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Flashcards in Cardio Deck (138)
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1
Q

AS

Significant negs

A

Infective endocarditis
LVF
Indicators of severity (narrow PP, quiet A2, S4)

2
Q

AS

Causes

A
  1. Senile calcification
  2. Bicuspid valve
  3. Rheumatic heart disease
3
Q

AS

Triad of symptoms

A

Dyspnoea
Angina
Syncope

4
Q

AS

Investigations

A

ECG (LVH, arrhythmia)

Bloods (FBC, U+E, BNP, lipids, glucose)

CXR (LVH)

Echo (severity, LV function, cause)

Coronary angiogram

5
Q

AS

Echo features of severe

A

Valve area <1cm2

Pressure gradient >40mmHg

Jet velocity >4m/s

6
Q

AS

Mx

A

General (MDT, optimise CV risk, monitor)

Surgical (valve replacement +/- CABG) - if symptomatic or
severe

Other (TAVI)

7
Q

MR

Significant negs

A

Infective endocarditis

AF

LVF

8
Q

MR

Causes

A

Functional: LV dilatation
Annular calcification
Rheumatic heart disease
Valve prolapse e.g. pap muscle rupture

9
Q

MR

Investigations

A

ECG (arrhythmias, LVH, P-mitrale)

Bloods (FBC, U+E, BNP, lipids, glucose)

CXR (LA/LV hypertrophy, oedema, calcification)

Echo (severity, LV function)

Coronary angiogram

10
Q

MR

Echo features of severe

A

Jet width >0.6cm
Systolic pulmonary flow reversal
Regurgitant volume >60ml

11
Q

MR

Mx

A

General (MDT, optimise CV risk, monitor)
Specific (AF, emboli, reduce after load)
Surgical (valve replacement/repair) if symptomatic

12
Q

AF

Significant negs

A

Murmur
Evidence of thyrotoxicosis
LVF
Bruising from warfarin

13
Q

AF

Cardiac causes

A

IHD
Rheumatic heart disease
Hypertension
Mitral valve pathology

14
Q

AF

Non-cardiac causes

A

Thyrotoxicosis
Alcohol
Pneumonia

Hypokalaemia
RA
Post-op
PE

15
Q

AF

Investigations

A

ECG (confirm Dx, look for cause e.g. ischaemia)

Bloods (FBC, U+E (K), TFTs, trops, D-dimer)

CXR (oedema, pneumonia)

Echo (valves, LV function)

16
Q

Acute AF (<48h)

Mx

A

If adverse signs: DC shock, seek help, amiodarone 300mg over 10-20 mins, repeat shock, amiodarone 900mg over 24h

If stable: control rate with b-b or diltiazem, consider digoxin or amiodarone if in heart failure, assess thromboembolic risk and consider anticoagulation

17
Q

Paroxysmal AF

Mx (need to clarify)

A

Pill in pocket

Prevention (b-b)

18
Q

Persistent AF

Rhythm control

A

Younger pts
>3w anticoagulation with warfarin, exclude thrombus with TOE
Cardioversion (DC/medical)

19
Q

Persistent AF

Rate control

A

b-b or rate limiting CCB

Can add digoxin

20
Q

AF

Other mx

A

Radiofrequency ablation of the AV node
Maze procedure
Pacing

21
Q

What are the causes of LEFT heart failure?

A
  1. Ischaemic heart disease
  2. Idiopathic dilated cardiomyopathy
  3. Hypertension
  4. Mitral and aortic valve disease
22
Q

What are the causes of RIGHT heart failure?

A

Left ventricular failure
Cor pulmonale
Tricuspid and pulmonary valve disease

23
Q

What is the NYHA classification?

A
  1. No breathlessness
  2. Breathless with moderate exertion
  3. Breathless with mild exertion
  4. Breathless at rest
24
Q

How do you investigate chronic heart failure?

A

ECG: ischaemia, hypertrophy, arrhythmia

Bloods: FBC, U+E, BNP, lipids glucose

CXR: ABCDEF

Echo - gold standard

25
Q

What do you look for in an echo for heart failure?

A

Global systolic and diastolic function
Focal/global hypokinesia
Hypertrophy
Valve lesions

26
Q

What is the management of heart failure?

A

General: MDT, optimise CV risk (conservative and medical), monitor

Specific (medical): b-b + ACEi, spiro, digoxin, cardiac resynchronisation therapy

Surgical: LVAD, heart transplant

27
Q

What are the three clinical signs of hyperexpansion?

