sphenoidal surgery
|
|
heme cx in adrenal failure
|
eosinophilia
|
|
how to dx adrenal insufficiency
|
cosyntropin (ACTH) stimulation test
|
|
how to manage levothyroxine doses in pts with h/o thyroid ca, now in remission
|
Suppress TSH to goal:
0.1-0.3 if non-metastatic <0.1 if + distant mets |
|
can dx of DM be made with 1 abnl glucose level
|
yes, but ONLY IF there are OVERT S/Sx of dm at the time of the reading
|
|
after how many wks on steroids does a pt need a taper?
|
> 3 wks
|
|
increased risk of which malignancy in acromegaly
|
colon ca
colonoscopy q 3-5 yrs |
|
tx of prolactinoma with visual sx
|
bromocriptine or cabergoline (will shrink tumor)
no surgery is needed! Sx resolve more quickly than MRI |
|
men 2a
|
medullary thryoid ca
pheochromocytoma hyperparathyroidism |
|
what must be done before surgery in a pt with pheo
... for how long? |
a-blockade for 10-14 days before surgery
|
|
apathetic thyrotoxicosis
|
seen in elderly
p/w apathy, depression, weight loss |
|
pattern on RAIU scan: subacute thyroiditis
|
diffuse, decreased uptake
|
|
pattern on RAIU scan: toxic multinodular goiter
|
diffuse, increased uptake
|
|
pattern on RAIU scan: painless thyroiditis
|
diffuse, decreased uptake
|
|
pattern on RAIU scan: post-partum thyroiditis
|
diffuse, decreased uptake
|
|
pathophys of sx in thyrotoxicosis in the setting of subacute thyroiditis
implication for tx? |
sx result from release of PRE-formed T4
Thus, will NOT respond to PTU/methimazole |
|
tx for subacute thyroiditis
|
NSAIDs
propranolol rarely, prednisone |
|
course of subacute thyroiditis
|
thyrotoxic phase x wks, hypothyroid x months
|
|
suppurative thyroiditis
s/sx? test of choice? |
non-thyrotoxic
overlying skin is erythematous Thyroid U/S may reveal abscess |
|
tx of suppurative thyroiditis
|
ABx + I&D
|
|
which rx displace T4 and T3 from TBG
|
ASA
furosemide heparin (in vitro) |
|
indications to tx Paget's dz of bone?
|
involvement of weight-bearing bones
neurologic sx hypercalcemia chf (high-output) refractory pain) |
|
vitamin d deficiency
ca? po4? pth? 25-D? |
Dx___?
Ca nl ---> low (late) Ph low PTH high 25-D low |
|
hypo-PTH
ca? po4? pth? 25-D? |
Dx___?
Ca low Ph high PTH low 25-D nl |
|
pseudo-hypo-PTH Type 2 (PTH-resistance, Gs-alpha mut)
ca? po4? pth? D-25? |
Dx___?
Ca low Ph high PTH high 25-D nl |
|
how often should fT4 and TSH be checked during pregnancy in a patient on tx?
