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near high yield > near high yeild > Flashcards

near high yeild Flashcards

1
Q

how is CGRP calcitonin gene related peptide involved in migraines

A

during cortico-spreding depression it causes the realise of CGRP this causes vasodilation and neurogenic inflammation

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2
Q

how do triptans work

A

triptans bind to serotonin and decrease CGRP release

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3
Q

what is the first line treatment for acute migraines

A

ibruprofan 400mg increase to 600mg if needed
or
aspirin 900mg
or
paracetamol 1000mg

these should be taken as the symptoms arise

consider triptan with NSAID
oral sumatriptan 50-100mg alone (or with naproxen is the most effective)

offer an anti - emetic such as metroclopromide or prochloperezine 10mg for nausea and vomiting

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4
Q

what is a contraindication to triptan use

A

cardiovascular disease as they cause vasoconstriction
stroke
hypertension

use rimegpant instead

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5
Q

what kind of drug is rimegepant

A

CGRP antagonist

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6
Q

what advice should be given with migraine medication

A

limit to 2 days a week or 10 days a month to avoid MOH

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7
Q

what is the preventive treatment (reduce the occurrence of migraines)

A

beta blocker - propranolol
topiramate *pregnancy contradiction
tricyclic antidepressants - amitriptyline 25- 75mg at night
candasartan 16mg *pregnancy contradiction
sodium valproate over 55
flunarizine CCB

DOSES SHOULD BE GRADUALLY INSCREASED

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8
Q

what are other preventative treatments

A

botox around the head
CGRP monoclonal antibodies monthly

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9
Q

what is the acute treatment for tension headaches

A

paracetamol
NSAIDS

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10
Q

what is the preventative treatment for tension headaches

A

tricyclic antidepressants amitriptyline

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11
Q

what is a key feature of tension headaches

A

bilateral described as a tight band

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12
Q

what is a differential for cluster headaches

A

paroxysmal hemicarina
they are shorter but more frequent can last up to 30mins.

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13
Q

what is the treatment for paroxysmal hemicarina

A

indomethacin

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14
Q

what is the normal duration of cluster headaches

A

5mins 3hrs and 1-8 episodes a day

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15
Q

what is the treatment for acute cluster headaches

A

triptans
6mg sumatriptan s/c
zolmathiptal nasal
ORAL TRIPTANS NOT EFFECTIVE

oxygen therapy 10-15l for ANS symptoms

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16
Q

what is the transitional therapy for cluster headaches

(shortens cluster from 1 month to a week for example)

A

oral prednisone taper by 10mg every 2 days

greater occipital block - steroid (depomedrone) and local anaesthetic (lidocaine) to reduce inflammation and headache

17
Q

what is the preventive treatment for cluster headache

A

veramipril 960mg
check each for heart block

toprimate

18
Q

what is the treatment for myasthenia gravis

A

antichoinesterase pyridostigmine
neostigmine

steriods - prednisolone

immunosupression - azathiprine

19
Q

what is the classic triad seen in meningitis

A

neck stiffness fever and altered mental status

neck won’t move to chin
fever >38
GCS<14

20
Q

what are the most common organisms of bacterial meningitis

A

neisseria meningitis
streptococcus pneumonia

21
Q

what is the most common cause of viral meningitis

A

enterovirosus

22
Q

what should you look for in meningococcal meningitis

A

a rash that does not blanch

23
Q

what is the corpus callosum

A

large bundle of nerve fibres connecting the cerebral hemispheres

24
Q

what is the treatment for Gillian bers syndrome

A

immmunitherapty

25
Q

what does the trigeminal nerve do

A

controls muscles of mastication and general sensation to the face
corneal reflex - see if they blink
mandibular branch - jaw reflex

26
Q

can HSV encephalitis cause hypo or hypernatremia

A

hypo - low sodium

27
Q

what are the signs of optic neuritis

A

acute painful vision lost
periocular pain - pain around the eye especially with eye movement
colour desaturation of red

28
Q

first line treatment for optic neuritis

A

iv methylpredisone

29
Q

what must be done prior to stroke treatment

A

CT scan to rule out intercranial haemorrhage

near high yield (3 decks)

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