A

Reduced cricosternal distance
Loss of cardiac dullness
Palpable/displaced liver edge

28
Q

What are the significant negatives in a COPD exam?

A

CO2 retention flap
Cor pulmonale i.e. signs of right heart failure
Clubbing (could indicate cancer)

29
Q

Differentials for COPD?

A

Chronic asthma

Bronchiectasis

30
Q

What is the definition of chronic bronchitis?

A

Cough productive of sputum for >/= 3months on >/= 2 consecutive years

31
Q

What is the definition of emphysema?

A

Histological description of alveolar wall destruction with airway collapse and air trapping

32
Q

Investigations in COPD?

A

Bedside: PEFR, BMI, sputum mc&s

SPIROMETRY: obstructive

Bloods: FBC (polycythaemia), ABG (T2 resp failure), CRP (infective exacerbation), Albumin (malnutrition), a1-AT

Imaging: CXR, echo (cor pulmonale)

33
Q

What do you find on spirometry with COPD?

A
Obstructive pattern
Increased total lung capacity and residual volume
FEV1 <80%
FEV1/FVC <0.7
Reduced transfer factor
34
Q

What are you looking for on a CXR in COPD?

A

Acute: consolidation, pneumothorax

Chronic:

  • Hyperinflation (>10 posterior ribs), flat diaphragm
  • PHT (prominent pulmonary arteries, peripheral oligaemia)
  • Bullae
35
Q

What is the general management of COPD?

A

MDT: dietician, physio, resp physician, specialist nurses

SMOKING CESSATION: specialist nurse and support programme, nicotine replacement therapy (varenicline = partial nicotinic agonist)

Pulmonary rehab therapy: tailored exorcise programme, disease education and psychosocial support

Comorbidities: nutrition, CV risk, vaccination (pneumococcal and seasonal flu)

36
Q

What is the medical management of COPD?

A

Anti muscarinics
b2 agonists
ICS

Theophylline

Home emergency pack for exacerbations

LTOT (aiming for PaO2 >8 for >15h/day) if stable non smokers with PaO2 <7.3 OR <8 with cor pulmonale or polycythaemia

37
Q

What is the GOLD classification?

A

Based on mMRC dyspnoea score (1-5) and airflow limitation (based on FEV1) and no. of exacerbations per year

38
Q

What is the mMRC dyspnoea score?

A
  1. SOB on vigorous exertion
  2. SOB on hurrying or walking up stairs
  3. Walks slowly or has to stop for breath
  4. Stops for breath after <100m / few mins
    Too breathless to leave the house or SOB on dressing
39
Q

How is airflow limitation classified?

A

Mild >80%
Moderate 50-79%
Severe 30-49%
Very severe <30%

40
Q

What are the significant negatives for pulmonary fibrosis exam?

A

Cyanosis
Cor pulmonale
Specific cause e.g. rheumatoid hands or sclerodactyly

41
Q

What are some differentials for pulmonary fibrosis?

A

Bronchiectasis

Chronic lung abscess

42
Q

What are the causes of UPPER zone fibrosis?

APENT

A
Aspergillosis (ABPA)
Pneumoconiosis (coal, silica)
EAA/hypersensitivity pneumonitis
Negative sero-arthropathy (ank spond)
TB

PPFE

43
Q

What are the causes of LOWER zone fibrosis?

STAIR

A
Sarcoid (mid zone)
Toxins: BANS ME
Asbestosis
IPF
Rheum: RA, SLE, SS, sjogren's PM/DM
44
Q

What are the drug causes of pulmonary fibrosis?

BANS ME

A
Bleomycin
Amiodarone
Nitrofurantoin
Sulfasalazine
Methotrexate
45
Q

What are the investigations for pulmonary fibrosis?

A

Bedside: PEFR, ECG (RVH)

Bloods: FBC, ABG, ESR and CRP (IPF)

Imaging: CXR (reticulonodular shadowing and reduced lung volume), HRCT (fibrosis and honeycomb lung)

SPIROMETRY: restrictive

Other: echo (PHT), BAL (for disease activity), biopsy

46
Q

What is the management of pulmonary fibrosis?

