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HCOLL > HCOLL > Flashcards

HCOLL Flashcards

1
Q

2 options for pharmacological management of cog ss of AD dementia

A

1st line: Acetylcholinesterase inhibitors (AChE-1) eg donepezil, rivastigmine, galantamine
2nd: NDMA antagonists eg memantanine

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2
Q

examples of cholinesterase inhibitors and use

A

donepezil, rivastigmine, galantamine

1st line dementia

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3
Q

what’s memantanine

A

NDMA antag for dementia 2nd line

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4
Q

when to use lorazepam or haloperidol for short term distress

A

lorazepam if PD or LBD
haloperidol
can use olanzapine

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5
Q

what is part of the multifactorial assessment for falls

A 
Hx 
assess gait, balance, mobility, weakness
OP risk
perceived functional ability and fear
visual
cog and neuro exam
urinary incontinence assessment
home hazards assessment 
CVS
Med review
(on admission postural BP, CK if long lie, ECG)
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6
Q

Prevention of falls

A

strength and balance training
environmental assessment
med review esp psychotropics

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7
Q

Fall: if no orthostatic hypo, abnormal ECG/CVS exam what are following steps of IX

A

24hr cardiac monitor and echo

if normal do tilt tallow with carotid sinus massage

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8
Q

CI for carotid sinus massage

A

MI/TIA/Stroke <3m
prev adverse reac
relative: VF/VT or carotid bruits

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9
Q

NICE risk increasing conditions for falls

A

dementia, delirium, LUTS in men, stroke, urinary incontinence due to neuro or in a women

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10
Q

possible meds in falls

A

ca and vit D

Fludrocortisin if very low unexplained BP

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11
Q

what percentage of over 80s fall every year

A

50%

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12
Q

falls assessment includes (look up)

A

HX, Ex, GALS, postural BP, HS, neuro, eye sight. ?fracture liaison?

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13
Q

criteria for the clinical dx of parkinsons

A

bradykinesia AND
muscle rigidity OR
resting tremor (4-6Hz) OR
postural instability with no other cause

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14
Q

imaging for parkinsons

A

SPECT scanning: DAT scan shows reduced ligand binding indicating degeneration of nigrostriatal neurones.

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15
Q

First line tx parkinsons

A

levodopa (co-beneldopa and sinemet)

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16
Q

eg of dopamine agonists used in PD and side effects

A

rotigotine and eropinorole

neuropsychiatric side effects ig impulse control disorder or hallucinations

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17
Q

MOAB inhibitors used in PD

A

selegiline and rasagaline

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18
Q

multiple myeloma screen consists of

A

ESR
serum IgGs
protein electrophoresis
urinary Bence-Jones proteins

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19
Q

Bone profile consists of

A

Ca, Vit D, phosphate, alkaline phosphate, parathyroid hormone

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20
Q

secondary causes of osteoporosis

A
  • primary hyperparathyroidism, thyrotoxicosis (high HT and PTH and calcium as increase turn over
  • steroid use/cushings (leads to decrease ca ab and increase ca extortion so causes secondary hyperparathyroidism
  • DM, CLD, CKD
  • immobility
  • anorexia/malab eg IBD, coeliac, ca deficiency, secondary hyperparathyroidism, chronic pancreatitis
  • chronic inflam eg RA or neoplastic disease
  • drugs: anticonvulsants, heparin, lithium, steroids, sex hormone ag eg goserelin, aromatase inhibition’s, SSRI, PPI, thiazolidinediones (for DM)
  • marfan, osteogenesis imperfecta, tener syn
  • myeloma and haemoglobinopathies
  • hypogonadism, meno <40
21
Q

define osteopenia

A

1-2.5 SD below average

22
Q

bone profile of osteoporosis

A

osteoporosis shows normal calcium, phosphate, ALP

23
Q

osteomalacia bone profile

A

decrease calcium, decrease phosphate, increase ALP

24
Q

pagets DB

A

normal Ca and normal phosphate, decrease ALP

25
Q

first line treatment for OP

A

Bisphosphonate eg Alendronate or risedronate
vit D and Ca if need
?HRT

26
Q

how would you manage pt with less than -2.5 DEXA

A

mod lifestyle and FUP DEXA within 2 years

27
Q

management person intermediate risk OP

A

DEXA if >-2.5 treat

28
Q

2nd line drug treatments for OP

A

Zolendronic acid, Raloxifene, Terpiramate, Denosumab

29
Q

treatment OP if renal impairment

A

Denosumab (monoclonal AB to RANK-L). 6 monthly subcut.

