Case 2

Focal seizures

Fully aware or focally impaired, occuring in specific brain areas which can spread

Generalised seizure

Loss of consciousness and widespread body involvement

Atonic seizure

Head drop, slump, loss of muscle control

Tonic seizures

Stiffness, crying, shouting, arched back

Myoclonic jerks

Muscle spasms or twitches, occur in hands, abdomen, legs

Absence seizure

Blank stare, rapid eye blinking, eye rolling

Tonic-clonic seizure

Periods of stiffness, jerking, shaking then muscle relaxation

Most common

Status epilepticus

Medical emergency

> 1 seizure occuring in 5 minutes or seizure >5 minutes without regaining consciousness

Paroxysmal

Suddent violent outburst of a seizure

Interictal

Time between seizures

SUDEP

Seizure induced death while asleep

Ictogenesis

Development of a seizure

Epileptogenesis

Development of epilepsy

Blood dyscrasias

Abnormalities in blood components:

anaemia

blood clotting issues

immune deficiencies

Lamotrigine

1st - focal

2nd - atonic, tonic, tonic-clonic

Levertiracetam

1st - focal

2nd - myoclonic, tonic-clonic

Sodium Valproate

1st - atonic, tonic, myoclonic, tonic-clonic

2nd - absence

Ethosuximide

Absence

Carbamazepine

2nd - focal

Dementia

Decline in cognitive function caused by various brain disorders and associated with age

Acetylcholinesterase inhibitors

Inhibit enzyme which breaks down Ach - high Ach = improved cognitive symptoms

Donzepil

Memantine

NMDA receptor antagonist = inhibits glutamate signalling = reduced activity

Risk factors for insomnia

Increasing age

Family history

Female

Stress, worrying

3P model of insomnia

Predisposing - age, female, sleep anxiety

Precipitating - lifestyle, environment, work

Perpetuating - reduced sleep efficiency, comorbidities, more sleep anxiety

Diazepam

Long acting benzodiazepine - stimulates GABA to produce its inhibitory effects, acting as a sedative

OTCs for insomnia

Sedative antihistamine - diphenhydramine, promethazine

Herbals - chamomile

Orexin antagonist - daridorexant

Melatonin - >55 year olds

Risk factors for GAD

Mental health disorder

Stress

Shy

PTSD

Diet

Family history

Drug treatment pathway for GAD

1. SSRI - sertraline, paroxetine

2. SNRI - duloxetine, venlafaxine

Two core symptoms for depression

Diminished interest in activities

Feeling down, depressed or hopeless

Treatment pathway for depression

1. Low intensity CBT

2. High intensity CBT

3. SSRI - citalopram, sertraline, paroxetine, fluoxetine

Bipolar disorder

Episodic, depressed or elated mood and increased activity

Acute depressive bipolar episode

1. Quetiapine

2. Fluoxetine + onlanzipine

3. Onlanzipine

4. Lamotrigine

Dyskinesia

Abnormal involuntary muscle spasms or movements which aren’t painful e.g. jerky or writhing

Tardive dyskinesia

EPS - involuntary movements of the face and jaw

Akathisia

EPS - severe feeling of inner restlessness - uncontrollable urge to move

Acute dystonia

EPS - sudden painful muscle contraction or spasm which can be painful e.g. twisting movements or abnormal posture

Naloxone vs naltrexone

1. Nalox = emergency treatment for opioid overdose

2. Naltrex = long-term prevention of opioid relapse

Tympanic membrane anatomy

1. Light reflex

2. Umbo - centre point of TM

3. Handle of malleus - bone

4. Lateral process of malleus

5. Annulus - thickened edge of TM

Outer ear conditions

Otitis externa, wax buildup

Middle ear conditions

Acute otitis media + OM with effusion

Inner ear conditions

Vertigo and tinnitus

Otitis externa

Inflammation of the ear canal due to bacterial infection

Light-coloured discharge, red, inflamed, odour

Impacted wax

Sebum and dead skin cells not removed by the body so builds up in the ear canal

Acute otitis media

Inflammation of the middle ear due to bacterial/viral infection

Pain, fever, irritable, bulging TM, cough, runny nose

Glue ear

AKA otitis media + effusion

Collection of fluid in ear but no inflammation or infection

Vertigo

False sense of spinning

Hearing loss, discharge, headache, tinnitus, N+V

Tinnitus

Perception of sound without it e.g. ringing ears

Hearing loss, loud sounds, Meniere’s disease, chemotherapy, NSAIDs

Symptomatic treatment for vertigo

Promethazine, cyclizine, cinnarizine, prochlorperazine

Meniere’s disease

Long episodes of vertigo, hearing loss, fullness, N+V

Otomycosis

Fungal infection of ear

Black spores, white soggy discharge

Cholesteatoma

Retraction of TM due to dead skin migration casing infection

Urgent ENT referral

Osteomas

Benign bone growth due to chronic cold water exposure

Wax build-up

Perforation

Tear in the TM with smooth, clear rounded borders and no inflammation

Grommets

Small tube in TM to drain it of fluid

Falls out by itself, refer to ENT

Glandular fever

Viral infection persisting months

Swollen lymph glands, general malaise, muscle aches, fever, appetite loss, headache, inflamed sore throat

Acute tonsilitis

Bacterial/viral infection of the tonsils

Sore throat, pain when swallowing, high temperature, fever, Quincy (white balls), difficulty breathing

Strep throat

Throat bacterial infection

Small red spots on roof of mouth, Scarlett fever, white patches on tonsils, flu-like symptoms