A

MDT: GP, pulmonologist, palliative care, physio, psych, specialist nurses, family

Rx specific cause: STEROIDS for EAA, sarcoid and CTD

Supportive care: STOP SMOKING, pulmonary rehab, LTOT, symptomatic tx e.g. anti tussives (codeine) and heart failure medication

Surgery: Lung transplant is only cure in IPF

47
Q

What are the significant negatives in a bronchiectasis exam?

A

cor pulmonale

specific causes e.g. RA hands, yellow nails, CF, IBD

48
Q

What is the differential for bronchiectasis?

A

IPF

Chronic lung abscess

49
Q

How can you classify the causes of bronchiectasis

A

Congenital or acquired

50
Q

What are the CONGENITAL causes of bronchiectasis?

A

CF
PCD/Kartagener’s
Young’s: azoospermia and bronchiectasis
Hypogammaglobulinaemia: XLA, CVID, SAD

51
Q

What are the ACQUIRED causes of bronchiectasis?

A

Idiopathic

Post infectious: pertussis, TB, measles

Obstruction: tumour, foreign body

Associated: RA, IBD (UC), ABPA

52
Q

What are investigations for bronchiectasis?

A

Bedside PEFR and urine dip (proteinuria - amyloid)

Bloods: FBC (ACD), serum Ig, Aspergillus (RAST, precipitins, IgE, eosinophilia), RA (anti CCP, RF)

CXR: tramlines and ring shadows (grapes)

HRCT: SIGNET RING SIGN: thickened dilated bronchi and smaller adjacent vascular bundle. Pools of mucus in saccular dilatations

Spirometry: obstructive

Other: bronchoscopy and mucosal biopsy, CF sweat test, aspergillum skin prick testing

53
Q

What are the complications of bronchiectasis?

A
Cachexia
PHT
Massive haemoptysis
T2 respiratory failure
Amyloidosis
54
Q

What is the CONSERVATIVE management of bronchiectasis?

A

MDT: GP, resp consultant, physio, dietician, immunologist

Physio: postural drainage, active cycle breathing, rehab

55
Q

What is the MEDICAL management of bronchiectasis?

A

ABX for exacerbations

Bronchodilators: nebuliser b-agonists

Tx underlying cause: CF (creon, ADEK), ABPA (steroids), Immune deficiency (IVIG)

Vaccination: flu, pneumococcus

56
Q

What is the SURGICAL management of bronchiectasis?

A

Indicated in severe localised disease or obstruction

57
Q

Significant negs for pleural effusion exam?

A

Absence of:

  • Fever
  • Clubbing
  • Raised JVP and peripheral oedema
  • Features of CTD
58
Q

Causes of pleural effusion (transudate)?

A
CCF
Renal failure
Reduced albumin
Hypothyroidism
Meig's syndrome
59
Q

Causes of pleural effusion (exudate)?

A
Infection: pneumonia, TB
Malignancy
Inflammation: RA, SLE
Infarction: PE
Trauma
60
Q

Investigations for pleural effusion?

A

Sputum MC&S and cytology

Imaging: CXR, US to guide pleurocentesis, volumetric CT

Bloods: FBC (low Hb), U+E (high Cr), LFTs: (low albumin), TFT (high TSH), ESR (CTD), raised Ca

Diagnostic pluerocentesis

61
Q

Expand on diagnostic pleurocentesis

A

Percuss upper border and go 1-2 spaces below, infiltrate town to pleura with lignocaine and aspirate with a 21G needle

Send for

  • Chemistry: protein, LDH, pH, glucose, amylase
  • Bacteriology: MCS, auramine stain, TB culture
  • Cytology
  • Immunology: RF, ANA, complement
62
Q

Features of empyema?

A

turbid fluid

low glucose

pH <7.2

63
Q

What is the management of pleural effusion?

A

Tx underlying cause

Drainage if symptomatic (<2L/24h) - repeated aspiration or ICD

Pleurodesis with talc if recurrent malignant effusion

Persistant effusions may require surgery

64
Q

Indications for lobectomy/pneumonectomy?

A

90% for non-disseminated bronchial carcinoma

Bronchiectasis
COPD (lung reduction surgery)
TB

65
Q

Operative mortality of lobectomy/pneumonectomy?

A

7% / 12%

66
Q

Location of lung Ca?

A

SCC: central

Adeno: peripheral

Small cell: central

67
Q

Complications of lung Ca?

