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TCBL > Altered function > Flashcards

Altered function Flashcards

1
Q

what is the classic triad of Parkinson’s disease symptoms?

A

resting tremor- ‘pill rolling tremor’, improves on voluntary movement
rigidity- resistance to passive movement, cogwheel rigidity
bradykinesia- movements become slower and smaller e.g. shuffling gait, smaller handwriting, reduced facial movements/expressions

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2
Q

what are the Parkinson’s plus syndromes?

A

multi system atrophy
dementia with levy bodies
progressive subnuclear palsy
corticobasal degeneration

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3
Q

what are the treatments of Parkinsons disease?

A

levodopa- synthetic dopamine, usually given with a drug which reduces breakdown (co-carledopa, co-benyldopa)
COMT inhibitors- e.g. entacapone, inhibits breakdown of levodopa
dopamine agonists- e.g. pergolide, stimulates dopamine receptors
monoamine oxidase-B inhibitors- e.g. selegine, rasagline, monoamine oxidase-B breaks down neurotransmitters such as dopamine

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4
Q

what are the components of total anterior circulation stroke (TACS)?

A 
unilateral weakness (and/or sensory deficit) of at least 2 of face, arm or leg 
homonymous hemianopia 
higher cortical deficit (dysphasia, visuospatial loss)
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5
Q

what are the components of a posterior circulation stroke?

A

ipsilateral cranial nerve palsy and contralateral motor/sensory deficit
bilateral sensory/motor deficit
cerebellar dysfunction
isolated homonymous hemianopia

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6
Q

how is stroke managed?

A

CT head to rule out haemorrhage
aspirin 300mg stat (after CT) and continued for 2 weeks
thrombolysis for Altepase (tissue plasminogen activator) if it can be administered within 4.5 hours of symptom onset
thrombectomy- mechanical removal of clot

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7
Q

what is a TIA?

A

focal neurological deficit which completely resolves within 24 hours of onset

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8
Q

what is the typical history and CT signs of an extradural haemorrhage?

A

typical history- young patient with a traumatic head injury, rupture of middle meningeal artery
CT scan- bi-convex shape

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9
Q

what is the typical history and CT signs of an subdural haemorrhage?

A

typical history- occur most commonly in elderly or alcoholic patients (more atrophy, rupture of bridging veins
CT scan- crescent shaped

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10
Q

what is the typical history of subarachnoid haemorrhage?

A

sudden onset occipital headache (thunderclap headache) which occurs during strenuous activity

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11
Q

what are the cerebellar signs?

A 
DANISH 
Dysiadochokinesia- inability to perform rapid alternating movements 
Ataxia
Nystagmus
Intention tremor 
Slurred, staccato speech 
Hypotonia
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12
Q

what are the most common causes of bacterial meningitis?

A

Neisseria meningitidis (meningococcal meningitis) and strep pneumonia (pneumococcal meningitis)

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13
Q

what are the typical symptoms of bacterial meningitis?

A

fever, neck stiffness, headache, photophobia, altered consciousness and seizures
non-blanching rash- meningococcal septicaemia

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14
Q

how is meningitis managed?

A

blood culture and lumbar puncture
antibiotics according to local guidelines
steroids to prevent hearing loss
inform public health

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15
Q

what are the most common causes of viral meningitis?

A

herpes simplex virus
enterovirus
varicella zoster virus

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16
Q

what is the management of migraine?

A

conservative- dark, quiet room, sleep
paracetamol
NSAIDs- ibuprofen, naproxen
Triptans- sumatriptan as migraine starts
prophylaxis- propanolol, topiramate, amitryptyline

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17
Q

red flags for raised intracranial pressure

A

posture dependant headache
nausea and vomiting
sleep disturbance
decreased level of consciousness

18
Q

how is otitis externa managed?

A

mild- acetic acid

moderate- topical antibiotic and steroid (e.g gentamicin and hydrocortisone)

19
Q

what is the 1st line antibiotic in otitis media?

A

amoxicillin

20
Q

what is a cholesteatoma?

A

an accumulation of benign keratinising squamous cells which are hyperproliferating. they produce proteolytic enzymes which are locally destructive, eroding adjacent bone.
presentation- foul smelling discharge, conductive hearing loss, attic retraction, discharging attic perforation

21
Q

what are some causes of sensorineural hearing loss?

A

prebycusis- age related
noise-related hearing loss
labrynthitis- associated with tinnitus, pressure and vertigo
merniere’s disease- vertigo, fluctuating hearing loss, tinnitus, feeling of fullness
ototoxin exposure
infection- measles, meningitis, shingles, mumps

22
Q

what are the 4 sets of paranasal sinuses?

