Pharm
Abortive tx of common migraines is best achieved with which medication class?
NSAID, triptans or dihydroergotamine
Characteristic of post lumbar puncture headache
Worse with sitting upright
What disorder is treated with light therapy?
Seasonal affective disorder
Pt presents with a slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilledema or headaches are reported. Likely diagnosis? (3x)
NORMAL PRESSURE HYDROCEPHALUS
37 y/o truck driver w numbness of L hand, inc severity in past 2 yrs. Reduced pinprick sensation on L little/ring fingers, atrophy of hypothenar muscle. What nerve is affected?
Ulnar
What drug is used to treat autonomic sx associated with heroin withdrawal?
Clonidine
Pt presents with a slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilledema reported. Likely diagnosis?
Normal Pressure Hydrocephalus
The factor most consistently associated with therapy outcome in psychotherapy research
Strength of therapeutic alliance
Pt who was admitted to the ER after a MVA receives IV dextrose 5% to provide access for administration of parenteral meds. Later, pt experiences confusion, oculomotor paralysis, and dysarthria. Symptoms were likely caused by:
WERNICKE’S ENCEPHALOPATHY
(give thiamine first)
Gait consisting of: postural instability, festination, & truncal rigidity. Lewy bodies visualized, also with involuntary acceleration. What condition is this seen in?
Parkinson's
What is a side effect common to both naltrexone and disulfiram?
(excluding general sx of nausea, dizziness, headaches)
Elevated LFTs
What type of memory is stored in the hippocampus and parahippocampal gyrus?
Declarative Memory (facts)
When compared to adolescents, 8-12 y/o children with depression most often show which symptom?
Somatic sx
While intoxicated with a psychomimetic drug, a young man reports "seeing sounds" and "patterns of colors like fireworks or colored flames" associated with real auditory stimuli. What is the name of this type of sensory experience?
Synesthesia
Pt w/ acute onset of pain and decreased vision in the R eye. Colors look faded when viewed through the R eye. On exam, has a R afferent pupillary defect and a swollen right optic disc. Pt spontaneously recovers over the next 6 wks. Likely to develop later
Multiple Sclerosis
47y/o pt w acute mania is unresponsive to pharmacotx. Pt's current med regimen includes lithium, divalproex, clonazepam, olanzapine, bupropion. ECT is begun, pt is continued on previous med regimen. After 2 ECT tx, pt becomes delirious. What may have caused the delirium?
Lithium
80 y/o with VH and worsening gait, episodic confusion, disturbed sleep, fighting in sleep, bilateral rigidity, masked facies. Levodopa/carbidopa improved movement temporarily. Diagnosis?
Dementia w Lewy Bodies
Treatment of choice for lithium intoxication who manifests impaired consciousness, neuromuscular irritability, and seizures is
Hemodialysis
(Level ≥2.5)
Substance found in several over-the-counter symptom cold remedies and is abused to produce a dissociative feeling
DEXTROMETHORPHAN
36 y/o pt w pain behind L ear progressing to numbness of L side of face, tearing of L eye, discomfort w low frequency sounds, left facial weakness on exam. Dx?
Idiopathic Bell's Palsy
The new onset of pathological gambling, increased libido, and hypersexuality in a patient with Parkinson disease is likely to be secondary to what drug
Pramipexole
25 y/o has headache and vomiting, dull pain in occipital region which is worse when lying down. Also has severe papilledema bilaterally. Lumbar puncture shows opening pressure of 80 w/ normal CSF chemistry, and 120 RBC's in last tube. D-dimer, FDP in blood are elevated. CT normal
Sagittal Sinus Thrombosis
27 y/o depressed patient treated with SSRI and tranylcypromine (and with 5-hydroxytryptophan) now presents with VH, mild confusion, myoclonic jerks, diaphoretic, flushing, restlessness. Dx?
Serotonin syndrome
Characteristic of memory during alcohol-induced blackouts
ANTEROGRADE AMNESIA FOR A TIME WHILE HEAVILY INTOXICATED
65 y/o pt fell several times past 6 mos. MSE nml. Smooth pursuit, saccadic movements impaired. Worse w vertical gaze. Full ROM w doll head maneuver. Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/labs unremarkable. Dx?
Progressive Supranuclear Palsy