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Vasovagal syncope
Occurs when there is excessive activation of PNS in response to certain stimuli such as heat fear stress. PNS activity causes systemic vasodilation and bradycardia- causes hypotension and cerebral hypoperfusion.
Collapse is often preceded by nausea faintness sweating ringing in ears. May have twitching/ uriary incontinence.
Recovery rapid.
Always ask about before during after- sob dizziness chest pain tongue biting incontinence postictal paralysis parestesia.
Investigation ecg glucose by lying and standing
Wolf Parkinson white syndrom
Abnormal accessory conduction pathway that connects atria to ventricles known as bundle of Kent. Extra pathway is able to conduct atrial depolarisation of ventricle faster than av node. May trigger dangerous arrhythmias SVT, VT,VF. Patients may be a symptomatic or suffer from dizziness palpitations, chest pain, syncope and sudden cardiac death. ECG changes in WPW include a shortened PR interval wide QRS complex slurred upstroke of r wave.
Radio ablation of the accessory pathway.
Erbs palsy
Damage to upper brachial plexus involves c5 c6 nerve roots. Commonly caused by traction injuries RTA.- motorcycle.
Flaccid paralyissi of arm abductors , lateral orators of shoulder and supinators- affected arm hangs limp and is medically rotated , extended at elbow and pronanted. WAITERS TIP. Loss of sensation over the lateral arm and forearm.
Long thoracic nerve
Supplies the serrated anteror- helps to stabilise the scapula. Nerve can be damaged during breast and axillary surgery. Lesions of nerve result in winging of scapula
Radial nerve
Supplies extensor of forearm and wrist. Damage will causes an inability to extend the wrist or MCP joints- risk drop. Loss of sensation in the snuff box
Accessory nerve
Shrug shoulders- supplies traps and scm. Can be damage during dissections of the neck.
Axillary nerve
Wraps around the surgical neck of the humerus. Damaged in 5-10% of anterior dislocations and also in fractures of the numeral neck. Supplies the deltoid muscle. Damage causes regimental badge sensory loss and loss of abduction from deltoid.if lifted above 90 degrees will stay there because of supraspinous.
Carpal tunnel syndrome
Compression of the distal median nerve in carpal tunnel as it passses behind flexor retinaculum.
More common in women- pregnancy, RA and hypothyroidism.
Numbness and tingling in radial 3 1/2 digits which may be followed by wasting of the air muscles.
Titles test- taspping over median nerve at wrist- bring symptoms
Phalens test- symptoms are produced when wrist is palmerflexed fro 1 min.
Neuropathic ulcer
Small, punched out well circumscribed and painless.
Patient usually has glove and stocking syndrome- diabetes complication.
Complications; superficial infection, abscess formation and osteomyelitis
Autonomic neuropathy
In diabetes in can cause postural hypotension- cant compensate for transient drop in by on standing- cerebral hypoperfusiin and collapse.
Auto also causes erectile dysfunction, gastroparesis, urinary retention and nocturnal diarrhoea
Charcots joint
Neuropathic joint disease.
Destruction of weight bearing joints secondary to sensory neuropathy.
Ankles and knees are most commonly affected.
Repeated unnoticed trauma and abnormal stress result in cartilage, ligament synovium and bone damage- grossly deformed and unstable but painless joint.
Nephropathy
30% can develop renal failure during lifetime
Glomerular involvement ischaemia and infection
Earliest detectable sign is microalbuminuria.
ACEi and ARBs are shown to reduce the progression and contribute to be control.
NECROBIOSIS LIPOIDICA
Rare 1% patients.
