DPD Flashcards
1
Q
Diagonsis of depression
A
2+ weeks of experiencing core symptoms
- Low mood
- Low energy/motivation
- Anhedonia
- Plus other symptoms
Feelings of worthlessness/excessive or inappopriate guilt
Recurrent thoughts of death, suicidal thoughts, suicide attempts
Reduced concentration, indecisiveness
Psychomotor agitation or retardation
Insomnia, hypersomnia
Significant appetite change +/- weight loss
2
Q
Difference between dementia + pseudodemntia
A
Dementia - if patient’s don’t remember something they will start getting a bit anxious because of not remembering
Pseudodementia - patients will not stress out at all, also lack of motivation to engage with the question
Depression can present as pseudodementia, so it’s a good differential on someone with symptoms of Dementia
3
Q
What is dementia
A
Chronic brain failure Progressive decline in Higher cortical functions Emotional regulation Behavioural symptoms
4
Q
Give the 5 types of dementia
A
Alzheimer's disease Mixed alzheimer's/vasular Vascular Lewy body Frontotemporal/Pick's disease
5
Q
Pathophysiology of AD
A
- Tau proteins
clamps of tau proteins in neuronal cell bodies result in microtubule + neuronal/axon instability - Amyloid precursour proteins
Form plaques/toxic aggregates on neurones + blood vessels –> cause neuronal cell death
6
Q
Pathophysiology of vascular dementia
A
- Multi-infarct dementia - there are lots of bits of brain that are vulnerable to little strokes
- Step-wise progression
- Focal neurological signs
7
Q
What is dementia with Lewy bodies
A
Diagnosed when cognitive symptoms begin before or at the same time as parkinsonism
8
Q
What is Parkinson’s disease dementia
A
dementia develops many years after the onset of motor symptoms, PD not related to dementia but just co-exists
PD then after many years dementia
9
Q
Features of Lewy body dementia
A
- Onset <1yr of onset of PD
- Parkinsonism
- Fluctuating attention + awareness
- Visual hallucinations - KEY feature
- REM sleep behaviour disorder
10
Q
Difference between Alzheimer’s disease and dementia with Lewy bodies
A
AD - dopamine transmission is normal in the striatum
DLB - loss of dopamine neurones in the striatum
11
Q
Features of frontotemporal dementia/Pick’s disease
A
- Typically affects frontal lobes Also known as Pick's disease Disinhibition Change in personality and social functioning Emotional blunting/liability Apathy Restlessness
12
Q
3 cognitive tests you can use to investigate dementia
A
- MMSE (mini-mental state examination)
Doesn’t tell you if someone has dementia
Just tells you that something is wrong
N: 25-30, Mild: 20-24, Moderate 13-19, Severe <12 - RUDAS (Rawland Universal Dementia Assessment Scale)
Similar to MMSE but for people whose English is not their first language or for people who are poorly educated
N: 23-30, Abnormal: <23 - ACEIII (Addenbrooke’s cognitive examination)
Bigger, fuller cognitive assessment than MMSE
Can give you more information on whether someone has dementia
N:88-100, Mild: 83-87, Moderate/severe: <83
13
Q
Key difference between dementia + delirium
A
In delirum you have decreased ability to direct, focus, sustain and shift attentione.g. a person with delirium will not be able to say the months backwards whereas a person with dementia will be
In delirium there is
- Disturbance of consciousness (in dementia consciousness is unaffected until late stage)
- Fluctuating (as opposed to dementia which is progressive)
- Visual hallucinations are common (in dementia they are uncommon except in Lewy body dementia)
14
Q
Lesion in the brain signs
A
Hemiparesis
15
Q
Lesion in the brainstem signs
A
CN lesions
ipsilateral
16
Q
Lesion in the cerebellum signs
A
DANISH Dysdiadochokinesia Ataxia Nystagmus Intention tremor Slurred, scanning speech Hypotonia
17
Q
Lesion in the spinal cord signs
A
Paraparesis = partial paralysis of the lower limbs
18
Q
Lesion in the NMJ signs
A
Fatiguability of muscle
19
Q
Hemisensory loss/ Sensation felt on one side
A
Contralateral Cerebral cortex lesion
20
Q
Loss of sensation at a level + downwards
A
Spinal cord lesion
21
Q
Pain + Loss of sensation in a particular dermatome / in the distribution of a nerve root
A
Nerve roots (radiculopathy)
22
Q
Loss of sensation in a specific area
A
Mononeuropathy
23
Q
Loss of sensation from a point onwards / glove + stockings distribution
A
Polyneuropathy
24
Q
Normal HbA1c value
Pre-diabetic HbA1c value
Diabetic HbA1c values
A
<42 mmol/mol
43-47 mmol/mol
>47 mmol/mol
25
Examples of basal bolus insulin
Detemir
Levemir
Galgrine
26
Treatment of diabetic neuropathy
Duloxetine
27
Pregabalin used for
Tx of neuropathic pain + epilepsy
28
Peripheral neuropathy ddx (7)
Drugs - hx (cyclosporin, amiodarone, metronidazole, isonazid)
Alcohol - hx, increased GGT + MCV
