EMQ Notes Flashcards
1
Q
What genes are associated with RA?
A
HLA-DR4, PTPN22
2
Q
What deformities are associated with RA.
A
Ulnar deviation
Swan-neck
Boutonnière
3
Q
What is the. Tx for RA?
A
Analgesia NSAIDs Corticosteroids DMARDS Biologics
4
Q
What is Felty’s syndrome?
A
RA, splenomegaly, leukopenia
5
Q
What are the 1st line Tx for RA?
A
Methotrexate- 1ce weekly with folic acid
Sulphasalazine- daily
Leflunomide
6
Q
When should methotrexate be avoided?
A
Pregnancy
7
Q
What are cytokines?
A
Proteins which regulate the immune system. They can be either pro- or anti-inflammatory
8
Q
What are some examples of biologic drugs for RA?
A
Anti-TNF: Infliximab Adalimumab Certolizumab Etanercept
9
Q
What are the risks of anti-TNF drugs?
A
Increased infections
TB reactivation
Development of autoantibodies
?risk of neoplasm?
10
Q
What is vasculitis?
A
Inflammation within or through a vessel wall leading to impairment of bloodflow & sometimes damage to vessel integrity
11
Q
What are the large vessel vasculitis’?
A
Polymyalgia rheumatica
Giant cell arteritis
Takayusus vasculitis
12
Q
What are the medium vessel vasculitis’?
A
Poly arteritis nodosa
Kawasakis disease
13
Q
What are the small vessel vasculitis’?
A
Wegener’s (granulomatous polyangiitis)
Microscopic polyangiitis
Churg-Strauss syndrome
Small vessel vasculitis
14
Q
What is polymyalgia rheumatica?
A
>60y.o. Pain & stiffness in the shoulder girdle, neck and pelvis Worse in the mornings Systemically- malaise, wt. Loss, ^ CRP & ESR (>60) Dramatic response to small steroid dose
15
Q
What is giant cell (temporal) arteritis?
A
Most common vasculitis (rare temporal artery biopsy
–> urgent high dose steroids
16
Q
What is takayusus vasculitis?
A
10mmhg difference between arms
Narrowing of the aorta/ main branches
17
Q
What type of vasculitis typically affects children?
A
Kawasakis (medium vessel)
Coronary artery vasculitis
18
Q
What are the features of poly arteritis nodosa
A
30-50 y.o.
Necrotising vasculitis, ^ESR, aneurysms mind-vessel
Tx- IV immunoglobulins
RF- Hep B
19
Q
What are the features of Wegener’s (granulomatous polyangiitis) and what is it associated with?
A
Affects upper/lower respiratory tracts–> cavitating lung lesions
Renal involvement –> glomerulonephritis
Assoc. W/ cANCA
20
Q
What are the features of Churg-Strauss syndrome?
A
Weakly ANCA assoc.
Eosinophilia, late onset asthma w/ pulmonary infiltrates
21
Q
What is anti-phospholipid syndrome?
A
Recurrent vascular thrombosis, pregnancy loss & Thrombocytopaenia assoc. W/ anti-phospholipid antibodies
Tx–> warfarin
22
Q
What type of disease is SLE?
A
Connective tissue disease.
Multi system autoimmune disease with autoantibody formation
23
Q
What are the antibodies assoc. W/ SLE?
A
ANA- 99% –> -ve excludes
Anti-sm= highly specific but only 20%
Anti-SSa (anti-ro) –> risk of Photosensitivity
Anti-SSb (anti-la) –> neonatal lupus and Sjogren’s
Anti-U1-RNP–> mixed connective tissue disease
24
Q
Who does SLE occur in most commonly?
A
9:1 f:m
Afrocarribean/ Chinese
25
What are the Tx for SLE?
Hydroxychloroquine --> skin/ joints
Prednisolone --> significant systemic disease
IV cyclophosphamide --> steroid resistance
26
What are the types of scleroderma?
1. Diffuse cutaneous systemic sclerosis
| 2. Ltd cutaneous systemic sclerosis (CREST)
27
What condition is strongly associated with scleroderma?
Raynauds (secondary)
28
What are the symptoms of systemic cutaneous sclerosis?
We. Loss and fatigue, rapidly progressing skin tightening (proximal to the elbows.
Risk of pulmonary fibrosis and a short hx of raynauds
29
What is the treatment for scleroderma?
No real therapy --> Tx of vascular symptoms
Can cause a renal crisis (death) via malignant HTN --> ACEi
PPIs
30
What are the types of inflammatory muscle disease?
