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Yr 4 - PassMed Corrections > Neuro > Flashcards

Neuro Flashcards

1
Q

Infarction of which artery can lead to locked in syndrome?

A

Basilar artery

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2
Q

Most important risk factor of a haemorrhagic stroke?

A

HTN

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3
Q

Presentation of Wallenberg syndrome (lateral medullary syndrome)?

A

DANVAH

D - Dysphagia (ipsi)
A - Ataxia (ipsi)
N - Nystagmus (ipsi)
V - Vertigo (ipsi)
A - Anaesthesia i.e. sensory loss (ipsi face, contra body)
H - Horner’s syndrome (ipsi)

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4
Q

What is thrombolysis done with in ischaemic stroke?

A

Alteplase

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5
Q

What is involved in 2ary prevention of ischaemic stroke (not due to AF)?

A

Following 2 weeks aspirin 300mg:

1) Clopidogrel 75mg lifelong (or aspirin + dipyridamole)

2) Atorvastatin 20-80mg

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6
Q

When must patients have presented within to have thrombolysis in ischaemic stroke?

A

4.5 hours of onset of stroke symptoms

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7
Q

A stroke affecting which artery presents with oculomotor nerve palsy (‘down and out’)?

A

Weber’s syndrome –> branches of posterior cerebral artery that supply the midbrain.

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8
Q

Referral for specialist assessment in TIA:

a) <7 days since TIA
b) >7 days since TIA

A

a) within 24 hours
b) within 1 week

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9
Q

Mechanism of alteplase?

A

Tissue plasminogen activator

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10
Q

What is a posterior inferior cerebral artery infarct also known as?

A

Lateral medullary syndrome / Wallenberg’s

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11
Q

When is a carotid endarterectomy considered in TIA or stroke?

A

Should only be considered if carotid artery stenosis is >70%

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12
Q

Mx of TIA?

A

Aspirin 300mg 2 weeks

Followed by lifelong clopidogrel 75mg

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13
Q

What scoring system measures disability or dependence in ADLs in stroke patients?

A

Barthel index

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14
Q

What blood tests are involved in ‘young’ people with stroke?

i.e. <55 y/o with no obvious cause of stroke

A

Thrombophilia & autoimmune screening

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15
Q

When is thrombectomy considered in ischaemic stroke (alongside thrombolysis)?

A

If <4.5h from onset AND confirmed occlusion of the proximal anterior circulation

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16
Q

Most likely mx of symptomatic chronic subdural bleeds?

A

Burr hole evacuation

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17
Q

When is an S3 heart sound normal?

A

<30 y/o

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18
Q

What medications can be used in the prophylaxis of migraines? (3)

A

1) propanolol

2) amitriptyline

3) topiramate

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19
Q

What condition is trigeminal neuralgia associated with?

A

MS

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20
Q

Which antiepileptic can cause SIADH?

A

Carbamazepine

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21
Q

1st line antiepileptic for focal seizure?

A

Lamotrigine or levetiracetam

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22
Q

When are antieplileptics started in the majority of cases?

A

After the 2nd epileptic seizure

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23
Q

What is involved in the mx of infantile spasms? (2)

A

1) ACTH

2) Vigabatrin

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24
Q

What condition may atonic seizures be indicative of?

A

Lennox-Gastaut syndrome

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25
Q

What is the characteristic EEG feature in infantile spasms?

A

Hypsarrhythmia

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26
Q

Mechanism of carbamazepine?

A

Binds to sodium channels, increasing their refractory period.

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27
Q

What are key contraindications to triptans?

A

Related to vasoconstriction caused by triptans:
- HTN
- Coronary artery disease
- Previous TIA/stroke/MI

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28
Q

1st line drug for prophylaxis of cluster headaches?

A

Verapamil

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29
Q

Features of hemiplegic migraines?

A

1) Hemiplegia
2) Ataxia (loss of coordination)
3) Impaired consciousness

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30
Q

What is familial hemiplegic migraine?

A

An autosomal dominant genetic condition that is characterised by hemiplegic migraines that run in families.

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31
Q

Management of an acute attack of a cluster headache?

A

1) High flow O2

2) Triptans

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32
Q

What vitamin can be used in the non-pharmacological prophylaxis of migraines?

A

Vitamin B2 (riboflavin)

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33
Q

Investigation of choice in cluster headaches?

A

MRI with gadolinium contrast

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34
Q

Management of acute migraine?

A

Often retreating to a dark, quiet room and sleeping.

Medical:
1) NSAIDs (e.g., ibuprofen or naproxen)
2) Paracetamol
3) Triptans (e.g., sumatriptan)
4) Antiemetics if vomiting occurs (e.g., metoclopramide or prochlorperazine)

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35
Q

what are hormonal headaches related to?

A

Low oestrogen

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36
Q

How does sodium valproate interact with the P450 system?

A

Inhibitor

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37
Q

What is 1st line for chronic or frequent tension headaches?

