Neurology Flashcards
What is shingles also known as?
Herpes Zoster Infection
What causes shingles?
reactivation of varicella zoster virus
Key risk factors for shingles
increasing age, immunosuppressive conditions, HIV
typical presentation of shingles
acute, unilateral, painful blistering rash
Which dermatomes are commonly affected in shingles
T1- L2
Features of shingles
prodromal period
- 2-3day hx of burning pain over the dermatomes affected
- may have fever, headache, lethargy
Rash
- erythematous, macular rash which becomes vesicular
- demarcated by dermatome and doesnt cross the midline
How is shingles diagnosed?
clinical diagnosis
What is the medical management of shingles?
Analgesia
- paracetemol and NSAIDs
- amitriptyline if first line insufficient
- oral corticosteroids if not responding to the above
Antivirals within 72hrs unless <50yo and mild rash/pain with no risk factors
Advice given to patient with shingles
remind them they are infectious until vesicles have crusted over usually 5-7 days following onset (avoid pregnant and immunosuppressed people)
What are the complications of shingles
- post- herpetic neuralgia
- herpes zoster ophthalmicus
- herpes zoster oticus (Ramsay Hunt syndrome):
What is syncope?
transient loss of consciousness with spontaneous complete recovery
What are the main causes of syncope?
- Reflex mediated (neurally mediated)
- Cardiac (arrhythmias and structural causes)
- Orthostatic (iatrogenic, dementia, volume depletion)
Which investigations should be carried out in syncope?
- ECG (?prolonged QT)
- lying standing BP / tilt table test
- Glucose
- Electrolytes
- FBC
- Underlying illness (CXR, CT, LP, ECHO etc)
Causes of cardiac syncope
arrhythmias - bradycardia / tachycardia structural - valvular - MI - HOCM
Treatment of cardiac syncope
treat the problem
- medicine (beta blockers, atropine)
- electrical cardioversion
- catheter ablation
- pacemaker
- implantable cardioverter defibrillator (ICD)
What is vasovagal syncope?
triggered by emotion, pain or stress. Often referred to as ‘fainting’
What is subarachnoid haemorrhage?
presence of blood in the subarachnoid space
What are the causes of SAH?
head injury (traumatic SAH) is the most common cause
spontaneous SAH (non-traumatic)
Causes of spontaneous SAH
- Intracranial aneurysm( ruptured ‘berry’ aneurysms)
- Arterial dissection
Which conditions are associated with berry aneurysms?
- Adult Polycystic Kidney Disease
- coarctation of the aorta
Classical presentation of SAH
- Thunderclap headache
- N&V
- Meningism (photophobia, stiff neck)
How can a SAH be confirmed?
CT head
LP if CT Head if negative
Neuro referral
Which findings on an LP are indicative of SAH
xanthochromia (result of RBC breakdown) and normal or raised opening pressure
After SAH is confirmed, which investigations can be carried out to identify a causative pathology?
CT inter-cranial angiogram (vascular lesion e.g aneurysm)
What is Multiple sclerosis?
autoimmune disorder characterised by demyelination in the central nervous system
Who is at higher risk of MS
women ages 20-40 living at higher latitude
How can MS be diagnosed
refer to neuro and bloods to exclude other causes
What are the most common initial presentations of MS
- optic neuritis
- transverse myelitis (inflammation within spinal cord)
- cerebellar sx ( dysmetria, ataxia, vertigo)
sx disseminated in time and space
Which investigations should be carried out for MS?
MRI
How is an acute relapse of MS treated?
High dose steroids (methylprednisolone) to shorten duration of relapse
What is a venous sinus thrombosis?
occurs when a blood clot forms in the brain’s venous sinuses. This prevents blood from draining out of the brain. As a result, blood cells may break and leak blood into the brain tissues, forming a hemorrhage.
What are the symptoms of venous sinus thrombosis?
- headaches
- n&v
- blurred vision
- LOC
- seizures
How is venous sinus thrombosis diagnosed?
