NIFF NAF AND TRIVAAA! Flashcards
(203 cards)
1
Q
What does aldosterone do?
A
Increases sodium reabsorption in the kidneys in exchange for K+ and H+
-triggered by angiotensin II
2
Q
What are typical LMN Signs?
A
Wasting
Decreased reflexes
Foot drop
Eventual weakness
3
Q
UMN signs
A
Spasticity Weakness Brisk reflexes Up going plantars May lose proprioception and vibration sense
4
Q
What does the radial nerve do?
A
C5-T1 Opens the fist BEST Brachioradialis Extensors Supinatior Triceps
5
Q
Phrenic nerve lesion
A
C3,4,5
If lesion get orthopnoea with raised hemidiaphragm on CXR
6
Q
What can damage the brachial plexus?
A
Radiation, trauma
Variable distribution of pain/parasthesia
7
Q
What does the median nerve supply?
A
C6-T1 LOAF Lubricles Opponens pollis Abductor pollis brevis Flexor pollis brevis
Precision grip
Carple tunnel syndrome
Sensation 3.5 fingers and palm
8
Q
What does the ulnar nerve supply?
A
C7-T1
Can’t cross fingers
Weak little finger abduction
Sensory loss over medial 1.5 fingers
9
Q
What does the lateral cutaneous nerve do?
A
L2-3
Anterolateral burning thigh pain from entrapment under inguinal ligament
10
Q
What does the siatic nerve do?
A
L4-s3
Hamstrings and all muscles below knee- therefore get foot drop
LaterAl loss of sensation below knee
11
Q
What does the peroneal nerve do?
A
- l4-l5
- Winds around fibular head comes off siatic nerve at the knee
- loss sensation over dorsum
- foot drop, weak ankle dorsiflexion/eversion
12
Q
What does the tibial nerve do?
A
L4-S3
Can’t stand on tip toes or invert foot toes
-sensory loss over sole
13
Q
C5, C6, C7, C8 effects if damaged
A
C5: weak deltoid and supraspinatus
C6: biceps and brachioradialis, numb thumb and index finger
C7: triceps and finger extension. Numb middle finger
C8: weak finger flexors, small muscles of hand, numb 5th and ring finger
14
Q
What is the treatment for PD?
A
MAO- B inhibitors- alternative to dopamine agonists in early PD.
S/E AF, postural HTN
Rasagiline, selegiline
COMT inhibitors
May lessen off time
Tolcapone- good but can cause liver problems so monitor LFTs
Levodopa- combined with a dopadecarboxlylase inhibitor
15
Q
What helps tremor in PD?
A
Anticholingergics
Help tremor but cause confusion in the old
SE- dry mouth, dizzy, reduction in vision, decreased HR, urinary retension, anxiety, confusion, increased excitement, decreased memory, hallucinations, insomnia
Benzhexol, orphenadrine
16
Q
Which dopamine agonist is used in the ‘rescue pen’ for sudden ‘.offs’ in PD?
A
Apomorphine
Potent dopamine agonist
17
Q
Which dopamine agonist can be given via a patch?
A
Ropinirole
18
Q
What drugs can cause pericardial disease?
A
Hydralazine (vasodilation for HTN)
Isoniazid (anti TB)
Procainaminde (antiarrythmic)
Penicillin
19
Q
What are the heart sounds if someone has acute myocarditis?
A
Soft S1 S4 gallop
20
Q
What drugs cause acute myocarditis
A
Herceptin (HER2 Expressing breast cx) Methyl dopa-for HTN Penicillin Phenytoin Sulphonamides Spirolactone Choranphenicol (Abx) Carbamazepine Cyclophosphamide
21
Q
How do you cardiovert AF?
A
Amiodarone and flecainide
22
Q
What meds do you use for complex partial seizures?
A
Carbamazepine
23
Q
What meds do you use for tonic clonic seizures?
A
Sodium valproate
24
Q
What meds do you use for tonic clonic seizures but chance of pregnancy?
A
Lamotrigine
25
What meds do you use for absent seizure if intolerant to sodium valproate?
Ethosuximide
26
What drugs cause a low sodium ?
Sulphonamides
SSRIs
Carbamazepine
Tricyclics
27
What drug causes cholestasis?