A

Amitriptyline

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38
Q

What are the 4 groups of treatment options in PD?

A

1) levodopa (+ peripheral decarboxylase inhibitors)

2) Dopamine agonists

3) COMT inhibitors

4) MAO-B inhibitors

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39
Q

Role of COMT inhibitors in PD?

A

COMT enzyme normally breaks down levodopa.

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40
Q

Which class of drug in PD provides the most improvement in motor symptoms?

A

Levodopa

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41
Q

Role of monoamine oxidase B inhibitors in PD?

A

MAO-B enzyme normally breaks down dopamine.

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42
Q

Give 3 examples of dopamine agonists used in PD

A

1) Bromocriptine

2) Cabergoline

3) Pergolide

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43
Q

Triad of features seen in multiple system atrophy?

A

1) Parkinsonism

2) Autonomic dysfunction e.g. postural hypotension, ED

3) Cerebellear dyfunction: ataxia

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44
Q

Give 2 examples of Monoamine oxidase-B inhibitors used in PD?

A

Selegiline
Rasagiline

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45
Q

In what type of dementia can delusions be seen (e.g. Capgras syndrome)?

A

LBD

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46
Q

What can be a key side effect of levodopa at peak dose?

A

Dyskinesia e.g. dystonia, chorea and athetosis (involuntary writhing movements)

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47
Q

What is a notable side effect of prolonged use of dopamine agonists e.g. bromocriptine?

A

Pulmonary fibrosis

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48
Q

Hz of tremor in PD vs BET?

A

PD - 3-5 hertz

BET - 6-12 hertz

49
Q

Why is levodopa a time sensitive medication?

A

Due to risk of acute dystonia if stopped abruptly (e.g. if admitted to hospital).

50
Q

PD medication can be associated with impulse control disorders.

These can occur with any dopaminergic therapy but are more common which which class of drug?

A

Dopamine agonists

51
Q

Give an example of a COMT inhibitor used in PD

A

Entacapone

52
Q

What may be given to manage dyskinesia associated with levodopa?

A

Amantadine (a glutamate antagonist)

53
Q

What enzyme breaks down levodopa?

A

COMT

54
Q

What type of headache commonly develops after a LP?

A

Low pressure headache (due to removal of some CSF which reduces the pressure around the brain).

55
Q

Mx of low pressure headache?

A

1) supportive initially (analgesia, rest)

2) IV fluids, caffeine

3) Blood patch

56
Q

How can ‘wearing off’ phenomenon in levodopa be managed?

A

By increasing the frequency of levodopa administration.

57
Q

Which type of dementia typically presents with fluctuating cognition in contrast to other forms of dementia?

A

LBD

58
Q

What should be considered in patients who remain conscious during whole-body convulsions, exhibit no post-ictal state and can remember what happened?

A

psychogenic non-epileptic seizure

59
Q

Compensatory tachycardia in postural hypotension caused by:

a) Parkinson’s disease

b) levodopa

A

a) no compensatory tachycardia due to autonomic dysfunction

b) compensatory tachycardia

60
Q

Is the mirena coil affected by enzyme inducers?

A

No

61
Q

What class of medication is ropinerole?

A

Dopamine agonist

62
Q

What class of drug is pizotifen?

A

Serotnin (5-HT3) antagonist

63
Q

Indication of pizotifen?

A

primarily as a preventive to reduce the frequency of recurrent migraine headaches.

64
Q

Which smoking cessation medication reduces the seizure threshold?

A

Bupropion

65
Q

Which smoking cessation medication is asscoiated with an increased risk of suicide?

A

Varenicline

66
Q

What steroid is indicated in acute MS flare?

A

Methylprednisolone

67
Q

What class of medciation is solifenacin?

A

Antimuscarinic

68
Q

What are 2 important investigations in MS?

A

1) MRI scan

2) LP - look for oligoclonal bands

69
Q

Mx of spasticity in MS? (2)

A

1) Baclofen

2) Gabapentin

70
Q

What is Romberg’s test?

A

Positive test is an inability to maintain an erect posture for >60s with eyes closed.

71
Q

What can be used to support breathing when the respiratory muscles weaken in MND?

A

NIV (usually BiPAP)

72
Q

Lhermitte’s sign can be seen in MS.

What is this?

A

paraesthesia in limbs on neck flexion

73
Q

Uhthoff’s phenomenon can be seen in MS.

What is this?

A

Worsening of vision following rise in body temp (e.g. after hot bath)

74
Q

Which MND carries the best prognosis?

A

Progressive muscular atrophy (affects LMNs only)

75
Q

What is the most common type of MND?

A

Amyotrophic lateral sclerosis (ALS)

76
Q

What is preferred way to support nutrition and has been associated with prolonged survival in MND?

A

PEG feeding

77
Q

Management of oscillopsia in MS?

A

Gabapentin (or memantine)

78
Q

What does Lhermitte’s sign indicate in MS?

