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1
Q

best imagine in cerebellar disease?

A

MRI

CT best for infarct/haemorrhage

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2
Q

which clotting factors are sensitive to temperature?

A

5 and 8

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3
Q

3 groups of opioid receptors?

A

Mu (u)
kappa
delta

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4
Q

what type of receptor are opioid receptors?

A

GPCRs

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5
Q

how do opioids work?

A

bind to opioid receptors (mainly u receptors) and potentiate effects of GABA transmission??

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6
Q

visual field defect in parietal lobe vs optic tract?

A

parietal lobe = quadrantanopia

optic tract = homonymous hemianopia

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7
Q

2 possible differentials for “strawberry tongue”?

A

Kawasaki disease

scarlet fever

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8
Q

features of kawasaki disease?

A 
strawberry tongue
uveitis/conjunctivitis
fever lasting >5 days which doesn't respond to paracetamol
shredding rash on extremities
coronary artery aneurysm
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9
Q

what is kawasaki disease?

A

type of vasculitis mainly affecting children

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10
Q

features of scarlet fever?

A

strawberry tongue
sore throat (group A strep)
sandpaper rash

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11
Q

what is scarlet fever?

A

illness developing from group A strep infection

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12
Q

where is the enteric nervous system found?

A

in the walls of the gut

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13
Q

how is the enteric nervous system involved in depression?

A

95% of the bodys serotonin is found in the gut

lack of serotonin can cause depression so a good gut biome can help with depression

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14
Q

how long must low mood last to be classed as depression?

A

2 weeks

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15
Q

which criteria is used by NICE in classifying depression?

A

DSM-5

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16
Q

DSM-5 criteria is divided into major and minor criteria, what are the 3 major criteria?

A

depressed mood continuously
lack of interest or pleasure (anhedonia)
fatigue or loss of energy (anergia)

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17
Q

what are the 6 minor criteria of DSM-5 for depression?

A
  1. significant weight loss when not dieting or weight gain
  2. insomnia or hypersomnia
  3. psychomotor agitation or retardation
  4. feelings of worthlessness of excessive guilt
  5. difficulty concentrating or indecisiveness
  6. recurrent thoughts of death or suicidal ideation
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18
Q

how is depression assessed?

A

hospital anxiety and depression (HAD) scale

patient health questionnaire (PHQ-9) scale

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19
Q

how is suicide risk assessed?

A

SADPERSON score

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20
Q

how is depression managed?

A 
general measures (sleep, diet, exercise etc)
1st line = CBT
antidepressants - SSRIs usually tried first
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21
Q

what is heart failure?

A

state of reduced cardiac output / increased intra-cardiac pressure

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22
Q

2 types of heart failure?

A

acute (decompensated)

chronic (compensated)

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23
Q

4 general causes of heart failure?

A

structural problem - valve disease e.g aortic stenosis etc
myocardial problem - post MI, ischaemic heart disease, hypertension, cardiomyopathy, alcohol etc
arrhythmia
increased peripheral demand - anaemia, pregnancy and sepsis

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24
Q

symptoms of heart failure?

