Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PPT year 4 > masterclass 2: MSK and rheumatology > Flashcards

masterclass 2: MSK and rheumatology Flashcards

1
Q

benign essential tremor patter

A

tremor is worse on movement and reduced at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

drugs that can induce parkinsons x4

A

SSRIs, beta-blockers, lithium, anti-psychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Multiple system atrophy response to levodopa

A

poor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how does Progressive supranuclear palsy differ from parkinsons

A

early instability and vidual probs (vertical gaze palsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how is LBD dif from parkinsons

A

memory loss before motor symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is dopamine use for

A

corordination of movement in the direct and indirect pathways in basal galnglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

parkinsons pathology

A

loss of dopaminergic neurons in the substantia nigra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

parkinsons triad

A

Resting tremor
Bradykinesia
Skeletal muscle rigidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what drug increases dopamine levels

A

levodopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what drugs reduce the breakdown of dopamine

A

MAOB inhibitors and COMT inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what drugs act directly on the dopamine receptors/dope agonist

A

Pramipexole/Ropinirole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

choice of drug in early Parkinsons

A

dopamine agonists or MAO-BIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

which drug is better for the motor symptoms of parkinsons

A

levodopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

who is more likely to get the motor symptoms of levodopa

A

younger people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

examples of MAOB inhibitors x2

A

selegiline, rasagiline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

which drug most effectively treats parkinsons

A

levodopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

when to use amantadine

A

dyskinesia isnt controlled by other meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is dyskinesia

A

impairment of voluntary movement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

useful adjuvant to enhance levodopa

A

COMT inhibitors - stop it being broken down and prolong levodopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when is an anticholinergic used in parkinsons

A

For disabling tremor and excessive salivation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what actually is levodopa

A

amino acid precurser of dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

dopamine and the BBB

A

cant cross

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

can levodopa cross BBB

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what else can convert levodopa

A

peripheral dopa-decarboxylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Carbidopa moa

A

Dopa decarboxylase (DDC) inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

name another Dopa decarboxylase (DDC) inhibitor

A

benserazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

dopamine and

A

controls the flow of information in the frontal lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

loss of dopamine and cognition

A

memory problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

excess of dopamine and cognition x2

A

psychosis and Schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

dopamine and boobs

A

Prolactin inhibitory hormone, acting on D2 receptors, preventing lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

dopamine and sick

A

emesis function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

dopamine and GI

A

Inhibits gastric stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

dopamine and the heart

A

Dopamine is converted to norepinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

dopamine antagonist example - GI motility

A

Domperidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

dopamine antagonist example - emesis

A

Example of an antagonist is Metoclopramide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

dif between noradrenaline and adrenaline

A

noradrenalin is released continuously and adrenalin is released in times of stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

indication for Co-careldopa

A

parkinsons only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

co-beneldopa indication

A

only parkinsons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

levodopa contraindications

A

Breast feeding
Severe psychiatric illness
Caution in severe pulmonary or cardiovascular disease
Severe nausea/GI motility problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is the problem with dopamine drugs and cardiovascular

A

converted to noradrenaine and adrenaline = tachycardia and hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what other endocrine abnormality does dopamine cause other than prolactin

A

reduce thyrotropin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is thyrotropin

A

TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

common side effects of levodopa

A

Nausea and vomiting
Abnormal dreams and sleep disturbances
Dizziness and syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

abnormal sleep and carledopa x3

A

sudden onset of sleep
wierd dreams
insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

motor problem in patients taking carledopa and what body part they affect

A

Involuntary movements, or dyskinesia, usually affecting the face and limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

when do the carledopa motor symptoms start

A

within 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

carledopa and clinical state

A

on-off effect, rapid worsening of symptoms for mins/hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

levodopa and BP

A

can cause postural hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

levodopa psychological side effects

A

dementia, depression and schizophrenia-like syndrome with delusions and hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

levodopa interactions

A

Monoamine oxidase inhibitors
General anaesthetics
Anti-hypertensives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

advice for patients taking levodopa

A

dont stop abruptly - MNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

interaction between levodopa and MAOi

A

hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

interaction between levodopa and GA

A

arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

risky activities with levodopa

A

driving and heavy machinery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

4 solutions to the wearing off phenominom

A

Adjust the dose
Smaller, more frequent doses
Prolonged-release levodopa preparations
take levodopa 30 minutes before food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

when to take Prolonged-release levodopa preparations

A

bedtime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

3 ways to manage on off fluctuations of levodopa

A

Combine levodopa with a dopamine agonist
Fewer doses of levodopa
Liquid forms of levodopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Pathophysiology of NMS

A

Depletion of dopamine in the hypothalamus/nigrostriatal pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

signs of NMS

A

rigidity, fever, altered GCS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

