January Formative Flashcards
1
Q
Initial loss of consciousness following a blunt force head injury, followed by a lucid period, before further deterioration
A
Extradural haematoma
2
Q
Older patient, low-impact trauma to the head. Causes progressive headache and confusion
A
Subdural haematoma
3
Q
- Ruptured berry aneurysm (or severe trauma)
- Sudden onset symptoms: thunderclap headache (time taken from beginning of headache to its maximum pain is seconds), meningism, loss of consciousness
A
Subarachnoid haemorrhage
4
Q
Subdural haemorrhage CT findings
A
Hypodense crescent-shaped appearance
5
Q
Subarachnoid haemorrhage CT findings
A
Hyperdense signal in the subarachnoid
space
6
Q
Extradural haemorrhage CT findings
A
Hyperdense biconvex lens appearance
7
Q
Multiple sclerosis CSF finding ?
A
IgG oligoclonal bands
8
Q
Tau proteins and amyloid proteins in CSF - diagnosis ?
A
Alzheimer’s
9
Q
Xanthochromia in CSF - diagnosis ?
A
Subarachnoid haemorrhage
(Yellow/pink discolouration due to haemoglobin catabolism)
10
Q
Which amino acid is overly expressed in Huntington’s disease?
A
Glutamate
11
Q
Early clinical signs = clumsiness, agitation, and abnormal eye movements.
Later clinical signs = choreiform (irregular, involuntary) movements, bradykinesia, rigidity, speech and swallowing impairment, and weight loss.
Diagnosis ?
A
Huntington’s
12
Q
Muscle fasciculations and weakness = LMN or UMN ?
A
LMN
13
Q
Increased tone and brisk reflexes = LMN or UMN ?
A
UMN
14
Q
Primary lateral sclerosis = UMN or LMN or both ?
A
UMN only
15
Q
Amyotrophic lateral sclerosis (ALS) = UMN or LMN or both ?
A
Both UMN and LMN
16
Q
Progressive muscular atrophy = UMN or LMN or both ?
A
LMN only
17
Q
Patient presents with muscle fasciculations, weakness, increased tone, and brisk reflexes
Diagnosis ?
A
ALS (both UMN and LMN signs)
+ frontotemporal dementia + thenar atrophy
18
Q
Reduced jaw and gag reflexes + tongue fasciculations = ?
A
Progressive bulbar palsy
19
Q
Slow speech + brisk jaw reflex = ?
A
Pseudobulbar palsy
20
Q
Which medications can cause drug-induced parkinsonism ?
(occurs weeks after starting the drug)
A
Chlorpromazine
Haloperidol
Lithium
Valproic acid
Metoclopramide
21
Q
Cogwheel rigidity + shuffling gait ?
A
Parkinsonism
22
Q
Involuntary spasms that begin early after exposure to antipsychotics (hours to days) are called ________ ?
A
Acute dystonic reactions
23
Q
Medical term for restlessness = ?
A
Akathisia
24
Q
Repetitive involuntary purposeless movements, usually orofacial
Onset many years after starting typical antipsychotics and the person often is not aware of it.
A
Tardive dyskinesia
(irreversible however it does not harm the person)
25
Which tract activates the extensor mechanism to prevent falls?
Vestibulospinal tract
(from vestibular nuclei of the pons and medulla)
26
Tract responsible for reflex to visual and auditory stimulus
Tectospinal tract
- originates in the superior colliculus of the
midbrain and extends down to the cervical spine
27
Tract responsible for control of breathing and cardiac control
Reticulospinal tract
- originates in the reticular formation in the brainstem
28
Origin of the vestibulospinal tract ?
Vestibular nuclei in the pons and medulla
29
Path of the tectospinal tract ?
Origin = superior colliculus of the midbrain
then extends down to the cervical spine
30
Origin of the reticulospinal tract ?
The reticular formation in the brain stem
31
Median nerve supplies:
LOAF
Lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
32
Seizures, severe headaches, blurred vision (due to raised ICP)
Can affect adults + children, most commonly in the frontal lobe
1. What is the diagnosis?
2. What can be seen on biopsy?
1. Oligodendrocytoma
2. 'Fried egg' appearance
33
- Suspected brain tumour
- Bilateral hemianopia and panhypopituitarism (pale, no axillary hair)
Pituitary carcinoma
34
- unilateral conductive hearing loss
- associated with the condition neurofibromatosis
Vestibular schwannoma
35
Transient ischaemic attack (TIA) - which drug is prescribed to minimise the risk of secondary insult ?
Aspirin 300mg
36
Which cranial nerve passes through the cribriform plate ?
Olfactory nerve
37
Which foramen does the vagus nerve pass through ?
Jugular foramen
38
CN VIII - motor/sensory/both ?
Vestibulocochlear nerve = sensory
Some say marry money but my brother says big brains matter more
39
Which foramen does the vestibulocochlear nerve pass through ?
Internal acoustic meatus
40
Which nerve is affected in uncal herniation?
