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neuro Flashcards

1
Q

investigation for meningitis

A

LUMBAR PUNCTURE

CI if:
-signs of severe sepsis or rapidly evolving raash
-severe resp or cardiac compromise
-significant bleeding risk
-signs of raised ICP (e.g. focal neurological signs, papilloedema, continuous or uncontrolled seizures or GCS 12 or lower)

if CI- CT + treat with antibiotics

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2
Q

LP of bacterial meningitis

A

cloudy CSF
High protein
Low glucose (<40%)
High WCC (neutrophils)
Culture/ gam stain +ve

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3
Q

LP viral meninigitis

A

Clear appearance
Mildly raised or normal protein
Normal glucose
High WCC (lymphocytes)
Negative culture

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4
Q

order of management bacterial meningitis

A

initial: ABCDE

IV access- bloods/ blood cultures

LP (if its going to take >1 hour then give IV antibiotics 1st)

IV dexamethasone before or with Abs
-do not give if post surgical, severly immunocompromised, <3 months, meningococcal or septic shock

IV antibiotics

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5
Q

medication given in bacterial meningitis meningitis?

A

<3 months= cefotaxime + amoxicillin (choramphenicol if penicillin allergic)

3 months- 49 years= ceftriaxone (or cefotaxime) +/- dexamethasone

> 50 years= ceftriaxone + amoxacillin +/- dexamethason

immunocompromised, alcoholic or diabetics= add amoxicillin (to cover listeria)

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6
Q

what should the contacts of someone with bacterial meningitis receive?

A

oral ciproflocaxin or rifampicin

-anyone they have been in contact with in past 7 days

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7
Q

most common cause of viral meningitis?

A

Enterovirus (coxsackie)

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8
Q

1st line investigations viral meningitis

A

LP + PCR

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9
Q

management viral meningitis

A

supportive

self limiting

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10
Q

most common cause of encephalitis

A

HSV 1

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11
Q

how does encephalitis present differently to meningitis?

A

focal neurological deficits
seizures

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12
Q

what are Kernigs + Brudzinkski

A

clinical tests for meningitis

Kernigs- knee extension is painful

Brudzinski- neck flexion causes knee flexion

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13
Q

investigations encephalitis?

A

MRI= imageing of choice
-BILATERAL TEMPORAL LOBE INVOLVEMENT is HSV

Lumbar puncture= essential

EEG useful

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14
Q

management of encephalitis?

A

Aciclovir

-regular monitoring with EEG + LPs

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15
Q

criteria for diagnosing migraine without aura

A

Migraine without aura (80%)- IHS CRITERIA
At least 5 attacks
4-72 hours
2 of: moderate/severe, unilateral, throbbing pain, worst movement
1 of: autonomic features e.g. N+V, photophobia/phonophobia

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16
Q

what are atypical migraine symptoms that may prompt further investigation (5)

A

-motor weakness
-double vision
-visual symptoms affecting only one eye
-poor balance
-decreased level of consciousness

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17
Q

management of acute migraine?

A

1st= NSAID/ paracetamol/ aspirin +/- triptan

2nd= prochlorperazine or metroclopramide

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18
Q

prophylaxis migraine

A

Propanolol

Topiramate (CI women of child bearing age as is teratogenic + lowers contraception effectiveness)

Amitriptyline

Non pharmacological: acupuncture + relaxation exercises

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19
Q

symptoms of migraine in children

A

usually bilateral + less severe

often GI upset is main concern

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20
Q

what is classified as chronic tension headache

A

15 or more headaches per month, for >3 months in the absence of medication overuse

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21
Q

management of tension headaches?

A

ACUTE
1st= aspirin, paracetamol + NSAIDs

Chronic/ frequent prophylaxis
-Up to 10 sessions of acupuncture over 5 to 8 weeks
-Physio + regular exercise
-Consider low dose amytriptiline

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22
Q

how long does acute and chronic sinusitis last

A

acute sinusitis <12 weeks

Chronic sinusitis 12 weeks or longer

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23
Q

investigations- chronic sinusitis

A

chronic sinusitis is often caused by polyps

1st= nasal endoscopy

gold standard imageing= CT of paranasal sinuses

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24
Q

management of acute sinusitis?

A

<10 days
-analgesia, reassure + safety netting

10 days or longer
-intranasal steroids (if over 12)
-Delayed antibiotic prescription to take if symptoms do not improve in 7 days or significantly worsen

antibiotics:
1st= phenoxymethylpenicillin
2nd= doxy, clarythromycin, erythromycin

