Altered function Flashcards
what is the classic triad of Parkinson’s disease symptoms?
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
what are the Parkinson’s plus syndromes?
multi system atrophy
dementia with levy bodies
progressive subnuclear palsy
corticobasal degeneration
what are the treatments of Parkinsons disease?
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
what are the components of total anterior circulation stroke (TACS)?
unilateral weakness (and/or sensory deficit) of at least 2 of face, arm or leg homonymous hemianopia higher cortical deficit (dysphasia, visuospatial loss)
what are the components of a posterior circulation stroke?
ipsilateral cranial nerve palsy and contralateral motor/sensory deficit
bilateral sensory/motor deficit
cerebellar dysfunction
isolated homonymous hemianopia
how is stroke managed?
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
what is a TIA?
focal neurological deficit which completely resolves within 24 hours of onset
what is the typical history and CT signs of an extradural haemorrhage?
typical history- young patient with a traumatic head injury, rupture of middle meningeal artery
CT scan- bi-convex shape
what is the typical history and CT signs of an subdural haemorrhage?
typical history- occur most commonly in elderly or alcoholic patients (more atrophy, rupture of bridging veins
CT scan- crescent shaped
what is the typical history of subarachnoid haemorrhage?
sudden onset occipital headache (thunderclap headache) which occurs during strenuous activity
what are the cerebellar signs?
DANISH Dysiadochokinesia- inability to perform rapid alternating movements Ataxia Nystagmus Intention tremor Slurred, staccato speech Hypotonia
what are the most common causes of bacterial meningitis?
Neisseria meningitidis (meningococcal meningitis) and strep pneumonia (pneumococcal meningitis)
what are the typical symptoms of bacterial meningitis?
fever, neck stiffness, headache, photophobia, altered consciousness and seizures
non-blanching rash- meningococcal septicaemia
how is meningitis managed?
blood culture and lumbar puncture
antibiotics according to local guidelines
steroids to prevent hearing loss
inform public health
what are the most common causes of viral meningitis?
herpes simplex virus
enterovirus
varicella zoster virus
what is the management of migraine?
conservative- dark, quiet room, sleep
paracetamol
NSAIDs- ibuprofen, naproxen
Triptans- sumatriptan as migraine starts
prophylaxis- propanolol, topiramate, amitryptyline
red flags for raised intracranial pressure
posture dependant headache
nausea and vomiting
sleep disturbance
decreased level of consciousness
how is otitis externa managed?
mild- acetic acid
moderate- topical antibiotic and steroid (e.g gentamicin and hydrocortisone)
what is the 1st line antibiotic in otitis media?
amoxicillin
what is a cholesteatoma?
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
what are some causes of sensorineural hearing loss?
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
what are the 4 sets of paranasal sinuses?
maxillary, ethmoid, frontal, and sphenoidal
where do the sinuses drain?
frontal, maxillary and anterior ethmoids drain into the middle meatus
posterior ethmoids drain into the superior meatus
sphenoid sinus drains into the sphenoethmoidal recess
how is rhinosinusitis manages?
analgesia- paracetamol, NSAIDs
nasal decongestant spray- xylometozaline
saline nasal irrigation
if no improvement- high dose steroid nasal spray for 14 days (mometasone or fluticasone)
what nerve innervates the laryngeal muscles?
vagus nerve via its branches the superior laryngeal nerve (cricothyroid) and the recurrent laryngeal nerve (all other muscles)
what are some causes of hoarseness?
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
what is benign paroxysmal positional vertigo?
otoconia (calcium carbonate crystals) become displaced into the semicircular canals. symptoms are triggered by movement
what is the dix-hallpike manoeuvre?
used to diagnosed BPPV
what is the epley manoeuvre?
treats BPPV
what are the signs of diabetic retinopathy?
dot and blot haemorrhages microaneurysms hard exudates cotton wool spots neovascularisation
how is diabetic retinopathy treated?
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
what are the signs of hypertensive retinopathy?
sliver/copper wiring ateriovenous nipping cotton wool spots hard exudates retinal haemorrhages- flame haemorrhages papilloedema
how does retinal detachment present?
painless peripheral vision loss- like a shadow coming down
sudden onset flashes and floaters
cobwebs
blurred/distorted vision
what are the different types of retinal detachment?
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
how is retinal detachment managed?
seal retinal tears- laser therapy, cryotherapy
retinal detachment surgery- vitrectomy, scleral buckling
what is glaucoma?
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
how does acute angle closure glaucoma happen?
iris bulges forward and seals off the trabecular meshwork causing blockage to the outflow of queues humour causing raised ocular pressure
how is glaucoma investigated?
visual acuity/visual fields intra-ocular pressure- goldmann tonometer assessing the angle- gonioscope fundoscopy- cup-disc ratio optical coherence tomography
how to manage glaucoma?
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
what is the presentation of acute angle closure glaucoma?
severely painful red eye blurred vision haloes around lights headache, nausea, vomiting O/E- hazy cornea, decreased visual acuity, fixed dilated pupil
how is acute angle closure glaucoma managed?
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
what are serious causes of acute red eye?
keratitis
scleritis
acute angle closure glaucoma
anterior uveitis
