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FCM Y1 SGUL > NEURO > Flashcards

NEURO Flashcards

1
Q

Peak incidence in 20-40s, common in pregnancy
acute, unilateral idiopathic facial paralysis
usually have preceding pain/tinging around the post-auricular region
forehead affected
altered taste
dry eyes
hyperacusis (loud sounds)

A

bell’s palsy

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2
Q

management of bell’s palsy

A

present with 72hrs = oral prednisolone
can provide eye patch/symptomatic relief

if no improvement in 3 weeks = ENT referral

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3
Q

which cranial nerve is affected in bell’s palsy

A

facial nerve - CN 7

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4
Q

initial pain in bag or legs
progressive, symmetrical weakness in all of the limbs
classically ascending from (legs upwards)
reduced/absence reflexes
hx of gastroenteritis
CN involvement sometimes or urinary retention

A

guillian-barre syndrome

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5
Q

what Ix done in guillian barre syndrome?

A

LP = elevated protein

nerve conduction studies

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6
Q

management of guillian barre syndrome

A

admit to neuro critical care
IVIG or plasmaphresis
pain control using gabapentin or opiates

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7
Q

motor sensory and optic symptoms seperated by time and space
tingling, paresthesia and numbness
optic neuritis - worse on eye movement
balance difficulties

commonly in females 20-40yrs

A

Multiple sclerosis

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8
Q

Ix for MS

A 
MRI = multiple areas of focal demyelination in the brain and plaques 
LP = oligoclonal bands
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9
Q

management of acute MS attack

A

high dose methylprednisolone for 5 days

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10
Q

management of MS

A

b-interferon injections
glatiramer acetate, natalizumab and fingolimoid
supportive measures

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11
Q

brisk tendon reflexes and hypertonia

A

MS spasticity

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12
Q

MS spasticity management

A

baclofen and gabapentin

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13
Q

more insidious progression of limb weakness, in the symmetrical ascending pattern in all limbs

A

Chronic inflammatory demyelinating polyneuropathy (CIDP)

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14
Q

management of CIDP

A

long term immunosuppression

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15
Q

burning feet
tingling and numbness
feet affected first - but all peripheries affected
stocking/glove distribution

A

diabetic peripheral neuropathy

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16
Q

Ix for diabetic neuropathy

A

nerve conduction studies

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17
Q

management of diabetic neuropathy

A

anticonvulsants = gabapentin/pregabalin
antidepressants = SNRI/Tricyclics
tramadol/weak opioid - but addiction risk
lidocaine patches/topical cream
supplements and therapies
exercise, weigth loss and diet

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18
Q

postural tremor - worse outstretched
improved by alcohol and rest
impaired use of spoon/fork

A

essential tremor

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19
Q

management of essential tremor

A

propranolol first line

can use primidone

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20
Q 
pill-rolling tremor
cogwheeling rigidity 
bradykinesia 
depression/dementia 
micrographia 
shuffling gait - leads to balance difficulties
A

parkinson’s disease

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21
Q

any Ix for PD?

A

usually clinical diagnosis

SPECT can be used if hard to distinguish from essential tremor

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22
Q

management of PD

A

First line = levodopa,

dopamine agonists = bromocriptine and ropinirole
MOA-B inhibitors = selegine
COMT inhibitors = entacapone

cycling meds as can build tolerance

severe cases - surgical = deep brain stimulation

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23
Q

postural instability and falls
impairment of vertical gaze
bradykinesia
cognitive impairment

A

progressive supranuclear palsy

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24
Q

parkinsonism

autonomic disturbance = erectile dysfunction and postural hypotension

A

multisystem atrophy

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25
Q

progressive cognitive impairment/fluctuating cognition, visual hallucinations

A

lewy body dementia

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26
Q

management of lewy body dementia

A

acetylcholinesterase inhibitors = rivastigmine and donepezil

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27
Q

35 years +
chorea = involuntary movements
dystonia
saccadic eye movements

A

huntington’s disease

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28
Q

what will HD pts need investigated?

