SPEACIALITIES TABLE Flashcards
What is the most common form of dementia?
Alzheimer’s disease
Alzheimer’s disease is characterized by progressive neurodegeneration.
What are the two main pathological features of Alzheimer’s disease?
- Amyloid plaques
- Tau tangles
Which brain regions are primarily affected in Alzheimer’s disease?
- Hippocampus
- Cerebral cortex
What neurotransmitter is typically reduced in Alzheimer’s disease?
Acetylcholine
What are some risk factors for Alzheimer’s disease?
- Advanced age (> 65)
- Apolipoprotein E (APOE) gene
- Downs syndrome
- CV risks (hypertension, hypercholesterolemia, diabetes, obesity)
- Traumatic brain injury
- Family history
- Low educational attainment
What are early symptoms of Alzheimer’s disease?
- Memory impairment
- Language impairment
- Executive dysfunction
What cognitive assessment tool indicates decline in cognitive function if MMSE score is less than what value?
27
What treatment options are available for mild to moderate Alzheimer’s disease?
- Cholinesterase inhibitors (Rivastigmine, Galantamine, Donepezil)
- NMDA inhibitor (Memantine for severe cases)
What is the second most common type of dementia?
Vascular dementia
How does vascular dementia primarily present?
Cognitive impairment due to cerebrovascular disease
What are common symptoms of vascular dementia?
- Stroke-like symptoms
- Sudden cognitive impairment
- History of cerebrovascular events
What imaging technique is used to identify vascular changes in vascular dementia?
MRI of the head
What is a key characteristic of Lewy body dementia?
Visual hallucinations
What are common symptoms of Parkinson’s disease?
- Resting tremor
- Bradykinesia
- Rigidity
- Postural instability
What is the primary treatment for Parkinson’s disease?
Levodopa
What is frailty in geriatric patients?
A susceptible state leading to increased vulnerability to stress
What are the criteria for frailty according to Fried et al.?
- Unintentional weight loss
- Exhaustion
- Weak grip strength
- Slow walking speed
- Low physical activity
What is delirium?
Acute change and fluctuating disturbance in attention, cognition, and consciousness
What are common causes of delirium?
- Medications
- Infections
- Low output state
- Metabolic disorders
What is the Rome IV criteria for constipation?
- < 3 bowel movements per week
- Hard stool 25% of time
- Excessive straining
- Manual evacuation needed
What is the primary treatment for constipation?
- Lifestyle modifications
- Laxatives (bulk-forming, osmotic, stimulant)
What is the difference between primary and secondary constipation?
- Primary: Functional issue with no organic cause
- Secondary: Caused by diet, medications, or underlying conditions
What is the significance of the 4AT screening tool?
It is used to screen for delirium in patients over 65 on admission.
What is a common symptom of hyperthyroidism that may affect older adults?
Cognitive impairment
What are some extrinsic factors contributing to incontinence?
- Co-morbidities
- Reduced mobility
- Medications
- Confusion
What are intrinsic factors affecting urinary incontinence?
- Bladder function issues
- Outlet function issues
What are the signs of postural hypotension?
Drop in systolic BP of 20mmHg or greater
What does the acronym ABCDE stand for in the context of emergency assessment?
Airway, Breathing, Circulation, Disability, Exposure
What should be considered when treating urinary retention in older adults?
Underlying causes such as medications or neurological conditions
What is the role of deep brain stimulation in Parkinson’s disease?
It is used for patients with motor symptoms not adequately controlled by medications.
What are the symptoms of normal pressure hydrocephalus?
- Gait disturbance
- Urinary incontinence
- Cognitive dysfunction
What is the condition characterized by confusion, delirium, and dementia?
These are cognitive impairments that can affect mobility and function
They may arise from various causes including medications or social circumstances.
What can excessive drinking lead to in terms of urinary function?
It can lead to increased urgency or incontinence
Timing of fluid intake can also play a role.
What are the effects of sedatives on urinary function?
Sedatives may impair the ability to move to the toilet
This can exacerbate incontinence issues.
