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MD3 Flashcards

1
Q

Pure sensory stroke is classically associated with a stroke in which area?

A

Thalamus

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2
Q

What is baclofen used for?

A

Spasms (generalised - systemic)

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3
Q

Bilateral strokes are highly suspicious for what stroke source?

A

Cardiogenic

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4
Q

What is mirabegron?

A

Sympathetic mimetic to decrease bladder release to help incontinence

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5
Q

What type of stroke causes hemineglect?

A

Right parietal

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6
Q

Cerebellar DANISH mnemonic?

A

Disdiadichokinesis
Ataxia
nystagmus
Intention tremor
Slurred speech
Hypotonia

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7
Q

Which area of the brain allows the the eyes to work together (a look left means one eye moving laterally and the other moving medially)

A

MLF

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8
Q

Why is foot drop dangerous in geriatrics?

A

Causes falls

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9
Q

Key differential to rule out in suspected delirium?

A

Stroke

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10
Q

List 4 components of a delirium workup.

A
  • CXR
  • bloods +/- cultures
  • bladder scan
  • urines
    +/- CT brain for stroke

CUBBS
Chest, urines, bloods, bladder, stroke

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11
Q

Which quick bedside test could seperate delirium from depression/dementia?

A

4AT

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12
Q

Best way to test inattention for suspected delirium?

A

Count backwards from 20 or list the months of the year backwards.

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13
Q

What is antalgic gait?

A

Odd gait due to pain

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14
Q

All anti-psychotics impact which chemical pathway in the brain?

A

Dopamine paths. This is why you can use Parkinsons as a way to workout what antipsychotics might do to a patient. eg. low dopamine gives erratic movements as in Parkinsons, so giving dopamine blockers in psychosis may cause dyskinesia. Likewise, giving dopamine agonists for Parkinsons’s patients may cause psychosis.

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15
Q

What is olanzipine and what are the main side effects?

A

the ‘panacea’ of psychosis but has a horrible metabolic profile - weight gain, sedation, appetite increase.

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16
Q

Pubic rami fractures are strongly linked to which condition?

A

osteoporosis

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17
Q

List 4 common causes of falls in geriatric patients:

A
  • hypotension
  • hypoglycemia
  • neuropathy
  • CNS drugs
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18
Q

What are the 2 main complications of falls in the elderly?

A

Bleeds and fractures (think osteoporosis)

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19
Q

Management of delirium in geriatrics?

A

REALLY IMPORTANT to avoid pharmacological intervention unless absolutely necessary - try to change the environment and get family involved first.

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20
Q

List the bloods for a Geris screen.

A

FBE, CMP, UEC, CRP, LFT, B12, Folate, Vit D, TFT, glucose

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21
Q

It is important to include ______ in ROS for geriatric patients.

A

Urinary symptoms

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22
Q

How to screen for depression in geriatrics?

A

GDS score, any score above 5 should be investigated

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23
Q

Define mild cognitive impairment?

A

Cognitive decline WITHOUT loss of independence or function

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24
Q

Which 3 categories are used to ‘treat’ mild cognitive impairment?

A
  • lifestyle - as with CVD risk factors
  • medicolegal - appoint POA
  • follow up in 12 months
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25
Q

‘missed appointments’ is medschool alarm bells for ____.

A

dementia

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26
Q

Management of early dementia?

A
  • support via dementia australia
  • confirm medico-legal done
  • Report to vicroads
  • Cholinesterase inhibitors
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27
Q

Which medications are used to slow the progression of dementia? What is the main side effect?

A

Cholinesterase inhibitors. GIT upset.

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28
Q

List some strategies to help patients with dementia.

A
  • routine
  • support of family
  • carer support
  • cleaners + meal prep
  • good GP relationship
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29
Q

Mnemonic for features of delirium?

A

FISC
Fluctuating
Inattention
Short/Acute
Change in Cognition

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30
Q

What is the screening tool for delirium/

A

4AT test

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31
Q

Mnemonic for investigations to order for suspected delirium?

A

SCRUBS (or SCRUBB)
Stroke (CTB)
CXR
Rationalisation of meds
Urine - dipstick + MCS
Bloods
Scan/Bladder USS

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32
Q

How to manage delirium?

