Subacute Sclerosing Panencephalitis (SSPE) Quiz

SSPE (Subacute Sclerosing Panencephalitis)

• Caused by chronic measles virus infection
• Leads to progressive damage to the central nervous system
• Presents with behavioral changes, seizures, and eventually severe neurological deterioration
• Diagnosis based on clinical history, EEG findings, elevated antibody titers in CSF, and typical brain findings
• Rare complication, usually fatal within 1-3 years after symptoms begin
• Vaccination is the most effective way to prevent SSPE

Post-Streptococcal Glomerulonephritis (PSGN)

• Common cause of acute glomerulonephritis in children
• Occurs 1-3 weeks after streptococcal infection (strep throat or skin infection)
• Clinical features include edema, hypertension, and decreased urine output
• Diagnosis confirmed by elevated ASO titers and low C3 complement levels
• Treatment is supportive, and the condition usually resolves spontaneously within weeks to months

Dumping Syndrome

• Common complication after gastric surgery
• Early dumping syndrome occurs within 30 minutes of eating and is caused by rapid gastric emptying
• Symptoms include abdominal fullness, nausea, vasomotor symptoms (flushing, lightheadedness), and diarrhea
• Late dumping syndrome occurs 1-3 hours after eating and is caused by reactive hypoglycemia
• Treatment involves dietary modifications (small, frequent meals; avoiding simple sugars) and, in severe cases, somatostatin analogs (octreotide)

Hyperprolactinemia

• Causes amenorrhea, galactorrhea, and infertility
• Treatment: bromocriptine, a dopamine agonist, is the first-line treatment
• Other dopamine agonists, such as cabergoline, can also be used
• Pituitary MRI should be performed to rule out a prolactinoma
• Regular monitoring of prolactin levels and symptoms is necessary during treatment

Chalazion

• Chronic granulomatous lesion of the meibomian gland in the eyelid
• Causes painless swelling of the eyelid
• Treatment: incision and drainage, triamcinolone injection, and antibiotics (bacitracin, doxycycline, azithromycin)

Vertebrobasilar Insufficiency

• Causes symptoms of vertigo, diplopia, and bilateral visual changes
• Diagnosis: clinical exam, imaging studies (MRI, CT), and angiography
• Treatment: anticoagulation, antiplatelet therapy, and surgical intervention

Raynaud's Phenomenon

• Causes digital ischemia and vasospasm
• Treatment: calcium channel blockers (nifedipine), peripheral vasodilators, and avoiding cold temperatures
• Beta-blockers may worsen Raynaud's symptoms by reducing peripheral blood flow

Congenital Heart Defects

• VSD (Ventricular Septal Defect) is the most common congenital heart defect
• Presents with a holosystolic murmur in neonates
• PDA (Patent Ductus Arteriosus) typically presents with a continuous or machinery-like murmur
• PFO (Patent Foramen Ovale) is a normal finding in neonates and typically causes a holosystolic murmur

Abdominal Aortic Aneurysm (AAA)

• Demographics: most common in men over 65, smokers, and those with a family history
• Classic presentation: often asymptomatic, may have back pain, pulsatile abdominal mass, or abdominal pain
• Treatment: surgical repair for aneurysms >5.5 cm or symptomatic, watchful waiting with regular imaging for smaller aneurysms
• Diagnostic criteria: diameter >5.5 cm on imaging
• Red flags: sudden severe back or abdominal pain (may indicate impending rupture)

Hepatitis C Virus (HCV) Management

• Demographics: risk factors include IV drug use, high-risk sexual behavior, blood transfusion before 1992
• Classic presentation: often asymptomatic, may have fatigue, jaundice
• Diagnostics: HCV RNA quantitative PCR to measure viral load
• Treatment: ribavirin, sofosbuvir, ledipasvir, and sustained virologic response

Nephrotic Syndrome

• Causes: minimal change disease, FSGS, membranous nephropathy, amyloidosis
• Diagnosis: clinical exam, imaging studies, and kidney biopsy

Sarcoidosis

• Presents with hilar lymphadenopathy and noncaseating granulomas of the lungs (and other organs)
• May get eye involvement (uveitis)
• Elevations of ACE, calcium, and uric acid are frequently seen

Pott's Disease

• TB of the spine
• Seen on x-ray as osteopenia and vertebral body breakdown

Hemophilia A

• Factor VIII deficiency
• Treatment: factor VIII replacement therapy

CHF (Congestive Heart Failure)

• Treatment: BB, ACE, spironolactone, hydralazine, Entresto (sacubitril/valsartan), diuretics
• B.A.S.H.E.D. for treatment: BB, ACE, spironolactone, hydralazine, Entresto, diuretics

Asthma

• B.I.O.M.E.S. for treatment: beta-agonists, ipratropium, magnesium, oxygen, corticosteroids, and epi

Multiple Sclerosis

• L.M.N.O.P. for symptoms: locomotor, memory, nystagmus, optic neuritis, paresthesia

Sinus Arrhythmia

• Normal variation in heart rate that occurs with breathing
• Heart rate increases slightly during inspiration

Alcoholic Cardiomyopathy

• Caused by chronic heavy alcohol use
• Pathophysiology: alcohol is directly toxic to the myocardium, leading to dilation and impaired contractility of the left ventricle
• Signs/symptoms: SOB, edema, JVD, S3 gallop, murmurs of mitral/tricuspid regurgitation
• Diagnosis: echocardiogram shows dilated left ventricle with decreased ejection fraction
• Treatment: alcohol cessation, guideline-directed medical therapy for heart failure (ACE, BB, loop diuretics)

Guillain-Barré Syndrome

• Usually caused by Campylobacter jejuni infection
• Diagnosis: clinical exam, imaging studies, and electromyography

Allergic Rhinitis

• Physical examination finding: pale turbinate bones

ANA (Antinuclear Antigen) Test

• Most commonly associated with and monitors progress of lupus
• Diagnosis: positive ANA test result

Cesarean Section

• Performed prior to the onset of labor and rupture of membranes to reduce perinatal HIV transmission
• Recommended in women with a viral load >1000 copies/mL

Asbestosis

• Caused by inhalation of asbestos fibers
• Presents with dyspnea, dry cough, and inspiratory crackles
• Chest X-ray: bilateral interstitial fibrosis, pleural plaques/thickening
• Pulmonary function tests: restrictive pattern, decreased lung volumes, and diffusing capacity of the lung for carbon monoxide
• Diagnosis: history of asbestos exposure, imaging studies, and PFTs
• Complications: cor pulmonale, respiratory failure, and lung cancer
• No specific treatment; supportive care (oxygen, pulmonary rehab)

Cushing's Syndrome

• Causes include pituitary tumors (Cushing's disease), adrenal tumors, and ectopic ACTH secretion
• Symptoms: central obesity, moon facies, buffalo hump, striae, easy bruising, and muscle weakness
• Diagnosis: 24-hour urinary free cortisol, late-night salivary cortisol, and low-dose dexamethasone suppression test
• Imaging studies (MRI, CT) are used to localize the source of excess cortisol production

Asthma Exacerbation

• Acute worsening of asthma symptoms, often triggered by viral infections, allergens, or irritants
• Severity assessment based on peak expiratory flow rate (PEFR), oxygen saturation, and degree of respiratory distress
  • Mild: PEFR >70% predicted or personal best, SpO2 >95%
  • Moderate: PEFR 40-70% predicted, SpO2 90-95%
  • Severe: PEFR <40% predicted

Heart Failure

• NYHA Class IV: unable to carry out physical activity without discomfort
• Symptoms: shortness of breath, fatigue, edema, and cough
• Treatment: medications (ACE inhibitors, beta blockers, diuretics), lifestyle changes, and surgical interventions

Nephritic and Nephrotic Syndromes

Nephritic Syndrome

• Glomerular inflammation causing hematuria, proteinuria, hypertension, and edema
• Causes: post-streptococcal glomerulonephritis, IgA nephropathy, lupus, and vasculitis
• Symptoms: hematuria, proteinuria, hypertension, and edema
• Diagnosis: urinary sediment, kidney biopsy, and serological tests