A

Disease in the cervical spinal cord in the dorsal column.

79
Q

How does optic neuritis typically present? Features?

A

Unilateral reduced vision:

1) Central scotoma

2) Pain on eye movement

3) Impaired colour vision

4) RAPD

80
Q

What may an electromyography show in MND?

A

a reduced number of action potentials with increased amplitude

81
Q

1st line mx in slowing disease progression in MND?

A

Riluzole

82
Q

What type of incontinence can be seen in MS?

A

Urge incontinence

Can use antimuscarinics e.g. solifenacin (get bladder scan first)

83
Q

What is often used 1st line for preventing MS relapse?

A

Natalizumab

84
Q

What are fasciculations?

A

Spontaneous involuntary muscle contractions and relaxations - due to LMN lesion.

Think MND.

85
Q

MRI with or without contrast in MS?

A

With contrast - to view demyelinating lesions.

86
Q

What is myasthenia gravis?

A

An autoimmune disorder caused by Abs directed against the ACh receptor at the NMJ.

This causes muscle weakness & fatigability.

87
Q

Muscle weakness in myasthenia gravis vs Lambert Eaton syndrome?

A

Lambert Eaton - proximal muscle weakness that improves with activity

Myasthenia gravis - weakness improves with rest

88
Q

What tumour may be associated with myasthenia gravis?

A

Thymoma

89
Q

What is the most important examination finding to check before starting triptans for migraines?

Why?

A

BP

Contraindicated in HTN

90
Q

Which medication is used to treat the symptoms of Lambert-Eaton myasthenic syndrome?

A

Amifampridine

This increases ACh in the synaptic clefts of peripheral nerve endings.

91
Q

Give 3 drugs that can cause peripheral neuropathy

A

1) amiodarone
2) isoniazid
3) cisplatin

92
Q

What medications may be used to treat the symptoms of benign essential tremor? (2)

A

1) Propanolol
2) Primidone

93
Q

What groups of muscles tend to be most affected in myasthenia gravis? (2)

A

1) Proximal muscles of limbs (ascending i.e. affects legs first)

2) Small muscles of head and neck

94
Q

What tool gives a score based on the clinical features and duration to identify a stroke in A&E?

A

ROSIER

95
Q

What is the imaging investigation of choice in a suspected TIA?

A

Diffuse weighted MRI

96
Q

What medication may be used to slow the progression of the disease and extend survival by several months in amyotrophic lateral sclerosis (ALS)?

A

Riluzole

97
Q

What cholinesterase inhibitor prolongs the action of acetylcholine and improves symptoms in myasthenia gravis?

A

Pyridostigmine

98
Q

When should statins be started after stroke?

A

48h after stroke onset

99
Q

What questionnaire can be used to assess whether pain is neuropathic?

A

DN4

100
Q

What is the first-line medical treatment for Guillain-Barré syndrome?

A

IV immunoglobulins

101
Q

What type of dementia is motor neurone disease most associated with?

A

Frontotemporal

102
Q

What 3 complications can subclinical hyperthyroidism lead to?

A

1) AF
2) Osteoporosis
3) Dementia

103
Q

Mechansim of bupropion?

A

Atypical antidepressant used for smoking cessation

Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist.

104
Q

How are triptans given in cluster headache?

A

SC

105
Q

What drug has the strongest evidence base for reducing relapse in multiple sclerosis?

A

Monoclonal antibodies e.g. natalizumab

106
Q

What is preferred drug for treatment of hyperthyroidism in pregnancy?

A

Propylthiouracil

107
Q

What score categorises patients into levels of frailty according to their function?

A

Rockwood frailty scale

108
Q

What can acute withdrawal of levodopa precipitate?

A

Neuroleptic malignant syndrome

109
Q

Which 2 dopamine agonists are most associated with pulmonary fibrosis?

A

Ergot derived:

1) Bromocriptine

2) Cabergoline

110
Q

What is cataplexy?

A

The sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened).

Features range from buckling knees to collapse.

111
Q

What condition is cataplexy strongly associated with?

A

Nacrolepsy

112
Q

What is the gold standard test for diagnosing venous sinus thrombosis?

A

MRI venography

113
Q

Following an SAH, how are most intracranial aneurysms now treated?

A

Coiling by an interventional neuroradiologist

114
Q

How can a head injury appear on an ECG?

A

‘Cerebral T waves’ –> global T wave inversion

115
Q

CT head scan is required within 8 hours for patients with a dangerous mechanism of injury.

What does this incliude?

A
  • Falling more than 1 metre
  • Falling from a height of 5 stairs or more
116
Q

Opening pressure on LP in SAH?

A

Normal or raised

117
Q

Next step in patients >65 y/o who experienced some loss of consciousness or amnesia following a head injury

A

CT scan within 8 hours

118
Q
A

Yr 4 - PassMed Corrections (36 decks)

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