30
Q

adverse effects of bisphosphonate

A

upper GI ss, osteonecrosis jaw, atypical fractures, dental

31
Q

what is raloxifene

A

Selective oestrogen R modulator for OP. used: secondary prevention, early meno, vertebral. Caution VT and TE disease

32
Q

when to use teriparatide for OP

A

Tx failure, severe OP (-4 BD or -3.5 and 2 fractures). caution if hypercaxlcaemia

33
Q

what is likely diagnosis Painless temporary loss of vision – curtain descending over vision
management

A

amourosis fugax
ix bloods (ESR, FBC, clotting, lipids), fundoscopy, carotid a doppler
aspirin 300mg PO and possibly carotid endartectomy

34
Q

causes amourosis fugax

A

atherosclerotic carotid a

embolic occlusion, GCA, SLE, mal HTN, hypercoagulability, post vitreous detachment, other ocular causes, neuro causes

35
Q

Define TACS and PACS

A

3/3 = TACS

  • Higher Dysfunction eg Dysphasia, decreased consciousness, Visuspatial Neglect, Asterognosis or Apraxia
  • Homonimous Hemianopia
  • Motor/Sensory Deficit or face/arm/leg (2/3)

PACS 2/3 these or higher dysfunction alone

36
Q

classify stroke of a pt with U/L hemiparesis and or hemisensory loss (ie pure sensory or pure motor or both) OR ataxic hemiparesis (ipsilateral pyramidal hemiparesis and cerebellar ataxia)

A

LACS

37
Q

POCS =

A
  • Cranial Nerve Palsy AND Contralateral Motor/Sensory deficit
  • Bilateral Motor OR Sensory Deficit
  • Conjugate Eye Movement problems
  • Cerebellar Dysfunction
  • Isolated Homonymous Hemianopia
38
Q

Mx TIA

A

ASPIRIN 300mg PO asap
if taking anticoags or bleeding disorder -> urgent CT
refer to specialist clinic <24hrs: carotid a doppler. may then do endarterectomy. or antithrombin therapy = clopidogrel and aspirin or aspirin and dipyridamone if not tolerating clopidogrel

39
Q

indications for <1hr urgent CT post stroke

A
  • ?acute stroke thrombolysis
  • on anticoags
  • any known bleeding disprder
  • decreasing GCS
  • severe headache at onsett
  • papilloedema/stiff neck
  • unexplained fluctuation SS
40
Q

what % deaths are stroke in UK

A

11%
20-30% mortality
130000 affected per year

41
Q

where does the blood go in SAH

A

Subarachnoid haemorrhage: Bleeding that occurs outside of the brain tissue, between the pia mater and arachnoid mater.

42
Q

Examination post stroke

A
  • General inspection
  • GCS (15 fully conscious. 8 worried about airway)
  • ABCDE
    Stable:
  • Neuro (where lesion ie UMN/LMN). Remember gait and pronator drift.
  • What’s involved ie speech, sensory, cerebellar, cranial nerves

NIH Stroke Scale (NIHSS)

  • Screening tool to assess stroke; location; severity; who to thrombolyse
  • Can also get patient to describe what’s happening in picture (higher cortical function)
  • Walk, observe gait

Rest examination:

  • CV
  • Clues as to cause: murmurs, BP, HR, HF, SBE, dissection
  • Resp: ?aspiration
  • Complications: pneumonia, PE

Imaging:

  • CT exclude bleed. If not a bleed, changes may take 12-24 hours to see (clot and tissue death). Bigger see effects faster than smaller one as more likely acute inflam changes.
  • MRI later

ECG: AF/MI?

Bloods: FBC, UE, coag, BM, ESR, LFTs, cholesterol.

