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Y3 Charis > DPD > Flashcards

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
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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

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3
Q

What is dementia

A 
Chronic brain failure
Progressive decline in
   Higher cortical functions
   Emotional regulation
   Behavioural symptoms
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4
Q

Give the 5 types of dementia

A 
Alzheimer's disease
Mixed alzheimer's/vasular
Vascular
Lewy body
Frontotemporal/Pick's disease
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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
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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
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7
Q

What is dementia with Lewy bodies

A

Diagnosed when cognitive symptoms begin before or at the same time as parkinsonism

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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

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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
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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

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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
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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
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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)
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14
Q

Lesion in the brain signs

A

Hemiparesis

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15
Q

Lesion in the brainstem signs

A

CN lesions

ipsilateral

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16
Q

Lesion in the cerebellum signs

A 
DANISH
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred, scanning speech
Hypotonia
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17
Q

Lesion in the spinal cord signs

A

Paraparesis = partial paralysis of the lower limbs

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18
Q

Lesion in the NMJ signs

A

Fatiguability of muscle

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19
Q

Hemisensory loss/ Sensation felt on one side

A

Contralateral Cerebral cortex lesion

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20
Q

Loss of sensation at a level + downwards

A

Spinal cord lesion

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21
Q

Pain + Loss of sensation in a particular dermatome / in the distribution of a nerve root

A

Nerve roots (radiculopathy)

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22
Q

Loss of sensation in a specific area

A

Mononeuropathy

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23
Q

Loss of sensation from a point onwards / glove + stockings distribution

A

Polyneuropathy

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24
Q

Normal HbA1c value
Pre-diabetic HbA1c value
Diabetic HbA1c values

A

<42 mmol/mol
43-47 mmol/mol
>47 mmol/mol

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25
Q

Examples of basal bolus insulin

A

Detemir
Levemir
Galgrine

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26
Q

Treatment of diabetic neuropathy

A

Duloxetine

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27
Q

Pregabalin used for

A

Tx of neuropathic pain + epilepsy

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28
Q

Peripheral neuropathy ddx (7)

A

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
Q

4 drugs that can cause peripheral neuropathy

A

Cyclosporin
Metronidazole
Amiodarone
Isonazid

30
Q

Normal range form MCV

A

80-100 fl

31
Q

Blurred optic disc ddx

A

Papilloedema

Papillitis (optic neuritis)

32
Q

Difference between papilloedema + papillitis (optic neuritis)

A

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
Q

Pain + paresthesia + decreased PP sensation on the anterolateral thigh Mx

A

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
Q

Treatment of neuropathic pain

A

Pregabalin
Carbamazepine
Gabapentin

35
Q

GCS eyes

A 
4
4 - open spontaneously
3 - open to voice
2 - open to pain
1 - do not open
36
Q

GCS verbal

A 
5
5 - Orientated
4 - confused but able to answer Q
3 - words discernible, inappropriate responses
2 - making sounds
1 - no response
37
Q

GCS motor

A

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
Q

AMTS

A
  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
Q

Spinal cord compression signs vs cauda equina syndrome signs

A

Spinal cord compression - LMN signs at level of lesion, UMN signs below lesion, sensory level
Cauda equina syndrome - LMN signs, saddle anaesthesia

40
Q

Causes of collapse DDx

A
  • Hypoglycaemia
- Cardiac   
Vasovagal   
Arrhythmias   
Outflow obstruction   
Postural hypotension
  • Brain
    Seizures (need to establish from the start of history taking if there were observers)
41
Q

Bilateral hilar lymphadenopathy differentials

A

Infection e.g. TB
Inflammation e.g. sarcoidosis
Malignancy e.g. lymphoma

42
Q

Pleural plaques

A

Asbestos related disease

found on the pleura and not in the lungs

43
Q

Asbestos related disease vs asbestosis

A

Asbestos related disease - pleural plaques

Asbestosis - pleural plaques + pulmonary fibrosis

44
Q

Gallstone pancreatitis ix + mx

A
  • 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
Q

Anti-HBs + Anti-HBe

A

You definitely had hep B in the past + you are immune

46
Q

anti-HBs + no anti-HBe

anti-HBs + anti-HBe

A

Vaccination

Infected

We only vaccinate people with anti-HBs and not anti-HBe

47
Q

How does liver disease due to alcohol end up in cirrhosis?

A

Fatty change –> Alcoholic hepatitis (inflammation + scarring) –> Cirrhosis (end stage liver disease)

48
Q

5 feautres of alcoholic disease on liver histology

A
  • Fatty change
  • Ballooning of cells
  • Mallory Denk bodies
  • Neutrophilic inflammation
  • Fibrosis (staining collagen blue)
49
Q

Vitamin deficiencies

B12
B1
B3
D
C
Folate
A 
B12 - pernicious anaemia
B1 - beri-beri
B3 - pellagra
D - rickets
C - scurvy
Folate - neural tube defects
50
Q

Signs of portal HTN (triad)

A

Caput medusae
Splenomegaly
Asictes

you get portal hypertension after you get cirrhosis

51
Q

One problem with TIPS

A

It will result in encephalopathy as toxins will not be filtered by the hepatocytes and will not be removed from the blood

52
Q

Management of UGIB as a result of ruptured varices

A

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
Q

What does the liver flap indicate?

A

Denotes liver failure

feature of encephalopathy
caused by built up of ammonia in the blood that is normally removed by the liver

54
Q

Micronodular cirrhosis

Macronodular cirrhosis

A

Micronodular cirrhosis - alcoholic hepatitis

Macronodular cirrhosis - viral hepatitis

55
Q

How does alcoholic hepatitis progress?

A
  1. Alcoholic hepatitis
2. Chronic stable liver disease
   Spider naevi
   Dupuytren's contracture
   Palmar erythema
   Gynaecomastia
  1. Portal HTN as a result of cirrhosis
    Ascites
    Visible veins
    Splenomegaly
  2. Liver failure
    Liver flap
    Fetor hepaticus
56
Q

What do scratch marks on the skin in a patient with jaundice indicate?

A

Bile duct obstruction

57
Q

Where are GIT cancers likely to metastasise?

A

Liver due to enterohepatic circulation

58
Q

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

(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
Q

How to differentiate between an direct and an indirect inguinal hernia

A

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
Q

Anaphylaxis mx

A
  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
  7. given after adrenaline + IVF
61
Q

What is Troisier’s sign?

A

Virchow’s node

62
Q

What is

Trousseau’s sign of latent tetany
Trousseau’s sign of malignancy

A

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
Q

What is hereditary haemorrhagic telangiectasia?

A

AD
Abnormal blood vessels in skin, mucous membranes, lungs, liver, brain
Recurrent GI + nose bleeds
Small dark coloured spots on lips

64
Q

Describe the pain pathway

A

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
Q

Disadvantages of NSAIDs

A

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
Q

Drugs that can be used for neuropathic pain

A

TCAs e.g. amitryptillin
Anti convulsants e.g. gabapentin, pregabalin
Morphine

67
Q

Mild opiates

Strong opiates

A

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
Q

Paracetamol dosage

A

1000 mg every 4-6h

Same dosage through any route

69
Q

Ibuprofen dosage

A

400 mg every 6h

Y3 Charis (35 decks)

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