clinical 7 Flashcards
when do you give thrombolylis in stroke
within 4.5 hours of onset of symptoms
once haemorrhage stroke has been ruled out
preventative drug given after an ischaemic stroke
clopidogrel
what do you give after an ischaemic stroke if clopidogrel is CI
aspirin plus modified release (MR) dipyridamole
facial nerve innervates what 4 areas
face - facial expression
ear - nerve to stapedius
taste - anterior 2/3rds
tear - lacrimal gland
Causes of bilateral facial nerve palsy (4)
sarcoidosis
Guillain-Barre syndrome
polio
Lyme disease
cholesterol level that requires statin after an ischaemic stroke
if more than 3.5
anti epileptic most associated with weight gain
sodium valproate
how does sodium valproate work
increases GABA activity
first line treatment for generalised seizures
sodium valproate
first line treatment for partial seizures
carbamazepine
second lin treatment for generalised if sodium valproate is not working
lamotrigine
carbamazepine may actually exacerbate ______ seizure
absent
frequency of migraine that requires prophylaxis
more than 2 a month
migraine prophylaxis in woman of child bearing age
propanolol
migraine prophylaxis in the with asthma
topiramate
drug that can be given as migraine prophylaxis
topiramate or propanolol
when do you give phenytoin
in status epileptics is continuing 10 mins after receiving diazepam or lorazepam
what can happen following a sub arachnoid haemorrhage
cerebral vasospasm
what do you give following a subarachnoid haemorrhage to prevent cerebral vasospasm
calcium channel blocker (ends in -pine)
if stroke due to a-fib, when do you start anticoagulation therapy (warfarin)
15 days after onset of symptoms
first line for spasticity in MS
baclofen or gabapentin
whig parkinson drugs make you lose impulse control
dopamine agonists
what is ‘anticipation’ in huntingtons
earlier onset in successive generations
drug that can cause parkinsinism
haloperidol (antipsychotic: decrease amount of dopamine, low dopamine associated with parkinson)
first line treatment for neuropathic pain
amitriptyline, duloxetine, gabapentin or pregabalin
first line treatment for trigeminal neuralgia
carmabazepine
bells palsy, what nerve
facial LMN
what is radiculopathy
nerve impingement/lesion at level of spine
‘triptan sensation’
tingling, heat, tightness (e.g. throat and chest), heaviness, pressure
moraine treatment in pregnancy
1st line: paracetamol
2nd: aspirin or ibuprofen is in 1st or 2nd trimester
who don’t you give neuroleptics (i.e. haloperidol) to and why
lewy body because it can cause non reversible parkinsonism
how can you differentiate parkinson from drug induced parkisonism
do not get rigidity and resting tremor in drug induced
acute migraine treatment
oral triptan + NSAID or titan + paracetamol
what makes essential tremor better
alcohol and propanolol
treatment for essential tremor
propanolol
anti body present 25% of people with Guillain-Barre syndrome
anti-ganglioside antibody (e.g. anti-GM1)
bilateral acoustic neuromas - what condition
neurofibromatosis type 2
neurofibromatosis type 2 inheritance and chromosome
autosomal dominant and is an inherited defect in chromosome 22.
Neurofibromatosis type 1 is due to a mutation in chromosome ___
17
tuberous sclerosis is often associated with a mutation in chromosome ___
16
what will indicated neurofibromatosis 1 rather than 2
Café-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
what will indicated neurofibromatosis 2 rather than 1
bilateral acoustic neuromas
dopamine agonists end in
-ine(Bromocriptine, cabergoline, apomorphine)
what is dystonia
sustained, abnormal posture cased by persistent contraction of large trunk or limb muscles
what is blepharospasm
twitch or spasm of eye
what is hemiballismus
uncontrolled flailing of limbs - lesion or dysfunction of subthalmic nucleus
nerve root level if weakness in knee extension and ankle dorsiflexion
L4
parts of peripheral nervous system that carries parasympathetic nerve fibres
craniosacral out flow: cranial nerves III, VII, IX, X and anterior rami of sacral spinal nerves which enter PELVIC splanchnic nerves
roots carry what fibres
just motor or just sensory
what carries both sensory and motor fibres
rami
wha makes up brachial plexus
anterior rami of C5 - T1
calcimine sulcus located where
occipital lobe (part of visual pathway)
what is galantamine
cholinesterase inhibitor
oliclonal bands are seen in what condition
MS - seen in gel of CSF (also get high lymphocytes)
receptive aphasia
wernicke’s (temporo-parietal area)
expressive aphasia
brocas (frontal lobe)
what is nominal aphasia
not being able to name familiar objects
middle cerebral artery supplies where
lateral aspect of parietal lobe
lateral aspect of parietal lobe is supplied by which artery
middle communicating
anterior cerebral artery supplies where
anterior corpus collosum and superior frontal gyrus
posterior cerebral artery supplies where
poseroventral nucleus of thalamus and inferior temporal gyrus
in brown squared syndrome at what level with pain and temp be lost
3 levels below the spinal lesion
part of brain responsible for memory, emotional reaction and decision making
amygdala
what ligament does an epidural needle pass through
filamentum flavum
level of epidural
L3/L4
what level does the spinal cord end
L2
subarachnoid space ends at what level
S2
dura that covers cerebellum
tentorium cerebelli
what causes a ‘blow pupil’
compression of oculomotor nerve by an uncal herniation
