Neuro, rheum, theaputics Flashcards by Hamish Reed-Embleton

Mixed UMN/LMN signs, wasting of muscles, sensation intact, mild frontotemporal dementia Sx=? dx?

MND
Nerve conduction studies and electromyography

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Adult, muscle weakness, cataracts and ptosis =

myotonic dystophy

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Symptoms of subacute degeneration of spinal cord

Ataxia
Loss of proprioception
Spasticity
Reduced reflexes

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What type of Ca channel to CCBs affect

L type channel

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Myoclonus elicited by a statle should make you think of a

mitochondrial disorder

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Lidocaine toxicity presentation

Perioral parasthesia first

SAMS
Slurred speech
Altered mental status
Muscle twitching
Seizures

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Long-standing Rheum A
Now diarrhoea, weight loss, plaques in the axilla, proteinuria, hepatosplenomegaly =? Dx?

AA Amyloidosis
Rectal biopsy

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60M Progressive dementia over 3 months with prodromal insomnia and depression = ? ix?

Sporadic CJD
Electroencephalography - EEG

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Differentiate sporadic and variant CJD on MRI

Sporadic - changes in putamen, cordate and cortex

Variant - pulvinar

variant pulverised

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Brittle asthma now acutely painful hip and unable to weight bare = ? ix?

AVN - needs MRI
[Steroid use]

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T score for osteoperosis? When is it different?

-2.5
-1.5 if on steroid therapy -> start bisphosphonates

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Heavy lifting - now pain over greater tuberosity of shoulder and painful arc on abduction =

supraspinatus

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IV nitroprusside, now SOB abdo pain widespread ST depression = ? rx?

Cyanide poisoning from nitroprusside

IV dicobalt edetate

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bodybuilder taking steroids hormones?

Raised testosterone
reduced LH (negative feedback from testosterone)

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Pure motor or sensory stroke is?

Lacunar

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TACS, PACS and lacunar stroke

TACS - Cerebral dysfunction, sensory, motor and visual

PACS - 2 of the 3 above

Lacunar - 1

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Exercise then a few hours after weakness =

hypokalemic periodic paralysis

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Meningioma of the cerebellar pontine angle

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2 options for rx of acute dystonic reaction

Procyclidine
trihexyphenidyl hydrochloride

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6-MP What drug can be fatal if co-administered

Allopurinol

[Prevents degradation of 6-MP

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Severe headache
hypotension
Low Na raised K
Meningisim, CN VI palsy, visual field defect

Pituitary apoplexy
with compression of optic chiasm

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Raynauds on atenolol for BP with creat 180. what should you do

Stop atenolol - worsens Raynaud’s
Start ramipril for renoprotection

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avPu, haemodynamically stable
Digoxin overdose what can be given other than fab frgaments?

phenytoin
[plus IV digibind (fab fragments)]

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Rheum DMARDs safeish in preg

Azathioprine, sulfasalazine and hydroxycloroquine

ASH is alright this time

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28F, Myasthenia, 6 weeks worsening sx with weight gain and ankle oedema

Pregnant - causes MG flares in first trimester

Hx gout new diagnosis UC. Plan to start azathioprine. What do you need to do?

Stop allopurinol check TPMT

Why do steroids cause bone fractures?

Alter PTH secretion

Stenosis of carotid for endarctectomy

>50% ONLY internal carotids

Brain surgery as a kid Now depression -> cognitive impairment and myoclonic jerks

CJD

When is schirmers test positive

<5mm wetting after 5 minutes

Infection / surgery -> very painful arm followed by proximal weakness and some sensory changes especially axillary

Brachial neuritis

Which DMARD may cause weakness, difficulty swallowing and a myasthenic picture

Penicillamine

Swollen knee polarised light of aspirate - needle-shaped

Gout

Rheum A, has paraesthesia of lateral 2 fingers =- key iX?

Carpal tunnel EMG / nerve conduction studies

On warfarin and given drug for fungus that inhibits mititic spindle of fungus - what happens to inr

Decreases - drug is Griseofulvin

Sudden visual loss affecting eye. Cotton wool spots and flame haeemorrhages in 1 quadrant. Prolonged APTT

BRVO - due to Antiphospholipid syndrome

Young onset ischemic event needs to check what

cocaine use

Rivaroxaban which factor inhibited

10a

Heparin affects

Antithrombin III

MG crisis of weekness unable to swallow needs

IV Ig

Most common side effect of donepezil / ACH inhib

insomnia anorexia, hallucinations, aggitation

sCJD in 50s what ix first?

