Medicine: Neuro Flashcards
Where can the tendon reflex arc be broken?
Stretch Receptor Afferent Pathway Spinal Cord Efferent Pathway Muscle Contraction
Therefore sensory + motor sign
What can lead to abnormal tone?
Reduced: LMN, myopathy, cerebellar
Pyramidal/Spasticity: clasp knife, velocity dependent, directional given away by posture
Extrapyramidal/Rigidity: lead pipe + palpable tremor = cog wheel
What can help you elicit cog wheel rigidity?
Froment Manoeuvre
Where is the lesion if the pt has normal hand function denoted by their lace up shoes but a scissoring gait?
T2-12
What should you look for if the pt has bilateral high stepping gait?
Pes Cavus
What would a motor and sensory peripheral neuropathy gait look like?
Foot Drop + Stamp
What is dystonia?
Abnormal interaction b/w agonist and antagonist eg writers cramp and spasmodic torticolis
What should you look for when testing shoulder aBduction?
The speed at which they raise their arms and to what height
How do you test power grip?
By pulling it apart w your own NOT by asking them to squeeze your fingers
How do you test the motor function of the ulnar nerve?
Stabilise, Observe, Feel
Place their hand on the couch/in yours, do each index/little in turn, apply resistance and feel the muscle bulk w other hand ie first dorsal interosseous/hypothenar eminence
What should you do if there is marked weakness in knee extension/flexion?
Swing their knee out and see if they can slide their foot up and down the couch
What are the additional UMN reflexes?
Finger Jerks
Hoffman Sign
Crossed Adductors
Absent Abdo Reflexes
What is coordination testing?
Finger nose/heel shin - intention tremor and dysmetria
Hand flip/foot tap - break in rhythm (PD) and dysdiadochokinesia (MS)
How is the SCM innervated?
Ipsilaterally
How can you exacerbate the signs on PD?
Rigidity: coactivate the contralateral limb by producing voluntary action
Bradykinesia: use big pincers/foot taps and observe for fading out and decline in amplitude
Tremor: place hands on their lap palms down and ask them to recite the mnths backwards w their eyes closed
What is the MRC scale of grading muscle power?
0: None
1: Flicker
2: Along
3: Gravity
4: +/-Weak
5: Normal
UMN Signs
Hypertonic Weakness Clonus Brisk Reflexes Pos Babibski’s
LMN Signs
Hypotonic Weakness Fasciculations Dec Reflexes Neg Babibski’s
Presenting query stroke
Acute onset, time critical, urgent CT as a potential candidate for thrombolysis within 4.5hrs, CIs to thrombolysis, contact stroke team, CTA target for thrombectomy
Absolute CIs to thrombolysis
Uncertain onset, GCS <8, SBP >185 or DBP >110, BM <2.7 or >22, pl <100k, INR >1.7, LMWH within 48h, advanced liver disease
Presenting query meningitis
Conscious level, signs of meningism, focal neuro, rash, fundoscopy
What can you give before abx when treating bacterial meningitis?
Dexamethasone 15-20mins before abx to reduce hearing loss
When would you aim for lower O2 sats around 88-92%?
Pts at risk of hypercapnic resp failure
What does a low diastolic blood pressure suggest?
Arterial vasodilation - anaphylaxis or sepsis
What does a narrow pulse pressure suggest?
Arterial vasoconstriction - cardiogenic shock or hypovolaemia
Does a normal CT scan exclude a stroke?
It only excludes a bleed and hence able to thromblyse
After stabilising meningitic pts where do they go?
HDU
What should you always know when analysing the ABG?
How much oxygen the pt is on and also compare to prev gas results
Spinothalamic Tracts (3)
Ant: Crude Touch
Lateral: Pain + Temp
Dorsal Columns (3)
Light Touch, Vibration, Proprioception
Spasicity vs Rigidity
Spasicity - unidirectional, velocity dependent, clasp knife phenomenon, umn lesion
Rigidity - all directions, velocity independent, cog wheel and lead pipe, parkinsons
How can you elicit receptive vs expressive dysphasia?
