Axon
07-08-2005, 02:45 PM
1531
Presents with the following:
Ripping or tearing pain - Abrupt onset of the pain. Acute, severe chest pain (Anterior chest pain can mimic acute myocardial infarction). Pain extending to the neck or jaw. Altered mental status. Cerebrovascular accident symptoms. (Any one of these have been asked).
You have ruled out MI…EKG looks OK.
Histology slide of media tear shown…
a) aortic dissection. (this is possible in Turner's syn)
1532
KNOW that connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome) can lead to commonly AORTIC DISSECTION.
1533
Please know that any pt. that they describe with a Bicuspid aortic valve, Coarctation of the aorta Takayasu arteritis Giant cell arteritis Pregnancy Crack cocaine Chronic Hypertension. All can have aortic dissection. Don't let them fool you by your picking an MI as the answer to the symptoms...
1534
KNOW how to identify an AORTIC DISSECTION in a CT scan or MRI. Note words like "false lumen", "double barrel". KNOW that you need to put in an Aortic stent used to buttress open the true lumen.
1535
Pt. comes in with cogwheeling rigidity, bradykinesia, and postural instability, and resting tremor (now we know from ******* J. Fox that age range is wide). Rigidity and bradykinesia tend to be more disabling than the tremor. The basic pathophysiology is what?
a) Parkinson's Disease. There isa lack of dopamine-producing cells in the basal ganglia. Associated hyperactivity of cholinergic neurons in the caudate nuclei results in an imbalance in the normal dopamine-to-acetylcholine ratio, which contributes to the symptoms. KNOW that there IS memory loss, dysphasia, and orthostatic hypotension. these are KEY.
1536
KNOW also that Depression and suicide affect up to 50% of Parkinson Dx. patients...
1537
Your Parkinson's Dx. pt. asks you what you can do for him/her SURGICALLY. What is the answer among choices?
a) Listen, mainly, SURGICAL lesioning options include thalamotomy and pallidotomy. But, you KNOW there are a LOT of Parkinson's Dx drugs available. But the surgical options include the aforementioned. Ventral intermediate nucleus thalamotomy is quite effective at relieving tremor, but its effects on the other clinical manifestations of PD seem to be less significant and more variable. Thalamotomy usually is reserved for a relatively small percentage of patients with predominantly drug-resistant tremor. At present, pallidotomy is the surgical procedure most commonly used for advanced PD. Surgery employs lesioning to disrupt the abnormal activity in the globus pallidus to disinhibit the motor thalamus and cortical motor areas, thereby improving motor functioning. Candidates for pallidotomy include patients who are disabled despite optimal medical management and who have responded to levodopa (L-dopa) therapy in the past but have developed complications from long-term L-dopa treatment. Rigidity, tremor, and bradykinesia all seem to respond to pallidotomy.
1538
often asked. MOA of Selegiline. What dx?
a) Parkinson's usual 1st line therapy. This is a MOA-B inhibitor and prevents dopamine breakdown.
KNOW that:
Avoid concomitant administration of selegiline with SSRIs or TCAs.
1539
OK, KNOW that:
Pergolide is a second line oft asked. Believed to exert therapeutic effects by direct stimulation of postsynaptic dopamine receptors in the corpus striatum. Used as an adjunct with levodopa/carbidopa for management of PD. REcall L-Dopa/carbidopa is PREsynaptic.
1540
Some asked me why I do this...OK, friends. I suffer from major depression even though I am a doctor and a Christian. I just feel better when I feel I am doing something that can help even one person without my asking for anything in return. I feel like a loser most of the time. Even though a lot of people offered me money, all I want is that you help others later with whatever God is calling you to do at the time...
OK,listen, I heard that... there was a question that pointed out that Parkinson's pts. have sometimes psycotic events. So they are given anti-psychotics.
KNOW that Dopamine antagonists (such anti-psychotics) such as the neuroleptics phenothiazines, butyrophenones, thioxanthenes, or metoclopramide may diminish effectiveness of pergolide, that dopamine agonist; because pergolide mesylate is more than 90% bound to plasma proteins, exercise caution if pergolide is coadministered with other drugs known to affect protein binding. OK?
