tues Flashcards
(125 cards)
1
Q
Hypoglycaemia treatment
A
tablet
buccal mucosa
IV 20% dextrose 100ml immedietely
glucagon IM
2
Q
T1DM
A
destruction of insulin-producing pancreatic cells
weight loss
3
Q
diagnosis of T1DM
A
Random blood glucose ≥ 11.1mmol/l or Fasting plasma glucose ≥ 7mmol/l
2-hour glucose tolerance ≥ 11.1mmol/l
HbA1C ≥ 48mmol/mol (6.5%)
4
Q
DKA
A
T1
Hyperglycemia (blood sugars >11 mmol/L)
Ketonemia (blood ketones >3 mmol/L)
Acidosis (pH <7.3 or bicarbonate <15 mmol/L)
5
Q
Kussmaul’s respiration
A
DKA
deep, sighing pattern of respiration, compensating for a metabolic acidosis by blowing off CO2
6
Q
treatment of DKA
A
0.9% NaCl, with the first litre ‘stat’
then K replacement
insulin IV
7
Q
hypoglycaemia defination
A
blood glucose level below 3.5 mmol/L
8
Q
miscarriage
A
<24 weeks
9
Q
symptoms of misscariage
A
pain
bleeding
loss of feotal tissue
10
Q
ectopic pregnancy
A
more pain than misscariage and less bleeding
11
Q
Threatened miscarriage
A
mild bleeding as foetus retained within the uterus as the cervical os is closed
can have no pain
12
Q
Inevitable miscarriage
A
heavy bleeding and pain, where the foetus is currently intrauterine but the cervical os is open
13
Q
management of miscarriage
A
misoprostol
Surgical management e.g. dilatation and curettage
14
Q
mechanism of NAC in treating paracetamol overdose?
A
NAC replenishes the store of glutathione which binds with toxin, which is then excreted
15
Q
breast engorgement
A
breasts being too full
pain but no infection
16
Q
Plugged breast Duct
A
Unilateral, localized hard lump
not usually systemic symptoms
17
Q
Breast Abscess
A
severe pain, fluctuant mass, localized heat, redness, and fever.
18
Q
antifungal post Puerperal mastitis treatment
A
miconazole
19
Q
epilepsy drug during pregnancy
A
lamotrigine
20
Q
Focal seizures
A
simple
complex
secondary generalised
21
Q
Generalized seizures
A
absence
tonic colonic
myoclonic
atonic
22
Q
complex seizure
A
lose consciousness
temporal lobe
23
Q
simple seizure
A
focal symptoms- related to one area of brain
24
Q
secondary generalised’ seizure
A
focal seizure that evolves into a generalized seizure, typically tonic-clonic
25
Absence seizures and treatment
pauses for less than 10 seconds
ethosuximide
26
Tonic-clonic seizures and treatment
loss of consciousness, stiffening (tonic), and jerking (clonic) of limbs
sodium valporate
27
Myoclonic seizures
sudden jerks of a limb, trunk, or face
sodium valproate
28
Atonic seizures
sudden loss of muscle tone, causing the patient to fall
sodium valproate
29
Syncope
sudden, transient loss of consciousness and postural tone followed by spontaneous recovery. Triggered by low blood flow to the brain.