A
  • supportive care
  • address predisposing factors
  • prevent complications
  • do not restrain
  • familar surroundings
  • family present
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33
Q

What is the main diagnostic tool for dementia?

A

DSM-5

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34
Q

2 key histological findings for Alzheimers?

A

amyloid beta plaques and neurofibrillary tangles

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35
Q

How does vascular dementia differ from Alzheimers?

A
  • cognition often degrades in stepwise manner with new infarcts
  • memory can be spared
  • focal neurology and slow info processing are more common than memory loss
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36
Q

Management of vascular dementia?

A

Same as for strokes/IHD

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37
Q

Compare the two broad types of Lewy Body disease.

A

Parkinson’s dementia
- Parkinsons present BEFORE dementia

Lewy Body Dementia
- parkinsonism develops AFTER dementia
- hallucinations

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38
Q

How does fronto-temporal dementia present?

A

Depends which of those lobes is targeted first.
Frontal - behavioural change/disinhibition

Temporal - primary progressive aphasia

USUALLY front-temporal dementia patients are younger

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39
Q

Which type of dementia are cholinesterase inhibitors ineffective in?

A

Front-temporal dementia

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40
Q

Why are CT brains readily given in geriatric patients and what do they rule out?

A

Radiation not an issue with few years of life left.
Rule out space occupying lesions and bleeds, most commonly chronic subdurals and meningiomas.

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41
Q

List 3 reasons MRIs might be difficult in an elderly patient.

A
  1. Difficulty lying still with reduced cognition
  2. Expensive
  3. Access
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42
Q

Which 3 areas of the CNS control micturition?

A

Micturition = urination
1. Pons
2. S2-4 for pudendal parasympathetic release
3. L roots for sympathetic

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43
Q

A right parietal stroke may cause ______.

A

Hemineglect

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44
Q

Which area of the brain allows the eyes to move in tandem?

A

milf
MLF - medial longitudinal fasiculus

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45
Q

Ischaemic strokes tend to improve for _____ weeks

A

6-8 then plateau

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46
Q

Foot drop and circumductive gait increase risk of ____ in older patients.

A

Falls

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47
Q

Which examination should be done first in potential delirium?

A

Neuro - rule out stroke

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48
Q

Name 3 systems that can cause asterixis.

A

Lung - CO2
Liver - Ammonia
Kidney - urea

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49
Q

‘Twitch and Itch’ are common long-term side effects of which group of medications?

A

opiods

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50
Q

Which two pathologies must be ruled out before diagnosing dementia?

A

Delirium and Depression

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51
Q

Which group of medications are contraindicated in delirium. List two exceptions to this rule.

A

BENZOS.
The two exceptions:
- alcohol withdrawal delirium
- Parkinson delirium wherein anti-psychotics cannot be given

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52
Q

One question to test for inattention in suspected delirium?

A

Count backwards from 20

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53
Q

All anti-psychotics act by blocking _____

A

the dopamine pathway

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54
Q

Side effect of olanzapine?

A

horrific metabolic profile - appetite up, weight gain, sedation

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55
Q

What are EPS of anti-psychotics?

A

Extra pyramidal side effects - eg. tardive dyskinesia. Erratic movements similar to Parkinsons due to long term antagonism of dopamine system (Parkinsons similar pathophysiology)

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56
Q

List 3 Diabetes related risk factors for falls in geriatric patients.

A
  1. Orthostatic hypotension due to autonomic dysfunction +/- BP lowering meds
  2. Hypoglycemia due to anti-hyperglycemics or low nutrition due to cognition
  3. Neuropathy - can’t feel limbs
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57
Q

List 3 major medication groups that contribute to falls.

A
  1. BP meds
  2. CNS meds (sedation)
  3. Anti Hyperglycemics
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58
Q

Does stroke cause syncope?

A

ONLY if its a huge brainstem stroke

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59
Q

Main 2 pathologies we are concerned about post fall?

A
  • fractures (osteoporosis)
  • bleeds (anti-coagulants)
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60
Q

Why do we tolerate elevated BSL (up to 15) in geriatric patients?

