NSS Flashcards
How to describe a MRI brain or CT head during an osce?
How to assess a neck lump in osce?
How to remember drops for treatment for glaucoma ?
ABC PAP
What are the main features of myotonic dystrophy?
Autosomal dominant
Trinucleotide repeat disorder- Anticipation occurs
Features:
mneumonic - F CAMP
Bilateral facial weakness
Frontal balding
Cataracts
Arrythmias
Myotonia (muscle spasm- prolonged muscle contraction)
Progressive Muscle weakness
Duchenne muscular dystrophy:
What kind of disorder is it?
Inheritance pattern?
When does it occur?
What gene is affected ?
Muscular dystrophy
X-linked recessive
3-5 years old in boys
Girls can only carry the faulty gene
Dystrophin gene
Duchenne muscular dystrophy: features on examination?
Gower’s sign
Calf pseudohypertrophy
proximal muscle weakness
cognitive impairment
Duchenne muscular dystrophy:
by how old will they be in a wheelchair?
life expectancy?
why do they die?
teenager- most by 12 yo
25-35yrs
affects also the cardiac muscle leading to dilated cardiomyopathy
How is duchenne MD Ix and managed?
raised creatinine kinase
genetic testing
mostly supportive
physiotherapist
OT
Mobility support- wheelchair/braces
Oral steroid can slow the progression of muscle weakness
What is beckers muscular dystrophy?
develops after the age of 10 years
intellectual impairment much less common
Features of all myopathies
symmetrical muscle weakness (proximal > distal)
common problems are rising from chair or getting out of bath
sensation normal, reflexes normal, no fasciculation
What are polymyositis and dermatomyositis
Inflammatory myopathies which are autoimmune and cause proximal muscle weakness
Dermatomyositis has skin involvement aswell
What can cause polymyositis and dermatomyositis?
Who does it affect ?
Malignancies- paraneoplastic syndromes
Viral infections-coxsackie and HIV
Middle aged females
Possible skin presentations in dermatomyositis ?
Gottron lesions (scaly erythematous patches) on the knuckles, elbows and knees
Heliotrope rash (a purple rash on the face and eyelids)
Periorbital oedema (swelling around the eyes)
Photosensitive erythematous rash on the back, shoulders and neck
How to treat polymyositis and dermatomyositis?
Physio and OT to help with muscle strength
High dose steroids
Immunosuppressants - Azathioprine and methotrexate
Side effects of oral isotretinoin?
*Mucocutaneous reaction: Dry skin, dry lips, dry eyes
*Fragile skin; avoid waxing
*Increased risk of skin infection & slower wound healing
*Increased sensitivity to the sun
*Deranged LFTs
*Hypercholesterolaemia
*Hypertriglyceridaemia
*Myalgia
*Arthralgia
*Depression +/- self-harm & suicide
name some stroke mimics : mneumonic behind
14 year old boy presents with reduced hearing and a previous cold which affected both ears.
What can you see on examination?
What is the investigations and management?
Retracted TM with middle ear bubbles and fluid visible through the pars tensa
Plaques of calcium deposits on the TM
Clear EAM
Otitis media with effusion
Mx:
Pure tone audiometry
Tympanometry
Self limiting usually
How to assess the EAM?
Look at EAM
- debris
-erythema
-discharge
- oedema
- foreign bodies
TM- check all 4 quadrants
- Cone of light-anterior inferior quad (loss is otitis media)
- colour- grey and translucent
- shape - bulging/retracted
- perforations- state size and position
- look at the attic of the TM for cholesteatoma
- scarring- tympanosclerosis develops due to chronic otitis media or tympanostomy tube- can cause conductive hearing loss if extensive
45yo recurrent ear infection, poor hearing, discharge from r ear, Abx used for ear infection and no resolution.
Describe picture
Inx and Management?
right ear
TM filled with white debris and black fungal spores
(aspergillus-black and candida- white)
Cannot visualise but TM perforation likely due to discharge
EAM can be erythematous
Otomycosis
Mx:
Consider microsuction of the debris
advise to keep ear dry
antifungal can be used if not perforated
If perforation: can heal itself but may need tympanoplasty
23, surfer, trouble clearing water from ear, got wax removal privately.
Describe picture
Inx and Management?
right ear
Swollen, narrowed EAM
bony swellings visualised on the anterior and posterior sides of canal
Swimmer’s osteoma (more common in cold water swimmer’s)
Mx:
no tx, keep ear dry, in severe cases can drill osteomas
4yo, boy, hearing affected, speech and lang delay
Several abx used for ear infections in past
Describe picture
Inx and Management?
Right ear
TM is retracted, dull
handle of malleus looking short due to retraction
radial blood vessels within the membrane
Otitis media with effusion
Mx:
Audiometry
watchful waiting
follow up in 3 months w/audiometry and consider grommet insertion, hearing aid or adenoidectomy
54yo, ear infections as a child, hearing test showed hyperacusis in right ear
Describe picture
Inx and Management?
right ear
Large brown deposit in the roof of the TM above the handle of the malleus
due to collection of proliferating squamous cells that may have bone erosion below it
Cholesteatoma with a attic crust
Mx:
Audiometry
CT scan
Plan for mastoid exploration
20yo, fem, pain and discharge from ear, hearing not recovered
Describe picture
Inx and Management?
RIGHT EAR
erythematous EAM
Yellow debris in eam
Perforation visualised on inferior quadrants of the TM
tympanosclerosis
Engorged vessels over tm
Perforation due to otitis media
Mx:
Audiometry
Keep ear dry
no eardrops
follow up in 2 months w/ audiometry
Tympanoplasty might be needed as large perforation
21, fem, 2w hx of headache and nausea
throughout the day and wakes her up at night
on the cocp
Same fundoscopy bilaterally
Describe picture ?
DDx?
Inx and Management?
venous engorgement and venous infiltration of optic disc
swollen optic disc -blurry margins
Also do VF, VA, Ishihara
Primary diagnosis:
venous sinus thrombosis
DDx:
Meningitis
Idiopathic intracranial HTN
SOL
Inx:
MR venogram
CT head
OCT
LP
74, fem, systemic HTN, Smoker
VA decreased in left eye
normal ant eye and clear vitreous
Describe picture ?
DDx?
Inx and Management?
Copper wiring
Hard exudates
Hypertensive retinopathy- stage 3
DRY ARMD
Diabetic retinopathy
Amsler, VA, VF
OCT, Fluorescein angiography
Mx:
Smoking cessation
HTN control
Diet
exercise
lifestyle advice
77, high myopia, sudden onset bumping into left side altered sensation on left side of body and slurring of speech
T2DM, HTN, Bil cataract surgery, smoker
VA- normal
VF- Left homonymous hemianopia
Describe picture ?
DDx
myopic peripapillary atrophy is seen- retina thins and the retinal pigment epithelium (RPE) is disrupted around the optic disc
defect in retina
Diagnosis: stroke
6month old, poor feeding, floppiness, irritability
Describe picture ?
DDx?
Inx and Management?
Bilateral multiple retinal haemorrhages
DDx
NAI
Lymphoproliferative disorder
Meningitis
SOL
Mx:
Skeletal survey - when NAI is suspected
CT
Haematological examinations
74, m, blurry r eye
HTN, T2DM, smoker
VA- reduced in R eye
