adolygu M&M Flashcards
(162 cards)
1
Q
What are the causes of cerebellar disorders?
A
P- paraneoplastic A- alcoholism S- Stroke/sclerosis T- Trauma R-Rare (fredrick's) I- Iatrogenic E- Endocrine (hypothyroid) S-space occupying lesions
2
Q
Define Bell’s Palsy
A
Complete one sided weakness of the face- a LMN disease in isolation.
3
Q
What is the scale for reporting muscle strength?
A
No power = 0 Twitching but no movement = 1 Movement but cannot overcome gravity = 2 Can overcome gravity = 3 Movement against gravity + resistance = 4 Normal strength = 5
4
Q
What is treatment for mild depression?
A
Low-intensity psycho-social intervention e.g. guded self help or low intensity CBT.
5
Q
What do you always do in a mental health history?
A
Suicide Risk!
6
Q
What does vertical gaze palsy in the context of a Parkinson’s exam suggest?
A
Progressive supranuclear palsy.
7
Q
What do you look for on MRI for supranuclear palsy?
A
Humming bird sign - The atrophy of the midbrain results in a profile of the brainstem (in the sagittal plane) in which the preserved pons forms the body of the bird, and the atrophic midbrain the head, with beak extending anteriorly towards the optic chiasm.
8
Q
Symmetrical Parkinson’s signs, hypotension and bladder instability suggests what?
A
Multi-systems Atrophy.
9
Q
What are the causes of Delerium?
A
P-Pain IN-Infection C-constipation and urinary retention H-hydration M-medications E-environment
10
Q
What are the 3 types of care home?
A
Care home without nursing, care home with nursing, specialist dementia care home.
11
Q
What investigations need to be done following a TIA?
A
ECG, Carotid artery ultrasound doppler, BMI, BM, FBC, U&E, LFT and Lipids.
12
Q
Define stroke
A
Clinical syndrome when blood supply to a part of the brain is restricted /compromised, This can be either due to Ischaemic stroke (blockage) or by Haemorrhagic stroke.
13
Q
What do you need to do to patient has recurrent falls?
A
Multifactorial Falls Assessment.
14
Q
What is the most common cause of acute neuromuscular weakness in the developed world?
A
Guillain-Barre Syndrome.
15
Q
What are the symptoms of an UMN lesion?
A
Increased reflexes, Increased tone and positive reflex and clonus.
16
Q
What are the symptoms of a LMN lesion?
A
Decreased reflexes, normal/decreased tone, fasicultions
17
Q
What part of the spinal cord transmits information about proprioception, fine touch and vibration?
A
Dorsal Cloumn.
18
Q
What part of the spinal cord transmits information about temperature and pain?
A
Spinothalamic tacts.
19
Q
What do you check visual acuity with?
A
Snellen chart.
20
Q
How do you test for saccades?
A
Hold palm to one side of the patient and fist to other, as to look at each in term.
21
Q
What does chest pain, breathlessness and collapse n exertion suggest?
A
Aortic stenosis.
22
Q
What is the treatment for Alzheimer’s?
A
Donepazil, galantamine and rivastigmine (mild)
Memantine- (advanced).
23
Q
What are donepazil and galantamine contraindicated in?
A
Bradycardia, LEft bundle branch block and prolonged QT - DO ECG before starting.
24
Q
What test do you need to do before starting memantine?
A
U+E as it can cause renal impairment.
25
What are the questions you need to ask to determine a patiwentient's insight?
R-rationale how do they?
A-attribute why are they ill?
T-treatment do they feel they need it?
E-engagement alternative explanations?
26
What are the complications of Rheumatoid Arthritis?
Pulmonary fibrosis, lung nodules, carpal tunnel syndrome, haemolytic anaemia, Felty's syndrome = splenomegaly and neutropenia.
27
How do you ask a patient about pain?
```
S-site.
O-onset.
C-character.
R-radiation.
A-alleviating factors.
T-timeline.
E-exacerbating factors.
S- score out of 10.
```
28
Where do hebredens nodes appear?
DIP joints.
29
Where do bouchard's nodes appear?
PIP joints.
30
What is the special test in the Hip exam?
Thomas test, ask patient to bring knee to chest whilst you have a hand under their lumbar spine, look for fixed flexion deformity in non raised leg.
31
What is the test for BPPV?
DIX-HALLPIKE maneuver patient ooks at you at 45 degree angle then lower head at 20 degrees over the edge of the couch- nystagmus is positive.
32
What is the definitive treatment for a cholesteatoma?
Mastoidectomy.
33
Variable and progressive weakness of the eyelid and ocular muscles suggests what?