A

Better than the risk of hypoglycemia, geriatric patients may not experiecne side effects of hypos and therefore might not notice and totally tank.

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61
Q

Which cognition test is approved for non-English speakers?

A

RUDAS

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62
Q

Which cognition test is best for checking executive function?

A

MOCA

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63
Q

Ladder of laxatives?

A

Coloxyl+senna > movicol > lactulose > glyceryl suppository > +/- microlax > fleet enema

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64
Q

3 exams to conduct for suspected cauda equina?

A

Lower Neuro
Urinary continence/catheter/bladder fullness
DRE rectal tone

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65
Q

List 3 causes of SIADH and 3 causes of Diabetes Insipidus

A

SIADH
- lung cancer
- stroke
- head injuries

DI
- brain tumours + pituitary
- removal of brain tumours
- lithium

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66
Q

Mnemonic for geriatric giants?

A

CODFOD Meds
- cognition
- opioids (pain)
- dementia
- falls
- osteoporosis
- delirium
- meds - polypharmacy

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67
Q

Examinations to perform for a fall?

A

need to examine for CAUSES and OUTCOMES
- cardio for arrythmia
- cranial nerve for ICP
-back exam + sacral
- chest wall tenderness
- neck movement
- hip movements

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68
Q

2 pillars of Wernicke-Korsakoff syndrome?

A
  • no memory laying
  • ophthalmaplegia
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69
Q

Why is future dental work a worry for patients started on bisphosphonates?

A

Osteonecrosis of the jaw

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70
Q

Risk of missing a denosumab dose?

A

More fracture risk than ever before

71
Q

Why is denosumab preferable in many patients to bisphosphonates?

A
  • easier
  • gentler on kidneys
72
Q

Rules for taking bisphosphonates?

A

Must sit upright for 30 mins after taking it to avoid osephagitis and can have no food in tummy, can only take it with water

73
Q

What is overflow diarrhea?

A

Liquids of colon escaping from rectum in constipated patient. Looks like diarrhea but is actually constipation, do AXR

74
Q

3 top causes of peripheral neuropathy?

A

Diabetes
Hypothyroid
B12 deficiency

75
Q

Why are neuropathic anti-convulsants a risk for geriatric patients?

A

They are sedating, falls risk.

76
Q

What is clorvescent?

A

K+ tablet replacement

77
Q

Compare the literal T10 spinal level to the T10 dermatome.

A

T10 level = xiphoid process
T10 dermatome = umbilicus

78
Q

What is functional incontinence?

A

Incontinence not due to a pathology but due to an inability to get to the toilet.

79
Q

Which cognition test is preferable for vascular dementia?

A

MOCA

80
Q

Name the big 4 pall care end of life meds.

A

The 4 Ms:
- midazolam
- morphine (often ordine)
- Metaclopramide
- Mucus (glycopyrolate = atropine lite)

81
Q

Describe the findings in neurogenic shock.

A
  • impaired neuro impact prevents vasoconstriction leading to systemic vasodilation
  • HR likely to be normal as not hypovolemic
  • skin often flushed instead of pale like other kinds of shock
82
Q

What are the 2 broad treatment groups for neuropathic pain?

A

Anti-convulsants (eg. pregabalin and gabapentin) and anti-depressants (eg. duloxetine and amitriptyline)

83
Q

Having rib fractures leads to a risk of which other pathology?

A

Pneumonia - no deep breaths

84
Q

Asthma attack mnemonic?

A

POSSUM
Pred/hydrocort (is faster)
Oxygen
SABA
SAMA - ipratropium
Uhhhhhdrenaline (adrenaline)
Magnesium Sulphate

85
Q

What is the key physiological feature of an asthma attack?

A

Hyperexpansion, leads to tamponade or pneumothorax

86
Q

Brand names for short acting morphine (liquid and pill) and for long acting morphine?

A

short - ordine (liquid)
short - sevredol (pill)
long - MS contin

87
Q

What to give instead of metaclopramide in Parkinsons?

A

Donperidone

88
Q

Mnemonic for Mental State Examination?

