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NIFF NAF AND TRIVAAA! Flashcards

1
Q

What does aldosterone do?

A

Increases sodium reabsorption in the kidneys in exchange for K+ and H+
-triggered by angiotensin II

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2
Q

What are typical LMN Signs?

A

Wasting
Decreased reflexes
Foot drop
Eventual weakness

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3
Q

UMN signs

A 
Spasticity 
Weakness 
Brisk reflexes 
Up going plantars 
May lose proprioception and vibration sense
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4
Q

What does the radial nerve do?

A 
C5-T1 
Opens the fist 
BEST 
Brachioradialis
Extensors 
Supinatior 
Triceps
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5
Q

Phrenic nerve lesion

A

C3,4,5

If lesion get orthopnoea with raised hemidiaphragm on CXR

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6
Q

What can damage the brachial plexus?

A

Radiation, trauma

Variable distribution of pain/parasthesia

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7
Q

What does the median nerve supply?

A 
C6-T1 
LOAF 
Lubricles 
Opponens pollis 
Abductor pollis brevis 
Flexor pollis brevis

Precision grip
Carple tunnel syndrome
Sensation 3.5 fingers and palm

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8
Q

What does the ulnar nerve supply?

A

C7-T1
Can’t cross fingers
Weak little finger abduction
Sensory loss over medial 1.5 fingers

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9
Q

What does the lateral cutaneous nerve do?

A

L2-3

Anterolateral burning thigh pain from entrapment under inguinal ligament

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10
Q

What does the siatic nerve do?

A

L4-s3
Hamstrings and all muscles below knee- therefore get foot drop
LaterAl loss of sensation below knee

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11
Q

What does the peroneal nerve do?

A
  • l4-l5
  • Winds around fibular head comes off siatic nerve at the knee
  • loss sensation over dorsum
  • foot drop, weak ankle dorsiflexion/eversion
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12
Q

What does the tibial nerve do?

A

L4-S3
Can’t stand on tip toes or invert foot toes
-sensory loss over sole

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13
Q

C5, C6, C7, C8 effects if damaged

A

C5: weak deltoid and supraspinatus

C6: biceps and brachioradialis, numb thumb and index finger

C7: triceps and finger extension. Numb middle finger

C8: weak finger flexors, small muscles of hand, numb 5th and ring finger

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14
Q

What is the treatment for PD?

A

MAO- B inhibitors- alternative to dopamine agonists in early PD.
S/E AF, postural HTN
Rasagiline, selegiline

COMT inhibitors
May lessen off time
Tolcapone- good but can cause liver problems so monitor LFTs

Levodopa- combined with a dopadecarboxlylase inhibitor

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15
Q

What helps tremor in PD?

A

Anticholingergics
Help tremor but cause confusion in the old

SE- dry mouth, dizzy, reduction in vision, decreased HR, urinary retension, anxiety, confusion, increased excitement, decreased memory, hallucinations, insomnia

Benzhexol, orphenadrine

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16
Q

Which dopamine agonist is used in the ‘rescue pen’ for sudden ‘.offs’ in PD?

A

Apomorphine

Potent dopamine agonist

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17
Q

Which dopamine agonist can be given via a patch?

A

Ropinirole

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18
Q

What drugs can cause pericardial disease?

A

Hydralazine (vasodilation for HTN)
Isoniazid (anti TB)
Procainaminde (antiarrythmic)
Penicillin

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19
Q

What are the heart sounds if someone has acute myocarditis?

A

Soft S1 S4 gallop

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20
Q

What drugs cause acute myocarditis

A 
Herceptin (HER2 Expressing breast cx)
Methyl dopa-for HTN 
Penicillin 
Phenytoin
Sulphonamides 
Spirolactone 
Choranphenicol (Abx) 
Carbamazepine 
Cyclophosphamide
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21
Q

How do you cardiovert AF?

A

Amiodarone and flecainide

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22
Q

What meds do you use for complex partial seizures?

A

Carbamazepine

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23
Q

What meds do you use for tonic clonic seizures?

A

Sodium valproate

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24
Q

What meds do you use for tonic clonic seizures but chance of pregnancy?

A

Lamotrigine

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25
Q

What meds do you use for absent seizure if intolerant to sodium valproate?

A

Ethosuximide

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26
Q

What drugs cause a low sodium ?

A

Sulphonamides
SSRIs
Carbamazepine
Tricyclics

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27
Q

What drug causes cholestasis?

A

Co amoxiclav

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28
Q

What are the side effects of ACE inhibitors?

A

Cough and hyperkalaemia

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29
Q

What are the causes of raised prolactin?

