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What is a situational syncope?

Scenario when vasovagal episode triggered by actions: couhging, urinating, having bloods taken.


What is Wolf Parkinson -White syndrome?

Is an abnormal conduction pathway connecting atria and V.- bundle of Kent. Able to conduct faster atrial depolaeisation to the V Myocard than AV node. --> ‼️ dangerous arrythmias, e.g. Supraventricular re entrant tachy, Ventr Tachy, + V Fib.

Pts can be asyx or dizziness, palpitations, chest pain, syncope + sudden cardiac death.

ECG changes: short PR, wide QRS compl, slurred upstroke of R wave,(delta wave)
Lifetime cure: radio-ablation of pathway.
Drugs: amiodarone, flecainidine- arrythmia prophylaxis.


What 2 drugs slow AV conduction?

Digioxin, verapamil
- should be avoided in WPW syndrome- can promote conduction across the acces pathway.
So can trigger arrytmias.


CVA- collapse

Embolic cerebral infracy 2o to AF.
Insufficient A contraction allows blood to stagnate and clot in atrial --> systemic circulation-> infract-> cerebral, limb, mesenteric infraction.

Warfarin or Aspirin anticoagulation therapy. Benefits Vs risks.

Warfarin sgould be avoided in pts w/ risks of falls + non-compliance.


Whats First dose HTN? How is it treated? Causes of collapse

Common SE of antihypertensives, esp assc w/ ACEIs.
To avoid this, start at low dose, and take pill at night before bed.
+ diuretics stopped for first few days, to ensure ot not dehydrated, adding to risk of first dose htn + syncope.


Causes of collapse: acute MI

Typically: central crushing pain that tpradiates ro arms and jaw, assc w/N, pallor, sweating.
Subgroup: absent. - silent MI. 25%
Common: elserly, diabetes- painless, 2o to autonomic neuropathy.
Atypical chest pain, epigastric pain, SOB, acute Pulm oedema,collapse, sudden death.

MI ahould be excluded in all cases of collapse❗️sudden onsent SOB, acute Pulm oedema + epigastric pain.
Tx same.


Nerve lesion in upper brachial plexus: what will happen?

Also knows as Erbs palsy- C5-6 nerve roots (brachial plexus: C5-T1)
Traction injuries, motorycle or birth injuries (pulling of babys arm) .

Flaccid paralysis of arm Abductors + lateral rotaors of shoulder + supinators so affected arm hanhs limp and is medially rotates, extended elbow + pronated - waiters tip position.
Loos of sensation: lateral arm and forearm.


Lower brachial plexus injuries:

Klumpkes palsy
C8-T1 nerve roots. Often caused by breech birth injuries- arms above head: and Motorcycle accidents. Claw hands in al, digits,(intrinsic muscles paralysis) and sensory loss (unlar border of elbow and hand)


What happens if the long thoracic nerve is damaged?

Of Bell supplies serratus anterior- helps stabilise the scapula.
Can be damaged during breast and axillary surgery, radiotherapy, axillary trauma.

Widening of scapula, it bcms prominent on pushing the arms against resistance.


What happens when the radial nerve is damaged?

Runs in close procimity to the humeral shaft in the spiral groove. Common causes of radial palsies: humeral shaft fracture-/ + bruising in upper arm.
Compression: crutches long use, elbow dislocation, Monteggia fractures.
Also!! Saturday nerve palsy!!- ppl who fall aslpee with their arm hanginh over the back of a chair.m


What happens if the accessory nerve is damaged?

CN11 supplies trapezius and sternocleidomastoid .
During dissection of the neck- can be damaged.
Weakness of shoulder shrugging, + inability to turn head against axaminer.m


What happens when teh axillary nerve is damaged?

Pc: anterior shoulder discloaction.
Nerve wraps around the surgical neck of the humerus. + humeral neck fractures,.
Supplies: deltoid muscle
--> rise to lateral cutaneous nerve of arm (sensation to upper outer arm).

Lesion- anaesthesia in upper outer arm- regimental badge patch area
+ paralysis of deltoid- limited arm abduction. The arm cannot be abducted, but if passively lifted above 90 , can be helf in abduction cz supraspinatus action.


What brach is the posterior interosseous nerve out of? What sx will its lesions cause?

Branch of the radial nerve - supply wrist and finger extensors. Except extensor carpi radialis longus(ECRL) - by proximal branch or radial nerve.

