OSCE Revision Flashcards
(370 cards)
1
Q
anterior cerebral artery blockage will lead to weakness of
A
lower limb contralaterally
2
Q
vascular dementia presentation
A
step wise progression
onset can be sudden or gradual
executive function deficits prominent early
mood disturbances and disorders are common
neuro deficits and gait problems early
later stages = psychosis, delusions, hallucinations, paranoia
can be alongside alzheimers
3
Q
AIDP
A
acute inflammatory demyelinating polyneuropathy
most common variant of GBS - 95% cases
4
Q
Weakly positive birefringent, rhomboid shaped crystals
A
Calcium pyrophosphate = pseudogout
5
Q
how to measure lying and standing BP
A
patient lay down for 5/10 minutes
take BP
then stand and take BP at 1 min and 3 min
6
Q
DVLA and stroke /TIA
A
group 1 - dont need to report. dont drive for 1 month and can drive if no sustained neuro deficits after 1 month
group 2 = 1 year cant drive
7
Q
risk factors for vascular dementia
A
main = HTN
smoking, diabetes, hyperlipidaemia, obesity, hypercholesterolaemia
8
Q
retinal detachment presentation
A
new onset floaters, photopsia (bright flashes), sudden onset progressing visual field loss - a dark shadow that moves inwards
RAPD if macula or >1/2 retina detaches
9
Q
Smith’s fracture
A
Volar displacement of radius head
10
Q
treatment of parkinsons disease
A
1) levodopa + dopa decarboxylase inhibitor
2) dopamine agonist
3) MAO-B inhibitor
11
Q
presentation of bacterial conjunctivitis
A
mucopurulent secretions, red eye, stinging, FB feeling, mild/moderate pain, glued eyes upon waking, papillae under eye lid
12
Q
Z shaped thumb
A
Sign of RA-MCPJ flexion and IPJ extension
13
Q
Negatively birefringent, needle shape crystals
A
Monosodium urate = gout
14
Q
co beneldopa
A
levodopa and Benserazide
15
Q
features of vascular parkinsonism
A
gradual or step wise deterioration small vessel disease symmetrical predominantly leg symptoms 50% respond to leva dopa
16
Q
prophylactic treatment for migraine
A
if > 2 headaches a month
propranolol, topiromate, amitriptyline
2nd line - sodium valproate, botox
17
Q
Ankle joint bones
A
Tibia, fibula and talus
18
Q
Radial inclination
A
Normal wrist has 25 degrees radial inclination
19
Q
presentation of parkinsons disease
A
resting tremor rigidity bradykinesia - reduced arm swing, progressive reduction in amplitude of repetitive movements fixed facial expression reduced blinking hypophonia (quiet voice) micrographia (little writing) gait disturbance hyposmia non motor symptoms - ANS: orthostatic hypotension, constipation, inconinence, sleep disorders, intense dreams, dysphagia, memory/ concentration problems.
20
Q
prophylaxis of further aacg attacks
A
laser peripheral iridotomy
21
Q
amiodarone
A
used for cardioversions in atrial fibrillation
22
Q
donepezil
A
cholinesterase inhibitor for dementia
23
Q
delirium
A
acute onset, fluctuating confusion due to an underlying treatable cause
24
Q
investigations for encephalitis
A
LP - PCR for HSV, VZV and enterovirus
MRI and bloods
25
blockage of middle cerebral artery will lead to weakness/sensory loss of
contralateral face and arm
26
signs of radial nerve palsy
```
wrist drop (no wrist extensors)
sensory loss of central posterior arm and thumb
```
27
Bouchards nodes
PIP joint swelling in OA
28
side effects of levodopa
dyskinesia with long term use
impulse control disorder
on/off fluctuations
reduced effect with time
nausea, vomiting, hypotension, poor appetite, psychological problems, sleep problems, hallucinations
29
how does viral conjunctivitis present
no/mild pain, watery discharge, diffuse red injections, mild itching, gritty feeling, lymphoid follicules under eyelid, pre-auricular lymphadenopathy
30
aetiology of delirium
```
Constipation
Hydration
Infection
Metabolic disturbance
Pain
Sleeplessness
```
```
Prescriptions
Hyperthermia or pyrexia
Organ dysfunction - renal/hepatic
Nutrition - vitamin deficiencies
Environmental
Drugs
```
others: hypoxia, surgery, hypoglycaemia, B12 deficiency, traumatic head injury, encephalitis
31
managing difficult delirium
use verbal/non verbal techniques to deescalate
if needed
short term haloperidol 0.5mg oral or 1mg IM
(not in parkinsons or LB dementia)
or Lorazepam
32
acute angle closure glaucoma presentation
severe, rapidly progressing pain, brick red eye, progressive headache on affected side, vomiting, rapidly progressing visual loss, corneal clouding, haloes, v high iop, mid dilated fixed pupil
33
Bamboo spine
Seen in ankylosing spondylitis , Due to ossification of the annulosus fibrosis and interspinous ligaments
34
hypoactive delirium
lethargy
slowness with everday tasks
inattention
excessive sleeping
35
5 common malignancies that spread to bone
Thyroid, lung, breast, renal, prostate
36
secondary prevention for TIA
```
treat AF
treat carotid stenosis
treat HTN
optimise diabetes
lifestyle changes
treat vascular risk factors
```
37
Carpal bones
Bones of the wrist - Scaphoid, lunate, triquetral, pisiform, Trapezium, trapezoid, capitate, hamate
38
how often should diabetic patients be screened for DR?