Nephrotic Syndrome

• Characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia, and edema
• Causes: minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy
• Symptoms: heavy proteinuria, edema, and lipid abnormalities
• Diagnosis: 24-hour urine protein, serum albumin, and lipid profile

Hematological Disorders

Essential Thrombocytosis

• Elevated platelet count
• JAK2 mutation
• Increased risk of thrombosis and hemorrhagic complications

Myelofibrosis

• Bone marrow fibrosis
• JAK2 mutation
• Anemia, splenomegaly, and extramedullary hematopoiesis

Waldenstrom's Macroglobulinemia

• IgM monoclonal gammopathy
• Hyper viscosity syndrome
• Lymphoplasmacytic lymphoma
• Anemia and peripheral neuropathy

Polycythemia Vera

• Elevated red blood cell count
• JAK2 mutation
• Splenomegaly and increased risk of thrombosis

Acute Myeloid Leukemia (AML)

• Blast cells in peripheral blood smear
• Auer rods in blast cells
• p53 mutation
• Cytogenetic abnormalities (e.g., t(8;21), inv(16))
• Bone marrow failure and frequent infections

Cardiovascular Disorders

Left Ventricular Aneurysm

• Complication of myocardial infarction, usually occurring 30 days post-MI
• Thinning and scar formation of infarcted myocardium leading to outward bulging
• Symptoms: heart failure, ventricular arrhythmias, and thromboembolic events
• Management: medications, anticoagulation, and surgical intervention if necessary

Malignant Hypertension

• Characterized by blood pressure >140/90 mmHg associated with nephropathy or encephalopathy
• Treatment: hydralazine and other antihypertensive medications

Asbestosis

• Caused by inhalation of asbestos fibers
• Presents with dyspnea, dry cough, and inspiratory crackles
• Chest X-ray: bilateral pulmonary fibrosis and pleural thickening
• Pulmonary function tests: restrictive pattern and decreased DLCO
• Diagnosis: history of asbestos exposure, imaging, and PFTs
• Complications: pulmonary hypertension, respiratory failure, and lung cancer

Neurology

• Vertebrobasilar TIAs are associated with symptoms such as dysarthria, hemiparesis, and sensory deficits.
• Amaurosis fugax is a symptom of retinal or ophthalmic artery ischemia, not vertebrobasilar ischemia.
• Raynaud's phenomenon is treated with calcium channel blockers, nifedipine, and beta blockers, which are the first-line treatment.

Cardiology

• Abdominal Aortic Aneurysm (AAA) is most common in men over 65, smokers, and those with a family history.
• Classic presentation of AAA includes asymptomatic, abdominal pain, or pulsatile abdominal mass.
• Treatment for AAA involves surgical repair for aneurysms > 5.5 cm or symptomatic, with alternatives being watchful waiting with regular imaging for smaller aneurysms.

Infectious Diseases

• Hepatitis C Virus (HCV) management involves demographics, classic presentation, and diagnostics.
• Risk factors for HCV include IV drug use, high-risk sexual behavior, and blood transfusion before 1992.
• Diagnostic criteria include HCV RNA quantitative PCR to measure viral load.

Hematology

• Essential Thrombocytosis is characterized by an elevated platelet count, JAK2 mutation, and increased risk of thrombosis.
• Myelofibrosis is associated with bone marrow fibrosis, JAK2 mutation, and splenomegaly.
• Polycythemia Vera is characterized by elevated red blood cell count, JAK2 mutation, and splenomegaly.
• Acute Myeloid Leukemia (AML) is characterized by myeloblasts on peripheral blood smear, Auer rods, and cytogenetic abnormalities.

Oncology

• ALL vs CML:
  • ALL is more common in children, with an acute onset, and presents with fever, bone pain, and bleeding.
  • CML is more common in adults, with a chronic, insidious onset, and presents with fatigue, weight loss, and splenomegaly.
  • Peripheral Blood Smear: ALL shows lymphoblasts, while CML shows a full spectrum of myeloid cells.
  • Cytogenetics: Both can have the Philadelphia chromosome, but it is more common in CML.