B12 deficiency - anaemia, increased MCV
DM - glucose, HbA1c
Hypothyroidism - TFTs
Uraemia - U+Es
Amyloidosis - hx of myeloma or chronic infection/inflammation
29
4 drugs that can cause peripheral neuropathy
Cyclosporin
Metronidazole
Amiodarone
Isonazid
30
Normal range form MCV
80-100 fl
31
Blurred optic disc ddx
Papilloedema
| Papillitis (optic neuritis)
32
Difference between papilloedema + papillitis (optic neuritis)
Papilloedema
- Can be due to SOL
- Progressively gets worse
- No pain
- No decreased visual acuity
Papillitis (optic neuritis)
- Can be due to MS
- Comes and goes
- Pain
- Decreased visual acuity
33
Pain + paresthesia + decreased PP sensation on the anterolateral thigh Mx
Compression of the lateral femoral cutaneous nerve running via the inguinal ligament
Mx - lose weight
If symptoms persist
- Carbamazepine
- Gabapentin (drugs for neuropathic pain)
34
Treatment of neuropathic pain
Pregabalin
Carbamazepine
Gabapentin
35
GCS eyes
```
4
4 - open spontaneously
3 - open to voice
2 - open to pain
1 - do not open
```
36
GCS verbal
```
5
5 - Orientated
4 - confused but able to answer Q
3 - words discernible, inappropriate responses
2 - making sounds
1 - no response
```
37
GCS motor
6
6 - obeys commands
5 - localises to pain/purposeful movement to painful stimulus
4 - withdraws to pain
3 - abnormal (spastic) flexion , decorticate posture
2 - extensor (rigid) response, decerberate posture
1 - no movement
38
AMTS
1. DOB
2. Age
3. Time
4. Year
5. Place
6. Recall - West Register street
7. Recognise doctor/nurse
8. Prime minister
9. Second WW
10. Count backwards from 10-1
39
Spinal cord compression signs vs cauda equina syndrome signs
Spinal cord compression - LMN signs at level of lesion, UMN signs below lesion, sensory level
Cauda equina syndrome - LMN signs, saddle anaesthesia
40
Causes of collapse DDx
- Hypoglycaemia
```
- Cardiac
Vasovagal
Arrhythmias
Outflow obstruction
Postural hypotension
```
- Brain
Seizures (need to establish from the start of history taking if there were observers)
41
Bilateral hilar lymphadenopathy differentials
Infection e.g. TB
Inflammation e.g. sarcoidosis
Malignancy e.g. lymphoma
42
Pleural plaques
Asbestos related disease
| found on the pleura and not in the lungs
43
Asbestos related disease vs asbestosis
Asbestos related disease - pleural plaques
Asbestosis - pleural plaques + pulmonary fibrosis
44
Gallstone pancreatitis ix + mx
- USS to confirm presence of gallstones
- EUS if stones are too small + you cant see them
- Wait to see if pt passes stones spontaneously
```
if LFTs still abnormal or if you can't see anything on the US
- MRCP
Dilated intrahepatic ducts
Dilated CBD w impacted calculi
Calculi in gallbladder
```
If stones still not resolving spontaneously
- ERCP ballon + dormia basket to collect stones, then stenting the ampulla
- if you go accidentally into the pancreatic duct rather than the ampulla --> pancreatits
45
Anti-HBs + Anti-HBe
You definitely had hep B in the past + you are immune
46
anti-HBs + no anti-HBe
anti-HBs + anti-HBe
Vaccination
Infected
We only vaccinate people with anti-HBs and not anti-HBe
47
How does liver disease due to alcohol end up in cirrhosis?
Fatty change --> Alcoholic hepatitis (inflammation + scarring) --> Cirrhosis (end stage liver disease)
48
5 feautres of alcoholic disease on liver histology
- Fatty change
- Ballooning of cells
- Mallory Denk bodies
- Neutrophilic inflammation
- Fibrosis (staining collagen blue)
49
Vitamin deficiencies
```
B12
B1
B3
D
C
Folate
```
```
B12 - pernicious anaemia
B1 - beri-beri
B3 - pellagra
D - rickets
C - scurvy
Folate - neural tube defects
```
50
Signs of portal HTN (triad)
Caput medusae
Splenomegaly
Asictes
you get portal hypertension after you get cirrhosis
51
One problem with TIPS
It will result in encephalopathy as toxins will not be filtered by the hepatocytes and will not be removed from the blood
52
Management of UGIB as a result of ruptured varices
o Sengstaken-Blakemore tube (NG tube w a balloon) - applying pressure on the veins will stop the varices from bleeding
o Endoscopists then go in with the endoscope + inject the veins with a sclerosant - stop bleeding
o Blood transfusion
o In this case Terlipressin won’t really work as the vessels in the varices don’t’ have a lot of muscle
- ----------------------------
- Combination of endoscopic variceal ligation (Band ligation)* + terlipressin** is first line
- ABCDE approach
- Fluids, regular monitoring
- Reduce portal HTN: Terlipressin
- OGD
* Alternatives include sclerotherapy + balloon therapy
* *Alternatives to terlipressin include vasopressin octreotide
prophylaxis for the prevention of varicieal bleeidng - propanolol, endoscopic band ligation, TIPPS
53
What does the liver flap indicate?
