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My General Practise > Oxford summary 5 > Flashcards

Oxford summary 5 Flashcards

1
Q

Prostate cancer

early Sx

A

asymptomatic
incidental increased PSA
hard nodule on DRE

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2
Q

Prostate cancer

Local disease Sx

A 
Prostatism, 
hard and nontender on DRE
Retention
haematuria 
LE odemea
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3
Q

Prostate cancer

Metastatic

A

Malaise, weight loss
Bone pain, pathological #, spinal cord compression
Ureteric compression –> RF

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4
Q

UTI cystitis PC

A 
frequency
dysuria
urgency
strangury
low pain
incontinence
retention
cloudy/ offensive urine
haematuria
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5
Q

UTI pyelonephritis PC

A 
loin pain
fever
rigors
malaise
V
haematuria
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6
Q

UTI Dx

A
  • Urine for leukocytes and nitrates
  • Bloods: U&E, Cr, eGFR, PSA if >40 male
  • USS, KUB
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7
Q

UTI Tx

A

•  fluid, alkanize urine with potassium citrate
• Trimethoprim 200mg bd, 3d for women, 7d for males, GU malformation, immunosuppression, relapse, recurrent
• Ciprofloxacin 500mg bd 7 days if pyelonephritis
HRT

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8
Q

Urethral Syndrome

A
  • Cystitis with –ve MSU, unknown cause
  • A/w cold, stress, nylon under wear, CHC, intercourse
  • Tx: fluids, lifestyle, topical E, doxycycline 100mg bd 14d or azithromycin 500mg od 6days
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9
Q

interstitial cystitis

A

• Middle-aged women
• Can lead to fibrosis of bladder wall
• Px: frequency, urgency, suprapubic pain
-ve MSU

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10
Q

BPH Sx

A

• Obstructive:  stream, double micturition, hesitancy, dribbling, incomplete empyting, straining
Irritative (detrusor hypertrophy): F, U, D, N

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11
Q

BPH Dx

A
  • RFT: U&E, Cr, eGFR
  • MSU: blood, glucose, M, C&S
  • US measurement of post-micturition residual
  • PSA
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12
Q

BPH comp

A

• Recurrent UTI, stones, haematuria
• Acute and chronic retention
• Overflow incontinence
Obstructive nephropathy

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13
Q

BPH tx

A

• Watchful waiting: if mild/ moderate and no complications
o  fluid/ caffeine intake, bladder retraining
• Medications
o α-adrenorecptor antagonists- prazosin, doxazoskin
5α-reductase inhibitors- finasteride. Takes 6mo to work

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14
Q

Acute bacterial prostatitis

A
  • Px: UTI symptoms + fever, arthralgia/ myalgia, low back/perineal/penile/ rectal pain
  • DRE: swollen, tender prostate
  • Investigation: MSU
  • Tx: ciprofloxacin 500mg bd or ofloxacin 200mg bd 4/52
  • Complications: acute retention, chronic prostatitis, abscess
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15
Q

Chronic prostatitis (chronic pelvic pain syndrome)

A

• Unknown cause.
• Px: >3mo
o Urological pain: lower abdo, pelvis/ perineum, penis, testicles, rectum, low back
o Irritative/ obstructive symptoms or ejaculatory probz
• Dx of exclusion
• Investigations: DRE, MSU, cytology, STI, PSA ± urodynamics
Tx: info, support, doxazosin 4mg od 6months

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16
Q

Low back pain red flags

A

• <20 or >55
• Non-mechanical pain, worse when supine, pain at night, thoracic pain
• Past hx of cancer, HIV, immunosuppression, IVDU
• Steroids
• Unwell, weightloss
• Widespread neurology
Structural deformity

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17
Q

Low back pain Hx

A

• Injury, duration
• Pain/ stiffness at rest/ night (inflammation= better with movement)
Numbness, weakness, bowel/ bladder symptoms