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25
management of chronic sinusitis?
1st= medical -Nasal saline irrigation -Topical steroids (reduce size of polyp + inflammation) -Oral steoroids (can be used short term or to reduce size pre surgery) -Antibiotics if bacterial cause is suspected 2nd= surgery Functional sinus surgery (FESS)- aims to restore normal sinus ventilation + drianage Balloon sinuplasty- less invasive than FESS, dilatees the sinus ostia to improve drainage
26
management of cluster headache
ACUTE 1st= high flow O2 Sub scut triptans Prophylaxis= verapamil refer to neurologist (may want to do MRI)
27
difference between paroxysmal hemicrania and cluster headaches
both= severe unilateral headache with autonomic features paroxysmal hemicrania= more frequent but shorter attacks typically in women -last <30 mins (10- 30) + up to 40 a day cluster headache= less frequent but longer attacks + more common in men -last 15 mins to 3 hours up to 8 a day (usually <5)
28
management of proxysmal hemicrania?
Indomethicin -will have an absolute response
29
management of trigeminal neuralgia
1st= carbamazepine other: -gabapentin -phenytoin -baclofen
30
normal hydrocephalus management + investigations
investigation= MRI/ CT showing enlarged 4th ventricle definitive= VP shunt avoid anticholingergics + refer for physio
31
GCS
Eyes (4) 4- spontaneous 3- voice 2- pain 1- no response Mouth (5) 5- orientated to place + person 4- confused 3- innapropriate words 2- inconprehensable sounds 1- no response Motors (6) 6- Obeys commands 5- Moves to localised pain 4- Flexes to withdraw from pain 3- abnormal flexion (decorticate) 2- abnormal extension (deceribrate) 1- no response
32
Cushing's triad?
-Decreased HR -irregular breathing -Bradycardia raised ICP
33
management of raised ICP?
Investigate + determine cause initial: -Maintain head in midline -head elevation 30 degrees -IV mannitol -Controlled hyperventilation -Removal of CSF (repeated lumbar punctures, drain from intraventriuclar monitor) -surgery to relieve pressure
34
management of idiopahic intracranial hypertension?
weight loss Carbonic anhydrase inhibitors (acetazolamie or topiramate) CDF diversion- LP or VP shunt Repeated lumbar punctures (Short term)
35
presentation spinal ALS
UMN (usually legs) + LMN (usually in arms) signs
35
conduction aphasia
speech fluent but repitition is poor
35
Progressive bulbar palsy presentation
palsy of tongue, muscles of chewing/ swallowing and facial muscles (due to loss of function of brainstem nuclei) -dysarthria -dysphagia -nasal regurgitation -choking (has worst prognosis)
36
Primary lateral sclerosis presentation
UMN signs only
37
Progressive muscular atrophy presentation
LMN signs only
38
most common genetic mutation ALS
SOD1 mutation
39
life prolonging medication MND
Riluzole -prolongs life by about 3 months need to do bloods regularly as can cause fatigue, hepatitis + renal failure
40
medication management of siallorhoea MND
1st= antimuscarinic (hyoscine) + glycopyronium bromide if cognitevely impaired
41
management of muscle cramps MND
1st= quinine 2nd= baclofen 3rd= tizanidine, dantrolene or gabapentin
42
management resp, speech + feeding needs MND
resp- home ventilation (Bipap) speech- speech therapy, technology from tablets to 'voice banking' feeding- PEG tube
43
management of muscle stiffness, increased spasticity or increased tone MND
-baclofen -tizanidine -dantrolene -or gabapentin
44
spinal muscular atrophy- what
rare genetic condition that presents similarly to MND but in children -loss of anterior horn cells causing LMN signs -cognition is preserved
45
investigations spinal muscular atrophy
Genetic testing- SMN1 deficiency on chromosome 5 (autosomal recessive) electrophysiology- diminished nerve signals Muscle biopsy- muscle fibre atrophy
46
most common complication of meningitis
sensorineural hearing loss
47
global aphasia
speech is not fluent + comprehension is not intact
48
where are Broca's and Wernicke's found?
Brocas area- inferior frontal gyrus Wernickes- superior temporal gyrus
49
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome) presentation
Ipsilateral: -Facial pain/ temperature loss Contralateral: -limb/ torso pain and temperature loss Ataxia + nystagmus
50
investigations for diagnosing MS
1st= bloods -FBC (anaemia) -Thyroid -B12 -Calcium -Glucose -Inflammatory markers -LFTs -U&Es -HIV serology if bloods normal= refer to neurology for: -T2 MRI head +/- spine -LP for CSF (oligoclonal bands)
51
management spasticity MS
1st= Baclofen or gabapentin Other options include diazepam, dantrolene and tizanidine
52
drug options to reduce amount of relapses MS?
Injectible: 1st= ocrelizumab or natalizumab Oral 1st= dimethyl fumarate (Tecfidera), teriflunomide (aubagio), fingolimod
53
fatigue management MS
amantidine
54
Oscillopsia management MS
gabapentin
55
bladder dysfunction management MS
1st= US bladder to check any residual volume residual volume= catheter no residual volume= anti cholinergics
56
how long can you not drive following TIA or stroke
stroke or 1 TIA- 1 month (may not need to inform DVLA) multiple TIAs over short period of time- 3 months off driving an inform DVLA
57
how long can you not drive following a single isolated seizure
6 months - if brain imaging and EEG normal 1 year is brain imaging/ EEG not normal epileptic- need to be seizure free for atleast 1 year
58
what defines status epilepticus
seizure lasting 5 minutes or longer OR 2 or more seizures in 5 minutes + the person does not return back to normal inbetween
59
management status epilepticus
ABCDE pre hospital= PR diazepam or buccal midazolam hospital= IV lorazepam after 5-10 mins repeat IV lorazepam ongoing: -levetiracetam -phenytoin -sodium valproate no response within 45 mins= general anaesthesia or phenobarbital
60
management of neuropathic pain
1st= amitriptyline, duloxetine, gabapentin or pregabalin if the first-line drug treatment does not work try one of the other 3 drugs tramadol may be used as 'rescue therapy' for exacerbations of neuropathic pain
61
mutation huntingtons
autosomal dominant on the HTT (huntington) on chromosome 4 Trinucleotide repeat disorder (repeat expansion of CAG)
62

4th year (13 decks)

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