Medicine Tips 6

Question 1

Temporal lobe seizure

Answer 1

HEAD
Hallucinations (auditory/gustatory/olfactory) 
Epigastric rising/Emotional 
Automatisms (lip smacking/grabbing)
Deja vu/Dysphasia post-ictal

Question 2

Frontal lobe seizure

Answer 2

Motor symptoms

Head/leg movements , posturing, post-ictal weakness

Question 3

Parietal lobe seizure

Answer 3

Sensory symptoms

Paraesthesia

Question 4

Occipital lobe seizure

Answer 4

Visual symptoms

Floaters/flashes

Question 5

Thyroid storm crisis management

Answer 5

IV hydrocortisone, propranolol, IV fluids

Question 6

Addisonian crisis management

Answer 6

IV hydrocortisone, IV fluids, glucose, antibiotics

Question 7

Myasthenic crisis management

Answer 7

Plasmaphoresis + IVIG

Question 8

Trigeminal neuralgia

Answer 8

Severe unilateral pain
Red flags - sensory changes, deafness or other ear problems, history of skin or oral lesions that could spread perineurally, pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose) or bilaterally, optic neuritis, FHx of MS, onset < 40 years
Mx - carbamazepine -> refer to neurology

Question 9

Multiple system atrophy

Answer 9

Parkinsonism + cerebellar signs + autonomic disturbance (ED, postural hypotension, atonic bladder)

Question 10

New York Heart Association (NYHA) classification

Answer 10

I - no limitation (ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations)
II - slight limitation of physical activity (comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea)
III - marked limitation of physical activity (comfortable at rest but less than ordinary activity results in symptoms)
IV - unable to carry out any physical activity without discomfort (symptoms of heart failure are present even at rest with increased discomfort with any physical activity)

Question 11

How many days before a surgery should you stop warfarin and what is target INR?

Answer 11

5 days before surgery

INR < 1.5

Question 12

Fast AF management

Answer 12

Rate control - > 65 years old, history of IHD
Beta blockers (atenolol), CCB (verapamil/diltiazem), digoxin 

Rhythm control - < 65 years old, symptomatic, first presentation, lone AF or AF due to a corrected precipitant, CCF
Sotalol, amiodarone, flecainide

Question 13

Orthostatic hypotension

Answer 13

3-2-1-drop

After 3 minutes of standing, drop in BP of 20 mmHg systolic or 10 mmHg diastolic

Question 14

Emphysema

Answer 14

Upper lobes - COPD

Lower lobes - alpha-1 antitrypsin deficiency

Question 15

Which medication could lead to a reduced awareness of the symptoms of a hypoglycemic event following insulin use?

Answer 15

Beta blockers

Question 16

Causes of mitral stenosis

Answer 16

Rheumatic fever, AF, carcinoid syndrome

Question 17

CHA2DS2-VASc score

Answer 17

C - congestive heart failure
H - hypertension
A - 2 for > 75 years; 1 for 65 - 74 years
D - diabetes
S - 2 for previous stroke/TIA
V - vascular disease
S - sex (female)

Score of 0 - do nothing
Score of 1 - if female, do nothing; if male, consider aticoagulation
Score of > 2 - offer anticoagulation

Question 18

Cerebellar vermis lesions

Answer 18

Gait ataxia

Question 19

Cerebellar hemisphere lesions

Answer 19

Finger-nose ataxia