at diagnosis and then annually
39
what are the 3 essential meds you cant miss in hospital
parkinsons meds
anti epileptics
insulin
40
strongst predictors of stroke prognosis
age and severity of stroke
41
AMT 4
age
dob
place
year
42
iridocorneal angle
the angle involved in glaucoma
43
latanoprost
prostaglandin analogue that lowers pressure in the eye by increasing drainage of aqueous humour
used in glaucoma
44
Aflibercept
Anti VEGF injection - used for wet AMD and oedema in DR
45
DVLA and epilepsy
1st unprovoked seizure = 6 months for group 1, 5 years for group 2
epileptic seizure = 12 months for group 1, 10 years for group 2
cant drive during period of AED withdrawal/changeover and for 6 months post
46
ropinirole
dopamine agonist for PD rx
47
Volar displacement
Displacement of the distal radius towards the palm of the hand #
48
4AT assessment
Alertness
AMT 4
Attention - months from december backwards
Acute onset and fluctuating
>4 = delirium
49
crescendo TIA
2+ in 1 week
50
classic gait abnormalities in parkinsons
small shuffling steps with stooped posture.
unsteadiness on turning
difficulty stopping - festination
tendency to fall
'freezing' in doorways/ patterned carpets
51
uveitis presentation
associated with systemic inflammatory conditions- especially ankylosing spondylitis.
dull orbital pain, red eye, reduced vision, synechia, flare, tearing, floaters, photophobia
52
apraclonidine
alpha 2 adrenergic agonist - used in glaucoma to lower IOP by stopping aqueous humour production
53
best AED for pregnancy
lamotrigine with folic acid 5 mg
54
posterior column syndrome
loss of proprioception/vibration/fine touch below the lesion. sensory ataxia and positive rhombergs
55
Methotrexate given with
Folic acid
56
most common vasculitis in adults , affecting branches of the external carotid
giant cell arteritis
57
pathway of spinothalamic tracts
decussates soon after entering spinal cord and ascends in contralateral side
58
gonioscopy
measures the angle between the cornea and iris
59
loteprednol
topical steroids eye drops
60
osteoporosis treatment
colecalciferol and calcium supplement
| alendronic acid - bisphosphanate
61
co careldopa
levodopa and carbidopa
62
Pilon #
Severe # to ankle – usually from jumping from a large height
63
signs of common peroneal nerve palsy
Hx of kneeling
| weakness of foot dorsiflexion (causing foot drop) and eversion
64
anomia
unable to identify objects
65
how to prevent stroke in patients with AF
warfarin (INR aim 2-3) or apixaban/dabigatran
66
PC of MS
optic neuritis, weakness or loss of sensation, ataxia, facial weakness, nystagmus, diplopia, vertigo, deafness, transverse myelitis, cognitive and psychological symptoms
67
treatment of optic neuritis
Iv methylprednisolone with GI protection
68
Leflunomide
DMARD
69
treatment for encephalitis
Benzylpencillin for bacterial meningitis
| IV acyclovir for HSV encephalitis
70
pseudodementia
due to a functional cause
depression
psychogenic
or hysterical
71
seizure
abnormal excessive neuronal activity in the brain leading to impairment of normal cognitive function
72
frontotemporal dementia treatment
antidepressants
| antipsychotics
73
differnetiate between essential tremor and parkinsons disease
DaTScan
imagies the dopamin reuptake in the basal ganglia.
normal in essential tremor and not in PD
74
Ranibizumab
anti VEGF - used for wet AMD and oedema in DR
75
pathophysiology of diabetic retinopathy
hyerglycaemia- ishaemia - neovasculisation - leaky vessels - haemorrhage and oedema
76
management for falls
treat underlying cause
optimise sight
optimise mobility - balance and strength training with physio
optimise enviroment - OT
optimise foot wear - podiatry
medication review and stop drugs increasing risk
check osteoporosis and treat
77
side effects of dopamine agonists
impulsive behaviours +++
| sleepines, fainting, nausea, constipation, confusion, hypotension, headaches, psychological problems
78
the different patterns of MS
RRMS 80% cases - becomes SPMS IN 50% of these
| PPMS 15% cases
79
stages of alzheimers dementia
1) mild cognitive impairment - short term memory loss (Temporal lobe)
2) mild AD - reading problems and poor object recognition (parietal lobe)
3) moderate AD - poor judgement, impulsivity, short attention (frontal lobe)
4) severe AD - vision problems (occipital lobe)
80
HAS BLED
- risk of bleeding on anticoag for AF
HTN
Abnormal LFTs/Renal function
Stroke
Bleeding
Labile INR
Elderly >65
Drugs/alcohol
81
optical coherence tomography
mandatory test for AMD diagnosis
| image of cross section of the retina
82
todds paresis
transient paralysis following seizure
| lasts 48hrs
83
chloramphenicol
topical eye drop antibiotic to treat bacterial conjunctivitis
84
epinastine
topical eye drop antihistamine for conjunctivitis
85
syncope
global cerebral hypoperfusion
86
Schatzker classification
Classifies tibial plateau fractures
87
secondary dementia
reversible dementias due to a medical condition
88
Volar tilt
Normal wrist has 10 degrees volar tilt
89
pathophysiology of lewy body dementia
pathology of LBD mimics idopathic parkinsons
| lewy bodys are composed of protein alpha synuclein
90
Mason classification
Classifies radial head fracturs 1=undisplaced 2 = displaced 3=comminuted
91
Boutonnieres deformity
Sign of RA-Hyperextended DIPJ and hyperflexed PIPJ
92
side effects of MAO B inhibitors
headache, aching joints, indigestion, flu-like symptoms, depression
can worsen side effects of ldopa - sickness and dyskinesia
93
entacapone
a cOMT inhibitor
| taken with ldopa will prevent its break down and have a longer effect
94
hypopyon
pus in anterior chamber
95
triad of normal pressure hydrocephalus
dementia
gait disorder
bladder instability
96
risk factors for ischaemic stroke
```
hypertension
carotid stenosis
AF
contraceptive pill
clotting disorder
diabetes
smoking
ischaemic heart disease
peripheral vascular disease
polycythaemia
```
97
scleritis
painful, associated with systemic inflammatory conditions (especially RA), pain with eye movement, visual loss
98
triad of encephalitis
fever, headache and altered mental status
99
prognosis of delirium
2/3 recover
| 1/3 wont recover completely- die or need care home
100
treatment for viral conjunctivitis
1) topical antihistamine +/- artificial tears
2) topical steroids
3) topical ganciclovir if confirmed adenovirus
101
Foot bones
Talus, Calcaneum, cuboid, navicular, 3 x cuneiforms
102
GBS prognosis
