➕ When patients with pseudotumor cerebri present with horizontal diplopia, one should suspect Abducens nerve palsy (cranial nerve VI). It has the longest subarachnoid course, and its nucleus is located in the pons, just ventral to the floor of the fourth ventricle. It innervates the lateral rectus muscle.
👍5
⏳ Case-based MCQ | #Case_464
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 25-year-old male is brought to the ED by his friends, who tell you that they were at a party until he started to complain of severe chest pain. They state that the patient did not have anything to drink but did appear to be excessively hyper during the party. As far as they know, he is not currently taking any medication. The patient has had problems with PCP abuse and marijuana in the past.
Vital signs: blood pressure 160/110 mmHg, temperature 38.6°C, heart rate of 110 bpm and respiratory rate of 25 bpm. On physical examination, you note dilated pupils bilaterally, diaphoresis and dry blood at the nares. His EKG shows diffuse ST-segment elevation.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 25-year-old male is brought to the ED by his friends, who tell you that they were at a party until he started to complain of severe chest pain. They state that the patient did not have anything to drink but did appear to be excessively hyper during the party. As far as they know, he is not currently taking any medication. The patient has had problems with PCP abuse and marijuana in the past.
Vital signs: blood pressure 160/110 mmHg, temperature 38.6°C, heart rate of 110 bpm and respiratory rate of 25 bpm. On physical examination, you note dilated pupils bilaterally, diaphoresis and dry blood at the nares. His EKG shows diffuse ST-segment elevation.
👍14❤1
Which of the following should be avoided in the treatment of the patient?
Anonymous Quiz
21%
A. Diazepam
18%
B. Aspirin
13%
C. Diltiazem
35%
D. Propranolol
13%
E. Hydralazine
👍18🤯13😁6
✔ D
The patient is most likely having a cocaine overdose. The presenting symptoms are characteristic of high sympathetic output. With a presentation of blood at the nares and diffuse ST-segment elevation on his EKG, one has to suspect a cocaine overdose.
With a cocaine overdose, one needs to avoid the use of beta-selective blockage (choice D). As cocaine inhibits the reuptake of norepinephrine, there is overwhelming alpha-1-receptor activity causing systemic and coronary vasoconstriction. If one inhibits the vasodilatory action of the beta-2-receptor with the use of propranolol, there is unopposed alpha-1 activity leading to coronary vasoconstriction and worsening of myocardial ischemia.
⚠ In order to control the sympathetic output caused by a cocaine overdose and prevent worsening myocardial ischemia, one needs to use diazepam (choice A), aspirin (choice B), diltiazem (choice C), and hydralazine (choice E).
🔖 Key point:
Avoid the use of beta-blockers in the treatment of cocaine, amphetamine, or other alpha-adrenergic stimulant overdose
The patient is most likely having a cocaine overdose. The presenting symptoms are characteristic of high sympathetic output. With a presentation of blood at the nares and diffuse ST-segment elevation on his EKG, one has to suspect a cocaine overdose.
With a cocaine overdose, one needs to avoid the use of beta-selective blockage (choice D). As cocaine inhibits the reuptake of norepinephrine, there is overwhelming alpha-1-receptor activity causing systemic and coronary vasoconstriction. If one inhibits the vasodilatory action of the beta-2-receptor with the use of propranolol, there is unopposed alpha-1 activity leading to coronary vasoconstriction and worsening of myocardial ischemia.
⚠ In order to control the sympathetic output caused by a cocaine overdose and prevent worsening myocardial ischemia, one needs to use diazepam (choice A), aspirin (choice B), diltiazem (choice C), and hydralazine (choice E).
🔖 Key point:
Avoid the use of beta-blockers in the treatment of cocaine, amphetamine, or other alpha-adrenergic stimulant overdose
👍32👏3
⏳ Case-based MCQ | #Case_465
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 42-year-old African-Canadian male recently travelled to the Caribbean for a scuba diving trip. Since his return, he has noted brief intermittent episodes of vertigo not associated with nausea or vomiting. He is concerned, however, because these episodes occurred after sneezing or coughing and then a couple of times after straining while lifting something. He has had no hearing loss and no vertigo with positional changes such as bending over or turning over in bed. He does mention that it gets worse when he is taking the elevator.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 42-year-old African-Canadian male recently travelled to the Caribbean for a scuba diving trip. Since his return, he has noted brief intermittent episodes of vertigo not associated with nausea or vomiting. He is concerned, however, because these episodes occurred after sneezing or coughing and then a couple of times after straining while lifting something. He has had no hearing loss and no vertigo with positional changes such as bending over or turning over in bed. He does mention that it gets worse when he is taking the elevator.