What are the intrinsic factors affecting bladder function?
Bladder strength can be:
* Too strong
* Too weak
* Outlet too strong
* Outlet too weak
* A mixture of both
What is the normal storage capacity of the bladder?
400-600ml with a pressure of <10cm
The detrusor muscle relaxes during filling.
What role do CNS connections play in bladder function?
They inhibit PNS tone and promote bladder relaxation
This allows for urine storage.
What is the function of the pontine micturition center?
It exerts storage program neural connections until voluntary voiding occurs
What is stress incontinence?
It occurs when the bladder outlet is too weak, causing urine to leak with increased abdominal pressure
Common in women, especially after childbirth or menopause.
What are potential treatments for stress incontinence?
Treatment options include:
* Lifestyle changes
* Physiotherapy
* Medications
* Surgery
What causes urge incontinence?
It is caused by an overactive bladder muscle that contracts unexpectedly
May be due to infections or neurological disorders.
What is the role of anti-muscarinic medications?
They relax the detrusor muscle
Examples include oxybutynin and tolterodine.
What is overflow incontinence?
It occurs when the bladder outlet is too strong, preventing proper emptying
More common in men, often linked to BPH.
What are common causes of overflow incontinence?
Causes include:
* Urethral blockage
* BPH
* Radiotherapy-induced strictures
What is an underactive bladder?
A condition where the bladder is weak and unable to empty properly
Often secondary to neurological diseases.
What are the side effects of Parkinson’s medications?
Side effects may include:
* Postural hypotension
* Nausea and vomiting
What are dopamine agonists used for?
They are used to manage motor fluctuations and dyskinesia in Parkinson’s disease
Examples include ropinirole and cabergoline.
What is the function of MAO-B inhibitors in Parkinson’s treatment?
They reduce dopamine breakdown and increase central uptake of levodopa
What is malignant hyperthermia?
A potentially fatal reaction to general anesthesia characterized by rapid temperature increase and muscle rigidity
Most commonly due to an inherited mutation in the ryanodine receptor.
What is the significance of trisomy 21?
It is associated with Down syndrome, characterized by specific physical features and developmental delays
Screening is offered to all women in the UK during early pregnancy.
What are café-au-lait spots and their significance in NF1?
Café-au-lait spots are skin markings that can indicate neurofibromatosis type 1 if present in greater number
Six or more spots are significant for diagnosis.
What is the role of genetic testing in prenatal care?
It helps in identifying conditions like trisomy 21 or NF1 during pregnancy
Invasive tests like amniocentesis carry a miscarriage risk.
What are the CRABBING features of neurofibromatosis type 1?
They include:
* Café-au-lait spots
* Relative with NF1
* Axillary freckling
* Bony dysplasia
* Iris hamartomas
* Neurofibromas
What is the primary treatment for overflow incontinence caused by BPH?
Treatment may include:
* Alpha blockers (e.g., tamsulosin)
* Anti-androgens (e.g., finasteride)
* Surgical options like TURP
What is the first line rescue dose of opiates in palliative care?
1/6 of the background 24-hour dose
Example: if 30mg every 12 hours, then 10mg breakthrough dose.
What is scoliosis?
A condition characterized by an abnormal lateral curvature of the spine.
What unusual angulation condition affects the tibia?
Pseudoarthrosis.
What should patients report regarding visual health?
Symptoms related to visual acuity and visual fields.
What percentage of patients may develop cancer or malignant changes?
5%.
What is the increased risk associated with breast cancer?
Increased risk of breast cancer.
What are the features associated with certain genetic conditions?
- Macrocephaly
- Short stature
- Dysmorphic features
- Learning difficulties
- Epilepsy
- Scoliosis.
What tumors are associated with neoplasia in the central nervous system?
- Optic gliomas
- Endocrine tumors.
What are common symptoms related to renal artery stenosis?
Raised blood pressure and hypertension.
What is NF2 neurofibromatosis type 2?
A genetic disorder characterized by bilateral acoustic neuromas and tumors on chromosome 22.
What gene is associated with NF2?