Oculomotor
41
43-year-old has a fixed, dilated left pupil. He admits to hitting his head yesterday during his rugby game. Magnetic resonance imaging reveals a
unilateral descending tentorial herniation.
Uncal hernation
42
What is an uncal herniation?
Temporal lobe herniates posteriorly
Impinges on 3rd nerve
43
What is a subfalcine herniation?
One half of the cerebrum herniates across the midline
- Causes compression of the anterior cerebral artery - - leading to motor and/or sensory weakness.
44
What is a cerebellar tonsillar herniation?
The cerebellum moves inferiorly
This compresses the medulla
- can lead to respiratory distress and death
45
What is a transcalverial herniation
A defect within the skull
Part of the brain herniates out through that opening
46
What is a central herniation?
Central part of the brain is inferiorly compressed towards the brainstem
47
The proportion of individuals carrying a particular allele of a gene (genotype) that also express the phenotype =
Penetrance
48
The genetic phenomenon which causes each generation to develop the disease at an earlier age =
Anticipation
49
In what conditions does anticipation occur ?
Common in trinucleotide repeat disorders
e.g. Huntington's, myotonic dystrophy
50
Define 'transformation' in genetics
The transfer and incorporation of foreign DNA into a host genome
51
Treatment of Guillain-Barre syndrome?
Plasma exchange (removes autoantibodies)
IV Immunoglobulin
52
Treatment for Lambert-Eaton myasthenic syndrome = ?
3,4-diaminopyridine
53
Bilateral proximal muscle weakness of insidious onset
- associated with small-cell lung cancer
- causes reduced or absent reflexes
Diagnosis ?
Lambert-Eaton myasthenic syndrome
54
Anti-voltage-gated calcium channel antibodies = what condition ?
Lambert-Eaton myasthenic syndrome
*also do a CT to rule out malignancy
55
Treatment for myasthenia gravis = ?
Pyridostigmine + steroids
56
Treatment for chronic inflammatory demyelinating polyradiculoneuropathy = ?
Oral steroids
57
Chloroquine - how does it affect myasthenia gravis ?
Precipitates or worsens myasthenia gravis
58
Treatment for absence seizure ?
Ethosuximide or sodium valproate
*remember sodium valproate shouldn't be prescribed to women of childbearing age
59
Several sudden lapses of consciousness, stares blankly and rubs fingers together for ten seconds before returning to consciousness.
Diagnosis ?
Absence seizures
60
Treatment for generalised tonic-clonic seizures ?
1st line = Sodium valproate or lamotrigine
2nd line = Levetiracetam or topiramate
61
Treatment for myoclonic seizures ?
1st line = Sodium valproate
2nd line = Levetiracetam
62
Treatment for focal seizures ?
Lamotrigine/carbamazepine
63
What drug class is mirtazepine ?
Tricyclic antidepressant
64
Side effects of sertaline
- Nausea and headaches
- Reduces libido
- Vivid dreams
- Transient increase in suicidal thoughts
- Increased anxiety
65
Drug used to combat side effects of SSRIs
Mirtazapine
(atypical antidepressant)
66
Which bipolar medication causes hypothyroidism?
Lithium
67
Schizotypal vs Schizoid vs Schizophrenic
68
Schizotypal =
- Odd thoughts, appearance, behaviour
- Interpersonal difficulties and social anxiety
**do not experience hallucinations or delusions
69
Schizoid =
Voluntary social isolation and indifference to others
**do not experience hallucinations or delusions
**do not exhibit odd thoughts, appearance or behaviour
70
Histrionic personality disorder =
- Unstable emotions
- Distorted self-image
- An overwhelming desire to be noticed
71
Schizoaffective disorder
Mood disorder + Psychosis
- Psychosis appears even when neither manic nor depressed
72
Which antidepressants causes dry mouth, constipation, and weight gain ?
Tricyclic antidepressants
(amitriptyline, clomipramine, dosulepin, imipramine, lofepramine, nortriptyline)
73
Treatment for Parkinson-associated delusions
Atypical antipsychotics
(Typical antipsychotics exacerbate dopamine receptor antagonism which causes motor symptoms of Parkinsons)
74
What receptors do atypical antipsychotics act on ?
Serotonin receptors
75
What receptors do typical antipsychotics act on ?
Dopamine receptors
76
1st line for medical-assisted detoxification in alcoholism?
Chlordiazepoxide
77
66 y.o., poor memory, slowing of movement and seeing children in his house when nobody is there
Diagnosis ?
Parkinson's
78
Scan for Parkinson's?
Dopamine active transfer (DAT) scan
79
What does a DAT scan involve?
Injection of a radioactive tracer (ioflupane) which binds to dopamine transporters.
80
Scan for dementia ?
SPECT (Single Photon Emission Computed Tomography) scan
81
Example of a persecutory delusion ?
Secret agents following you
82
Examples of a delusion of reference ?
Hidden signs in newspapers, on billboards, car registration plates etc.