A 
Primary hypothyroidism 
Prolactinaemia
Polycystic ovaries 
Physiological 
Pregnancy 
Phenothiazine, metacloPramide, domPeridone
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30
Q

What comprises Fallots tetralogy

A

1) VSD
2) pulmonary stenosis
3) RV Hypertrophy
4) aorta overriding the VSD
Some also have ASD
The degree of pulmonary stenosis indicates the severity of the illness

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31
Q

What is Homans sign?

A

Sign of DVT

pain in the calf on forceful and abrupt dorsiflexion

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32
Q

What does wells score do?

A 
Probability of a PE/DVT 
1Point for each of: 
-cancer 
-paralysis or plaster for past 6 months 
-best rest >3 days or surgery in past 4w 
- localised tenderness 
- entire leg swollen 
- calf >3cm larger than unaffected leg 
-putting oedema greater than other leg 
-collateral superficial veins

If alternative diagnosis is more likely than DVT -2 points

High: =/>3 (75%)
Mod=1-2 (17%)
Low=

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33
Q

What are the CXR findings for PE?

A

S1 Q3 T3
Hamptoms hump- wedge shaped configuration at lung periphery due to infarcted lung
Westermark sign - pulmonary oligemia (local reduction in blood perfusion)

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34
Q

If pts have a moderate wells score and you want to effectively exclude PE and their d dimer is negative what test can you do?

A

Rapid quantitative ELISA

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35
Q

What is the warfarin therapy for someone after PE?

A

Start on enoxaparin 1mg/kg every 12 hours for 5 days
Start warfarin 1-5mg a day
Can stop enoxaparin after 5 days if INR >2.0
Warfarin continued at 2.0-3.0 for 3 months

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36
Q

What is the gold standard of diagnosis of PE?

A

CTPA

V/Q recommended in pregnancy

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37
Q

Warfarin- how does it work?

A
  • Interferes with vit I dependant carboxylate of Gla domains of FII, FVII, FIX, FX and essential for formation of active forms
  • Full Anticoagulation when Vit k dependant clotting factors decrease to 10-20%
  • half life 47hrs
  • bound to albumin in circulation
  • cp450 metabolism
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38
Q

Target INR for DVT, AF, PE?

A

2-3

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39
Q

Target INR for artificial cardiac valve?

A

3-3.5

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40
Q

What are the side effects of warfarin?

A
  • teratogenic- 6-12w gestation
  • bleeding
  • skin necrosis
  • pancreatitis
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41
Q

What do you give to reverse warfarin?

A

Vit K (konakion)
INR >8
Lasts about 1-2w
If acute setting- fresh frozen plasma

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42
Q 
Unfractionated heparin 
Mr? 
Animal origin in uk? 
What do you easily reverse it with? 
Is monitoring necessary?
A 
5000-35000Da 
Pigs! (Other countries cows) 
Protamine sulphate 
Yes- APTTR
Bound to plasma proteins so hard to say how much it is going to work
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43
Q

LMWH
Who to you Monitor in?
Mr?

A

Mr- 3000-5000Da
Not plasma protein bound so more predictable effect
Monitor by anti-Xa level only in children, pregnancy, over/under weight, renal failure, when on oral anti coagulant too, recurrent VTE/high risk bleeding
exclusively cleared by the kidney

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44
Q

What are the complications of heparins?

A

Bleeding
Osteoporosis
Heparin induced thrombocytopenia (leads to platelet activation and thrombosis) if happens stop heparin and start another anticoagulants but not warfarin

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45
Q

What is rivaroxaban?

A

Direct FXa inhibitor
PO, OD
No monitoring
NICE licensed for total hip and knee replacement

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46
Q

What is dabigatran?

A

Direct thrombin inhibitor
PO TDS
No monitoring
NICE approved for extended prophylaxis for total hip and knee replacement

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47
Q

What is haemophilia A a deficiency of?

A

Factor 8
Give desmopressin which gets the level up to half of normal
Can also get acquired (aabs against F8 and happens in makes and females)

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48
Q

What is haemophilia b a deficiency of?

A

Factor 9

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49
Q

What are the Vit K dependant clotting factors?

A

2, 7, 9, 10

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50
Q

What is alteplase?

A

Fibrinolytic enzyme irritating t-PA

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51
Q

What is the inheritance for von willebrand disease?

A

Dominant

Treat with TXA, DDAVP, VWF concentrate

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52
Q

What are the causes of raised fibrin degradation products? (D dimer)

A

Trauma
Recent surgery
VTE
liver/ kidney impairment

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53
Q

What are the encapsulated organisms you are more at risk of if you have your spleen removed?

