16/06 Flashcards
1
Q
acanthosis nigricans sinister cause
A
GI cancer
2
Q
drug induced acne
A
monomorphic eg just pustules due to steroids
3
Q
mucosal involvement blisters
A
pemphigus vulgaris
4
Q
Superficial epidermal
A
Red and painful, dry, no blisters
5
Q
Partial thickness (superficial dermal)
A
Pale pink, painful, blistered. Slow capillary refill
6
Q
Partial thickness (deep dermal)
A
Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure
7
Q
full thickness
A
White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain
8
Q
when to refer burns to 2ndary care
A
superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
9
Q
curlings ulcer
A
acute peptic stress ulcer
10
Q
mild steroid
A
hydrocortisone
11
Q
mod steroids
A
betametasone valerate 0.025 (betnovate)
Clobetasone butyrate 0.05% (Eumovate)
12
Q
potent steroids
A
Fluticasone propionate 0.05% (Cutivate)
Betamethasone valerate 0.1% (Betnovate)
13
Q
very potent steroid
A
Clobetasol propionate 0.05% (Dermovate)
14
Q
erysipelas
A
localised skin infection caused by Streptococcus pyogenes (localised cellulitis)
15
Q
tx of erysipelas
A
flucloxacilllin
16
Q
target lesions
A
erythema multiforme
17
Q
erythrasma
A
groin or axillae
overgrowth of the diphtheroid Corynebacterium minutissimum
18
Q
erythrasma invx
A
Wood’s light reveals a coral-red fluorescence.
19
Q
erythrasma mx
A
Topical miconazole or antibacterial
20
Q
guttate psoriasis preciptant
A
strep infection
21
Q
hirsutism
A
androgen dependant
22
Q
hypertrichosis
A
androgen independant
23
Q
assessment of hirsutism
A
Ferriman-Gallwey scoring system
24
Q
tx of hirsutism wide spread
A
co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin)
25
tx of hirsutism face
topical eflornithine (CI in preg and breast feeding)
26
impetigo cause
staph aureus or strep pyogenes
27
mx of localised impetigo
hydrogen peroxide 1%
topical fusidic acid
if resistance suspected -> topical mupirocin
28
extensive impetigo mx
fluclox
pen allergic -> erythromycin
29
leukoplakia
premalignant condition which presents as white, hard spots on the mucous membranes of the mouth
more common in smokers
30
Lesions 0-1mm thick
1cm
31
Lesions 1-2mm thick
1-2cm
32
Lesions 2-4mm thick
2-3cm
33
Lesions >4 mm thick
3cm
34
tx of venoux ulceration
compression bandaging
oral pentoxifylline
35
shingles vaccine
all patients aged 70-79 years
36
tinea capitis cause
Trichophyton tonsurans
37
tinea corporis (ringworm) causes
Trichophyton rubrum and Trichophyton verrucosum
38
atopic eruption of pregnancy
commonest skin disorder
eczematous, itchy red rash
39
polymorphic eruption of pregnancy
3rd trim
abdo striae
periumbilical area often spared
emollients, steroids
40
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
41
pretibial myoxedema
symmetrical, erythematous lesions seen in Graves' disease
shiny, orange peel skin
42
sebhorreic dermatitis cause
Malassezia furfur
43
punctum
sebaceous cyst
44
scabies mx
permethrim 5%
45
rosacea predominant erythema/flushing
topical brimonidine gel
46
psoriasis mx
potent corticosteroid + vitamin D analogue OD
vit D analogue twice daily
steroid twice daily or coal tar
dithranol
phototherapy or systemic therapy
47
psoriasis genetic assocs
HLA-B13, -B17, and -Cw6
48
pityriasis versicolour cause
Malassezia furfur
49
nickel dermatitis
type 4 hypersensitivity
50
rare t cell lymphoma affecting skin
Mycosis fungoides
51
chemotherapy nausea mx
5-HT3 antagonists eg ondansetron
52
wernickes aphasia lesion
superior temporal gyrus supplied by the inferior division of the left MCA
53
brocas aphasia lesion
inferior frontal gyrus supplied by the superior division of the left MCA
54
wernickes aphasia
receptive
sentences that make no sense, word substitution and neologisms but speech remains fluent - 'word salad'
55
comprehension aphasia
wernickes - impaired
brocas - normal
conduction - normal
56
brocas aphasia
expressive
Speech is non-fluent, laboured, and halting
Repetition is impaired
57
conduction aphasia lesion
stroke affecting the arcuate fasiculus - the connection between Wernicke's and Broca's area
58
conduction aphasia
Speech is fluent but repetition is poor. Aware of the errors they are makin
59
