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Year 5/6 > Medicine: Neuro > Flashcards

Medicine: Neuro Flashcards

1
Q

Where can the tendon reflex arc be broken?

A 
Stretch Receptor
Afferent Pathway
Spinal Cord
Efferent Pathway
Muscle Contraction

Therefore sensory + motor sign

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2
Q

What can lead to abnormal tone?

A

Reduced: LMN, myopathy, cerebellar

Pyramidal/Spasticity: clasp knife, velocity dependent, directional given away by posture

Extrapyramidal/Rigidity: lead pipe + palpable tremor = cog wheel

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3
Q

What can help you elicit cog wheel rigidity?

A

Froment Manoeuvre

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4
Q

Where is the lesion if the pt has normal hand function denoted by their lace up shoes but a scissoring gait?

A

T2-12

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5
Q

What should you look for if the pt has bilateral high stepping gait?

A

Pes Cavus

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6
Q

What would a motor and sensory peripheral neuropathy gait look like?

A

Foot Drop + Stamp

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7
Q

What is dystonia?

A

Abnormal interaction b/w agonist and antagonist eg writers cramp and spasmodic torticolis

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8
Q

What should you look for when testing shoulder aBduction?

A

The speed at which they raise their arms and to what height

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9
Q

How do you test power grip?

A

By pulling it apart w your own NOT by asking them to squeeze your fingers

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10
Q

How do you test the motor function of the ulnar nerve?

A

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

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11
Q

What should you do if there is marked weakness in knee extension/flexion?

A

Swing their knee out and see if they can slide their foot up and down the couch

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12
Q

What are the additional UMN reflexes?

A

Finger Jerks
Hoffman Sign
Crossed Adductors
Absent Abdo Reflexes

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13
Q

What is coordination testing?

A

Finger nose/heel shin - intention tremor and dysmetria

Hand flip/foot tap - break in rhythm (PD) and dysdiadochokinesia (MS)

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14
Q

How is the SCM innervated?

A

Ipsilaterally

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15
Q

How can you exacerbate the signs on PD?

A

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

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16
Q

What is the MRC scale of grading muscle power?

A

0: None
1: Flicker
2: Along
3: Gravity
4: +/-Weak
5: Normal

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17
Q

UMN Signs

A 
Hypertonic
Weakness
Clonus
Brisk Reflexes
Pos Babibski’s
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18
Q

LMN Signs

A 
Hypotonic
Weakness
Fasciculations
Dec Reflexes
Neg Babibski’s
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19
Q

Presenting query stroke

A

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

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20
Q

Absolute CIs to thrombolysis

A

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

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21
Q

Presenting query meningitis

A

Conscious level, signs of meningism, focal neuro, rash, fundoscopy

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22
Q

What can you give before abx when treating bacterial meningitis?

A

Dexamethasone 15-20mins before abx to reduce hearing loss

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23
Q

When would you aim for lower O2 sats around 88-92%?

A

Pts at risk of hypercapnic resp failure

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24
Q

What does a low diastolic blood pressure suggest?

