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THIRD YEAR > Neuro 3 > Flashcards

Neuro 3 Flashcards

1
Q

primary generalised seizure treatment

A

sodium valproate
lamotrigine and carb 2nd line
topirmate
levetricatem

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2
Q

absence seizures treatment

A

sodium val can ethosusmide 1st line
topiramte
leveticenam

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3
Q

myoclonic treatment

A

sodium val 1st
clonazepam and lamotrigene 2nd
leveteracam
topirmate

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4
Q

simple partial seziures

A

without loss of consciousness

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5
Q

complex

A

with loc

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6
Q

complex partial seizures with what is common

A

with hippocampal sclerosis

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7
Q

treatment for partial seizures

A

lamotriegen 1st line
sodium val 2nd
carbamazapine, topiramte
add on: gabapentin, tiaglibine, pregabalin, zonisamide, vigabatrin, clonazepam

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8
Q

carb

A

can make primary generalised seizures worse

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9
Q

hepatic enzyme inducers

A

carb, ozarbemazapine, phenobarb, phytion, primidone, topiramate

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10
Q

what do hepatic enzymes lead to

A

reduced efficacy of COCP
can’t use implant, POP
depot more freq
morning after pill not adequate - increase dose

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11
Q

treatment for women on hepatic enzyme inducers

A

folic acid and vitamin K

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12
Q

general treatment of status epileptics

A 
phenytoin (check levels)
keppra
valproate
BZDs
50ml in 50% dextrose if glucose low
IV thiamine if alcohol or nutritionally impaired
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13
Q

prolonged seizures and at home

A

diazepam 10-20mg recta

midalezem 10-20mg buccal

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14
Q

prolonged seizures immediate control

A

lorazepam 4mg IV
Diazepam 10-20mg IV
Diazepam rectal 10-20mg
midalozam IM 5-10mg

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15
Q

sustained control in established eplepsy

A

reestablish AED by NGT/PO/IV phenytoin

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16
Q

sustained control in other px

what needs to monitored

A

fosphenytoin 18mg/kg IV 100-150mg/min
Phenobarb 15mg/kg 100mg/min
Phyntoin 18mg/kg 10mg/min

ECG

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17
Q

if status persists

A

ITU

general anaesthesia with thiopentone or propofol

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18
Q

what increases the risk of alzheimers

A

downs

apoldprotein E4

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19
Q

macroscopic pathology of alzheimers

A 
decreased size and weight of brain (corticol atrophy)
widening of sulci and narrowing of gyri
secondary hydrocephalus
frontal, temp, parietal lobes affected 
brainstem and cerebellum normal
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20
Q

microscopic features of alzheimers

A

intracytoplasmic neurofiblirally tangles
a beta amyloid plaques
amyloid antipathy
extensive neuronal loss with astrocytes

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21
Q

patho of LB

ix

A

degen of substantia nivea remaining nerve cells have lewy bodies
degen of cortical areas with formation of cortical lewy bodies

which can be defenced by immunochemical staining for the protein ubiquitin

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22
Q

patho of huntingotns

A

loss of neurones in caudate nucleus and cerebral cortex accompanied by reactive fibrillary glands

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23
Q

patho of picks

A

extreme atrophy of cerebral cortex in frontal and temporal lobes
brain weight <1kg
neuronal loss and astrocytosis
picks cells - swollen neurones
intracytoplasmic filamentous inclusions - picks bodies

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24
Q

mild mod dementia treatment

severe

A

1st line acetylcholinesterase inhibitors - donepizil, galantine, rivastigmine
2nd line menantine

severe memantine

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25
Q

how is vascular dementia treated

A

underlying cause - hypertension, DM, hyperlipideamia, anti platelets

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26
Q

why UML where is the damage

A

lesion above anterior horn cells

spinal cord, brian stem, motor cortex

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27
Q

LMN where

A

at anterior horn cells, plexus, peripheral nerve

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28
Q

glove stocking pattern of loss

A

peripheral neuropathy

length dependant

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29
Q

GBS

rx

A

paraplegia acute over 4w

immunoglobulin infusion or plasma exchange

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30
Q

axonal treatment

A

treat cause

physio/orthotics/pain relief

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31
Q

axonal vasculitis rx

A

pulsated IV methylprednisolone and cyclophosphamide

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32
Q

demyelinating inflam neuropathy

A

IV Ig, steroids, aziothioprine, mychephenelate, cyclophosphamide

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33
Q

bulbar
who
always what
type ofMND

A

weakness and wasting of facial muscles
chewing talking swallowing

F>M
always generalised into ALS
LMN

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34
Q

AML symp

A

lmn in arms - weak flexors

umn in legs - weak flexors

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35
Q

MND doesn’t have what

A

sensory symptoms

36
Q

primary lateral sclerosis

A

UMN signs only

37
Q

progressive muscular atrophy

A

LMN signs only

affects distal muscles before proximal

38
Q

MND mutation

A

TDp43 inclusion in 95%

C9OR F72 in 10%

39
Q

cord transection symptoms

A

everything affected
cervical - quadraplegia
L/T/S - paraplegia

40
Q

cord compression - brown sequard syndrome

A

ipsilateral motor and dorsal column - loss of tactile/vibration/proprioception/motor function
contralateral loss of temp and pain sensations

41
Q

central cord syndrome

A

hyperextesntion or flexion of already steotatic neck
UL weakness - cape like
lower limb power and dorsal column preserved