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18
Q

Low back pain Exam

A

• Deformity: kyphosis, loss of lumbar lordosis, scoliosis
• Palpate for tenderness, step deformity, muscle spasm
• Assess: flexion, extension, lateral flexion, rotation
• LE wasting, power, sensory, reflexes
Straight leg raise: sciatica present if back/ butt pain

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19
Q

Low back pain causes by age

A

• 15-30: postural, mechanical, disk, trauma, #, AS, spondylolisthesis, pregnancy
• 30-50: postural, disk, spondylarthropathies, discitis, degenerative join disease
• >50: postural, degenerative, pagets, cancer, osteoporotic collapse, myeloma
Other: referred pain, spinal stenosis, CE tumour, infection

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20
Q

Low back pain Sx

A 
•	Early: asymptomatic, incidental PSA, hard nodule on DRE
•	Local disease 
o	Prostatism, hard and nontender on DRE
o	Retention, haematuria 
o	LE odemea 
•	Metastatic 
o	Malaise, weight loss 
o	Bone pain, pathological #, spinal cord compression
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21
Q

low back pain

Xray indications:

A

• <25 to exclude Ankolysing spondylitis
• Elderly: collapse, malignancy
History of trauma

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22
Q

Cauda Equina Syndrome

A

• Compression below L3- most likely a disk
• Px: numbness of buttocks, backs of thighs, urinary/ faecal incontinence, LMN weakness
o L4: loss of dorsiflexion of foot
o S1: loss of ankle reflex, plantarflexion, eversion of foot

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23
Q

Spinal cord compression

A

• 5% of cancer patients, 70% in thoracic region
• Px: back pain worse with movement
o Neurologic: constipation, weakness, hesitancy, lesions above L1= UMN and below L1= LMN and CE syndrome
• Management: tx <48hrs from first neurological symptom

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24
Q

Scoliosis

A

Lateral curvature a/w rotation of vertebrae ± ribs or wedging of vertebrae

Causes
o Idiopathic, congenital (butterfly vertebrae)
o TB, metabolic- bone dysplasia, cancer, RT
o NM: cerebral palsy, NF, freidreichs ataxia, muscular dystrophy
o S1: loss of ankle reflex, plantarflexion, eversion of foot

Px: difference in shoulder height, spinal curvature, difference in space btw trunk and UL

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25
Q

Shoulder problems Hx

A

Pain and stiffness
o Joint pain- anterior and radiates down arm
o Top of shoulder= AC joint or cervical spine
o Referred pain from neck, heart, mediastinum, diaphragm

Deformity: swelling, winging
LOF

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26
Q

Shoulder problems exam

A
  • Look: posture, asymmetry, wasting, swelling, scars
  • Feel: tenderness, warmth, swelling, crepitus
  • Move/ measure: compare sides, range of movements, power
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27
Q

Shoulder problems clues

A

Intra-articular: painful limitation of movement- all directions
Tendonitis: painful limitation of movement in one plane
Tendon rupture/ neurological: painless weakness

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28
Q

Shoulder problems red falgs

A

History of cancer, constitutional symptoms
Recent bacterial infection, IVDU, immunosuppression
Constant/ worsening rest pain
Structural deformity

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29
Q

Stiff, painful shoulder joint DDx

A
  • Adhesive capsulitis- 1° or 2° to DM/ Intrathoracic pathology
  • Inflammation, infection
  • OA, polymyalgia rheumatica
  • Prolonged immobilization
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30
Q

Shoulder dislocation- anterior>

A
  • Due to fall on arm/ shoulder
  • Flattening of deltoid and head of humerus anterior bulge
  • Damage axillary nerve  no sensation on deltoid patch
  • Recurrent dicloation: follows trauma, usually bc labral tear
  • 25% elderly a/w rotator cuff injury
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31
Q

Acromiocalcivular joint problems

A
  • Pain on top of shoulder due to trauma or OA
  • Px: joint tenderness, painful palpation + passive horizontal add
  • Management: NSAIDS ± local steroid injection
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32
Q

Shoulder OA

A

Hx of trauma
A/w crystal-induced inflam and 2° to gout, haemochromatosis
Imaging for synovitis- USS/ MRI
Should replacement if severe