83
PTSD 1st and 2nd line treatments
1st line = trauma-focused CBT
2nd line = SSRIs or venlafaxine
84
High-risk anorexia nervosa features:
* BMI less than 13 with weight loss more than 1kg per week
* Prolonged QT syndrome, HR less than 40, BP systolic less than 80
* Core temperature less than 34 ºC
* Unable to rise from squat without using arms for leverage
* Cognitive impairment
85
New mother - within 2 weeks:
- sleep disturbances
- confusion
- irrational ideas
- hallucinations
- mania
- delusions
Puerperal psychosis
(feature of bipolar disorder !!)
86
Peaked T waves on ECG =
Hyperkalaemia
(Tall, tented T waves)
87
No P waves =
Heart block
87
Q waves in V1 on ECG =
Artifact of previous MI
88
At fast rates, P waves can be difficult to visualise
How do you visualise them ?
Vagal manoeuvres or adenosine
89
Supraventricular tachycardia - what rate ?
150-220bpm
90
Right border of the heart is mainly which chamber ?
Right atrium
91
Medical management of ectopic pregnancy =
IM methotrexate
92
1st line surgical management of ectopic pregnancy ?
Laparoscopic salpingectomy
93
Dyspareunia =
Pain having sex
94
1st line investigation for endometriosis = ?
Transvaginal ultrasound
95
Medical management of urge urinary incontinence = ?
Oxybutynin
96
Surgical management of stress incontinence = ?
Bulking material injection therapy
97
Medical management of urge incontinence in frail patients (concern about anticholinergic effects)
Mirabegron
98
Hypertension management in pregnancy
Labetalol - contraindicated by asthma
Nifedipine
Methyldopa
99
What pathological process does a cervical smear detect ?
Dysplasia
100
Primary vs secondary amenorrhoea
Primary = never had period before
Secondary = had periods before
101
Hyperemesis, bleeding and snowstorm appearance on USS
Diagnosis ?
Complete molar pregnancy (a.k.a. trophoblastic)
102
Management of complete molar pregnancy ?
Surgical removal
+ tissue sent to histology
103
Why is conservative management of molar pregnancy not an option?
Risk of choriocarcinoma
104
Abortion induction medication ?
Oral mifepristone
then, sublingual misoprostol
105
At what BMI is COCP contraindicated ?
> 39
106
- lower abdominal pain
- nausea
- intermittent post-coital bleeding for the past
2-3 weeks
- yellow discharge
- high temperature
Pelvic inflammatory disease
107
Most common cause of pelvic inflammatory disease =
Chlamydia/gonorrhoea
108
First line investigation for pelvic inflammatory disease ?
Vulvo-vaginal swabs for chlamydia/gonorrhoea
109
Treatment for post-partum haemorrhage ?
IV synctocinon
110
Histology of ovarian mass shows:
- transitional epithelium (native to the
bladder, not the ovaries)
- coffee bean nuclei
Brenner epithelial ovarian tumour
- often found incidentally during surgery or on pelvic
examination
111
Adnexa =
Ovary + fallopian tube
+ associated vessels and ligaments
112
Hobnail cells on ovarian histology =
Clear cell ovarian tumour
113
Endometriosis + chocolate cysts on ovarian histology
Endometroid epithelial ovarian tumour
114
Does oestrogen promote or inhibit contractility in labour?
Oestrogen promotes contractility
115
Which hormone inhibits contractility in the late stages of pregnancy?
Progesterone
116
Primary sclerosing cholangitis = men or women ?
Predominantly men
117
Primary biliary cholangitis = men or women ?
Women
118
Primary biliary cholangitis signs & symptoms =
- widespread itch with no rash
- xanthelasma
- antimitochondrial antibodies
119
Antimitochondrial antibodies positive =
Primary biliary cholangitis
120
Barrel chest + hyperresonance on auscultation =
Emphysema
121
Fine crepitations, pink frothy sputum and
orthopnoea (dyspnoea when lying flat)
Pulmonary oedema
122
Left ventricular failure (caused by pulmonary oedema, evidenced by cardiomegaly)
1st line treatment ?
Furosemide
123
Which hallmark of cancer is present in the genetic condition Xeroderma Pigmentosum?
Disordered repair mechanism
124
Xeroderma pigmentosum = deficiency in what enzyme ?
Endonuclease
- UV light causes photoproducts to form which bind together and create lesions in DNA strands
- Endonuclease fixes the hole left in the DNA strand
125
Acute decline after sore throat: earache + fever + difficulty opening mouth
Peritonsillar abscess - requires surgery
126
Polycystic kidney disease - what imaging modality ?
Ultrasound
127
High creatinine levels indicate ...
Blocked urinary tract / kidney problems / dehydration
128
Hypovolaemia causing pre-renal AKI
Treatment = ?
Fluid challenge with crystalloid
129
Tetralogy of Fallot =
PVOH
1. Pulmonary stenosis,
2. Ventricular septal defect
3. Overriding aorta
4. Hypertrophic right ventricle
130
CAGE questionnaire =
Alcohol dependence
131
Scale used to diagnose postnatal depression
Edinburgh Postnatal Depression Scale
132
Subdural vs extradural CT findings?
Subdural = Banana
Extradural = Lemon
