Geries Flashcards by Annie Caldwell

Presentation of digoxin toxicity

Disorientation
Vomiting
Mental confusion
Amnesia
Depression
Yellow visual field discolouration (xanthopsia)

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What are lewy bodies made up of?

Alpha synuclein

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When is ECT recommended

Life threatning depressive stupor
- especially when refusing to eat or drink
Treatment resistant depression

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WHat does paralysis of the deltoid muscle cause

Weakness of shoulder abduction, particularly after 30 degrees of abduction (supraspinatus assists in the first 30)
Weakness of drawing arm forward and internal rotation

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What causes osteomalacia

Lack or impaired metabolism of Vitamin D

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What kind of drug is rifampicin

cytochrome p450 enzyme inducer

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Interaction of rifampicin and warfarin

Increased metabolism of warfarin and a fall in INR

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Drugs that can reduce INR when on warfarin

Rifampicin
Phenytoin
Carbamazepine
St johns wort

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Drugs that can increase INR when on warfarin

Erythromycin
Metronidazole
Cipro
Cimetidine
Allopurinol

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Triad of NPH

Gait disturbance
Incontinence
Cognitive impairment

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CT features of NPH

Ventricular enlargement

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Treatment of NPH

Large volume CSF removal (LP or lumbar drain)
If benefits from above - VP shunt placement

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Type of gait in NPH vs PD

NPH - broad based shuffling gait
PD - narrow based shuffling gait

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When does senile degenetative AS occur

Progressive calcification of the valve leaflets in response to long standing haemodynamic stress

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What can cause subacute combined degeneration of the spinal cord

Vitamin B12 deficiency

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Features of walderstroms macroglobulinaemia

Hepatosplenomegaly
Anaemia
Thrombocytopenia
Raised plasma viscosiity
Raised IgM

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Immeediate treatment of increased plasma viscosity of walderstoms macroglobulinaemia

Urgent plasmapheresis

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Treatment of mild - mod alzheimers

Acetylcholinesterase inhibiting drugs e.g.
- donepezil
- rivastigmine
- galantime

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Treatment of severe alzheimers

Memantime

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MMSE score for someone with severe alzheimers

< 10 / 30

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Why does digoxin take a while to work

High degree of protein binding

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Indicators of DIC

Hx of malignancy
Thrombocytopenia
Prolonged PT, APTT
Reduced fibrinogen levels

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What do brainstem strokes cause

Contralateral weakness
Ipsilateral sympathetic pathway (horners syndrome)
Ipsilateral hypoglossal nerve causing tongue weakness on the affected side
Medial longitudinal fasciculus causing nystagmus as part of an ipsilateral internuclear opthalmoplegia
Body sensory loss on contralteral side
Facial sensory loss on ipsilateral side

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Presentation of cerebellar strokes

Ipsilateral weakness
DANISH
- dysdiadokokinesis
- ataxia
- nystagmus
- intention tremor
- slurred speech
- hypotonia

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Neuro exam of myasthenia gravis

Proximal muscle weakness Ptosis No muscle wasting or fasiculation Sensation normal Tone normal Reflexes normal

Antibodies of myasthenia gravis

anti-acetylcholine receptor Abs

Treatment of myasthenia gravis

Acetylcholinesterase inhibitors Oral corticosteriods

When is Lambert Eatson syndrome seen

Bronchial carcinoma

Neurology of Lambert Eaton syndrome

Proximal muscle weakness May improve initially on exercise Lessens as exercise is sustained Reflexes reduced or absent

Presentation of GBS

Ascending pattern of progressive symmetrical weakness, starting in lower extremeties Neuropathic pain may develop Reflexes reduced or absent

Why does TMP exacerbate poor renal function

Compettive inhibition of creatinine secretion

Diagnosis for amyloidosis on histology post biopsy

Congo red staining

Who should you not give haloperidol to

PD patients

What can risperdione worsen

PD symptoms

Treatment of VT with no adverse features

Amiodarone

Presentation of SCC

Ulcerated nodular lesion Surrounding paraesthesia Hyperkeratotsis

What can SCC evolve from

actinic keratosis

What causes melanosis coli

Long term laxative abuse Over time this leads to pigment deposition in the mucosa

What area of the brain do the cranial nerves pass through

Jugular foramen

Lesions that affect brocas area result in what

Expressive aphasia

Features of PSP (progressive supranuclear palsy)

Falls seen very shortly after onset of Sx Symmetrical (proximal > distal) rigidity Poor response to levodopa Dysphagia Decreased verbal fluency Supranuclear gaze palsy (loss of vertical gaze)

Is autonomic dysfunction common or uncommon in PSP

Uncommon

Features of MSA (multi-system atrophy)

Cerebellar signs Autonomic dysfunction

Features of corticobasal degeneration

Asymmetrical signs Predominantlely presents with rigidity Alien limb syndrome (unable to control movements of an isolated limb) leading to a sensation that the limb is foreign Apraxia Aphasia as the disease progresses

Features of lewy body dementia

Fluctuating confusion/onset of dementia Persistent visual hallucinations Spontaenous parkinsonism REM sleep disorder Unexplained syncope

Presentation of primary polycythaemia

Headaches Itching

Mutation of primary polycythaemia

JAK2 gene

Blood results of primary polycythaemia

Raised Hb Raised hct Raised WCC Raised platelets Erythropoietin low

Treatment of bipolar disorder

1. Lithium 2. Add valproate

Investigation of a chronic leukaemia

Immunophenotyping / flow cytometry

Pathologically, what does tonsillar herniation cause

Increase in BP Fall in HR

What indicates a restrictive filling pattern (heart)

Dilated atria

What can be seen in the myocardium to indicate amyloid?