Co amoxiclav
28
What are the side effects of ACE inhibitors?
Cough and hyperkalaemia
29
What are the causes of raised prolactin?
```
Primary hypothyroidism
Prolactinaemia
Polycystic ovaries
Physiological
Pregnancy
Phenothiazine, metacloPramide, domPeridone
```
30
What comprises Fallots tetralogy
1) VSD
2) pulmonary stenosis
3) RV Hypertrophy
4) aorta overriding the VSD
Some also have ASD
The degree of pulmonary stenosis indicates the severity of the illness
31
What is Homans sign?
Sign of DVT
| pain in the calf on forceful and abrupt dorsiflexion
32
What does wells score do?
```
Probability of a PE/DVT
1Point for each of:
-cancer
-paralysis or plaster for past 6 months
-best rest >3 days or surgery in past 4w
- localised tenderness
- entire leg swollen
- calf >3cm larger than unaffected leg
-putting oedema greater than other leg
-collateral superficial veins
```
If alternative diagnosis is more likely than DVT -2 points
High: =/>3 (75%)
Mod=1-2 (17%)
Low=
33
What are the CXR findings for PE?
S1 Q3 T3
Hamptoms hump- wedge shaped configuration at lung periphery due to infarcted lung
Westermark sign - pulmonary oligemia (local reduction in blood perfusion)
34
If pts have a moderate wells score and you want to effectively exclude PE and their d dimer is negative what test can you do?
Rapid quantitative ELISA
35
What is the warfarin therapy for someone after PE?
Start on enoxaparin 1mg/kg every 12 hours for 5 days
Start warfarin 1-5mg a day
Can stop enoxaparin after 5 days if INR >2.0
Warfarin continued at 2.0-3.0 for 3 months
36
What is the gold standard of diagnosis of PE?
CTPA
| V/Q recommended in pregnancy
37
Warfarin- how does it work?
- Interferes with vit I dependant carboxylate of Gla domains of FII, FVII, FIX, FX and essential for formation of active forms
- Full Anticoagulation when Vit k dependant clotting factors decrease to 10-20%
- half life 47hrs
- bound to albumin in circulation
- cp450 metabolism
38
Target INR for DVT, AF, PE?
2-3
39
Target INR for artificial cardiac valve?
3-3.5
40
What are the side effects of warfarin?
- teratogenic- 6-12w gestation
- bleeding
- skin necrosis
- pancreatitis
41
What do you give to reverse warfarin?
Vit K (konakion)
INR >8
Lasts about 1-2w
If acute setting- fresh frozen plasma
42
```
Unfractionated heparin
Mr?
Animal origin in uk?
What do you easily reverse it with?
Is monitoring necessary?
```
```
5000-35000Da
Pigs! (Other countries cows)
Protamine sulphate
Yes- APTTR
Bound to plasma proteins so hard to say how much it is going to work
```
43
LMWH
Who to you Monitor in?
Mr?
Mr- 3000-5000Da
Not plasma protein bound so more predictable effect
Monitor by anti-Xa level only in children, pregnancy, over/under weight, renal failure, when on oral anti coagulant too, recurrent VTE/high risk bleeding
exclusively cleared by the kidney
44
What are the complications of heparins?
Bleeding
Osteoporosis
Heparin induced thrombocytopenia (leads to platelet activation and thrombosis) if happens stop heparin and start another anticoagulants but not warfarin
45
What is rivaroxaban?
Direct FXa inhibitor
PO, OD
No monitoring
NICE licensed for total hip and knee replacement
46
What is dabigatran?
Direct thrombin inhibitor
PO TDS
No monitoring
NICE approved for extended prophylaxis for total hip and knee replacement
47
What is haemophilia A a deficiency of?
Factor 8
Give desmopressin which gets the level up to half of normal
Can also get acquired (aabs against F8 and happens in makes and females)
48
What is haemophilia b a deficiency of?
Factor 9
49
What are the Vit K dependant clotting factors?
2, 7, 9, 10
50
What is alteplase?
Fibrinolytic enzyme irritating t-PA
51
What is the inheritance for von willebrand disease?
Dominant
| Treat with TXA, DDAVP, VWF concentrate
52
What are the causes of raised fibrin degradation products? (D dimer)
Trauma
Recent surgery
VTE
liver/ kidney impairment
53
What are the encapsulated organisms you are more at risk of if you have your spleen removed?