Forearm fractures: wrist drop and inability to extend fingers. No sensory loss .

The anterior interossous nerve is a motor branch of the median nerve, of the foreaem. - rare lesions, deel laceration.

Anterior interrosus nerve- motor fibers to flexor pollicis longus, medial part of flexor digitorum profundus and pronator quadratus. - weakness in thumb and index finger- deformity in pinch mechanicm.


What hapoens in compression of distal median nerve?

Can occur in Carpal tunnel syndrome, as it passes behind the flexor rerinaxulum.
CT syndrome more xommon in women, during pregnancy and with certain med conditions- RA, acromegaly, hypothyroidism.

Sx: tingling in radial 3 1/2 digits, followed by wasting in thenar eminance (median nerve) .
To confirm CT- Tinels test- tapping over median nerve over weist produces sx.
Phanels test- sx reproduced when wrist hold palmarflexed for 1min.


What happens on proximal nerve lesion damage?

Entrapment b4 it enters carpal tunnel- pain in anterior distal arm and forearm, + loss of sensation in 3.5 radial difits.
Tinels and phanels are -ve .
Forearm fractures and elbow discloaction


What hapoens when the ulnar nerve is damaged?

Damaged behind elbow (proximal lesion) and at wrist (distal)
Also supplies sensation to medial skin of palm + back of hand + medial 1.5 digits.
Distal lesions- only loss of sensation to digits. Cx the branches of ulnar nerve supplying skim of medial hand (palmar cutaneous + dorsal cutaneous) originaye proximal ro wrist. + hand weakness.

Ulnar nerve: also supplying foream extensors _ claw hands in 4th + 5th digits (hyperextenstioj of metacarpal joints w/ flexion of IP joints.
+ loss pf sensation in ulnar side of hand.

Clawing of hand in proximal lesion not as marked as distal lesions one cz flexor digitorum profundus intact resulting in flexion of IP joints, amd an exacerbated flexion deformity.


What are the LOAF muscles?

Lateral 2 lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis


Causes of collapse- caso vagal syncope

Syncope- sudden loss ofC. Pre- syncope- feeling of light headness.
Occurs when Xs overactivation of parasympathetic nervous sx in response to stimuli : 1. Heat, 2. Fear, 3. Stress.

Parasymp activity--> 1. Systemic vasodilation, 2. Bradycardia
↪️ which trigger: Hypotension, N+V, ringing of ears.

Witness: twitching, Loss of urinary incontinence- may be confused with seizure activity.

Q: about - chest pain, SOB, urinary incontinence, tongue biting, palpitations, weakness + paraesthesia.
ECGs, blood glucose, lying + standing BP.


What happens in SAH?

Thunder clap , occipital pain acc by Vomitting.
Irritability, photophobia, neck stiffness (meningism), ⬇️ consciousness.

CT ALLw/ first ever- worse ever H
SAH (fresh blood within V - white- butterfly)
CT: false -ves 15%

LP >12hrs to see if blood or yellow CSF -erythrocyte breakdown

Cerebral a vasospasm- complication--> ischaemic brain injury + damage. Administration of nimodipine (CCB) reduces this risk.


Is is SAH usually caused from?

Cerebral a aneyrisms- morre common in circle of Willis, ploycystic kidney disease, and collagen defects (Ehlers Danols syndrome). Usually


Cluster H, what happens?

Pc: Unilateral severe periorbital H, assc w: conjuctival injection, lacrimation, and nasal congestion.

30-90mins. Same time round each tpday,moften early.

M>F, aasc w/ heavy smoking, and alcohol comsumption.
Acute attacks may be relieved by 100% humidified oxygen.


Are there any prophylactic therapies to Cluster Hs?

Verapimil and ergotamine- CCBs


What happens in trigeminal neuraligia?

Sharp, stabbing pains in 2nd and 3rd division of nerve.
Pain: severe brief and repetative -> flinch. "Tic douloureux"

Triggers: touching or eating
Older women
Improves and relapses

Compresion of nerve, at entry into brainstem by loops of cerebellar arteries,.


How do u manage trigeminal pain?

Carbamezapine, phenytoin, gabapectin - All impove neuropathic pain


Migraine- what happens?

May be caused by vasodialation of extracranial a.
Triad: paroxysmal Hs, N/V + auras. (Often visual)
Severe unilateral throbbing H with photophobia and V.
Pts prefer to lie in a dark room and sleep