MRI venography
CT venography
Treatment of venous sinus thrombosis
Heparin
Warfarin for long term
What is a Cavernous sinus thrombosis
the formation of a clot within the cavernous sinus
What is the most common cause of CST
infection
Common clinical features of CST
headache, unilateral periorbital oedema, proptosis (eye bulging), photophobia and cranial nerve palsies
Which nerve is most commonly affected in CST
abducens nerve (CN VI)
Complication of CST
Where the cause is infection, thrombosis of the cavernous sinus can rapidly progress to meningitis.
Investigations requested in suspected CST
CT Head/ MRI
FBC
Blood culture
?LP
How is CST treated
Abx for causative infection
Which seizures last a few seconds and are associated with a quick recovery
Absence
What may provoke an absence seizure
hyperventilation or stress
Who is most commonly affected by absence seizures?
3-10 years old and girls are affected twice as commonly as boys
How are absence seizures managed?
sodium valproate and ethosuximide are first-line treatment
Prognosis of absence seizures
good prognosis - most become seizure free in adolescence
Status epilepticus is defined as…
a single seizure lasting >5 minutes OR
>= 2 seizures within a 5-minute period without the person returning to normal between them
Why is the priority in Status epilepticus to terminate seizure activity
can lead to irreversible brain damage
What is the immediate management of Status epilepticus?
ABC
IV benzodiazepines
What may be used in management if there is ongoing status epilepticus
phenytoin or phenobarbital infusion
What is a febrile convulsion?
seizures provoked by fever in otherwise normal children
clinical features of febrile convulsion
usually occur early in a viral infection
usually lasting less than 5 minutes
most commonly tonic-clonic
How can a generalise seizure be further classified
Motor- e.g tonic-clonic
Non-motor - e.g absence
Sx of epilepsy
bite their tongue
incontinence of urine
post-ictal phase
Which investigations are ordered following a patients first seizure?
EEG and MRI
First line tx for generalised seizure
sodium valproate
First line tx for focal seizure
carbamazepine
What are the guidelines for driving post seizure?
- Generally patients cannot drive for 6 months following a seizure.
- For patients with established epilepsy they must be fit free for 12 months before being able to drive
What is the difference between a generalised and focal seizure?
Focal onset seizures start in one area and can spread across the brain and cause mild or severe symptoms, depending on how the electrical discharges spread. Generalized seizures can start as focal seizures that spread to both sides of the brain.
What happens in tonic-clonic seizure?
Tonic - muscles stiffen - LOC - tongue biting Clonic - rhythmical jerking
What is Bell’s palsy?
Acute, unilateral facial nerve (CN VII) paralysis
- rapid onset ( < 72 hours)
Features of Bell’s palsy
- Lower motor neuron facial nerve : forehead affected
- Post-auricular pain (preceding paralysis)
- Altered taste
- Dry eyes
Facial muscle weakness (unilateral):
- drooping of the eyebrows
- corner of the mouth
- loss of the nasolabial fold
What is the bell’s phenomenon?
The eye can’t be closed- eyeball rotates upwards and outwards
What is the management of bell’s palsy?
- oral prednisolone within 72 hours
- Seek specialist advice
- Eyecare: prescription of artificial tear + eye lubricants
What is the follow-up for bell’s palsy?
If paralysis shows no improvement after 3 week, refer to ENT urgently
What is the prognosis for bell’s palsy?
Full recovery within 3-4 months
What dose of prednisolone is given in bell’s palsy?
50 mg for 10 days
What are the two main ascending tracts of the spinal cord and what information do they carry?
