finals neuro/rheum

Question 1

how to manage hypogycaemia?

Answer 1

mild hypo (patient conscious)
- A-E
-consume fast acting carbs (e.g. glucose tablet, a small can of coke, sweets or fruit juice0
-consume some slow-acting carbs after (e.g. toast)
- AVOID CHOCOLATE

severe hypo (e.g. seizures/ patines unconscious)
- A-E
- Administer 200ml of 10% dextrose IV
- IF no IV access administer 1mg/kg of glucagon IM (wont work if hypo is caused by alcohol because of drug mechanism)

Question 2

what is the first line treatment for Alzheimer’s disease?

Answer 2

Donepezil

Question 3

how does chronic mesenteric ischaemia present?

Answer 3

Diffuse, colicky abdominal pain, which worsens after eating
Significant weight loss, as patients avoid eating due to the pain

Gastrointestinal bleeding, presenting as melaena or haematochezia (secondary to mucosal sloughing)

An epigastric bruit may be present, indicative of turbulent flow in the narrowed vessels.

Question 4

what are some examples of aura with migraines and what is it?

Answer 4

Aura can affect vision, sensation or language. Visual symptoms are the most common. These may be:

Sparks in the vision
Blurred vision
Lines across the vision
Loss of visual fields (e.g., scotoma)

Sensation changes may include tingling or numbness. Language symptoms include dysphasia (difficulty speaking).

Question 5

what does a hemiplegic migraine mimic that is it important to rule out?

Answer 5

stroke

Question 6

what 3 drugs can be given for migraine prophylaxis and when shouldn’t they be given?

Answer 6

-Propranolol (a non-selective beta blocker)
-Amitriptyline (a tricyclic antidepressant)
-Topiramate (teratogenic and very effective contraception is needed)

propanalol- asthma
topiramate- caution in women of childbearing age

Question 6

when should triptans be taken and can you take another if it doesn’t work?

Answer 6

Triptans (e.g., sumatriptan) are taken as soon as a migraine headache starts. They should halt the attack. If the attack resolves and then reoccurs, another dose can be taken. If it does not work the first time, another second dose should not be taken for the same attack.

Question 6

what pain relief shouldnt be taken for migraines and can actually make them worse?

Answer 6

opiods

Question 7

what is the management for tension headaces?

Answer 7

Reassurance
Simple analgesia (e.g., ibuprofen or paracetamol)

Amitriptyline is generally first-line for chronic or frequent tension headaches.

Question 8

how do cluster headaches present?

Answer 8

Cluster headaches are severe and unbearable unilateral headaches, usually centred around the eye.

Cluster headaches cause severe pain. They are sometimes called “suicide headaches” due to their severity.

Associated symptoms are typically unilateral:

Red, swollen and watering eye
Pupil constriction (miosis)
Eyelid drooping (ptosis)
Nasal discharge
Facial sweating

Question 9

how to manage a cluster headache? acute and phrophylaxis

Answer 9

Treatment options during acute attacks are:

• Triptans (e.g., subcutaneous or intranasal sumatriptan)
• High-flow 100% oxygen (may be kept at home)

Verapamil is the first line for prophylaxis (to prevent attacks).

Question 10

where do cluster headaches get their name from?

Answer 10

They are called cluster headaches as they come in clusters of attacks and then disappear for extended periods. For example, a patient may suffer 3-4 episodes a day for weeks or months, followed by a pain-free period lasting several years. Attacks last between 15 minutes and 3 hours.

A typical patient is a 30-50 year old male smoker. They may have triggers, such as alcohol, strong smells or exercise.

Question 11

what is the first line treatment for trigeminal neuralgia?

Answer 11

Carbamazepine

Question 12

what condition is trigeminal neuralgia commonly associated with?

Answer 12

multiple sclerosis

Question 13

how does trigeminal neuralgia present?

Answer 13

intense facial pain in the distribution of the trigeminal nerve, which has three branches

90% of cases unilateral

pain comes on suddenly and can last seconds to hours. It may be described as an electricity-like, shooting, stabbing or burning pain. It may be triggered by touch, taking, eating, shaving or cold.

Question 14

what are the three brancehs of the trigeminal nerve

Answer 14

v1- opthalmic
v2- maxillary
v3- mandibular

Question 15

difference between orbital and pre orbital cellulitis. How to distinguish between them?

