Psych Flashcards
DSM-V= XS widespread WORRY for MORE days > than not = Hard to control At least 6 moooooonths
ICD-10 Anxiety syx MOST days for SEVERAL months elements of: Apprehension/Autonomic overactivity/Motor tension \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
low mood +/- anhedonia + emotional/cog/physical/behav syx
DSM-5:
5/9 defining syx = 2/+ weeks
Sufficient severity - - >
clinically significant dx in general-functioning
Subthreshold depressive = ? /9 syx
Persistent subthreshold dysthymia = ? years
_____________
Re-EXPeriencing AVOIDance HYPERarousal Interpersonal relationships difficulties Mood NEGative
Negative alterations @thinking/self-perception
Emotional NUMBING
Emotional DYSREG
Dissociation
GAD
______________
Depression
Subthreshold depressive = 2/9 syx
Persistent subthreshold dysthymia = 2 years
___________
___________
PTSD
UNWANTED INTRUSIVE
Thought /Image / Urge =
REPEATEDLY enters person’s mind - - >
marked ANXIETY DISTRESS - - >
CAN lead to repetitive behaviours/mental acts
___________________
Obsssion –DRIVE–> REPETITIVE behaviours/mental acts
i.e. O –> C
Types of compulsion?
-PERSON AWARE OF THIS
____________________
Perfectionism+Control @EXPENSE of: -flexibility to be EFFICIENT/gain experience -come at the EXPENSE of completing task -PERSON unAWARE OF THIS
Obsession
___________
Compulsion =
-OOObservable OOOvert
-UNobservable COOOvert - mental
___________
Anankastic OCPD
- diff to OCD where:
anxiety-inducing and involuntary thoughts –>
unwanted/unhealthy acts/behaviours
YOUU ARE AN ANAKASTIC SON OF GUN YOU PIECE OF..
Mood =
ABnormally + Persistently
- Elevated / EXPansive / Irritable
A.
1 WEEEEEEEK + 3/+ DIGFAST*:
- Is severe –> FHP
____________________
B.
- 4 days
- NOT severe enough to cause FHP syx
_____________
C.
4/+
- depressive, OR
- manic/hypomanic, OR
- mixed episodes OR
within 12-month period.
___________
D.
Both
-hypomanic AND depressive states
over 2/+ years
symptoms NOT ’t severe enough
for bipolar I or bipolar II (hypomania).
___________
__________
-Cerv cancer + St IA tumour + Gold standard tx =
?surg ± ? clearance
-Cerv cancer + St IA tumour + MAINTAIN FERTILITY =
?procedure 2 maintain fertility + ? margins
Cervi Cancer + stage IB /+ = -? + ? \_\_\_\_\_\_\_\_\_\_ Endomet Cancer Ix: ?scan -> ?biopsy –inconclusive-biopsy--> ?ix + ?sampling (?d+c)
Endomet Cancer Tx:
-localised disease =
?surg –Hrisk–> post-op ?
Endomet Cancer Tx
@Frail elderly women + NOT suitable for surg ?
?Ix for PMB
__________
Ovarian Cancer Tx?
All stages?
Stagaes 2-4?
__________
A. Manic episode - Bipolar 1
FHP:
-Marked impairment in social/occupational FUNCTION OR
-Necessitate HOSPITALzation,
OR
-PSYCHOTIC syx e.g. delusions /hallucinations.
*Distractibility, Irresponsibility, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness
___________
B. Hypomania - Bipolar 2
__________
C. RAPID-CYCLING bipolar disorder = x4/12m \_\_\_\_\_\_\_\_\_\_\_ D. Cyclothymia = 2yrs \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
-Cerv cancer + St IA tumour + Gold standard tx =
TAH ± Node clearance
-Cerv cancer + St IA tumour + MAINTAIN FERTILITY =
Cone biopsy + Neg margins
Cervi Cancer + stage IB /+ =
-RT + Chemo
__________
Endomet Cancer Ix = TVUSS, Pipelle, Hystero+Sample
TVUSS -> Pipelle biopsy
–inconclusive–>
Hysteroscopy + directed sampling (dilation + curettage)
Endomet Cancer Tx @ localised disease =
TAH + B/L Sooph –Hrisk–> post-op RT
Endomet Cancer Tx
@Frail elderly women + NOT suitable for surg =
—Progestogen tx
Endometrial biopsy for PMB
__________
Ovarian Cancer Tx?
All stages = LaparoTOMY tumour excision
Stagaes 2-4 = Chemo
__________
At least 4
- depressive, OR
- manic/hypomanic, OR
- mixed episodes OR
within a 12-month period.
___________
HYPOmanic
(+)
Depressive states =
over 2/+ years
- NOT severe enough to be
Bipolar 1 (mania) / Bipolar 2 (hypomania).
___________
___________
SOBOE is ** classic **
exertional syncope, exertional chest pain, peripheral oedema and cyanosis
raised JVP with prominent ‘a’ waves
right ventricular heave,
loud P2, tricuspid regurgitation
Questions:
mean pulmonary artery pressure of >=? mHg
Ix? To measure what?
- ) Tx underlying condition eg chronic lung dx copd
- ) Do what test? Aim? What to administer?
AVTEN Pos: give what?
AVTEN Neg: give what?
3.) Progressive symptoms should be considered for a??
RAPID-CYCLING bipolar disorder = x4/12m
—basically 4 mania/depresssive Syx / year
___________
Cyclothymia = 2yrs -HYPOman+Dep / 2yrs -Steven Fry? \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
mean PAP of >= 25 mHg
Ix: cardiac catheterization = measure
right heart pressures
1.) Tx underlying condition eg chronic lung dx copd
2.) Acute Vasodilator Testing -Epoprostenol IV -NO inhaled -aims to decide which pts have fall in PAP after vasodilators -eg. IV epoprostenol/inhaled NO
AVTEN Pos = mean PAP reduce
-Nifedipine - CCB
AVTEN Neg: mean PAP NOT affected
- ILoprost - PROSTacyclins
- Bosentan - ERB
- Sildenafil - PDEi
3.) Progressive syx should be considered for a heart-lung transplant.
__________
Prosta-ilopr, Endo-bosentan, PDEi-sildenafil
- PROSTacyclins: trePROSTinil, iloPROST
- ERB: Endothelin receptor blockers: bosentan, ambrisentan - decrease pulmonary vascular resistance in PPHtn
- PDEi: Phosphodiesterase inhibitors: sildenafil
? is the SSRI of choice in kids-teens
? is the SSRI of choice in OBESITY
? is SSRI of choice in heart disease pts
Prescribe SSRI + what ?! = prevent what ?!
? Has least side effects
What electrolyte dx and what else?
? has a higher incidence of discont PURSM symptoms than other SSRIs
? in preggers
-?@BFeed
? Has least side effects
- SSRI avoid what WANTm??
____________________
Classification of depression
____________________
Tx of depression: 1 2 3
(1 .DONT FORGET THE FKN questionaires!!)
Fluoxetine in kids-teens/OBESITY
Sertraline = IHD + Depresion
SSRI + PPI = prevent UGIB!!!!!!
Citalopram/Sertraline = LEAST side-effects
SSRI = Cause SIADH and EDysfunct too
Paroxetine has a higher incidence of discont PURSM* symptoms than other SSRIs
- Sertraline/Parox-Fluox in preggers
- Sertraline @BFeed
CITALOPRAM Has least side effects
- SSRI avoid what Warf/Asp/Nsaid/Triptan-MAOi
*Paraesthesia Unsteadiness Restless + sleep dx, Sweating Mooooooood change \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2+ syx = subthreshold --2 YEARS--> persistent dysthmyia
5+ depression -mid -mod -severe (no psych/psychotic syx) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
- HADS PHQ BD1-2 !!!!!!!
2.
2/+
Subclin dysthymia/mild not want Tx =
WW2W
Subclin persistent dysthymia/mild =
IAPT - LIPS (sIlvercloud, sTruc ex, sElf-help)
CBT-group
3. 5/+ mild/mod: ADep + HIPS = CBT IPT Couple Tx -time take ~4w -initially worsen monitor/wk 1m -cont 6m after remission
FLUOXETENE is the SSRI of choice in children and adolescents
GAD Tx
when to refer to psych?
________
OCD tx
YICS
________
PTSD tx
________
________
pros and cons of OCP
1) GAD 7 - - >
CBT:
2a) LIPS - sIlvercloud, sTruc ex, sElf-help
2b )HIPS/SSRI/SNRI - dulox/venlefax/pregabalin
-CBT/StructEx
- - > 3) Refer Psych @ harm psych dx neglect drugs \_\_\_\_\_\_\_
Y-BOCS IAPT -CBT ERP SSRI/TCA -Clomipramine Refer Psych + ssri/clomi + cbt erp \_\_\_\_\_\_\_
Mild: Subclin = WW + f/u 4w
Mod/Severe = clinically significant
Mod - no TIPS
Severe - TIPS
-Refer Psych for CBT / Exposure Tx / EMDR Drugs - SSRI/SNRI=Venlafaxine \_\_\_\_\_\_ \_\_\_\_\_\_\_
pros:
Ov/Endo cancer prevent
Colo cancer prevent
Periods lighten(fibroid)/pain ease (endometriosis)
cons:
breast/ cervical cancer
VTE
Section: Time? HCPs?