A

Haemophilus influenzae
Neisseria meningitis
Streptococcus pneumoniae

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54
Q

Causes of small cell anaemia?

A
  • iron deficiency
  • anaemia of chronic disease
  • thalassemia
  • sideroblastic anaemia
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55
Q

Causes of normocytic anaemia?

A 
Anaemia of chronic disease
Combined deficiency -iron and folate 
Marrow infiltration /fibrosis 
Endocrine disease
Haemolytic anaemia

Acute blood loss

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56
Q

Cause of large cell anaemia

A
  • Vit B12 deficit
  • folate deficiency
  • normoblastic
  • alcohol
  • high reticulocytes
  • liver disease
  • hypothyroid
  • azathoprine
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57
Q

When do you need to suspect multiple myeloma?

A 
CRAB 
C - elevated Calcium 
R- renal impairment 
A: anaemia 
B: bone pain
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58
Q

What do you use to constrict the pupils?

A

Pilocarpine (miotic)

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59
Q

What do you use to dilate the pupils?

A

Tropicamide 1% and phenylephrine 2.5%

Avoid if hx angle closure glaucoma

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60
Q

What is amblyopia? And how do you treat it?

A

Amblyopia Is a visual acuity

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61
Q

Which muscle does CNIV Supply?

A

Superior oblique

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62
Q

People with severe depression ALWAYS need to start medication. What is the first line?

A

SSRIs
Citalopram, fluoxetine or sertraline (safe if angina or recent MI)
Warn pts takes several weeks for meds to take effect
SE- initial anxiety, nausea, disturbed sleep, headaches
May increase suicidality
Hyponaturemia reported with all antidepressants but higher in SSRIs

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63
Q

What are the side effects of tricyclic antidepressants?

A

TOXIC IN OVERDOSE
don’t give if suicidal ideation

Mainly anticholinergic 
Dry mouth 
Constipation 
Headache 
Blurred vision 
May incl arrhythmias
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64
Q

After 1st line antidepressant therapy if after 4-6 weeks no or limited response is seen what can you try next?

A

Mirtazapine (a2 adrenoreceptor antagonist so increases central NADL and serotonin neurotransmission)

Venlafaxine (serotonin and NADL reuptake inhibitor) associated with higher withdrawal effects

Tricyclics (lofepramine or amitriptyline)

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65
Q

What is the treatment of choice for mild depression?

A

Watchful waiting or psychological treatment

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66
Q

What is the diagnostic criteria for mild depression?

A

2 weeks

At least 2 of the core features
AND 2 or more symptoms

Causes some distress but able to continue with usual activities

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67
Q

What is the diagnostic criteria for moderate depression?

A

4 or more symptoms present including 2 of the core features

Likely to have great difficulties undertaking daily activities

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68
Q

What is the diagnostic criteria for severe depression?

A

all 3 of the core features and a total of at least 8 symptoms
Symptoms are marked and distressing often including feelings of suicidality, guilt, somatic symptoms
Can be divided into depression with or without psychotic symptoms

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69
Q

What is the diagnostic criteria a manic episode?

A

ELEVATED MOOD/or IRRITABILITY

AND 3 other symptoms for at least 1 week, unless a hospital admission has been required (allow shorter duration)

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70
Q

What is the diagnostic criteria for hypomania?

A

Symptoms of mania but less severe and of shorter duration (4 consecutive days)
Does not tend to lead to hospital admission or distrust daily activities

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71
Q

What is the diagnostic criteria for bipolar affective disorder?

A

At least 2 episodes of mood disturbance (elevated OR depressed) but one of these MUST be hypomania or mania

Depressive episode is not required,
Diagnosing a depressive episode same as someone suffering from depression alone

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72
Q

What is rapid cycling?

A

They have 4 or more episodes of either mania/hypomania and/or depression
In a 12 month period

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73
Q

What drugs can lead to manic episodes and increase the risk of a manic episode in someone with mania?

A

Cocaine, ecstasy, amphetamines

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74
Q

If a 1st degree relative has bipolar affective disorder, how much are your chances increased by?

A

X7
90% concordance between monozygotic twins
Mean onset is 21

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75
Q

Name 3 antipsychotics you can use to treat a manic episode

A

Olanzapine
Quetiapine
Risperidone

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76
Q

What is good in the short term for managing mania?

A

Lorazepam (benzo)

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77
Q

Name 2 mood stabilisers

A

Lithium
Semisodium valproate
Good if responded to them before

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78
Q

What should you do it someone is having a manic episode and they are on antidepressants?

A

Should be reduced and stopped during the episode

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79
Q

What can you prescribe as prophylactic medication in bipolar affective disorder?

