(Test Bank) Divine Intervention Step 2Ck Podcasts Notes - Read Only File, Latest Update 2020.

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Divine Intervention Step 2CK Podcasts Notes - Read Only File LAST UPDATE: AUGUST 25, 2020 Official Errata To submit any errors ( revised weekly! ) please use this document: Click to report errors here! Announcements: ● Episodes 19, 45, and 206 have been rewritten, replaced, and edited for clarity. ● Document margins were reduced from 1.0 to 0.5. Same content but reduced file size by ~50 pages. Podcast Episodes Pending: ● Ep 257 [Clutch Bilirubin Podcast] ○ Help us transcribe this episode here -> Google Doc - Ep 257 [Clutch Bilirubin Podcast] ● Ep 256 [Rapid Review Series 41] ○ Help us transcribe this episode here -> Google Doc - Ep 256 [Rapid Review Series 41] ● Ep 255 [Legendary Step 2CK/3 Pharmacology] ○ Help us transcribe this episode here -> Google Doc - Ep 255 [Legendary Step 2CK/3 Pharmacology] ● Ep 22 [OBGYN Shelf Review] ○ Help us transcribe this episode here -> Google Doc - Ep 22 [OBGYN Shelf Review] Recently Completed: ● Ep 253 [Starling Forces and the NBME] ○ Thank you!! ● Ep 251 [The HY Thyroid Podcast] ○ Thank you!! Questions, comments, or feedback regarding this file? Refer to the thread on Reddit here, or reach out to u/Coffee_Beast directly on Reddit. 1 Common abbreviations you’ll find on the following pages: #1 RF = number one risk factor NBS = next best step MCC = most common cause MCCOD = most common cause of death Tx = treatment Dx = diagnosis MI = most important MIPF = most important prognostic fa ctor MIRF = most important risk factor MSC = most serious complication ML = most likely MLM = most likely mechanism MLCP = most likely clinical presentation NBSIM = next best step in management POOP = pain out of proportion Table of Contents 2 Episode 17: Peds Diseases of The Pediatric Population Part 1. 6 Episode 19: Neurology Shelf review part 1 10 Episode 21: Comprehensive Pediatric 3rd Year Shelf Review 16 Episode 26: USMLE Radiology 19 Episode 29: 3rd Year Medicine Shelf Review Part 1 21 Episode 30: Comprehensive Medicine Shelf Review Session 2. 34 Episode 31: Comprehensive Medicine Shelf Review. Session 3. 61 Episode 32: Comprehensive Medicine Shelf Review Session 4 96 Episode 36: Ophthalmology 121 Episode 37: Risk Factors 125 Episode 41: Antibiotic Guide 127 Episode 45: Neurology Clerkship Shelf Review Part 2 133 Episode 46: Neurology Clerkship Shelf Review Part 3 139 Episode 47: Neurology Clerkship Shelf Review Part 4 143 Episode 48: Neurology Clerkship Shelf Review Part 5 145 Episode 49: Neurology Clerkship Shelf Review Part 6 151 Episode 58: Neurology Clerkship Shelf Review Part 7 159 Episode 59: Neurology Clerkship Shelf Review Part 168 Episode 65: Ventilator Physiology for the USMLEs 175 Episode 94: Rapid Review, Series 1, Peds 176 Episode 95: Rapid Review, Series 2, Peds 177 Episode 97: “Most Important ” 180 Episode 100: The Clutch Micro 181 Episode 102: The “Clutch” cancer podcast (IN PROGRESS) 185 Episode 102: The “Clutch” cancer podcast (Version 2) 190 Episode 104: ACLS, Arrhythmias, and HY Cardiac Pharm 198 Episode 111: The “Clutch” Pharmacology Podcast Round 1 201 Episode 112: The “Clutch” Pharmacology Podcast Round 2 212 Episode 118: Confusing Breast Pathologies 227 Episode 119: Rapid Review Series 3 (IM) 227 3 Episode 120: Rapid Review Series 4 (IM/Peds) 