Polymyositis --> most common
| Dermatomyositis --> skin involvement, muscle inflammation + heliotrope rash around the eyes
31
What is the Tx for inflammatory muscle disease?
Steroids
| Methotrexate/Azathioprine
32
What is Sjogren's, who does it affect and what major risk is it assoc. W/?
Connective disorder--> lymphocytic infiltration of exocrine glands = sicca complex, purpura.
Typically middle aged females
44x risk of lymphoma
33
What are the primary RF for varicose veins?
FH, Fe w/ OCP, age, pregnancy, obesity, standing for long periods
34
How does blood pass from deep to superficial veins in the leg?
Perforators @ sapheno-femoral and sapheno-popliteal jct
35
What tests are performed to diagnose where the vascular incompetence is in varicose veins?
Trendelenburg test- sapheno-femoral jct incompetence
Perthe's test- deep femoral vein competence
36
What is lymphoedema?
Accumulation of fluid in tissues from inadequate drainage --> incurable & progressive
37
What is the function of lymph & the lymphatic system?
Gather fluid & proteins from tissue spaces and returns it to the circulation
38
What are the 3 types of chronic oedema & what is the lymph load for each?
1. Lymphoedema- normal lymph load
2. Lymphovenous oedema- lymphatic overload=> failure
3. Dependency oedema - lymphatic overload => failure
39
What is Allergic Bronchopulmonary aspergillosis?
Allergic pneumonitis reaction to aspergillous spore --> airway plugging & dilatation
- occupational exposure
40
What are the signs/symptoms of allergic Bronchopulmonary aspergillosis and its Tx?
4-6hr post exposure, fever, SOB, cough, ^WCC (IL-8, eosinophils, cd4/8)
Alleviated by Ag removal, immunosuppression to
41
What is an aspergilloma?
Fungus ball within old cavities (TB, abscess, Bronchiectasis)
--> Haemoptysis & halo sign
Air in cavities = aerobic growth => fruiting bodies w/ spores
42
What is chronic grAnulomatous pneumonia?
Often caused by aspergillous
| Slow spreading infection w/ mild symptoms
43
What is invasive pulmonary aspergillosis?
Serious--> spreads rapidly throughout the body from pulmonary infection in susceptible pt. (Immunocompromised/suppressed etc)
44
What is the Tx for invasive pulmonary aspergillosis and shy is it hard?
Voriconazole, capsofungin
Can spread to the bowel wall, liver& kidneys --> hepatic dollar carcinoma
45
What are the Sx of invasive pulmonary aspergillosis?
Chronic productive cough, Haemoptysis, night sweats, fevers.
IX-->!IgE, serum aspergillous Ab
46
What are the 2 growth forms of fungus?
1. Yeast- round & grow via budding w/ pseudohyphae
| 2. Filamentous- grow via hyphae production
47
What are fungal cell walls made up of?
Chitin, glucans, polymers
48
How do azoles work and what are the 2 groups?
Inhibit cell membrane synthesis--> p450 =
49
What are echinocandins?
Antifungal- inhibit B-glucan synthesis (cell wall)
| Caspofungin--> IV only vs aspergillus and candida
50
What are allylamines?
Anti fungal that inhibit squalene --> less ergosterol
Terbinafine (lamisil) --> dermatophyte infections
51
What are examples of Polyenes & how's it work?
Amphotericin B, Nystatin
Bind to ergosterol
52
What is the Tx for candida?
Clotrimazole TOP/PV
| Fluconazole 150mg
53
What is the Tx for fungal mail infection?
Terbinafine 250mg
54
What immune cell is present in the synovial fluid in rheumatoid arthritis?
Neutrophil
55
What is the Tx for a patient with candidaemia (non-CNS)?
Fluconazole PO 4-800mg OD
Capsofungin
If neutropaenia --> AmBisome IV
56
What is the Tx for non- CNS aspergillosis?
Voriconazole IV
57
What is type 1 hypersensitivity?
Allergy
Mediated by IgE
Fast response: free Ag cross-links IgE on mast cells --> histamine
58
What is type 2 hypersensitivity and give examples?
Antibody mediated: IgM/IgG
Ab binds to Ag on target cell --> destruction by MAC
E.g. Goodpastures, graves, Thrombocytopaenia
59
What is type 3 hypersensitivity?
Immune mediated, e.g. RA
IgG binds to soluble Ag --> immune complex --> initiates local inflammation
60
What is type 4 hypersensitivity?