MRI Then LP for protein 14-3-3

20s resting tremor and raised transaminases

Wilsons

Polymyalgia key iX

ESR

Dry red patches that became scaly. Areas of hair loss. worse in summer

Discoid lupus

Intention myoclonus following cerebral hypoxia eg OOHCA

lance adams syndrome

Weakness of finger flexors and quadriceps with mild rise in CK

Inclusion body myositis

Sensory loss over middle fingers of hand

Most specific test for sCJD

Real time quaking induced conversion test RTQuICT

BIG pile of aspirin 30 mins ago

gastric lavage

Excercise induced muscle pain and dark urine? ix?

McArdle sydrome [muscle phosphylase deficiency] Serum lactate following exercise

Confirmed xanthochromia on LP with normal CT. What next

MRA

Cluster heache but actually 30 episodes per day and in a woman = rx?

Paroyxsmal hemicrania Indomethcin

Neuroleptic malignant syndrome Rx

Bromocriptine

Causes of chronic urticaria

Asprin NSAIDs Opiates

Cholinesterase inhibitor toxicity 2 parts Rx

Atropine Pralidoxime

5/12 of TB rx. now photosensitive ras on face rx?

Has Drug-induced lupus Stop all meds and monitor

CO posioning 1st line Rx

Non rebreath 100% O2

Toxic alcohol 1st drug

Fomepizole

Fatty with heachache and CN6 palsy Normal CT LP raised pressure Plan?

CT Venography -Need to exclude thrombus [IIH is a diagnosis of exclusion]

How to excrete in urine more aspirin in overdose

Sodium bicarb

Stange cause of IIH

Vit A excess

Antidepressant choice if pt on warfarin, aspirin or heparin to avoid increased bleeding risk

Mirtazapine

How to test for testosterone doping

Urinary testosterone:epitesosterone ratio

Liver transplant ref criteria

ph <7.3 or lactate >3 after fluid within 24hrs -Cr >300 -PT >100s or INR >6.5 -Grade III/IV encephalopathy

Nodules on hand with DIP joint space erosions

multicentric reticulohistocytosis

Monitoring pagets

6 monthly ALP

AntiGBM rx

plasma exchange + steroids [not cyclophosphamide]

photosensitivity after recent admission with AF

amiodarone

Rheum arthritis and develops this - Which drug makes it worse? better?

MTX - worse Rituxumab - better

HTN comes in with reduced GCS and hypoglycaemia

Bb overdose Glucagon

Bilateral haemangiomas and left flank mass

VHL

Dermatomyositis high or low dose pred

Higjh

Diagnostic criteria for diabetic nephropathy

GFR <60 for 3 months Urine ACR >3mmol/L for 3 months

Old houses, anaemia, neuropathy and ckd rx?

lead poisoning Any of: Penicillamine DMSA calcium disodium

Best imaging for pagets

Skeletal survey [Not isotope bone scan]

1st line pyelonephritis oral

Cefalexin

Teenager with fam Hx of PKD normal US When re scan

when they are 20

Which farm thing if hypersalivation, constricted pupils, sweating

Organophosphate insecticides [cholinergic intoxication]

Most effective antipsychotic for parkinsons psychosis

Clozapine

Dark urine with pigmentation of ears and sclera Joint pain

Alkaptonuria

SAH and hypertension 1st line

Labetalol

Which juice worst for wafarin

Cranberry [not grapefruit]

What National insititute of health stroke scale NIHSS has a 50% risk of haemorrhagic transformation

>15

Gottrons papules

Cyanide poisoning rx

dicobalt edetate

PFO with TIAs rx

Closure of PFO

what is the trio of miller fisher

Ophthalmoplegia Ataxia Areflexia

which diretics -> gout

Thiazides -> reduce renal uric acid excretion

weakness of what causes winging of the scapular

serratus anterior

where are the red macules and papules in fabry

peri umbilical

RTA and now dizziness when moves head

BPPV

Sclerosis sx positive anti centromere why SOBOE

Pulmonary artery HTN [Fibrosis if positive anti-topoisomerase]

