MLA Paper 1 Flashcards
motor neuron disease: types
typically LMN signs in arms and UMN signs in legs
in familial cases the gene responsible lies on chromosome 21 and codes for superoxide dismutase
Amyotrophic lateral sclerosis (50% of patients)
Primary lateral sclerosis
* UMN signs only
Progressive muscular atrophy
* LMN signs only
* affects distal muscles before proximal
* carries best prognosis
Progressive bulbar palsy
* palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei
* carries worst prognosis
Upper vs lower motor neuron signs
common clinical sign that may be found with a mid shaft humeral fracture
Wrist drop
- radial nerve runs in the radial groove of the mid shaft of the humerous
- very vulnerable to damage in a mid shaft fracture
Axillary nerve located near proximal humerus !
this type of medication has the strongest evidence base for reducing relapse in multiple sclerosis
Natalizumab : monoclonal antibody
Note: amantadine can reduce fatigue
antagonises alpha-4-beta-1 integrin found on surface of leucocytes - reducing migration of leukocytes across the blood brain barrier
Multiple sclerosis: specific problems and management
1. Fatigue –> amantadine , mindfullness training and CBT
2. Spasticity –>
* 1st line:baclofen & gabapentin
* 2nd line: diazepam, dantrolene and tizanidine, physio
3. Bladder dysfunction
* urgency, incontinence, overfloq?
* USS
* If significant residual volume –> intermittent self-catheterisation
* If no significant residual volume –> anticholingerics may improve
4. Oscillopsia (visual fields appear to oscillate)
* 1st line: Gabapentin
what type of imaging should be used to view demyelinating lesions?
MRI w/ contrast
Will show plaques representing areas of demyelination
‘Tear drop’ poikilocytes are seen in:
Myelofibrosis
Seen within the cytoplasm of myeloid blast cells
Smear cells are typically seen in
chronic lymphocytic leukaemia (CLL)
they are remnants of cells and have no identifiable plasma membrane or nuclear structure
these type of cells are generally found in hereditary spherocytosis or autoimmune haemolytic anaemia
SPHEROCYTES
Sphere shaped cells rather than donut shaped , more fragile than normal red blood cells.
these type of cells are generally seen within iron-deficiency anaemia or hyposplenism
TARGET CELLS
Increase in red cell surface area or decrease in intracellular haemoglobin
first line treatment in otitis externa
Ciprofloxacin and dexamethasone
Topical antibiotics with or without steroid
Chicken pox exposure in pregnancy:
- Ask patients chicken pox history
- check maternal blood for varicella antibodies
- If confirmed not immune then considr varicella immunoglobulin (effective up to 10 days post exposure, given at any point)
- oral aciclovir now 1st choice of PEP (day 7 to day 14 after exposure)
Infective endocarditis in intravenous drug users most commonly affects
tricuspid valve
If a mild-moderate flare of distal ulcerative colitis doesn’t respond to topical (rectal) aminosalicylates then what should be added
oral aminosalicylates
e.g. mesalazine / sulphalazine
What test is used for the diagnosis of T1DM?
Random plasma glucose >11 is diagnostic for T1DM or fasting plasma glucose > 7
This
classically presents with a sore throat, fever, headache, bright red tongue and a coarse, red rash
SCARLET FEVER
Scarlet fever: management
10 days of phenoxymethylpenicillin or azithromycin (if pen allergic)
Notifiable disease.
Children can reutrn to school 24 hours after commencing antibiotics
This condition presents with an erythematous polymorphous rash, strawberry tongue, cervical lymphadenopathy, bilateral conjunctivitis, oedema, erythema, and skin peeling of the hands and feet.
