Medicine

• Keywords:: 000 Index
• Related: Step 3, Step 1, mksap, notes

Todos

• tolearn
• MKSAP todos
  • heart murmurs

Organ Systems

• Allergy and Immunology
• Rheumatology
• Cardiology
• Dermatology
• Endocrine
• ENT
• GI
• Hemeonc
• ID
• MSK
• Nephrology
• Urology
• Neurology
• Pulmonology
• Podiatry

Subject Areas

• General
• Biostats
• Psychiatry
• [[Geriatric

carotid artery disease

• related: Neurology

All patients with carotid artery atherosclerosis should receive careful medical management, including smoking cessation, low-dose aspirin, statin therapy, and appropriate control of hypertension and diabetes.  In addition, select patients should also be considered for revascularization with carotid endarterectomy (CEA):

• In **symptomatic pa

GBS

• related: Neurology
• tags: #neuro

Classic GBS (AKA AIDP) presents as a progressive, symmetric ascending weakness or paralysis, often a few days to a week after a respiratory or gastrointestinal infection (especially Campylobacter jejuni).  About one-third of patients have no history of antecedent illness.  As the weakness ascends (eg, difficulty walking with 3/5 strength in the

gbs management

• related: Neurology

• high risk of respiratory failure: frequent measure vital capacity and negative inspiratory force
• plasma exchange or IVIG to combat antibodies against nerves
• Patients with GBS should receive plasma exchange or IVIG if:
  • Nonambulatory
  • Within 4 weeks of symptom onset
• Those who are ambulatory and recovering generally do not require treatmen

lumbar puncture

• related: Neurology

CSF lactate

• Lactate > 4 is sign of infection

Traumatic tap

A RBC count exceeding 6,000/mm3 may indicate traumatic LP, but other important causes, mainly subarachnoid hemorrhage (SAH), should be ruled out. WBC elevation in traumatic LP is commonly explained by the blood leak if approximately one WBC is present per 750-1000 RBCs. The protein level

Pseudotumor cerebri

• related: Neurology
• tags: #neurology

• aka idiopathic intracranial hypertension
• pt:
  • women, childbearing age, obese
  • Vitamin A excess (isotretinoin for acne)
  • Danazol (old synthetic steroid used to suppress gonadotrophins, replaced by GnRH agonists). Glucocorticoids
  • OCP
  • Tetracyclines
• patho: not understood
• sx:
  • chronic pulsatile headache, variable, visual di

transverse mylelitis

• related: Neurology, cauda equina syndrome
• tags: #neurology

Transverse myelitis is an inflammation of the spinal cord. The term myelitis refers to inflammation of the spinal cord; transverse refers to the pattern of changes in sensation—there is often a band-like sensation across the trunk of the body, with sens

vertigo common causes

• related: Neurology
• tags: #neurology

BPPV

• Path: otolith
• symptoms: recurrent, reproducable vertigo lasting < 1 min
• diagnosis: Dix-Hallpike, look for rotary nyastagmus
• treatment: Epley

Vestibular Neuritis or labyrinthritis (+hearing loss)

• path: vira

indication for CT scan after minor head trauma

• related: Neurology

This patient has an acute head injury. He did not lose consciousness and has no additional neurological symptoms (eg, vomiting, diplopia) or signs (eg, cranial nerve deficits, altered sensorium). However, elderly patients with seemingly minor trauma may have more extensive injury than is initially apparent; therefore, they warrant more thorough evaluation than younger patients with similar inju

migraine

• related: Neurology, Headache2

Demographics

People that suffer migraines are often 10-30 years of age; females are more commonly affected than males.

The pathophysiology of migraines is poorly understood, but it is thought to be due to neuronal dysfunction.

