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finals > neuro > Flashcards

neuro Flashcards

1
Q

indications for carbamazepine

A

epilepsy, particularly partial seizures (no role in absence seizures)
trigeminal neuralgia
bipolar disorder

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2
Q

imaging for acoustic neuroma

A

MRI of cerebellopontine angle

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3
Q

which vitamin deficiency can lead to Wernicke’s encephalopathy

A

thiamine B1

it is found in Pabrinex

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4
Q

mx of Bell’s palsy

A

prednisolone if seen within 72h of onset

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5
Q

ix for ? Guillain-Barre syndrome

A 
lumbar puncture (rise in protein with normal WCC)
nerve conduction studies
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6
Q

secondary prevention after stroke

A

clopidogrel lifelong

aspirin + dipyridamole lifelong if clopidogrel CI/not tolerated

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7
Q

conduction dysphasia

A

speech fluent, repetition poor

comprehension intact

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8
Q

Broca’s (expressive) dysphasia

A

non-fluent laboured and halting speech
repetition impaired
comprehension intact

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9
Q

Wernike’s (receptive) dysphasia

A

speech is fluent but sentences make no sense, word substitution and neologisms - ‘word salad’
comprehension impaired

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10
Q

driving rules after first unprovoked seizure, normal brain imaging and EEG

A

cannot drive for 6 months

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11
Q

driving rules after first unprovoked seizure, abnormal brain imaging and EEG

A

cannot drive for 12 months

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12
Q

what FBC abnormality can phenytoin cause

A

megaloblastic anaemia

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13
Q

which medication in parkinson’s disease mx can cause impulse control disorders

A

dopamine receptor agonists, e.g. Bromocriptine, Cabergoline

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14
Q

first line mx for spasticity in MS

A

Baclofen and Gabapentin

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15
Q

most appropriate anti-emetic in Parkinson’s

A

Domperidone

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16
Q

features of Cushing’s triad

A 
raised ICP causing:
1. bradycardia
2. irregular breathing
3. widening pulse pressure
(also have hypertension)
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17
Q

sodium valproate effect on P450 system

A

inhibition

increases INR if taking warfarin

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18
Q

first-line options for neuropathic pain

A

amitriptyline
duloxetine
gabapentin
pregabalin

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19
Q

features of anterior cerebral artery stroke

A

contralateral hemiparesis and sensory loss

LL>UL

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20
Q

features of middle cerebral artery stroke

A

contralateral hemiparesis and sensory loss UL>LL
contralateral homonymous hemianopia
aphasia - dominant hemisphere strokes

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21
Q

when is carotid endarterectomy considered

A

in a patient who has had a TIA w carotid artery stenosis >70%

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22
Q

when would you consider multiple system atrophy over parkinson’s?

A

autonomic disturbance, e.g. atonic bladder, postural hypotension

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23
Q

cluster headache prophylaxis

A

Verapamil

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24
Q

cluster headache acute mx

A

SC Sumatriptan and high flow oxygen

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25
Q

features of Bell’s palsy

A

LMN facial nerve palsy therefore forehead is affected
inability to raise eyebrow and drooping of mouth on affected side
hyperacusis
post-auricular pain

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26
Q

acute mx of seizures

A

check airway and give oxygen if appropriate
place patient in recovery position
benzodiazepines are indicated in prolonged seizures - rectal Diazepam 10-20mg in adults

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27
Q

for thrombectomy in acute ischaemic stroke, when would an extended target time of 6-24h be considered?

A

if there is the potential to salvage brain tissue as shown by advanced brain imaging, e.g. CT perfusion

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28
Q

features of Wernicke’s encephalopathy

A 
CAN OPEN
Confusion
Ataxia
Nystagmus
Ophthalmoplegia
PEripheral 
Neuropathy
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29
Q

what is ‘saturday night palsy’

A

radial nerve palsy caused by compression of the radial nerve against humeral shaft

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30
Q

how may cataplexy present

A

laughter followed by fall or collapse

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31
Q

features of median nerve palsy

A 
damage at wrist = carpal tunnel syndrome
- paralysis and wasting of thenar eminences
- weak opposition and abduction of thumb
- sensory loss to palmar aspect of lateral 2 ½ fingers
- commonly damaged in Colle's fracture
damage at elbow = above plus
- unable to pronate
- weak wrist flexion
- ulnar deviation of wrist
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32
Q

features of ulnar nerve palsy

A

hypothenar wasting

weak thumb adduction

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33
Q

mx of myasthenic crisis

A

IV immunoglobulins

plasma electrophoresis

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34
Q

ix for MS

A

MRI with contrast

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35
Q

bilateral facial nerve palsy and bilateral parotid gland enlargement

A

sarcoidosis

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36
Q

cause of vertical nystagmus vs horizontal nystagmus

A

vertical - suggests central cause (e.g. cerebellar stroke)

horizontal - suggests peripheral cause (e.g. viral labyrinthitis)

37
Q

what happens when controlled hyperventilation is used for raised ICP?

