passmed Flashcards
wernicke aphasia
receptive. lesion of superior temporal gyrus. supplied by inferior division of left middle cerebral artery. forms speech before sending to broca. lesions: sentence not make sense, word salad. comprehension impaired
broca aphasia
expressive. lesion of inferior frontal gyrus, supplied by superior division of left middle cerebral artery. speech is not fluent, laboured, repitition impaired. comprehension is normal
conduction aphasia
usually due to stroke affecting arcuate fasciculus (connection between wenicke’s and broca’s area). speech is fluent but repetition is poor. aware of errors making, comprension is normal
global aphasia
large lesison resulting in severe expressive and receptive aphasia, may still communicate using gestures
stroke in anterior cerebral artery
contralateral hemiparesis and sensory loss, lower extremity> upper
middle cerebral artery stroke
contralateral hemiparesis (paralysis occuring on side of the body opposite to the side of the brain in which lesion occurs) and sensory loss, upper extremity> lower. controlateral homonymous hemianopia (only see one side (left/right) of the visual world of each eye), aphasia (difficulty with their language or speech)
posterior cerebral artery
contralateral homonymous hemianopia and macular sparing, visual agnosia (impairment in recognizing visually presented objects, despite otherwise normal vision)
weber’s syndrome
branches of posterior cerebral artery that supply midbrain (ipsilateral CN III palsy, controlateral weakness of upper and lower extremity)
posterior inferior cerebellar artery
ipsilateral: facial pain and temperature loss. contralteral: limb/torso pain and temperature loss. ataxia (group of disorders that affect co-ordination, balance and speech), nystagmus (rhythmical, repetitive and involuntary movement of the eyes.)
epilepsy of temporal lobe
Hallucaintions (auditory/ gustatory/olfactory), epigastric rising/emotional, automatisms (lip smacking/grabbing/plucking), deja vu/dysphasia
epilepsy of frontal lobe (motor)
head/leg movements, posturing, post-ictal weakness, jacksonian march (distal limb to ipsilateral face)
epilepsy of parietal lobe
sensory, paraesthesia
occipital lobe
visual, floaters/ flashes (small dark dots, squiggly lines, rings, cobwebs and flashes of light)
cause of AKI-prerenal
ischaemia/ lack of blood flowing to kidneys. eg hypovolaemia secondary to diagghoea/vomiting, renal artery stenosis
cause of AKI- intrinsic
intrinsic damage to glomeruli, renal tubes or intersitirum of kidneys. could be due to toxins (drugs, contrast etc) or immune mediated glomulernephritis. other examples eg acute tubular necrosis (ATN), acute interstitial nephritis, rhabdomyolysis
cause of AKI-post renal
obstruction to urine coming from the kidneys resulting in things ‘backing up’ and affecting normal renal function. eg kidney stones in ureter/ bladder, benign prostatic hyperplasia, external compression of the ureter
RF for AKI
CKD, other organ failure/ Chronic disease (eg DM), history of AKI, use of drugs with nephrotoxic potential (NSAID, ACEi, ARB) oliguria (urine output less than 0.5ml/kg/hr(
PC for AKI
many early AKI may experience no symptoms, but possible symptoms are reduced urine output, pulmonary and peripheral oedema, arrhythmias (secondary to changes in K and acid base balance), features of uraemia (eg pericarditis, or encephalopathy)
how to detect AKI
U&E blood test (Na, K, Urea, Creatinine)
rise in serum creatinine of 26 micromol/l, or greater within 48 hours.
50% rise in known serum creatinine
fall in urine output.
urinalysis
can do renal US if no identifiable cause for deterioration
treatment of H.pylori
triple therapy: amoxicilin, clarithromycin, omeprazole
management of AKI
supportive, careful fluid balance, review pt medication to see what makes things worse/ better for AKI
safe to continue in AKI: paracetamol, warfarin, statins, aspiring (cardioprotective dose of 75mg 1d), clopidogrel, beta blockers
should be stopped as may worsen renal function: NSAID, aminoglycosides, ACEi, ARB, diuretics
medication to stop in AKI as inc risk of toxicity: metformin, lithium, digoxin
how to manager hyperkalaemia
stabilisation of cardiac membrane: IV calcium gluconate
ST shift in K from extracellular to intracellula: 50ml 50% dextrose, and 10 units insulin. nebulised salbutamol
Remove K+ from the body: calcium resonium (orally/enema), loop diuretic, dialysis
SLE manifestations
autoimmune disease, oral and nasal painless ulcers, pancytopenia, malar or discord rash, serositis, athropathy, photosensitivity, headache, renal involvement.
how would you test for SLE?
antinuclear antibodies (ANA), so if not ANA positive, not SLE. but if ANA positive, it could be ANA or something else as well (highly sensitive but not specific). anti dsDNA and anti smith (both highly specific but not sensitive)
how would you monitor for SLE
inflammatory markers (ESR, active disease CRP may be normal but raised CRP may suggest underlying infection). complement level (C3/C4) low in active disease. anti dsDNA can be used for disease monitoring
what are the branches of the aorta
T12: coeliac trunk, L1: left renal artery, L2: testicular or ovarian arteries L3: inferior mesenteric artery L4: bifurcation of the abdominal aorta
what are the things in relation to the gall bladder
ant: liver, post: covered by peritoneum, transverse colon, 1st part of duodenum. lat: right lobe of liver, medi: quadrate lobe of liver
vasculature to gall bladder
cystic artery (branch of right hepatic artery), venous drainage directly to liver. lund’s node is sentinel lymph node of the gall bladder
what are things in relation to common bile duct
origin: confluence of cystic and common hepatic ducts
medially: hepatic artery, posteriorly: portal vein
dodenum is anterio, pancreas: medial and lateral. right renal vein: post
arterial supply: branches of hepatic artery and reotroduodenal branches of gastroduodenal artery
relation of hepatobiliary triangle
medially: common hepatic duct, inferiorly: cystic duct, superiorly: inferior edge of liver. contents: cystic artery
what supplies medial aspect of leg
saphenous nerve which arises from femoral nerve
what supplies lateral foot
sural nerve which arises from common fibular and tibial nerves
what supplies dorsum of the foot
majority from the superficial fibular nerve
what supplies web space between the 1st and 2nd toe and sole of foot
deep fibular nerve, tibial nerve
what does the musculocutaneous nerve innervate
C5-C7, motor= wlbow flexion (supplies biceps brachii) and supination. sensory to lateral part of forearm. isolated injury usually injured as part of brachial plexus
what does the axillary nerve innervate
C5,C6. shoulder abduction (deltoid muscle). sensory: inferior region of the deltoid muscle. injury to humeral neck fracture/ dislocation. results in flattened deltoid
what does radial nerve innervate
C5-C8. extension (forearm, wrist, fingers, thumb), sensory: small area between dorsal aspect of the 1st and 2nd metacarpal, injury to humeral midshaft, palsy results in wrist drop
median nerve
C6, C8, T1. LOAF muscles.
palmar aspect of later 3 and 1/2 fingers. wrist lesion–> carpal tunnel syndrome. wrist: paralysis of thenar muscles, opponens pollicis
elbow: loss of pronation of forearm and weak wrist flexion
ulnar nerve
C8, T1. motor: intrinsic hand muscles except LOAF. wrist flexion