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33
Q

Frozen shoulder aka adhesive capsulitis

A

40-60years, diabetics and intrathoracic path (MI, lung disease)
Painful, stiff shoulder with global limitation of movement- ER>
Pain worse at night
Management: blood glucose, NSAIDs, physiotherapy, steroid IA

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34
Q

Rotator cuff injury

Acute tendonitis

A
  • Excessive use/ trauma in <40
  • Px: severe pain in upper arm, immobile, cant lie on that side
  • Resolves spontanelously after few days
  • Middle age- due to inflamm around calcific deposits- steroid IA
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35
Q

Rotator cuff injury

Subacromial impingement

A
  • Pain in limited arc of abduction- 60-120° or during IR
  • <40 a/w glenohumeral instability- CT laxity or labral injury
  • > 40: due to chronic rotator cuff tendinitis or functional cuff weakness/ tear
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36
Q

Rotator cuff injury

Investigations Dx + Tx

A

Dx
Xray- calcification of supraspinitious tendon in acute tendinitis & irregularities/ cysts at humeral GT if chronic cuff tendonitis

Tx
Rest, immobilization + physiotherapy
NSAIDS, subacromial steroid injections

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37
Q

Rotator cuff injury DDx

A

Acute tendonitis

Rotator cuff tear (+ subacromial impingemet)

Subacromial impingement

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38
Q

Elbow problems Hx

A 
•	Pain and stiffness
o	Joint pain- diffuse
o	Tendonitis- localized on epicondyles
•	Deformity: swelling, winging 
•	LOF 
Neurology: numbness/ paraesthesia distal to elbow
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39
Q

Elbow problems exam

A

• Look: carrying angle, effusion, swelling, muscle wasting
• Feel: tenderness, warmth, swelling, crepitus, pulses
Move: active and passive

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40
Q

Elbow problems DDx

A 
Tennis elbow: epicondylitis
Golfer’s elbow
Dislocated elbow
Olecranon bursitis
Ulnar neuritis 
Pulled elbow
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41
Q

Dislocated elbow

A
  • Due to fall on outstretched hand with flexed elbow

* Ulna displaced back, swollen in fixed flexion, can be with #

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42
Q

Olecranon bursitis

A
  • Traumatic due to repeated pressure on elbow
  • Pain and swelling
  • Aspirate fluid  microscopy to exclude gout/ sepsis
  • Hydrocortisone if not sepsis
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43
Q

Ulnar neuritis

A
  • Narrowing of ulnar grove due to OA, RA, #  pressure on ulnar nerve  ulnar neuropathy
  • Px: clumsiness of hand  weakness ± muscle wasting, sensation
  • Tx: surgical decompression ± nerve conduction studies
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44
Q

Pulled elbow

A
  • <5- traction injury to elbow  subluxation of radial head
  • Occurs when pulled by hand
  • Px: child not using arm, L>
  • Management: anterior pressure with thumb on randial head while supinating and extending forearm
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45
Q

Tennis elbow: epicondylitis def

A

Tenderness over lateral epicondyle + lateral pain on resisted wrist extension

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46
Q

Golfer’s elbow def

A

Tenderness over medial epicondyle + medial pain on resisted wrist pronation

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47
Q

Acute gout

Risks:

A
  • FH
  • Obesity, alcohol, high purine diet
  • Diuretics, cytotoxic treatment
  • RF, leukaemia, psoriasis, ketosis, surgery, acute infection
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48
Q

Acute gout Px:

A

painful swollen joint, red skin ± fever

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49
Q

Acute gout Investigations:

A
  • Bloods:  WCC, ESR, blood urate
  • Microscopy of synovial fluid: sodium monourate crystals
  • Xray
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50
Q

Acute gout Management:

A

Rest, elevate joint, ice packs
NSAIDs- naproxen 500mg bd- caution if GI issues
Or colchine 500mg bd increased to qds. SE: N, V, D
Steroid injection of IM- depo- medrone 80-120mg

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51
Q

Acute gout Prevention:

A

Weight loss, avoid alcohol, red meat, yeasts, muscles
Avoid thiazides and aspirin
Allopurinol 100-300mg od + colchine 500mcg bd OR NSAIDs
Febuxostate if not working or uricosuric- sulfinpyrazone

52
Q

Hyperuricaemia causes

A
  • Drugs: cytotoxics, thiazides, ethambutol
  • increased cell turnover: lymphoma, leukaemia, psoriasis, haemolysis, muscle necrosis
  • decreased excretion: primary gout, CRF, lead nephropathy, hyperPT
53
Q

Chronic gout:

A
  • Recurrent attacks

* Tophi in pinna, tendons, joints + joint damage

54
Q

Calcium pyrophosphate deposition disease: pseudogout
A/w OA, hyperPT, haemochromatosis
Acute attack can be triggered by intercurrent illness/ metabolic disturbance
PC:

Investigations:

Tx

A

less severe, knee/ wrist/ shoulder

Xray- chondrocalcinosis- calcification of articular cartilage + joint crystals

Tx like gout
chronic = erosive = refer

55
Q

Septic arthritis:

A

<5, hip and knee
Systematically unwell, immobilizes joint
Swollen, hot tender joint
Tx: IV abx ± surgical washout

56
Q

T-score:

Osteoporosis:

Osteopenia:

Z-score:

Dexa scan:

A

compare bone mineral density with young adult mean

BMD >2.5 SD below young adult mean

T-score between -1 and -2.5

compare BMD of subjects and age-matched control
Predict osteoporosis risk for future

measure BMD

57
Q

Osteoporosis Causes: 1° or 2°

A
  • Endocrine: Hypogonadism, hyperthyroidism, hyperparathyroidism, hyperprolactinaemia, cushings, T1DM
  • GI: coeliac, malabsorption, IBD, chronic liver, chronic pancr
  • RA, inflammatory arthropathies
  • Immobility, MM, haemoglobinopathy, systemaic mastocysosis, CF, COPD, CKD, homocystinuria
58
Q

Fragility fracture

A

Due to fall ≤ standing height
#: hip, wrist- colles
Osteoporotic vertebral collapse: pain,  height, kyphosis
Analgesia 3-6months, Calcitonin after 3mo if all fail

59
Q

Predicting fracture risk

Glucocorticoid use + OP

A

FRAX and Qfracture- don’t need BMD and 10y prob of hip #

Minimize use and add bisphosphonate if >65 or hx fragility #

60
Q

Osteoporosis Tx

A 
lifestyle
alendronic acid 70mg once a week
raloxifene SERM
Denosumab 60mg q6 months
HRT
Teriparitide injection
61
Q

alendronic acid SE

A

osteonecrosis of jaw

atypical femoral fracture

62
Q

Osteoarthritis Sx

A

• Pain ± stiffness, synovial thickening, deformity, effusion, crepitus, muscle weakness and wasting,  function
• Hip, knee and base of thumb
Exaggerbations that last weeks to months

63
Q

Osteoarthritis Dx

A

Xray: loss of joint space, cysts, sclerosis of subchondral bone, osteophytes
FBC, ESR, ANA

64
Q

Osteoarthritis Tx non meds

A

Rest, NSAIDs, steroid injection, physiotherapy
weight reduction, walking still, physiotherapy

Aspiration of joint effusion and LA steroid joint injections

65
Q

Osteoarthritis meds

A

Nonpharm: exercise, weight loss, footwear, stick, TENS
Paracetomol 1g qds and/or topical NSAIDs
+ opioids, oral NSAIDs or Cox-2 inhibitors (+ omeprazole 20mg)
Antideppressant- amitriptyline 10-75mg nocte
Capsaicism cream if knee/ hand

Other drugs
Glucosamine: OTC- modifies progression
Strontium ranelate:  progression & pain and  mobility

66
Q

RA PC

A
  • Middle age>, females >
  • Symmetrical small joints- pain, stiffness, swelling, LOF
  • Joint damage, deformity, and instability occur later
  • Other: monoarthritis, migratory arthritis, systemic features
67
Q

