Neuro
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    Diseases

  • Dementia: Problem w memory, cognition, and it's interfering w life.
    • Alzheimer's disease: dementia (esp short term memory), old age, MRI shows brain atrophy, tx w cholinesterase inh (donepezil), NMDA inh (memantine).
    • Lewy body dementia: dementia (esp attention, task completion), fluctuating cognition, hallucinations, Parkinsonism, REM disorder (act out dreams), MRI shows grossly nl brain.
    • Vascular dementia: dementia, stroke symptoms, Hx of stroke, MRI shows cerebral vascular dz.
    • Frontotemporal dementia: apathy, disinhibition, motor problems, MRI shows bilateral frontal, temporal lobe atrophy.
    • PSP: imbalance, apathy, slurred speech, difficulty swallowing, pathology shows tau positive neurofibrillary tangles.
    • Corticobasal degeneration: alien hand syndrome (pt is unable to control one of his/her hand), rigidity, MRI shows asymmetric brain atrophy.
    • CJD: dementia, ataxia, startle myoclonus, atypically young age, MRI shows caudate, putamen infiltration, autopsy shows prions.
    • Huntington's disease: upper body chorea, dementia, depression, AD FHx, caudate atrophy, dx w genetic testing (CAG repeat, chr 4).
  • Movement probems
    • Parkinson's disease: resting tremor (pill-rolling, unilat onset, goes away w motion), bradykinesia (slow, shuffling gait, turns), rigidity, sub nigra depig (dopamine↓), tx w L-dopa, deep brain stim.
    • Essential tremor: bilateral upper body (hand, voice) tremor, alleviates w EtOH, positive FHx.
    • ALS: weakness (task performance, swallowing, walking) with both upper (Babinski, hyperreflexia) and lower (fasciculations) motor neuron dmg (sensory intact)..
    • Huntington's disease: upper body chorea, dementia, depression, AD FHx, caudate atrophy, dx w genetic testing (CAG repeat, chr 4).
    • Friedrich's ataxia: cerebellar ataxia (limb/finger-to-nose, gait/staggering), young age, AR FHx, lower limb areflexia, dx w genetic testing (GAA expansion in frataxin).
  • Neuropathies: sensory (loss, numb/ting), motor (weakness/atrophy)
    • Polyneuropathies: distal sensory (loss, numb/ting) and motor (weak, atrophy, areflexia)
      • Guillain-Barre syndrome: ascending weakness, infection trigger, hyporeflexia, dx w LP (protein↑), EMG (conduction↓), serology (anti-GQ1b).
      • Multiple sclerosis: relapsing neuro symptoms (numb/ting, vision, paresis, gait), MRI (lesions in diff part of CNS), LP (oligoclonal bands).
      • Charcot-Marie-Tooth: muscle atrophy (weak, cramp), arched feet, foot drop, decreased sensory (touch, position), AD or Xlink FHx.
      • Diabetic neuropathy: distal sensory loss, Hx of diabetes, watch out for foot injury/infection.
      • CIDP: Chronic/relapsing Guillain-Barre (ascending weakness, hyporeflexia, conduction block), tx w immunosuppression.
    • Leukodystrophies: prob w forming myelin bcz accumulation of lipids
      • ALD: kids w neuro probs (cognitive, behavioral, blindness, paresis), Xlink FHx, dx w VLCFA↑, MRI (occipital wht matter lesion).
      • MLD: neuro deficit (cognitive, behavior, motor, ataxia), AR FHx, arylsulfatase activity↓, conduction velocity↓.
      • Krabbe's disease: neuro symptoms, AR FHx, galactocerebrosidase↓, conduction velocity↓.
    • Motor neuron dz: no sensory symptoms, anterior horn dmg
      • ALS: weakness (task performance, swallowing, walking) with both upper (Babinski, hyperreflexia) and lower (fasciculations) motor neuron dmg (sensory intact)..
      • Spinal muscular atrophy: floppy infant, muscle wasting, lower motor neuron dmg (fasciculations), AR FHx.
      • Poliomyelitis: muscle weakness, paralysis, hyporeflexia, acute onset, sensory intact, dx by detecting virus in stool, pharynx.
  • Myopathies: proximal weakness, CK↑
    • Congenital
      • Duchenne muscular dystrophy: muscle weakness (proximal, esp thighs, hips), atrophy, difficulty walking, Gower's (difficulty getting up), pediatric onset, Xlink FHx.
      • Becker's muscular dystrophy: mild Duchenne's (muscle weakness, atrophy, Gower's) with later age of onset (school age).
      • Myotonic dystrophy: muscle weakness (esp wrist), atrophy, cataract, cardiomyopathy, myotonia, AD FHx, dx w genetic testing (CTG repeat).
      • Facioscapulohumeral muscular dystrophy: muscle weakness of face, scapula, humerus, AD FHx.
      • McArdle's disease (type 5): excercise-induced muscle cramps, second wind, dark urine (rhabdomyolysis), CK↑, due to defect gly phosphorylase, dx w biopsy (glycogen vacuoles in myocytes).
      • CPT-II deficiency: muscle cramps, rhabdomyolysis, triggered by exercise, fasting, cold.
      • Mitochondrial myopathy: vision problems (ptosis, eye paresis), stroke-like episodes, dx w muscle biopsy (ragged red fibers).
    • Acquired/inflammatory
      • Polymyositis: proximal muscle weakness, pain, dysphagia, CK↑, fascicle inflammation, tx w steroids.
      • Dermatomyositis: proximal muscle weakness, pain, dysphagia, skin (rash, Gottron/red knuckles), CK↑, assoc w cancer, biopsy shows perifascicle inflammation & atrophy.
      • Inclusion body myositis: muscle weakness (esp quads, finger flexor), atrophy, dysphagia, CK↑, biopsy (endomysial inflam, rim vacuoles, inclusion bodies).
  • Neuromuscular junction: fatigable/facilitation weakness, no sensory symptoms
    • Myesthenia gravis: weakness (fatigable, worse w use), ptosis, anticholinesterase alleviation, EMG demonstrates fatigability, tx w pyridostigmine.
    • Lambert-Eaton syndrome: limb weakness that gets better w use, Hx of small cell lung cancer, EMG demonstrates facilitation (AP↑ after period of stimulation).
    • Botulism: descending paralysis: starts at eyes, face, jaw, spread downward to arms, legs, diaphragm.