42
Q

anterior cord syndrome

A

dorsal column fine

43
Q

posteriori cord syndrome

A

only dorsal column affected

44
Q

treatment for cord stuff

A

methylprednisolone bolus 24 hour infusion

45
Q

rebreeding SAH when

rx

A

first 14d. 50% in first 6m

surgical clipping, endovascular

46
Q

delayed ischaemia SAH what when

rx

A

delayed ischaemic neuro deficit d3-12
altered consciousness, focal deificit, vasospasm

nimodipine given to all px for 3w

triple h therapy - induced hypertension, hypokalaemia, haemodilution to prevent vasospasm

47
Q

hydrocephalus SAH

A

increased headache or altered conscious level. transient

CSF drainage

48
Q

hyponatraemia SAH

A

SIADH. transient. dont fluid restrict

NA. fludrocortisone

49
Q

seizures SAH

A

anti convulsive therapy

50
Q

intracerberal haem secondary cause what

A

charcot bouchards- secondary to htn - micro aneurysms on small perforating arteries 50%

51
Q

tremor and <45

A

do TFTs

52
Q

dystonic tremor is what

rx

A

tremor produced by dystonic muscle contraction

propanolol, primidone
atenolol, gabapentin, satolol

53
Q

myoclonus is what

A

brief electric shock like jerks

hiccups and hypnotic jerks when falling asleep. common

54
Q

symp myoclonus with encephalopathy

A

liver disease
renal failure
alcohol
lithium

55
Q 
symp myoclonus without encephalopathy 
and dementia 
and parkinsons
focal/segmental 
other
A

alzheimers, LB
multisystem
spinal cord/root/plexus injury
whipple dx, coeliac

56
Q 
juvenile myoclonus epilepsy onset 
is what 
triggers 
symp 
EEG
rx
what aggravates it
A 
teens
myoclonic jerks and generalised seizures 
alcohol and no sleep 
symp worse in morning 
3-5 Hz polyspine wave pattern 
valproate and levetiracetam
carbamazepine
57
Q

tourette syndrome dx

A

both multiple motor tics and one or more vocal tics
tics must occur lots of times during day nearly every day or intermittently for 1 year with no longer 3months tic free
age of onset <18
exclusion of obv secondary causes

58
Q

rx of tourettes

A

clonidine, terbrabenazine

CBT

59
Q

dystonia is what

A

disorder of movement - involuntary sustained muscle contraction leads to twisting and repetitive movement or abnormal posturing

60
Q

primary dystonia

secondary dystonia

A

focal <28 segmental

generalised >28 symptomatic

61
Q

torsion dystonia when

rx

A

gene locus 9q34 gene product torsin A
before 28 usually in childhood usually legs then spreads and becomes generalised
cervical dystonia - botox
deep brain stimulisation

62
Q

curare (extract)

A

non blocking extract from plants

d tubocurarine

63
Q

curare

A

occupies same position on ACh receptor but does not open ion channel
no muscle contraction so no respiration

64
Q

treatment of myasthenia gravis

A

acetylcholinesterase inhibitor - pyridostigmine
steroids and azathioprine - steroids not to be used accurately
thyectomy
acute - plasma exchange or immunoglobulin

65
Q

botulism how to get it

A

clostridium botulinum found in soil

IV users - black tar heroin

66
Q

what happens in botulism

A

cleave pre synaptic proteins involved in vesicle formation and block vesicle docking with pre synaptic membrane

67
Q

symp of botulism

A

rapid onset weakness without sensory loss

68
Q

migraine with aura criteria

A

2 of: mod/severe, unilateral throbbing, pain, worse on movement
1 of: autonomic features photophobia/phonophobia

69
Q

why does stress lead to migraine

A

causes serotonin to be released
blood vessels contract and dilate
chemicals including substance P irritate nerves blood vessels causing pain

70
Q

treatment for migraine

A

lifestyle - diet, hydration, stress, regular exercise
aspirin 900mg, naproxen 250mg, ibobrifen 400mg and/- anti emetic
take as early as possible decrease in headache at 2 hours

71
Q

triptans

A

5HT agonist
rizatriptan/frovatriptan
treat at start of headache
oral, sublingual, subcut

72
Q

prophylaxis for migraines when and what

A

3 or more in a month or very severe migraine

propanolol once daily orally
topiramate 25-100mg
amitriptillyinge, gabapentin, pizotofen, sodium valproate

73
Q

when imaging

A

> 55

known malignancy/prev malignancy

74
Q

TCAs

A

unilateral trigmenal distribution pain with ipsilateral cranial autonomic features - ptosis, miosis, nasal stuffiness, N/V, tearing, lid oedema

75
Q

clusters when

A

around sleep/seasonal variation

76
Q

clusters treatment

A

acute - high flow o2 for 20 mins, subcut somatotroptan 6mg

steroids decrease over 2 weeks

77
Q

clusters prophylaxis

A

verapamil or pred

78
Q

paroxysmal hemicrania

A

elderly 50-60 w>m

short and more frequent than others

79
Q

treatment for paroxysmal hermicrania

A

indomethian

80
Q

SUNCT

A 
short lived 15-20s
unilateral 
neuralgia from headache
conjunctival injections 
tearing
81
Q

treatment SUNCT

A

lamotrigene

gabapentin

82
Q

new onset unilateral cranial autonomic features

A

MRI brain MRI angio

83
Q

trigmenal neuralgia treatment

A 
carb
gabapentin
phenytoin
baclofen
surgical - ablation/decompression
84
Q

MRI in trigmenal neuralgia

A

atypical features, poor response to medical treatment or surgery being considered

85
Q

treatment for tension headaches

A

relaxation therapies

small doses of amitriptyline

THIRD YEAR (27 decks)

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