A
RLNP
Phrenic nerve palsy
SVCO
Horner's
AF
68
Q

Lung cancer paraneoplastic syndromes? ENDO

A

ADH –> SIADH
ACTH –> cushings syndrome
Serotonin –> carcinoid
PTHrP –> raised Ca

69
Q

Lung cancer paraneoplastic syndromes? RHEUM

A

Dermato/polymyositis

70
Q

Lung cancer paraneoplastic syndromes? NEURO

A

Cerebellar degeneration

Peripheral neuropathy

71
Q

Lung cancer paraneoplastic syndromes? DERM

A

Acanthosis nigerians

Trousseau’s syndrome: thrombophlebitis migrans

72
Q

Features of metastatic lung Ca?

A

Pathological #

Hepatic failure

Confusion, fits, focal neuro

Addison’s

73
Q

Ix in lung cancer?

A

Bloods

Dx of mass: CXR + volumetric CT

Determine cell type: cytology and histology

Staging: CT (neck, thorax, abdo brain), PET, radio nucleotide bone scan, thoracoscopy, mediastinoscopy and LN sampling

Pulmonary function tests

74
Q

Blood tests in lung cancer?

A

FBC: anaemia, raised WCC

U+E: low Na

LFTs: deranged due to mets

Bone profile: raised Ca

75
Q

CXR and CT findings in lung cancer?

A

CXR: coin lesions, effusions, consolidation or collapse, hilar LNs, bony mets

76
Q

Determining cell type in lung cancer?

A

Cytology: induced sputum and US guided pleurocentesis

Histology: percutaneous FNA (adenocarcinoma), endoscopic transbronchial biopsy (SCC)

77
Q

General management for ALL lung cancers?

A

MDT

STOP SMOKING

Optimise nutrition and CV function

78
Q

NSCLC management?

A

Surgery if no mets - wedge resection, lobectomy, pneumonectomy

Curative radio: if poor cardio/resp function

Chemo

79
Q

SCLC management?

A

Usually disseminated at presentation

Some benefit with chemo

80
Q

Palliative care in lung cancer?

A

Analgesia: opiates for pain and cough

Radiotherapy: haemoptysis, bone or CNS mets

SVCO: dex and radio or intravascular stent

Persistent effusions: chemical pleurodesis

81
Q

Parkinsons examination, inspection?

A

Asymmetrical resting tremor: 5Hz (exacerbated by counting backwards)

Hypomimia

Extrapyramidal posture

82
Q

Parkinsons examination, ARMS?

A

Demonstrate bradykinesia

Tone: cogwheel

NORMAL power and reflexes

Coordination: abnormal in MSA

83
Q

Parkinsons examination, EYES?

A

Movements: nystagmus (MSA), vertical gaze palsy (PSP)

Saccades: slow initiation and movement

84
Q

Parkinsons examination, EXTRAS?

A

Glabellar tap

GAIT (make sure you walk with them and support): slow initiation, shuffling, hurrying (festination), absent arms swing

Write sentence and draw spiral

BP lying and standing

85
Q

Parkinsons examination, COMPLETION?

A

MMSE

86
Q

Causes of parkinsonism?

A

Idiopathic PD

Parkinsons plus: MSA, PSP, CBD

Multiple infarcts in substantia nigra

Wilson’s disease

Drugs: neuroleptics, anti-emetics (metoclopramide)

87
Q

PD history?

A

Symptoms: tremor, rigidity, bradykinesia

Autonomic: post hypotension, urinary probs

ADLs: handwriting, buttons etc

Sleep: turning in bed, insomnia, daytime sleepyness

Complications: depression, drug SEs esp. motor fluctuations

Cause: sudden onset, eye or balance problems

88
Q

Parkinsons investigations?

A

Bloods: caeruloplasmin (reduced in Wilsons)

Imaging

  • CT/MRI to exclude vascular cause
  • DaT scan if unsure about diagnosis (ioflupane123 injection which ends to dopaminergic neurons and allows visualisation of the substantia nigra)
89
Q

GENERAL management of parkinson’s?

A

MDT: neurologist, PD nurse, physio, OT, social worker

Assess disability e.g. unified PD rating scale

Physiotherapy: postural exercises

Depression screening

90
Q

SPECIFIC management of parkinson’s?

A

L DOPA + carbidopa
Da agonists
MOA-O inhibitor
COMT inhibitors

91
Q

Adjunctive therapy in parkinson’s?

