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Neuro > clinical 1 > Flashcards

clinical 1 Flashcards

1
Q

first line treatment for migraines prophylaxis

A

propranolol or topiramate

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2
Q

first line migraine prophylaxis for woman of child baring age

A

Propranolol

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3
Q

what is contraindicated in woman with migraine history

A
  • combination contraceptive pill

- topiramate

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4
Q

used to treat migraine attacks

A

Zolmitriptan (triptan) + NSAID or paracetamol

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5
Q

what condition is relieved by “shacking hands”

A

carpal tunnel syndrome

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6
Q

C6 entrapment will have what features

A

proximal weakness: e.g. weakness of the biceps muscle or reduced biceps reflex.

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7
Q

what is xanthochromia

A

yellowing of CSF from bilirubin, indicating subarachnoid haemorrhage

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8
Q

when will xanthochromia appear

A

minimum of 12 hours after onset

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9
Q

Guillain-Barre syndrome weakness has what pattern

A
  • 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
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10
Q

features of migraine (6)

A 
unilateral 
throbbing 
aura 
nausea
photosensitivity 
associated with menstruation
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11
Q

headache described as ‘tight band’

A

tension headache

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12
Q

bilateral headache indicates what type

A

tension

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13
Q

unilateral headache

A

migraine, temporal arteritis or cluster

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14
Q

headaches with intense pain around eyes

A

cluster

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15
Q

cluster headache time scales

A

twice a day 15min-2hrs

cluster lasts 4-12 weeks

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16
Q

eye features associated with cluster headache

A

lacrimation, lid swelling, redness

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17
Q

most likely person to suffer a cluster headache

A

male who smokes

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18
Q

features of temporal arteritis

A

Typically patient > 60 years old

Usually rapid onset

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19
Q

who is most likely to get a medication overuse headache

A

those using opioids and triptans, may have psychiatric co-morbidity

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20
Q

Which type of motor neuron disease carries the worst prognosis?

A

Progressive bulbar palsy

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21
Q

what happens in progressive bulbar palsy

A

palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei

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22
Q

Which type of motor neuron disease carries the BEST prognosis?

A

Progressive muscular atrophy

23
Q

motor neurone disease occurs at what age

A

> 40

24
Q

motor neurone disease presents with what features

A

both upper and lower motor neuron signs

25
Q

4 types of motor neurone disease

A

amyotrophic lateral sclerosis
primary lateral sclerosis
progressive muscular atrophy
progressive bulbar palsy

26
Q

most common form of motor neurone disease

A

Amyotrophic lateral sclerosis (50% of patients)

27
Q

gene and enzyme associated with Amyotrophic lateral sclerosis

A

chromosome 21 and codes for superoxide dismutase

28
Q

signs of progressive muscular atrophy

A

LMN signs only

affects distal muscles before proximal

29
Q

signs of primary lateral sclerosis

A

UMN signs only

30
Q

signs of amyotrophic lateral sclerosis

A

typically LMN signs in arms and UMN signs in legs

** familial association**

31
Q

when do you give aspirin to someone having a stroke

A

only once a hemorrhagic stroke has been excluded

32
Q

when do you give thrombolysis in stroke

A
  • it is administered within 4.5 hours of onset of stroke symptoms
  • haemorrhage has been definitively excluded (i.e. Imaging has been performed)
33
Q

Contraindications to thrombolysis (11)

A
  • 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
34
Q

signs of normal pressure hydrocephalus

A

Urinary incontinence + gait abnormality + dementia

35
Q

how do you treat normal pressure hydrocephalus

A

ventriculoperitoneal shunting

36
Q

what will imaging of normal pressure hydrocephalus show

A

enlarged 4th ventricle

37
Q

what is thought to be the cause of normal pressure hydrocephalus

A

thought to be secondary to reduced CSF absorption at the arachnoid villi

38
Q

management of cluster headaches

A

acute: 100% oxygen, subcutaneous or a nasal triptan
prophylaxis: verapamil, prednisolone

39
Q

Painful third nerve palsy =

A

posterior communicating artery aneurysm

40
Q

features of 3rd nerve palsy (3)

A

eye is deviated ‘down and out’
ptosis
pupil may be dilated (sometimes called a ‘surgical’ third nerve palsy)

41
Q

first line treatment for post-herpetic neuralgia

A

amitriptyline, duloxetine, gabapentin or pregabalin first-line.

42
Q

most common presentation of MS

A

optic neuritis

43
Q

appearance, glucose, protein & WBC of bacterial meningitis

A

appearance - cloudy
glucose - low 1g/l
WBC - 5-10 thousand polymorphs/mm³

44
Q

appearance, glucose, protein & WBC of viral meningitis

A

appearance - clear/cloudy
glucose - 60-80% plasma
protein - normal
WBC - 15-1000 lymphocytes/mm³

45
Q

appearance, glucose, protein & WBC of tuberculous meninigits

A

appearance - Slight cloudy, fibrin web
glucose - low ( 1 g/l)
WBC -10 - 1,000 lymphocytes/mm³

46
Q

WBC’s seen in bacterial meningitis

A

polymorphs

47
Q

WBC’s seen in viral meningitis

A

lymphocytes

48
Q

motor response for GCS

A
  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None
49
Q

visual response for GCS

A
  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None
50
Q

eye opening for GCS

A
  1. Spontaneous
  2. To speech
  3. To pain
  4. None
51
Q

appearance - cloudy
glucose - low 1g/l
WBC - 5-10 thousand polymorphs/mm³

A

viral

52
Q

appearance - cloudy
glucose - low 1g/l
WBC - 5-10 thousand polymorphs/mm³

A

bacterial

53
Q

appearance - Slight cloudy, fibrin web
glucose - low ( 1 g/l)
WBC -10 - 1,000 lymphocytes/mm³

A

TB

Neuro (20 decks)

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