paeds/psych/cancer/opic/stroke/specialsenses Flashcards
1
Q
1st line ix for stroke
A
non contrast ct head to rule out bleed
2
Q
What scale can be used to predict disability following stroke/ TIA?
A
The Barthel index is a scale that measures disability or dependence in activities of daily living in stroke patients
3
Q
causes of peripheral neuropathy
A
alcohol
b12 deficiency
ckd
cancer
diabetes
vasculitis
4
Q
what does ct head for sah show
A
hyperattenuation in the subarachnoid space
blood appears w hite; this will be m ixed in w ith the CSF. This will lie w ithin the interhem ispheric fissure, basal
cisterns and ventricles
5
Q
what will LP show for SAH
A
increased rbc
xanthochromia- yellow colour caused by bilirubin
6
Q
what is kernigs sign
A
when you bend the hip and knee to 90 degrees , pain on extending the knee
caused by meningeal irritation
7
Q
what is the pterion
A
frontal
sphenoid
temporal
parietal
8
Q
subdural haemorrhage cause & ct scan
A
high impact trauma
bridging vein
CT imaging is the first-line investigation and will show a crescentic collection, not limited by suture lines. They will appear hyperdense (bright) in comparison to the brain. Large acute subdural haematomas will push on the brain (‘mass effect’) and cause midline shift or herniation/ compression of the ventricles
9
Q
extradural haemorrhage cause
A
middle meningeal artery
young person with trauma
lucid interval
bi convex shape on ct, limited by suture lines
rapidly declines
fracture of temporal bone
10
Q
rf for strok
A
htn
smoker
alcohol
diabetes
hyperlipidaemia
heart disease (e.g. atrial fibrillation, valvular), peripheral
vascular disease, previous TLA, polycythaemia rubra vera, carotid
artery disease, hyperlipidaemia, clotting disorders, combined
oral contraceptive pill, excess alcohol.
11
Q
give some metabolic causes of seizure
A
- hypoG
- hypoNa
- uraemia
- hypoCa
- anoxia
- water intoxication
12
Q
what is epilepsy
A
T ran sien t occurrence o f in term itten t, abnorm al electrical activity
o f p art o f the brain. T h is tends to be stereotyped and often
m anifests itself as seizures.
13
Q
epilepsy different types + mx
A
Absence- girls, age 3-10, stress/ hyperventilation
Ethosuximide/ sodium valproate
AVOID carbamazepine- exacerbates absence seizure
Generalised tonic clonic
1st line Sodium valproate
2nd line lamotrigine or carbamazepine
Focal
1st line Carbamazepine/ lamotrigine
2nd line levetiracetam, sodium valproate, oxcarbazepine
Myoclonic
1st line sodium valproate
2nd line clonazepam, lamotrigine
14
Q
The cranial nerves II, III, IV and VI are involved in vision and
movement of the eye. What are the six routinely performed tests
clinically to assess these cranial nerves?
A
Visual acuity, visual fields, fundoscopy, pupillary light response
(direct and indirect), pupillary accommodation, eye movements.
15
Q
Brown-Sequard syndrome
A
- caused by lateral hemisection of the spinal cord
- ipsilateral weakness below lesion
- ipsilateral loss of proprioception and vibration sensation (dorsal column- posteriorly in spinal cord, decussates at medulla)
- contralateral loss of pain and temperature sensation (spinothalamic tract- anterior spinal cord)
16
Q
carpal tunnel ix
A
nerve conduction studies
electromyography
mri wrist
uss
17
Q
Give two complications associated with long-term levodopa
treatment?
A
On-off fluctuations, dyskinesias, weaning off phenomenon
18
Q
give 2 clinical features other than headache that can be due to raised icp
A
Vomiting, papilloedema, seizures, focal neurology, decreased
conscious level.