A

Arterial vasodilation - anaphylaxis or sepsis

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25
What does a narrow pulse pressure suggest?
Arterial vasoconstriction - cardiogenic shock or hypovolaemia
26
Does a normal CT scan exclude a stroke?
It only excludes a bleed and hence able to thromblyse
27
After stabilising meningitic pts where do they go?
HDU
28
What should you always know when analysing the ABG?
How much oxygen the pt is on and also compare to prev gas results
29
Spinothalamic Tracts (3)
Ant: Crude Touch Lateral: Pain + Temp
30
Dorsal Columns (3)
Light Touch, Vibration, Proprioception
31
Spasicity vs Rigidity
Spasicity - unidirectional, velocity dependent, clasp knife phenomenon, umn lesion Rigidity - all directions, velocity independent, cog wheel and lead pipe, parkinsons
32
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
33
What can interfere w dx of receptive dysphasia?
Deaf, confused, different language
34
What is the best way to elicit a cerebellar lesion?
Ask the pt to tap out a rhythm
35
What can interfere w testing dysdiadochokinesia?
Parkinson’s
36
Cerebellar Signs in H+N (3)
Over/undershooting saccades, nystagmus, slurred staccato speech
37
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
38
What does the EMG show in cerebellar dysfunction?
Triphasic EMG w phases: high first, delayed second, rebound third
39
How do you differentiate b/w sensory and cerebellar ataxia?
Check for toe proprioception to inc/exc sensory
40
What are the nerve roots for each reflex?
``` S1/2 - Ankle L3/4 - Knee C5 - Biceps C6 - Supinator C7 - Triceps ```
41
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
42
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
43
When you say a certain part of the neuro exam was normal what do you mean?
Normal for those patient demographics
44
What are the four broad categories of neuropathy?
Motor, Sensory, Motor Sensory, Autonomic
45
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
46
What should you always ask before any sensory examination?
The pt to outline any areas of sensory abnormality
47
The three dys of speech
Dysphasia (language), dysphonia (voice), dysarthria (articulation)
48
What are the two types of dysphonia? NB: the pt isn’t breathless
Vocal Cord: aDduction - strained aBduction - breathy
49
What should you test next after eliciting a hemiparesis of the face, arm and leg? (2)
Speech + Sensory
50
What is the premise of the Romberg’s test?
You require two of the following to maintain balance whilst standing: proprioception, vestibular function, vision
51
How do you elicit the spastic catch in the upper limb?
Start distally and attempt: wrist extension, supination, elbow extension
52
What could give a false neg fhx?
Disputed paternity, estrangement, suicide
53
How do you test the motor function of the radial, ulnar and median nerves?
Wrist extension, finger aBduction, breaking okay sign
54
How do you test the sensory function of the radial, ulnar and median nerves?
Dorsal thumb web space, ulnar palmar aspect, median palmar aspect
55
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
56
CNS Anatomy
Cerebral hemispheres, basal ganglia, cerebellum, spinal cord
57
PNS Anatomy
Anterior horn cells, nerve roots inc cauda equina, brachial and lumbosacral plexi, peripheral nerves, NMJ, muscle
58
What you say T8 what three different levels can this be referring to?
Vertebrae, canal, cord
59
What signs do you usually pick up in a pt w MND?
UMN: brisk reflexes LMN: fasciculations
60
Why do you get wasting in both UMN and LMN lesions?
UMN: disuse trophy - not sig LMN: lack of supply - significant
61
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
62
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
63
Which muscle raises the forehead?
Frontalis
64
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
65
Which muscles are spared in UMN facial weakness?
Frontalis + Orbicularis Oculi
66
Are the CN nuclei UMN or LMN?
LMN
67
Where on the brainstem does each CN nuclei originate?
Midbrain: 3+4 Pons: 567 Junction: 8 Medulla: 9-12 and either above/below decussation
68
Cribriform Plate
CN1 + ant ethmoidal nerves
69
Optic Canal
CN2 + ophthalmic artery
70