What is the most likely cause of this patient's vertigo?
Anonymous Poll
18%
A. Vestibular neuronitis
17%
B. Meniere’s disease
20%
C. Benign paroxysmal positional vertigo
32%
D. A perilymphatic fistula
12%
E. Multiple sclerosis triggered by a rapid change in climate
👍23👎1
✔ D
A perilymphatic fistula (choice D) between the middle and inner ear may be caused by barotrauma from scuba diving, as well as by direct blows, heavy weight-bearing, and excessive straining (e.g., with sneezing or bowel movements.) This patient's recent trip involved two of these potential factors. Most patients with fistulas find that their symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes).
⚠ Vestibular neuronitis (choice A) is a more sudden, unremitting syndrome.
⚠ Meniere's disease (choice B) is manifested by episodes of vertigo, associated with hearing loss and often with nausea and vomiting.
⚠ Benign paroxysmal positional vertigo (choice C) is more likely in older individuals and is associated with postural change.
⚠ Multiple sclerosis (choice E) requires symptoms in multiple areas and is not thought to be provoked by climate change.
🔖 Key point:
A perilymphatic fistula between the middle and inner ear may be caused by barotrauma from scuba diving, as well as by direct blows, heavy weight-bearing, and excessive straining. Most patients with fistulas find that their symptoms get worse with changes in altitude (e.g., elevators, airplanes, travel over mountain passes) or air pressure.
A perilymphatic fistula (choice D) between the middle and inner ear may be caused by barotrauma from scuba diving, as well as by direct blows, heavy weight-bearing, and excessive straining (e.g., with sneezing or bowel movements.) This patient's recent trip involved two of these potential factors. Most patients with fistulas find that their symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes).
⚠ Vestibular neuronitis (choice A) is a more sudden, unremitting syndrome.
⚠ Meniere's disease (choice B) is manifested by episodes of vertigo, associated with hearing loss and often with nausea and vomiting.
⚠ Benign paroxysmal positional vertigo (choice C) is more likely in older individuals and is associated with postural change.
⚠ Multiple sclerosis (choice E) requires symptoms in multiple areas and is not thought to be provoked by climate change.
🔖 Key point:
A perilymphatic fistula between the middle and inner ear may be caused by barotrauma from scuba diving, as well as by direct blows, heavy weight-bearing, and excessive straining. Most patients with fistulas find that their symptoms get worse with changes in altitude (e.g., elevators, airplanes, travel over mountain passes) or air pressure.
👍28
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⚠ 🔔 𝐒𝐀𝐕𝐄 𝐓𝐇𝐈𝐒 𝐋𝐈𝐒𝐓 𝐅𝐎𝐑 𝐀 𝐑𝐀𝐈𝐍𝐘 𝐃𝐀𝐘 ! ⤵
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7. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗚𝗘𝗥𝗠𝗔𝗡𝗬 🇩🇪
8. 𝗣𝗥𝗔𝗖𝗧𝗜𝗖𝗘 𝗜𝗡 𝗔𝗨𝗦𝗧𝗥𝗔𝗟𝗜𝗔 🇦🇺
9. 𝗠𝗕𝗕𝗦 & 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗜𝗧𝗔𝗟𝗬 🇮🇹
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14. 𝗚𝗘𝗥𝗠𝗔𝗡 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗕𝗢𝗢𝗞𝗦 🇩🇪
15. 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗥𝗘𝗦𝗘𝗔𝗥𝗖𝗛 🎓
16. 📸 𝗗𝗘𝗥𝗠𝗔𝗧𝗢𝗟𝗢𝗚𝗬 𝗔𝗧𝗟𝗔𝗦
17. 𝗢𝗘𝗧 𝗣𝗥𝗘𝗣𝗔𝗥𝗔𝗧𝗜𝗢𝗡 🔡