19
Q
Give two examples of space-occupying lesions which may be
causing the raised intracranial pressure
A
Neoplasm, haematoma, abscess, granuloma, aneurysm
20
Q
cushings triad in raised icp
A
widening pulse pressure
bradycardia
irregular breathing
21
Q
idiopathic intracranial htn mx
A
weight loss
diuretics e.g. acetazolamide
topiramate is also used, and has the added benefit of causing weight loss in most patients
repeated lumbar puncture may be used as a temporary measure but is not suitable for longer-term management
surgery: optic nerve sheath decompression and fenestration may be needed to prevent damage to the optic nerve. A lumboperitoneal or ventriculoperitoneal shunt may also be performed to reduce intracranial pressure
22
Q
why fbc in epistaxis
A
low plts- can be cause of epistaxis
low hb- anaemia due to bleed
23
Q
other blood tests for epistaxis
A
INR as she is on warfarin, LFTs as deranged liver function may
lead to insufficient synthesis of clotting factors, group and save in
case transfusion is necessary
24
Q
ddx for sore throat in child
A
tonsillitis
scarlet fever
infectious mononucleosis
agranulocytosis
malignancy
diphtheria
25
tonsillitis- why is penicillin V given as opposed
to am oxicillin?
Am oxicillin will cause a maculopapular rash if the cause of the
symptoms is infectious mononucleosis instead o f acute tonsillitis.
26
recurrent laryngeal nerve- which cranial nerve is it a branch of, which side is RLN palsy commoner on and why, give 2 causes of RLN palsy and symptoms of vocal cord palsy other than hoarseness
* vagus nerve
* left- longer than right
* thyroid surgery, thyroid malignancy, idiopathic
* hoarseness, low voice volume, voice fatigue, SoB, cough
27
How can you discriminate an upper motor neurone lesion from a
lower motor neurone lesion affecting the face?
umn- forehead sparing- suspect stroke
lmn- doesnt spare forehead- less urgetn
28
mx & long term consequences of bells palsy
* lmn palsy- forehead not spared
* within 72hrs presentation- give pred 5-10 days 50-60mg
* Damage to the eye - consequence of reduced lacrimation and inability to close eye; altered taste; psychological impact.
29
Describe the pathogenesis of BPPV
T h e re is displacement of an otolith or otoconia within the
semicircular canals. The heavier otolith causes abnormal
movement of the endolymph within the canal, giving the
sensation of vertigo.
30
causes for vertigo besides bppv
Meniere’s disease, vestibular neuronitis, acoustic neuroma,
multiple sclerosis, cholesteatoma, trauma, drugs (gentamicin,
diuretics, metronidazole, among others).
also posterior circulation stroke
31
difference between childrens ET to adults
Shorter, narrower and more horizontal - poor drainage, more
likely to suffer middle ear infections.
32
name 2 portions of eardrum
pars flaccida
pars tensa (main middle bit)
33
otitis media eardrum otoscopy findings
Bulging eardrum, reddening or dull appearance, prominent blood
vessels, (+/- perforation).
34
describe eczema rash
. Erythematous, scaly, excoriations, lichenification, crust and
weeping if infected.
typically symmetrical flexural distribution
35
eczema herpaticum
Eczema herpeticum describes a severe primary infection of the skin by herpes simplex virus 1 or 2.
It is more commonly seen in children with atopic eczema and often presents as a rapidly progressing painful rash.
On examination, monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.
As it is potentially life-threatening children should be admitted for IV aciclovir.
36
classical signs of psoriasis
well demarcated, red, scaly
37
plaque psoriasis- where to examine
extensor surfaces, sacrum and scalp
nails
38
complications psoriasis
psoriatic arthropathy (around 10%)
increased incidence of metabolic syndrome
increased incidence of cardiovascular disease
increased incidence of venous thromboembolism
psychological distress
39
types of malignant melanoma
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
40
RF MM
sun exposure
fair skin
fhx
sunburn
lentigo maligna
41
malignant melanoma prognosis
breslow thickness
thickness of the lesion correlates mortality
42
characteristic appearance BCC
many types of BCC are described. The most common type is nodular BCC, which is described here
sun-exposed sites, especially the head and neck account for the majority of lesions
initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central 'crater'
42
characteristic appearance BCC
many types of BCC are described. The most common type is nodular BCC, which is described here
sun-exposed sites, especially the head and neck account for the majority of lesions
initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central 'crater'
43
bcc mx
Mohs micrographic surgery.
surgical removal
curettage
cryotherapy
topical cream: imiquimod, fluorouracil
radiotherapy
44
actinic keratoses
small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
multiple lesioms may be present
premalignant
sun exposure
fluororacil
topical diclofenac if mild AKs
45
pathophys acne
Increased production of sebum. Pilosebaceous follicles become
blocked and infected.