Superior Orbital Fissure
CNs 3-6 + lacrimal nerve, superior ophthalmic vein, branch of the inferior ophthalmic vein
71
Foramen Rotundum
CN5 - Maxillary Branch
72
Foramen Ovale
CN5 - Mandibular Branch
73
Foramen Spinosum
Middle meningeal artery + vein
74
Internal Acoustic Meatus
CN7+8, vestibular ganglion, labyrinthine artery
75
Jugular Foramen
CN9-11, jugular bulb, inferior petrosal and sigmoid sinuses
76
Hypoglossal Canal
CN12
77
Foramen Magnum
CN11, medulla and meninges, vertebral arteries, anterior and posterior spinal arteries, dural veins
78
Which foramen goes through the ethmoid bone?
Cribriform Plate
79
Which foramen go through the sphenoid bone?
``` Optic Canal Superior Orbital Fissure Foramen Rotundum Foramen Ovale Foramen Spinosum ```
80
Which foramen go through the petrous part of temporal bone?
Internal acoustic meatus and anterior aspect of jugular foramen
81
Which foramen go through the occipital bone?
Posterior aspect of jugular foramen, hypoglossal canal, foramen magnum
82
What are the afferent + efferent nerves of the light reflex?
Afferent - 2nd | Efferent - 3rd
83
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
84
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
85
When does vertebrae pathology switch from UMN -> LMN signs in the legs?
L1
86
What are the sinister causes of a headache?
VIVID: vascular, infection, vision threatening, raised ICP, carotid dissection
87
What examination can you do to distinguish central vs peripheral vertigo?
HiNTs: head impulse, nystagmus, skew
88
How is BPPV dx + tx?
Dx: Dix-Hallpike Test Tx: Epley Manoeuvre
89
What ix can you carry out for a suspected TIA w/o delaying transport to hosp? (2)
Glucose + ECG
90
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
91
Raised ICP: Cushing’s Reflex
Inc BP Dec HR Irregular Breathing
92
Ddx for Raised ICP (5)
Meningitis/Encephalitis/Abscess, Cerebral Oedema, Hydrocephalus, Haemorrhage, Tumour
93
What are the different types of jerking?
Chorea, Myoclonic, Tics
94
What is the early sign of papilloedema?
Loss of venous pulsation at the optic disc
95
What makes back pain an emergency?
Loss of bladder function
96
What should you always measure whilst performing a LP?
Opening Pressure
97
Ddx of Foot Drop
Common peroneal, sciatic, L5, CMT, MND, glioblastoma
98
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
99
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)
100
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
101
What can a DaT scan be helpful in distinguishing between?
PD vs essential tremor, vascular, drug induced
102
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
103
What are CIs for taking levodopa? (3)
Psychosis, Glaucoma, MAO-AI
104
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
105
What is the genetic basis of Huntington’s disease?
Expansion of CAG repeat on chr4
106
Headache Red Flags
``` Papilledema Seizures Focal Neuro Cancer/HIV Visual Disturbance Postural Change Pregnancy N+V Vasculitis Diabetes Worsening AM Sx ```
107
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
108
Mx of IIH
Consrv: neuro-ophthalmology input + optimise wt Medical: acetazolamide/topiramate, loop diuretics, prednisolone Surgical: optic nerve decompression + CSF shunting
109
What are the triggers for a migraine?
``` Chocolate Hangovers Orgasms Cheese/Caffeine Oral Contraceptives Lie Ins Alcohol Travel Exercise ```
110
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
111
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
112
What considerations must you consider with topiramate?
Teratogenic + Dec Pill Efficacy
113
What is the typical pt w cluster headaches?
Male, Smoker, FHx
114
Tx of Cluster Headaches
Prophylactic: verapamil 360mg Attacks: 100% O2 + s/c triptan 6mg
115
What are the common triggers for trigeminal neuralgia?
``` Washing Shaving Talking Eating Dental ```
116
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
117
What HiNTs results are consistent with peripheral vertigo?
A pos head impulse test, unidirectional and horizontal nystagmus, negative skew test
118
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
119
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
120
Mx of TIA
