3rd Year Formative January

Question 1

What is Vascular Parkinsonism caused by?

Answer 1

Small strokes and Infarcts which can go unnoticed and therefore untreated.

Question 2

What is the sort of timescale for Vascular Parkinsonism?

Answer 2

Tends to have a slow onset.. Months to years.

Question 3

Will Vascular Parkinsonism Respond to Levodopa?

Answer 3

No, due to the ischaemia.

Question 4

Where does the vestibulospinal tract arise?

Answer 4

Originates from the vestibular nuclei of the pons and the medulla.

Question 5

What is the main job of the vestibulospinal tract?

Answer 5

To activate antigravity muscles (extenders of legs and flexors of arms)
- Stops us falling over when pushed

Question 6

What is the Reticulospinal Tract responsible for?

Answer 6

Many Functions including control of breathing and cardiac control.

Question 7

Where does the Reticulospinal tract arise from?

Answer 7

The Reticular formation in the Brainstem.

Question 8

What is the Immediate management of a TIA?

Answer 8

Aspirin 300mg on Arrival.

Question 9

What is the management of a Stroke on arrival?

Answer 9

Must determine whether Ischaemic or Haemorrhagic
- CT scan first

Question 10

What is the first line management of an Ischaemic Stroke?

Answer 10

Aspirin 300mg

Question 11

What is the management of a Haemorrhagic stroke?

Answer 11

Neurosurgical evaluation for potential surgical intervention.

Question 12

What are clinical features of LEMS?

Answer 12

Lambert-eaton Myasthenic Syndrome
- Bilateral weakness of the thighs (proximal muscles) of insidious onset.
- Causing reduced or absent reflexes.

Question 13

What can LEMS often be associated with?

Answer 13

Small cell Lung Cancer

Question 14

What is used to Diagnosed LEMS, and which Antibodies can be tested for?

Answer 14

NCS
Anti-Voltage Gated Calcium Channel Antibodies.

Question 15

What is the Treatment of LEMS?

Answer 15

3,4-Diaminopyridine

Question 16

What is the treatment of Guillain-Barre Syndrome?

Answer 16

Plasma Exchange

Question 17

What does Chloroquine do to patients with MG?

Answer 17

Precipitates or worsens features of MG.

Question 18

What is the Treatment of MG?

Answer 18

Pyridostigmine + Steroids.

Question 19

What is the mainstay of treatments for chronic inflammatory demyelinating Radiculopathies?

Answer 19

Oral Steroids.

Question 20

What Anticonvulsant medication is used in the treatment of Abscence seizures?

Answer 20

Ethosuximide in women.
Sodium Valproate in Men.

Question 21

What is the treatment of Idiopathic Intracranial Hypertension?

Answer 21

• Weightloss,
• Carbonic Anhydrase inhibitors (Acetazolamide, Topiramate)
• Ventricular atrial/lumbar peritoneal shunt
• Monitor visual fields and CSF pressure

Question 22

In what patients does IIH occur?

Answer 22

Young Overweight females, Often have Polycystic Ovaries too.

Question 23

What are some side effects of SSRIs?

Answer 23

• Reduced Libedo
• Vivid Dreams
• Transient increase in suicidal thoughts
• Increased Anxiety.

Question 24

What Atypical Antidepressant can be administered alongside SSRIs to block their side effects?

Answer 24

Mirtazapine

Question 25

What 4 dimensions define Emotionally unstable personality disorder/Borderline personality disorder?

Answer 25

• Interpersonal Instability dimension (which has features of fear of abandonment and intense unstable relationships)
• Cognitive and/or self disturbance (which consists of paranoid ideas, dissociative symptoms, and identity disturbances).
• Affective and emotional dysregulation; And
• Behavioural Dysregulation dimension, which has impulsivity and suicidal behaviour.

Question 26

How do tricyclics work?

Answer 26

By blocking re-uptake of Monoamines into the pre-synaptic terminal e.g. (noradrenaline, 5-HT)
e.g. Imipramine

Question 27

What type of drug is Phenelzine?

Answer 27

An IRREVERSIBLE Monoamine Oxidase inhibitor - (inhibits monoamine oxidase A and B)

Question 28

What type of Legislation allows police to detain a schizophrenic patient who is at risk of harm immediately?

Answer 28

An Emergency Detention Certificate.

Question 29

What legislation could be used to keep a Schizophrenic patient in hospital for a while, or to force them to receive treatment?

Answer 29

A Compulsory treatment order (CTO)
- initially up to 6 months
- Requires 2 independent reports from 2 doctors (2 AMP’s or AMP+GP)

A Short term detention order (STDO)
- up to 28 days for assessment/treatment
- Approved Medical Professional + MHO (mental health officer)

Question 30

What is the are the 5 criteria for Detention under the mental health act?

Answer 30

1. likely Mental disorder
2. Significantly impaired decision making ability
3. Determining Tx required
4. Significant risk
   
   1. health, Safety or walfare of Patient
   2. Safety of others
5. Informal / voluntary care not appropriate.

Question 31

What is the First line Treatment given to Help patients with Alcohol Detoxification?

Answer 31

Chlordiazepoxide (A Benzodiazepine)
- Can cause a high rate of relapse after successful medicated withdrawal.

Question 32

What is the first line treatment for Delerium Tremens?

Answer 32

Oral Lorazepam

Question 33

What is the Treatment given in Alcohol withdrawal to reduce the chance of developing Wernickies Encephalopathy?

Answer 33

Pabrinex

Question 34

What type of Drug Is Nifedipine?

Answer 34

A Calcium Channel Blocker
- used in the Tx of Preeclampsia and GH