229 Episode 121: Rapid Review Series 5 (IM/Peds) 231 Episode 123: Ethics I 233 Episode 125: Rapid Review Series 6 (IM) 235 Episode 126: Rapid Review Series 7 (IM) 237 Episode 127: Rapid Review, Series 8 OB/GYN 238 Episode 128: Rapid Review Series 9 (IM) 239 Ep 129: (Targeted Pulmonary Review) 241 Episode 130 : Rapid Review Series 10 (Peds) 248 Episode 131: Rapid Review Series 11 (OB, Psych, IM, Neuro) 250 Episode 132: Weird topics of Social Sciences 253 Episode 132: Weird topics of Social Sciences (Version 2) 256 Episode 134: Rapid Review Series 12 (IM/ Cardi ology) 264 Episode 135: The Clutch Electrolytes 265 Episode 137: Next Best Step In Management Series 1 270 Episode 138: The Clutch Genetic Disease 275 Episode 141: Rapid Review Series 13 (IM) 281 Episode 143: Biostats Review 285 Episode 145: Rapid Review, Series 14, Surgery 296 Episode 153: Rapid Review, Series 15, Surgery 298 Episode 156: Rapid Review, Series 16, OB/GYN 300 Episode 158: Rapid Review, Series 17, Surgery 300 Episode 159: Rapid Review Series 18 (IM) 301 Episode 161: The Clutch Antibody 304 Episode 163: Rapid Review, Series 19, Surgery (Abdomen) 307 Episode 164: The Clutch Toxicology Podcast (Drugs of abuse, overdose, withdrawal, toxidromes) 310 Episode 166: Rapid Review Series 20 (Psych) 316 Episo de 167: Rapid Review Series 21 Cardio 317 Episode 169: Clutch Nephrotic/Nephritic Syndrome 320 Episode 169: Clutch Nephrotic/Nephritic Syndrome (Version 2) 322 4 Episode 173: The Clutch Immunodeficiency Diseases Podcast 324 Episode 174: Rapid Review Series 22 (IM) 328 Episode 175: Rapid Review Series 23 (Psych) 330 Episode 177: Rapid Review Series 24 (OGBYN) 333 Episode 180: Hematology 335 Episode 181: Comprehensive NBME Emergency M edicine Shelf Review Series 1 336 Episode 182: Comprehensive NBME Emergency Medicine Shelf Review Series 2 349 Episode 183: Comprehensive NBME Emergency Medicin e Shelf Review Series 3 351 Episode 184: NBME weird 364 Episode 187: Rapid Review Series 25 370 Episode 189: Rapid Review Se ries 26 373 Episode 195: Rapid Review Series 27 376 Episode 196: Rapid Review Series 28 378 Episode 197: Bias in Biostatistics 381 Episode 198: Clutch Hypertensive Integrations. 383 Episode 199: Rapid Review Series 29 386 Episode 202: Rapid Review Series 30 389 Episode 203: Leukemia and Lymphoma 392 Episode 204: Military Part 1 394 Episode 206: Family Medicine Shelf Review Series 1 395 Episode 207: Geriatrics 399 Episode 207: Geriatrics (Version 2) 401 Episode 208: Transfusion Reactions 402 Episode 209: Family Medicine Shelf Review Series 2 404 Episode 210: Rapid Review Series 31 406 Episode 211: Rapid Review Series 32 407 Episode 212: Family Medicine Shelf Review Series 3 (GI) 410 Episode 213: Family Medicine Shelf Review Series 4 (GI) 414 Episode 214: Family Medicine Shelf Review Series 5 - GI 415 Episode 214: Family Medicine Sh elf Review Series 5 - GI (Version 2) 419 5 Episode 215: Acetylcholine and The NBME 421 Episode 217: Family Medicine Shelf Review Series 6 - Pulm 424 Episode 217: Family Medicine Shelf Review Series 6 - Pulm (Version 2) 427 Episode 219: Rapid Review Series 34 429 Episode 220: Rapid Review Series 34 431 Episode 221: Trauma 436 Episode 223: NBME Peds Shelf Add -On: The HY Newborn 437 Episode 224: Genetic Diseases 2: Chromosomes 441 Episode 225: Rapid Review Series 35 446 Episode 226: Iron labs 448 Episode 227: Rapid Review Series 36 (OBGYN + Others) 449 Episode 228: CLEAN -SP 1 Palliative 451 Episode 230: CLEAN -SP 2 Quality/Safety 452 Episode 231: Military Part 2 453 Episode 232: Vasculitis 455 Episode 233: Shock 457 Episode 233: Shock (Version 2) 459 Episode 234: CLEAN -SP 2 Medication/Transition of Care 460 Episode 237: (HIV) 462 Episode 238: Rapid Review Series 37 463 Episode 239: OBGYN Risk Factors 466 Episode 240: Rapid Review Series 38 (Ortho and OBGYN) 467 Episode 242: Dermatology Part (1 of 3) 469 Episode 243: Water Soluble Vitamins 472 Ep 244: (Cardiac Valvular Disorders) 475 Ep 245: (Rapid Review Series 39) 480 Ep 246: (Derm Part 2 of 3) 481 Ep 247: (Rapid Review Series 40) 486 Ep 24 8: [New Free 120 Q1 -10 (2020)] 488 Ep 249: (Blood Oxygen Content and the USMLEs) 488 6 Ep 250: [HY Vaccine] 491 Ep 251: [The HY Thyroid Podcast] 495 Ep 252 [Post Exposure Prophylaxis and the NBMEs] 499 Ep 253 [Starling Forces and The NBMEs] 501 ---------------------------------------------------------------------------------------------------------------------------- Episode 17: Peds Diseases of The Pediatric Population Part 1. 7 GI PROBLEMS IN KIDDOS ● 7 yo Asian male w/ chronic watery diarrhea + stool positive for reducing sugars + positive hydrogen breath test → lactose intolerance = lactase deficiency ○ Tx: ■ Infant: soy -based formula ■ Child: Avoid lactose ● 23 mo w/ bowed LE (vit D def) + diffuse blisteri ng rash over patellae (dermatitis herpetiformis) + diffuse muscle wasting + MCV 60L (iron deficiency), serum Ca+ 7.1L → celiac disease ○ Dx: ■ tTG-IgA *but IgA deficiency is common ■ If IgA deficient → check gliadin Ab (IgG) ■ Duodenal bx: flattening of micro villi, intraepithelial lymphocytes ○ Tx: ■ Avoid gluten ■ Vitamins ■ For dermatitis herpetiformis: dapsone ● Caution in G6PD deficiency ● IgA deficiency ○ Anaphylactic transfusion reaction (type I hypersensitivity rxn) ● 8 mo drinks cow milk, causes bloody stool → milk protein allergy ○ Outgrown by age 1 ○ Tx: formula with casein hydrolysate ● 5 yo kid w/ chronic constipation, immigrant from South America, rectal e xam is accompanied by an explosive expulsion of poop → Hirschsprung's disease ○ Failure of neural crest cell migration to distal colon ○ Dx: distal colon biopsy w/ absence of Auerbach’s plexus ○ Tx: resect affected bowel, end -to-end anastomosis ○ Association: Down syndrome ○ Mimic: Trypanosoma cruzi (Chagas) destroys enteric nervous system → megacolon ● 18 mo w/ recent URI, now with severe abdominal pain & bloody diapers + RLQ mass → intussusception ○ Pressure necrosis of bowel if not corrected quickly ○ Lead point for te lescoping: Mecklel’s diverticulum, hyperplasia of Peyer’s patches in terminal ileum ○ Dx: ■ US w/ target sign ■ Air enema (diagnostic & therapeutic) ○ Tx: surgery is air enema not effective ○ If a kid gets septic after air enema? Think bowel perforation, do XR (see free air under diaphragm), give abx & straight to OR ● 4 yo with 12 hrs of severe abdominal pain and n/v + WBC 13k + US w/ echogenic material (likely fecolith) in the RLQ and fat stranding ○ Dx: Appendicitis ■ How to dx: US (Kid) ○ PE findings (challenging / not always given in Peds population vignettes) ■ McBurney’s point tenderness ■ Psoas sign 8 ■ Obturator sign (pain with internal rotation of hip) ■ Rovsing’s sign (palpation of LLQ → pain in RLQ) ○ Tx: IVF, broad -spectrum abx (e.g. amp + gent + clinda/metro OR ceftriaxone + metro), lap appy ○ Complications: abscess, perforation GENETICS REVIEW ● Myotonic dystrophy → trinucleotide repeat disorder ○ CTG repeat ● Fragile X Syndrome → trinucleotide repeat disorder ○ CGG repeat ● Angelman → maternal deletion or paternal uniparental disomy (both chromosomes from dad) ● Prader -Willi Syndrome → paternal deletion or maternal uniparental disomy (both chromosomes from mom) ● Beckw ith Wiedemann Syndrome → imprinting disorder of chromosome 11, can be caused by paternal uniparental disomy ● Trisomy 21 → maternal nondisjunction or unbalanced robertsonian translocation ● Mom passing a disease to all her kids → mitochondrial inheritance ○ Ex: MELAS (Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke -like episodes) ○ Ex: MERRF (Myoclonic epilepsy with ragged red fibers ) ○ Ex: Leber's hereditary optic neuropathy & other optic neuropathies CHROMOSOME DISORDERS ● Down’s syndrome = Trisomy 21 ○ Gene tic pathophysiology? ■ maternal nondisjunction (failure to separate in meiosis I or II) ■ Robertsonian translocation (RT) ○ Early onset neuro dz? Alzheimer dz (presenilin is on chromosome 21) ○ Classic hematologic malignancy? ALL (TdT positive) ■ “ALL fall Down” ○ Considerations before beginning sports? Cervical XR to screen for atlanto -axial instability ○ Hand findings? Single palmar crease ○ Common cardiac defect? Endocardial cushion defects (endocardial cushion derived from neural crest) ○ Common GI defects? ■ Hirschprung’s ■ duodenal atresia (bilious vomiting, double bubble) ■ pyloric stenosis (first 8 weeks of life, non -bilious vomiting, olive -shap ed mass, erythromycin exposure increases risk) ○ Maternal quad screen findings ■ High beta -hcg & inhibin A ■ Low AFP & estriol ■ “HIGH” → Hcg & inhibin are high ○ How many chromosomes are found in a RT carrier (balanced RT)? 46 ○ How many chromosomes are found in a pa tient with Downs Syndrome from a RT (unbalanced RT)? 46 ● Prominent occiput + overlapping digits + clenched fists + rocker bottom feet → Edward syndrome (trisomy 18) 9 ● Microcephaly + cleft lip/palate + polydactyly + rocker bottom feet → Patau syndrome (trisomy 13) ● 5 yo M with a long face, large ears, and large testicles → Fragile X syndrome ○ CGG repeat ○ Inheritance? X -linked, trinucleotide repeat ■ Genetic anticipation (worsens with each generation) ○ Dx: FMR1 genetic testing ○ Psych association: ADHD, Autism ○ Neuro association: mild intellectual disability, seizures ■ Most common cause of inherited ID in the US! ● Tall male + Gynecomastia + Infertility + no facial hair → Kleinfelter syndrome ○ Karyotype? 47XXY ● Female with a low posteri or hairline, webbed neck, congenital lymphedema or cystic hygroma, and short stature → Turner syndrome ○ Karyotype? 45X ○ Aortic pathologies? Bicuspid aortic valve → early AS, coarctation of the aorta → hypertension in arms & hypotension in legs ○ Renal patholog y? Horseshoe kidney ○ How can the short stature be corrected? Give growth hormone ○ How can the development of secondary sexual characteristics be promoted at puberty? Give estrogen ○ What is the “kind” of hypogonadism associated with this disorder? hypergonadotropic hypogonadism (streak ovaries → no estrogen → no negative feedback → high L H/FSH) ○ As an aside, what is the male equivalent (similar findings) of Turner’s syndrome? Noonan syndrome ■ Is this disorder only present in males? NO! ■ What