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An 81-year-old woman presents to the clinic for memory and behavior problems. Her granddaughter reports that the patient has been increasingly forgetful over the last one year. Over the last three months, the patient has been getting more frustrated and angry. She has become very paranoid. She often needs help to choose proper clothing for the season and occasion. Her MMSE score is 16/30. After a full neurological examination and cognitive testing, a diagnosis of late-onset Alzheimer disease is made. She is prescribed a centrally acting, rapid, and reversible acetylcholinesterase inhibitor. Which of the following is the most common side effect of this medication?
An 81-year-old woman presents to the clinic for memory and behavior problems. Her granddaughter reports that the patient has been increasingly forgetful over the last one year. Over the last three months, the patient has been getting more frustrated and angry. She has become very paranoid. She often needs help to choose proper clothing for the season and occasion. Her MMSE score is 16/30. After a full neurological examination and cognitive testing, a diagnosis of late-onset Alzheimer disease is made. She is prescribed a centrally acting, rapid, and reversible acetylcholinesterase inhibitor. Which of the following is the most common side effect of this medication?
A 57-year-old man with a history of schizophrenia presents to the clinic with complaints of uncomfortable involuntary spasms of the neck. The patient is accompanied by his brother, who reports he started to notice the symptoms a couple of weeks prior. The severity of the movement progressively worsened since the onset. When asked about his medication profile, the brother notes that the patient has been taking the same neuroleptic for a year. The patient has remained compliant with the medication. He has not had a psychotic relapse in the past year. Development of which abnormal motor manifestation occurs most frequently in the setting of this pathological state?
A 57-year-old man with a history of schizophrenia presents to the clinic with complaints of uncomfortable involuntary spasms of the neck. The patient is accompanied by his brother, who reports he started to notice the symptoms a couple of weeks prior. The severity of the movement progressively worsened since the onset. When asked about his medication profile, the brother notes that the patient has been taking the same neuroleptic for a year. The patient has remained compliant with the medication. He has not had a psychotic relapse in the past year. Development of which abnormal motor manifestation occurs most frequently in the setting of this pathological state?
Torticollis
A patient requiring drainage of an abscess was administered lidocaine, a commonly used local anesthetic. If the patient mistakenly receives a toxic dose of lidocaine intravenously, it is possible to observe
A patient requiring drainage of an abscess was administered lidocaine, a commonly used local anesthetic. If the patient mistakenly receives a toxic dose of lidocaine intravenously, it is possible to observe
A previously healthy 40-year-old woman began to complain of slow thinking, lack of coordination, and short jerky nonrhythmic arm movements. The woman has no history of psychiatric or neurological diseases, but has relatives with the same manifestations. Although further research is needed, it is very likely that the most appropriate treatment will be found
A previously healthy 40-year-old woman began to complain of slow thinking, lack of coordination, and short jerky nonrhythmic arm movements. The woman has no history of psychiatric or neurological diseases, but has relatives with the same manifestations. Although further research is needed, it is very likely that the most appropriate treatment will be found
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Which of the following drugs is used to treat attention deficit hyperactivity disorder, enuresis, and chronic pain?
Which of the following drugs is used to treat attention deficit hyperactivity disorder, enuresis, and chronic pain?
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A 56-year-old woman who underwent a hysterectomy is transferred to the postsurgical unit. As her post-anesthetic medications wear off, she has a noticeable facial grimace, and complains of severe pain. What method of pain management would be most appropriate for this patient?
A 56-year-old woman who underwent a hysterectomy is transferred to the postsurgical unit. As her post-anesthetic medications wear off, she has a noticeable facial grimace, and complains of severe pain. What method of pain management would be most appropriate for this patient?
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A 38-year-old man presents with lower back pain. A physical examination shows painful and diminished forward flexion with tenderness over both buttocks. Laboratory tests show an elevated erythrocyte sedimentation rate. Rheumatoid factor and antinuclear antibody are negative. HLA-B27 is positive. X-rays of his lumbar spine and sacroiliac joints are normal. He is diagnosed with ankylosing spondylitis. Which of the following is the appropriate first-line pharmacotherapy?
A 38-year-old man presents with lower back pain. A physical examination shows painful and diminished forward flexion with tenderness over both buttocks. Laboratory tests show an elevated erythrocyte sedimentation rate. Rheumatoid factor and antinuclear antibody are negative. HLA-B27 is positive. X-rays of his lumbar spine and sacroiliac joints are normal. He is diagnosed with ankylosing spondylitis. Which of the following is the appropriate first-line pharmacotherapy?
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A 29-year-old male with a past medical history of human immunodeficiency virus (HIV) infection, well-controlled on antiretroviral therapy for 1 year presents to the clinic for follow-up. His CD4 count last week was 500 cells/microliter. He reports a constant cough for the last 2 weeks. His chest x-ray shows bilateral infiltrates. Pneumocystis jirovecii pneumonia is confirmed with sputum antigen testing and treatment is started. What is the next step in the management of his HIV?
