16/06 Flashcards
acanthosis nigricans sinister cause
GI cancer
drug induced acne
monomorphic eg just pustules due to steroids
mucosal involvement blisters
pemphigus vulgaris
Superficial epidermal
Red and painful, dry, no blisters
Partial thickness (superficial dermal)
Pale pink, painful, blistered. Slow capillary refill
Partial thickness (deep dermal)
Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure
full thickness
White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain
when to refer burns to 2ndary care
superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
curlings ulcer
acute peptic stress ulcer
mild steroid
hydrocortisone
mod steroids
betametasone valerate 0.025 (betnovate)
Clobetasone butyrate 0.05% (Eumovate)
potent steroids
Fluticasone propionate 0.05% (Cutivate)
Betamethasone valerate 0.1% (Betnovate)
very potent steroid
Clobetasol propionate 0.05% (Dermovate)
erysipelas
localised skin infection caused by Streptococcus pyogenes (localised cellulitis)
tx of erysipelas
flucloxacilllin
target lesions
erythema multiforme
erythrasma
groin or axillae
overgrowth of the diphtheroid Corynebacterium minutissimum
erythrasma invx
Wood’s light reveals a coral-red fluorescence.
erythrasma mx
Topical miconazole or antibacterial
guttate psoriasis preciptant
strep infection
hirsutism
androgen dependant
hypertrichosis
androgen independant
assessment of hirsutism
Ferriman-Gallwey scoring system
tx of hirsutism wide spread
co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin)
tx of hirsutism face
topical eflornithine (CI in preg and breast feeding)
impetigo cause
staph aureus or strep pyogenes
mx of localised impetigo
hydrogen peroxide 1%
topical fusidic acid
if resistance suspected -> topical mupirocin
extensive impetigo mx
fluclox
pen allergic -> erythromycin
leukoplakia
premalignant condition which presents as white, hard spots on the mucous membranes of the mouth
more common in smokers
Lesions 0-1mm thick
1cm
Lesions 1-2mm thick
1-2cm
Lesions 2-4mm thick
2-3cm
Lesions >4 mm thick
3cm
tx of venoux ulceration
compression bandaging
oral pentoxifylline
shingles vaccine
all patients aged 70-79 years
tinea capitis cause
Trichophyton tonsurans
tinea corporis (ringworm) causes
Trichophyton rubrum and Trichophyton verrucosum
atopic eruption of pregnancy
commonest skin disorder
eczematous, itchy red rash
polymorphic eruption of pregnancy
3rd trim
abdo striae
periumbilical area often spared
emollients, steroids
Pemphigoid gestationis
pruritic blistering lesions
peri-umbilical region, later spreading to the trunk, back, buttocks and arms
usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
oral corticosteroids are usually required
pretibial myoxedema
symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin
sebhorreic dermatitis cause
Malassezia furfur
punctum
sebaceous cyst
scabies mx
permethrim 5%
rosacea predominant erythema/flushing
topical brimonidine gel
psoriasis mx
potent corticosteroid + vitamin D analogue OD
vit D analogue twice daily
steroid twice daily or coal tar
dithranol
phototherapy or systemic therapy
psoriasis genetic assocs
HLA-B13, -B17, and -Cw6
pityriasis versicolour cause
Malassezia furfur
nickel dermatitis
type 4 hypersensitivity
rare t cell lymphoma affecting skin
Mycosis fungoides
chemotherapy nausea mx
5-HT3 antagonists eg ondansetron
wernickes aphasia lesion
superior temporal gyrus supplied by the inferior division of the left MCA
brocas aphasia lesion
inferior frontal gyrus supplied by the superior division of the left MCA
wernickes aphasia
receptive
sentences that make no sense, word substitution and neologisms but speech remains fluent - ‘word salad’
comprehension aphasia
wernickes - impaired
brocas - normal
conduction - normal
brocas aphasia
expressive
Speech is non-fluent, laboured, and halting
Repetition is impaired
conduction aphasia lesion
stroke affecting the arcuate fasiculus - the connection between Wernicke’s and Broca’s area
conduction aphasia
Speech is fluent but repetition is poor. Aware of the errors they are makin
global aphasia
Large lesion affecting all 3 of the above areas resulting in severe expressive and receptive aphasia
May still be able to communicate using gestures
peripheral (finger to nose) ataxia
cerebellar hemisphere lesions
gait ataxia
cerebellar vermis
when to refer bells palsy to ENT
3 wks no improvement
erb Duchenne paralysis loc of damage
C5, C6 roots that may be caused by breech presentation
