Longterm conditions Flashcards
1
Q
What are the types of lung cancers?
A
Non-small cell lung cancer, small cell cancer, mesothelioma, carcinoid tumour
2
Q
What are the types of non-small cell lung cancers?
A
Adenocarcinoma, squamous cell carcinoma, large cell carcinoma, large cell neuroendocrine carcinoma
3
Q
Which is the most common type of lung cancer?
A
Non-small cell cancer
4
Q
What is the most common type of non-small cell lung cancer?
A
Adenocarcinoma
5
Q
WHat is an adenocarcinoma?
A
A cancer that arises from glandular tissue
6
Q
What is an adenocarcinoma in situ?
A
An adenocarcinoma arising from alveolar cells
7
Q
What is squamous cell carcinoma?
A
Cancer arising from the squamous cells
8
Q
What is a large cell cancer?
A
Cancer that is too poorly differentiated to tell what parent tissue it originated from
9
Q
What is a neuroendocrine tumour?
A
Tumour that releases hormones
10
Q
What are the signs and symptoms of a non-small cell lung cancer?
A
Cough, chest pain, SOB, haemoptysis, recurrent chest infections, lethargy, fever, malaise, weightloss, appetitie loss, wheezing, hoarseness, bone pain, spinal impingement, signs of a space occupying lesion
11
Q
What are the radiological signs of a non-small cell lung cancer?
A
Hilar enlargement, pulmonary nodule, mass or infiltrate, mediastinal widening, pleural effusion, atelectasis
12
Q
What is atelectasis?
A
Partial or complete of lung or lung lobe, occurs when alveoli deflate
13
Q
What are the the diagnostic tests for a non-small cell lung cancers?
A
CXR, bronchoscopy, sputum cytology, mediastinoscopy, thoracentesis, thorascopy, thransthoracic needle biopsy
14
Q
WHat are the treatments available for a non-small cell lung cancer?
A
Surgery (lobectomy, pneumonectomy, Wedge resection), chemo, radio
15
Q
What is small-cell lung cancer?
A
An aggressive subset of cancer that is fatal within weeks if not treated, of a neuroendocrine origin and associated with distinct paraneoplastic syndromes
16
Q
What is the pathophysiology of small cell lung carcinoma?
A
Arises in peribronchial locations and infiltrates into bronchial submucosa.
Widespread metastasis occurs via lympnodes to spread into liver, mediastinum, bones, adrenal glands and the brain
17
Q
what are the indications of poor prognosis in small-cell lung cancer?
A
Relapse, weightloss of greater than 10%, hyponatremia, poor performance status
18
Q
What are paraneoplastic syndromes?
A
Rare disorders that occur due to the triggering of the immune system in response to a neoplasm
A collection of symptoms arising due to the secretions of a neoplasm
19
Q
Name 10 symptoms that can occur due to paraneoplastic syndromes
A
Cachexia, fever, dysgeusia, polymyositis, dermatomyositis, secondary kidney amyloidosis, chronic anaemia, rhrombocytopenia, maranteric endocarditis, itching, hypercalcermia
20
Q
what is hepatocellular carcinoma?
A
Primary malignancy of the liver occurring in patients with pre-existing chronic liver cirrhosis and disease
21
Q
How do hepatocellular carcinomas usually present?
A
Either in routine screeining or when they become sympptommatic
22
Q
What are the presentations of hepatocellular carcinoma?
A
Jaundice, weightloss, anaemia, thrombcytopenia, hyponatremia, bleeding disorderscachexia, abdominal pain, abdominal mass/swelling
23
Q
What lab tests and results can be seen iin hepatocellular carcinoma?
A
Anaemia, low PT, thrombocytopenia, raised serum creatinine, hyponatremia, Raised LFTs, hypoglycemia, raised bilirubin
24
Q
What imaging studies are done on patients with hepatocellular carcinoma?
A
US, CT, MRI
25
Who is the typical patient of laryngeal cancer?
50-70, male
26
What are the risk factors for laryngeal cancer? Name 10
Smoking, obesity, reflux, alcohol, male, HPV, increasing age, exposure to paint, asbestos, radiation, diesel and gasoline fumes, metal or plastic workers, diets low in leafy greens and high in salt preserved meats and dietary fats
27
Which type of laryngeal tumour is usually discovered first?
Glottic tumours because they alter voice and are therefore symptomatic early
28
Which laryngeal tumours are usually discovered late?
Supraglottic tumours because the first symptom is usually obstruction, which only occurs if the tumour has grown to a large size
29
What type of cancer is laryngeal carcinoma usually?
Squamous cell carcinoma
30
What are the signs and symptoms of laryngeal carcinoma
Dysphonia, aphonia, dysphagia, dysnea, neck mass, otalgia, Blood tinged sputum, aspiration, cachexia, fatigue, weakness, pain, halitosis, expectoration of tissue
31
WHat is otalgia?
