WBR0384

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pharmacology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::An obese 40-year-old female presents to the physician's office with complaints of recent headaches, nausea, and vomiting. After appropriate work-up, you diagnose the patient with pseudotumor cerebri and decide to administer pharmacologic therapy to treat her condition. For which of the following clinical uses is pharmacologic therapy most helpful for?]]
Answer A	AnswerA::Raynaud phenomenon
Answer A Explanation	AnswerAExp::Dihydropyridine calcium channel blockers are used for symptomatic relief of Raynaud phenomenon.
Answer B	AnswerB::Idiopathic hypercalciruria
Answer B Explanation	AnswerBExp::Thiazide-type diuretics are useful for idiopathic hypercalciruria. A common side effect of thiazides is hypercalcemia; in contrast to loop diuretics that lose serum calcium.
Answer C	AnswerC::Glaucoma
Answer C Explanation	AnswerCExp::Acetazolamide is a diuretic that inhibits carbonic anhydrase. It is also used to treat 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 for motion sickness.
Answer E	AnswerE::Pulmonary arterial hypertension
Answer E Explanation	AnswerEExp::Endothelin-1 receptor antagonist is used to treat pulmonary hypertension.
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. Pharmacologic therapy includes acetazolamide. Acetazolamide is a diuretic that inhibits carbonic anhydrase. It is also used to treat 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 that generally affects middle-aged obese women. In addition to lumbar puncture and weight loss, acetazolamide can be used to treat pseudotumor cerebri. Other uses of acetazolamide include glaucoma, altitude sickness, and alkalinization of urine. Reference: Wall M. Idiopathic intracranial hypertension. Neurologic clinics. 2010;28(3):593-617. Educational Objective: References: ]]
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