HIV

• Women with 3 consecutive negative annual Pap smears may be screened every 3 years if:
  • Age ≥ 30
  • No history of CIN 2 or 3, immunosuppression, or in utero DES exposure

Psychiatry

• Schizoid personality disorder is characterized by:
  • Emotional coldness and detachment
  • Social isolation and aloofness
  • Prefers solitary activities
  • Lacks close relationships or confidants

Gastroenterology

• G6PD deficiency is more common in African Americans, Middle Easterners, and those of Mediterranean descent.
• Prevalence in African American males in the US is ~10%.
• Oxidative stressors can trigger hemolysis, which presents with anemia, fatigue, and dark urine.

Pulmonology

• Lung Cancer Screening Recommendations:
  • Low-dose CT (LDCT) for high-risk individuals
  • Ages 50-80 years
  • ≥ 30 pack-year smoking history
  • Current smoker or quit within past 15 years
  • Discontinue screening if ≥ 15 years since quitting smoking

Miscellaneous

• Tetralogy of Fallot is commonly associated with a palpable right ventricular lift.
• Cervical Conization:
  • Surgical procedure to remove a cone-shaped portion of the cervix
  • Indications include diagnosis and treatment of cervical dysplasia or carcinoma in situ
• The heterophile test is used for the diagnosis of infectious mononucleosis in children and adults.
• Heart Valve Replacement and Anticoagulation:
  • Mechanical valves need lifelong warfarin (INR 2.5-3.5)
  • Bioprosthetic valves may only need anticoagulation for 6 months post-op
  • Bridge with heparin or LMWH when stopping warfarin for procedures
• Nail Pitting:
  • Caused by defective layering of superficial nail plate by proximal nail matrix
  • Associated with psoriasis
• Terry's nails:
  • Nail plate turns white with ground glass appearance
  • Distal band of brown color
  • Obliteration of lunula
  • Seen in cirrhosis
• Nail Clubbing:
  • Bulbous swelling of soft tissue at nail base
  • Associated with lung problems, IBS, and CA
• Chadwick's sign:
  • A blue discoloration of the vagina early in pregnancy
  • Usually appears by 6-8 weeks of gestation
• Guillain-Barre syndrome:
  • Progressive, symmetric, ascending weakness and areflexia
  • No fever or sensory deficits
  • CSF: elevated protein, normal glucose, and normal WBCs
• Eye Foreign Body:
  • Most common in males, 20-40 years old
  • Symptoms: pain, tearing, blurred vision, and foreign body sensation
  • Exam: check visual acuity, evert eyelids, fluorescein stain, and slit lamp exam
  • Treatment: topical anesthetic, remove foreign body, and antibiotic ointment
• Lumbar Radiculopathy vs. Herniated Disk:
  • Compression of nerve roots
  • Unilateral, straight leg raise
  • Narrowing, degenerative disk disease
  • Bilateral, extension, claudication, and rest

Acute Pancreatitis

• Presents with severe, sudden-onset abdominal pain and vomiting
• Elevated lipase and amylase levels are key diagnostic markers
• Risk factors: alcoholism and hypertriglyceridemia
• CT scan can reveal pancreatic inflammation and necrosis
• Treatment: supportive care, pain management, and addressing underlying cause

Sickle Cell Anemia

• Autosomal recessive disorder
• If both parents are carriers, there is a 25% chance of having a child with sickle cell anemia
• Sickle cell trait provides some protection against malaria
• Genetic counseling is essential for couples with sickle cell trait

Pyelonephritis

• Bacterial infection of the kidney
• Levoquinolone antibiotic is the most appropriate choice for outpatient treatment
• Other antibiotics used include ceft and tmpsmx
• Urine culture and sensitivity guide antibiotic selection
• Hospitalization may be necessary for severe cases or immunocompromised patients

Measles

• Presents with fever, cough, runny nose, and conjunctivitis
• Koplik spots (small white spots on buccal mucosa) are pathognomonic for measles
• Rash appears 3-5 days after onset of symptoms and spreads from head to trunk and extremities
• Complications: pneumonia, encephalitis, and subacute sclerosing panencephalitis (SSPE)

Subacute Sclerosing Panencephalitis (SSPE)

