involves perforating arteries around the internal capsule, thalamus and basal ganglia presents with 1 of the following: 1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three. 2. pure sensory stroke. 3. ataxic hemiparesis

Ageing Flashcards by S B

anterior cerebral artery stroke

contralateral hemiparesis and sensory loss

lower > upper

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middle cerebral artery stroke

contralateral hemiparesis and sensory loss
upper > lower

contralateral homonymous hemianopia

aphasia

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posterior cerebral artery stroke

contralateral homonymous hemianopia with macular sparing

visual agnosia

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Total anterior circulation infarcts sx

involves middle and anterior cerebral arteries

unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
homonymous hemianopia
higher cognitive dysfunction e.g. dysphasia

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Partial anterior circulation infarcts sx

involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 of the above criteria are present

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Lacunar infarcts sx

involves perforating arteries around the internal capsule, thalamus and basal ganglia

presents with 1 of the following:

unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
pure sensory stroke.
ataxic hemiparesis

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Posterior circulation infarcts sx

involves vertebrobasilar arteries

presents with 1 of the following:

cerebellar or brainstem syndromes
loss of consciousness
isolated homonymous hemianopia

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basilar artery stroke Sx

locked in syndrome

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what is weber syndrome

branches of the posterior cerebral artery that supply the midbrain

ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

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what is lateral medullary syndrome/Wallenberg syndrome

posterior inferior cerebellar artery

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

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70 year old taxi driver with trouble calculating change and with navigation - where is affected

parietal lobe

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what is a common side effect of alpha blockers

postural hypotension

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fall and syncope = DDx

arrthymia
orthostatic hypotension
vasovagal
valve disease i.e. aortic stenosis

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what are common drugs that increase the risk of falls

BZDs
antipsychotics 
antihypertensives 
antidepressants 
anticholinergics 
Class 1A antiarrthymias 
opiates 
diuretics 
parkisons medication

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what is the intervention for falls with the most supportive evidence it works

Strength and balance training

Must be 3x week for minimum 12 weeks

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being on how many drugs are considered a risk factor for falls

> 4

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4 drugs that are frequently associated with adverse effects in the elderly

warfarin
digoxin
insulin
BZDs

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side effects of NSAIDs

GI haemorrhage
decline in GFR
decreased effectiveness of diuretics, anti hypertensive agents

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what anti-emetics cannot be used in parkinsons

prochlorperazine

metoclopramide

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what can beta blocker not be prescribed with

verapamil

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who can not get non-cardioselective beta blockers (e.g. propranolol, sotalol)

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patients with COPD

who should CCB be stopped in

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people with chronic constipation

what drugs do Potassium rich food [i.e. bananas,oranges, green leafy vegetables] interact with

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ACEIs, ARBs, K-sparing diuretics

what drugs do food with lots of Vit E and K [Apples, chickpeas, spinach, nuts, spinach, kiwi, broccoli] interact with

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Warfarin

what is important to note about these foods; Chicken, turkey, milk, soy,cheese, yogurt

alter PH Interacts with: Antibiotics, thyroid meds, Digoxin, diuretics

what is the relation of Amitrytilline and BPH

makes it worse there is a risk of urinary retention

what food/drink should you AVOID with a statin

grapefruit juice

what food/drink should you AVOID with metronidazole

alcohol

what food/drink should you AVOID with warfarin

cranberry

what food/drink should you AVOID with thyroxine

calcium get decreased absorption

what drug should not be prescribed with warfarin

NSAID = risk of bleed

what would a combination of ACEi and spironolactone cause

Hyperkalaemia

what would a combination of digoxin and verapamil cause

digoxin toxicity

what would a combination of fluoxetine and phenelzine cause

serotonin syndrome

what conditions are Triptans contraindicated in

IHD uncontrolled HTN Lithium SSRI

what antibiotics can not be given to someone on a statin

clarithromycin

what is the criteria for Delirium

Disturbance in attention Change in cognition Acute Fluctuates

how does hypoactive delirium compare to hyperactive

hyperactive - agitation and restless hypoactive - sleepy and slow

what are the hallmarks of Delirium

Acute and fluctuating Inattention Altered level of consciousness Disorganised thinking

what is the 4AT

assessment test for delirium and cognitive impairment

what are the categories of 4AT and the points you can get in that category

Alertness [out of 4 points] AMT4 [out of 2 points] - [age, dob, place, current year] Attention [out of 2 points] - say months of the year backwards starting from December Acute change or Fluctuating course [out of 4 points]

what are the score cut-offs for 4AT

4 or above = possible delirium +/- cognitive impairment 1-3 = possible cognitive impairment 0 = delirium unlikely

medication for Tx of delirium

Haloperidol - 0.25-0.5mg PO, max 5mg a day Quetipine - for Parkinsons patients or Lewy Body Dementia Lorazepam - ONLY if alcohol or BZDs withdrawal

what score is used to assess risk of stroke in AF

CHA2DS2-VASc ``` Congestive HF Hypertension Age > 75 [2pts] Diabetes Stroke or TIA previously [2pts] Vascular disease Age 65-74 [1pt] Sex (female) ``` Score more than 1 = offer anti-coagulation

what are the options for anti-coagulation for AF

Warfarin - INR target 2-3 NOACS

symptoms of opioid overdose

hallucinations, myoclonus, drowsiness

what is MR and what is it used for

Modified release (MR) Background pain Twice daily tablet

what is morphine IR and what is it used for

``` Immediate release (IR) Breakthrough pain ``` ‘PRN’ tablet (sevredol) or liquid (oramorph) which is approx 1/6 of total background dose

Patient on Codeine 60mg four times a day (total daily dose 240mg) - what is the equivalent morphine dose

24mg morphine divide by 10 = weak opiate

conversion factor for PO morphine to SC

Morphine is twice as potent given SC To work out SC dose, divide PO dose by 2 Oral MST 10mg bd [20mg total] = SC morphine 10mg over 24 hours

what is common [anticipatory] prescribing for end of life

Pain / SOB = Morphine 2mg scut hourly Distress = Midazolam 2mg scut N/V = Levomepromazine 2.5mg eight hourly Secretions = Hyoscine butylbromide injection (Buscopan® 20mg SC hourly

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