Myasthenia Gravis.
34
What would you expect to see in the LP of a person with MS?
Oligochlonal bands .
35
What is the commonest for of MS?
Relapsing -remitting, attacks with complete or partial recovery - there is no progression between attacks.
36
At what age should patients be routinely asked about falling?
65 years.
37
What are Important questions to ask after a patient falls?
Previous falls? Vision, cognition, continence, gait, osteoporotic risk factors?
38
What are Important questions to ask in the History of presenting complaint portion of falls history?
Before: Where/when/preceding symptoms/ why do they think they fell?
During: Lose consciousness, injure themselves?
After: Able to get up? any complications? given help?
39
What investigations are needed following falls?
Bone profile, TFTs, B12, Folate, FBC, U&E, ECG.
40
What can cause falls (mnemonic) ?
Drugs, Age related, Medical causes, Environmental.
41
Wat do you need to do if a patient comes in with suspected stroke?
Call the stroke team, URGENTLY! CT to look for haemorrhagic stroke, ECG to look for arrhythmia and Bloods (BM, FBC, hypercholesterolemia and clotting screen).
42
what is the difference between dysarthria and dysphagia?
```
dysarthria= disorder of speech.
dysphagia= disorder of language.
```
43
What is on the thrombolysis checklist?
clinical symptoms of acute stroke.
Measurble deficit on NIHSS.
Onset of symptoms within 4.5 hours.
Haemorrhagic stroke excluded by CT.
44
What are the risks of alteplase thrombolysis?
6% risk of haemorrhage (2-3% life threatening)
| 7% risk of angioedema.
45
What symptoms need to be present to diagnose a total anterior circulation stroke? TACS
Unilateral weakness of face, arm and leg.
Homonymous Hemianopia.
Higher cerebral dysfunction (dysphagia, visuospatial disorder).
46
What symptoms need to be present to diagnose a partial anterior circulation stroke? PACS
Any 2 of: Unilateral weakness of face, arm and leg.
Homonymous Hemianopia.
Higher cerebral dysfunction (dysphagia, visuospatial disorder).
47
What symptoms need to be present to diagnose a posterior circulation stroke?
Any 1 of: Cerebellar or brainstem syndromes,
2. Loss of consciousness.
3. Isolated homonymous hemianopia.
48
What symptoms need to be present to diagnose Lacunar stroke?
No evidence of higher cerebral dysfunction and 1 of:
Unilateral weakness of face, arm or leg.
Pure sensory stroke.
Ataxic hemiparesis.
49
Define a TIA
Transient ischaemic attack- a stroke who's symptoms resolve in 24hours.
50
How is stroke risk calculated following a TIA?
Using the ABCD2 score.
51
What is the DVLA guidelines on driving after TIA?
Can't drive a car for 1 month.
| Can't drive a bus/coach for a year.
52
What are the components of the confusion assessment method ?
1. Acute onset and fluctuting course+
2. Inattenton (count backwards) and either.
3. Disorganized thinking or
4. Altered levels of consciousness hyper/hypoalert.
53
What is the management of delerium?
Treat the underlying cause, reorientation and de-escelation techniques. If deescalation don't work and patient v agitated consider low dose anti-psychotic (check for contraindications).
54
What investigations are appropriate for delerium?
FBC, U&E, LFTs, BM, CRP, serum calcium, bowel chart, fluid balance chart, urine dip, urine culture, ECG and chest X-ray.
55
What other tests would you like to do following a parkinson's examination?
Assess micrographia, lying and standing BP, formally test cognition.
56
What would you expect from a patient with expressive dysphasia?
Patient speaks with difficulty but may have understanding in tact. Pathology of Broca's area.
57
What would you expect from a patient with receptive dysphasia?
Patient speaks fluently but does not make sense. Patient unaware of this, neologisms and parophasia. Pathology of Wernicke's area.
58
What electrolyte abnormalities would you expect to see in refeeding syndrome?
Phosphate, magnesium and potassium.
59
What are the components of the MUST score?
Measure BMI. See if there has been unintended decrease in % BMI of more than 5% in last 3-6 months, any acute disease effect.
60
What are the requirements for an Advanced Directives to be legal?
Decision made with capacity, is specific enough, made without duress and that it is signed and witnessed.
61
What antibodies are associated with SLE?
ANA. anti-dsDNA, Anti Ro, Anti La, complement.
62
Define fibromyalgia
A chronic (>3 months) widespread, (being on both sides of the body, above and below waist, along axial spine) pain disease. Associated with difficulty sleeping, poor concentration and memory.
