Medical conditions Flashcards
Percentage of the population affected by migraine
5-10%
Distribution of headache most common in migraine
Unilateral
Type of aura most common in migraine
Fortification spectrum/scintillating scotoma
Symptoms of basilar migraine
Headache Aura Difficulty speaking Vertigo Ringing in ears
Precipitants of migraine
Alcohol Cheese Chocolate Skipping meals Missing sleep Oral contraceptives Stress
Most common type of sensory aura in migraine
Pins and needles starting in the hand on one side of the body and spreading to the face on the same side
Chromosome affected in Wilson’s disease
13
Usual age of onset of Wilson’s disease
10-25
Affects on the brain of Wilson’s disease
Degeneration of the lenticular nucleus
Traditional first line treatment for Wilson’s disease
Penicillamine
Percentage of the population with chronic schizophrenia who suffer from primary polydipsia
20%
Features of primary polydipsia not often seen in other causes of polydipsia
No complaining of thirst
No nocturnal polyuria
No nocturnal polydipsia
Number of seizures after which treatment with an anti-epileptic drug is usually indicated
2
First line treatment for focal seizures
Carbamazepine
Lamotrigine
First line treatment for generalised tonic clonic seizures
Sodium valproate
First line treatment for absence seizures
Ethosuximide
Sodium valproate
First line treatment for myoclonic seizures
Sodium valproate
First line treatment for tonic or atonic seizures
Sodium valproate
Primary management for psychogenic polydipsia
Fluid restriction
Inheritance pattern of Wilson’s disease
Autosomal recessive
First line treatment for tonic clonic seizures if sodium valproate unsuitable
Lamotrigine
Percentage of epilepsy deaths caused by SUDEP
20-30%
Age group more at risk of SUDEP
Adults
Main risk factor for SUDEP
Frequent generalised tonic clonic seizures
Risk reduction strategies to prevent SUDEP
Nocturnal supervision
Nocturnal listening device
Definition of SUDEP
Sudden, unexpected, non-traumatic death of someone with epilepsy
Can be a preceding seizure but deaths due to status epilepticus do not count
No structural or toxicological cause of death found on post-mortem
Most common cause of polyuria
Diabetes insipidus
Disease resulting from vitamin A deficiency
Night blindness/nyctalopia
Diseases resulting from vitamin B1 (thiamine) deficiency
Beriberi
Wernicke-Korsakoff syndrome
Disease resulting from vitamin B3 deficiency
Pellagra
Disease resulting from vitamin C deficiency
Scurvy
Disease resulting from vitamin D deficiency
Rickets
Features of vitamin B3 deficiency (pellagra)
Dementia
Dermatitis
Diarrhoea
Most common cause of vitamin B3 deficiency (pellagra)
Alcoholism
Features of wet berbieri disease
Signs and symptoms of heart failure
Features of dry berieri disease
Difficulty walking Loss of sensation in the lower legs Paralysis of the lower legs Confusion Vomiting
Features of vitamin B12 deficiency
Seborrhoeic dermatitis Atrophic glossitis Angular cheilitis Confusion Increased sleep
Features of vitamin B12 deficiency
Anaemia Lower limb neuropathy Lethargy Glossitis GI upset
Features of folate deficiency
Often asymptomatic
Glossitis
Rarely paraesthesia, numbness, cognitive changes
Dietary sources of folate
Green vegetables
Pulses
Fortified cereals, bread etc.
Causes of vitamin B12 deficiency
Inadequate consumption e.g. in a vegan diet
Impaired absorption e.g. pernicious anaemia, gastric resection, IBD, chemotherapy related irradiation of the ileum
Drugs e.g. colchicine, metformin
Dietary sources of vitamin B12
Animal protein
Oral replacement
Issue with replacing folate first if someone is deficient in both folate and B12
Can unmask neurological symptoms of B12 deficiency
Condition which in males causes ambiguous or externally appearing female genitalia at birth, but with testes, and virilisation at puberty. In females causes excessive virilisation.
