Mixture Flashcards
Occlusion of which cerebral artery would cause personality changes
Anterior
Symtpoms of MCA stroke
Aphasiaheadachehemiplegiaweakness+others
DEXA scan results for osteoporosis
Normal >-1Osteopenia -1-2.5osteoporosis < -2.5
Polypharmacy definition
the concurrent use of multiple medications by a patient (~5)
What is overflow incontinence
Inability to completely empty bladder
rf for overactive bladder
high caffeinealcoholsome medicines
What is a total anterior circulation stroke
affects parts of brain supplied by anterior and middle cerebral arteries
Presentation of total anterior circulation stroke
unilateral weakness of face arm and leghigh cerebral dysfunctionhomonymous hemianopia
Horner’s syndrome presentation
unilateral anhidrosis (abscnece of sweating on face)enophthalmos (inset eye)miosis (constricted pupil)and ptosisAlways remember lung apical (Pancoast) tumour compressing the sympathetic chain
What is mydriasis
dilated pupil
What is the medication for MND
riluzole (only one)
what is the first-line drug for Alzheimers
donezepil (acetylcholinesterase inhibitor) or rivastigmine
What is the drug of choice for severe ALzheimers
memantine
What is the treatment of choice for trigeminal neuralgia
carbamazepine(else - lamotrigine, gabapentin, phenytoin)
triggers of migraine
ChocolateHangoverOrgasmCheeseOral contraceptieLie insAlcoholTumultExerciseOthers: periods, injury, bright lights/boises, huger, smoking
First line prevention of migraine
topiramate OR propranolollook for contraindications in stemtopiramate = teratogenicpropranolol = x asthma
What s corticobasal degenereation
Parkinson plus syndromeHas alien hand syndrome (limbs moving on own)+apraxia +aphasia
What is progressive supranuclear palsy
Parkinson plus syndromesupranucear opthalmoplegia (initially cant look down, then cant look left and right)neck dystonia, balance issues and cognitive impairment
Action of ropinirole
Activates dopamine receptors to mimic the action of dopamine (alternative to L-dopa)
What can be used for meningitis close contact prophylaxis
oral ciprofloxacin or rifampicin.
Criteria for orthostatic hypotension
A drop in blood pressure of at least 20 systolic or 10 diastolic within 3 minutes of standing
aortic dissection presentation
10/10 pain in centre of chest or back, radiating to neck/jaw and spreading caudally. Receding pain. Sweaty, weak left sided pulse
Features of PE o ECG
ST depression or sinus tachycaria
Signs of PE on CXR
Fleischner sign (dilated central pulmonary vessel)Westermark sign (collapse of vasculature distal to PE)Hampton’s hump (wedge shaped infarct
Treatment for pericarditis
NSAIDs first linecolchicine
What is the mechanism of action of N-acetylcysteine in the treatment of paracetamol overdose
Replenishes stores of glutathione in hepatocytes. This binds to NAPQI which is the toxic product from paracetamol
What can be used to reverse heparin
protamine
what can be used to reverse warfarin
beriplexvitamin k
What drugs should be given to MI patients on arrival to hospital
bisoprolol, clopidogrel and LMWH
which crystals are seen in gout
negatively birefringent needles
which crystals are seen in pseudogout
positively birefringent crystals
what is aspirin
cox 1 inhibitor
what is clopidogrel
p2y12 inhibitor
What is tamsulosin and what are its side effects
an alpha blocker used for benign prostatic hyperplasia. common side effects are dizziness and sexual dysfunction
What should be done in HELLP syndrome
deliver baby!
what can small cell carcinoma of the lung secrete
ADH or ACTH
what can squamous cell carcinoma of the lung secrete
PTH and hence cause hypercalcaemia
what is Conn’s syndrome
primary hyperaldosteronism
features and treatment of Conn’s syndrome
Hypernatraemia and hypokalaemiatreatment is potassium sparing diuretic - spironolactone
treatment of h.pylori infection
PPI + clarithromycin + metronidazole
Stages of CKD
- >
- 60-893A. 45-593B. 30-444. 15-29
should you treat a second seizure
yes if there hasnt been sufficient time to recover, administer a benxodiazepine
what is the first medical treatment for COPD
- SABA or SAMA2. LABA + LAMA3. +ICS
aki stage 1
creatinine <2x baseline/ urine output <0.5ml/kf for >6 consecutive hours
aki stage 2
creatinine 2-3x baseline/urine output <0.5ml/kg for >12 consecutive hours
aki stage 3
creatinine >3x baseline/urine output <0.5ml/kg >24 hours
some drugs that cause aki
NSAIDACEiARBsCCBsa-blockersb-blockersopiodsdiureticsacyclovirtrimethoprimlithium
what is a static risk factor
one that cant be changed
what is error of inheriting thinking
when a working diagnosis is handed over and accepted without consideration
what is error of ignorance
unconscious incompetence
Which nerve lesion spares the forehead
UMN lesion! think stroke
which nerve involves the forehead
LMN! remember a LMN should be ipsilateral as it is after the decussation
What is the treatment of temporal arteritis
prednisolone high dose!risk of amaurosis fugax
What is diagnostic of temporal arteritis
temporal artery biopsy
what else are those with temporal arteritis at risk of
AAA so would want to do a CT abdomen
Wernicke Korsakoff syndrome presentation
encephalopathyophthalmoplegiaataxiaamnesiaconfabulation
first line treatment for guillain barre
IV immunoglobulins
treatment of kawasaki disease
aspirin and IVIG!
