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3 Long term conditions EJR > week 2 > Flashcards

week 2 Flashcards

1
Q

definition of epilepsy

A

2 or more recurrent unprovoked seizures

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2
Q

definition of seizure

A

clinical manifestation of abnormal synchronous neural discharge

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3
Q

definition of syncope

A

transient loss of consciousness due to cerebral hypoperfusion

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4
Q

how does a dissociative attack look different to a seizure

A 
asynchronous leg jerking
often around other people
no-post ictal syndromes
head shaking
forced eye closure

often hx of psychiatric conditions

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5
Q

differentials of a seizure (LoC)

A

cardiogenic - vasovagal, othrostatic, carotid sinus, structural arrhythmias

TIA

migraine

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6
Q

how to tell the difference between a syncope and a seizure

A

take detailed history from witness

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7
Q

what to clarify in seizure history?

A 
situation
warning signs
trigger
during
aftermath
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8
Q

what are the different types of seizures

A

partial seizure - simple and complex

generalised seizure - absence, tonic clonic etc.

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9
Q

difference between simple and complex partial seizure

A

patients who have had a complex seizure have no memory of the seizure, they lose consciousness

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10
Q

what is a jacksonian seizure

A

simple partial seizure starting in the medial motor cortex going up the motor cortex slice

often starts with mouth, tongue and lips going distally to hands and legs

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11
Q

how to investigate a epilepsy/seizure

A

detailed history
ECG
EEG
MRI

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12
Q

what to look for in an ECG of someone who had a seizure

A

prolonged QT interval
signs of MI
heart block

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13
Q

what can an EEG tell you in a seizure

A

interictal epileptic discharge
risk of recurrence
capture non-epileptic attacks

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14
Q

what are common automatisms

A

lip smacking, tongue actions, hands and finger gestures

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15
Q

prodromal symptoms of temporal lobe epilepsy

A 
butterfly in stomach
fear
aura
smells/visual hallucinations
deja-vu
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16
Q

how does a generalised tonic clonic seizure look like

A

may have cry
tonic phase with arms and legs extended and stiff
then clonic phase with synchronous jerking of limbs

postictal phase - drowsy, confused

aftermath - tongue biting, incontinence

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17
Q

difference between an absence seizure and a complex partial seizure

A

absence seizures usually start in childhood, the complex partial seizure can be at any age.

absence seizures are generalised onset seizures

absence seizures usually have no warnings, complex partial seizure usually have an aura

complex partial seizure lasts >30s, absence seizures last around 10 s or less

complex partial seizure have post ictal phase

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18
Q

what kind of seizure is a medial temporal lobe seizure

A

complex partial seizure

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19
Q

drug used for partial epilepsy

A

carbamazepine

lamotrigine

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20
Q

drug used for generalised epilepsy

A

sodium valproate

lamotrigine (teratogenic-risk)

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21
Q

definition of multiple sclerosis

A

multiple episodes of CNS dysfunction, disseminated in space and time

22
Q

risk factors of MS

A

genetics

vitamin D deficiency/low sun light

23
Q

pathophysiology of MS

A

immune system is activated by unknown cause, antibody production against CNS myelin and oligodendrocytes

24
Q

what is visible on MRI in a patient with MS

A

demyelination, plaques

25
Q

where are MS plaques often located

A

optic nerves
brain stem
spinal cord
cerebellar connections

26
Q

3 patterns of disease in MS

A

RRMS
PPMS
SPMS

27
Q

investigations and diagnosis of MS

A

clinical diagnosis, can be supported by MRI scan showing plaques, CSF showing oligoclonal bands, and evoked potentials showing prolonged conduction time

28
Q

what can trigger an MS episode

A

heat
inflammation
raised body temperature
infection

29
Q

common symptoms of MS

A

optic neuritis
brainstem syndromes
spinal cord lesions

30
Q

what eye symptoms are common in MS attacks

A

blurred vision/ or loss of
reduced saturation of red colours
unilateral eye pain

31
Q

what spinal cord lesion symptoms are common in MS

A

sensory changes
weakness
bladder and bowel dysfunction

32
Q

what MS symptoms are often associated with brainstem lesions

A 
nystagmus
vertigo
diplopia
facial palsy
dysarthria
ataxia
tremors
33
Q

some long term complications and complaints of MS patients

A 
fatigue
mood/depression
memory & concentration
vision impairment
swallowing and speech
sensory dysfunction
sexual dysfunction
bowel and bladder dysfunction
34
Q

4 medical options for MS management

A

steroids for short term attacks
beta-interferons
natalizumab
alemtuzumab

35
Q

possible side effect of natalizumab

A

progressive multifocal leucoencephalopathy

36
Q

what is the triad of parkinsonism

A

bradykinesa
rigidity
resting tremor

37
Q

what are some pre-motor symptoms of PD

A

loss of smell
depression
REM sleep disorder
constipation

38
Q

what are some symptoms of PD affecting the head/face

A 
mask face - loss of emotional expression
dysphagia/dysarthria/dysphonia
blurred vision
hypersalivation
anosmia
39
Q

what are some symptoms of PD affecting the MSK system

A

micrographia
dystonia
instability

40
Q

what are some gait symptoms of PD

A

shuffling gait
loss of arm swinging
freezing

41
Q

what are some GI symptoms of PD

A

constipation

incontinence

42
Q

what are some autonomic symptoms of PD

A

erectile dysfunction
dry eyes
bladder dysfunction

43
Q

what are some neuro psychiatric symptoms of PD

A

dementia
depression
impulse control disorders

44
Q

what else can cause parkinsonism

A

antipsychotics (haloparidol, sodium valproate)
antiemetics (metoclopromide)
head trauma
cerebrovascular d/z

45
Q

medical options for parkinsons disease

A

L-dopa
MAO-B inhibitors
COMT inhibitor
dopamine agonists

46
Q

what scoring system is used in suspected PE

A

wells score

47
Q

when is a D dimer test done in suspected PE

A

4 or less

48
Q

what is involved in a wells score

A

presence of DVT
tachycardia >100
immobilisation of 3 days or more in the last month
hx of PE or DVT
haemoptysis
cancer
dx of PE is more likely than anything else

49
Q

what is done if someone is suspected of PE and has a wells score of over 4

A

hospital admission
CTPA
LMWH

50
Q

what is done if someone is suspected of PE and has a wells score of ≤4

A

D dimer - if +ve then do CTPA

if D dimer -ve then consider alternative diagnosis

3 Long term conditions EJR (8 decks)

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