General Flashcards
4 types of dementia?
Alzheimer’s
Vascular
Lewy body
Frontotemporal
Pathophysiology of Alzheimer’s?
Beta amyloid plaques accumulation
Neurofibrillary tau tangles
Alzheimer’s symptoms?
5 As
Amnesia- short term worse than long
Aphasia
Agnostia- doesn’t recognise things
Apraxia- misusing objects as fail to identify
Continuous decline
Key facts about vascular dementia.
Cumulative effect of many small strokes
Step wise decline
Key facts about Lewy body dementia?
Fluctuates
Hallucinations with no other cause
Associated with Parkinson’s?
Key facts about fronto temporal dementia
U65 more common
Associated with MND
Behavioural change- e.g. hypersexual, aggressive, adventure seeking
What’s included in a confusion screen?
FBC -anaemia, infection
U&E - electrolytes
LFTs- encephalopathy, raised ammonia
CRP- infection
Haemostatics- iron, B12, folate
TFTs - more often hypothyroidism
Calcium
Phosphate
Magnesium
Cognitive screening tests?
AMT/ Abbreviated mental state test
6-CIT
Mini mental state
More detailed cognitive tests?
Addenbrookes cognitive exam (ACE)- /100
Cambridge cognition test
Alzheimer’s mild to moderate pharmacological tx?
Acetylcholinesterase inhibitors:
- Rivastigmine
- Donepazil
- Galantamine
Moderate to severe Alzheimer’s pharmacological tx?
NMDA receptor antagonist
- Memantine
If completely necessary to sedate a patient for their own safety (and no treatable cause found). What would you use?
0.5mg lorazepam, preferably oral
What is delerium?
Acquired, acute onset of altered consciousness or inattention.
Can be hyper or hypo
Causes of delerium?
PINCH ME (or MEDs)
Pain
Infection
Nutrition
Constipation
Hydration
Metabolic
Electrolytes
Drugs/alcohol
E.g. could they need chlordiazepoxide to treat their alcohol withdrawal rather than a sedating benzo
5 features of the mental capacity act?
- Presumed to have capacity
- Supported to make decisions
- Right to make an unwise decision
- Best interests is core to decision
- Intervention must be least restrictive
Assessing capacity features?
Understand
Retain
Evaluate
Communicate
What is used a a safeguard to staff when someone’s is treated without capacity?
DOLS
Deprivation of liberty standard
SSRIs are usually first line for anxiety, what’s usually second line? And examples
SNRIs
E.g.
Duloxetine
Venlafaxine
Management of panic disorder?
1st- CBT or drug therapy
1st SSRIs. If CI or no response after 12 weeks, try imipramine or clomipramine
Myeloma classically presents with/causes?
Lethargy
Hypercalcaemia
Pancytopenia
AKI
How does myeloma often present?
CRABBI
Calcium raised- constipation, nausea, anorexia, confusion
Renal
Anaemia- bone marrow infiltration
Bleeding- thrombocytopenia
Bones- bone marrow infiltration, particularly in spine
Infection
What is Graves’ disease?
Autoimmune disease caused by TSH receptor antibodies leading to hyperthyroidism
Which regions of an ECG are lateral leads?
1, aVL, V5, V6
What region on an ECG represent anterior aspect of heart, and it’s major artery?
Supplied by left anterior descending artery
V1-V4
What region on an ECG represent inferior aspect of heart, and it’s major artery?
Right coronary artery
II, III, aVF
Changes to ECGs post STEMI. Immediate and after few days?
Immediate
- hyperacute T waves
- then… ST elevation or new LBBB
Over next few days
- pathological Q waves
- T wave inversion
Complications post MI?
Cardiac arrest
Arrhythmias
Heart failure
DVT/PE
pericarditis
Causes of acute pulmonary oedema?
Post MI
Valvular disease
Arrhythmias e.g. complete heart block
Non- cardiac
- fluid overload 2nd to renal failure or overloaded
- post head injury
- ARDS
Red swollen legions over shins, diagnosis?
And causes?
Erythema nodosum
Inflammation of sub-cut fat under shins
Painful, raised lumps, settle and turn into bruises
Mx: find and treat cause
Can last 6 weeks +
Causes:
Infection: strep, TB
Systemic: sarcoidosis, IBD, Behcets
Malignancy/ lymphoma
Drugs: penicillins, sulphonamides, COCP, pregnancy
Erythema nodosum causes?
Many but key ones are
- Sarcoidosis
- Inflammatory bowel disease
Others
- strep throat infections
- gastroenteritis
- mycoplasma. pneumoniae
- TB
- pregnancy
- medications e.g. COCP, NSAIDS
Define bronchiectasis?
Abnormal permanent dilatation of bronchi and bronchioles, usually caused by and leads to infections
Common colonisers in CF?
Pseudomonas.aeruginosa
Strep.pneumonia
Haem,influenzae
Causes of bronchiectasis?