A

genetic testing for CAG trinucleotide expansion

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29
Q

management of huntingtons

A

previously incurable, new arising tx

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30
Q

rapid onset of dementia
myoclonus/twitching
all areas of the neurological system affected = gait, sensation, memory, strength, speech and visual losses
in younger pts may have anxiety, withdrawal, dysphonia

A

Creutzfeldt-jakob disease

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31
Q

Creutzfeldt-jakob disease cause

A

prion proteins

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32
Q

Creutzfeldt-jakob disease Ix

A

CSF normal, hyperintense signals in MRI

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33
Q

common in females
unilateral severe throbbing heachache - up to 72hrs
nausea and vomiting
photosensitivity
phonophobia
can be precipitated by aura (usually visual)

can be menstrual related

A

migraine

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34
Q

what is needed for diagnosis

A

5 attacks of the symptoms

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35
Q

management for migraines

A

first line = oral triptan & NSAIDs - nasal triptan in younger patients

metoclopramide + propranolol = preferred in child bearing age / first not tolerated

menstrual migraine = frovatriptan or zolmitriptan

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36
Q

headache = tight-band around the head/pressure
episodic
few other associated symptoms

A

tension headache

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37
Q

management of tension headaches

A

first line = aspirin, paracetamol, NSAIDs

prophylaxis = acupuncture/low dose amitriptyline

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38
Q

headache with intense sharp pain around an eye
unilateral redness, lacrimation and lid swelling around affected eye
rhinorrhea
restless patient
same time each day, can feel it coming on

A

cluster headache

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39
Q

management of cluster headache

A

acute = 100% oxygen and SC triptan

prophylaxis = verapamil (bridging prednisolone when initiating)

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40
Q 
loss of consciousness 
nausea/vomiting 
confusion 
smell of alcohol 
difficulty walking

may have injured head via high-impact trauma
otherwise may present more insidiously

A

subdural haemorrhage

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41
Q

investigations for SDH

A

CT head = crescent shaped feathered fluid, midline shift/mass effect

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42
Q

management of SDH

A

neurosurgical intervention = decompressive craniotomy or burr holes

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43
Q 
caused by trauma to the side of the head - not necessarily high impact trauma 
LOC
focal neurological deficit 
tympanic tap
lucid interval after trauma
A

epidural haemorrhage

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44
Q

which artery is affected in EDH

A

middle meningeal artery

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45
Q

investigations for EDH

A

CT - biconcave collection of blood (suture view)

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46
Q

management for EDH

A

craniotomy and evacuation haematoma

47
Q

Headache: typically sudden-onset/thunderclap, severe and occipital
Nausea and vomiting
Meningism (photophobia, neck stiffness)
Coma
Seizures
Sudden death
ECG changes including ST elevation may be seen

A

subarachnoid haemorrhage

48
Q

Ix for SAH

A

CT = hyperdensitiy/brighter in the basal cisterns, sulci

LP within 12hrs = xanthochromia + raised opening pressure

49
Q

management of SAH

A

immediate neurosurgery referral - usually treated with coil

nimodipine 21days given to prevent vasospasms

50
Q

main cause of SAH

A

intracranial aneurysms/ saccular ‘berry’ aneurysms)

linked to Polycystic kidney and Ehler-Danlos

51
Q 
headaches 
seizures 
impaired consciousness/confusion 
CN lesions = unilateral deafness, diplopia, pulsatile tinnitus 
focal neuro signs 
papiloedema
A

cavernous sinus thrombosis

52
Q

Ix for cavernous sinus thrombosis

A

CT/MRI venograms

53
Q

management cavernous venous thrombosis

A

heparin/warfarin

54
Q 
headaches - similar to raised ICP
seizures 
impaired consciousness/confusion 
CN lesions = unilateral deafness, diplopia, pulsatile tinnitus 
focal neuro signs
A

venous sinus thrombosis

55
Q 
muscle fatigue after repetition of movements
facial weakness 
proximal arm weakness 
ptosis 
diplopia
A

myasthenia gravis

56
Q

Ix for MG?

A

electromyography and serologic testing for Ach antibodies

57
Q

management for MG?

