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