Ear pain
32
What can be seen in the history of a patient with laryngeal carcinoma?
weightloss, fatigue, hoarseness, dysphagia, dysnea, ear pain, pain, coughing up blood or solid matter
33
Which scan is used to diagnose laryngeal carcinoma?
CT scan
34
What is the therapy for early stage laryngeal cancer?
Radiation or surgical techniques that preserve anatomical function
Transoral laser microsurgery
35
What is the therapy for late stage laryngeal cancer?
laryngectomy, reconstruction and post-op chemo
| open partial laryngectomy
36
What are the signs and symptoms of oesophageal cancer?
Dysphagia, bleeding, weightloss, fatigue, bone pain, hoarseness, persistent cough, hepatomegaly, lymphadenopathy
37
What is the pathophysiology of oesophageal adenocarcinoma?
Reflux > Barret's oesophagus > Adenocarcinoma
38
What are the investigations used for oesophageal cancer and why?
Oesophagogastroduodenoscopy (visualization and biopsy), endoscopic US and PET scan (staging), bronchoscopy and CT (for metastasis)
39
What is the treatment for early (stage I) oesophageal cancer?
Endoscpic therapy
40
What is the treatment for intermediate (stage II-III) oesophageal cancer?
Chemo and surgery
41
What is the treatment for end stage (stage IV) oesophageal cancer
Chemo or supportive and symptomatic care
42
What arethe options for surgery in oesophageal cancer?
```
Transhiatal esophagectomy (THE)
Transthoracic esophagectomy (TTE)
Minimally invasive esophagectomy
Endoscopic mucosal resection (EMR)
```
43
What type of cancer is oral cancer usually?
Squamous cell carcinoma
44
WHat do oral cancers typically look like?
Speckled/verrocous (premalignant, white lesions (non-malignant) velvety red plaques (malignant)
45
What can oral cancers manifest as?
| name 8
A red lesion (erythroplakia)
A granular ulcer with fissuring or raised exophytic margins
A white or mixed white and red lesion
A lump sometimes with abnormal supplying blood vessels
An indurated lump/ulcer (ie, a firm infiltration beneath the mucosa)
A nonhealing extraction socket
A lesion fixed to deeper tissues or to overlying skin or mucosa
Cervical lymph node enlargement, especially if hardness is present in a lymph node or fixation
46
What are the causes of oral cancer?
Smoking, alcohol, oral health, socioeconomic status, diet low in fresh fruit and veg, infective agents
47
What are the tests in oral cancer usually for?
to rule out metastasis
48
WHat are the advantages and disadvantages of using radiotherapy fororal cancers?
ADvantages: no need for anaesthesia, salvage surgery available, function maintained
Disadvantages:Side effects, not commonly curative, subsequent surgery is more difficult
49
What are the side effects of mouth cancer therapy?
Mucositis, oral ulceration, infections, bleeding, pain, taste loss, trismus, caries, xerostomia
50
What is the most common bone cancer?
Osteosarcoma
51
What is the major cause of death due to osteosarcoma?
pulmonary metastatic disease
52
What tests are used for diagnosis in patients with metastatic bone disease?
Serum alkaline phosphatase (marker of bone destruction)
| Serum protein electrophoresis, urinalysis, urine protein electrophoresis
53
What imaging studies are used for evaluating metastatic bone disease and why?
Radiography (assessment of extent of tumour and degree of cortical erosion), CT (bone destruction), MRI (anatomic assessment of lesion), Bone scan (activity of lesion), angiography (devascularization of vascular metastasisi)
54
What treatments are used for metastatic bone disease?
Radiotherapy, surgery, surgical fixation of ling bones, monoclonal antibody antineoplastic agents, calcium metabolism modifiers
55
What are the most common sites of metastatic bone disease?
Spine, pelvis, ribs, limb girdles
56
WHat are the signs and symptoms of bladder cancer?
Painless gross haematuria, irritative bladder symptoms (dysuria, urgency, frequency), palpable mass, pelvic or bony pain
57
What are the diagnostic tests available for bladder cancer?
Urinalysis, urine culture to rule out infection, voided urine cystology, urinary tumour marker testing
58
what is the treatment of non muscle invasive bladder cancer?
transurethral resection of bladder tumour, followed by intravesical BCG vaccine, postop chemodose, repeat resection if necessary
59
How is muscle invasive bladder cancer treated?
radical cystoprostatectomy, ant. pelvic exenteration (in women), bbilateral pelvic lymphadenectomy, creation of urinary diversion, chemo
60
What is the most common type of bladder cancer?
Transitional cell carcinoma
61
WHat are the signs and symptoms of colon cancer?
Iron deficiency anarmia, rectal bleeding, abdo pain, change in bowel habit, intestinal obstruction or perforation, fatigue, malaise, weight loss, palpable abdo mass, hepatomegaly, ascities
62
What lab tests and procedures can be done to diagnose colon cancer?
FBC, LFTs, serum carcinoembryonic anitgen
| Colonoscopy, Sigmoidoscopy, Biopsy of suspicious lesions, Double-contrast barium enema
63
What radiological studies can be used for colorectal cancer?