A 29-year-old male with a past medical history of human immunodeficiency virus (HIV) infection, well-controlled on antiretroviral therapy for 1 year presents to the clinic for follow-up. His CD4 count last week was 500 cells/microliter. He reports a constant cough for the last 2 weeks. His chest x-ray shows bilateral infiltrates. Pneumocystis jirovecii pneumonia is confirmed with sputum antigen testing and treatment is started. What is the next step in the management of his HIV?
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Which of the following statements best defines concussion?
Which of the following statements best defines concussion?
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What is the preferred injection site when vaccinating an 8-week-old child?
What is the preferred injection site when vaccinating an 8-week-old child?
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Your 65 year old grandfather who has a history of heart disease begins to have an attack of exertional angina while working beside you in his garden. He gestures towards a dark glass vial in his pocket that has a prescription label indicating it contains nitroglycerin triturate. How would you help him administer this dosage form?
Your 65 year old grandfather who has a history of heart disease begins to have an attack of exertional angina while working beside you in his garden. He gestures towards a dark glass vial in his pocket that has a prescription label indicating it contains nitroglycerin triturate. How would you help him administer this dosage form?
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A 47-year-old male presents to the clinic due to an ongoing diagnosis of gouty arthritis. His serum uric acid level is elevated, and febuxostat is prescribed. Approximately one week later, he returns complaining of a painful episode that "feels like a gout attack." Which of the following is the best explanation for this episode?
A 47-year-old male presents to the clinic due to an ongoing diagnosis of gouty arthritis. His serum uric acid level is elevated, and febuxostat is prescribed. Approximately one week later, he returns complaining of a painful episode that "feels like a gout attack." Which of the following is the best explanation for this episode?
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A child is admitted with nausea, vomiting and diarrhea and the doctor prescribes several medications. Which of the following statements is true about this patient? (More than one answer is possible)
A child is admitted with nausea, vomiting and diarrhea and the doctor prescribes several medications. Which of the following statements is true about this patient? (More than one answer is possible)
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An 18-year-old female presents to the clinic for acne with a topical retinoid and a benzoyl peroxide wash. With treatment, she develops dry flaking skin. What would be the best moisturizing agent for her that can help clear her acne, hydrate her skin and also reduce its flaking?
An 18-year-old female presents to the clinic for acne with a topical retinoid and a benzoyl peroxide wash. With treatment, she develops dry flaking skin. What would be the best moisturizing agent for her that can help clear her acne, hydrate her skin and also reduce its flaking?
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A 57-year-old man was admitted to the Department of Invasive Surgery after an acute myocardial infarction. The patient presents with rapidly developing symptoms of heart failure with reduced ejection fraction, and several medications are discussed. What furosemide, dobutamine and digoxin have in common is that they
A 57-year-old man was admitted to the Department of Invasive Surgery after an acute myocardial infarction. The patient presents with rapidly developing symptoms of heart failure with reduced ejection fraction, and several medications are discussed. What furosemide, dobutamine and digoxin have in common is that they
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A 27-year-old drug addict injected himself with what he thought was methamphetamine, but did not get any methamphetamine-like effects. The patient was admitted to the Emergency Department with suspected antimuscarinic poisoning. An expected symptom of antimuscarinic poisoning is
A 27-year-old drug addict injected himself with what he thought was methamphetamine, but did not get any methamphetamine-like effects. The patient was admitted to the Emergency Department with suspected antimuscarinic poisoning. An expected symptom of antimuscarinic poisoning is
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A 55-year-old male presents with an inability to open his mouth. He reports that he woke up this morning and could not open his mouth, which he has never experienced. His past medical history includes hypertension, ischemic heart disease, and type 2 diabetes mellitus. He was recently started on metoclopramide for diabetic gastropathy. In addition, he takes metformin, glimepiride, amlodipine, losartan, aspirin, bisoprolol, and atorvastatin. Examination reveals restricted mouth opening and deviation of the head to the left. The maximal interincisal distance is 10 mm. Which of the following agents is most likely responsible for this patient's presentation?
A 55-year-old male presents with an inability to open his mouth. He reports that he woke up this morning and could not open his mouth, which he has never experienced. His past medical history includes hypertension, ischemic heart disease, and type 2 diabetes mellitus. He was recently started on metoclopramide for diabetic gastropathy. In addition, he takes metformin, glimepiride, amlodipine, losartan, aspirin, bisoprolol, and atorvastatin. Examination reveals restricted mouth opening and deviation of the head to the left. The maximal interincisal distance is 10 mm. Which of the following agents is most likely responsible for this patient's presentation?
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A 52-year-old woman consults you regarding prolonged insomnia. Which of the following would we prescribe, since it has no anticonvulsant or muscle relaxant effect and minimally affects REM-sleep? Its effects are antagonized by flumazenil.
A 52-year-old woman consults you regarding prolonged insomnia. Which of the following would we prescribe, since it has no anticonvulsant or muscle relaxant effect and minimally affects REM-sleep? Its effects are antagonized by flumazenil.