A

mood stabilisers- lithium or semisodium valproate OR the antipsychotic orlanzapine

Minimises the number and severity of episodes of mania or depression.

May need to combine them
DONT GIVE sodium/ semisodium valproate to children of childbearing age

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80
Q

What do you need to monitor when prescribing lithium?

A

Regular and close monitoring- blood levels, especially when initiating or changing dose.

  • check levels every 3 months if on a stable dose.
  • monitor LFTs and TFTs every 3 months.
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81
Q

What are the side effects if lithium?

A

Fine tremor, nausea, GI upset, polyuria, weight gain, metallic taste

Signs of toxicity

  • coarse tremor and ataxia
  • muscle weakness
  • severe nausea and diarrhoea
  • drowsiness, coma, death
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82
Q

What are the first rank symptoms of schizophrenia also known as?

A

Schneider’s first rank symptoms

83
Q

What are the 1st rank symptoms of schizophrenia?

A
  • thought insertion, broadcast, withdrawal, echo
  • running 3rd person commentary
  • voices arguing
  • passivity of affect, impulse, volitions (actions), somatic (body is being controlled)
  • delusional perceptions (normal sensory perception as having a meaning) often intended for the patient alone- which is why others disbelieve them.,
84
Q

What is the diagnostic criteria for schizophrenia?

A
  • at least 1 first rank symptom present for most of the time for at least 1 month
    OR
    At least 2 of:
    -persistent hallucinations in any form every day for at least a month.
    -neologisms (made up words) or thought distribution leading to incomprehensible or irrelevant speech.
    -catatonia- over activity or limited/no movements
    -negative symptoms (self neglect, limited activity, reduced amount if speech, limited emotional responses
85
Q

What is paranoid schizophrenia?

A

Delusions and hallucinations often persecutory.
Most common
Best prognosis

86
Q

What is hebephrenic schizophrenia?

A

Jumbled speech and inappropriate behaviour which is often silly

87
Q

What is simple schizophrenia?

A

Negative symptoms only, no delusions or hallucinations

88
Q

What is residual schizophrenia?

A

Get delusions and hallucinations followed by negative symptoms

89
Q

What is catatonic schizophrenia?

A

Disturbed movements- under or over activity

90
Q

What are the risk factors for schizophrenia?

A 
Urban 
Male 
Younger age (peak onset is 20yrs old) 
Slow or delayed childhood development 
Pregnancy complications/traumatic birth 
Maternal infection ( influenza) 
FHx- genetic link with heritability 60-80% 
Afro Caribbean
91
Q

Name some atypical antipsychotics

A

Newer form
Orlanzapine
Quetiapine
Risperidone (may have fewer metabolic side effects)

Clozapine

  • used in treatment resistant schizophrenia - at least 2 others must have been tried, one of which must be atypical
  • not suitable for chaotic or poorly adhering
  • risk of agranulocytosis and need regular WBC levels- Weekly initially,
  • increased risk if metabolic side effects
92
Q

What are the side effects with atypical antipsychotics?

A

Metabolic-
-weight gain, increased risk MI, DM,

hyperproplactinarmia (espec clozapine)

  • reduced/absent periods
  • gynaecomastia
  • excessive/increased growth of body hair
  • sedation

Also extrapyramidal side effects but they are worst in typical

93
Q

Name some typical antipsychotics

A

Haloperidol
Promethazine
Chlorpromazine

94
Q

What are the side effects if typical antipsychotics?

A

-extrapyramidal incl:
- acute muscle dystonia
-tardive dyskinesia (repetitive, involuntary movements, often of the torso or lips)
- Parkinsonisms
Can get metabolic too but these more common in typical than atypical

95
Q

Which drugs can be given in a depot?

A

Risperdal
Depixol
Clopixol
Piportil

96
Q

What are obsessions?

A

Intrusive, distressing thoughts
Pt recognises them as their own (different from a delusion)
Accompanied by a feeling something bad will happen
Not all progress to acts- May result in rumination (dwelling on the thought)

If they do lead to an act- compulsion

97
Q

What is a compulsion?

A

Feel a strong need to perform a certain action despite knowing it’s silly/unnecessary.

  • usually try to resist unsuccessfully
  • performed as an attempt to relieve anxiety these thoughts cause
  • provide temporary relief.
98
Q

What is the 1at line treatment for mild OCD?

A

Low intensity psychological therapy- 10 therapist hours

Exposure response prevention therapy

99
Q

What is the recommended treatment for adults with moderate OCD?