Chest radiography
Chest computed tomography
Abdominal barium study
Abdominal/pelvic CT
Contrast ultrasonography of the abdomen and liver
Abdominal/pelvic MRI
Positron emission tomography, including fusion PET-CT scan
64
What is the management of colon cancer?
Colectomy primarily
| Cryotheraby, radiofrequency ablation, chemo,
65
What is the most common type of colon and rectal cancer?
Adenocarcinoma
66
What are the signs and symptoms of bowel cancer?
Change in bowel habit, occult bleeding, abdo pain, back pain, urinary symptoms, malaise, pelvic pain, emergencies like peritonitis
67
What are the diagnostic tests for rectal cancer?
DRE, rigid proctoscopy
68
What blood tests are diagnositic for rectal cancer?
Bloods, serum chemistries, liver and renal function test, carcinoembryonic antigen, cancer antigen assay
69
What screening tests are diagnositic for rectal cancer?
Guaiac-based FOBT, stool DNA screening, fecal immunochemical test, rigid protoscopy, flexible sigmoidoscopy, combined glucose based \FOBT and flexible sigmoidoscopy, double-contrast barium enema, CT colonography, fiberoptic flexible colonoscopy
70
What is the treatment of rectal cancer?
Surgery (transanal excision, transanal endoscopic microsurgery, endocavity radiotherapy, sphincter-sparing procedures), radiation, chemo, radioembolization, vaccines, antineoplastic agents
71
What are the three pathways for rectal cancer pathophysiology?
APC gene
Hereditary nonpolyposis colorectal cancer pathway
UC dysplasia
72
What is the definition of chronic bronchitis?
Presence of a chronic productive cough for 3 months during each of 2 consecutive years
73
What is the definition of emphysema?
abnormal. permanent enlargement of air spaces distal to the terminal bronchioles, accompaned by wall destruction without obvious fibrosis
74
What are the symptoms of COPD?
Productive cough, breathlessness, wheeze, chest illness
75
What are the signs of COPD?
Tachypnea, bronchial breathing, cyanosis, raised JVP, peripheral oedema, use of accessory muscles to breathe, hyperinflated chest, hyperresonant chest, wheezing, reduced breath sounds, prolonged expiration, coarse inspiratory crackles
76
How many stages of COPD are there?
4
77
What are the risk factors of COPD?
Smoking, asbesotos, coal mining, alpha-1-antitrypsin deficiency, IV drug use, immunodeficiency, vasculitis, connective tissue disorder
78
What are the common CXR findings in COPD?
Hyper inflation of chest, flattening of diaphragm, increased retrosternal air space, long, narrow heart shadow, rapidly tapering vascular shadow, hyperlucency of lungs, cardiomegaly, hyperlucency of lungs
79
What examinations should be used to investigate COPD?
Spirometry, ABG, CXR, CT chestsodium retention (serum sodium), alpha1antitrypsin (patients belo 40), sputum, BNP (differentiate from CHF)
80
What ABGs indicate respiratory acidosis?
pH<7.35
| CO2>45
81
What can cause respiratory acidosis?
Acute- failure of ventilation (resp depression, airway obstruction, neuromuscular disease, myasthenia, lateral sclerosis, guillan-barre)
Chronic (COPD due to reduced responsiveness to hypoxia and hypercapnia, increased VQ mismatch, dereased diaphragmatic function)
82
What ABGs indicate respiratory alkosis?
pH>7.45
| CO2<35
83
What ABGs indicate metabolic acidosis?
pH<7.35
| HCO3<22
84
What ABGs indicate metabolic alkosis?
pH>7.45
| HCO3>26
85
What values in spirometry are diagnostic for COPD?
FEV1/FVC < 70%
86
What is the normal range for blood pH?
7.35-7.45
87
What are the causes of respiratory alkalosis?
CNS causes (meningitis, pain, hyperventilation, anxiety, panic disorders, fever, tumour, trauma, encephalitis, psychosis) high altitude, right-to-left shunts, progesterone, drug toxicity, catecholamines, nicotine
88
What are the causes of metabolic acidosis?
Ketoacidosis, lactoacidosis, renal failure, toxic ingestions, impaired renal secretion, GI or renal HCO3- loss
89
What are the causes of metabolic alkalosis?
Hypokalemia, hypomagnesia, diuretics, gastric acid loss (vomitting, villous adenoma), hyperaldosteronism
90
What is pulmonary rehabilitation?
Pulmonary rehabilitation includes patient education, exercise training, psychosocial support and advice on nutrition.
Pulmonary rehabilitation has been shown to improve exercise capacity, reduce breathlessness, improve health-related quality of life, and decrease healthcare utilisation.
91
How is COPD treated?
Bronchodilation (beta agonists and anticholinergics), tiotropium (long acting beta agonist), Umeclidinium bromide(bronchial muscle relaxant, antimuscarinic), phosphodiesterase inhibitors (bronchodilation)
92
What are the medications used for smoking cessation?