Dorsal - fine touch, proprioception, vibration sense
Spinothalamic - pain and temperature
What is the descending tract of the spinal cord called and what does it carry?
corticospinal tract carries motor information
Which signs indicate there is a problem with the spinal cord rather than with the other parts of the nervous system?
often bilateral and asymmetrical
mixed upper and lower motor neuron signs as the spinal cord is part of both the CNS and PNS
- upper signs : increased tone, clonus, hyperreflexia
- lower signs: muscle wasting, flaccid paralysis, reduced reflexes
sphincter involvement (e.g urinary retention/constipation)
autonomic dysfunction indicates lesion is above T6
How to tell where in the spinal cord the problem is
cervical if all 4 limbs affected
thoracic if only lower limbs affected
above C3 if resp difficulties and diaphragm affected
What is Amyotrophic lateral sclerosis
(motor neuron disease)
affects both upper (corticospinal tracts) and lower motor neurons
results in a combination of upper and lower motor neuron signs
What features are seen in neoplastic spinal cord decompression?
back pain, may be worse on coughing or lying down
- lower limb weakness
- sensory loss or numbness
- neuro signs dependent on level of lesion
- -above L1 usually UMN in legs and sensory
- below L1 usually LMN in legs and perianal numbness
Which investigation should be requested following suspected neoplastic spinal cord decompression?
urgent whole MRI spine within 24hrs of presentation
Management of neoplastic spinal cord decompression
high-dose oral dexamethasone
urgent oncological assessment for consideration of radiotherapy or surgery
What are the symptoms of diabetic peripheral neuropathy?
Sensory loss:
- Tingling
- Numbness - unable to feel light touch
- Cannot feel pain
- Unable to detect change in temperature
Management of diabetic peripheral neuropathy
1st line = amitriptyline, duloxetine, gabapentin or pregabalin
- glycaemic control
- referral to podiatry
What are the presentations of diabetic foot disease?
- neuropathy: loss of sensation
2. ischaemia: absent foot pulses, reduced ankle-brachial pressure index (ABPI), intermittent claudication
What is involved in annual diabetic foot check?
- screening for ischaemia: done by palpating for both the dorsalis pedis pulse and posterial tibial artery pulse
- screening for neuropathy: a 10 g monofilament is used on various parts of the sole of the foot
What is guillain-barre syndrome?
immune-mediated demyelination of the peripheral nervous system often triggered by an infection
What infection triggers guillain-barre syndrome?
campylobacter jejuni
What are the characteristic features of guillain-barre syndrome?
Progressive, symmetrical weakness of all limbs
- usually ascending (leg first)
- reflexes reduced or absent
- mild sensory symptoms
What are the other features for guillain-barre syndrome?
- Weakness
- Maximum severity at 2 weeks after initial onset , stops progressing after 5 weeks
- Facial weakness, dysphasia, dysarthria
- May lead to resp failure - Pain – neuropathic pain esp in legs, possible back pain
- Reflexes – may be reduced or absent
- Sensory symptoms – paraesthesia & sensory loss starting in the lower extremities
- Autonomic symptoms – reduced sweating, heat tolerance, urinary hesitancy
How do you diagnose GBS?
Clinical assessment
What investigations may be helpful in diagnosing GBS?
- Nerve conduction studies – most useful confirmatory test, if initially normal should be repeated after 2 weeks.
- Lumbar puncture – elevated level of CSF protein with normal white cell count, week 1 after symptom onset
Management of GBS
- Admission to hospital, preferably hospital with Neuro Critical Care capabilities
- Intravenous Immunoglobulin or Plasmapheresis.
- -> IVIG - contraindicated in IgA deficiency or renal impairment - DVT prophylaxis – until able to walk independently
- Watch pt. closely for need of intubation
- Initiate cardiac monitoring –
- HTN management
- Pain control – gabapentin, opiates, carbamazepine
- Physical Therapy to avoid contractures, maintain flexibility
- Rehabilitation MDT approach
Psychological support for pt. and family
What does Chronic IDP stand for?
chronic inflammatory demyelinating polyneuropathy
Symptoms of Chronic IDP
- Initially present with some limb weakness which will slowly progress to symmetrical weakness in muscles of the hands, feet, shoulder and hip.
- Symptoms may be progressive, episodic or monophasic (1-3 years).