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Death of neurons in this CNS pathway causes Parkinson's disease
Death of neurons in this CNS pathway causes Parkinson's disease
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After eating a meal including sardines, cheese, and red wine, a patient takes selegiline for Parkinson's disease. His blood pressure rises to 187/133 mmHg. The patient was admitted to the Emergency Department. What is the most likely explanation for this unusual reaction to selegiline
After eating a meal including sardines, cheese, and red wine, a patient takes selegiline for Parkinson's disease. His blood pressure rises to 187/133 mmHg. The patient was admitted to the Emergency Department. What is the most likely explanation for this unusual reaction to selegiline
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A 52-годишна жена се консултира с Вас по повод на продължително безсъние. Кое от посочените бихне назначили, тъй като не притежава антиконвулсивен нито миорелаксиращ ефект и минимално повлиява REM-съня? Ефектите му се антагонизират от flumazenil
A 52-годишна жена се консултира с Вас по повод на продължително безсъние. Кое от посочените бихне назначили, тъй като не притежава антиконвулсивен нито миорелаксиращ ефект и минимално повлиява REM-съня? Ефектите му се антагонизират от flumazenil
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A 57-годишен мъж постъпва в Отделение по инвазивна хирургия след остър миокарден инфаркт. Пациентът показва бързо развиващи се симптоми на сърдена недостатъчност с намалена фракция на изтласквани и се обсъжда прилагане на няколко лекарства. Общото за furosemide, dobutamine и digoxine е това, че те
A 57-годишен мъж постъпва в Отделение по инвазивна хирургия след остър миокарден инфаркт. Пациентът показва бързо развиващи се симптоми на сърдена недостатъчност с намалена фракция на изтласквани и се обсъжда прилагане на няколко лекарства. Общото за furosemide, dobutamine и digoxine е това, че те
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Study Notes
General Information
- Information provided was extracted from medical documents.
- Notes focus on patient cases and treatment details.
- Information is accurate and concise, focusing on key facts.
- The notes are focused on medical topics, rather than general information.
Alzheimer's Disease Treatment (Donepezil)
- Donepezil is a centrally acting, rapid, reversible acetylcholinesterase inhibitor.
- Approved for all stages of Alzheimer's disease.
- Common side effects are gastrointestinal (nausea, diarrhea, vomiting).
- Other side effects include muscle cramps, fatigue, and anorexia, more common with higher doses
- Side effects are typically mild, transient (up to 3 weeks), and often resolve with continued use.
- Donepezil can cause bradycardia and heart block, especially in those with underlying heart conditions.
- Syncopal episodes (fainting) have been reported.
- Weight loss in about 5% of patients, higher incidence with higher doses.
Schizophrenia and Extrapyramidal Symptoms (EPS)
- A 57-year-old man with schizophrenia experienced worsening neck spasms.
- The patient had been taking the same neuroleptic (antipsychotic medication) for a year.
- The most frequent manifestation in this case was Torticollis.
- Tardive dystonia is also a possible symptom (less frequent than torticollis).
- Tardive manifestations can include blepharospasm, pharyngeal dystonia, oromandibular dystonia, and dystonia of the lips and tongue; dystonia of arms, legs, and trunk is less frequent.
Ankylosing Spondylitis
- First-line pharmacotherapy for seronegative spondyloarthropathies is NSAIDs (Nonsteroidal anti-inflammatory drugs)
- Systemic corticosteroids should be used sparingly.
- Non-biologic DMARDs are not effective for axial spondyloarthropathies like ankylosing spondylitis.
- Plain film X-rays helpful in detecting late changes such as "shiny corner," "bamboo spine," and "squaring" of vertebral bodies; MRI useful for early inflammation signs.
Lidocaine Toxicity
- Lidocaine is a commonly used local anesthetic.
- Intravenous overdose can cause CNS effects like seizures and cardiovascular depression (less severe).
- Massive hepatocellular damage can occur later in overdose cases.
Pain Management in Postoperative Patients
- In postoperative patients, PCA (patient controlled analgesia) pumps are often an effective pain management method.
- PCA administration works by patient-initiated release of analgesic (often morphine) allowing for better pain management, compared to other methods of medication delivery.
Attention Deficit Hyperactivity Disorder (ADHD), Enuresis, and Chronic Pain
- Bupropion is a medication used for ADHD, enuresis, and chronic pain.
Gout Treatment (Febuxostat)
- Acute gout flares can occur during febuxostat treatment, even if uric acid levels decrease.
- This is due to mobilization of urate crystals from joints/tissues.
- Low-dose anti-inflammatory medication is often prescribed in the first few weeks or months of the urate lowering treatment to manage gout flare symptoms.
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Description
This quiz covers the treatment of Alzheimer's disease with Donepezil, a reversible acetylcholinesterase inhibitor. It addresses the common side effects, special considerations for patients with heart conditions, and the prevalence of weight loss among users. Test your knowledge on this important medication's effects and implications.
