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Assalamualaikum wbt

Sorry lambat follow up with email. Jarak dari Union Street around 5.5 miles – 15 minutes by car.

Details as below:

1. Route ke Rowett Institute (AB21 9SB):

a) Dari mana jua anda bermula, pandu ke arah airport

b) Pusing kiri di (A)

c) Pusing kiri di (B)

d) Pusing kanan di (C)

e) Pusing kiri di (D)

f) “You have arrived at your destination”

2. Pengangkutan Awam:

a) Pada esok hari, hanya Stagecoach yang beroperasi (tiada Firstbus)

b) Servis yang perlu diambil perhatian:

Service 10 (via Forresterhill)

Service 307/737 (via Great Northern Road)

c) Perhentian bus yang perlu diambil untuk ke Rowett Institute:

Forrit Brae

Nota: Perhentian ini adalah sebelum roundabout ke Airport (rujuk gambarajah)

d) Perjalanan ke Rowett Institute dari perhentian bas lebih kurang 10 minit (sila rujuk arahan no. 1)

Service 10

Aberdeen Bus Station – Airport – Inverness

Station	Abdn Bus Station	Forresterhill	Airport Terminal
Time	0905 1005 1105 1205 1305 1405 1505	0915 1015 1115 1215 1315 1415 1515	0924 1024 1124 1224 1324 1424 1524

Inverness – Airport – Aberdeen Bus Station

Station	Airport Terminal	Forresterhill	Abdn Bus Station
Time	1832 1932 2027 2147	1845 1945 2040 2200	1856 1956 2051 2211

Service 307/737

Aberdeen Bus Station – Airport – Inverurie

Station	Aberdeen Bus Station	Bucksburn Post Office	Blackburn Leys Hotel
Time	1300	1321	1331
	1315	1336	1346
	1330	1351	1401
	1345	1406	1416
	1400	1421	1431
	1415	1436	1446
	1430	1451	1501
	1445	1506	1516

Inverurie – Airport – Aberdeen Bus Station

Station	Blackburn Leys Hotel	Bucksburn Post Office	Aberdeen Bus Station
Time	1809	1819	1845
	1854	1904	1930
	1919	1935	1953
	1949	2005	2023

Indications for Tonsillectomy

1. recurrent infection

2. sleep apnoea

3. tumour growth

Steroids

1. Examples: Methylprednisolone, betamethasone, dexamethasone, hydrocortisone, cortisone acetate, triamcinolone, deflazacort

2. Side-effects:

• diabetes
• osteoporosis
• AVN of femoral head
• euphoria + other paranioa; also depression
• proximal myopathy --> muscle wasting
• peptic ulceration
• Cushing's
• suppression of growth in children
• adrenal atrophy (long-term). Important to avoid abrupt after long term use (>3 wks) as: 1) acute adrenal insufficiency; then 2) hypotension; then 3) death!
• Atypical infections
• chickenpox with atypical features (i.e. rash not a feature e.g. pneumonia, hepatitis, DIC)
  

Case Study

• 66 yr old gentleman
• 2 yrs hx of unsteadiness on feet - shuffle when walking
• noticed weakness in the legs
• loss of balance
  
• increase in freqeuncy of micturition
• reduced in memory
  
• in recent 2-3 months, starts to develop tremors in hands when try to do something
• loss of bladder control
• symptoms get worst
• no significant finding in PMHx, DHx, FHx and SHx

Dx:

• Normal pressure hydrocephalus(NMH) aka adult onset hydrocephalus

Triad of NMH:

• ataxia
• dementia
• incontinence

Investigation:

• MRI

Management:

• ventriculo-peritoneal shunt
  

Leg Claudication

Neurogenic (nerve root compression)

• pain on exertion (walking a distance/climbing up hills or stairs)
• relieved by bending forward
• sensory symptoms ie pins and needles

Cardiogenic (peripheral vascular disease)

• pain on exertion (walking a distance/climbing up hills or stairs)
• relieved by hanging legs over side of bed (at night)
• no sensory symptoms
  

Parkinson's disease

Pathology

• Idiopathic, degenerative
• progressive death of dopaminergic neurone in substantia nigra
• relative excess of acetylcholine

Onset usually around 6th-7th decade

Triad of classical symptoms

• akinesia/bradykinesia (usually upper body)
  
• resting tremor (asymmetrical, abolished by movement)
  
• rigidity (asymmetrical)

Other features

• lack of arm swing
• short step
  
• Parkinsonian face (flat face?)
• postural instability
• dementia

Examination

• bradykinesia: do alternate supination/pronation tap
• rigidity: check tone, remember to distract the patient

Investigation

• therapeutic trial of levodopa (walking test before and after taking levodopa)

Management

• education and support
• physiotherapy, occupational therapy, speech and language therapy
• drugs (levodopa, sinemet, selegiline)

Differentials

• essential tremor
• Alzheimer
• drug
• Lewy body dementia
• multisystem atrophy
• progressive supranuclear palsy
  

Headache

• commonest headache - tension headache
• commonest debilitating headache - migraine
• commonest brain tumour - brain mets

1 question that would distinguish between different types of headache:

what would you do when you get the headache?

• lie down and sleep - migraine
• keep on doing activity as before - tension headache
• bang head with hand/on the wall - cluster headache