A
  1. long acting acetylcholinesterase inhibitors - pyridostigmine and mestinon
  2. prednisolone and azathioprine/cyclosporin

sometimes thymectomy (remove thymus)

58
Q

all-over muscle weakness that may cause double vision or a wobbly walk.
respiratory depression - breathing and talking difficulties- subcostal recession
commonly due to use of B-blocker

A

MG crisis

59
Q

MG crisis management

A

IVIG + plasmapheresis

60
Q

abnormal tone in early infancy
delayed motor milestones
abnormal gait
feeding difficulties

A

cerebral palsy

61
Q

management of cerebral palsy

A

oral diazepam, baclofen and botulinum toxin A = treat spasticity
anticonvulsants
analgesia

62
Q

transient loss of consciousness, rapid onset
short duration
spontaneous complete recovery

A

syncope

63
Q

investigations needed for syncope

A

ECG = check, prolonged QT
glucose level
electrolytes, FBC

64
Q

causes of syncope

A

reflex/vasovagal = can be triggered from emotion/pain/stress or due to coughing/urinating

orthostatic = volume depletion, autonomic failure, drugs,

cardiac = arrhythmias or MI, PE

65
Q

management of syncope

A

treat if underlying cause identified
optimise glucose + hydration
review medications
close follow up

66
Q

progressive headaches
signs of raised ICP = N/V, headache worse on lying down
aggravated by valsalva

A

brain/CNS tumour

67
Q

CNS/brain tumour Ix

A

MRI scan

68
Q

management of CNS/brain tumour

A

usually surgery (reduces ICP even if not fully resectable)

69
Q

global functional alteration of mental status
changes to memory,
changes to mood
difficulties thinking

A

acute encephalitis

70
Q

confusion, memory loss or mood changes

repeated blows to the head/ repeated concussions

A

chronic encephalitis

71
Q

management of chronic encephalitis

A

supportive = helmets, avoid risky activities, allowing time for full recovery from concussion

72
Q 
patients present with weakness in arms or legs 
usually asymmetric 
weakness of facial muscles - difficulty speaking, swallowing, chewing or coughing 
fasiculations/twitching 
stiffness 
weight loss 
muscle atrophy 
worsening fatigue
A

Amyotrophic lateral sclerosis

73
Q

Amyotrophic lateral sclerosis investigations needed?

A

usually clinical

nerve conduction studies can be done to exclude neuropathy

74
Q

management of ALS?

A

riluzole/rilutek
symptomatic tx
PT, OT, speech+language therapy

75
Q

pain/pins and needles in thumb, index, middle finger
unusually the symptoms may ‘ascend’ proximally
patient shakes his hand to obtain relief
symptoms classically at night
muscle wasting at thenar eminence
+ve tinels and phalen’s test

A

carpal tunnel syndrome

76
Q

investigations for carpal tunnel syndrom

A

electrophysiology - prolongs APs

77
Q

management of carpal tunnel syndrome

A

corticosteroid injection
wrist splints at night
surgical decompression

78
Q

which nerve is affected in wrist drop

A

radial nerve

79
Q

which nerve is affected in foot drop

A 
peroneal nerve (L4, L5, S1, S2)
sometimes L5 radiculopathy results in foot drop
80
Q

a single seizure lasting >5 minutes,

OR

> = 2 seizures within a 5-minute period without the person returning to normal between them

A

status epilepticus

medical emergency - hypoxic state

81
Q

management of status epilepticus

A

ABC = airway adjunct, oxygen, check blood glucose

glucose if BM low and thiamine & Mg2+ if alcoholic

phenytoin or phenoarbital infusion

first line = benzodiazepines = diazepam/lorazepam
can repeat once after 10-20mins

no response in 45mins = general anesthesia

82
Q

acute treatment of seizures

A

benzodiazepine first line = lorazepam/diazepam

83
Q

recurrent seizures

A

epilepsy

84
Q

Ix after first seizure

A

electroencephalogram (EEG) and neuroimaging (usually a MRI).

85
Q

long term epilepsy management

A

generalised seizure = sodium valproate

focal seizures = carbamazepine

other tx options include = lamotrigine, levetiracetam

86
Q

seizure with isolated motor symptoms which may spread across one side of the body
may have some sensory changes

A

simple partial seizure

87
Q

seizure where patient has aura (nausea, fear olfactory hallucinations) followed by impaired responsiveness - stereotyped motor movements

A

complex partial seizure

88
Q 
progressive memory loss despite alertness 
inability to solve problems 
language difficulties 
wandering/inattention 
personality changes 
symptoms worse at night/sundowning
A

alzheimer’s disease

89
Q

Diagnosis of alzheimer’s

A

usually clinical

Neuropsychiatric testing useful

90
Q

widespread cerebral atrophy

neurofibrillary tangles

A

alzheimer’s disease

91
Q

management of alzheimer’s

A

first line = acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)

second line = memantine (an NMDA receptor antagonist)

other mx options include:

  • activities promoting wellbeing
  • CBT
  • highly structured routines
92
Q 
motor weakness
speech problems (dysphasia)
swallowing problems
visual field defects (homonymous hemianopia)
balance problems
>24hrs
A

Stroke

93
Q

what indicates a haemorrhagic stroke ?