Antipl: 2w aspirin -> long term clopidogrel/ticagrelor BP: ACEi/CCB +/- diuretic Cholesterol: atorvastatin Diabetic: meds if indicated
121
What is the Bamford classification of strokes?
Tbc
122
What is Guillian-Barre syndrome?
An ascending progressive acute inflammatory demyelinating polyradiculopathy usually triggered by an infection
123
Sx of GBS
Weakness Paraesthesia Autonomic Pain
124
What will the LP show in GBS?
N/High Protein + N/Low WCC
125
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
126
What is the lesion in INO?
Medial Longitudinal Fasciculus Unilateral: Stroke vs Bilateral: MS
127
What are the examination findings of INO?
Weakness in aDduction of the ipsilateral eye Nystagmus in aBduction of the contralateral eye
128
What are the eponyms of MS? (6)
``` Devic’s Syndrome Lhermitte’s Sign Uhthoff’s Phenomenon Charles Bonnet Syndrome Pulfrich Effect Argyll Robertson Pupil ```
129
What diagnostic criteria is used for MS?
McDonald +/- MRI/LP
130
How can MS affect the eyes?
Optic Neuritis Internuclear Ophthalmoplegia Argyll Robertson and Marcus Gunn Pupil
131
Where is the stroke if there’s double vision upon look laterally?
Midbrain
132
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
133
What anticoagulation should the pt receive from 2wks following a stroke if they also have AF?
DOAC/Warfarin
134
What can be used to assess ADL’s following a stroke?
Barthel’s Index
135
What is Miller Fisher syndrome?
Variant of GBS w ophthalmoplegia, ataxia and areflexia
136
What antibody is seen in the serum of pts with Miller Fisher syndrome?
Anti-GQ1b
137
Ddx for Bilateral Ptosis
MG, Dystrophy, Mitochondrial Disease
138
What are the classic pt demographics w bells palsy? (3)
20-40yo Female Pregnant
139
Is the forehead affected in bells palsy?
Yes it’s only unaffected in UMN
140
What others sx could a pt w bells experience? (4)
Dry eyes, altered taste, hyperacusis, post auricular pain
141
Tx of Bells Palsy
Pred 1mg/kg for 10d + consider artificial tears and eye taping at night
142
What are the tx targets for ischaemic stroke after you’ve excluded haemorrhagic?
Thrombolysis w alteplase within 4.5hrs of onset + thrombectomy within 6hrs
143
What is the most common comp of meningitis?
Sensorineural hearing loss
144
Why would a laminectomy be performed?
To relieve pressure on the spinal cord
145
What is microvascular decompression classically the surg option for?
Disabling trigeminal neuralgia if medical mx fails
146
How does Parkinson’s lead to postural hypotension w/o compensatory tachycardia upon standing up?
It’s due to autonomic failure
147
What are the causes of postural hypotension w compensatory tachycardia? (4)
The 4D’s: deconditioning, dysfunctional heart, dehydration, drugs
148
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
149
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
150
Which seizures can carbamazepine exacerbate? (2)
Absence + Myoclonic
151
When can you consider stopping AEDs and for over how long?
Seizure free for >5yrs and stopped over 2-3mnths
152
Def of TIA
A transient episode of neuro dysfunction caused by focal brain, spinal cord or retinal ischaemia w/o acute infarction
153
What are the metabolic consequences of refeeding syndrome?
Hypokalaemia Hypomagnesaemia Hypophosphataemia Abnormal Fluid Balance
154
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
155
How is hypophosphataemia classified?
Mild 0.64-0.80 Mod 0.32-0.64 Severe <0.32
156
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
157
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
158
What is the gold standard test for DCM?
MRI
159
Tx of DCM
Decompressive surgery +/- physio and analgesia
160
What type of tremor is the essential tremor?
Postural that can be exacerbated by outstretching the arms
161
How does internuclear ophthalmoplegia px?
The lateral gaze w abnormality shows: Ipsilateral - impairment of aDduction Contralateral - can aBduct but w nystagmus
162
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
163
What doesn’t MND typically affect?
Extraocular Muscles + Cerebellum
164
What are cutaneous features of tuberous sclerosis? (5)
Ash leaf spots, Shagreen patches, angiofibromas, subungual fibromata +/- cafe-au-lait spots
165