A 
breathlessness (including paroxysmal nocturnal dyspnoea from left side)
reduced exercise tolerance
weight gain
oedema (ankle or sacral)
ascites (right sided)
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25
signs of heart failure?
pulmonary oedema (bibasal crackles and left sided wheeze) pleural effusion (reduced air entry at bases) pitting oedema at ankles/sacrum ascites (right sided) raised JVP (right side) displaced apex beat and S3 heart sound
26
how is heart failure severity assessed?
New York Heart Association (NYHA) criteria
27
what are the 4 classes of severity according to NYHA?
``` class 1 = no limitations of normal physical activity class 2 = slight limitation of physical activity due to symptoms like breathlessness class 3 = slight activity causes symptoms class 4 = unable to carry out any activity due to symptoms ```
28
how is heart failure investigated?
ECG CXR ECHO
29
ECG features of heart failure?
LVH may show increased precordial voltages | may show risk factors such as AF
30
CXR features of heart failure?
cardiomegaly (>50% of cardiothoracic ratio) prominent upper lobe veins fluid in fissures diffuse interstitial shadowing (perihilar bat wings) kerly B lines pleural effusion
31
ECHO features of heart failure?
should be done within 48 hrs of acute heart failure identifies valvular disease, ventricular dysfunction and shunts assesses ejection fraction preserved EF is >40% while <40% is classed as reduced
32
how is acute heart failure managed?
1. sit patient up 2. high slow oxygen 3. IV diuretics (furosemide) 4. withhold nephrotoxic drugs and beta blockers) 5. opiates, vasodilators, CPAP, inotropic agents
33
how is chronic heart failure managed?
1st line = beta blockers + ACE inhibitors (but dont start both at same time!) 2nd line = either an aldosterone agonist (e.g spironolactone) if potassium is low or angiotensin 2 blocker (e.g losartan) or hydralazine + nitrate if potassium is normal should also give one off pneumococcal vaccine and annual flu vaccine
34
acute coronary syndrome is defined as what?
syndrome of: - unstable angina or - non-STEMI or - STEMI
35
acute coronary syndrome should be clinically suspected if a patient presents with what symptoms?
central crushing chest pain +/- radiation to jaw or arms
36
other associated symptoms of acute coronary syndrome?
breathless (may be the only symptoms in diabetics) nausea and vomiting sweaty and clammy
37
most important first tests in acute coronary syndrome?
``` ECG (differentiates between STEMI and NSTEMI and unstable angina) troponin 1 (serial troponin tests 6 hrs apart to differentiate NSTEMI and unstable angina) ```
38
acute management of acute coronary syndrome?
MONAT or MONAC - morphine - oxygen - nitrates (GTN) - aspirin 300mg - tricagrelor/clopidogrel
39
how do unstable angina, NSTEMI and STEMI differ?
all have symptoms of acute coronary syndrome only STEMI has abnormal ECG only unstable angina has normal troponin (other 2 are raised)
40
ECG features of STEMI?
ST elevation 1mm in limb leads (II, III, aVF) or ST elevation 2mm in chest leads (V1 - V6)
41
ECG features of anterior MI (STEMI)?
ST elevation in V1-V4 | LAD artery
42
ECG features of anterolateral MI (STEMI)?
ST elevation in I, V5, V6 | left circumflex artery
43
ECG features of inferior MI (STEMI)?
ST elevation in II, III, aVF | right coronary artery
44
ECG features of posterior MI (STEMI)?
reciprocal changes in anteroseptal leads V1-V3 ST depression tall broad R waves upright T waves right coronary artery or posterior descending artery
45
definitive management of STEMI?
percutaneous coronary intervention (PCI)
46
definitive management of NSTEMI or unstable angina?
grace score helps decide further management - whether they need an angiogram or secondary prevention measures
47
secondary prevention of acute coronary syndrome?
``` general health advice (smoking, diet etc) medication - aspirin 75mg - some may need second anti-platelet - beta blocker - ACE inhibitor - statin ```
48
what causes hand, foot and mouth disease?
coxackie A16 virus
49
what does parvovirus B16 cause?
slapped cheek syndrome
50
what is a syndrome?
set of clinical features which appear together and are usually associated with certain conditions
51
what is nephrotic syndrome?
due to increased permeability of proteins through a damaged basement membrane of the glomerulus
52
what is nephritic syndrome?
inflammation of the kidney which can affect glomerulus (glomerulonephritis) or tubules/renal tissue (tubulo-interstitial nephritis)
53
features of nephrotic syndrome?
massive proteinuria >3.5g/day hypo-albuminaemia (serum albumin <30g/L) oedema (facial/periorbital in children and peripheral in adults) hypogammaglobulinaemia (predisposes to recurrent infection) hypercholesterolaemia + hyperlipidaemia + loss of anti-thrombin 3 (causes prothrombin state - DVT, PE, MI etc)
54
primary causes of nephrotic syndrome?
minimal change disease focal segmental glomerulosclerosis membranous glomerular disease membranoproliferative glomerulonephritis
55
most common cause of nephrotic syndrome in children vs adults?
``` children = minimal change disease adults = focal segmental glomerulosclerosis ```
56
secondary causes of nephrotic syndrome?
diabetes (most common 2ndary cause) others eg infection drugs (penacillamine, gold, NSAIDs) metabolic (amyloidosis)
57
features of nephritic syndrome?
limited proteinuria <3.5g/day oliguria and azotemia (raised urea and creatinine) fluid retention (periorbital, peripheral and pulmonary oedema) uraemic symptoms (anorexia, pruritis, nausea) red cell casts in urine (haematuria) hypertension
58
causes of nephritic syndrome?
IgA nephropathy (buerger's disease) post - group A strep glomerulonephritis rapidly progressive glomerulonephritis alport syndrome
59
types of rapidly progressive GN?
linear anti-basement membrane antibody (goodpasture syndrome) granular (immune complex deposition) - post strep GN or diffuse proliferative SN in lupus pauci-immune: wegner granulomatosis, microscopic polyangitis, churg strauss
60
general management of nephrotic and nephritic syndrome
blood tests renal biopsy nephrotic = fluid and salt restriction, diuretics, corticosteroids in certain areas nephritic = fluid and salt restriction, treat hypertension (ACEi's), consider steroids and immunosuppression in some cases
61
what blood tests done in nephrotic and nephritic syndrome?
``` FBC U&Es LFT albumin Ig C3, C4 ANA ANCA anti-dsDNA ```

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