Geries Flashcards
Presentation of digoxin toxicity
Disorientation
Vomiting
Mental confusion
Amnesia
Depression
Yellow visual field discolouration (xanthopsia)
What are lewy bodies made up of?
Alpha synuclein
When is ECT recommended
Life threatning depressive stupor
- especially when refusing to eat or drink
Treatment resistant depression
WHat does paralysis of the deltoid muscle cause
Weakness of shoulder abduction, particularly after 30 degrees of abduction (supraspinatus assists in the first 30)
Weakness of drawing arm forward and internal rotation
What causes osteomalacia
Lack or impaired metabolism of Vitamin D
What kind of drug is rifampicin
cytochrome p450 enzyme inducer
Interaction of rifampicin and warfarin
Increased metabolism of warfarin and a fall in INR
Drugs that can reduce INR when on warfarin
Rifampicin
Phenytoin
Carbamazepine
St johns wort
Drugs that can increase INR when on warfarin
Erythromycin
Metronidazole
Cipro
Cimetidine
Allopurinol
Triad of NPH
Gait disturbance
Incontinence
Cognitive impairment
CT features of NPH
Ventricular enlargement
Treatment of NPH
Large volume CSF removal (LP or lumbar drain)
If benefits from above - VP shunt placement
Type of gait in NPH vs PD
NPH - broad based shuffling gait
PD - narrow based shuffling gait
When does senile degenetative AS occur
Progressive calcification of the valve leaflets in response to long standing haemodynamic stress
What can cause subacute combined degeneration of the spinal cord
Vitamin B12 deficiency
Features of walderstroms macroglobulinaemia
Hepatosplenomegaly
Anaemia
Thrombocytopenia
Raised plasma viscosiity
Raised IgM
Immeediate treatment of increased plasma viscosity of walderstoms macroglobulinaemia
Urgent plasmapheresis
Treatment of mild - mod alzheimers
Acetylcholinesterase inhibiting drugs e.g.
- donepezil
- rivastigmine
- galantime
Treatment of severe alzheimers
Memantime
MMSE score for someone with severe alzheimers
< 10 / 30
Why does digoxin take a while to work
High degree of protein binding
Indicators of DIC
Hx of malignancy
Thrombocytopenia
Prolonged PT, APTT
Reduced fibrinogen levels
What do brainstem strokes cause
Contralateral weakness
Ipsilateral sympathetic pathway (horners syndrome)
Ipsilateral hypoglossal nerve causing tongue weakness on the affected side
Medial longitudinal fasciculus causing nystagmus as part of an ipsilateral internuclear opthalmoplegia
Body sensory loss on contralteral side
Facial sensory loss on ipsilateral side
Presentation of cerebellar strokes
Ipsilateral weakness
DANISH
- dysdiadokokinesis
- ataxia
- nystagmus
- intention tremor
- slurred speech
- hypotonia
Neuro exam of myasthenia gravis
Proximal muscle weakness
Ptosis
No muscle wasting or fasiculation
Sensation normal
Tone normal
Reflexes normal
Antibodies of myasthenia gravis
anti-acetylcholine receptor Abs
Treatment of myasthenia gravis
Acetylcholinesterase inhibitors
Oral corticosteriods
When is Lambert Eatson syndrome seen
Bronchial carcinoma
Neurology of Lambert Eaton syndrome
Proximal muscle weakness
May improve initially on exercise
Lessens as exercise is sustained
Reflexes reduced or absent
Presentation of GBS
Ascending pattern of progressive symmetrical weakness, starting in lower extremeties
Neuropathic pain may develop
Reflexes reduced or absent
Why does TMP exacerbate poor renal function
Compettive inhibition of creatinine secretion
Diagnosis for amyloidosis on histology post biopsy
Congo red staining
Who should you not give haloperidol to
PD patients
What can risperdione worsen
PD symptoms
Treatment of VT with no adverse features
Amiodarone
Presentation of SCC
Ulcerated nodular lesion
Surrounding paraesthesia
Hyperkeratotsis
What can SCC evolve from
actinic keratosis
What causes melanosis coli
Long term laxative abuse
Over time this leads to pigment deposition in the mucosa
What area of the brain do the cranial nerves pass through
Jugular foramen
Lesions that affect brocas area result in what
Expressive aphasia
Features of PSP (progressive supranuclear palsy)
Falls seen very shortly after onset of Sx
Symmetrical (proximal > distal) rigidity
Poor response to levodopa
Dysphagia
Decreased verbal fluency
Supranuclear gaze palsy (loss of vertical gaze)
Is autonomic dysfunction common or uncommon in PSP
Uncommon
Features of MSA (multi-system atrophy)
Cerebellar signs
Autonomic dysfunction
Features of corticobasal degeneration
Asymmetrical signs
Predominantlely presents with rigidity
Alien limb syndrome (unable to control movements of an isolated limb) leading to a sensation that the limb is foreign
Apraxia
Aphasia as the disease progresses
Features of lewy body dementia
Fluctuating confusion/onset of dementia
Persistent visual hallucinations
Spontaenous parkinsonism
REM sleep disorder
Unexplained syncope
Presentation of primary polycythaemia
Headaches
Itching
Mutation of primary polycythaemia
JAK2 gene
Blood results of primary polycythaemia
Raised Hb
Raised hct
Raised WCC
Raised platelets
Erythropoietin low
Treatment of bipolar disorder
- Lithium
- Add valproate
Investigation of a chronic leukaemia
Immunophenotyping / flow cytometry
Pathologically, what does tonsillar herniation cause
Increase in BP
Fall in HR
What indicates a restrictive filling pattern (heart)
Dilated atria
What can be seen in the myocardium to indicate amyloid?
