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Finals > General > Flashcards

General Flashcards

1
Q

4 types of dementia?

A

Alzheimer’s
Vascular
Lewy body
Frontotemporal

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2
Q

Pathophysiology of Alzheimer’s?

A

Beta amyloid plaques accumulation
Neurofibrillary tau tangles

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3
Q

Alzheimer’s symptoms?

A

5 As
Amnesia- short term worse than long
Aphasia
Agnostia- doesn’t recognise things
Apraxia- misusing objects as fail to identify

Continuous decline

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4
Q

Key facts about vascular dementia.

A

Cumulative effect of many small strokes
Step wise decline

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5
Q

Key facts about Lewy body dementia?

A

Fluctuates
Hallucinations with no other cause
Associated with Parkinson’s?

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6
Q

Key facts about fronto temporal dementia

A

U65 more common
Associated with MND
Behavioural change- e.g. hypersexual, aggressive, adventure seeking

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7
Q

What’s included in a confusion screen?

A

FBC -anaemia, infection
U&E - electrolytes
LFTs- encephalopathy, raised ammonia
CRP- infection
Haemostatics- iron, B12, folate
TFTs - more often hypothyroidism
Calcium
Phosphate
Magnesium

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8
Q

Cognitive screening tests?

A

AMT/ Abbreviated mental state test
6-CIT
Mini mental state

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9
Q

More detailed cognitive tests?

A

Addenbrookes cognitive exam (ACE)- /100
Cambridge cognition test

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10
Q

Alzheimer’s mild to moderate pharmacological tx?

A

Acetylcholinesterase inhibitors:
- Rivastigmine
- Donepazil
- Galantamine

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11
Q

Moderate to severe Alzheimer’s pharmacological tx?

A

NMDA receptor antagonist
- Memantine

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12
Q

If completely necessary to sedate a patient for their own safety (and no treatable cause found). What would you use?

A

0.5mg lorazepam, preferably oral

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13
Q

What is delerium?

A

Acquired, acute onset of altered consciousness or inattention.
Can be hyper or hypo

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14
Q

Causes of delerium?

A

PINCH ME (or MEDs)
Pain
Infection
Nutrition
Constipation
Hydration
Metabolic
Electrolytes
Drugs/alcohol
E.g. could they need chlordiazepoxide to treat their alcohol withdrawal rather than a sedating benzo

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15
Q

5 features of the mental capacity act?

A
  1. Presumed to have capacity
  2. Supported to make decisions
  3. Right to make an unwise decision
  4. Best interests is core to decision
  5. Intervention must be least restrictive
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16
Q

Assessing capacity features?

A

Understand
Retain
Evaluate
Communicate

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17
Q

What is used a a safeguard to staff when someone’s is treated without capacity?

A

DOLS
Deprivation of liberty standard

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18
Q

SSRIs are usually first line for anxiety, what’s usually second line? And examples

A

SNRIs
E.g.
Duloxetine
Venlafaxine

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19
Q

Management of panic disorder?

A

1st- CBT or drug therapy
1st SSRIs. If CI or no response after 12 weeks, try imipramine or clomipramine

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20
Q

Myeloma classically presents with/causes?

A

Lethargy
Hypercalcaemia
Pancytopenia
AKI

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21
Q

How does myeloma often present?

A

CRABBI

Calcium raised- constipation, nausea, anorexia, confusion

Renal

Anaemia- bone marrow infiltration

Bleeding- thrombocytopenia

Bones- bone marrow infiltration, particularly in spine

Infection

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22
Q

What is Graves’ disease?

A

Autoimmune disease caused by TSH receptor antibodies leading to hyperthyroidism

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23
Q

Which regions of an ECG are lateral leads?

A

1, aVL, V5, V6

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24
Q

What region on an ECG represent anterior aspect of heart, and it’s major artery?

A

Supplied by left anterior descending artery

V1-V4

25
Q

What region on an ECG represent inferior aspect of heart, and it’s major artery?

A

Right coronary artery

II, III, aVF

26
Q

Changes to ECGs post STEMI. Immediate and after few days?

A

Immediate
- hyperacute T waves
- then… ST elevation or new LBBB
Over next few days
- pathological Q waves
- T wave inversion

27
Q

Complications post MI?

A

Cardiac arrest
Arrhythmias
Heart failure
DVT/PE
pericarditis

28
Q

Causes of acute pulmonary oedema?

A

Post MI
Valvular disease
Arrhythmias e.g. complete heart block

Non- cardiac
- fluid overload 2nd to renal failure or overloaded
- post head injury
- ARDS

29
Q

Red swollen legions over shins, diagnosis?
And causes?

A

Erythema nodosum

Inflammation of sub-cut fat under shins
Painful, raised lumps, settle and turn into bruises

Mx: find and treat cause
Can last 6 weeks +

Causes:
Infection: strep, TB
Systemic: sarcoidosis, IBD, Behcets
Malignancy/ lymphoma
Drugs: penicillins, sulphonamides, COCP, pregnancy

30
Q

Erythema nodosum causes?

A

Many but key ones are
- Sarcoidosis
- Inflammatory bowel disease

Others
- strep throat infections
- gastroenteritis
- mycoplasma. pneumoniae
- TB
- pregnancy
- medications e.g. COCP, NSAIDS

31
Q

Define bronchiectasis?

A

Abnormal permanent dilatation of bronchi and bronchioles, usually caused by and leads to infections

32
Q

Common colonisers in CF?

A

Pseudomonas.aeruginosa
Strep.pneumonia
Haem,influenzae

33
Q

Causes of bronchiectasis?

