Y3 Charis > DPD > Flashcards

DPD Flashcards

(69 cards)

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1
Q

Diagonsis of depression

A

2+ weeks of experiencing core symptoms

  • Low mood
  • Low energy/motivation
  • Anhedonia
  • Plus other symptoms
    Feelings of worthlessness/excessive or inappopriate guilt
    Recurrent thoughts of death, suicidal thoughts, suicide attempts
    Reduced concentration, indecisiveness
    Psychomotor agitation or retardation
    Insomnia, hypersomnia
    Significant appetite change +/- weight loss
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2
Q

Difference between dementia + pseudodemntia

A

Dementia - if patient’s don’t remember something they will start getting a bit anxious because of not remembering

Pseudodementia - patients will not stress out at all, also lack of motivation to engage with the question

Depression can present as pseudodementia, so it’s a good differential on someone with symptoms of Dementia

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3
Q

What is dementia

A 
Chronic brain failure
Progressive decline in
   Higher cortical functions
   Emotional regulation
   Behavioural symptoms
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4
Q

Give the 5 types of dementia

A 
Alzheimer's disease
Mixed alzheimer's/vasular
Vascular
Lewy body
Frontotemporal/Pick's disease
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5
Q

Pathophysiology of AD

A
  • Tau proteins
    clamps of tau proteins in neuronal cell bodies result in microtubule + neuronal/axon instability
  • Amyloid precursour proteins
    Form plaques/toxic aggregates on neurones + blood vessels –> cause neuronal cell death
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6
Q

Pathophysiology of vascular dementia

A
  • Multi-infarct dementia - there are lots of bits of brain that are vulnerable to little strokes
  • Step-wise progression
  • Focal neurological signs
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7
Q

What is dementia with Lewy bodies

A

Diagnosed when cognitive symptoms begin before or at the same time as parkinsonism

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8
Q

What is Parkinson’s disease dementia

A

dementia develops many years after the onset of motor symptoms, PD not related to dementia but just co-exists

PD then after many years dementia

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9
Q

Features of Lewy body dementia

A
  • Onset <1yr of onset of PD
  • Parkinsonism
  • Fluctuating attention + awareness
  • Visual hallucinations - KEY feature
  • REM sleep behaviour disorder
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10
Q

Difference between Alzheimer’s disease and dementia with Lewy bodies

A

AD - dopamine transmission is normal in the striatum

DLB - loss of dopamine neurones in the striatum

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11
Q

Features of frontotemporal dementia/Pick’s disease

A 
- Typically affects frontal lobes 
Also known as Pick's disease
Disinhibition 
Change in personality and social functioning 
Emotional blunting/liability
Apathy
Restlessness
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12
Q

3 cognitive tests you can use to investigate dementia

A
  • MMSE (mini-mental state examination)
    Doesn’t tell you if someone has dementia
    Just tells you that something is wrong
    N: 25-30, Mild: 20-24, Moderate 13-19, Severe <12
  • RUDAS (Rawland Universal Dementia Assessment Scale)
    Similar to MMSE but for people whose English is not their first language or for people who are poorly educated
    N: 23-30, Abnormal: <23
  • ACEIII (Addenbrooke’s cognitive examination)
    Bigger, fuller cognitive assessment than MMSE
    Can give you more information on whether someone has dementia
    N:88-100, Mild: 83-87, Moderate/severe: <83
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13
Q

Key difference between dementia + delirium

A

In delirum you have decreased ability to direct, focus, sustain and shift attentione.g. a person with delirium will not be able to say the months backwards whereas a person with dementia will be

In delirium there is

  • Disturbance of consciousness (in dementia consciousness is unaffected until late stage)
  • Fluctuating (as opposed to dementia which is progressive)
  • Visual hallucinations are common (in dementia they are uncommon except in Lewy body dementia)
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14
Q

Lesion in the brain signs

A

Hemiparesis

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15
Q

Lesion in the brainstem signs

A

CN lesions

ipsilateral

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16
Q

Lesion in the cerebellum signs

A 
DANISH
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred, scanning speech
Hypotonia
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17
Q

Lesion in the spinal cord signs

A

Paraparesis = partial paralysis of the lower limbs

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18
Q

Lesion in the NMJ signs

A

Fatiguability of muscle

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19
Q

Hemisensory loss/ Sensation felt on one side

A

Contralateral Cerebral cortex lesion

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20
Q

Loss of sensation at a level + downwards

A

Spinal cord lesion

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21
Q

Pain + Loss of sensation in a particular dermatome / in the distribution of a nerve root

A

Nerve roots (radiculopathy)