• Progressive, fatal disorder caused by persistent measles virus infection
• Memory loss, myoclonic jerks, and brain inflammation are symptoms
• MRI and antibody testing aid diagnosis

Raynaud's Phenomenon

• CCBs, nifedipine, and BBs are first-line treatments
• Beta blockers may worsen Raynaud's symptoms by reducing peripheral blood flow

Abdominal Aortic Aneurysm (AAA)

• Most common in men over 65, smokers, and those with a family history
• Classic presentation: asymptomatic; may have back pain, pulsatile abdominal mass, or abdominal pain
• Treatment: surgical repair for aneurysms >5.5cm or symptomatic; watchful waiting with regular imaging for smaller aneurysms

Hepatitis C Virus (HCV) Management

• Risk factors: IV drug use, high-risk sexual behavior, blood transfusion before 1992
• Classic presentation: often asymptomatic, may have fatigue, jaundice
• Diagnostics: HCV RNA quantitative PCR to measure viral load
• First-line treatment: ribavirin, sofosbuvir, ledipasvir

Myasthenia Gravis

• Chronic autoimmune disorder affecting the neuromuscular junction
• Antibodies against acetylcholine receptor (AChR) or muscle-specific kinase impair contraction
• Peak incidence: 20-40 years old, women > men (2:1 ratio)
• Clinical presentation: fatigable weakness of muscles, worsens with repetition and improves with rest
• Diagnostic evaluation: edrophonium test, EMG, and MuSK antibody testing
• Treatment: pyridostigmine, prednisone, azathioprine, IVIG, and thymectomy

Viral Conjunctivitis

• One of the most common causes of viral conjunctivitis is adenovirus type 8
• Contaminated fomites can be a source of infection
• No specific antiviral agent for treatment; symptomatic relief with topical antihistamine/decongestants and warm compresses

Ovulation

• Occurs within 1-2 days of the LH surge and at the time of elevated estrogen levels

Factor V Leiden

• Most common associated abnormality in young adults with otherwise unexplained thrombosis

Acute Respiratory Distress Syndrome (ARDS)

• Severe, acute lung injury causing noncardiogenic pulmonary edema
• Risk factors: sepsis, pneumonia, aspiration, trauma, pancreatitis
• Pathophysiology: alveolar-capillary membrane damage
• Clinical presentation: acute onset dyspnea, tachypnea, hypoxemia, and bilateral diffuse opacities on chest X-ray
• Management: supportive care, treat underlying cause, consider mechanical ventilation and prone positioning

Acute Pancreatitis

• Presents with severe abdominal pain and elevated lipase and amylase levels
• Risk factors include alcoholism and gallstones
• Diagnosis involves imaging studies to reveal pancreatic inflammation and necrosis
• Treatment involves supportive care, pain management, and addressing the underlying cause

Sickle Cell Anemia

• Autosomal recessive disorder
• If both parents are carriers, there is a 25% chance of having a child with sickle cell anemia
• Sickle cell trait provides some protection against malaria
• Genetic counseling is essential for couples with sickle cell trait

Pyelonephritis

• Bacterial infection of the kidney
• Treatment involves antibiotics, with levofloxacin being the most appropriate choice for outpatient treatment
• Urine culture and sensitivity should guide antibiotic selection
• Hospitalization may be necessary for severe cases or immunocompromised patients

Measles

• Presents with fever, cough, runny nose, and conjunctivitis
• Koplik spots (small white spots on the buccal mucosa) are pathognomonic for measles
• The rash appears 2-5 days after the onset of symptoms and spreads from the head to the trunk and extremities
• Complications include pneumonia, encephalitis, and subacute sclerosing panencephalitis (SSPE)

Subacute Sclerosing Panencephalitis (SSPE)

• Progressive, fatal disorder caused by persistent infection with the measles virus
• Characterized by memory loss, myoclonic seizures, and brain inflammation
• Diagnosis involves MRI and detection of anti-measles antibodies

Argyll-Robertson Pupils

• Irregular pupils that constrict poorly to light but accommodate normally to near vision
• Seen in tabes dorsalis, neurosyphilis, and Adie's tonic pupil syndrome
• Caused by lesions in the dorsal midbrain affecting the light reflex pathway while sparing the accommodation reflex pathway
• Associated with loss of deep tendon reflexes, ataxia, and positive Romberg sign in tabes dorsalis

