27/3/22 Flashcards
Epidural puncture site
Lumbar puncture site
Epidural - L3-4
Lumbar - L4-5
What bony feature do you feel for head engangment in childbirth
Ischial spine (4cm above bone = -4cm)
What muscles make up the levator ani?
label in diagram
Puborectalis
Pubococcygeus
Ileococcygeous
label in diagram
Name the bones of the hand
So long to pinky here comes the thumb
Scaphoid Lunate Triquetrium Pisiform Hamate Capitate Trapezoid Trapezium
Names the tarsal bones from cranial view
Call the cops nobody calls Colin cunt
Calcaneus Talus Cuboid Navicular 3x cuneiform
Go look at xray of pelvis and complete it
DO IT
What is the word used to describe when someone’s affect is far more reactive than you think it should be
Labile
Multiple Sclerosis
Describe how a patient would present to clinic
What tests would you do to confirm
How would you explain the condition to them
What management and treatment would you give them
Multiple neurological deficits that are seperated by location and time frame
Classic triad =
- Nystagmus + optic neuritis + double vision
- Intention tremor + muscle spasms
- Dysarthria (difficulty talking)
MRI - check for white plaques
CSF (lumbar puncture at L4/5) - oligoclonal bands present
MS is an autoimmune condition (condition where body attacks itself). We have millions of nerves in our body that carry signals between each other. You can think of them like the cables for the telly - they have a thick layer around that protects them - this thick layer also means signals can run smoothly and quickly. In MS the immune system attacks that nice coating called myelin. This means signals are lost and can cause numerous symptoms like the ones you are experiencing. The most common type is relapsing-remitting - where you will have bad spells of symptoms and then will experience some recovery as the myelin repairs itself but it will never go back to normal. It’s important to stress that there is nothing you have done to cause this.
There is no cure.
In general use disease modifying therapy
Tecfedira and aubagio no1
With acute relapse
- mild = symptomatic treatment
- mod = oral steroids
- severe = Iv steroids and admit
MND
Describe how a patient would present to clinic
What tests would you do to confirm
How would you explain the condition to them
What management and treatment would you give them
Mixed picture of UMN and LMN
With no sensory deficiet
In bulbar ALS can get early involvement of tongue and bulbar symptoms
MRI can be useful to rule out other causes
MND has many forms. It can cause lots of different motor symptoms and it is impossible to predict where these will occur and when. In a healthy individual signals get transmitted from the brain to the muscles down nerves called motor neurons. Unfortunately in MND these signals no longer trasmit properly and muscles affected can weaken and eventually stop working. Most cases are entirely random and it’s just an horrible hand that you have been dealt. Pause - ask questions.
There is no cure and there is only currently one drug that has been shown to improve survival by 3 months - riluzole. As this only adds time onto the end of life when symptoms are at their worst a lot of patients choose not to take it.
Other than that it is symptom control with botox and baclofen to reduce spasticity
Important for early discussion of advanced care planning.
Parkinson’s
Describe how a patient would present to clinic
What tests would you do to confirm
How would you explain the condition to them
What management and treatment would you give them.
What are the side effects of the medication
Pill-rolling tremor - improves on finger to nose test
Shuffling gait and stooped posture
Cog-wheel rigidity in upper and lower limbs
Bradykinesia
Blank expression
Usually a clinical diagnosis
Parkinson’s disease is the most common neurological disorder. It is caused by the breakdown of dopamine producing nerves (neurons) in the brain (substantia nigra in midbrain). Without enough dopamine our body struggles to control movement. This is a progressive disease so it will get worse as time goes on.
There is no cure. But drugs to help with symptoms.
Levodopa (dopamine agonist that carries BBB) and carbidopa (dopa decarboxylase i. - which breaks down levodopa before it reaches BBB)
Can cause N+V and hallucinations and make you v tried throughout the day
Given initally along with domperidone (anti-emetic)
These drugs also have the ‘on-off phenomenon’ -> work better at certain times of day randomly
What condition is this sign associated with:
Forward flexion of the neck sends an electric shock down back and radiates to limbs
Multiple sclerosis
What can help you differentiate from drug induced Parkinsonism and Parkinson’s Disease?
What drugs can cause drug induced?
Drug - symmetrical
PD - asymmetrical
Metoclopramide
Typical anti-psychotics
What neuro condition is assoc. with pesticide use?
Parkinson’s disease
What can be used to reduce spasicity in patients?
Botox
Baclofen
What are the signs and symptoms of UMN vs LMN defect
UMN
- hyperreflexia
- increased tone
- spastic gait
- exaggerated jaw-jerk
- extensor plantar response
LMN
- muscle wasting
- weakness
- fasciculations
- absent or reduced deep tendon reflexes
UMN = tight and tense
LMN = slow and wasting and fitting
What is the most common cause of encephalitis?
HSV
What signs and symptoms are characterisitc of Lewy Body dementia
- visual hallucinations
- fluctuating cognition = “good days and bad days”
- loss of concentration and attention
- parkinsonism
- early phase: loss of exectutive function (ability to carry out tasks) but recognition and recall preserved
Name some classical features of fronto-temporal dementia
Personality change
- lack of attention to personal hygiene
- hoarding/criminal behaviour
- ignoring social etiquette
- new eating habits
- repetitive behaviours
In early stages tend to perform well on cognition
What type of headache presents more commonly in men than women?
Describe it’s presentation and how you would manage the condition and acute attacks
Cluster headache
Periorbital pain Eye symptoms e.g. lacrimation, ptosis Acute onset Very painful Occur 1-2 day for 4-12wk period and then nothing followed by another 'cluster' Last 15mins-3hrs
- Avoid triggers
- Prophylaxis - verapamil
Acute attack
= 100% O2
= subcutaneous/nasal triptan
How is trigeminal neuralgia managed?
- Carbamazepine (anti-convulsant)
~microvascular decompression
Describe the differences in presentation between a migraine and tension headache
How do you manage both
Migraine
- unilateral
- sometimes with visual symptoms
- pulsitile
- photophobia and can’t hear loud noises
- lasts 4-72hrs
Keep a migraine diary to find triggers and then avoid
Reduce caffiene intake, drink H20 and sleep well
Prophylaxis - propranolol/toprimate
Acute = sumatriptan and pain relief and anti-emetic
Tension headache
- bilateral
- non-pulsitile
- around head like a headband
Minimise stressers
Pain relief
What aspects of a headache make you think raised ICP?
Worse in morning, coughing, when bent over and lying down
Improve after standing up and vomiting
~disturb sleep
New onset focal neuro deficet/personality change
Reduced level of conciousness
What red flag symptoms do you need to ask about for headache
- new onset focal neuro defiect/personality change/cognitive dysfunction -> raised ICP, enecphelitis, meningitis
- neck stiffness and altered mental state - bacterial/fungal/viral meningitis
- temporal region of headache with jaw claudication (pain and discomfort on chewing) - temporal arteritis in GCA
- weight loss - malignancy
- rash - meningococcal sepsis
- loss/reduced level of conciousness - raised ICP
- recent head trauma - subdural
- headache with severe eye pain, reduced vision and N+V - acute closed angle glucoma
- limb and facial weakness
- aura?
- balance
- new seizures - malignancy
If someone presents with migraine with aura when do you tell them to take their acute medicine - at beginning of headache or beginning of aura.
Also what is the drug again?
Sumatriptan - beginning of headache
When does meningitis become a notifiable disease?
How is it managed?
Upon clinical suspicion
With IM benzyl penicillin