46
s/e oral isotretinoin
dry skin, dry lips, dry eyes
depression
muscle aches
migraine
teratogenic- need effective contraception
47
scc of skin- worse prognosis site? risk factors?
ear and lip
sun exposure, age, renal transplant & immunosuppression
48
bowens disease
precursor for scc
may sometimes be diagnosed and managed in primary care if clear diagnosis or repeat episode
topical 5-fluorouracil
typically used twice daily for 4 weeks
often results in significant inflammation/erythema. Topical steroids are often given to control this
cryotherapy
excision
49
what virus causes shingles
herpes simplex virus 3
50
what is the characteristic appearance of shingles
vesicles
crusting
erythematous
swollen plaques
dermatome
NEVER crosses midline !
51
commonest chronic complication of shingles
post herpetic neuralgia
most commonly resolves with 6 months but may last longer
52
RF for developing pressure sores
stroke
Elderly, cardiovascular disease, obesity, poor nutrition, immobility,
smoking, neurologically impaired, faecal incontinence, urinary
incontinence
53
what are the 4 grades of pressure sore
1. erythema nonblanchable, skin intact
2. partial thickness skin loss
3. full thickness skin loss
4. full thickness tissue loss, exposed bone
54
what to address in mx of pressure ulcer
Nutrition, antibiotics if infected, regular dressings, need for
debridement, pain relief, patient positioning, tissue viability
referral, pressure relieving mattress/chair.
55
lichen sclerosus clinical features, mx
itch, pain during sex, dysuria, constipation
mx- topical steroids and emollients
56
coeliac disease skin association
dermatitis herpatiformis
57
Dermatofibroma
Dermatofibromas (also known as histiocytomas) are common benign fibrous skin lesions. They are caused by the abnormal growth of dermal dendritic histiocyte cells, often following a precipitating injury. Common areas include the arms and legs.
Features
solitary firm papule or nodule, typically on a limb
typically around 5-10mm in size
overlying skin dimples on pinching the lesion
58
fungal nail infection mx
if due to dermatophyte
amorolfine 5% nail lacquer
fingernail- 6 months
toenails- 9-12 months
if more extensive dermatophyte infection
oral terbinafine
fingernail- 6wks-3months
toenail- 6 months
if due to candida
oral itraconazole
59
impetigo- cause & mx
* cause- staph aureus, strep pyogenes
* mx- not systemic disease: topical hydrogen peroxide cream 1%
* otherwise- topical abx = topical fusidic acid
* or oral abx- fluclox, alt eryth if allergic
* 48hrs school exclusion after starting abx
60
stuck on appearance mole in elderly...
Seborrhoeic keratoses
large variation in colour from flesh to light-brown to black
have a 'stuck-on' appearance
keratotic plugs may be seen on the surface
reassurance about the benign nature of the lesion is an option
options for removal include curettage, cryosurgery and shave biopsy
61
shin lesions ddx
erythema - strep infection, IBD, sarcoid
pretibial myxoedema- graves
pyoderma gangrenosum- idiopathic, IBD
necrobiosis lipoidica diabeticorum
62
breast cancer screening programme
50-70 mammogram evry 3 yrs
can have it after but make ur own app
63
who gets hormonal therapy in breast cancer and side effects
oestrogen receptor positive tumours
pre/peri menopause- tamoxifen- risk of VTE, endo cancer, menopausal sx
post menopause- letronozole or anastrozole (aromatase inhibitor)
64
RF cerebral palsy
antenatal factors:
* preterm birth (with risk increasing with decreasing gestational age)[1],[2]
* chorioamnionitis
* maternal respiratory tract or genito-urinary infection treated in hospital
perinatal factors:
* low birth weight
* chorioamnionitis
* neonatal encephalopathy
* neonatal sepsis (particularly with a birth weight below 1.5 kg)
* maternal respiratory tract or genito-urinary infection treated in hospital
postnatal factors:
* meningitis.