RA signs

A

Peripheral joints>, symmetrical pain, effusions, swelling
Morning stiffness
Feet: subluxation of metatarsal heads in feet and claw toes –> painful walking, bakers cysts
Cervical spine: pain, subluxation, atlanto-axial instability –> cord compression

68
Q

RA nonarticular features

A

o Nodules on extensor surfaces
o Eye: sjogren’s, episcleritis, scleritis
o Lungs: effusions, fibrosing alveolitis, nodules
o Heart: pericarditis, MV disease, conduction probz
o Skin: palmar erythema, vasculitis, rashes
o Neuro: nerve entrapement, mononeuritis, peripheral neuropathy
o Feltys syndrome: RA, leucopenia, splenomegaly  anemia and thrombocytopenia

69
Q

RA Dx

A

• FBC, ESR/ CRP, ANA, Rheumatoid factor, anti-CCP

X-ray: periarticular OP/ soft tissue swelling  loss of joint space, erosions, joint destruction

70
Q

RA Comp

A

• Physical disability, depression
• Osteoporosis
• Infections, lymphoma
CVD, amyloidosis

71
Q

RA Tx

A

Physical therapy: exercise, splints, appliances, strapping

NSAIDs + simple analgesia
Ibuprofen 200-400mg tds
Naproxen 500mg bd
Celecoxib 100mg bd- COX2 inhibitor if no CVD

Corticosteroids
IA injection- triamcinolone up to 3x/year

DMARDs
Check baseline U&E, Cr, eGFR, LFTs, FBC, urinalysis

72
Q

DMARD examples

A 
Methotrexate 7.5-25mg weekly
Sulfasalazine 1g bd/tds
IM gold 50mg monthly
Pencillamine 500-750mg/day
Azathioprine 1.5-2.5mg/kg/day 
Ciclosporin 1.25mg/kg bd 
Hydroxychloroquine 200-400mg/day
Leflunomide 10-20mg/day
73
Q

Methotrexate 7.5-25mg weekly

A

Chest XRAY within 1 year of starting, baseline lung function

SE: signs of infection, respiratory symptoms, B12/folate def

74
Q

Sulfasalazine 1g bd/tds

SE

A

rash, N&D, BM suppression, B12/folate def

75
Q

IM gold 50mg monthly

SE

A

Chest XRAY within 1 year of starting

sore throat, bleeds, bruising, SOB, cough, oral ulcers, rashes, altered taste

76
Q

Pencillamine 500-750mg/day

SE

A

rash, altered taste

77
Q

Azathioprine 1.5-2.5mg/kg/day

SE

A

GI, rash, BM suppression, avoid live vaccines

78
Q

Ciclosporin 1.25mg/kg bd

SE:

A

rash, gum soreness, hirsutism, RF, HT

79
Q

Hydroxychloroquine 200-400mg/day

SE

A

Baseline eye check and annual visual acuity

rash, GI, ocular- rare

80
Q

Leflunomide 10-20mg/day

A

rash, GI, HT, increased ALT

81
Q

Fit Hx

A
  • What happened? Where? When? Witnesses?
  • Any warning signs? Precipitating events?
  • LOC? do they remember?
  • Incontinence? Biting tonge? Jerking?
  • How did they feel after
82
Q

Fits exam

A

• Skin: café-
o Au- lait spots- NF
o Adenoma sebaceum- tuberous sclerosis
o Trigeminal capillary haemangioma- Sturge Weber synd
• CV abnormalities- HR, rhthym, mumers, bruits, BP
• Neurological deficits

83
Q

Dizziness and giddiness

A

Vertigo: room spinning
Imbalance: cant walk straight- nerve disease, PC, cerebellum
Faintness: seizure diseases, postural hypo, vasovagal fainting, hyperventilation, hypoglycemia, arrhythmia, cough syncope

84
Q

Syncope
Abrupt and transient LOC due to reduced CF

Dx:

A

o Prodromal symptoms: N, sweating, blurring, loss of vision, light- headedness, dizziness, tinnitus
o Anoxic phase: LOC, pallor, sweating, pupil dilates, tachypnea, bradycardia,  muscle tone so eyes roll up and may fall
o Recovery: lie horizontal- color, pulse and consciousness will return
o After: confusion, amnesia, drowsiness not prolonged. In continence and injury rare

85
Q

Hypoglycaemia

A

Pallor, sweating, tachycardia, confusion, behavioral changes

Can lead to hyperglycaemia, coma ± fit

86
Q

headache Hx + exam

A

socrates

Examination
• Fever, purpuric skin rash
• BP, neuro exam- fundi, acuity, gait
• Palpate sinuses, examine neck

87
Q

Headaches red flags

A
  • Fever + worsening headache ± purpuric rash
  • Thunderclap headache- peak intensity <5min
  • Progressive
  • A/w postural change
  • Head trauma, personality/ cognitive/ personality change
88
Q

Acute new headache

A

• Meningitis: fever, photophobia, stiff neck, rash
o IV/ IM penicillin V + admit
• Encephalitis: fever, confusion,  consciousness
• Subarachnoid haemorrhage: thunder clap ± stiff neck
• Head injury” injury, conscious, lucidity period, amnesia
• Viral illness, sinuisitis, dental caries, tropical illness

89
Q

Acute recurrent headache

A
  • Migraine: aura, visual probz, N/V, triggers
  • Cluster headache: pain at night in 1 eye for 2-3mo, pain free >1y
  • Exertional or coital headache : NSAID or propranolol before
  • Trigeminal neuralgia: pain for secs in nerve disturb
  • Glaucoma: red eye, haloes,  acuity, pupils abnormal
90
Q

Subacute headache

A

Giant cell arteritis:
>50
scalp tenderness
INCREASED ESR

91
Q

Chronic headache

A

Tension type headache: band around head, stress, low mood

Carvicogenic headache: uni or bi band, scalp tenderness

Medication overuse: rebound on stopping analgesia

ICP: worse at morning, sneezing, DECREASED pulse, INCREASED BP, neuro signs

Pagets disease: >40y, bowed tibia, INCREASED Alk Phos

92
Q

Status Epilepticus: >1 minute without regaining consciousness or >5minutes with medication

A

airway is clear
recovery position
No medications for first 5 minutes
>5min: midazolam buccal liquid or recal diazepam or IV lorazepam
call for ambulance
administer drugs again after 10-15 min, check blood glucose

93
Q

Delirium tremens:

A

Major alcohol withdrawl symptoms 2-3 days after cessation

pyrexia, tachy, HT, tachypnea

visual/ tactile hallucinations, acute delirium, apprehension

tremor, fits, fluctuation consciousness

94
Q

Migraine

Tx acute attack

A

combination with
Sumatriptan 50-100mg po +

naproxen 500mg bd or paracetamol 1g qds ±

prochlorperazine 5mg/ metoclopramide 10mg/domperidone 10-20mg-antiemetic

95
Q

Migraine Tx chronic attack

A

Psychological factors: stress, anxiety, depression
Environment: noise, bright/ flickering lights, strong smells, stuff atmosphere, extreme heat
Food: lack of, infrequent meals, caffeine, chocolates
Sleep: overtiredness, change in sleep pattern, travel
Health: hormonal, HT, toothache/ pain in eye, sinuses

96
Q

Migraine Prophylaxis if ≥4 attacks/ month or severe

A

Propranolol 80-160mg or topiramate 20-50mg od/bd
Gabapentin up to 1200mg/d or acupuncture
Botulinum type A toxin
Riboflavin 400mg od

97
Q

Trigeminal neuralgia Tx

A

o Carbamazepine 100mg od/bd and increase dose 200-400
o Pregabalin 75mg bd- max 300mg bd
Amitriptyline start at 25mg at night and increase by 10-25mg every 5-7days to max of 75mg- 10mg in elderly

98
Q

Cluster headache Tx

A

o Acute: O2 for 10-20min, sumatriptan 6mg sc or 20mg nasal- 5HT1 agonist
o Prophylaxis: verapamil 80mg tds/qds if frequent + ECG