normal = max disability at 4 weeks
20% will have persistent neuro problems (of which 50% will be severe)
3-7% mortality
20% can't walk unaided at 6 months
103
tia management
aspirin 300mg
risk asses for stroke
secondary prevention
104
Hallux valgus
Bunion , The big toe turns into valgus (laterally) towards the other toes
105
Susceptible nerve in humeral neck fracture
Axillary nerve
106
Susceptible nerve in elbow fracture
Ulnar nerve
107
dorsal columns carry
sensation of fine touch, proprioception and vibration
108
differentials of headache
```
tension headache
cluster
migraine
drug induced
meningitis
space occupying lesion
GCA
sinusitis
acute glaucoma
trigeminal neuralgia
subarachnoid haemorrhage
```
109
Odontoid peg
Peg on C2 vertebrae
110
presentation of giant cell arteritis
temporal head ache, scalp tenderness, jaw claudication, upper limb pain on use, polymyalgia rheumatica, partial or complete visual loss, systemic symptoms
111
causes of orthostatic hypotension
hypovolaemia - haemorrhage /vomiting /diarrhoea /dehydration
iatrogenic - betablockers, diuretics, vasodilators, alcohol, antidepressants, phenothiazines
autonomic failure - diabetic neuropathy, Parkinson's disease, spinal cord injury
112
vascular dementia pathophysiology
caused by multiple small cerebrovascular infarcts, small vessel disease and a single cerebrovascular accident
113
alzheimers dementia pathophysiology
```
amyloid plaques - clumps of amyloid and degenerated neurons
neurofibrillary tangles (mostly made of tau proteins)
```
114
hyperactive delirium
```
agitation
delusions
hallucinations
aggression
wandering
```
115
proptosis
abnormal protrusion of eye/s
116
physiological tremor features
increased SNS stimulation e.g. due to stress
| action tremor
117
Multiple sclerosis characteristics
1) formation of lesions/plaques - in white matter (optic nerve/brain stem/ basal ganglia/ spinal cord/ corpus callosum
2) destruction of myelin sheath - demyelination
3) inflammation - cell mediated ( a break in the BBB allows them entry into the CNS)
118
presentation of early macular degeneration
central vision loss (scotoma or poor acuity), reduced contrast sensitivity, light glare, metamorphopsia
119
myasthenia gravis
a neuromuscular autoimmune condition - caused by antibodies against nicotinic acetylcholine receptor
120
forehead sparing is seen in
UMN palsy
121
Ulnar deviation
At the MCP joints-Might develop to subluxation
122
presentation of allergic conjunctivitis
severe itch, tearing, diffuse redness, papillae present
123
otorrhoea
discharge from ear
124
POCs criteria
1 of 3 present
- isolated homonymous hemianopia
- LoC
- cerebellar or brain stem syndrome
125
pathophysiology of CPOAG
reduced aqueous humour flow through the trabecular meshwork - raised IOP - hydrostatic pressure on the optic nerve and compromise of vasculature causing ischaemia leads to retinal ganglion apoptosis
126
galantamine
cholinesterase inhibitor for dementia
127
Pre-patellar bursitis
Housemaids knee – able to flex and relatively pain free
128
optic neuritis presentation
peri orbital/retro occular pain - worse on movement, loss of visual acuity with scotoma, RAPD, loss of colour vision, optic disc swelling, perception of seeing light due to eye movement or pressure on eye, swelling of optic disc on fundoscopy
129
presentation of CRAO
sudden painless loss of vision, RAPD
| pale oedematous retina and cherry red spot fovea (underlying choroid)
130
differentials for space occupying lesion
infection - abscess, empyema, granuloma (TB)
vascular - stroke/haemorrhage
neoplasm - primary or secondary (glioblastoma)
hydrocephalus
131
corticospinal tracts
lateral tract decussates in the medulla
| anterior decussates in the cervical/thoracic spine
132
cholesteatoma presentation
painless otorrhea - frequent or unremitting
progressive conductive hearing loss
erosion into local structures may lead to vertigo, headaches and facial nerve palsy
recurrent otitis media
133
Lewy body dementia core features
1. visual hallucinations
2. REM sleep disturbance
3. fluctuating cognition, attention and arousal
with 1+ cardinal features of parkinsonism
134
treatment of AACG
emergency
| 1. brinzolamide (carbonic anhydrase) with timolol (beta blocker) and brimonidine (alpha 2 antagonist)
135
most common cause of bacterial conjunctivitis
staphylococus
| streptococcus
136
4 main factors that lead to development of pressure sore
interface material
shear
friction
moisture
137
aetiology of falls
| DAME
Drug induced
Age related - vision/instability
Medical - acute illness/syncope/seizure/stroke
Environmental
138
herpes keratitis sign
dendritic/geographic ulcer
139
treatment of endophthalmitis
intravitreal antibiotic injection if bacterial
140
treatment for AF
rate control - beta blocker or rate controlling CCB
2nd line = combo
rhythm control if rate control not working: amiodarone or electrical conversion
141
aphasia
inability to comprehend or produce languange/communicate
142
Hydroxychloroquine
DMARD
143
which level in the spine separates lower and upper limb innervation
T6
144
what is 3:1 atrial flutter
the beat is only conducted to the ventricles every 3 atria beats
HR = 100bpm
145
keratitis presentation
odeama and opacification of the cornea, corneal ulcer, redness, pain, discharge, lid oedema, reduced vision, photophobia, high IOP
146
Management of hip OA
Total hip replacement
147
drugs which induce parkinsonism
dopamine receptor antagonists
metaclopremide
haloperidol
cyclizine
prochlorperazine
148
natalizumab
anti lymphocyte moniclonal antibody
| used in very active MS
149
cyclizine
used to treat vertigo/motion sickness
150
Sulfalazine
DMARD – good for fertile women
151
cholesteatoma
presence of keratinising squamous epithelium (skin) is present in the middle ear as a result of TM perforation (90%) or retraction
152
treatment for dry amd
no treatment
stop smoking, diet changes - eat dark leafy greens and take zinc and antioxidant vitamin supplements
counselling, visual rehabilitation
153
Syndesmophytes
Due to ossification of annulosus fibrosis. Irregular in psoriatic arthritis and regular in ankylosing spondylitis
154
hard exudates
precipitates of proteins leaking from blood vessels
155
The fibula lies on the _______ side
Lateral
156
Rheumatoid factor
Rheumatoid arthritis marker
157
investigations for suspected epilepsy
bloods - fbc, inflammatory markers, U&Es, LFTs (GGT), glucose - toxicity screen?