Varenicline, nicotine replacement, bupropion
93
What medications are used for sputum lysis in COPD?
Mucolytic(N-acetylcysteine)
94
What are the contents of a COPD rescue pack?
Predinsalone and amoxicillin?
95
What are COPD rescue packs used for?
Exacerbation of COPD
96
Define heart failure
Failure of the heart to pump enough blood to fulfill the needs of the body
97
What should be asked about in the history of patients with suspected heart failure as co-morbidites or risk factors? (name 10)
Myopathy, alcohol, smoking diabetes, familial valve problems, valve problems, previous MI, hyperlipidaemia, hypertension, sleep-disordered breathing, rheumatic fever, PVD, chemotherapy to chest, thyroid disease
98
WHat are the symptoms of heart failure? Name 10
Dyspnea at rest, exertional dysnea, orthopnea, PND, pleural oedema, chest pain, palpitations, fatigue, nocturia, oligouria, cerebral symptoms (elderly patients w/ advanced HF)
99
What causes orthopnea?
When lying down, blood pools in the thoracid compartment. The failing LV cannot pumpthe excess blood without dilating. This increases pulmonary venous and capillary pressure, causing pulmonary oedema
100
What are the mechanisms of dysnea at rest in HF?
Decreased pulmonary function due to decreased compliance and increased airway resistance
Increased ventilatory drive secondary to hypoxemia due to ventilation/perfusion (V/Q) mismatching
Respiratory muscle dysfunction, with decreased respiratory muscle strength, decreased endurance, and ischemia
101
What causes nocturia and oligouria in HF?
Recumbency reduces the deficit in cardiac output in relation to oxygen demand, renal vasoconstriction diminishes, and urine formation increases.
102
What signs can be seen in the examination of a patient with HF?
Ascites, raised JVP, cardiomyopathy, orthopnea, cyanosis,icterus,malar flush, diminished pulse, dusky skin, tachycardia, diaphoresis, crackles in the lung bases, cardiac wheeze, frothy pink sputum, S3 gallop, pulsus alternans, cachexia
103
What are the underlying causes of HF?
Structural abnormalities that effect circulation, pericardium, or valves, leading to increased haemodynamic burden or myocardial or coronary insufficiency
104
What investigations should be done in a patient with suspected HF?
ECG, BNP, FBC, CXR, Echocardiogram, LFTs, U & Es, TSH, treadmill testing, lipid profile
105
What is the surgical treatment for HF?
Electrophysiological intervention, revascularization, ventricular assist devices,heart transplant, artificial heart, valve repair/replacement, ventricular restoration, extracirporeal membrane oxygenation
106
What is the pharmacological treatment for HF?
Diuretics, vasodilatorsm inotropic agents, anticoagulants, beta blockes, digoxin
107
What are the non pharmacological treatments for HF?
Attention to weight gain, reduced sodium, O2, noninvasive positive pressure ventilation, fluid restriction, exercise
108
What are the percipitating causes of HF?
Underlying heart disease (eg valvular stenosis), other conditions (feverm anemia, infection) or medications (chemo, NSAIDs) that alter homeostasis of patient
109
What are the fundamental causes of HF?
biochemical or physiological processes
110
What are the underlying causes of systolic HF?
Coronary artery disease, HTN, DM, arrhytmia, valvulardisease, myocarditis, congenital, idiopathic, cardimyopathy
111
What are the underlying causes of diastolic HF?
Coronary artery disease, DM, HTN, valvular disease, hypertrophic cardiomyopathy, restricive cardiomyopathy, constrictive pericarditis
112
Whhat are the underlying causes of acute HF?
Drugs, sepsis, MI, myocarditis, acute valvular regurgitation, arrythmia
113
what are the underlying causes of right sided heart failure?
LVF, cor pulmonale, coronary artery disease, pulmonary hypertension, pulmonary valve stenosis, pulmonary embolism, chronic pulmonary disease, neuromuscular disease
114
WHat are the precipitating causes of HF?
profound anaemia, myxoedema, thyrotoxicosis, paget's, cor pulmonale, obesity, pregnancy, nutritional deficiencies, glomerunephritis
115
What are the signs and symptoms of angina pectoris?
Retrosternal chwst discomfort localized to epigastrium, back, neck, jaw or shoulders, percipitated by exertion, eating, cold or emotional stress
116
What tests are used for diagnosing Angina pectoris?
ECG, coronary angiography, treadmill tests, CXR, BNP, troponin
117
How is angina pectoris treated?
Managing risk factors (smoking, obesity, hyperlipidaemia, HTN,
sublingual GTN
118
What are the surgical treatments available for angina pectoris?
Revascularization, treatment of underlying cause
119
WHat is the criteria for diabetes testing?
