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Neuro > clinical 3 > Flashcards

clinical 3 Flashcards

1
Q

2 main categories of seizures

A

generalised and partial

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2
Q

general seizures include (4)

A

grand mal (tonic-clonic)
petit mal (absence seizures)
myoclonic: brief, rapid muscle jerks
partial seizures progressing to generalised seizures

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3
Q

types of partial seizure

A

simple (no disturbance of consciousness or awareness)
complex (consciousness is disturbed)
temporal lobe → aura, déjà vu, jamais vu; motor → Jacksonian

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4
Q

type of tremor improved by alcohol

A

essential tremor

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5
Q

which tremor has a strong family history

A

essential tremor (autosomal dominant)

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6
Q

in what position is essential tremor worse

A

outstretched arms

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7
Q

which features would suggest a tremor is caused by thyrotoxicosis

A

hyperthyroid signs: Weight loss, tachycardia, feeling hot

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8
Q

3 common signs of cerebellar disease

A

intention tremur
past pointing
nystagmus

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9
Q

in what gender is parkinsons more common

A

males 2:1

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10
Q

what is pathophysiology of parkinsons

A

degeneration of dopaminergic neurons in the substantia nigra

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11
Q

classic triad of features in parkinsons

A

tremor, bradykinesia, rigidity

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12
Q

type of rigidity in parkinsons

A

leap pipe

cog wheel: due to superimposed tremor

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13
Q

what are triptans

A

specific 5-HT1 agonists used in the acute treatment of migraine

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14
Q

contraindications of triptans

A

history of/risk of: ischaemic heart disease or cerebrovascular disease

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15
Q

what drug do you give in a prolonged seizure

A

rectal benzodiazapine (diazepam) usually 10mg in >12yrs, can give up to 30mg

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16
Q

site of stroke: Contralateral hemiparesis and sensory loss, lower extremity > upper

A

Anterior cerebral artery

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17
Q

site of stroke: Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

A

Middle cerebral artery

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18
Q

site of stroke: Contralateral homonymous hemianopia with macular sparing
Visual agnosia

A

Posterior cerebral artery

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19
Q

site of stroke: Ipsilateral CN III palsy

Contralateral weakness

A

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)

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20
Q

site of stroke: Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

A

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

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21
Q

site of stroke: Symptoms are similar to Wallenberg’s, but:

Ipsilateral: facial paralysis and deafness

A

Anterior inferior cerebellar artery (lateral pontine syndrome)

22
Q

site of stroke: Amaurosis fugax

A

retinal artery

23
Q

site of stroke: ‘Locked-in’ syndrome

A

Basilar artery

24
Q

in ABCD2 score which 2 factors give highest risk of having a stroke

A
  • unilateral weakness

- TIA >60 mins ** 2 points each **

25
Q

what is cataplexy

A

describes the sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)

26
Q

cataplexy is strongly associated with which other condition

A

narcolepsy

27
Q

high stepping gait suggests what

A

foot drop from neuropathy

28
Q

if high stepping gait (indicting foot drop) is unilateral, where is the most likely site of lesion

A

a common peroneal nerve

29
Q

if foot drop is bilateral this indicates what type of neuropathy

A

peripheral

30
Q

in regards to facial palsy, how do UMN and LMN features differ

A

upper motor neurone lesion spares upper face (forehead) where lower affects all of face

31
Q

what 4 conditions can cause bilateral facial palsy

A

sarcoidosis
Guillain-Barre syndrome
polio
Lyme disease

32
Q

way to remember what the facial nerve innervates

A

face (expression), ear (tapedius), taste (anterior 2/3), tear

33
Q

first line treatment for generalised seizures

A

sodium valproate

34
Q

how does sodium valproate work

A

by increasing GABA activity

35
Q

which anti epileptic drug causes weight gain

A

sodium valproate

36
Q

type of 5-HT drug used in:

acute:
prophylaxis:

A

acute: 5-HT receptor agonist
prophylaxis: 5-HT receptor antagonist

37
Q

who should get migraine prophylaxis

A

if 2+ migraines a month

38
Q

low CSF glucose indicates what

A

TB meningitis or bacterial

39
Q

CSF glucose in viral meningitis is usually

A

60-80% plasma glucose

40
Q

which 2 anti epileptic drugs should not be given together due to skin reactions

A

sodium valproate and lamotrigine

41
Q

at what point should anti seizure medication be started

A

after 2nd seizure - unless meets other criteria that suggest to start after 1st seizure

42
Q

criteria for starting anti seizure medication after 1st seizure

A
  • the patient has a neurological deficit
  • brain imaging shows a structural abnormality
  • the EEG shows unequivocal epileptic activity
  • the patient or their family or carers consider the risk of having a further seizure unacceptable
43
Q

first line treatment for partial seizures

A

carbamazepine

44
Q

first line treatment for generalised seizures

A

Sodium valproate

45
Q

which drug may actually exacerbate absence seizure

A

carbamazepine

46
Q

propanolol is a prophylaxis for migrane, but who shouldn’t get this

A

those with asthma

47
Q

migraine prophylaxis for those with asthma

A

topiramate

48
Q

preferred drug deliver method for triptans in:

12-17yrs
> 17yrs

A

12-17 yrs = nasal

> 17 yrs = oral

49
Q

if first line acute treatment of migraine doesn’t work, what is then used

A

non-oral preparation of metoclopramide or prochlorperazine and consider adding a non-oral NSAID or triptan

50
Q

woman of child baring age should receive which migraine prophylaxis

A

propanolol (topiramate may be teratogenic and it can reduce the effectiveness of hormonal contraceptives)

51
Q

if first line migraine prophylaxis fails what is recommended

A

10 sessions of acupuncture over 5-8 weeks’ or gabapentin

Neuro (20 decks)

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