|
q2-3 mo
|
|
how long will a single subQ steroid dose stay in the body and continue to have effects
|
5-7 days
|
|
euthyroid sick syndrome
labs early/mild? labs late/severe? |
seen in hospitalized pts
Early in course/mild: low t3, nml t4 and tsh Late in course/severe: low t3, t4, and tsh |
|
pseudo-hypo-PTH Type I (PTH-resistance, Albright's hereditary osteodystrophy)
S/Sx?___ Ca ? Ph ? PTH ? 25-D ? TSH ? fT4 , fT3 ? |
Dx: ____
S/Sx: short 4th/5th metacarpals, round facies, Auto Dom Ca low Ph high PTH high 25-D nl TSH high fT4, fT3 low (b/c resistance to TSH!) |
|
pt with osteoporosis resistant to bisphosphonates
w/u? dx? |
SPEP and UPEP
suspect multiple myeloma! |
|
indication for parathyroidectomy in pts with hyperparathryoidism
|
Ca >10.5 or very high po4 and not responding to conservative management
PTH >1000 Bone pain, pruritis calciphylaxis soft tissue calcification |
|
sx of ethylene glycol toxicity
|
tachypnea, agitation, slurred speech, confusion, flank pain, ataxia, nystagmus
--> coma |
|
what lab test will confirm organophosphate poisoning
|
plasma cholinesterase levels
|
|
sx of organophosphate poisoning
|
SLUDGEM
|
|
tx of ethylene glycol toxicity
how does it work |
fomepizole
inhibitor of ADH |
|
what is the first step to tx of heat stroke
|
evaporative cooling
|
|
complication associated with nitroprusside
who in particular is at risk? |
cyanide toxicity
esp in pts with renal failure |
|
sx of cyanide toxicity
|
lactic acidosis
tachycardia MS changes, sz, coma |
|
cardiac issues associated with hypothermia
|
bradycardia
PVCs |
|
sx of salicylate intoxication
|
tinnitus
restlessness n/v/abd pain decreased consciousness fever metabolic acidosis hyperventilation w/o subj feelings of sob AKI transient hepatotoxicity coagulopathy encepalopathy non-cardiogenic pulmonary edema |
|
tx of ASA o/d
|
gastric lavage
activated charcoal alkalization of urine to enhance secretion |
|
adverse rxn to metoclopramide
how to tx |
acute dystonic rxn in high doses
diphenhydramine -> benztropine if that doesn't work |
|
how to tx organophosphate poisoning
|
atropine - to reverse nicotinic receptors
pralidoxime (2-PAM) - regenerates cholinesterase by binding the organophosphate) |
|
indications for carotid endarterectomy
|
Sx and >70 % stenosis
|
|
how to manage TIA with <30% carotid stenosis
|
ASA or other anti-platelet
|
|
infections associated with Guillan-Barre
|
Campylobacter
CMV EBV HIV HSV |
|
what % of G-B pts will develop respiratory failure?
how to monitor? |
25-30%
check bedside spirometry FVC |
|
sx dominant temporal lobe lesion
|
homonymous upper quadrantanopsia
aphasia (receptive or transcortical > expressive) |
|
sx NON-dominant temporal lobe lesion
|
homonymous upper quadrantanopsia
impaired perception of complex sounds |
|
sx dominant parietal lobe lesion
|
geistmann syndrome
(acalculia, finger agnosia, agraphia, r/l confusion) |
|
sx NON-dominant parietal lobe lesion
|
APRAXIA (construction apraxia, difficulty dressing)
confusion |
|
tick paralysis
sx? |
from neurotoxin-secreting tick
5-6 days after exposure --> ascending paralysis in hours to days |
|
how to tx tick paralysis
|
remove the tick!
sx resolve in hours |
|
Pt c/o dementia
w/u labs? |
CBC - anemia? infx?