- Symptoms should last > 8 weeks
- Loss of sensation, numbness, tingling, pins and needles
Clinical features of Chronic IDP
- Muscle atrophy in hands, feet, shoulders and hips
- Absent or diminished deep tendon reflexes
- Impaired responses to sensory stimulation
- Ataxic gait
- Some cranial nerve involvement such as dysphagia or diplopia
Investigations of Chronic IDP
- NCS
- Lumbar Puncture
- Peripheral nerve biopsy
Management of Chronic IDP
Conservative:
- Physical and occupational therapy to prevent accumulating disability over time and encouraging active lifestyle.
Medical :
1st line:
- Intravenous Immunoglobulin (IVIG)
- Plasma exchange – may only be effective for several weeks and therefore may require an intermittent treatment schedule. - Corticosteroids – used in with immunosuppressants.
- Long term immunosuppression :
Takes the attack off the peripheral nerves - Pharmacotherapy for neuropathic pain : e.g. gabapentin & pregabalin
Features of migraine
- a severe, unilateral, throbbing headache
- -> attacks may last up to 72 hours - associated with nausea, photophobia and phonophobia
- patients characteristically go to a darkened, quiet room during an attack
- ‘classic’ migraine attacks are precipitated by an aura.
- typical aura are visual, progressive, last 5-60 minutes and are characterised by transient hemianopic disturbance or a spreading scintillating scotoma
Management of migraine
Headache diary, avoid triggers – sleep, stress, hydrate, regular meals
- Acute:
- -> 1st line: triptan and NSAID
- -> simple analgesia – ibuprofen, aspirin, paracetamol before onset
- -> Anti-emetic: metoclopramide
- -> Follow-up within 2-8 weeks - Preventative: propranolol, topiramate or amitriptyline
- Refer: migraine > 72 hours, typical aura: motor weakness, poor balance, headache changes
What medication is contraindicated in migraine with aura?
COCP
Symptoms of tension headache
- often described as a ‘tight band’ around the head or a pressure sensation.
- bilateral
- tends to be of a lower intensity than migraine
- may be related to stress
Management of tension headache
- Acute: 1st line (aspirin, paracetamol or an NSAID)
- Prophylaxis: 10 sessions of acupuncture over 5-8 weeks
- -> Low dose amitriptyline (10-75mg)
- —–>Not responsive – stop and discuss neuro
- —–>Responsive – attempt withdrawal 4-6 months
Symptoms of cluster headache
- Unilateral periorbital pain
- Ipsilateral autonomic symptoms: eyelid oedema, facial sweating or flushing, nasal congestion, conjunctival injection, lacrimation
- Brief attacks of < 3 hours duration
- pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
- clusters typically last 4-12 weeks
Management of cluster headache
- acute: 100% oxygen, subcutaneous triptan
- prophylaxis: verapamil is the drug of choice.
- Seek specialist advice from a neurologist if a patient develops cluster headaches with respect to neuroimaging
What is essential tremor?
Autosomal dominant condition which usually affects both upper limbs
Features of essential tremor
- postural tremor: worse if arms outstretched
- improved by alcohol and rest
Management of essential tremor
1st line = propanolol at low dose
What is parkinson’s disease?
Progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra
What is the classic triad of features of parkinson’s disease?
- Bradykinesia
- short, shuffling steps
- difficulty initiating movement - Tremor
- worse when stessed or tired
- ‘pill-rolling’ - Rigidity
- lead pipe
How is parkinson’s diagnosed?
usually clinical
What investigation can distinguish between essential tremor and parkinson’s?
- Single-photon emission computed tomography
How do you differentiate between parkinson’s disease and drug-induced parkinsonism?
In drug-induced parkisonism:
- motor symptoms are generally rapid onset and bilateral
- rigidity and rest tremor are uncommon
Management of parkinson’s disease
Only specialist should initiate treatment:
1st line:
Levodopa - if motor symptoms affecting QOL
Dopamine agonist - if motor symptoms not affecting QOL
What is huntington’s disease?
- inherited neurodegenerative condition.
- progressive and incurable condition that typically results in death 20 years after the initial symptoms develop.