Answer 15

pre orbital -
an eyelid and skin infection in front of the orbital septum (in front of the eye). It presents with swollen, red, hot skin around the eyelid and eye.

orbital cellulitihs an eyelid and skin infection in front of the orbital septum (in front of the eye). It presents with swollen, red, hot skin around the eyelid and eye. infection of the actual eye

A CT scan can help distinguish them. aslo orbital has painful eye movements/ reduced eye movement and visual changes whereas pre orbital is just the swelling of eyelid

Question 16

symptoms and treatment of preoribtal cellulits?

Answer 16

swollen, red, hot skin around the eyelid and eye.

Treatment is with systemic antibiotics (oral or IV). Preorbital cellulitis can develop into orbital cellulitis, so vulnerable patients (e.g., children) or severe cases may require admission for monitoring.

Question 17

symptoms and treatment of oribtal cellulits?

Answer 17

Orbital cellulitis is an infection around the eyeball involving the tissues behind the orbital septum. Symptoms include pain with eye movement, reduced eye movements, vision changes, abnormal pupil reactions, and proptosis (bulging forward of the eyeball).

Orbital cellulitis requires emergency admission under ophthalmology and intravenous antibiotics. Surgical drainage may be needed if an abscess forms.

Question 18

different between complex and simple febrile convulsion?

Answer 18

Febrile convulsions can be described as complex when they consist of partial or focal seizures, last more than 15 minutes or occur multiple times during the same febrile illness.

Question 19

Does having febrile seizures increase the risk of having epilepsy in the future?

Answer 19

Children who have had a febrile seizure have a slightly increased chance of having epilepsy later in life, but this is rare.
2-5%

Question 20

what can Alpha-1 Antitrypsin Deficiency lead to?

Answer 20

lung and liver problems

Question 21

MAINTENANCE FLUID REQUIREMENTS IN CHILDREN

Answer 21

1st 10kg of bodyweight at 100ml/kg/day
2nd 10kg of bodyweight at 50ml/kg/day
Remaining bodyweight at 20ml/kg/day
The fluid type routinely used is 0.9% sodium chloride + 5% dextrose. Potassim is added as required depending on their U&Es.

Question 22

What does LOSS stand for oseoarthiritis?

Answer 22

L – Loss of joint space

O – Osteophytes (little bits of exta bone growing)

S – Subarticular sclerosis (increased density of the bone along the joint line)

S – Subchondral cysts (fluid-filled holes in the bone)

Question 23

what are the hand signs seen in osteoarthritis?

Answer 23

-Heberden’s nodes (in the DIP joints) -Bouchard’s nodes (in the PIP joints) -Squaring at the base of the thumb (CMC joint) -Weak grip -Reduced range of motion

Question 24

Investigations for asthma?

Answer 24

The NICE guidelines (2020) recommend initial investigations in patients with suspected asthma: Fractional exhaled nitric oxide (FeNO) Spirometry with bronchodilator reversibility Where there is diagnostic uncertainty after initial investigations, the next step is testing the peak flow variability. Where there is still uncertainty, the next step is a direct bronchial challenge test with histamine or methacholine. spirometry- should show obstructive picture reversibility testing- giving a bronchodilator (e.g., salbutamol) before repeating the spirometry. Greater than 12% increase in FEV1 on reversibility testing supports a diagnosis of asthma. Fractional exhaled nitric oxide (FeNO) measures the concentration of nitric oxide exhaled by the patient. Nitric oxide is a marker of airway inflammation. Peak flow diary Direct bronchial challenge testing is the opposite of reversibility testing. Inhaled histamine or methacholine is used to stimulate bronchoconstriction, reducing the FEV1 in patients with asthma. NICE say a PC20 (provocation concentration of methacholine causing a 20% reduction in FEV1) of 8 mg/ml or less is a positive test result.

Question 25

why cant someone go home after they are stable from anaphylaxis?

Answer 25

All children should have a period of assessment and observation after an anaphylactic reaction, as biphasic reactions can occur, meaning they can have a second anaphylactic reaction after successful treatment of the first.

Question 26

Once a diagnosis of anaphylaxis is established, there are three medications given to treat the reaction. What are they?

Answer 26

Intramuscular adrenalin, repeated after 5 minutes if required Antihistamines, such as oral chlorphenamine or cetirizine Steroids, usually intravenous hydrocortisone

Question 27

what must you do in the after management of anaphylaxis.