17-beta hydroxysteroid dehydrogenase 3 deficiency
Condition which affects only genetic males and at birth causes atypical genitalia ranging from externally female appearing to male appearing with small penis and hypospadias. There are normal internal male genitalia and often undescended testes. Virilisation occurs at puberty but usually little body hair
5-alpha reductase 2 deficiency
Condition affecting genetic males where there is either partial or complete inability of the cells to respond to androgens. Phenotype can be male with some reduced virilisation through to female depending on degree of inability to respond to androgens
Androgen insensitivity syndrome
Group of disorders characterised by impaired cortisol synthesis which can lead to increased or decreased glucocorticoids, mineralocorticoids, and sex steroids
Congenital adrenal hyperplasia
Types of classic congenital adrenal hyperplasia
Salt-wasting
Simple-virilising
Features of salt-wasting congenital adrenal hyperplasia
Insufficient aldosterone production and hyponatraemia
Vomiting
Dehydration and hypovolaemia in infancy
Features of simple-virilisation congenital adrenal hyperplasia
In females - ambiguous genitalia at birth
In males - often no signs at birth. Early virilisation during childhood
Causative organism of Lyme disease
Borrelia Burgdorferi
Illness seen in people who handle pets (especially tropical birds) characterised by macular rashes, fever, joint pains and splenomegaly
Chlamydia pstitaccii
Causative organism of syphilis
Treponema pallidum
Three core features of multisystem atrophy
Parkinsonism
Autonomic failure
Cerebellar ataxia
Three presentations of multisystem atrophy
Shy-Drager syndrome
Striatonigral degeneration
Olivopontocerebellar atrophy
Central feature of Shy-Drager syndrome
Autonomic symptoms
Central feature of Striatonigral degeneration
Parkinsonism
Central feature of olivopontocerebellar atrophy
Cerebellar features
Syndrome associated with acoustic neuromas
Neurofibromatosis II
Features of acoustic neuroma
CN VIII features - hearing loss, tinnitus, dizziness
CN V features - absent corneal reflex
CN VII features - facial palsy
Investigation of choice for acoustic neuroma
MRI cerebellopontine angle
Sex who more commonly suffers from cluster headaches
Male
Features of a cluster headache
Severe pain lasting up to two hours Occurs most/every day for several weeks at a time Pain around one eye with watering Nasal stuffiness Restlesness Miosis and ptosis in a minority of cases
Management for cluster headaches
100% oxygen
Triptan
Classical cause of Guillain-Barré syndrome
Campylobacter jejuni
Features of Guillain-Barré syndrome
Progressive ascending weakness of all four limbs
Few sensory symptoms
Occasionally back pain in early stages
Areflexia
Cranial nerve symptoms
Autonomic involvement e.g. urinary retention
Features of normal pressure hydrocephalus
Gait instability
Urinary incontinence
Dementia
Most common age to develop MS
20-40
More common sex to develop MS
Female
Countries where MS is the most common
Countries furthest away from the equator
Three clinical types of MS
Primary progressive
Relapsing remitting
Secondary progressive
Most common clinical type of MS
Secondary progressive
General effect of pregnancy on MS
Fewer relapses during pregnancy
No effect on long term prognosis
Common eye signs of MS
Optic neuritis - painful unilateral visual loss
Internuclear ophthalmoplegia - diplopia and/or nystagmus due to midbrain lesion
Ocular motor cranial nerve lesion - issue with eye movements
Sign in MS where symptoms worsen in hot temperatures
Uthoff’s phenomenon
Sign in MS where an electrical sensation runs down the back on bending the neck
Lhermitte’s sign
Percentage of MS which is primary progressive
5-10%
Percentage of MS which is relapsing remitting
20-30%
Percentage of MS which is secondary progressive
60%
Percentage of patients with sarcoidosis who have psychiatric problems
20%
Most common psychiatric problems in sarcoidosis
Depression
Psychosis
Pathological process in sarcoidosis
Granulomata - collections of inflammatory cells - forming in various body parts
Most common areas of the body affected by granulomata in sarcoidosis
Lungs
Skin
Lymph nodes
Rash often seen in sarcoidosis
Erythema nodosum
Clinical features of progressive supranuclear palsy
Loss of balance
Lunging forward when walking
Dementia
Difficulty moving the eyes vertically
Most common Parkinson’s plus syndromes
Multiple system atrophy (Shy-Drager syndrome, striatonigral degeneration, and sporadic olivopontocerebellar atrophy)
Progressive supranuclear palsy
Corticobasal degeneration
Modern equivalents for the subtypes of multiple system atrophy
MSA with predominant parkinsonism
MSA with cerebellar features
No new equivalent for Shy-Drager syndrome
Top three most common brain tumours in children
Astrocytoma
Medulloblastoma
Ependymoma