  • Neurocutaneous
    • Tuberous sclerosis: infantile spasms (epilepsy), mental retardation, skin probs (facial angiofibroma, ash leaf spots, rough patches), AD FHx.
    • Neurofibromatosis 1: neurofibromas on skin, birthmarks (cafe-au-lait), cognitive deficits, iris (Lisch) nodules, AD FHx.
    • Neurofibromatosis 2: bilateral acoustic schwannoma, meningioma, cataracts, mild skin probs (neurofibroma, birthmarks), AD FHx.
    • Sturge-Weber syndrome: port wine stain on face, seizure, glaucoma, MRI shows leptomeningeal angioma.
  • CNS tumors
    • Glioma: headache, seizure, neuro deficits, dx w MRI, biopsy (astrocytoma, ependymoma, oligodendroglioma).
      • Astrocytoma: headache, seizure, neuro deficits, dx w MRI, biopsy (pilocytic, diffuse, anaplastic, glioblastoma).
        • Pilocytic astrocytoma: headache, n/v, neuro deficits, young age, dx w MRI (enhancing cyst), biopsy (eosinophilic fibers and granules).
        • Diffuse astrocytoma: headache, seizure, neuro deficits, young age, MRI shows diffuse non-enhancing infiltrations (pons, hemispheres), biopsy shows cell atypia.
        • Anaplastic astrocytoma: headache, seizure, neuro deficits, MRI shows diffuse, non-enhancing infiltration, biopsy shows anaplasia, mitosis.
        • Glioblastoma multiforme: memory loss, personality changes, headache, seizure, neuro deficits, old age, dx w MRI (ring enhancing tumor), biopsy (malignant, rim-crowding necrosis).
      • Ependymoma: headache, n/v, ataxia, papilledema, young age, dx w MRI (cerebellar enhancing mass), biopsy (perivascular & circular rosettes).
      • Oligodendroglioma: headache, seizure, neuro deficits, dx w MRI (diffuse/patchy), biopsy (fried eggs/perinuclear halo).
    • Meningioma: headache, seizure, neuro deficits, dx w MRI (extra-axial, dural tail), biopsy (whorling, psammoma/calcification).
    • Medulloblastoma: headache, n/v, ataxia, young age, dx w MRI (cerebellar mass), biopsy (embryonal cells w circular arrangements).
    • Nerve sheath tumor
      • Vestibular schwannoma: hearing loss, tinnitus, imbalance, assoc w neurofibromatosis 2, dx w MRI (internal auditory canal mass), biopsy (biphasic hyper-hypocellularity, Verocay bodies).
      • Neurofibroma: axon-containing nerve sheath tumor, presents as polyp-like lumps on skin, assoc w neurofibromatosis 1.
    • Metastatic: lung, breast, melanoma, kidney
    • solid, circumscribed tumors
      • Pilocytic astrocytoma: headache, n/v, neuro deficits, young age, dx w MRI (enhancing cyst), biopsy (eosinophilic fibers and granules).
      • Ependymoma: headache, n/v, ataxia, papilledema, young age, dx w MRI (cerebellar enhancing mass), biopsy (perivascular & circular rosettes).
    • Young age group
      • Medulloblastoma: headache, n/v, ataxia, young age, dx w MRI (cerebellar mass), biopsy (embryonal cells w circular arrangements).
      • Pilocytic astrocytoma: headache, n/v, neuro deficits, young age, dx w MRI (enhancing cyst), biopsy (eosinophilic fibers and granules).
      • Diffuse astrocytoma: headache, seizure, neuro deficits, young age, MRI shows diffuse non-enhancing infiltrations (pons, hemispheres), biopsy shows cell atypia.
      • Ependymoma: headache, n/v, ataxia, papilledema, young age, dx w MRI (cerebellar enhancing mass), biopsy (perivascular & circular rosettes).
    • Good prognosis
      • Vestibular schwannoma: hearing loss, tinnitus, imbalance, assoc w neurofibromatosis 2, dx w MRI (internal auditory canal mass), biopsy (biphasic hyper-hypocellularity, Verocay bodies).
      • Neurofibroma: axon-containing nerve sheath tumor, presents as polyp-like lumps on skin, assoc w neurofibromatosis 1.
      • Meningioma: headache, seizure, neuro deficits, dx w MRI (extra-axial, dural tail), biopsy (whorling, psammoma/calcification).
      • Ependymoma: headache, n/v, ataxia, papilledema, young age, dx w MRI (cerebellar enhancing mass), biopsy (perivascular & circular rosettes).
    • WHO grading
      • grade 1: benign
        • Meningioma: headache, seizure, neuro deficits, dx w MRI (extra-axial, dural tail), biopsy (whorling, psammoma/calcification).
        • Pilocytic astrocytoma: headache, n/v, neuro deficits, young age, dx w MRI (enhancing cyst), biopsy (eosinophilic fibers and granules).
      • grade 2: atypia
        • Diffuse astrocytoma: headache, seizure, neuro deficits, young age, MRI shows diffuse non-enhancing infiltrations (pons, hemispheres), biopsy shows cell atypia.
        • Ependymoma: headache, n/v, ataxia, papilledema, young age, dx w MRI (cerebellar enhancing mass), biopsy (perivascular & circular rosettes).
      • grade 3: malignant
        • Oligodendroglioma: headache, seizure, neuro deficits, dx w MRI (diffuse/patchy), biopsy (fried eggs/perinuclear halo).
        • Anaplastic astrocytoma: headache, seizure, neuro deficits, MRI shows diffuse, non-enhancing infiltration, biopsy shows anaplasia, mitosis.
      • grade 4: very malignant
        • Medulloblastoma: headache, n/v, ataxia, young age, dx w MRI (cerebellar mass), biopsy (embryonal cells w circular arrangements).
        • Glioblastoma multiforme: memory loss, personality changes, headache, seizure, neuro deficits, old age, dx w MRI (ring enhancing tumor), biopsy (malignant, rim-crowding necrosis).
  • Intracranial pressure↑: headache, n/v, papilledema
    • Hydrocephalus: headache, papilledema, large head in peds, dx w CT, US in newborns.
      • obstruction: aqueduct, monro, tumor
      • impaired absorption: subarachnoid villi
      • overproduction: rare, choroid plexus
      • Normal pressure hydrocephalus: gait ataxia, dementia, urinary incontinence, dx w MRI (ventriculomegaly w/o atrophy), LP (alleviates symptoms), tx w shunting.