Features of huntington’s disease
Typically develop after 35 years of age:
- chorea
- personality changes (e.g. irritability, apathy, depression) and intellectual impairment
- dystonia
- saccadic eye movements
What can peripheral neuropathy conditions be divided into?
- Motor loss
2. Sensory loss
What conditions cause motor loss in peripheral. neuropathy?
- Guillain-Barre syndrome
- lead poisoning
- chronic inflammatory demyelinating polyneuropathy (CIDP)
- diphtheria
What conditions cause sensory loss in peripheral. neuropathy?
- diabetes
- uraemia
- leprosy
- alcoholism
- vitamin B12 deficiency
- amyloidosis
What nerve damage causes a foot drop?
Peroneal nerve (L4-L5, S1-S2)
What nerve damage causes a wrist drop?
Radial nerve
What is carpel tunnel syndrome?
When carpel tunnel is swollen/inflammed - the median nerve is affected
Symptoms of carpel tunnel syndrome
- Aching, tingling, pins & needles
- Symptoms can spread up the arm
- Worse on movement
- temporary relief by hanging had out of bed at night or shaking vigorously
What examination tests do you carry out for carpel tunnel syndrome?
Phalens
- hold wrist fully palmarflexed
- tap on wrist reproduces symtpoms
Tinel’s sign
- tapping over dorsum of the wrist percipitates pain
What does wasting of the thenar eminence indicate?
Median nerve affected
What investigation can be carried out for carpel tunnel syndrome?
NCS
Management of carpel tunnel syndrome
- Spontaneously resolves 3-6 months < 30 y/o
- Splint
- Steroid injection?
- Referral for surgical decompression
What do you not prescribe for carpel tunnel syndrome?
NSAIDs
What is myasthenia gravis?
Autoimmune disorder from insufficient functioning ACh receptors
Affect women > men
What is the key feature of myasthenia gravis?
muscle fatigability
- worsens with activity
- improves after rest
What other features can you get with myasthenia gravis?
- extraocular muscle weakness: diplopia
- proximal muscle weakness: face, neck, limb girdle
- ptosis
- dysphagia
What is the diagnostic test for myasthenia gravis?
- Serological testing for ACh receptor antibodies
- Repetitive EMG
Management of myasthenia gravis
1st line = pyridostigmine
(long-acting acetylcholinesterase inhibitors)
- Eventually immunosuppression : prednisolone
Management of myasthenic crisis
- plasmapheresis
- IV immunoglobulins
What is cerebral palsy?
disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain
What is the classification of cerebral palsy?
- Spastic
- dyskinetic
- ataxic
- mixed
What non-motor problems can children with cerebral palsy develop?
- learning difficulties (60%)
- epilepsy (30%)
- squints (30%)
- hearing impairment (20%)
What are the possible manifestations of cerebral palsy?
- abnormal tone early infancy
- delayed motor milestones
- abnormal gait
- feeding difficulties.
Management of cerebral palsy?
- MDT approach
- Oral diazepam - for spasticity
- Anticonvulsant , analgesia
What is stroke?
sudden interruption in the vascular supply of the brain
What are the types of stoke?
- Ischaemic
- subtype: TIA
- ‘ blockage in blood vessel’ - Haemorrhagic
- blood vessel burst leading to reduction in blood
What are the symptoms of a stroke?
- Motor weakness
- speech problems (dysphasia)
- swallowing problems
- visual field defects
- balance problems
What are some symptoms more common with haemorrhagic stroke than ischaemic?
- decrease in consciousness
- headache
- N & V
- Seizures
What is the FAST campaign?
- Face - ‘Has their face fallen on one side? Can they smile?’
- Arms - ‘Can they raise both arms and keep them there?’
- Speech - ‘Is their speech slurred?’
4, Time - ‘Time to call 999 if you see any single one of these signs.’
What are the 2 types of imaging used in stroke?
CT
MRI
1st line = non-contrast CT head
What criteria needs to be met for immediate treatment of ischaemic stroke?