30 with some ataxia then sudden deterioration CT demonstrates hydrocephalus?

haemangioblastoma in cerebellum

Dermatomes c5-t1

Dermatome C7 extends to the middle finger and divides dermatomes C5 and C6 (lateral) from C8 through T1 (medial). C5: lateral aspect of arm C6: lateral aspect of forearm and hand C7: middle finger and ray C8: medial aspect of hand T1: medial aspect of forearm

Dermatomes L2-S5

2, 3, 4, 5, stand on S1, lie on S2, sit on S3, wipe S4/S5 Slap thigh lateral then medial: L2 then L3 Slap lower legs medial then lateral: L4 then L5 Stand on sole of foot: S1 Lie on back of thigh and calf: S2 Sit on buttocks: S3 Wipe perianal area: S4, S5

Why hyperGycaemia with steroids

increased glucomeogenesis

Diabetes old shoulder injury now swelling and loss of function

Charcot joint

Want to make a Dx of common peroneal palsy

nerve conduction studies

Night blindness and sensorineural deafness =? ix?

Refsum disease phytanic acid levels

On carbamazepine and wants to start COCP

Higher dose of COCP as carbamazepine is a liver inducer

PCI on Aspriin fonda and clopi then has a UGI bleed which shouldd you stop

Fonda only at first [aspirin and clopi to stop stent thrombosis]

Farmer spraying crops now dowsy, profuse sweating and salivation rx?

Wash contaminated areas Atropine + pralidoxime ]May need ventilation if no response]

Atery for parietal lobe

MCA

Confirm lambert eaton syndrome

EMG + nerve condiction

Key finding to differentiate fredricks and Charcot marine tooth

Only fredricks has dysarthria

Diarrhoea, myalgia, anterior uveitis and superficial thrombophlebitis

Bechets

Patches of hairloss with scaring and plaques behind ears / cheeks

discoid lupus

Gynecomastia medications

DISCO MTV Digoxin Isoniazid Spironolactone Cimetidine Oestrogen

3 weeks fevers, oligoarthritis, and pericarditis

Adult onset juvenile chronic arthritis

T2DM, hypercholesterol and long standing pain and swelling

Gout

Unilateral parkinsonism with apraxia and 'alien limb'

Corticobasal syndrome

Gym goer gets sick and needs intubated then recovers after 3 hrs

Gamma-hydroxybutyrate overdose

Cluster headache prevention

Verapamil

Bechets with DVT rx

Pred + azithro/cyclo/ciclo

What does osteomalacia look like on xray

Low density bands extending from the cortex

Wrist and ankle swelling with pustular lesions. Aspirate demonstrates lots of white cells

Gonococcal

Poor conrolled diabetes

cerebral abscess

Weakness, sensory ipsilateral sx and headache ix?

MRI brain

Homeless with HAGMA and blurred vision

Methanol poisioning

Amiodarone develops thyrotoxicosis with positive thyroid antibodies and multinodular goitre ? rx?

Amiodarone TYPE 1 Antithyroid drugs

Test for EPO abuse

Urine

Compression fracture of L4 in 74F. rx?

bisphosphonates§

Weepy unilateral reaction affecting 1 nipple rx?

Likely Padgets -> refer breast clinic

Left sided TIAs with 100% occlusion Right carotid rx?

Clopi [complete occlusion is a CI to endarctectomy

Key ix for vertebral artery dissection

MRA

Frontal balding, myotonia, cataracts, wasting of sternocleidomastoid, dysphagia and general muscle weakness =? ix?

Myotonic dystrophy EMG [not biopsy]

Quads and forearm weakness

Inclusion body myositis

Pre eclampsia how to redue BP

Labetalol [Mg is for seizure prevention]

2 key antiemetics in preg

Cyclizine promethazine

sclerosis which antibodies highest risk for renal crisis

Anti RNA polymerase III

Amlodipine overdose rx?

Calcium chloride ....CCBs

TB rx develops this rash due to?

Isoniazid - drug-induced lupus

Better than beta interferon for MS relapse prevention

fingolimod

myasthenia best Ix

EMG

Painful swolllen joints Rx?

MTX + steroids

hypertensive stroke target systolic bp

140mmHg