18. 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗔𝗠𝗔𝗭𝗢𝗡 🌐
19. 𝗠𝗘𝗗𝗜𝗖𝗖𝗢𝗨𝗡𝗧 - 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗔𝗖𝗖𝗢𝗨𝗡𝗧
1. 🧩 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗠𝗡𝗘𝗠𝗢𝗡𝗜𝗖𝗦 (𝗟𝗘𝗔𝗥𝗡 𝗘𝗔𝗦𝗜𝗟𝗬)
2. 𝗖𝗔𝗦𝗘 - 𝗕𝗔𝗦𝗘𝗗 𝗠𝗖𝗤𝗦 💯
3. 🇨🇦 𝗠𝗖𝗖𝗤𝗘 𝗣𝗥𝗘𝗣𝗔𝗥𝗔𝗧𝗜𝗢𝗡
4. 🩺 𝗘𝗗𝗟 𝗠𝗘𝗗𝗜𝗖𝗢𝗦 (𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗕𝗢𝗢𝗞𝗦 𝗔𝗡𝗗 𝗟𝗜𝗡𝗞𝗦)
5. 📚 𝗘𝗗𝗟 𝗣𝗛𝗔𝗥𝗠
6. 🏛 𝗢𝗡𝗟𝗜𝗡𝗘 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗦𝗖𝗛𝗢𝗢𝗟
7. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗚𝗘𝗥𝗠𝗔𝗡𝗬 🇩🇪
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9. 𝗠𝗕𝗕𝗦 & 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗜𝗧𝗔𝗟𝗬 🇮🇹
10. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗨𝗞 🇬🇧
11. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗨𝗦 🇺🇸
12. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗖𝗔𝗡𝗔𝗗𝗔 🇨🇦
13. 𝗙𝗥𝗘𝗡𝗖𝗛 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗕𝗢𝗢𝗞𝗦 🇫🇷
14. 𝗚𝗘𝗥𝗠𝗔𝗡 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗕𝗢𝗢𝗞𝗦 🇩🇪
15. 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗥𝗘𝗦𝗘𝗔𝗥𝗖𝗛 🎓
16. 📸 𝗗𝗘𝗥𝗠𝗔𝗧𝗢𝗟𝗢𝗚𝗬 𝗔𝗧𝗟𝗔𝗦
17. 𝗢𝗘𝗧 𝗣𝗥𝗘𝗣𝗔𝗥𝗔𝗧𝗜𝗢𝗡 🔡
18. 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗔𝗠𝗔𝗭𝗢𝗡 🌐
19. 𝗠𝗘𝗗𝗜𝗖𝗖𝗢𝗨𝗡𝗧 - 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗔𝗖𝗖𝗢𝗨𝗡𝗧
👍10👎1
Forwarded from Medical Mnemonics
🧩 Medical Mnemonics
Learn Saccular Aneurysm Characters remembering the name of MASHA; A 22-year-old Iranian woman has died after being arrested by Iran's morality police earlier.
May Mahsa Amini rest in peace.🥀🖤
✌We stand for #Woman_Life_Freedom.
💻 Join us on the official Instagram page: Online Medical School
#neurology
〰〰〰〰〰〰〰〰〰〰〰
©Medical Mnemonics
Learn Saccular Aneurysm Characters remembering the name of MASHA; A 22-year-old Iranian woman has died after being arrested by Iran's morality police earlier.
May Mahsa Amini rest in peace.🥀🖤
✌We stand for #Woman_Life_Freedom.
💻 Join us on the official Instagram page: Online Medical School
#neurology
〰〰〰〰〰〰〰〰〰〰〰
©Medical Mnemonics
👍9❤1🤔1
⏳ Case-based MCQ | #Case_465
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 14-year-old girl is brought into the ED by her mother as she is worried about her daughter's weight. On history, she has lost 13.5 kg in the last six months and admits to fatigue, dry skin, hair loss, constipation, and poor concentration at school.
Upon hospital admission, the patient is started on nasogastric feeds to meet minimum caloric requirements. A few days after being admitted, the patient starts complaining of nausea, "stabbing" abdominal pain as well as vomiting without diarrhea. An abdominal radiograph shows a distended stomach but is otherwise normal.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 14-year-old girl is brought into the ED by her mother as she is worried about her daughter's weight. On history, she has lost 13.5 kg in the last six months and admits to fatigue, dry skin, hair loss, constipation, and poor concentration at school.
Upon hospital admission, the patient is started on nasogastric feeds to meet minimum caloric requirements. A few days after being admitted, the patient starts complaining of nausea, "stabbing" abdominal pain as well as vomiting without diarrhea. An abdominal radiograph shows a distended stomach but is otherwise normal.