Criteria
1. patients present with 4.5 hours of onset of stroke symptoms
- the patient has not had a previous intracranial haemorrhage, uncontrolled hypertension, pregnant etc
What is the immediate management of ischaemic stroke?
Alteplase (< 4.5 hours)
Aspirin 300mg within 24 hours
What is the management of confirmed haemorrhagic stroke?
Neurosurgical consultation
Those not suitable for surgery:
- Supportive: stop anticoag + antithrombotic meds
- ? lower BP acutely
What is the surgical option for acute ischaemic stroke?
Thrombectomy
Secondary prevention for stroke
1st line = Clopidogrel
2nd line = aspirin + modified-release (MR) dipyridamole
What other factors need to be treated in stroke?
- fluid management
- Glycaemic control
- BP
- Feeding assessment + management
What is TIA?
a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction. (<24 hours)
Clinical features of TIA
- unilateral weakness or sensory loss.
- aphasia or dysarthria
- ataxia, vertigo, or loss of balance
symptoms typically resolve within 1 hour
Immediate management of TIA
Contraindications
Aspirin 300 mg immediately, unless
- the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)
- the patient is already taking low-dose aspirin regularly: continue the current dose of aspirin until reviewed by a specialist
- Aspirin is contraindicated: discuss management urgently with the specialist team
What is the advice on driving for TIA?
Do not drive until seen by specialist
What investigation should be carried out for TIA?
- MRI - to detect territory of ischaemia
- Urgent carotid doppler
CT should be done unless alternative diagnosis
Management of TIA
1st line = Clopidogrel
What is raised intracranial pressure?
Additional volume in the brain + ventricles
Features of raised ICP
- headache
- vomiting
- reduced levels of consciousness
- papilloedema
- Cushing’s triad
- widening pulse pressure
- bradycardia
- irregular breathing
What investigations should be carried out for raised ICP?
- Neuroimaging = underlying causes
2. Invasive ICP monitoring
Management of raised ICP
- Head elevation to 30 degrees
- IV mannitol
- Controlled hyperventilation
- Removal of CSF
What is temporal arteritis?
Large vessel vasculitis which overlaps with polymyalgia rheumatica (PMR).
Features of temporal arteritis
- Jaw claudication
- temporal headache
- eventually leads to vision loss as optic nerve loses blood supply as large to medium vessels becomes narrowed.
- Can be systemically unwell.
- Hard, non-pulsating temporal artery (normal = pulsating, able to palpate and doesn’t feel hard)
What is the gold standard investigation for temporal arteritis?
USS and biopsy
- raised ESR > 50mm/hr
Management of temporal arteritis
Urgent steroid course = high dose glucocorticoids
- as soon as diagnosis is suspected before biopsy
- no visual loss = high dose prednisolone
- visual loss = IV methylprednisolone before high-dose prednisolone
What is vasculitis?
Inflammation of small vessels
- May be drug reaction
Symptoms of vasculitis
- Itching, burning purpuritic rash
- 1-3mm lesions, often on legs
Treatment of vasculitis
- Treat underlying cause, if known
- Compression stockings, elevation
- Sedating antihistamine
- Colchicine/Dapsone if no systemic involvement
- High-dose steroid if systemic involvement, +/- methotrexate, azathioprine
What is Alzheimers?
progressive degenerative disease of the brain
Non-pharmacological management of Alzheimers
offer wellbeing services and group cognitive stimulation therapy
pharmacological management of Alzheimers
First line: acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine)
Second line: memantine (an NMDA receptor antagonist)
When should antipsychotics be given to patients with Alzheimers?
when pt is at risk of harming themselves or others or has delusions/hallucinations causing them severe distress
What is the most common causative pathogen in enchephalitis?
HSV-1
Symptoms of enchephalitis
confusion or disorientation. seizures or fits. changes in personality and behaviour. difficulty speaking. weakness or loss of movement in some parts of the body. loss of consciousness.
Which investigations should be requested in ?encephalitis
CSF
PCR for HSV
MRI
EEG
What might you see in CSF of encephalitic patient
lymphocytosis, elevated protein
What is the tx of all cases of suspected encephalitis?
