Medicine (3)

Question 1

Types of shock

Answer 1

• Cardiogenic
• Obstructive
• Hypovolaemic
• Distributive
• Septic
• Anaphylactic
• Neurogenic

Question 2

Neutropenic sepsis

• definition (criteria)
• cause
• treatment

Answer 2

Question 3

Hepatic vs cholestatic LFT picture

Answer 3

Question 4

What’s that?

Answer 4

‘Beads on a string appearance’

PRIMARY SCLEROSING CHOLANGITIS (PSC)

• associated with IBD

Question 5

Change in bowel habit - differentials

Answer 5

Question 7

Causes of cerebellar syndrome

Answer 7

• Multiple Sclerosis
• Cerebellar or Brainstem stroke
• Space-occupying lesion
• Severe hypothyroidism
• Alcohol abuse
• Phenytoin
• Multiple system atrophy
• Paraneoplastic syndrome (anti-hu)
• Lesions at the cerebellopontine angle
• Rarer: (Wilson’s/Refsum’s/Friedreich’s/
• AVED)

Question 8

Cerebellar signs

Answer 8

Question 9

Mnemonic for differentials in neurology

Answer 9

Demyelination

Alcohol

Infarct

Space-occupying lesion

Inherited (Friedreich’s/AVED)

Epilepsy medication (phenytoin)

System atrophy (multiple)

Question 10

What’s Uhthoff’s phenomenon?

Answer 10

Uhthoff’s phenomenon → worsening of neurologic symptoms in multiple sclerosis (MS) and other neurological, demyelinating conditions when the body gets overheated from hot weather, exercise, fever, or saunas and hot tubs.

Question 11

(3) main patterns of MS

Answer 11

• Relapsing remitting MS: symptoms → recovery → stability → symptoms etc.
• Secondary progressive MS: gradually worsening MS usually after RRMS
• Primary Progressive MS: gradually worsening of the disease from onset without remissions

Question 12

Buzzwords (exam) for MS

Answer 12

Buzzwords for examinations:

internuclear ophthalmoplegia or rapid afferent pupillary defect = MS

Question 13

Diagnostic criteria for MS

Answer 13

Evidence of dissemination of lesions of the central nervous system in both time and space

The revised McDonald Criteria

Question 14

Ix for MS

Answer 14

Mainly to support a diagnosis of MS and to exclude other conditions:

Bloods:

• Aquaporin 4 antibotics (neuromyelitis optica – MS mimicker)
• Vitamin B12
• HIV screen
• ESR

Imaging: MRI head and spinal cord (detect demyelination)

Invasive

• LP for CSF – may show unmatched oligoclonal IgG bands

Question 15

Management of MS

Answer 15

Conservative:

• Education
• MDT

Medical: *different criteria for different drugs (specialist use)

• Relapse management → methylprednisolone

Disease-modifying drugs:

• Monoclonal antibodies: Alemtuzumab, ocrelizumab
• Oral drugs: Cladribine, Fingolimod, Terflunomide, Natalizumab
• Subcutaneous: beta-interferon, Glatiramer acetate

Complications management:

Fatigue/mobility/depression/pain/spasticity/memory impairment/incontinence/sexual

Question 16

Management of fatigue in MS

Answer 16

Fatigue

• exclude other causes (e.g. anaemia, thyroid or depression)
• trial of amantadine → increase dopamine in certain parts of the body
• mindfulness training
• CBT

Question 17

Management of spasticity re to MS

Answer 17

Spasticity

• baclofen and gabapentin → first-line
• Other options: diazepam, dantrolene and tizanidine
• physiotherapy
• cannabis and botox are undergoing evalulation

Question 18

Management of bladder dysfunction related to MS

Answer 18

Bladder dysfunction

• may take the form of urgency, incontinence, overflow etc
• get an ultrasound first → to assess bladder emptying - anticholinergics may worsen symptoms in some patients
• if significant residual volume → intermittent self-catheterisation
• if no significant residual volume → anticholinergics to improve urinary frequency

Question 19

Management of oscillopsia in MS patients

Answer 19

Oscillopsia (visual fields apper to oscillate)

• gabapentin is first-line

Question 20

Causes of parkinsonism

Answer 20

• Idiopathic Parkinson’s disease
• Cerebrovascular (vascular parkinsonism)
• Drug-induced (prochlorperazine, metoclopramide)
• Metabolic diseases (Wilson’s)
• Parkinson’s-plus syndromes (Progressive nuclear palsy (PSP), Multiple Systems Atrophy (MSA), Corticobasal degeneration (CBD), Lewy-Body Dementia

Question 21

Presentation/symptoms of Parkinson’s

Answer 21

• Tremor (present at rest)
• Rigidity (tone – with superimposed tremor leads to cogwheel rigidity)
• Akinesia (or bradykinesia)
• Postural instability (without other cause)

* symptoms of Parkinson’s disease are usually asymmetrical (used to differentiate from drug-induced parkinsonism where the symptoms

are usually bilateral).

Question 22

Non-motor symptoms of Parkinson’s disease

Answer 22

• Depression
• Dementia
• Rapid Eye Movement (REM)
• Behaviour Sleep Disorder
• Visual hallucinations
• Urinary frequency/Urgency

Question 23

What could be seen on examination in a patient with Parkinson’s disease?

Answer 23

Question 24

Conservative management of pt with Parkinson’s disease

Answer 24

• MDT
• Education about the condition to the patient and their family
• to not suddenly stop any anti-parkinsonian medication as it can precipitate acute akinesia or neuroleptic malignant syndrome
• Patients are required to inform the DVLA about their condition

Question 25

Medical management of **Parkinson's disease**

Answer 25

* If motor symptoms are affecting quality of life → ***Levodopa*** * If motor symptoms are not affecting quality of life → d**opamine agonist,** a **monoamine oxidase B inhibitor** or **levodopa** * Other medications with can be used include: **Amantadine, COMT inhibitors** and **antimuscuarinics** * Advanced therapies e.g. ***Duodopa*** and ***Apomorphine*** ⇒ used in later stages * ***Fludrocortisone*** or ***Midodrine*** (an alpha-1 agonist) → if orthostatic hypotension requires treatment

Question 26

Causes of UMN and LMN signs

Answer 26

Question 27

UMN vs LMN signs

Answer 27

Question 28

What's that?

Answer 28

Question 29

What's that?

Answer 29

Question 30

Diagnostic criteria for migraine without aura

Answer 30

Question 31

Treatment (acute and prophylactic) of: * tension-type headache * cluster headache * migraine

Answer 31

Question 32

Red flags for headaches

Answer 32