ACH Flashcards
What is the criteria for:
- Total anterior circulation stroke?
- Partial anterior circulation stroke?
- Posterior circulation stroke?
- Lacunar syndrome?
- Contralateral weakness (and/or sensory loss) of face, arm, and leg + Contralateral homonymous hemianopia + Higher cerebral dysfunction (dysphasia, visuospatial disorder – neglect)
- Only 2 of the criteria for total anterior stroke
- CN palsy and contralateral motor/sensory deficit; bilateral motor/sensory deficit; conjugate eye movement disorder; cerebellar dysfunction; isolated homonymous hemianopia
- pure motor or sensory deficit; unilateral weakness; ataxic hemiparesis
What are the initial investigations for stroke?
Bloods: FBC, ESR, blood glucose
Imaging: CT head, ECG to rule out AF
What is the initial management for stroke? (4)
What options are available for ischaemic stroke? (2)
What DVT prophylaxis should be used?
What is the long-term management of ischaemic stroke? (5)
What are the DVLA rules?
Aspirin 300mg and PPI (continue for 2 weeks), oxygen if sats <95%, maintain good blood glucose and blood pressure control
Thrombolysis (4.5h) or thrombectomy (6h)
Mechanical - medical can cause transformation to haemorrhagic stroke
Clopidogrel, atorvastatin, anti-hypertensive (if hypertension), carotid USS, stroke rehab
Only have to report if still having problems after 1 month
What other conditions can mimic TIA? (8)
Hypoglycaemia Todd's paresis Migraine GCA Syncope Retinal detachment Labyrinth disorder - can be mistaken for posterior circulation TIA Venous sinus thrombosis
What is the initial investigations for TIA?
What is the initial management? (2)
What scoring system is used to assess future risk of stroke?
Bloods: FBC, ESR, U&Es, glucose, lipids, LFTs, TFTs
Imaging: ECG, USS carotids
Aspirin 300mg STAT
Refer to TIA clinic to be seen in 24h
ABCD2
What is the long-term management of TIA?
What are the DVLA rules? (2)
Clopidogrel, atorvastatin, antihypertensives, anticoagulation if AF
Surgery if carotid stenosis
Must not drive for 1 month but no need to inform
If have multiple TIAs, must notify - free for 3 months before driving again
What initial investigations should you order for someone presenting with a fall?
Bloods: FBC, U&Es, bone profile, TFTs, B12 and folate
Imaging: ECG
Microscopy: urine dip and culture if signs of infection
What tests can you use to assess gait and balance after a fall? (2)
Timed Up and Go
Turn 180 Test
At what age should men and women be assessed for fragility fracture?
At what ages should it be considered if there are also risk factors?
When can you go straight to a DEXA?
Women >65, Men>75
Women 50-64, Men 50-74
> 50 with history of fragility fracture, <40 with a major risk factor i.e. have a medical condition affecting bone mineral density
Which endocrine disorders affect bone mineral density? (4)
Diabetes, Cushing’s, hyperthyroidism, hyperparathyroidism
What else should you consider alongside ordering a DEXA scan? (4)
Calcium and vitamin D deficiency
Risk factors for falls
Other causes of pathological fractures e.g. malignancy, Paget’s
Secondary osteoporosis
What are some secondary causes of osteoporosis? (5)
GI conditions e.g. IBD, coeliac, chronic pancreatitis
COPD
Endocrine disorders
Rheumatological disorders i.e. any inflammatory arthropathies
Chronic liver disease
What is the medical management for those at risk of osteoporosis? (4)
What lifestyle advice can you give to those at risk of oseoporosis? (4)
Bisphosphonates, calcium and vitamin D supplements, HRT for premature menopause
Stop smoking, drink within limits, take regular exercise, balanced diet
What are the causes of delirium?
Drugs and dehydration Electrolytes Level of pain Impaction of faeces Respiratory Infection Urinary retention Metabolic/MI
What electrolyte abnormalities causes confusion? (2)
What respiratory abnormalities cause confusion? (2)
What metabolic/endocrine abnormalities cause confusion? (5)
Hypercalcaemia, hyponatraemia
Hypoxia, hypercapnia
Liver, renal, thyroid, B12, folate