Top four most common primary brain tumours in adults
Glioblastoma multiforme
Anaplastic astrocytoma
Meningioma
Most common kind of brain tumour in adults
Metastasis
Pathology of a bulbar palsy
Lower motor neuron lesion of CN IX, X and XII
Pathology of a pseudobulbar palsy
Upper motor neuron lesion of CN IX, X and XII
Features of bulbar palsy
Absent gag reflex Wasted tongue Tongue fasciculations Nasal speech Absent or normal jaw jerk Normal emotions
Features of pseudobulbar palsy
Increased gag reflex Spastic tongue Increased jaw jerk Spastic dysarthria Labile emotions
Clinical features of amyotrophic lateral sclerosis
Both upper and lower motor neuron signs
Alternative names for amyotrophic lateral sclerosis
Motor neuron disease
Lou Gehrig’s disease
Pathology of Brown-Séquard syndrome
Damage to one whole half of the spinal cord
Tracts affected in Brown-Séquard syndrome
UMN pathway of the corticospinal tract
Dorsal column
Spinothalamic tract
Features of Brown-Séquard syndrome
Ipsilateral spastic weakness below the site of the lesion
Ipsilateral loss of proprioception and touch below the site of the lesion
Contralateral loss of pain and temperature below the site of the lesion
Most common cause of subacute combined degeneration of the spinal cord
Vitamin B12 deficiency
Tracts affected in subacute combined degeneration of the spinal cord
Dorsal tract
Lateral corticospinal tract
Features of subacute combined degeneration of the spinal cord
Bilateral spastic weakness
Bilateral loss of proprioception and vibration sensation
Cause of anterior cord syndrome
Ischaemia of the anterior spinal artery
Tracts affected in anterior cord syndrome
Lateral corticospinal tracts
Lateral spinothalamic tracts
Features of anterior cord syndrome
Bilateral spastic weakness
Bilateral loss of pain and temperature sensation
Cause of syringomyelia
Cyst or cavity forming within the spinal cord
Tracts affected in syringomyelia
Ventral horns
Lateral spinothalamic tracts
Features of syringomyelia
Flaccid weakness especially of the hands
Loss of pain and temperature sensation
Clinical features of a subdural haemorrhage
Headache
Signs of raised ICP
Fluctuating consciousness
Risk factor for subdural haemorrahge
Old age
Alcohol excess
Anticoagulation
Pathology of a subdural haemorrhage
Collection of blood between the dura mater and the arachnoid mater
Clinical features of an epidural haematoma
Features of raised ICP
Lucid interval
Pathology of an epidural haematoma
Collection of blood between the outside of the dura mater and the skull
Most common site for an epidural haematoma
Temporal region due to a ruptured middle meningeal artery
Features of trigeminal neuralgia
Severe facial pain lasting up to a minute
Often triggered by light touch
Limited to one or more divisions of the trigeminal nerve
Electric-shock like
First line treatment for trigeminal neuralgia
Carbamazepine
Alternative name for obesity hypoventilation syndrome
Pickwickian syndrome
Serum osmolality seen in SIADH
Decreased - <275mOsm/kg
Urine osmolality seen in SIADH
Increased - >100mOsm/kg
Urine sodium seen in SIADH
Increased - >20mmol/L
Season SIADH is seen more commonly in
Summer
Age and sex more often affected by SIADH
Older, female
First line treatment for SIADH
Fluid restriction
Second line treatment for SIADH
Demeclocycline
Drugs most commonly causing SIADH
Antidepressants - especially SSRIs and SNRIs
Carbamazepine
Cyclophosphamide
Medical causes of SIADH
CNS causes - infections, tumours, bleeds, hydrocephalus, MS, GBS, MSA
Cancers - SCLC, mesothelioma, GI cancers, GU cancers, lymphoma, sarcoma
Pneumonia, lung abscess, sarcoidosis
Features of corticobasal degeneration
Asymmetrical symptoms Apraxia Aphasia Parkinsonism Alien hand syndrome
Immunoglobulin in the CSF which has a specific response in anti-NMDA encephalitis
IgG
Most common subtype of CJD
sCJDMM1 and sCJDMV1
HIV associated condition which has been eradicated following introduction of HAART
HIV related toxoplasmosis
Risk factors for pancreatitis relevant to psychiatry
Heavy alcohol use
Eating disorders
Characteristic presentation of parotitis
Painless swellings on the face, usually resolve spontaneously
Type of seizures associated with auras
Complex partial
Seizure location associated with auras
Temporal lobe
CNS cells most commonly infected by HIV
Macrophages
Microglia
Most common CNS opportunistic infection among patients with AIDS
Toxoplasma gondii
Usual inheritance pattern of acute intermittent porphyria
Autosomal dominant
Most common symptom of acute intermittent porphyria
Abdominal pain
Treatment for an acute attack of acute intermittent porphyria
Haemin
10% glucose infusion
Prion disease which has the slowest course
Kuru
Incubation period of kuru before symptoms become evident
Up to 40 years
Features of Kleine Levin syndrome
Hypersomnolence Hyperphagia Hypersexuality Confusion Irritability Restlessness Euphoria Delusions/hallucinations
