finals neuro/rheum Flashcards
how to manage hypogycaemia?
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)
what is the first line treatment for Alzheimer’s disease?
Donepezil
how does chronic mesenteric ischaemia present?
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.
what are some examples of aura with migraines and what is it?
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).
what does a hemiplegic migraine mimic that is it important to rule out?
stroke
what 3 drugs can be given for migraine prophylaxis and when shouldn’t they be given?
-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
when should triptans be taken and can you take another if it doesn’t work?
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.
what pain relief shouldnt be taken for migraines and can actually make them worse?
opiods
what is the management for tension headaces?
Reassurance
Simple analgesia (e.g., ibuprofen or paracetamol)
Amitriptyline is generally first-line for chronic or frequent tension headaches.
how do cluster headaches present?
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
how to manage a cluster headache? acute and phrophylaxis
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).
where do cluster headaches get their name from?
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.
what is the first line treatment for trigeminal neuralgia?
Carbamazepine
what condition is trigeminal neuralgia commonly associated with?
multiple sclerosis
how does trigeminal neuralgia present?
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.
what are the three brancehs of the trigeminal nerve
v1- opthalmic
v2- maxillary
v3- mandibular
difference between orbital and pre orbital cellulitis. How to distinguish between them?
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
symptoms and treatment of preoribtal cellulits?
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.
symptoms and treatment of oribtal cellulits?
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.
different between complex and simple febrile convulsion?
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.
Does having febrile seizures increase the risk of having epilepsy in the future?
Children who have had a febrile seizure have a slightly increased chance of having epilepsy later in life, but this is rare.
2-5%
what can Alpha-1 Antitrypsin Deficiency lead to?
lung and liver problems
MAINTENANCE FLUID REQUIREMENTS IN CHILDREN
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.
What does LOSS stand for oseoarthiritis?
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)
what are the hand signs seen in osteoarthritis?
-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
Investigations for asthma?
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.
why cant someone go home after they are stable from anaphylaxis?
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.
Once a diagnosis of anaphylaxis is established, there are three medications given to treat the reaction. What are they?
Intramuscular adrenalin, repeated after 5 minutes if required
Antihistamines, such as oral chlorphenamine or cetirizine
Steroids, usually intravenous hydrocortisone
what must you do in the after management of anaphylaxis.
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.
How to use an epi pen?
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.
what are the guidelines for taking GTN and when to call an ambulance?
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
what is the management of angina (broken down into 3)
-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
what does a cardiac stress test involve and what is it testing for?
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).
what is an ectopic and how is it treated
mobitz type 1 vs mobitz type 2 in 2nd degree heart block
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.
Which heart blocks do you treat and why. Also how do u treat them
motbitz type 2 and complete because they both have a risk of asystole.
refer to cardiology for pacemaker.
