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MSRA > Neuro > Flashcards

Neuro Flashcards

1
Q

Migraine Tx

A

1 - Triptan (5HT-1 ago) + NSAID/paracetamol
(if 12-17 - consider intranasal triptan)

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2
Q

Migraine prophylaxis

A

Popranolol OR
Topimarate (avoid in women of childbearing age)

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3
Q

Migraine Dx criteria

A

A - at least 5 attacks
B - headache 4-72 hrs
C - 2 characteristics; unilateral, pulsating, mod/severe pain. aggravated by movement
D _ asso with N/V or photo/phonophobia
E - nil other cause

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4
Q

Parkinsons disease Tx

A

if the motor symptoms are affecting the patient’s quality of life: levodopa
if not: dopamine agonist (non-ergot derived), levodopa or MAO-B inhibitor

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5
Q

Parkinsons D - Symptoms persist despite optimized Levodopa OR patient dev dyskinesia - Tx?

A

Add non-ergot derived DA, MAO-Bi, COMTi

Non-ergot derived DA - ropinarole
ergot-derived DA (if symptoms not controled with ^): brominodine, carbergoline,
MAO-Bi - selegiline
COMTi - entacapone, tolcapone

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6
Q

Levodopa common adverse effects

A

Dry mouth, anorexia, palpitations, Postural HTN, psychosis
on-off phenomenon
Dyskinesia at peak dose

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7
Q

CN VI palsy

A

Abducens
Defect in abduction - horizontal diplopia

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8
Q

CN IV palsy

A

Trochlear - commonly caused by head trauma
-> vertical diplopia (double vision when going down stairs, worse when looking away from side of lesions)

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9
Q

CN III palsy

A

Oculomotor
Down and out, ptosis, dilated + fixed pupil

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10
Q

confusion, gait ataxia, disorientation, periph neuropathy, nystagmus

A

Wernickes encephalopathy (thiamine def)
Loss of reflexes

Dev to Korsakoffs P (confabulation + amnesia)

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11
Q

Contralateral hemiparesis and sensory loss, legs > arms

A

ACA stroke

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12
Q

Contralateral hemiparesis and sensory loss, arms> legs
Contralateral homonymous hemianopia
Aphasia

A

MCA stroke

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13
Q

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

A

PCA stroke

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14
Q

Down/out dilated pupil
Contralateral weakness

A

Weber’s syndrome
(branches of the posterior cerebral artery that supply the midbrain)

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15
Q

Unilat facial pain and temperature loss
Contralateral limb/torso pain and temperature loss
Ataxia, nystagmus

A

lateral medullary syndrome / Wallenberg syndrome
(Posterior inferior cerebellar artery)