      • Chiari II malformation: small 4th ventricle, cerebellar herniation (vermis, tonsils), assoc w myelomeningocele, hydrocephalus, dx w MRI.
      • Dandy-Walker malformation: dilated 4th ventricle, cerebellar vermis agenesis, enlarged posterior cranial fossa.
      • Myelomeningocele: protrusion of spinal cord and meninges out of spine, assoc w Chiari II, hydrocephalus.
    • Brain herniation: coma, fixed pupils, decorticate (upper brain), decerebrate (lower brain)
      • Transtentorial herniation: brain (uncal, central/diencephalon) herniation thru tentorial notch, duret hemorrhage if rips pontine branches of basilar artery.
        • Uncal herniation: pupil dilation (ipsi), hemiplegia (ipsi or contra), decerebrate posture, coma.
        • Central herniation: diencephalon herniates thru tentorial notch, duret hemorrhage.
      • Tonsillar herniation: cerebellar tonsils herniates thru foramen magnum, compresses medulla → respiratory arrest, death.
    • Brain hemorrhage: headache, n/v, altered mental status, neuro deficits, dx w CT
      • Epidural hematoma: headache, altered mental status, hx of head trauma, dx w CT (lens shaped blood pool under skull).
      • Subdural hematoma: headache, altered mental status, hx of head trauma w loss of consciousness, dx w CT (crescent/wavy pool of blood under the skull).
      • Subarachnoid hemorrhage: berry aneurysm rupture causes sudden onset of headache, dx w CT (diffuse hyperdensities), LP (RBC).
      • Berry aneurysm: thin vessels in circ of willis, assoc w PCKD, rupture causes subarachnoid hemorrhage, stroke, dx w angiography.
      • Intracerebral hemorrhage: headache, vomiting, stroke symptoms, neuro deficits, dx w CT (lump hyperdensity in brain).
    • IIH: headache, episodic vision loss, pulsatile tinnitus, papilledema, dx by MRI (exclude hemorrhage), LP (pressure↑, nl cell count).
  • Stroke: sudden onset of neuro deficits (unilateral weakness, facial droop, slurred speech), can be ischemic (thombosis/focal, emboli/multifocal, hypotension/diffuse) or hemorrhagic (subarach, intracerebral).
    • Medial pontine syndrome: basilar paramedian dmg causing contra weakness (CST), contra sens loss (DCML), ipsi eye no abduct (CN 6).
    • Lateral pontine syndrome: AICA dmg causing contra pain/temp loss (spinothalamic), ipsi horner (hypothalamospinal), ipsi face sens & motor (trigem nuc, CN7), ipsi deaf, vertigo (CN8), ipsi ataxia (cerebellar penduncle).
    • Medial medullary syndrome: anterior spinal artery dmg causing contra weakness (CST), contra sens loss (DCML), ipsi tongue deviation (CN 12).
    • Lateral medullary syndrome: PICA dmg causing contra pain/temp (spinothalamic), ipsi horner (hypothalamospinal), ipsi face sensory (trigem), ipsi hearing/balance (CN 8), swallowing (CN 9, 10).
    • Ischemic stroke: thrombosis (focal CT), embolism (multifocal CT), or hypotension (diffuse CT), tx w aspirin, clopidogrel, heparin, alteplase (< 3hr onset, no bleeding risk).
    • Hemorrhagic stroke: stroke due to intracranial bleeding, tx: remove anticoag meds, lower bp, seizure prophylaxis, surgery.
  • Spina bifida: folic acid deficiency during pregnancy
    • Meningocele: heniation of meninges only, no nerve tissue
    • Myelomeningocele: protrusion of spinal cord and meninges out of spine, assoc w Chiari II, hydrocephalus.
    • Spina bifida occulta: tuft of hair, dimple, or birthmark over the skin of affected vertebrae, which has a small split (xray).
  • Infections
    • Bacterial meningitis: fever, headache, stiff neck, photophobia, petechiae, dx w LP (cloudy, protein↑, glc↓, PMN), tx w ceftriaxone.
    • Viral meningitis: milder bacterial meningitis symptoms, LP shows lymphocytes, commonly caused by enterovirus.
    • Viral encephalitis: headache, AMS, seizures, neuro deficits, LP (lymphocytic, RBCs), commonly caused by HSV1 (temporal lobe), tx w acyclovir.
    • PML: neuro deficit (AMS, hemiparesis, ataxia) in AIDS pt, dx w PCR (JC virus DNA), brain biopsy (multifocal wht matter demyelination).
    • Cryptococcal meningitis: immunocompromised (AIDS, transplant), meningitis symptoms, dx w LP (India ink, antigen, culture), tx w amphotericin B, fluconazole.
    • Cysticercosis: seizures, headache, CT shows enhancing cyst, serology detects antigen).
  • Headaches
    • Tension headache: common headache (pressure, bilateral, steady), tx w acetaminophen, NSAIDs.
    • Migraine: headache (severe, unilateral, throbbing, long-lasting), photophobia, phonophobia, improves w rest, tx w triptans.
    • Cluster headache: headache (severe, unilateral, not alleviated by rest, wakes pt from sleep), autonomic symps (tearing, ptosis, runny nose), onset clustering, tx w triptans.
  • Peds
    • Developmental delay
      • Fragile X syndrome: abnormal facies, mental retardation, developmental delay, macroorchidism, boys more affected.
      • Down's syndrome: abnormal facies (flat), mental retardation, single palmar crease.
      • PKU: fair skin, musty ordor, seizure, mental retardation, AR FHx, due to mut Phe hydroxylase (Phe → Tyr).
      • Fetal alcohol syndrome: facies (small upper lip, no philtrum), developmental delay, behavioral problems, Hx of mom drinking.
    • Developmental regression
      • Rett syndrome: developmental delay in girls, decreased head circumference, seizures, hand movements.
      • Tay-Sachs disease: developmental regression, Ashkenazi Jews, cherry red spot in retina.
      • Neimann-Pick disease: developmental regression, hepatomegaly, cherry red spot on retina.
      • Hurler syndrome: deveopmental delay, facies (gargoylism), hepatosplenomegaly, dwarfism, tx w marrow transplant.
    • ADHD: hyperactivity, impulsivity, inattention.
    • Autism: problem w social interaction, communication, stereotypical movement (hand-flapping) & behavior (repetitive, lining things up).
