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ENT, neuro, eyes > Presentations > Flashcards

Presentations Flashcards

1
Q

Ischaemia vs hypoxia

A

Ischameia is lack of blood flow to provide adequate oxygenation and lads to tissue hypoxia = reduced oxygen

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2
Q

What does VGEF respond to?

A

Ischaemia, hypoxia and inflammation

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3
Q

What is neovascularisation

A

Proliferation adnd migration of endothelila cells to form new vessel

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4
Q

How are retinal vessels different from normal vessles

A
  • Absence of sympathetic nerve supply
  • Autoregulation of blood flow
  • Presence of blood-retinal barrier
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5
Q

Why does high blood pressure affect vision so much?

A

Renal vessels are different

  • Absence of sympathetic nerve supply
  • Autoregulation of b;lood flow
  • Presence of blood-retinal barrier
    HPTN therefore transferred directly t retinal vessels
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6
Q

What sign is found exclusively in diabetic of all the retinopathies eg not in hypertensive?

A

Microaneurysms

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7
Q

Red flag head and neck cancers

A
  • Stridor
  • New persistent nefck lump,
  • dysphagia,
  • unilateral odynophagia,
  • middle ear effusion - elderly, cancer is post nasal space - eustachian tube drainage blocked
    • Asian people more likely to have sinonasal cancers - watch for
  • referred ear pain, smoking is risk factor
  • over 45
  • Persitent = over 2 weeks
  • Laryngeal
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8
Q

Red flags in back pain

A
  • Sphincter/ gait distrubance
  • Progressive motor loss
  • Saddle anaesthesisa
  • Non-mechanical pain at rest
  • Fevere or weigth loss
  • Under 20 or over 50
  • Thoracic pain
  • Prev history cancer
  • HIV/immuosupresssion
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9
Q

How investigate a neck lump?

A
  • US with biopsy
  • MRI neck with contrast - soft tissue disease
  • High resolution CT neck with contrast - thyroid cartliage
  • CT chest - mets
  • Panenodoscopy under GA
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10
Q

What is a PEG

A

Percutaneous gastrostomy

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11
Q

Red flags in hoarseness

A
  • Persistent sore throat/odynophagia
  • Persistent dysphagia
  • Persistent unilateral otalgia
  • Persisten cough/SOB
  • Has he lost weight?
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12
Q

Signs of CNIII involvement

A
  • Eye down and out (MR, IR, SR, IO)
  • Mydriasis )pupillary constriction)
  • Ptosis (levator palpebrae superiosis)
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13
Q

CNVI sign

A
  • Diplopia on R gaze (LR)
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14
Q

Causative agent of mastoiditis often is

A

Strep pneumoniae

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15
Q

What disease do you avoid haloperidol in?

A

Parkinsons/Lewy body dementia as causes parkinsonism, dysphagia and increased risk of stroke

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16
Q

What is a dol?

A

deprication of liberty dafeguards

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17
Q

Medications causing deliriym

A
  • Anitcholinergic meds - TCAs amitryptilline, oxybutynin, tolteroidine
  • Furosemide, codeien, digoxin, tramadol, warfarin, nifedipine, metoclopramide
  • Sedatives - benzos
  • Opioid analgesics - dose
  • Anti-parkinsonian drugs - LDopa, dopamine antagonists
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18
Q

What is the investigation for vestibular schwannoma?

A

MRI

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19
Q

Discharging ear with pain differntials

A
  • Otitis externa or media
  • Foreign body
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20
Q

Discharging ear without pain differentials

A

Chronic suppurative otitis media (CSOM) woth perforation
cHRONIC INFECTION
cholesteatoma

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21
Q

Function of the larynx

A

Protext AW
Phonation
Regulate air flow into lungs

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22
Q

Most common to most ommon causes of hoarseness

A
  • Infective laryngtiis
  • Viral
  • Fungal - steroid inhalers
  • Laryngopharyngeal reflux
  • Vocal cord polyps + nodules
  • Neuromuscular conditions
  • Vocal cord paralysis - vagus/RLN issues, intrinsiv muscle issues, cricoarytenoid joint issues
  • Cancer - layrngeal - voice box (H+N, distal affeting vagus/RLN)
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23
Q

What is an early sign of epiglotitis ?

A

Hoarse voice
H influenzae

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24
Q

Why is hoarse voice significant in malignancy?

A

Commonest and often only sign of laryngeal cancer

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25
Q

Cerebellar signs

A

Dysdiodokinesia
Ataxia
Nystagmus
intention tremor
Slurred speech
Hypotonia

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26
Q

Which motor neurone lesions are atrophy and fasciculations seen in?

A

LMN

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27
Q

What is tone like in UMN vs lMN?

A

UMN - spasticity
LMN - Reduced

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28
Q

What are reflexes like in UMN or LMN lesions?

A

UMN - brisk
LMN - diminished

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29
Q

Whcih tremors are asymmetrical?

A

Parkinsonism, intention

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30
Q

What tremor worsens with stress and improves with rest?

A

Essential - symmetrical

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31
Q

What is most common tremor seen in parkinsonism?

A

Pill rolling

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32
Q

What happens to parkinsonian tremor at rest and on cognitive task?

A

Cognitive task - induces
Rest worsens

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33
Q

Which side of body is intention tremor on?

A

Ipsilateral to damage

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34
Q

When is intention tremor induced?

A

At end of purposeful movement ie finger to nose test

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35
Q

In which tremor would DANISH symptoms also be experienced?

A

Intention

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36
Q

What would EARLY AUTONIMIC SYMPTOMS suggest with coarse tremor?

A

MS -
orthostatic hypotension, erectile dysfunction, bladder disturbance, odd nocturnal breathing patterns

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37
Q

What would early hallucinations and coarse tremor suggest?

A

Parkinsonism with lewy bodies

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38
Q

What drugs can cause a coarse tremor?

A

Anti-emetics - betahistine, metaclopramide
Antipsychotics

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39
Q

What motor symptoms are suggested with parkinsonism with coarse tremor?

A

Slowness of movement must be present
Difficulty turning in bed
Shuffling gait
Reduced arm swing

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40
Q

Non motor early signs o parkinsons

A

Loss of smell
Depression
Dream entactment or fragmented sleep
Nocturia, urinary urgency, constipation

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41
Q

What does essential tremor improve with

A

Alcohol, beta blockers

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42
Q

What is chorea

A

Involuntary irregular, non rhytmic, rapid and unsustained movements flow randomly from one part of body to other
Unpredicatble in timing, direction and distribution

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43
Q

What causes dystonia>

A

Agonist and antagonist muscles of body contract together -> twisted posture of limb neck or trunk
Involve same muscle groups

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44
Q

What is myoclonus?

A

Sudden, brief, jerks caused by muscular contraction - postive
or inhibition - negative eg asterixis

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45
Q

What is restless leg syndrome?

A

An unpleasant, crawling sensation in legs or arms, esp when sat and relaxing, prominent in the evening. Disappears when walking

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46
Q

What are tics

A

Abnormal, stereotypuc, repetitive movements (motr tics) or abnormal sounds (phonic tics). Temproray suppression but need to be released at some point

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47
Q

what movements are hyperkinetic

A

Myoclonus
TIc
Dystonia
Atacia
Chorea
Functional;

48
Q

Hypokinetic movements

A

Bradykinesia
Resting tremor
Postural instability
Rigidity

49
Q

Causes of parkinsonism

A

parkinsons disease
Lewy body dementia
Antipsychotics - block dopamine
PSP (PD plus vertical gaze palsy)
MSAA - PD with ANS problems

50
Q

Features ass with headache that are red flags

A
  • Fever
  • Rash
  • Photophobia
  • Nausea and vomitting
  • Papilloedema
  • neurological deficit
  • impaired consciousness
  • Change in personality/behaviour
  • Dizzy
  • Seizures
  • Visual symptoms
51
Q

What is raised ICP ass with?

A
  • Headache worse in morning
  • Worse on postrual change eg bending forward
  • Focal neurological symptoms
  • Visual changes/obscuration - w posture often
52
Q

What can a space occupying lesion cause

A
  • Focal neurology
  • seizures
  • Altered behaviour
  • Symptoms primary malignancy, often not headahce alone, Hx suggests raised ICP
53
Q

What lesion is ass with valsalva manourvre

A

Posteroir

54
Q

What headahce causes get worse on lying down

A

Space occupying lesion
Venous sinus thrombosis

55
Q

What headahce cause gets worse ons tanding?

A

CSF leak

56
Q

Primary causes of headache

A

Tension
Migraine
Cluster

57
Q

Secondary causes of headache

A

Sinusitis
- Otitis media
- Medication withdrawel
- Menstrual headache
- Med overuse
- Cervical paraspinak tenderness
- Dental care
- Acute hydrocephalus
- Space occupying lesion
- Papilloedema -
- Giant cell arteritis - 50+

58
Q

Signs of acute hydrocephalus

A
  • ataxia, lethargy, confusion, vomitting
59
Q

Symptoms of Giant cell arteritis

A
  • Lateralising headache over weeks
  • Sight threatening
  • Amorosis fugax
  • TIAs
  • Temporal pain and tenderness
  • Jaw claudication
  • Visual disturbances and field defects eg floaters
60
Q

Investigation giant cell artteritis

A
  • Check ESR/doppler of temporal artery
61
Q

What is giant cell arteritis?

A

systemic vasculitis of medium-sized and large-sized arteries

62
Q

Autonomic and neurologica symptoms in cluster headahce

A
  • Autonomic symptoms
    • Nose run, sweat, red eyes, lacrimation
    • Looks like an allergy
    • Episodic
  • Neuralgia
    • Precipitated by touching
    • Tingling etc
63
Q

Symptoms of benigin intercranial HPTN -> raised ICP

A
  • Autonomic symptoms
    • Nose run, sweat, red eyes, lacrimation
    • Looks like an allergy
    • Episodic
  • Neuralgia
    • Precipitated by touching
    • Tingling etc
64
Q

What is the MRC muscle power scale score 1-5

A

0 = no contraction
1 = flicker or trace of contraction
2 = active movement with gravity eliminated
3 = active movement against gracity
4 = active movement against gravity and resistance
5 = normal power

65
Q

Types of gait

A

Antalgic
Ataxic
Hemiplegic
High stepping
Trendelenbergs
Waddling

66
Q

What is high stepping gait caused by?

A

Weakness of dorsiflexors - common peroneal damage or peripheral neuropathy

67
Q

What can ataxia affect?

A

Eys - nystagmus, hypermetria
Speech - dysarthria, slurred speech
Limb movements - intention tremor, hypermetria aka past point and overshoot
Gait - broad based, wobbly

68
Q

Indications for lumbar puncture

A

Sus meningitis
Sus SAH
Cpnfusion, meningeal malignancies. demyelinating disorders
Intrathecal meds administration
Treat hydrocephalus or benign intracranial HPTN

69
Q

LP contraindications

A

Signs of raised ICP
Convulsions until stabilised
Shock
Abnormal clotting profile
Superficial infection voer LP site

70
Q

Complications of LP

A

Post LP headahche
Infection
Bleeding
Cerebral herniation
Minor neurologic symtpoms such as radicular pain or numbeness
Late onset epidermoid tumours of thecal ssac
Back pain

71
Q

What is the investgiation of choice for epilpesy?

A

MRI

72
Q

Conditions do nerve conduction studies for

A

GBS

Charcot-marie tooth

Carpal tunnel

Neuropathy

Herniated disc

Sciatica

73
Q

Path for movements in the brain

A
  • Cortex
  • Basal ganglia
  • Cerebellum
  • Nerve
  • Muscle
74
Q

Ascending peripheral polyneuropathy signs

A
  • Symptoms start distally + progress proximally
  • LMN signs
  • Affect motor and sensory
75
Q

Cervical cord compression signs

A

Bilateral UMN signs

  • Brisk refleces
  • reased tone
  • Below leele of lesion
  • Slow progressive spastic paraperesis
76
Q

What reflex dermatome is S1

A

Ankle jerks

77
Q

Knee jerks dermatome

A

L2, L3, L4

78
Q

What dermatome does bicep jerks originate from?

A

C5

79
Q

What jerks originate form C6

A

Supinator jerks

80
Q

What jerk originates from C7

A

Triceps

81
Q

Abdominal nerve roots

A

T8-11

82
Q

What would a L cerebellar problem shpw?

A
  • Contralateral UMN and sensory signs
  • Language problem
  • No movement disorder

Eg chorea, parkinsonism, hemibalismus

83
Q

What classification is used for strokes?

A

Bamford

84
Q

What does hyperkinesia originate from brain?

A

No negative feedback to the brain

85
Q

Grey matter function

A

Most motor and sensory
Higher functions of brain

86
Q

What matter does gross damage effect?

A

Grey

87
Q

What is white matter

A

Myelinated axons, communication areas between brain

88
Q

What matter do demyelinating diseases effect?

A

White

89
Q

Function of basal gnaglia

A

Movement, posture, muscle tone,
Emotional learning/states, behaviours

90
Q

What forms the lentiform nucleus?

A

Putamen and globus pallidus

91
Q

What is the pleasure cnetre of the brain

A

Nucleus accumbens

92
Q

What is the basal ganglia made up of?

A

Corpus striatum and amygdala

93
Q

What part of brain senses fear and disgust?

A

Amygdala

94
Q

What is corpus striatum split inot

A

Neostraitum - caudate nucleus, putamen
Paleostriatum - globus pallidus

95
Q

what conditions affect the basal ganglia

A

Parkinson, huntnigtons

96
Q

Function of the brainstem

A

Regulates cardiac and respiratory function

97
Q

What can be used to verify brainstem death

A

Corneal and gag reflex absence

98
Q

What arteyr stroke can cause locked in syndrome

A

Basilar

99
Q

What is Guillian Barre syndrome

A

Demyelinating polyneuropathy autoimmune
Virus triggers immune system antibodies to attack nerves

100
Q

What is indication for nerve conduction studies

A
  • For paraesthesias - numb, tingling, burning
  • Weakness arms/legs
101
Q

When is MRI especially helpful in epilepsy

A
  • <2 year presentation or adulthood
  • suggestioon focal onset history, exam or EEG - unless clear evidence benign focal epilepsy
  • Seizures continue in spite of first line medication
102
Q

When is a EEG done in children/young adult s

A

-after second seizure in children/YA

-EEG is supportive, not used as diagnostic for epilepsy

103
Q

Signs of Guillian Barre syndrome

A

Spreads up - painful paraesthesia from feet
Extreme weakness and areflexia

104
Q

What test do in Guillian Barre syndrome to assess severity?

A

Spirometry - whether has reached repiratory muscles yet

105
Q

Hwo can treat guillian Barre sundrome

A

Immunoglobulins

106
Q

What viruses cause Guillian Barre syndrome?

A

Campylobacter GE, viral

107
Q

Where does central dural sinus get venous drainage from?

A

Facial veins

108
Q

Why do face, nose and tonsil infections pass into cranium?

A

Via cavernous sinus - ICA, CNs
Triangle of death - infection site

109
Q

SPondylysis vs spondylisthesis

A

Spondylosis = arthritis of spine
Spondylisthesis = slipped disc

110
Q

CURB 65

A

Confusion

  • Not themselves = delirium
  • Think clearly - feel a bit muddled

Urea >7mmol - urine output in GP - whiskey rather than water

Resp rate = 30 breaths/min

BP < 90 mmHg systolic, 60 diastolic

> 65 yrs

111
Q

Memory assessments for dementia

A

Minicog
6CIT
MMSE - 10 qs

112
Q

Which antibiotic reacts with statins

A

Clarithromycin

113
Q

CENTOR criteria

A
  • Tonsilar exudate
  • Tender anterior cervical lymphadenopathy or lymphadenitis
  • Histoy of fever over 28
  • Absence of cough
  • Each = 1 point
  • 3/4 = likelihood 36-52% of isolating strep
114
Q

Most common cause sore throat

A

Strep pygoenes/GABHS

115
Q

FEVER PAIN index

A
  • Temperature >38.5 degrees
  • History of a fever

Purulence - swab, picture, inspect

Attend Rapidly - within 3 days after onset symptoms

Inflamed tonsils - severely

No cough or coryza - inflammation mucus membranes in nose

Each point is 1 point - max = 5, above 3 = =swab

General aches + pains - more systemic

116
Q

What is the S1Q3T3 pattern

A

S wave in lead I - R shift of axis
Q wave and T wave inversion in lead III

117
Q

What type of anaemia does alochol cause

A

Macrocyitc

ENT, neuro, eyes (34 decks)

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