clinical 1 Flashcards
first line treatment for migraines prophylaxis
propranolol or topiramate
first line migraine prophylaxis for woman of child baring age
Propranolol
what is contraindicated in woman with migraine history
- combination contraceptive pill
- topiramate
used to treat migraine attacks
Zolmitriptan (triptan) + NSAID or paracetamol
what condition is relieved by “shacking hands”
carpal tunnel syndrome
C6 entrapment will have what features
proximal weakness: e.g. weakness of the biceps muscle or reduced biceps reflex.
what is xanthochromia
yellowing of CSF from bilirubin, indicating subarachnoid haemorrhage
when will xanthochromia appear
minimum of 12 hours after onset
Guillain-Barre syndrome weakness has what pattern
- all 4 limbs (peripheral nerves)
- ascending i.e. the lower extremities are affected first, however it tends to affect proximal muscles earlier than the distal ones
features of migraine (6)
unilateral throbbing aura nausea photosensitivity associated with menstruation
headache described as ‘tight band’
tension headache
bilateral headache indicates what type
tension
unilateral headache
migraine, temporal arteritis or cluster
headaches with intense pain around eyes
cluster
cluster headache time scales
twice a day 15min-2hrs
cluster lasts 4-12 weeks
eye features associated with cluster headache
lacrimation, lid swelling, redness
most likely person to suffer a cluster headache
male who smokes
features of temporal arteritis
Typically patient > 60 years old
Usually rapid onset
who is most likely to get a medication overuse headache
those using opioids and triptans, may have psychiatric co-morbidity
Which type of motor neuron disease carries the worst prognosis?
Progressive bulbar palsy
what happens in progressive bulbar palsy
palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei
Which type of motor neuron disease carries the BEST prognosis?
Progressive muscular atrophy
motor neurone disease occurs at what age
> 40
motor neurone disease presents with what features
both upper and lower motor neuron signs
4 types of motor neurone disease
amyotrophic lateral sclerosis
primary lateral sclerosis
progressive muscular atrophy
progressive bulbar palsy
most common form of motor neurone disease
Amyotrophic lateral sclerosis (50% of patients)
gene and enzyme associated with Amyotrophic lateral sclerosis
chromosome 21 and codes for superoxide dismutase
signs of progressive muscular atrophy
LMN signs only
affects distal muscles before proximal
signs of primary lateral sclerosis
UMN signs only
signs of amyotrophic lateral sclerosis
typically LMN signs in arms and UMN signs in legs
** familial association**
when do you give aspirin to someone having a stroke
only once a hemorrhagic stroke has been excluded
when do you give thrombolysis in stroke
- it is administered within 4.5 hours of onset of stroke symptoms
- haemorrhage has been definitively excluded (i.e. Imaging has been performed)
Contraindications to thrombolysis (11)
- Previous intracranial haemorrhage
- Seizure at onset of stroke
- Intracranial neoplasm
- Suspected subarachnoid haemorrhage
- Stroke or traumatic brain injury in preceding 3 months
- Lumbar puncture in preceding 7 days
- Gastrointestinal haemorrhage in preceding 3 weeks
- Active bleeding
- Pregnancy
- Oesophageal varices
- Uncontrolled hypertension >200/120mmHg
signs of normal pressure hydrocephalus
Urinary incontinence + gait abnormality + dementia
how do you treat normal pressure hydrocephalus
ventriculoperitoneal shunting
what will imaging of normal pressure hydrocephalus show
enlarged 4th ventricle
what is thought to be the cause of normal pressure hydrocephalus
thought to be secondary to reduced CSF absorption at the arachnoid villi
management of cluster headaches
acute: 100% oxygen, subcutaneous or a nasal triptan
prophylaxis: verapamil, prednisolone
Painful third nerve palsy =
posterior communicating artery aneurysm
features of 3rd nerve palsy (3)
eye is deviated ‘down and out’
ptosis
pupil may be dilated (sometimes called a ‘surgical’ third nerve palsy)
first line treatment for post-herpetic neuralgia
amitriptyline, duloxetine, gabapentin or pregabalin first-line.
most common presentation of MS
optic neuritis
appearance, glucose, protein & WBC of bacterial meningitis
appearance - cloudy
glucose - low 1g/l
WBC - 5-10 thousand polymorphs/mm³
appearance, glucose, protein & WBC of viral meningitis
appearance - clear/cloudy
glucose - 60-80% plasma
protein - normal
WBC - 15-1000 lymphocytes/mm³
appearance, glucose, protein & WBC of tuberculous meninigits
appearance - Slight cloudy, fibrin web
glucose - low ( 1 g/l)
WBC -10 - 1,000 lymphocytes/mm³
WBC’s seen in bacterial meningitis
polymorphs
WBC’s seen in viral meningitis
lymphocytes
motor response for GCS
- Obeys commands
- Localises to pain
- Withdraws from pain
- Abnormal flexion to pain (decorticate posture)
- Extending to pain
- None
visual response for GCS
- Orientated
- Confused
- Words
- Sounds
- None
eye opening for GCS
- Spontaneous
- To speech
- To pain
- None
appearance - cloudy
glucose - low 1g/l
WBC - 5-10 thousand polymorphs/mm³
viral
appearance - cloudy
glucose - low 1g/l
WBC - 5-10 thousand polymorphs/mm³
bacterial
appearance - Slight cloudy, fibrin web
glucose - low ( 1 g/l)
WBC -10 - 1,000 lymphocytes/mm³
TB