Delayed (cell-mediated) e.g. Contact dermatitis
T-cells: Th1 activated by APCs for future Ag presentation (memory)
Th1 activate macrophages --> inflammatory response
61
What causes pre-renal AKI?
Insufficient perfusion of kidneys --> reduced GFR without cellular injury
- hypovolaemia
- altered intrarenal haemodynamics
- 3rd space sequestration
62
Why do NSAIDs cause AKI?
Impair the renal ability to adapt to decreased perfusion by inhibiting PGE2 (vasodilators for renal circulation)
63
What is intrinsic AKI?
Damage to the kidney itself.
- ischaemic (50%) --> hypotension, sepsis, CVD
- Nephrotoxicity (35%) --> aminoglycosides, radiocontrast, cisplatin, pigment Nephrotoxicity (rhabdo)
64
What is 3rd space sequestration?
Fluid in the 3rd space --> bowel obstruction, peritonitis, pancreatitis.
= hypovolaemia + ^ intra-Abdo pressure -> reduced renal bloodflow
65
Why does radiocontrast cause AKI?
Hypertonic and induces transient vasocodilation followed by prolonged vasoconstriction --> renal ischaemia
Is 3rd highest in hospital cause
66
What can cause acute tubulo-interstitial nephritis?
Drugs --> penicillins, cephalosporins, sulphonamides, Rifampicin, NSAIDS
Infection
67
What can cause post-renal AKI?
Obstruction --> ureter, bladder, urethra from stricture, malignancy, fibrosis etc.
68
What can result from post-renal AKI?
Hydronephrosis
| Inability to conc. Urine --> alkaline Polyuria = metabolic alkalosis
69
What criteria is used to asses AKI?
RIFLE
70
What can the presence of RBC casts indicate?
Glomerulonephritis
71
What can the presence of WBC casts in urinalysis indicate?
Pyelonephritis or interstitial nephritis
72
What does lipiduria indicate?
Nephrotic syndrome (fatty casts)
73
What causes pigmented casts?
Haemoglobinuria or myoglobinuria.
--> rhabdomyolysis
74
What is multiple myeloma?
Blood cancer => proliferation of 1 clone of plasma cells. These infiltrate bone marrow and interfere with blood cell production=> haematological abnormalities
75
What protein is assoc. With multiple myeloma?
Tam-Horsfall proteins
Light chains bind to this and precipitate into tubules => obstruction, rupture and giant cell formation
76
What does the kidney do to auto regulate its blood supply?
High BP => barostretch receptors cause afferent constriction to protect the glomerulus
High GFR => ^ tubular flow => ^ Na & Cl to macular densa -> afferent constriction by JGA
77
What affects does angiotensin 2 have?
- ^ sympathetic activity
- adrenal gland ^ aldosterone
- arterial constriction
- posterior pituitary => ADH (^h2o resorption)
- tubular Na & Cl resorption, K excretion so h2o retained
78
Where is ACE produced?
Lung, endothelium and glomeruli
79
How does angiotensin 2 increase glomerula pressure?
It causes afferent and efferent arterioles, however the efferent is narrower therefore ^ glomerula pressure
80
Where is renin produced and what causes a high renin state?
Renin is produced from the glomerula apparatus
High renin States:
- vol. depletion
- low cardiac output
- reduced intravascular vol. (cirrhosis, nephrotic syndrome)
- reduced renal perfusion
81
what drugs can affect the RAS and what does it lead to?
Can lead to Hyperkalaemia
- ACEi (ramipril)
- ARBs
- Aliskiren (binds to renin so prevents angiotensinogen -> at1
- Spirinolactone (reduces aldosterone)
82
What drugs can lead to Hypokalaemia?
```
Loop diuretics (furosemide)
Thiazides (bendroflumethiazide)
```
83
What drugs can inhibit tubular creatinine secretion?
Trimethoprim
Cimetidine
Probecinid
84
What is rhabdomyolysis?
Muscle necrosis and release of intracellular constituents into circulation
85
How does rhabdomyolysis cause AKI?
```
Obstruction by Haem pigment casts
PCT injury by Haem iron
Volume depletion (10-12L fluid may accumulate in damaged tissues)
```
86
How is rhabdomyolysis diagnosed?
Hx
Red/brown urine
^ serum CK & LDH
E- abnormalities (hyperkalaemia, hyperphosphataemia, hyperuricaemia, Hypocalcaemia)
87
What is the pathophysiology of reseeding syndrome?
- Insulin secretion resumes from ^ sugar intake reducing glycogen, fat and protein synthesis.