Factors that can precipitate migraines include:

• Stress
• Oral contraceptives
• Menstruation
• Exertion
• **F

optic neuritis

• related: Neurology

This patient with acute vision loss and eye pain unassociated with trauma has signs and symptoms suggestive of optic neuritis, including pain with eye movement, loss of color vision out of proportion to the vision loss, and an afferent pupillary defect. Two thirds of optic neuritis cases occur in women. The average age of onset is between 20 and 40 years, and it is often associated with multiple sclerosis. Most of these patients ha

headache

• related: Neurology
• tags: #note

Approach to the Patient with Headache

• 3 headache types
  • primary headaches: specific disorder
    • migraine, tension, cluster, trigeminal neuralgia
  • secondary headaches: underlying process. Acute or subacute. Progressive or unstable
    • posttraumatic, whiplash
    • ischemic, TIA, cervical artery dissection, sinus thrombosis
    • bleeding: SAH,

Cognitive Impairment

• related: Neurology
• tags: #neurology

Definition

Cognitive impairment is the progressive loss of cognitive function in at least one major category: memory, language, executive function, visuospatial function, or behavior. When the level of cognitive impairment is progressive, involves more than one cognitive function, and results in a loss of independent function, it is considered a dementia syndrome. Fixed cognitive disorders occurring

Disorders of Spinal Cord

• related: Neurology
• tags: #neurology

Presenting Symptoms and Signs of Myelopathy

Myelopathy (any disorder involving the spinal cord) arises from extrinsic (external compression) and intrinsic (intramedullary) pathologic causes. Recognition and treatment of spinal cord injury in a timely manner is crucial, given the vital anatomy contained within this small-diameter structure.

Determining the location and mechanism of injury is cru

Head Injury

• related: Neurology
• tags: #neurology

Head Injury

Traumatic Brain Injury

Traumatic brain injury (TBI) results from biomechanical forces applied to the structures of the head and neck. Damage may be temporary or permanent and may arise from functional or structural alterations in the central nervous system. Severity is determined by clinical findings and imaging results. When indicated, noncontrast CT is the imaging modality of choice because

Headache and Facial Pain

• related: Neurology
• tags: #neurology

Approach to the Patient with Headache

Formal classification of headache disorders identifies three headache subtypes: primary headaches, secondary headaches, and painful cranial neuralgias. Primary headaches, or those in which the symptoms are due to a specific headache disorder, are more commonly seen in practice and are defined by clinical criteria. Primary headache disorders include migraine,

Neuro Oncology

• related: Neurology
• tags: #neurology

Approach to Intracranial Tumors

Both benign and malignant intracranial tumors can have devastating neurologic consequences because of the obvious space constraints within the skull and potential surgical inaccessibility (if in the thalamus or brainstem, for example). Presenting symptoms of intracranial tumors appear in Table 51. Intra

Neuromuscular Disorders

• related: Neurology
• tags: #neurology

Overview

Peripheral and central nervous system disorders can be differentiated on the basis of history and neurologic examination findings (Table 44). Neuromuscular disorders include myopathies, neuromuscular junction disorders, peripheral neuropathies, plexopathies, radiculopathies, and motor neuron diseases (**[Table 45](ht

Seizures and Epilepsy

• related: Neurology
• tags: #neurology

Clinical Presentation of Seizures

Epilepsy is defined as at least two unprovoked seizures more than 24 hours apart, or one unprovoked seizure with a risk of further seizures that is similar to the risk after two unprovoked seizures (at least 60%). The term “epileptic seizure” does not imply that the seizure is related to epilepsy; rather, it means that the seizure is “real”—that is, secondary t

Stroke

• related: Neurology
• tags: #neurology

Definition of Stroke

Stroke is the leading cause of serious disability among adults and the fifth leading cause of death in the United States. Its incidence increases with each decade of life. The World Health Organization defines stroke as a disease of sudden-onset focal neurologic deficits associated with dysfunction in the brain, retina, or spinal cord due to occlusion or rupture of a cerebral or spinal artery

Movement Disorders

• related: Neurology
• tags: #neurology

Overview of Movement Disorders

Movement disorders are characterized by hypokinetic and hyperkinetic patterns of motor output. The most typical hypokinetic pattern, parkinsonism, is characterized by paucity and slowness of movements. Hyperkinetic disorders are categorized on the basis of the type of involuntary excessive movements displayed (**[Table 31](https://mksap18.acponline.org/app/topics/nr/tabl

