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Year 4 - 5 Qs A Day > 4/6 > Flashcards

4/6 Flashcards

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1
Q

DDx of stroke sx

A

Migraine
Seizure
SOL - tumour, abscess, haematoma
MS
Functional episode

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2
Q

Anterior uveitis examination findings and management

A
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3
Q

Postnatal depression
- what is important extra to ask

What are ddx?

How is it managed and complications screened for?

A

MUST ask about danger to self AND BABY - how is baby being cared for? any concerns about baby and their development?

Baby blues - appears 2-3days post birth and lasts UP TO 2 WEEKS
Postnatal depression - can appear any time 1 year post birth
GAD
Postpartum psychosis
(remember organic causes too)

Screen with regular mental health checkups and use the Edinburgh Postnatal Depression screening score

Manage
- CBT
- Self-lead help - exercise, sleep and eat well

If wanting to start on an SSRI must seek specialist advice

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4
Q

When approaching mental health differentials how should you answer?

A

Psych ddx

Organic and other cause ddx

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5
Q

How to remember the difference between Webers (ventral midbrain syndrome) and Wallenburg (lateral medullary syndrome)

A

Weak Weber and Wobbly Wallenberg

Weber = weakness (in eyes and body)
Wallenberg = ataxia but no weakness

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6
Q

What meds can be used in meniere’s disease?

A

Prevention = betahistine = B for Before the attack

Antiemetic used during attack = prochloperazine = P for post/during the attack

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7
Q

Sensitivity vs specificity?

A

Sensitivity = likelihood of identifying a Positive case
Sepcificity = likelihood of identifying a Negative case

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8
Q

Invx and management of meningitis

A

Invx
- Neuro exam with two specific test
-> KErnig’s = Knee Extension - increases headache
-> brudziNsKi = Neck flexion causes Knee flexion

Bloods
- baseline + glucose + lactate + clotting profile + CRP

Imaging
Neuroimaging if signs of raised ICP

Special Test
LP - contraindicated if sepsis/bleeding risk/raised ICP

===========================================
Management
Conservative
ABCDE
Contacts in last 7 days - single dose ciprofloxacin
Shock - IV fluids
If meningococcal -> inform public health

Medical
- if awaiting LP results or if LP delayed >1hr - start Abx

Child <3mnth - amox + cefotaxime
>3mnth - cefotaxime

Adult <60 - IV ceftriaxone
>60 - IV amox + ceftriaxone

HSV likely cause - aciclovir
If not meningococcal sepsis (rash), septic shock, recently out of surgery or immunocomprimised-> IV dexamethasone

Warn that some people are left with sensironeural hearing loss after

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9
Q

How is renal calculi managed?

A

If septic with degraned renal function = emergency = urgent decompression (put tube into kidneys to decompress them and then remove the stone once infection subsided)

<5mm can watch and wait
- if distal can use medical explusion therapy (tamulosin)

<2cm
- ESWL
- Utereroscopy - for distal/middle ureteric stones and PREGNANT

> 2cm/complex calculi (staghorn/cysteine stones)
- percutaneous nephrolithotomy

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10
Q

Why do we need USS in bruised scrotum?

A

To rule out rupture
- If not ruptured - fine just leave it and it will heal
- If ruptured - need surgical exploration and repair

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11
Q

Acute vs chronic urinary retention?

A

Acute = painful

If can palpate the bladder up to the umblicus = chronic

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12
Q

What does a 3 way catether allow?

A

To aspirate and flush the bladder

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13
Q

What is the most common cause of encephalitis?

What does it cause on CT head?

How is it managed?

A

HSV1

Focal bilateral temporal lobe involvement

2g IV ceftriaxone BD and 10mg/kg aciclovir TDS for 2wks

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14
Q

What is the triad for juvenille myoclonic epilepsy?

A
  • myoclonic jerks
  • absecne seizures
  • generalised tonic-clonic seizures
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15
Q

What is the most important thing to monitor prognosis with in Guilain-Barre Syndrome?

A

FVC - measure lung capacity

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16
Q

DDx of different types of tremor

A

Essential - both hands, present when moving and resting
= idiopathic

Intention - worse on movement
- anxiety and fear
- anti-epletics w.g. phenytonin and carbmazepine

Cerebellar - high amplitude and bypass finger to nose
- MS and alcoholism

Resting - parkinsons
- improves on movement

17
Q

What med is used in painful diabetic neuropathy?

A

Duloxetine

18
Q

Where is the atrophy in Alzeihmer’s

A

Cortex and hippocampus

19
Q

Type of MND and its presentation?

A

ALS = UMN and LMN (looks like ALL)
PMA = only LMN (looks like PMS - which affects down there)
PLS = UMN only (when saying pls you look up all cute)

Bulbar = involvement of tongue and worst prognosis

20
Q

What is RAPD and in what situations would you see it?

A

Relative Afferent Pupillary Defect

Damage to the afferent fibres (found within CNII) - cause pupillary light reflex

Causes
- Significant retinal damage -> CRAO/CRVO and large retinal detachement
- Signifcant optic neuropathy -> optic neuritis, secondary compression from SOL

21
Q

What do you do before going to finger counting with visual acuity?
What distance do you do finger counting from?

A

If pt can’t read the top line of the Snellen chart - half the distance before going to finger counting -> can you see light?

1m

22
Q

Run through how you do a cranial nerve exam

A

CN 1
= any change in your smell?

CN2
= inital observation of the eye
= acuity assessment if 6/6 or lower then other pinhole
= shine light in eyes individual then swinging
= look at wall then look at pen (should constrict when looking closer)
= colour vision with one eye closed
= visual fields
= blind spot with red pen
= “at this point I would do fundoscopy”

CN3,4.6
= H movements - “can you see double/pain at any point”

CN5
= sensation with cotton - same on both sides?
= clench jaw against fingers
= open mouth against resistance

CN7
= facial movements
= change in taste?

CN8
= any change to hearing?
= whisper in ear with other ear covered
= Rinne’s = on mastoid - tell me when it stops then move to AC
= Weber’s - where do you hear it loudest - middle or towards an ear

CN 9 and 10
= “any change to voice or difficulty swallowing”
= cough, swallow and say ‘ah’ while viewing the palate
= would like to do gag reflex but obvs wont

CN 11
= turn head against resistance
= shrug shoulders against resistance

CN 12
= look at tongue and then get to push against sides of mouth

23
Q

What vit deficency can cause colour blindness?

A

Vit A

24
Q

What does an enlarged blind spot a sign of?

A

Papilloedema

25
Q

Why do you sometimes get hyponatremia post subachronid?

A

Assoc. with SIADH

26
Q

What is the most appropriate anti-emetic in gastroparesis (often caused by diabetes)?

A

Metoclopramide (pro-kinetic so gets food into the stomach and can help control blood sugars)

27
Q

two first line meds for spasicity in MS?

A

Gabapentin
Baclofen

28
Q
A

Year 4 - 5 Qs A Day (122 decks)

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