A 
Moderate means they have moderate functional impairment. Or low impact psychological therapy had proven ineffective. 
EITHER short course SSRI 
OR 
more intensive psycholoigcal treatment
Exposure response prevention therapy

These treatments are equally effective,
NB all pts avoid alcohol- make it worst and stop the drugs working

100
Q

Treatment for OCD with severe functional impairment?

A

Combo of SSRI and psycholoigical therapy - fluoxetine (selective inhibitor) usually needed for 12. Dose needed is higher than needed in depression. Increased risk of relapse if drug stopped early or is too low dose
Exposure response prevention therapy

101
Q

Define panic disorder

A

4 panic attacks in a month (mod)

4 in a week (severe)

102
Q

What can use used in panic disorder?

A

Sedating antihistamine

Cholrphenamine

103
Q

What is the treatment for PTSD?

A

Trauma focused CBT
Stress management
Relaxation techniques
Eye movement desensitisation and reprocessing
Form of Psychotherapy
Helps process distressing memories more fully which reduces emotional
Impact of the memory

NB
Debriefing after a traumatic event especially group debriefing has been shown to he detrimental and not used

Can use drugs:
Sertraline and mirtazapine

104
Q

What is the diagnostic criteria for anorexia nervosa?

A

-weight loss leading to body weight at least 15% below normal or expected weight for age and height
OR BMI

105
Q

What is the diagnostic criteria for bulimia nervosa?

A
  • recurrent episodes of over eating at least twice a week for a 3m period. Large amounts of food eaten in shirt space of time
  • preoccupation with food and eating and a compulsive desire to eat (craving)

attempt to counteract this behaviour by:

  • self induced vomiting
  • purging
  • alternate episodes of starvation
  • use drugs to control weight
106
Q

What is EDNOS?

A

Don’t meet all the above criteria for bulimia or anorexia nervosa but some features may be present.

107
Q

What is the prophylaxis following rheumatic fever

A 
-penicillin V 250mg/12h PO 
OR 
-sulfacliazine 1g/day PO 
OR 
-erythromycin 250mg/12h PO

If no carditis: 3 years/ until 21 years old
If carditis or valvular disease: until 40yo
If carditis and no valvular: for 10 years

108
Q

What antibiotics do you use for infective endocarditis? Blind therapy

A

Native valve:

  • amoxicillin
  • /+ gentamicin
  • if pen allergic- vancomycin and gentamicin

Prosthetic valve:
Vancomycin
+ gentamicin
+ rifampicin

109
Q

What abx do you use for infective endocarditis caused by staphs?

A
  • native: flucloxacillin

- prosthetic: flucloxacillin + rifampcin+ gentamicin (review this one after 2w)

110
Q

What abx do you use for infective endocarditis caused by streps?

A
  • benzlypenicillin

If pen allergic
-vancomycin + gentamycin

111
Q

What abx do you use for infective endocarditis caused by enterococcus?

A

Amoxicillin+gentamycin

112
Q

What abx do you use for infective endocarditis caused by HACEK organisms?

A

-amoxicillin and gentamycin for 4w

6w if prosthetic

113
Q

What criteria is used to diagnose infective endocarditis?

A 
Dukes criteria 
Need 1 major and 3 minor 
Or 
2 major 
Or 
5 minor 
-major: 
-2 blood cultures positive typical or 3 different sites all positive. 
-endocardium involved- negative ECHO 
-new valvular regurgitation

Minor:

  • fever >38C
  • predisposition
  • positive blood culture if isn’t a major
  • positive ECHO but major not met.
  • vascular immunological signs
114
Q

What is the treatment for stable angina?

A

-all patients get aspirin, statin, GTN spray

1st line: B blocker or CCB (verapamil or diltazem)
2nd: increase dose to the max tolerated
3rd: add either B Blocker of CCB (dihydropyride if combined)
If you can’t add these, consider: nicorandil, ivabradine or ranolazine

DO NOT USE B BLOCKER WITH VERAPAMIL- Complete heart block

115
Q

What can you treat migraine with?

A

Triptinate

116
Q

How do you treat a sex and exercise headache?

A

Amitriptoline

117
Q

What visual field defect is caused by pituitary tumour?

A

bitemporal superior quadrantanopia

118
Q

Which bacteria are alcoholics more prone to?

A

Klebsiella

119
Q

What organism causes erythema multiform?

A

Mycoplasma

120
Q

Causes of acute pancreatitis

A 
GET SMASHED 
Gallstones 
ERCP 
Trauma 
Steriods 
Mumps (cox B) 
Autoimmune 
Scorpion venom 
Hyperlipidlemia 
ETOH 
Drugs
121
Q

How does aspirin work?