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
60
peripheral (finger to nose) ataxia
cerebellar hemisphere lesions
61
gait ataxia
cerebellar vermis
62
when to refer bells palsy to ENT
3 wks no improvement
63
erb Duchenne paralysis loc of damage
C5, C6 roots that may be caused by breech presentation
64
erb Duchenne paralysis
winged scapula
65
klumpkes palsy loc of damage
T1 due to tracion
66
klumpkes palsy
loss of intrinsic hand muscles
67
brain abscess mx
surgery
IV 3rd-generation cephalosporin + metronidazole
dex
68
tumour to bone
prostate/breast
69
tumour to brain
lung
70
craniopharyngioma
Most common paediatric supratentorial tumour
Derived from remnants of Rathke pouch
71
brown sequard syndrome cause
lateral hemisection of the spinal cord
72
brown sequard syndrome features
ipsilateral weakness below lesion
ipsilateral loss of proprioception and vibration sensation
contralateral loss of pain and temperature sensation
73
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
74
CSF circulation
1. Lateral ventricles (via foramen of Munro)
2. 3rd ventricle
3. Cerebral aqueduct (aqueduct of Sylvius)
4. 4th ventricle (via foramina of Magendie and Luschka)
5. Subarachnoid space
6. Reabsorbed into the venous system via arachnoid granulations into superior sagittal sinus
75
charcot marie tooth disease
hereditary peripheral neuropathy -> motor loss
hx of sprained ankles, foot drop etc
76
first unprovoked/isolated seizure DVLA
6 mo off driving
77
benign rolandic epilepsy
M
paraesthesia (e.g. unilateral face), usually on waking up
78
juvenile myoclonic epilepsy
F
infrequent generalized seizures, often in morning/following sleep deprivation
79
infantile spasms (West syndrome)
brief spasms beginning in the first few months of life (salam attacks)
EEG: hypsarrhythmia
serious neuro abnormality
80
Lennox-Gastaut syndrome
may be extension of infantile spasms
ketongenic diet may help
81
frontal lobe
motor seizures
82
parietal lobe
sensory seizures
83
occipital lobe
visual seizures
84
essential tremor tx
propranolol
85
extradural haematoma cause
temporal region - fracture of pterion -> middle meningeal artery
86
foot drop
common peroneal nerve injury
L5 ridiculopathy
sciatic nerve injury eg post hip surgery
87
4th nerve palsy
eye deviated upwards and outwards
vision worse on going downstairs/reading book
88
ipsilateral CN III palsy and contralateral hemiparesis
weber syndrome - posterior cerebral artery
89
ejection systolic murmur loudest on INSPIRATION
pulmonary stenosis
90
mirror image nuclei
reedsternburg cells/hodgkins lymphoma
91
herpes simplex encephalitis affected lobe
usually temporal and inferior frontal lobes
92
LEMS (SCLC)
repeated muscle contractions lead to increased muscle strength
93
lateral medullary syndrome
posterior inferior cerebellar artery
94
lateral medullary syndrome feautures
ataxia
nystagmus
ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner's
contralateral: limb sensory loss
95
levodopa prescribing
combined with decarboxylase inhibitor (e.g. carbidopa or benserazide) to prevent peripheral metabolism of L-dopa to dopamine
96
CSF polymorphs
bacterial
97
CSF lymphocytes
viral or TB
98
ALS drug tx
Riluzole
99
AML
LMN signs in arms and UMN signs in legs
100
Primary lateral sclerosis
UMN signs only
101
Progressive muscular atrophy
LMN signs only
affects distal muscles before proximal
carries best prognosis
102
worst prognosis MND
progressive bulbar palsy
103
dawson fingers on FLAIR images
MS
104
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)
105
drugs MS
natalizumab
ocrelizumab
106
fatigue MS
amantadine
107
spasticity MS
baclofen or gabapentin
108
bladder dysfunction MS
residual volume - self-catheterisation
no residual volume - anticholinergics
109
oscillopia MS
gabapentin
110
multiple system atrophy features
parkinsonism
autonomic disturbance
cerebellar signs
111
MG
muscle fatigueability
112
narcolepsy diagnosis
multiple sleep latency EEG
113
narcolepsy mx
daytime stimulants (e.g. modafinil) and nighttime sodium oxybate
114
NF1
Café-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas (Lisch nodules) in > 90%
Scoliosis
Pheochromocytomas
115
NF2
Bilateral vestibular schwannomas