  • Psychiatric
    • General anxiety disorder: anxiety for > 6 months.
    • Major depressive disorder: depression, lack of interest, can't concentrate, for > 2 weeks.
    • Bipolar disorder: Mania (severe high, intereferes w life) or hypomania (high) episodes with or without depression episodes.
    • Dysthymia: > 2 years of chronic depression, less severe but longer lasting than major depressive disorder.
    • Cyclothymia: > 2 years of hypomania w depression, it's like chronic bipolar.
    • PTSD: severe anxiety, fear, flashbacks, nightmares, triggered sight/sound/smell of a previous traumatic event, Hx of combat, rape.
    • Schizophrenia: Paranoid, delusional, lack of expressions, poverty of speech, hallucinations.
    • Obsessive compulsive disorder: obsession (fear of contamination), compulsion (excessive handwashing), occurs > 1 hr per day, ego dystonic (pt knows it's a problem).
    • Conversion disorder: neuro symptoms due to psych issues.
    • Somatization disorder: multiple pains, onset before age 30.
    • Hypochondriasis: health phobia: worries that any little symptom is a deadly disease.
    • Pain disorder: severe pain, interferes w life, triggering event/stressor.
    • Body dysmorphic disorder: obsessed w body image, concerned over perceived defect.
  • Drug-induced
    • Reye's syndrome: Kids using aspirin develops rash, vomiting, fever, AMS, liver dmg.
    • Malignant hyperthermia: muscle rigidity/spasm, fever, tachycardia, acidosis, rhabdomyolysis, Hx of gen anesthesia, succinylcholine usage, tx w dantrolene.
    • Neuroleptic malignant syndrome: fever, AMS, sweat, rigidity, autonomic dysfunction, Hx of antipsychotics, Tx w dantrolene.
    • Serotonin syndrome: fever, headache, AMS (delirium, anxiety), sweat, tachycardia, n/v/d, Hx of antidepressants, Tx w benzodiazepine.
  • Eye problems
    • Hyperopia: far-sighted, can't see near, bcz eye too short or lens not refracting hard enough, tx w convex lens.
    • Myopia: near-sighted, can't see far, bcz eye too long, lens over-refracting, tx w concave lens.
    • Prespyopia: elderly, can't see near (need reading glasses) bcz lens too rigid.
    • Amblyopia: lazy eye (poor acuity), tx w eye patch on good eye (forces lazy eye to work).
    • Astigmatism: blurry vision, squinting, due to lens shape abnormality (introduces different focal points).
    • Glaucoma: intraocular pressure↑ causes nerve damage (optic disk cupping, cup-disk ratio↑), visual field loss, can be open angle (chronic, pressure can escape) or closed angle (acute, pain, headache, see halos), tx w PGs, beta-blk.
    • Macular degeneration: central vision distortion/loss, dx w funduscope (yellow drusen/debris for dry form, hemorrhage/vessels for wet form), tx w vitamins C, E, beta carotene, Zn, Cu, anti-VEGF (wet form).
    • Cataract: foggy vision bcz of cloudy lens, tx w surgery to replace lens.
    • Diabetic retinopathy: visual loss, curtains, floaters, retinal exam shows blot hemorrhages, cotton wool spots, angiogenesis, macula edema, tx w panretinal photocoag, vitrectomy, VEGF inh.
    • Retinal detachment: floaters, vision loss, visual field loss, retinal break (rheg) or distortion (non-rheg), tx w pneumatic retinopexy, scleral buckle, vitrectomy.
    • Conjunctivitis: red/pink eye, irritation, tearing, pus (bacterial), itchy (allergy), hx of cold (viral).
    • Keratitis: corneal inflammation, pain, blurry vision, corneal inflammation, pus (bacterial), white/feathery (fungal), dendritic (herpes), tx w antibiotics, chlorhexidine (ameba), -cyclovirs (herpes).
    • Trachoma: eye irritation, discharge, turned-in lashes/lid margins, corneal pannus, caused by Chlamydia, Tx w azithromycin.
    • Corneal abrasion: pain, tearing, photophobia, blurry vision, dx w fluorescein stain/cobalt-blue light, tx w tape lids shut.
    • Subconjunctival hemorrhage: the whites of the eyes are red, hx of hypertension, bleeding dz, severe cough/strain/strangling.
    • Hyphema: blurry vision, red tinge or pool of blood in cornea, due to blood in anterior eye compartment.
  • Eye adnexa problems
    • Blepharitis: gritty eyes, flakes/crusts on lashes.
    • Meibomitis: oily tear film, yellow dots (meibomian glands) on eyelid margins.
    • Stye: painful pustule on eyelid, redness, tx w drainage.
    • Chalazion: painless lump (cyst, lipogranuloma) on eyelid due to blocked meibomian gland.
    • Dry eye syndrome: blurry vision, tearing, gritty feeling, tx w artificial tears, punctal plug, omega 3s.
    • Sjogren's syndrome: female, dry eyes, dry mouth, Hx of rheumatic dz.
  • Ear problems
    • Conductive hearing loss
      • Otitis externa: earache aggravated by external ear manipulation, ear canal findings (red, scaley, discharge), tx w ear canal cleaning, antibiotic/antiseptic.
      • Otitis media: earache, hearing loss, fever, Hx of URTI, rhinitis, dx w tympanic membrane findings, tx w amoxicillin.
      • Otosclerosis: progressive conductive hearing loss due to fixation of stapes footplate from bone overgrowth, Hx of hormonal changes (pregnancy), osteogenesis imperfecta, Paget's.
      • Cholesteatoma: recurrent ear discharge, conductive hearing loss, vertigo, otoscope reveals keratin cyst.
    • Sensorineural hearing loss
      • Presbycusis: old age, bilateral sensorineural hearing loss, esp high freq.
      • Meniere's disease: episodic vertigo, hearing loss (low freq, sensorineural), tinnitus (low pitch), due to endolymph↑, tx w diuretic, low salt diet, endolymph drainage.
      • Vestibular schwannoma: hearing loss, tinnitus, imbalance, assoc w neurofibromatosis 2, dx w MRI (internal auditory canal mass), biopsy (biphasic hyper-hypocellularity, Verocay bodies).
      • Meningioma: headache, seizure, neuro deficits, dx w MRI (extra-axial, dural tail), biopsy (whorling, psammoma/calcification).
