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My Final Year 4 Revision > OSCE Revision > Flashcards

OSCE Revision Flashcards

1
Q

anterior cerebral artery blockage will lead to weakness of

A

lower limb contralaterally

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2
Q

vascular dementia presentation

A

step wise progression
onset can be sudden or gradual
executive function deficits prominent early
mood disturbances and disorders are common
neuro deficits and gait problems early
later stages = psychosis, delusions, hallucinations, paranoia
can be alongside alzheimers

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3
Q

AIDP

A

acute inflammatory demyelinating polyneuropathy

most common variant of GBS - 95% cases

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4
Q

Weakly positive birefringent, rhomboid shaped crystals

A

Calcium pyrophosphate = pseudogout

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5
Q

how to measure lying and standing BP

A

patient lay down for 5/10 minutes
take BP
then stand and take BP at 1 min and 3 min

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6
Q

DVLA and stroke /TIA

A

group 1 - dont need to report. dont drive for 1 month and can drive if no sustained neuro deficits after 1 month
group 2 = 1 year cant drive

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7
Q

risk factors for vascular dementia

A

main = HTN

smoking, diabetes, hyperlipidaemia, obesity, hypercholesterolaemia

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8
Q

retinal detachment presentation

A

new onset floaters, photopsia (bright flashes), sudden onset progressing visual field loss - a dark shadow that moves inwards
RAPD if macula or >1/2 retina detaches

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9
Q

Smith’s fracture

A

Volar displacement of radius head

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10
Q

treatment of parkinsons disease

A

1) levodopa + dopa decarboxylase inhibitor
2) dopamine agonist
3) MAO-B inhibitor

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11
Q

presentation of bacterial conjunctivitis

A

mucopurulent secretions, red eye, stinging, FB feeling, mild/moderate pain, glued eyes upon waking, papillae under eye lid

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12
Q

Z shaped thumb

A

Sign of RA-MCPJ flexion and IPJ extension

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13
Q

Negatively birefringent, needle shape crystals

A

Monosodium urate = gout

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14
Q

co beneldopa

A

levodopa and Benserazide

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15
Q

features of vascular parkinsonism

A 
gradual or step wise deterioration 
small vessel disease 
symmetrical 
predominantly leg symptoms 
50% respond to leva dopa
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16
Q

prophylactic treatment for migraine

A

if > 2 headaches a month

propranolol, topiromate, amitriptyline

2nd line - sodium valproate, botox

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17
Q

Ankle joint bones

A

Tibia, fibula and talus

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18
Q

Radial inclination

A

Normal wrist has 25 degrees radial inclination

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19
Q

presentation of parkinsons disease

A 
resting tremor 
rigidity
bradykinesia  - reduced arm swing, progressive reduction in amplitude of repetitive movements 
fixed facial expression 
reduced blinking 
hypophonia (quiet voice)
micrographia (little writing) 
gait disturbance 
hyposmia 
non motor symptoms - ANS: orthostatic hypotension, constipation, inconinence, sleep disorders, intense dreams, dysphagia, memory/ concentration problems.
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20
Q

prophylaxis of further aacg attacks

A

laser peripheral iridotomy

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21
Q

amiodarone

A

used for cardioversions in atrial fibrillation

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22
Q

donepezil

A

cholinesterase inhibitor for dementia

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23
Q

delirium

A

acute onset, fluctuating confusion due to an underlying treatable cause

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24
Q

investigations for encephalitis

A

LP - PCR for HSV, VZV and enterovirus

MRI and bloods

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25
Q

blockage of middle cerebral artery will lead to weakness/sensory loss of

A

contralateral face and arm

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26
Q

signs of radial nerve palsy

A 
wrist drop (no wrist extensors) 
sensory loss of central posterior arm and thumb
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27
Q

Bouchards nodes

A

PIP joint swelling in OA

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28
Q

side effects of levodopa

A

dyskinesia with long term use
impulse control disorder
on/off fluctuations
reduced effect with time

nausea, vomiting, hypotension, poor appetite, psychological problems, sleep problems, hallucinations

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29
Q

how does viral conjunctivitis present

A

no/mild pain, watery discharge, diffuse red injections, mild itching, gritty feeling, lymphoid follicules under eyelid, pre-auricular lymphadenopathy

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30
Q

aetiology of delirium

A 
Constipation 
Hydration 
Infection 
Metabolic disturbance 
Pain
Sleeplessness
Prescriptions
Hyperthermia or pyrexia 
Organ dysfunction - renal/hepatic 
Nutrition - vitamin deficiencies
Environmental 
Drugs

others: hypoxia, surgery, hypoglycaemia, B12 deficiency, traumatic head injury, encephalitis

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31
Q

managing difficult delirium

A

use verbal/non verbal techniques to deescalate

if needed
short term haloperidol 0.5mg oral or 1mg IM
(not in parkinsons or LB dementia)

or Lorazepam

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32
Q

acute angle closure glaucoma presentation

A

severe, rapidly progressing pain, brick red eye, progressive headache on affected side, vomiting, rapidly progressing visual loss, corneal clouding, haloes, v high iop, mid dilated fixed pupil

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33
Q

Bamboo spine

A

Seen in ankylosing spondylitis , Due to ossification of the annulosus fibrosis and interspinous ligaments

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34
Q

hypoactive delirium

A

lethargy
slowness with everday tasks
inattention
excessive sleeping

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35
Q

5 common malignancies that spread to bone

A

Thyroid, lung, breast, renal, prostate

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36
Q

secondary prevention for TIA

A 
treat AF
treat carotid stenosis
treat HTN 
optimise diabetes 
lifestyle changes 
treat vascular risk factors
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37
Q

Carpal bones

A

Bones of the wrist - Scaphoid, lunate, triquetral, pisiform, Trapezium, trapezoid, capitate, hamate

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38
Q

how often should diabetic patients be screened for DR?

