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THIRD YEAR > Neuro 2 > Flashcards

Neuro 2 Flashcards

1
Q

secondary causes of demyelination

A

central pontine myelinosis, progressive multifocal leucoencephalopathy, subacute sclerosis pariencephalitis, AIDs, axonal degeneration

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2
Q

MS when

A

any age but childhood and over 50 is rare

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3
Q

where are the plaques

A

in white matter (so external brain and spinal cord looks fine)
commonly in optic nerve, periventricular white matter, corpus callous, brain stem and spinal cord

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4
Q

what can plaques of MS act like

A

SOL

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5
Q

acute MS

chronic MS

A

yellow/brown, ill defined edge

well demarcated grey/brown, classically lateral ventricles

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6
Q

ix for MS

A

MRI

CSF - 90% show oligoclonal bands

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7
Q

relapsing remitting

A

distinct symptom that fade away partially or completely

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8
Q

secondary progressive

A

relapsing and remitting that stops relapsing

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9
Q

progressive relapsing

A

relapses then doesn’t relapse again

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10
Q

primary progressive

A

no remissions just worsens

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11
Q

commonest type of MS

A

relapsing remitting

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12
Q

treatment of fatigue

A

amontodine
modafinic if sleepy
hyperbaric oxygen

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13
Q

treatment of acute exacerbation

A

methylprednisolone PO
severe - admit and IV steroids
regular relapses - aziothoprine

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14
Q

pyramidal

A

OT, physio

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15
Q

spasticity

A

physio, baclofen, gabapentin, botulonim toxin

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16
Q

sensory

A

gabapentin, amitrip, acupuncture, ligocaine infusion

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17
Q

LUT

A

oxybutinin, desmopressin, catheter

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18
Q

DMARDs first line

A

interferon beta and copioxon

tecfidera (dimethylfumeratic)

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19
Q

DMARDs second line

A

tysabri (natalzimub) or lemtrada (alemtrizumab)

fingolimed

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20
Q

third line DMARD

A

mitoxantrone

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21
Q

first line when

A

interferon beta and copioxone or tecfidera (dimethyl)

at least 2 attacks both times recovered partially or completely, can walk 100m
relapsing remitting

22
Q

tysabri (natalzimub) or lemtrada (alemtrizumab)

A

monoclonal antibodies

highly active RR rapidly evolving or high disease activity despite treatment with interferon beta

23
Q

mitoxantrone

A

Relapsing progressive
12 infusions over 2 years
cardiac toxicity dose related

24
Q

motor features of parkinson’s

A

tremor, muscular rigidity, amnesia, resting tremor, gait, postural impairment

25
Q

non motor features of parkinsons

when

A

olfactory dysfunction, cognitive impairment, psych symptoms, sleep disorders, autonomic dysfunction, pain and fatigue, RBD

can be present for a decade before motor symptoms

26
Q

commonest neuro degen

2nd

A

alzheimers

parkisnosn

27
Q

after 17 yrs of parkinson’s

A

80% gait freezing

50% choking

28
Q

after 20 yrs of parkinsosn

A

83% have dementia

29
Q

ix for RBD

A

overnight polysomnography to rule out mimics - obstructive sleep apnea, seizures, rapid eye movement parasomnia

30
Q

rx of RBD

cx

A

clonazapam or melatonin at bedtime

isolated increases the risk of neurodegen dx
with PD - severe autonomic dysfunction, gait impairment, dementia

31
Q

loss of what in pd

A

dopimergic neurones in the SNpc and lewy body pathology sections through the brain stem show loss of normally black pigment in substantia nigra and locuscoerleus
pigment correlates with dopinemergic loss

32
Q

SNCA Px

LRRK2 Px

A

inherited

dom PD

33
Q

treatment of early px

A 
levodopa and careldopa/sinemet
dopamine agonist (ropinirole, pramipexole)
MAO/bi - selegiline
34
Q

treatment of late px

A

patient on levodopa and developed motor complications

MAOIB, apomorphine, entacapone (COMTI)

35
Q

anticholinergic in px

A

trihexypheridyl/clozapine for tremor

cause confusion in elderly

36
Q

SE of DA

A

nausea, daytime solemence, oedema, avoid in patients with history of addiction, OCD, impulse personality
commonly associated with hallunicaiton - not given to elders esp those with cognitive impairment

37
Q

long term cx of levodopa and DA

A

motor fluctuations and dyskinesia in later stages
non motor fluctuations
psychosis

38
Q

decrease fluctuations

A

Add DA, MAOBI, COMTI (tolapone, entacapone)

39
Q

direct delivery of stable levedopa

A

carbidopa gel/duodopal into dueodenum

40
Q

sub cut infusion od

A

apomorphine - potent DA

41
Q

psychosis

A

clozapine

2nd quetiapone

42
Q

visual hallucinations and delusions in dementia

also for

A

rivastigamine

late stage dementia in PD

43
Q

when does dyskiniesia occur with levedopa

A

movements at peak of concentration

or at beginning and end of dose (biphasic dyskinesia)

44
Q

constipation
GI motility
fatigue
orthostatic hypotension

A

polyethyleneglyco
domperidone
methylphenidate, madanfil
clomperidone, fludrestirone, midorine, pyridogmiostigine

45
Q

vascular parkinsonism symp

ix

A

lower body predom affected
no resting tremor
other signs of brain lesions vascular

poor levodopa response. do structural brain imaging

46
Q

drug induced

A

symm. coarse postural tremor. tardy dystonia. akathesia

47
Q

essential tremor

A

symm postura/kinetic 12Hz
autosomal dom
alcohol responsive
propanolol

48
Q

resting tremor in parkinson’s

A

3-6Hz

49
Q

multisystem atrophy
who
ix

A

60-70s
suboptimal and short lived levedopa response
only 1/3 get a response

MRI
cerebellar and pontine atrophy
hot cross bun sign

50
Q

progressive supra nuclear palsy

ix

A

vertical supranuclear palsy
reterocolitis
staring

no response to levedopa

51
Q 
fragile x tremor and ataxia syndrome 
what is it 
who
symp
females
children
ix
A 
abnormal number of CGGs in FMRI gene
>50s
cerebellar symptoms
premature ovarian failure, early menopause
classical fragile x syndrome

Mri - T2 hypersensitivities in middle cerebellar peduncles
molecular testing to confirm

THIRD YEAR (27 decks)

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