general obs and lying and standing blood pressure
ECG
158
alzheimers dementia presentation
> 60 YO
memory loss most prominent
gradual onset with slow progressive decline
evidence of varying changes in planning, reasoning, speech and orientation
decline in ADLs
personality, mood and interests change - apathetic,irritable
159
Diclofenac
Nsaid
160
myasthenia gravis treatment
anticholinesterase inhibitors - e.g. nyostigmine
| immunosuppressants e.g. prednisolone and azathioprine
161
Colchicine
2nd line in gout if nsaids are CI becoz of renal impairment
162
when is an MRI indicated for seizures ?
new onset seizures in adulthood
focal seizures
seizures not responding to medication
163
treatment of scleritis
ophthalmologist referral
| systemic steroids/NSAIDs +/- topical antibiotics
164
Intracapsular# treatment
Cannulated screws for non-displaced fractures, Hemiarthroplasty for displaced NOF #s
165
csf analysis of bacterial meningitis
Appearance: Cloudy and turbid
Opening pressure: Elevated (>25 cm H₂O)
WBC: Elevated >100 cell/µL (primarily polymorphonuclear leukocytes (>90%))
Glucose level: Low (<40% of serum glucose)
Protein level: Elevated (>50 mg/dL)
166
management of migraine
1st line = NSAIDs, antiemetics (domperidone), sumatriptan/zolmitriptan
167
treatment of CPOAG
1) medical: pressure lowering eyedrops
latanoprost, timalol, brinzolamide, apraclonidine
2) laser trabeculoplasty - peripheral iridotomy
3) surgical - trabeculectomyor aqueous shunt
168
presentation of endophthalmitis
pain, decreased vision, hazy eye appearance, floaters, hypopyon, swollen eyelid
169
furosemide
loop diuretic
| inhibits Na-K-Cl co transporter in the thick ascending loop of henle
170
Fat pad
Signe up blood and fat in the joint capsule
171
differentials for sudden loss of vision
```
acute angle closure glaucoma
retinal detachment
retinal artery/vein occlusion
giant cell arteritis
orbital cellulitis
endophthalmitis
vitreous haemorrhage
optic neuritis
wet AMD
```
172
concerns about abuse of vulnerable elderly should be reported to
hospital safegaurding team
173
consequences of malnutrition
```
delayed wound healing
impaired immune response
reduced mobility
increased length of hosp stay
depression/ reduced qol
```
174
parkinsons disease
slowly progressing neurodegenerative disease with early prominent death of dopaminergic neurons in the substantia nigra pars compacta.
this leads to dopamine deficiency in the basal ganlia - causing parkinsonism
175
GBS treatment
```
plasma exchange
IV immunoglobulins
Neuropathic pain relief
DVT prophylaxis
ICU admission for ventilation
```
176
pramipexole
dopamine agonist for PD rx
177
csf analysis of viral meningitis
Appearance: Clear
Opening pressure: Normal or elevated
WBC: Elevated (50 – 1000 cells/µL, primarily lymphocytes, can be PMN early on)
Glucose level: Normal (>60% serum glucose however may be low in HSV infection)
Protein level: Elevated (>50 mg/dL)
178
DR treatment
1) photocoagulation (thermal laser) of the macular and pan retinal areas. it occluded microaneurysms reducing leakage and therefore oedema
2) Intravitreal injections if macula oedema (anti VEGF)
3) intravitreal steroids for refractory disease
179
differentials for red eye
```
conjunctivitis
scleritis
episcleritis
uveitis
keratitis
AACG
trauma / foreign body
dry eyes
```
180
presentation diabetic retinopathy
painless gradual decrease in central vision
| may have sudden onset of floaters if harmorrhage
181
central causes of vertigo
migraine
brainstem ishcaemia
cerebellar stroke
multiple sclerosis
182
classic clinical findings for CPOA Glaucoma
raised IOP >21mmHg
increased cup:disc ration >0.6
or 0.2 discrepancy btwn both eyes
arcuate scotoma
183
cardinal symptoms of parkinsonism
rigidity
rest tremor
bradykinesia
184
intention tremor features
coarse
caused by cerebellar lesion = stroke/trauma/ MS/ chronic alcoholism /lithium
worse with goal directed movement
associated features = ataxia, gait instability, hypotonia, dysarthria, poor rapid movement , nystagmus
185
GBS
autoimmune inflammatory polyneuropathy leading to demyelination and axonal degeneration
186
FOOSH
Fall on out stretched hand
187
what are the geriatric giants (5 x I)
```
incontinence
Instability/immobility
Intellectual impairment
Impaired homeostasis
Iatrogenic - pressure sores/ constipation
```
188
dementia
disorder of mental processes marked by memory disorders, personality changes and impaired reasoning
189
Anti Epileptic Drugs
Sodium Valproate
| Lamotrigine
190
treatment for wet amd
anti-VEGF (vascular endothelial GF) injections
given monthly for first 3 months
5 day course of abx eye drop post injection
191
frontotemporal dementia presentation
can present as one of 3 clinical pictures:
1) behavioural and personality changes presentation -
2) semantic presentation - progressive decline in the understanding of word meanings, but speech fluent
3) non-fluent presentation - speech not fluent.