      • Alport's syndrome: hematuria and hearing loss due to bad collagen (skin biopsy lack alpha5, renal biopsy shows thick/frayed GBM).
    • Vertigo
      • Benign positional vertigo: episodic vertigo lasting < 1min, triggered by head movement, dx w Dix-Hallpike maneuver (rotational nystagmus), tx w canalith repositioning (Epley maneuver).
      • Vestibular neuritis: acute severe vertigo, n/v, imbalance, due to HSV reactivation in vestibular nerve, tx w steroids, valcyclovir.
      • Labyrinthitis: severe vertigo, sensorineural hearing loss, hx of URTI, tx w therapy/exercises (Brandt-Daroff).
      • Meniere's disease: episodic vertigo, hearing loss (low freq, sensorineural), tinnitus (low pitch), due to endolymph↑, tx w diuretic, low salt diet, endolymph drainage.
      • Cholesteatoma: recurrent ear discharge, conductive hearing loss, vertigo, otoscope reveals keratin cyst.
  • Other
    • VHL: multisystem tumors: CNS hemangio (neuro), retina angio (vision loss), renal (hematuria), endolymph (hearing loss), AD FHx, dx w VHL mutation.
    • Delirium: Fluctuating mental status (cognition, orientation, attention).
    • Anorexia: < 15% of normal weight, amenorrhea, fear of wt gain.
    • Bulimia: nl or overweight, binge eating episodes w purging (vomit) or nonpurging (exercise/fasting), at least 2x per week for 3 mo.
    • Rhinosinusitis: rhinitis (congestion, drainage) + sinusinits (sinus pressure/tenderness).
    • Pancoast tumor: apex lung tumor pressing on symp chain (Horner), brachial plexus (arm pain/weak), recurrent laryngeal nerve (hoarse), SVC (facial swelling).
    • Laryngeal cancer: neck mass, hoarseness, throat discomfort, Hx of smoking, EtOH, dx w laryngoscopy, biopsy.
    • Salivory gland tumor: painless mass, facial nerve palsy (malignant), pleomorphic adenoma (benign, most common), the -carcinomas (malig).
      • Pleomorphic adenoma: painless mass on face (saliva gland), most common salivary gland tumor, dx w biopsy (benign, myoepithelial).
      • Whartin's tumor: painless mass on face (saliva gland), Hx of smoking, old age, dx w biopsy (benign, cystic spaces, pyknotic nuclei, lymphoid).
      • Mucoepidermoid carcinoma: painless mass on face (salivory gland), kids, dx w biopsy (malig, squam, mucus).
      • Adenoid cystic carcinoma: painless mass on face (saliva gland), dx w biopsy (malig, cystic).

    • Drugs by Neurotransmitters

  • Acetylcholine: SE: SLUDS (salivation, lacrimation, urination, defecation, sweating).
    • Agonist
      • Edrophonium: Tx: test for Myesthenia Gravis (alleviate), cholinergic crisis (aggravate). Mech: Ach agonist (inh cholinesterase). Fact: short acting.
      • Pyridostigmine: Tx: Myesthenia Gravis. Mech: Ach agonist (inh cholinesterase).
      • Neostigmine: Tx: Myesthenia Gravis, reversal of nondepolarizing muscle relaxants. Mech: Ach agonist (inh cholinesterase).
      • Rivastigmine: Tx: Dementia (Alzheimer, Parkinson). Mech: Ach agonist. SE: n/v.
      • Donepezil (Aricept,): Tx: Alzheimer. Mech: Ach agonist (inh cholinesterase).
    • Anticholinergic: Mech: acetacholine antag. SE: tachycardia, dry mouth. Fact: Benzatropine, muscle relaxants.
      • Benzatropine (Cogentin,): Tx: Parkinson tremor. Mech: anticholinergic. SE: dry mouth, constip, urinary retention.
      • Succinylcholine: Tx: muscle relaxant for intubation. Mech: depolarizing NMJ blk. SE: malignant hyperthermia.
      • Vecuronium: Tx: muscle relaxant for intubation. Mech: Ach antag (nondepolarizing NMJ blk). Fact: reverse w Neostigmine.
  • Monoamine
    • Catecholamine
      • Norepinephrine
        • Agonist
          • Atomoxetine: Tx: ADHD. Mech: NE reuptake inh.
          • Amphetamine (Adderall,): Tx: ADHD. Mech: NE, 5HT, DA agonist (stimulant).
          • Methylphenidate: Tx: ADHD, narcolepsy. Mech: NE, DA agonist (stimulant).
          • Dextroamphetamine: Tx: ADHD. Mech: release NE, DA, stimulant.
          • MAOI: Tx: depression. Mech: monoamine (NE, 5HT) agonist (inh breakdown). SE: hypertensive crisis (tyramine).
            • Iproniazid: Tx: depression. Mech: MOAI.
            • Tranylcypromine: Tx: atypical depression, anxiety. Mech: MAOI (NE, 5HT agonist). SE: hypertensive crisis (tyramine).
            • Phenelzine: Tx: atypical depression, anxiety. Mech: MAOI (NE, 5HT agonist). SE: hypertensive crisis (tyramine).
        • Antagonist
          • Reserpine: Tx: psychosis. Mech: deplete NE, serotonin (blk vescicle storage). SE: depression.
      • Dopamine
        • Agonist
          • Levodopa: Tx: Parkinson. Mech: converted to dopamine by dopa carboxylase. SE: psychosis, n/v, dyskinesia.
        • Antagonist
          • Haloperidol: Tx: psychosis. Mech: dopamine antag. SE: lots of EPS (movement disorders, neuroleptic malig syndrome).
          • Chlorpromazine: Tx: psychosis. Mech: dopamine antag. SE: anticholinergic. Fact: less EPS, less potent.
          • Olanzapine: Tx: schizophrenia, bipolar. Mech: DA, 5HT, antag. SE: wt gain.
    • Serotonin: Mech: 5HT receptors.
      • Agonist
        • SSRI
          • Fluoxetine (Prozac,): Tx: depression, anxiety. Mech: SSRI.
          • Citalopram (Celexa, Cipramil,): Tx: depression. Mech: SSRI.
          • Sertraline: Tx: depression. Mech: SSRI. Fact: less cognitive side effects.
          • Paroxetine (Paxil,): Tx: depression. Mech: SSRI. SE: wt gain.