NMS management x3

A

mainly supportive, some evidence for use dantrole, bromocriptine or Lorazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

whats dantrolene

A

muscle relaxer

62
Q

what does diagnosis of epilepsy require

A

2 unprovoked seizures, more than 24 hours apart

63
Q

whats a seizure

A

Sudden, transient and unpredictable occurrence of signs and symptoms due to abnormal electrical activity in the brain

64
Q

cerebrovascular causes of seizure x3

A

infarction, haemorrhage or venous thrombosis

65
Q

other causes of seizure - loads

A

head injury, intra-cranial surgery, CNS infections (meningitis/encephalitis), neurodegenerative diseases (dementia), autoimmune disease, neoplasm, genetic causes, drugs, metabolic disturbance

66
Q

indications for starting AED

A

after one seizure if neurological deficit, EEG shows epileptic activity, risk of further seizure unacceptable, structural abnormality on brain imaging

67
Q

dyscognitive seizure

A

impaired awareness

68
Q

Generalised seizures

A

discharge affects the whole brain and associated with impaired consciousness

69
Q

focal seizure AED

A

lamotrigine or carbamazapine

70
Q

Generalised seizures AED

A

Na V

71
Q

drug that Suppresses the initial seizure discharge and the spread of seizure activity

A

Na V

72
Q

moa of Na V x4

A

potentiation of inhibitiory GABA effects
use-dependent blockade of sodium channels stabilising neuronal membranes
attenuation of excitatory glutamate
inhibition of T-type calcium channels.

73
Q

contraindications to Na V x2

A

pmh/fmh of hepatic dysfunction

metabolic disorders

74
Q

NaV side effects x5

A 
GI disturbances
Weight gain
Transient hair loss with regrowth of curly hair
Neurological features
Blood dyscrasias
75
Q

AED drug that causes weight gain

A

NaV

76
Q

AED that causes hair loss

A

NaV

77
Q

examples of metabolic disorders that are contraindicated with NaV x3

A

porphyrias
mitochondrial disorders
urea cycle disorder.

78
Q

what is prophyria important for

A

haemoglobin function

79
Q

GI problems with NaV x

A

N+V, anorexia, abdominal pain, bowel disturbance to pancreatitis and hepatotoxicity

80
Q

AED that can cause pancreatitis and hepatotoxicity

A

NaV

81
Q

NaV and neurological problems x5

A

ataxia, tremor, confusion, encephalopathy, coma

82
Q

Blood dyscrasias and NaV x2

A

anaemia and thrombocytopenia

83
Q

which drugs run the risk of hepatotoxicity with NaV x5

A

Statins, alcohol, antibiotics, anti-fungals, chemotherapy agents

84
Q

interaction drugs with NaV

A

Cytochrome P450 inhibitor

85
Q

monitoring with NaV

A

monitor LFTs before and for first 6 months

86
Q

what to do before surgery with NaV

A

FBC - bleeding risk

87
Q

when to do NaV drug concentration levels

A

Suspect non-adherence or toxicity

Clinical conditions such as status epilepticus or organ failure

88
Q

which AED is safe during pregnanct

A

lamotrigine - same as background risk

89
Q

lamotrigine moa

A

Use-dependent inhibition of sodium channels. Stabilises presynaptic neuronal membrane, suppressing release of excitatory amino acid glutamate which plays a key role in the generation of seizures

90
Q

lamotrigine target

A

Selectively targets neurons that synthesise glutamate and aspartate.

91
Q

cautions for lamotrigine

A

myoclonic seizures and Parkinson’s disease

Renal failure and hepatic failure

92
Q

why is lamotrigine contraindicated with parkinsons

A

exacerbates

93
Q

why is lamotrigine contraindicated with mycoclonic seizures

A

exacerbates

94
Q

lamotrigine side effects x5

A 
Hypersensitivity syndrome
Rashes
GI disturbances
CNS effects
Bone marrow suppression
95
Q

lamotrigine and hypersensitivity syndrome features x4

A

fever, rash, lymphadenopathy and hepatic dysfunction

96
Q

lamotrigine and rashes

A

can be self-limiting

Stevens-Johnson syndrome and toxic epidermal necrolysis

97
Q

lamotrigine and CNS problems

A

drowsiness, headache, fatigue, dizziness, double vision, ataxia and tremor

98
Q

AED that can suppress bone marrow

A

lamotrigine

99
Q

which drugs might increase the CNA side effects when combined with lamotrigine x6

A

Alcohol, anti-psychotics, local anaesthetics, opioids, anti-histamines, benzodiazepines

100
Q

lamotrigine and COCP

A

reduces contraceptive efficacy

101
Q

lamotrigine and desogestrel

A

increased lamotrigine exposure

102
Q

AED and pregnancy

A

offered 5 mg per day of folic acid before any possibility of pregnancy

103
Q

SUDEP

A

sudden unexpected death in epilepsy

104
Q

risk factors for SUDEP x4

A

tonic-clonic seizures, refractory epilepsy, AED polytherapy and associated neurological co-morbidity

