Gen Med Flashcards
Most common cause of CAP (and treatment?)
Strep pneumonia (doxy)
Miosis of the eye is what?
Constriction of the pupils by the p’symp NS
Atropine does what?
Blocks P’symp on musc R’s. Ie, decreases SLUDGEM
SLUDGEM?
Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis, Miosis
Adrenergic Receptors: a1? a2? B1? B2?
a1 = smooth mm contractoin, vasoconstriction of BVs and increased sodium from kidneys a2 = vasodilation of arteries, vasoCONstrictino of coronaries, decreased smooth mm activity in gut B1 = increased HR, increased Contractility B2 = bronchodilation, smooth mm relaxation, sk mm dilation, decreased histamine release
S+S of HypERcalcaemia?
Stones - kidney stones and nephrocalcinosis,
Bones - OP, osteomalacia, arthritis
Groans - constipation, indigestion, N+V, PUD (increased gastric acid secretion), acute pancreatitis,
Thrones - polyuria, Diabetes Insipidus and osborne waves, Psychiatric overtones - memory, lethargy, depression
+ HTN
S+S of HypOcalcaemia
CATS go numb:
- Convulsions
- Arrhythmias
- Tetany - chvostek (face), Trouseau (hand/BP cuff)
- Numbness of mouth, hand, feet
When does pupil sparing occur
P’symp fibers are found peripherally thus receive blood supply longer than central fibers in compression of CNIII
Empiric treatment for meningitis?
1yr
2 months - Ceftriaxone + steroids (to decrease hearing loss)
+Add acyclovir if viral suspected
Common causes of Meningitis:
Neonates?
>2months?
Adults?
Neonates:
Group B streptococcus
E. coli and other Gram-negative organisms
Listeria monocytogenes
Over 2 months age:
Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae type B (in unimmunised children)Treatment of meningococcus?
Benpen 4 hourly
Wilson’s disease
Copper accumulation (hepatolenticular degeneration)
- Autosomal recessive
- Presents as neurological, psych or liver disease
- Often in 6-20 year olds with fatigue, encephalopathy/confusion, increased bleeding, portal HTN, ascites
B12?
- other name?
- S+S of deficiency
Cobalamin.
- Found in meat/animal products
- req INTRINSIC factor
- deficiency = macrocytic anaemia, pallor, SOB, CP, palp, fatigue
- O/E: glossitis, dec vibraiton sense, distal numbness and parasthesia, mm weakness, decreased reflexes, plus UMN signs, diarrhoea + anorexia
- personality changes - depression, iritability, psychosis
Ddx dementia with VITAMIN D VEST
Vit D defic Intracranial tumour Trauma Anoxia Metabolic (DM) Infection (HIV, enceph) Normal pressure Hydroceph Degenerative - AD, Huntingtons, CJD Vascular Endocrine (hypothyroid) Space occupying lesion Toxic - alcohol
Aphasia
Partial or total loss of the ability to communicate verbally or with written words.
Nominal Aphasia = Naming difficulties
Apraxia
Inability to perform skilled voluntary motor sequences that cannot be accounted for by weakness, sensory loss, impaired comprehension or inattention
(Ideomotor - combing hair, blowing out candle)
(Ideational - inability to sequence actions - preparing and mailing and envelope)
(Constructional - inability to draw/copy a figure)
(dressing - inability)
Extrapyramidal signs are what?
Dystonia - continuous spasms and muscle contractions), Akathisia (motor restlessness), Parkinsonism (characteristic symptoms such as rigidity, bradykinesia, and tremor), and Tardive dyskinesia (irregular, jerky movements)
Often caused by antipsychotics, any D2 antagonists like metoclopramide, plus some antidepressants, like SSRIs and more
Agnosia
Disorder in recognition of the significance of sensory stimuli in the presence of intact sensation and naming
Gerstmann’s syndrome
Parietal lesion of the DOMINANT (L) Hemisphere:
- agraphia, acalculia, finger agnosia and L-R disorientation
Neglect occurs most severely with which type of lesion?
Non-dominant (R) sided parietal lesions
Pharmacological Rx of Alzheimers Disease
1) Anticholinesterase inhibitors
- donepezil, rivastigmine, galantamine
2) NMDA-R antagonist - during later stages (MMSE
Frontotemporal dementia/Pick’s dementia S&S
Behavioural variant of FTD most common - social conduct disorder
Language variants:
- progressive nonfluent aphasia: laboured articulation/speech, anomia, word-finding difficulty
- semantid dementia: fluent, normal rate, anomia, use words of generalisation (‘thing’), or supraordinate catagories (animal instead of dog)
- 3rd most common type of dementia
*Early decline in social interpersonal conduct, emotional blunting and loss of insight with supportive features of declinein personal hygeine etc IN THE ABSENCE OF severe amnesia, aphasia, perceptual disorder
Lewy Body dementia
Progressive cog decline interfering with social or occupational funtion
- *memory loss not often early feature
- FLUCTUATING cognition with pronounced variation in alertness and attention
- recurrent VISUAL HALLUCINATIONS
- PARKINSONISM (not to be conf w parkinsons’ disease dementia)
- slightly quicker decline/average life expectancy than AD
Delirium v Dementia Definition Onset: Course Consciousness Attention Orientation Memory Thinking Perception Behaviour
Delirium : Dementia
A state of temporary confusion : Progressive irreversible decline
Rapid : insiduous
Short, with DIURNAL fluctuations : Chronic, progressive, often worse at night
Attention: impaired, distractable ++
Consciousness: altered, confused (usaully worse at night or on waking) : clear except in extreme cases
Memory: Recent and immediate impaired : recent and remote impaired
Thinking: disorganised and incoherent : impoverished
Perceptions: misperceptions common : misperceptions usually absent