erb Duchenne paralysis
winged scapula
klumpkes palsy loc of damage
T1 due to tracion
klumpkes palsy
loss of intrinsic hand muscles
brain abscess mx
surgery
IV 3rd-generation cephalosporin + metronidazole
dex
tumour to bone
prostate/breast
tumour to brain
lung
craniopharyngioma
Most common paediatric supratentorial tumour
Derived from remnants of Rathke pouch
brown sequard syndrome cause
lateral hemisection of the spinal cord
brown sequard syndrome features
ipsilateral weakness below lesion
ipsilateral loss of proprioception and vibration sensation
contralateral loss of pain and temperature sensation
cerebellar syndrome
D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremour
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia
CSF circulation
- Lateral ventricles (via foramen of Munro)
- 3rd ventricle
- Cerebral aqueduct (aqueduct of Sylvius)
- 4th ventricle (via foramina of Magendie and Luschka)
- Subarachnoid space
- Reabsorbed into the venous system via arachnoid granulations into superior sagittal sinus
charcot marie tooth disease
hereditary peripheral neuropathy -> motor loss
hx of sprained ankles, foot drop etc
first unprovoked/isolated seizure DVLA
6 mo off driving
benign rolandic epilepsy
M
paraesthesia (e.g. unilateral face), usually on waking up
juvenile myoclonic epilepsy
F
infrequent generalized seizures, often in morning/following sleep deprivation
infantile spasms (West syndrome)
brief spasms beginning in the first few months of life (salam attacks)
EEG: hypsarrhythmia
serious neuro abnormality
Lennox-Gastaut syndrome
may be extension of infantile spasms
ketongenic diet may help
frontal lobe
motor seizures
parietal lobe
sensory seizures
occipital lobe
visual seizures
essential tremor tx
propranolol
extradural haematoma cause
temporal region - fracture of pterion -> middle meningeal artery
foot drop
common peroneal nerve injury
L5 ridiculopathy
sciatic nerve injury eg post hip surgery
4th nerve palsy
eye deviated upwards and outwards
vision worse on going downstairs/reading book
ipsilateral CN III palsy and contralateral hemiparesis
weber syndrome - posterior cerebral artery
ejection systolic murmur loudest on INSPIRATION
pulmonary stenosis
mirror image nuclei
reedsternburg cells/hodgkins lymphoma
herpes simplex encephalitis affected lobe
usually temporal and inferior frontal lobes
LEMS (SCLC)
repeated muscle contractions lead to increased muscle strength
lateral medullary syndrome
posterior inferior cerebellar artery
lateral medullary syndrome feautures
ataxia
nystagmus
ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss
levodopa prescribing
combined with decarboxylase inhibitor (e.g. carbidopa or benserazide) to prevent peripheral metabolism of L-dopa to dopamine
CSF polymorphs
bacterial
CSF lymphocytes
viral or TB
ALS drug tx
Riluzole
AML
LMN signs in arms and UMN signs in legs
Primary lateral sclerosis
UMN signs only
Progressive muscular atrophy
LMN signs only
affects distal muscles before proximal
carries best prognosis
worst prognosis MND
progressive bulbar palsy
dawson fingers on FLAIR images
MS
indications for disease modifying drugs in MS
relapsing-remitting disease + 2 relapses in past 2 years + able to walk 100m unaided
secondary progressive disease + 2 relapses in past 2 years + able to walk 10m (aided or unaided)
drugs MS
natalizumab
ocrelizumab
fatigue MS
amantadine
spasticity MS
baclofen or gabapentin
bladder dysfunction MS
residual volume - self-catheterisation
no residual volume - anticholinergics
oscillopia MS
gabapentin
multiple system atrophy features
parkinsonism
autonomic disturbance
cerebellar signs
MG
muscle fatigueability
narcolepsy diagnosis
multiple sleep latency EEG
narcolepsy mx
daytime stimulants (e.g. modafinil) and nighttime sodium oxybate
NF1
Café-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas (Lisch nodules) in > 90%
Scoliosis
Pheochromocytomas
NF2
Bilateral vestibular schwannomas
Multiple intracranial schwannomas, mengiomas and ependymomas
neuroleptic malignant syndrome mx
stop antipsychotic
fludis
dantrolene/bromocriptine
neuropathic pain first lines
amitriptyline, duloxetine, gabapentin or pregabalin
neuropathic pain rescue med
tramadol
normal pressure hydrocephalus mx
ventriculoperitoneal shunting
parkinsons path
degeneration of dopaminergic neurons in the substantia nigra
parkinsons tremor
worse when stressed or tired, improves with voluntary movement