- This requires PO4-, K which are already depleted so used up
- Intracellular movement of E- occurs w/ reduction in serum E-
- This => arrhythmias (C.O.D)
- Intracellular ATP depleted
88
What are the contraindications for a PEG?
```
Absolute:
- absence on stomach
- inability to transilluminate
Relative:
- unlikely to survive >30days
- coagulopathy
- varices, Ascites, inflammatory disease
```
89
What is short bowel syndrome?
State of malabsorption & malnutrition that occurs following massive anatomical/functional loss of the small intestine
90
What are the functions of the duodenum?
Secretion of CCK & secretin
| Absorption of Ca, Mg, folate, Fe
91
What are the functions of the jejunum?
Absorption of glucose, aa, fat, thiamine & vit C
| Primary absorptive site for most nutrients via long leafy villi,
92
What is the function of the ileum?
Absorption if fluid, E-, bile acids/salts, vit B12, ADEK, P & Zn
Secretion of enteroglucagon
93
What are the causes of short bowel syndrome?
Surgical removal of >1/2 small intestine
- > necrotising enterocolitis (premature infants)
- > congenital (Hirschsprung's, omphalocoele)
- > Crohn's, infarction, malignancy
94
What are chronic complications of short bowel syndrome?
Malabsorption -> bile salts -> gallstones
^oxalate- ^ risk of stones
Loss of ileal brake
^ risk of metaplasia
Hypergastrinaemia due to loss of feedback loop
95
What is nociceptive pain?
Pain caused by stimulation of nociceptive receptors & transmitted via intact neural pathways
96
What is neuropathic pain?
Pain caused by damage to neural structures
97
What are the types of nociceptor?
Ad-fibres --> fast & specific, myelinated, fast but unimodal. Activity inhibits transmission
C-fibres --> slow & flexible, unmyelinated, slow and polymodal
98
What is the ascending pain pathway?
Axons enter dorsal horn --> ascend Leissaur's tract --> enter substantia gelatinosa --> synapse with 2' nociceptor --> cross & ascend lateral spinothalamic --> synapse ventral posterolateral nucleus of the thalamus (relay station)
99
How does paracetamol work?
Reduce PG synthesis
Minimal anti-inflammatory action
MOA unknown
Antipyrexial
100
How do NSAIDs work?
Inhibit PG production (incl COX-2), but also cox 1 (gastroprotection, platelet aggregation, renal perfusion)
101
What are the weak opioids?
Codeine, dihydrocodeine, tramadol
Ceiling effect due to S.E.
102
What are the strong opioids?
Morphine, fentanyl, hydromorphone, diamorphine, methadone, pethidine, oxicodone
103
What adjuvants can be used in pain relief?
Antiepileptics (gabapentin, carbamazepine)
Anti-depressants (amitryptiline, doxetine)
Ketamine (NMDA receptor ant)
Entonox
104
What is chronic pain?
Pain that persists beyond normal healing/ >3-6/12
Multifactorial
105
What are the 3 main theories on perspectives of pain?
Intensive- emotional state caused by intentional stimuli
Single wire- disturbance passed along nerve fibres to the brain
Specificity- pain is a specific system
106
What are the key parts of the haemopoietic system?
Stem cells
Bone marrow (bone bursary)
107
Where are stem cells derived from?
Haemangioblast (aorta, gonadal, mesonephros).
108
What are the different types of lymphoid cells?
```
B-cells = antibodies in response to Ag
T-cells = respond to antibody proliferation
```
109
What are the types of myeloid cell?
RBCs
Platelets
Monocytes
Neutrophils
110
What 2 chains are there in haemoglobin?
```
2 Alpha
2 beta (foetal in neonates)
```
111
What are the glob in chains made from & what does damage to these lead to?
Protoporphyrin
Damage --> sideroblastic anaemia
112
What causes aplastic anaemia?
Damage of bone marrow including blood stem cells
- -> deficiency of all cell types
- ----> if only RBC then = red cell aplasia
113
Which globin chains are affected in sickle cell anaemia?
Both beta-chains are affected for symptomatic sickle cell anaemia
114
What chromosomes code for each globin chain?
```
Alpha= chromosome 16
Beta= chromosome 11
```
115
What type of blood cell is polychromatic?
Reticulocyte
116
Why is the rhesus group particularly important in pregnant women?
If the mother is RhD-ve and has developed anti-D and the foetus is RhD+ve then the anti-D can cross the placenta and destroy the foetal RBC
117
What antigen does the blood group O have?
