HCOLL Flashcards

Question

first line treatment for OP

Answer 1

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

Answer 2

mod lifestyle and FUP DEXA within 2 years

Answer 3

DEXA if >-2.5 treat

Answer 4

Zolendronic acid, Raloxifene, Terpiramate, Denosumab

Answer 5

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

Answer 6

upper GI ss, osteonecrosis jaw, atypical fractures, dental

Answer 7

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

Answer 8

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

Answer 9

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

Answer 10

atherosclerotic carotid a | embolic occlusion, GCA, SLE, mal HTN, hypercoagulability, post vitreous detachment, other ocular causes, neuro causes

Answer 11

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

Answer 12

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

Answer 13

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

Answer 14

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

Answer 15

11% 20-30% mortality 130000 affected per year

Answer 16

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

Answer 17

- 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

Answer 18

- 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

Answer 19

- 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

Answer 20

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

Answer 21

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

Answer 22

- 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

Answer 23

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

Answer 24

- 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.