Part 2



Dyspnoea, exercise limitation, wheeze, sputum

Increased RR, reduced chest expansion, barrel chest

Reduced breath sounds, asterixis, cyanosis, cor pulmonale

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Expiratory flow limitation is a marker of this disease

Increased RR during exercise

EELV increases despite limitation reducing IC and IRV

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COPD Exacerbation

Decreased PaO2

Increased PaCO2

Decreased pH

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Mild - SABD, Moderate - SABD + Abx + Steroid

Treatment for Mild COPD exacerbation

Treatment for moderate COPD exacerbation

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What disease are these the main triggers for:

Virus -

Influenza / Parainfluenza
Respiratory syncytial virus

Bacteria -
Haemophilus influenzae

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Diabetes Insipidus

PC: polyuria and polydipsia 

Blood glucose normal 

Urine osmolality is 220 

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Chronic lymphocytic leukemia

Most common form of this cancer in adults 


Often none, 

Anorexia, weight loss, Bleeding, infections, Lymphadenopathy 



Hypogammaglobulinaemia leading to recurrent infections 

Haemolytic anaemia 

Transformation to high grade lymphoma 

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Toxic multinodular goitre

60 year old F 

PC: Heat intolerance and weight loss 


Free T4 level high 

TSH decreased 

Enlarged thyroid gland with patchy uptake 

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Ulcerative Colitis

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) 

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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 

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Ant. Spinal artery occlusion

Bilateral spasticparesis 

Bilateral loss of pain and temperature sensation 

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Ipratropium is an example of what medication 

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A 25 y/o F 

Hx: irregular periods, Hirsutism


elevated LH:FSH ratio

 Raised testosterone levels 

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Pelvic inflammatory disease

A 20 year old F 


1 week Hx of crampy, constant lower abdo pain 

Intermenstrual bleeding 



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Macular degeneration

Elderly female smoker 

Reduced Visual Acuity 

Complaining of 'blurred vision' 

Central scotoma and fundoscopy reveals multiple drusen

Photopsia (flickering or flashing lights)

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Forward hilt trunk 



Shuffling gait 

Tremor at rest 

Smaller handwriting 

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Lose of dopamine neurones from the substantia nigra 

'Dopaminergic nigrostriatal tract degeneration' 

Loss of pigmented cell bodies in substantia nigra pars compacta 

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Aggregation of alpha synuclein forming Lewy bodies 

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

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Mutations in genes encoding for 

Alpha synuclein 




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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 

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Anticholinergic / Muscarinic receptor antagonists

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

Side effects:

Confusion, mood changes 

Constipation, blurred vision, dry mouth 

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Carbidopa (sinemet), benserazide (madopar), COMT-I

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

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Acute side effects:


Postural HTN 


Chronic (within 3 years a third of patients):

Motor fluctuations (freezing)

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

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Amantadine (NMDA glutamate R blocker)

Only drug that provides relief for L-dopa induced dyskinesia 

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MAO B inhibitors



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Muscurinic antagonists, MAO-B-I, DA agonists, L-DO

Four types of drugs given to Parkinson's patients 

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Cognitive failure accompanied by:

Deterioration in day-to-day function 

Evidence of long term progression, has to be getting worse 

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Language deficit


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High motor function


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Perceptual deficit 

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Slow onset 

Lasts months to years

Attention is preserved 

Alertness is usually normal 

Fragmented sleep 

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Rapid onset 

Lasts hours to weeks 

Attention fluctuates 

Either hypo or hyper vigilant 

Frequent sleep disturbance 

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Gradual onset 

Memory involved early on (first thing to go)

Progressive cognitive decline 

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Vascular dementia

Stepwise deterioration in cognitive function

Sudden change 

Often co-exists with AD 

Vascular risk factors 

Not always accompanied by neurological symptoms 

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Dementia with LB

Day to day fluctuation in cognition 

Visual hallucinations very early 

Disturbances in consciousness 

Parkinsonsism (anti-psychotic sensitivty) 

Falls / syncope 

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Fronto-temporal dementia

Early decline in social / personal conduct 

Different variants affecting: behaviour or language 

Memory preserved in early stages 

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AChE inhibitors

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

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AChE inhibitors




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