dopamine receptor agonists issues
impulse control disorders and excessive daytime somnolence
paroysmal hemicrania tx
indomethacin
pituitary apoplexy
Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage or infarction
pituitary apoplexy mx
urgent steroid replacement due to loss of ACTH
fluid balance
surgery
factors favouring true epileptic seizures
raised serum prolactin
tongue biting
wrist drop
radial nerve
cushings triad of raised ICP
widening pulse pressure
bradycardia
irregular breathing
thrombylysis with alteplase conditions
administered within 4.5 hours of onset of stroke symptoms
haemorrhage has been definitively excluded
thrombylysis + thrombectomy
within 6 hours of onset
confirmed occlusion of the proximal anterior circulation
antiplatelets stroke
aspirin 300mg as soon as haemorrhage excluded
2ndary prevention = clopidogrel or aspirin + MR dipyridamole
crescenteric collection not limited by suture lines
subdural haematoma
cause of chronic subdural haematoma
rupture of small bridging veins
elderly and alcoholic brain bleed
chronic subdural haematoma
trigeminal neuralgia tx
carbamazepine
which cardiac drug may precipitate digoxin toxicity
thiazides
role of benzos
enhance the effect of GABA
testing for brain death
fixed pupils
no corneal reflex
absent oculo-vestibular reflexes
no response to supraorbital pressure
no cough reflex
no obsered resp effort
suspected SAH, if CT head is done within 6 hours of symptom onset and is normal
no LP
suspected SAH, if CT head is done more than 6 hours after symptom onset and is normal
do a LP
when should LP be performed in suspected SAH
12 hours following the onset of symptoms to allow the development of xanthochromia
SAH LP findings
xanthochromia
normal or raised opening pressure
after SAH is confirmed, what invx
CT intracranial angiogram to determine cause
tx of intracranial aneurysms
coiling
predictive factors in SAH
conscious level on admission
age
amount of blood visible on CT head
acute severe hydrocephalus initial mx
external ventricular drain into right ventricle and bag at bedside
long term CSF diversion technique for hydrocephalus
ventriculoperitoneal shunt
electrolyte abnormality leading to long QT
hypokalaemia
hydrocephalus eye sign in child
impaired upward gaze (sunsetting of the eyes)
painful mouth end of life
Benzydamine hydrochloride mouthwash or spray
which cardiac meds can worsen glucose tolerance
THIAZIDES
which antihypertensives should be avoided in pts with HOCM
ACEi
what cancer does myelodysplasia progess to
AML
key about advance directives
refer to a specific tx in a specific circumstance
confirmation of death after cardiac arrest when cpr has been attempted
observe for signs of life for 5 mins
no palpable central pulse
no HS
cardiac monitor confirming 5 mins of asytole
absence of pupillary light reflex, corneal reflex and no response to supraorbital pressure
confirmation of death after cardiac arrest when DNACPR in place
absence of pupillary light reflex, corneal reflex and no response to supraorbital pressure
no palpable central pulse and no HS for 2 mins
no chest wall movements or breath sounds for 2 mins
no additional monitoring required in these pts
GP confirmation of expected death
temp <35
No spontaneous movements.
No respiratory effort (examine for at least one minute).
No heart sounds or palpable pulses (examine for at least one minute).
No corneal reflex.
Pupils are fixed and dilated.
capacity
a. understand the information relevant to the decision
b. retain that information
c. use or weigh that information as part of the process of making the decision
d. communicate the decision made by talking, sign language or other means
what is used to treat pts in emergency scenarios
common law
what is used to treat pts for physical disorders that dont have capacity and refuse
Mental Capacity Act
what is used to treat pts for mental disorders that does have capacity and refuse
mental health act
non urgent transfer of RBCs time
90-120 mins
SSRI in children and adolescents
fluoxetine
too much NaCl
hyperchloraemia metabolic acidosis
APS
prolonged APTT and low platelets
chronic alcoholism electrolyte abnormality
hypomagnesaemia
how to reduce hypercalciuria to prevent renal stones
thiazides
how to reduce hypercalciuria to prevent renal stones
thiazides
how to reduce hypercalciuria to prevent renal stones
thiazides
what does parvovirus exposure cause in sickle cell disease
aplastic crisis