Diabetes symptoms plus:a random venous plasma [glucose] ≥ 11.1 mmol/l or
a fasting plasma [glucose] ≥ 7.0 mmol/l (whole blood ≥ 6.1 mmol/l) or
two hour plasma [glucose] ≥ 11.1 mmol/l two hours after 75g anhydrous glucose in an oral glucose tolerance test (OGTT).
120
What is the pathophysiology of t2diabetes?
```
increased glucose production caused by increased hepatic glucose production, increased carb intake, redusced peripheral glucose uptake and decreased insulin production
Beta cell dysfunction
Insulin resistance
Genetic factors
Amino acid metabolism
```
121
What are the complications of t2 diabetes?
CV risk due to hyperlipidaemia, cognitive decline, diabetic retinopathy, diabetic neuropathy, poor healing, depression, vasculopathy, end stage renal disease, cancer
122
What are the RF of T2 diabetes?
Overweight, obesity, race, family historym history f gestational diabetes, polycystic ovarian syndrome, hypertension, hyperlipidaemia
123
What are the symptoms of t2D?
polyuria, polydipsia, weightloss, polyphagia, blurred vision, paraesthesia, yeast infections
124
What are the signs of T2DM?
Mostly asymp, can have blurred vision, reduced touch sensation, acanthosis nigricans, eye haemorrhages
125
What are the tests done for T2D
Impaired glucose tolerance test, glycated hemoglobin studies, urinary albumin tests, BM,
126
What tests are used to differentiate T2DM and T1DM?
fasting C-peptide level, autoantibodies
127
What are the treatments available for T2D?
Biguanides, sulfonylureas, Alpha-glucosidase inhib, meglitinide derivatives, thiazolidinediones, glucagonlike peptides, dipeptidyl peptidase IV inhib, selective na-glucose transporter 1 inhib, insulins
128
Name a biguanide
Metronidazole
129
How does metronidazole work?
lowers basal plasma [glucose] by decreasing hepatic glucaneogenesis and interstinal glucose absorption
improves insulin sensitivity by increasing peripheral glucose uptake
130
Name some sulfonylureas
Glyburidem glipizide, glimepiride
131
How do sulfonylureas work?
insulin secretagogues that stimulate insulin release from pancreatic beta cells
132
What is a common side effect of sulfonylureas?
hypos
133
How do meglitinide derivatives work?
Shorter acting insulin secretagogues
134
How do alpha-glucosidase inhibitors work?
Prolong carb absorbtion, Prevent post food glucose surges
135
What is a common side effect of alpha-glucosidase inhibitors?
Farting
136
How do thiazolidinediones work?
Insulin sensitizers, require insulin to work
137
How does DPP-4 inhib work>
Prolong the action of incretin hormones
138
How do SGLT2 inhibss work?
Lowers renal glucose threshold, increasing renal glucose excretion
139
What is the pathophysiology if T1DM?
Lack of insulin caused by autoimmune attack of pancreatic beta cells
140
What are the common symptoms of T1DM?
Polyuria, polydispsia, polyphagia, lassitude, nausea, blurred vision and fatigue
141
What causes fatigue in t1DM?
Muscle weakness from catabolic state of insulin deficiency, hypovolemia and hypokalemia
142
What causes polyuria in t1DM?
Osmotic diueresis due to hypo
143
What causes blurred vision in T1DM?
Effect of hypoosmolar state on lens and vitreous humour (glucose causes swelling, altering the shape and therefore focus of the lens)
144
What are the common complications of diabetes?
Infections, visual blurring, senile cataracts, diabetic retinopathy, nephropathy, neuropathy, coronary atherosclerosis, gangrene
145
What is Atopic dermatitis?
Chronic, pruritic, inflammatory skin disease of unknown arigin, associated with IgE
146
What is atopic dermatitis associated with?
Food allerfy, asthma, allergic rhinitis
147
What are the classic features of atopic dermatitis?
Pruritis, early onset, ecxema, atopy, xerosis
148
Describe a lesion of atopic dermatitis
Erythematous, lichenified and possibly exudative plaque. crusting is common
149
What are the causes of atopic dermatitis?
Genetics, infection, hygiene, food allergy, climate, tobacco
150
Name 5 possible differentials for atopic dermatitis
Allergic contact dermatitis, scabies, immunodeficiency, plaque psoriasis, zinc deficiency, tinea corporis, seborrheic dermatitis,
151
What is the treatment of atopic dermatitis?
Moisturizers topical steroids and immunomodulators if necessary
152
What is a seizure?
Physical symptoms manifesting due to electrical overexcitement of the brain
153
WHat are the causes of seizures?
Genetic predisposition, alcohol withdrawal, hypo, head trauma, stroke, space occupying lesions
154
What is required in the diagnosis of epilepsy?
Occurence of at least 2 unrpovoked seizures
155
Describe an absence seizure
Type of generalized seizure with impaired awareness, with childhood onset and a history of 'staring spells'
156
Describe a compllex partial seizure
A seizure affecting only a part of the brain but with impaired awareness
157
Describe a tonic clonic seizure
A genralized seizure characteristic of it's tonic phase (where all the muscles clench) and clonic phase (where the body undergoes rhythmic jerks). Often precededed by a high pitched whine caused by the diaphragm pushing air through a closed glottis
158
What diagnostic tests can be done on a patient with a seizure?