Speckled appearance

What forms the posterior cerebral arteries

Basilar artery

What do the posterior cerebral arteries supply

Occipital lobe

What causes anton syndrome

Bilateral occipital lobe infarcts

What kind of meningitis are the elderly at increased risk of

Listeria meningitis

Who should be covered for listeria meningitis and what drug should be added to ceftriaxone?

> 60 and immunosuppressed Amoxicillin

Anti-emetic of choice in PD

Ondansetron

What does the nerve root L1/2 supply

Sensory to anterior groin Motor supply to hip flexors

If the L4 nerve root is involved in damage, what would you expect to see

Sensory disturbance of the anterior thigh

If L4/5 was affecred, what would you expect to see

Altered sensation in the lower leg

If L5/S1 nerve root was affected, what would you expect to see

Altered sensation below the knee and over the foot Foot drop

2/3rds of leg ulcers are due to what

Chronic venous insufficiency

If ABPIs are statisfactory, what is the management of venous ulcers

Compression

Genetics of HD

AD Huntington gene on chromosome 4 CAG repeat expansion

Pathological findings in HD

Neurodegeneration in the cortex and striatum, especially in the caudate nucleus

What is characteristic of HD

Chorea (random dancing movements flitting from one body part to another) Can also have - parkinsonsim - frontal subcotical cognitive impairment - behavioural disturbance - slow, saccardic eye movements - depression - dementia

Example of management of chorea in HD

Anti-dopaminergic agents such as tetrabenazine

Main role of the hippocampus

Memory Spatial navagation

Lesions affecting the substantia nigra would result in what

Parkinsonism

Pathology of LBD

Accumulation of aggregated form of alpha-synuclein into lewy bodies with vulnerable neurons

Treatment of acitiinic keratosis

Topical 5-FU

Half life of amiodarone

25-30 days Cessation may take several months for the drug concentration has fallen to an insiginifant level

Mechanism of action of allopurinol

Reduced urate production

What may gouty arthritis be precipitated by

Diuretic therapy

What is listeria particularly assosiated with

Pates and soft cheeses

What is predominant in CSF of a listeria meningitis

Lymphocytes

What is predominant in a CSF of bacterial meningitis

Neutrophils

CSF abnormalities in bacterial meningitis

Opening pressure > 180 WBCs 10 - 10,000 Neutrophils predominate CSF glucose < 0.4 Glucose < 2.2 Protein > 0.45

What blood film would you see if you had metastatic ca with bony mets, and were anaemic

Nucleated RBCs

What is seen on a blood film with haemolytic anaemia

Heinz bodies

What is seen on a blood film with hyposplenism

Howell-Jolly bodies

What is seen on a blood film of hereditary spherocytosis

Spherocytes

Mechanism of action of amiodarone

K channel antagonist (delay in repolarisation, increasing AP and increased effective refractory period)

Mechanism of action of digoxin

Inhibition of the sodium potassium ATPase

What type of drug is donepezil

Acetylcholinesterase inhibitor

Examples of acetylcholinestase inhibitors

donepezil rivastigmine galantimine

Physiological effects of IPPV

Increased lung volumes Increased intrathoracic pressure Increased pulmonary vascular resistance Reduced systemic BP Reduced venous return and cardiac output

WHat is tardive dyskinesia

Movement disorder assosiated with long term use of anti-psychotics

What is akathisia characterised by

Motor restlesseness

Septate hyphae and invovlement of sinuses suggect diagnosis of which infection

Aspergillus

WHat supplies the pons

Branches of the basillar artery

Tx for UTI in patients with efgr < 45

pivmecillinam

Genetic basis for alzheimers disease

APOE e4 allele carriage

Role of rivastigmine in PD

Symptoms of dementia

What drug has a role in reducing "off periods" in PD

Entacapone

Risk factors for osteonecrosis of the jaw secondary to bisphosphonate therapy

Dental caries (MOST IMPORTANT) Smoking > 65 Long term use of corticosteriods

Scoring system to assess independence in patients with a stroke

Barthel index

Treatment of LBD

Donepezil

Treatment of restless legs syndrome

Gabapentin and pregabalin

Management of N/V secondary to bowel obstruction in terminal care

Haloperidol

Site of action of bendroflumethiazide

Distal convoluted tubule