Haemophilus influenzae
Neisseria meningitis
Streptococcus pneumoniae
54
Causes of small cell anaemia?
- iron deficiency
- anaemia of chronic disease
- thalassemia
- sideroblastic anaemia
55
Causes of normocytic anaemia?
```
Anaemia of chronic disease
Combined deficiency -iron and folate
Marrow infiltration /fibrosis
Endocrine disease
Haemolytic anaemia
```
Acute blood loss
56
Cause of large cell anaemia
- Vit B12 deficit
- folate deficiency
- normoblastic
- alcohol
- high reticulocytes
- liver disease
- hypothyroid
- azathoprine
57
When do you need to suspect multiple myeloma?
```
CRAB
C - elevated Calcium
R- renal impairment
A: anaemia
B: bone pain
```
58
What do you use to constrict the pupils?
Pilocarpine (miotic)
59
What do you use to dilate the pupils?
Tropicamide 1% and phenylephrine 2.5%
| Avoid if hx angle closure glaucoma
60
What is amblyopia? And how do you treat it?
Amblyopia Is a visual acuity
61
Which muscle does CNIV Supply?
Superior oblique
62
People with severe depression ALWAYS need to start medication. What is the first line?
SSRIs
Citalopram, fluoxetine or sertraline (safe if angina or recent MI)
Warn pts takes several weeks for meds to take effect
SE- initial anxiety, nausea, disturbed sleep, headaches
May increase suicidality
Hyponaturemia reported with all antidepressants but higher in SSRIs
63
What are the side effects of tricyclic antidepressants?
TOXIC IN OVERDOSE
don't give if suicidal ideation
```
Mainly anticholinergic
Dry mouth
Constipation
Headache
Blurred vision
May incl arrhythmias
```
64
After 1st line antidepressant therapy if after 4-6 weeks no or limited response is seen what can you try next?
Mirtazapine (a2 adrenoreceptor antagonist so increases central NADL and serotonin neurotransmission)
Venlafaxine (serotonin and NADL reuptake inhibitor) associated with higher withdrawal effects
Tricyclics (lofepramine or amitriptyline)
65
What is the treatment of choice for mild depression?
Watchful waiting or psychological treatment
66
What is the diagnostic criteria for mild depression?
2 weeks
At least 2 of the core features
AND 2 or more symptoms
Causes some distress but able to continue with usual activities
67
What is the diagnostic criteria for moderate depression?
4 or more symptoms present including 2 of the core features
Likely to have great difficulties undertaking daily activities
68
What is the diagnostic criteria for severe depression?
all 3 of the core features and a total of at least 8 symptoms
Symptoms are marked and distressing often including feelings of suicidality, guilt, somatic symptoms
Can be divided into depression with or without psychotic symptoms
69
What is the diagnostic criteria a manic episode?
ELEVATED MOOD/or IRRITABILITY
AND 3 other symptoms for at least 1 week, unless a hospital admission has been required (allow shorter duration)
70
What is the diagnostic criteria for hypomania?
Symptoms of mania but less severe and of shorter duration (4 consecutive days)
Does not tend to lead to hospital admission or distrust daily activities
71
What is the diagnostic criteria for bipolar affective disorder?
At least 2 episodes of mood disturbance (elevated OR depressed) but one of these MUST be hypomania or mania
Depressive episode is not required,
Diagnosing a depressive episode same as someone suffering from depression alone
72
What is rapid cycling?
They have 4 or more episodes of either mania/hypomania and/or depression
In a 12 month period
73
What drugs can lead to manic episodes and increase the risk of a manic episode in someone with mania?
Cocaine, ecstasy, amphetamines
74
If a 1st degree relative has bipolar affective disorder, how much are your chances increased by?
X7
90% concordance between monozygotic twins
Mean onset is 21
75
Name 3 antipsychotics you can use to treat a manic episode
Olanzapine
Quetiapine
Risperidone
76
What is good in the short term for managing mania?
Lorazepam (benzo)
77
Name 2 mood stabilisers
Lithium
Semisodium valproate
Good if responded to them before
78
What should you do it someone is having a manic episode and they are on antidepressants?
