13/3 Flashcards
Epilepsy, dermatomes, MG vs Lambert eaton
Pathology of myasthenia gravis vs Lambert-eaton syndrome
How do they present?
MG - autoimmune condition against POST-SYNAPTIC ACh receptors
Lambert-eaton - autoimmune condition against PRE-SYNAPTIC voltage gated Ca+ channels -> prevents release of ACh
Affects the small muscles of head and neck (PROXIMAL - can be important to differentiate between this and Gullian-barre) more
- Drooping eyelids
- bilateral facial weakness
- diplopia
How are focal seizures managed vs generalised seizures
How are absence seizures managed in children?
FoCal (C in focal = carb.. first)
1. carbamazepine
2. lamotrigine
GeneraLiSed (S and L = sodium/lamotrigine first)
1. lamotrigine/sodium valproate
2. carbamazepine
Absence
- ethosuximide
What is more associated with retinal detachment - hypermetropia or myopia?
Myopia - due to enlongated shape of lens putting increased pressure on retina
Osteoporosis management
What should be done in patient 75+ following a fragility fracture?
What is a fragility fracture?
Start on alendronate + vit D
Fracture from standing height or less, in absence of significant trauma
What type of bug is neiserria meningitidis?
What is the most common complication post meningitis?
Gram negative diplococci
Sensorineural hearing loss
Radiculopathy vs neuropathy
Go over dermatomes on the body.
What dermatomes are associated with the following sites:
- umbilicus
- nipple
- badge patch area
- big toe
- little toe
- perineum
- heel
- T10
- T4
- C5
- L5
- S1
- S4
- S1
Big toe = largest of 5 = L5
Little toe = smallest 1 = S1
How do you remember the anatomical positions for S nerve roots?
You stand on S1(heel and little toe)
You lie on S2 (posterior knee and thigh)
You sit on S3 (bum)
You wipe S4 (bum hole)
How is anterior uveitis managed?
Steroid + mydiatric drops
What is the difference between simple and complex focal seizures?
Complex = lose conciousness
Simple = remain concious
What side effects are associated with carbamazepine?
Hyponatremia
Agranulocytosis
What is the management of status epilecus?
ABCDE + DFG
- bucal midazolam/ IV lorazepam
- wait 5 mins - bucal midazolam/ IV lorazepam
wait 5 mins - phenyotonin/sodium valproate
If no response in 45 mins - general anaesthesia
What kind of tumours are MG and Lambert-eaton associated with?
MG - thyomas
Lambert-eaton - small cell lung cancer
What role does ACh have on muscles?
Causes muscle contraction
How can you tell the difference between Lambert-eaton and myasethina gravis?
MG - good response to edrophium/pyriodostigimine (acetylcholinterase inhibitors - improves amount of ACh at junction)
Lambert-eaton does not have a response
- manage with amifampridine
MG - muscle weakness worsens a lot after exertion unlike Lambert - improves after exertion
What investigation is done in MG and Lambert-eaton?
Nerve conduction studies
May want to image for potential thyoma (MG) or small cell lung cancer (Lambert-eaton)
If someone is identified as a carrier of MRSA (done via nasal swab) - what is done?
Nasal mupirocin
Chlorhexidine for the skin
What medical management is used for diarrhoea dominant IBS vs constipation dominant IBS?
LOPeramide for SLOP
- anti-diarrhoea
linaCLOTide for CLOT
- anti-constipation
How do you calculate the anion gap?
What is normal?
(Na + K) - (HCO3 + Cl)
8-14