        • SNRI
          • Venlafaxine (Effexor,): Tx: depression, anxiety, migraine, neuro pain. Mech: SNRI. SE: hypertension.
        • TCA (Tricyclic,): Tx: depression. Mech: SNRI. SE: GI (constipation, n/v), cardio (hypotension, tachy), CNS (seizure, suicide).
          • Amitriptyline: Tx: depression, migraine, pain. Mech: TCA (NE, 5HT agonist).
          • Imipramine: Tx: depression, bedwetting. Mech: TCA (NE, 5HT agonist).
        • Triptan: Tx: migraine. Mech: serotonin agonist. SE: MI.
          • Sumatriptan: Tx: migraine. Mech: serotonin agonist. SE: MI.
        • Buspirone: Tx: gen anxiety disorder. Mech: serotonin agonist (5HT1a).
        • DHE (dihydroergotamine,): Tx: migraine. Mech: serotonin agonist. SE: nausea.
        • MAOI: Tx: depression. Mech: monoamine (NE, 5HT) agonist (inh breakdown). SE: hypertensive crisis (tyramine).
      • Antagonist
        • Ondansetron: Tx: n/v. Mech: serotonin antag.
        • Risperidone (Risperdal,): Tx: schizophrenia, autism. Mech: 5HT, DA antag.
        • Olanzapine: Tx: schizophrenia, bipolar. Mech: DA, 5HT, antag. SE: wt gain.
  • Excitatory amino acids
    • Glutamate: Mech: excitatory, NMDA receptor.
      • Antagonist
        • Memantine: Tx: Alzheimer. Mech: NMDA antag.
        • Ketamine: Tx: anesthesia. Mech: NMDA antag (high affinity). Fact: good for cardio stability, IM ok.
        • Dextromethorphan: Tx: cough. Mech: NMDA antag.
    • Aspartate
  • Inhibitory amino acids
    • GABA: Mech: inhibitory.
      • Agonist (inhibitory)
        • Benzodiazepine: Tx: anxiety, epilepsy, EtOH withdrawal. Mech: GABA agonist. SE: resp depression esp w EtOH. Fact: the -pams and -zolams.
          • Diazepam (Valium,): Tx: anxiety. Mech: benzodiazepine (GABA agonist).
          • Clonazepam: Tx: epilepsy, sleep disorders, anxiety. Mech: benzodiazepine (GABA agonist). Fact: long acting.
          • Alprazolam (Xanax,): Tx: anxiety. Mech: benzodiazepine (GABA agonist).
          • Lorazepam (Ativan,): Tx: status epilepticus, sedation. Mech: benzodiazepine (GABA agonist).
          • Temazepam (Restoril,): Tx: insomnia. Mech: benzodiazepine (GABA agonist).
          • Oxazepam: Tx: EtOH withdrawal. Mech: benzodiazepine (GABA agonist).
          • Midazolam: Tx: epilepsy, anesthesia. Mech: benzodiazepine (GABA agonist).
        • Barbituate: Tx: sedative. Mech: GABA agonist. SE: resp depression.
          • Phenobarbital: Tx: epilepsy (neonatal spasm, status epi). Mech: barbituate (GABA agonist). SE: sedation, P450 inducer.
          • Thiopental: Tx: induction gen anesthesia. Mech: barbituate (GABA agonist). Fact: potent, rapid onset.
        • Propofol (Diprivan,): Tx: general anesthesia. Mech: GABA agonist, Na ch blk. Fact: fast recovery.
        • Zolpidem: Tx: insomnia. Mech: GABA agonist.
        • Zaleplon (Sonata,): Tx: insomnia. Mech: GABA agonist.
        • Eszopiclone (Lunesta,): Tx: insomnia. Mech: GABA agonist.
        • Valproic acid: Tx: epilepsy. Mech: GABA agonist, Na ch blk. SE: liver failure (esp kids), wt gain, plt↓, P450 inh, teratogen.
      • Antagonist (excitatory)
        • Flumazenil: Tx: benzodiazepine OD. Mech: GABA antag. SE: seizure.
    • Glycine
  • Peptides
    • Opioid: Tx: pain. Mech: mu (main analgesic), kappa, delta. SE: n/v, constipation, itch.
      • Agonist
        • Morphine: Tx: pain. Mech: opioid, mu agonist. SE: constipation.
        • Meperidine (Pethidine, Demerol,): Tx: pain in labor. Mech: opioid. SE: seizure.
        • Oxycodone: Tx: pain. Mech: opioid. SE: constipation.
        • Fentanyl: Tx: pain. Mech: opioid (mu). SE: n/v/d, or constipation. Fact: potent.
        • Codeine: Tx: cough, pain. Mech: opioid. SE: constipation. Fact: oral ok.
        • Tramadol: Tx: pain. Mech: opioid. Fact: weak.
        • Methadone: Tx: opioid withdrawal. Mech: opioid.
      • Antagonist
        • Naloxone (Narcan,): Tx: opiate OD/abuse. Mech: opioid (mu) antag (competitive). Fact: short acting, re-dosing needed.
        • Naltrexone: Tx: Alcoholism. Mech: opioid antag (mu, k). SE: GI.
        • Methylnaltrexone (MNTX, Relistor,): Tx: constipation (opioid SE). Mech: opioid antagonist (peripheral).
      • Mixed
        • Buprenorphine: Tx: opioid dependence. Mech: mixed opioid agonist/antagonist.
    • Cannabinoid
  • Histamine
    • Antagonist
      • Diphenhydramine: Tx: allergy. Mech: antihistamine.
      • Ranitidine (Zantac,): Tx: GERD, PUD. Mech: H2 antag.
  • Melatonin
    • Agonist
      • Ramelteon: Tx: insomnia (esp trouble falling asleep). Mech: melatonin agonist. Fact: not addictive.
  • Na ch blk
    • Local anesthetic: Mech: Na ch blk. SE: arrhythmia, allergy & met-Hb (esters). Fact: the -caines: amides (-i-caines) and esters, effects prolonged by epi.
    • Lamotrigine: Tx: epilepsy, bipolar. Mech: Na ch blk. SE: skin (severe, Stevens-Johnson).
    • Phenytoin: Tx: epilepsy. Mech: Na ch blk. SE: gingival hyperplasia, P450 inducer, teratogen.
    • Carbamazepine: Tx: epilepsy, bipolar, trigem neuralgia. Mech: Na ch blk. SE: WBC↓.