is the mechanism of inheritance? AD ■ Genetic mutation? PTPN11 mutation ■ What is one good “cardiac clue” on exams to help with differentiating this counterpart from Turner’s syndrome? RVOT problems (e.g. pulmonic stenosis) IMPRINTING DISORDERS ● Male with short stature, obesity, small testicles & penis, huge appetite → Prader -Willi syndrome ○ Neonate: hypotonic, feeding difficulties, cryptorchidism ○ Paternal chromosome is usually “on”, maternal chromosome is imprinted ○ Deletion of paternal chromosome ■ “Prader has no papa” ○ Maternal uniparental disomy ● Female with ataxia, small face, uncontrollable laughter → Angelman syndrome ○ Maternal chromosome is usually “on”, maternal chromosome is imprinted ○ Deletion of maternal chromosome ■ “M” in AngelMan for Mom ○ Paternal uniparental disomy VACTERL / CHARGE / CATCH -22 ASSOCIATIONS ● VACTERL association ○ V = vertebral ○ A = anal atresia 10 ○ C = cardiac defect ○ TE = TE fistula (often with esophageal atresia) ○ R = renal defect ○ L = limb defect ● CHARGE association ○ C = coloboma (keyhole defect in iris) ○ H = heart defect ○ A = atresia of the choanae (blue but pinks up when they cry) ○ R = retardation ○ G = GU anomalies ○ E = ear anomalies ● CATCH -22 association? DiGeorge syndrome = velocardiofacial syndrome ○ Failure of 3rd and 4rd pharyngeal pouches, derived from endoderm, to develop normally ○ Cardiac abnormality (commonly interrupted aortic arch , truncus arteriosus and tetralogy of Fallot ) ○ Abnormal facies (e.g. micrognathia) ○ Thymic aplasia (no thymic shadow o n newborn CXR) → T cell deficit → viral & fungal deficits ○ Cleft palate & cognitive deficits ○ Hypoparathyroidism → hypocalcemia → seizure and/or QT prolongation ○ 22q11 deletion --------------------------------------------------------------------------------- ------------------------------------------- Episode 19: Neurology Shelf review part 1 ● Brain tumor that causes loss of “verti cal gaze” → pinealoma (causes Parinaud’s syndrome) ○ Pathophys? Compression of superior colliculus, which is the vertical conjugate gaze center ● 13 mo child with history of hypopigmented macules + seizures. → tuberous sclerosis ○ Hypopigmented macules = ash leaf spots ○ Associated seizure syndrome? West syndrome (infantile spasms) ■ EEG finding? Hypsarrhythmia ■ Tx? ACTH or vigabatrin ● Most common primary brain tumor in kids → pilocytic astrocytoma ○ Histology? Rosenthal fibers ○ Marker? GFAP (glial cell marker) ● Medulloblastoma ○ Location? Cerebellar vermis ○ Histology? Homer -Wright rosettes ● Brain tumor presenting as hydrocephalus → ependymoma ○ Histology? Periva scular pseudorosettes or ependymal rosettes ● Brain tumor causing visual problems in kid → craniopharyngiomas ○ Derived from? Rathke’s pouch ○ Imaging? Calcified suprasellar mass ○ Complications? ■ Bitemporal hemianopsia (2/2 optic chiasm compression) 11 ■ Anterior pit uitary hormone deficiencies (2/2 pituitary stalk/gland compression) ● MC cause of brain tumor in adults → metastasis ○ Location? Grey -white junction ○ Imaging? Multiple well -circumscribed lesions ● Most common primary brain tumor in adults → GBM ○ Imaging? Butterf ly-shaped mass that crosses corpus callosum + edema + central necrosis ○ Marker? GFAP (glial cell marker) ○ MC brain tumor excluding mets ● Bilateral acoustic neuromas ○ Pathophys? Schwannoma of CN8 ○ Location? Cerebellopontine angle ■ #1 