A

Anti platelet - inhibits thromboxane A2 production

122
Q

How does clopidogrel work?

A

Anti platelet

Inhibits ADP binding to it’s platelet receptor

123
Q

How does enoxaparin work?

A

Activates antithrombin III therefore potentiates the inhibition of coagulation factor Xa
Fondaparinux acts in the same way

124
Q

How does bivalirudin work?

A

Reversible direct thrombin inhibitor

125
Q

What Abx do you prescribe for an animal bite?

A

Co amoxiclav
If pen allergic
Metronidazole and doxycycline
Organism is pasturella multiocida

126
Q

Important side effect of amiodarone

A

Thyrotoxicosis

127
Q

What is the 1st line treatment for UC?

A

Aminosalicylates

If don’t respond after 4w use prednisolone

128
Q

What is the target weight gain for someone with anorexia nervosa per week?

A

1-1.5kg

129
Q

What drug do you use to detox from alcohol or stimulant drugs eg cocaine and amphetamines?

A

-benzodiazepines

130
Q

What drug do you use to detox from heroine/opiate abuse?

A
  • Methadone
  • buprenorphine (partial opioid agonist) blocks opioid receptors and prevents the effect of using other opiates
  • Naltrexone - opioid agtagonist which prevents reuse of opiates by interaction leading to unpleasant physical symptoms
  • Lofexedine- alpha 2 agonist which reduces opiate withdrawal symptoms
131
Q

What does acamprosate do?

A

Reduce alcohol cravings- MUST be abstinent

132
Q

What vitamins do you need to replace in alcohol abuse?

A

Thiamine/im pabrinex and Vit B12

133
Q

When does delirium tremens occur?

A

1-3 days after alcohol cessation

134
Q

How does delirium tremens present?

A
  • disorientation
  • visual hallucinations (insects or small people)
  • physical signs- sweating, pyrexia, tachypnoea, tachycardia
135
Q

How do you treat delirium tremens?

A 
Benzodiazepines 
Correct electrolyte abnormalities 
Vit replacement 
Rehydration 
Nurse in well lit room and consistent environment
136
Q

What is wernickes triad?

A

acute onset, high morbidity/mortality

1) acute confusion/agitation
2) eye signs (nystagmus)
3) ataxia (broad based gait with cerebellar signs)

137
Q

What causes wernickes ?

A

Thiamine deficiency leading to ischemic damage to the brainstem

Requires urgent treatment with thiamine replacement (im pabrinex)
To prevent progression to Korsakoff’s syndrome

138
Q

What is Korsakoff’s syndrome?

A
  • acute symptoms of wernickes
  • these resolve and leave an amnesic syndrome
  • confabulation (making up history/facts subconsciously to fill in memory gaps) is a key feature
139
Q

What are the main features of dissociative (conversion disorder) ?

A
  • symptoms appear suddenly
  • symptoms remit after a few weeks/months
  • association between symptoms and stressful events/needs
140
Q

What are the main features of somatinization disorder?

A
  • at least 2 years multiple and variable symptoms
  • preoccupation with symptoms causes persistent distress and leads to patient seeking repeated consultations/sets of investigations (>3)
  • won’t accept reassurance nothing physically wrong.
  • 6 or more symptoms from 2 or more of: GI, CV, GU, skin and pain symptoms
141
Q

What is the diagnostic criteria for hypochondriasis?

A

-persistent belief (>6m) of the presence of up to 2 serious physical illnesses
OR Preoccupation with a presumed deformity or disfigurement.
-interferes with life and causes distress.
-refuse to accept medical reassurance

142
Q

What is the diagnostic criteria for factitious disorder?

A
  • pt feigns or produces symptoms intentionally
  • aim to adopt the ‘sick role’
  • often combines with relationship / personality difficulties
  • no evidence of external motivation- eg money (not malingering)
  • aka munchausens or hospital hopper syndrome
143
Q

What is the treatment for emotionally unstable personality disorder?

A
  • dialectical behavioural therapy

- mentalization based treatment

144
Q

Features of paranoid PD?

A
  • sensitive to set backs
  • bears grudges
  • suspicious and combative in nature in respect to their personal rights
  • excessive self importance
145
Q

Features of schizoid PD?

A
  • emotional detachment and coldness, unable to express emotions
  • limited relationships and indifference to others opinions
146
Q

Features of Dissocial PD?

A
  • low tolerance to frustration
  • inable to experience guilt
  • disregard others feelings and irresponsible attitude to social rules
147
Q

What are the features of histrionic PD?

A
  • self dramatisation
  • inappropriate seductivesness
  • concern with physical attractiveness
148
Q

Features of obsessive PD?

