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Lancaster FINALS _slide > Medicine (3) > Flashcards

Medicine (3) Flashcards

1
Q

Types of shock

A
  • Cardiogenic
  • Obstructive
  • Hypovolaemic
  • Distributive
  • Septic
  • Anaphylactic
  • Neurogenic
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2
Q

Neutropenic sepsis

  • definition (criteria)
  • cause
  • treatment
A
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3
Q

Hepatic vs cholestatic LFT picture

A
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4
Q

What’s that?

A

‘Beads on a string appearance’

PRIMARY SCLEROSING CHOLANGITIS (PSC)

  • associated with IBD
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5
Q

Change in bowel habit - differentials

A
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6
Q
A
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7
Q

Causes of cerebellar syndrome

A
  • 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)
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8
Q

Cerebellar signs

A
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9
Q

Mnemonic for differentials in neurology

A

Demyelination

Alcohol

Infarct

Space-occupying lesion

Inherited (Friedreich’s/AVED)

Epilepsy medication (phenytoin)

System atrophy (multiple)

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10
Q

What’s Uhthoff’s phenomenon?

A

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.

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11
Q

(3) main patterns of MS

A
  • 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
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12
Q

Buzzwords (exam) for MS

A

Buzzwords for examinations:

internuclear ophthalmoplegia or rapid afferent pupillary defect = MS

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13
Q

Diagnostic criteria for MS

A

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

The revised McDonald Criteria

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14
Q

Ix for MS

A

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
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15
Q

Management of MS

A

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

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16
Q

Management of fatigue in MS

A

Fatigue

  • exclude other causes (e.g. anaemia, thyroid or depression)
  • trial of amantadine → increase dopamine in certain parts of the body
  • mindfulness training
  • CBT
17
Q

Management of spasticity re to MS

A

Spasticity

  • baclofen and gabapentin → first-line
  • Other options: diazepam, dantrolene and tizanidine
  • physiotherapy
  • cannabis and botox are undergoing evalulation
18
Q

Management of bladder dysfunction related to MS

A

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
19
Q

Management of oscillopsia in MS patients

A

Oscillopsia (visual fields apper to oscillate)

  • gabapentin is first-line
20
Q

Causes of parkinsonism

A
  • 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
21
Q

Presentation/symptoms of Parkinson’s

A
  • 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).

22
Q

Non-motor symptoms of Parkinson’s disease

A
  • Depression
  • Dementia
  • Rapid Eye Movement (REM)
  • Behaviour Sleep Disorder
  • Visual hallucinations
  • Urinary frequency/Urgency
23
Q

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

A
24
Q

Conservative management of pt with Parkinson’s disease

A
  • 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
25
Q

Medical management of Parkinson’s disease

A
  • If motor symptoms are affecting quality of life → Levodopa
  • If motor symptoms are not affecting quality of life → dopamine 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
26
Q

Causes of UMN and LMN signs

A
27
Q

UMN vs LMN signs

A
28
Q

What’s that?

A
29
Q

What’s that?

A
30
Q

Diagnostic criteria for migraine without aura

A
31
Q

Treatment (acute and prophylactic) of:

  • tension-type headache
  • cluster headache
  • migraine
A
32
Q

Red flags for headaches

A

Lancaster FINALS _slide (31 decks)

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