Quick recall 3 Flashcards
Drug options for reducing the risk of relapse in MS
- Natalizumab (IV)
- Ocrelizumab (anti-cd20 monoclonal antibody)
- Fingolimond
- beta interferon
- glatiraemer acetate
Multiple sclerosis: tackling
- Fatigue
- Spasticity
- Bladder dysfunction
- Oscillopsia (visual fields appear to oscillate)
- Fatigue
–> trial of amantadine - Spasticity
–> baclofen and gabapentin
OR –> diazepam, dantrolene and tizanidine
–> physio - Bladder dysfunction
–> significant residual volume: intermittent self catheterisation
–> no significant volume: ACH to improve urinary frequency - Oscillopsia (visual fields appear to oscillate)
The loss of proprioception and vibration sense (dorsal columns) points towards
subacute combined degeneration of the spinal cord
Lip smacking + post-ictal dysphasia are localising features of a
temporal lobe seizure
paediatric Status epilepticus guidelines
- Buccal midazolam / Iv Lorazepam (2 max doses)
- IV lorazepam
- IV levetiracetam, phenytoin or sodium valproate
- RSI , anaesthetics, using thiopental sodium
reflexes and nerve roots
- ankle
- knee
- bicep
- tricep
Ankle - S1-S2
Knee - L3-L4
Bicep - C5-C6
Triceps - C7-C8
Primary Motor Cortex = Motor Sx = Frontal Lobe
Primary Somatosensory Cortex = Sensory Sx = Parietal Lobe
F = Frontal = Fidgetting
P = Parietal = Paraesthesia
Migraine mx: ACUTE
1ST LINE
- oral triptan + nsaid
OR
- oral triptan + paracetamol
If 12-17 years –> nasal triptan?
Migraine mx: prophylaxis
- Propranolol
- Topiramate (avoid in women of childbearing age)
- amitriptylline
10 sessions acupuncture.
Others
- candesaratan
- calcitonin gene related peptide receptor
Mx myasthenia gravis
- Long acting ACH inhibitors
–> PYRIDOSTIGMINE
Autonomic dysreflexia can only occur if the spinal cord injury occurs above the
T6 level
The combination of severe hypertension, flushing and sweating without a congruent response in heart rate in the context of spinal cord injury indicates an autonomic dysreflexia
Cushing’s triad:
widening pulse pressure
bradycardia
irregular breathing
treatment of choice for essential tremor
Propranolol
resting tremor is seen in parkinsons and this is managed with co-careldopa
this characteristically presents with sensorineural deafness and congenital cataracts.
Rubella!
Rubella the sensitive cat
This may also be associated with cerebral palsy, anaemia, and jaundice. Also is associated with congenital sensorineural deafness
Congenital cytomegalovirus infection
Primary amenorrhoea, little or no axillary and pubic hair, elevated testosterone →
androgen insensitivity syndrome
- bilateral lower pelvic swellings likely to be undescended testes
Alzheimer’s disease causes widespread cerebral atrophy mainly involving the:
cortex and hippocampus
Metabolic alkalosis + hypokalaemia → ?
prolonged vomiting
interpret ecg & likely diagnosis
peaked or ‘tall-tented’ T waves (occurs first)
loss of P waves
broad QRS complexes
sinusoidal wave pattern
Hyperkalaemia: management
- Stablisation of cardiac membrane only –> IV calcium gluconate
- Short term shift K+ from extracellular to intracellular fluid
–> combined insulin / dextrose infusion
–> nebulised salbutamol - Removal of potassium from body
a) calcium resonium (orally or enema)
b) loop diuretics
c) dialysis
A 41-year-old man presents with a persistent itch rash that has been present for the past few weeks. On examination he has erythematous, scaly lesions underneath the eyebrows, around the nose and at the top of his chest. He also has a history of dandruff which is well controlled with over the counter shampoos.
likely diagnosis and tx:
1st line tx –> topical ketoconazole
Inguinal Hernia -> get INto surgery
Umbilical Hernia -> UM I’ll wait and see
Inguinal Hernia -> get INto surgery
Umbilical Hernia -> UM I’ll wait and see
features of Wernicke’s encephalopathy
CAN OPEN
Confusion
Ataxia
Nystagmus
Ophthamoplegia
PEripheral
Neuropathy
Retrograde amnesia and confabulation are features of Korsakoff’s psychosis
The three criteria for aneurysm surgery are:
- An asymptomatic aneurysm larger than 5.5 cm in diameter.
- An asymptomatic aneurysm which is enlarging by more than 1 cm per year.
- A symptomatic aneurysm. This is the only criteria, apart from emergency rupture, which requires urgent surgery rather than an elective procedure.
these are used in the used in the management of alcohol withdrawal
Decreasing doses of long-acting benzodiazepines
e.g. chlordiazepoxide
55 Male: RTA unconsciouss.
OE: multiple cuts and bruises, skin warm and flushed. PEARL. No respiratory distress.
ECG: sinus bradycardia
likely cause for patients presentation:
- low HR, warm flushed peripheries indicates spinal shock as underlying cause.
- loss of sympathetic outflow resulting in hypotension and bradycardia , warm peripheries due to v.dilation and inability to vasoconstrict
NEUROGENIC SHOCK
Complications of thyroid surgery
damage to parathyroid glands can result in hypocalcaemia
- prolonged QT
Visual hallucinations with dementia
Lewy body dementia
Myxoedemic coma is treated with
thyroxine and hydrocortisone
Thyrotoxic storm is treated with
beta blockers, propylthiouracil and hydrocortisone
4Hs
Hypothermia
Hypoxia
Hypovolaemia
Hypokalaemia / hyperkalaemia / hypoglycaemia
4Ts
Tension pneumothorax
Toxins
Tamponade
Thrombosis
In the acute management of DKA: mx
- Insulin –> fixed rate
- Continue regular injected long acting
- Stop short acting injected insulin
Hepatitis serology
If patient has antigen: active infection
IgM - acute
IgG - chronic
ECG shows:
Polymorphic changes: Torsades de pointes
Anterior uveitis is most likely to be treated with
- Steroid eye drops: prednisolone acetate
–> treats underlying infection - Mydriatic eye drops (cyclopentolate)
–> dilate eye and reduce pain
Vestibular neuronitis vs Labrinthitis
Vestibular neuronitis = inflammation of the vestibular nerve, which deals with balance but not hearing
Labyrinthitis = inflammation of labyrinth, which deals with both balance AND hearing
Hyponatraemia correction may lead to:
osmotic demyelination syndrome
Hypernatreamia correction may lead to:
cerebral oedema
Acute dystonia secondary to antipsychotics is usually managed with:
Procyclidine
Human bites, like animal bites, should be treated with
co-amoxiclav
