Medicine (3) Flashcards
Types of shock
- Cardiogenic
- Obstructive
- Hypovolaemic
- Distributive
- Septic
- Anaphylactic
- Neurogenic
Neutropenic sepsis
- definition (criteria)
- cause
- treatment
Hepatic vs cholestatic LFT picture
What’s that?
‘Beads on a string appearance’
PRIMARY SCLEROSING CHOLANGITIS (PSC)
- associated with IBD
Change in bowel habit - differentials
Causes of cerebellar syndrome
- 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)
Cerebellar signs
Mnemonic for differentials in neurology
Demyelination
Alcohol
Infarct
Space-occupying lesion
Inherited (Friedreich’s/AVED)
Epilepsy medication (phenytoin)
System atrophy (multiple)
What’s Uhthoff’s phenomenon?
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.
(3) main patterns of MS
- 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
Buzzwords (exam) for MS
Buzzwords for examinations:
internuclear ophthalmoplegia or rapid afferent pupillary defect = MS
Diagnostic criteria for MS
Evidence of dissemination of lesions of the central nervous system in both time and space
The revised McDonald Criteria
Ix for MS
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
Management of MS
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
Management of fatigue in MS
Fatigue
- exclude other causes (e.g. anaemia, thyroid or depression)
- trial of amantadine → increase dopamine in certain parts of the body
- mindfulness training
- CBT
Management of spasticity re to MS
Spasticity
- baclofen and gabapentin → first-line
- Other options: diazepam, dantrolene and tizanidine
- physiotherapy
- cannabis and botox are undergoing evalulation
Management of bladder dysfunction related to MS
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
Management of oscillopsia in MS patients
Oscillopsia (visual fields apper to oscillate)
- gabapentin is first-line
Causes of parkinsonism
- 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
Presentation/symptoms of Parkinson’s
- 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).
Non-motor symptoms of Parkinson’s disease
- Depression
- Dementia
- Rapid Eye Movement (REM)
- Behaviour Sleep Disorder
- Visual hallucinations
- Urinary frequency/Urgency
What could be seen on examination in a patient with Parkinson’s disease?
Conservative management of pt with Parkinson’s disease
- 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
Medical management of Parkinson’s disease
- 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
Causes of UMN and LMN signs
UMN vs LMN signs
What’s that?
What’s that?
Diagnostic criteria for migraine without aura
Treatment (acute and prophylactic) of:
- tension-type headache
- cluster headache
- migraine
Red flags for headaches