Should be reduced and stopped during the episode
79
What can you prescribe as prophylactic medication in bipolar affective disorder?
mood stabilisers- lithium or semisodium valproate OR the antipsychotic orlanzapine
Minimises the number and severity of episodes of mania or depression.
May need to combine them
DONT GIVE sodium/ semisodium valproate to children of childbearing age
80
What do you need to monitor when prescribing lithium?
Regular and close monitoring- blood levels, especially when initiating or changing dose.
- check levels every 3 months if on a stable dose.
- monitor LFTs and TFTs every 3 months.
81
What are the side effects if lithium?
Fine tremor, nausea, GI upset, polyuria, weight gain, metallic taste
Signs of toxicity
- coarse tremor and ataxia
- muscle weakness
- severe nausea and diarrhoea
- drowsiness, coma, death
82
What are the first rank symptoms of schizophrenia also known as?
Schneider's first rank symptoms
83
What are the 1st rank symptoms of schizophrenia?
- thought insertion, broadcast, withdrawal, echo
- running 3rd person commentary
- voices arguing
- passivity of affect, impulse, volitions (actions), somatic (body is being controlled)
- delusional perceptions (normal sensory perception as having a meaning) often intended for the patient alone- which is why others disbelieve them.,
84
What is the diagnostic criteria for schizophrenia?
- at least 1 first rank symptom present for most of the time for at least 1 month
OR
At least 2 of:
-persistent hallucinations in any form every day for at least a month.
-neologisms (made up words) or thought distribution leading to incomprehensible or irrelevant speech.
-catatonia- over activity or limited/no movements
-negative symptoms (self neglect, limited activity, reduced amount if speech, limited emotional responses
85
What is paranoid schizophrenia?
Delusions and hallucinations often persecutory.
Most common
Best prognosis
86
What is hebephrenic schizophrenia?
Jumbled speech and inappropriate behaviour which is often silly
87
What is simple schizophrenia?
Negative symptoms only, no delusions or hallucinations
88
What is residual schizophrenia?
Get delusions and hallucinations followed by negative symptoms
89
What is catatonic schizophrenia?
Disturbed movements- under or over activity
90
What are the risk factors for schizophrenia?
```
Urban
Male
Younger age (peak onset is 20yrs old)
Slow or delayed childhood development
Pregnancy complications/traumatic birth
Maternal infection ( influenza)
FHx- genetic link with heritability 60-80%
Afro Caribbean
```
91
Name some atypical antipsychotics
Newer form
Orlanzapine
Quetiapine
Risperidone (may have fewer metabolic side effects)
Clozapine
- used in treatment resistant schizophrenia - at least 2 others must have been tried, one of which must be atypical
- not suitable for chaotic or poorly adhering
- risk of agranulocytosis and need regular WBC levels- Weekly initially,
- increased risk if metabolic side effects
92
What are the side effects with atypical antipsychotics?
Metabolic-
-weight gain, increased risk MI, DM,
hyperproplactinarmia (espec clozapine)
- reduced/absent periods
- gynaecomastia
- excessive/increased growth of body hair
- sedation
Also extrapyramidal side effects but they are worst in typical
93
Name some typical antipsychotics
Haloperidol
Promethazine
Chlorpromazine
94
What are the side effects if typical antipsychotics?
-extrapyramidal incl:
- acute muscle dystonia
-tardive dyskinesia (repetitive, involuntary movements, often of the torso or lips)
- Parkinsonisms
Can get metabolic too but these more common in typical than atypical
95
Which drugs can be given in a depot?
Risperdal
Depixol
Clopixol
Piportil
96
What are obsessions?
Intrusive, distressing thoughts
Pt recognises them as their own (different from a delusion)
Accompanied by a feeling something bad will happen
Not all progress to acts- May result in rumination (dwelling on the thought)
If they do lead to an act- compulsion
97
What is a compulsion?
Feel a strong need to perform a certain action despite knowing it's silly/unnecessary.
- usually try to resist unsuccessfully
- performed as an attempt to relieve anxiety these thoughts cause
- provide temporary relief.
98
What is the 1at line treatment for mild OCD?
Low intensity psychological therapy- 10 therapist hours
| Exposure response prevention therapy
99
What is the recommended treatment for adults with moderate OCD?
