Pearls

Question 1

DELIRIUM features

Answer 1

Disordered thinking: slow, irrational, rambling, jumbled up, incoherent ideas.

Euphoric, fearful, depressed or angry: Labile mood, eg anxious then torpid.

Language impaired: Speech is reduced or gabbling, repetitive, and disruptive.

Illusions/delusions/hallucinations: Tactile or visual (auditory suggests psychosis).

Reversal of sleep–awake cycle: May be drowsy by day and hypervigilant at night.

Inattention: Focusing, sustaining, or shifting attention is poor; no real dialogue.

Unaware/disorientated: Doesn’t know it’s evening, or his own name, or location.

Memory deficits: Often marked. (Later he may be amnesic for the episode.)

Question 2

vascualr dementia %, caused by..?

Answer 2

∼25% of all dementias. It represents the cumulative effects of many small strokes, thus sudden onset and stepwise deterioration is characteristic (but often hard to recognize). Look for evidence of vascular pathology (bp↑, past strokes, focal cns sign

Question 3

Fronto-temporal (Pick’s3) dementia:

Answer 3

Frontal & temporal atrophy without Alzheimer histology genes on chromosome 9 are important, as in MND.

Signs: 
Executive impairment; 
behavioural/personality change; 
early preservation of episodic memory and spatial orientation; 
disinhibition (not always bad); 
hyperorality, 
stereotyped behaviour, 
emotional unconcern.

Question 4

Alzheimers Hallmarks pathologically, risk factors

Answer 4

senile plaques and neurofibrillary tangles

1st-degree relative with ad; Down’s syndrome; homozygosity for apolipoprotein e (apoe) e4 allele; picalm, cl1 & clu mutations;187 vascular risk factors (↑ bp, diabetes, dyslipidaemia, ↑ homocysteine, af); ↓ physical/cognitive activity; depression; loneliness (risk ↑ × 2; simply living alone is not a risk factor

Question 5

Huntingtons
Macroscopically
Microscopically

Answer 5

Macroscopically: shrinkage of caudate and Putamen, Microscopically: Neuronal loss astrocytosis Intranuclear Ubiq +ve inclusions
autosomal dominant, triplet (CAG) expansion affecting chromosome 4. Severity depends on the number of triplets. Has full penetrance in offspring. Tetrabenzane can be used to help with movement disturbances.

Question 6

Ix findings in osteomalacia

Answer 6

Ix: ↓Ca →↑PTH→↓PO4, ↑ALP but not as high as in Paget’s/

Question 7

Ix in Pagets

Answer 7

↑↑ALP, normal Ca & PO4. ↑Ca can occur in bed rest

Question 8

PLASMA OSMOLALITY

Answer 8

= 2x(Na + K) + urea + glucose. Normal between 280 and 310 mosmol/kg

Question 9

causes of HYPERNATREMIA

Answer 9

High body Na (retention of Na>H2O): cushings, conns,steroids, iatrogenic – high Na intake. Also: DI, HHS

Question 10

• PHAEOCHROMOCYTOMA symptoms and IX

Answer 10

Sx: headaches, anxiety, HTN, Ix urine vanillylmandelic acid and metaenphrine
•5H
o	HTN
o	HOT
o	HEADACHE
o	HEART PALPITATIONS
o	HYPERHIDROSIS

Question 11

PILOCARPINE is what and used for

Answer 11

is a direct muscarinic agonist, and is the first-line topical therapy for acute angle closure glaucoma. It causes decreased aqueous production and uveoscleral outflow. In an acute angle closure glaucoma attack, pilocarpine causes pupillary constriction which opens the angle by pulling the peripheral iris away from the trabeculum

Question 12

SENSORY NEGLECT occurs —–

Answer 12

in non-dominant hemisphere lesion, usually RIGHT PARIETAL LOBE.

Question 13

what can cause cause contralateral flinging limb movements.?( lesions where)

Answer 13

• SUBTHALAMIC NUCLEUS LESIONS

Question 14

• NORMAL PRESSURE HYDROCEPHALUS

Answer 14

dementia
+ ataxia
+ urinary incontinence

Question 15

LATERAL MEDULLARY SYNDROME

Answer 15

causes ipsilateral cerebellar signs + vertigo, vomiting,
dysphagia (CNX),
loss of sensation to pain on ipsialteral side of face (CNV descending tract) but contralateral side of body (ascending spinothalamic)
+ ipsilateral Horner’s.
Aka Wallenberg syndrome.

Question 16

WERNICKE’S ENCEPHALOPATHY + korsakoff

Answer 16

ophthalmoplegia (or nystagmus),
ataxia,
global confusion.

Can progress to Korsakoff’s – rThere is ↓ability to acquire new memories, confabulation (invented memory, owing to retrograde amnesia), lack of insight & apathy.

Question 17

Lamber-Eaton

Answer 17

Lambert-Eaton is a syndrome of autoimmunity against PRESYNAPTIC voltage gated calcium channels. Weakness improves as the movement continues

Question 18

Meniere’s

Answer 18

triad of vertigo, tinnitus, deafness. Amu have N&V