👍16🔥6❤2
Which of the following diagnoses must be ruled out in this particular patient?
Anonymous Poll
14%
A. Viral gastroenteritis
49%
B. Superior mesenteric artery syndrome
15%
C. Appendicitis
17%
D. Nutcracker syndrome E. Renal colic
5%
E. Renal colic
👍6
✔ B
Superior mesenteric artery syndrome (SMA) (choice B) is the correct answer. This rare, but life-threatening condition must be considered in any patient with a history of rapid weight loss presenting with gastrointestinal symptoms. SMA syndrome describes the compression of the third portion of the duodenum by the abdominal aorta and the overlying superior mesenteric artery (see image below). Retroperitoneal fat and lymphatic tissue normally serve as a cushion for the duodenum, protecting it from compression by the SMA. This cushion effect is lost in cases of rapid weight loss. The resulting duodenal obstruction causes symptoms of epigastric pain (especially postprandial), nausea, vomiting, and early satiety. Abdominal CT scan is the modality of choice to make the diagnosis however signs of duodenal obstruction (gastric distension) may be present on radiographs.
⚠ Viral gastroenteritis (choice A) can have the described symptoms, but would typically be accompanied by lower GI tract symptoms as well (diarrhea). In addition, given this risk for SMA syndrome in this patient, a viral illness would be a diagnosis of exclusion.
⚠ While appendicitis (choice C) could be a possibility in any patient with nausea, vomiting and abdominal pain, the fact that she lacks fever and has a normal white count make it less likely. In addition, appendicitis would not explain the findings of stomach distension on the radiograph.
⚠ Nutcracker syndrome (choice D) describes compression of the left renal vein between the aorta and the SMA. Symptoms are typically left flank pain and hematuria due to venous hypertension. This is an anatomical entrapment syndrome and, unlike SMA syndrome, is not related to sudden weight loss.
⚠ Renal colic (choice E) typically presents with lower back/flank pain radiating to the groin. Most urinary calculi develop from the age of 20-40 (peak from 35-45 years), making it less likely in this adolescent.
🔖 Key point:
Superior mesenteric artery syndrome is rare, but life-threatening condition that must be considered in any patient with a history of rapid weight loss presenting with gastrointestinal symptoms. SMA syndrome describes the compression of the third portion of the duodenum by the abdominal aorta and the overlying superior mesenteric artery.
Superior mesenteric artery syndrome (SMA) (choice B) is the correct answer. This rare, but life-threatening condition must be considered in any patient with a history of rapid weight loss presenting with gastrointestinal symptoms. SMA syndrome describes the compression of the third portion of the duodenum by the abdominal aorta and the overlying superior mesenteric artery (see image below). Retroperitoneal fat and lymphatic tissue normally serve as a cushion for the duodenum, protecting it from compression by the SMA. This cushion effect is lost in cases of rapid weight loss. The resulting duodenal obstruction causes symptoms of epigastric pain (especially postprandial), nausea, vomiting, and early satiety. Abdominal CT scan is the modality of choice to make the diagnosis however signs of duodenal obstruction (gastric distension) may be present on radiographs.
⚠ Viral gastroenteritis (choice A) can have the described symptoms, but would typically be accompanied by lower GI tract symptoms as well (diarrhea). In addition, given this risk for SMA syndrome in this patient, a viral illness would be a diagnosis of exclusion.
⚠ While appendicitis (choice C) could be a possibility in any patient with nausea, vomiting and abdominal pain, the fact that she lacks fever and has a normal white count make it less likely. In addition, appendicitis would not explain the findings of stomach distension on the radiograph.
⚠ Nutcracker syndrome (choice D) describes compression of the left renal vein between the aorta and the SMA. Symptoms are typically left flank pain and hematuria due to venous hypertension. This is an anatomical entrapment syndrome and, unlike SMA syndrome, is not related to sudden weight loss.
⚠ Renal colic (choice E) typically presents with lower back/flank pain radiating to the groin. Most urinary calculi develop from the age of 20-40 (peak from 35-45 years), making it less likely in this adolescent.
🔖 Key point:
Superior mesenteric artery syndrome is rare, but life-threatening condition that must be considered in any patient with a history of rapid weight loss presenting with gastrointestinal symptoms. SMA syndrome describes the compression of the third portion of the duodenum by the abdominal aorta and the overlying superior mesenteric artery.
❤21👍17👏4
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