WBR0384

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pharmacology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::An obese 40-year-old woman presents to the physician's office with complaints of recent headaches, nausea, and vomiting. The patient is found to have elevated opening pressure on lumbar puncture. She is advised to lose weight and is then prescribed a pharmacologic therapy to treat her condition. The patient's prescribed medication is also indicated for which other condition?]]
Answer A	AnswerA::Raynaud phenomenon
Answer A Explanation	AnswerAExp::Dihydropyridine calcium channel blockers are indicated for symptomatic relief of Raynaud phenomenon.
Answer B	AnswerB::Idiopathic hypercalciuria
Answer B Explanation	AnswerBExp::Thiazide-type diuretics are indicated to treat idiopathic hypercalciuria.
Answer C	AnswerC::Glaucoma
Answer C Explanation	AnswerCExp::Acetazolamide is a diuretic that inhibits carbonic anhydrase in the proximal convoluted tubules. It is indicated for pseudotumor cerebri, altitude (not motion) sickness, glaucoma, and conditions that require alkalinization of urine.
Answer D	AnswerD::Motion sickness
Answer D Explanation	AnswerDExp::First generation antihistamines, such as dimenhydrinate, are useful to relieve symptoms of motion sickness. In contrast, acetazolamide may relieve symptoms of altitude sickness.
Answer E	AnswerE::Post-infectious cough
Answer E Explanation	[[AnswerEExp::Post-infectious cough is defined as cough that persists after the symptoms of the primary infection have resolved. Post-infectious cough may be acute (up to 3 weeks), subacute (3 to 8 weeks), or chronic (more than 8 weeks). It is usually a self-limited condition, and the majority of patients do not require any treatment. A minority of patients may require inhaled ipratropium bromide, inhaled or oral steroids, or even central antitussive agents (such as codeine) for symptomatic relief. Neither acetazolamide nor furosemide has any role in post-infectious cough.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Pseudotumor cerebri (idiopathic intracranial hypertension) is a neurological condition characterized by elevated intracranial pressure (ICP). Common symptoms are headache, nausea, vomiting, and pulsatile tinnitus. The disease usually affects middle-aged obese women. Lumbar puncture and measurement of opening pressure is diagnostic and often therapeutic, either permanently or temporarily. Weight loss is key for management of pseudotumor cerebri. Patients are often prescribed furosemide, a loop diuretic, or acetazolamide, a diuretic that inhibits carbonic anhydrase in the proximal convoluted tubule. Acetazolamide is also indicated to relieve symptoms of altitude (not motion) sickness, glaucoma, and conditions that require alkalinization of urine. Furosemide is another pharmacologic option for pseudotumor cerebri. Educational Objective: Pseudotumor cerebri is a neurological condition characterized by an elevated intracranial pressure. It generally affects middle-aged obese women. In addition to lumbar puncture and weight loss, acetazolamide can be used to treat pseudotumor cerebri. Other indications of acetazolamide include glaucoma, altitude sickness, and alkalinization of urine. References: Wall M. Idiopathic intracranial hypertension. Neurologic clinics. 2010;28(3):593-617. First Aid 2014 page 547]]
Approved	Approved::Yes
Keyword	WBRKeyword::Acetazolamide, WBRKeyword::Glaucoma, WBRKeyword::Urinary alkalinization, WBRKeyword::Pseudotumor cerebri, WBRKeyword::Headache, WBRKeyword::Furosemide, WBRKeyword::Carbonic anhydrase inhibitor, WBRKeyword::Altitude sickness
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