extra Flashcards
1
Q
most comm0n cause of cerebral abascess in HIV pts
A
toxoplasmosis
2
Q
best initial test for suspected brain abscess
A
Ct with contrast
3
Q
initial antibiotic for brain abscess
A
ceftriaxone, metronidazole and vanc
4
Q
congenital heart disease and recurrnet sinusitis are predisoping factors for brain abscess
A
5
Q
lyme disease can be the first indication of bells palsy
A
ELISA - borrelia burgdorferi
6
Q
mainstay for brain abscess
A
burr hole and if larger or recurrent = craniotomy
7
Q
what differentiates brain abscess from tumour
A
biopsy
8
Q
differential for a ring enhancing lesion on brain
A
glioblastoma multiforme
9
Q
msot accurate investgation for brain abscess
A
biopsy
10
Q
most common cause of death in alzheimers
A
penumonia becuase of reduced swallowing
11
Q
early onset alzheimers asscoiated with presenelin 1 and 2
A
late associated with apollipoporetin e4 allele
12
Q
– is particularly sensitive to damage in alzheiemrs
A
hippocampus
13
Q
shrinkage of the amygdala - memory ct scan may show starfish sign
A
alzheimers
14
Q
vit e can be used for
A
alzheimers/ vascualr dementia
15
Q
dementia is more common in
A
females
16
Q
all pts with cognitive impairment must be evaualted for
A
hypothyroidism and depression
17
Q
pseudodemntia is cognitive impairment secondary to
A
major depressive disorder
18
Q
elderly with acute symptoms of major depression
A
pseudodementia - treat with SSRI
19
Q
initial investigation of dementia to help exldue other cuases
A
blood screen
20
Q
lewy body dementia is
A
fluctuating
21
Q
typical antipsychotics can worsen
A
lewy body dementia
22
Q
dat scan can be used for
A
lewy body dementia
23
Q
encephalitis most commonly caused by
A
hsv1
24
Q
if suspect encephalitis do not wait for cause before starting treatment - start Iv aciclovir
A
25
U&es and tfts to rule out
reversible causes of essential tremor
26
extradural haematoma causes
ipsilateral dilated pupil
27
middle meningeal arery rupture
extradural - pterion fracture
28
encephalitis want to do
virology PCR - from lumabr pucnture and csf analysis
29
most dangerous complciation of a subarachnoid haemorrhage
rebledding
30
normal ct if suspect sub arachnoid haemorrhage do
lumbar puncture
31
most common site for berry aneurysm
junction of anterior communicating and anterior cerebral
32
if positive ct for subarachnoid haemorrhage then do
Ct angiography
33
findings will be normal on CT for subarahnoid haemorrhage if do less than
6hrs
34
lumbar puncture should be done at least how long after symptoms for subarachnoid haemorrhage
12- xanthocrhomia
35
do start dementia drugs MMSE should be greater than
12 as if below side effects outweigh benefits
36
major cause of death 3-10 days after SAH
vasopasm causing an ishaemic infarct
37
anticoagulants such as warfarin increase risk of
subdural haemorrhage in elderly
38
which haemorrhage crosses suture line
subdural
39
new bleeding will appear
hyperdense
40
chronic subdural haemorrhage more likely in alcholics and the elderly due to
cerebral atrophy which stretches the bridging veins
41
blood test important in subdural haemorrhage
coagulation screen
42
initial antibiotics for meningococcal meningitis
benzylpenicillin or cefotaxime
43
kernigs sign
meningitis
44
initial antibiotics for pneumococcal menigntis
Iv cefotaxime
45
patient contact less than 7 days ago from memnigntococaal meningjtis should be given
ciprofloxacin
46
mx of bacterial meningitis in primary care
Im/IV benzylpenicillin at earliest opportunity
47
diagnostic investigation for bacterial meningitis
LP - CSF findings
48
non blanching rash indicates what
meningococcal sepsis
49
patients with bacterial meningitis may be given -- to avoid hearing loss
dexamethasone
50
bacterial meningitis initial empiral antibiotics if 3months to 5 years
Iv cefotaxime
51
bacterial meningitis if less than 3 months or over 50
cefotaxime and amoxicillin so basically just add amox
52
kernigs sign
knee extension - meningitis