    • Drugs by Uses

  • Anesthesia
    • Local anesthetic: Mech: Na ch blk. SE: arrhythmia, allergy & met-Hb (esters). Fact: the -caines: amides (-i-caines) and esters, effects prolonged by epi.
      • Lidocaine: Tx: local anesthesia. Mech: Na ch blk. SE: arrhythmia.
      • Benzocaine: Tx: topical local anesthesia. Mech: Na ch blk. SE: arrhythmia, allergy, methemoglobinemia.
      • Procaine: Tx: local anesthesia for pt w liver dz. Mech: Na ch blk. SE: arrhythmia, allergy, methemoglobinemia. Fact: metab by serum pseudocholinesterase (spares liver).
      • Tetracaine: Tx: local anesthesia for pt w liver dz. Mech: Na ch blk. SE: arrhythmia, allergy, methemoglobinemia. Fact: metab by serum pseudocholinesterase (spares liver).
    • General anesthetic: SE: halothanes cause malig hyperthermia.
      • Thiopental: Tx: induction gen anesthesia. Mech: barbituate (GABA agonist). Fact: potent, rapid onset.
      • Ketamine: Tx: anesthesia. Mech: NMDA antag (high affinity). Fact: good for cardio stability, IM ok.
      • Fentanyl: Tx: pain. Mech: opioid (mu). SE: n/v/d, or constipation. Fact: potent.
      • Nitrous oxide: Tx: gen anesthesia in conj w other agents to boost onset. SE: cavity expansion, ICP↑. Fact: fast onset.
      • Halothane (Fluothane,): Tx: gen anesthesia in poor places. SE: hepatitis, nephrotox, cardio, malig hyperthermia. Fact: the -fluranes, high brain affinity, liver metab.
  • Muscle relaxants
    • Succinylcholine: Tx: muscle relaxant for intubation. Mech: depolarizing NMJ blk. SE: malignant hyperthermia.
    • Vecuronium: Tx: muscle relaxant for intubation. Mech: Ach antag (nondepolarizing NMJ blk). Fact: reverse w Neostigmine.
    • Rocuronium: Tx: muscle relaxant for intubation. Mech: Ach antag (nondepolarizing NMJ blk). Fact: reverse w Neostigmine.
    • Pancurinium: Tx: muscle relaxant for intubation. Mech: Ach antag (nondepolarizing NMJ blk). Fact: reverse w Neostigmine.
  • Myesthenia Gravis
    • Edrophonium: Tx: test for Myesthenia Gravis (alleviate), cholinergic crisis (aggravate). Mech: Ach agonist (inh cholinesterase). Fact: short acting.
    • Pyridostigmine: Tx: Myesthenia Gravis. Mech: Ach agonist (inh cholinesterase).
    • Neostigmine: Tx: Myesthenia Gravis, reversal of nondepolarizing muscle relaxants. Mech: Ach agonist (inh cholinesterase).
  • Anxiolytic & Hypnotic
    • Benzodiazepine: Tx: anxiety, epilepsy, EtOH withdrawal. Mech: GABA agonist. SE: resp depression esp w EtOH. Fact: the -pams and -zolams.
      • Diazepam (Valium,): Tx: anxiety. Mech: benzodiazepine (GABA agonist).
      • Clonazepam: Tx: epilepsy, sleep disorders, anxiety. Mech: benzodiazepine (GABA agonist). Fact: long acting.
      • Alprazolam (Xanax,): Tx: anxiety. Mech: benzodiazepine (GABA agonist).
      • Lorazepam (Ativan,): Tx: status epilepticus, sedation. Mech: benzodiazepine (GABA agonist).
      • Temazepam (Restoril,): Tx: insomnia. Mech: benzodiazepine (GABA agonist).
      • Oxazepam: Tx: EtOH withdrawal. Mech: benzodiazepine (GABA agonist).
      • Midazolam: Tx: epilepsy, anesthesia. Mech: benzodiazepine (GABA agonist).
    • Barbituate: Tx: sedative. Mech: GABA agonist. SE: resp depression.
      • Thiopental: Tx: induction gen anesthesia. Mech: barbituate (GABA agonist). Fact: potent, rapid onset.
      • Phenobarbital: Tx: epilepsy (neonatal spasm, status epi). Mech: barbituate (GABA agonist). SE: sedation, P450 inducer.
    • Buspirone: Tx: gen anxiety disorder. Mech: serotonin agonist (5HT1a).
    • Zolpidem: Tx: insomnia. Mech: GABA agonist.
    • Zaleplon (Sonata,): Tx: insomnia. Mech: GABA agonist.
    • Eszopiclone (Lunesta,): Tx: insomnia. Mech: GABA agonist.
    • Ramelteon: Tx: insomnia (esp trouble falling asleep). Mech: melatonin agonist. Fact: not addictive.
  • Substance abuse / OD
    • EtOH
      • Disulfram: Tx: alcoholism. Mech: inh alcohol dehydrogenase.
      • Benzodiazepine: Tx: anxiety, epilepsy, EtOH withdrawal. Mech: GABA agonist. SE: resp depression esp w EtOH. Fact: the -pams and -zolams.
      • Oxazepam: Tx: EtOH withdrawal. Mech: benzodiazepine (GABA agonist).
      • Naltrexone: Tx: Alcoholism. Mech: opioid antag (mu, k). SE: GI.
    • Opioid
      • Naloxone (Narcan,): Tx: opiate OD/abuse. Mech: opioid (mu) antag (competitive). Fact: short acting, re-dosing needed.
      • Clonidine: Tx: hypertension, opioid withdrawal. Mech: α2 agonist.
      • Methadone: Tx: opioid withdrawal. Mech: opioid.
    • Benzodiazepine
      • Flumazenil: Tx: benzodiazepine OD. Mech: GABA antag. SE: seizure.
  • Antidepressant
    • SSRI
      • Fluoxetine (Prozac,): Tx: depression, anxiety. Mech: SSRI.
      • Citalopram (Celexa, Cipramil,): Tx: depression. Mech: SSRI.
      • Sertraline: Tx: depression. Mech: SSRI. Fact: less cognitive side effects.
      • Paroxetine (Paxil,): Tx: depression. Mech: SSRI. SE: wt gain.
    • SNRI
      • Venlafaxine (Effexor,): Tx: depression, anxiety, migraine, neuro pain. Mech: SNRI. SE: hypertension.