63
How do you diagnose fibromyalgia?
Diagnosis of exclusion- TSH, 25-hydroxy vitamin D, Vitamin B12, iron studies, magnesium, ESR, CRP and any inflammatory condition possible from history.
64
What lifestyle recommendations do you make for people with gout?
Lose weight, reduce alcohol., avoid sugar sweetened drinks, avoid heavy meals, steak, marmite and offal. eat low-fat dairy produce, exercise regularly and take vitamin C supplaments.
65
What does pseudogout look like on microscopy?
Rhomboid shaped crystals, positively bifringent, blue under polarised light.
66
Is warfarin a contraindication for joint aspiration?
No.
67
What tool is used to evaluate fracture risk and risk of developing osteoporosis?
FRAX tool.
68
How do you advise patients to take bisphosphonates?
Take one tablet once a week, in the morning 30 mins before breakfast. Remain upright for 30 minutes after taking.
69
What is the main complication of bisphosphonates?
Osteonecrosis of the jaw- see dentist before starting therapy!
70
How do you advise patient to take methotrexate?
Take 1 tablet once a weekly, we'll build up dose slowly. Take a folic acid supplement on another day of the week.
71
What is the worst complication of methotrexate and what should you advise patient?
Myelosuppression! Seek medical assistance if you have fever,m unexplained bruising or bleeding. Also SoB and jaundice (lung fibrosis liver failure).
72
What condition is levodopa contraindicated in?
Glaucoma.
73
How do you advise patients to take levodopa?
Take tablet 3-4 times daily with food, must take at the same time everyday!
74
What tests do you need to do before starting methotrexate?
LFTs, U&E, FBCs. Then every 2 weeks after therapy started.
75
What tests do you need to do before starting Lithium?
U&E, LFTs, TSH, FBCs, bHCG and ECG.
76
What tests do you need after starting lithium?
Serum lithium levels at 12 hours then every week until stable for 4 weeks, then every three months. Check TFTs, U&E and every 6 months.
77
What is a contraindication for SSRIs?
Poorly controlled epilepsy, Mania.
78
What are the side-effects of lithium?
Fine tremor, abdo pain, metallic taste and thirst.
79
What are the side-effects of atypical antidepressants?
Constipation, weight gain, lethargy, postural hypotension and dizzyness, movement disorders. NEUROLEPTIC MALIGNANT SYNDROME.
80
What is the most serious complication of atypical antipsychotics and what do you advise patient?
Neuroleptic malignant syndrome - fever, rigidity, agranulocytosis and withdrawal. Go seek medical help if you get a fever.
81
What does a lithium overdose look like?
Neuromuscular problems like dysarthria, twitching, dizziness and vomiting.
82
What is a positive Trendelenberg test?
Hip goes down on contralateral side- therefore weakness of abductor muscles. Gluteus medoius and miunimus.
83
What are the principles of treating a fracture
Reduce, Stabilise, Rehabilitate.
84
What do you comment on when interpreting an x-ray of a bone?
1. Site of fracture
2. Type of fracture? (transverse, oblique, spiral)
3. Simple or communited?
4. Displaced or not?
5. Angulated or not?
6. Is the bone of normal consistency?
85
If there a pain on passive stretch of a patients limb following trauma/surgery, what do you suspect?
Compartment Syndrome.
86
What do you need to do before starting treatment for otitis externa?
Swab the external auditory canal.
87
How do you diagnose Generalised Anxiety Disorder?
Excessive anxiety occurring for more than 3 months, associated with any 3 of: restlessness and feeling 'on edge', easily fatigued, difficulty concentrating, irritability, muscle tension and sleep disturbance.
88
If someone has panic attacks and you suspect anxiety, what do you need to do?
Rule out organic causes therefore do TFTs and ECG.
89
What are the 3 types of personality disorder?
Emotional, Anxious and Suspicious.
90
What are the 4 principles of medical ethics?
Non-maleficence, Beneficence, Justice and Autonomy.
91
How do you differentiate between a Parkinsonism tremor and an essential tremor.
Parkinsonism is a fine, unilateral, pill rolling tremor better on movement.
Essential tremor is bilateral, worse on movement and involves jaw tremor.
92
What are some useful investigations following a fall?
BM, FBC, U+E, LFT, Calcium, bone profile, TFTs, B12, folate and ECG/. Also asses, vision, cognition, continence and any home hazards.
93
What % of carotid stenosis requires urgent endarterectomy?
over 70%. + anti platelet therapy and alternative is stenting.
94
What investigations do you need to do following TIA
Carotid artery ultrasound doppler, ECG, BMI, Blood glucose, FBC, U+E, LFTs and lipids.
