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Finals passmed > Neuro > Flashcards

Neuro Flashcards

1
Q

What is the triad of symptoms of Wernicke’s encephalopathy?

A

Confusion, ataxia and nystagmus

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2
Q

What causes Wernicke’s encephalopathy?

A

thiamine deficiency (mostly secondary to chronic alcohol consumption)

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3
Q

What is the management of Wernicke’s encephalopathy?

A

IV pabrinex (B and C vitamins)

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4
Q

What is Korsakoff’s syndrome?

A

Wernicke’s encephalopathy - if untreated - causes amnesia (antero and retrograde) and confabulation

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5
Q

What medications are used for migraine prophylaxis?

A

Propranolol or topiramate (in asthmatics but not in women of child-bearing age)

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6
Q

What is the first line treatment for an acute migraine episode?

A

oral triptan and NSAID/paracetamol

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7
Q

What is the most common presentation of a posterior communicating artery aneurysm?

A

painful third nerve palsy

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8
Q

What is the management of idiopathic intracranial hypertension?

A

Acetazolamide (carbonic anhydrase inhibitor)

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9
Q

What are the indications for doing a CT scan within 1 hour of a head injury?

A
  • GCS < 13 initially or <1 after 2 hrs
  • skull fracture
  • seizure
  • focal neurological signs
  • more than one episode of vomiting
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10
Q

When would you do a CT scan within 8 hours after a head injury?

A
  • age > 65
  • history of bleeding/clotting disorders
  • > 30 mins of retrograde amnesia
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11
Q

What imaging do you use to diagnose MS?

A

MRI brain and orbits with contrast

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12
Q

What are the features of optic neuritis?

A
  • unilateral decrease in visual acuity and colour discrimination
  • pain worse on movement
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13
Q

What is the management of optic neuritis?

A

high dose steroids

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14
Q

What investigations should you do for a TIA?

A

Carotid artery doppler, CT/MR angiography

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15
Q

What is tardive dyskinesia?

A

involuntary repetitive movements affecting any part of the body, but mainly face and tongue - s/e of long term anti-psychotic use

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16
Q

What is acute dystonia?

A

Occurs within days of starting or increasing antipsychotic dose. Sustained muscle contractions leading to abnormal postures

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17
Q

What are the features of temporal arteritis?

A

patient >60, rapid onset < 1 month, headache, jaw claudication, tender temporal artery, visual changes

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18
Q

What may you see on temporal artery biopsy of someone with temporal arteritis?

A

skip lesions

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19
Q

What is the management of temporal arteritis?

A
  • urgent high-dose glucocorticoids
  • urgent ophthalmology review (if visual symptoms)
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20
Q

What causes visual loss in temporal arteritis?

A

anterior ischaemic optic neuropathy - swollen pale disc ad blurred margins on fundoscopy

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21
Q

Which ocular cranial nerve palsy is commonly found in patients with raised ICP?

A

oculomotor - down and out

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22
Q

What is the first line antibiotic used for bacterial meningitis?

A

IV ceftriaxone or cefotaxime (50yrs + those plus amoxicillin)
IV dexamethasone

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23
Q

What is the management of raised ICP?

A
  • get critical care input
  • secure airway, high flow oxygen
  • IV access - bloods and cultures
  • IV dexamethasone
  • IV abx if needed
24
Q

Which antibiotic is used for listeria meningitidis?

A

IV amoxicillin + gentamicin

25
Q

Which antibiotic should be used as prophylaxis for contacts of meningitis?

A

ciprofloxacin

26
Q

What is the initial management of an acute ischaemic stroke?

A

exclude haemorrhagic stroke, then 300mg aspirin.
If within 4.5 hours - thrombolysis (alteplase)
If within 6 hours - thrombectomy if in proximal anterior circulation

27
Q

What is used for the secondary prevention of strokes?

A

clopidogrel
If not aspirin plus dipyramidol

28
Q

What is the first line anti-coagulant for stroke prevention?

A

DOACs - apixiban/rivaroxiban

29
Q

How do you manage an aneurysm following a subarachnoid haemorrhage?

A

Aneurysm coiling

30
Q

What are the features of an extradural haematoma?

A
  • acceleration-deceleration injury/blow to side of head
  • may have a lucid interval
31
Q

Which blood test can differentiate a seizure and a functional seizure?

A

Prolactin (10-20 mins after) raised in epileptic seizure

32
Q

What is the treatment of a brain abcess?

A

IV ceftriaxone/other cef, plus metronidazole

33
Q

What is the typical presentation of a pontine haemorrhage?

A

reduced GCS, paralysis, bilateral pin point pupils

34
Q

What are the features of Creutzfeldt-Jakob disease?

A

Rapid onset dementia and myoclonus due to prion proteins

35
Q

When do you get autonomic dysreflexia?

A

spinal cord injury above T6

36
Q

What is the cushing’s triad?

A

bradycardia, hypertension, bradypnoea

37
Q

What is the management of tonic-clonic epilepsy?

A
  • levetiracetam or lamotrigine in women of childbearing age
  • sodium valproate in everyone else
38
Q

What is the management of absence seziures?

A

1st line: ethosuximide
2nds: men: sodium valproate
women: lamotrigine or levetiracetam

39
Q

What is the management of myoclonic seizures?

A

men: sodium valproate
women: levetiracetaM

39
Q

what is the management of tonic/atonic seizures?

A

Men: sodium valproate
Women: lamoTrigine

40
Q

What is cataplexy?

A

sudden, transient loss of muscular tone when experiencing strong emotions

41
Q

What is weber’s syndrome and how does it present?

A

Midbrain stroke - ipsilateral CN III palsy with contralateral hemiparesis - may have dilated unresponsive pupils if bad

42
Q

What is the management of viral meningitis?

A

supportive - antivirals don’t really help

43
Q

What medication is typically used for thrombolysis in an ischaemic stroke?

A

Alteplase

44
Q

What time frame can you give thrombolysis and thrombectomy?

A

thrombolysis - within 4.5 hours
thrombectomy - within 6 hours or within 24 hours if chance to salvage brain tissue

45
Q

Which medication is used to prevent vasospasm in subarachnoid haemorrhage?

A

CCB - nimodipine

46
Q

Does a diabetic oculomotor palsy affect the pupil?

A

Not always - parasympathetic fibres are less affected by ischaemia

47
Q

What is used for long term prophylaxis of cluster headaches?

A

CCBs like verapamil

48
Q

What is the management of raised intracranial pressure?

A

elevate head to 30 degrees, IV mannitol, controlled hyperventilation (low pCO2 causes vasoconstriction in brain), removal of CSF

49
Q

What is cushings triad?

A

widening pulse pressure, bradycardia, irregular breathing

50
Q

Which antiemetic is used for intracranial causes of nausea and vomiting?

A

Cyclizine - can also give dexamethasone alongside

51
Q

What are the features of degenerative cervical myelopathy?

A

Can have pain/loss of function/loss of sensation/autonomic function - usually progressive
+ve hoffman’s sign - flick finger on one hand, causes reflex twitching of finger on other hand

52
Q

What is cushings triad?

A

Hypertension, bradycardia and irregular breathing - raised ICP

53
Q

When is intraventricular haemorrhage most likely to occur?

A

Premature babies

54
Q

What investigation do you do after a subarachnoid haemorrhage seen on a CT scan?

A

CT angiogram

55
Q

Which type of weighted MRI is water white?

A

T2 weighted - H2O is white

56
Q

Which cerebral event causes torsades de points?

A

SAH

Finals passmed (23 decks)

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