65
other than neuro what examination for cerebral palsy do you want to do & why
* MSK - contractures
* Eyes – strabismus and visual problems
* Ears – deafness
* Developmental examination
* GI – GORD (epigastric tenderness)
* Resp – recurrent pneumonias
66
what hormone is structurally similar to bhcg
LH
67
why is pth high in chronic renal failure
low absorption of calcium from gut and kidneys and bones
leads to hypocalcaemia
leads to PTH secretion
= secondary hyperPTH (high PTH, low or normal Ca)
over time, the pth gland will increase (hyperplasia) in size- tertiary hyperPTH (high pth, high Ca)
68
what is NIHSS
National Institute of health Stroke Scale
It objectively quantifies impairment caused by stroke
Measure things like LOC, horizontal eye movement, visual field defect, faacial palsy, motor arm, motor leg
69
why do sca pts not exhibit sx until 6/12 of age
high levels of fetabl haemoglobin HbF masks the effect of the disease until 6 months when HbF declines
70
rouleaux formation...
A 'rouleaux formation' is a stacking of red blood cells seen in a blood film. It is characteristic of a myeloma.
71
most common malignancy associated with acanthosis nigricans
gastrointestinal adenocarcinaoma
72
schneiders first rank sx
1. delusional perception
2. third person auditory hallucination
3. thought disorder (withdrawal/ insertion/ broadcast)
4. passivity phenomenon
73
core sx depression
low mood
low energy
low interest = anhedonia
74
OTHER SX OF DEPRESSION
cognitive- lack of concentration, negative thoughts, excessive guilt, suicidal ideation
biological- low libido, early morning awakening, diurnal variation in mood, poor appetite/weight loss, psychomotor retardation
psychotic- 2nd person auditory hallucinations, delusions (hypochondriacal/guilt/nihilistic/persecutory)
75
how to avoid antidepressant discontinuation syndrome
switch to fluoxetine, then wean off fluoxetine
or reduce daily dose gradually
76
list some rf for schizophrenia
fhx biggest one- twins/sibling/parent
childhood abuse
low socioeconomic status
substance misuse
cannabis
adverse life events
migrants
neurochemical- increased dopamine, reduced glutamate, serotonin, gaba
77
negative sx of schizophrenia
avolition (reduced motivation)
asocial behaviour
anhedonia
alogia (poverty of speech)
affect blunted
attention deficit- lack of conc.
78
organic differentials for anxiety
hyperthyroidism
anaemia
phaeochromocytoma
hypoglycaemia
caffeine/ alcohol consumption
withdrawl from drugs
79
organic differentials for anxiety
hyperthyroidism
anaemia
phaeochromocytoma
hypoglycaemia
caffeine/ alcohol consumption
withdrawl from drugs
80
difference between ptsd and adjusment disorder
adjustment disorder-non catastrophic event, sx within 1 month of the event
ptsd- extremlely traumatic event, sx must occur within 6months of the event
81
how is dx of postural hypotension made
Postural hypotension may be defined as a fall of systolic blood pressure > 20 mmHg on standing.
or diastolic > 10
or systolic >30 in pts with htn
within 3 mins of standing
82
what are some causes of postural hypotension
antihypertensives
hypovolaemia, dehydration
autonomic dysfunction- diabetes, parkinsons
alcohol
83
pharmacological and non-pharmacological mx of postural hypotension
F ull-length compression hosiery, education on recognising
symptoms and taking action, high-salt diet, bed tilt
Fludrocortisone, midodrine.