DATED MNEMONIC?
2--? ----- AMHP/NR*+2docs 3--?------- AMHP+2 docs<24hr \_\_\_\_\_\_\_ 4--?-- GP+AMHP/NR+2docs 5(2)--?-- DOC
5(4)–?– NURSE
136 < ?
2
3
4
5(2)
5(4)
135
136
Which one can do:
- GP: ?
- Nurse: ?
- AMHP: ?
Community pt NOT comply w/ meds - - > bring to hosp for Tx
A death occurs whilst under the MHA. What to do?
Definition: section 1 - MH dx Assx: 2 Tx: 3 Emergency: 4 Detention: 5
D A-2--28d ----- AMHP/NR*+2docs T-3--6m ------- AMHP<24hr+2 docs \_\_\_\_\_\_\_ E-4--3d -- AMHP/NR+2docs+GP D-5(2)--3d -- DOC
D-5(4)–6hrs – NURSE
136 < 24hrs
___________
2:
28d
AMHP/NR*+2docs
Against wishes
- 6m
AMHP+2 docs<24hr
Against wishes - 3d emergency
GP+AMHP/NR+2docs
5 Voluntary inpatient detain for:
(2) - 3d doc
(4) - 6hr nurse
135: HOME police break in
136: POLICE police break in < 24 hr
*NR = nearest relative
GP: 4
Nurse: 5(4)
AMHP: 2, 3, 4
Community not comply w/ meds - 17
MHA death = Reported to the CORONER!!!
MR: (Valsalva -> Syst @mitral-area)
SAM AsH #LVH=deep Q @V1-3ish
OFTEN ASYMPTOMATIC
-SOBOE, angina
Ex -> Syncope #sudden-death
O/E: Jerky/Bisfriens pusle
ECG: deep Q @V1-3ish + ST depr + T-invert
-HOCM assoc w/ which arrythmic dx?
\_\_\_\_\_\_\_\_\_ B12 def -> tracts: -? dx - ataxia -? dx - fine movement of ipsilateral limbs -? dx - prop/vib + fine touch
Subacute Degen SC
- HIGH-STEP-GAIT
- Eye dx
- Reflex: kneeLMN ankleLMN plantarUMN
Neuro syx YES = ?
Neuro syx NO = ? -> -DietRelated= ? -DietUnRelated= ? \_\_\_\_\_\_
Brown Sequard:
_________________
If damaged above T1, may present with?
______________
Classic ** pt accidentally BURN their hands WITHOUT Realising **.
- WASTE of SMALL muscles @HAND
- ‘cape-like’ (neck arms trunk)
- SENSORY loss of pain + temperature
-Preservation of what sensory modality #?Tract
crossing ? TRACTS
@ ? ? of Spinal Cord
#FIRST tracts to be affected
Ix? Assoc w/ ?Malformation
___________
P Painless retention E Eversion of foot weak N No ankle/knee jerk I Impotence S Saddle anaesthesia -Anatomy of compression?
Ix? Tx? Anatomy?
________
__________
- prob/vibr dx
|—–> Ataxia + Romberg POS + DTRs absent - fine touch dx -> Charcot
- Accom Reflex Present - Pupil Reflex Absent
_______
BOTH UMN+LMN dx: 1)-UMN: Pseudobulbar palsy #BSC \+ 2)-LMN: ?cell involvement #WATFR \+ 3)-NO SENSORY/BOWEL-BLADDER dx... this shit is NORMAL
Dx? Tx = survival?
_________
EXCRUCIATING pain @leg-muscles ---bum/ hip/ thigh ABSENT REFLEXES ----HbA1c 120 \_\_\_\_\_\_\_\_\_\_\_\_
Fever + WATFR = ?cell involvement
- -CSF = high WCC + normal CSF BM + norm/high Prot #LYMPHocytes
- -Replicate in GI tract -> kill ?cell
Floppy HYPOtonic baby Flaccid paralysis Fasciculations @tongue #WATFR LMN: Symm Weakness. \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
-BSC syx!!! STIFF spastic tongue DONALD Duck Speech BRISK Jaw Jerk i.e. HYPERREFLEXIA \_\_\_\_\_\_\_\_
WATFR Palsy of the -?CN = swallow/ taste post 1/3 -?CN swallow/ speech -?CN = ?Traps -?CN = Hypoglssal = Tongue WATFR movement Brainstem Motor Nuclei ?CNs #LoF -Prognosis? \_\_\_\_\_\_\_\_\_\_
Towards VS Away
Hypoglossal - Tongue ? Accessory - ? + cant turn to? V3 jaw ? Vagus - uvula ? \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
Classical histories of :
1. Recent 'diagnosis' of Parkinson's... -POOR response to levodopa -------impaired BALANCE #Falls -------O/E vertical-GAZE Palsy #Symm onset
2. Recent 'diagnosis' of Parkinson's... -POOR response to levodopa --IMPOTENT --urinary RETENTION --OLD \_\_\_\_\_\_\_\_
- Motor: Foot-DROP = WEAK LOWER-Extremity
- Sensory dx –> Foot DEFORMITY
- —-pes Cavus=HIGH Arch
- —-Hammer-toe
Mitral Regurg #systolic
Syst Ant Motion of Ant Mitral leaflet
Asym Hypertrophy #LVH=deep Q @V1-3ish
-HOCM assoc w/ Wolff-Parkinson White
\_\_\_\_\_\_\_\_\_ SCD: Subacute Combo Degen of SC B12 def -> tracts: -Spinocerebellar dx - ataxia -CorticoSpinal dx - fine movement of ipsilateral limbs -DC-ML dx - prop/vib + fine touch
B12 def tx:
Neuro syx YES =
Admit + ?IM-HCB
Neuro syx NO = IM-HCB x3/w/2w --> -DietRelated=OralCyanoCobalamin -DietUnRelated=IM-HCB/3m \_\_\_\_\_\_\_\_\_
Same:
@level =
- ALL SENSATION
- LMN
@below level:
- Prop/Vib + FINE-touch #DC-ML
- UMN #CSTract
Opp:
-Pain/Temp + CRUDE-touch: below level - #SPTract
__________________
T1 dx ->
OculoSymp Dx
#IPSILAT Horners
____________
Syringomyelia
-Preservation of Prop/Vibr + FINE-touch #DC-ML
Dx = ST-AC
crossing SSSPINOTHALAMIC TTTRACTS
@AAANTERIOR CCCOMMISSURE of Spinal Cord
#FIRST tracts to be affected
Ix: MRI
Assoc w/ Arnold Chiari Malformation
_______
Cauda Equina -MRI -> Neurosurg+Steds -spinal roots L2 and below \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
Tabes Doraslis-DORSAL-COLUMN-ML -Accommodation Reflex Present (ARP) -Pupillary Reflex Absent (PRA) #House-Case \_\_\_\_\_\_\_\_
ALS-Lou Gehrig
- ALS dismutase dx
- Riluzole confers survival
1)-UMN: Pseudobulbar palsy #BSC
2)-LMN: ANT HORN cell involvement #WATFR
3)-NO SENSORY/BOWEL-BLADDER dx… this shit is NORMAL
_______
DM Amyotrophy = ABSENT REFLEXES
__________
Fever + LMN signs (WAFER = ?cell involvement)
-CSF = high WCC + normal CSF BM + norm/high Prot
-Replicate in GI tract -> kill ANTERIOR HORN cell
——PolioMyelitis
____________
____________
UMN PSEUDOBulbar Palsy BSC
Stiff Spastic Tongue, Donald Duck, HyperReflexic Jaw-Jerk
_______
LMN PROGRESSIVE Bulbar palsy WATFR -9CN = swallow/ taste post 1/3 -10CN swallow/ speech -11CN = ?Traps -12CN = Hypoglssal = Tongue WATFR movement Brainstem Motor Nuclei ?CNs #LoF -WORST Prognosis \_\_\_\_\_\_\_\_\_\_
Hypoglossal - Tongue TOWARDS
Accessory - ipsi shoulder droop + cant turn to opp side
V3 jaw TOWARDS
Vagus - uvula AWAY!!!!!
Floppy Flaccid Fascic baby = Spinal Musc Atrophy
-Werdnig Hoffman
_________
_________
- Progressive supranuclear palsy #PSP
- Multi-system atrophy
_________
Charcot Marie Tooth aka HSMN Hereditary Motor Sensory Neuropathy
Li: Stop = method?
Lithium monitoring?
Amiodarone monitoring?
_________
Mania tx? SALER
@bipolar - depression only Tx?
