Exam 2 Flashcards
Drugs which can cause parkinsonism(2)
Anti-emetics e.g. metoclopramide
anti-psychotics
Four cardinal symptoms of Parkinsons disease
Resting tremor
Rigitidy
Bradykinesia
Postural/gait impairment
Non-motor symptoms of Parkinsons disease (4)
Depression
Constipation
Hyposmia
Dementia
Poor levodopa response suggests..
Vascular parkinsonism
Postural tremor, symmetrical which improves with alcohol
Essential tremor
Causes of a flapping tremor (3)
Liver disease
Renal failure (uraemia)
Hypercapnia
Aetiology of an intention tremor
Cerebellar lesion/alcohol
Causes of chorea (2)
Huntingtons disease Sydenhams chorea (post-strep)
First-line management of Parkinsons disease (2)
Levodopa+ decarboxylase inhibitor e.g. carbidopa to reduce peripheral metabolism of dopamine
Adverse effects of levodopa (3)
On-off effect
Reduced effectiveness with time
Dyskinesia
Bromocriptine is an example of what? Give two other drugs in the same class
Dopamine agonist. Cabergoline, ropinorole
Adverse effects of dopamine agonists (3)
Excessive daytime somnolence
Impulse control disorders
Fibrosis
Inflammatory demyelinating disease of the CNS presenting with focal neurological deficit
Multiple sclerosis
Demyelination of the medial longitudinal fasciculus causes…
Internuclear opthalmoplegia- failure of adduction of contralateral eye during lateral gaze with nystagmus in abducting eye
Investigations in MS:
a) LP
b) MRI
c) evoked potentials
a) oligoclonal bands in CSF- represents IgG reponse in the CNS
b) high-signal plaques
c) delayed
Management of acute exacerbations of MS
Steroids- if severe, admit and give IV
In MS, what is a) amantadine and b) modafinil indicated for?
a) fatigue
b) daytime somnolence
Disease modifying treatment in MS? (2) What is the aim of this?
Interferon beta
Glitiramer acetate.
Reduce relapse rate in relapsing-remitting MS.
Electric-shock like sensation caused by neck flexion? What other conditions is this caused by?
Lhermitte’s phenomenon
Cervical spondylosis, SCDC, cord tumours
Symptoms/signs of optic neuritis (4)
Blurred vision
Washed-out colours
Eye pain
Relative afferent pupillary defect
Commonest brain region affected in stroke and symptoms of this (3)
Middle cerebral artery
Contralateral hemiparesis and sensory loss (upper>lower)
Contralateral homonymous hemianopia
Aphasia
How does the hemiparesis/sensory loss in anterior cerebral artery strokes differ from middle?
Affects more the lower limb than the upper
Ataxia + disorders of gaze and vision/other cranial nerve lesions: stroke location?
Posterior circulation
Indications for thrombolysis (2)
Haemorrhagic stroke excluded on CT
Patient is within 4.5 hours of symptoms
Secondary prevention of stroke
Control of blood pressure, cholesterol, diabetes
Clopidogrel as an antiplatelet
Warfarin for cardio-embolic stroke
Agent and dose used for thrombolysis
Recombinant tissue plasminogen activator, 0.9mg/kg/hour
