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Lancaster FINALS _slide > Medicine (4) > Flashcards

Medicine (4) Flashcards

1
Q

Contraindication to thrombolysis

A
  • active internal bleeding
  • recent haemorrhage, trauma or surgery (including dental extraction)
  • coagulation and bleeding disorders
  • intracranial neoplasm
  • stroke < 3 months
  • aortic dissection
  • recent head injury
  • pregnancy
  • severe hypertension
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2
Q

Drugs used in thrombolysis and their MoA

A

Drugs include streptokinase/alteplase

MoA: Work as tissue plasminogen activators

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3
Q

Treatment of ischaemic stroke (outside of thrombolysis window)

A

Aspirin 300mg (once haemorrhagic stroke excluded)

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4
Q

Management of patient with a stroke (following acute admission)

A

Conservative

  • Stroke rehabilitation – physiotherapy, SALT, depression screening
  • Education and optimizing modifiable risk factors (e.g. smoking/alcohol/weight/diet)
  • Patients are required to inform the DVLA following a stroke
  • Treatment of the complications of stroke (bowel/bladder problems, fatigue, contractures)

Medical

  • Antiplatelet therapy (if no AF) with clopidogrel or anticoagulation (if AF present) with warfarin/NOAC.
  • Control medical risk factors (hypertension, hyperlipidaemia, diabetes mellitus, obstructive

sleep apnoea)

Surgical

• A carotid endarterectomy can be considered if stenosis is >70%

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5
Q

Signs and symptoms associated with anterior cerebral a. stroke

A
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6
Q

Signs and symptoms associated with Middle cerebral a. stroke

A
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7
Q

Signs and symptoms associated with posterior cerebral a. stroke

A
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8
Q

What happens with Basilar a. stroke?

A

Locked-in syndrome

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9
Q

Signs and symptoms associated with anterior inferior cerebellar a. stroke

A
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10
Q

Signs and symptoms associated with posterior inferior cerebellar a. stroke

A
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11
Q

Features of Total Anterior Circulation stroke

A

Total anterior circulation infarct (TACI)

  • Highest total mortality (60% by one year) and very poor chance of making a good recovery to independent living (less than 5%)

Three features- all three are present:

  1. Contralateral hemiparesis
  2. Contralateral homonymous hemianopia
  3. Higher cortical dysfunction

(dysphasia or dyspraxia or inattention)

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12
Q

Features of Partial Anterior Circulation infract

A

Partial anterior circulation infarct (PACI)

Two out of the three features of TACI; typically

  1. Higher cortical dysfunction plus
  2. Contralateral weakness or sensory loss
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13
Q

Features of Posterior Circulation infract

A

Any of the three main possibilities:

  1. Contralateral homonymnous hemianopia OR
  2. Cerebellar signs OR
  3. Brainstem signs (e.g. quadraplegia, gaze/visual disturbance)
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14
Q

Features of Lacunar infarct

A

Presents with 1 of the following:

  1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
  2. pure sensory stroke.
  3. ataxic hemiparesis
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15
Q

What other conditions can mimic stroke?

A
  • Hypoglycaemia
  • Head injury
  • Subdural haemorrhage
  • Intracranial tumours
  • Hemiplegic migraine
  • Post-seizure (Todd’s paresis)
  • CNS infection (e.g. toxoplasmosis, abscess, herpes encephalitis)
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16
Q

Causes of vertigo

A
  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Generalised Age-Related Dysequilibrium
  • Vestibular Migraine
  • Meniere’s Disease
  • Acoustic Neuroma
  • Labyrinthitis
  • Vertebrobasilar ischaemia
  • Stroke
17
Q

Causes of hearing loss

18
Q

Features of acoustic neuroma

19
Q

Management of Meniere’s disease

A

Conservative

• Consider the risks before driving, operating dangerous machinery, using ladders or going

swimming.

  • Be encouraged to move around after an attack – Vestibular rehabilitation
  • Sound therapy, relaxation techniques, and avoiding silent environments for tinnitus
  • An acute attack of vertigo will normally settle within 1–2 days in most people.

Medical

  • Short-term (7-14 days) prochlorperazine or an antihistamine (cinnarizine, cyclizine)
  • Prevention of attacks: Trial of betahistine (16mg TDS)

Surgical

• intratympanic ototoxic drugs (aminoglycosides)

20
Q

Causes of unilateral and bilateral facial n. palsy

21
Q

Features of 3rd nerve palsy + causes

A

3rd Nerve Palsy (dropped and dilated)

  • Eye is deviated down and out
  • Dilated Pupil
  • Dropping Eyelid

Causes: Diabetes/Stroke/Trauma/Posterior Communicating Artery Aneurysm (painful)

22
Q

Features of 6th nerve palsy + causes

A

6th Nerve Palsy

• Failure of abduction of the affected eye leading to diploplia

Causes: Diabetes/Stroke/Trauma/Idiopathic

23
Q

Features of median n. palsy + causes

A

Median Nerve

  • May have positive Tinel’s/Phalen’s
  • Affects LOAF

Causes: Diabetes/Trauma/Neoplasm/RA

24
Q

Features of common peroneal nerve problems

A

Common Peroneal Nerve

• Foot drop (ask the patient to dorsiflex against resistance)

Caused by trauma to the fibula head

25
Mnemonic for causes of peripheral neuropathy
26
Guillian-Barre Syndrome * Aetiology * Features * Ix * Mx
**Aetiology:** immune-mediated demyelination of the peripheral nervous system by antibodies, often triggered by infection (Campylobacter jejuni). Anti-GM1 antibodies (in 25% patients) **Features:** ascending weakness, areflexia, autonomic disturbance **Ix:** BEDSIDE SPIROMETRY (assess for respiratory compromise) IgG oligoclonal bands in CSF **Treatment:** IVIG/plasma exchange/VTE prophlaxis/ventilatory support
27
Features of **myasthenia gravis**
* muscle fatigability → muscles become progressively weaker during periods of activity and slowly improve after periods of rest * extraocular muscle weakness: diplopia * proximal muscle weakness: face, neck, limb girdle * ptosis * dysphagia Associations * thymomas in 15% * autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders, rheumatoid, SLE * thymic hyperplasia in 50-70%
28
Aetiology of Myasthenia Gravis
**Myasthenia gravis** * an autoimmune disorder * results in insufficient functioning acetylcholine receptors * antibodies to acetylcholine receptors are seen in 85-90% of cases
29
Ix of Myasthenia Gravis
* single fibre electromyography * CT thorax to exclude thymoma * CK normal * autoantibodies: around 85-90% of patients have antibodies to **acetylcholine receptors**. In the remaining patients, about about 40% are positive for **anti-muscle-specific tyrosine kinase antibodies** * Tensilon test: ***IV edrophonium*** reduces muscle weakness temporarily - not commonly used anymore due to the risk of cardiac arrhythmia
30
Treatment of Myasthenia Gravis
* long-acting anticholinesterase inhibitors e.g. ***pyridostigmine*** * immunosuppression: ***prednisolone*** initially * thymectomy Management of myasthenic crisis * plasmapheresis * intravenous immunoglobulins
31

Lancaster FINALS _slide (31 decks)

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