95
What is used to calculate chance of patient having a stroke in AF?
CHA2DS2-VASc
| Congestive heart failure, Hypertension, Age>75, Diabetes, Stroke, Vascular disease, Age> 65 and sex (female).
96
How do you test for tremors in a Parkinsons examination?
Resting tremor- close eyes count backwards from a 100 by 7s.
Postural tremor- Hands outstretched.
Action tremor- ask to perform action with hands and do finger to nose test.
Bradykinesia- Ask patient to press thumb to index finger tap quickly and assess rhythm, cadence and amplitude.
97
Define Parkinsonism
A clinical triad that includes resting tremor, bradykinesia and rigidity. (often they have gait/postural instability too).
98
What is the questionnaire for assessing anxiety ?
GAD7 questionnaire.
99
What category of symptoms do you need to ask about in anxiety?
Psychological.
Biological.
Behavioural.
100
For how long does a patient need to be on SSRI following first episode of depression?
9-12 months, wean off.
101
What are the ICD 10 requirements for diagnosing schizophrenia?
```
Delusional perception (normal percept has a special meaning)
Auditory hallucination (3rd person and argumentative, provides running commentary and thought echo)
Delusion of control (someones making me do things/affecting my feelings)
Thought interference: Insertion, withdrawal, broadcasting
```
102
What do you always need to ask in patients with history of memory loss (other than risk assess) ?
Functional levels, washing, dressing, cooking.
103
Define subluxation
Anatomy of joint disrupted but contact remains between articular surfaces.
104
Define dislocation
Complete disruption of the joint with no contact between joint spaces.
105
What questions should you ask in a Mania history?
```
M- Mood?
A- Activity levels?
N- Naughty (spending? alcohol? sex?)
I- Insomnia
C- Confidence increased?
C- Concentration decreased?
```
106
What are the components of CAGE questioning?
Considered cutting back?
Annoyed by people suggesting you should cut back?
Guilty feeling about drinking?
Eye-opener, needing a drink to start the day?
107
Patients are deemed to have capacity unless they have a dysfunction of the brain and are unable to...
Understand information.
Retain it.
Weigh up risks and benefits.
Are able to communicate their decision back.
108
What is most likely cause for an acute onset, painless limp in an 8 year old?
Transient synovitis of the hip.
109
What are the side-effects of allopurinol?
Rash (10% of patients) must go and see Dr immediately as it may cause:
Hypersensitivity syndrome may occur (20-25% mortality).
110
What is the aim of prophylactic gout treatment?
Maintain serum uric acid level below 300µmol/L.
111
What are the types of yellow flags for pain?
Biomedical- Severe pain, disability, multiple sites).
Psychological- Belief that pain = harm, fear/avoidance, catastrophic thinking.
Social- Lack of confidence, low expectation of returning to work, heavier work, poor work relationships, social dysfunction, medico-legal issues.
112
What are the risk factors for fibromyalgia?
Low household income, lack of further education, female, FH, traumatic event, inflammatory conditions, armed forces.
113
What is nephrotic syndrome?
Heavy proteinuria (>3.5g/24h), hypoalbuminaemia and oedema.
114
What can be the symptoms of nephritic syndrome?
Haematuria (can be microscopic), proteinuria (<2g/24h), hypertension, oedema, oligouria/ anuria.
115
What are the symptoms of normal pressure hydrocephalus?
Triad of dementia, bladder instability and gait disorder.
116
What are the symptoms of idiopathic Parkinson's disease?
ASYMMETRICAL SIGNS!! Pill rolling resting tremor, rigidity, bradykinesia and gait/postural instability.
117
What is the treatment for an essential tremor?
A beta blocker - Propanolol.
118
What are the treatments for Parkinsons?
Co-beneldopa, Rasagaline, Rivastigmine.
119
What is the prognosis for patients with delerium?
1/3 recover quickly.
1/3 recover slowly.
1/3 do not recover.
120
What are the orders of the ossicles from lateral to medial?
Malleus, Incus, Stapes.
121
Define cholesteatoma?
Abnormal collection of skin cells in the middle ear associated with discharge. Keratin may accumulate in the pars flaccida.
122
What is the WHO definition for Osteoporosis ?
2.5 deviations below the average for a young person of the same sex and race.
123
What are the causes of dupuytren's contracture?
Alcoholic liver disease, phenytoin treatment, manual labour and trauma to the hand.
124
What is the treatment for borderline personality disorder?
Dialectical behaviour therapy.
125
What is the screening tool used for depression?
PHQ-9.