What are neuro features of tuberous sclerosis? (2)
Developmental Delay + Epilepsy
166
Ocular Hamartomas: NF vs TS
NF: iris ie Lisch nodules vs TS: retinal
167
Autonomic Dysreflexia
Spinal cord injury @ >= T6 characterised by HTN + bradycardia
168
Where does the autonomic nervous system leave the CNS?
Sympathetic: thoracolumbar Parasympathetic: medulla + sacral
169
Cushing’s Triad
HTN, Bradycardia, Irr Breathing
170
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
171
What is the first line tx for trigeminal neuralgia?
Carbamazepine
172
Where is the lesion in conduction aphasia?
Arcuate Fasiculus b/w Broca’s + Wernicke’s
173
Where is the lesion in Broca’s expressive aphasia?
Inf Frontal Gyrus supplied by superior division of left MCA
174
Where is the lesion in Wernicke’s receptive aphasia?
Sup Temporal Gyrus supplied by inferior division of left MCA
175
Ddx of non fluent speech
Comprehension relatively intact - broca’s Comprehension impaired - global
176
Ddx of fluent speech
Comprehension relatively intact - conduction Comprehension impaired - wernicke’s
177
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
178
Ischaemic Stroke + AF
Aspirin 300mg OD 2wks before any anticoags
179
Triptan CI
IHD
180
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
181
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
182
What should you exclude in an older pt w headache + sev unilateral eye pain?
Glaucoma
183
Which cranial nerves are affected in vestibular schwannomas?
V VII VIII
184
What is the class hx of vestibular schwannoma?
Vertigo Tinnitus Hearing Loss Absent Corneal Reflex
185
What is given during an acute relapse of MS?
5d methylpred
186
Which nerve supplies the nail bed of the index finger?
Median
187
Which nerve supplies the medial aspect of the dorsum?
Ulnar
188
Aside from the extensors what else does the posterior interosseous branch innervate?
Supinator + Abductor Pollicis Longus
189
What are the most common antiepileptics?
Gen: Na Valproate - P450 inhibitor Focal: Carbamazepine - P450 inducer 2nd Line: Lamotrigine - SJS
190
Which comp of bacterial meningitis is routinely tested for?
Sensorineural Hearing Loss
191
What is classified as a MOH?
Using triptans/opioids on 10d or more per mnth for 3m AND sx resolve within 2m of stopping
192
Acute mx of cluster headache
100% O2 + S/C Triptan
193
Prophylactic mx of cluster headache
Verapamil
194
Which haematoma is limited to the suture lines?
Epidural
195
Mx of Raised ICP
Ix and tx underlying cause, head elevation to 30°, IV mannitol, controlled hyperventilation, CSF removal
196
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
197
What is included in GAPS?
FBC, U+E, LFT, TFT, CRP, glucose, calcium, vit D, B12, folate, iron, ferritin, transferrin
198
What can the density of a subdural haematoma tell you?
It becomes less dense over time so it’ll appear mixed following a rebleed
199
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.
200
Which vasc territory is involved for a TACS?
MCA
201
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
202
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
203
Which drugs can be used to sedate a pt?
1. Lorazepam 0.5mg PO | 2. Haloperidol 0.5mg PO
204
Why are these drugs PO > IV?
Risk of resp arrest
205
Why is haloperidol second > first line?
Risks of giving it to pts w Parkinson’s disease or Lewy body dementia
206
List drugs that cause hypoNa
``` Carbamazepine Citalopram Indapamide Spironolactone Bisacodyl Omeprazole ```
207
Which electrolyte disturbance does salbutamol cause?
HypoK
208
List drugs that predispose to urinary retention
Amitriptyline Oxybutinin Codeine
209
Which CXR view can you tell there is definite cardiomegaly?
PA
210
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
211
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)
212
What’s the ECG finding in hypothermia?
J wave formation
213
Which core temp implies hypothermia?
<35°C
214
What is the recommended rate of rewarming?
0.5-2 degrees per hr
215
What might be the first sign of too rapid rewarming?
Falling BP
216
Comps of hypothermia
``` MI DIC Arrhythmia Pneumonia Renal Failure ```

Year 5/6 (20 decks)

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