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22
Q

Loss of sensation in a specific area

A

Mononeuropathy

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23
Q

Loss of sensation from a point onwards / glove + stockings distribution

A

Polyneuropathy

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24
Q

Normal HbA1c value
Pre-diabetic HbA1c value
Diabetic HbA1c values

A

<42 mmol/mol
43-47 mmol/mol
>47 mmol/mol

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25
Examples of basal bolus insulin
Detemir Levemir Galgrine
26
Treatment of diabetic neuropathy
Duloxetine
27
Pregabalin used for
Tx of neuropathic pain + epilepsy
28
Peripheral neuropathy ddx (7)
Drugs - hx (cyclosporin, amiodarone, metronidazole, isonazid) Alcohol - hx, increased GGT + MCV B12 deficiency - anaemia, increased MCV DM - glucose, HbA1c Hypothyroidism - TFTs Uraemia - U+Es Amyloidosis - hx of myeloma or chronic infection/inflammation
29
4 drugs that can cause peripheral neuropathy
Cyclosporin Metronidazole Amiodarone Isonazid
30
Normal range form MCV
80-100 fl
31
Blurred optic disc ddx
Papilloedema | Papillitis (optic neuritis)
32
Difference between papilloedema + papillitis (optic neuritis)
Papilloedema - Can be due to SOL - Progressively gets worse - No pain - No decreased visual acuity Papillitis (optic neuritis) - Can be due to MS - Comes and goes - Pain - Decreased visual acuity
33
Pain + paresthesia + decreased PP sensation on the anterolateral thigh Mx
Compression of the lateral femoral cutaneous nerve running via the inguinal ligament Mx - lose weight If symptoms persist - Carbamazepine - Gabapentin (drugs for neuropathic pain)
34
Treatment of neuropathic pain
Pregabalin Carbamazepine Gabapentin
35
GCS eyes
``` 4 4 - open spontaneously 3 - open to voice 2 - open to pain 1 - do not open ```
36
GCS verbal
``` 5 5 - Orientated 4 - confused but able to answer Q 3 - words discernible, inappropriate responses 2 - making sounds 1 - no response ```
37
GCS motor
6 6 - obeys commands 5 - localises to pain/purposeful movement to painful stimulus 4 - withdraws to pain 3 - abnormal (spastic) flexion , decorticate posture 2 - extensor (rigid) response, decerberate posture 1 - no movement
38
AMTS
1. DOB 2. Age 3. Time 4. Year 5. Place 6. Recall - West Register street 7. Recognise doctor/nurse 8. Prime minister 9. Second WW 10. Count backwards from 10-1
39
Spinal cord compression signs vs cauda equina syndrome signs
Spinal cord compression - LMN signs at level of lesion, UMN signs below lesion, sensory level Cauda equina syndrome - LMN signs, saddle anaesthesia
40
Causes of collapse DDx
- Hypoglycaemia ``` - Cardiac Vasovagal Arrhythmias Outflow obstruction Postural hypotension ``` - Brain Seizures (need to establish from the start of history taking if there were observers)
41
Bilateral hilar lymphadenopathy differentials
Infection e.g. TB Inflammation e.g. sarcoidosis Malignancy e.g. lymphoma
42
Pleural plaques
Asbestos related disease | found on the pleura and not in the lungs
43
Asbestos related disease vs asbestosis
Asbestos related disease - pleural plaques Asbestosis - pleural plaques + pulmonary fibrosis
44
Gallstone pancreatitis ix + mx
- USS to confirm presence of gallstones - EUS if stones are too small + you cant see them - Wait to see if pt passes stones spontaneously ``` if LFTs still abnormal or if you can't see anything on the US - MRCP Dilated intrahepatic ducts Dilated CBD w impacted calculi Calculi in gallbladder ``` If stones still not resolving spontaneously - ERCP ballon + dormia basket to collect stones, then stenting the ampulla - if you go accidentally into the pancreatic duct rather than the ampulla --> pancreatits
45
Anti-HBs + Anti-HBe
You definitely had hep B in the past + you are immune
46
anti-HBs + no anti-HBe anti-HBs + anti-HBe
Vaccination Infected We only vaccinate people with anti-HBs and not anti-HBe
47
How does liver disease due to alcohol end up in cirrhosis?
Fatty change --> Alcoholic hepatitis (inflammation + scarring) --> Cirrhosis (end stage liver disease)
48
5 feautres of alcoholic disease on liver histology
- Fatty change - Ballooning of cells - Mallory Denk bodies - Neutrophilic inflammation - Fibrosis (staining collagen blue)
49
Vitamin deficiencies ``` B12 B1 B3 D C Folate ```
``` B12 - pernicious anaemia B1 - beri-beri B3 - pellagra D - rickets C - scurvy Folate - neural tube defects ```
50
Signs of portal HTN (triad)
Caput medusae Splenomegaly Asictes you get portal hypertension after you get cirrhosis
51
One problem with TIPS
It will result in encephalopathy as toxins will not be filtered by the hepatocytes and will not be removed from the blood
52
Management of UGIB as a result of ruptured varices