Patients may have a fever lasting 5 days
KAWASAKI DISEASE
this presents with a diffuse erythematous facial rash appearing on one or both cheeks (resembling a ‘slapped cheek’) in children
Parvovirus b19
Critieria for discharge post asthma exacerbatio
- Been stable on their discharge medication for 12-24 hours
- Inhaler technique checked and recorded
- PEF > 75% of best or predicted
this is a test for infectious mononucleosis, glandular fever, detecting the Epstein Barr virus
Monospot test
these medications are known to exacerbate plaque psoriasis
Beta blockers
B - beta blockers
L - lithium
A - ACEi
N - NSAIDs
Q - quinines
Prophylaxis for spontaneous bacterial peritonitis:
Patients with ascites (and protein concentration <= 15 g/L) should be given oral ciprofloxacin as prophylaxis
Treat - Cefotaxime
Prevent - Ciprofloxacin
How might you reduce the risk of hypertensive disorders in pregnancy?
women should take 75-150mg daily from 12 weeks gestation until birth
> 1 high risk factors
2 moderate risk factors
pulseless VT management
CPR and Defibrillation
VT with a pulse
Synchronised DC cardioversion
Polymyalgia rheumatic: tx
Tx
–> prednisolone e.g. 15mg/od
Patients typically respond dramatically to steroids!
Weakness is not considered a symptom of polymyalgia rheumatica –> its mainly due to pain inhibition
Patients with heart failure with reduced LVEF should be given
beta blocker and an ACE inhibitor as first-line treatment
Drugs that may lead to serotonin syndrome?
STEAM
S: SSRI
T: Tramadol
E: Ecstasy
A: Amphetamines
M: MAOi
lithium toxicity: management
- Mild-moderate = volume resuscitation with normal saline
- Haemodialysis in severe toxicity
- Sodium bicarbonate (increasing alkalinity of urine thus promotes lithium excretion)
Dialysis Indications
A - Acidosis
E - Electrolyte (Refractory Hyperkalaemia)
I - Ingested Toxins (SLIME = Salicylates, Lithium, Isopropanol, Methanol/Mg Laxatives, Ethylene Glycol)
O - Refractory oedema
U - Uraemic Encephalopathy/Carditis
What is subclinical hypothyroidism?
TSH raised, but T3,T4 normal.
No obvious symptoms.
Management
1. TSH > 10 and free thyroxine normal range : offer levothyroxine if TSH level is >10 on 2 separate occasions 3 months apart
- TSH between 5.5-10 and free thyroxine w/i normal range
a) < 65 years then consider 6 month trial of levothyroxine if TSH level between .5-10 on two separate occasions three months apart AND hypothyroidism symptoms - If older: (over 80) then watch and wait strategy is used
If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given either …………. or …………. to maintain remission
Oral azathioprine or oral mercaptopurine to maintain remission
Topical aminosalicylate may be used to induce and maintain remission of mild to moderate ulcerative colitis.
Painful shin rash + cough → sarcoidosis?
What abnormality is most likely to be seen on bloods:
serum ACE level
Irreducible, painful lump inferolateral to the pubic tubercle → ?
strangulated femoral hernia
triad of falling BP, rising JVP and muffled heart sound is characteristic of
BECKS TRIAD
CARDIAC TAMPONADE
Mx –> urgent pericardiocentesis
Warfarin drug interactions
Inducers:
“SCARS”
* S → Smoking
* C → Chronic alcohol intake
* A → Anti- epileptics: Phenytoin, Carbamazepine, Phenobarbitone (all barbiturates)
* R → Rifampicin
* S → St John’s Wort
Inhibitors:
“ASS-ZOLES”
* A → Antibiotics: Ciprofloxacin, Erythromycin, Isoniazid
* S → SSRIs: Fluoxetine, Sertraline
* S → Sodium Valproate
* - Zoles → Omeprazole, Ketoconazole, Fluconazole
Galeazzi vs Monteggia’s fracture
- G: Galeazzi
- R: radius
- I: inferior
- M: Monteggia
- U: ulna
- S: superior
Acute heart failure with hypotension: mx
inotropic support on the high dependency unit
e.g. dobutamine
INR 5.0-8.0 (no bleeding) -
withhold 1 or 2 doses of warfarin, reduce subsequent maintenance dose
INR
Major bleeding (e.g. variceal haemorrhage, intracranial haemorrhage)
- Stop warfarin
- Give intravenous vitamin K 5mg
- Prothrombin complex concentrate - if not available then FFP*
