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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
What region on an ECG represent inferior aspect of heart, and it’s major artery?
Right coronary artery II, III, aVF
26
Changes to ECGs post STEMI. Immediate and after few days?
Immediate - hyperacute T waves - then… ST elevation or new LBBB Over next few days - pathological Q waves - T wave inversion
27
Complications post MI?
Cardiac arrest Arrhythmias Heart failure DVT/PE pericarditis
28
Causes of acute pulmonary oedema?
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
Red swollen legions over shins, diagnosis? And causes?
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
Erythema nodosum causes?
Many but key ones are - Sarcoidosis - Inflammatory bowel disease Others - strep throat infections - gastroenteritis - mycoplasma. pneumoniae - TB - pregnancy - medications e.g. COCP, NSAIDS
31
Define bronchiectasis?
Abnormal permanent dilatation of bronchi and bronchioles, usually caused by and leads to infections
32
Common colonisers in CF?
Pseudomonas.aeruginosa Strep.pneumonia Haem,influenzae
33
Causes of bronchiectasis?
- Post-infection- untreated/inadequately treated - Post-obstruction- foreign body, tumour, lymphadenopathy - Congenital - Immunodeficiency - Allergic bronchopulmonary aspergillosis - Alpha 1 antitripsin deficiency - RA - UC
34
Signs of bronchectasis?
Clubbing of fingernails Course crepitations Symptoms - chronic productive cough - occasional haemoptysis - recurrent LRTI
35
Investigation for bronchiectasis?
High resolution CT scan
36
Normal pO2 and pCO2 (in kPa)
pO2 10.5-13.5 kPa pCO2 4.7- 6 kPa
37
PE on ECG findings?
'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
Lung cancer most commonly metastasises to where? (4 places)
Brain Bone Liver Adrenals
39
What's used to stage lung cancer?
PET cancer Bone scan
40
Investigations for lung cancer?
CXR Staging CT scan- contrast PET-CT- shows where is metabolically active Bronchoscopy with endobronchial US (EBUS) Histology analysis- biopsy
41
Chest xray findings with lung cancer?
Peripheral opactity- ie consolidation in lung field Hilar enlargement Pleural effusion- usually unilateral Collapse
42
What neurological conditions is associated with a type of lung cancer? And what type of lung cancer is this?
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
How does Lambert Eaton syndrome present?
- 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
Staging for lung cancer?
TNM staging Tumour- size and nearby spread Nearby spread to lymph nodes Metastases
45
How does superior vena cava obstruction present?
Severe SOB Severe headache Perioribital swelling Raised JVP Dilated neck veins Dilated veins across chest
46
Steroid side effects?
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
Trigeminal neuralgia 1st line?
Carbamazepine
48
Acne treatment pathway?
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
What two LFTs will be very high in cholestasis?
ALP - alkaline phosphatase GGT- gamma glutamyl transferase
50
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?
Paget’s disease of bone Raised ALP- with calcium and phosphate normal Bisphosphonates- oral risedronate or IV zolendronate
51
Ex-alcoholic with confusion, distended abdomen, spider naevi and hepatic flap. Diagnosis? Treatment 1st line?
Hepatic encephalopathy Lactulose
52
Blood marker specific for liver cirrhosis?
Alpha fetoprotein
53
Ca 19-9 indicative of what?
A tumour marker Indicative of cholangiocarcinoma (cancer of bile ducts) or pancreatic cancer Can be raised in other condiations, not too specific
54
What is Courvoisier’s law?
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
A tumour marker indicative of bowel cancer?
Carcinoembryonic antigen (CEA)
56
What is a raised Carcinoembryonic antigen a marker of?
A tumour marker indicative of bowel cancer
57
78yo M attends with recent urinary incontinence, has become forgetful and a shuffling gait. Top differentials?
- Normal pressure hydrocephalus: triad of gait abnormality, dementia and urinary incontinence - Parkinson’s - Delirium - Dementia
58
Management of normal pressure hydrocephalus?
Ventriculoperitoneal shunt (into peritoneal cavity) Usually develops after a head injury, SA, or meningitis. It’s a reversible cause of dementia
59
What blood markers indicate tumour lysis syndrome?
High uric acid/urate High phosphate High potassium/hyperkalaemia Low calcium

Finals (13 decks)

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