Speckled appearance
What forms the posterior cerebral arteries
Basilar artery
What do the posterior cerebral arteries supply
Occipital lobe
What causes anton syndrome
Bilateral occipital lobe infarcts
What kind of meningitis are the elderly at increased risk of
Listeria meningitis
Who should be covered for listeria meningitis and what drug should be added to ceftriaxone?
> 60 and immunosuppressed
Amoxicillin
Anti-emetic of choice in PD
Ondansetron
What does the nerve root L1/2 supply
Sensory to anterior groin
Motor supply to hip flexors
If the L4 nerve root is involved in damage, what would you expect to see
Sensory disturbance of the anterior thigh
If L4/5 was affecred, what would you expect to see
Altered sensation in the lower leg
If L5/S1 nerve root was affected, what would you expect to see
Altered sensation below the knee and over the foot
Foot drop
2/3rds of leg ulcers are due to what
Chronic venous insufficiency
If ABPIs are statisfactory, what is the management of venous ulcers
Compression
Genetics of HD
AD
Huntington gene on chromosome 4
CAG repeat expansion
Pathological findings in HD
Neurodegeneration in the cortex and striatum, especially in the caudate nucleus
What is characteristic of HD
Chorea (random dancing movements flitting from one body part to another)
Can also have
- parkinsonsim
- frontal subcotical cognitive impairment
- behavioural disturbance
- slow, saccardic eye movements
- depression
- dementia
Example of management of chorea in HD
Anti-dopaminergic agents such as tetrabenazine
Main role of the hippocampus
Memory
Spatial navagation
Lesions affecting the substantia nigra would result in what
Parkinsonism
Pathology of LBD
Accumulation of aggregated form of alpha-synuclein into lewy bodies with vulnerable neurons
Treatment of acitiinic keratosis
Topical 5-FU
Half life of amiodarone
25-30 days
Cessation may take several months for the drug concentration has fallen to an insiginifant level
Mechanism of action of allopurinol
Reduced urate production
What may gouty arthritis be precipitated by
Diuretic therapy
What is listeria particularly assosiated with
Pates and soft cheeses
What is predominant in CSF of a listeria meningitis
Lymphocytes
What is predominant in a CSF of bacterial meningitis
Neutrophils
CSF abnormalities in bacterial meningitis
Opening pressure > 180
WBCs 10 - 10,000
Neutrophils predominate
CSF glucose < 0.4
Glucose < 2.2
Protein > 0.45
What blood film would you see if you had metastatic ca with bony mets, and were anaemic
Nucleated RBCs
What is seen on a blood film with haemolytic anaemia
Heinz bodies
What is seen on a blood film with hyposplenism
Howell-Jolly bodies
What is seen on a blood film of hereditary spherocytosis
Spherocytes
Mechanism of action of amiodarone
K channel antagonist (delay in repolarisation, increasing AP and increased effective refractory period)
Mechanism of action of digoxin
Inhibition of the sodium potassium ATPase
What type of drug is donepezil
Acetylcholinesterase inhibitor
Examples of acetylcholinestase inhibitors
donepezil
rivastigmine
galantimine
Physiological effects of IPPV
Increased lung volumes
Increased intrathoracic pressure
Increased pulmonary vascular resistance
Reduced systemic BP
Reduced venous return and cardiac output
WHat is tardive dyskinesia
Movement disorder assosiated with long term use of anti-psychotics
What is akathisia characterised by
Motor restlesseness
Septate hyphae and invovlement of sinuses suggect diagnosis of which infection
Aspergillus
WHat supplies the pons
Branches of the basillar artery
Tx for UTI in patients with efgr < 45
pivmecillinam
Genetic basis for alzheimers disease
APOE e4 allele carriage
Role of rivastigmine in PD
Symptoms of dementia
What drug has a role in reducing “off periods” in PD
Entacapone
Risk factors for osteonecrosis of the jaw secondary to bisphosphonate therapy
Dental caries (MOST IMPORTANT)
Smoking
> 65
Long term use of corticosteriods
Scoring system to assess independence in patients with a stroke
Barthel index
Treatment of LBD
Donepezil
Treatment of restless legs syndrome
Gabapentin and pregabalin
Management of N/V secondary to bowel obstruction in terminal care
Haloperidol
Site of action of bendroflumethiazide
Distal convoluted tubule
