Questions and Answers
What is the pathologic hallmark of Parkinson's disease observed in post-mortem histology?
Which medication is NOT used to manage symptoms of Alzheimer's disease?
What are the cardinal symptoms of Parkinson's disease, summarized by the acronym TRAP?
What effect does dopamine have on the body in Parkinson's disease?
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Which system is primarily responsible for the motor symptoms seen in Parkinson's disease?
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How is Memantine used in the treatment of Alzheimer's disease?
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What is a common early symptom of Parkinson's disease?
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Which feature characterizes the muscle rigidity seen in Parkinson's disease?
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What role do acetylcholinesterase inhibitors play in the management of Alzheimer's disease?
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What is the significance of the Mini-Mental Status Exam (MMSE) score when using Memantine?
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What is the main cause of hemorrhagic stroke?
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Which type of hemorrhage occurs outside the brain tissue?
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What initial signs may indicate Herpes Zoster Ophthalmicus?
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Which imaging technique is used to confirm a hemorrhagic stroke diagnosis?
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What medication might be administered for increased intracranial pressure due to an epidural hematoma?
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Which of these factors is NOT commonly associated with the pathophysiology of hemorrhagic stroke?
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Which treatment may be necessary for subarachnoid hemorrhage?
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Which cranial nerve is primarily involved in Herpes Zoster Ophthalmicus?
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What is the primary risk factor for vascular dementia?
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Which cognitive assessment tool is restricted by trademark but known for its high sensitivity and specificity for dementia?
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What spectrum of symptoms is associated with Lewy body dementia?
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What is a typical characteristic of frontotemporal dementia (Pick’s Disease)?
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Which of these is a primary treatment for dementia related to cholinergic deficiencies?
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Which component is NOT evaluated in the Mini-Mental State Examination?
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What is a common cause of delirium in hospitalized elderly patients?
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Which of the following is a defining feature of substance-induced dementia?
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How is a definitive diagnosis of dementia typically established?
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What does a score of 20 or less on the Mini-Mental State Exam suggest?
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What is the primary treatment goal for managing Type 1 diabetes regarding A1C levels?
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Which of the following is a common side effect of Metformin?
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Which medication class is known to stimulate insulin release from pancreatic beta cells?
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Which of the following statements about diabetic neuropathy is true?
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What is the primary mechanism of action for SGLT2 inhibitors?
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What type of diabetes is characterized by a combination of insulin resistance and relative impairment of insulin secretion?
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What common side effect is associated with the use of Thiazolidinediones?
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Which of the following describes the Somogyi phenomenon?
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Which medication should be stopped 24 hours before a contrast procedure?
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For patients with diabetes, what is recommended daily monitoring frequency for glucose levels?
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Which type of neuropathy is characterized by 'stocking-glove' sensory loss?
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Which condition could potentially arise as a long-term complication of diabetic neuropathy?
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What is a common class of medications used to manage cholesterol levels in diabetic patients aged 40-75?
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What is the primary use of dual antiplatelet therapy in TIA management?
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Which therapy is appropriate for low-risk TIA patients with a risk score under 4?
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What is the recommended treatment approach for patients with cardiogenic TIA due to nonvalvular atrial fibrillation?
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What is the significance of the ABCD2 score in TIA management?
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Which of the following is a long-term strategy to reduce the risk factors associated with TIA?
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Study Notes
Diabetic Ketoacidosis and Management
- Diabetic Ketoacidosis (DKA) manifests through lethargy, hyperglycemia, and hyperosmolar syndrome.
- Somogyi phenomenon: hypoglycemic episodes followed by rebound hyperglycemia.
- Dawn phenomenon: increased blood glucose levels in the morning due to hormonal changes overnight.
- Treatment includes dietary control and insulin therapy, essential for all Type 1 diabetes patients.
- A1C goal is to maintain levels < 7; regular checks every 3 months are needed.
- Insulin regimen can include basal insulin (e.g., Glargine) with long-acting or intermediate-acting variations.
- Pre-meal bolus insulin is necessary, with dosage based on fasting blood sugar, meal composition, and activity.
- Daily glucose monitoring (4-7 times); recommended times include pre-meal, at 3 am occasionally.
- Daily aspirin for prevention required for men over 50 and women over 60 with one cardiovascular disease risk factor.
- Blood pressure should be managed with ACE inhibitors or ARBs, potentially combined with thiazide-like diuretics or calcium channel blockers.
- Statin therapy recommended for cholesterol management in individuals aged 40-75.
Type 2 Diabetes Mellitus
- Characterized by insulin resistance and impaired insulin secretion; patients produce insulin but are unable to utilize it effectively.
Anti-Hyperglycemic Agents
- Biguanides (Metformin): Reduces hepatic glucose production and enhances insulin sensitivity; leads to weight loss; contraindicated in renal impairment, can cause lactic acidosis.
- Sulfonylureas: Stimulate insulin release from β-cells; causes weight gain and hypoglycemia. 1st generation (e.g., Tolbutamide) and 2nd generation (e.g., Glipizide) are available, with second-generation being preferred for fewer side effects.
- Meglitinides (Repaglinide and Nateglinide): Similar action to sulfonylureas but with a lower risk of hypoglycemia.
- α-Glucosidase Inhibitors: Slow carbohydrate absorption, causing gastrointestinal side effects; caution in patients with bowel conditions.
- Thiazolidinediones (e.g., Pioglitazone): Increase insulin sensitivity; potential for fluid retention and increased risk of heart failure.