MC tumor at cerebellopontine angle → acoustic neuroma ■ #2 MC tumor at cerebellopontine angle → meningioma ○ Tumor marker? S -100 ○ Associated syndrome? NF -2 ● Brain tumor that presents as parasagittal mass along falx cerebri → meningioma ○ Histology? Psammoma bodies (“laminated calcifications”) ● 2 yo child with abdominal mass that crosses midline + myoclonus + weird eye movements + calcified mass on imaging → neuroblastoma ○ Alternate location: posterior mediastinum ○ Associated syndr ome? ■ NF-1 ■ Beckwith -Weideman syndrome ● Neuroblastoma / Wilms tumor / hepatoblastoma ● Hemihypertrophy ● Macroglossia ● Enlarged abdominal organs ● Abdominal wall defects ● Hypoglycemic seizure in newborn ○ Pathophys? hyperplasia of beta cells of pancreatic islets ● 2 yo child with abdominal mass that does not cross midline + no calcifications → Wilms tumor ● Frontal lobe tumor → oligodendroglioma ○ Histology? fried egg appearance ● Brain tumor that produces EPO → he mangioma blastoma ○ Associated syndrome? VHL syndrome ○ Treat because they can cause a life -threatening hemorrhage! ● Recent viral illness + vertigo + tinnitus → labyrinthitis ● Feeling like room is spinning with positional changes + nystagmus with provocative maneuvers → BPPV (caused by otolith displacement) ○ Diagnostic maneuver? Dix -Hallpike ○ Tx? Epley / Semont maneuver 12 ● Anesthesia over medial thigh + weak thigh adduction → obtur ator nerve injury ○ Nerve roots? L2 -L4 ● Anesthesia over lateral thigh → lateral femoral cutaneous nerve injury ● 7 yo kid with ataxia + hypertrophic cardiomyopathy + LE hyporeflexia → Freidrich’s ataxia ○ Pathohpys? ■ GAA repeats → LOF mutation in frataxin gene ( iron binding protein) → iron overload causes oxidative damage ● Destruction of dorsal columns of spinal cord → hyporeflexia ● Cerebellar destruction → ataxia ○ Inheritance? AR ■ Unlike other trinucleotide repeat disorders, which are AD ○ Repeat? GAA ○ MC cause of deat h? CHF 2/2 hypertrophic cardiomyopathy ● 35 yo F with a BMI of 35 with visual difficulty and severe intermittent headaches. She takes tetracycline for acne. → idiopathic intracranial hypertension (“pseudotumor cerebri”) ○ Imaging/Procedure Mgmt: ■ 1st step? Fun doscopic exam → shows papilledema ■ 2nd step? Head CT → is normal ■ 3rd step? LP → shows elevated OP ○ Tx? ■ Weight loss ■ Acetazolamide (carbonic anhydrase inhibitor) ■ Serial LPs ■ VP shunt ○ Tx for severe visual difficulties? optic nerve fenestration (relieves pressure) ○ Triggers? ■ Tetracyclines (i.e. female patient getting acne tx) ■ Vit A derivatives ● Management of ischemic stroke (caused by blockage w/i blood vessel) ○ Initial imaging? Non -contrast head CT to DDx ischemic stroke vs. hemorrhagic stroke b/c blood looks just like contrast ☺ ○ Next imaging? MRI ○ Time window for tPA administration? 3 -4.5 hrs ■ Up to 6 hrs if you can inject tPA directly into involved vessel ○ HY contraindications to TPA administration ■ Bleeding disorder ■ GI bleeding ■ Recent brain surgery ○ Blood pressure management? ■ Permissive HTN (BP up to 220/120) in patients with ischemic strokes only in pt’s that cannot NOT get TPA 13 ● Why? Increased BP keeps vessels perfused, which optimizes blood flow to ischemic penumbra of brain ■ If getting tPA, BP < 185/110 ■ If hemorrhagic stroke with high BP, can lower BP with labetalol, nitroprusside, nicardipine ● 78 yo has 15 min episode of