Presents with the following:
Ripping or tearing pain - Abrupt onset of the pain. Acute, severe chest pain (Anterior chest pain can mimic acute myocardial infarction). Pain extending to the neck or jaw. Altered mental status. Cerebrovascular accident symptoms. (Any one of these have been asked).
You have ruled out MI…EKG looks OK.
Histology slide of media tear shown…
a) aortic dissection. (this is possible in Turner's syn)
1532
KNOW that connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome) can lead to commonly AORTIC DISSECTION.
1533
Please know that any pt. that they describe with a Bicuspid aortic valve, Coarctation of the aorta Takayasu arteritis Giant cell arteritis Pregnancy Crack cocaine Chronic Hypertension. All can have aortic dissection. Don't let them fool you by your picking an MI as the answer to the symptoms...
1534
KNOW how to identify an AORTIC DISSECTION in a CT scan or MRI. Note words like "false lumen", "double barrel". KNOW that you need to put in an Aortic stent used to buttress open the true lumen.
1535
Pt. comes in with cogwheeling rigidity, bradykinesia, and postural instability, and resting tremor (now we know from ******* J. Fox that age range is wide). Rigidity and bradykinesia tend to be more disabling than the tremor. The basic pathophysiology is what?
a) Parkinson's Disease. There isa lack of dopamine-producing cells in the basal ganglia. Associated hyperactivity of cholinergic neurons in the caudate nuclei results in an imbalance in the normal dopamine-to-acetylcholine ratio, which contributes to the symptoms. KNOW that there IS memory loss, dysphasia, and orthostatic hypotension. these are KEY.
1536
KNOW also that Depression and suicide affect up to 50% of Parkinson Dx. patients...
1537
Your Parkinson's Dx. pt. asks you what you can do for him/her SURGICALLY. What is the answer among choices?
a) Listen, mainly, SURGICAL lesioning options include thalamotomy and pallidotomy. But, you KNOW there are a LOT of Parkinson's Dx drugs available. But the surgical options include the aforementioned. Ventral intermediate nucleus thalamotomy is quite effective at relieving tremor, but its effects on the other clinical manifestations of PD seem to be less significant and more variable. Thalamotomy usually is reserved for a relatively small percentage of patients with predominantly drug-resistant tremor. At present, pallidotomy is the surgical procedure most commonly used for advanced PD. Surgery employs lesioning to disrupt the abnormal activity in the globus pallidus to disinhibit the motor thalamus and cortical motor areas, thereby improving motor functioning. Candidates for pallidotomy include patients who are disabled despite optimal medical management and who have responded to levodopa (L-dopa) therapy in the past but have developed complications from long-term L-dopa treatment. Rigidity, tremor, and bradykinesia all seem to respond to pallidotomy.
1538
often asked. MOA of Selegiline. What dx?
a) Parkinson's usual 1st line therapy. This is a MOA-B inhibitor and prevents dopamine breakdown.
KNOW that:
Avoid concomitant administration of selegiline with SSRIs or TCAs.
1539
OK, KNOW that:
Pergolide is a second line oft asked. Believed to exert therapeutic effects by direct stimulation of postsynaptic dopamine receptors in the corpus striatum. Used as an adjunct with levodopa/carbidopa for management of PD. REcall L-Dopa/carbidopa is PREsynaptic.
1540
Some asked me why I do this...OK, friends. I suffer from major depression even though I am a doctor and a Christian. I just feel better when I feel I am doing something that can help even one person without my asking for anything in return. I feel like a loser most of the time. Even though a lot of people offered me money, all I want is that you help others later with whatever God is calling you to do at the time...
OK,listen, I heard that... there was a question that pointed out that Parkinson's pts. have sometimes psycotic events. So they are given anti-psychotics.
KNOW that Dopamine antagonists (such anti-psychotics) such as the neuroleptics phenothiazines, butyrophenones, thioxanthenes, or metoclopramide may diminish effectiveness of pergolide, that dopamine agonist; because pergolide mesylate is more than 90% bound to plasma proteins, exercise caution if pergolide is coadministered with other drugs known to affect protein binding. OK?