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16
Q

Transient loss of vision in one eye - curtain coming down

A

Amaurosis Fugax
Retinal/opthalmic artery stroke

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17
Q

Stroke - > locked in syndrome

A

Basilar artery

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18
Q

isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

A

Lacunar stroke
Common sites = basal ganglia, thalamus, internal capsule `

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19
Q

Tx for tonic clonic siezures

A

Male - Na Val
Female - lamo/lev

Na Val -> Neural tube defect

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20
Q

Tx for focal seizure

A

1 - lamo/lev
2 - Carbamaz

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21
Q

Tx for absence seirzures

A

1 - Ethosuximide
2 - Men = Na Val, Women = Lamo/lev

Carbamaz may make seizures worse

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22
Q

Tx for myoclonic seizures

A

Male - Na Val
Women - Lev

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23
Q

Tx for tonic/atonic seizures

A

Male = Na Val
Woman = Lamo

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24
Q

Childhood seizures (tonic-clonic) that happen at night

A

benign rolandic epilepsy
Nil tx - stop by adolescence

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25
Epilepsy meds in pregnancy
Na Val -> neural tube defects (stop over 3 mo - stay on contraception while weaning) Phenytoin - asso with cleft palate Best = lamo (or sometimes lev) Can consider stopping if fit free for 2 years All women on 5mg folic acid
26
Tx for MS
Acute relapse - high dose steroids for 5 days Reducing risk of relapse - Natalizumab, To Tx spasticity - Baclofen/gabapentin
27
Small pupil, ptosis, sunken eye (enopthalmos), lack of sweating
Horners syndrome
28
Child (3-12 mo) sudden, brief spasms/ seizures where drawn up legs, occur in clusters
West syndrome/infantile spasms Asso with dev delay Tx ACTH hormone
29
Adolescent - sudden brief jerks of limbs, often in the morning
Juvenile myoclonic epilepsy (janz syndrome) triggered by sleep dep, flashing lights, stress/alco
30
progressive asymmetrical limb weakness
MND
31
MND classic features
Asymetrical limb weakness Mix of UMN and LMn signs Wasting of small hand muscles + progressive atrophy Fasciculations Eyes spared
32
10-15yrs, absent ankle jerks, progressive ataxia, upgoing plantars, bent spine
Friedrichs ataxia Auto R Also assoc with kyphoscoliosis, cardiomyopathy, HOCM, DM, high arched palate
33
Middle-aged, ireg muscle movements, personality changes
Huntingtons - typically presents > 35ys Chorea, personality changes, dystonia Auto Dom Defect in gene on Chr 4
34
New onset liver disease with neurological signs / parkinsonism
Wilsons disease: Hep/cirrhosis, basal ganglia degen, renal tubular acidosis, blue nails + kayser Fleischer rings `
35
Ix + Tx wilsons disease
Ix - reduced serums ceruloplasmin / reduce serum total copper (free copper increased) Tx = penicillamine
36
Head inj - lucid period then deterioration
Extradural - lens shaped haematoma
37
Fluctuating consciousness, focal neurological deficit, common in elderly #
Subdural - may be Hx of head inj but may not remember Gradual decline in consciousness Papilloedema, pupil changes, gait abn, hemiparesis/hemiplegia Due to rupture of bridging veins CT - crescent
38
Loss of digital dexterity, pain, numbness, urinary/faecal incontinence
DCM +ve Hoffmans sign Ix - MRI cervical spine Tx - refer to spinal services for decompressive surgery (can represent)
39
Tx for acute ischaemic stroke
Aspirin 300mg Asap If chol > 3.5 - start statin Thrombolysis (alteplase) if administered within 4.5hrs of onset and imaging excludes haemorrhagic (BP should be <185/110) Thrombectomy if within 6 hours of inset if imaging confirmed occlusion of proximal anterior/posterior circulation
40
Unable to raise forhead, altered taste,. post-auricular pain, hyperacusis
Bells palsy Tx - prednisolone + eye care
41
Tx for cluster headache
Acute Tx - 100% O2. Subcut Triptan Prophylaxis - verapamil
42
Parkinsons disease features
Bradykinesia, short shuffling gait, difficult initiating movement Tremor - pill rolling, worse at rest, improvement by voluntary movement Lead pipe rigidity, cogwheeling NB - natural PD - asymetrical Drug induced PD - rapid onset rigidity/tremor, bilat
43
Phenytoin SEs
Used to Tx seizures SEs P450 inducer Dizziness, diplopia, slurred speech, confusion Gingival hyperplasia Megaloblastic anaemia + periph neuropathy Hepatitis, dupytrens contracture Teratogenic, cleft palate, congen heart disease
44
Tx for trigeminal neuralgia
Carbamazepine
45
Essential tremor ft + Tx
Bilat postural trmor - worse when arms extended Improved by alcohol + rest Tx = propranolol
46
Tx for neuropathic pain
Amitriptyline, duloxetine, gabapentin, pregabalin Tramadol = rescue therapy
47
homonous hemianopia - lesion site?
asymmetrical defects: lesion of the optic tract symmetrical/complete defects: lesion of optic radiation or occipital cortex macula sparing: lesion of occipital cortex
48
Homonous quadratonopia - lesion sites
Parietal - inferior Temporal - Superior
49
Bitemproal hemianopia - lesion site
lesion of optic chiasm upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
50
Aphasia - sentences that make no sense, word substitution and neologisms but speech remains fluent. Understanding impaired
Wernicke's (receptive) aphasia 'word salad' lesion of the superior temporal gyrus
51
Aphasia - Speech is non-fluent, laboured, and halting. Repetition is impaired. Comprehension normal
Broca's (expressive) aphasia Lesion of inferior frontal gyrus
52
Aphasia - Speech is fluent but repetition is poor. Aware of the errors they are making. comprehension normal
Conduction aphasia - stroke affecting the arcuate fasiculu
53
Injury -> foot drop
Common peroneal nerve lesion (injured at neck of femur) -> weakness of foot dorsiflexion (toes up), and eversion, sensory loss over dorsum
54
Dermatomes of hand
C6 = thumb + index C7 = middle finger + palm C8 = ring + little finger
55
Dermatomes of abdomen
T4 - nipple (the teat pore) T10 - umbilicus (bellybuT10) L1 - Inguinal lig (1nguinal Lig)
56
Dermatomes of legs
L4 - knees (down on aLL 4s) L5 - big toe (largest of 5 toes) S1 - small toe (the Smallest 1)
57
DVLA - epilepsy + strokes
1st unprovoked/isolated seizure - 6 months off Multiple seizures - must be seizure free for 12 mo to apply Single explained syncope - off for 4 mo Single unexplained syncope - 6 mo 2 or more episodes - 12mo Stroke/TIA - 1 month Multiple TIAs - 3 months off
58
Pyrexia, muscle rigidity, HTN/tachycardia, agitated delerium
NMS Onset hours-days after med change Ix - raised CK Tx - stop antipsychotic, IVF
59
Nerve injury -> wrist drop
Radial nerve
60
Nerve injury -> claw hand
Ulnar nerve
61
Disorder where person believes a frienis d replaced by imposter
Capgras
62
Progressive muscle weakness in child 5-10, calf pseudohypertrophy
Duchenne muscular dystrophy X linked rec Gowers sign - swings arm,s to stand from squatted position Sometimes intellectual impairment wheelchair bound by 12, dead by 25 Becker - dev after 10y, no intel imp
63
fever, headache, psychiatric symptoms, seizures, vomiting
Encephalitis HSV-1 = 90% of cases Start Iv aciclovir
64
Overweight female, headache, vision changes
Idiopathic intracranial hypertension Tx - weight loss, acetazolamide
65
Drugs that exacerbate MG
Penicillamine, Quinidine, Beta-blockers, Lithium, phenytoin, abx
66
Headache, vomiting, wide pulse pressure, ireg breathing, bradycardia
Raised ICP - cushings triad
67
Injury -> loss of ankle reflex, sensory loss below knee, paralysis of knee flexion
Sciatic nerve lesion Commonly inj in femur neck fractures/ posterior hip dislocation
68
CIs for triptans
Hx of or Risk factors for ischaemic heart disease or cerebrovascular disease
69
Depigmented spots, rough patches of skin over lumbar spine, developmental delay, epilepsy
Tuberous sclerosis
70
Alzheimers Tx
Ach inh - Donepezil, galantamine, rivastigmine NMDA R anta - memantine NB - donepezil CI in bradycardia
71
Gradual reduction in memory, personality changes
Frontotemporal lobar degen
72
Progressive cog impairment, hallucinations, fluctuating cognition
Lewy body dementia

MSRA (21 decks)

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