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1
Q

pre-synaptic NMJ disorders (2)

A

lambert eaton
botulism

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2
Q

pathophysiology of lambert eaton

A

antibodies against pre-synaptic calcium channels

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3
Q

treatment of lambert eaton

A

treat underlying cancer
immunosuppress eg steroids and azathioprine
3,4 diaminopyridine

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4
Q

how to distinguish lambert eaton from myasthenia

A

strength increases with use in lambert
fatigues in use in myasthenia

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5
Q

pathophysiology of myasthenia

A

antibodies against post synaptic Ach receptors

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6
Q

main feature of lambert eaton

A

repeated muscle use leads to increased muscle strength

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7
Q

cancer assoc with myasthenia

A

thymoma

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8
Q

eye symptoms in myasthenia

A

diplopia- double vision
ptosis

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9
Q

in myasthenia if negative for anti- acetylcholine receptor antibodies what antibody should be checked for

A

anti-muscle-specific tyrosine kinase antibodies

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10
Q

investigation for myasthenia

A

EMG + ct to exclude thymoma

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11
Q

treatment of myathenia

A

pyridostigmine - anticholinesterase inhibitor

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12
Q

what antibiotic is contr-indicated in myasthenia and why

A

Gentamicin as it can reduce the effectiveness of neuromuscular transmission and exacerbate symptoms of the disease.

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13
Q

what drugs can make myastheni aworse

A

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

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14
Q

treatment of HTn in CKD

A

first lin e= ACEi
seocnd - furosemide

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15
Q

what part of sleep has increased cerebral blood flow w

A

REM Sleep

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16
Q

what type of sleep is the majority

A

non rem sleep

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17
Q

what is parasomnia

A

acting out dreams

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18
Q

when is parasomnia seen

A

parkinsons

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19
Q

what is sleep walking an example of

A

parasomnia

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20
Q

investigation for narcolepsy

A

overnight polysomnopgraphy

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21
Q

what is the criteria to diagnose chronic insomnia

A

trouble falling asleep or staying asleep at least three nights per week for 3 months or longer.

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22
Q

what medications can cause insomnia

A

steroids

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23
Q

treatment of short term insomnia

A

hort-acting benzodiazepines or non-benzodiazepines (zopiclone, zolpidem and zaleplon).

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24
Q

time fram for subacute headache

A

mins to hours

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25
Q

criteria fro migraine

A

min 5 attacks lasting 4-72 hours
2 of : severe unilat, throbbing , worse on movement
and 1 of - n&v or photo/phonophobia

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26
Q

examples of auras

A

hemianopic loss
central scotoma

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27
Q

what neurotransmitter is invloved with migrains

A

serotonin

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28
Q

first line treatment for migraine

A

triptan and NSAID
triptan and paracetamol

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29
Q

what type of drugs are triptans

A

5-ht receptor agonist

30
Q

prophylaxis of migraine , 1st, 2nd and 3rd line

A

1st - amitriptyline
2nd - propanalol
3rd - topiramate

31
Q

what patient group should topiramate be avoided in and why

A

women of child bearing age - teratogenic and reduces effectiveness of contraception

32
Q

when should prophylaxis be offered in migraine

A

more than 3 attacks in a month

33
Q

chronic tension headache defined as

A

tension headache occur on 15 or more days per month.

34
Q

acute treatment of tension headache

A

NSAID, aspirin or paracetamol

35
Q

prophylaxis of tension headache

A

amirtiptyline or acupuncture - 10 sessions over 5-8 weeks

36
Q

what are the 4 type of trigeminal autonomic cephalgias

A
  1. cluster
  2. paroxysmal hemicrania
  3. hemicrania continua
    SUNCT
37
Q

who tends to get cluuster headaches

A

young men 30-40

38
Q

how long do clusters tend to last in cluster headaches

A

4-12 weeks

39
Q

how long does an apisode of lcuster headache last

A

15mins- 2hours

40
Q

what can trigger a cluster headache

A

alcohol

41
Q

what autonomic features are seen in all the trigeminal autonomic cephalgias

A
  • nasal stuffiness
  • ptosis
    -miosis - small pupils
  • tearing
    -puffy eyelid
  • N&V
42
Q

what investigation is done in those with trigeminal cephalgias

A

MRI with gadalinium contrast

43
Q

management of acute cluster headache

A

high flow oxygen for 20 mins
s/c sumatriptan

44
Q

prophylaxis for cluster headach

A

verapamil

45
Q

features of paroxysmal hemicranis

A

severe unilateral headache- usually orbital or temporal region with unilat autonomic features

46
Q

duration and frequency of episodes in paroxysmal hemicranis

A

<30 mins
1-40 times a day

47
Q

treatment for paroxsymal hemicranis

A

indomethicine

48
Q

what is a SUNCT headache

A

short - 15-120 seconds
unilateral
nearalgiform headache
conjunctival injections
tearing

49
Q

treatment for a SUNCT headache

A

lamotrigene or gabapentin

50
Q

risk factors for idiopathic intracranial hypertension

A

female
obesity
pregancy
drugs - COCP, steroids, tetracyclines, lithium , retinoids

51
Q

management of intercranial hypertension

A

acetazolamide and weight loss

52
Q

LP pressure in IIH

A

increased opening pressure

53
Q

management of trigeminal neuralgia

A

carbamazapine

54
Q

gold strandard for treating brain aneurysms

A

DSA - digital subtraction angiography

55
Q

normal ICP

A

7-15mmHg

56
Q

most common cause of cauda equina

A

the most common cause is a central disc prolapse
this typically occurs at L4/5 or L5/S1

57
Q

investigation for cauda equina

A

MRI

58
Q

first line treatment options for neuropathic pain

A

amitriptyline duloxetine, gabapentin or pregabalin

59
Q

what should be used for rescue therapy in neuropathic pain

A

tramadol

60
Q

what can be used for localised neuropathc pain

A

topical capsaicin

61
Q

symptoms in wernickes

A

opthalmoplegia/ nystagmus
ataxia
encephalopathy
(+ peripheral neuropathy)

62
Q

investigations in werniceks

A

MRI
decreased red cell transketolase

63
Q

symptoms in korsakoffs

A

wernickes - opthal/nystag, atax, enceph

PLUS - antero/retrograde amnesia and confabulation

64
Q

how long after alcohol withdrawal does delirium tremens kick in

A

48-72 hrs

65
Q

where is the lesion in wernickes aphasia (receptive)

A

superior temporala gyrus

66
Q

where is lesion in brocas apahasi

A

inferior frontal gyrus

67
Q

what type of aphasia auses word salad

A

wernickes

68
Q

where is the lesion in coductive aphasia

A

arcuate fasiculus - the connection between wernickes and brocas

69
Q

what type pf aphasia results in poor repitiion

A

conductive aphasia

70
Q

where is the lesion in erbs palsy

A

C5, 6

71
Q

where is the lesion in trunkal ataxia/ gait ataxia

A

cerebellar midline

72
Q

where is the lesion in past pointing

A

cerebellar hemisphere

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