complete vision in one eye that has since resolved. → amaurosis fugax (TIA) ○ Classic presentation? Painless loss of vision in one eye, “curtain coming down” ○ Dx? ■ Non-contrast head CT ■ Brain MRI ■ Echo (to look for origin of clot) ■ Carotid US ○ NBSIM? Probably carotid US on shelf exam ○ Prevention of further episodes? ■ Aspirin ■ Aspirin + dipyridamole ■ If aspirin contraindicated, clopidogrel ○ Indications for carotid endo ■ >70% stenosis ■ Symptomatic ○ #1 modifiable RF for a stroke? HTN ● 6 yo M wi th difficulty walking + uses arms to “walk up” his legs/thighs (Gower’s sign) + hypertrophy of calves bilaterally. → Duchenne muscular dystrophy ○ Gene? DMD ○ Mutated protein? Dystrophin (stabilizes sarcolemma to cytoskeleton) ○ Inheritance? X -linked recessive ○ Dx? ■ Increased creatine kinase levels ■ Genetic testing for dystrophin gene mutation ○ Tx? ■ Steroids ■ High-calorie nutrition ○ MC cause of death? Respiratory failure or cardiac causes ● Muscular dystrophy + intelligence + life expectancy in the 50s → Becker muscular dystrophy ○ Pathophys? Have some functional dystrophin ○ Gene? DMD ○ Mutated protein? Dystrophin ○ Inheritance? X -linked recessive ● Ataxia + confusion + ophthalmoplegia → Wernicke encephalopathy ○ Reversible ○ Imaging? Hemorrhagic infarct of mamillary bodies ○ Pathophys? Vitamin B1 deficiency ○ Function of which enzyme affected? Transketolase in pentose phosphate pathway 14 ■ Decreased transketol ase activity ○ Tx? IV thiamine then glucose ○ Note : “ophthalmoplegia” means eye problem; pt’s with Wernicke -Korsakoff can have any eye problem, e.g. nystagmus, lateral gaze palsy, etc. ● Complication of untreated Wernicke encephalopathy? Korsakoff syndrome ○ Irreversible ○ Sxs: ataxia + confusion + ophthalmoplegia + amnesia + confabulation ● 40 yo F with diplopia or droopy eyelids worse at end of day + difficulty swallowing + weird speech → myasthenia gravis ○ Pathophys? Antibodies to post -synaptic nicotinic ACh recept or ○ Dx? anti -AChR or anti -MUSK Ab testing ■ NOT edrophonium test/Tensilon test (no longer standard of care) ○ Tx? AChE inhibitors (e.g. pyridostigmine) ○ Associated malignancy finding? Thymoma (anterior mediastinal mass) ● NBSIM for patients with myasthenia gravis ? CT chest to look for thymoma ○ b/c removal of thymoma can resolve myasthenia gravis ● Smoker with proximal muscle weakness that improves with use → LEMS ○ Pathophys? Antibodies to presynaptic voltage -gated Ca++ channel ● Lateral medullary syndrome (Wallenberg syndrome) causes dysphonia, dysphagia, and loss of gag reflex ○ Blood vessel occluded? PICA occlusion ○ Loss of pain and temperature on left face → L trigem inal nerve ○ Loss of pain and temperature on right side of the body→ L spinothalamic tract ■ Located in lateral brainstem ■ Decussates at anterior white commissure → contralateral sxs ○ Absent gag reflex, dysphonia, dysphagia → CN9/10 ■ Medulla ○ Vertigo → CN8 ■ Pons/Medulla ○ Ptosis and miosis on left (Horner’s) → L sympathetic tract to superior cervical ganglion ■ Located in lateral brainstem ● Medial medullary syndrome causes tongue deviation to ipsilateral side ○ Blood vessel occluded? Anterior spinal artery occlusion ○ Right sided paralysis → L corticospinal tract ■ Runs through medial brainstem ■ Decussates at level of medullary pyramids ○ Tongue deviation to the left. → L CN12 ■ Tongue deviation to ipsilateral side