A

Domperidone for nausea

Quetiapine for psychosis

Citalopram for depression

92
Q

Features of parkinson’s? TRAPPS PD

A
Tremor
Rigidity
Akinesia
Postural instability
Postural Hypotension
Sleep disorder

Psychosis
Depression

93
Q

Sleep disorder in parkinson’s?

A

Affects 90%

Insomnia and frequent waking leading to EDS

REM sleep disorder (loss of muscle atonia and violent enactment of dreams)

Da side effects: insomnia, drowsiness, EDS

94
Q

Autonomic dysfunction seen in PD

A
Postural hypotension
Constipation
Hypersalivation
Urgency, nocturia, frequency
ED
Hyperhidrosis
95
Q

L-DOPA SEs (DOPAMINE)

A
Dyskinesia
On-off phenomena
Psychosis
ABP reduced
Mouth dryness
Insomnia
N/V
EDS
96
Q

MSA pathology

A

Papp-lantos bodies: a-synuclein inclusions in glial cells

97
Q

MSA features

A

Autonomic dysfunction: postural hypotension

Parkinsonism

CEREBELLAR ataxia

NB: if autonomic features predominate, may be referred to as Shy Drager Syndrome

98
Q

PSP features?

A

Postural instability: FALLS

Vertical gaze palsy

Pseudobulbar palsy: speech and swallowing problems

Parkinsonism: symmetrical and tremor is unusual

99
Q

CBD features?

A

Unilateral parkinsonism ESPECIALLY RIGIDITY

Aphasia

Astereognosis: cortical sensory loss –> alien limb phenomenon: autonomous arm movements

100
Q

Lewy body dementia pathology?

A

a-synuclein and ubiquitin lewy bodies in brainstem and neocortex

101
Q

Features of lewy body dementia?

A

Fluctuating cognition

Visual hallucinations

Parkinsonism

102
Q

Vascular parkinsonism features?

A

Sudden onset

Parkinsonism worse in LEGS

Pyramidal signs

Prominent gait abnormality

103
Q

Causes of tremor?

A

Resting: parkinsonism

Intention: cerebellar

Postural - worse with arms outstretched: endocrine (hyperthyroid), alcohol withdrawal, Toxins (b-agonists), sympathetic (anxiety)

104
Q

Benign essential tremor features?

A

AD

Occur on movement and worse with anxiety or caffeine

Doesn’t occur with sleep

Better with alcohol

105
Q

UMN signs?

A

Increased tone

Pyramidal distribution of weakness: legs - extensors > flexors, arms - flexors > extensors

Hyper-reflexia

Extensor plantars

106
Q

Common causes of spastic paraparesis?

A

MS

Cord compression

Cord trauma

Cerebral palsy

107
Q

Less common causes of spastic paraparesis?

A

Familial

Vascular e.g. aortic dissection –> beck’s syndrome

Infection: HTLV1

Tumour: ependymoma

Syringomyelia

108
Q

Causes of mixed upper and lower motor neurone?

A

Friedrich’s ataxia

Tabes dorsalis

Cord compression/conus

SCDC

MND

Also polio (anterior horn cells)

109
Q

Causes of spastic hemiparesis?

A

Stroke

MS

SOL

Cerebral palsy

110
Q

Investigation of UMN signs

A

MRI cord and brain

Further Ix depends on cause e.g. MS (LP, Abs, evoked potentials), compression (FBC, CXR, DRE), SCDC (B12 level, PA Abs)

111
Q

Mx of UMN stuff

A

Supportive:
MDT: GP, neurologist, radiologist, neurosurgeon, specialist nurses, physio, OT

Orthoses

Mobility aids

Urinary: ICSC

Contractures: baclofen, botulinum injection, physio

112
Q

Causes of cerebellar syndrome? DAISIES

A
Demyelination
Alcohol
Infarct: brainstem stroke
SOL
Inherited
Epilepsy meds: phenytoin
System atrophy, multiple
113
Q

Cerebellar syndrome, key causes?

A
LMS
Vestibular schwannoma
VHL
Friedrich's ataxia
Ataxia telangiectasia
Wilson's
114
Q

Definition of MS?

A

Chronic inflammatory condition of the CNS characterised by multiple plaques of demyelination disseminated in time and space

115
Q

Presentation of MS?

A

TEAM

Tingling
Eye: optic neuritis, bilateral INO
Ataxia and other cerebellar signs
Motor: usually spastic paraparesis

116
Q

Optic neuritis in MS?

