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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
where are MS plaques often located
optic nerves brain stem spinal cord cerebellar connections
26
3 patterns of disease in MS
RRMS PPMS SPMS
27
investigations and diagnosis of MS
clinical diagnosis, can be supported by MRI scan showing plaques, CSF showing oligoclonal bands, and evoked potentials showing prolonged conduction time
28
what can trigger an MS episode
heat inflammation raised body temperature infection
29
common symptoms of MS
optic neuritis brainstem syndromes spinal cord lesions
30
what eye symptoms are common in MS attacks
blurred vision/ or loss of reduced saturation of red colours unilateral eye pain
31
what spinal cord lesion symptoms are common in MS
sensory changes weakness bladder and bowel dysfunction
32
what MS symptoms are often associated with brainstem lesions
``` nystagmus vertigo diplopia facial palsy dysarthria ataxia tremors ```
33
some long term complications and complaints of MS patients
``` fatigue mood/depression memory & concentration vision impairment swallowing and speech sensory dysfunction sexual dysfunction bowel and bladder dysfunction ```
34
4 medical options for MS management
steroids for short term attacks beta-interferons natalizumab alemtuzumab
35
possible side effect of natalizumab
progressive multifocal leucoencephalopathy
36
what is the triad of parkinsonism
bradykinesa rigidity resting tremor
37
what are some pre-motor symptoms of PD
loss of smell depression REM sleep disorder constipation
38
what are some symptoms of PD affecting the head/face
``` mask face - loss of emotional expression dysphagia/dysarthria/dysphonia blurred vision hypersalivation anosmia ```
39
what are some symptoms of PD affecting the MSK system
micrographia dystonia instability
40
what are some gait symptoms of PD
shuffling gait loss of arm swinging freezing
41
what are some GI symptoms of PD
constipation | incontinence
42
what are some autonomic symptoms of PD
erectile dysfunction dry eyes bladder dysfunction
43
what are some neuro psychiatric symptoms of PD
dementia depression impulse control disorders
44
what else can cause parkinsonism
antipsychotics (haloparidol, sodium valproate) antiemetics (metoclopromide) head trauma cerebrovascular d/z
45
medical options for parkinsons disease
L-dopa MAO-B inhibitors COMT inhibitor dopamine agonists
46
what scoring system is used in suspected PE
wells score
47
when is a D dimer test done in suspected PE
4 or less
48
what is involved in a wells score
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
what is done if someone is suspected of PE and has a wells score of over 4
hospital admission CTPA LMWH
50
what is done if someone is suspected of PE and has a wells score of ≤4
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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