```
Moderate means they have moderate functional impairment. Or low impact psychological therapy had proven ineffective.
EITHER short course SSRI
OR
more intensive psycholoigcal treatment
Exposure response prevention therapy
```
These treatments are equally effective,
NB all pts avoid alcohol- make it worst and stop the drugs working
100
Treatment for OCD with severe functional impairment?
Combo of SSRI and psycholoigical therapy - fluoxetine (selective inhibitor) usually needed for 12. Dose needed is higher than needed in depression. Increased risk of relapse if drug stopped early or is too low dose
Exposure response prevention therapy
101
Define panic disorder
4 panic attacks in a month (mod)
| 4 in a week (severe)
102
What can use used in panic disorder?
Sedating antihistamine
| Cholrphenamine
103
What is the treatment for PTSD?
Trauma focused CBT
Stress management
Relaxation techniques
Eye movement desensitisation and reprocessing
Form of Psychotherapy
Helps process distressing memories more fully which reduces emotional
Impact of the memory
NB
Debriefing after a traumatic event especially group debriefing has been shown to he detrimental and not used
Can use drugs:
Sertraline and mirtazapine
104
What is the diagnostic criteria for anorexia nervosa?
-weight loss leading to body weight at least 15% below normal or expected weight for age and height
OR BMI
105
What is the diagnostic criteria for bulimia nervosa?
- recurrent episodes of over eating at least twice a week for a 3m period. Large amounts of food eaten in shirt space of time
- preoccupation with food and eating and a compulsive desire to eat (craving)
attempt to counteract this behaviour by:
- self induced vomiting
- purging
- alternate episodes of starvation
- use drugs to control weight
106
What is EDNOS?
Don't meet all the above criteria for bulimia or anorexia nervosa but some features may be present.
107
What is the prophylaxis following rheumatic fever
```
-penicillin V 250mg/12h PO
OR
-sulfacliazine 1g/day PO
OR
-erythromycin 250mg/12h PO
```
If no carditis: 3 years/ until 21 years old
If carditis or valvular disease: until 40yo
If carditis and no valvular: for 10 years
108
What antibiotics do you use for infective endocarditis? Blind therapy
Native valve:
- amoxicillin
- /+ gentamicin
- if pen allergic- vancomycin and gentamicin
Prosthetic valve:
Vancomycin
+ gentamicin
+ rifampicin
109
What abx do you use for infective endocarditis caused by staphs?
- native: flucloxacillin
| - prosthetic: flucloxacillin + rifampcin+ gentamicin (review this one after 2w)
110
What abx do you use for infective endocarditis caused by streps?
- benzlypenicillin
If pen allergic
-vancomycin + gentamycin
111
What abx do you use for infective endocarditis caused by enterococcus?
Amoxicillin+gentamycin
112
What abx do you use for infective endocarditis caused by HACEK organisms?
-amoxicillin and gentamycin for 4w
| 6w if prosthetic
113
What criteria is used to diagnose infective endocarditis?
```
Dukes criteria
Need 1 major and 3 minor
Or
2 major
Or
5 minor
-major:
-2 blood cultures positive typical or 3 different sites all positive.
-endocardium involved- negative ECHO
-new valvular regurgitation
```
Minor:
- fever >38C
- predisposition
- positive blood culture if isn't a major
- positive ECHO but major not met.
- vascular immunological signs
114
What is the treatment for stable angina?
-all patients get aspirin, statin, GTN spray
1st line: B blocker or CCB (verapamil or diltazem)
2nd: increase dose to the max tolerated
3rd: add either B Blocker of CCB (dihydropyride if combined)
If you can't add these, consider: nicorandil, ivabradine or ranolazine
DO NOT USE B BLOCKER WITH VERAPAMIL- Complete heart block
115
What can you treat migraine with?
Triptinate
116
How do you treat a sex and exercise headache?
Amitriptoline
117
What visual field defect is caused by pituitary tumour?
bitemporal superior quadrantanopia
118
Which bacteria are alcoholics more prone to?
Klebsiella
119
What organism causes erythema multiform?
Mycoplasma
120
Causes of acute pancreatitis
```
GET SMASHED
Gallstones
ERCP
Trauma
Steriods
Mumps (cox B)
Autoimmune
Scorpion venom
Hyperlipidlemia
ETOH
Drugs
```
121
How does aspirin work?
