Last minute useful Flashcards
A 45-year-old man presents with dizziness and right-sided hearing loss. Which one of the following tests would most likely indicate an acoustic neuroma?
Jerky nystagmus
Left homonymous hemianopia
Tongue deviated to the left
Fasciculation of the tongue
Absent corneal reflex
Loss of corneal reflex - think acoustic neuroma
You review a 24-year-old woman in the high dependency unit. She is moaning but unable to form words, and appears to open her eyes when you speak to her. She is unable to follow commands but withdraws from a painful stimulus. What is her GCS?
5
7
9
10
12
9
GCS: Motor (6 points) Verbal (5 points) Eye opening (4 points).
Can remember as ‘654…MoVE’
- Best eye response: 3 (opens to voice)
- Best verbal response: 2 (incomprehensible sounds)
- Best motor response: 4 (withdraws from pain)
screening test for CF
Immunoreactive tryspin (IRT)
Trypsinogen normally produced in pancreas and carried to small intestine where it changes from inactive ‘proenzyme’ to active ‘enzyme’ trypsin.
Blocked pancreatic ducts in CF impede passage of trypsinogen into gut and result in build up in the blood. Can be detected and measured as IRT levels increase.
Best screening test for CF, but several other causes for raised IRT.
recurrent UTI investigations
Should be investigated for underlying cause and renal damage
Investigation cause:
1) US scans
- All children under 6 months with their first UTI should have an abdominal ultrasound within 6 weeks, or during the illness if there are recurrent UTIs or atypical bacteria
- Children with recurrent UTIs should have an abdominal ultrasound within 6 weeks
- Children with atypical UTIs should have an abdominal ultrasound during the illness
2) Micturating cystourethrogram (MCUG)
- Used to investigate atypical or recurrent UTIs in children <6 months or when family history of VER or poor urinary flow on US
- Involves: catheterising child, injecting contrast into bladder and taking X-rays to determine whether contrast is refluxing into ureters
o Children given prophylactic antibiotics for 3 days before
3) Investigating renal damage: DMSA (Dimercaptosuccinic acid) scan
- Used 4-6 months after illness
- Involves injecting radioactive material (DMSA) and using a gamma camera to assess how well material is taken up by the kidneys
- If patches of kidney doesn’t take up material -> indicates scarring due to previous infection
Type of Cerebral Palsy
Spastic: hypertonia (increased tone) and reduced function resulting from damage to upper motor neurones
Dyskinetic: problems controlling muscle tone, with hypertonia and hypotonia, causing athetoid movements and oro-motor problems. This is the result of damage to the basal ganglia.
Ataxic: problems with coordinated movement resulting from damage to the cerebellum
Mixed: a mix of spastic, dyskinetic and/or ataxic features
null value for risk ratio
0
null value for odds ratio
1
Answer: b
An odds ratio of less than the null value of 1.0 indicates that being a gym member might be a protective factor against depression (but note that the confidence interval spans the null value of 1).
interpret
Example interpretation
6 out of the 7 RCTs had an OR > 1.00 indicating greater odds for survival amongst patients taking aspirin after MI
Only 1 RCT (the largest) had a statistically significant result, but its OR was less than the other RCTs with an OR > 1.00
Pooled estimate OR = 1.11 (95% CI: 1.04 to 1.19) leads to the conclusion that aspirin increases the chance of surviving after a MI (p<0.05)
cervical screening
25 -50 every 3 years
>50 every 5 years
breast cancer screening
50-70 every 3 years
bowel cancer screening
60-74 every 2 years
Trotters syndrome
nasopharyngeal malignancy
1) Unilateral conductive hearing loss
2) Trigeminal neuralgia
3) Defective mobility of the soft palate
tests for myeloma
BLIP
- bence jones in the urine
- serum Light chain
- serum Immunoglobulin
- serum protein electrophoresis
symptoms of myeloma
Calcaemia
Renal failure
Anaemia
Bone invasion (raindrop skull)
management of essential thrombocythaemia
Low risk of developing blood clots
- Low dose aspirin
High risk of developing blood clots
- Low dose aspirin
- Oral chemo such as hydroxycarbamide
- Anagrelide
- Interferon alpha
presentation of polycythaemia vera
Presentation of PV
Thrombosis e.g. stroke/ MI
Viscosity symptoms
o Headache
o Drowsiness
o Transient visual disturbances
Pruritis- esp after warm bath
Skin- plethoric complexion
Pain in stomach due to enlarged spleen
High BP
Gout
management of polycythaemia vera
Low risk for blood clots
- Venesection (remove around a pint)
Once a week to begin with
- Low dose aspirin
Thin blood
High risk of clots
- Venesection
- Low dose aspirin
- Chemotherapy
–> Small increase in risk of developing leukaemia
–> E.g. hydroxycarbamide
- Targeted treatment if chemo does work
–>Peginterferon alfa 2a
–> Busulfan
- Allopurinol
- Radiotherapy
ASD poor prognostic marker
cognitive : IQ<50
behavioural: no speech by 5
role of the health visitor
offer support and ecourgaement to famility through the early years from birth
monitor progress, advise, useful resources and refer to GP
managing refeeding
B vitamins
slow reintroduction of food
AF tests
echocardiogram
24hr tape
pulse oximtry overnight
TFT
most important drug for AF
anticoagulation
apixiban MOA
anticoagulant inhibits factor Xa (like rivaroxaban)
