1st April [28th-4th] Flashcards
What is Ramsay Hunter syndrome?
Group of three neurological syndromes. Main presenteation is facial nerve palsy due to a herpes zoster virus.
Types 1-3 of Ramsay Hunter
type 1 = cerebellar syndrome [incl. myoclonic epilepsy, ataxia, tremor, dementia]
type 2 = facial nerve paralysis, vertigo, deafness, pain
type 3 = neuropathy deep palmar branch ulnar nerve [rareist]
When is orlistat used?
overweight people to lose weight
What is orlistat?
Class of medication called lipase inhibitors, prevents fat in foods being absorbed intestines, then removed by stools.
Muscles in the rotator cuff
Supraspinatus, infraspinatus, subscapularis and teres minor
What is rotator cuff tendonitis
Rotator cuff tendonitis refers to inflammation of the tendons of the rotator cuff muscles. This usually occurs secondary to repetitive use of the shoulder joint.
The muscle most commonly affected is the supraspinatus. During abduction, it ‘rubs’ against the coraco-acromial arch. Over time, this causes inflammation and degenerative changes in the tendon itself
Movements of the rotator cuff muscles
Subscapularis: Medial (internal) rotation of the shoulder
Supraspinatus: Abduction of the arm
- Necessary for the initial 0 to 15 degrees of shoulder abduction motion
- The deltoid muscle abducts the arm beyond 15 degrees
Infraspinatus: Lateral (external) rotation of the shoulder
Teres Minor: Lateral (external) rotation of the shoulder
Tx of a stye?
soak clean flannel in warm water, hold against eye 5-10m, repeat 3-4 times per day
Avoid wearing contact lenses and eye make-up until stye has burst and healed.
What is a stye?
A stye is caused by staphylococcal bacteria. This bacterium is found in the nose and is transferred easily to the eye when you rub your nose, then your eye.
Bacteria can cause inflammation or infection of the eyelash follicle, oil glands that drain through ducts into the eyelashes. When the duct is clogged, oil can’t drain and backs up into the glands. The gland becomes swollen and inflamed, causing the stye.
What is blepharitis?
Common ocular condiiton characterised by chronic inflammation, scaling, reddening and crusting of the eyelid.
Cx of blepharitis?
Not sight-threatening, but cna lead to permanent alterations in the eyelid margin
Cause blepharitis
Different variations of blepharitis can be classified as seborrheic, staphylococcal, mixed, posterior or meibomitis, or parasitic
Tx for menorrhagia
1st line - LNG-IUS Mirena [long-term Tx, in for at least q2m].
2nd line - tranexamic acid, NSIADs [like mefenmic acid reduces 25% menstrual loss], traneamic acid [50% loss], COC [50% reduction]
3rd line - with progestogens, either norethisterone or injected long-acting progestens like Depo-Provera every 12w
Tx for earwax
2/3 drops olive/almond oil twice daily for a few days. After 2w wax should fall out.
No evidence ear candles or ear vacuums ger ride of earwax.
What is a meningioma?
Tumour that forms on membranes that cover brain/spinal cord. Slow growing, as many as 90% are benign. Different Sx depend on what structures it presses on.
Charles bonnet syndrome
Group of visual hallucinations brain’s adjustment to vision loss. Most common elderly who have lost their sight.
What is the drug riveroxibane used for?
Anticoagulation medication used to prevent blood vclots. Specifically used to Tx DVT and pulmonary emboli and prevent blood v=clots in AF following knee surgery.
Rule of thumb old men and prostate
80% prostate cancer by 80, 100% by 100
What is telengiectasia?
Condition which widened tiny blood vessels [caalled venules] cause threadlike red lines or patterns in skin. From gradually and often clustewrs. Spider veins.
Pre=diabetes HbA1c
42-47mmol/mol, 48 if diabetic
What is patellofemoral syndrome?
Pain as a result of problems with kneecap and femur. Pain generally worse front of knee and comes on gradually. Worsen excessive use and climbing.
Who is HRT unsuitable for?
Hx breast, ovarian or womb cancer Hx of blood clots HTN that is untreated Liver disease Pregnancy
[menopausal Sx typically last 5-10 years, average 7y]
Alterantive to HRT
- Lifestyle measures like exercising regularly, eating healthy diet, cutting down on coffee/alcohol/spicy foods/stop smoking.
- Tibolone - medicine similar to combined HRT, but may not be as effectivr and is only suitable for women who had last period more than a year ago
- Antidepressants - some AD might help with hot flushes and night sweats, although can cause unpleasant SE like agitation and dizziness
- Clonidine - non-hormonal medicine may help reduce hot flushes and night sweats some women, although benefits small
Guidance for HRT
Wiltshire HRT
- points like oestrogen only if no uterus [unopposed oestrogen if womb and not progresterone can thicken lining of womb and lead to Ca]
- sequential combined [uterus; monthly bleed]
Sx of B12 defieincy, Tx, common cause B12 defieincy
Fatigue, tiredness, breathlessness, hadache, pale skin, palpitations, pins and needles, depression, yellowing of skin, decline cognition function
Tx - hydroxocobalamin, or cyanocobalamin. Both injectable.
Cause commonly perniicious anaemia
Example medication for neuropathic pain
Amtriptyline - headaches and depression
Duloxetine - bladder problems and depression
Pregabalin and gabapetin - treat epilepsy, headache, anxiety
Dx for fibromyalgia
First, r/o conditionslike MS/RA/MS The Dx - severe pai in 3-6 different areas of your body, or milder pain in 7 or more different areas - Sx have stayed similar level for 3m - no other reason for Sx
Gout vs pseudogout
Gout
- abrupt onset, red, hot swollen, painful joint, most often big toe less frequently ankle, knee wrist, elbow, finger, usually confined to just one joint early disease
- caused by high uric acid
- Dx by history/exam/bloods/aspiration/USS/XR
- Tx: acute flare then COC, colchicine, dietary changes, uric acid loweirn drugs
CPPD
- abrupt onset red hot swollen joint, most often knee/wrist/ankle/spinal ligaments
- CPPD crystals build up in cartilage
- Dx same as gout, except no CT
- TX NSAIDs, COC, colchicine
AIDs defining cancers
Kaposi sarcoma
Non-Hodgkin lyphoma [NHL]
Cervical cancer
Sx, cause, PP, Mx
Contagious skin infestations by the mite Sarcoptes sabei.
Most common Sx - severe itchiness, pimple-rash. Occasionally burrows may appear.
Sx due to allergic reaction to the mites.
Mx - sexual contacts/people living should be Tx. Bedding/clothing washed.
Mx - premethrin most effective. Ivermectin also another option.
Sx of lyphoma
Enlarged lymph nodes, fever, drenched sweats, unintented weight loss, ithcing, tiredness.
Enlarged LN are painless.
Sweats common night.
Other Sx: enlarged spleen or liver.
Categories of lymphomas [according to the WHO]
Lymphoma means blood malignancies that develop from lymphocytes. 4 categories [WHO]:
- NHL
- HL
- Multiple myeloma
- Immunoproliferative diseases
Differences between HL and NHL
Different type of lymphocyte affected;
- HL marked presence of Reed-Sternberg cells, 15-24 y/o. Progresses almost orderly fashion throughout body.
- NHL these are not present, 60+ y/o. Various sites of the body, often Dx at an older age.
Types of mastalgia
Cyclic and non-cyclic [breast pain]
Breast examination
Inspection Hands above head Hands below head Palpation LN
Asymetry, swelling, skin changes, nipple changes, masses.