TSH B12 UA - infx |
|
sx of subcortical dementia
|
EPS
parkinsonism visual hallucinations gaze palsies |
|
adverse effects to L-dopa
if severe, what should you suspect? |
visual hallucinations
confusion agitation if this occurs, suspect lewy body dementia |
|
when should BP be lowered in ischemic stroke
|
if >220/120 or evidence of end-organ damage
|
|
adverse effects of carbamazepine
|
neutropenia / cytopenias
renal failure constipation glaucoma |
|
acute tx of migraine
|
triptans
|
|
-triptans
MOA? |
5ht agonist --> vasoconstriction, and decreased plasma extravastation
|
|
ppx rx for migraines
1st line? menstrual? |
#1 = topiramate, valproate, metoprolol, propranolol
#2 = timolol, amitriptyline, venlafaxine frovatriptan (menstrual migraine) (WITHDRAWN: methysergide - retroperitoneal/pulm fibrosis) |
|
s/sx of phenytoin toxicity
earliest s/sx? |
1st = lateral gaze nystagmus
blurred vision, diplopia ataxia, slurred speech --> coma |
|
interaction btw phenytoin and coc
|
increases metabolism of coc
|
|
how to tx acute ms exacerbation
|
#1 = IV steroids (methylprednisolone)
(no role for steroids in chronic mgmt) |
|
how to prevent ms relapses in RRMS (DMARDs)
Rx -> SE |
#1 IFN-B -> flu-like, flushing, hepatotox, SI
#1 glatiramer (myelin "decoy") -> lipoatrophy at injection site #2 natalizumab (Tysabri) (anti-a4-integrin, prevents lymphocyte adhesion) -> PML (MUST CHECK JC virus) #3 mitoxantrone -> systolic dysfunction, AML! fingolimod teriflunomide |
|
how to follow sx of ms
|
repeat MRI 3 mos after initial imaging
neurologic s/sx improvement LAGS MRI improvements |
|
rx in women with MS who would like to get pregnant
which are teratogenic? |
Teratogenic: IFN-B, glatiramer
(should be stopped several months before conception) |
|
riluzole
moa? uses? |
anti-glutamatergic
(may increase re-uptake, may inhibit depol by acting on Na or Ca channels) prolongs survival in ALS, delays need for tracheostomy |
|
Describe neurologic s/sx in B12 deficiency / subacute combined degeneration
|
dorsal column impairment
lat column impairment (--> brisk reflexes) LE > UE involvement |
|
meralgia paresthetica
|
= lateral cutaneous femoral nerve entrapment
|
|
what cells do glial tumors arise from
|
astrocytes
|
|
medial medullary syndrome
|
contralateral spastic hemiplegia
contralateral vibratory / proprioception impairment tongue deviation TOWARD side of the lesion |
|
effect of transfusion of pRBCs in pt with... renal failure, liver failure, shock or hypothermia
how to monitor for? how to prevent this complication? |
HYPOCALCEMIA!
occurs b/c inability of citrate to be metabolized into lactic acid ---> citrate binds Ca --> hypoCa Monitoring: must check IONIZED Ca PPx: 10% Ca-gluconate (for every 500 ml pRBCs) |
|
describe senile gait
|
"walking on ice"
(wide stance, hip and knees flexed, arms flexed and extended) |
|
describe spastic paresis gait
|
"scissoring gait"
foot drags with every step |
|
describe drunken sailor gait
|
cbl ataxia
jerky, zig-zag pattern |
|
describe distal LMN dz gait
|
"steppage gait"
foot drop |
|
what happens to bilirubin in ineffective erythropoeisis
|
defective DNA synthesis -> megakaryoblastic changes in bone marrow + hemolysis --> hyperbili (indirect)
|
|
adverse effects of valproic acid
|
abnl LFTs
increased urinary frequency n/v/d hair loss weight gain |
|
tx of delirium in elderly
|
haldol > bdz
(bdz --> may increase confusion/agitation) |
|
2 CT findings in NPH
|
big ventricles
NO effacement of sulci |
|
miller fischer test
|
pre-post LP gait assessment
used to clinically dx NPH |
|
Cluster HA, PPx?
|
lithium
CCB |
|
t or f:
ASA is contraindicated in pts with ulcer dz |
true
(to prevent GIB) |
|
tx of spasticity after stroke
DOC? 2nd line? |
#1: dantrolene
#2: BDZ and baclofen (but they have CNS effects as well --> drowsy, not alert) |
|
tx of superior saggital sinus thrombosis
|
heparin (even in setting of hemorrhagic infarct)
|
|
who gets saggital sinus thrombosis
|
pregnancy
trauma infx vasculitis |
|
sx of saggital sinus thrombosis
|
hemiparesis
papilledema sz |