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PACES Management > Neuro > Flashcards

Neuro Flashcards

1
Q

Medical management of meningitis

A

IM benzylpenicillin in community

Cefotaxime

amoxicillin/ampicillin for listeria cover if elderly/neonate

Dexamethasone (not for <3m or paediatric meningococcal)

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2
Q

Management of chronic cvryptococcus meningitis

A

ambisome +/- flucytosine

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3
Q

treatment of encephalitis

A

IV aciclovir 10mg/kg + IV ceftriaxone

IV amoxicillin if immunocompromised/>50y

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4
Q

acute management of meningitis other than antibiotics

A

blood cultures
check for raised ICP
airway support/fluid support/vasopressors

if no raised ICP, LP <1h
dexamethasone 10mg

if raised ICP, IV antibiotics, A-E, dexamethasone

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5
Q

Status management

A

Oxygen 100%, bloods, toxicology screen +/- fluids

buccal midazolam OR pr diazepam OR IV lorazepam

10 mins: IV lorazepam

30 mins: IV phenytoin/phenobarbitone

60 mins: rapid induction anaesthesia e.g. propofol

consider thiamine at 30m if alcohol/malnourished

glucose treatment

treat acidosis if severe
consider dex if cerebral tumour/vasculitis after senior consultation

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6
Q

Trauma guidelines for CT head immediately

A 
GCS<13 or <15 2h-post
skull fracture
seizure
focal neurology
vomiting >1
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7
Q

Trauma guidelines for CT head within 8h

A

Warfarin

LOC AND either
Age >65
bleeding/clotting problem
30m retrograde amnesia
dangerous mechanism of injury
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8
Q

Trauma guidelines for CT spine immediately

A 
GCS <13
pt intubated
?surgery
Clinical suspicion AND:
age 65/high impact injury/focal neurology/paraesthesia
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9
Q

Management for ischaemic stroke

A

antiplatelet immediately once confirmed for 2w

alteplase <4.5h
thromboectomy if alteplase not indicated <6h

statin after 48h

no AF: Clopidogrel long-term
AF: Apixaban long-term

Slowly lower any HTN

catheterise
hold anti-coagulation for AF for 14d
find cause e.g. AF, carotid artery stenosis

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10
Q

Management for haemorrhagic stroke

A

Rapid blood pressure lowering if SBP >150 and no CI

reverse anticoagulation
refer to neurosurgeons e..g decompressive hemicraniectomy

Stroke rehab

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11
Q

Management for SAH

A

CT
LP if CT inconclusive after 12h

nimodipine ASAP after confirmation for vasospasm
can use normal saline as well

monitor GCS for rebleed and Na for SIADH

coiling with IR or surgical clipping

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12
Q

Management for raised ICP

A 
sit up to 30 degrees
if intubated hyperventilate them
mannitol OR hypertonic saline used with caution
steroids (if oedema surrounding tumours)
fluid restriction

refractory disease = pentobarbital coma, hypothermia and decompressive hemicraniectomy

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13
Q

management of cauda equina

A

PO dex if metastatic

decompressive laminectomy/discectomy if <48h

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14
Q

Management of spinal compression

A

PO dex +/- external beam radiotherapy OR surgery

think if unfit for surgery

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15
Q

Management of TIA

A

aspirin 300mg for 2w

no af: clopidogrel + statin long-term

af: apixaban + statin

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16
Q

Management of subdural haematoma

A

reverse clotting abnormalities
ICP management

neurosurgery for evacuation if large

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17
Q

Management of extradural haematoma

A

urgent neurosurgical intervention (clot evacuation and ligation)

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18
Q

Management of Parkinson’s

A

MDT approach
Home environment review
OT/PT

memory clinic
levodopa + carbidopa
antiemetic e.g. domperidone

consider rasagiline (MAO-B),

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19
Q

Management of Alzheimer’s

A

MDT approach
community organisation e.g. Alzheimer’s Association
Home environment review
OT/PT

anticholinersterase:
donepezil, galantamine, rivastigmine

memantine if severe (NMDAr antagonist)

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20
Q

management for MS

A

acutely: steroids
chronically: beta-interferon, natalizumab for MS

Life optimisation:
anti-spasmodics
pain (gabapentin, pregabalin)
laxatives
catheter/oxybutinin
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21
Q

Management for Myaesthenia Gravis

A

long-acting AChE inhibitors (pyridostigmine, neostigmine)
immunosuppression (pred, azathioprine)

check for thymoma

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22
Q

Management for myasthenic crisis

A

plasmapharesis/IVIG

intubation

23
Q

Management for Lambert Eaton Syndrome

A

treat cancer

immunosuppression (pred +/- azathioprine)