Prolactin (usually raised 3-4x in generalised seizure), CT or MRI to eliminate structural abnormalities, EEG, phenytoin levels (to establish control of previously diagnosed epileptic patient)
159
What does an EEG show during an epileptic attack
Many and wild squiggly lines
Epileptiform changes
focal sslowing
diffuse background slowing
intermittent diffuse intermixed slowing
160
What is the first line treatment of focal seizures?
Carbamazepine, Iamotrigine
161
What's the first line treatment of generalized seizures?
Sodium valproate, Iamotrigine
162
What's the first line treatment of absence seizures?
Ethosuximide, sodium valproate
163
What's the first line treatment of myoclonic seizures?
sodium valproate
164
What's the first line treatment of tonic seizures?
sodium valproate
165
What's the first line treatment of atonic seizures?
sodium valproate
166
What are the causes of falls?
Medication, vasovagal syncope, cough, defaecation or micturition syncope, orthostatic hypotension, autonomic dysfunction, , epilepsy, confusion, epilepsy, environmental
167
what are the risk factors for falls?
polypharmacy, osteoporosis, epilepsy, dementia, delirium, vision or hearing impairment, parkinsons, thyroid problems, vertigo,
168
What is the definition of syncope
Transient loss of consciousness due to hypoperfusion of the brain
169
What investigations can be done on a patient presenting with syncope?
FBC, ECQ CXR, BM, BNP, CK, U & E, urine dipstick, CT head, tilt table
170
What drugs can increase falls risk?
Antihypertensives, diuretics, B blockers, sedatives, hypnotics, tricyclics, benzos,
171
What can cause orthostatic hypotension?
autonomic dysfunction, mediction
172
What test can be done to diagnose autonomic dysfunction?
lying and standing BP
173
Where is the femur most likely to be fractured?
Neck
174
What is the division between intracapsular and extracapsular?
Intertrochanteric line
175
How many grades of femoral neck fractures are there?
4
176
Describe a grade I neck of femur fracture
incomplete or valgus impacted fracture
177
Describe a grade II neck of femur fracture
Complete fracture without bone displacement
178
Describe a grade III neck of femur fracture
Complete fracture with partial bone displacement
179
Describe a grade IV neck of femur fracture
Complete fracture with total displacement of fracture fragments
180
What is the classic clinical presentation of a neck of femur fracture?
Little old lady who fell down and was unable to get up, shortened and externally rotatated leg
181
What can occur due to long periods of immobility?
Rhabdomyolysis
182
What can rhabdomyolysis cause?
Acute kidney injury
183
How can rhabdomyolysis be diagnosed?
Raised creatinine kinase
184
How can a neck of femur fracture be diagnosed?
Xray pelvis
185
What is the treatment for an intracapsular NOF fracture
Total or partial hip replacement,
| Hip screw in the young
186
What is the treatment for an extracapsular NOF fracture?
Hip screw
187
WHy is there a difference in the surgical management of intra and extracapsular NOF fractures?
An intracapsular fracture interrupts the blood supply to the head of the femur, causing avascular necrosis
188
What are the indications for a joint replacement surgery?
Moderate to severe joint arthritis that causes pain and/or interferes with daily living
189
What are the contraindications for a joint surgery?
Severe osteoporosis, increased falls risk (dementia or alcoholism), Infection, nicotine. Weight is not an exclusion criteria, but obesity reduces the life span of a hip joint
190
What are the parts of the prosthesis seen in a hip replacement?
Cup (socket) and beall (femoral stem of hip replacement)
191
What happens after hip replacement surgery?
Patient recuperates in hospital for 3-5 days,
Patient is encouraged to walk
Patient must avoid certain movements
192
What types of movement must be avoided in patients with a recent hip replacement?
Crossing legs, deep hip bends, extreme rotating or bending of the hip joint.
Patients may sleep with a special pillow for a few weeks
193
What is the focus of physio in patients with a hip replacement?
Promoting blood flow to the joint, incresing range of motion, increasing muscle strength, reducing scar tissue formation
194
What are the complications of a total hip replacement?
Complications due to analgesia, hip dislocation, different leg lengths, infection, hip stiffness (due to scar tissue formation), damage to surrounding tissue, allergic reaction to bone cement, increased pain
195
What are the complications of knee replacement surgery?
Wounds, PE, stiffness, pain, haematoma, bleeding, blood clots, surrounding tissue damage, infection, dislocation
196
How long does a knee replacement last?
20 for a total, 10 for a partial
197
What are the types of knee replacement surgery?
Total knee replacement, patellofemoral replacement, complex or revision knee replacement, partial knee replacement
198
What is multiple sclerosis?
Immune-mediated (T-cell) demylinating disease of the CNS. Causes significant physical disability within 20-25 years
199
What is characteristic of an episode of MS?