99
Q

Facial pain tx

A
  • Atypical= no cause, tx with Paracetamol or NSAIDS

* If doesn’t work- amitriptyline 1075mg nocte

100
Q

Raised ICP PC

A
  • Headache + drowsiness, LOC, V, focal neuology ± seizures
  • Irritability, VI nerve palsy, pupil change, papilloedema
  • Dropping pulse, raising BP
101
Q

Benign intracranial hypertension

A

Symptoms without cause
Young, obese women
Tx: repeat LP, ventriculo-peritoneal shunt, diuretics, dexameth

102
Q

Brain abscess

A

Haematological spread, direct, or local extension
Px:  ICP, focal neurology, systemic/ local effects over 2-3wk
Tx: IV abx ± surgical drainage

103
Q

Hydrocephalus

A

Communicating: decreased reabsorption of CSF. Post meningitis, SAH, trauma, neoplastic infiltration of subarachnoid space

Non- communicating: CSF flow blocked due to obstruction in ventricles. Congenital malformation, tumour, brain abscess, SAH, meningeal scarring, trauma

Px: infants with macrocephaly, convulsions, developmental delay ± spacity. Adults with
increasing ICP

104
Q

Intracranial tumours
1° tumours
2°

A 
Astrocytoma 
Oligodendroglioma 
Glioblastoma multiforme 
Ependymoma 
Meningioma 
Cerebellar haemangioblastoma

met from breast, lung or melanoma

105
Q

Intracranial tumours Px:

A

increased ICP
Seizures- 25-30%
Evolving neurology: >50%
False localizing signs: VI nerve palsy –> double vision
Local effects- skull base masses, proptosis, epistaxis
Personality change

106
Q

Intracranial tumours Prognosis:

Intracranial tumours DDx:

A

gliomas have <50% 5 year survival

stroke
MS
injury
vasculitis
encephalitis
Todd’s palsy
metabolic/ electrolyte disturbance
space occupying lesion
107
Q

Meningitis and Encephalitis early PC

A 
rapid onset <48hrs 
Fever, vomiting, malaise, poor feeding, lethargy 
Severe leg pain- cant walk 
Cold hands/ feet with fever 
Pale skin ± cyanosis around lips
108
Q

Meningitis and Encephalitis

Sx

A

Headache, stiff neck, photophobia, Kernig’s sign +ve
Increased ICP symptoms
Septicaemia symptoms

109
Q

Meningitis and Encephalitis

late onset effects

A

Hearing loss
Ongoing neurological probz- fits, hemiparesis
Orthopaedic probx- bone/ joint damage  poor limb growth
Psychosocial effects

110
Q

increased ICP

A 
Drowsiness, reduced consciousness 
Abnormal tone/ posture 
Focal neurological signs, fits, vomiting 
Irritability 
Bradycardia, hypertension 
Bulging fontanelle in baby
111
Q

Septicemia

A 
Fever, arthiritis 
Hypotension, tachycardia, tachpnoea 
Cold peripheries, mottled skin, cyanosis, cap refill >2sec
Peripheral O2 sat ≤95%
± rash= meningococcus
112
Q

Meningitis and Encephalitis prophylactic Abx

A

Ciprofloxacin 500mg single dose OR

Rifampicin 600mg bd for 2 days, turns urine red

113
Q

Meningococcal Vaccinations

A

• Group C: 40% meningococcal disease
Group B: for the rest
Group A: in other parts of world

•	Meningoccocal A + C vaccine: travelling to high risk area
•	Meningitis B vaccination- Bexsero 
o	Need booster after 1 month 
o	2-11: after 2 months 
o	<2: 3 doses 1 month apart
•	Meningitis C conjugate vaccine 
o	Infants: 3 and 12 months, booster at 13years
o	HIV+v
114
Q

Parkinsonism

A

Tremor- coarse, mostly at rest, “pill-rolling”
Cogwheel rigidity
Difficulty initiating movement
Slowness of movement
Shufflng and festinant gait: small steps, flexed to “catch up”
Micrographia- small handwriting