Amaurosis Fugax

• Transient monocular vision loss, often due to emboli from carotid artery atherosclerosis or cardiac source
• Other causes include migraines, retinal detachment, and optic neuritis

Anisocoria

• Unequal pupil sizes
• Causes include Horner's syndrome, third nerve palsy, pharmacologic dilation, physiologic anisocoria, and Adie's tonic pupil

Horner's Syndrome

• Caused by disruption of sympathetic innervation to the eye and face
• Classic triad: miosis (constricted pupils), ptosis (drooping eyelids), and anhidrosis (lack of sweating on affected side of face)
• Etiologies include stroke, tumor, dissection, and cluster headache
• Diagnosis involves clinical evaluation, plus imaging (CT/MRI) to identify lesion location

Celiac Disease

• Greater than 10 grams of fecal fat in 24 hours is most consistent with a malabsorption syndrome such as celiac sprue

Spinal Stenosis and Lumbar Radiculopathy

• Spinal Stenosis: narrowing of the spinal canal, often due to degenerative changes
• Lumbar Radiculopathy: nerve root compression, often due to herniated disc
• Symptoms include leg pain, numbness, weakness, and positive straight leg raise test
• MRI shows compression of nerve roots in lumbar radiculopathy and narrowed spinal canal in spinal stenosis

Alcoholic Hepatitis

• AST:ALT ratio in alcoholic hepatitis is 2:1
• Treatment involves observing mild-moderate cases, treating severe cases, and following up in 2-3 days
• Unreliable patients may require a higher dose of antibiotics

Coronary Artery Spasm

• Caused by focal constriction of coronary arteries
• Can occur in normal or atherosclerotic vessels
• Triggered by smoking, stress, cold, triptans, and medications (e.g., cocaine)
• ECG shows transient ST-segment elevation during episodes
• Treatment involves using CCBs and nitrates

Prinzmetal Angina (Variant Angina)

• Caused by coronary artery spasm
• Occurs at rest, often at night or early morning
• Not typically triggered by exertion
• ECG shows transient ST-segment elevation during episodes
• Treatment involves using CCBs and nitrates

Hemochromatosis

• Autosomal recessive inherited disorder
• Causes cirrhosis, bronze skin pigmentation, and abnormal iron accumulation in tissues
• Intensive phlebotomy is the treatment of choice until the iron overload is corrected

Lung Lesions

• Typical doubling times for lung lesions:
  • Malignant: 1-3 months
  • Hamartoma: 15-20 months
  • Inflammatory (Infectious): 20-40 days
• Different types of lung lesions:
  • Adeno(carcinoma)
  • SCC
  • SCLC
  • Granuloma

Visual Field Defects

• Bitemporal hemianopia: loss of vision in the outer half of both visual fields
  • Lesion: Optic chiasm
  • Common causes: Pituitary tumor, craniopharyngioma, meningioma
• Binasal hemianopia (rare): loss of vision in the inner half of both visual fields
  • Lesion: Bilateral optic nerve lesions at the junction of the optic nerve and chiasm
  • Common causes: Bilateral optic nerve gliomas
• Homonymous hemianopia: loss of vision in the same half of both visual fields
  • Right homonymous hemianopia: lesion in the left optic tract or left occipital lobe
  • Left homonymous hemianopia: lesion in the right optic tract or right occipital lobe
  • Common causes: Stroke, tumor, occipital lobe

Aortic Insufficiency

• Definition: AoV disease causing blood regurgitation into the LV
• Causes: Bicuspid AoV, rheumatic fever, endocarditis, Ao root disease
• Symptoms: Dyspnea, fatigue, angina, wide pulse pressure
• Signs: Diastolic murmur, bounding pulses, displaced PMI
• Diagnosis: Echocardiogram
• Treatment: Medications (vasodilators, ACE inhibitors) for mild-moderate cases, valve replacement for severe cases

