In the treatment of osteoporosis, what are the effects of bisphosphonates
- Pyrophosphate analogue which adsorbs to hydroxyapatite crystal
- Inhibit bone resorption
- Alter osteoclast activation and function
- Reducse bone turnover
What are some indications for bisphsophonates
- Osteoporosis
- Treatment of hypercalcaemia of malignancy
- Elderly patients taking oral corticosteroids longer than 3 months
How would you advice a patient on taking bisphosphonate
- Best taken on an empty stomach
- 30 minutes before food and drink large glass of water
- Should be swallowed whole
- Should be taken in an upright position (sitting or standing) and the patient remain so for 30 minutes after administration
- Calcium containing products (milk) should be taken at least 2 hours before or after taking bisphosphonate
Name some examples of bisphosphnates
- Alendronate
- 70mg is weekly preparation
- Risedronate
What are the top three most common dementias from most to least common
- Alzheimer’s Disease
- Vascular Dementia
- Lewy Body Dementia
Describe the course of alzheimer’s disease
- Gradually progressive memory and cognitive impairment
- With behavioural changes (apathy, aggression, depression) + delusions/hallucinations
- No lucid intervals
Describe the course and RF in history of patient with vascular dementia
- Previous hx of HTN, stroke, diabetes
- Progresses in a stepwise manne
Features of Lewy body dementia
- Present with complex vidsual hallucinations
- Lewy bodies are intracytoplasmic neuronal inclusion bodies and may also occur in PD (where they involve the basal ganglia)
- Lucid periods occur
What are some differential diagnoses for dementia and therefore what are some investigations you would order
- Treatable causes
- Infection (chest/urine)
- Hypothyroidism
- Low B12/folate
- Low thiamine
- Syphilis
- Cerebral tumour
- Subdural
- Hydrocephalus
- HIV if appropriate
- Vasculitidies
Investigations: FBC, ESR, CXR, MSU for culture, serum Ca, LFTs, TFTs, Syphilis serology, serum B12/folate, Autoantibody screen, blood glucose, cranial imaging (CT/MRI)
Pathology of alzheimers disease and feature on imaging
- Accumulation of Beta-amyloid in senile plaques, and neuronal damage with neurofibrillary tangles
- # Cerebral atrophy is often observed
Regarding the management of alzheimer’s disease, True or false:
- Antidepressants should be considered in patients with associated depression
- Multidisciplinary support of patient and carer is essential
- Anticholinesterase medications may benefit some patient groups
- Sudden deterioration should prompt investigation for concurrent illness
- Sedative medications should be prescribed routinely to facilitate sleeping
- Antidepressants should be considered in patients with associated depression TRUE
- Multidisciplinary support of patient and carer is essential TRUE
- Anticholinesterase medications may benefit some patient groups TRUE
- Sudden deterioration should prompt investigation for concurrent illness TRUE
- Sedative medications should be prescribed routinely to facilitate sleeping FALSE
Sedatives, neuroleptics and TCAs should be used with care as they may worsen cognition.
Common causative organism for otitis externa
Pseudomonas
What organism can cause gas gangrene
Clostridium perfringens
Management of EBV infectious mononucleosis
- Supportive with hydration/fluids
- Short course of corticosteroids#
- Advice patient to avoid contact sport for 6 weeks to minimise splenic rupture
Diagnosis of infectious mononucleosis
Paul-Bunnell (?monospot)
Infects B lymphocytes leading to production of a heterophile antibody. This antibody can be detected by a latex agglutination with the Paul Bunnell antigen
