WPW, AD & ATAXIA

Q. DOC for a pateint with Wolf-Parkinson-White syndrome ...
a) Procainamide
b) Disopyramide
c) Quinidine
d) Amiodarone

Ans:  a) Procainamide

Treatment: Accessory Pathway-Mediated Tachycardias

 " In life-threatening situations, DC cardioversion should be used to terminate the AF. In nonlife-threatening situations, procainamide at a dose of 15 mg/kg administered IV over 20–30 min will slow the ventricular response and may organize and terminate AF. Ibutilide can also be used"

Ref: Harrison Internal Medicine 18 th ed.



Q. An 84 year old woman with Alzheimer's dementia has recently become incontinent and more confused than usual. What is the diagnosis?
a) Detrusor overactivity
b) Neuropathic bladder
c) Nocturnal enuresis
d) Urinary tract infection
e) Uterine prolapse

Ans:  d) Urinary tract infection

UTI is very common in Alzheimer disease that results in sudden deterioration of consciouslevel. Patient may beome profoundly confused.
Neuropathic bladder do not results in confusion.


Q. A 38 year old man with longstanding alcohol dependence has vertigo and a tremor every morning. What is the diagnosis?
a) Anxiety
b) Benign positional vertigo
c) Cerebellar degeneration
d) Optic neuritis
e) Temporal lobe epilepsy

Ans: cerebellar degeneration

In patients with alcohol-related ataxia, the symptoms affect gait and lower limbs more than arms and speech, often also with signs of peripheral neuropathy. The ataxia can stabilise or even improve with stopping alcohol, but worsen in those who continue. Brain imaging typically shows vermis atrophy.
Alcohol is directly toxic to the cerebellum, causing degeneration of the anterior superior vermis and hemispheres. 

ANTICONVULSANTS

ANTICONVULSANTS:

Q. A 35-year-old woman, recently diagnosed with simple partial seizures, started the prescribed therapy. Her past history was unremarkable, but her mother was known to suffer from acute intermit tent porphyria. Which of the following anticonvulsant drugs would be appropriate for this patient?
A. Diazepam
B. Ethosu ximide
C. Valproic acid
D. Carbamazepine
E. Phenytoin
F. Lamotrigine

Ans:  F.  Lamotrigine

Explanation:  Lamotrigine is effective in simple partial seizures, as well as in generalized tonic-clonic and absence seizures. It appears to have comparable effectiveness with more traditional anticonvulsant drugs, such as valproic acid, carbamazepine, and phenytoin. The primary mechanism of action of lamotrigine most likely includes a frequency-dependent blockade of voltage-gated Na+ channels. C−E Valproic acid, carbamazepine, and phenytoin are firstchoice drugs in partial seizures, but they are contraindicated when there is a risk of acute intermittent porphyria, because they can trigger an attack. Because acute intermittent porphyria is an autosomal disorder, it is bet ter to avoid these drugs in patients whose parents are known to suffer from the disease, as in this case. A, B Diazepam and ethosuximide are not effective in simple partial seizures.

Q. A 53-year-old man suffering from partial seizures had been receiving a high dose of carbamazepine for 6 months. Which of the following dose-related adverse effects most likely occurred during the therapy?
A. Gingival hyperplasia
B. Hallucinat ions
C. Ataxia
D. Stevens−Johnson syndrome
E. Heart failure
F. Dilut ional hyponatremia

Ans: C. Ataxia

Explanation: Some of the adverse e ects of carbamazepine are related to cerebellar-vestibular impairment. The most common  dose-related adverse effect of this kind is ataxia (up to 15%

of patients). A This would be an adverse e ect of phenytoin. It does not occur with carbamazepine. B, D−F All these are serious but quite rare adverse effects of carbamazepine.

 
Q. A 24-year-old woman with a long history of absence seizures had been successfully managed with valproic acid for the past 5 years. The patient had recently married, and during her last visit she expressed the desire to start a family. Which of the following drugs would be most appropriate for this patient to substitute for valproic acid therapy?
A. Carbamazepine
B. Clonazepam
C. Phenytoin
D. Ethosuximide
E. Phenobarbital
F. Tiagabine

Ans: D. Ethosuximide

Explanation: Valproic acid is classified by the U.S. Food and Drug Administration as pregnancy category D because it increases the 
 risk of neural tube defects (up to 20-fold) when given during pregnancy. Ethosuximide is instead classi ed as pregnancy category C and is a rst-line drug for absence seizures. A−C, E, F These drugs are not effective (and some of them can even be dangerous) in absence seizures.