What does temporal arteritis have a strong association with
polymyalgia rheumatica ~50%
what causes a convergent squint (esotropia)
hypermetropia (long sightedness) causes image to focus behind the retina.myopia = short sightedness
What receptors do beta agonists act on
G protein-coupled receptors - cause smooth muscle relaxation and hence bronchodilation
how might gastric cancer resent
palpable mass, ascites, dysphagia
what might you see on the xray of someone with heart failure
A- alveolar oedema (bat wing opacities)B - Kerley B linesC - cardiomegalyD - dilated upper lobe veinsE - pleural effusion
what is measured to assess managment of heart failure
serum natriuretic peptide-pro BNP
when to do an audit score
to establish history of drinking problems, do this first if insufficient info in the stem!
treatment of cluster headache
high flow oxygen and sumatriptan (unless contraindicated by IHD)
prophylaxis of cluster headaches
verapamil
what mass can myasthenia gravis present with
thyoma in 15% shown as a large anterior mediastinal mass on CT
how can myasthenia gravis be diagnosed
ice test or Tensilon test
Symptoms of normal pressure hydrocephalus
urinary incontinencedementiagait disturbance
what might a myoclonic seizure encompass
brief, involuntary jerking movements in limbs or facial muscles, without loss of consciousness
what is a common cause of isolated seizures
head trauma
what connects the lateral ventricles to the third ventricle
foramen of monro
what connects the third and fourth ventricles
cerebral aqueduct
what is the temperature phenomenon in MS called
Uhthoff’s phenomenon
presentation of primary biliary cholangitis
fatiguejaundicepruritis
associations of PBC
Anti-mitochondrial antibodies!!!!!also look for associated autoimmune conditions
signs of nephrotic syndrome
pitting oedemaheavy preoteinuriahyperlipidaemia
complications of nephrotic syndrome
DVT (hypercoaguable state)pleural effusionsincreased risk of infection (loss of IG in urine)
thyrotoxicosis signs
very fast heart beatirregularly irregular pulseweight lossstressfine tremor
what organism causes syphillis
Treponema Pallidum - spirochaete.Think painless sore presentation
what organism is candida
pseudohyphae
what blood markers indicate PCOS
Low FSH raised LHmay also have raised testosteronecheck for impaired glucose tolerance!!!!
management for those with primary adrenal insufficiency with febrile illness/broken bone/diarrhoea or cold
must double the dose orf corticosteroid!!!(hydrocortisone)dont need to double e.g. fludrocortisone
risk factors for SAH
Elhers Danlossmokingalcoholcocainepolycystic kidneyscoarctation of the aorta
SAH on CT
white star shape
where might biliary colic pain refer to
between the scapulae
what is charcots triad
fever, RUQ, jaundice
what is charcots triad indicative of
cholangitis
Signs of basal skull fracture
panda eyesBattle’s sign (bruising behind ear)CSF from noseURGENT CT needed
How to tell if chronic subdural haematoma
commonly in elderly or alcoholicsold blood is DARK on a CT
how to tell acute subdural haematoma
blood will be lighter than brain tissue = acute bleed
Treatment of frontotemporal dementia
DO NOT OFFER memantine or acetyl cholinesterase inhibitors.SSRIs may provide symptomatic relief, other than that no treatment!!!!