Multiple Sclerosis

• related: Neurology
• tags: #neurology

Presenting Signs and Symptoms

Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system (CNS) that causes inflammatory damage to the brain, spinal cord, and optic nerve. Most of the overt clinical symptoms of MS occur as a direct consequence of functional interruption of critical axonal pathways by inflammatory lesions. Relapses or flares involve development of neurologic symptom

brachial plexopathy

• related: Neurology
• tags: #neurology

This patient’s presentation is consistent with brachial plexopathy, which is most commonly associated with breast and apical lung cancer. Brachial plexopathy can occur from direct cancer invasion or from radiation injury.  Patients typically develop gradual weakness in the brachial plexus distribution; the above table summarizes the differences bet

cauda equina syndrome

• related: Neurology, transverse mylelitis
• tags: #neurology

Cauda equina syndrome affects the lumbosacral roots as they exit the spinal cord and is usually caused by a herniated disk or tumor.  Clinically, patients will present with severe unilateral pain in the saddle region that radiates down to the legs with associated asymmetrical lower-extremity weakness (p

Bell's palsy

• related: Neurology
• tags: #neurology

Cause

• herpes simplex virus activation Secondary causes for facial nerve palsy include diabetes mellitus, Lyme disease, sarcoidosis, HIV, vasculitis, and malignancy.

Symptoms

Bell palsy is idiopathic paralysis of the facial nerve (cranial nerve VII) that leads to unilateral paralysis of upper and lower facial muscles. In contrast, upper facial muscles are spared in central facial weaknes

neuroleptic malignant syndrome NMS as result of medication withdrawal

• related: Neurology
• tags: #neurology

Although rigidity can be seen in Parkinson disease, the combination of this patient's confusion, fever, diffuse rigidity, and autonomic instability (eg, diaphoresis, hypertension, tachycardia) in the context of recently stopping his Parkinson medication is suggestive of **neuroleptic m

multiple myleoma can cause peripheral neuropathy

• related: Neurology
• tags: #neurology

This patient's clinical features of bilaterally progressive distal sensory loss, ankle areflexia, and high-stepping ataxic gait with positive Romberg sign (reflecting loss of proprioceptive function) are consistent with peripheral neuropathy.  Peripheral neuropathy can be caused by a variety of conditi

tia triansient ischemic attack

• related: Neurology, Stroke
• tags: #neurology

TIA is characterized by a temporary focal neurologic deficit with an absence of infarction on neurologic imaging. Similar to those of acute ischemic stroke, symptoms of TIA include hemiparesis, mono-ocular or visual field loss, dysarthria, aphasia, and sensory loss. The presence of ==paresthesia, isolated dizziness or vertigo, or memory loss=

NMS vs serotonin syndrome

• related: Neurology, pharmacology
• tags: #note

This patient's presentation is consistent with serotonin syndrome, which presents as a triad with varying degrees of:

• Mental status changes
• Autonomic hyperactivity, and
• Neuromuscular abnormalities

Gastrointestinal symptoms and diaphoresis are also common.  This syndrome can occur after i

triansient global amnesia

• related: Neurology
• tags: #neurology

The patient's presentation is consistent with transient global amnesia (TGA), a condition in which transient loss of memory for recent events and difficulty retaining new information occur (anterograde amnesia).  Patients are disoriented to place or time, become anxious or upset, and may repeatedly ask questions such as where they are and why they are there.  However, **self-awa

myasthenia crisis

• related: Neurology, gbs guillain barre syndrome
• tags: #neurology

This patient's presentation is consistent with myasthenic crisis, defined as severe weakness from myasthenia gravis requiring intubation.  Myasthenic crisis is usually due to weakness of the respiratory muscles but can also present as severe oropharyngeal weakness resulting in dysphagia and aspiratio

Medicine

• Related: Step 1, mksap, notes

Todos

• tolearn

Organ Systems

• Allergy and Immunology
• Rheumatology
• Cardiology
• Dermatology
• Endocrine
• ENT
• GI
• Hemeonc
• ID
• MSK
• Nephrology
• Urology
• Neurology
• Pulmonology
• Podiatry

Subject Areas

• General
• Biostats
• Psychiatry
• Geriatrics
• OBGYN
• Pediatric
• [