126
What are the risk factors for developing schizophrenia?
Family history, smoking cannabis and birth complications.
127
What does a brief stabbing pain when brushing teeth or chewing suggest?
Trigeminal Neuralgia.
128
Intermittent Amaurosis Fugax suggests what?
TIA.
129
What are the cranial nerves of the ocular motion?
CN3, CN4 (superior oblique) and CN6 (lateral rectus).
130
What would a CN4 palsy look like?
Affected eye cannot turn in and down.
131
What would CN6 palsy look like?
Affected eye cannot abduct, (look to the side).
132
How is the Swinging Light Test performed?
Ask patient to concentrate on wall behind you, swing light back and forth between eyes (2 seconds on each).
133
What is abnormal and what is RAPD response to the swinging light test?
Normal- Both pupils should constrict then relax a little each time the light is shone.
RAPD- Both pupils dilate when the light is swung across the affected side.
134
What is the special test in a foot and ankle exam?
Simmons test, squeeze calf and look for plantar flexion of foot, absence suggests Achilles tendon rupture.
135
What are the special tests to do in a hand and wrist exam?
Phalen's test (reverse prayer sign)
| Tinel's test (tap median nerve at course through wrist).
136
What are the components of the comprehensive geriatrics assessment?
Physical health, Mental health, Social circumstances, Functional abilities and Environment.
137
What do you need to do when giving information to a colleague?
Situation.
Background.
Assessment.
Recommendations.
138
Name some cognitive assessments?
ACE III, MMSE.
139
What are the geriatric giants?
Immobility, Incontinence, Falls and Confusion.
140
What is the treatment for acute alcohol withdrawal?
Chlordiazepoxide titrated according to the CIWA score.
141
Tenderness of the greater trochanter of the femur suggests what?
Trochanteric bursitis.
142
What type of fracture would you expect to see in the elderly?
Compression fracture.
143
In what types of people would you expect to see stress fractures?
Athletes.
144
When would you decide to do a hemiarthroplasty versus complete hip replacement?
Patients with displaced intercapsular fracture of the femur. Complete hip replacent is for more mobile patients compared to hemiarthroplasty.
145
What pathologies can a fluorescein stain identify?
Corneal abrasions, microbial keratitis and a dendritic ulcer (HSV-2 infection).
146
What is the main emergency you need to suspect in sudden vision loss following occular surgery?
Infective endophthalmitis.
147
What is a Hypopyon?
Pus in the anterior chamber of the eye.
148
What are the symptoms of orbital cellulitis?
Injected and swollen conjunctiva, periocular oedema, erythema of effected eye's eyelids and limitation of right upgaze.
149
What would you expect to see in the CSF of a Guillain-Barre Syndrome patient?
Cytoalbuminocytologic dissociation.
150
What infection is associated with Guillain-Barre Syndrome?
Campylobacter Jejuni.
151
How do you perform a Romberg's test?
Ask the patient to stand with legs together and close their eyes. If they start to fall it's positive and means sensory ataxia.
152
What investigations do you need to get if you suspect a stroke?
Call stroke team urgently (4.5h thrombolysis window).
CT brain o look for haemorrhagic stroke .
ECG to look for arrhythmia.
Bloods BMs (hypoglycaemia), FBC (infection), test for hypercholesterolaemia and clotting disorders.
153
What is the most likely risk factor for Personality disorders?
Childhood abuse - 75%.
154
What does the perceptions portion of the MSE contain?
questions identifying possible illusions, hallucinations and derealisations.
155
Define dementia
Defined as a chronic disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes and impaired reasoning.
156
What is the type of dementia you get from repeated head injuries such as concussion?
Chronic traumatic encephalopathy or pugalistic dementia.
157
What does a normal LP look like?
```
Opening pressure <20.
WCC< 5WBC.
RCC None.
Protein- <0.45g/L.
Glucose should be approx 2/3 of plasma glucose.
```
158
What is a dead giveaway for tonic-clonic seizure?
Bilateral tongue biting.
159
What are the appropriate investigations for suspected generalized tonic-clonc seizure?
Vital Signs, 02 sats, BMs, ECG, Neurological exam, Check for hyponatraemia and hyocalcaemia. Consider CT is neuro exam is abnormal.
160
What is the management of status epilipticus?
> 5 mins IV Lorazepam
If no response in 10mins then Phenytoin -call for help
If no response to step 2 withing 30 mins proceed with intubation and ventilation.
161
How do you structure requesting examinations?
At bedside, other non-invasive and invasive.
162
How do you structure suggesting management?
Conservative, Medical, Surgical