what antibodies are present in guillain barre syndrome
anti-gangliside
what would temporal arteritis show on a temporal artery biopsy
granulomatous inflammation(note has skip lesions so a negative biopsy does not exclude)
What is Ramsay Hunt syndrome
caused when singles occurs in the facial nerve.Associated with a painful herpetic rash in the ear canal
How is Ramsay Hunt syndrome managed
oral aciclovir or corticosteroidsto manage the pain give pregabalin as it is neuropathic pain
Test results for Myasthenia Gravis
Anti-MuSK antibodies in serumincreased jitter with single-fibre EMG
triad of normal pressure hydrocephalus
dementiaataxiaurinary incontinence
what is the definitive treatment for normal pressure hydrocephalus
ventriculoperitoneal shunt
acute management of cluster headache
high flow O2 and subcutaneous sumatriptan
What is Lambert-Eaton myasthenic syndrome
condition caused by neuroendocrine small cell lung cancer (paraneoplastic - a condition that arrises from cancer elsewhere in body).auto-immune antibodies against sodium voltage-gated ion channels
symptoms of Lambert-Eaton myasthenic syndrome
muscle weakness which improves with usehyporeflexiahistory of smoking/lung cancer risk
extradural haemorrhage on CT
biconvex (lemon shape) collection of blood that does not cross the suture lines
how would NPH present on CT
dilated ventricles
how would subdural haematoma present on CT
crescent shape that crosses the suture linesdark = old bloodlight = new
complication of SAH
blood in basal cisterns can lead to vasospasm as there is blood surrounding the cerebral arteries
how can vasospasm be prevented in SAH
nimodipine (CCB)
presentation of posterior inferior cerebellar artery stroke PICA
ipsilateral loss of pain and temperature on the faceipsilateral Horner’scontralateral loss of pain and temperature sensation on the body
Presentation of anterior inferior cerebellar artery AICA stroke
Same as PICA+ ipsilateral facial paralysis and hearing loss
presentation of progressive bulbar palsy
quiet nasal speech, flaccid, fasciculating tongue, absent gag reflex
presentation of pseudobulbar palsy
spastic tongue, hot-potato speech and drisk jaw jerk
B12 deficiency neurological presentation
can cause subacute combined degeneration of the spinal cord:loss of vibration and proprioceptionspasticityataxia
what is internuclear ophthalmoplegia
impaired adduction of eye on SAME side as lesionhorizontal nystagmus of the abducting eye on the contralateral side
cause of internuclear ophthalmoplegia
lesion in the medial longitudinal fasciculus (controls horizontal eye movements by interconnecting the III, IV and VI CN)located in the midbrain/ponsCAUSES:Multiple sclerosisvascular
what is syringomyelia
collection of csf within the spinal cord
presentation of syringomyelia
cape-like loss of sensation to temperature but preservation of other sensories.Classic example is patient who burns their hands and doesnt realisealso spastic weakness, paraesthesia, neuropathic pain, bowel and bladder dysfunction
investigation and management of syringomyelia
full spine MRIbrain MRI as STRONGLY ASSOCIATED WITH ARNOLD CHIARI MALFORMATIONtreatment - shunt/treat cause
what is arnold chiari malformation
downward displacement of cerebellar tonsils through foramen magnum. congenital/traumaFeatures:non-communicating hydrocephalusheadachesyringomyelia
what is used in acute MS relapse
methylprednisolone IV or oral to shorten lengthBaclofen for MS spasms
common cause of neuroleptic malignant syndrome
hospitalisation of someone and not giving them parkinson meds
difference between bacteria, tb and fungi on LP
bacteria = high lymphocytesfungi and tb low lymphocytestb cloudy with fibrin web appearancefungi/bacteria cloudy
how long until someone can drive withdrawing/changing epilepsy medication
6 months when AEDs withdrawn/changed
when can you drive a car with epilepsy
1 year seizure free
when can you drive a car after having a single seizure
6 months
how long until can drive a bus/lorry with one off seizure
5 years
how long until drive bus or lorry with multiple seizure
10 years
presentation of acoustic neuroma (scwanomma)
gradual onset unilateral hearing loss +/- vertigo.neurofibromatosis type 2 is associated with bilateral schwanommas
how to take alendronic acid
once a week on the same day, firsth thing in the morning. Stand upright for the first 30 minutes and don’t eat anything for 30 minutes
how to take vitamin D when on alendronic acid
take same time everyday but not within 4 hours of alendronic acid
features of Huntington’s disease
develop after 35 years if age (but shows anticipation)choreapersonality change (irritable, apathy, depression)intellectual impairmentdystoniasaccadic eye movements (jerky)typically live for 20 years after development
osgood schlatter disease
seen in sporty teenagerspain, tenderness and swelling over the tibial tubercle (knee)supportive management
osteochondritis dissecans
pain after exerciseintermittend swelling and locking