- GLP-1 Agonists: Lower blood glucose while promoting insulin secretion; mainly cause gastrointestinal issues with no weight gain.
- DPP-4 Inhibitors (e.g., Sitagliptin): Increase GLP-1 levels; potential for renal failure and pancreatitis.
- SGLT2 Inhibitors: Promote urinary glucose excretion; associated with urinary tract infections and dehydration.
Diabetic Neuropathy
- Complication of Diabetes Mellitus characterized by various types:
- Symmetric Polyneuropathy: Common type showing distal sensory loss in a "stocking-glove" pattern; can lead to foot ulcers.
- Autonomic Neuropathy: Symptoms include orthostatic hypotension and gastroparesis.
- Mononeuropathy: Often affects peripheral nerves, leading to conditions like carpal tunnel syndrome.
- Management focuses on optimizing glucose control and pharmacotherapy for painful neuropathy.
Dementias and Cognitive Dysfunction
- Various types include Alzheimer's, vascular dementia, substance-induced dementia, Lewy body disease, and frontotemporal dementia, each with unique characteristics and management approaches.
- Diagnosis includes history, cognitive assessments like the MMSE or MoCA, screening for B12 deficiency, and neuroimaging as needed.
- MMSE is a primary tool for evaluating cognitive function; scoring < 25 suggests impairment.
Delirium
- An acute, reversible confusion state often caused by medical conditions or medication side effects.
- Diagnosis includes ruling out other causes, requiring extensive lab tests and MRI for detailed evaluation.
- Management focuses on addressing underlying causes and may include cholinesterase inhibitors for symptom relief in cases linked to Alzheimer's.
Parkinson's Disease
- A neurodegenerative disorder characterized by decreased dopamine leading to motor control issues.
- Classic symptoms include tremor, rigidity, bradykinesia, and postural instability (TRAP).
- Nonmotor symptoms may include anosmia, psychiatric issues, and constipation.
- Management involves stopping any aggravating medications; currently, there is no cure for the disease.### Intense Risk Factor Management
- Thrombolytics are contraindicated in treating Transient Ischemic Attack (TIA).
- Noncardiogenic treatment includes antiplatelet therapy along with risk score assessment.
Dual Antiplatelet Therapy
- Combination of Aspirin and Clopidogrel significantly reduces the risk of future TIA or strokes in high-risk patients (risk score ≥4).
- This dual therapy is initiated while the ischemic mechanism is being evaluated.
- Alternatively, Aspirin combined with extended-release Dipyridamole is another option.
Aspirin Monotherapy
- Aspirin (162-325 mg/day) is used solely for low-risk TIAs (risk score under 4).
Long-term Management
- Focus on reducing modifiable risk factors such as Diabetes Mellitus, hyperlipidemia, hypertension control, smoking cessation, weight reduction, and regular exercise.
- Statin therapy is advised regardless of LDL cholesterol levels.
- Aim to address factors contributing to plaque buildup and heart blood supply issues.
Revascularization
- Carotid endarterectomy is recommended for patients with 50-99% internal carotid artery stenosis and a life expectancy of 5+ years, along with Aspirin.
- Endovascular intervention and stenting are considered only if life expectancy is also 5+ years.
Cardiogenic TIA Management
- In cases of Nonvalvular Atrial Fibrillation, treatment includes oral anticoagulants.
- Options for oral anticoagulation: Warfarin or direct oral anticoagulants like Dabigatran, Rivaroxaban, Apixaban, and Edoxaban.
ABCD2 Score Assessment
- The ABCD2 score assesses the risk of stroke following a TIA, with the highest risk occurring in the days after the TIA.
- This scoring aids in predicting stroke risk during the 3-90 days post-TIA.
Hemorrhagic Stroke
- Secondary to hypertension, categorized into intra-axial and extra-axial hemorrhages.
- Extra-axial hemorrhages occur outside of brain tissue, including epidural hematoma, subdural hematoma, and subarachnoid hemorrhage.
- Intra-axial hemorrhages occur inside the brain tissue, such as intracerebral hemorrhage.
Causes and Diagnosis of Hemorrhagic Stroke
- Common causes of rupture include weakened blood vessels, primarily aneurysms and arteriovenous malformations (AVM).
- CT scans are essential for diagnosing bleeding.
Treatment for Hemorrhagic Stroke
- IV Mannitol is administered if increased intracranial pressure (ICP) is present for epidural hematomas and intracerebral hemorrhages.
- Blood pressure regulation in subarachnoid hemorrhage may involve nicardipine, nimodipine, or labetalol.
- Hematoma evacuation may be necessary.
Herpes Zoster Ophthalmicus
- A potentially sight-threatening condition caused by the reactivation of the Varicella Zoster virus (shingles).
Pathophysiology
- Post-initial infection, the varicella zoster virus remains dormant in the dorsal root ganglia or trigeminal ganglia, later reactivating in the ophthalmic division of cranial nerve V.
Clinical Manifestations
- Prodromal symptoms include headache, malaise, and fever.
- Unilateral pain or hypesthesia in the affected eye, forehead, and scalp may occur, preceding or following the prodromal phase.
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Description
This quiz covers the key concepts related to diabetic ketoacidosis, including hyperglycemic hyperosmolar syndrome and associated phenomena like the Somogyi and dawn phenomena. It emphasizes dietary control, insulin treatment, and monitoring A1C levels for effective management. Test your knowledge on these crucial diabetes management strategies.