A

-rigid and stubborn in manner
-obsessive traits incl excessive doubt and caution, perfectionism
Pre occupation with rules

149
Q

Features of anxious (avoidant) PD?

A

Persistent and pervasive tension and anxiety.
Belief they are socially inept
Preoccupation with criticism and avoid social suituations/relationships due to fear of rejection

150
Q

Features of dependant PD?

A

Allow others to make life choices and rely heavily on others for reassurance.

  • feel uncomfortable alone
  • will never put own needs above own, unwilling to make demands on others
151
Q

What can you give to enhance cognition in mild-mod AD?

A

Anticholinesterase inhibitors
Donepezil
Galantamine
Rivastigmine
CI- heart block, arrhythmias as can have severe bradycardic effect.
SE- nausea, diarrhoea, insomnia, headache

Slow decline and improve behaviour
Monitor MMSE every 6m

152
Q

What drug is licensed for moderate to severe dementia?

A

Memantine
NMDA antagonist

Neuroprotective and therefore disease modifying.

153
Q

Managing acutely disturbed patients- if de escalation doesn’t work, what can you do next?

A
  • offer oral medication- benzos or fast acting antipsychotics (haloperidol or promethazine)
  • if refusing and danger- im lorazepam or midazolam

NB must not combine lorazepam and olanzapine- Resp depression

154
Q

If a patient develops oculogyric crisis or painful dystonia as a side effect of antipsychotics, what can you give?

A

Procyclidine (anti cholingeric) iv,PO or Im

Long term can reduce these and reduce Parkinson’s symptoms

NOT to treat tardive dyskinesia

155
Q

What can be used to treat EPSE more long term?

A

Benzos, baclofen and physical therapy

156
Q

What us neuroleptic malignant syndrome?

A

Life threatening neurological reaction occurring in response to antipsychotic medication

More common in younger men, those on depot and those who have not received antipsychotic meds before
-fever, sweating, autonomic fluctuation, muscle rigidity, cognitive changes and confusion. Raised creatininezzz..z.. kinase

157
Q

What is serotonin syndrome?

A

Potentially life threatening adverse drug reaction, rapid onset
Overdose,interactions (MDMA, LSD)
Leads to high serotonin levels.
Myoclonus, autonomic features, tremor

Hydration and benzos

158
Q

What does phenytoin do?

A

Anti epileptic - not first line anymore
Blocks Na channels
Lots of side effects
Need serum levels monitoring

159
Q

What does carbamazepine do?

A

Blocks sodium channels

serum levels monitoring useful

160
Q

What does phenobarbital do?

A

Prolonged GABA mediated Cl channel opening
Blocks some Na channels
Most widely prescribe AED

serum levels monitoring- useful in some pts

161
Q

What does lamotrigine do?

A

Sodium channel blocker

Monitor levels in pregnancy

162
Q

What does sodium valproate do?

A

Effective in all seizure types
1st choice in idiopathic generalised epilepsy and myoclonic epilepsy
Significant pregnancy risk

May enhance GABA transmission in specific circuits
Blocks sodium channels.
Modulates t type Ca channel

163
Q

What does levetricetam do?

A

Important AED rapidly gained an important place in clinical practise.

Reduces high voltage activated Ca currents
Reverses inhibition of GABA gated currents
Binding of reversible specific binding site SC2a (synaptic vesicle protein)

164
Q

What does topiramate do?

A

Blocks voltage gated Na channels at high firing frequencies
Increases frequencies at which GABA opens Cl channels
Antagonises glutamate action

165
Q

What is the first line therapy to treat osteoporosis?

A

Alcendronate
Risedronate
These are bisphosphinates

166
Q

What is drusen a sign of?

A

DRY DRUSEN

Dry macular degeneration

167
Q

Which cancer is barrets and GORD associated with?

A

Oesophageal adenocarcinoma

168
Q

What 3 things are associated with normal pressure hydrocephalus?

A

Urinary incontinance
Gait abnormal
Dementia

169
Q

What drugs cause an increase I’m creatinine?

A

Cimetidine

Trimethoprim

170
Q

Which bit of the brain is a triple watershed area?

A

Parieto-occipital sulcus

171
Q

Which drugs cause lung fibrosis?

A

Amiodarone

Nitroflutoin

172
Q

How do you monitor heparin?

A

APTT

173
Q

What is fovilles syndrome?

A

Pontine lesion

Facial nerve palsy and ipsilateral gaze palsy and contralateral hemiparaesis

174
Q

What is Millard gubler syndrome?