Receptive - ask them to do something
Expressive - what is this, repeat this sentence after me, make your own sentence up about
What can interfere w dx of receptive dysphasia?
Deaf, confused, different language
What is the best way to elicit a cerebellar lesion?
Ask the pt to tap out a rhythm
What can interfere w testing dysdiadochokinesia?
Parkinson’s
Cerebellar Signs in H+N (3)
Over/undershooting saccades, nystagmus, slurred staccato speech
Cerebellar Signs in Limbs (7)
Ataxia, difficulty tapping out rhythm, past pointing of nose to finger + knee to toe, dysdiadochokinesia, intention tremor, hypotonia, slow to dampen reflexes due to rebound oscillation
What does the EMG show in cerebellar dysfunction?
Triphasic EMG w phases: high first, delayed second, rebound third
How do you differentiate b/w sensory and cerebellar ataxia?
Check for toe proprioception to inc/exc sensory
What are the nerve roots for each reflex?
S1/2 - Ankle L3/4 - Knee C5 - Biceps C6 - Supinator C7 - Triceps
How do you test for the knee jerk if the pt is in an above knee cast?
Test by hitting above the knee or anterolateral thigh
If you have umn signs in the leg, but normal function of the intrinsic muscles of the hands, where is the lesion confined to?
The thoracic spine as C8+T1 must be in tact for hand function and a lesion below L1 would result in LMN signs
When you say a certain part of the neuro exam was normal what do you mean?
Normal for those patient demographics
What are the four broad categories of neuropathy?
Motor, Sensory, Motor Sensory, Autonomic
What should you get the pt to do after gait to exacerbate problems?
Generally: heel toe walking to remove gait base, hopping, squatting
Specifically: Stand on toes (S1/2 weakness), stand on heels (L4 weakness), great toe dorsiflexion (L5 weakness)
NB: looking to see if they’re the same height on both sides
What should you always ask before any sensory examination?
The pt to outline any areas of sensory abnormality
The three dys of speech
Dysphasia (language), dysphonia (voice), dysarthria (articulation)
What are the two types of dysphonia?
NB: the pt isn’t breathless
Vocal Cord:
aDduction - strained
aBduction - breathy
What should you test next after eliciting a hemiparesis of the face, arm and leg? (2)
Speech + Sensory
What is the premise of the Romberg’s test?
You require two of the following to maintain balance whilst standing: proprioception, vestibular function, vision
How do you elicit the spastic catch in the upper limb?
Start distally and attempt: wrist extension, supination, elbow extension
What could give a false neg fhx?
Disputed paternity, estrangement, suicide
How do you test the motor function of the radial, ulnar and median nerves?
Wrist extension, finger aBduction, breaking okay sign
How do you test the sensory function of the radial, ulnar and median nerves?
Dorsal thumb web space, ulnar palmar aspect, median palmar aspect
At which point on the legs would you expect sx of peripheral neuropathy on the arms?
Just above the knees as it is length dependent
CNS Anatomy
Cerebral hemispheres, basal ganglia, cerebellum, spinal cord
PNS Anatomy
Anterior horn cells, nerve roots inc cauda equina, brachial and lumbosacral plexi, peripheral nerves, NMJ, muscle
What you say T8 what three different levels can this be referring to?
Vertebrae, canal, cord
What signs do you usually pick up in a pt w MND?
UMN: brisk reflexes
LMN: fasciculations
Why do you get wasting in both UMN and LMN lesions?
UMN: disuse trophy - not sig
LMN: lack of supply - significant
What is the distribution of weakness in the limbs due to an UMN lesion?
Upper Limbs: extension > weaker > flexion
Plus weak shoulder aBductors
Lower Limbs: flexion > weaker > extension
Plus weak hip aBductors and foot eversion
What are important findings from a neuro exam to document?
