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Jonah's Med Notes > Core Knowledge > Flashcards

Core Knowledge Flashcards

1
Q

What are the key common features of Stroke?

A

Vision loss or visual field defect

Weakness

Aphasia

Impaired Co-Ordination (ataxia)

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2
Q

What are the first investigations to order in Stroke?

A

Non-contrast CT scan

MRI Brain

Serum Glucose - exclude hypoglycaemia

UEC - Rule out renal failure and metabolic causes

Cardiac Enzymes and ECG - exclude arrhythmia or ischaemia

FBC - Excludes anaemia or thrombocytopenia prior to possible initiation of thrombolytics, anticoagulants, or antithrombotics.

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3
Q

DDX of ischaemic stoke

A

Intracerebral haemorrhage
TIA
Hypoglycaemia
Seizure
Brain tumour

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4
Q

Management of Ischaemic stroke

A

Intravenous thrombolysis

Aspirin

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5
Q

What are the key features of a TIA?

A

By definition TIA symptoms are brief and the majority will resolve within the first hour.

Patient/caregiver report of focal neurological deficit

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6
Q

What are strong risk factors for TIA? (5)

A

AF

Valvular disease

Carotid stenosis

Congestive heart failure

Hypertension

Diabetes mellitus

Cigarette smoking

Alcohol abuse

Advanced age

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7
Q

How is TIA managed?

A

Similar to MI

Anticoagulation

Antiplatlet

Lipid Lowering Agent

Lifestyle Modification (Weight loss, smoking cess, alcohol reduction, regular exercise)

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8
Q

What are the key diagnostic factors of Parkinson’s disease? (5)

A

Presence of risk factors (advancing age, fam hx)

Bradykinesia

Resting tremour

Cogwheel Rigidity

Postural Instability

Masked facies

Hypophonia

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9
Q

What are the ddxs for Parkinson’s disease? (5)

A

Progressive supranuclear palsy (PSP)

Multiple system atrophy (MSA; formerly Shy-Drager syndrome)

Lewy body dementia

Corticobasal degeneration

Alzheimer’s disease with parkinsonism

Drug-induced parkinsonism

Metabolic abnormalities

Normal pressure hydrocephalus

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10
Q

How is Parkinson’s disease managed?

A

Levodopa (L-DOPA) mainstay therapy

Dopamine Agonists – Bromocriptine, Pergolide
Anticholinergics for tremor – Benztropine, Benzhexol

Complimentary drugs to enhance L-DOPA:

Carbidopa/Benserazide (DOPA decarboxylase inhibitor)
Tolcapone/Entacapone (COMT Inhibitor)
Selegeline – MAO-B Inhibitor

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11
Q

What is Progressive Supranuclear Palsy?

A

Parkinsonian sx and vertical gaze palsy

Tremor might not be as prominent.

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12
Q

Parkinsonian Symptoms. Strong sx of autonomic dysfunction especially orthostatic hypotension; UMN sx: hyperreflexia, primitive reflexes; cerebellar sx; nystagmus

A

Shy-Drager Syndrome

AKA Multiple Systems Atrophy

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13
Q

What are the Lung causes of Dyspnoea? (7)

A

Pneumonia
Pneumothorax
Pulmonary Embolism
Pleural Effusion
Pulmonary Cancer
Obstructive Lung Disease
COPD and Asthema
Restrictive Lung Disease
Alveolar Haemorrhage

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14
Q

What are the cardiac causes of Dyspnoea?

A
  • MI
  • CHF
    • SYS or DIA
    • Ischemic or Non-Ischemic
    • All cardiomyopathies
    • Pericardial tamponade
    • Valve issues
  • Arrhythmia
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15
Q

What are the cardinal features of Guillian-barre?

A

Preceding viral illness

Progressive symmetrical muscle weakness usually affecting lower extremities before upper extremities and proximal muscles before distal muscles accompanied by paraesthesias in the feet and hands.

Respiratory distress
Speech problems
Paraesthesia

Areflexia / Hyporeflexia

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16
Q

What are the investigations for Gullian Barre?

A

Nerve conduction studies

Lumbar puncture (LP) - elevated CSF protein with normal cell count

LFTs (AST and ALT)

Spirometry (may show reduced vital capacity)

17
Q

What are the ddxs for Guillain-Barre syndrome?

A

Myasthenia gravis
Lambert-Eaton myasthenic syndrome (LEMS)
Botulism
Polymyositis

18
Q

What is the difference between LEMS and Myasthinia Gravis?

A

Lambert–Eaton myasthenic syndrome is caused by autoantibodies to the presynaptic membrane.

Myasthenia gravis is caused by autoantibodies to the postsynaptic acetylcholine receptors.

LEMS improves over time.

Myasthinia Gravis fatigues.

19
Q

How is Guillian-Barre treated?

A

IVIG

20
Q

What are the cardinal features of MS?

A

Visual disturbance in one eye
Peculiar sensory phenomena
Female
Age 20 to 40 years
Fatigue
Urinary frequency
Bowel dysfunction
Spasticity/increased muscle tone
Increased deep tendon reflexes

21
Q

What are the ddxs for MS?

A

Vitamin B12 deficiency

Ischaemic stroke

Guillain-Barre syndrome
Amyotrophic lateral sclerosis (ALS)
Systemic lupus erythematosus

22
Q

How is MS treated? (5)

A

Methylprednisolone

Interferon Beta 1a/1b

Glatiramer

Fingolimod

Natalizumab

23
Q

What is the pathophys of MS?

A

Immune-mediated inflammatory disease that attacks myelinated axons in the central nervous system, destroying the myelin and the axon in variable degrees.

Thought to be linked to T-cells crossing the BBB

24
Q

What are the types of headache?

A

Migraine

Cluster

Tension

SAH

25
Q

How is migraine treated?

A

Abortive - Tryptans

High flow oxygen

NSAIDs

Anti-emetics

Hydration

Caffeine

26
Q

How are cluster headaches treated?

A

High dose Oxygen

Sumatriptan

27
Q

How are tension headaches treated?

A

Simple analgesia

Chronic - amitriptyline

28
Q

When is another drug added in Hypertension?

A

Not tolerated or target not reached after 3 months

29
Q

What is the standard first line drug for hypertension?

A

ACE Inhibitors

30
Q

What is not a standard first line drug for hypertension?

A

Beta Blockers

31
Q

What investigations should be ordered in Hypertension?

A

ECG - LV Hypertropher

Fasting metabolic panel with estimated GFR - end organ damage, conns syndrome

Lipid panel - Metabolic Syndrome

Urinalysis - End organ damage

Hb - Decreased in chronic renal failure

Thyroid-stimulating hormone

32
Q

What are the causes of seizures?

A

V - Vascular Malformation (CT / MRI)

I - Infection (CBC), Inherited conditions

T - Trauma (Hx)

A - Alzheimers (H)

M - Metabolic derangements (CMP) - low Ca, Na, Mg, Glucose.

I - Idiopathic

N - Neoplasm (CT / MRI)

S - pSychiatric.

33
Q

What are the general principles of AEDs?

A

Inhibition of sodium channel function

Inhibition of calcium channel function

Enhancement of GABA action

34
Q
A

Jonah's Med Notes (8 decks)

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