Anti platelet - inhibits thromboxane A2 production
122
How does clopidogrel work?
Anti platelet
| Inhibits ADP binding to it's platelet receptor
123
How does enoxaparin work?
Activates antithrombin III therefore potentiates the inhibition of coagulation factor Xa
Fondaparinux acts in the same way
124
How does bivalirudin work?
Reversible direct thrombin inhibitor
125
What Abx do you prescribe for an animal bite?
Co amoxiclav
If pen allergic
Metronidazole and doxycycline
Organism is pasturella multiocida
126
Important side effect of amiodarone
Thyrotoxicosis
127
What is the 1st line treatment for UC?
Aminosalicylates
| If don't respond after 4w use prednisolone
128
What is the target weight gain for someone with anorexia nervosa per week?
1-1.5kg
129
What drug do you use to detox from alcohol or stimulant drugs eg cocaine and amphetamines?
-benzodiazepines
130
What drug do you use to detox from heroine/opiate abuse?
- Methadone
- buprenorphine (partial opioid agonist) blocks opioid receptors and prevents the effect of using other opiates
- Naltrexone - opioid agtagonist which prevents reuse of opiates by interaction leading to unpleasant physical symptoms
- Lofexedine- alpha 2 agonist which reduces opiate withdrawal symptoms
131
What does acamprosate do?
Reduce alcohol cravings- MUST be abstinent
132
What vitamins do you need to replace in alcohol abuse?
Thiamine/im pabrinex and Vit B12
133
When does delirium tremens occur?
1-3 days after alcohol cessation
134
How does delirium tremens present?
- disorientation
- visual hallucinations (insects or small people)
- physical signs- sweating, pyrexia, tachypnoea, tachycardia
135
How do you treat delirium tremens?
```
Benzodiazepines
Correct electrolyte abnormalities
Vit replacement
Rehydration
Nurse in well lit room and consistent environment
```
136
What is wernickes triad?
acute onset, high morbidity/mortality
1) acute confusion/agitation
2) eye signs (nystagmus)
3) ataxia (broad based gait with cerebellar signs)
137
What causes wernickes ?
Thiamine deficiency leading to ischemic damage to the brainstem
Requires urgent treatment with thiamine replacement (im pabrinex)
To prevent progression to Korsakoff's syndrome
138
What is Korsakoff's syndrome?
- acute symptoms of wernickes
- these resolve and leave an amnesic syndrome
- confabulation (making up history/facts subconsciously to fill in memory gaps) is a key feature
139
What are the main features of dissociative (conversion disorder) ?
- symptoms appear suddenly
- symptoms remit after a few weeks/months
- association between symptoms and stressful events/needs
140
What are the main features of somatinization disorder?
- at least 2 years multiple and variable symptoms
- preoccupation with symptoms causes persistent distress and leads to patient seeking repeated consultations/sets of investigations (>3)
- won't accept reassurance nothing physically wrong.
- 6 or more symptoms from 2 or more of: GI, CV, GU, skin and pain symptoms
141
What is the diagnostic criteria for hypochondriasis?
-persistent belief (>6m) of the presence of up to 2 serious physical illnesses
OR Preoccupation with a presumed deformity or disfigurement.
-interferes with life and causes distress.
-refuse to accept medical reassurance
142
What is the diagnostic criteria for factitious disorder?
- pt feigns or produces symptoms intentionally
- aim to adopt the 'sick role'
- often combines with relationship / personality difficulties
- no evidence of external motivation- eg money (not malingering)
- aka munchausens or hospital hopper syndrome
143
What is the treatment for emotionally unstable personality disorder?
- dialectical behavioural therapy
| - mentalization based treatment
144
Features of paranoid PD?
- sensitive to set backs
- bears grudges
- suspicious and combative in nature in respect to their personal rights
- excessive self importance
145
Features of schizoid PD?
- emotional detachment and coldness, unable to express emotions
- limited relationships and indifference to others opinions
146
Features of Dissocial PD?
- low tolerance to frustration
- inable to experience guilt
- disregard others feelings and irresponsible attitude to social rules
147
What are the features of histrionic PD?