A

BAPTISM At Church
Behaviour
Appearance
Perception
Thoughts
Insight
Speech
Mood
Affect
Cognition

89
Q

What 4 things to check to declare patient dead?

A
  1. response to voice
  2. pupils fixed and non-reactive
  3. pulses and heart sounds
  4. breath sounds
90
Q

What time of the day are steroids most likely to cause agitation?

A

After midday when levels are meant to be dropping

91
Q

Name one IV and one oral treatment for Reynauds.

A
  1. IV - iloprost infusion - prostacyclin for vasodilation
  2. Nifedipine (Ca+ blocker, think Amlodipine)
92
Q

Mnemonic for DIC causes?

A

DICk MOPS
DIC - malignancy, OBG, pancreatitis, sepsis

93
Q

Mnemonic for most important pancreatitis severity markers.

A

RANSONS CRITERIA - SILC
Sugar (glucose) up
Immune - WBC up
LDH up
Ca2+ down

94
Q

Name a liver safe opioid.

A

There aren’t any. Some are better than others, consider hydromorphone.

95
Q

Name 2 causes of non-megaloblastic macrocytic anaemia.

A
  • hypothyroid
  • alcohol
96
Q

Pain from 60 degrees to 120 degrees in shoulder abduction is consistent with?

A

Shoulder impingement

97
Q

What is a timed up and go?

A

Part of the Comprehensive Geriatric Assessment that asks a patient to stand, walk 3 metres then return to their seat and sit back down. Should only take 10 seconds.

98
Q

Normochromic, Normocyctic anaemia is typical of which pathology?

A

Anaemia of chronic disease

99
Q

Name the 3 pronged approach for osteoporosis.

A
  1. Medication (either denosumab or bisphosphonate)
  2. Vit D supplement
  3. Strength training
100
Q

Name the key non-pharmacological management for falls risk.

A

FALLS AND BALANCE CLINIC

101
Q

What is the key to managing venous insufficiency and what do you need to check before you take this path?

A

COMPRESSION.
Need to check for PVD before you do this or you’ll occlude weak arteries - do an ABPI.

102
Q

3 pronged management for geriatric wounds?

A
  1. Compression
  2. Dressing
  3. Wound clinic
103
Q

How does fear of falling contribute to falls risk?

A

Fear of falling –> reduced mobilisation –> deconditioning

104
Q

Which 3 components are needed for balance control?

A
  • CNS function (cerebellum)
  • sensory input (sight and proprioception)
  • effector response
105
Q

List 3 management points for falls risk.

A
  • EXERCISE
  • medication review
  • vit D supplement
  • falls and balance clinic
106
Q

Operate early and mobilise early are two key aspects of which pathology?

A

NOF

107
Q

List two pathologies that may arise from long term PPI use.

A
  • C.diff risk
  • B12 deficiency
108
Q

What is a prescribing cascade?

A

Assigning a new medication to deal with the sides effects of another medication - it keeps snowballing.

109
Q

Why does venous insufficiency cause ulcers?

A

Fluid causes pressure build up which cuts off supply leading to hypoxia and tissue death.

110
Q

What is ulcer ‘slough’?

A

Yellow coating of an ulcer that resembles puss but is not due to an infection - rather it is a product of dying inflammatory cells

111
Q

What is the key management for a diabetic foot ulcer and which pathology should you be looking out for each time you review the foot?

A

Key management = taking pressure of ulcer - aided by podiatrist.

Keep an eye out for osteomyelitis.

112
Q

Reactive arthritis, Rheumatoid arthritis and enteropathic spondyloarthropathies cause which eye related conditions?

A

reactive - conjunctivitis

RA - scleritis

Enteropathic - uveitis

113
Q

Which body areas are most prone to pressure sores?

A

Bony prominences

114
Q

How to definitively manage an arterial ulcer?

A

Need to restore flow. Eg. angioplasty

115
Q
A
116
Q

What is micturition?

A

Urination

117
Q

If a patient has bilateral ischemic strokes, what should you suspect?

A

More proximal cause - eg. cardioembolic

118
Q

Hemineglect is caused by strokes in which brain area?