192
Swan neck deformity
Sign of RA-Hyperflexed DIPJ and hyperextended PIPJ
193
what is a significant orthostatic hypotension
a different of 20 mmhg btwn lying and standing BP
194
treatment of CRAO
firm occular massage
anterior chamber paracentesis and IOP reducing drugs
isosorbide mononitrate for dilation for dilation of retinal artery
manage underlying cause
195
rotigotine
dopamine agonist for PD rx
196
what are the 5 factors for Frieds frailty phenotype ?
```
weakness
weight loss
fatigue
slowness
reduced physical activity
```
197
episcleritis presentation
focal isolated red patch with tenderness over this area. mild watering.
associated in many cases with inflammatory disease - systemic vasculitis or CTDs
198
signs of AF
fatigue, palpitations, syncope, breathlessness, chest pain, stroke/tia
199
spinothalamic tract carries
crude touch, pain and temperature
200
photopsia
perceived flashes of light
201
treatment of MS
vit D supplements
Methylprednisolone 500mg for 5 days during relapse
for active disease (2 attacks in 2 yrs) = interferon beta or glatiramer acetate (both injections)
teriflunomide or demethyl fumurate may be preferred b/c oral
v. active disease = natalizumab
202
nerve conduction studies are used to diagnose
```
GBS
peripheral neuropathy
peroneal, radial, ulnar etc nerve palsies
carpal tunnel
spinal disc herniation
```
203
treatment of haemorrhagic stroke
return clotting levels to normal with vit k or prothrombin complex concentrate
204
metamorphopsia
distortion of lines - seen in macular degeneration
205
bells palsy is treated with
25mg OD steroidss for 10 days and eye care
206
severe non-proliferative (pre-proliferative) DR
multiple haemorrhages, exudates, cotton wool spots, venous beading, microaneurysms within all 4 quadrants
207
diagnosis of MS
CSF analysis - oligoclonal bands
MRI - type 1 - gadolinium contrast
need 2 DIS lesions and 2 DIT lesions evidence - either clinical or imaging or 1 yr neuro progression
208
glatiramer acetate
immunomodulating drug for MS
| sub cutaneous injections OD
209
what is endophthalmitis
inflammation of the anterior or posterior chamber, usually exogenous cause - injections/trauma/surgery
210
how fast do the atria contract in atrial flutter
300 bpm
211
treatment of neuropathic pain in MS
carbamazapine
amitrityline
pregablin
212
dopa decarboxylase inhibitor
carbidopa or benserazide
| stops too much dopamine being produced peripherally from ldopa
213
what is geographic atrophy
well demarcated areas of hypo/hyper pigmentation seem on the retina due to extensive and irreversible damage and death to retinal cells.
seen in advanced AMD
214
csf analysis of MS
Oligoclonal bands of IgG on electrophoresis (CSF and Serum)
Appearance: Clear
Opening pressure: Normal
WBC: 0 – 20 cells/µL (primarily lymphocytes)
Glucose level: Normal
Protein level: Mildly elevated (0.45 – 0.75 g/L)
215
GBS presentation
3 weeks after resp/GI infection (cambylobacter jejuni)
symmetrical progressive weakness and SL starting in lower limbs and moving upwards. Can lead to facial weakness, dysphagia and resp failure
216
csf analysis of subarachnoid haemorrhage
Appearance: Blood stained initially, then xanthochromia (yellowish) >12 hours later
Opening pressure: Elevated
WBC: Elevated (WBC to RBC ratio of approx 1:1000)
RBC: Elevated
Glucose level: Normal
Protein level: Elevated
217
brinzolamide
used to treat glaucoma
| carbonic anhydrase inhibitor -- block water flow into the eye, stopping aqueous humour production
218
panophthalmitis
inflammation of the entire eye
219
csf analysis of GBS
Appearance: Clear or xanthochromia
Opening pressure: Normal or elevated
WBC: Normal
Glucose level: Normal
Protein level: Elevated (>5.5 g/L)
220
essential tremor features
```
fine tremor
onset with certain postures
worse with voluntary movement
improves with alcohol
hereditary
bilateral
```
221
apraxia
motor disorder
| difficulty performing tasks or movements when asked
222
types of action tremor
essential tremor
physiological tremor
intention tremor
223
exclusion criteria for thrombolysis
```
subarachnoid haemorrhage
recent trauma/head injury or surgery
hx intracranial bleeding
active bleeding
inr 1.4
pregnant
HTN >185/100
recent non compresive arterial punctre or LP
```
224
alteplase
recobinant tissue plasminogen activator
| for thrombolysis in stroke/MI
225
precipitants for epileptic seizure
acute illness, poor sleep/jet lag, missing AED dose, excess alcohol, new meds, recreational drugs, GI disturbance, fatigue
226
keratitis management
corneal scraping for culture
topical antibiotics if bacterial
acyclovir/ganciclovir if herpes and same day ophthalm referral
227
causes of seizure
metabolic disturbance - hypoglycaemia, electrolyte disturbance, alcohol or drug intoxication, adrenal insufficiency
space occupying lesions
head trauma
stroke
medication
epilepsy
228
cortical dementia leads to ___________ memory impairment
severe
229
vascular dementia treatment
antiplatelet therapy (aspirin/clopidogrel)
lifestyle modifications
cholinesterase inhibitors - rivastigmine, donepezil, galantamine
BP control
statins
diabetic control
230
refractory epilepsy
failed to control seizures with 2 AEDs
231
orbital cellulitis treatment
IV antibiotics - vencomycin, clindamycin, cefotaxime
| if failure to respond @48 hours - surgical drainage
232
treatment of ramsay hunt syndrome
acyclovir and steroids
233
CAM assessment
need 1 + 2 + 3/4 to be CAM +ve = delirium diagnosis
Acute onset and fluctuating
Inattention
Disorganised thinking
Conciousness altered
234
important electrolytes in falls
calcium
magnesium
potassium
235
TACs criteria
- unilateral weakness and sensory loss of face, arm + leg
- homonymous hemianopia
- higher cerebral dysfunction e.g. dysphasia
236
gonococcal conjunctivitis signs
severely purulent with eye lid swelling
237
what are the only 2 interventions which are proven to decrease risk of falls?
