MLA Flashcards
what type of laxative is ispaghula hulk?
bulk forming
what type of laxative is docusate?
softener/ mild stimulant
what type of laxative is bisacodyl/ senna/ glycerin ?
stimulant
what types of laxative is macrogel?
osmotic
what is important with osmotic and bulk forming laxatives?
adequate fluid intake
when should stimulant laxatives not be used?
intestinal obstruction
when should osmotic laxatives not be used?
IBS
what is first line in drug induced constipation?
stimulant laxatives
what laxative is typically used in chronic constipation?
bulk fomring
what laxative is typically used in chronic constipation in IBS/ frail patients?
stool softeners
what is first line for faecal impaction?
enema
then movicol
beckers MD
Beckers muscular dystrophy is very similar to Duchennes, however the dystrophin gene is less severely affected and maintains some of its function. The clinical course is less predictable than Duchennes. Symptoms only start to appear around 8 – 12 years. Some patient require wheelchairs in their late 20s or 30s . Others able to walk with assistance into later adulthood. Management is similar to Duchennes.
myotonic dystrophy
Myotonic dystrophy is a genetic disorder that usually presents in adulthood. Typical features are:
Progressive muscle weakness
Prolonged muscle contractions
Cataracts
Cardiac arrhythmias
TOM TIP: The key feature of myotonic dystrophy to remember is the prolonged muscle contraction. This may present in exams with a patient that is unable to let go after shaking someones hand, or unable to release their grip on a doorknob after opening a door. When doing an upper limb neurological examination always shake the patients hand and observe for difficulty releasing their grip
fasciulohumeral MD
Facioscapulohumeral muscular dystrophy usually presents in childhood with weakness around the face, progressing to the shoulders and arms. A classic initial symptom is sleeping with their eyes slightly open and weakness in pursing their lips. They are unable to blow their cheeks out without air leaking from their mouth.
occulopharyngeal MD
Oculopharyngeal muscular dystrophy usually presents in late adulthood with weakness of the ocular muscles (around the eyes) and pharynx (around the throat) as the name suggests. It typically presents with bilateral ptosis, restricted eye movement and swallowing problems. Muscles around the limb girdles are also affected to varying degrees
Limb girdle MD
Limb-girdle muscular dystrophy usually presents in teenage years with progressive weakness around the limb girdles (hips and shoulders)
emery dreifus MD
Emery-Dreifuss muscular dystrophy usually presents in childhood with contractures, most commonly in the elbows and ankles. Contractures are shortening of muscles and tendons that restrict the range of movement in limbs. Patients also suffer with progressive weakness and wasting of muscles, starting with the upper arms and lower legs
Contralateral hemiparesis and sensory loss, lower extremity > upper
anterior cerebral artery stroke
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
middle cerebral artery
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
posterior cerebral artery
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Symptoms are similar to Wallenberg’s (see above), but:
Ipsilateral: facial paralysis and deafness
Anterior inferior cerebellar artery (lateral pontine syndrome)
‘Locked-in’ syndrome
basilar artery
what are UKMEC 3 conditions?
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
what are UKMEC4 conditions?
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
describe surgery planning in breast cancer
surgery and planning in breast cancer:
if no axillary lymphadenopathy then axillary US > sentinal node biopsy
if palpable lymphadenopathy, axillary node clearance is indicated.
when is radiotherapy given in breast cancer?
with wide local excision
describe hormonal therapy in breast cancer
hormonal therapy if hormone receptor positive - tamoxifen in pre and peri menopause. anastrozole in post.
trastuzuman (herceptin) in HER2 positive
what is management of intrahepatic cholestasis of pregnancy?
induction of labour at 37-38 weeks
ursodeoxycholic acid for symptom control
what happens in shaken babies?
retinal haemorrhages, subdural haematoma and encephalopathy
symptoms of focal frontal lobe seizures
-Pelvic thrusting, kicking, pedalling, thrashing or rocking movements
-Screaming, swearing or laughing
-Unintentionally passing urine (urinary incontinence)
-Your head or eyes turning to one side
-Having unusual body movements, such as stretching one arm while the other bends
-Twitching, jerking or stiffening of muscles in one area of your body
occipital focal seizures symptoms
Seeing flashing lights, colours or simple patterns
Seeing more complex images, such as pictures of people, animals or scenes
Not being able to see as well as usual, or not being able to see at all
Having eye movements you can’t control, such as your eyes closing, moving to one side or moving quickly from side-to-side
Repeated blinking
parietal lobe seizure symptoms
Having feelings of numbness or tingling
Prickling, crawling or electric-shock sensations, which may spread along the affected body part
Sensations of burning, cold or pain
Feeling like part or all of your body is moving or floating
Feeling like a body part has shrunk, become bigger or is missing
Sexual sensations
Difficulty understanding language, reading, writing or doing simple maths
Seeing things as bigger or smaller than they really are, or seeing things that aren’t there