53
fungal meningitis
amphotericine B and fluocystosine
54
soap bubble in the white matter of the brain
cryptococcus
55
vaccination agaisnt pneumococcal 23 serotypes is given at
65y/o
56
halo appearance on india ink stain
cryptococcus
57
fungal meningitis has
lymophocyte predominance and then same as bacteria with increased protein and decreased glucose
58
most common type of meningitis
viral
59
most common cause of viral meningitis
enteroviruses eg cocksackie and echoviruses. followed by hepres simplex
60
mx for confirmed viral meningitis - suportive eg analgesia. use of aciclovir is unlear but if has signs of encephalitis then defos give aciclovir
61
how does viral meningitis differ from fungal
viral has normal glucose and fungal has decreased glucose
62
what HSv is more common to cause viral meningitis
2
63
for viral meningitis gold standard for identifying the underlying organisms
CSF PCR
64
nerve conduction studies in motor neuron are
normal
65
non invasive ventilaltion (usually BiPap) at night also given for
MND
66
ALS (MND) usually has spastic paralysis in lower limbs and what paralysis in upper
flaccid
67
riluzole is a
glutamate inhibitor- prolongs life by 3 months
68
treat suspected viral meningitis as bacterial until diagnosis exluded so give
empirical antibiotics
69
ALS usually begins at
cervical lesion of the spinal cord
70
progressive bulbar palsy affects what motor neruones
upper and lower
71
als typically begins in
hands and feet
72
what is unaffected in mnd
sensory, bladder and bowel and occular muscles
73
Primary lateral scleoriss affects
upper motor neurones
74
suspect myasthenia gravis and negative for anti AChR antibodies can then consdier testing for Anti MUSK antibodies
75
ice pack over eyelids will improve symptoms in
myasthenia gravis
76
edrophonium differentiates myasthenic crisis from cholinergic crissi
if symptoms improve then myasthenic
77
ALS - spastic paralyis in
lower limbs
78
myasthenia gravis is a
type 2 hypersensitivity reaction
79
drugs contraindicated in myasthenia gravis
aminoglycosides eg gentamicin
80
all pts with myasthenia gravis should have a
thymus CT or MRI
81
myasthenia gravis - antibodies against post synaptic
NICOTINC ach
82
only anti emetic that is safe in parkinsosn
domperidone
83
what triptan should be avoided in clsuter headaches
oral
84
verapamil affects heart so do ECG prior to use in
cluster headahces
85
investigation of choice to rule out other underlying brain lesions in cluster headahce
MRI with gadolinium contrast
86
in cluster headahces pain with each attack occurs
at the same time each day and on the same side of the head
87
episodic cluster headahces have pain free periods lasting over
3 months
88
difference between cluster headahces and horner sydnrome
forehead sweating in cluster headahce and anhidrosis in horners
89
cluster headaches more common in
males
90
symptoms of migraine improve during
pregnancy
91
refer if suspect first bout of cluster headache
92
supplement that can be given for migraine
riboflavin
93
migraine prophylaxis - propanol cannot be given if asthmatic. topiramate should be avoided in child bearing age so
acupuncture or amitripylien
94
prophylaxis for tension headahce
acupuncture
95
riboflavin
supplement given for migraines
96
acute mx of tension headachs
paracetemol, Nsaids or aspirin
97
pt with raised icp should be position with head elevation
of 30 degrees
98
first lien pharmacological mx for raised ICP
IV mannitol
99
pts with raised icp should have a
Ct/MRi to rule out space occupying lesion
100
prochloperazine and metoclopramide may be given to migraine patients even in the abscence on nasuea and vomitting as shown to alleviate other migraine symptoms such as pain and discomfort
101
leading cause of raised iCP
traumatic brain injuries
102
controlled hyperventillation can be used in raised ICP that works by vasoconstricting cerebral arteries
as decreased pco2 causes vasoconstriction of the cerebral arteries