home hazard assessment
| exercise programme to improve balance and strength
238
PACs criteria
2 of the 3 TACs criteria
- unilateral weakness and SL of arm, leg and face
- homonymous hemianopia
- higher cerebral dysfunction
239
characteristics of wet AMD
10% cases, advanced MD
fragile blood vessels grow in the subretinal space (between RPE and Bruchs) - leads to haemorrhage, exudate, irreversible damage
240
miller fisher syndrome
a variant of GBS - inflammatory neuropathy of the cranial nerves. leads to ophthalmoplegia
241
ganciclovir
topical anti viral eye drops for confirmed adenovirus conjunctivitis
242
stroke complications
```
haemorrhagic transformation
DVT
seizure
orolingual edema - thrombolysis SE
depression
aspiration pneumonia
brain oedema - raised ICP
```
243
Weber classification
Classifies based on the location of distal fibula fracture relative to the syndesmosis A = distal, B = at same level, C= proximal
244
csf analysis of tuberculosis
Appearance: Opaque, if left to settle it forms a fibrin web
Opening pressure: Elevated
WBC: Elevated (10 – 1000 cells/µL, Early PMNs then mononuclears)
Glucose level: Low
Protein level: Elevated (1-5 g/L)
245
presentation of CRVO
ischaemic = sudden painless loss of vision, RAPD
| many haemorrhages in all 4 quadrants
246
treatment for essential tremor
propranolol or primidone
247
goldmann tonometry
measures IOP
248
presbyopia
gradual loss of focusing power due to loss of elasticity of the lens
249
treatment of CRVO
laser therapy - photocoagulation
anti-VEGF
steroids
250
causes of cardiovascular syncope
arrhythmia
structural cardiovascular disease - hypertrophic cardiomyopathy
structural pulmonary disease - pulmonary embolism
251
retinal detachment treatment
retinopexy: 1) a gas bubble is injected into the vitreous chamber and patient positioned so that the retinal break closes.
2) retinal-choroid adhesion induced around the edges of the tear using cryotherapy/laser or both
252
Jones fracture
at the base of the 5th metatarsal
253
ramsay hunt syndrome
herpes zoster infection of facial nerve
| pc = facial droop, vertigo, tinnitus, facial rash/blisters, pain
254
dementia mortality
frontotemporal dementia - 8 years from diagnosis
| lewy body dementia - 7 years post diagnosis
255
Colles fracture
Fracture of the head of the radius with dorsal displacement – towards back of the hand
256
Tension band wire
Surgical method to fix olecranon #s
257
signs of L5 root compression
foot drop, weakness of eversion and inversion and no ankle reflex
258
dopamine agonists
used for Parkinson's treatment
pramipexole
ropinirole
rotigotine
259
management of cluster headaches
acute - subcut/nasal triptans
| prophylaxis - verapamil and prednisolone before attack
260
ABCD2 score
```
risk of having a stroke after TIA
Age >60
Blood pressure >140/90
Clinical features unilateral weakness or speech disturbance
Duration <1 hr or >1 hr
Diabetes
```
high risk >4- needs investigations within 24 hours
<4 needs within 1 week
261
treatment of status epilepticus
1) IV lorazepam -> IV diazepam -> buccal/IM midazolam
2) if no response in 10 mins - IV phenytoin
3) 2nd IV AED if not working - sodium valproate or lamotrigine
4) if no response at 30 mins from onset- sedation and ICU admission
262
prochlorperazine
anti emetic
| dopamine 2 receptor antagonist
263
differentials for transient LoC
```
reflex syncope (vasovagal, carotid sinus hypersensitivity, situational)
cardiovascular syncope - LoC due to reduced CO
orthostatic hypotension
```
seizure
264
MUST score
tool to identify patients at risk of malnutrition
265
sarcopenia
reduced muscle mass in elderly
266
Chondrocalcinosis
Radiographic feature of pseudogout – calcifications in the joint space
267
differentials of Parkinsonism
1. idiopathic
2. drug induced
3. vascular dementia
4. essential tremor
5. normal pressure hydrocephalus
268
bells palsy
LMN facial palsy
269
non-proliferative (background) DR
haemorrhages (dot and blot), microaneurysms, exudates and cotton wool spots outside of temporal arcades
270
confusion screen includes..