30
management for focal seizures
Lamotrigine or Levetiracetam for focal
Carbamazepine- but not for myoclonic
oxcarbazepine
zonisamide
lacosamide
31
vascular dementia - what is it
second most common
risk factors for vascular disease
32
Lewy body dementia symptoms
Fluctuating cognition
visual hallucinations
Parkinsonism
REM sleep behavior disorder
33
Frontotemporal dementia symptoms
changes in personality and behavior
/language difficulties with relative sparing of memory
34
Normal pressure hydrocephalus symptoms
Gait disturbance
urinary incontinence
cognitive impairment
35
treatment of vascular dementia
cognitive enhancers
cholinesterase inhibitor/ memantine
36
parkinsons epidemiology
second most common neurodegenerative disorder
37
cause of parkinsons
accumulation of lewy bodies
misfolded alpha synuclein which lead to death of dopamine cells in substantia nigra in basal ganglia
38
basal ganglia
coordiantion of mov
39
management of parkinsons
levodopa
40
side effects of medication for parkinsons and how to manage that
Postural hypotension- carbidopa
Nausea & vomiting- domperidone
41
side effects of domperidone
Hallucinations
Confusion
Dyskinesia
Psychosis
42
Dopamine agonists
Ropinirole
rotigotine
Apomorphine
43
MAO-B Inhibitors
Selegiline
Rasagiline
can cause serotonin syndrome
44
treatment of dyskinesia with parkinsons
amantadine
45
Multiple System Atrophy
autonomic dysfunction, early postural instability
symptomatic control
46
lewy body dementia vs parkinnsons
Parkinson’s disease starts in the basal ganglia/brainstem and then progresses upwards towards cerebral cortex (hence dementia is late), whereas in LBD process is the other way around
parkinsons starts with motor symptoms before cognition
47
Alzheimer's disease pathophysiology
Amyloid Plaques- accumulation leads to inflammation
Tau Tangles
neuronal loss and brain atrophy
Reduced acetylcholine
48
genetic disposition to alzheimers
(APOE) gene
Down's syndrome/ trisomy 21 (APP gene)
49
management for alzheimers
cholinesterase inhibitors (e.g. donepezil) and N-methyl-D-aspartate (NMDA) receptor antagonists (e.g. memantine),
risperidone for psycohological/behavioral
50
Postpartum psychosis
within first 2 weeks of delivery
51
Postpartum psychosis management
olanzapine and quetiapine while breast feeding
52
prophylaxis for migraine when asthmatic
amytriptilline
53
Serotonin syndrome
causes
SSRIs
(SNRIs)
monoamine oxidase inhibitors (MAOIs)
tricyclic antidepressants
MDMA and cocaine.
54
Serotonin syndrome symptoms
anxiety, agitation, restlessness
hyperthermia, tachycardia, hypertension
tremor, clonus, myoclonus, seizures
55
management of serotonin syndrome
cyproheptadine only if serious
56
acute management of epilepsy
10m
Diazepam 10−20 mg rectally
repeated 15 minutes later/midazolam 10 mg buccally
IV- Lorazepam repeated once after 10−20 minutes
Levitiracetam
Phenytoin
Sodium Valproate
57
Tension pneumothorax
air
RTA, lung biopsies
58
signs of tension pneumothorax
Tracheal deviation away from affected
Decreased chest expansion on affected side
Hyperresonance over the affected
59
treatment of tension pneumothorax
large-bore needle, which is typically inserted into the 5th intercostal space in the mid-axillary line
chest drain for massive and if patient stable
60
where does spinal cord end
L1-2
61
upper motor neurone
start in cerebral cortex then travel to spinal cord/ brainstem
62
lower motor neurone
from brainstem/spinal cord to muscle
63
upper motor neurone symptoms
if lower motor neurone intact then connection from spinal cord to muscle is working but brain to spinal cord is not
hypereflexia
hypertonia- spasticity- high tension
64
lower motor neurone symptoms
brain to spinal cord is fine
spinal cord to muscle isn't working
no reflexes
hypotonia- no tension
65
Chronic myeloid leukaemia
Philadelphia chromosome
translocation of chromosome 9 and 22
BCR-ABL1 fusion gene
too many myeloid cells- inflammation and phagocytosis
66
epidermiology of chronic myeloid leukaemia
middle age
men
67
chronic myeloid leukamia symptoms and signs
Weight loss
Tiredness
Fever
Sweating
splenomegaly
Bleeding (due to thrombocytopenia- no platelets)
Gout
68
dysdiadochokinesia
can't do alternating rapid mov
69
cerebellar symptoms on the same side of body results in lesion where
same side as symptoms
70
acute myeloid leukemia- what is it
stops making myeloid cells so build up of blast cells and crowds out normal cells like RBC (anemia), platelets (thrombocytopenia), neutrophils (ill)
71
signs of acute myeloid leukemia
+ve for myeloperoxidase via cytoplasmic staining
auer rods
72
sign of acute lymphoblastic leukemia
TdT +ve via nuclear staining
72
types of lymphoblastic leukemia/lymphoma
B and T
73
B lymphoblastic leukemia signs
C10,19,20 surface marker cells
74
treatment of B lymphoblastic leukemia
chemo
75
genetic B lymphoblastic leukemia
t 12,21 - children
good prognosis
t 9,22 - adults
poor prognosis
76
T lymphoblastic leukemia sign
CD2-CD8 surface markers
77
acute lymphoblastic lymphoma symptoms
T cells
thymus mass
Teenagers
78
AML epidermiology
50-60 yo
79
types of AML
acute promyelocytic leukemia
monoblast AML
megakaryoblast AML
erythroblast AML
80
what conditions can lead to AML
myelodysplastic syndrome
myelodysplasia
81
acute promyelocytic leukemia
t 15,17
build up of promyelocytes leading to lots of auer rods
increasing coagulation risk and DIC so emergency
82
treatment of acute promyelocytic leukemia
ATRA- derivative of vit A which helps the neutrophils to mature and reduces leukemic burden
83
monoblast AML
build up of monoblasts
no myeloperoxidase
gums!