Symptomatic episodes seperate in location and time
200
What is the classic pattern of MS?
Relapsing and remitting
201
What occurs in the CNS due to MS
Myelin loss, plaque formation, oligodendrocyte destruction, relative axon sparing, reactive astrogliosis
202
What is optic neuritis?
One of the common presentations of MS, characterized by rapidly developing visual impairment in 1 or both eyes, recovering with little defect. Some changes to colour and contrast may be permanent
203
What are the risk factors of MS?
Genetics, geography, lack of vitamin D, viral infection
204
Name 10 classical MS presentations
sensory loss, spinal cord symptoms ( motor or autonomic), spasticity, heat intolerance, fatigue, trigeminal neuralgia, optic neuritis, depression, frank dementia, bipolar disorder, euphoria, cerebellar signs (ataxia, dysarthria, tremor), facial myokymia, pain, subjective cognitive difficulties
205
What is facial myokymia?
Irregular twitching of facial muscles
206
What eye symptoms can occur due to MS?
Diplopia, optic neuritis (pain on movement of eye, usually unilaterally, that presents acutely)
207
What are the spinal cord symptoms that can occur with MS?
Bladder, bowel and sexual dysfunction, muscle cramping secondary to spasticity
208
What is acute transverse myelitis?
Acuteloss of motor, sensory, autonomic, reflex and sphincter function below the level of the lesion
209
What type of transverse myelitis usually occurs in patients with MS?
Partial
210
WHat does the typical MS patient look like?
young, white and female
211
Name some examination findings in a patient with MS
Increased tone or stiffness, hyperreflexic, localised weakness, focal sensory disturbance
212
What are the types of MS?
Relapsing remitting,
primary progressive
secondary progressive,
Progressive-relapsing
213
Which type of MS has the poorest prognosis?
Primary progresive
214
What is the best test to confirm MS diagnosis?
MRI to show evidence of fibrosis
215
What is used to treat MS?
Interferons and antibodies
| Steroids can increase the rate of recovery but don't modify disease
216
What are the two common neurological findings in parkinsons?
Lewy bodies and loss of pigmented dopaminergic cells in the substantia niagra
217
What is the most common presenting feature of Parkinsons'?
Tremor
218
Name some other causes of a tremor?
Cerebellar lesions, dystonic tremor, essential tremor, anxiety
219
Which part of the body is affected by parkinson's?
The basal ganglia (substantia niagra) of the brain
220
What does the basal ganglia regulate?
Cortical output for normal movemet
221
What is the general pathophysiology of parkinson's?
Decreases ( through direct and indirect pathway), the inhibition of the globus pallidus internus and the substantia niagra. increasing the inhibition of the cortex
222
What are the risk factors of parkinsons'?
WHO THE FUCK KNOWS?
| TBH, they think its genetic and environmental, but no one can figure out the triggers
223
What can predict more rapid rate of motor progression in parkinnsons'?
Older age of onset, initial rigidity/hypokinesia, male, postural instability/gait dificulty
224
Whatcan predict a slower progression course and longer therapeutic benefit from Levadopa?
Presentation with a tremor
225
What is the parkinsons triad?
tremor, bradykineasia, rigidity
226
What are the non motor symptoms of parkinsons?
Hyposmia, constipation, urinary urgency, forgetfulness, excessive saliva
227
What are the initial clinical symptoms of parkinsons?
Tremor, reduced dexterity, sleep disturbances, decreased facial expression, soft voice, slowness of thinking, depression, weakness, malaise
228
What type of tremor does parkinsons cause?
A pill rolling, resting tremor
229
How can brady kinaesia present?
Decreased facial expression,softer speech, drooling, slowness in rising from bed, falls, small, effortful hand writing, decreased dexterity
230
What are the four cardinal signs of Parkinsons' dsease?
resting tremor, rigidity, postural instability, bradykinaesia
231
How can rigidity be tested?
Presence of cog wheeling or lead piping
232
What is the diagnostic test for Parkinsons?
It is a clinical test. MRI and CT are usually unremarkable. Tests tend to exclude differentials
Reduced intake of flurodopa can be seen in PET imaging in the basal ganglia
233
What is the treatment for Parkinsons?
Levodopa with carbidopa
MOA-B inhibitors
Dopamine agonists
234
What signs and symptoms suggest parkinsons plus?
Early onset of dementia, postural instability and hallucinations. Impaired vertical gaze, nystagmus, unexplained pyramidal tract signs, symmetriccal signs, postural hypotension and urinary incontinence
235
What is psoriasis?
A complex, multifactorial inflammatory disease involving the hyperproliferation of keratinocytes in the epidermis (with increased epidermal cell turnover)
236
What are the types of psoriasis?
Nail, pustular, guttate, arthritis, scalp, plaque, chronic stationary, oral, eruptive, erythrodermic
237
What is chronic stationary psoriasis?
the most common type of psoriasis, involves scalp, extensor surfaces, genitals, umbilicus and lumbrosacral and retroauricular regions
238
Where does plaque psoriasis usually affect?