NF2 gene, which codes for the protein merlin.
What type of tumors are schwannomas?
Benign tumors of Schwann cells.
What are acoustic neuromas?
Tumors of the auditory nerve.
What condition is characterized by progressive muscle wasting and weakness?
Myotonic dystrophy.
What gene mutation causes myotonic dystrophy?
Trinucleotide CTG repeat in the DMPK gene.
What are early signs of myotonic dystrophy?
- Bilateral late onset cataracts.
- Muscle weakness and stiffness.
What can cause respiratory compromise in myotonic dystrophy patients?
Anaesthetic during surgery.
What is Tuberous Sclerosis Complex (TSC)?
A genetic disorder with variable expression and features like kidney cysts and skin lesions.
What is the triad of symptoms for Tuberous Sclerosis?
- Epilepsy
- Learning difficulty
- Skin lesions.
What is the mean age of onset for Amyotrophic Lateral Sclerosis (ALS)?
55 years.
What are the main symptoms of ALS?
- Progressive muscle weakness
- Wasting
- Increased reflexes.
What is Duchenne muscular dystrophy?
An X-linked recessive disorder causing progressive proximal muscle weakness.
What is a characteristic sign in Duchenne muscular dystrophy?
Gower’s sign.
What is the genetic mutation associated with Huntington’s disease?
CAG expansion in the HTT gene.
What are the cognitive changes associated with Huntington’s disease?
- Poor planning and memory
- Subcortical dementia.
What is Marfan’s syndrome?
A genetic disorder affecting connective tissue.
What is Alpha 1 antitrypsin deficiency?
A genetic condition leading to lung and liver disease due to low levels of the protein.
What is cystic fibrosis?
A genetic disorder affecting the lungs and digestive system due to mutations in the CFTR gene.
What is haemochromatosis?
A genetic condition causing excessive iron accumulation in the body.
What is Wilson’s disease?
A genetic disorder leading to copper accumulation in the body.
What is MODY1?
Maturity Onset Diabetes of the Young type 1, a genetic form of diabetes.
What is a key indicator of a hereditary cancer risk?
Cancer in two or more close relatives on the same side of the family.
What is retinoblastoma?
A malignant tumor of the retina caused by a mutation in the RB1 gene.
What is the risk associated with BRCA mutations?
Increased risk of breast and ovarian cancer.
What is the purpose of prophylactic mastectomy in BRCA1 mutation carriers?
To reduce breast cancer risk to 5%.
What is the significance of laparoscopic oophorectomy in cancer prevention?
It reduces the risk of ovarian cancer.
What is Familial Adenomatous Polyposis (FAP)?
A genetic condition leading to numerous colorectal polyps.
What characterizes Hereditary Nonpolyposis Colorectal Cancer (HNPCC)?
Germline mutations in mismatch repair genes.
What is a common symptom of colorectal cancer?
Bleeding and constipation.
What is Turner syndrome?
A condition caused by the absence of one X chromosome in females.
What hormonal changes are associated with Turner syndrome?
Primary amenorrhea and elevated FSH/LH levels.
The normal intracranial pressure
7-15mmHg
The Centor criteria are: score 1 point for each (maximum score of 4)
for tonsilitis
presence of tonsillar exudate
tender anterior cervical lymphadenopathy
history of fever
absence of cough
3/-4-> streptoccoi pyogenes
The adrenal medulla releases two main hormones:
Epinephrine (adrenaline)
Norepinephrine (noradrenaline)
Conn’s syndrome
primary hyperaldosteronism. Aldosterone binds to and activates the Na+/K+ pump on the cell wall, which causes the movement of potassium into the cell. Excess aldosterone, as is present in Conn’s syndrome, causes excess movement of potassium into the cell, which causes hypokalaemia.
lack of smell (anosmia) in a boy with delayed puberty.
delayed puberty secondary to hypogonadotropic hypogonadism. It is usually inherited as an X-linked recessive trait.
kallmans
Insulin decreases serum potassium through stimulation of the Na+/K+ ATPase pump
a. true
b. false
true