Li: Stop = reduce dose/4w
Li/ 1w @start/dose change Li / 3m TUBS / 6m --TFT/ U+E-Ca/ BMI-ECG / Stop=reduce dose/4wk
Amiodarone: CXR U+E / 6m LFT / 6m TFT / 6m --stop-Amiod--> 12m ECG / 12m \_\_\_\_\_\_\_\_\_
Stop AD/Taper APsych -HORQ -switch Li +/- Valproate ECT @ catatonia/Severe or long mania Refer urgent @ mania/routine @hypomania* -danger -severe depression -mania -advanced statement/power of attorney
@hypomania*
<4d + no psych dx
Depression only: Fluox Lamotrigine + olanzapine Olanzapine Quetiapine
rugby team, drunk AF, pulls pants down shows dick to everyone
witness brutal murder. recounts situation in UNemotional fashion
_________________
Delusion that a friend or partner has been replaced by an IDENTICAL-looking IMPOSTER
Delusional idea that a person whom they consider to be of Higher SOCIAL/PROFESSIONAL standing is in LOVE with her
Delusional idea that the various people that the patient meets are in fact the SAME person
________________
Belief that infected with PARASITES / ‘BUGS’ under their skin
Irrational belief that one’s partner is having an AFFAIR with no objective evidence
Delusional idea that one is DEAD -rotting? \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
- Breakdown of
-they can’t remember shit ?
-they themself/ outside world = unreal ?
-identity dx ?
______________
1.
- multiple physical SSSymptoms
- REFUSES to accept reassurance / neg test results
- present for at least 2 years
- belief in presence of
- underlying serious CCCONDITION, e.g. CCCancer
- REFUSES to accept reassurance / neg test results
… AKA ?
____________________
- got a ballet or piano recital…
-Loss of MOTOR / SENSORY function
-NOT faking/seeking gain
Ddx?
-INDIFF to their apparent disorder = Dx
____________________
4. A. intentional PRODUCTION of physical/psych symptoms -Insulinoma/SU -> -PrePro -> Pro -> C-pep + Insulin(munchausen)
Fuck themSELVES UP cos … why not, right?!
B. Parent brings in kid
Investigated, kid is actually fine
Parent fakes signs/symptoms
E.g. Diabetic parent, well kid, but kid somehow has hypoglycaemia 🤔🤔🤔🤔🤔🤔
i.e. Fuck THEIR kid/patient UP cos … why not, right?!
- A. Faking / exaggeration of syx - - >
financial or other GAIN GAIN GAIN GAIN GAIN GAIN
-Sick note / whiplash
i.e. FUCK themSELF up for GAIN GAIN GAIN GAIN
B. maltreatment = caregiver who fabricates/induces sx or syx @child/dependent adult/pet --> external, tangible GAIN GAIN GAIN GAIN GAIN GAIN
i.e. Fuck THEIR kid/patient for GAIN GAIN GAIN GAIN GAIN GAIN
Identification
Isolation
________________
Capgras - IMPOSTER
De Clerambault - SOCIAL/PROF higher STATUS in LOVE
Fregoli - SAME
________________
EkBom PARASITosis syndrome
Othello - AFFAIR
Cotard - DEAD -nihilistic = rotting \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
- Dissociation = MAID
-memory = amnesia
-awareness=depersonalization = they themself or outside world = unreal.
-ID
_____________ - SSSomatisation dx
somat symp somat symp somat symp somat symp somat symp somat symp somat symp
- HypoCCChondrial disorder
AKA Illness anxiety disorder
- condition chondriasis condition condrisis condition chondriasis condition chondriasis condition chondriasis conditoin chondriasis condition chondriasis condition chondriasis
____________________ - Conversion dx
Converts ones mental stress -> physical
-indiff = la belle
____________________ - A. Factitious Munchausen’s Dx
- c-peptide low
B. Munchausen’s by proxy
- A. Malingering
B. Malingering by PROXY
Dancing eyes + feet = ?Brain ?LC
Ovarian teratoma –>
Psych dx, memory dx, encephalitis, seizures, dyskinesias, autonomic dx, language dx = Anti-??
Sudden onset of multiple seborrheic keratoses
___________________
? lung cancer (anti-??),
? /breast cancers (anti-??), and
? lymphoma (anti-??)
Migratory superficial thrombophlebitis
___________________
SmLCC –> weakness ? with movement
–WADDLING gait = girdle weakness
Thymoma -
Low Ig=?
Anemia = low Hb + low retic=?
Weakness ? with movement
Myelodysplasia - tender purple plaques
Opso-myo clonus - Ataxia Syndrome
@ Neuroblastoma/SmLCC
Ovarian teratoma -
Anti-NMDA encephalitis
Sign of Leser-Trelat @ GI / Visceral cancer
___________________
SmLCC lung cancer (anti-Hu),
Gynae/breast cancers (anti-Yo)
Hodgkin lymphoma (anti-Tr)
Pancreatis cancer - Trousseau
___________________
Lambert-Eaton Syndrome
- Antibodies against presynaptic Ca2+ channels at NMJ
- Weakness IMPROVE with movement
Thymoma - Good Syndrome = low Ig, Red cell aplasia = Anemia/ low RETIC MyGravis - PostSynap Ach ABs -Weakness get WORSEN with movement Plasmapharesis, IVIg, PyridoStig, Thymectomy
Sweet Syndrome
(good = low Ig #thymoma, Sweet = purple plaque #MyeloDysp)
Diff between: Parkinson’s+Dementia VS Lewy-body?
-Parkinson’s + Dementia = ?
-Lewy-body = ?
__________
Parkinson symptoms
Tremor = WORSE as pt gets closer to target eg. Nose
- indicative of ?dx
Undershooting / Overshooting
Essential tremor VS Parkinson’s disease -
NICE recommend what to differentiate?
Parkinson Tx?
Parkinon’s TRAPS =
-Asymmetric/Symmetric?, pill-rolling @?,
-? with voluntary movement
(Rememer Back 2 the Future guy ice skating?!)
Tremor = WORSENS as reaches out to examiner’s finger
-? tremor = ? dx
?-pointing - pointing BEYOND the finger @finger-nose test = ? dx # ?
Tremor = worsens @OUTstetched arms = ? Dx
-bi/unilateral? + worsens/improve? with action
__________
Classical histories of :
1. Recent 'diagnosis' of Parkinson's... -POOR response to levodopa -------impaired BALANCE #Falls -------O/E vertical-GAZE Palsy #Symm onset
2. Recent 'diagnosis' of Parkinson's... -POOR response to levodopa --IMPOTENT --urinary RETENTION --OLD \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
Global deficit Relentlessly PROGRESSIVE decline -? - fine AND gross motor -? - impulsive -? - speech fucked
Apo-Lipo-Protein
Beta-amyloid plaques
Neurofibrillary tangles
Down’s Trisomy 21 therefore HRisk
—-Dx? Tx?
When to avoid galantamine?
When to avoid donepezil?
____________
2 causes of fluctuating GCS?
Fluuuuuuuuuuctuating GCS
Hallucinations
REM sleep dx
Parkinsonism
@LewyBody = Avoid which meds?
Similar to ?? hematoma - fluctuating GCS!!
__________
YOUNG < 65
RAPID AF ONSET!!!!!!
Personality/Speech dx:
3 types:
- PERSONALITY change and social-conduct dx - PERSONALITY ??’s dx
- APHASIA SPEEEEECH ChrProgAphasia
- Semantic
Memory + VisuoSpatial skills FINE
Neurofibrillary tangles
_________
Stepwise decline in cognition
-BG: CardioVascular Dx
_________
________
Acoustic neuroma = ? SVT
Menieres = ? of SVT + aural fullness
Diff between Parkinson’s + Dementia V Lewy-body?
-Parkinson’s + Dementia =
TRAPS –1/+yr–> Cog dx
-Lewy-body =
TRAPS + Cog dx
<1yr of each other
__________
Tremor - Pill-rolling RESTING
Rigidity - cogwheel LEADpipie
Akinesia brady
Post Instability
Tremor = WORSE as pt gets closer to target
–Intention tremor @ cerebellar dx #DANISH
dysdiadocho, ataxia, nystagmus, INTENTION TREMOR, staCCCato slurring , hypoTonia
Dysmetria - Under/Overshooting - ALS/MS
ET v Parkinsons =
NICE recommend 123I‑FP‑CIT SPECT
Levo/carbi
- Motor improve/cx increase
- ADLs improve
- Adverse rxns decrease (hallucinations/impulse/sleep)
- Time inc = effectiveness decrease
AMANTADINE/DBS
Selegeline MAOi - Tyramine foods, Off-time
Entacapone - COMTi - off-time reduce
Ropinirole/CabergolineCardiacFibrosis - hallucinations/impulse/sleep
DBS
Parkinon’s TRAPS =
-Asymmetric, pill-rolling @rest,
-IMPROVE with voluntary MOVEMENT
(Rememer Back 2 the Future guy ice skating?!)
