passmed :) Flashcards
what are the macroscopic and microscopic and biochemical changes in alzheimers disease?
macroscopic: widespread cerebral atrophy, particularly involving the cortex and hippocampus
microscopic: cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein. Hyperphosphorylation of the tau protein has been linked to AD
biochemical: there is a deficit of acetylcholine from damage to an ascending forebrain projection
what antipsychotic should be avoided in parkinsons?
haloperidol - it is a dopamine antagonist
what antidepressant should not be used in those with Alzheimer’s?
. One example of this is the use of tricyclic antidepressants in patients with dementia, due to the risk of worsening cognitive impairment.
what levels of drop in BP count as postural hypertension?
a. A drop in systolic BP of 20mmHg or more (with or without symptoms)
b. A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with or without symptoms)
c. A drop in diastolic BP of 10mmHg with symptoms (although clinically much less significant than a drop in systolic BP).
what score is used to assess pressure sores?
waterlow score
what is the action of memantine and when is it used?
NMDA receptor antagonist
used in Alzheimer’s
what are the features of acute fatty liver of pregnancy?
abdominal pain nausea & vomiting headache jaundice hypoglycaemia severe disease may result in pre-eclampsia
what are the features of cholestasis of pregnancy?
pruritus, often in the palms and soles no rash (although skin changes may be seen due to scratching) raised bilirubin
what is the RMI and what are the three components?
RMI is a pre-surgical prognostic criteria
it is based on CA125 levels, menopausal status and US findings
what cancers does the combined oral contraceptive pill increase and decrease the risk of?
increases risk of breast and cervical cancer
protective against ovarian and endometrial cancer
how are fibroids managed if fertility is wanted?
myomectomy
A 19-year-old woman who is 9 weeks into her first pregnancy is seen in the early pregnancy assessment unit with vaginal bleeding. Her ultrasound scan confirms a viable intrauterine pregnancy. However, the high vaginal swab has isolated group B streptococcus (GBS). How should she be managed?
intrapartum IV benzylpenicllin
where is an ectopic pregnancy likely to occur?
the isthmus of the fallopisan tube
how should you manage a woman who has come into contact with chickenpox for the first time in pregncny?
varicella zoster immunoglobulin
what is tranexamic acid used for?
heavy menstrual bleeding
how should dysmenorrhoea be managed?
mefenamic acid
what is an absolute contraindication to caesarean section?
previous vertical caesarean scar
A 35-year-old obese gravida 3 para 2 has developed a swollen and tender left leg; she is currently at 32 weeks of gestation and started on the appropriate treatment regimen. Due to her weight, the clinician decides to monitor her treatment with a specific blood test. Which blood test is this?
Anti-Xa activity
The guidance states that: ‘In clinically suspected DVT or PE, treatment with low-molecular-weight heparin (LMWH) should be commenced immediately until the diagnosis is excluded by objective testing, unless treatment is strongly contraindicated.’
The guidance also states that: ‘Routine measurement of peak anti-Xa activity for patients on LMWH for treatment of acute VTE in pregnancy or postpartum is not recommended except in women at extremes of body weight (less than 50 kg and 90 kg or more) or with other complicating factors (for example, with renal impairment or recurrent VTE).’ and that ‘Routine platelet count monitoring should not be carried out.’
how do you medically manage a miscarriage?
misoprostol
what is laryngomalacia and how does it present?
Laryngomalacia is a very common, benign cause of noisy breathing in infants
Laryngomalacia should be suspected in an otherwise well infant with noisy breathing. It is caused by a congenital softening of the cartilage of the larynx, causing collapse during inspiration. Laryngomalacia can present at birth, and worsens in the first few weeks of life. It usually self-resolves before 2 years of age.
when a child is on Ritalin (Methylphenidate) what do you need to monitor?
Methylphenidate, a stimulant, may suppress appetite and cause growth impairment in children. It is advised to monitor growth as well as blood pressure and pulse in these patients on a regular basis.
what score is used to assess the health of a new born baby?
apgar
You are working in a busy emergency department. A worried mother brings her 3-year-old boy to see you. He has been crying excessively for the last 12 hours and has had bilious vomiting on multiple occasions. The boy passed one stool around 2 hours ago which contained small amounts of blood.
With the patients likely diagnosis what initial investigation would you do?
Ultrasound is the investigation of choice for intussusception
when should you consider pneumonia in children?
Consider a diagnosis of pneumonia if the child has:
high fever (over 39°C) and/or
persistently focal crackles.