A

at diagnosis and then annually

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39
Q

what are the 3 essential meds you cant miss in hospital

A

parkinsons meds
anti epileptics
insulin

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40
Q

strongst predictors of stroke prognosis

A

age and severity of stroke

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41
Q

AMT 4

A

age
dob
place
year

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42
Q

iridocorneal angle

A

the angle involved in glaucoma

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43
Q

latanoprost

A

prostaglandin analogue that lowers pressure in the eye by increasing drainage of aqueous humour
used in glaucoma

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44
Q

Aflibercept

A

Anti VEGF injection - used for wet AMD and oedema in DR

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45
Q

DVLA and epilepsy

A

1st unprovoked seizure = 6 months for group 1, 5 years for group 2
epileptic seizure = 12 months for group 1, 10 years for group 2
cant drive during period of AED withdrawal/changeover and for 6 months post

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46
Q

ropinirole

A

dopamine agonist for PD rx

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47
Q

Volar displacement

A

Displacement of the distal radius towards the palm of the hand #

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48
Q

4AT assessment

A

Alertness
AMT 4
Attention - months from december backwards
Acute onset and fluctuating

> 4 = delirium

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49
Q

crescendo TIA

A

2+ in 1 week

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50
Q

classic gait abnormalities in parkinsons

A

small shuffling steps with stooped posture.
unsteadiness on turning
difficulty stopping - festination
tendency to fall
‘freezing’ in doorways/ patterned carpets

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51
Q

uveitis presentation

A

associated with systemic inflammatory conditions- especially ankylosing spondylitis.
dull orbital pain, red eye, reduced vision, synechia, flare, tearing, floaters, photophobia

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52
Q

apraclonidine

A

alpha 2 adrenergic agonist - used in glaucoma to lower IOP by stopping aqueous humour production

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53
Q

best AED for pregnancy

A

lamotrigine with folic acid 5 mg

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54
Q

posterior column syndrome

A

loss of proprioception/vibration/fine touch below the lesion. sensory ataxia and positive rhombergs

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55
Q

Methotrexate given with

A

Folic acid

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56
Q

most common vasculitis in adults , affecting branches of the external carotid

A

giant cell arteritis

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57
Q

pathway of spinothalamic tracts

A

decussates soon after entering spinal cord and ascends in contralateral side

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58
Q

gonioscopy

A

measures the angle between the cornea and iris

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59
Q

loteprednol

A

topical steroids eye drops

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60
Q

osteoporosis treatment

A

colecalciferol and calcium supplement

alendronic acid - bisphosphanate

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61
Q

co careldopa

A

levodopa and carbidopa

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62
Q

Pilon #

A

Severe # to ankle – usually from jumping from a large height

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63
Q

signs of common peroneal nerve palsy

A

Hx of kneeling

weakness of foot dorsiflexion (causing foot drop) and eversion

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64
Q

anomia

A

unable to identify objects

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65
Q

how to prevent stroke in patients with AF

A

warfarin (INR aim 2-3) or apixaban/dabigatran

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66
Q

PC of MS

A

optic neuritis, weakness or loss of sensation, ataxia, facial weakness, nystagmus, diplopia, vertigo, deafness, transverse myelitis, cognitive and psychological symptoms

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67
Q

treatment of optic neuritis

A

Iv methylprednisolone with GI protection

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68
Q

Leflunomide

A

DMARD

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69
Q

treatment for encephalitis

A

Benzylpencillin for bacterial meningitis

IV acyclovir for HSV encephalitis

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70
Q

pseudodementia

A

due to a functional cause
depression
psychogenic
or hysterical

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71
Q

seizure

A

abnormal excessive neuronal activity in the brain leading to impairment of normal cognitive function

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72
Q

frontotemporal dementia treatment

A

antidepressants

antipsychotics

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73
Q

differnetiate between essential tremor and parkinsons disease

A

DaTScan
imagies the dopamin reuptake in the basal ganglia.
normal in essential tremor and not in PD

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74
Q

Ranibizumab

A

anti VEGF - used for wet AMD and oedema in DR

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75
Q

pathophysiology of diabetic retinopathy

A

hyerglycaemia- ishaemia - neovasculisation - leaky vessels - haemorrhage and oedema

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76
Q

management for falls

A

treat underlying cause
optimise sight
optimise mobility - balance and strength training with physio
optimise enviroment - OT
optimise foot wear - podiatry
medication review and stop drugs increasing risk
check osteoporosis and treat

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77
Q

side effects of dopamine agonists

A

impulsive behaviours +++

sleepines, fainting, nausea, constipation, confusion, hypotension, headaches, psychological problems

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78
Q

the different patterns of MS

A

RRMS 80% cases - becomes SPMS IN 50% of these

PPMS 15% cases

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79
Q

stages of alzheimers dementia

A

1) mild cognitive impairment - short term memory loss (Temporal lobe)
2) mild AD - reading problems and poor object recognition (parietal lobe)
3) moderate AD - poor judgement, impulsivity, short attention (frontal lobe)
4) severe AD - vision problems (occipital lobe)

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80
Q

HAS BLED

A
  • risk of bleeding on anticoag for AF

HTN
Abnormal LFTs/Renal function
Stroke

Bleeding
Labile INR
Elderly >65
Drugs/alcohol

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81
Q

optical coherence tomography

A

mandatory test for AMD diagnosis

image of cross section of the retina

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82
Q

todds paresis

A

transient paralysis following seizure

lasts 48hrs

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83
Q

chloramphenicol

A

topical eye drop antibiotic to treat bacterial conjunctivitis

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84
Q

epinastine

A

topical eye drop antihistamine for conjunctivitis

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85
Q

syncope

A

global cerebral hypoperfusion

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86
Q

Schatzker classification

A

Classifies tibial plateau fractures

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87
Q

secondary dementia

A

reversible dementias due to a medical condition

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88
Q

Volar tilt

A

Normal wrist has 10 degrees volar tilt

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89
Q

pathophysiology of lewy body dementia

A

pathology of LBD mimics idopathic parkinsons

lewy bodys are composed of protein alpha synuclein

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90
Q

Mason classification

A

Classifies radial head fracturs 1=undisplaced 2 = displaced 3=comminuted

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91
Q

Boutonnieres deformity

A

Sign of RA-Hyperextended DIPJ and hyperflexed PIPJ

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92
Q

side effects of MAO B inhibitors

A

headache, aching joints, indigestion, flu-like symptoms, depression
can worsen side effects of ldopa - sickness and dyskinesia

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93
Q

entacapone

A

a cOMT inhibitor

taken with ldopa will prevent its break down and have a longer effect

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94
Q

hypopyon

A

pus in anterior chamber

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95
Q

triad of normal pressure hydrocephalus

A

dementia
gait disorder
bladder instability

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96
Q

risk factors for ischaemic stroke

A 
hypertension 
carotid stenosis
AF
contraceptive pill
clotting disorder 
diabetes
smoking 
ischaemic heart disease 
peripheral vascular disease 
polycythaemia
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97
Q

scleritis

A

painful, associated with systemic inflammatory conditions (especially RA), pain with eye movement, visual loss

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98
Q

triad of encephalitis

A

fever, headache and altered mental status

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99
Q

prognosis of delirium

A

2/3 recover

1/3 wont recover completely- die or need care home

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100
Q

treatment for viral conjunctivitis

A

1) topical antihistamine +/- artificial tears
2) topical steroids
3) topical ganciclovir if confirmed adenovirus

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101
Q

Foot bones

A

Talus, Calcaneum, cuboid, navicular, 3 x cuneiforms

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102
Q

GBS prognosis

A

normal = max disability at 4 weeks
20% will have persistent neuro problems (of which 50% will be severe)
3-7% mortality
20% can’t walk unaided at 6 months

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103
Q

tia management

A

aspirin 300mg
risk asses for stroke
secondary prevention

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104
Q

Hallux valgus

A

Bunion , The big toe turns into valgus (laterally) towards the other toes

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105
Q

Susceptible nerve in humeral neck fracture

A

Axillary nerve

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106
Q

Susceptible nerve in elbow fracture

A

Ulnar nerve

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107
Q

dorsal columns carry

A

sensation of fine touch, proprioception and vibration

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108
Q

differentials of headache

A 
tension headache 
cluster 
migraine 
drug induced 
meningitis
space occupying  lesion 
GCA 
sinusitis 
acute glaucoma 
trigeminal neuralgia 
subarachnoid haemorrhage
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109
Q

Odontoid peg

A

Peg on C2 vertebrae

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110
Q

presentation of giant cell arteritis

A

temporal head ache, scalp tenderness, jaw claudication, upper limb pain on use, polymyalgia rheumatica, partial or complete visual loss, systemic symptoms

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111
Q

causes of orthostatic hypotension

A

hypovolaemia - haemorrhage /vomiting /diarrhoea /dehydration

iatrogenic - betablockers, diuretics, vasodilators, alcohol, antidepressants, phenothiazines

autonomic failure - diabetic neuropathy, Parkinson’s disease, spinal cord injury

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112
Q

vascular dementia pathophysiology

A

caused by multiple small cerebrovascular infarcts, small vessel disease and a single cerebrovascular accident

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113
Q

alzheimers dementia pathophysiology

A 
amyloid plaques - clumps of amyloid and degenerated neurons 
neurofibrillary tangles (mostly made of tau proteins)
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114
Q

hyperactive delirium

A 
agitation 
delusions
hallucinations 
aggression 
wandering
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115
Q

proptosis

A

abnormal protrusion of eye/s

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116
Q

physiological tremor features

A

increased SNS stimulation e.g. due to stress

action tremor

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117
Q

Multiple sclerosis characteristics

A

1) formation of lesions/plaques - in white matter (optic nerve/brain stem/ basal ganglia/ spinal cord/ corpus callosum
2) destruction of myelin sheath - demyelination
3) inflammation - cell mediated ( a break in the BBB allows them entry into the CNS)

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118
Q

presentation of early macular degeneration

A

central vision loss (scotoma or poor acuity), reduced contrast sensitivity, light glare, metamorphopsia

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119
Q

myasthenia gravis

A

a neuromuscular autoimmune condition - caused by antibodies against nicotinic acetylcholine receptor

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120
Q

forehead sparing is seen in

A

UMN palsy

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121
Q

Ulnar deviation

A

At the MCP joints-Might develop to subluxation

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122
Q

presentation of allergic conjunctivitis

A

severe itch, tearing, diffuse redness, papillae present

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123
Q

otorrhoea

A

discharge from ear

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124
Q

POCs criteria

A

1 of 3 present

  • isolated homonymous hemianopia
  • LoC
  • cerebellar or brain stem syndrome
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125
Q

pathophysiology of CPOAG

A

reduced aqueous humour flow through the trabecular meshwork - raised IOP - hydrostatic pressure on the optic nerve and compromise of vasculature causing ischaemia leads to retinal ganglion apoptosis

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126
Q

galantamine

A

cholinesterase inhibitor for dementia

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127
Q

Pre-patellar bursitis

A

Housemaids knee – able to flex and relatively pain free

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128
Q

optic neuritis presentation

A

peri orbital/retro occular pain - worse on movement, loss of visual acuity with scotoma, RAPD, loss of colour vision, optic disc swelling, perception of seeing light due to eye movement or pressure on eye, swelling of optic disc on fundoscopy

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129
Q

presentation of CRAO

A

sudden painless loss of vision, RAPD

pale oedematous retina and cherry red spot fovea (underlying choroid)

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130
Q

differentials for space occupying lesion

A

infection - abscess, empyema, granuloma (TB)
vascular - stroke/haemorrhage
neoplasm - primary or secondary (glioblastoma)
hydrocephalus

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131
Q

corticospinal tracts

A

lateral tract decussates in the medulla

anterior decussates in the cervical/thoracic spine

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132
Q

cholesteatoma presentation

A

painless otorrhea - frequent or unremitting

progressive conductive hearing loss

erosion into local structures may lead to vertigo, headaches and facial nerve palsy

recurrent otitis media

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133
Q

Lewy body dementia core features

A
  1. visual hallucinations
  2. REM sleep disturbance
  3. fluctuating cognition, attention and arousal

with 1+ cardinal features of parkinsonism

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134
Q

treatment of AACG

A

emergency

1. brinzolamide (carbonic anhydrase) with timolol (beta blocker) and brimonidine (alpha 2 antagonist)

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135
Q

most common cause of bacterial conjunctivitis

A

staphylococus

streptococcus

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136
Q

4 main factors that lead to development of pressure sore

A

interface material
shear
friction
moisture

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137
Q

aetiology of falls

DAME

A

Drug induced
Age related - vision/instability
Medical - acute illness/syncope/seizure/stroke
Environmental

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138
Q

herpes keratitis sign

A

dendritic/geographic ulcer

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139
Q

treatment of endophthalmitis

A

intravitreal antibiotic injection if bacterial

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140
Q

treatment for AF

A

rate control - beta blocker or rate controlling CCB
2nd line = combo
rhythm control if rate control not working: amiodarone or electrical conversion

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141
Q

aphasia

A

inability to comprehend or produce languange/communicate

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142
Q

Hydroxychloroquine

A

DMARD

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143
Q

which level in the spine separates lower and upper limb innervation

A

T6

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144
Q

what is 3:1 atrial flutter

A

the beat is only conducted to the ventricles every 3 atria beats
HR = 100bpm

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145
Q

keratitis presentation

A

odeama and opacification of the cornea, corneal ulcer, redness, pain, discharge, lid oedema, reduced vision, photophobia, high IOP

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146
Q

Management of hip OA

A

Total hip replacement

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147
Q

drugs which induce parkinsonism

A

dopamine receptor antagonists

metaclopremide
haloperidol
cyclizine
prochlorperazine

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148
Q

natalizumab

A

anti lymphocyte moniclonal antibody

used in very active MS

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149
Q

cyclizine

A

used to treat vertigo/motion sickness

150
Q

Sulfalazine

A

DMARD – good for fertile women

151
Q

cholesteatoma

A

presence of keratinising squamous epithelium (skin) is present in the middle ear as a result of TM perforation (90%) or retraction

152
Q

treatment for dry amd

A

no treatment
stop smoking, diet changes - eat dark leafy greens and take zinc and antioxidant vitamin supplements
counselling, visual rehabilitation

153
Q

Syndesmophytes

A

Due to ossification of annulosus fibrosis. Irregular in psoriatic arthritis and regular in ankylosing spondylitis

154
Q

hard exudates

A

precipitates of proteins leaking from blood vessels

155
Q

The fibula lies on the _______ side

A

Lateral

156
Q

Rheumatoid factor

A

Rheumatoid arthritis marker

157
Q

investigations for suspected epilepsy

A

bloods - fbc, inflammatory markers, U&Es, LFTs (GGT), glucose - toxicity screen?
general obs and lying and standing blood pressure
ECG

158
Q

alzheimers dementia presentation

A

> 60 YO
memory loss most prominent
gradual onset with slow progressive decline
evidence of varying changes in planning, reasoning, speech and orientation
decline in ADLs
personality, mood and interests change - apathetic,irritable

159
Q

Diclofenac

A

Nsaid

160
Q

myasthenia gravis treatment

A

anticholinesterase inhibitors - e.g. nyostigmine

immunosuppressants e.g. prednisolone and azathioprine

161
Q

Colchicine

A

2nd line in gout if nsaids are CI becoz of renal impairment

162
Q

when is an MRI indicated for seizures ?

A

new onset seizures in adulthood
focal seizures
seizures not responding to medication

163
Q

treatment of scleritis

A

ophthalmologist referral

systemic steroids/NSAIDs +/- topical antibiotics

164
Q

Intracapsular# treatment

A

Cannulated screws for non-displaced fractures, Hemiarthroplasty for displaced NOF #s

165
Q

csf analysis of bacterial meningitis

A

Appearance: Cloudy and turbid
Opening pressure: Elevated (>25 cm H₂O)
WBC: Elevated >100 cell/µL (primarily polymorphonuclear leukocytes (>90%))
Glucose level: Low (<40% of serum glucose)
Protein level: Elevated (>50 mg/dL)

166
Q

management of migraine

A

1st line = NSAIDs, antiemetics (domperidone), sumatriptan/zolmitriptan

167
Q

treatment of CPOAG

A

1) medical: pressure lowering eyedrops
latanoprost, timalol, brinzolamide, apraclonidine
2) laser trabeculoplasty - peripheral iridotomy
3) surgical - trabeculectomyor aqueous shunt

168
Q

presentation of endophthalmitis

A

pain, decreased vision, hazy eye appearance, floaters, hypopyon, swollen eyelid

169
Q

furosemide

A

loop diuretic

inhibits Na-K-Cl co transporter in the thick ascending loop of henle

170
Q

Fat pad

A

Signe up blood and fat in the joint capsule

171
Q

differentials for sudden loss of vision

A 
acute angle closure glaucoma
retinal detachment 
retinal artery/vein occlusion
giant cell arteritis 
orbital cellulitis 
endophthalmitis 
vitreous haemorrhage 
optic neuritis 
wet AMD
172
Q

concerns about abuse of vulnerable elderly should be reported to

A

hospital safegaurding team

173
Q

consequences of malnutrition

A 
delayed wound healing 
impaired immune response 
reduced mobility 
increased length of hosp stay 
depression/ reduced qol
174
Q

parkinsons disease

A

slowly progressing neurodegenerative disease with early prominent death of dopaminergic neurons in the substantia nigra pars compacta.
this leads to dopamine deficiency in the basal ganlia - causing parkinsonism

175
Q

GBS treatment

A 
plasma exchange 
IV immunoglobulins 
Neuropathic pain relief 
DVT prophylaxis 
ICU admission for ventilation
176
Q

pramipexole

A

dopamine agonist for PD rx

177
Q

csf analysis of viral meningitis

A

Appearance: Clear

Opening pressure: Normal or elevated

WBC: Elevated (50 – 1000 cells/µL, primarily lymphocytes, can be PMN early on)

Glucose level: Normal (>60% serum glucose however may be low in HSV infection)

Protein level: Elevated (>50 mg/dL)

178
Q

DR treatment

A

1) photocoagulation (thermal laser) of the macular and pan retinal areas. it occluded microaneurysms reducing leakage and therefore oedema
2) Intravitreal injections if macula oedema (anti VEGF)
3) intravitreal steroids for refractory disease

179
Q

differentials for red eye

A 
conjunctivitis 
scleritis
episcleritis
uveitis 
keratitis 
AACG 
trauma / foreign body 
dry eyes
180
Q

presentation diabetic retinopathy

A

painless gradual decrease in central vision

may have sudden onset of floaters if harmorrhage

181
Q

central causes of vertigo

A

migraine
brainstem ishcaemia
cerebellar stroke
multiple sclerosis

182
Q

classic clinical findings for CPOA Glaucoma

A

raised IOP >21mmHg
increased cup:disc ration >0.6
or 0.2 discrepancy btwn both eyes
arcuate scotoma

183
Q

cardinal symptoms of parkinsonism

A

rigidity
rest tremor
bradykinesia

184
Q

intention tremor features

A

coarse
caused by cerebellar lesion = stroke/trauma/ MS/ chronic alcoholism /lithium
worse with goal directed movement
associated features = ataxia, gait instability, hypotonia, dysarthria, poor rapid movement , nystagmus

185
Q

GBS

A

autoimmune inflammatory polyneuropathy leading to demyelination and axonal degeneration

186
Q

FOOSH

A

Fall on out stretched hand

187
Q

what are the geriatric giants (5 x I)

A 
incontinence 
Instability/immobility 
Intellectual impairment 
Impaired homeostasis
Iatrogenic - pressure sores/ constipation
188
Q

dementia

A

disorder of mental processes marked by memory disorders, personality changes and impaired reasoning

189
Q

Anti Epileptic Drugs

A

Sodium Valproate

Lamotrigine

190
Q

treatment for wet amd

A

anti-VEGF (vascular endothelial GF) injections
given monthly for first 3 months
5 day course of abx eye drop post injection

191
Q

frontotemporal dementia presentation

A

can present as one of 3 clinical pictures:

1) behavioural and personality changes presentation -
2) semantic presentation - progressive decline in the understanding of word meanings, but speech fluent
3) non-fluent presentation - speech not fluent.

192
Q

Swan neck deformity

A

Sign of RA-Hyperflexed DIPJ and hyperextended PIPJ

193
Q

what is a significant orthostatic hypotension

A

a different of 20 mmhg btwn lying and standing BP

194
Q

treatment of CRAO

A

firm occular massage
anterior chamber paracentesis and IOP reducing drugs
isosorbide mononitrate for dilation for dilation of retinal artery
manage underlying cause

195
Q

rotigotine

A

dopamine agonist for PD rx

196
Q

what are the 5 factors for Frieds frailty phenotype ?

A 
weakness 
weight loss 
fatigue 
slowness 
reduced physical activity
197
Q

episcleritis presentation

A

focal isolated red patch with tenderness over this area. mild watering.
associated in many cases with inflammatory disease - systemic vasculitis or CTDs

198
Q

signs of AF

A

fatigue, palpitations, syncope, breathlessness, chest pain, stroke/tia

199
Q

spinothalamic tract carries

A

crude touch, pain and temperature

200
Q

photopsia

A

perceived flashes of light

201
Q

treatment of MS

A

vit D supplements
Methylprednisolone 500mg for 5 days during relapse
for active disease (2 attacks in 2 yrs) = interferon beta or glatiramer acetate (both injections)
teriflunomide or demethyl fumurate may be preferred b/c oral
v. active disease = natalizumab

202
Q

nerve conduction studies are used to diagnose

A 
GBS
peripheral neuropathy 
peroneal, radial, ulnar etc nerve palsies
carpal tunnel
spinal disc herniation
203
Q

treatment of haemorrhagic stroke

A

return clotting levels to normal with vit k or prothrombin complex concentrate

204
Q

metamorphopsia

A

distortion of lines - seen in macular degeneration

205
Q

bells palsy is treated with

A

25mg OD steroidss for 10 days and eye care

206
Q

severe non-proliferative (pre-proliferative) DR

A

multiple haemorrhages, exudates, cotton wool spots, venous beading, microaneurysms within all 4 quadrants

207
Q

diagnosis of MS

A

CSF analysis - oligoclonal bands
MRI - type 1 - gadolinium contrast
need 2 DIS lesions and 2 DIT lesions evidence - either clinical or imaging or 1 yr neuro progression

208
Q

glatiramer acetate

A

immunomodulating drug for MS

sub cutaneous injections OD

209
Q

what is endophthalmitis

A

inflammation of the anterior or posterior chamber, usually exogenous cause - injections/trauma/surgery

210
Q

how fast do the atria contract in atrial flutter

A

300 bpm

211
Q

treatment of neuropathic pain in MS

A

carbamazapine
amitrityline
pregablin

212
Q

dopa decarboxylase inhibitor

A

carbidopa or benserazide

stops too much dopamine being produced peripherally from ldopa

213
Q

what is geographic atrophy

A

well demarcated areas of hypo/hyper pigmentation seem on the retina due to extensive and irreversible damage and death to retinal cells.
seen in advanced AMD

214
Q

csf analysis of MS

A

Oligoclonal bands of IgG on electrophoresis (CSF and Serum)
Appearance: Clear

Opening pressure: Normal

WBC: 0 – 20 cells/µL (primarily lymphocytes)

Glucose level: Normal

Protein level: Mildly elevated (0.45 – 0.75 g/L)

215
Q

GBS presentation

A

3 weeks after resp/GI infection (cambylobacter jejuni)
symmetrical progressive weakness and SL starting in lower limbs and moving upwards. Can lead to facial weakness, dysphagia and resp failure

216
Q

csf analysis of subarachnoid haemorrhage

A

Appearance: Blood stained initially, then xanthochromia (yellowish) >12 hours later

Opening pressure: Elevated

WBC: Elevated (WBC to RBC ratio of approx 1:1000)

RBC: Elevated

Glucose level: Normal

Protein level: Elevated

217
Q

brinzolamide

A

used to treat glaucoma

carbonic anhydrase inhibitor – block water flow into the eye, stopping aqueous humour production

218
Q

panophthalmitis

A

inflammation of the entire eye

219
Q

csf analysis of GBS

A

Appearance: Clear or xanthochromia

Opening pressure: Normal or elevated

WBC: Normal

Glucose level: Normal

Protein level: Elevated (>5.5 g/L)

220
Q

essential tremor features

A 
fine tremor 
onset with certain postures
worse with voluntary movement
improves with alcohol 
hereditary 
bilateral
221
Q

apraxia

A

motor disorder

difficulty performing tasks or movements when asked

222
Q

types of action tremor

A

essential tremor
physiological tremor
intention tremor

223
Q

exclusion criteria for thrombolysis

A 
subarachnoid haemorrhage 
recent trauma/head injury or surgery 
hx intracranial bleeding
active bleeding
inr 1.4 
pregnant
HTN >185/100
recent non compresive arterial punctre or LP
224
Q

alteplase

A

recobinant tissue plasminogen activator

for thrombolysis in stroke/MI

225
Q

precipitants for epileptic seizure

A

acute illness, poor sleep/jet lag, missing AED dose, excess alcohol, new meds, recreational drugs, GI disturbance, fatigue

226
Q

keratitis management

A

corneal scraping for culture
topical antibiotics if bacterial
acyclovir/ganciclovir if herpes and same day ophthalm referral

227
Q

causes of seizure

A

metabolic disturbance - hypoglycaemia, electrolyte disturbance, alcohol or drug intoxication, adrenal insufficiency

space occupying lesions

head trauma

stroke

medication

epilepsy

228
Q

cortical dementia leads to ___________ memory impairment

A

severe

229
Q

vascular dementia treatment

A

antiplatelet therapy (aspirin/clopidogrel)
lifestyle modifications
cholinesterase inhibitors - rivastigmine, donepezil, galantamine
BP control
statins
diabetic control

230
Q

refractory epilepsy

A

failed to control seizures with 2 AEDs

231
Q

orbital cellulitis treatment

A

IV antibiotics - vencomycin, clindamycin, cefotaxime

if failure to respond @48 hours - surgical drainage

232
Q

treatment of ramsay hunt syndrome

A

acyclovir and steroids

233
Q

CAM assessment

A

need 1 + 2 + 3/4 to be CAM +ve = delirium diagnosis

Acute onset and fluctuating
Inattention
Disorganised thinking
Conciousness altered

234
Q

important electrolytes in falls

A

calcium
magnesium
potassium

235
Q

TACs criteria

A
  • unilateral weakness and sensory loss of face, arm + leg
  • homonymous hemianopia
  • higher cerebral dysfunction e.g. dysphasia
236
Q

gonococcal conjunctivitis signs

A

severely purulent with eye lid swelling

237
Q

what are the only 2 interventions which are proven to decrease risk of falls?

A

home hazard assessment

exercise programme to improve balance and strength

238
Q

PACs criteria

A

2 of the 3 TACs criteria

  • unilateral weakness and SL of arm, leg and face
  • homonymous hemianopia
  • higher cerebral dysfunction
239
Q

characteristics of wet AMD

A

10% cases, advanced MD
fragile blood vessels grow in the subretinal space (between RPE and Bruchs) - leads to haemorrhage, exudate, irreversible damage

240
Q

miller fisher syndrome

A

a variant of GBS - inflammatory neuropathy of the cranial nerves. leads to ophthalmoplegia

241
Q

ganciclovir

A

topical anti viral eye drops for confirmed adenovirus conjunctivitis

242
Q

stroke complications

A 
haemorrhagic transformation 
DVT
seizure 
orolingual edema - thrombolysis SE
depression 
aspiration pneumonia 
brain oedema - raised ICP
243
Q

Weber classification

A

Classifies based on the location of distal fibula fracture relative to the syndesmosis A = distal, B = at same level, C= proximal

244
Q

csf analysis of tuberculosis

A

Appearance: Opaque, if left to settle it forms a fibrin web

Opening pressure: Elevated

WBC: Elevated (10 – 1000 cells/µL, Early PMNs then mononuclears)

Glucose level: Low

Protein level: Elevated (1-5 g/L)

245
Q

presentation of CRVO

A

ischaemic = sudden painless loss of vision, RAPD

many haemorrhages in all 4 quadrants

246
Q

treatment for essential tremor

A

propranolol or primidone

247
Q

goldmann tonometry

A

measures IOP

248
Q

presbyopia

A

gradual loss of focusing power due to loss of elasticity of the lens

249
Q

treatment of CRVO

A

laser therapy - photocoagulation
anti-VEGF
steroids

250
Q

causes of cardiovascular syncope

A

arrhythmia
structural cardiovascular disease - hypertrophic cardiomyopathy
structural pulmonary disease - pulmonary embolism

251
Q

retinal detachment treatment

A

retinopexy: 1) a gas bubble is injected into the vitreous chamber and patient positioned so that the retinal break closes.
2) retinal-choroid adhesion induced around the edges of the tear using cryotherapy/laser or both

252
Q

Jones fracture

A

at the base of the 5th metatarsal

253
Q

ramsay hunt syndrome

A

herpes zoster infection of facial nerve

pc = facial droop, vertigo, tinnitus, facial rash/blisters, pain

254
Q

dementia mortality

A

frontotemporal dementia - 8 years from diagnosis

lewy body dementia - 7 years post diagnosis

255
Q

Colles fracture

A

Fracture of the head of the radius with dorsal displacement – towards back of the hand

256
Q

Tension band wire

A

Surgical method to fix olecranon #s

257
Q

signs of L5 root compression

A

foot drop, weakness of eversion and inversion and no ankle reflex

258
Q

dopamine agonists

A

used for Parkinson’s treatment
pramipexole
ropinirole
rotigotine

259
Q

management of cluster headaches

A

acute - subcut/nasal triptans

prophylaxis - verapamil and prednisolone before attack

260
Q

ABCD2 score

A 
risk of having a stroke after TIA 
Age >60 
Blood pressure >140/90
Clinical features unilateral weakness or speech disturbance 
Duration <1 hr or >1 hr 
Diabetes

high risk >4- needs investigations within 24 hours
<4 needs within 1 week

261
Q

treatment of status epilepticus

A

1) IV lorazepam -> IV diazepam -> buccal/IM midazolam
2) if no response in 10 mins - IV phenytoin
3) 2nd IV AED if not working - sodium valproate or lamotrigine
4) if no response at 30 mins from onset- sedation and ICU admission

262
Q

prochlorperazine

A

anti emetic

dopamine 2 receptor antagonist

263
Q

differentials for transient LoC

A 
reflex syncope (vasovagal, carotid sinus hypersensitivity, situational)
cardiovascular syncope - LoC due to reduced CO
orthostatic hypotension

seizure

264
Q

MUST score

A

tool to identify patients at risk of malnutrition

265
Q

sarcopenia

A

reduced muscle mass in elderly

266
Q

Chondrocalcinosis

A

Radiographic feature of pseudogout – calcifications in the joint space

267
Q

differentials of Parkinsonism

A
  1. idiopathic
  2. drug induced
  3. vascular dementia
  4. essential tremor
  5. normal pressure hydrocephalus
268
Q

bells palsy

A

LMN facial palsy

269
Q

non-proliferative (background) DR

A

haemorrhages (dot and blot), microaneurysms, exudates and cotton wool spots outside of temporal arcades

270
Q

confusion screen includes..

A 
glucose
LFTs
UandEs
B12/folate
hemantics 
calcium 
FBC 
INR
TFTs

CXR
Urine dipstick /culture

271
Q

etiology of retinal artery occlusion

A

emboli - carotid or atria

thrombus

272
Q

EEG

A

electroencephalograph

273
Q

clinical signs of cataracts

A

no red reflex, reduced visual acuity and clouding of lens

274
Q

Garden classification

A

For NOF# 1 – incomplete fracture, not displaced, 2- complete fracture not displaced, 3 – complete fracture partially displaced, 4- complete fracture completely displaced

275
Q

keratitis

A

inflammation of the cornea

276
Q

Galeazzi fracture

A

of distal radius with dislocation of the distal radio-ulnar joint

277
Q

The 4 Rs of fractures

A

Resuscitation, Reduction, Restriction (immobilisation), Rehabilitation

278
Q

LACs criteria

A

1 of the following

  • pure sensory stroke
  • unilateral weakness/SL of face/arm/leg
  • ataxic hemiperisis
279
Q

bloods for dehydration

A

hyponatraemia

raised urea

280
Q

Heberdens nodes

A

DIP joint swelling in OA

281
Q

normal IOP

A

10-21 mmHg

282
Q

subcortical dementia leads to ___________ memory impairment

A

moderate

283
Q

presentation of bells palsy

A

unilateral facial droop
hyperacusis - sensitivity to high pitch sounds
inability to close eyes
reduced lacrimation

284
Q

agnosia

A

inability to interpret sensory input

e.g. visual agnosia

285
Q

dopa decarboxylase

A

converts levodopa into dopamine

286
Q

AED interactions to avoide

A

sodium valproate and lamotrigine

titrate carefully during swap over period

287
Q

etiology of retinal vein occlusion

A

systemic disease - atherosclerosis, diabetes, hypertension
hypercoagulable state
glaucoma or retinal vasculitis

288
Q

DSM 5 diagnostic criteria of Alzheimers dementia

A

significant cognitive decline in 1+ areas of cognition which impacts complex activities e.g. paying bills
+ memory loss
+ aphasia/ apraxia/ agnosia/ disturbance in executive function
+gradual progressive course

289
Q

resting tremor features

A 
4-6Hz 
pill rolling 
seen in parkinsonism 
improved with action 
usually apparent in 1 limb/1 side for months-years b4 becoming generalised
290
Q

anti-vegf injection names

A

ranibizumab (lucentis)

aflibercept (eylea)

291
Q

baclofen

A

treatment for spasticity

given to MS patients

292
Q

signs of UMN

A 
spasticity 
hyperreflexia 
pronator drift 
babinski upgoing 
clonus
293
Q

management of ischaemic stroke

A

CT non contrast brain imaging
Thrombolysis with alteplase if within 4.5 hours of onset symptoms
Mechanical clot retrieval
aspirin 300mg for 2 weeks and then clopidogrel
start statins

294
Q

CHADS VASC

A

-risk of having stroke with AF

Congestive heart failure
Hypertension 
Age >65 or >75 
Diabetes 
Stroke 
Vascular disease 
Female
295
Q

rasagiline, selegiline

A

MAO B inhibitors

treatment for parkinsons

296
Q

Susceptible nerve in humeral mid shaft fracture

A

Radial nerve

297
Q

pathway of dorsal columns

A

ascends ipsilaterally and decusates in the brain

298
Q

dysgraphia

A

unable to write or draw - clock drawing test

299
Q

ACE 3

A

addenbrooks cognitive assessment - cognitive function test for assessment of dementia

300
Q

diagnostic criteria for parkinsons disese

A

bradikenesia + resting tremor/ rigidity/ postural instability

exclude-vascular dementia, head injuries, neurleptic treatment, encephalitis, affected relative,sustained remssion, unilateral only after 3 yrs,

301
Q

Allopurinol

A

1st line prophylactic treatment for gout

302
Q

physical examination for patient with falls

A 
neurovascular exam 
MSK exams of lower limbs
cardiorespiratory 
cognition 
visual exam 
vestibular exam
303
Q

treatment of giant cell arteritis

A

oral prednisolone or IV methylprednisolone

recurrent attacks - treat with methotrexate once weekly

304
Q

Monteggia fracture

A

of proximal ulna with dislocation of the radial head

305
Q

cotton wool spots

A

result of damage to the nerve fibres - due to an accumulation of axoplasmic material in the nerve layer

306
Q

treatment of alzheimers

A
  • supportive and environmental measures
  • Cholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine. delay progression by 6-12 months
  • memantine if above not tolerated
307
Q

investigations for optic neuritis

A

MRI of optic nerves

FBC, ESR, CRP

308
Q

proliferative DR

A

neovascularisation at disc and elsewhere.

309
Q

Charles Bonne syndrome

A

Sensory Deficits leads to hallucinations

310
Q

rate limiting CCB

A

diltiazam or verapamil

311
Q

peripheral causes of vertigo

A 
BPPV
menieres 
acoustic neuroma
cholesteatoma 
vestibular neuritis
312
Q

what are drusen

A

discrete yellow deposits between the RPE and Bruch’s Membrane. due to a build up of waste products usually removed by the RPE

313
Q

treatment for bacterial conjunctivitis

A

simple infection will settle within 1-2 weeks

chloramphenicol

314
Q

Clinical signs of scaphoid fracture

A

Pain in anatomical snuff box on palpation, pain on palpation of scaphoid tubercle, pain on telescoping of the thumb

315
Q

rivastigmine

A

cholinesterase inhibitor for dementia

316
Q

Closed reduction

A

Bones realigned without surgery

317
Q

Brown sequard syndrome

A

hemisection
Ipsilateral loss of motor control and proprioception/fine touch/ vibration. contralateral loss of pain and temperature sensation

318
Q

Anti-ccp

A

Rheumatoid arthritis marker

319
Q

differentials of gradual loss of vision (5)

A 
Refractive error
cataracts
age related macular degeneration 
diabetic retinopathy 
chronic primary open angle glaucoma
320
Q

orbital cellulitis presentation

A

systemic fever/malaise, proptosis, pain with eye movement, diplopia, RAPD, restricted eye movement, blurred vision, oedema, erythema, blepharitis, conjunctivitis
if optic nerve involved - papilloedema and optic neuritis

321
Q

Monosodium urate crystals

A

Build up in joints leads to gout

322
Q

management of GCA

A

high dose steroids 60 mg ASAP

bloods and temporal artery biopsy

323
Q

uveitis treatment

A

ophthalmology referral
steroid eye drops or peri/intraoccular injection
oral steroids if severe

324
Q

treatment of allergic conjunctivitis

A 
artificial tears, cool compress, 
sodium cromoglicate (mast cell stabiliser) and antihistamine (epinastine)
325
Q

hypermetropia treatment

A

longsightedness - fixed with convex glasses

326
Q

most common cause of viral conjunctivitis

A

adenovirus

327
Q

Intertrochanteric # treatment

A

Dynamic hip screw

328
Q

Commonest hip replacement

A

Cemented total hip replacement

329
Q

teriflunomide

A

used to treat MS - oral med

330
Q

re-feeding syndrome

A

nutrition reintroduced to severely malnourished patients can lead to potentially fatal shifts in electrolytes and fluid

331
Q

differentials for bells palsy

A 
acute otitis media 
choleostoma 
viral infection (EBV, CMV)
GBS/ MS 
trauma or iatrogenic 
neoplasm - parotid malignancy
332
Q

presentation of cataracts

A

gradual loss of vision, glare, haloes, sensitivity to light, faded colours

333
Q

drugs with high anticholinergic burden

A 
amitriptyline 
olanzapine
oxybutynin
quetiapine 
amantadine
334
Q

convulsive status epilepticus

A

seizure > 5 mins or > 3 seizures in 1 hour

335
Q

Calcium pyrophosphate crystals

A

Pseudogout

336
Q

initial investigations for fall

A

bloods - BM, U&Es, FBC, inflam markers
ECG
bone profile
TFTs, B12, folate - peripheral neuropathy causes?