84
megakaryoblast AML
build up of megakaryoblasts
no myeloperoxidase
downs before 5yo
85
myelodysplastic syndrome
build up of blasts in bone marrow
86
bells palsy
unilateral, lower motor neuron facial weakness
damage to facial nerve - can affect forehead
87
treatment of bells palsy
50mg of oral prednisolone or prednisone once daily for 10 days, followed by a taper
88
how much folic acid in pregnancy
400 micrograms
5mg for if higher risk of neural tube defects
89
position of uterus
anteverted
anteflexed
90
Thoracic outlet syndrome
compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet
91
Thoracic outlet syndrome areas of pain
neck
shoulder
arm
parasthesia too
92
ankle reflex nerve roots
S1,2
93
lacunar stroke symptoms
just hemiparesis- one sided muscle weakness
hemisensory loss/ hemiparesis with limb ataxia
94
which stroke most common
ischaemic
95
Ischaemic stroke types
50% large vessel atherosclerosis e.g.
25% intracranial small vessel atherosclerosis
20%-cardio embolic-
96
large vessel atherosclerosis example
carotid artery stenosis
97
what is ischaemic stroke
blocked artery reducing blood floor to brain
98
what is haemorragic stroke
artery breaks creating bleeding in brain
99
TIA
self resolves within 24h
100
frontal lobe
mov and making decisions
101
parietal lobe
sensory
spatial awareness
102
temporal
hearing
smell
memory
languages
103
occipital
vision
104
brainstem parts
midbrain
pons
medulla
105
brainstem function
HR
BP
Breathing
consciousness
106
which arteries supply brainstem and cerebellum
basilar -
vertebral
107
what does post cerebral artery supply
occipital mainly
some of temporal and thalamus
108
pathophysiology of atherosclerosis
irritant like tabaco damages endothelium
plaque forms
fibrous cap comes off
cheesy filling is thrombogenic (forms clots)
clot formation blocks artery and blood flow
109
what is a plaque
soft cheesy middle
hard fibrous cap
fats, proteins, cholesterol, calcium, inflammatory markers
110
embolic stroke pathophysiology
blood clot breaks off and lodges in another artery and blocks blood flow
typically from atherosclerosis OR heart from AF - stasis in blood flow
111
lacunar stroke
middle cerebral artery
means lake- damaged brain forms cysts like lakes
due to hyaline arteriosclerosis - arterial wall filled with protein
due to hypertension and diabetes
112
pathophysiology of cells in ischaemic stroke
build up of Na and Ca in cells
Na- brings water in cell causing swelling
cytotoxic edema
Ca- reactive O2 radicals which damages mitochondria causing apoptosis to go out of cell
inflammation
113
pathophysiology of herniation from stroke
inflammation causes swelling
114
types of herniation
cingulate
uncal
cerebellar tonsil
115
anterior/middle cerebral artery stroke symptoms
numbness
sudden muscle weakness
116
brocas area where and function
left frontal lobe
speech production
117
wenickes area
right temporal lobe
speech comprehension
118
posterior cerebral artery stroke symptoms
visual
119
genetalia nerve roots
S2,3
120
what part of brain is affected in huntingtons
basal ganglia
121
How does Bevacizumab work
monoclonal antibody directed against vascular endothelial growth factor (VEGF)
122
test for bells palsy
corneal reflex
123
4th nerve palsy symptoms
trochlear
down and out
124