None, therefore no antigen to them
118
What chromosome are the genes that code for blood type found?
Chromosome 9
119
What factors can increase iron absorption?
Low gastric pH, vitamin c, anaemia, ^ erythropoeisis
120
What factors can reduce iron absorption?
Phylate, tannins, ^ gastric pH, Ca, chelating drugs, adequate Hb levels
121
What are the 2 main iron chelators and what is the difference?
Desferrioxamine (renal excretion)
| Deferasirox (faecal excretion)
122
Which blood groups are universal donors/recipients?
O RhD-ve= universal donor
AB RhD+ve = universal recipient
123
What are the different immunoglobulins and what are their functions?
IgM- fix complement, opsonisation (1st made)
IgG- fix complement, opsonisation, cross placenta
IgA- protect mucosal surfaces
IgE- parasites, anaphylaxis, allergy
124
What is an epileptic seizure?
A transient event experienced by an individual as a result of a synchronous & excessive discharge of cerebral neurones
125
What is epilepsy?
The continuing tendency to have seizures secondary to a variety of pathological processes
126
What is a tonic-clonic seizure?
```
Tonic phase (lose consciousness (10-20s)
Clonic phase (contorting & relaxing in jerky movements
Post-ictal confusion
```
127
What is the difference between a generalised and a partial(focal) seizures?
```
Generalised= discharge from the whole brain
Partial/focal= starts in 1 part and spreads
```
128
What different types of generalised seizure?
Tonic-clonic
Myoclonic --> jerky movements, throwing/dropping things
Absence --> periods absence. May have flickering eyes etc.
129
How can partial seizures be described?
Complex --> loss of awareness/consciousness & can => generalised
Simple --> don't lose consciousness
- post-ictal confusion, head turns away from side affected
Can be split by region affected (temporal, frontal etc)
130
What factors may indicate a temporal seizure?
Arrest, autonism (semi-purposeful movement), aura
131
What are the symptoms of a non-epileptic attack?
Awake/aware, asynchronous movements, >20mins, gradual onset, no response to anti-epileptics, biting tip of tongue, carpet burns etc
132
What is the gold standard for diagnosis of epilepsy?
Multiple seizures and a video EEG
133
What is JME?
Juvenile myoclonic epilepsy
8-18 y.o., FHx, myoclonic, GTCs, absences.
Seizures on waking, alcohol and sleep deprivation
Sodium Valproate
134
What is the treatment for idiopathic generalised epilepsy?
1st line= Sodium valproate
| 2nd line= Lamotrigine/levetiracetam
135
What is the treatment for focal/partial epilepsy?
1st line= carbemazepine or Lamotrigine
| 2nd line= leveracetam
136
What is status epilepticus and what is the treatment?
A seizure or series of seizures >30mins without regaining consciousness.
Early-> IV lorazepam
Established -> IV phenytoin
Refractory -> ITU & GA
137
What is SUDEP?
Sudden unexplained death in epileptic patient
| = non-traumatic unexplained death in epileptic, normal postmortem, unknown mechanism
138
What is a coma?
A state of unrousable unconsciousness with no meaningful interaction and unawareness of external stimuli.
GCS
139
What is locked-in syndrome?
De-efferented motor-tracts (complete paralysis below CNIII
| Awareness and arousal retained w/blinking & vertical eye movements intact
140
What prevents coma assessment?
Metabolically derranged/ endocrine dysfunction
Hypothermic
Sedative drugs
141
What can be used to assess brain stem function?
Corneal respons, gag reflex, response to hypercapnia, vestibulo-ocular response
142
What is brain death?
pt. Maintained by artificial ventilation & persistent HB but in whom the degree of brain damage is such that recovery is impossible
143
What is penetrance?
Probability that gene carrier will develop the disease
144
What is expressively?
Extent to which a gene is expressed in 1 person
145
What are examples as autosomal recessive conditions?
Tay Sachs
Neuronal ceroid lipofuscinosis
Mucopolysaccharidosis
146
Examples of x-linked recessive conditions?
DMD, Becker MD, fragile X
147
Example of autosomal dominant conditions?
Huntingdon's, neurofibromatosis, tuberous sclerosis, HMSN 1, Bon hippel lindau,
148
Examples of mitochondrial disease?
Leber's hereditary optic neuropathy
Kearn sayre syndrome
Mitochondrial encephalomyopathies
149
What is pre-eclampsia?
Diffuse vascular endothelial dysfunction with circulatory disturbances involving renal, hepatic, CVS, CNS & coagulation.