105
Q

how to minimise the risk of SUDEP

A

seizure control

106
Q

define stroke

A

sudden onset focal neurological deficits

107
Q

main imagine in acute setting of stroke

A

CT

108
Q

CT of acute ischemic stroke

A

Hyperdense MCA sign

109
Q

what is used for thrombolysis

A

alteplase

110
Q

when to start alteplase

A

presentation withing 4.5 hours and haemorrhage is excluded

111
Q

whats altaplase

A

copy of tissue plasminogen activator (t-PA)

112
Q

what does tissue plasminogen activator do

A

coverts plasminogen to plasmin

113
Q

whats plasmin

A

enzyme responsible for clot breakdown and fibrinolysis

114
Q

alteplase contraindications - other than bleeding/past brain bleed/susceptible to bleeding x7

A 
neurosurgery/head trauma/stroke in past 3 months
uncontrolled hypertension
known AV malformation/neoplasm/aneurysm
suspected endocarditis
abnormal blood glucose
115
Q

relative contraindications for alteplase - about the stroke x3

A

Minor/rapidly improving symptoms
seizure at stroke onset
severe stroke

116
Q

side effects of altaplase x5

A 
Haemorrhage
Anaphylactic reactions
Hypotension
Nausea and vomiting
Cerebral oedema
117
Q

other relative contraindications of alteplase

A

major surgery or serious trauma in previous 2 weeks
previous GI/urinary tract haemorrhage in previous 3 weeks
recent lumbar puncture or arterial puncture
post MI pericarditis
pregnancy

118
Q

why do you get hypotension with alteplase

A

enzymatic release of the vasodilator bradykinin

119
Q

what to do if someone gets hypotension with alteplase

A

stop = rapid recover and can continue

120
Q

why do you get cerebral oedema with alteplase

A

reperfusion

121
Q

do you use aspirin in acute ishcemic stroke

A

yes start within 24 hours, after if had thrombolysis

122
Q

how long are people on aspirin for with ischemic stroke

A

2 weeks and then swap to antithrombotic

123
Q

standard anti thrombotic for acute stroke

A

clopidogrel 75mg

124
Q

clopidogrel Target

A

ADP Receptor

125
Q

clopidogrel action

A

Irreversible Inhibitor

126
Q

clopidogrel effect

A

Inhibits binding of adenosine diphosphate (ADP) to its platelet receptor

127
Q

clopidogrel overall effect

A

inhibits platelet aggregation

128
Q

clopidogrel contraindicatons x3

A

Active bleeding
Avoid in pregnancy
Caution in hepatic/renal impairment

129
Q

clopidogrel and surgery

A

stop 7 days before

130
Q

clopidogrel side effects x6

A 
Bleeding
GI disturbances
Rashes
Headache
dizziness
paraesthesia
131
Q

clopidogrel interactions x6

A 
Anticoagulants and anti-platelets
NSAIDs
SSRIs
PPIs
Erythromycin
132
Q

PPIs and erythromycin and fluoxetine interaction with clopidogrel

A

reduces antiplatelet effect

133
Q

which antithrombotic can cause parasthesia

A

clopidogrel

134
Q

3 CV things you might want to investigate for stroke pt

A

Ipsilateral carotid artery stenosis
Atrial fibrillation
Structural cardiac disease

135
Q

carotid artery stenosis test

A

carotid doppler

136
Q

who should receive surgery for carotid artery stenosis

A

50-99% or 70-99%

137
Q

when should people get surgery for carotid artery stenosis

A

2 weeks post stroke

138
Q

scores to calculate with stroke patients

A

chadsvasc and hasbled scores

139
Q

whats chadsvasc for

A

AF stroke risk

140
Q

hasbled score

A

risk of major bleeding for patients on anticoagulation

141
Q

structural cardiac disease investigation

A

echo

142
Q

stroke pt systolic BP should be below

A

130

143
Q

atorvastatin moa

A

HMG-CoA reductase inhibitors

144
Q

atorvastatin and LDL

A

more clearnace due to more receptors

145
Q

atorvastatin cautions x6

A 
Elderly patients
High alcohol intake 
liver disease
Hypothyroidism
Patients at risk of muscle toxicity
Haemorrhagic stroke
146
Q

atorvastatin interactions x3

A

Macrolide antibiotics
Penicillin antibiotics
Colchicine

147
Q

atorvastatin and macrolids

A

increased statin exposure

148
Q

atorvastatin and penicillins

A

increased risk hepatotoxicity

149
Q

atorvastatin and colchicine

A

increased risk of rhabdomyolysis

150
Q

stroke and driving rules

A

cant drive for one month

PPT year 4 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions