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Y3 Medicine > Random 5 > Flashcards

Random 5 Flashcards

1
Q

What is the treatment for viral pericarditis?

A

Idiopathic or Viral Pericarditis
1st line: exercise restriction and NSAIDS (+ PPI) for 1-2 weeks.

2nd line: colchicine (SE: diarrhoea, use in caution in those with renal or hepatic impairment).

3rd line: corticosteroids (for those who cannot tolerate or refractory to NSAIDS)

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2
Q

How does Trospium work?

A

Used to treat an overactive bladder.

Trospium blocks the action of acetylcholine, a neurotransmitter that stimulates certain muscles, including those in the bladder. By inhibiting these signals, trospium helps to relax the bladder muscles, allowing the bladder to hold more urine and reducing the sudden urge to urinate.

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3
Q

What is Zopiclone?

A

Zopiclone is a medication used to treat insomnia, a condition characterized by difficulties falling asleep, staying asleep, or experiencing poor-quality sleep. It belongs to a class of drugs called sedative-hypnotics, which work by affecting certain chemicals in the brain to help people sleep.

How Zopiclone Works:
Zopiclone is a central nervous system depressant. It enhances the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. By increasing the effects of GABA, zopiclone helps to induce sleep, reduce the time it takes to fall asleep, and prolong the duration of sleep.

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4
Q

What is Citalopram?

A

Citalopram is an antidepressant medication that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). It is commonly prescribed to treat major depressive disorder, panic disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, and other mental health conditions.

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5
Q

Why is the leg shortened, abducted and externally rotated in a displaced #NOF?

A

Externally rotated
- Short lateral rotators of the hip (piriformis, obturator internus, superior and inferior gemelli and quadratus femoris)

Abduct
- Gluteus medius and minimus

Shortening
- Rectus femoris, adductor magnus and the hamstring muscles

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6
Q

What troponin level indicates a heart attack?

A

More than 0.40ng/ml

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7
Q

What three things are used to diagnose acute liver failure?

A
  1. INR of >1.5
  2. Confusion
  3. Deranged LFT’s
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8
Q

Tacrolimus

A

Used for excema and to prevent rejection of ‘stents, organs etc’

Inhibits the activity of T lymphocytes.

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9
Q

What drug can be used instead of atorvastatin if there is liver damage?

A

Ezetimibe
Selective cholesterol-absorption inhibitor
Inhibits NPC1L1 tranpsorter at brush border of small intestine.

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10
Q

What is budd-chiari syndrome?

A

Budd-Chiari syndrome is a condition in which the hepatic veins (veins that drain the liver) are blocked or narrowed by a clot (mass of blood cells). This blockage causes blood to back up into the liver, and as a result, the liver grows larger. The spleen (an organ located on the upper left side of the abdomen that helps fight infection by filtering the blood) may also grow larger.

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11
Q

What does it mean as a general rule of thumb when AST>ALT

A

Fibrosis of the liver

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12
Q

What does a raised ALT signify?

A

Hepatitis

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13
Q

What does a raised ALP signify?

A

Biliary duct blockage

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14
Q

What does a raised GGT signify?

A

Alcoholics also in fatty liver disease

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15
Q

What can be given in a stress echocardiogram if you are unable to exericse?

A

Dobutamine

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16
Q

What is broken heart syndrome?

A

Broken-heart syndrome, also known as stress cardiomyopathy or takotsubo syndrome, can occur when a person experiences severe emotional or physical stress.

It is called also ‘Takotsubo cardiomyopathy’ because the left ventricle resembles an octopus pot (what they use to catch octopi) on an angiography.

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17
Q

What findings on a dobutamine stress echocardiogram do you look for?

A

Utilizes an increasing dose of dobutamine (max 40mcg/kg/min) with simultaneous 2D precordial echocardiography

Looks for new or worsening wall motion abnormalities as an indicator of impaired perfusion, left ventricular systolic or diastolic dysfunction, valvular heart disease

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18
Q

What is the ‘new name’ for dementia?

A

Major neurocognitive disorders

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19
Q

What are the 6 domains of cognitive function?

A
  • Learning and memory
  • Social
  • Complex attention
  • Executive function
  • Perceptual meter
  • Language
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20
Q

Have a look through the mini mental state exam

A

Google

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21
Q

Why do we diagnose dementia in the community? What confounding factors are there in the community?

A

Infection, opioids, lack of sleep

22
Q

How do we diagnose dementia in the community?

A

The National Institute for Health and Care Excellence (NICE) guidelines for diagnosing dementia in the UK can be summarized into a simple process:

Assessment: A healthcare professional assesses the person’s symptoms, medical history, and conducts a physical and cognitive examination.

Cognitive Testing: The person undergoes a simple cognitive test (like MMSE or MoCA) to evaluate memory and thinking skills.

Blood Tests: Blood tests are done to rule out other possible causes of symptoms, such as vitamin deficiencies or thyroid problems.

Brain Imaging: Brain scans (MRI or CT) are considered to check for brain changes or other conditions causing dementia.

Specialist Referral: If the cause is unclear or if the person is younger than 65, they are referred to a specialist (usually a neurologist or geriatrician) for further assessment.

Diagnosis: Based on assessments and test results, a diagnosis is made, and appropriate support and treatment are provided.

23
Q

What are the two broad categories of cognitive assessment you can do at the bedside for a patient with dementia?

A

Executive Dysfunction:

Definition: Executive functions are higher-order cognitive abilities that allow people to plan, organize, initiate, sustain, and inhibit complex behavior. Executive dysfunction refers to difficulties in these cognitive processes.
Examples: Individuals with executive dysfunction might have trouble with decision-making, multitasking, problem-solving, impulse control, attention regulation, or goal setting.
Causes: Executive dysfunction can result from various conditions, including certain types of dementia (such as frontotemporal dementia), traumatic brain injury, stroke, or other neurological disorders.
Visuospatial and Perceptual Dysfunction:

Definition: Visuospatial and perceptual skills involve understanding and interpreting visual information, including spatial relationships and the perception of objects and their properties.
Examples: Difficulties with visuospatial and perceptual skills can lead to problems with tasks like reading maps, judging distances, recognizing faces, or coordinating movements based on visual input.
Causes: Visuospatial and perceptual dysfunction can be a feature of several conditions, including Alzheimer’s disease, Parkinson’s disease, Lewy body dementia, and certain types of brain injury.

24
Q

What is the most common form of dementia?

A

Mixed dementia. Vascular and Alzheimer’s

25
Q

What is the difference between Parkinson’s disease and lewy body dementia with parkinsonism?

A

If the dementia and movement disorder develop within a year of each other, it is referred to as Lewy Body Dementia; if they develop a year apart, it is referred to as Parkinson’s Disease Dementia. It is thought that in Parkinson’s, the inclusions first affect the substantia nigra to cause the movement disorder before ascending to involve the paralimbic and neocortical areas to result in dementia; in Lewy body dementia, it starts at the top and eventually descends to the substantia nigra, hence the difference in the timing of these two closely inter-related conditions.

Also parkinson’s tends to cause rigidity in the upper limbs and lewy body is the lower limbs.

26
Q

What are some risk factors for dementia?

A
  • Smoking
  • Diabetes
  • Obesity
  • Alcohol
  • Depression
  • Isolation
  • Head injury
  • Hypertension
27
Q

What is the pathophysiology of Alzheimer’s?

A

Amyloid plaques (amyloid beta) and neurofibrillary tangles (soluble tau proteins)

28
Q

What do tau proteins do?

A

Stabilizes the microtubules and gives nutrients to the axon terminals.

29
Q

How would you describe the progression of vascular dementia and why?

A

Step-wise. Associated with infarcts.Caused by impaired blood flow to areas of the brain due to vascular damage i.e. lots of micro-infarcts in someone with cardiovascular disease risk factors
Can have a ‘step-wise’ progression due to progressive infarcts over time

30
Q

What are lewy body deposits of?

A

Alpha synuclein

31
Q

What is the primary problem with lewy body dementia?

A

Cognitive decline

32
Q

What is REM sleep disorder?

A

Act out their dreams while they sleep

33
Q

Why are patients with lewy body dementia sensitive to neuroleptics?

A

Neuroleptics which may be given to manage agitation/hallucination (i.e. dopamine blocking medication) can trigger rigidity and Parkinsonism, whilst dopaminergic agents that may be given to help with the rigidity may worsen the hallucinations, therefore the management can be difficult.

There is a loss of dopamine.

34
Q

What is a daTSCAN?

A

A DaTscan, also known as a dopamine transporter scan, is a diagnostic imaging technique used to assess the levels of dopamine transporters in the brain. It is particularly useful in differentiating between Parkinson’s disease and other movement disorders that might have similar symptoms.

35
Q

Which type of dementia is strongly linked genetically?

A

Fronto-temporal

36
Q

What medication is best for lewy body dementia?

A

Rivastigmine

37
Q

Have a look at the reisberg dementia scale

A

Google

38
Q

What proteins are associated with fronto-temporal dementia?

A

Abnormal accumulation of specific proteins, including tau, TDP-43 (TAR DNA-binding protein 43), and FUS (Fused in Sarcoma), is associated with different subtypes of FTD. Here’s a brief overview of their roles in FTD:

39
Q

What is Wernicke’s encephalopathy?

A

Wernicke’s encephalopathy is a neurological disorder caused by thiamine (vitamin B1) deficiency, manifesting in a triad of specific clinical symptoms: ataxia, confusion, and ocular abnormalities.

The primary causes of Wernicke’s encephalopathy include:

Chronic alcohol abuse: Alcohol interferes with thiamine absorption and utilization.
Malnutrition: This can occur due to inadequate dietary intake, malabsorption disorders, or increased requirements.
Bariatric surgery: Rapid weight loss and reduced nutrient absorption can lead to thiamine deficiency.
Hyperemesis gravidarum: Persistent severe vomiting in pregnancy may lead to nutrient deficiencies, including thiamine.

40
Q

What is Kuru?

A

Kuru is a prion disease that was transmitted among the Fore people of Papua New Guinea through cannibalistic rituals. The disease is now rare, as these practices have been discontinued.

41
Q

What is Creutzfeldt-Jakob disease?

A

Creutzfeldt-Jakob disease is caused by prions, misfolded proteins that induce normal proteins within the brain to misfold and aggregate, leading to neuronal loss.

Leads to dementia, rapid decrease in movement and loss of mental function

42
Q

What percentage of dementia is preventable?

A

50%

43
Q

What is Korsakoff’s syndrome?

A

Korsakoff’s syndrome is a chronic memory disorder, often occurring as a late complication of untreated Wernicke’s encephalopathy. It is characterized by profound anterograde amnesia, limited retrograde amnesia, and confabulation.

44
Q

What are the three types of fronto-temporal dementia?

A
  1. Behavioural-variant
  2. Semantic
  3. Progressive nonfluent aphasia
45
Q

What is first line treatment for heart failure?

A

ACEi and BB

46
Q

Is nitrofurantoin safe in a low egfr?

A

NO should be stopped around 45mL/min

47
Q

What are examples of drugs used in prostate carcinoma?

A

Gnrh antagonists which slow cancer growth.
For example Degarelix.

48
Q

Why would ALP be high in a patient with prostate carcinoma?

A

Bone mets

49
Q

What are some side effects of Degarelix?

A

Hot Flashes: Feeling suddenly warm, sometimes with sweating and a flushed face.

Fatigue: Feeling tired or weak.

Nausea: Feeling the urge to vomit, though not everyone experiences this.

Muscle or Joint Pain: Aches or pains in the muscles or joints.

Chills: Feeling cold or shivery.

Diarrhea or Constipation: Changes in bowel habits.

50
Q

Give an example of a prescription cascade.

A

Donepezil (cholinesterase inhibitor). This leads to urinary incontinence. Then you are prescribed oxybutynin. Side effects are dizziness, leads to falls in elderly patients.

Y3 Medicine (17 decks)

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