dementia Flashcards
what age is classed as early onset alzheimers
<65
how is beta amyloid produced
cleavage of APP
what is a lewy body
intracytoplamic eosinophiic inclusion with dense core surrounded by alpha-synuclein fibrils
what atrophys first in huntingtons disease
basal ganglia - partic caudate nucelus
micropathophysiology in huntingtons
degen of striatal nucelus - l oss of inhibitory regulatory of motor activity
what are pick cells and picks bodies and when are they seen
cells = swollen neurons seen in frontotemporal dementia
bodies = intracytoplasmic filamentous inclusions
seen in frontotemporal dementia (picks disease)
Focal gyral atrophy with a knife-blade appearance is characteristic of what dementia
picks disease
what lobes atrophy in picks
frontal first and temporal
what happens in transient global amnesia
transient (4-6 hours) abrupt onset anterograde amnesia - cant make new memeories
treatment of myathenic crisis
plasmaphoresis
IVIG
symptoms of temporal lobe seizure
A sudden sense of unprovoked fear or joy
A deja vu experience — a feeling that what’s happening has happened before
A sudden or strange odor or taste
A rising sensation in the abdomen, similar to being on a roller coaster
in what dementia may cognition be fluctuating
lewy body
treatment of lewy body dementia
anti cholinesterase inhibitors
dx of lewy body
clinical
DAT/SPECT
what casues CJD
prion proteins
features of CJD
rapid onset dementis
myoclonus
investigations in CJD
CSF
EEG
MRI
most common CJD
sporadic
what causes variant CJD
eating meat form a cow with
mad cow- bovine spongiform encephalopathy
what is the hallmark of CJD
spongiform change
mean feature of posterior cortical atrophy
visual agnosia - man who thought wife was a hat
terry pratchett
features in primary prgoressive aphasia
semantic (naming memory) - language goes first
what mmse score indicates dementia
<24
what NCIE recommended scoring systems are used for dementia and score
10-CS 0-5 =cog impair
what test is used to assess delirium and score is indicitive
4AT and >4
what blood tests are doen in dementia
FBC
U&E
LFT
TFT
B12/folate
Calcium
Glucose
ESR/CRP
first line sedative in delirium
0.5mg haloperidol
treatment of delirium in parkansonian patients
reduce parkinson meds or olanzapine
management of severe alzheimers
memantine
first line option is alzheimers
acetylcholinesterase inhibs
donepezil
rivastigmine
galantamine
when is donepezil contraindicated
in patients with bradycardia
how many mediations is classed as polypharmacy
4+
what type of dementia shows fluctuating cognition
lewy body
what questionnarie is used for frailty
PRISMA-7
for non cell cycle secific antibiotics what is more important dose or duration
dose
side effect of cisplatin
ototoxicity
nephrotoxicity
peripheral neuropathy
hypomagneium
side effects of vincrsitine
peripheral neuropathy
side effects of cyclophosphamide
haemorrhagic cystitis
myelosuppresion
bladder cancer
management of neoplastic spinal cord comrpession
dexamethasone
what cancer is most commonly associated with superior vena cava compression
lung
features of SVC compression
dyspnoea is the most common symptom
swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
headache: often worse in the mornings
visual disturbance
pulseless jugular venous distension
tumour marker for breast cancer
CA 15-3
tumour marker forr colorectal cancer
carcinoembronic antigen (CEA)
treatment for agitation in pallative care
haloperidol
midazolam in terminal phase
tx of hiccups in palliative care
chlorpromazine
empirical anti emetic in palliative care
metoclopramide
in chemically mediated nausea in palliative care what is used
ondansetron, haloperidol and levomepromazine
what should be given for palliative nausea in cerebral mets
cyclizine and dex
palliative nausea TX in vestibular symtpoms
cyclizine
in palliative care in cortical nausea- due to anxiety, pain, fear and/or anticipatory nausea what anti-emetic should be given
benzos
if not cyclizine
what route should be taken for palliative care anti emetics if oral not available
parenteral
example of pain regime in palliative care
20-30 mg MR morphine and 5mg breakthrough morphine
GIVE LAXATIVE - nausea and drowsy should be transient
what ratio of morphine is breakthrough compared to daily dose
one sixth eg 5mg for 30mg
what pain medication is given in palliative care in mild renal impairement
oxycodone
what palliative care medication is given in severe renal imapirement
alfentanil, fentanyl, buprenorphine
how much can you increase an opiate dose by
30-50%
if switching codeine/tramadol to morphine what should you do to dose
divide by 10
when switching oral morphine to oral oxycodoe what should you do to the dose
divide by 1.5/2
what shoudl you do to dose when switching oral morphine to subcut
half it
palliative treatment of secretions
hyoscine
conversion of oral morphine to sucut diamorphine
divide by 3
blood screen in demetia patient
FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels
