Neuro Flashcards
1
Q
% split between ICA and vertabral artery for TIA
A
90% ICA
10% Vertabral
2
Q
What evaluates stroke risk in patients with af
A
CHA2DS2-VASc
3
Q
ACA affected in TIA Sx
A
Weak numb contralateral leg
4
Q
MCA affected in TIA Sx
A
Weak numb contralateral side of the body, face drooping with forehead spared, dysphasia
5
Q
PCA affected in TIA Sx
A
Vision loss (contralateral homonymous hemianopia w/ macular sparing)
6
Q
Vertebral artery affected in TIA Sx
A
Cerebellar syndrome
CN lesions 3-12
Sensory + motor ataxia
7
Q
How can you assess someone’s proprioception
A
Romberg test
8
Q
Wha tool is used to recognition of a stoke in emergency room
A
ROSIER
9
Q
Treatment for TIA
A
Acutley:- Apirin 300mg
Prophylaxis long term:- Clopidogrel+ Atorvastatin
10
Q
% split between haemorrhagic and ischemic stroke
A
85% Ischaemic
Haemorrhagic 15%
11
Q
What is pronator drift
A
In stroke patients ask the patient to lift their arms to the ceiling, pronator take over. Arm on affected will pronate + palms face down
12
Q
What is a crescendo TIA
A
Two or more TIA’s in a week
13
Q
Gold standard investigation for stroke
A
Diffusion-weighted MRI
NCCT head if not possible
14
Q
What is a lacunar stroke
A
Most common type of ischemic stroke. Blockage of lenticulostriate Arteries that supply the deep brain structures
15
Q
Treatment for ischemic stroke
A
Presents within 4.5hours clot-buster- Alteplase IV
Aspirin 300 mg 2 weeks
Lifelong clopidogrel 75mg
Thrombectomy
16
Q
Treatment for haemorrhagic stroke
A
Neurosurgery referral
IV mannitol for raised ICP
Atorvastatin, ramipril prophylaxis
17
Q
Examples of primary headache
A
Migraine
Cluster
Tension
Drug overdose
18
Q
Causes of secondary headache
A
Infection
Trauma
Cerebrovascular disease
19
Q
What is a migrane
A
Episodes of recurrent throbbing headache +/- aura, often with vision change
20
Q
Who is most at risk from a migrnae
A
Woman under 40
21
Q
What can trigger a migraine
A
CHOCOLATE
Chocolate
Hangover
Orgasms
Cheese
Oral contraceptive
Lie ins
Alcohol
Tumult (loud noise)
Exercise
22
Q
Describe build up to migrane
A
Prodrome:- days before attack, mood change
Aura:- minutes before headache, visual phenomena, zig-zag lines
Throbbing headache lasting 4-72hr
23
Q
Sx of migraine
A
1< Unilateral pain, throbbing, motion-sickness, moderate to severe pain
1 of N+V, photophobia
24
Q
Treatment for migraine
A
Acute:- Oral triptan or aspirin 900mg
Prophylaxis:- Beta-blocker (propanolol) or topiramte is athma
Consider antiemetics
25
What is a cluster headache
Unilateral preorbital pain with autonomic features
26
How long does a cluster headache last
15-160 minutes
27
What is the most disabling primary headache
Cluster
28
RF for cluster headache
Male, smoker, genetics
29
Sx of cluster headache (not autonomic)
Crescendo, unilateral preorbital excruciating pain, may affect temples, face flushing
30
Autonomic Sx of cluster headache
Conjunctival infection + lacrimation (watery bloodshot eyes)
Ptosis
Miosis (dilated unilateral pupil)
Rhinorrhoea (runny nose)
31
How many attacks to make diagnosis of cluster headache
5
32
Treatment for cluster headache
Acutely:- Triptans (sumatriptan)
Prophylaxis:- Veramaprill (CCB)
33
What is a tension headache
Bilateral generalised headache, radiates to kneck
34
What is the most common primary headache
Tension
35
Trigger for tension headache
Stress
36
Sx of tension headache
Rubber band tight around head, bilateral pain, feel it in the trapezius
Mild to moderate severity
No motion sickness, photophobia, aura
37
Treatment for tension headache
Simple analgesia:- Aspirin or paracetamol
38
What is trigeminal neuralgia
Unilateral shocking pain in 1 or more of trigeminal branches
39
RF for trigeminal neuralgia
Multiple sclerosis, old age, female
40
What can trigger trigeminal neuralgia
Eating, shaving, talking, brushing teeth
41
Sx of trigeminal neuralgia
Electrical shock pain in v1/v2/v3 for secs to 2 minuets
42
How many attacks for diagnosis of trigeminal neuralgia
3
43
Treatment for trigeminal neuralgia
Carbamazepine
Consider surgery
44
What is the classical presentation of giant cell arteritis
50 y/o Caucasian women presents with unilateral tender scalp, intermittent jaw claudication
Worst case amaurosis fugax
45
What is amaruosis fugax
Transient vision loss in one eye, curtain over the field of view
46
What is GS investigation for giant cell artritis
and what do you see
Temporal artery biopsy, big sample as many skip lesions
Granulomatous non-caseating inflammation of intima+ media w/ skip leasion
47
How would you describe the anaemia in GCA
Normocytic normochromic
48
Are ESR/ CRP affected in GCA
Yes both are raised
49
Treatment for GCA
Corticosteroids (prednisolone)
If any sign of amaurosis fugax/ vision change give high dose IV methylprednisolone STAT
50
Cuases of sezuire
VITAMIN DE
Vascular
Infection
Trauma
Autoimmune
Metabolic
Idiopathic (epilepsy)
Neoplasms
Dematia + Drugs
Eclampsia
51
RF for Epilepsy
Inherited
Dementia
52
Epileptic seizure vs non-epileptic
Epileptic:- Eyes open, Synchronous movements, can occur in sleep
53
Pathology of epileptic seizure
Imbalance between inhibitory GABA and excitatory glutamate
54
How long do epileptic seizures usually last
Less than 2 mins
55
Periods involved with epileptic seizure
Prodrome
Aura
Ictal Event
Post ictal period
56
2 types of generalised seizures
Tonic-clonic
Absenece
57
What happens in tonic-clonic seizure
No aura
Tonic phase:- rigidity, fall to floor
Clonic phase:- Jerking of limbs
Upgazing open eyes, incontinence, tongue biting
58
What occurs in absence seizure
Moments of staring blankly into space (secs to mins) then carrying on from where they left of
59
What size spike is seen on EEG in absence seizure
3Hz
60
What type of epilepsy is the aura period seen most commonly in
Temporal lobe epilepsy
61
What can happen in the aura period
Deja-vu + auto spasms
Lip smacking, rapid blinking
62
What can be seen in post ictal period
Headache, Confusion, Todd's paralysis (if motor cortex affected), Dysphasia, amnesia, sore tongue (only in epileptic seizure not in syncope)
63
What are 2 types of focal seizure?
Simple focal (no loss of consciousness) and complex focal (loss of consciousness) +ve ictal period
64
Sx of focal temporal epilepsy
Aura, dysphasia, postictal
65
Sx of focal frontal epilepsy
Jacksonian march + todds palsy
66
Sx of focal parietal epilepsy
Paraesthesia (pins and needles)
67
Sx of occipital focal sezure
Vision change
68
Investigation to perform after seizure
EEG
CT HEAD + MRI (examine hippocampus)
Bloods:- rule out metabolic cause/ infection
69
Treatment for epilepsy
Sodium valproate (tetragonic)
Lamotrigine
70
Complication of epilepsy
Status epilepticus:- seizures lasting more than 5 minutes or back-to-back seizures
71
Treatment for status epileptics
Benzodiazepines; Lorazepam IV
If doesn't work then lorazepam again then phenytoin
72
Pathology of Parkinson's
Loss of dopaminergic neurons from substania nigra pars compacta
73
RF for parkinsons
fHx, male, older age,
74
Why does loss of dopmanigeric neurons cause Parkinsons
Do longer send signals to SN pars reticula, don't send to thalamus to inhibit cortex.
75
Cardinal symptoms of parkinsons (parkinosonisum)
Bradykinesia, resting tremor, rigidity, postural instability
76
Other than cardinal symptoms, what seen in parkisons
Shuffling gait, pill-rolling thumb, cogwheel/ lead pipe forearm.
77
Is Pakinsons typically symmetrical or asymmetrical
Asymmetrical
78
Treat for Parkinsons
LDOPA+ decarboxylase inhibitor (beneldopa)
79
Problem with LDOPA
Works very well initially but body becomes resistant so dont want to give to early
80
Most common form of dementia
Alzhiemers
81
Pathological features of Alzheimers
Amyloid plaques (breakdown product of amyloid precursor protein) and tall neurofibrillary tangles in the cerebral cortex.
Cortical scarring + brain atrophy and decrease in Ach neurotransmitter)
82
RF for alzhimers
Downs:- inevitable APP gene mutation
ApoE4 allele
83
Sx of alzhimers
Agnosia (dont recognise)
Apraxia (cant do basic motor skills)
Aphasia (cant talk as well as normal)
Steady decline
84
How does disease progress in vascular dementia
Stepwise
85
Dx of vascular dementia
Hx of TIA/ Stroke, UMN signs and general decrease in cognition
86
Progression of lewy body dementia
Fast, death most common within 7 years post-diagnosis
87
Pathological features of Lewy body dementia
Spherical lewy body proteins (alpha-synuclein+ ubiquitin aggregates) are deposited in cortex
88
Name for parkinons before lewy bpdy dementia
Parkinson dementia
IF L.B.D. before Parkinsons:- lewy body dementia with parkinsonism
89
The inheritance pattern for frontotemporal dementia and which chromosome
Autosomal dominant, chromosome 17
90
RF for frontotemporal demetia
fHx
fHx of MND
91
Pathological features of frontotemporal dementia
Frontotemporal atrophy
92
Sx of frontotemporal dementia
Temporal affected:- speech and language
Frontal:- thinking + memory affected
93
What exam used in dementia
Mini-Mental Strae Exam
>25:-normal
18-25:- impaired
<17:- severely impaired
94
Management for dementia (non pharmacological)
Social stimulation, exercise
95
Pharmacological treatment for Alzheimer's
Achase-I (Donedazil/ rivastigmine)
96
Pharmacological treatment for vascular dementia
Antihypertensives:- rampiprill
97
Inheritance pattern for Huntington's disease
Autosomal dominant with full penetrance
98
What is gene abnormality in Huntington's disorder
CAG repeats on chromosome 4 affecting HTT gene. The more trinucleotide repeats to early and more severe symptoms.
99
What does mutation in huntingtons lead to
Lack of GABA+ excessive nigrostantial pathwya
100
Number of trinucleotide repeats in Huntington's chorea
<35:- no huntington
35-55:- huntongtons
60+ severe huntington
101
Sx of huntington
Chorea, dementia, psychiatric issues, depression
102
Management for huntington
Extensive counselling (inevitable symtpoms)
DA antagonist for chorea + etrabenzine
103
What type of hypersensitivity in MS
Type 4 vs myelin basic protein of oligodendrocytes
104
RF for MS
Female, 20-40, autoimmune disease, fHx, EBV
105
3 types of Multiple Sclerosis
Relapsing-Remitting MC:- Sx, incomplete recovery, Sx
Primary progressive:- Gradual deterioration
Secondary progressive:- Relapsing-remitting into primary progressive (75% or RR cases)
106
What is the first presenting symptom in MS
Optic neuritis/ blurred vision
107
Symptoms of MS
Paratheisa, blurred vision, uthoffs phenomenon (Sx exacerbated after heat e.g shower)
108
Signs of MS
Optic neuritis (cant see red properly), Lhermite phenomenon (electric shock sensation with kneck flexion), charcots neurological triad
UMN signs
109
What is charcots triad in nuerology
Dysarthria
Nystagmus
Intention tremour
110
What criteria is used in the diagnosis of MS
McDonald's criteria:- 2 or more attacks disseminated in time (separate events) and space (different parts of CNS)
111
GS investigation for MS
MRI brain + cord
112
Nerve roots that can be affected by myelopathy spinal cord compression
C1-L1/2
113
Causes of myelopathy
Vertebral body neoplasms
Spinal body pathology (e.g. disc prolapse/ hernaiation)
114
Most common cause of Vertabral body neoplasm
Mets from lung, breast, RCC, melanoma
115
Sx of Myelopathy
Progressive leg weakness with UMN signs
Sensory loss below lesion
Sphincter involvement uncommon
116
Investigations for myelopathy
MRI cord ASAP
CXR if malignancy suspected
117
Treatment for myelopathy
Neurosurgery
118
What is corda equina syndrome
Compression below conus medullaris (EMERGENCY)
119
Cause of cauda equina
Occurs in 2% of lumbar herniation (L4/5 or L5/S1)
120
Sx of cauda equina
Leg weakness with LMN signs
Saddle anaesthesia (perianal numbness)
Bladder/ bowel disfunction + sphincyter involvment common
121
Diagnostic investigation in cauda equina
MRI cord + testing nerve roots
122
Treatment for cauda equina
Neurosurgery ASAP
123
What are median nerve roots
C6-T1
124
RF for carpal tunnel syndrome
Female, hypothyroidism, acromegaly, pregnancy, RA, obesity
125
Sx of carpal tunnel syndrome
Gradual onset:- weakness of grip, aching hand/ forearm, paraesthesia of hand, wasting of thenar eminence
126
When is pain worst in carpal tunnel syndrome?
At night, relieved by hanging hand of side of the bed
127
What tests for carpel tunnel syndrome
Phalen test:- flex wrist for 1 minute, +ve if paraesthesia + pain at wrist
Tinels test:- (tapping wrist causes tingling)
EMG diagnostic if above tests uncertain
128
Managment for carpal tunnel syndrome
Wrist splint at night + steroid injection (acutely very painful)
Last resort:- surgical decrompression
129
What nerve roots is the radial nerve
C5 to T1
130
How does radial nerve palsy present
Wrist drop
131
What nerve roots is ulnar nerve
C8 + T1
132
How does ulnar nerve palsy present
Claw hand
133
At what spinal level is a sciatica lesion
L5/S1
134
What can cause sciatica
Spinal:- Disc herniation/ prolapse
Non-spinal:- piriformis syndrome, tumour pregnancy
135
Sx of sciatica
Pain from buttock down lateral leg to pinky toe
Weak plantarflexion + absent ankle jerk
136
How do you examine for sciatica
Can't do straight leg raise test without pain
137
How do you confirm sciatica
MRI
138
What can cause sub-arachnoid haemorrhage
Berry aneurysm, circle of Willis rupture
139
What can cause subdural haemorrhage
Briding vein rupture
140
What can cause an extra dural haemorrhage
Middle meningeal artery, trauma
141
Most common berry aneurysm rupture location
Anterior communicating artery/ ACA junction
142
Risk factor for subarachnoid haemorrhage
Hypertension
Smoking
FHx
Autosomal dominant polycystic kidney disease
50+
Female
143
Sx of subarachnoid haemorrhage
Occipital thunderclap headache
Decrease in consciousness
Nerve palsy CN3+6
Kernig sign/ Brudzinski sign
144
What is Kernig sign
Can't extend leg when knee is flexed
145
What is Bridzinski's sign
When the neck is elevated, knee unintentionally flexes
146
Describe Glasgow coma score
Out of 15 Eyes4, Verbal5, Motor6
15:- normal
8:- Comatose
3:- Unresponsive
147
GS investigation for subarachnoid haemorrhage
CT Head
148
What do you do after CT head if +ve/-ve in Subarachnoid haemorrhage
+ve:- Ct angiography to show the extent of the rupture
-ve:- wait 12hr then do lumbar puncture- will see Xanthocheomia (yellowish CSF due to RBC haemolysis)
149
Treatment for subarachnoid haemorrhage
Neurosurgery:- endovascular coiling
Also, give Nimodipine (CCB) to reduce cerebral artery spasm
150
How long is time period for acute/ subacute/ chronic sub dural haemorrhage
<3, 3-31, >21
151
What type of injury can cause a subdural haemorrhage
Deceleration injury and in abused children (shaken baby syndrome)
152
Sx of subdural haemorrhage
Gradual onset with a latent period as bleeding is small
Signs of increased ICP:- Cushing's triad (bradycardia, increased pulse pressure, irregular breathing)
Fluctuating GCS
Papilo oedema
153
GS investigation for subdural haemorrhage
NCCT head:- Bana or crescent-shaped, not confined to suture lines, midline shift
154
How to tell is SD haemorrhage is acute/ chronic on NCCT head
Acute:- Hyperdense (bright)
Subacute:- Isodense
Chronic:- Hyopdense (darker than brain)
155
Treatment for subdural haemorrhage
Burr Hole + craniotomy
IV mannitol to decrease ICP
156
Complications of SD haemorrhage
Brainstem herniation, respiratory arrest
157
Who gets extra dural haemorrhage the most
Young adults 20-30, male
158
Why does extradural haemorrhage risk decrease with age
Dura more firmly adhered to the skull
159
Progression of extra dural haemorrhage
Initial event then lucid interval (hours/ days/ weeks) then rapid deterioration
160
Sx of Extradural haemorrhage
Decrease in GCS
Cushing's triad/ papilledema
161
Why do you get rapid deterioration after lucid interval in ED haemorrhage
Blood clots become haemolysed and take up water. Increases volume in skull and thus ICP
162
What do you see on NCCT head in extradural haemorrhage
Lens-shaped hyperdense bleed.
Contained to suture lines
Midline shift
163
Treatment for ED haemorrhage
Surgery. IV mannitol to decrease ICP
164
UMN lesion signs (not arm vs legs)
Hypertonia, rigidity, spasticity
Hyperreflexia
No fasciculation
Babinski +ve
165
How does power differ in extensor/ flexor in arms/ legs
Arm:- Flexor> extensor
Leg:- Extensor> flexor
166
LMN lesion signs
Hypotonia+ muscle wasting
Hypoflexia
Fasciculations
Babinski -ve
Generally decreased power
167
RF for MND
Male, fHx, older age
168
What mutation is present in motor neuron disease
SOD-1 mutation
169
What does MND never affect
Eye muscle:- MS +MG do
Sensory function:- MS +polyneuropathies do
Sphincters
170
Types of MND
Amyotrophic lateral sclerosis MC
Progressive Muscular atrophy
Primary lateral Sclerosis
Progressive Bulbar Palsy
171
What cranial nerves are affected in bulbar palsy
CN9-12
172
Which MND has the worst prognosis
Progressive bulbar palsy as big chance of resp failure
173
What investigation can you perform in MND and what does it show
Electromyography:- Fibrillation potentials
174
Management for MND
Riluzole (antiglutaminergic) :- slows progression
Non-invasive ventilation used at home to support breathing at night
175
Complications of MND
Resp failure, aspiration pneumonia, swallowing failure
176
Is meningitis a notifiable disease
Yes
177
Most common cause of meningitis
Viral (Enteroviruses, HSV-2, V2V)
178
Most severe cause of meningitis
Bacterial (S. pneumoniae + N, meningitides)
179
RF for meningitis
Extremes of age
Immunocompromised
Crowded area
Not vaccinated
180
What bacteria most common in mengingitis in neonates (+ others)
Group B alpha haemolytic strep (S. agalactia)
Listeria, E. Coli, S. pneumaniae
181
Causes of meningitis in infants (3m to 6y)
S. Pneumoniae
N. Meningitidis
H. Influenza (less common due to vaccine)
182
Causes of meningitis in adults (6-60)
S. pneumonia
N. Meningitidis
183
Causes of meningitis in elderly 60+
S. pneumonia
N. meningitides
184
Why is group B alpha haemolytic strep the most common cause of meningitis in neonates
Colonisies matenral vagina
185
Main Sx of N. meningitidis
Non-blanching purpuric rash
186
What type of bacteria is N. meningitidis
Gram -ve diplococci
187
What type of bacteria is S. pneumoniae
Gram +ve diplococci in chains
188
What type of bacteria is group B strep
Gram +ve cocci in chains
189
What type of bacteria is Listeria monocytogenes
Gram +ve bacillis
190
Where can Listeria be found
Cheese
191
What does PCV vaccine protect against
S. pneumoniae
192
Symptoms of meningitis
Headache, neck stiffness, photophobia
193
Signs in meningitis
Kernig:- cant extend knee when hips flexed
Brudzinski:- When neck flexed, knees +hips automatically flex)
194
What investigation do you carry out in suspected meningitis
Lumbar puncture from L3/4 and CSF analysis
195
When is a lumbar puncture contraindicated
When ICP is high
196
CSF analysis results on bacterial infection
High opening pressure
Appearance:- cloudy yellow
WCC:- Raised neutrophils
Protein:- High
Glucose vs serum levels:- low (<50%)
197
CSF analysis results of viral infection
Normal opening pressure
Appearance:- Clear/ Normal
WCC:- Raised lymphocytes
Protein:- Normal
Glucose vs serum levels:- >60%
198
CSF analysis of Fungal infection
Raised opening pressure
Appearance:- Cloudy
WCC:- raised lymphocytes
Protein:- Raised
Glucose vs serum levels:- low <50%
199
Treatment for bacterial meningitis in hospital
Ceftriaxone/ cefotaxime + Steroids (dexamethasone)
Amoxicillin covers Listeria
200
Treatment if a patient presents to GP with non-blanching rash + meningococcal septicemia suspected
IM Benzylpenicillin + immediate hospital referral
201
Management of close contact of meningitis infection
7+ dasy
One off dose ciprofloxacin
202
Why do you give steroids in meningitis
Reduce frequency and severity of hearing loss
203
Treatment for herpes simplex virus meningitis
Aciclovir
204
Complications of meningitis
Disseminated intravascular coagulation
Waterhouse friedrichsen syndrome
205
What is waterhouse friedrichsen syndrome
Adrenal insufficiency cause by intra adrenal haemorrhage as a result of meningococcal DIC
206
What is most common cause of encephalitis
Herpes simplex virus 1
207
Other than HSV, what can cause encephalitis
CMV, EBV, HIV, Toxoplasmosis (close contact with cats)
208
RF for encephalitis
Immunocompromised
Extremes of age
209
Sx of encephalitis
Fever, headache, encephalopathy, focal neurology (temporal lobe most commonly affected)
210
Investigations to perform in encephalitis
Lumbar puncture and send CSF for PCR
CT scan is LP contraindicated
Then MRI
211
What is the treatment for Encephalitis?
Acyclovir (very good vs HSV)
Ganciclovir vs Cytomegalovirus
212
Are primary or secondary brain tumours more common?
Secondary
213
What are examples of primary brain tumours with the most common
Astrocytoma (90%)
Oligodendrocytoma
Meninggioma + Schwannoma
214
Causes of secondary brain tumour with most common
NSCLC (MC)
Brain
Melanoma
RCC
Gastric cancer
215
Sx of astrocytoma
Raised ICP (Cushing's triad)
Focal neurology
Epileptic seizures
Lethargy + weight loss
CN6 Palsy
Pappilodema
216
1st line investigation for astrocytoma
MRI to locate tumour
217
After you've located the astrocytoma, what is the next investigation
Biopsy to determine grade (1-4)
218
Treatment for astrocytoma
Surgery
Chemo (before/during/after surgery)
Steroids may help
219
What are Sx in Brown Sequard
Ipsilateral motor weakness
Ipsilateral DCML dysfunction (proprioception, 2-point distinction)
Contralateral spinothalamic dysfunction (pain)
220
What is Myasthenia Gravis
Autoimmune Response vs NMJ postsynaptic receptors
221
What type of hypersensitivity is Myasthenia Gravis
Type 2
222
The typical age of presentation with myasthenia gravis
Women under 40 (more related to autoimmune disease) or Men over 60 9more related to thymoma)
223
What cancer is Myanthesia Gravis associated with
Thymoma
224
What are 2 antibodies present in myasthenia gravis and which is more prevalent
Anti Ach-R 85%
Anti MuSK 15%
225
How do anti-Ach-R antibodies cause Myanthesia Sx
Bind to postsynaptic receptor + inhibit competitively Ach binding (more binding with exertion)
Activate compliment system leading to damage to cells at the postsynaptic membrane.
226
How to do Anti-MuSK antibodies cause Sx in myasthenia Gravis
MuSK helps synthesise Ach-R so less Ach-R expression
227
Sx of Myasthenia Gravis
Worse later on in the day/ with exertion, starts @ head + neck and progresses to the lower body
Weak eye muscles (Diplopia)
Ptosis
Myasthenic Snarl (difficult smiling)
Jaw Fatiguability
Swallowing difficulty (bulbar weakness)
Speech Fatigubailty
228
What test can you carry out to aid in diagnosis of Myasthenia Gravis
Tensilon/ Edrophonium test
Administer edrophonium (fast acting Ach ase inhibitor) then increase in muscle power for a few secs
229
Other than serology/ edrophonium what should you do in MG
CT thyroid
230
1st line treatment for MG
ACHase inhibitors; Pyradostigmine/ Neostigmine
231
2nd line treatment for MG
Immunosuppression (steroids)
232
Complication of MG
Myasthenic crisis; Acute Sx worsening with severe resp weakness
233
How to treat a myasthenic crisis
Plasma exchange + IV Ig
BIPAP for resp failure
234
Classic age of onset for GBS
Male, 15-30 or 50-70
235
MC cause of GBS
C. Jejuni
236
What is the pathophysiology of GBS
Molecular mimicry, organism antigens very similar to those on Schwann cells. Results in antibody production vs Schwann cell and leads to demyelination and acute polyneuropathy
237
Sx of GBS
Post-infection presents with ascending symmetrical muscle weakness + paralysis.
Loss of deep tendon reflexes
Autonomic involvement in 50%
238
Investigations to perform in GBS
Nerve conduction studies
LP at L3/4:- raised protein + normal WCC
(Inflammation but no infection)
239
Treatment for GBS
IV Ig for 5 days + plasma exchange
240
When is IV Ig contraindicated
When a patient has IgA deficiency as allergic reaction
241
What is Wernicke's Encephalopathy
Reversible acute emergency due to severe B1 (thiamine) deficiency
242
Main cause of Wernikes Encephalopathy
Alcohol
243
Sx of Wernikes Encephalopathy
Ataxia, Confusion, Opthalmoplegia
244
Dx of Wernikes Encephalopathy
Clinically recognised and supported with Macrocytic anemia and deranged LFTs
245
Acute treatment for Wernikes Encephalopathy
Parenteral Pabrinex (vit B1 + others) for 5 days
246
Prophylaxis Management for Wernikes Encephalopathy
Oral Thiamine
247
Complication of Wernikes Encephalopathy
Korsakoff Syndrome:- When WE is left too long without Tx, Severe Thiamine deficiency
Hig levels of memory loss. Irreversible damge
248
Inheritance pattern for Duchenne Muscular Dystrophy
X linked recessive
249
What happens in Duchenne Muscular Dystrophy
Muscel replaced with adipose tissue
250
Sx of Duchene muscular Dystrophy
Difficulty getting up from laying down (Growers sign) and skeletal deformities (scoliosis)
251
Dx of Duchenne Muscular Dysttrophy
Prenatal tests and DNA genetic tests
252
Tx for Duchenne
Supportive
253
What is reactivation of VZV known as
Shingles
254
Sx of Herpes Zoster (Chicken pox/ Shingles)
Painful rash confined to a dermatome
255
Treatment for Herpes zoster
Oral Aciclovir