    • TCA (Tricyclic,): Tx: depression. Mech: SNRI. SE: GI (constipation, n/v), cardio (hypotension, tachy), CNS (seizure, suicide).
      • Amitriptyline: Tx: depression, migraine, pain. Mech: TCA (NE, 5HT agonist).
      • Imipramine: Tx: depression, bedwetting. Mech: TCA (NE, 5HT agonist).
    • MAOI: Tx: depression. Mech: monoamine (NE, 5HT) agonist (inh breakdown). SE: hypertensive crisis (tyramine).
      • Iproniazid: Tx: depression. Mech: MOAI.
      • Tranylcypromine: Tx: atypical depression, anxiety. Mech: MAOI (NE, 5HT agonist). SE: hypertensive crisis (tyramine).
      • Phenelzine: Tx: atypical depression, anxiety. Mech: MAOI (NE, 5HT agonist). SE: hypertensive crisis (tyramine).
    • Atypical
      • Bupropion: Tx: depression, smoking cessation. Mech: NE, DA agonist (reuptake inh). SE: seizure. Fact: no wt gain or sexual dysfunction.
      • Trazodone: Tx: depression w insomnia. Mech: 5HT antag (blk post-syn receptors). SE: priapism.
  • Bipolar
    • Lithium: Tx: mania, bipolar. SE: CNS (ataxia, tremor, seizure, AMS), Renal, GI. Fact: use w food, stay hydrated.
    • Carbamazepine: Tx: epilepsy, bipolar, trigem neuralgia. Mech: Na ch blk. SE: WBC↓.
    • Valproic acid: Tx: epilepsy. Mech: GABA agonist, Na ch blk. SE: liver failure (esp kids), wt gain, plt↓, P450 inh, teratogen.
    • Lamotrigine: Tx: epilepsy, bipolar. Mech: Na ch blk. SE: skin (severe, Stevens-Johnson).
  • Epilepsy
    • Phenobarbital: Tx: epilepsy (neonatal spasm, status epi). Mech: barbituate (GABA agonist). SE: sedation, P450 inducer.
    • Phenytoin: Tx: epilepsy. Mech: Na ch blk. SE: gingival hyperplasia, P450 inducer, teratogen.
    • Carbamazepine: Tx: epilepsy, bipolar, trigem neuralgia. Mech: Na ch blk. SE: WBC↓.
    • Levetiracetam (Keppra,): Tx: epilepsy.
    • Gabapentin: Tx: epilepsy, neuro pain for pt w liver dz.
    • Pregabalin: Tx: epilepsy, neuro pain.
    • Topiramate (Topamax,): Tx: epilepsy, migraine. SE: memory problems.
    • Ethosuximide: Tx: absence seizure. Mech: Ca ch blk.
    • Clonazepam: Tx: epilepsy, sleep disorders, anxiety. Mech: benzodiazepine (GABA agonist). Fact: long acting.
    • Valproic acid: Tx: epilepsy. Mech: GABA agonist, Na ch blk. SE: liver failure (esp kids), wt gain, plt↓, P450 inh, teratogen.
    • Lamotrigine: Tx: epilepsy, bipolar. Mech: Na ch blk. SE: skin (severe, Stevens-Johnson).
  • Antipsychotic: Mech: dopamine antag. SE: EPS (movement disorders, neuroleptic malig syndrome).
    • Typical: SE: EPS
      • Chlorpromazine: Tx: psychosis. Mech: dopamine antag. SE: anticholinergic. Fact: less EPS, less potent.
      • Haloperidol: Tx: psychosis. Mech: dopamine antag. SE: lots of EPS (movement disorders, neuroleptic malig syndrome).
    • Atypical: SE: wt gain
      • Risperidone (Risperdal,): Tx: schizophrenia, autism. Mech: 5HT, DA antag.
      • Clozapine: Tx: schizophrenia. SE: agranulocytosis, wt gain. Fact: little EPS.
      • Olanzapine: Tx: schizophrenia, bipolar. Mech: DA, 5HT, antag. SE: wt gain.
  • ADHD, Narcolepsy
    • Amphetamine (Adderall,): Tx: ADHD. Mech: NE, 5HT, DA agonist (stimulant).
    • Methylphenidate: Tx: ADHD, narcolepsy. Mech: NE, DA agonist (stimulant).
  • Autism
    • Risperidone (Risperdal,): Tx: schizophrenia, autism. Mech: 5HT, DA antag.
    • Aripiprazole (Abilify,): Tx: schizophrenia, autism. Mech: D2 partial agonist.
  • Parkinson
    • Levodopa: Tx: Parkinson. Mech: converted to dopamine by dopa carboxylase. SE: psychosis, n/v, dyskinesia.
    • Carbidopa (Lodosyn,): Tx: Parkinson in conj w L-dopa. Mech: DDC antag (inh peripheral conv of prodrug, so more can cross the BBB).
  • Alzheimer
    • Donepezil (Aricept,): Tx: Alzheimer. Mech: Ach agonist (inh cholinesterase).
    • Rivastigmine: Tx: Dementia (Alzheimer, Parkinson). Mech: Ach agonist. SE: n/v.
    • Memantine: Tx: Alzheimer. Mech: NMDA antag.
  • Migraine
    • Triptan: Tx: migraine. Mech: serotonin agonist. SE: MI.
    • DHE (dihydroergotamine,): Tx: migraine. Mech: serotonin agonist. SE: nausea.
  • Anti-inflammatory
    • NSAID: Tx: pain, inflammation, cardiovascular. Mech: inh cox1,2, PG. SE: GI (cox 1), MI (cox2), renal (bcz PG inh), preg (duct art closure).
      • Aspirin: Tx: pain, inflammation, cardiovascular. Mech: irreversible inh cox1,2 (PG, thromboxane A2). SE: GI, allergy, renal, Reye's.
      • Ibuprofen: Tx: pain, inflammation. Mech: reversible cox1,2 blk.
      • Indomethacin: Tx: when other NSAIDs aren't strong enough. Mech: NSAID. SE: GI. Fact: potent.
      • Sulindac: Tx: pain, inflammation. Mech: NSAID. Fact: long t1/2, daily dosing.
      • Celecoxib (Celebrex,): Tx: pain, inflammation. Mech: cox2 inh. SE: MI. Fact: less GI tox.
    • Acetaminophen (Tylenol, Paracetamol,): Tx: pain, fever. SE: liver tox.