Can appear to have new stroke but actually just old SS coming back.
ESR: Giant cell arteritis. Send to ophthalmology.
TFTs: hyperthyroidism and AF closely linked

43
Q

Examination post stroke

A
  • General inspection
  • GCS (15 fully conscious. 8 ?airway)
  • ABCDE
    Stable:
  • Neuro (where lesion ie UMN/LMN). Remember gait and pronator drift.
  • What’s involved ie speech, sensory, cerebellar, cranial nerves

NIH Stroke Scale (NIHSS) - Walk, observe gait

Rest examination:

  • CV
  • Clues as to cause: murmurs, BP, HR, HF, SBE, dissection
  • Resp: ?aspiration
  • Complications: pneumonia, PE

Imaging:

  • CT exclude bleed. If not a bleed, changes may take 12-24 hours to see (clot and tissue death). Bigger see effects faster than smaller one as more likely acute inflam changes.
  • MRI later

ECG: AF/MI?

Bloods: FBC, UE, coag, BM, ESR, LFTs, cholesterol.

Can appear to have new stroke but actually just old SS coming back.
ESR: Giant cell arteritis. Send to ophthalmology.
TFTs: hyperthyroidism and AF closely linked

44
Q

Acute stroke Mx

A
  • FAST admit to specialist stroke unit
  • ABCDE (o2 if hypoxic, BM 4-11)
  • Hx and exam (NIHSS-stroke severity score)– - BAMFORD classification
  • CT
  • Within 4.5hrs-thrombolysis? alteplase 0.9mg/kg
  • ECG (AF/LVH/ischaemic changes)
  • Bloods (FBC, UE, LFTS, ESR, Glc, Lipids, CRP, TFT, G/S, clotting, vasculitis and thrombophilia screen)
  • Direct admission to stroke unit
  • Hydration and nutrition (swallow assessment)
  • ?fundoscopy if SAH
  • ?CXR if ?aspiration
  • MRI with DWI if uncertain after CT
  • Antiplatelets (if NOT a bleed): clopidogrel (or aspirin and dipyridamole). Aspirin 300mg PO once CT excluded bleed.
  • Statins
  • Antihypertensives
  • Assess/investigate risks (Echo, CDs)
  • VTE prophylaxis
  • Positioning
  • Early MDT assessment
  • Refer to vascular surgery if carotid doppler shows stenosis >50%
  • malignant MCA syn -> decompressive hemicraniotomy
  • if on warfarin and IC bleed: give vit K and prothrombin complex concentrate (optaplex). if heparin give protamine sulphate.
  • LP 12 hrs after haemorrhagic if CT clear
    malignant MCA syn -> decompressive hemicraniotomy
  • surgical evaluation or CSF shunt if primary IC haemorrhage has caused hydrocephalus
  • ASD -> paradoxical embolism and stroke, consider for shunt closure
45
Q

what to include in management of IC haemorrhage if on anticoags

A

if on warfarin and IC bleed: give vit K and prothrombin complex concentrate (optaplex). if heparin give protamine sulphate.

46
Q

indication for carotid endarterectomy

A

Refer to vascular surgery if carotid doppler shows stenosis >50%

47
Q

surgical management of acute stroke

A
  • malignant MCA syn -> decompressive hemicraniotomy
  • surgical evaluation or CSF shunt if primary IC haemorrhage has caused hydrocephalus
  • ASD -> paradoxical embolism and stroke, consider for shunt closure
48
Q

when to do LP in stroke mx

A

LP 12 hrs post haemorrhage stroke if CT negative. xanthochromia confirms SAH

49
Q

secondary prevention of ischaemic stroke

A
  • Antiplatelets: aspirin 300mg PO 2/52 then clopidogrel 75mg PO life (dipyridamole 200mg PO BD if can’t tolerate)
  • statin: atorvastatin 80mg PO after 2/52
  • antiHTN: after 2/52 if >185/110, ss HTN or other RF
  • anticoagulant if indicated eg DOAC/warfarin for AF, do chadvcasc.
  • lifestyle
  • metformin if need to keep BM 5-15
  • mx comorbidities
  • Can resume driving 4/52. don’t need to inform DVLA if satisfactory clinical improvement.

HCOLL (1 decks)

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