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Flashcards in Geriatrics Deck (49)
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1

Neural causes of syncope

• Neural causes:
○ Vasovagal (most common):
§ Severe pain, fear, blood phobia
§ Orthostatic stress eg prolonged standing or in hot places
○ Situational eg micturition, Cough, sneeze
Carotid sinus hypersensitivity - while shaving, tight collar

2

Postural hypotension causes of syncope

Postural hypotension:
○ Autonomic failure - postprandial, medication, MSA, parkinsons, diabetic neuropathy
Hypovolemia - haemorrhage, addisons, dehydration

3

Cardiac arrhythmia causes of syncope

○ Long QT
○ Drug induced arrhythmia
AV conduction disease

4

Structural cardiopulmonary causes of syncope

○ Aortic stenosis
○ ACS
○ Pericardial tamponade
HOCM

5

Hx of syncope

• Was LOC complete?
• How long LOC? How quickly did it come on?
○ Vasovagal is brief complete LOC not lasting more than 20 secs
• Warning sx?
• Recovery spontaneous and total?
○ Postictal sx - seizure
• Situational trigger?
• Change In meds?
FHx of sudden death? - HOCM

6

Ix of syncope

Ix:
• LS BP
• Cardiac exam
• ECG
• FBC - anaemia
Fasting BM - hypoglycaemia

7

Syncope differentials

Syncope differentials:
• Epilepsy
• Narcolepsy
• Dizziness without LOC
• TIA/Stroke
Hypoglycaemia

8

Rules on driving for seizures

Seizures:
• 1st seizure - No driving for 6 mths
• Multiple seizures:
Seizure free for 12 months - may qualify for license

9

Rules on driving for syncope

Syncope:
• Simple faint - no restriction
• Single episode, explained & treated - 4 wks off
• Single episode, unexplained - 6 mths off
2+ eps - 12 mths off

10

Stroke driving rules

• 1 mth off driving may not need to inform DVLA if no residual neurological deficit
Multiple TIAs over short period of time - 3 mths off + inform DVLA

11

Tremor differentials and classification

Classifying tremors:
• Rest - PD (pill rolling, bradykinesia)
• Intention - Cerebellar disease
• Tremor on movement - Essential tremor, thyrotoxicosis, anxiety, drugs (beta agonists)

12

inheritance of essential tremor, S&S, tx

Benign auto dom condition which affects both upper limbs

S&S:
• Postural tremor worse if arms outstretched
• Improved by alcohol and rest

Tx:
• Propanolol


13

guillan barre S&S and causes

S&S:
• Ascending weakness
• Parasthesia
• Hyporeflexia
• Severe cases lead to muscle weakness and resp failure

Caused by:
• Often triggered by infection Campylobacter jejuni
• Lymphomas esp hodgkins
• Pregnancy
• Surgery
• Drugs

14

Explain ROSIER tool

ROSIER tool to assess stroke likelihood:
• New onset asymmetrical facial weakness, limb weakness, speech disturbance, or visual field defect - 1 point each
• LOC or seizure = -1 point
• Stroke likely if >0 points

15

Tx of stroke

Acute Tx:
• ABCDE
• High flow o2
• Optimise BM
• Ischemic stroke:
○ IV alteplase if within 4.5 hrs of symptoms
○ 300mg Aspirin
• Hemorrhagic stroke:
○ Neurosurgery referral

16

S&S of intracranial abscess

S&S:
• Fever
• Headache
• GCS lowered
• Focal deficits
• Generalised tonic clonic seizures
• Meningism
• Infants - Bulging fontanelles

17

ix and tx of intracranial abscess

Ix:
• FBC
• Blood cultures
• LP - rules out meningitis. Only if no signs of raised ICP
• CT head
• Abscess aspiration for culture

Tx:
• Drain and culture
• Sepsis 6
• IV dexamethasone if cerebral oedema suspected
• Surgery - surgical excision of abscess

18

S&S of NPH

Wet, wobbly, and whacky:
• Urinary incontinence, gait ataxia, dementia

19

Ix and tx of NPH

Ix:
• Imaging reveals hydrocephalus with enlarged 4th ventricle

Tx:
• Ventriculoperitoneal shunting

20

Patho and S&S of degenerative cervical myelopathy

Spinal stenosis at the cervical level

S&S:
• Pain in limbs and neck
• Loss of motor function
• Loss of sensory function - numbness
• Loss of autonomic function - continence, impotence

21

Ix and tx of degen cerv myelopathy

Ix:
• MRI cervical spine

Tx:
• Surgical Decompression

22

S&S of parkinsons

S&S:
• Classic triad:
○ Bradykinesia - short shuffling steps (MUST HAVE)
○ Tremor - pill rolling typical
○ Rigidity - lead pipe rigidity
• Mask like facies
• Drooling of saliva
• Depression

Sx worse on one side than other usually

23

Tx of parkinsons

Tx:
• Delay tx until onset of disabling sx and then introduce dopamine receptor agonist (DRA)
• DRA:
○ Bromocriptine
○ ADR - day time somnolence, impulse control disorders
• Levodopa:
○ Reduced effectiveness over time usually 2 yrs
○ ADR - dyskinesia, dry mouth, anorexia, postural hypotension

24

Patho of huntingtons

Patho:
• Auto dom
• Huntingtin protein accumulates in brain and causes damage

25

S&S and ix of huntingtons

S&S:
• Involuntary movements
• Argumentative behaviour
• Depression
• Chorea - quick, "dancing" movements of hand and face
• Rigidity
• Dystonia
• Dementia
• Weight loss

Ix:
• FHx
• DNA analysis
• CT head

26

Tx of huntingtons

Tx:
• Antidepressants
• Tranqs to control chorea

27

S&S of multi systems atrophy

S&S:
• Parkinsonism
• Postural hypotension
• Ataxic gait - uncoordinated movements, drunk like

28

S&S of myasthenia gravis. when is it a crisis

S&S:
• Weakness and fatiguability
• Ptosis
• Diplopia
• Dysphagia
• Dysarthria
• Myasthenic crisis - Resp function affected

29

Ix and tx of MG

Ix:
• Ach receptor antibodies
• Tensilon test - anticholinesterase test
• CXR - look at thymus (thymus abnormal in majority)

Tx:
• Anticholinesterases eg pyridostigmine
• Surgery - thymectomy
• Immunosuppressants - steroids, DMARDs
• Myasthenic crisis - IV immunoglobulins, plasmapheresis

30

Patho of syringomyelia and S&S

Patho:
• Development of cysts in spinal cord that compress

S&S:
• Asymmetrical initially
• Wasting and weakness of arms
• Spinothalamic sensory loss - pain and temp
• Loss of reflexes