A

Non-dominant parietal (right)

119
Q

3 molecules/systems that can cause metabolic flap?

A

Urea - kidney
Ammonia - liver
CO2 - lung

120
Q

Name two causes of delirium that would benefit from benzodiazepines over anti-psychotics.

A

Alcohol induced/withdrawal delirium and Lewy Body/Parkinsons delirium

121
Q

Which test separates dementia and delirium?

A

4AT

122
Q

What is an Antalgic gait?

A

Limp due to pain

123
Q

What are the two key physio rehab components for post fall management?

A

Core strength and balance retraining

124
Q

List 4 key precipitants of falls in geriatric patients.

A
  1. Orthostatic hypotension
  2. Hypoglycaemia
  3. Peripheral neuropathy
  4. Any CNS drugs
125
Q

What are the two major post falls risks?

A
  1. Bleeds
  2. Fractures
126
Q

Which vital sign can be a good indicator of aspiration?

A

o2 sats

127
Q

Approximately what BSL would be tolerated in geri populations.

A

Under 15 is fine, don’t want to risk hypos causing falls

128
Q

Which cognitive test is approved for foreign speaking translators?

A

RUDAS

129
Q

List some falls prevention strategies.

A
  • supervision/assist
  • high visibility room
  • walking aids
  • proxy buzzer
  • lower bed/crash mat
130
Q

Mnemonic for geriatric giants?

A

CODFODmeds
Continence
Osteoporosis
Delirium
Falls
Opioids (pain)
dementia
Meds - polypharmacy

131
Q

MOA of tiatropium and ipratropium?

A

Tiatropium - LAMA
ipratropium - SAMA

132
Q

What is a physiological advantage of denosumab over bisphosphonates?

A

Avoids eGFR issues

133
Q

Instructions for taking bisphosphonates?

A

To avoid osephagitis - sit up for 30 mins after taking it and take it with only water nothing else, before food

134
Q

Fluctuating cognition is a key feature of ______ ?

A

Delirium

135
Q

Which opioid is safe in CKD?

A

Fentanyl

136
Q

What is the KICA test for?

A

Cognitive test for First Nations people

137
Q

Top 3 causes of peripheral neuropathy?

A

Diabetes, B12 deficiency, hypothyroid (and alc is in there somewhere)

138
Q

What is clorvescent?

A

Potassium tablet

139
Q

Best cognitive test for executive dysfunction?

A

MOCA - great for vascular dementia

140
Q

Two side effects common to chronic opioid use?

A

Opioid itch and opioid twitch

141
Q

What are the big 4 end of life pall care medications? (Mnemonic)

A

The four M’s:
- midazolam
- morphine - often S/C
- metaclopramide
- mucolytics (glycopyrolate)

142
Q

2 broad medication classes used for neuropathic pain?

A

Anticonvulsants and anti-depressants (duloxetine and amytriptiline)

143
Q

Mnemonic for asthma treatment?

A

POSSUM
Pred (actually do hydrocortisone)
O2
SABA
SAMA
uhhhDrenaline (adrenaline)
Magnesium sulphate

144
Q

Why is anxiety during an asthma attack a huge problem?

A

Anxiety increases RR, causing tachypnea and even further reducing length of expiratory phase. This adds to hyperexpansion of the lungs and can result in tamponade or pneumothorax

145
Q

What kind of words are often used to describe neuropathic pain?

A

Electric type words like shock or zap

146
Q

What is the alternative to metaclopramide given to Parkinson’s patients?

A

Donperidone

147
Q

What is the typical breakthrough (PRN) dose given to patient?

A

1/6th of regular dose - same agent

148
Q

What are the four components of verifying a patient has died?

A
  1. Response to voice/pain
  2. Pupil response
  3. Pulse/ heart sounds
  4. Breathing sounds (turn of O2 first)
149
Q

Nifedipine and iloprost are used for which condition?

A

Reynauds.
Iloprost is a prostacylcin analogue
Nifedipine is a calcium channel blocker

150
Q

Mnemonic for causes of DIC?