115
Q

Parkinsonism Causes

A

PD/ AD
Post- encephalitis, toxins, trauma, normal P hydrocephalus
Drugs: haloperidol, chlorpromazine, metoclopramide

Stop drug. If schiz- do not stop but add procyclidine 2.5mg tds- antimuscarinic

116
Q

Parkinsons meds

A

Dopamine receptor agonists- bromocriptine, pergolide

L-dopa: precurose or dopamine

MAO B inhibitors: selegline, rasagaline

Amantadine: for bradykinesia, dyskinesia, tremor, rigidity

Inhibit dopamine breakdown: entacapone, tolcapone

117
Q

Bromocriptine, pergolide

A

first line
Gradually increase and withdraw
Can use with L-Dopa during  off times and motor impairment
A/w pulmonary, retroperitoneal, pericardial fibrosis  check CXR ± spirometry, ESR, Cr

118
Q

L-Dopa
start with low dose and slowly increase
Only in PD
Given with cardidopa or benserazide- prevent peripheral breakdown- don’t cross BBB
Improves bradykinesia and rigidity > tremor
With time: increased response and SE:

A

On-off effect- fluctuation between exaggerated involuntary movements and periods of immobility

End- of- dose effect- duration of benefit reduces with each dose
decreased with selegiline/ rasagaline OR entacpone/ tolcapone

abnormal involuntary movements

119
Q

Acute Stroke causes

A
  • Cerebral infarction: thrombus or embolus from LA or LV
  • Intracerebral or subarachnoid haemorrhage: direct neuronal injury and pressure  adjacent ischaemia
  • Sudden BP, vasculitis, venous- sinus thrombosis, CA dissection
120
Q

Acute Stroke PC

A
  • Hx: sudden CNS symptoms or stepwise progression

* Ex: neurological signs (dysphagia, incontinence), BP, HR and rhythm, murmur, carotid bruits, systemic signs

121
Q

TIA risk

A 
ABCD2 
o	Age: <60= 2 or ≥60=1 
o	BP: systolic ≥140 or diastolic ≥90 
o	Clinical: uni weakeness= 2, speech w/o weakness =1 
o	Duration: ≥1hr=2, 10-59min=1, <10min=0
o	Diabetes: 1
122
Q

TIA management

Symptoms <24 hours

A

Admit if > TIA in <1 week
If symptoms stopped- aspirin 75mg od
FBC, ESR, U&E, Cr, eGFR, lipids, glucose, thrombophilia, clotting
Tx HT, hyperlipideamia

123
Q 
CHA2DS2- VASc score
CCF= 1
HT=1 
>75=2 and 65-74= 1
DM= 1
F= 1 or Prior stroke/ TIA= 2
Vascular disease= 2
A

0= low risk. No antithrombotic or aspirin

1= moderate. Aspirin or anticoagulation po

≥2= high. Anticoagulant PO

124
Q

secondary prevention

A

• Lifestyle: smoking, exercise, diet, salt, alcohol
• Antiplatelet: not on warfarin and non-hemorrhagic stroke
o Clipidogrel 75mg od OR
o Aspirin 75mg od + dipyridamole S/R 200mg bd
• Oral anticoagulation: rheumatic MV disease, prosthetic valves, dilated cardiomyopathy, AF
o Warfarin vs dabigatran
• Antihypertensives
o Cholesterol: simvastatin 40mg od if total is >3.5mmol/L

125
Q

Carotid stenosis and carotid endarterectomy

A

Endarterectomy decreases mortality if carotid stenosis symptomatic

126
Q

HAS-BLEED: risks vs benefits

A

• Uncontrolled, SBP>160=1
• Abnormal LFT= 1
• Abnormal RFT=1
• Stroke hx= 1
• Prior major bleed/ predisposition of bleed= 1
• Labile INR= 1
• ≥65= 1
• Drugs predisposing to bleeding- antiplatelet, NSAIDs=1
• Alcohol= 1
≥3= 1 year bleed risk on anticoagulation

My General Practise (8 decks)

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