Multiple intracranial schwannomas, mengiomas and ependymomas
116
neuroleptic malignant syndrome mx
stop antipsychotic
fludis
dantrolene/bromocriptine
117
neuropathic pain first lines
amitriptyline, duloxetine, gabapentin or pregabalin
118
neuropathic pain rescue med
tramadol
119
normal pressure hydrocephalus mx
ventriculoperitoneal shunting
120
parkinsons path
degeneration of dopaminergic neurons in the substantia nigra
121
parkinsons tremor
worse when stressed or tired, improves with voluntary movement
122
dopamine receptor agonists issues
impulse control disorders and excessive daytime somnolence
123
paroysmal hemicrania tx
indomethacin
124
pituitary apoplexy
Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage or infarction
125
pituitary apoplexy mx
urgent steroid replacement due to loss of ACTH
fluid balance
surgery
126
factors favouring true epileptic seizures
raised serum prolactin
tongue biting
127
wrist drop
radial nerve
128
cushings triad of raised ICP
widening pulse pressure
bradycardia
irregular breathing
129
thrombylysis with alteplase conditions
administered within 4.5 hours of onset of stroke symptoms
haemorrhage has been definitively excluded
130
thrombylysis + thrombectomy
within 6 hours of onset
confirmed occlusion of the proximal anterior circulation
131
antiplatelets stroke
aspirin 300mg as soon as haemorrhage excluded
2ndary prevention = clopidogrel or aspirin + MR dipyridamole
132
crescenteric collection not limited by suture lines
subdural haematoma
133
cause of chronic subdural haematoma
rupture of small bridging veins
134
elderly and alcoholic brain bleed
chronic subdural haematoma
135
trigeminal neuralgia tx
carbamazepine
136
which cardiac drug may precipitate digoxin toxicity
thiazides
137
role of benzos
enhance the effect of GABA
138
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
139
suspected SAH, if CT head is done within 6 hours of symptom onset and is normal
no LP
140
suspected SAH, if CT head is done more than 6 hours after symptom onset and is normal
do a LP
141
when should LP be performed in suspected SAH
12 hours following the onset of symptoms to allow the development of xanthochromia
142
SAH LP findings
xanthochromia
normal or raised opening pressure
143
after SAH is confirmed, what invx
CT intracranial angiogram to determine cause
144
tx of intracranial aneurysms
coiling
145
predictive factors in SAH
conscious level on admission
age
amount of blood visible on CT head
146
acute severe hydrocephalus initial mx
external ventricular drain into right ventricle and bag at bedside
147
long term CSF diversion technique for hydrocephalus
ventriculoperitoneal shunt
148
electrolyte abnormality leading to long QT
hypokalaemia
149
hydrocephalus eye sign in child
impaired upward gaze (sunsetting of the eyes)
150
painful mouth end of life
Benzydamine hydrochloride mouthwash or spray
151
which cardiac meds can worsen glucose tolerance
THIAZIDES
152
which antihypertensives should be avoided in pts with HOCM
ACEi
153
what cancer does myelodysplasia progess to
AML
154
key about advance directives
refer to a specific tx in a specific circumstance
155
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
156
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
157
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.
158
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
159
what is used to treat pts in emergency scenarios
common law
160
what is used to treat pts for physical disorders that dont have capacity and refuse
Mental Capacity Act
161
what is used to treat pts for mental disorders that does have capacity and refuse
mental health act
162
non urgent transfer of RBCs time
90-120 mins
163
SSRI in children and adolescents
fluoxetine
164
too much NaCl
hyperchloraemia metabolic acidosis
165
APS
prolonged APTT and low platelets
166
chronic alcoholism electrolyte abnormality
hypomagnesaemia
167
how to reduce hypercalciuria to prevent renal stones
thiazides
168
how to reduce hypercalciuria to prevent renal stones
thiazides
169
how to reduce hypercalciuria to prevent renal stones
thiazides
170
what does parvovirus exposure cause in sickle cell disease
aplastic crisis