A

DIC(k) MOPS
DIC
Malignancy
OBG
Pancreatitis
Sepsis

151
Q

Mnemonic for Ranson’s criteria?

A

SILC
Sugar (glucose up)
Immune cells (WBC up)
LDH up
Calcium down (think of all the calcium being used up by forming pancreatic calcifications evident in chronic pancreatitis)

152
Q

2 causes of non-megaloblastic macrocytic anaemia?

A

Hypothyroid and alcoholism

153
Q

Pain on 60 to 120 degrees of shoulder abduction is associated with which pathology?

A

Shoulder impingement

154
Q

If you have mania, you are 100% experiencing which pathology (the only 100% specific finding in psych)

A

Bipolar

155
Q

What is FEP?

A

First episode psychosis - doesn’t really count as schizophrenia yet

156
Q

What are the four dopamine paths and how may anti-psychotics impact these paths?

A
  1. Mesolimbic pathway - responsible for positive symptoms (hallucinations, psychosis) - responds well to anti-psychotics
  2. Mesocortical pathway - responsible for negative symptoms (apathy, social withdrawal etc) - respond poorly to anti-psychotics
  3. Nigrostriatal (think substantia nigra, the Parkinson’s pathway) - blocking this path with anti-psychotics leads to extra-pyramidal side effects eg. tardive dyskinesia
  4. Tuberoinfundibular - pituitary dopamine path, blocking the dopamine in this path with anti-psychotics removed prolactin inhibition so you can get prolactin build up
157
Q

How to differentiate Parkinson’s and extra pyramidal side effects on exam?

A

The pill rolling tremor: Parkinsons will cause a UNILATERAL pill rolling tremor whereas EPSE will cause bilateral effects

158
Q

What are the main side effects of typical vs atypical anti-psychotics?

A

Typical - tardive dyskinesia
Atypical - metabolic syndrome

159
Q

What class of anti-psychotics are aribiprazole and brexpiprazole?

A

Ari- 3rd Gen - partial dopamine agonist that outcompetes dopamine in body, blocking receptors. MAKES PTs RESTLESS

Brex - 4th Gen - same mechanism as above with less restless side effects.

160
Q

Difference between schizophrenia vs schizoaffective?

A

Schizophrenia = just psychotic symptoms
Schizoaffective = psychosis and depressed mood symptoms
Depression with psychotic characteristics = big mood problems with precipitated psychotic symptoms

All on the same sort of spectrum

161
Q

List some of clozapine’s key side effects.

A
  • myocarditis
  • seizures
  • drooling
  • neutropenia

Then the other classic atypical antipsychotic sides: constipation, weight gain, sedation etc.

162
Q

Dangerous complication of rapid hyponatremia?

A

Cerebral edema

163
Q

How might anti-psychotics impact the bladder?

A

Cause urge incontinence due to anti-cholinergic effects

164
Q

If you give an anti-depressant to a depressed patient and they become manic, what is their underlying diagnosis?

A

Bipolar. All manic people have bipolar.

165
Q

Are SSRIs/SNRIs given in bipolar?

A

No because they will the person into mania

166
Q

What is Beck’s triad and what does it indicate?

A

Cardiac tamponade
- JVP up
- muffled heart sounds
- hypotension

167
Q

Rose coloured rash is typical of which pathology?

A

Salmonella infection (typhoid)

168
Q

What is sulfasalazine?

A

DMARD

169
Q

Food poisoning after 3 hrs from an egg salad is likely due to?

A

Staph aureus - few organisms can cause food poisoning so quickly - consider staph, bacillus cereus and vibrio

170
Q

What is cystic medial necrosis?

A

Large vessel genetic disease that causes aortic aneurysms and dissections

171
Q

Convert oral morphine to subcut

A

Divide by 2 or 3 (sources say different things) - 30mg ordine becomes 10mg sub cut for example

172
Q

Convert 10mg morphine to hydromorphone

A

2mg - it’s 5x stronger

173
Q
A
174
Q

What is Lambert Eaton syndrome and who gets it?

A

Like myasthenia but can be overcome by movement and less eye involvement. Attacks pre synaptic terminal. Happens in patients in lung cancer.

MD (15 decks)

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