Anterolateral aspect of the lower limb
Usually begins as a red small nodule that increases in size and flattens over time. Eventually it becomes depressed irregular scaly waxy and develops brownish yellowish discolouration.
small cell lung tumour
Incidence 20%
Squamous 35%
ADENO 30%
Large cell 15%
Cause horners Ectopic ADH secretion Ectopic adrencorticotrophic hormone Ectopic PTH- squamous cell Carcinoid syndrome- right sided murmur, cutaneous flushes, apparent cyanosis, hepatomegaly, cough wheeze dyspnea, diarrhoea, cramps n.v Gynecomastia EL syndrome Clubbing HPOA
CF
Incidence is 1 in 1500, in Ireland
Defective gene carried by 1 in 19
Caused by an abnormal CFTR located on chromo 7
Most common mutation is delta f 508
G551d mutation
Neonatal- jaundice, bowel obs or rectal prolapse
Mgmt involves physio antibiotics pancreatic enzyme supplements newer drugs eg lumacaftir/ ivacaftir
Complications; diebaetes mellitus, hepatic cirrhosis, infertility in males, servers pul htn, cor pulmonale and chronic lung infection- pseudomonas aeruginosa
Mesothelioma
Malignant Timor of the pleura.
Asbestos is the most potent cause.
20 year lag time between contact and development.
Present with chest pain and symptoms of a pleural effusion.
The effusion tends to be blood stained.
Definitive diagnosis is made by pleural biopsy.
No curative tx, radio may slow growth
Asbestos related lung disease
Asbestos can cause pleural plaque- asymptomatic calcified pleural thickening resembling holly leaves.
Asbestosis is a diffuse fibrosis of the lungs and pleura.
Develops in people who have been exposed to large amounts over years
Clinical ft clubbing progressive dyspnoea and lower zone onspiratory creeps.
No specific mgmt, steroids don’t work
Minimal change gloperulonephritis
Type of nephrotic syndrome - loss of large amounts of protein in the urine due to a leaky glomerular BM.
Fts include; proteinura, peripheral oedema, hypoalbuminemai, hypertension, hyperlipidaemia hypercoag and increased risk of infection.
In children main cause of nephrotic syndrome is minimal change glomerulnephritis >90% of cases.
On biopsy histology is normal. Tx involves steroid therapy, fluid restriction, low salt, penicillin prophylaxis and ace inhibitors to reduce proteinuri ADN STATINS.
Membranous glomerulonephritis
Most common cause of nephrotic syndrome in adults.
Immune complexes are formed when circulation Ab bind to BM antigens. Immune complexes activate an IR that involves the complement cascade. Response damages the BM making it more permeable.
Usually idiopathic but may be secondary to SLE, hep , systemic infection and drugs.
Tx is same as for minimal change disease.
Prognois is variable- 1/3 recover spontaneously. 1/3 respond to IS. 1/3 end stage renal failure.
Good pastures syndrome
Rare condition where autoAb are formed against the BM and the alveolar membrane.
Ab trigger a type II rxn that causes renal failure pulmonary haemorrhage and haemoptysis.
Condition is usually detected by anti glomerular BM ab in the serumand via renal biopsy.
Biopsy often shows focal or diffuse crescent Iv.
Tx witth plasmapheresis, steroids and immunosuppression.
IgA nephropathy
Most common cause of primary glomerular nephritis.
IgA Ab are deposited within the mesangium and trigger an immune response via activation of the complement cascade.
IgA nephropathy maybe asymptomatic fro many years and may be discovered incidentally when dipstick showed microscopic haematuria and proteinuria.
May also present as haematura usually within 2days of an upper RTI.
Renal biopsy required for diagnosis
30% people will develop end stage renal failure.
Post strep glomerulonephritis
Seen 1-2 weeks after a group A beta haemolytic strep- tonsilitis/ cellulitis.
Immune complex deposition in BM
Patients present with acute nephrotic syndrome- fluid retention, peripheral oedema ,HTN, protein and blood in ursine. Unwind is dark In colour- Pepsi urine
Management is supportive with fluid restriction and antihypertesnive meds.
CSF Results in Cryptoccus neoformans
Clear fluid, low abc, neutrophils, low glucose, high protein, positive India ink stain
CSF results in mumps
No organisms present, high wbc