Lithium Toxicity and Thyroid Effects

• Lithium has a narrow therapeutic index and can cause toxicity at levels above 1.5
• Signs of toxicity: Nausea, vomiting, diarrhea, ataxia, tremors, seizures, coma
• Lithium can cause hypothyroidism and hyperthyroidism due to inhibition of thyroid hormone release
• Monitor lithium levels, TSH, and free T4 levels every 6-12 months in patients on lithium therapy
• If hypothyroidism develops, treat with levothyroxine while continuing lithium

Acne Vulgaris Treatment

• Mild: Topical retinoids, benzoyl peroxide, or combination products
• Moderate: Topical retinoids + oral antibiotics for 3-4 months
• Severe: Oral isotretinoin for 4-6 months; monitor for teratogenicity and other side effects
• Maintenance: Topical retinoids ± benzoyl peroxide to prevent recurrence

Cardiovascular Disease

• Dilated cardiomyopathy is often caused by chronic alcohol use
• Argyll-Robertson pupils: irregular pupils that constrict poorly to light but accommodate normally to near vision
• Seen in tabes dorsalis, diabetes, and Adie's tonic pupil syndrome
• Caused by lesions in the dorsal midbrain affecting the light reflex pathway while sparing the accommodation reflex pathway

Seizure Disorders

• Amaurosis fugax: Transient monocular vision loss, often due to emboli from carotid artery atherosclerosis or cardiac source
• Anisocoria: Unequal pupil sizes
• Causes of anisocoria: Horner's syndrome, third nerve palsy, pharmacologic dilation, physiologic anisocoria, Adie's tonic pupil
• Myoclonic seizures: Brief, shock-like muscle contractions
• Treatment: Valproic acid, Keppra, Topamax
• Complex partial seizures: Sxs include automatism with loss of awareness
• Treatment: Tegretol, Lamictal
• Simple partial seizures: Sxs include no loss of awareness, may secondarily generalize
• Treatment: Carbamazepine, Keppra, phenytoin

Diabetes Mellitus

• Gastroparesis: Delayed gastric emptying, often due to autonomic neuropathy
• Symptoms: Early satiety, bloating, nausea, vomiting, abdominal pain
• Diagnosis: Gastric emptying study
• Treatment: Dietary modifications, metoclopramide, erythromycin
• Complications: Malnutrition, poor glycemic control, bezoars

Lung Cancer Screening

• Recommended for high-risk individuals
• Ages 50-80 years
• ≥30 pack-year smoking history
• Current smoker or quit within the past 15 years
• Discontinue screening if >15 years since quitting smoking

Tetralogy of Fallot

• Palpable RV lift
• AFP

Fetal Aneuploidy Screening

• First trimester (11-14 weeks): Nucal translucency, PAPP-A, hCG
• Quad screen (15-22 weeks): AFP, hCG, inhibin A, uE3
• CVS (10-13 weeks) or amniocentesis (>15 weeks) for high-risk results
• Ultrasound markers: NT, absent nasal bone, echogenic bowel, shortened femur/humeral bones
• Integrated screening: 1st & 2nd trimester tests combined

ALS

• Characteristic hallmark: Progressive weakness + UMN signs (hyperreflexia, spasticity, positive Babinski sign) and LMN signs (muscle atrophy, fascics, sensory deficits) without sensory deficits

Asbestosis

• Caused by inhalation of asbestos fibers
• Presents with dyspnea, dry cough, inspiratory crackles
• Chest X-ray: Bilateral interstitial fibrosis, pleural thickening, and calcified pleural plaques
• PFTs: Restrictive pattern, decreased lung volumes, normal FEV1/FVC ratio
• Diagnosis: History of asbestos exposure + imaging + PFTs
• Complications: COPD, lung cancer, pleural plaques, pleurisy

Malignant External Otitis

• Severe infection of external auditory canal, typically in elderly patients with diabetes or immunocompromised
• Caused by Pseudomonas aeruginosa
• Presents with severe otalgia, otorrhea, granulation tissue in ear canal
• Can spread to temporal bone, cranial nerves, brain
• Diagnosis: Clinical exam, culture of ear drainage, CT/MRI
• Treatment: Prolonged course of antibiotics, strict glucose control, surgical debridement