o Sengstaken-Blakemore tube (NG tube w a balloon) - applying pressure on the veins will stop the varices from bleeding o Endoscopists then go in with the endoscope + inject the veins with a sclerosant - stop bleeding o Blood transfusion o In this case Terlipressin won’t really work as the vessels in the varices don’t’ have a lot of muscle - ---------------------------- - Combination of endoscopic variceal ligation (Band ligation)* + terlipressin** is first line - ABCDE approach - Fluids, regular monitoring - Reduce portal HTN: Terlipressin - OGD * Alternatives include sclerotherapy + balloon therapy * *Alternatives to terlipressin include vasopressin octreotide prophylaxis for the prevention of varicieal bleeidng - propanolol, endoscopic band ligation, TIPPS
53
What does the liver flap indicate?
Denotes liver failure feature of encephalopathy caused by built up of ammonia in the blood that is normally removed by the liver
54
Micronodular cirrhosis | Macronodular cirrhosis
Micronodular cirrhosis - alcoholic hepatitis | Macronodular cirrhosis - viral hepatitis
55
How does alcoholic hepatitis progress?
1. Alcoholic hepatitis ``` 2. Chronic stable liver disease Spider naevi Dupuytren's contracture Palmar erythema Gynaecomastia ``` 3. Portal HTN as a result of cirrhosis Ascites Visible veins Splenomegaly 4. Liver failure Liver flap Fetor hepaticus
56
What do scratch marks on the skin in a patient with jaundice indicate?
Bile duct obstruction
57
Where are GIT cancers likely to metastasise?
Liver due to enterohepatic circulation
58
A 60-year-old male presents with an inguinal hernia of recent onset. Which of the following statements is TRUE? (A) The hernia is more likely to be direct than indirect (B) Presents through the posterior wall of the inguinal canal, lateral to the deep inguinal ring. (C) Is covered anteriorly by the transversalis fascia. (D) Is more likely than a femoral hernia to strangulate. (E) The sac is congenital
(A) The hernia is more likely to be direct than indirect Clue is in the age - you get weakening of the abdominal walls with age Even though generally an indirect inguinal hernia is more common than a direct one
59
How to differentiate between an direct and an indirect inguinal hernia
Reduce the hernia and put your hand over the deep inguinal ring Get patient to cough - if the hernia reappears then it means it is direct (through the abdominal wall) if it doesnt reappear it means it's indirect (through the deep inguinal ring which you are blocking with your hands) deep inguinal ring: • Midpoint of inguinal ligament • 1.5cm above midpoint • Opening in transversalis fascia
60
Anaphylaxis mx
1. Help 2. Remove trigger 3. Lie flat + raise legs 4. IV adrenaline 0.5mg 1:1000 5. ABC (incl IVF) 6. IV chlorphenamine (anti-histamine), IV hydrocortisone 6. given after adrenaline + IVF
61
What is Troisier's sign?
Virchow's node
62
What is Trousseau’s sign of latent tetany Trousseau’s sign of malignancy
Trousseau’s sign of latent tetany – sign of hypocalcaemia on inflating BP cuff – spasm of hand Trousseau’s sign of malignancy – thrombophlebitis as an early sign of gastric or pancreatic cancer
63
What is hereditary haemorrhagic telangiectasia?
AD Abnormal blood vessels in skin, mucous membranes, lungs, liver, brain Recurrent GI + nose bleeds Small dark coloured spots on lips
64
Describe the pain pathway
tissue injury --> release of chemicals --> stimulation of pain receptors (noxious chemicals, heat, cold, pressure)--> activation of αδ or c fibres in the spinal cord --> fibres travel through dorsal root ganglion and go into dorsal horn --> there they synapse with a second nerve --> second nerve decussates and goes up to the thalamus (second relay station) --> thalamus connects with many parts of the brain (cortex, limbic system, brainstem) --> pain perception occurs in the cortex then modulation mainly by the brainstem descending inhibition from brain to dorsal horn --> decreases pain signal
65
Disadvantages of NSAIDs
o GI side effects – gastric irritation + ulceration o Renal side effects – nephrotoxicity (constriction of afferent arteriole, reduction in renal artery flow, decreased GFR) o We don’t really give them to elderly people bc they have poor renal function o Bronchospasm in severe asthmatics Asthma – can cause bronchospasm Hx of gastric/duodenal ulcers – can cause gastric erosions + ulcerations Aspirin – severe risk of GIB from gastric erosions + ulcerations Moderate/severe HF – can cause fluid retention Diverticular disease - increases the risk of bleeding
66
Drugs that can be used for neuropathic pain
TCAs e.g. amitryptillin Anti convulsants e.g. gabapentin, pregabalin Morphine
67
Mild opiates | Strong opiates
Mild - codeine, dihydrocodeine, tramadol codeine - not good for chronic pain Strong - morphine, methadone, fentanyl, pethidine, oxybutinin Morphine - good for chronic cancer pain Pethidine - not good for chronic pain
68
Paracetamol dosage
1000 mg every 4-6h | Same dosage through any route
69
Ibuprofen dosage
400 mg every 6h
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