Answer 27

keep in for observation in case of a biphasic reaction. Anaphylaxis can be confirmed by measuring the serum mast cell tryptase within 6 hours of the event. Tryptase is released during mast cell degranulation and stays in the blood for 6 hours before gradually disappearing. Remember to measure mast cell tryptase within 6 hours of an anaphylactic reaction. This is a common exam question and also something that will impress senior colleagues if it is part of your management plan when managing children with anaphylaxis.

Question 28

How to use an epi pen?

Answer 28

Prepare the device by removing the safety cap on the non-needle end. (it wont work unless you remove the cap, this is how you activate it) Grip the device in a fist with the needle end pointing downwards. Do not put your thumb over the end, because if the device is upside down you will inject your thumb with adrenalin and could risk losing it. Administer the injection by firmly jabbing the device into the outer portion of the mid thigh until the device clicks. This can be done through clothing. EpiPen advise holding it in place for 3 seconds and Jext advise 10 seconds before removing the device. Remove the device and gently massage the area for 10 seconds. Phone an emergency ambulance. A second dose may be given (with a new pen) after 5 minutes if required.

Question 29

what are the guidelines for taking GTN and when to call an ambulance?

Answer 29

Take the GTN when the symptoms start Take a second dose after 5 minutes if the symptoms remain Take a third dose after a further 5 minutes if the symptoms remain Call an ambulance after a further 5 minutes if the symptoms remain

Question 30

what is the management of angina (broken down into 3)

Answer 30

-Immediate symptomatic relief during episodes of angina -Long-term symptomatic relief -Secondary prevention of cardiovascular disease Immediate- GTN (headaches and dizziness due to vasodiation) Longterm- For long-term symptomatic relief, first-line is with either, or a combination, of: Beta blocker (e.g., bisoprolol) Calcium-channel blocker (e.g., diltiazem or verapamil – both avoided in heart failure with reduced ejection fraction) secondary prevention- Medications for secondary prevention can be remembered with the “four As” mnemonic: A – Aspirin 75mg once daily A – Atorvastatin 80mg once daily A – ACE inhibitor (if diabetes, hypertension, CKD or heart failure are also present) A – Already on a beta blocker for symptomatic relief + surgical interventions in severe disease where medical treatment is not controlling symptoms. Percutaneous coronary intervention (PCI)- scars around the brachial and femoral arteries (previous PCI) and along the inner calves (saphenous vein harvesting scar) Coronary artery bypass graft (CABG) - midline sternotomy scar

Question 31

what does a cardiac stress test involve and what is it testing for?

Answer 31

nvolves assessing the patient’s heart function during exertion. This can involve having the patient exercise or giving medication (e.g., dobutamine) to stress the heart. The options for assessing cardiac function during stress testing are an ECG, echocardiogram, MRI or a myocardial perfusion scan (nuclear medicine scan).

Question 32

what is an ectopic and how is it treated

Question 33

mobitz type 1 vs mobitz type 2 in 2nd degree heart block

Answer 33

type 1- p wave gradually gets larger then drops off type 2- P waves randomly dropped. There is usually a set ratio of P waves to QRS complexes, for example, three P waves for each QRS complex (3:1 block). The PR interval remains normal.

Question 34

Which heart blocks do you treat and why. Also how do u treat them

Answer 34

motbitz type 2 and complete because they both have a risk of asystole. refer to cardiology for pacemaker.

Question 35

cardiac output=

Answer 35

Stroke volume x heart rate

Question 36

what is a common Iatrogenic cause of acute HF/LVF?

Answer 36

aggressive IV fluids in a frail elderly patient with impaired left ventricular function

Question 37

treatment of of acute HF/LVF?

Answer 37

S – Sit up O – Oxygen D – Diuretics I – Intravenous fluids should be stopped U – Underlying causes need to be identified and treated (e.g., myocardial infarction) M – Monitor fluid balance

Question 38

inotropes vs vasopressors

Answer 38

Inotropes are medications that alter the contractility of the heart. Positive inotropes act to increase the contractility of the heart. This increases cardiac output (CO) and mean arterial pressure (MAP). They are used in patients with a low cardiac output, for example, due to acute heart failure, recent myocardial infarction or following heart surgery. Vasopressors are medications that cause vasoconstriction (narrowing of blood vessels). This increases the systemic vascular resistance and, consequently, mean arterial pressure (MAP). Vasopressors are commonly used by anaesthetists as a bolus dose or in ICU as an infusion to improve patient’s blood pressure and, therefore, tissue perfusion.