- self dramatisation
- inappropriate seductivesness
- concern with physical attractiveness
148
Features of obsessive PD?
-rigid and stubborn in manner
-obsessive traits incl excessive doubt and caution, perfectionism
Pre occupation with rules
149
Features of anxious (avoidant) PD?
Persistent and pervasive tension and anxiety.
Belief they are socially inept
Preoccupation with criticism and avoid social suituations/relationships due to fear of rejection
150
Features of dependant PD?
Allow others to make life choices and rely heavily on others for reassurance.
- feel uncomfortable alone
- will never put own needs above own, unwilling to make demands on others
151
What can you give to enhance cognition in mild-mod AD?
Anticholinesterase inhibitors
Donepezil
Galantamine
Rivastigmine
CI- heart block, arrhythmias as can have severe bradycardic effect.
SE- nausea, diarrhoea, insomnia, headache
Slow decline and improve behaviour
Monitor MMSE every 6m
152
What drug is licensed for moderate to severe dementia?
Memantine
NMDA antagonist
Neuroprotective and therefore disease modifying.
153
Managing acutely disturbed patients- if de escalation doesn't work, what can you do next?
- offer oral medication- benzos or fast acting antipsychotics (haloperidol or promethazine)
- if refusing and danger- im lorazepam or midazolam
NB must not combine lorazepam and olanzapine- Resp depression
154
If a patient develops oculogyric crisis or painful dystonia as a side effect of antipsychotics, what can you give?
Procyclidine (anti cholingeric) iv,PO or Im
Long term can reduce these and reduce Parkinson's symptoms
NOT to treat tardive dyskinesia
155
What can be used to treat EPSE more long term?
Benzos, baclofen and physical therapy
156
What us neuroleptic malignant syndrome?
Life threatening neurological reaction occurring in response to antipsychotic medication
More common in younger men, those on depot and those who have not received antipsychotic meds before
-fever, sweating, autonomic fluctuation, muscle rigidity, cognitive changes and confusion. Raised creatininezzz..z.. kinase
157
What is serotonin syndrome?
Potentially life threatening adverse drug reaction, rapid onset
Overdose,interactions (MDMA, LSD)
Leads to high serotonin levels.
Myoclonus, autonomic features, tremor
Hydration and benzos
158
What does phenytoin do?
Anti epileptic - not first line anymore
Blocks Na channels
Lots of side effects
Need serum levels monitoring
159
What does carbamazepine do?
Blocks sodium channels
| serum levels monitoring useful
160
What does phenobarbital do?
Prolonged GABA mediated Cl channel opening
Blocks some Na channels
Most widely prescribe AED
serum levels monitoring- useful in some pts
161
What does lamotrigine do?
Sodium channel blocker
| Monitor levels in pregnancy
162
What does sodium valproate do?
Effective in all seizure types
1st choice in idiopathic generalised epilepsy and myoclonic epilepsy
Significant pregnancy risk
May enhance GABA transmission in specific circuits
Blocks sodium channels.
Modulates t type Ca channel
163
What does levetricetam do?
Important AED rapidly gained an important place in clinical practise.
Reduces high voltage activated Ca currents
Reverses inhibition of GABA gated currents
Binding of reversible specific binding site SC2a (synaptic vesicle protein)
164
What does topiramate do?
Blocks voltage gated Na channels at high firing frequencies
Increases frequencies at which GABA opens Cl channels
Antagonises glutamate action
165
What is the first line therapy to treat osteoporosis?
Alcendronate
Risedronate
These are bisphosphinates
166
What is drusen a sign of?
DRY DRUSEN
| Dry macular degeneration
167
Which cancer is barrets and GORD associated with?
Oesophageal adenocarcinoma
168
What 3 things are associated with normal pressure hydrocephalus?
Urinary incontinance
Gait abnormal
Dementia
169
What drugs cause an increase I'm creatinine?
Cimetidine
| Trimethoprim
170
Which bit of the brain is a triple watershed area?
Parieto-occipital sulcus
171
Which drugs cause lung fibrosis?
Amiodarone
| Nitroflutoin
172
How do you monitor heparin?
APTT
173
What is fovilles syndrome?
Pontine lesion
| Facial nerve palsy and ipsilateral gaze palsy and contralateral hemiparaesis
174
What is Millard gubler syndrome?