- Post-infection- untreated/inadequately treated
- Post-obstruction- foreign body, tumour, lymphadenopathy
- Congenital
- Immunodeficiency
- Allergic bronchopulmonary aspergillosis
- Alpha 1 antitripsin deficiency
- RA
- UC
Signs of bronchectasis?
Clubbing of fingernails
Course crepitations
Symptoms
- chronic productive cough
- occasional haemoptysis
- recurrent LRTI
Investigation for bronchiectasis?
High resolution CT scan
Normal pO2 and pCO2 (in kPa)
pO2 10.5-13.5 kPa
pCO2 4.7- 6 kPa
PE on ECG findings?
‘S1Q3T3’ but actually rarely seen. Any signs of right heart strain e.g. incomplete RBBB
Deep S wave on lead 1
Deep Q wave with inverted T wave in lead 3
+ sinus tachycardia
Lung cancer most commonly metastasises to where? (4 places)
Brain
Bone
Liver
Adrenals
What’s used to stage lung cancer?
PET cancer
Bone scan
Investigations for lung cancer?
CXR
Staging CT scan- contrast
PET-CT- shows where is metabolically active
Bronchoscopy with endobronchial US (EBUS)
Histology analysis- biopsy
Chest xray findings with lung cancer?
Peripheral opactity- ie consolidation in lung field
Hilar enlargement
Pleural effusion- usually unilateral
Collapse
What neurological conditions is associated with a type of lung cancer? And what type of lung cancer is this?
Lambert Eaton myasthenic syndrome
Associated with small cell lung cancer. Antibodies against lung cancer are similar to bodies voltage gated calcium channels –> these are needed for acetylcholine release in pre synaptic terminals–> less acetylcholine released
How does Lambert Eaton syndrome present?
- Proximal muscle weakness- most notably proximal leg weakness
- Double vision (diplopia)- intraocular muscle weakness
- Drooping eyelids (ptosis)- levator muscle weakness
- Slurred speach and dysphagia- oropharyngeal muscle weakness
Autonomic dysfunction causing
- Dry mouth
- Blurred vision
- Impotence
- Dizziness
Staging for lung cancer?
TNM staging
Tumour- size and nearby spread
Nearby spread to lymph nodes
Metastases
How does superior vena cava obstruction present?
Severe SOB
Severe headache
Perioribital swelling
Raised JVP
Dilated neck veins
Dilated veins across chest
Steroid side effects?
Endocrine- adrenal suppression, hyperglycaemia
Change in fat distribution- central obesity, buffalo hump, moon face
Skin- bruising, skin thinning
Eyes- cataracts
MSK- muscle wasting, osteoporosis, a vascular necrosis of femoral head
Psych- psychosis, euphoria
CVS- hypertension
Immunosuppression
Peptic ulcers
Trigeminal neuralgia 1st line?
Carbamazepine
Acne treatment pathway?
Topical benzoyl peroxide
Topical retinoids *needs contraception
Topical abx e.g. clindamycin
- prescribed with benzoyl peroxide to reduce resistance
Oral abx e.g. lymecycline
COCP e.g. co-cyprindiol- higher risk VTE
Oral retinoids e.g. isotretinoin- specialist only, teratogenic!
What two LFTs will be very high in cholestasis?
ALP - alkaline phosphatase
GGT- gamma glutamyl transferase
73yo M with headaches and pain in limbs and recent hearing deteriation. What are you suspecting and what blood tests finding is usually abnormal in this condition?
What would you use to treat this condition?
Paget’s disease of bone
Raised ALP- with calcium and phosphate normal
Bisphosphonates- oral risedronate or IV zolendronate
Ex-alcoholic with confusion, distended abdomen, spider naevi and hepatic flap.
Diagnosis? Treatment 1st line?
Hepatic encephalopathy
Lactulose
Blood marker specific for liver cirrhosis?
Alpha fetoprotein
Ca 19-9 indicative of what?
A tumour marker
Indicative of cholangiocarcinoma (cancer of bile ducts) or pancreatic cancer
Can be raised in other condiations, not too specific
What is Courvoisier’s law?
A palpable gallbladder with jaundice is unlikely to be gallstones. Usually cholangiocarcinma or pancreatic cancer
* pancreatic cancer is more common though so more likely on an exam situation
A tumour marker indicative of bowel cancer?
Carcinoembryonic antigen (CEA)
What is a raised Carcinoembryonic antigen a marker of?
A tumour marker indicative of bowel cancer
78yo M attends with recent urinary incontinence, has become forgetful and a shuffling gait. Top differentials?
- Normal pressure hydrocephalus: triad of gait abnormality, dementia and urinary incontinence
- Parkinson’s
- Delirium
- Dementia
Management of normal pressure hydrocephalus?
Ventriculoperitoneal shunt (into peritoneal cavity)
Usually develops after a head injury, SA, or meningitis.
It’s a reversible cause of dementia
What blood markers indicate tumour lysis syndrome?
High uric acid/urate
High phosphate
High potassium/hyperkalaemia
Low calcium