103
body does what in ICP
increases MAP
104
start back risk assessmment tool is for
herniated discs/ sciatica
105
75% of herniated discs will improve after 4 weeks due to re- absorption of the prolapsed disc over time
106
straight leg test for
herniated disc
107
nsaids for herniated disc
better than paracetemol
108
surgical mx for herniated disc
decompression via laminectomy
109
what infarcts can cause quadriplegia and locked in syndrome
brainstem
110
hypoattenuation suggests what kind of stroke
ischaemic
111
contraindications for thrombolysis
intracranial haemorrhage, pregnancy and uncontrolled hypertension
112
secondary prevention for ishcaemic stroke
clopidogrel and statin . aspirin is given in slocpidogrel is contraindicated
113
Tia is a subtype of
ischaemic stroke
114
initial mx of all ishcaemic strokes
aspirin
115
history suggestive of a stroke should have what initial invesygoation to rule ou tmain differentials
blood glucose
ecg to rule out arrythmias
116
iniital mx of stroke within 4.5hrs
aspirin 300mg, thrombolysis (alteplase) stating after 48hrs
117
anticoagulation should not be started until -- days since the onset of an ischaemic stroke
14 days
118
locked in syndrome affects what artery
basilar
119
language centre is most found in the dominant hemisphere which is commonly the
left hemisphere
120
lateral pontine syndrome affects ipsilateral
facial nerve palsy
121
strokes can cause aphasia if they occur in the
domiant hemisphere
122
medial midbrain (webers)
occulomotor palsy ans contralateral hemiparesis
123
anterior cerebral artery also supplies the
anterior limb of the internal capsule
124
posterior inferior cerebella artery supplies the
lateral medulla - horners
125
anterior - deafness
posterior - horners
anterior- lateral pons
posterior - lateral medulla
126
anterior spinal artery supplies the
medial medulla
127
posterior inferior cerebellar artery syndrome also affects cranial nerve 10 causing
dysphagia
128
medial midbrain stroke causes
CN 3 palsy and contrlateral hemiparesis
129
basilar artery supplies the
medial pons
130
anterior limb of of internal capsule -
posterior limb of internal capsule - middle cerebral artery
131
lacunar stroke is most commonly due to occlusion of what arteries
lenticulostriate
132
posterior cerebral artery supplies the thalamus so causes
contralateral sensory abnormalities
133
corpus callosum mostly supplies by
anterior cerebral
134
artery supplies the language centres
middle cerebral
135
hemi neglect strokes are in the
non dominant hemispere
136
MCA supplies the superior temporal lobe and the PCA supllies the
inferior temporal lobe
137
carotide artery endarterectomy if carotid stenosis greater than
70%
138
do NOt do Ct for TIa unless there is clinical suspicion of an alternative daignsosis. just do carotid imaging
139
if present with TIA that occured less than 7 dyas ago
give aspirin adn urgent assessment bu stroke physician
140
aspirin contraindicated in
bleeding disorders, taking anticoagulatnts or taking low dose aspirin regularly
141
trigeminal neuralgia common affects what divisions of CNv
mandibular and/or maxillary
142
bilateral trigemninal neuralgia suspect
MS
143
in wernickes encephalopahty the
mamillary bodies and ventricle wallsa of the brain are affected by petechial haemorrhages
144
most common occular sign of wernickes
nystagmus
145
investigation would do in werniceks
MRI and RBC tranketolase activty (would be decreased)
146
CIN do
LLETZ
147
if smear psotive then what is done
cytological examination
148
hpv 18 and 18 -
cervical cancers
149
who has decreased risk of cervical cancer
if never been sexually active
150
CIN 1 usually
regresses
151
abrupt bradycardia after rupture of membranes suggests
umbillical cord prolapse
152
CTPA in preg increases maternal breast cancer
v/q scan increases risk of childhood cancer
153
initial investigations for suspected PE in preg
ECG and CXR
154
