Anatomy/investigations Flashcards
Vessel location w Contralateral homonymous hemianopia
Posterior cerebral artery if with macular sparing / visual agnosia
Middle cerebral artery if w Contralat hemiparesis and sensory loss, upper extremity > lower, aphasia
Anterior Vs posterior inferior cerebellar artery
BOTH sudden onset vertigo and vomiting
Anterior: ipsilat facial paralysis and deafness
Posterior: ipsilat facial PAIN and temp loss, contralat limb pain and temp loss, ataxia
Jejunal biopsy shows deposition of macrophages containing PAS-positive granules
Whipple’s (Tropheryma whippelii infection)
oral co-trimoxazole for a year
homonymous quadrantanopias
PITS
Parietal-Inferior, Temporal-Superior
Imaging for ? Parathyroid adenoma
Sestamibi parathyroid scan
technetium99 labelled
Central retinal vein Vs artery occlusion
Vein is severe retinal haemorrhage, cheese and Pizza🍕
Artery is cherry red spot 🍒 on pale retina
Management of SAH
CT intracranial angiogram to identify if aneurysm or AVM etc
. If aneurysm then can be treated with coil
histoplasmosis diagnosis
Fine needle aspirate and Groccott strain
massive extradural haemorrhage, most likely caused by.,.
ruptured middle meningeal artery.
Echinococcus granulosus
hydatid liver disease
signs of Syringomyelia
‘cape-like’ (neck and arms) distribution, loss of sensation to TEMP but preservation of light touch, proprioception and vibration
collection of CSF within the spinal cord
symps due to crossing spinothalamic tracts in the anterior commissure
description of syringomyelia anatomy
collection of CSF within the spinal cord
symps due to crossing spinothalamic tracts in the anterior commissure
brachial neuritis presentation
acute onset of unilat (occasionally bilat) severe pain, followed by shoulder and scapular weakness several days later
Can be after vaccine
X-rays: ‘rain-drop skull’ (likened to the pattern rain forms after hitting a surface and splashing, where it leaves a random pattern of dark spots)
multiple myeloma
slightly different from in primary hyperparathyroidism - ‘pepperpot skull’
increased signal in the left temporal lobe, confined predominantly to the grey matter
herpes simplex encephalitis
Which nerve weakness causes wrist drop?
Radial nerve weakness
Which nerve compression causes deltoid weakness and patch of sensory distrubance over upper outer arm?
Axillary nerve compression
weakness of left triceps
sensory impairment of third digit of his left hand and index / ring fingers.
C7 nerve root compression
Median nerve compression would not give triceps weakness.
Tensilon test
aka edrophonium chloride test
myasthenia gravis
tests for myasthenia gravis
Tensilon test: IV edrophonium reduces muscle weakness temporarily - not commonly used any more due to the risk of cardiac arrhythmia
single fibre electromyography: high sensitivity (92-100%)
around 85-90% of patients have antibodies to acetylcholine receptors. In the remaining patients, about about 40% are positive for anti-muscle-specific tyrosine kinase antibodies
Which blood tests could confirm anaphylaxis?
mast cell tryptase immediately, 1-2h for peak
get third baseline sample after >24h
peaks at 1-2h
half-life is roughly 2h
but remain elevated for up to 12h
what mutation causes polycythaemia vera
JAK 2 V617F mutation in 95%
JAK2 exon 12 mutation much rarer
what investigations would you expect in Wilson’s
slit lamp examination for Kayser-Fleischer rings (only found in 50% but v specific)
REDUCED serum caeruloplasmin
REDUCED total serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)
free (non-ceruloplasmin-bound) serum copper is increased
increased 24hr urinary copper excretion
investigation for Haemochromatosis
raised transferrin saturation index raised ferritin and iron low TIBC liver biopsy: Perl's stain C282Y and H63D mutations