IV Aciclovir
Life threatening complication of meningitis
septicaemia resulting in permanent damage of nerves or brain
Symptoms of meningitis
headache, neck stiffness, photophobia, confusion, fevers, non-blanching rash
Gold standard investigation for meningitis
lumbar puncture
Characteristic CSF findings in bacterial meningitis
cloudy, low glucose, high protein
What should be given to patients with suspected meningococcal disease in a pre-hospital setting?
IM benzylpenicillin
When should you suspect hiv ?
- unusually severe/prolonged symptoms that are recurrent or unexplained
- conditions related to immunosuppression (shingles/oral candidiasis)
- lymphadenopathy
- pyrexia
- weight loss
HIV risk factors
- coming from high prevalence area
- sex between men and men
- injecting drug use
When should asymptomatic patients with HIV be tested after possible exposure?
at 4 weeks
How is HIV monitored
HIV viral load and CD4 lymphocyte cell count
What are people with CD4 count <200 at a higher risk of?
HIV-related opportunistic infections and cancers
How is HIV treated
antiretrovirals - suppresses viral replication but does not eliminate HIV therefore treatment is lifelong
The causative pathogen of tuberculosis
Mycobacterium tuberculosis
Which vaccine offers protection against TB
BCG
What are the 2 types of TB
PRIMARY
infection occurring in previously uninfected host , usually asymptomatic
SECONDARY
If the host becomes immunocompromised the initial infection may become reactivated.
Gold standard investigation for active TB
Sputum culture
What investigations may be requested in ?active TB
Sputum culture -GOLD STANDARD
CXR
NAAT
What is a classical finding in CXRs in active TB
Upper lobe cavitation and hilar lymphadenopathy
What is the standard therapy for treating active TB and how long should they be given
first 2 months: Rifampicin Isoniazid Pyrazinamide Ethambutol
continue for further 4 months:
Rifampicin
Isoniazid
How is latent TB treated
3 months of isoniazid (with pyridoxine) and rifampicin OR 6 months of isoniazid (with pyridoxine)
pyridoxine reduces the occurence of isoniazid side effects
Give key side effects for TB drugs
Rifampicin : red/orange secretions
Isoniazid: peripheral neuropathy
Pyrazinamide: hyperuricaemia=gout
Ethambutol : optic neuritis
Primary and secondary features of syphilis
Primary features
- chancre
- lymphadenopathy
Secondary features - occurs 6-10 weeks after primary infection
- systemic symptoms: fevers, lymphadenopathy
- rash on trunk, palms and soles
- condylomata lata (painless, warty lesions on the genitalia )
Investigations for ?syphilis
clinical diagnosis and GUM referral for serology and microscopic
Management of syphilis
IM Benzathine penicillin
How is lyme disease spread
ticks
key features of lyme disease
erythema migrans (bulls eye rash) systemic features (headaches, lethargy, fever)
How is lyme disease diagnosed
clinical if erythema migrans is present
ELISA antibodies to Borrelia burgdorferi
Management of lyme disease
doxycyline/amox (pregnancy)
What is a prion disease and what is the most common
A prion is a type of protein that can trigger normal proteins in the brain to fold abnormally.
Creutzfeldt-Jakob disease
features of prion disease
rapid onset dementia and myoclonus
What is Whipples disease
Whipple disease is a rare bacterial infection that most often affects your joints and digestive system. Whipple disease interferes with normal digestion by impairing the breakdown of foods, and hampering your body’s ability to absorb nutrients, such as fats and carbohydrates.
If no response in status epilepticus within 45 minutes, what is the next step?
Induction of general anaesthesia
2nd line for generalised tonic-clonic seizures
Lamotrigine
Carbamzepine
2nd line for focal seizures
levetiracetam
Specific types of generalised seziures
tonic-clonic (grand mal) tonic clonic typical absence (petit mal) atonic
Classifications of seizures
Focal
Generalised
Unknown onset