A

maxillary, ethmoid, frontal, and sphenoidal

23
Q

where do the sinuses drain?

A

frontal, maxillary and anterior ethmoids drain into the middle meatus
posterior ethmoids drain into the superior meatus
sphenoid sinus drains into the sphenoethmoidal recess

24
Q

how is rhinosinusitis manages?

A

analgesia- paracetamol, NSAIDs
nasal decongestant spray- xylometozaline
saline nasal irrigation
if no improvement- high dose steroid nasal spray for 14 days (mometasone or fluticasone)

25
Q

what nerve innervates the laryngeal muscles?

A

vagus nerve via its branches the superior laryngeal nerve (cricothyroid) and the recurrent laryngeal nerve (all other muscles)

26
Q

what are some causes of hoarseness?

A

functional dysphonia
infection/inflammation- acute/chronic laryngitis
benign vocal cord leisions- nodules (singers nodes), cysts, polyps
malignancy- laryngeal cancer
neurological- laryngeal nerve palsy, stroke, Parkinsons, motor neurone disease, myasthenia graves

27
Q

what is benign paroxysmal positional vertigo?

A

otoconia (calcium carbonate crystals) become displaced into the semicircular canals. symptoms are triggered by movement

28
Q

what is the dix-hallpike manoeuvre?

A

used to diagnosed BPPV

29
Q

what is the epley manoeuvre?

A

treats BPPV

30
Q

what are the signs of diabetic retinopathy?

A 
dot and blot haemorrhages 
microaneurysms 
hard exudates 
cotton wool spots 
neovascularisation
31
Q

how is diabetic retinopathy treated?

A 
laser photocoagulation (pan retinal photocoagulation)- reduces the oxygen demand of the retina thus reducing the VEGF produced due to ischaemia which reduces neovascularisation 
anti-VEGF- not recommended as photocoagulation is better and injection carries risk of endopthalmitis
32
Q

what are the signs of hypertensive retinopathy?

A 
sliver/copper wiring 
ateriovenous nipping 
cotton wool spots 
hard exudates 
retinal haemorrhages- flame haemorrhages 
papilloedema
33
Q

how does retinal detachment present?

A

painless peripheral vision loss- like a shadow coming down
sudden onset flashes and floaters
cobwebs
blurred/distorted vision

34
Q

what are the different types of retinal detachment?

A

rhegmatogenous- commonest form of retinal detachment. as the virtuous skinks and partly separates from the retina a tear may develop allowing fluid to enter the sub retinal space causing detachment
exudative- fluid/exudate forms underneath retina, often due to inflammation or malignancy
tractional- seen in diabetic retinopathy, where abnormal vasculature causes contraction of the virtuous which pulls on the retina

35
Q

how is retinal detachment managed?

A

seal retinal tears- laser therapy, cryotherapy

retinal detachment surgery- vitrectomy, scleral buckling

36
Q

what is glaucoma?

A

progressive optic neuropathy causing specific optic nerve abnormalities (disc cupping) and field defects (arcuate field defects). it is commonly associated with raised intra-ocular pressure

37
Q

how does acute angle closure glaucoma happen?

A

iris bulges forward and seals off the trabecular meshwork causing blockage to the outflow of queues humour causing raised ocular pressure

38
Q

how is glaucoma investigated?

A 
visual acuity/visual fields  
intra-ocular pressure- goldmann tonometer 
assessing the angle- gonioscope 
fundoscopy- cup-disc ratio 
optical coherence tomography
39
Q

how to manage glaucoma?

A

aim is to reduce intra-ocular pressure, to slow the progression
PHARMACOLOGICAL
prostaglandin analogue (latanoprost) eye drops- increase outflow
beta-blockers (timolol)- decrease production
carbonic anhydrase inhibitors (brimonidine)- decrease production
sympathomimetics (brimondine)- decrease production and increase outflow
INTERVENTIONAL
selective laser tracbeculoplasty
trabeculectomy

40
Q

what is the presentation of acute angle closure glaucoma?

A 
severely painful red eye 
blurred vision 
haloes around lights 
headache, nausea, vomiting 
O/E- hazy cornea, decreased visual acuity, fixed dilated pupil
41
Q

how is acute angle closure glaucoma managed?

A

refer to ophthalmologist
pilocarpine eye drops- constricts pupil
IV diamox- carbonic anhydrase inhibitor-decreases production of aqueous humour
laser iridectomy- makes a hole in the iris to allow aqueous humour to flow

42
Q

what are serious causes of acute red eye?

A

keratitis
scleritis
acute angle closure glaucoma
anterior uveitis

TCBL (4 decks)

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