Denotes liver failure
feature of encephalopathy
caused by built up of ammonia in the blood that is normally removed by the liver
54
Micronodular cirrhosis
| Macronodular cirrhosis
Micronodular cirrhosis - alcoholic hepatitis
| Macronodular cirrhosis - viral hepatitis
55
How does alcoholic hepatitis progress?
1. Alcoholic hepatitis
```
2. Chronic stable liver disease
Spider naevi
Dupuytren's contracture
Palmar erythema
Gynaecomastia
```
3. Portal HTN as a result of cirrhosis
Ascites
Visible veins
Splenomegaly
4. Liver failure
Liver flap
Fetor hepaticus
56
What do scratch marks on the skin in a patient with jaundice indicate?
Bile duct obstruction
57
Where are GIT cancers likely to metastasise?
Liver due to enterohepatic circulation
58
A 60-year-old male presents with an inguinal hernia of recent onset. Which of the following statements is TRUE?
(A) The hernia is more likely to be direct than indirect
(B) Presents through the posterior wall of the inguinal canal, lateral to the deep inguinal ring.
(C) Is covered anteriorly by the transversalis fascia.
(D) Is more likely than a femoral hernia to strangulate.
(E) The sac is congenital
(A) The hernia is more likely to be direct than indirect
Clue is in the age - you get weakening of the abdominal walls with age
Even though generally an indirect inguinal hernia is more common than a direct one
59
How to differentiate between an direct and an indirect inguinal hernia
Reduce the hernia and put your hand over the deep inguinal ring
Get patient to cough - if the hernia reappears then it means it is direct (through the abdominal wall)
if it doesnt reappear it means it's indirect (through the deep inguinal ring which you are blocking with your hands)
deep inguinal ring:
• Midpoint of inguinal ligament
• 1.5cm above midpoint
• Opening in transversalis fascia
60
Anaphylaxis mx
1. Help
2. Remove trigger
3. Lie flat + raise legs
4. IV adrenaline 0.5mg 1:1000
5. ABC (incl IVF)
6. IV chlorphenamine (anti-histamine), IV hydrocortisone
6. given after adrenaline + IVF
61
What is Troisier's sign?
Virchow's node
62
What is
Trousseau’s sign of latent tetany
Trousseau’s sign of malignancy
Trousseau’s sign of latent tetany – sign of hypocalcaemia on inflating BP cuff – spasm of hand
Trousseau’s sign of malignancy – thrombophlebitis as an early sign of gastric or pancreatic cancer
63
What is hereditary haemorrhagic telangiectasia?
AD
Abnormal blood vessels in skin, mucous membranes, lungs, liver, brain
Recurrent GI + nose bleeds
Small dark coloured spots on lips
64
Describe the pain pathway
tissue injury --> release of chemicals --> stimulation of pain receptors (noxious chemicals, heat, cold, pressure)--> activation of αδ or c fibres in the spinal cord --> fibres travel through dorsal root ganglion and go into dorsal horn --> there they synapse with a second nerve --> second nerve decussates and goes up to the thalamus (second relay station) --> thalamus connects with many parts of the brain (cortex, limbic system, brainstem) --> pain perception occurs in the cortex
then modulation mainly by the brainstem
descending inhibition from brain to dorsal horn --> decreases pain signal
65
Disadvantages of NSAIDs
o GI side effects – gastric irritation + ulceration
o Renal side effects – nephrotoxicity (constriction of afferent arteriole, reduction in renal artery flow, decreased GFR)
o We don’t really give them to elderly people bc they have poor renal function
o Bronchospasm in severe asthmatics
Asthma – can cause bronchospasm
Hx of gastric/duodenal ulcers – can cause gastric erosions + ulcerations
Aspirin – severe risk of GIB from gastric erosions + ulcerations
Moderate/severe HF – can cause fluid retention
Diverticular disease - increases the risk of bleeding
66
Drugs that can be used for neuropathic pain
TCAs e.g. amitryptillin
Anti convulsants e.g. gabapentin, pregabalin
Morphine
67
Mild opiates
| Strong opiates
Mild - codeine, dihydrocodeine, tramadol
codeine - not good for chronic pain
Strong - morphine, methadone, fentanyl, pethidine, oxybutinin
Morphine - good for chronic cancer pain
Pethidine - not good for chronic pain
68
Paracetamol dosage
1000 mg every 4-6h
| Same dosage through any route
69
Ibuprofen dosage
400 mg every 6h