Question 39

right sided HF symptoms vs left sided HF symptoms

Answer 39

right: Raised JVP Odema ascites englarged liver and spleen Left: Paroxsymal dyspnea pulmonary congestion: wheezze, crackles cough

Question 40

hf with preserved EF vs HF with reduced ejection fraction difference

Answer 40

preserved: clinical features of HF but EF of over 50% Reduced: EF less than 50%

Question 41

what is the medical treatment of chronic heart faliure?

Answer 41

A – ACE inhibitor (e.g., ramipril) titrated as high as tolerated B – Beta blocker (e.g., bisoprolol) titrated as high as tolerated A – Aldosterone antagonist when symptoms are not controlled with A and B (e.g., spironolactone or eplerenone) L – Loop diuretics (e.g., furosemide or bumetanide)

Question 42

what are some causes of chronic heart failure?

Answer 42

Ischaemic heart disease Valvular heart disease (commonly aortic stenosis) Hypertension Arrhythmias (commonly atrial fibrillation) Cardiomyopathy

Question 43

essential vs secondary hypertension? and the most common cause of secondary hypertension?

Answer 43

Essential hypertension accounts for 90% of hypertension. This is also known as primary hypertension. It means a high blood pressure has developed on its own and does not have a secondary cause. Secondary causes of hypertension can be remembered with the “ROPED” mnemonic: R – Renal disease O – Obesity P – Pregnancy-induced hypertension or pre-eclampsia E – Endocrine D – Drugs (e.g., alcohol, steroids, NSAIDs, oestrogen and liquorice) Renal disease is the most common cause of secondary hypertension. When the blood pressure is very high or does not respond to treatment, consider renal artery stenosis. Renal artery stenosis can be diagnosed with duplex ultrasound or an MR or CT angiogram.

Question 44

lifestyle advice for hypertension?

Answer 44

healthy diet stopping smoking reducing alcohol caffeine and salt intake taking regular exercise

Question 45

what is the step ladder treatment for hypertension? for step 4 how do you pick between two options

Answer 45

Step 1: Aged under 55 or type 2 diabetic of any age or family origin, use A. Aged over 55 or Black African use C. Step 2: A + C. Alternatively, A + D or C + D. Step 3: A + C + D Step 4: A + C + D + fourth agent (see below) step 4 depends on serum potassium. if 4.5 or less- spironolactone of more than 4.5 then alpha or beta blocker

Question 46

what is malignant/accelerated hypertension?

Answer 46

Accelerated hypertension, also called malignant hypertension, refers to extremely high blood pressure, above 180/120, with retinal haemorrhages or papilloedema. emergency-go hospital

Question 47

causes of primary vs seconary hyperaldosteronism

Answer 47

Primary hyperaldosteronism is when the adrenal glands are directly responsible for producing too much aldosterone. Serum renin will be low as the high blood pressure suppresses it. The adrenals may produce too much aldosterone for several possible reasons: Bilateral adrenal hyperplasia (most common) An adrenal adenoma secreting aldosterone (known as Conn’s syndrome) Familial hyperaldosteronism (rare) Secondary hyperaldosteronism is caused by excessive renin stimulating the release of excessive aldosterone. Excessive renin is released due to disproportionately lower blood pressure in the kidneys, usually due to: Renal artery stenosis Heart failure Liver cirrhosis and ascites

Question 48

how do you screen for the difference between primary and secondary hyperaldosteronism?

Answer 48

The aldosterone-to-renin ratio (ARR) is used as a screening test: High aldosterone and low renin indicate primary hyperaldosteronism (adrenals producing high amounts of aldosterone so renin low as trying to suppress this) High aldosterone and high renin indicate secondary hyperaldosteronism (bp in kidneys is percieved to be low so high amounts of renin produced to try bump bp but actuallly bp is high its just in the kidneys its low due to renal artery stenosis for example).

Question 49

symptoms of hyperaldosteronism?

Answer 49

low sodium (not always) high BP alkalosis on blood gas Hyperaldosteronism is worth remembering as the most common cause of secondary hypertension. Consider testing for hyperaldosteronism in patients with hypertension, who are younger, fail to respond to treatment or have a low potassium. Be aware that potassium levels may be normal in hyperaldosteronism.

Question 50

treatment of hyperaldosteronism?