Occlusion of the basilar artery branches in the pons gives lateral rectus palsy (6cn)
Ipsilateral facial paralysis
Contralateral hemiplegia
175
What are the abs in MS?
MOG, MBP
these can predict the time to conversion to definite MS
NMO-IgG- devics
176
What monoclonal abs are used in Ms?
Alemtuzumab
Natalizizumab- decreases relapsing remitting my 67% and lesions by 92%
VLA REceptor blocker and allows immune cells to cross BBB
177
Which renal stones are semi opaque on X-ray?
Cystine
178
Which renal stones are radiolucent on X-ray?
Urate
| Xanthine
179
What is leriches syndrome?
1) clarification of buttocks and thighs
2) atrophy of leg muscles
3) impotence
Atherosclerotic occlusion problems
180
What is Lhermitte's sign?
Flex neck and get electric shock in trunk and limbs.
| MS, cervical spondylitis, subacute combined degeneration of the cord, trigeminal neuralgia
181
What is uhthoffs phenomenon?
Decrease in vision on exercise, hot meals and hot baths
182
What has low factor VIII and high APTT and normal INR?
Haemophilia A
Give desmopressin
Avoid im and NSAIDS
183
What is factor IX deficiency?
Haemophillia B
184
How do you diagnose AML?
Bm biopsy
| Auer rods
185
When does the Ph have a good and worst prognosis?
Good- CML
| Bad- acute lymphoblastic leukaemia
186
How do you treat CML?
Imatimib- specific for Ph ch
Stem cell transplant only chance of cure
Insidious onset
May be features if gout
High WBC low Hb
High b12 high urate
187
What is the most common leukaemia?
```
Chronic lymphocytic leukaemia
Usually incidental finding on Fbc
Enlarged rubbery non tender nodes
High lymphocytes
Rule of 1/3s
```
188
Which Hodgkin lymphoma has the best prognosis?
Nodular scelerosising- most common
Lymphocyte depleting- worst prognosis and least common
189
Which is the most common non Hodgkin lymphoma?
Diffuse large B cell lymphoma
190
What thing in the blood test means there's a worst prognosis in non Hodgkin lymphoma?
High LDH
| Means high cell turn over
191
In myeloma what do you get on electrophoresis?
Monoclonal band or paraprotien on serum or urine electrophoresis
BENCE JONES proteins - urine
High calcium and bone lesions
Renal problems due to lots of abs
Tx chemo and pred
192
amyloidosis
```
1) AD, T2DM
Fibrillar light chain deposition
Restrictive cardiomyopathy
Nerves
Gut
Vascular
```
Tx- melphalan and pred
Secondary- reflecting chronic inflammation as acute ph protien
Familiar- transyhtretin in liver, transplant cures
POSTIVE CONGO RED STRAIN
193
What can protein c and protein s cause?
Clots
Skin necrosis espec if on warfarin
Neonatal purpura fulminans- fatal if intreated
194
Where is atherosclerosis?
Pseudo AAA
Aortic dissection.
Intima
Adventicia
Media
195
Benefit of aspirin in ACS?
Reduction CV Mort
And non fatal MI
And reocculsion rates
40% of people reduction progression non stable Angina to MI
75mg after- reduction in events
196
Benefits of Thienopyrides in ACS?
Reduce major cardiac events, thrombosis and restenosis rates
34% non responders to clopidogrel
197
What is the treatment for FH?
Statin atorvastatin
Ezetimibe - inhibits cholesterol absorption
Resin/bile acid sequestrant- cholestyramine
Apheresis
198
What happens with warfarin and abx?
Increase warfarin affects as abx decrease gut flora so less Vit k is made
199
What happens with valproate and phenytoin?
Valproate displaces phenytoin and inhibits it's metabolism
200
ASA and NSAIDS and methotrexate?
ASA and NSAIDS displace methotrexate so decrease it's excretion- get serious methotrexate tox
201
Amiodarone and digoxin?
Amiodarone displaces digoxin and impairs it's excretion
202
What do you get with multiple myeloma?
```
CRAB
High Calcium
renal impairment
Anaemia
Bone pain
```
203
What are the tumour markers for testicular cx?
alpha FP
bHCG
LDH
US then remove. Don't waste time CT can mx very quickly