Alert, Oriented, GCS
Facial droop, speaking in full sentences, gait assessment
T - N; P - 5/5; R - equal bilaterally w downgoing plantars; C - N; S - grossly intact in modalities tested
Which muscle raises the forehead?
Frontalis
Where is the damage in receptive + expressive dysphasia?
Receptive: Wernicke’s area in the dominant temporal lobe
Expressive: Broca’s area in the dominant frontal lobe
Which muscles are spared in UMN facial weakness?
Frontalis + Orbicularis Oculi
Are the CN nuclei UMN or LMN?
LMN
Where on the brainstem does each CN nuclei originate?
Midbrain: 3+4
Pons: 567
Junction: 8
Medulla: 9-12 and either above/below decussation
Cribriform Plate
CN1 + ant ethmoidal nerves
Optic Canal
CN2 + ophthalmic artery
Superior Orbital Fissure
CNs 3-6 + lacrimal nerve, superior ophthalmic vein, branch of the inferior ophthalmic vein
Foramen Rotundum
CN5 - Maxillary Branch
Foramen Ovale
CN5 - Mandibular Branch
Foramen Spinosum
Middle meningeal artery + vein
Internal Acoustic Meatus
CN7+8, vestibular ganglion, labyrinthine artery
Jugular Foramen
CN9-11, jugular bulb, inferior petrosal and sigmoid sinuses
Hypoglossal Canal
CN12
Foramen Magnum
CN11, medulla and meninges, vertebral arteries, anterior and posterior spinal arteries, dural veins
Which foramen goes through the ethmoid bone?
Cribriform Plate
Which foramen go through the sphenoid bone?
Optic Canal Superior Orbital Fissure Foramen Rotundum Foramen Ovale Foramen Spinosum
Which foramen go through the petrous part of temporal bone?
Internal acoustic meatus and anterior aspect of jugular foramen
Which foramen go through the occipital bone?
Posterior aspect of jugular foramen, hypoglossal canal, foramen magnum
What are the afferent + efferent nerves of the light reflex?
Afferent - 2nd
Efferent - 3rd
What are the respective actions produced from C5-T1?
aBduction C5
aDduction C7
Biceps C5-6
Triceps C7-8
Extensor Carpi Radialis C6
Extensor Carpi Ulnaris C7
Fingers + Thumb C8-T1
What causes a mixed UMN and LMN picture? (2)
MND + spinal cord pathology that also affects the anterior horn cells i.e. UMN below and LMN at level
When does vertebrae pathology switch from UMN -> LMN signs in the legs?
L1
What are the sinister causes of a headache?
VIVID: vascular, infection, vision threatening, raised ICP, carotid dissection
What examination can you do to distinguish central vs peripheral vertigo?
HiNTs: head impulse, nystagmus, skew
How is BPPV dx + tx?
Dx: Dix-Hallpike Test
Tx: Epley Manoeuvre
What ix can you carry out for a suspected TIA w/o delaying transport to hosp? (2)
Glucose + ECG
Tx for a suspected TIA
If within last week give aspirin 300mg immediately and arrange urgent assessment by specialist unless: contraindicated, on low dose regularly, bleeding disorder
Raised ICP: Cushing’s Reflex
Inc BP
Dec HR
Irregular Breathing
Ddx for Raised ICP (5)
Meningitis/Encephalitis/Abscess, Cerebral Oedema, Hydrocephalus, Haemorrhage, Tumour
What are the different types of jerking?
Chorea, Myoclonic, Tics
What is the early sign of papilloedema?
Loss of venous pulsation at the optic disc
What makes back pain an emergency?
Loss of bladder function
What should you always measure whilst performing a LP?
Opening Pressure
Ddx of Foot Drop
Common peroneal, sciatic, L5, CMT, MND, glioblastoma
Cauda Equina vs Conus Medullaris
CE: dec tone, dec reflexes, downgoing plantars
CM: inc tone, dec reflexes, upgoing plantars
Both have saddle anaesthesia, bladder/bowel dysfunction, erectile dysfunction
Ix for GBS
Bedside: thorough neuro exam, spirometry 4hrly, ECG
Bloods: FBC, U+Es, LFTs, CRP, ESR, Glucose, ABG (T2RF)
Imaging: CXR, LP (inc protein + normal WCC), nerve conduction studies (slow)
Ddx of Parkinson’s Disease
Depression + Essential Tremor
Plus Syndromes: MSA (autonomic insufficiency), PSP (loss of vertical gaze), CBD (alien limb), LBD (fluctuating cognition)
Secondary: vascular, drug induced, toxins, trauma, CNS infection
Young Pts: Wilsons, Huntingtons, dopa-responsive dystonia
What can a DaT scan be helpful in distinguishing between?
PD vs essential tremor, vascular, drug induced
Mx of PD
Consrv: MDT and carers, postural exercises and wt lifting, monitor mood and BP
Medical: predominantly used for sx control, start levodopa and carbidopa early, dopamine agonists if <70yrs as it has more non-motor SEs, MAO-BI/COMT inhibitors
Surgical: ablation and deep brain stimulation are only short term solutions and don’t prevent disease progression
What are CIs for taking levodopa? (3)
Psychosis, Glaucoma, MAO-AI
How can you give parkinson’s medications if the pt is NBM?
Use a NGT with L-dopa dose in dispersible form OR rotigotine patch at equivalent dose
What is the genetic basis of Huntington’s disease?
Expansion of CAG repeat on chr4
Headache Red Flags
Papilledema Seizures Focal Neuro Cancer/HIV Visual Disturbance Postural Change Pregnancy N+V Vasculitis Diabetes Worsening AM Sx
What is the typical pt w idiopathic intracranial hypertension?
Obese female in her 3rd decade who presents with: signs of raised ICP, narrowed visual fields, blurred vision, sixth nerve palsy, enlarged blind spot
Mx of IIH
Consrv: neuro-ophthalmology input + optimise wt
Medical: acetazolamide/topiramate, loop diuretics, prednisolone
Surgical: optic nerve decompression + CSF shunting
What are the triggers for a migraine?
Chocolate Hangovers Orgasms Cheese/Caffeine Oral Contraceptives Lie Ins Alcohol Travel Exercise
What is the diagnostic criteria for a migraine w/o aura?
> =5 Headaches lasting 4-72h AND N+V AND any two of: unilateral, pulsating, impairs routine activity
Tx of Migraine
Prophylactic: propranolol 40-120mg/12h or topiramate 25-50mg/12h
Attacks: warm/cold pack, rebreathing into paper bag, oral triptan combined w paracetamol/NSAID
What considerations must you consider with topiramate?
Teratogenic + Dec Pill Efficacy
What is the typical pt w cluster headaches?
Male, Smoker, FHx
Tx of Cluster Headaches
Prophylactic: verapamil 360mg
Attacks: 100% O2 + s/c triptan 6mg
What are the common triggers for trigeminal neuralgia?
Washing Shaving Talking Eating Dental
Mx of Trigeminal Neuralgia
You must do a MRI to exclude secondary causes: aneurysm, tumour, MS
Start carbamazepine first line and if refractory tertiary referral for surgical options
Screen for depression which can often accompany recurrent headaches
What HiNTs results are consistent with peripheral vertigo?
A pos head impulse test, unidirectional and horizontal nystagmus, negative skew test
What is the ABCD2 score used for?
Stratifies which pts are at high risk of having a stroke following a suspected TIA: a score of >=4 must be assessed by specialist <24h and <4 are seen within 7d
Workup for TIA
Bedside: obs/ABPM + ECG/24h tape/echo
Bloods: FBC, U+Es, LFTs, CRP, ESR, Glucose, Lipids
Imaging: unenhanced CT head if any concern wrt intracranial bleeding, CXR (infection aspiration sarcoidosis), carotid doppler US +/- angiography
Mx of TIA
Antipl: 2w aspirin -> long term clopidogrel/ticagrelor
BP: ACEi/CCB +/- diuretic
Cholesterol: atorvastatin
Diabetic: meds if indicated
What is the Bamford classification of strokes?
Tbc
What is Guillian-Barre syndrome?
An ascending progressive acute inflammatory demyelinating polyradiculopathy usually triggered by an infection
Sx of GBS
Weakness
Paraesthesia
Autonomic
Pain
What will the LP show in GBS?
N/High Protein + N/Low WCC
Mx of GBS
Always call for senior support
Supportive: resp, freq turning to prevent pressure sores and contractures, VTE prophylaxis
Medical: IVIG, plasmapheresis, analgesia
Prognostic: involve PT and OT to aid recovery and psychological input support counselling
What is the lesion in INO?
Medial Longitudinal Fasciculus
Unilateral: Stroke vs Bilateral: MS
What are the examination findings of INO?
Weakness in aDduction of the ipsilateral eye
Nystagmus in aBduction of the contralateral eye
What are the eponyms of MS? (6)
Devic’s Syndrome Lhermitte’s Sign Uhthoff’s Phenomenon Charles Bonnet Syndrome Pulfrich Effect Argyll Robertson Pupil
What diagnostic criteria is used for MS?
McDonald +/- MRI/LP
How can MS affect the eyes?
Optic Neuritis
Internuclear Ophthalmoplegia
Argyll Robertson and Marcus Gunn Pupil
Where is the stroke if there’s double vision upon look laterally?
Midbrain
What is the antiplatelet regime for a stroke/TIA once a haemorrhagic stroke is excluded?
All OD 2wks Aspirin 300mg -> long term Clopidogrel 75mg OR if CI Aspirin 75mg combined w slow release dipyridamole
What anticoagulation should the pt receive from 2wks following a stroke if they also have AF?
DOAC/Warfarin
What can be used to assess ADL’s following a stroke?
Barthel’s Index
What is Miller Fisher syndrome?
Variant of GBS w ophthalmoplegia, ataxia and areflexia
What antibody is seen in the serum of pts with Miller Fisher syndrome?
Anti-GQ1b
Ddx for Bilateral Ptosis
MG, Dystrophy, Mitochondrial Disease
What are the classic pt demographics w bells palsy? (3)
20-40yo
Female
Pregnant
Is the forehead affected in bells palsy?
Yes it’s only unaffected in UMN
What others sx could a pt w bells experience? (4)
Dry eyes, altered taste, hyperacusis, post auricular pain
Tx of Bells Palsy
Pred 1mg/kg for 10d + consider artificial tears and eye taping at night
What are the tx targets for ischaemic stroke after you’ve excluded haemorrhagic?
Thrombolysis w alteplase within 4.5hrs of onset + thrombectomy within 6hrs
What is the most common comp of meningitis?
Sensorineural hearing loss
Why would a laminectomy be performed?
To relieve pressure on the spinal cord
What is microvascular decompression classically the surg option for?
Disabling trigeminal neuralgia if medical mx fails
How does Parkinson’s lead to postural hypotension w/o compensatory tachycardia upon standing up?
It’s due to autonomic failure
What are the causes of postural hypotension w compensatory tachycardia? (4)
The 4D’s: deconditioning, dysfunctional heart, dehydration, drugs
What are other features of Parkinson’s aside from the triad of bradykinesia, tremor, rigidity? (6)
Mask-like facies, quiet monotonous speech, flexed posture, micrographia, postural hypotension, psych
When does NICE suggest starting AEDs after the first seizures? (3)
The pt considers the risk unacceptable or has a neuro deficit, brain imaging shows structural abnormality, EEG shows unequivocal epileptic activity
Which seizures can carbamazepine exacerbate? (2)
Absence + Myoclonic
When can you consider stopping AEDs and for over how long?
Seizure free for >5yrs and stopped over 2-3mnths
Def of TIA
A transient episode of neuro dysfunction caused by focal brain, spinal cord or retinal ischaemia w/o acute infarction
What are the metabolic consequences of refeeding syndrome?
Hypokalaemia
Hypomagnesaemia
Hypophosphataemia
Abnormal Fluid Balance
What do you prescribe for pts at risk of refeeding syndrome?
Start at up to 10kcal/kg/day and inc to full needs over 4-7days
PLUS vit B co strong, 2-4K, 0.2-0.4Mg, 0.3-0.6PO4 all in mmol/kg/day
How is hypophosphataemia classified?
Mild 0.64-0.80
Mod 0.32-0.64
Severe <0.32
How is hypophosphataemia tx?
Mild-Mod: phosphate sandoz effervescent tabs w each tab containing 20.4Na, 3.1K, 16.1PO4
Severe: IV phosphate polyfusor w each 500ml containing 81Na, 9.5K, 50PO4
What is Hoffman’s sign?
A reflex test to assess for cervical myelopathy by gently flicking one finger and looking for twitching of the others
What is the gold standard test for DCM?
MRI
Tx of DCM
Decompressive surgery +/- physio and analgesia
What type of tremor is the essential tremor?
Postural that can be exacerbated by outstretching the arms
How does internuclear ophthalmoplegia px?
The lateral gaze w abnormality shows:
Ipsilateral - impairment of aDduction
Contralateral - can aBduct but w nystagmus
Where is the lesion in INO?
The medial longitudinal fasciculus located in the paramedian area of midbrain and pons that interconnects the 3/4/6 CNs
What doesn’t MND typically affect?
Extraocular Muscles + Cerebellum
What are cutaneous features of tuberous sclerosis? (5)
Ash leaf spots, Shagreen patches, angiofibromas, subungual fibromata +/- cafe-au-lait spots
What are neuro features of tuberous sclerosis? (2)
Developmental Delay + Epilepsy
Ocular Hamartomas: NF vs TS
NF: iris ie Lisch nodules vs TS: retinal
Autonomic Dysreflexia
Spinal cord injury @ >= T6 characterised by HTN + bradycardia
Where does the autonomic nervous system leave the CNS?
Sympathetic: thoracolumbar
Parasympathetic: medulla + sacral
Cushing’s Triad
HTN, Bradycardia, Irr Breathing
What are the red flags for trigeminal neuralgia?
Onset <40yo, fhx of MS, optic neuritis, pain only in ophthalmic division, sensory changes, deafness, hx of skin or oral lesions that could spread perineurally
What is the first line tx for trigeminal neuralgia?
Carbamazepine
Where is the lesion in conduction aphasia?
Arcuate Fasiculus b/w Broca’s + Wernicke’s
Where is the lesion in Broca’s expressive aphasia?
Inf Frontal Gyrus supplied by superior division of left MCA
Where is the lesion in Wernicke’s receptive aphasia?
Sup Temporal Gyrus supplied by inferior division of left MCA
Ddx of non fluent speech
Comprehension relatively intact - broca’s
Comprehension impaired - global
Ddx of fluent speech
Comprehension relatively intact - conduction
Comprehension impaired - wernicke’s
Bitemporal Hemianopia Ddx
Optic chiasm lesion or compression: inferior comp is upper quadrant defect from pituitary macroadenoma + superior comp is lower quadrant defect from craniopharyngioma
Ischaemic Stroke + AF
Aspirin 300mg OD 2wks before any anticoags
Triptan CI
IHD
What are indications for urgent CT head in pts w headache? (5)
Vomiting >1 w no other cause, new neuro deficit, red GCS, valsalva or positional headaches, progressive headache w fever
What is the ROSIER score?
After excluding hypoglycaemia:
-1 for LOC or seizure
+1 for asymmetric weakness in face, arm, leg, speech disturbance, visual field defect
If total score >0 a stroke is likely
What should you exclude in an older pt w headache + sev unilateral eye pain?
Glaucoma
Which cranial nerves are affected in vestibular schwannomas?
V
VII
VIII
What is the class hx of vestibular schwannoma?