84
factors predisposing falls in elderly
Arthritis, reduced cognition, polypharmacy, reduced visual input,
reduced muscle strength, reduced proprioception, increased
reaction time.
postural hypotension
85
how do penicillins work
cell wall synthesis inhibition
86
how do bacteria develop penicillin resistant
beta lactamase production
breaks down beta lactam ring
87
why are penicillins given in combo with other drugs eg co amociclav
the additional drugs are beta lactamase inhibitors
reduces resistance
88
common reversible causes of dementia
b12 deificency
thiamine deficiency
normal pressure hydrocephalus
hypoglycaemia
hypothyroid
uraemia
89
abnormalities on MRI scan for AD
Cortical atrophy, ventricular enlargement, hippocampal atrophy.
90
drugs causing urinary retneiton
Anticholinergics (e.g. tolterodine, oxybutynin), NSAIDs (e.g.
naproxen, diclofenac, ibuprofen).
90
drugs causing urinary retneiton
Anticholinergics (e.g. tolterodine, oxybutynin), NSAIDs (e.g.
naproxen, diclofenac, ibuprofen).
91
how does duloxetine improve stress incontinence
snri
more noraderenaline available
increases the tone of the internal urethral sphincter
92
tia definition
The original definition of a TIA was time-based: a sudden onset of a focal neurologic symptom and/or sign lasting less than 24 hours, brought on by a transient decrease in blood flow. However, this has now changed as it is recognised that even short periods of ischaemia can result in pathological changes to the brain. Therefore, a new 'tissue-based' definition is now used: a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.
93
ix of tia
mri head
carotid doppler
if >70% stenosis = carotid endarterectomy
94
score used for determining stroke risk following tia
abcd2
age, bp, clinical features, diabetes,duration
95
where do fragility fractures commonly occur
pelvis
hip
vertebrae
proximal humerus
proximal radius
96
advice when taking bisphosphonate
Swallow whole, take in fasting state, wash down with plenty of
water, remain upright for 30 mins after taking the tablet, avoid
food and drink for 30 m inutes after taking the tablet
97
bisphosphonate s/e
A bdo pain, dyspepsia, nausea, abdo distension,
oesophageal ulceration, upper GI bleed.
98
what 2 ix for myeloma screen
Urinary Bence Jones protein, serum electrophoresis.
99
what is seen on plain radiographs for myeloma
Lytic lesions
99
what is seen on plain radiographs for myeloma
Lytic lesions
100
treatment of msccc
dex
spinal cord decompression
rt
101
treatment of msccc
dex
spinal cord decompression
rt
102
MYELOMA COMPLICATIONS
renal failure
hypercalcaemia
anaemia
thrombocytopenia
neutropenia
recurrent infections
hyperviscosity
103
other causes of parkinsonism
Drug-induced Parkinsonism (e.g. antipsychotics), Lewy body
dementia, Shy-Drager syndrome, multiple system atrophy,
vascular disease.
104
why arent younger pts with parkinsons disease not commonly given levodopa
It becomes gradually ineffective over many years; therefore, held
until necessary
105
other causes of raised psa beside prostate ca
Benign prostatic hypertrophy, prostatitis, post-prostatic biopsy,
post-digital rectal examination
106
Name the five distressing end-of-life symptoms that the Liverpool Care Pathway
addresses, and name a drug it recommends to use for each.
Pain (morphine), agitation (midazolam), nausea (cyclizine),
respiratory tract secretions (hyoscine butylbromide/
hydrobromide), dyspnoea (morphine).
107
causes of a urethral stricture
sti- gonorrhoea
idiopathic
iatrogenic- indwelling catheter trauma
lichen sclerosus
penile fracture
hypospadias
108
aortic stenosis- who gets a valve replacement?