A

Occlusion of the basilar artery branches in the pons gives lateral rectus palsy (6cn)
Ipsilateral facial paralysis
Contralateral hemiplegia

175
Q

What are the abs in MS?

A

MOG, MBP
these can predict the time to conversion to definite MS

NMO-IgG- devics

176
Q

What monoclonal abs are used in Ms?

A

Alemtuzumab
Natalizizumab- decreases relapsing remitting my 67% and lesions by 92%
VLA REceptor blocker and allows immune cells to cross BBB

177
Q

Which renal stones are semi opaque on X-ray?

A

Cystine

178
Q

Which renal stones are radiolucent on X-ray?

A

Urate

Xanthine

179
Q

What is leriches syndrome?

A

1) clarification of buttocks and thighs
2) atrophy of leg muscles
3) impotence

Atherosclerotic occlusion problems

180
Q

What is Lhermitte’s sign?

A

Flex neck and get electric shock in trunk and limbs.

MS, cervical spondylitis, subacute combined degeneration of the cord, trigeminal neuralgia

181
Q

What is uhthoffs phenomenon?

A

Decrease in vision on exercise, hot meals and hot baths

182
Q

What has low factor VIII and high APTT and normal INR?

A

Haemophilia A
Give desmopressin
Avoid im and NSAIDS

183
Q

What is factor IX deficiency?

A

Haemophillia B

184
Q

How do you diagnose AML?

A

Bm biopsy

Auer rods

185
Q

When does the Ph have a good and worst prognosis?

A

Good- CML

Bad- acute lymphoblastic leukaemia

186
Q

How do you treat CML?

A

Imatimib- specific for Ph ch
Stem cell transplant only chance of cure

Insidious onset
May be features if gout
High WBC low Hb
High b12 high urate

187
Q

What is the most common leukaemia?

A 
Chronic lymphocytic leukaemia 
Usually incidental finding on Fbc 
Enlarged rubbery non tender nodes
High lymphocytes 
Rule of 1/3s
188
Q

Which Hodgkin lymphoma has the best prognosis?

A

Nodular scelerosising- most common

Lymphocyte depleting- worst prognosis and least common

189
Q

Which is the most common non Hodgkin lymphoma?

A

Diffuse large B cell lymphoma

190
Q

What thing in the blood test means there’s a worst prognosis in non Hodgkin lymphoma?

A

High LDH

Means high cell turn over

191
Q

In myeloma what do you get on electrophoresis?

A

Monoclonal band or paraprotien on serum or urine electrophoresis

BENCE JONES proteins - urine
High calcium and bone lesions
Renal problems due to lots of abs

Tx chemo and pred

192
Q

amyloidosis

A 
1) AD, T2DM 
Fibrillar light chain deposition 
Restrictive cardiomyopathy 
Nerves 
Gut
Vascular

Tx- melphalan and pred

Secondary- reflecting chronic inflammation as acute ph protien

Familiar- transyhtretin in liver, transplant cures

POSTIVE CONGO RED STRAIN

193
Q

What can protein c and protein s cause?

A

Clots
Skin necrosis espec if on warfarin
Neonatal purpura fulminans- fatal if intreated

194
Q

Where is atherosclerosis?
Pseudo AAA
Aortic dissection.

A

Intima
Adventicia
Media

195
Q

Benefit of aspirin in ACS?

A

Reduction CV Mort
And non fatal MI
And reocculsion rates
40% of people reduction progression non stable Angina to MI

75mg after- reduction in events

196
Q

Benefits of Thienopyrides in ACS?

A

Reduce major cardiac events, thrombosis and restenosis rates
34% non responders to clopidogrel

197
Q

What is the treatment for FH?

A

Statin atorvastatin
Ezetimibe - inhibits cholesterol absorption
Resin/bile acid sequestrant- cholestyramine
Apheresis

198
Q

What happens with warfarin and abx?

A

Increase warfarin affects as abx decrease gut flora so less Vit k is made

199
Q

What happens with valproate and phenytoin?

A

Valproate displaces phenytoin and inhibits it’s metabolism

200
Q

ASA and NSAIDS and methotrexate?

A

ASA and NSAIDS displace methotrexate so decrease it’s excretion- get serious methotrexate tox

201
Q

Amiodarone and digoxin?

A

Amiodarone displaces digoxin and impairs it’s excretion

202
Q

What do you get with multiple myeloma?

A 
CRAB
High Calcium 
renal impairment 
Anaemia 
Bone pain
203
Q

What are the tumour markers for testicular cx?

A

alpha FP
bHCG
LDH

US then remove. Don’t waste time CT can mx very quickly

MBBS3 (6 decks)

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