Answer 50

Medical management is with aldosterone antagonists: Spironolactone Eplerenone Treating the underlying cause involves: -Surgical removal of the adrenal adenoma -Percutaneous renal artery angioplasty via the femoral artery to treat renal artery stenosis investigations for route cause: CT or MRI to look for an adrenal tumour or adrenal hyperplasia Renal artery imaging for renal artery stenosis (Doppler, CT angiogram or MR angiography) Adrenal vein sampling of blood from both adrenal veins to locate which gland is producing more aldosterone

Question 51

most commonly affected part of the bowel for diverticular disease?

Answer 51

sigmoid common

Question 52

risk factors for diverticulosis

Answer 52

age low fibre diet obesity NSAID use

Question 53

which type of laxatives should be avoided in diverticulitis and why?

Answer 53

stimulant laxatives e.g. senna as they irritate the gut

Question 54

investigation for diverticulits

Answer 54

-CRP and ESR – usually raised -Ultrasound / CT – can show wall thickening, diverticulae, and also abscess or perforation Sigmoidoscopy – if other investigations have been inconclusive

Question 55

management of diverticulitis

Answer 55

-Antibiotics (usually metronidazole) -Fluids -Analgesia – but be careful! You don’t want to give a constipating analgesic avoid NSAIDS (remember risk factor fir diverticulitis) and svoid Opiods long term -weight loss -high fibre, laxatives if necessary but avoid stimulants. Surgery – to resect the sigmoid colon – in severe cases

Question 56

What is a key red flag symptom for an urgent 2ww referral for endoscopy?

Answer 56

Remember dysphagia as a critical red flag. Any patient presenting with the feeling that food is getting stuck on the way down needs an urgent two week wait referral for an endoscopy.

Question 57

what marker would be abnormal in paget's disease?

Answer 57

paget's disease presents with normal electrolytes but markedly raised ALP.

Question 58

what is the most common ecg change in a pe

Answer 58

Sinus tachycardia with right ventricular strain This is the most likely ECG pattern seen in pulmonary embolism. Sinus tachycardia is related to increased sympathetic outflow to maintain cardiac output, while the right ventricular strain is related to high pulmonary artery pressures.

Question 59

what is a key complication in the treatment of DKA that can cause a drop in GCS, new onset headache and bradycardia?

Answer 59

cerebral oedema Cerebral oedema is a severe complication of diabetic ketoacidosis that more frequently occurs in children and presents with new-onset headache, changes to GCS, and bradycardia. It is due to rapid correction of hyperglycaemia, which causes a shift of water out of the brain cells. It is managed by senior clinicians due to its high mortality. Slowing IV fluids would be the first step in the management of this patient, as well as alerting seniors as soon as this has been done.

Question 60

Is neuro imaging for brain bleeds CT done with contrast on non-contrast?

Answer 60

non-contrast

Question 61

When should a lumbar puncture for a suspected SAH be done?

Answer 61

12 hours after onset of smyptoms if ct is done within 6 hours and nothing comes up think about different differentials but don't completely exclude SAH

Question 62

what will a lumbar puncture done 12hours after a SAH show?

Answer 62

xanthochromia

Question 63

what disease does the ziehl-neelsen stain test for

Answer 63

tuberculosis

Question 64

what are symptoms of hypercalcaemia?

Answer 64

stone, bones, groans and moans -Kidney stones -Painful bones -Abdominal groans (constipation, nausea and vomiting) Remember any GI symptoms -Psychiatric moans (fatigue, depression and psychosis) Remember can just be fatigue

Question 65

what are symptoms of hypocalcemia

Answer 65

-muscles twitching, spasms and cramps (tetany) -parasthesia particulary numbness or tingling in feet and hands. numbness or tingling around the mouth.

Question 66

what are the causes and what will the PTH and calcium level be in primary, secondary and teritiary hyperparathyroidsm?

Answer 66

Primary: tumour, PTH- high C-high Secondary low vit D or CKD, PTH-high C- low or normal Tertiary prolonged low vit pleading to hyperplasia on PT glands, PTH- high C-high

Question 67

What is the role of the parathyroid glands

Answer 67

calcium regulation

Question 68

what is the relationship between calcium and phosphate levels?

Answer 68

Within the body calcium and phosphate are inversely related: as blood calcium levels rise, phosphate levels fall. and vice versa.

Question 69

what are chvostek's sign and trousseau's sign?

Answer 69

The Chvostek sign is a clinical finding associated with hypocalcemia, or low levels of calcium in the blood. This clinical sign refers to a twitch of the facial muscles that occurs when gently tapping an individual's cheek, in front of the ear. The Trousseau sign of latent tetany is one of the clinical signs associated with hypocalcemia, or low calcium levels in the blood. activate blood pressure cuff about 20 over systolic pressure for 2-3 minutes this occludes brachial artery and positive sign the wrist will flex up

Question 70

what are the 4 features of myeloma?

Answer 70

C – Calcium (elevated) R – Renal failure A – Anaemia (most common feature) B – Bone lesions and bone pain

Question 71

what causes anaemia in myeloma?

Answer 71

he cancerous plasma cells invade the bone marrow (bone marrow infiltration), resulting in suppression of the other blood cell lines, leading to anaemia (low haemoglobin), leukopenia (low white blood cells) and thrombocytopenia (low platelets). Anaemia in myeloma is normocytic (normal size) and normochromic (normal colour).

Question 72

lethargic, weight loss, painful round shin lesions, swelling in ankles- diagnosis and investigations?

Answer 72

sarcoidosis I - Raised calcium and ACE ACE usually used as screening test/

Question 73

treatment for sarcoidosis

Answer 73

conservative in mild symptoms if treated steroids for 6 months -2 years (bisphosphonates to protect from osteoporosis)

Question 74

Symptoms of sarcoidosis (Inflammatory disease)

Answer 74

can affect any organ but lungs most commonly affected Lungs: Mediastinal lymphadenopathy Pulmonary fibrosis Pulmonary nodules Systemic Symptoms: Fever Fatigue Weight loss Liver: Liver nodules Cirrhosis Cholestasis Eyes: Uveitis Conjunctivitis Optic neuritis Heart: Bundle branch block Heart block Myocardial muscle involvement Kidneys: Kidney stones (due to hypercalcaemia) Nephrocalcinosis Interstitial nephritis Central nervous system: Nodules Pituitary involvement (diabetes insipidus) Encephalopathy Peripheral Nervous System: Facial nerve palsy Mononeuritis multiplex Bones: Arthralgia Arthritis Myopathy

Question 75

What are two main causes of erthyema nodusm? raised red tender painful lesions on the shins

Answer 75

IBD and sarcoidosis

Question 76

Lofgren’s syndrome refers to a specific presentation of sarcoidosis with a classic triad of symptoms which are :

Answer 76

Erythema nodosum Bilateral hilar lymphadenopathy Polyarthralgia (joint pain in multiple joints)

Question 77

what muscle group is affected in a positive trandelenburg test?

Answer 77

gluteal/abductors

Question 78

what histological finding would you find in lung cancer causing cushings syndrome?

Answer 78

small cell lung cancer

Question 79

what histological finding would you find in lung cancer SIADH presenting as hyponatremia?

Answer 79

small cell lung cancer

Question 80

what histological finding would you find in lung cancer causing hypercalcemia?

Answer 80

squamous cell carinoma

Question 81

Superior vena cava obstruction is a complication of lung cancer. It is caused by direct tumour compression on the superior vena cava. how does it present?

Answer 81

facial swelling, difficulty breathing, and distended neck and upper chest veins. Pemberton’s sign is where raising the hands over the head causes facial congestion and cyanosis. SVC obstruction is a medical emergency.

Question 82

what is the first line investigation for suspected lung cancer and what would it show?

Answer 82

chest x ray Hilar enlargement Peripheral opacity (a visible lesion in the lung field) Pleural effusion (usually unilateral in cancer) Collapse

Question 83

what is the most common type of cancers for non-smokers?

Answer 83

adenocarinoma

Question 84

allmost all of this type of lung cancer is caused by smoking?

Answer 84

small cell lung cancer

Question 85

how does Recurrent laryngeal nerve palsy present and what is it caused by?

Answer 85

horse voice a tumour pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum.

Question 86

lung cancer can cause a phrenic nerve palsy, how does this present?

Answer 86

due to nerve compression, causes diaphragm weakness and presents with shortness of breath.

Question 87

Limbic encephalitis is a paraneoplastic syndrome where the immune system makes antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas. This causes symptoms such as hallucinations, confusion and seizures. short-term memory impairment- this is caused by which type of lung cancer

Answer 87

small cell lung cancer all of the paraneoplastic syndrome are caused by small cell lung cancer apart from hypercalcemia which is caused by scc