Tremor = WORSENS as reaches out to examiner’s finger
-Intention tremor = cerebellar dx #DANISH
past-pointing - pointing BEYOND the finger @finger-nose test = cerebellar + ALS / MS #Dysmetria
Tremor = worsens @OUTstetched arms = essential tremor
-BIlateral + WORSEN with action
-Propranolol -> Primidone
__________
Progressive Supranuclear Palsy #PSP
Multi-system atrophy
________
__________
- dysPRAXIA - fine AND gross motor
- dysINHIBITION - impulsive
- dysPHASIA - speech fucked
Alzheimer’s = ALAN GaRD MAdcl
AAAAlzheimer/LLLewy (not antipsychs/galantamine) = AAAChi –> NNNMDAblocker
AChi:
- GGGalantamaine(avoid @LewyBody w/ APsychotics)
- RRRivastigmine/
- DDDonepezil(avoid @AVBlock, BRADYcard NTSEuthyroid)
NmdaBlocker:
- Memantine @:
- -aDDDd-on @mild/mod,
- -aCCChi CI,
- -aLLLone @ severe
Avoid Galantamine + APsych @Lewy Body’s
Avoid Donepezil @Brady/ AVN block/ NTSEuthyroid
____________
2 causes of fluctuating GCS?
- subduraLLL hematoma
- LLLewyBodyDementia
Lewy body dementia
haLewycinations
Parkinsonism: Tremor pill-rolling/resting Rigidity - cogwheel/lead-pipe Akinesia/Bradykinesia Post Instability Shuffling gait
@LewyBody = Avoid @
- Antipsychotics - parkinonism TRAP EPSE
- Galantamine
@Donepezil = Avoid @
-AVNblock, BRADYcard, NTSEuthryoid
Similar to Subdural hematoma - fluctuating GCS!!
_____________
Fronto Temporal-Serial killer type
-Rapid onset
Personality PICK'S disease \_\_\_\_\_\_\_\_\_ Stepwise decline in cognition = VASC DEMENTIA \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
Acoustic neuroma = PROGressive SVT
Menieres = Intermittent attacks of SVT + aural fullness
*PRAD: Pyrexia, Rigidity (high ?BLOODS), Autonomic syx, Delirium - ORP
SSRI/MAOi/Ecstasy –>
RAPID onset PRAD*
HYPOOOreflexia NOOORMAL pupils
-ALL low - onset time, reflexes, pupils
- Dx? Tx?
Antipsych/ Parkinson-med stop –>
SLOW onset PRAD*
HYPERreflexia, DILATED pupils
-ALL HIGH - onset time, reflexes, pupils
- Dx? Tx?
__________________
Paraesthesia Unsteadiness RESTLESS + sleep dx, Sweating Mooooooood change
?? has a higher incidence of discontinuation symptoms than other SSRI
___________
?? is indicated for patients with schizophrenia who have not responded adequately to at least 2 TWOOOOOOOOO antipsychotics.
? = Choreoathetoid Chewing/Pouting retardedly
Occulogyric crisis / Torticolis = ?
Mirtazapine is a
Serotonin + Noradrenergic antidepressant ->
block alpha2 adrenoreceptors
increases neurotramsitter release by
ECT - ? are a short term side effect
-Bodily sensation CONTROLLED by ext influence ?
-Object is perceived –>
Sudden Intense Delusional Insight into the objects meaning
——-Delusional perception
- Severe type of LOOSE associations w/
UNEXPECTED and ILLOGICAL leaps
from one idea to another #schizophrenia. - Accelerated Leaps from
one topic to another w/
UNDERSTOODish links between them
#mania - Repetition of ideas / words
despite TOPIC CHANGE attempt - Ideas = related to each other
by the fact they SOUND SIMILAR / RHYME.
‘I was on my way to the store the chore the bore some more’
___________
- AntiPsychotic HORQ - in old ppl issue?
- APsych:
a) EPSEs? - Treat EPSE w/ ??
b) Parkinson symptoms??
Tremor = worsens as reaches out for target. Dx? Ax?
Under/Overshooting #past-pointing. Dx? Ax?
_____________
Receptors of typicalsAlpha HE MEN??
*PRAD: Pyrexia, Rigidity (high CK), Autonomic syx, Delirium - ORP
- SeRAPIDtotonin Serotonin Syndrome
-CyproPhetadine/Chlorpromazine
(DONT get confused with Alco withdrawal = Chlordiazypoxide -> Carbemazapine)
2. NMS: Anti-pSLOOOOOOOOWcotic Stop APsych/Start Parkinson-meds, IVF, -Dantrolene/?DopAgonists - bromocriptine \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SSRI Discontinuation Syx
Paroxetine has a higher incidence of discontinuation symptoms than other SSRIs
______________________
CLOZAPINE is indicated for patients with schizophrenia who have not responded adequately to at least 2 TWOOOOOOOOOOOO antipsychotics
Tard dyskinesia - CCP Choreoathetoid Chewing/Pouting retardedly
Occulogyric crisis / Torticolis = Acute Dystonia
Mirtazapine is a
Serotonin + Noradrenergic antidepressant ->
block alpha2 adrenoreceptors
increases neurotramsitter release by
ECT - cardiac arrhythmias are a short term side effect
-Bodily sensation CONTROLLED by ext influence = passivity phenomenon
-Object is perceived –>
Sudden Intense Delusional Insight into the objects meaning
——-Delusional perception
- Knight’s move thinking is a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.
- Flight of ideas, a feature of mania, is thought disorder where there are leaps from one topic to another but with discernible links between them.
- Perseveration =
repetition of ideas / words
despite TOPIC CHANGE attempt - Clang associations are when ideas are related to each other only by the fact they sound similar or rhyme.
‘I was on my way to the store the chore the bore some more’
___________ - AntiPsychotic HORQ - in old ppl = VTE/stroke
2.a)
Tard dyskinesia - CCP Choreoathetoid Chewing/Pouting retardedly
Restless akathisia
Acute dystonia - Torticollis, Oculogyric crisis
Parkinsonism EPSE - TRAP
—Treat EPSE w/ procyclidine/BENZOtropine (dont fucking say bromocriptine)
b) Tremor - Pill-rolling RESTING Rigidity - cogwheel LEADpipie Akinesia brady Post Instability Shuffling gait
Intention tremor @ cerebellar dx #DANISH
Dysmetria - over/undershooting - MS/ALS cerebellar dx #DANISH
____________
Alpha receptors - post hypotn Histamine - sleep/?Weight Muscarinic blocker - opposite of SLUDS Endo - prolactin NMS - slow onset PRAD, HYPERreflexia/clonus, DILATED pupils
Aortic dissection BICUSPID aortic valve MarfanEhlers/Turner's and Noonan -Preg/syph -> Chest pain radiate 2 back
SUSPECT PE?
- ? criteria to r/o PE
- ? the criteria must be ABSENT to have NEG/POS PERC to rule-out PE
- this should be done when you think there is a LOW PRE-TEST probability of PE, but want more REASSURANCE that it isn’t the diagnosis
- this low probability is defined as < ?%
Pearly penile papules - Tx?
Bone pain + Deformity (which 2 met bone dx cause this…) -> X-ray
generalised osteopenia,
-erosion of the terminal phalyngeal tufts (?WTF is this called) and
-sub-periosteal resorption of bone
-particularly the radial aspects of
2nd + 3rd middle phalanges.
-Dx?
STEPWISE progression of symptoms in dementia - think ? dementia
Aortic dissection BICUSPID aortic valve MarfanEhlers/Turner's and Noonan -Preg/syph -> Chest pain radiate 2 back THORACIC AORTIC DISSECTion \_\_\_\_\_\_\_\_\_\_
SUSPECT PE?
- PERC criteria to r/o PE
- ALL the criteria must be ABSENT to have NEG PERC to rule-out PE
- this should be done when you think there is a LOW PRE-TEST probability of PE, but want more REASSURANCE that it isn’t the diagnosis
- this low probability is defined as < 15%
Pearly penile papules are not a cause for concern and do not require intervention
Bone pain + Deformity (OM / Paget..) -> X-rayX-ray
generalised osteopenia,
-erosion of the terminal phalyngeal tufts (acro-osteolysis) and
-sub-periosteal resorption of bone
-particularly the radial aspects of
2nd + 3rd middle phalanges.
-Hyperparathyroidism.
STEPWISE progression of symptoms in dementia - think vascular dementia
M. OD. G S D \_\_\_\_\_\_\_
Delirium V Dementia
________
SHORT hx, RAPID onset
Pt C/O
–BIOLOGICAL symptoms e.g. WL/sleep dx/ ?poor memory
Test:
Reluctant to take tests / Disappointed with results
MMSE score: VARIABLEEEEE
? memory loss
Ddx - Depression vs. dementia???????
1w - mania 2w - OCD/Depression 3w - Gad/panic 4w - schizo 24w - dementia \_\_\_\_\_\_\_
Delirium V Dementia
Emotions - fear/agitation Fluct syx = worse @night GCS low Hallucination/ Illusion/ Delirium \_\_\_\_\_\_\_\_
Depression > Dementia
- MMSE score: VARIABLEEEEE
- Conc Appetite/WL Sleep Energy Sex-drive #BIO-syx
- GLOBAL memory loss
Hamartoma @ CNS - Skin - Retina-white
ANGIOF..? (sebacum ?) (Fibromata SUB?)
ANGIOMy..?
A?-leaf #?pigment / S?green @ ?-spine
M?valve dx Tub Sclerosis Other = ? nose Mentally ? S? \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
1.
Cafe au ?
Intellectual ?
Cutaneous ?
? iris hamartomas
Optic ?
-?iomas - > focal neuro
P ? –> HTN >180/120…
Seizure
2. B/L vestib schwanomas AKA -acoustic neuromas \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
AD: SLAP / Ehlers
- Sclera blue / Scoliosis
- Lens dislocation upward
- aRm:Height >1.05
- aOrtic sinus dilation
- aDom / Arch palate-high
-P: Planus/ Excavatum
_________
Childhood w/ fractures + deformities
-BLUE sclera + hearing/ visual dx
-ALL BONE PROFILE BLOODS FKN NORMAL!!!!!
___________
-Elastin
-HypermoB?
? @kids/?@adults /9
-L X
-E X
-Ret Angiod Streaks
-SAH
AR/MProlapse
_________
Hemangioma / Hemorrhage / HTN - Cysts-Sac
- Phaeo / RCC*=?-cell #HTN
- endoLYMPH ? tumours
- CYSTS: ? / ?
- Hemangiomas -> Haemorrhage (?what kind of ICH?* / ?eye)*
_______
lesions around lips/mouth
bleeder/ epistaxis
Hamartoma @ CNS - Skin - Retina-white
ANGIOFibromata (sebacum adenoma) (Fibromata SUBungual)
ANGIOMyoLipoma - LymphAngioLeioMyo-Matosis
ASHEN-leaf #HYPOpigment / Shagreen @lumbar-spine
MRegurg Tub Sclerosis Other = butterfly nose Mentally RETARDED Seizure \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
Neurofibromatosis type 1
-LISCH nodules iris hamartomas
Cafe au lait
Intellectual dx
Cutaneous NEUROFIBROMAS
? iris hamartomas/ Cataracts
Optic GLIOMAS
-meningiomas - > focal neuro
Phaeo!!!!
Seizure/Cataracts
Neurofibromatosis type 2
_________
_________
MarFIBRILLINan
_________
Osteogenesis imperfecta:
Childhood w/ fractures + deformities
-BLUE sclera + hearing/ visual dx
-ALL BONE PROFILE BLOODS FKN NORMAL!!!!!
Ehlers L A S T I N
-Elastin
-HypermoBEIGHTON
6 @kids/5@adults /9
-L X
-E X
-Ret Angiod Streaks
-SAH
AR/MProlapse
______
Von Hippel-Lindau
-CEREbellar haemangiomas: –> SAH*
- RETinal haemangiomas –> vitreous* haemorrhage
- renal CYSTS (premalig) –> clear-cell RCC*
- Phaeo / RCC*=clear-cell #HTN
- endoLYMPH sac tumours
- CYSTS: Epididymal / HPB
- Hemangiomas -> Haemorrhage (SAH* / Vitreous)*
HHT = Osler Weber Rendu
SSRI:
- kids/teens/OBESITY
- Heart dx
- Cause what electrolyte dx and what else too??
_______________ - SSRI avoid what WANTm??
_______________ - ?? has a higher incidence of discont PURSM syx than other SSRIs
- Paraesthesia
- Unsteadiness
- RESTLESS + sleep dx,
- Sweating
- Mooooooood change - ?? / ?? @preggers
- ? @BFeed - Postnatal depression Tx?
_______________ - Prescribe what else w/ SSRIs? To prevent what?
- Mirtazapine is generally more sedating at ?? doses
_____________________
- Kid/teens - Fluoxetene Fkn kids
- Heart dx - Sertraline
- Sertraline SIADH / EDyx
_______________
4. SSRI avoid: Warfarin - antiplt effect #XSbleeding Aspirin NSAID Triptans/MAOi #SerotSyn \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
- Paroxetine has a HIGHER incidence of Discontinuation PURSM Syx than other SSRIs
- PPPreg - PPPaRoxetene/Sertraline
- Sertraline @BFeed
7. PND tx: CBT + Sertraline/Paroxetene - PNDep < 4-12 wks Edinburgh Scale is a screening tool for postnatal depression \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
- SSRI + PPI = prevent UGIB!!!!!!
- Mirtazapine is generally more sedating at LOWER DOSES
__________________
Cremaster L??, Anal Wink S??
Reflex: Ankle S??, Knee L?? Bicep C?? BRadialis C?? Tricep C?? \_\_\_\_\_\_\_\_\_\_\_
Thumb C?
Middle Finger C?
Little finger C?
________________
Nipple ?
BellyButton - ?
Coeliac ?
_______________________
Inguinal?
SMA ?
MID-Thigh?
IMA ?
________________________
Kneecap ?
Big Toe ?
Lat foot small toe ?
_______________________
Cremaster L1/2, Anal Wink S3/4
Reflex: Ankle S1/2, Knee L3/4 Bicep C5/6 BRadialis C5/6 Tricep C7/8 \_\_\_\_\_\_\_\_\_\_
Thumb C6, Middle Finger C7, Little finger C8
_______________________
Nipple T4
BellyButton - T10
Coeliac T12
_______________________
1nguinal L1
SupMA L1
MidThigh L3
InfMA L3
_______________________
Kneecap L4 all 4’s…
Big Toe L5 ;
Lat foot small toe S1
________________________
MR: (Valsalva -> Syst @mitral-area)
SAM AsH #LVH=deep Q @V1-3ish
OFTEN ASYMPTOMATIC
-SOBOE, angina
Ex -> Syncope #sudden-death
O/E: Jerky/Bisfriens pusle
ECG: deep Q @V1-3ish + ST depr + T-invert
-HOCM assoc w/ which arrythmic dx?
\_\_\_\_\_\_\_\_\_ B12 def -> tracts: -? dx - ataxia -? dx - fine movement of ipsilateral limbs -? dx - prop/vib + fine touch
Subacute Degen SC
- HIGH-STEP-GAIT
- Eye dx
- Reflex: kneeLMN ankleLMN plantarUMN
Neuro syx YES = ?
Neuro syx NO = ? -> -DietRelated= ? -DietUnRelated= ? \_\_\_\_\_\_
Brown Sequard:
_________________
If damaged above T1, may present with?
______________
Classic ** pt accidentally BURN their hands WITHOUT Realising **.
- WASTE of SMALL muscles @HAND
- ‘cape-like’ (neck arms trunk)
- SENSORY loss of pain + temperature
-Preservation of what sensory modality #?Tract
crossing ? TRACTS
@ ? ? of Spinal Cord
#FIRST tracts to be affected
Ix? Assoc w/ ?Malformation
___________
P Painless retention E Eversion of foot weak N No ankle/knee jerk I Impotence S Saddle anaesthesia -Anatomy of compression?
Ix? Tx? Anatomy?
________
__________
- prob/vibr dx
|—–> Ataxia + Romberg POS + DTRs absent - fine touch dx -> Charcot
- Accom Reflex Present - Pupil Reflex Absent
_______
BOTH UMN+LMN dx: 1)-UMN: Pseudobulbar palsy #BSC \+ 2)-LMN: ?cell involvement #WATFR \+ 3)-NO SENSORY/BOWEL-BLADDER dx... this shit is NORMAL
Dx? Tx = survival?
_________
EXCRUCIATING pain @leg-muscles ---bum/ hip/ thigh ABSENT REFLEXES ----HbA1c 120 \_\_\_\_\_\_\_\_\_\_\_\_
Fever + WATFR = ?cell involvement
- -CSF = high WCC + normal CSF BM + norm/high Prot #LYMPHocytes
- -Replicate in GI tract -> kill ?cell
Floppy HYPOtonic baby Flaccid paralysis Fasciculations @tongue #WATFR LMN: Symm Weakness. \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
-BSC syx!!! STIFF spastic tongue DONALD Duck Speech BRISK Jaw Jerk i.e. HYPERREFLEXIA \_\_\_\_\_\_\_\_
WATFR Palsy of the -?CN = swallow/ taste post 1/3 -?CN swallow/ speech -?CN = ?Traps -?CN = Hypoglssal = Tongue WATFR movement Brainstem Motor Nuclei ?CNs #LoF -Prognosis? \_\_\_\_\_\_\_\_\_\_
Towards VS Away
Hypoglossal - Tongue ? Accessory - ? + cant turn to? V3 jaw ? Vagus - uvula ? \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
Classical histories of :
1. Recent 'diagnosis' of Parkinson's... -POOR response to levodopa -------impaired BALANCE #Falls -------O/E vertical-GAZE Palsy #Symm onset
2. Recent 'diagnosis' of Parkinson's... -POOR response to levodopa --IMPOTENT --urinary RETENTION --OLD \_\_\_\_\_\_\_\_
- Motor: Foot-DROP = WEAK LOWER-Extremity
- Sensory dx –> Foot DEFORMITY
- —-pes Cavus=HIGH Arch
- —-Hammer-toe
Mitral Regurg #systolic
Syst Ant Motion of Ant Mitral leaflet
Asym Hypertrophy #LVH=deep Q @V1-3ish
-HOCM assoc w/ Wolff-Parkinson White
\_\_\_\_\_\_\_\_\_ SCD: Subacute Combo Degen of SC B12 def -> tracts: -Spinocerebellar dx - ataxia -CorticoSpinal dx - fine movement of ipsilateral limbs -DC-ML dx - prop/vib + fine touch
B12 def tx:
Neuro syx YES =
Admit + ?IM-HCB
Neuro syx NO = IM-HCB x3/w/2w --> -DietRelated=OralCyanoCobalamin -DietUnRelated=IM-HCB/3m \_\_\_\_\_\_\_\_\_
Same:
@level =
- ALL SENSATION
- LMN
@below level:
- Prop/Vib + FINE-touch #DC-ML
- UMN #CSTract
Opp:
-Pain/Temp + CRUDE-touch: below level - #SPTract
__________________
T1 dx ->
OculoSymp Dx
#IPSILAT Horners
____________
Syringomyelia
-Preservation of Prop/Vibr + FINE-touch #DC-ML
Dx = ST-AC
crossing SSSPINOTHALAMIC TTTRACTS
@AAANTERIOR CCCOMMISSURE of Spinal Cord
#FIRST tracts to be affected
Ix: MRI
Assoc w/ Arnold Chiari Malformation
_______
Cauda Equina -MRI -> Neurosurg+Steds -spinal roots L2 and below \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
Tabes Doraslis-DORSAL-COLUMN-ML -Accommodation Reflex Present (ARP) -Pupillary Reflex Absent (PRA) #House-Case \_\_\_\_\_\_\_\_
ALS-Lou Gehrig
- ALS dismutase dx
- Riluzole confers survival
1)-UMN: Pseudobulbar palsy #BSC
2)-LMN: ANT HORN cell involvement #WATFR
3)-NO SENSORY/BOWEL-BLADDER dx… this shit is NORMAL
_______
DM Amyotrophy = ABSENT REFLEXES
__________
Fever + LMN signs (WAFER = ?cell involvement)
-CSF = high WCC + normal CSF BM + norm/high Prot
-Replicate in GI tract -> kill ANTERIOR HORN cell
——PolioMyelitis
____________
____________
UMN PSEUDOBulbar Palsy BSC
Stiff Spastic Tongue, Donald Duck, HyperReflexic Jaw-Jerk
_______
LMN PROGRESSIVE Bulbar palsy WATFR -9CN = swallow/ taste post 1/3 -10CN swallow/ speech -11CN = ?Traps -12CN = Hypoglssal = Tongue WATFR movement Brainstem Motor Nuclei ?CNs #LoF -WORST Prognosis \_\_\_\_\_\_\_\_\_\_
Hypoglossal - Tongue TOWARDS
Accessory - ipsi shoulder droop + cant turn to opp side
V3 jaw TOWARDS
Vagus - uvula AWAY!!!!!
Floppy Flaccid Fascic baby = Spinal Musc Atrophy
-Werdnig Hoffman
_________
_________
- Progressive supranuclear palsy #PSP
- Multi-system atrophy
_________
Charcot Marie Tooth aka HSMN Hereditary Motor Sensory Neuropathy
Relation of GABA drugs w/ Cl- channels
-benzos
-barbiturates
________________
How to taper BENZOS:
1. Switch patients to the equivalent dose of ?
2. Reduce dose by ? every ? weeks
_______________
1 -MAIN inhibitory neurotransmitter?
2-Benzo mechanism?
3 -Alco chronic consumption mechanism?
_________________
4 -Alco withdrawal mechanism?
_____________
Cl- channel opening INC: -Freq-BENzo -Duration-BARBiturate Frequently BENd - During BARBeque \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
- Switch pts to equivalent dose of DIAZEPAM
- Reduce dose by 1/8th / 2 WEEKS
_____________
1 -GABA = main inhibitory neurotransmitter
—GABA + NMDA-Glut = INCR INHIBITION
2 -Benzo: INC
- FREQ of Cl- channels –>
- GABA-mediated inhibition
- Alcohol chronic = INC:
-GABA-mediated inhibition
-NMDA-type Glutamate receptors inhibition
_________________ - Alco withdrawal: DEC
-GABA med-inhibition
-NMDA-type glutamate receptors inhibition
I.e. INC TRANSmission for BOOOOTH!
_________________
Alco withdrawal tx
_______
PCOS
Hirsutism and acne
Tx - ?? –> ?? and what else??
Infertility Tx -
? —> (? > ?)
Amenorrhoea tx?
- COCP (not @ ?/UKMEC3-4)
- MirenaLevonorgestrel= fatso+need contracep
- Cyclical POP = Medroxyprog = BUT this NOT ? dose !!!
-TVUSS - Endomet thickness
(THICK = ?action … due to ? )
(NORM = ?hormonals )
_________
Aside from ovarian cancer, what else can CA125 be rasied in? C-OPE
Ovarian cancer types: MOST COMMON CAUSE OF OVARAN: -CANCER = ? cancer -BENIGN tumour < 25y = ? -ENLARAGEment @reproductive age = ?
Epithelium
Germ-cell
Sex-cord
Type of Ovarian Cyst
-Follicular > Corpus luteum
Complex cyst = ?dx = Mx?
- Chlordiazypoxide
- Carbemazapine
_______
Hirsutism and acne -
Dianette/COCP –>
-Eflornithine +
-Flutamide/Finasteride/Spiro
Infertility -
WL –> (CLOMIFENE #refer > metformin)
Amenorrhoea:
- COCP (not @fatso/UKMEC3-4)
- MirenaLevonorgestrel-iuS= fat+need contracep
- Cyclical Prog = Medroxyprog = NOT contracep dose !!!
-TVUSS - Endomet thickness
(THICK = refer ?hyperplasia/cancer)
(NORM = MMC
COCP | iuS | POP-medroxyprog-cyclical
_______
CA125
- Ovarian Cancer/Cysts,
- Periods,
- Endometriosis
Ovarian cancer types: MOST COMMON CAUSE OF OVARAN: -CANCER = SEROUS cancer -BENIGN tumour < 25y = DERMOID Teratoma -ENLARAGEment @reproductive age = FOLLICULAR cyst
-Epithelium - sero / mucinous –>
(@rupt = pseudomyx peritonei)
MUCIN IN ABDO!!!!! BLUERGH
-Germ-cell ChorioTropho/ Embryonic/ Terotoma-dermoid/ YolkSac/ Dysgerminoma
-Sex-cord = Granulosa / Thecoma / Leydig-Sertoli
Type of Ovarian Cyst
-Follicular > Corpus luteum
Complex cyst = cancer = REFER
Thought disorders
- Answer a question
Give XS, unnecessary detail
Does EVENTUALLY return to original point. - wandering from a topic
NOT returning to original point. - New word formations
- Incoherent speech = real words strung together into nonsense sentences.
- Severe type of LOOSE associations w/
UNEXPECTED and ILLOGICAL leaps
from one idea to another #schizophrenia. - Accelerated Leaps from
one topic to another w/
UNDERSTOODish links between them
#mania - Repetition of ideas / words
despite an attempt to CHANGE the TOPIC. - Repetition of SOMEONE ELSE’S speech, including the QUESTION ASKED.
- Ideas = related to each other
by the fact they SOUND SIMILAR / RHYME.
‘I was on my way to the store the chore the bore some more’
Thought disorders
- Circumstantiality -
XS UNecessary detail - > eventually return 2 original point - Tangentiality refers to wandering from a topic without returning to it.
- Neologisms are new word formations, which might include the combining of two words.
- Word salad is completely incoherent speech where real words are strung together into nonsense sentences.
- Knight’s move thinking is a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.
- Flight of ideas, a feature of mania, is thought disorder where there are leaps from one topic to another but with discernible links between them.
- Perseveration =
repetition of ideas / words
despite an attempt to CHANGE the TOPIC. - Echolalia is the
repetition of SOMEONE ELSE’S speech,
including the QUESTION ASKED. - Clang associations are when ideas are related to each other only by the fact they sound similar or rhyme.
‘I was on my way to the store the chore the bore some more’
Anorexia features
- what’s low
- what’s RAISED 3G’s and 3C’s?
Screening?
Anorexia features: -BMI < ? ?obs chart Amenorrhoea > ?m ?Thermia ?weird hair on arms #hypertrichosis*
*Porph Cut Tardis
Anorexia-Lanugo
Terminalis-Languinosa
@anorexia CBT/Mantra SSC/M Focal Psych Family Tx @kids
SElf-help @bulimia
CBT
Family Tx @kids
Refer:
- unstable obs RR BP HR Temp
- ? test fail using ?
- ?bloods fucked-which?
- BMI ?
Bulimia RFs
-Raised G’s and C’s:
GH, Glucose, Glands-salivary
Cort, Carot, Chol*
-MOST things LOW
-SCOFF screening
Anorexia features: -BMI <17.5 low BP/HR Amenorrhoea >3m HypoThermia Lanugo
Refer
- unstable obs RR BP HR Temp <35
- SQUAT test FAIL using ARMS
- Electrolytes
- BMI < 15
Bulimia RFs - PRINCESS Diana @season 4 the crown!!!
- fuked family interactions
- women
- low esteem
- depression
- high expectations/conform
- obesity
*Cortisol, Carotinaemia, Cholesterol
70+M a/w
gradual loss of voice / 6 m
DDx?
Ax?
__________
1.
- fooooot EEEEEEVersion (i.e. inversion FINE!)
- sensory loss in 1st web space
- dorsiflexion / toe extension
2.
-Ankle EEEEEVersion (i.e. inversion FINE!)
- sensory loss @ANT-LAT lower leg + foot-DORSUM
(NOTTTTTT the 1ST web space).
- -> ? -> ?
@lat thigh, lower leg, foot-dorsum, 1ST WEB SPACE
- foot INversion + EVersion BOTH fucked
- hip abduction
- pain and sensory loss
- Common peroneal fucked too (as above)
4.
-weak PLANTARflex + low sensation @LAT malleolus
Aphonia = inability to speak
Ax:
Recurrent laryngeal nerve palsy (TT/Tumour)
PSYCHOgenic
_________
Deep peroneal nerve-failed:
- fooooot EEEEEEVersion (i.e. inversion FINE!!!)
- sensory loss in 1st web space
- dorsiflexion / toe extension
Superficial peroneal nerve-failed:
-Ankle EEEEEVersion (i.e. inversion FINE!!!)
- sensory loss @ANT-LAT lower leg + foot-DORSUM
(NOTTTTTT the 1ST web space).
L5 nerve root –> sciatic –> CPeron = S/D
@lat thigh, lower leg, foot-dorsum, 1ST WEB SPACE
- foot INversion + EVersion BOTH fucked
- hip abduction
- pain and sensory loss
- Common peroneal fucked too (as above)
S1 nerve root dx
-weak PLANTARflex + low sensation @LAT malleolus
Factors favouring pseudoseizures
Factors favouring true epileptic seizures
__________
Delirium > Dementia
__________
ALS and polio are UMN or LMN conditions??
Which has worst prognosis?
-PseudoBulbar or PROGressive Palsy?
__________
Stiff spastic tongue Donald Duck Speech Brisk Jaw Jerk i.e. HyperReflexia -get the BSC syx!!! \_\_\_\_\_\_\_\_
Palsy of the -Tongue -Chewing muscles -Swallowing and -Facial muscles due to loss of function of Brainstem Motor Nuclei -get WATFR syx!!!
Pseudoseizures FACTOrs:
- FHx epilepsy/Females
- ALONE = don’t occur
- CRYING after seizure
- Thrusting pelvic
- Onset = GRADUAL
Favour true epilep seizures:
- Tongue biting
- PROLACTIN
__________
-Emotions = fear, agitation
-Fluct Syx = worse @night, normal periods
-GCS impaired
-Hallucinations/Illusions/Delusions #perception
__________
ALS = UMN + LMN + Norm Sensory/Bowel-Bladder
Polio are LLLLLLLMN conditions
WORST Prognosis = PROGressive bulbar palsy
_________
PseudoBulbar Palsy
_______
PROGressive bulbar palsy
-WORST Prognosis
re-experiencing e.g. flashbacks, nightmares
avoidance e.g. avoiding people or situations
hyperarousal e.g.hypervigilance, sleep problems
-Dx?
1. Difficult w/ stable relationships Emotional AF - angry/impulsive - sex Fear of abandonment Impulsive + suicidal -hears voices BUT recognises thse are her OWN #PSEUDO-hallucination
- Perfectionism+Control @EXPENSE of:
-flexibility to experience/EFFICIENCY
-come at the EXPENSE of completing task
-PERSON UNAWARE OF THIS like Monica
________________________
3. FEAR of Criticism/Rejection --> Avoid stuff like: A)-certain jobs -- ppl-interaction B)-relationships -- sex (was i good? big enough...?) C)-isolated BUT: 1. wants to be around ppl AND 2. to be LIKED
4. LUSH Loyalty questioner!!! Unforgiving Sensitive AF - thinks being attacked Hidden meaning/conspiracy \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
5. LAND Lonerrrrrrr - NO friends Anhedonia-AF No interest in friends/intimacy-sex, Doesn't give a fuck about praise / criticism -like House MD
6.
a) Diff beteen delusional and ‘ideas of reference’?
b) ALIOU
Affect = fffffffucked Lonerrrrrrr - NO friends IoRef - Odd beliefs / magical thinking ODD speeeeeech but still coherent Unusual behav/perceptual disturbance Paranoid AF
re-experiencing e.g. flashbacks, nightmares
avoidance e.g. avoiding people or situations
hyperarousal e.g.hypervigilance, sleep problems
-PTSD !!!
- EU-BPD - SAIMA AFI’s girl
- Emotionally Unstable Borderline PD
- Psychotherapy -mood stabilisers/anti-psych - Anankastic - OC PD
- DIFF to OCD where:
anxiety-inducing and involuntary thoughts –>
unwanted/unhealthy acts/behaviours
________________________ - Avoidant
- Paranoid - like you, you PRICK
________________________ - Schizoid - like House MD
- a) Diff beteen delusional and ‘ideas of reference’?
delusions = NO insight
IoRef = HAS insight
b) SCHIZOTYPAL
First-rank Schizophrenia:
- Withdrawal, insertion, broadcast
- 3rd person = hearing 2/+ voices
- Bodily sensation CONTROLLED by ext influence
-Object is perceived –>
Sudden Intense Delusional Insight into the objects meaning
__________
When to give anti-D @rhesusNEG mums:
If mum had Acne Rosacea, tx?
Preg + Pit.Versicolor, tx?
Thought dx
Auditory hallucinations
Passivity phenomenon
Delusional perception
________
Abortion/Miscarriage >12w TransPlacentalHaemorrhageRisk(procedures) -procedures/abdo trauma/iuDeath Ectopic Evac after miscarriage
- I AM DE
Acne Rosacea tx = 8-12 weeks
mild/mod - ltd pap/pust =
-TOP: Ivermectin / Azelaic/Metro @preg/BFeed
mod/severe - ext pap/pust ± plaques
-PO Doxy / Erythro @preg/BFeed
______
Pityriasis versicolor Ix: skin scraping MCS @preg/BFeed = give Ketoncon Preg/BFeed CI: Selenium / Flucon/Itracon Tx: ASKIF
Mood –> Affect
Antipsychotic Ix:
__________
Suidice common social classes..?
________
When to give anti-D to mum?
A. Booking visit
B. 11 - 13 weeks
C. 28 wks –> 34wks
D. 36 wks
Positive serum AFP/Prev NTD ->
USS ->
Amniocentesis for AFP/AChi w12 16-20
@HIV, mum viral load < 50 @ w?
-what delivery recommended?
-what should be started 4 hrs b4 c-section?
After birth:
-mum CD4 < 50, what administered to neonate?
-mum CD4 > 50, what administered to neonate?
_______
BF advantages?
MMR CI
Mood - how they FEEL
Affect - how they APPEAR - emotional state
Antipsychotic Ix:
- FBC/U+E/LFT
- BMI/BM/BP
- CVD: lipids/ECG/QRisk
Suidice = social classes 1 + 5
________
Abortion/Miscarriage >12w TransPlacentalHaemorrhageRisk(procedures) -procedures/abdo trauma/iuDeath Ectopic Evac after miscarriage
A. 8-12 wks -
- Booking
- overlap w/ Down’s nuchal scan
B. 11-13 -Down's + Nuchal scan -overlap w/ booking \_\_\_\_\_\_\_\_\_\_ C. 28 wks - 1st dose of anti-D prophylaxis @RhNEG - 2nd Anemia/AlloAB test @28w
34 wks: 2nd dose of anti-D prophylaxis @RhNEG \_\_\_\_\_\_\_\_\_\_ D. 36 wks: -BFeed / Blues -ECV ?Presentation legit -Vit K
@viral load < 50 @ w36: VAG > C-section - IF c-section, then b4 c-section: IV zidovudine After birth: < 50: PO zidovudine @neonate > 50: Triple ART @neonate \_\_\_\_\_\_\_\_
Mother:
- BabyBond
- Reduce BreastCancer / PPH-risk
Kid: i-AIRD
- Infections
- Allergy/ IBD / RA / DM 1
MMR CI Live vaccine <4w Ig tx / 3m Preg avoid @MMR<4w Preg avoid @MMR<4w IC Neomycin allergy
Influenza vacc = egg allergy?
SHORT hx, RAPID onset
Pt C/O ?poor memory
Biological symptoms e.g. WL/sleep dx
Test:
Reluctant to take tests / Disappointed with results
MMSE score: VARIABLEEEEE
GLOBAL memory loss
Ddx - Depression vs. dementia???????
