DAY 1 Flashcards
(24 cards)
Causes of bradycardia/arrhythmia?
MI esp inferior -> AV nodal artery block
Heart block
Drugs - B-blockers, digoxin
Vasovagal - over active response to a trigger
Sick sinus syndrome (SA node dysfunction)
Hypothyroidism/hypothermia
What is a conjugate gaze palsy? What can cause it?
Inability to move both eyes in same direction.
Horizontal - lesion in the brain stem and connecting nerves, normally pons
Vertical - lesions in midbrain, if downward - PSP
What is RA? Features? Ix? Rx?
Autoimmune condition that causes symmetrical polyarthritis.
Joints involved usually PIP, MCP and MTP. Joints are red, hot, tender. Morning stiffness > 1 hr. Worse with movement.
Examination
Radial deviation at wrist
Ulnar deviation at MCP
Swan neck, Boutennieres, z deformity of thumbs
Ix - RF, ESR, anti-CCP
What is the difference between a medical third and a surgical third palsy?
Parasympathetic fibres run outside the nerve.
Pupil sparing refers to medical third.
Pupil affecting known as surgical third.
Medical - DM, hyperlipidaemia, HTN
Acute abdomen peritonitis clinical features include?
Causes of peritonitis Perforated - peptic ulcer - colonic tumour - gallbladder - appendix - spleen - AAA
Hx - severe generalised abdominal pain
Exam movement with respiration Guarding Rebound tenderness Percussion tenderness Severe pain to light palpation Board-like rigidity
Spexifix Ix
Erect CXR
Urgent ct ABDO/pelvis
What are standard investigations for the acute abdomen?
Bloods
- CBE - EUC - LFT - CRP - amylase - Group and hold
- blood culture if pyrexial
- urine dipstick + culture
- urine bHCG
Features of small bowel vs large bowel obstruction?
Small bowel
- acute-> gradual
- high-pitched tingling
- central and colicky abdominal tenderness
- causes: post-surgical adhesions (scR tissue), hernias (protusion of an organ through a weakened section of abdominal wall), volvulus (loop of bowel is twisted about a focal point)
- radiology: central location, 30mm diameter, plicae circularis
Large bowel
- more gradual
- bowel sounds normal
- tenderness localised
- causes: colon cancer, strictures from chronic conditions e.g. IBD, diverticular disease, sigmoid volvulus
- radiology: located peripherally, 60mm diameter, haustra spanning part of bowel
What gives you hyperactive bowel sounds? What gives you diminished?
Small bowel obstruction
Paralytic ileus
What is an ileus?
An aperistaltic bowel not caused by bowel obstruction. Common after abdominal SURGEry.
Other causes: drugs, acute pancreatitis
ABDO x-ray: multiple loops of gas filled bowel projected centrally.
Hx: prolonged non-colicky abdominal pain, constipation, bloating
No bowel sounds because bowel is inactive
6 things for acute ABDO management?
NBM O2 Fluids ABx Analgesia
What is the basal ganglia? What conditions are associated with?
Group of nuclei of varied origin (striatum, globus, pallidus, sub thalamic nuclei, substantia Nigra, situated at base of forebrain strongly connected to the cerebral cortex and thalamus. Associated with movement.
Common conditions associated with it include: Parkinson’s disease.
What are anti-dopaminergics?
Used for treatment of schizophrenia, bipolar, nausea and vomiting.
Examples include:
Anti emetics: metoclopramide, droperidol,
Atypical antipsychotics: clozapine, respiridone, olanzapine, quetipine
TCAs
Side effects: EPS e.g. Akathisia (restlessness), Parkinsonism, tardive dyskinesia (involuntary, repetitive purposeless movements)
What are the Parkinson’s plus syndromes?
MSA - degeneration of nerve cells in specific areas of the brain. E.g. Movement, balance, autonomic functions. Unknown cause, minimal response to dopamine medications.
- 50 y/o men
- urinary incontinence
- ortho static hypotension
- early erectile dysfunction
- cerebellar features
What is progressive supra nuclear palsy?
Gradual degenerative disorder of specific area of Brain.
Cardinal features
- supra nuclear opthalmoplegia
- neck dystonia
- Parkinsonism
- pseudo bulbar palsy (UMNL of CN motor nuclei)
- imbalance and walking difficulties
No cure.
What is a pseudobulbar palsy?
Slow and indistinct speech Dysphagia Small, stiff spastic tongue Brisk jaw jerk Dysarthria Labile affect
What is the Pseudobulbar affect?
Involuntary crying
Uncontrolled episodes of crying/laughter
What is Corticobasal degeneration?
Asymmetrical characterized by
- cortical features: difficulty identify objects, apraxia
- basal ganglion features
Types of DI?
Neurogenic
- deficiency of ADH
Nephrogenic
- insensitivity to ADH
Delirium screen?
Consider
CBE EUC LFT BGL ABG (SEPTIC SCREEN: urine, CXR, blood cultures)
May also: ECG, LP, EEG, CT/MRI
What is an EEG?
Measures electrical activity along the scalp.
Diagnose - epilepsy, encephalopathy, brain death,
What is wernickes encephalopathy?
Thiamine deficiency
Confusion, ataxia and nystagmus
Always consider in alcoholics, eating disorders, malnutrition.
Primary clinical diagnosis
Rx
- urgent thiamine to prevent korakoffs syndrome
What is Korsakoff’s syndrome?
Hypothalamic damage and cerebral atrophy.
Decreased ability to form new memories, confabulation, lack of insight and apathy.!
Where is magnesium found? Complications of too much and too little?
65% in bones
35% in cells
Decreased - neuromuscular excitability: muscle weakness, tremor, seizures, tetany,
Causes - diuretics, severe diarrhoea, Ketoacidosis, alcohol abuse, reduced Ca and K and PO4
Rx - mg salts, PO or IV
Increased - neuromuscular depression (muscle weakness, respiratory failure), paralysis, complex in ATP, vasodilation and shock
Causes - impaired renal secretion Rx - antidote is Ca gluconate - IV hydrate - haemodialysis
What is hepatic encephalopathy?
Confusion, loc, coma from liver failure.
Causes
- excessive nitrogen
- hyponatraemia
- hypokalemia
- alkalosis
- hypoxia
- Dehydration
- infection: pneumonia, SBP
Rx
- lactulose
