passmed year 5 Flashcards
what is the best way to refer someone if they think they have had a TIA
refer to TIA clinic and then they will need MRI
MRI findings for someone with MS and where are they found
sagital view
dawsons fingers
perpendicular to corpus callosum
also
high signal T2 lesions
periventricular plaques
long-term prophylaxis of cluster headaches
verampamil
vasodilatory effects on cerebral arteries
stopping anti epileptic drugs - time frame adn how long do you need to be seizure free
Can be considered if seizure free for > 2 years, with AEDs being stopped over 2-3 months
1hou rhisotry of sudden onset headache
vomit and nausea
new onset facila pain over rigth maxilla
venus sinus thrombosis
gold standard for venous sinus thrombosis
MR venogram
mx of venous sinus thrombosis
LMWH
Lateral sinus thrombosis palsy to what nerves
6th and 7th
Cavernous sinus thrombosis cx
local infection (e.g. sinusitis), neoplasia, trauma
periorbital erythema and oedema
what nerves involved in cavernous sinus thrombosis
3,4,6,5
a sagittal sinus thrombosis will also present with seizures and hemiplegia
what is seen on venography
empty delta sign
The ‘4Ds’ can be useful in remembering causes of postural hypotension with compensatory tachycardia
Deconditioning.
Dysfunctional heart: aortic stenosis.
Dehydration: disease (acute illness, adrenal insufficiency), dialysis, drugs (diuretics, narcotics).
Drugs: anti-anginals, anti-parkinsonian medications (levodopa), antidepressants, antipsychotics, anti-benign prostatic hyperplasia drugs (tamsulosin).
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
posterior cerebral a.
difference between bleed in cerebellar vermis and cerebella hemisphere stroke
Cerebellar hemisphere lesions cause peripheral (‘finger-nose ataxia’)
Cerebellar vermis lesions cause gait atax
seizures in the morning/following sleep deprivation
Juvenile myoclonic epilepsy
most likely operation to be done for symptomatic chronic subdural bleeds
subdural bleed symptomatic
If the patient was asymptomatic and the subdural haemorrhage was found incidentally, there may be a preference fo
conservative mx
management choice for symptomatic acute subdural haemorrhage
decompresssive craniectectmy - useful if reacculuaiton of blood or there is a solid haematoma that cannot be removed via burr hole evacuation
status elipticus at home what can you give
in the prehospital setting PR diazepam or buccal midazolam may be given
status elipticus in hosp
in hospital IV lorazepam is generally used.
does sulcal widening normal happen as part of ageing and what condition presents with ventriculomegaly out of proportion to sulcal enlargement.
normal pressure hydrocephalus
Vitamin B12 deficiency
subacute combined degeneration of spinal cord
dorsal column usually affected first so what happens prior to distal paraesthesia
joint position and vibration lost
predom motor loss - peripheral neuropathy
Guillain-Barre syndrome
porphyria
lead poisoning
hereditary sensorimotor neuropathies (HSMN) - Charcot-Marie-Tooth
chronic inflammatory demyelinating polyneuropathy (CIDP)
diphtheria
predom sensory loss peripheral neuropathy
diabetes
uraemia
leprosy
alcoholism
vitamin B12 deficiency
amyloidosis
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA what should happen
admit immediatley to exclude h
neuroleptic malignant syndrome features
pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion
mx of NMS
stop antipsychotic
patients should be transferred to a medical - ntensive care units
IV fluids to prevent renal failure
dantrolene - and decreasing the release of calcium from the sarcoplasmic reticulum
bromocriptine, dopamine agonist, may also be used
why can yoy not stop parkinsons meds - take L dopa for example
it is important not to acutely stop levodopa, for example, if a patient is admitted to hospital
if a patient with Parkinson’s disease cannot take levodopa orally, they can be given a dopamine agonist patch as rescue medication to prevent acute dystonia
how do we manage bladder dysfuncction in MS
ultrasound KUB - first to assess bladder emptying
if significant residual volume → intermittent self-catheterisation
if no significant residual volume → anticholinergics may improve urinary frequency
nystagmus in werncikes encephalopathy caused by what
lateral rectus palsy
cushing triad in raised ICP
widening pulse pressure
bradycardia
irregular breathing
and HTN
features of bells palsy
forehead affected
post-auricular pain (may precede paralysis)
altered taste - ant two thirds of tongue
dry eyes
hyperacusis
anti epileptic drug mos associated with weight gain
sodium val po weight
diabetes insipidus due to a craniopharyngioma causes what visual field defect
lower bitemporal hemianopia