Vertigo
Tinnitus
Hearing Loss
Absent Corneal Reflex
What is given during an acute relapse of MS?
5d methylpred
Which nerve supplies the nail bed of the index finger?
Median
Which nerve supplies the medial aspect of the dorsum?
Ulnar
Aside from the extensors what else does the posterior interosseous branch innervate?
Supinator + Abductor Pollicis Longus
What are the most common antiepileptics?
Gen: Na Valproate - P450 inhibitor
Focal: Carbamazepine - P450 inducer
2nd Line: Lamotrigine - SJS
Which comp of bacterial meningitis is routinely tested for?
Sensorineural Hearing Loss
What is classified as a MOH?
Using triptans/opioids on 10d or more per mnth for 3m AND sx resolve within 2m of stopping
Acute mx of cluster headache
100% O2 + S/C Triptan
Prophylactic mx of cluster headache
Verapamil
Which haematoma is limited to the suture lines?
Epidural
Mx of Raised ICP
Ix and tx underlying cause, head elevation to 30°, IV mannitol, controlled hyperventilation, CSF removal
What do you do w a pt w new unexplained confusion?
Always admit for further ix: Geriatric Admission Profile (GAPS), CXR and MSU for infection, ECG for arrhythmia, CT head for bleed
What is included in GAPS?
FBC, U+E, LFT, TFT, CRP, glucose, calcium, vit D, B12, folate, iron, ferritin, transferrin
What can the density of a subdural haematoma tell you?
It becomes less dense over time so it’ll appear mixed following a rebleed
What is the Bamford Stroke Classification for the four types?
Unilateral weakness +/or sensory deficit of the face, arm and leg PLUS homonymous hemianopia PLUS higher cerebral dysfunction
Partial Anterior Circulation Syndrome (PACS) - 2/3
Total Anterior Circulation Syndrome (TACS) - 3/3
Lacunar Stroke Syndrome (LACS) is defined as pure motor or pure sensory deficit.
Posterior Stroke Syndrome (POCS) presents differently to those describe above. It can have a varied clinical picture such with sx such as vertigo, dizziness, nystagmus and ataxia.
Which vasc territory is involved for a TACS?
MCA
When do you tx the HTN during the acute mx of an ischaemic stroke?
Hypertensive heart failure, MI, encephalopathy, nephropathy
Aortic Dissection
PET or Eclampsia
What are the potential underlying causes of delirium that can be addressed initially before more invasive tests?
Drugs / Dehydration
Electrolyte Imbalance
Level of Pain
Infection / Inflammation
Respiratory Failure
Impaction of Faeces
Urinary Retention
Metabolic Disorder / MI
Which drugs can be used to sedate a pt?
- Lorazepam 0.5mg PO
2. Haloperidol 0.5mg PO
Why are these drugs PO > IV?
Risk of resp arrest
Why is haloperidol second > first line?
Risks of giving it to pts w Parkinson’s disease or Lewy body dementia
List drugs that cause hypoNa
Carbamazepine Citalopram Indapamide Spironolactone Bisacodyl Omeprazole
Which electrolyte disturbance does salbutamol cause?
HypoK
List drugs that predispose to urinary retention
Amitriptyline
Oxybutinin
Codeine
Which CXR view can you tell there is definite cardiomegaly?
PA
What is a positive postural BP test?
A drop in SBP of >=20mmHg, DBP of >=10mmHg w sx or to below 90 mmHg on standing
Mx of postural hypotension
Conservative: withdraw offending meds, rise slowly, avoid prolonged standing, raise head of bed, exercise, inc salt and water intake
Pharmacological: fludrocortisone (fluid overload and electrolyte imbalance SEs)-> midodrine (cardiac SEs)
What’s the ECG finding in hypothermia?
J wave formation
Which core temp implies hypothermia?
<35°C
What is the recommended rate of rewarming?
0.5-2 degrees per hr
What might be the first sign of too rapid rewarming?
Falling BP
Comps of hypothermia
MI DIC Arrhythmia Pneumonia Renal Failure