```
glucose
LFTs
UandEs
B12/folate
hemantics
calcium
FBC
INR
TFTs
```
CXR
Urine dipstick /culture
271
etiology of retinal artery occlusion
emboli - carotid or atria
| thrombus
272
EEG
electroencephalograph
273
clinical signs of cataracts
no red reflex, reduced visual acuity and clouding of lens
274
Garden classification
For NOF# 1 – incomplete fracture, not displaced, 2- complete fracture not displaced, 3 – complete fracture partially displaced, 4- complete fracture completely displaced
275
keratitis
inflammation of the cornea
276
Galeazzi fracture
of distal radius with dislocation of the distal radio-ulnar joint
277
The 4 Rs of fractures
Resuscitation, Reduction, Restriction (immobilisation), Rehabilitation
278
LACs criteria
1 of the following
- pure sensory stroke
- unilateral weakness/SL of face/arm/leg
- ataxic hemiperisis
279
bloods for dehydration
hyponatraemia
| raised urea
280
Heberdens nodes
DIP joint swelling in OA
281
normal IOP
10-21 mmHg
282
subcortical dementia leads to ___________ memory impairment
moderate
283
presentation of bells palsy
unilateral facial droop
hyperacusis - sensitivity to high pitch sounds
inability to close eyes
reduced lacrimation
284
agnosia
inability to interpret sensory input
| e.g. visual agnosia
285
dopa decarboxylase
converts levodopa into dopamine
286
AED interactions to avoide
sodium valproate and lamotrigine
| titrate carefully during swap over period
287
etiology of retinal vein occlusion
systemic disease - atherosclerosis, diabetes, hypertension
hypercoagulable state
glaucoma or retinal vasculitis
288
DSM 5 diagnostic criteria of Alzheimers dementia
significant cognitive decline in 1+ areas of cognition which impacts complex activities e.g. paying bills
+ memory loss
+ aphasia/ apraxia/ agnosia/ disturbance in executive function
+gradual progressive course
289
resting tremor features
```
4-6Hz
pill rolling
seen in parkinsonism
improved with action
usually apparent in 1 limb/1 side for months-years b4 becoming generalised
```
290
anti-vegf injection names
ranibizumab (lucentis)
| aflibercept (eylea)
291
baclofen
treatment for spasticity
| given to MS patients
292
signs of UMN
```
spasticity
hyperreflexia
pronator drift
babinski upgoing
clonus
```
293
management of ischaemic stroke
CT non contrast brain imaging
Thrombolysis with alteplase if within 4.5 hours of onset symptoms
Mechanical clot retrieval
aspirin 300mg for 2 weeks and then clopidogrel
start statins
294
CHADS VASC
-risk of having stroke with AF
```
Congestive heart failure
Hypertension
Age >65 or >75
Diabetes
Stroke
Vascular disease
Female
```
295
rasagiline, selegiline
MAO B inhibitors
| treatment for parkinsons
296
Susceptible nerve in humeral mid shaft fracture
Radial nerve
297
pathway of dorsal columns
ascends ipsilaterally and decusates in the brain
298
dysgraphia
unable to write or draw - clock drawing test
299
ACE 3
addenbrooks cognitive assessment - cognitive function test for assessment of dementia
300
diagnostic criteria for parkinsons disese
bradikenesia + resting tremor/ rigidity/ postural instability
exclude-vascular dementia, head injuries, neurleptic treatment, encephalitis, affected relative,sustained remssion, unilateral only after 3 yrs,
301
Allopurinol
1st line prophylactic treatment for gout
302
physical examination for patient with falls
```
neurovascular exam
MSK exams of lower limbs
cardiorespiratory
cognition
visual exam
vestibular exam
```
303
treatment of giant cell arteritis
oral prednisolone or IV methylprednisolone
| recurrent attacks - treat with methotrexate once weekly
304
Monteggia fracture
of proximal ulna with dislocation of the radial head
305
cotton wool spots
result of damage to the nerve fibres - due to an accumulation of axoplasmic material in the nerve layer
306
treatment of alzheimers
- supportive and environmental measures
- Cholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine. delay progression by 6-12 months
- memantine if above not tolerated
307
investigations for optic neuritis
MRI of optic nerves
| FBC, ESR, CRP
308
proliferative DR
neovascularisation at disc and elsewhere.
309
Charles Bonne syndrome
Sensory Deficits leads to hallucinations
310
rate limiting CCB
diltiazam or verapamil
311
peripheral causes of vertigo
```
BPPV
menieres
acoustic neuroma
cholesteatoma
vestibular neuritis
```
312
what are drusen
discrete yellow deposits between the RPE and Bruch's Membrane. due to a build up of waste products usually removed by the RPE
313
treatment for bacterial conjunctivitis
simple infection will settle within 1-2 weeks
| chloramphenicol
314
Clinical signs of scaphoid fracture
Pain in anatomical snuff box on palpation, pain on palpation of scaphoid tubercle, pain on telescoping of the thumb
315
rivastigmine
cholinesterase inhibitor for dementia
316
Closed reduction
Bones realigned without surgery
317
Brown sequard syndrome
hemisection
Ipsilateral loss of motor control and proprioception/fine touch/ vibration. contralateral loss of pain and temperature sensation
318
Anti-ccp
Rheumatoid arthritis marker
319
differentials of gradual loss of vision (5)
```
Refractive error
cataracts
age related macular degeneration
diabetic retinopathy
chronic primary open angle glaucoma
```
320
orbital cellulitis presentation
systemic fever/malaise, proptosis, pain with eye movement, diplopia, RAPD, restricted eye movement, blurred vision, oedema, erythema, blepharitis, conjunctivitis
if optic nerve involved - papilloedema and optic neuritis
321
Monosodium urate crystals
Build up in joints leads to gout
322
management of GCA
high dose steroids 60 mg ASAP
| bloods and temporal artery biopsy
323
uveitis treatment
ophthalmology referral
steroid eye drops or peri/intraoccular injection
oral steroids if severe
324
treatment of allergic conjunctivitis
```
artificial tears, cool compress,
sodium cromoglicate (mast cell stabiliser) and antihistamine (epinastine)
```
325
hypermetropia treatment
longsightedness - fixed with convex glasses
326
most common cause of viral conjunctivitis
adenovirus
327
Intertrochanteric # treatment
Dynamic hip screw
328
Commonest hip replacement
Cemented total hip replacement
329
teriflunomide
used to treat MS - oral med
330
re-feeding syndrome
nutrition reintroduced to severely malnourished patients can lead to potentially fatal shifts in electrolytes and fluid
331
differentials for bells palsy
```
acute otitis media
choleostoma
viral infection (EBV, CMV)
GBS/ MS
trauma or iatrogenic
neoplasm - parotid malignancy
```
332
presentation of cataracts
gradual loss of vision, glare, haloes, sensitivity to light, faded colours
333
drugs with high anticholinergic burden
```
amitriptyline
olanzapine
oxybutynin
quetiapine
amantadine
```
334
convulsive status epilepticus
seizure > 5 mins or > 3 seizures in 1 hour
335
Calcium pyrophosphate crystals
Pseudogout
336
initial investigations for fall
bloods - BM, U&Es, FBC, inflam markers
ECG
bone profile
TFTs, B12, folate - peripheral neuropathy causes?