symptomatic
or asyptomatic and valvular gradient >40 or signs of ventricular dysfunction
109
hypoglossal nerve injury
causes by carotid endarterectomy
paralysis of tongue muscles
"lick the lesion"- the tongue will deviate towards the side of the lesion due to the overactivity of the strong genioglossus nerve
110
urticaria rash
pale, pink raised skin. Variously described as 'hives', 'wheals', 'nettle rash'
pruritic
111
mrsa mx
vancomycin
112
notching of the inferior border of the ribs on cxr =
coarctation of aortia- collateral vessels
113
how to diagnosie active tb
gold standard is sputum culture
sputum smear- ziehl neelson stain - 3 samples required
114
inr 5-8 on warfarin, no sign of a bleed
Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose
115
pressure ulcer- which member of mdt can assess it
district nurse
116
impetigo mx
hydrogen peroxide 1% cream
or topical fusidic acid (abx)
or systemic disease flucoloxacillin
117
who to refer for bariatric surgery
very obese pts bmi 40-50
esp those with diabetes
rather than it being last resort
118
where do venous ulcers occur
above ankle/ medial malleolus
painless
119
how to recognise an arterial ulcer
Occur on the toes and heel
Typically have a 'deep, punched-out' appearance
Painful
There may be areas of gangrene
Cold with no palpable pulses
Low ABPI measurements (normal is 0.9-1.2, <0.9 is arterial disease, or >1.3 in diabetics too)
120
autism 3 main characteristics
1. social impairment/ issues with social interaction
2. impaired communication skills/ speech delay
3. restrictive repetitive activities/ behaviours or interests
121
non medical professional who can aid diagnosis of autism
* teacher
* speech and language therapist
* community psychiatric nurse
* occupational therapist
* educational psychologist
122
medical conditions that are often co-morbid with autism
* epilepsy
* tuberous sclerosis
* fragile X
* adhd
* dyspraxia
* hearing impairment
* anxiety
* visual impairment
123
what are the 2 main predictors of poor prognosis in autism
1. iq < 50
2. no communicative speech before age 5
124
factors associated with elder person being a victim of abuse
* social isolation
* memory problems
* communication problems
* being dependent on carer
* poor relationship with carer
* carer has addictions eg alcohol/ drugs
* carer relies on victim for home/ finances/ emotional support
125
re-feeding syndrome biochemical abnormalities
* hyperglycaemia
* hypophosphataemia
* hypomagnesaemia-may predispose to torsades de pointes
* hypokalaemia
* thiamine deficiency
126
how to reduce risk of refeeding syndrome
* refeed slowly- <50% energy requirements if theyve eaten little or nothing in more than 5 days or have other rf
* checking bloods, replace electrolytes prior to starting to feed
* replace B vitamines
127
serious complicatyions of anorexia
* hf
* bradycardia, arrhythmia
* mitral valve prolapse
* osteoporosis
* infertility
* anaemia, leucopenia
* wernickes enceph/ korsakoff
128
psychological tx for anorexia nervosa
* individual eating disorder focused cbt (CBT-ED)
* MANTRA
* specialist supportive clinical management (SSCM)
129
why do pts with PD develop bradykinesia
neuronal degeneration in nigrostrial pathway
lead sto doapmine deficiency in the basal ganglia
130
name 2 dopamine receptor agonist drugs
* ropinirole
* bromocriptine
* pramiprexole
131
why should dopamine be held off for as long as possible/ used in low dosage in youngers pts
* may be neurotoxic and speed up PD progression
* can cause dyskinesia (involuntary movements)
* leads to motor fluctuations- on/off, freezing
* wearing off
* non motor s/e- nausea, hallucinations, low bp
*
132
procyclidine s/e
confusion, disorientation, visual hallucination
nausea
urinayr retention
visual disturbance
dry mucous membrane
constipation
impaired memory
anxiety/nervousness
133
why pts with advanced PD may develop confusion, disorientation, visual hallucinations
* onset of PD dementia
* intercurrent illness eg infection
134
mx of hyperCa in first 24hrs
* iv normal saline
* careful observation of fluid balance
* stop acei
(iv bisphosp started after 24hrs)
135
ct head guidelines head injury within 1 hr
* GCS < 13 on initial assessment
* GCS < 15 at 2 hours post-injury
* suspected open or depressed skull fracture
* any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign).
* post-traumatic seizure.
* focal neurological deficit.
* more than 1 episode of vomiting
136
pt attends diabetic clinic, thereaftyer develops acute glasucoma, why
may hav used mydriatic - dilates pupil, exacerbating untreated narrow angle