Extensor surfaces of knees, elbows, scalp and trunk
239
What is guttate psoriasis?
type of psoriasis that presents predominanyly on the trunk after a URTI with a group A beta-haemolytic streptococci. More itchy
240
What is inverse psoriasis?
Occurs on flexor surfaces
241
Where does pustular psoriasis usually develop?
palms or soles, or diffusely around the body
242
What is erythrodermic psoriasis?
Typically encompasses nearly the entire body surface area with red skin and a diffuse, fine, peeling skin
243
What is the pathophysiology of psoriasis?
Trigger causes an autoimmune, t cell mediated infiltration of the epidermis, inducing keratinocyte proliferation and cytokine production. Parakeratosis occurs, causes poorly adherent stratum corneum leading the flaking and scales
An increase in epidermal cell turnover
244
What does psoriasis usually look like?
Erythamatous plaque, papules or macules, well demarcated, non coherent with silvery plaques and a glossy homogenous erythema
245
How does plaque psoriasis present?
Raised inflamed lesions covered by white scale
246
How does guttate psoriasis present?
Small salmon pink paules
247
How does pustular psoriasis present?
Sterile pustules diffused around the body
248
How does nail psoriasis present?
Thickened and yellowish nails, nail may separate from nail bed
249
What are the complicationcs of psoriasis?
Secondary infections, psoriatic arthritis, mitral valve prolapse
250
What lab studies should be done for psoriasis?
RF, ESR, check if fluid from pustules is sterile, perform fungal studies
251
What is the treatment of psoriasis?
light therapy, stress reduction, climatotherapy
moisturizers and salicylic acid as scale removing agents, topical corticosteroids, keratolytics, vit D analogues, immunemodulators
252
What is the typical presentation of rheumatoid arthritis?
Symmetrical swollen proximal joints, with stiffness, pain worst at morning,
253
Name five less common presentations of rheumatoid arthritis
Widespread systemic arthritis,
Persistent monoarthritis of a single joint
Systemic illness with extra auricular symptoms
Recurrent soft tissue problems (eg carpal tunnel, frozen shoulder)
Recurrent mono/poly arthritis
254
What are the early signs of rheumatoid arthritis?
Swollen and tender mcp, pip, wrist and mtp joints. Check for synovitis and tendinitis
255
What are the late signs of rheumatoid arthritis?
Swan neck deformity, ulnar deviation, z thumb, dorsal wrist subluxation, with similar foot changes
256
What are the extra articulate signs of rheumatoid arthritis?
Nodules, lymphadenopathy, vasculitis, scleritis, episcleritis, fibrosing alveolitis, obliterating bronchitis, carpal tunnel, splenomegaly, raynaud's, peripheral neuropathy, amyloidosis, osteoporosis
257
What blood tests can be done for RA?
ESR, CRP, RF,Anti CCP, ANA
258
Which of the blood tests for RA is most diagnostic?
AntiCCP
259
What can be seen in a radiograph for rheumatoid arthritis>
Soft tissue swelling, symmetric or concentric joint space narrowing, osteoporosis, marginal bone erosion
260
What is the first line therapy for RA?
Methotrexate
261
What is early RA treated with?
Disease modifying anti-rheumatic drugs
262
What are the possible surgical treatments for RA?
Synovectomy, tenosynovectomy,, tendon realignment, recontructive surgery
263
What types of medication are used for RA?
DMARDS steroids, NSAIDS, analgesics
264
What signs are present in a TACS
```
All three of the following:
1. Unilateral weakness (and/or sensory
deficit) of face, arm and leg
2. Homonymous hemianopia
3. Higher cerebral dysfunction (dysphasia,
visuospatial disorder)
```
265
What signs are present in a PACS
```
Two of:
1. Unilateral weakness (and/or sensory
deficit) of face, arm and leg
2. Homonymous hemianopia
3. Higher cerebral dysfunction (dysphasia,
visuospatial disorder)
```
266
What signs are present in a POCS
One of
1. Cerebellar or brainstem syndromes
2. Loss of consciousness
3. Isolated homonymous hemianopia
267
What signs are present in a LACS
one of:
Unilateral weakness (and/or sensory deficit)
of face and arm, arm and leg or all three.
Pure sensory stroke.
Ataxic hemiparesis.
268
Why is a CT Head important for a suspected stroke?
To identify haemorrhaagic strokes and treat ischaemic strokes and haemorrhagic strokes accordingly
269
What are the four important stroke mimics?
Migraine, Hypothermia, hypoglycaemia, epilepsy
270
What are the RF for strokes?
Anticoagulants, AF, age, sex, Cholesterol, HTN, family history,
271
What is the acute management of haemorrhagic strokes?
Reversal of thrombolytic treatment - Vit K + serum plasma proteins
272
What is the acute management of ischaemic strokes?
300mg aspirin