337
signs of LMN lesion
hyporeflexia
flaccidity
fasciculations
atrophy
338
characteristics of DRY AMD
90% cases, gradual progression
drusen are seen on fundoscopy
10-15% will develop wet amd
339
myopia treatment
short sightedness - fixed with concave glasses
340
Parts of a psychiatric history
```
Pc/HPC
Past psychiatric history
Past medical history
Medications
Family history
Personal history
- birth, early childhood
- schools
-higher education
-qualifications
-employment
-relationships
-psychosexual history
-current living situations
-forensic history
Alcohol and drugs
Premorbid personality
```
341
Diagnosis of depression (ICD 10 )
1) need 2 key symptoms: low mood, anhedonia, fatigue
2) other symptoms: appetite changes, sleep changes, poor concentration, agitation or retardation, low self confidence, guilt or self blame thoughts, suicidal thoughts
lasting > 2 weeks
4 symptoms = mild
5-6 = moderate
7+ = severe
342
organic causes of depression
medication - steroids, beta blockers, statins, progesterone, isotretinoin
chronic pain, hypothyroidism, Addison's disease, MS, diabetes, cerebrovascular disease, alcohol and substance abuse
343
manic episode criteria
1) A 1 week+ period of expansive mood with abnormally elevated energy
2) severe enough to cause social/work impairment or hospitalisation or psychotic symptoms are present
3) 3 or more of the following: grandiosity, decreased need for sleep, more talkative, flight of ideas/racing thoughts, distractibility, increased goal directed activity/psychomotor agitation, excessive involvement in risky behaviours e.g business ventures/sex
344
hypomanic episode criteria
same symptoms as above
lasting over 4 consecutive days
uncharacteristic but not impairing functioning of patient
no psychotic symptoms
345
treatment for subthreshold depression
active monitoring
reassess in 2 weeks
provide info about depression
346
treatment for persistent subthreshold depression and mild-moderate depression
1st line = low intensity psychological intervention (CBT therapy)
only consider meds if patient has previous moderate/severe depression or this episode has lasted >2 yrs
2nd line = high intensity psychosocial intervention (CBT/IPT) OR an antidepressant
347
treatment for moderate-severe depression
antidepressant combined with high intensity psychological intervention
348
treatment for severe or resistant depression
consider inpatient care
349
when to consider ECT for depression?
need rapid response
life threatening depression
all other treatments have failed
350
fluoxetine
SSRI
351
venlafaxine
SNRI antidepressant
352
duloxetine
SNRI antidepressant
353
Mirtazapine
antidepressant
| blocks alpha 2 receptor causing raised Na and 5HT
354
treatment with antidepressant - step wise approach
1) SSRI - start at half the dose and titrate up every 14 days
if no response after 4-6 weeks :
2) switch SSRI or start SNRI
3) mirtazapine
4) augmenting agent - antipsychotic/lithium
5) TCA
6) MAO-I
355
amitriptyline
TCA
356
what demographic factors increase a patients suicide risk
```
male
older > 45 yo
single/widowed/divorced
social isolation
living alone
low income/ unemployed
doctor/farmer
Fhx of suicide/substance misuse/depression
```
357
what details about a suicide attempt increase a patients suicide risk
```
final acts
preparation
high perceived legality
precaution against being found
violent methods
discovered by chance
resists mediccal intervention
downplaying the seriousness
```
358
which antidepressants are most likely to cause discontinuation syndrome
venlefaxine and peroxetine
359
organic causes of psychosis
```
delirium
dementia
temporal lobe epilepsy
CNS infection
brain injury/trauma
metabolic disorder - vit b12
thyroid disease
cushings syndrome
high dose steroids
huntingtons
extreme fatigue
alcohol/drug withdrawal
hypoxia
```
360
treatment of 1st psychotic episode
1) 2nd gen oral antipsychotic
| 2) with psychological intervention e.g. family therapy or individual CBT
361
atypical antipsychotics
| 2nd gen
```
aripiprazole
clozapine
quetiapine
olanzapine
risperidone
```
362
MHA
| section 2
allows for mental health assessment
lasts up to 28 days
signed by 2 doctors (1 approved) and 1 AMHP
patient can appeal within 14 days via specialist tribunal
363
MHA section 3
for treatment
lasts up to 6 months
signed by 2 doctors and 1 AMHP
can be challenged with tribunal
364
MHA section 4
```
emergency admission only
for assessment
signed by 1 doctor
lasts 72 hours
cant be appealed
```
365
MHA section 5 (2)
allows for an inpatient to be kept in hospital due to mental illness.
lasts 72 hours
can't appeal
signed by responsible clinician
366
MHA section 5 (4)
emergency holding order for hospital inpatients
signed by 1 registered nurse
lasts 6 hours
cant be renewed
367
MHA section 135
emergency section to bring you from any premises (incl. home) to hospital
made by a police and doctor and AMHP
can be held for 72 hours
can't be appealed
368
MHA section 136
```
emergency situation
bring patient from public to hospital
by police and doctor
lasts 72 hours
can't be appealed
```
369
akathisia
movement disorder
| inner restlessness
370
extrapyramidal side effects
parkinsonism
dystonia
dystonia
acute dyskinesia
