Part 2

Dyspnoea, exercise limitation, wheeze, sputum

Increased RR, reduced chest expansion, barrel chest

Reduced breath sounds, asterixis, cyanosis, cor pulmonale

Expiratory flow limitation is a marker of this disease

Increased RR during exercise

EELV increases despite limitation reducing IC and IRV

Decreased PaO2

Increased PaCO2

Decreased pH

Treatment for Mild COPD exacerbation

Treatment for moderate COPD exacerbation

What disease are these the main triggers for:

Virus -

Influenza / Parainfluenza
Respiratory syncytial virus

Bacteria -
Haemophilus influenzae

PC: polyuria and polydipsia 

Blood glucose normal 

Urine osmolality is 220 

Most common form of this cancer in adults 

Features: 

Often none, 

Anorexia, weight loss, Bleeding, infections, Lymphadenopathy 

Complications:

Anaemia 

Hypogammaglobulinaemia leading to recurrent infections 

Haemolytic anaemia 

Transformation to high grade lymphoma 

60 year old F 

PC: Heat intolerance and weight loss 

Ix:

Free T4 level high 

TSH decreased 

Enlarged thyroid gland with patchy uptake 

Bloody diarrhoea, Abdo pain in left lower quadrant 

Tenesmus, Primary sclerosing cholangitis 

Colorectal cancer 

Continuous disease, starts at rectum and never spreads beyond ileocaecal valve 

No inflammation beyond submucosa, Crypt abscesses 

Depletion of goblet cells, Granulomas are infrequent 

Widespread ulceration, Pseudopolyps 

Radiology - loss of haustrations, superficial ulceration, long standing disease (colon is narrow and short) 

Diarrhea 

Weight loss, Upper GIT symptoms 

Gall stones secondary to reduced bile acid reaborption, Oxalate renal stones 

Obstruction, fistulas, colorectal cancer 

Lesions anywhere mouth to anus, Skip lesions may present 

Inflammation in all layers, Increased goblet cells and granulomas 

Deep ulcers, skip lesions give a cobble stone appearance 

Radiology - Small bowel enema, strictures (Kantor's string sign), proximal bowel dilation, 'rose thorn' ulcers, fistulae 

Bilateral spasticparesis 

Bilateral loss of pain and temperature sensation 

Ipratropium is an example of what medication 

A 25 y/o F 

Hx: irregular periods, Hirsutism

Bloods:

elevated LH:FSH ratio

 Raised testosterone levels 

A 20 year old F 

PC:

1 week Hx of crampy, constant lower abdo pain 

Intermenstrual bleeding 

Dyspareunia 

Dysuria 

Elderly female smoker 

Reduced Visual Acuity 

Complaining of 'blurred vision' 

Central scotoma and fundoscopy reveals multiple drusen

Photopsia (flickering or flashing lights)

Forward hilt trunk 

Bradykinesia 

Hypokinesia 

Shuffling gait 

Tremor at rest 

Smaller handwriting 

Lose of dopamine neurones from the substantia nigra 

'Dopaminergic nigrostriatal tract degeneration' 

Loss of pigmented cell bodies in substantia nigra pars compacta 

Aggregation of alpha synuclein forming Lewy bodies 

Multiple NT dysfunction disorder (DA, NA, 5-HT, ACh) 

Mutations in genes encoding for 

Alpha synuclein 

LRRK2 

PINK1

DJ-1 

Infiltration of microglia leading to release of inflammatory mediators 

Increased glutamate transmission by NMDA receptor -> opening of intracellular CaC and therefore excitotoxic cell death 

Mitochrondiral dysfunction -> reduced ATP and increased radicals (ETC leaky leading to more H2O2 to enter fenton reaction) 

Neurotrophic factors that maintain survival don't work (GDNF) 

Alpha synuclein accumulation -> toxic oligomers 

Given to treat tremor in PD, minimal effect against bradykinesia and rigidity 

Side effects:

Confusion, mood changes 

Constipation, blurred vision, dry mouth 

Due to peripheral conversion of L-Dopa we co-adminster with what drugs? 

Acute side effects:

Nausea 

Postural HTN 

Psychological 

Chronic (within 3 years a third of patients):

Motor fluctuations (freezing)

Induced dyskinesia (excess, hyperkinetic involuntary movements, face and limbs mostly affected) 

Only drug that provides relief for L-dopa induced dyskinesia 

Selegiline 

Rasagiline 

Four types of drugs given to Parkinson's patients 

Cognitive failure accompanied by:

Deterioration in day-to-day function 

Evidence of long term progression, has to be getting worse 

Aphasia 

Apraxia 

Perceptual deficit 

Slow onset 

Lasts months to years

Attention is preserved 

Alertness is usually normal 

Fragmented sleep 

Rapid onset 

Lasts hours to weeks 

Attention fluctuates 

Either hypo or hyper vigilant 

Frequent sleep disturbance 

Gradual onset 

Memory involved early on (first thing to go)

Progressive cognitive decline 

Stepwise deterioration in cognitive function

Sudden change 

Often co-exists with AD 

Vascular risk factors 

Not always accompanied by neurological symptoms 

Day to day fluctuation in cognition 

Visual hallucinations very early 

Disturbances in consciousness 

Parkinsonsism (anti-psychotic sensitivty) 

Falls / syncope 

Early decline in social / personal conduct 

Different variants affecting: behaviour or language 

Memory preserved in early stages 

Current treatment in dementia in aim to prolong conservation of memory by boosting ACh in the system 

Donepezil 

Galantamine 

Rivastigmine