Year 3 Flashcards
Wernicke’s encephalopathy - clinical features triad
confusion
ataxia
opthalmoplegia
Wernicke’s encephalopathy management
thiamine replacement (IV Pabrinex)
Korsakoff’s syndrome features
profound anterograde amnesia, limited retrograde amnesia and confabulation
Ischaemic stroke management
thrombolysis: alteplase within 4.5 hours of symptom onset
thrombectomy: within 6 hours (but kinda fine within 12 or 24 hours)
aspirin
TIA investigations
MRI non contrast
Carotid ultrasound
bacterial meningitis: common organisms in neonates
listeria
group B strep
E coli
bacterial meningitis: common organisms in infants and young children
H influenza
bacterial meningitis: common organisms in adults
neisseria meningitidis
strep pneumoniae
bacterial meningitis: common organisms over age 65
listeria
strep pneumoniae
viral meningitis common organism
enteroviruses (echovirus, coxsackievirus)
Bacterial meningitis: LP CSF findings
cloudy
high protein (cause lots of bacteria)
low glucose (bacteria using it up)
high WCC (neutrophils)
opening pressure usually elevated
Viral meningitis: LP CSF findings
clear
normal protein
normal glucose
high WCC (lymphocytes)
negative culture
opening pressure normal or elevated
bacterial meningitis adult management
Ceftriaxone IV 2g BD + Dexamethasone IV 10mg QDS (started with or just before first dose of antibiotics for 4 days)
When would you add in amoxicillin to the bacterial meningitis treatment in adults
adults >60 or immunocompromised
generalised tonic clonic seizure treatment
- sodium valproate
- lamotrigine or levetiractam
focal seizure treatment
- lamotrigine or levetiracetam
- carbamazepine second line
myoclonic seizure treatment
- sodium valproate
- levetiracetam
tonic and atonic seizure treatment
- sodium valproate
- lamotrigine
absence seizure treatment
ethosuximide
focal seizures - frontal lobe features
- head/leg movements
- post-ictal weakness
- jacksonian march
focal seizures - temporal lobe features
- aura
- deja vu
- automisms (lip smacking)
focal seizures - parietal lobe feature
paraesthesia
first unprovoked epileptic seizure or a single isolated seizure - driving rules
no driving for 6 months
upper motor neurone signs
spasticity
hyperreflexia
babinskis reflex
lower motor neurone signs
fasciculations
muscle wasting (atrophy)
progressive muscular atrophy (MND)
only lower motor neurone features
primary lateral sclerosis (MND)
only upper motor neurone features
rare
medical treatment of migraine - acute
NSAID (aspirin, naproxen, ibuprofen)
If gastroparesis consider antiemetic
Triptans (5HT agonist)
migraine medical prophylaxis
propanalol
amitriptyline
topiromate
do you get nausea/vomiting in tension headache
no
hydrocephalus presentation
related to increased ICP
- early morning headaches
- N+V
- lethargy
- vision disturbances
- balance problems
- cognitive difficulties
normal pressure hydrocephalus - Hakim’s triad
dementia
magnetic gait
incontinence
typical patient with idiopathic cranial hypertension
younger, overweight female
many have polycystic ovaries
medical management of trigeminal neuralgia
1st line: carbamazepine
gabapentin
phenytoin
cluster headache management
acute: high flow O2 100% with a subcutaneous or nasal triptan, steroids
prophylaxis: verapamil
paroxysmal hemicrania
like cluster headache but more common in women
severe unilateral headache
10-30mins duration
1-40 a day
what has absolute response to indomethicin
paroxysmal hemicrania and hemicrania continua
typical antipsychotics examples
haloperidol
prochloperazine
fluphenazine
chlorpromazine
typical antipsychotics mechanism of action
non-selectively block D2 and other receptors
reduce positive symptoms
atypical antipsychotics examples
olanzapine
rispiridone
quetiapine
aripiprazole
clozapine
amisulpride
clozapine monitoring
ECG and FBC before starting
FBC every week for 18 weeks then every 2 weeks thereafter
weight on each visit
HELLP syndrome
haemolysis, elevated liver enzymes, low platelets
early vs late preeclampsia
<34 weeks vs >34 weeks
pre-eclampsia clinical features
hypertension
proteinuria
oedema
may be asymptomatic
pre-eclampsia management
low dose aspirin
cure is birth
hallmark feature of eclampsia
new onset tonic-clonic type seizure, in the presence of pre-eclampsia
eclampsia management
IV labetalol to control BP
Stop seizures - IV magnesium sulphate
Fluid balance
Delivery
Auer rods
AML
Philadelphia chromosome
CML
CML chromosome translocation
9:22
CML 3 phases
chronic, accelerated, blast
CML management
stem cell/bone marrow transplant
tyrosine kinase inhibitors e.g. imatinib
What leukaemia can cause warm autoimmune haemolytic anaemia
CLL
smear or smudge cells
CLL
which leukaemia can transform into high-grade lymphoma
CLL
Lymphoma risk factors
HIV
EBV
which lymphoma is associated with H pylori infection
MALT lymphoma
reed sternberg cell
hodgkins lymphoma
what is R-CHOP chemo used for
non-hodgkins lymphoma
