What are the imaging features of Multiple Sclerosis?
- Peri-Ventricular White Matter Lesions not necessarily matching the clinical picture
- This is because the central nervous system (CNS) inflammation does not always cause demyelination or axonal damage of clinical significance, and the CNS can recover from these foci of inflammation.
What are the features of NMO?
= Neuromyelitis Optica (Devic’s Disease)
- longitudinally extensive transverse myelitis
- aquaporin 4 receptor
- CNS demyelinating disease
- optic tracts + spinal cord
How is Benign Paroxysmal Positional Vertigo (BPPV) diagnosed?
- Hallpike test
- Delayed onset (a few seconds) torsional nystagmus on descent facing one side only
- The nystagmus should wear off after around 20 seconds, and on repeat testing it lasts a shorter amount of time (‘fatiguing’)
- This is the basis of vestibular exercises
What is Benign Paroxysmal Positional Vertigo (BPPV)?
- Nystagmus + Vertigo
- Caused by debris blocking the normal flow of endolymph in the labyrinth, leading to misreporting of positional change by the vestibules, and a discrepancy between actual position and the position of the head according to the vestibules
- Management = The Epley Manoeuvre
How is C Difficile Diarrhoea managed?
- Metronidazole + Vancomycin
- Use Soap + Water! (alcohol gel does not kill C Difficile pores)
What are the causes of Hepatomegaly?
- Obstruction: Budd-Chiari
- Viral Hepatitis
- Biliary Tract Obstruction
- Myeloproliferative Disease
- Metastatic Liver Disease (e.g. hepatocellular carcinoma)
- Polycystic Disease
What is Sclerosing Cholangitis?
- Inflammation, fibrosis and subsequent stricture formation of the bile ducts
- Leads to cholestasis and eventual cirrhosis
- Intra- and extrahepatic bile ducts
- Ulcerative Colitis association
- Liver biopsy is diagnostic
- Treatment is primarily symptomatic
- Ursodeoxycholic acid may delay disease progression
- Liver transplant is curative in some cases
What is Primary Biliary Cirrhosis?
- 50 year old female
- Chronic granulomatous inflammation of the interlobular bile ducts causing cholestasis
- Deranged LFTs
- Liver Biopsy
- Anti-Mitochondrial Antibodies
- Ursodeoxycholic Acid
- Liver Transplant
Which parts of the heart do the Coronary Circulation supply?
- The Left Anterior Descending artery normally supplies the anterior wall of the left ventricle and the inter-ventricular septum
- It arises from the left coronary artery, as does the Circumflex artery, which supplies the posterior and lateral sides of the left ventricle
- The Right Coronary Artery usually supplies the SAN (sino-atrial node), AVN (atrio-ventricular node), right ventricle and inferior part of the left ventricle
What is the epidemiology and management of Gallstones?
- Patients with the 5 Fs – fat, forty, female, fair (Caucasian) and fertile (pre-menopausal)
- Management is by removal of the gallbladder (cholecystectomy), usually performed laparoscopically
How is Ankylosing Spondylitis diagnosed?
- Schober’s Test - two fingers are placed 10 cm apart on the lower back of the patient (5 cm above and below the L5 vertebra in the midline) and the patient is asked to flex. An increase between the fingers of < 5 cm indicates spinal stiffness
- X-Ray of the hip shows blurred margins of the sacroiliac joints (sacroiliitis)
- erosion of the corners of the vertebral bodies (Romanus Lesions)
- development of bony spurs (Syndesmophytes)
- calcification of the spinal ligaments (Bamboo Spine)
What are the associations of Ankylosing Spondylitis?
- Apical Lung Fibrosis
- Anterior Uveitis
- Achilles Tendonitis/Plantar Fasciitis
- Aortic Regurgitation
Double Impulse Apex Beat
Tapping Apex Beat
The increased force in closing the mitral valve
What are the features of Multiple Myeloma?
- Bone Pain
- Pathological Fracture
- Renal Failure
- Pancytopenia due to Marrow Infiltration
How is Multiple Myeloma diagnosed?
2 of the Following Criteria:
- Marrow Plasmacytosis
- Serum/Urinary Immunoglobulin-Light Chains (Bence Jones protein)
- Skeletal Lesions (Osteolytic Lesions, Pepperpot Skull and Pathological Fractures)
People who have evidence of serum or urine monoclonal antibodies but do not fulfil the criteria for multiple myeloma are said to have ‘Monoclonal Gammopathy of Uncertain Significance’
What is the management of Multiple Myeloma?
- Bone Pain may be controlled with analgesia, bisphosphonates and orthopaedic intervention
- Renal Failure, caused by the deposition of light chains within the kidney, is usually managed by promoting fluid intake although renal replacement therapy may be required
- Infection, Anaemia and Bleeding caused by pancytopenia secondary to marrow infiltration can be managed with broad-spectrum antimicrobials, erythropoietin therapy and blood product replacement, respectively
- Cure = Allogeneic Stem Cell Transplantation, but high morbidity and for < 55 years old
- Palliative = Chemotherapy
What is the management of a High INR?
INR = (measured PT/normal PT) ^ ISI ( international sensitivity index)
- A moderately high INR with no bleeding can usually be corrected by omitting a dose of warfarin
- In situations when the INR is significantly raised without** bleeding** the warfarin should be omitted and an oral dose of vitamin K prescribed
- A high INR associated with active bleeding warrants a dose of oral or intravenous vitamin K plus the administration of a prothrombin complex concentrate such as Beriplex®, which contains the deficient factors II, VII, IX and X
- When a prothrombin complex concentrate is not available, fresh–frozen plasma may be used as an alternative