__________
Antipsychotic Ix:
Suidice = social classes ?
________
__________
Duod
Jej
Term Ileum
_______
TICS MATCH RALPH FBD
1. Microcytic:
- Normocytic:
- Macrocytic:
Non-megalo?
Megalo?
P450 inducers = INR low or high?
P450 inhibitors - INR low or high?
___________
Depression > Dementia
________
Antipsychotic Ix:
- FBC/U+E/LFT
- BMI/BM/BP
- CVD: lipids/ECG/QRisk
Suidice = social classes 1 + 5
________
Duod - Iron
Jej - Folate
Term Ileum - B12
___________
TICS MATCH RALPH FBD
- Microcytic:
- Thalassaemia, Iron Def, ChrDx, Sidero - Normocytic:
- Marrow dx
- Acute blood loss
- Thyroid LOW
- ChrDx early / CKD
- Hemolytic
3. Macrocytic: Non-megalo -Myelo-prolif/dysp/mm -Reticulocytosis -Alco XS - GGT CDT high MCV -LF -Preg -HypoT
Megalo:
-Folate, B12, Drugs (allop/phenyt/OHcarbimide)
P450 inducers = INR low
- Phenytoin
- Carbemazapine
- Barbituates
- Rifampicin
- Alco
- SUs
P450 inhibitors - INR HIGH -PPI/grapefruit -LF -Allopurinol -NSAID -Cranberry -DISULFIRAM -Erythromycin -Valproate -Isoniazid -Cipro/Ketocon -Ethanol -Sulfonamides \_\_\_\_\_\_\_\_\_\_
Things you get wrong in the heart shit:
Salicylates - ?
?* tremor HYPERreflexia ataxia - ?
TCA - ?
Ax
Aortic stenosis:
<65 - ?Ax
For BIOprosthetic valve for OLDER
Inc risk of ?
> ? get aortic one
> ? get mitral one
S2 = Loud @ ?
Paradox s2 ?
3rd degree complete block ?
RBBB ?
RAD vs LAD
?vessel - MMMMI - ?vessel
?height ?habitus = RAD
Peaked P-pulmonale #RAH
-TS >RVH(PS/PAH)
Pulses paradoxes? PAH
Tamponade/ Severe asthma:
- PAH, AR/ASD, High Left EDV
_________
Organophosphates
Heparin
Ethylene glycol*
Methanol*
Salicylates
?* tremor HYPERreflexia ataxia
TCA-wide QRS, tachy
Cyanide*
Digoxin = bradycardia, reverse tick t-wave inversion, eye syx green/yellow vision
Lead/Arsenic*
_________
LVH: deep S @V1-2; tall R @V5-6
- Pulse = slow rising/narrow pressure
- Apex = thrill
- S4
Tx for:
- Asyx?
- Asyx >40/50mmHg + LV sys dx?
- Syx?
Common Ax @ <65 ? >65 ? iNFECTION? \_\_\_\_\_\_\_\_\_\_\_\_\_
For bioprosthetic valve for OLDER Inc risk of?? >age? get aortic one >age? get mitral one AC needed? give what antithrombotic Tx?
For mechanical valve for YOUNGER
Inc risk of??
AC needed? And what else if IHD??
____________
S1-2 sounds?
-Soft -Loud
Wide split ??
Paradox split??
Fixed split??
S4-3 sounds?
____________
Causes of 1st and 2nd degree block KIMBAD
Causes of 3rd degree complete block iFASC
____________
Pericardial rub - ??
Pleural rub - ??
Pericardial knock - ??
____________
Causes of LBBB
RBBB causes?
____________
Ax LAD
Ax RAD
_______
ECG signs:
Tall R @V5+6
Inverted T @V5+6, 1, VL
LBBB+LAD
R tall @V1
Inverted T @V1+2,
RBBB+RAD
Bifid/Broad P-mitrale +/- AF = ?
(what letter does Bifid P look like? 🤔)
Peaked P-pulmonale = ?
____________
Pulses paradoxes? PAH
Slow rising/plateau?
_________
COLLAPSING? API
Pulsus alternans?
_________
Bisfriens pulse - DOUBLE systolic beat
Jerky
_________
J wave Osborn @ECG
Widespread/SADDLE ST elevation
_________
PR depression?!
pericardial knock
_______
- Collapsing pulse = ?
- Wide Pulse Pressure = ?
- Narrow Pulse Pressure = ?
- slow rising pulse =?
Things you get wrong in the heart shit:
Salicylates - Bicarb/dialysis
Lithium* tremor HYPERreflexia ataxia - IVF/dialysis
TCA - Bicarb
Ax
Aortic stenosis:
<65 - BICUSPID aortic valve #TURNER
For BIOprosthetic valve for OLDER
Inc risk of CALCification
>65 get aortic one
>70 get mitral one
S2 = Loud @
- HTN, Hyperdymamic states,
- ASD-PulHtn
Paradox s2
-WPW-b, AS/LBBB, RVPacing, PDA
3rd degree complete block:
iHD, Fibrosis; AS; Surg/Trauma; Congen
RBBB=PE, ASD, Normal
RAD vs LAD
Lat (circumflex) - MMMMI - Inf (RCA)TTTTall thin = RAD
Peaked P-pulmonale #RAH
-TS >RVH(PS/PAH)
Pulses paradoxes? PAH
Tamponade/ Severe asthma:
- PAH, AR/ASD, High Left EDV
_________
Organophosphates - atropine
Heparin - protamine sulfate
Ethylene glycol - Fomepizole/ Ethanol / Dialysis
Methanol - Fomepizole>Ethanol / Dialysis
Salicylates - Bicarb/dialysis
Lithium* tremor HYPERreflexia ataxia - IVF/dialysis
TCA - Bicarb
Cyanide - OH-cobalamin
Digoxin - Dig-specific Antibodies
Lead/Arsenic*- dimercaperol / edetate
________
AStenosis
-S4=HOCM/HTN/ASten
Asyx = OBSERVE
Asyx >40/50mmHg + LV sys dx = SURG
Syx = valve replacement -> balloon valvuloplasty
Ax Aortic stenosis: <65 - BICUSPID aortic valve #TURNER >65 - calcification Rheumatic Fever \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
For bioprosthetic valve for OLDER Inc risk of calcification >65 get aortic one >70 get mitral one Long term AC not needed, give aspirin
For mechanical valve for YOUNGER
Inc risk of thrombosis
Give warfarin + aspirin if IHD.
____________
S1 = AV valves mitral/tricuspid closing
soft @Regurg
loud @MS
S2 = Aortic/pul closing soft @ASten Loud @ -HTN, Hyperdymamic states, -ASD-PulHtn
Wide s2-
delay RV empty
-(PS; PAH{MRegurg severe}; RBBB)
Paradox s2
-WPW-b, AS/LBBB, RVPacing, PDA
Fixed s2 - ASD
S4 = atria contract against STIFF ventricle
HOCM/HTN
ASten
S3 = diastolic filling of ventricle Const pericarditis - pericard knock, X+Y, X ✔️; Dilated CM, MRegug NORMAL<30y \_\_\_\_\_\_\_\_\_\_\_\_
1st and 2nd degree:
K+low; IHD; myocarditis;
Beta-blockers; Athletes; Digoxin
3rd degree complete block:
iHD, Fibrosis; AS; Surg/Trauma; Congen
____________
Pericardial rub - pericarditis
Pleural rub - pneumonia/PE
Pericardial knock - C. Pericarditis
____________
LBBB=CM, HTN, AS, IHD
RBBB=PE, ASD, Normal
___________
RAD vs LAD
A(R>S @ V1) - WWPW - B (S»>R + Tinvert)+ VT
AAAArm switch/dextrocardia
RRRRVH - LVH
Lat (circumflex) - MMMMI - Inf (RCA)
TTTTall thin = RAD
Left post fasicle - HHHHemiblock - left ant fasicle/(bifasicular)
p176 ECG John Hampton book \_\_\_\_\_\_\_ LVH: R>25mm @V5+6 Inverted T @ V5+6, 1, VL LBBB+LAD
RVH:
R tall @ V1
Inverted T @ V1+2,
RBBB+RAD
Bifid/Broad P-mitrale +/- AF = LAH
-MS -> LAH
Peaked P-pulmonale #RAH
-TS >RVH(PS/PAH)
As per John Hampton p112
____________
Tamponade/ Severe asthma:
- PAH, AR/ASD, High Left EDV
AS
_________
AR/PDA/ Incr requirement
LVF
_________
HOCM/Aortic valve Dx
HOCM
_________
J = hypothermia HyperCalcemia
Widespread ST elevate = pericarditis
_________
PR depression = most sensitive for pericarditis!!!!!
pericardial knock = constr pericard
_______.
- Collapsing pulse = AR/PDA/ Incr requirement
- Wide Pulse Pressure = AR/PDA/3rd HB
- Narrow Pulse Pressure = ASten
- slow rising pulse = ASten