HTN and proteinuria
150
When does pre-eclampsia most commonly present?
>34 weeks in a primigrav mother
151
What are the risk factors for pre-eclampsia?
```
Previous pre-eclampsia
HTN
Diabetes
Autoimmune
Renal disease
Thrombophilias
```
152
What are the possible complications of pre-eclampsia?
Eclampsia
HELLP syndrome
Stroke
IUGR
153
What is HELLP syndrome?
Haemolysis, elevated liver enzymes, low platelet count.
Occurs in ~20% of severe pre-eclampsia
154
What is the management of pre-eclampsia?
Delivery
Prophylaxis (aspirin, antioxidants)
Drugs (avoid in 1st trimester)- methyldopa, nifedipine, hydralazine, labetalol
Dexamethasone in 2 doses before delivery
155
Why does HTN occur in pregnancy?
Vasodilation causes an initial reduction in BP then increases after 24 weeks.
If the initial reduction doesn't occur, then gestational HTN can occur
156
How can pregnancy mimic HF?
Increased stroke volume and output
Reduced peripheral resistance
Increased angiotensin 2
157
What are the 2 types of twins?
Monozygotic --> single zygote splits into 2 equal zygotes
| Dizygotic --> 2 zygotes form by fertilisation of 2 eggs by 2 sperm
158
What is chorionicity?
The placentation between the twins
159
What is amnionicity?
the relationship of the amniotic sac between the twins.
- DZ is always diamniotic and dizygotic
- MZ can be any combination
160
What is Sheehan's syndrome?
Decreased arterial blood supply/spasm & risk of necrosis to the anterior pituitary as a result of the increased blood requirement during pregnancy.
161
What happens to the anterior pituitary in pregnancy?
Increases in size due to increased requirement for prolactin.
162
What is asynclitism?
Babies head tilts to its shoulder
163
What are the indications for operational delivery?
Foetal distress
Maternal distress
Lack of advance
(All the 2nd stage of labour)
164
What is dementia?
Progressive decline of global cognitive function usually affecting the cortex as a whole. Memory is especially affected & intellect gradually fails, loss of emotional control, deterioration of social behaviour and loss of motivation.
165
What is the most common type of dementia?
Alzheimer's (50%)
166
What is alzheimers?
Degeneration of the cortex with insidious onset and gradual deterioration.
Neuropathology: plaques and tangles with reduced cholinergic neurotransmission
167
What genes are implicated in early onset Alzheimer's?
Presnilin gene on chromosome 1 & 14
168
What genes are associated with late onset Alzheimer's?
Apolioprotein E gene on chromosome 19
169
What are the clinical features of Alzheimer's?
Progressive memory loss, reduced language, apraxia, agnosia, progressive loss of executive function, behavioural change
170
How does vascular dementia present?
Sudden onset, stepwise deterioration, mood and behavioural change
171
What is the neuropathology of vascular dementia?
Atherosclerosis, single/multiple emboli, small vessel disease
172
What is lewy-body dementia?
Dementia that presents with fluctuating cognition, vivid visual hallucinations, mild parkinsonian features, repeated falls, neuroleptic sensitivity
173
What is Pick's disease?
Fronto-temporal dementia.
Progressive deterioration of social behaviour
174
What can cause secondary dementia?
HIV, SLE, CJD, renal failure, toxicity, normal pressure hydrocephalus,
Korsakoff's
175
What are Acetylcholinesterase inhibitors used for and examples?
Mild to moderate Alzheimer's.
Donepezil
Rivostigmine
Galantamine
176
How do Acetylcholinesterase inhibitors work?
- Increase the function of cholinergic neurones by reducing NT breakdown
- Reduce the formation of B- amyloid plaques (neurotoxic)
177
What are NMDA receptor antagonists for?
Moderate to severe Alzheimer's
E.g. Memantine
178
How do NMDA receptor antagonists work?
Excess Glutamate is toxic to neurones. When they're damaged the glutamate is released.
Memantine blocks the receptors
179
What are antipsychotics used for in dementia and e.g.?
Tx of behaviour/psychiatric symptoms of Alzheimer's.
Risperidone (reduces agitation and aggression)
180
What is Korsakoff's syndrome?
Irreversible damage to the medial thalamus and mammillary bodies causing anterograde and retrograde amnesia and confabulation.
Caused by thiamine deficiency.
181
What is aphasia and what are the 2 types?
Speech disorder where it's difficult to name objects and w/ repetition.
Broca's and Wernicke's