A

decrease in the level of consciousness:
headache is also much more common
nausea and vomiting is also common
seizures

94
Q

assessment/Ix of stroke

A

FAST
ROSIER score - exclude hypoglycaemia first! = A stroke is likely if > 0.

non contrast CT = first line radiological investigation for suspected stroke

95
Q

management of stroke

A

Acute ischaemic stroke
Thrombolysis with should only be given if:
it is administered within 4.5 hours of onset of stroke symptoms
make sure haemorrhage has been definitively excluded

secondary prevention
clopidogrel
if contraindicated/not tolerated = aspirin plus MR dipyridamole

96
Q 
Unilateral weakness or sensory loss.
Dysphasia.
Ataxia, vertigo, or incoordination.
Syncope.
Sudden transient loss of vision in one eye (amaurosis fugax). 
Homonymous hemianopia.
Cranial nerve defects.
<24hrs
A

TIA

97
Q

management of TIA

A

Aspirin 300mg and refer for specialist assessment

further management/ prevention
clopidogrel
if contraindicated/not tolerated = aspirin plus MR dipyridamole

98
Q 
headache
vomiting
reduced levels of consciousness
papilloedema
Cushing's triad = widening pulse pressure + bradycardia + irregular breathing
A

raised ICP/pseudotumor cerebri

99
Q

investigate raised ICP/pseudotumor cerebri

A

CT

LP - opening pressure

100
Q

management of raised ICP/pseudotumor cerebri

A

head elevation to 30º
IV mannitol may be used as an osmotic diuretic
controlled hyperventilation
removal of CNS - shunting/serial LPs

if due to tumour = Na+ restriction -> Carbonic anhydrase inhibitor (such as acetazolamide) to decrease rate of production of CSF
Diuretics are second line therapy

101
Q 
headache 
jaw claudication 
visual disturbances
= amaurosis fugax
blurring
double vision
tender palpable temporal artery
A

temporal arteritis

102
Q

Ix for temporal arteriris

A

raised inflammatory marker = CRP/ESR
diagnostic = temporal artery biopsy

CK & EMG normal

103
Q

management of temporal arteritis

A

urgent high dose of prednisolone if no visual loss
if visual loss = IV methylprednisolone

urgent ophthalmology review = same-day

(sometimes bisphosphonates & low-dose aspirin given)

104
Q

fever, headache, psychiatric symptoms, seizures, vomiting
focal features e.g. aphasia
peripheral lesions (e.g. cold sores)

A

encephalitis

105
Q

Ix for encephalitis

A

CSF = lymphocytosis, elevated protein

PCR for HSV

106
Q

management for encephalitis

A

IV acyclovir started in all suspected cases

(HSV responsible for 95% of cases

107
Q 
headache
fever
nausea/vomiting
photophobia
drowsiness
seizures
neck stiffness
purpuric rash
A

meningitis

108
Q

cloudy appearance , low glucose, high protein and high WBCs

A

bacterial meningitis

109
Q

clear/slightly cloudy
high glucose
protein normal
raised WBC

A

viral meningitis

110
Q

slightly cloudy, fibrin web, low glucose, high protein, elevated WBC

A

Tuberculous meningitis

111
Q

management of meningitis

A

IV antibiotics, usually to include ceftriaxone/cefotaxime + amoxicillin
ampicilin added in >50yrs

IV dexamethasone

prophylaxis offered to patient contacts

112
Q

HLA-B27 positive
middle aged man

diarrhoea, weight loss
large-joint arthralgia
lymphadenopathy
skin: hyperpigmentation and photosensitivity

A

whipple’s disease

113
Q

Ic for whipple’s

A

jejunal biospy PAS granules

114
Q

management of Whipple’s

A

co-trimoxazole for a year

FCM Y1 SGUL (15 decks)

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