A
  • Post-infection- untreated/inadequately treated
  • Post-obstruction- foreign body, tumour, lymphadenopathy
  • Congenital
  • Immunodeficiency
  • Allergic bronchopulmonary aspergillosis
  • Alpha 1 antitripsin deficiency
  • RA
  • UC
34
Q

Signs of bronchectasis?

A

Clubbing of fingernails
Course crepitations

Symptoms
- chronic productive cough
- occasional haemoptysis
- recurrent LRTI

35
Q

Investigation for bronchiectasis?

A

High resolution CT scan

36
Q

Normal pO2 and pCO2 (in kPa)

A

pO2 10.5-13.5 kPa
pCO2 4.7- 6 kPa

37
Q

PE on ECG findings?

A

‘S1Q3T3’ but actually rarely seen. Any signs of right heart strain e.g. incomplete RBBB

Deep S wave on lead 1
Deep Q wave with inverted T wave in lead 3

+ sinus tachycardia

38
Q

Lung cancer most commonly metastasises to where? (4 places)

A

Brain
Bone
Liver
Adrenals

39
Q

What’s used to stage lung cancer?

A

PET cancer
Bone scan

40
Q

Investigations for lung cancer?

A

CXR
Staging CT scan- contrast
PET-CT- shows where is metabolically active
Bronchoscopy with endobronchial US (EBUS)
Histology analysis- biopsy

41
Q

Chest xray findings with lung cancer?

A

Peripheral opactity- ie consolidation in lung field
Hilar enlargement
Pleural effusion- usually unilateral
Collapse

42
Q

What neurological conditions is associated with a type of lung cancer? And what type of lung cancer is this?

A

Lambert Eaton myasthenic syndrome
Associated with small cell lung cancer. Antibodies against lung cancer are similar to bodies voltage gated calcium channels –> these are needed for acetylcholine release in pre synaptic terminals–> less acetylcholine released

43
Q

How does Lambert Eaton syndrome present?

A
  • Proximal muscle weakness- most notably proximal leg weakness
  • Double vision (diplopia)- intraocular muscle weakness
  • Drooping eyelids (ptosis)- levator muscle weakness
  • Slurred speach and dysphagia- oropharyngeal muscle weakness

Autonomic dysfunction causing
- Dry mouth
- Blurred vision
- Impotence
- Dizziness

44
Q

Staging for lung cancer?

A

TNM staging

Tumour- size and nearby spread
Nearby spread to lymph nodes
Metastases

45
Q

How does superior vena cava obstruction present?

A

Severe SOB
Severe headache
Perioribital swelling
Raised JVP
Dilated neck veins
Dilated veins across chest

46
Q

Steroid side effects?

A

Endocrine- adrenal suppression, hyperglycaemia
Change in fat distribution- central obesity, buffalo hump, moon face
Skin- bruising, skin thinning
Eyes- cataracts
MSK- muscle wasting, osteoporosis, a vascular necrosis of femoral head
Psych- psychosis, euphoria
CVS- hypertension
Immunosuppression
Peptic ulcers

47
Q

Trigeminal neuralgia 1st line?

A

Carbamazepine

48
Q

Acne treatment pathway?

A

Topical benzoyl peroxide
Topical retinoids *needs contraception
Topical abx e.g. clindamycin
- prescribed with benzoyl peroxide to reduce resistance
Oral abx e.g. lymecycline
COCP e.g. co-cyprindiol- higher risk VTE
Oral retinoids e.g. isotretinoin- specialist only, teratogenic!

49
Q

What two LFTs will be very high in cholestasis?

A

ALP - alkaline phosphatase
GGT- gamma glutamyl transferase

50
Q

73yo M with headaches and pain in limbs and recent hearing deteriation. What are you suspecting and what blood tests finding is usually abnormal in this condition?
What would you use to treat this condition?

A

Paget’s disease of bone
Raised ALP- with calcium and phosphate normal

Bisphosphonates- oral risedronate or IV zolendronate

51
Q

Ex-alcoholic with confusion, distended abdomen, spider naevi and hepatic flap.
Diagnosis? Treatment 1st line?

A

Hepatic encephalopathy

Lactulose

52
Q

Blood marker specific for liver cirrhosis?

A

Alpha fetoprotein

53
Q

Ca 19-9 indicative of what?

A

A tumour marker
Indicative of cholangiocarcinoma (cancer of bile ducts) or pancreatic cancer
Can be raised in other condiations, not too specific

54
Q

What is Courvoisier’s law?

A

A palpable gallbladder with jaundice is unlikely to be gallstones. Usually cholangiocarcinma or pancreatic cancer
* pancreatic cancer is more common though so more likely on an exam situation

55
Q

A tumour marker indicative of bowel cancer?

A

Carcinoembryonic antigen (CEA)

56
Q

What is a raised Carcinoembryonic antigen a marker of?

A

A tumour marker indicative of bowel cancer

57
Q

78yo M attends with recent urinary incontinence, has become forgetful and a shuffling gait. Top differentials?

A
  • Normal pressure hydrocephalus: triad of gait abnormality, dementia and urinary incontinence
  • Parkinson’s
  • Delirium
  • Dementia
58
Q

Management of normal pressure hydrocephalus?

A

Ventriculoperitoneal shunt (into peritoneal cavity)
Usually develops after a head injury, SA, or meningitis.
It’s a reversible cause of dementia

59
Q

What blood markers indicate tumour lysis syndrome?

A

High uric acid/urate
High phosphate
High potassium/hyperkalaemia
Low calcium

Finals (13 decks)

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