A

hyperventilation -> reduced CO2 -> vasoconstriction of cerebral arteries -> reduced ICP

38
Q

indications for urgent CT head in headache

A 
vomiting >1 with no other cause
new neurological deficit
reduction in GCS
valsalva or positional headaches
progressive headache with fever
39
Q

most common primary brain tumours in adults

A
  1. glioblastoma - poor prognosis

2. meningioma - arise from dura mater

40
Q

most common primary brain tumour in children

A

pilocytic astrocytoma

41
Q

acute mx of stroke

A
  1. Aspirin 300mg
  2. thrombolysis with Alteplase if within 4.5 h of onset and haemorrhage is excluded
  3. thrombectomy with thrombolysis if within 6 h of onset for occlusion of proximal anterior circulation
    1. thrombectomy within 6-24h for occlusion of proximal anterior circulation and potentially salvageable brain tissue
42
Q

what monitoring is needed when giving phenytoin infusion

A

cardiac monitoring due to its pro-arrhythmogenic effects

43
Q

features of extradural haemorrhage

A

lucid interval

biconvex haemorrhage on imaging

44
Q

ix for myasthenia gravis

A

antibody screen

45
Q

myasthenia gravis vs Lambert-Eaton + which antibodies to check for each

A

weakness in myasthenia gravis worsens after exercise (check ACh receptor antibodies)
weakness in Lambert-Eaton improves (check voltage-gated Ca-channel antibodies)

46
Q

causes of upper vs lower quadrant bitemporal hemianopia

A 
upper = inferior chiasmal compression, commonly pituitary tumour
lower = superior compression, commonly craniopharyngioma
47
Q

ix for venous sinus thrombosis

A

MR venogram

48
Q

features of venous sinus thrombosis

A

headache, nausea and vomiting

may use COCP and have FHx of VTE

49
Q

which anti-epileptic may cause weight gain

A

sodium valproate

“sodium val-pro-weight”

50
Q

mx of idiopathic intracranial hypertension

A

acetazolamide

51
Q

describe the tremor seen in Parkinson’s

A

unilateral tremor that improves with voluntary movement

52
Q

features of Weber’s syndrome

A

ipsilateral CNIII palsy
contralateral weakness
weBer’s = Brainstem stroke

53
Q

features of normal pressure hydrocephalus

A

urinary incontinence
gait abnormality
dementia
enlarged fourth ventricle on imaging

54
Q

what can provoke absence seizures

A

hyperventilation or stress

55
Q

when may stopping anti-epileptic drugs be considered

A

>2 years seizure free

AEDs stopped over 2-3 months

56
Q

common biochemical complication of SAH

A

hyponatraemia

57
Q

which CCB is used to prevent vasospasm in aneurysmal SAH

A

Nimodipine

58
Q

head injury with signs of meningeal irritation

A

SAH

59
Q

when should ICP monitoring be used

A

those with GCS 3-8 and abnormal CT scan

it is also appropriate if CT scan is normal

60
Q

Todd’s paresis

A

post-ictal weakness seen in frontal lobe epilepsy

61
Q

driving rules post-TIA

A

can start driving if symptom free after 1 month - no need to inform DVLA

62
Q

features of pontine haemorrhage

A

Pinpoint Pupils (Point to Pons and oPiates)
Quadriplegia
Life threatening stroke associated with HTN

63
Q

long-term prophylaxis of cluster headaches

A

Verapamil

64
Q

ECG findings in SAH

A

Torsades de pointes - polymorphic VT

65
Q

features of Horner’s

A

miosis (pupillary constriction)
ptosis
enophthalmos
anhidrosis

66
Q

mx of brain abscess

A

IV ceftriaxone (3rd gen cephalosporin) + metronidazole

67
Q

features of CN III palsy

A

if due to intracranial bleed, the palsy will be on the same side
fixed, dilated pupil, unresponsive to light
down and out pupil
ptosis

68
Q

which anti-emetic (used for migraine attacks) can cause extrapyramidal side-effects in children and young adults

A

metoclopramide

69
Q

isolated rise in protein on CSF indicates

A

Guillain-Barre syndrome

70
Q

when does autonomic dysreflexia occur

A

in spinal cord injury at or above T6

71
Q

Jacksonian march

A

type of focal aware frontal lobe seizure

characteristically affects peripheral body part then spreads

72
Q

CI to triptan use for migraines

A

history of ischaemic heart disease

73
Q

Nelson’s syndrome

A

rapid enlargement of pituitary adenoma that occurs after bilateral adrenalectomy

74
Q

which dementia is associated with MND

A

frontotemporal

75
Q

what pathology is proptosis/exophthalmus and down and out pupil seen in

A

cavernous sinus syndrome

76
Q

features of brain abscess

A

headache
fever
focal neurology
recent acute sinusitis (source of infection)

77
Q

prophylactic mx of migraines

A

propranolol and topiramate
avoid topiramate in women of child-bearing age as it can cause congenital abnormalities if they fall pregnant
avoid propranolol in asthma

78
Q

imaging for stroke

A

NON-contrast CT head

79
Q

cause of bitemporal hemianopia

A

compression of optic chiasm, e.g. due to pituitary adenoma

80
Q

mx of temporal arteritis

A

high-dose prednisolone as soon as dx is suspected BEFORE temporal artery biopsy

81
Q

drug causes of intracranial hypertension

A 
COCP
steroids
tetracyclines
vitamin A
lithium
82
Q

features of temporal lobe seizure

A 
HEAD
Hallucinations
aura (Epigastric rising/emotional)
Automatisms (**lip smaking/grabbing/plucking**)
Deja vu/dysphasia (post ictal)
83
Q

imaging for neck fracture

A

CT scan

84
Q

features of encephalopathy

A

fever, headache
psychiatric symptoms
seizures
vomiting

85
Q

most common cause of encephalopathy

A

herpes simplex virus

86
Q

mx of status epilepticus

A

ABC, airway adjunct and oxygen as needed
check blood glucose
pre-hospital - rectal diazepam; hospital - IV lorazepam (can be repeated after 10-20 mins)
for established status - second-line agent such as phenytoin
no response within 45 min - general anaesthesia

87
Q

features of epidural haematoma

A

combination of neurological deficit and severe back pain

epidurals are CI in coagulopathies due to this reason

88
Q

most appropriate med for acute confusional state in Parkinson’s patients

A 
lorazepam
AVOID antipsychotics (i.e. Haloperidol)

finals (25 decks)

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