337
Q

signs of LMN lesion

A

hyporeflexia
flaccidity
fasciculations
atrophy

338
Q

characteristics of DRY AMD

A

90% cases, gradual progression
drusen are seen on fundoscopy
10-15% will develop wet amd

339
Q

myopia treatment

A

short sightedness - fixed with concave glasses

340
Q

Parts of a psychiatric history

A 
Pc/HPC 
Past psychiatric history 
Past medical history 
Medications
Family history 
Personal history 
- birth, early childhood 
- schools 
-higher education 
-qualifications 
-employment 
-relationships 
-psychosexual history 
-current living situations 
-forensic history 
Alcohol and drugs 
Premorbid personality
341
Q

Diagnosis of depression (ICD 10 )

A

1) need 2 key symptoms: low mood, anhedonia, fatigue
2) other symptoms: appetite changes, sleep changes, poor concentration, agitation or retardation, low self confidence, guilt or self blame thoughts, suicidal thoughts
lasting > 2 weeks

4 symptoms = mild
5-6 = moderate
7+ = severe

342
Q

organic causes of depression

A

medication - steroids, beta blockers, statins, progesterone, isotretinoin
chronic pain, hypothyroidism, Addison’s disease, MS, diabetes, cerebrovascular disease, alcohol and substance abuse

343
Q

manic episode criteria

A

1) A 1 week+ period of expansive mood with abnormally elevated energy
2) severe enough to cause social/work impairment or hospitalisation or psychotic symptoms are present
3) 3 or more of the following: grandiosity, decreased need for sleep, more talkative, flight of ideas/racing thoughts, distractibility, increased goal directed activity/psychomotor agitation, excessive involvement in risky behaviours e.g business ventures/sex

344
Q

hypomanic episode criteria

A

same symptoms as above
lasting over 4 consecutive days
uncharacteristic but not impairing functioning of patient
no psychotic symptoms

345
Q

treatment for subthreshold depression

A

active monitoring
reassess in 2 weeks
provide info about depression

346
Q

treatment for persistent subthreshold depression and mild-moderate depression

A

1st line = low intensity psychological intervention (CBT therapy)
only consider meds if patient has previous moderate/severe depression or this episode has lasted >2 yrs

2nd line = high intensity psychosocial intervention (CBT/IPT) OR an antidepressant

347
Q

treatment for moderate-severe depression

A

antidepressant combined with high intensity psychological intervention

348
Q

treatment for severe or resistant depression

A

consider inpatient care

349
Q

when to consider ECT for depression?

A

need rapid response
life threatening depression
all other treatments have failed

350
Q

fluoxetine

A

SSRI

351
Q

venlafaxine

A

SNRI antidepressant

352
Q

duloxetine

A

SNRI antidepressant

353
Q

Mirtazapine

A

antidepressant

blocks alpha 2 receptor causing raised Na and 5HT

354
Q

treatment with antidepressant - step wise approach

A

1) SSRI - start at half the dose and titrate up every 14 days
if no response after 4-6 weeks :
2) switch SSRI or start SNRI
3) mirtazapine
4) augmenting agent - antipsychotic/lithium
5) TCA
6) MAO-I

355
Q

amitriptyline

A

TCA

356
Q

what demographic factors increase a patients suicide risk

A 
male 
older > 45 yo
single/widowed/divorced 
social isolation 
living alone 
low income/ unemployed
doctor/farmer 
Fhx of suicide/substance misuse/depression
357
Q

what details about a suicide attempt increase a patients suicide risk

A 
final acts
preparation 
high perceived legality 
precaution against being found 
violent methods
discovered by chance
resists mediccal intervention
downplaying the seriousness
358
Q

which antidepressants are most likely to cause discontinuation syndrome

A

venlefaxine and peroxetine

359
Q

organic causes of psychosis

A 
delirium 
dementia 
temporal lobe epilepsy 
CNS infection 
brain injury/trauma 
metabolic disorder - vit b12
thyroid disease
cushings syndrome 
high dose steroids 
huntingtons 
extreme fatigue 
alcohol/drug withdrawal 
hypoxia
360
Q

treatment of 1st psychotic episode

A

1) 2nd gen oral antipsychotic

2) with psychological intervention e.g. family therapy or individual CBT

361
Q

atypical antipsychotics

2nd gen

A 
aripiprazole
clozapine
quetiapine
olanzapine 
risperidone
362
Q

MHA

section 2

A

allows for mental health assessment
lasts up to 28 days
signed by 2 doctors (1 approved) and 1 AMHP
patient can appeal within 14 days via specialist tribunal

363
Q

MHA section 3

A

for treatment
lasts up to 6 months
signed by 2 doctors and 1 AMHP
can be challenged with tribunal

364
Q

MHA section 4

A 
emergency admission only
for assessment 
signed by 1 doctor 
lasts 72 hours 
cant be appealed
365
Q

MHA section 5 (2)

A

allows for an inpatient to be kept in hospital due to mental illness.
lasts 72 hours
can’t appeal
signed by responsible clinician

366
Q

MHA section 5 (4)

A

emergency holding order for hospital inpatients
signed by 1 registered nurse
lasts 6 hours
cant be renewed

367
Q

MHA section 135

A

emergency section to bring you from any premises (incl. home) to hospital
made by a police and doctor and AMHP
can be held for 72 hours
can’t be appealed

368
Q

MHA section 136

A 
emergency situation 
bring patient from public to hospital 
by police and doctor
lasts 72 hours 
can't be appealed
369
Q

akathisia

A

movement disorder

inner restlessness

370
Q

extrapyramidal side effects

A

parkinsonism
dystonia
dystonia
acute dyskinesia

My Final Year 4 Revision (16 decks)

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