Tues Flashcards
large vessel atherosclerosiss stroke
carotid artery stenosis
atherosclerosis then goes to smaller cerebral artery
causes of ischeamic stroke
large vessel atherosclerosis
cardio embolic
15% of strokes are haemorrhagic.
rare- vasculitis
cardio embolic stroke
atrial fibrillation there is stasis of blood flow in the left atrium
so thrombus in LA then goes to brain
Haemorrhagic stroke
rupture of a cerebrospinal artery.
total anterior circulation infarct (TACI)
A TACI involves the anterior AND middle cerebral arteries on the affected side
total anterior circulation infarct symptoms
Contralateral hemiplegia/hemiparesis, AND
Contralateral homonymous hemianopia, AND
Higher cerebral dysfunction (e.g. aphasia, neglect)
partial anterior circulation infarct (PACI)
anterior OR middle cerebral artery on the affected side.
partial anterior circulation infarct symptoms
Contralateral hemiplegia or hemiparesis, AND
Contralateral homonymous hemianopia
OR
higher cerebral dysfunction ONLY
lacunar infarct (LACI)
small deep perforating arteries, supplying internal capsule or thalamus.
lacunar infarct symptoms
pure motor stroke, pure sensory stroke, sensorimotor stroke, ataxic hemiparesis or dysarthria-clumsy hand syndrome.
posterior circulation infarct (POCI)
vertebrobasilar arteries and associated branches (supplying the cerebellum, brainstem, and occipital lobe).
posterior circulation infarct symptoms
Cerebellar dysfunction, OR
Conjugate eye movement disorder-can’t move eyes together
OR
Bilateral motor/sensory deficit, OR
Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit, OR
Cortical blindness/isolated hemianopia.
posterior stroke syndromes
basilar artery occlusion
Anterior inferior cerebellar artery
Wallenberg’s syndrome
Weber’s syndrome/medial midbrain syndrome
Anterior inferior cerebellar artery
lateral pontine syndrome
pontine cranial nerve nuclei.
Basilar artery occlusion
locked in syndrome (quadriparesis/both arms and legs with preserved consciousness and ocular movements), loss of consciousness, or sudden death.
Wallenberg’s syndrome
lateral medullary syndrome) causes ipsilateral Horner’s syndrome,
ipsilateral loss of pain and temperature sensation on the face,
and contralateral loss of pain and temperature sensation over the contralateral body.
Weber’s syndrome/medial midbrain syndrome
paramedian branches of the upper basilar and proximal posterior cerebral arteries): causes an ipsilateral oculomotor nerve palsy and contralateral hemiparesis.
acute stroke management
Alteplase (tissue plasminogen activator) within 4.5 hours of symptom onset and with no contraindications to thrombolysis
Mechanical Thrombectomy can be performed in patients with anterior circulation strokes and some post
contraindications to thrombolysis
recent head trauma, GI or intracranial haemorrhage, recent surgery, acceptable BP, platelet count, and INR >1.7
ipsilateral carotid artery stenosis more than 50%
carotid endarterectomy.
chronic stroke management
lower hypertension 2 weeks post
Clopidogrel 75 mg
high dose atorvastatin 20-80
ischaemic stroke secondary to atrial fibrillation chronic stroke management
warfarin (target INR 2-3. or a direct oral anticoagulant (such as Rivaroxaban or Apixiban) 2 weeks post-stroke.
Haemophillia A which clotting factor
8
right sided inferior homonymous quadrantanopia - in stroke affects what
left parietal lobe
Left temporal lobe stroke causes what optic symptom
right sided superior homonymous hemianopia
Damage to the left occipital lobe causes what
Right sided homonymous hemianopia with macular sparing
C. diff infection symptoms
gram-positive
watery diarrhoea
abdominal cramps
nausea,
dehydration
fever
weight loss
C. diff complications
toxic megacolon
pseudomembranous colitis
C diff management
Oral vancomycin
2nd- fidaxomicin
3rd - oral vancyomycin +/- IV metronidazole
when contraception after pregnancy
after 3 weeks
Diaphragm post delivery
6 weeks after
Intrauterine contraception post delivery
right after delivery or 4 weeks after
Progestogen-only contraception post delivery
can be started anytime
Combined hormonal contraception (CHC) (e.g. the combined oral contraceptive pill, patch or vaginal ring) post delivery
3 weeks after if have no risk of VTE
6 weeks if breastfeeding
Lactational amenorrhoea
when can’t get pregnant for 6 months post delivery if fully breastfeeding and no periods
NSAIDS and pregnancy
teratogenic
risk of premature closure of foetal ductus arteriosus in utero
resistant pulmonary hypertension of the newborn
delayed onset of labour
Cyclical mastalgia
sore boobs
trastuzumab side effects
for breast cancer
cardiac function
risks of COCP
stroke
migranes
Decompressive hemicraniectomy for stroke
less than 60 years old
reduced consciousness,
CT-defined infarct of at least 50% of the middle cerebral artery territory
mania treatment when patient has depression
stop antidepressant and start antipsycotic
antipsycotics
haloperidol
olanzapine
quetiapine
risperidone
what does cocaine cause
anxiety
diarrhoea
hypertensoin
heart problems
what is used in a colposcopy procedure are taken up by abnormal cervical cells to enhance their appearance
Acetic acid- makes abnormal cells look white instead of pink
local anaesthetic for cervical biopsy
Lidocaine
medication for MS for spasticity
baclofen
MS
chronic, inflammatory, autoimmune disease of the central nervous system, characterised by the demyelination and axonal loss of neurons
acute management of MS
Glucocorticoids
1g of intravenous methylprednisolone 3 days OR
plasma exchange
chronic management for spasticity for MS
Baclofen
wilsons disease
copper accumulation in liver and brain
ATP7B gene
wilsons disease
serum vs urine
high urine
low serum copper
wilsons disease management
Chelators
D-penicillamine/ trientine
zinc salts
induce metallothioneins, promoting a negative copper balance and reducing free plasmatic copper.