24
Q

management for MND

A

MDT (PT/OT, dietician, specialist nurse)
riluzole extends life by 3m

supportive management e.g. PEG feeding, analgesia, antispasmodics, NIV

25
Q

Management for BPPV

A

Epley
Semont manoeuvre

consider: lorazepam
consider surgery

26
Q

Management of Meniere’s

A

salt restrict
less: caffeine alcohol, smoking, stress

meclozine or promethazine

consider oral steroids or intratympanic injection

if sudden hearing loss: oral pred

tinnitus maskers

consider hearing aid, endolymph sac surgery

27
Q

GBS management

A

spiro (FVC measurements 6hly)
IVIG OR plasma exchange

DVT prophylaxis
?mechanical management
neuropathic pain management
fluids
antihypertensives
28
Q

migraine management

A

prophylaxis: propanolol, CCB, antiepileptics, amitriptylline
consider menstrual cycle control

ongoing: NSAIDs, antiemetic
2nd line paracetamol monotherapy + antiemetic

3rd: triptan + antiemetic

avoid triggers: chocolate, wine, alcohol, smoking, stress, sleep deprivation

29
Q

causes of peripheral neuropathy

A 
Alcohol
B12
Thiamine
Diabetic
Amyloidosis
CMT
Infections: Botulinum, diphtheria, lyme disease
30
Q

difference between polymyositis and polymyalgia rheumatica

A

polymyositis = tenderness/weakness

polymyalgia = pain and stiffness without weakness

31
Q

polymyalgia management

A

pred

32
Q

polymyalgia investigation

A

CK
Biopsy
antibodies
malignancy screen

33
Q

contraindications to thrombolysis

A 
LP in last week, GI haemorrhage 3w, stroke last 3m
HTN >200
Ongoing bleeding
Pregnant
ICH
Seizure at onset
Brain cancer
Varices
34
Q

what is false localising sign

A

6th nerve palsy doesn’t actually tell you where the lesion is as it takes a really long route

35
Q

paediatric guidelines for CT head within 1h

A

NAI
Post-traumatic seizure but no history of epilepsy
GCS <14
GCS <15 after 2h
base of skull fracture
Focal neurology
<1yo, bruise/swelling/laceration >5cm on head

36
Q

CT SAH sensitivity

A

> 95% if done within 6h

if negative but high clinical suspicion, do LP after 12h of onset

37
Q

MCA stroke symptoms

A

Motor: upper body, facial droop

Visual: Eyes deviate towards lesion (looking at it), contralateral homonymous hemianopia

Other: verbal deficits -Broca’s aphasia or Wernicke’s

38
Q

ACA stroke symptoms

A

Motor: lower body, pelvis

Other Urinary incontinence, personality change, aphasia

39
Q

PCA stroke symptoms

A

Visual: contralateral homonymous hemianopia, visual hallucinations, visual agnosia

Other: Dysphagia, dysarthria, cerebellar signs

40
Q

lacunar stroke symptoms

A

pure contralateral motor (branches of ACA and MCA)

41
Q

absence seizure drugs

A

ethosuxamide, lamotrigine, valproate

42
Q

partial seizure drugs

A

carbamazepine, valproate, lamotrigine, levetiracetam

43
Q

tonic clonic seizure drugs

A

valproate, lamotrigine, carbamazepine

44
Q

tonic/atonic seizures drugs

A

valproate

45
Q

myoclonic seizure drugs

A

valproate, topiramate, levetiracetam

46
Q

Bamford TACS

A

triad of

1) homonymous hemianopia
2) hemiplegia +/- sensory deficit
3) higher cerebral dysfunction (speech)

47
Q

Bamford PACS

A

2 of

1) homonymous hemianopia
2) hemiplegia +/- sensory deficit
3) higher cerebral dysfunction (speech)

48
Q

Bamford POCS

A

Any of

1) Cranial nerve dysfunction
2) Bilateral motor/sensory dysfunction
3) Conjugate eye movement disorder
4) Isolated hemianopia
5) Cerebellar signs

49
Q

Bamford Lacunar

A 
No loss of higher cerebral function + 1 of:
Pure sensory
Pure motor
Sensorimotor 
Ataxic hemiparesis
50
Q

carotid endarterectomy indications

A

stenosis >50% + stroke/TIA
Carried out within 2w

stenosis >70%

51
Q

stroke scoring systems on admission

A

NIHSS
ROSIER
CT-ASPECT

52
Q 
Dermatomes
Back of head
Shoulder
3rd finger
Nipple
Umbilicus
Hip
Big Toe
Little Toe
A 
Back of head C2
Shoulder C4
3rd finger C7
Nipple T4
Umbilicus T10
Hip L2
Big Toe L5
Little Toe S1
53
Q

Management of cluster headaches

A

acute: SC sumitriptan and 100% high flow oxygen

prevent recurrence: verapamil

54
Q

lesions to optic radiations in temporal and parietal lobes lead to what type of visual defect

A

quadrantanopia

PITS = Parietal inferior, Temporal Superior

PACES Management (11 decks)

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