definition of a TIA
TIA is now tissue-based, not time-based: a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction
neuropathic pain caused by
diabetic neuropathy
post-herpetic neuralgia
trigeminal neuralgia
prolapsed intervertebral disc
neuropathic treatment 1st or 2nd line
what is used for localised neuropathic pain
first-line treatment
amitriptyline
duloxetine, gabapentin or pregabalin
2nd line one not tried above
topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia
encepahltiis what shoudl u always do
start aciclovir
most likely cause of encephalitis
HSV-1
key feature of myasthenia
fatiguability
medication overuse headahce best - how do you manage opiods and other painkilelrs
simple analgesia + triptans: stop abruptly
opioid analgesia: withdraw gradually
visual agnosia sign of what artery stroke
PCA
SO causes eye to do what
eye to internally rotate and depress while adducted.- trochelar nerve
what is spastic paraparesis
Spastic paraparesis describes a upper motor neuron pattern of weakness in the lower limbs
eg - paraesthesia in her lower limbs, both of which have persisted for the past 3 weeks. She recalls experiencing bilateral leg stiffness about a year ago,
raised ICP through trans-tendotrial herniation can compress what nerve
3rd
mx of raised ICP
head elevation to 30º
IV mannitol may be used as an osmotic diuretic
controlled hyperventilation
removal of CSF - LP for idiopathic , ventirucloperitoneal shunt for hydrocephalus and drain and montiro
how does controlled hyperventialtion reduce ICP
Hyperventilation reduces blood carbon dioxide, in turn causing cerebral vasoconstriction and a reduction in intracerebral pressure (ICP). This must be controlled so as to avoid under-perfusion of potentially ischaemic brain regions.
when do you treat HTN in a stroke setting
Hypertension should not be treated in the initial period following an ischaemic stroke (unless prior to thrombolysis)
limbic encephalitis 3 main sx
memory loss, confusion, and seizures.
radiculopathy(pinched nerves) caused by
Degenerative changes: As people age, the discs in their spine can dry out, stiffen, and bulge, which can lead to bone spurs forming around the discs. These bone spurs can narrow the openings where the nerve roots exit the spine, known as foramina, which can pinch the nerve. This process is called foraminal stenosis.
Herniated discs: A herniated disc can occur when the material inside a disc tears and compresses a nerve root.
Trauma: Falls, car accidents, or other trauma can cause radiculopathy.
Bone spurs: Bone spurs can grow on the vertebrae and pinch a nerve root.
what is atelectasis
the collapse of a lung or part of a lung, also known as a lobe
how does sodium bicarbonate reverse the metabolic acidosis caused by tricyclic overdose
When administered intravenously, sodium bicarbonate dissociates into sodium (Na+) and bicarbonate (HCO3-) ions.
The bicarbonate ions consume hydrogen ions (H+) and convert to carbonic acid (H2CO3).
Carbonic acid converts to water (H2O) and carbon dioxide (CO2), which are exhaled from the lungs
atypical cause of atypical GBS
shingles vaccination - small amount of cases linked to infection
Antiganglioside antibodies can be used to test for GBS - what are examples of some of those antibodies
nti-GM1 (IgM) with multifocal motor neuropathy, GQ1b (IgG) with the Miller-Fisher syndrome and GM1 (IgG) with the Guillain-Barre syndrome
inflammatory neuropathies can cause arrhymias - what do you need to monitor this
ECG
what is the difference between myelopathy vs neuropathy
Myelopathy affects the spinal cord, while neuropathy affects the peripheral nervous system
myelopathy sx - pain, decreased balance and coordiantion, difficult walking , bladder and bowel function lost
nueoapthy more particular part
GBS MRI findings
thickening and thickening and contrast enhancement of the spinal nerve roots, especially in the region of the cauda and conus medullaris contrast enhancement of the spinal nerve roots, especially in the region of the cauda and conus medullaris
normally in the anterior nerve roots
why are steriods not used in GBS
reduce nerve regeneration delaying recovery so give IV immunoglobulins instead especially if off feet
Precursor to lymes disease is a
cranial neuropathy such as trigeminal neuralgia or LR palsy
Monoclonal means one is going out of control - technically means immunocompromised as not mounting any other response
so what is the diffference between this and polyclonal - Monoclonal antibodies
Monoclonal antibodies
Produced from a single clone of cells, which are all identical to each other. This makes monoclonal antibodies extremely specific, as they bind to a single epitope on an antigen.