iniital investigation for ectopic is preg test although investigation of chocie is US
155
bhcg over what suggests ectopic
1500
156
if there is an adnexal masss in ectopic then avoid examinig iit
because of increased risk of ruptured pregnancy
157
contraceptions that are rf for ectopics are
the coils and progesterone only pill
158
meds for endometrial pain
1- paracetemol and nsaids
2- hormonal - COCP or progestogens
159
mirenal coil is first line for fibroids but if not mefanmic/tranexamic
definitive - mymoectomy
160
investigation for fibroids
transvaginal US
161
fibroids typically regress when
post menopause
162
what shrinks size of fibroids
GnRh agonists eg lupron
163
fasting glucose for diabetes is 7 and gestational is greater than
5.6
2 hour glusoe - greater than 7.8 (11.1 for normal DM)
164
most common medical disroder in preg
gestation hypertension then gestational diabetes
165
hypertension in pregnancy if over
140/90
166
2nd line for hyperemesis gavidarum
ondansetron(avoid in first sem) and metoclpramide
167
avoid metoclopraide in pregnancy for greater than 5 days as can then cause
extrapyradmidal side effects
168
hyperemesis gavidarum ususally stopped at
20 weeks
169
-- used to treat vasomotor symtoms in menopause
SSRI eg fluoxetine
170
Hrt increases risk of what cancers
breats and ovarian
171
obesity increases risk of what in pregnancy
miscarriage
172
initial investigation for ovarian cancer
CA125
173
definitive investigation for ovarian cancer
diagnostic laparotomy
174
if ca125 levels are riased in suspected ovarian cancer then do
US of the pelvis
175
preg test should be done if presenting with PID to rule out
ectopci
176
if placenta praevia present at 32 weeks then
rescan US every 2 weeks
177
what us is done in ovarian cancer if ca 125 is elevated
PELVIC
178
how is placental abruption investigated
CTG to monitor fetal distress
179
mx of placental abruption if less than 36 weeks and not infetal distress
oberve closely and give steriods
180
mx of placental abruption if fetus is dead
induce delviery vaginally
181
first line pharmacological approach for PPH
oxytocin
182
surgical mx for PPH
intrauterine balloon tamponade
183
in PPH get the mother in what position
lying flat
184
labetalol also first line for
pre eclampsia
185
pre eclampsia can cause
growth retardation
186
pre eclampsia also raised
transaminases - ASt and ALT
187
Help syndrome is a severe form of
pre eclampsia
188
aspirin from -- week in pre eclampsia
12
189
abortion greater thna 15 weeks
D and C
190
abortion if under 13 weeks
suction termination
191
abortion pill can be taken up to -- weeks at home
10
192
lorazepam for alcohol withdrawl and hepatic failure
193
seizures occur how long after alcohol withdrawl
36hrs
194
2 first line for alchol withdrawl
chlrodizepoxide or diazepam (benzos)
lorazepam may be preferrable if got hepatic failrue
195
first line for delirium tremens and alcohol withdrawl seizure
oral lorazepam
196
first line pharmacological for bulimia
SSRI specifically fluoxetine
197
patietns with delirium and has a history of parkinsons disease should be treated with quetiapine or clozapine rather than
haloperidol/ olanzapine
198
delirium typically lasts
6 weeks in hospital
199
depression if how long
2 weeks
200
Gad needs to be at least how long
6 months
201
z drugs should be avoided in
older people (>55)
202
SSRi given for body dysmorphic disorder
fluoxetine
203
what is like the adult version of conduct disorder
antisocial personality disorder
204
OCD personality - unaware their behaviour is problematic or causing them distress
205
schizotypal
odd behaviours
206
SNRI that can be given for PTSD
venlafaxine
207
schizophrenia symptoms need have been present for at least
1 month
208
avoidant personality disorder crave what
social contact
209
Nsaids not recommended in what trimester
3rd
210
if got renail impairment give unfractionated heparin as prophylaxis
211
transient tachypnoea of the newborn can occur form
c- section
