4/6 Flashcards
DDx of stroke sx
Migraine
Seizure
SOL - tumour, abscess, haematoma
MS
Functional episode
Anterior uveitis examination findings and management
Postnatal depression
- what is important extra to ask
What are ddx?
How is it managed and complications screened for?
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
When approaching mental health differentials how should you answer?
Psych ddx
Organic and other cause ddx
How to remember the difference between Webers (ventral midbrain syndrome) and Wallenburg (lateral medullary syndrome)
Weak Weber and Wobbly Wallenberg
Weber = weakness (in eyes and body)
Wallenberg = ataxia but no weakness
What meds can be used in meniere’s disease?
Prevention = betahistine = B for Before the attack
Antiemetic used during attack = prochloperazine = P for post/during the attack
Sensitivity vs specificity?
Sensitivity = likelihood of identifying a Positive case
Sepcificity = likelihood of identifying a Negative case
Invx and management of meningitis
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
How is renal calculi managed?
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
Why do we need USS in bruised scrotum?
To rule out rupture
- If not ruptured - fine just leave it and it will heal
- If ruptured - need surgical exploration and repair
Acute vs chronic urinary retention?
Acute = painful
If can palpate the bladder up to the umblicus = chronic
What does a 3 way catether allow?
To aspirate and flush the bladder
What is the most common cause of encephalitis?
What does it cause on CT head?
How is it managed?
HSV1
Focal bilateral temporal lobe involvement
2g IV ceftriaxone BD and 10mg/kg aciclovir TDS for 2wks
What is the triad for juvenille myoclonic epilepsy?
- myoclonic jerks
- absecne seizures
- generalised tonic-clonic seizures
What is the most important thing to monitor prognosis with in Guilain-Barre Syndrome?
FVC - measure lung capacity
DDx of different types of tremor
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
What med is used in painful diabetic neuropathy?
Duloxetine
Where is the atrophy in Alzeihmer’s
Cortex and hippocampus
Type of MND and its presentation?
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
What is RAPD and in what situations would you see it?
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
What do you do before going to finger counting with visual acuity?
What distance do you do finger counting from?
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
Run through how you do a cranial nerve exam
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
What vit deficency can cause colour blindness?
Vit A
What does an enlarged blind spot a sign of?
Papilloedema
Why do you sometimes get hyponatremia post subachronid?
Assoc. with SIADH
What is the most appropriate anti-emetic in gastroparesis (often caused by diabetes)?
Metoclopramide (pro-kinetic so gets food into the stomach and can help control blood sugars)
two first line meds for spasicity in MS?
Gabapentin
Baclofen