Polyclonal antibodies
Produced from multiple clones of cells, each producing antibodies to different epitopes on an antigen. This gives polyclonal antibodies a broader range of epitope recognition.
ritixumab works on what cell type
CD(cluster of differentiation)-20 present on B cell
- for any conditon with b cell pathology such as myasthenia and MS
if cannot use IV immunnolgobulins what can you do
when should you do bloods
plasma exchange - seperate blood and plasma(water and protein so could be cancer cells in here) then replace the plasma with fluid and add to blood and give back.
This is why you must do all your tests before doign the plasma exchnage
what is post concussion syndrome
Post-concussion syndrome - set of symptoms that can occur after a concussion. PCS is a mild traumatic brain injury (TBI) and is diagnosed when concussion symptoms persist longer than three months.
Symptoms of PCS can include:
- headaches, dizziness, nausea, sensitivity to light or loud noises, blurred vision, and fatigue
- Psychological symptoms, such as depression, anxiety, and irritability
- Cognitive symptoms, such as trouble concentrating and memory proble
MDN how do we support and give nutrition
Percutaneous gastrostomy tube (PEG) is the preferred way to support nutrition in patents with motor neuron disease
nutritional support long-term (usually more than 4 weeks)
NG tubes not used long term
when do we use TPN
This is a form of parenteral feeding and is indicated in cases where there is a non-functional, inaccessible, or perforated gastrointestinal tract
TPN requires close observation and follow-up and carries complications such as sepsis and liver dysfunction.
tramadol two moa
tramadol has a dual mechanism of action, acting as both a weak opioid agonist and a reuptake inhibitor of serotonin and norepinephrine.
A craniopharyngioma gives a bitemporal inferior quadrantanopia visual field defect
what does a pituitary adenoma give
Visual examination reveals a bitemporal superior quadrantanopia.
what tool recommended by NICE to assess stroke symptoms in an acute setting.
ROSIER
‘Young’ stroke blood tests include - under 55 and on obvious cause of stroke
Autoimmune and thrombophilia screening
adhesive capsulitis 1st line
physio
explain how subactue combined degeneration of the spinal cord presents
The loss of proprioception and vibration sense (dorsal columns) points towards subacute combined degeneration of the spinal cord. Lateral columns are also affected and would cause spasticity and brisk knee reflexes. Babinski sign is typically positive. This picture occurs as a result of B12 deficiency.
A 22-year-old man presents with a one day history of a generalised headache. He prefers being in the dark and says he is ‘sleepy’. He has no neck stiffness. His temperature is 38.2ºC
meningitis
asymptomatic gallbladder stones
how do you manage
reassure
how long do you need to stop a ppi before upper gi endoscopy
As this patient is having an upper GI endoscopy, she should stop her omeprazole, a proton pump inhibitor, two weeks before her procedure. The reason for this is so that the pathology can be identified during the procedure.
suspected perforated peptic ulcer what ix
erect cxr
first line for tx of pbc
Ursodeoxycholic acid is the correct answer. It is used first-line in the treatment of PBC to improve liver function, slow disease progression and delay the need for liver transplant.
This patient has presented with dyspepsia without any alarm features and she is not any drugs that could precipitate her symptoms. She should therefore be advised regarding lifestyle factors and then either given
a full dose proton pump inhibitor(PPI) for 1 month, or she should be tested and treated for Helicobacter pylori.
Ongoing diarrhoea in Crohn’s patient post-resection with normal CRP how do we manage
cholestyramine
when might nissens fundoplication be used
Nissen fundoplication is a surgical procedure used to strengthen and tighten the lower oesophageal sphincter in patients suffering from severe gastro-oesophageal reflux disease (GORD).
In life-threatening C. difficile infection treatment is
ORAL vancomycin and IV metronidazole
drug-induced cholestasis
COCP
PSC ix
ERCP/MRCP are the investigations of choic
Glimepiride - sulphnlyurea se
SIADH