A

Pain on eye movement, rapid loss of central vision

Uhthoff’s phenomenon: vision worsens with heat

O/E: reduced acuity and colour vision, white disc, central scotoma, RAPD

117
Q

Tell me about INO?

A

Disruption of MLF connecting CN6 to CN3

Weak adduction of IPSILATERAL eye

Nystagmus of contralateral eye

Convergence is preserved

118
Q

Diagnosis?

A

Clinical using McDonald criteria: demonstration of lesions disseminated in time and space

119
Q

Investigations in MS?

A

MRI: Gd enhancing can show active inflammation, typically plaques are in the periventricular white matter

LP: IgG oligoclonal bands

Abs: Anti MBP, NMO IgG (Devic’s syndrome)

Evoked potentials: delayed auditory, visual and sensory

120
Q

Differentials for MS?

A

CNS sarcoidosis

SLE

Devic’s: Neuromyelitis optica

  • MS variant with transverse myelitis and optic atrophy
  • Distinguished by presence of NMO IgG
121
Q

Principles of treatment?

A

MDT: neurologist, radiologist, GP, specialist nurses, physio, OT, family

Acute attack

Preventing replace

  • DMARD
  • Biologicals

Symptomatic

122
Q

MS acute attack Mx?

A

Methylpred, doesn’t influence long term outcomes but reduces duration and severity of attacks

123
Q

MS preventing attack mx?

A

DMARDs:
- INF-b

Biological
- Natalizumab

124
Q

Symptomatic tx in MS?

A

Fatigue: amantadine

Depression: SSRI

Pain: amitriptyline

Spasticity: baclofen, gabapentin and physio

Urgency/frequency: intermittent self catheterisation or anticholinergics

ED: sildenafil

Tremor: clonazepam

125
Q

Poor prognostic signs in MS?

A

Older female
Motor signs at onset
Many relapses early on
Many MRI lesions

126
Q

LMN signs?

A

Wasting
Fasciculations
Hypotonia
Hyporeflexia

127
Q

Bilateral, symmetrical, distal LMN?

A

HMSN
Paraneoplastic
Lead poisoning
Acute: GBS, botulism

128
Q

Bilateral, symmetrical, proximal LMN?

A

Inherited: musc dystrophy

Inflammation: poly/dermatomyositis

Endocrine: cushing’s, acrobatics, thyrotoxicosis, diabetic amyotrophy

Drugs: alcohol, statins, steroids

Malignancy: paraneoplastic

129
Q

Unilateral LMN ddx?

A

Single limb with no sensory signs = polio

Group of muscles with same supply:

  • segmental: nerve roots, plexus
  • peripheral: mononeuropathy
130
Q

Hand wasting ddx?

A

Anterior horn: syringiomyelia, MND, polio

Roots (C8 T1): spondylosis

Brachial plexus: compression/avulsion

Neuropathy: HSMN, mononeuritis multiplex (DM)

Muscle: disuse (RA), myotonic dystrophy

131
Q

Investigations in prox myopathy?

A
Bloods: DM, muscle damage, endocrine, abs
CXR
EMG
Genetic analysis
Muscle bx
132
Q

Causes of mainly sensory neuropathy?

A
DM
Alcohol
B12 def
CRF and cancer
Vasculitis
Drugs e.g. isoniazid, vincristine
133
Q

Causes of mainly motor neuropathy?

A

HMSN
Paraneoplastic: lung ca, RCC
Lead poisoning
Acute: GBS and botulism

134
Q

Investigations for peripheral polyneuropathy?

A

Dipstick (glucose)

Bloods: glucose, LFT, b12/folate, U+E, TFTs, ESR/CRP etc

Imaging: CXR to exclude paraneoplasms

Other: nerve conduction, EMG, genetic (PMP22 gene in CMT), nerve bx

135
Q

What do nerve conduction studies show?

A

Reduced conduction speed = demyelination

Reduced conduction amplitude = axonal degeneration

136
Q

General mx of peripheral polyneuropathy?

A

MDT

Foot care and shoe advice

Splinting to prevent contractures

137
Q

Specific mx of peripheral polyneuropathy?

A

Optimise glycemic control

Replace nutritional deficiencies

Avoid alcohol etc

Treat vasculitis with steroids and other immunosuppressants

Neuropathic pain: amitriptyline

GBS: IVIG

138
Q

Causes of facial nerve palsy?

A

Bell’s

Ramsay Hunt

Cholesteatoma

Lyme disease