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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
how is vascular dementia treated
underlying cause - hypertension, DM, hyperlipideamia, anti platelets
26
why UML where is the damage
lesion above anterior horn cells | spinal cord, brian stem, motor cortex
27
LMN where
at anterior horn cells, plexus, peripheral nerve
28
glove stocking pattern of loss
peripheral neuropathy | length dependant
29
GBS | rx
paraplegia acute over 4w | immunoglobulin infusion or plasma exchange
30
axonal treatment
treat cause | physio/orthotics/pain relief
31
axonal vasculitis rx
pulsated IV methylprednisolone and cyclophosphamide
32
demyelinating inflam neuropathy
IV Ig, steroids, aziothioprine, mychephenelate, cyclophosphamide
33
bulbar who always what type ofMND
weakness and wasting of facial muscles chewing talking swallowing F>M always generalised into ALS LMN
34
AML symp
lmn in arms - weak flexors | umn in legs - weak flexors
35
MND doesn't have what
sensory symptoms
36
primary lateral sclerosis
UMN signs only
37
progressive muscular atrophy
LMN signs only | affects distal muscles before proximal
38
MND mutation
TDp43 inclusion in 95% | C9OR F72 in 10%
39
cord transection symptoms
everything affected cervical - quadraplegia L/T/S - paraplegia
40
cord compression - brown sequard syndrome
ipsilateral motor and dorsal column - loss of tactile/vibration/proprioception/motor function contralateral loss of temp and pain sensations
41
central cord syndrome
hyperextesntion or flexion of already steotatic neck UL weakness - cape like lower limb power and dorsal column preserved
42
anterior cord syndrome
dorsal column fine
43
posteriori cord syndrome
only dorsal column affected
44
treatment for cord stuff
methylprednisolone bolus 24 hour infusion
45
rebreeding SAH when | rx
first 14d. 50% in first 6m | surgical clipping, endovascular
46
delayed ischaemia SAH what when | rx
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
hydrocephalus SAH
increased headache or altered conscious level. transient | CSF drainage
48
hyponatraemia SAH
SIADH. transient. dont fluid restrict | NA. fludrocortisone
49
seizures SAH
anti convulsive therapy
50
intracerberal haem secondary cause what
charcot bouchards- secondary to htn - micro aneurysms on small perforating arteries 50%
51
tremor and <45
do TFTs
52
dystonic tremor is what | rx
tremor produced by dystonic muscle contraction propanolol, primidone atenolol, gabapentin, satolol
53
myoclonus is what
brief electric shock like jerks | hiccups and hypnotic jerks when falling asleep. common
54
symp myoclonus with encephalopathy
liver disease renal failure alcohol lithium
55
``` symp myoclonus without encephalopathy and dementia and parkinsons focal/segmental other ```
alzheimers, LB multisystem spinal cord/root/plexus injury whipple dx, coeliac
56
``` juvenile myoclonus epilepsy onset is what triggers symp EEG rx what aggravates it ```
``` 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
tourette syndrome dx
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
rx of tourettes
clonidine, terbrabenazine | CBT
59
dystonia is what
disorder of movement - involuntary sustained muscle contraction leads to twisting and repetitive movement or abnormal posturing
60
primary dystonia | secondary dystonia
focal <28 segmental | generalised >28 symptomatic
61
torsion dystonia when | rx
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
curare (extract)
non blocking extract from plants | d tubocurarine
63
curare
occupies same position on ACh receptor but does not open ion channel no muscle contraction so no respiration
64
treatment of myasthenia gravis
acetylcholinesterase inhibitor - pyridostigmine steroids and azathioprine - steroids not to be used accurately thyectomy acute - plasma exchange or immunoglobulin
65
botulism how to get it
clostridium botulinum found in soil | IV users - black tar heroin
66
what happens in botulism
cleave pre synaptic proteins involved in vesicle formation and block vesicle docking with pre synaptic membrane
67
symp of botulism
rapid onset weakness without sensory loss
68
migraine with aura criteria
2 of: mod/severe, unilateral throbbing, pain, worse on movement 1 of: autonomic features photophobia/phonophobia
69
why does stress lead to migraine
causes serotonin to be released blood vessels contract and dilate chemicals including substance P irritate nerves blood vessels causing pain
70
treatment for migraine
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
triptans
5HT agonist rizatriptan/frovatriptan treat at start of headache oral, sublingual, subcut
72
prophylaxis for migraines when and what
3 or more in a month or very severe migraine propanolol once daily orally topiramate 25-100mg amitriptillyinge, gabapentin, pizotofen, sodium valproate
73
when imaging
>55 | known malignancy/prev malignancy
74
TCAs
unilateral trigmenal distribution pain with ipsilateral cranial autonomic features - ptosis, miosis, nasal stuffiness, N/V, tearing, lid oedema
75
clusters when
around sleep/seasonal variation
76
clusters treatment
acute - high flow o2 for 20 mins, subcut somatotroptan 6mg | steroids decrease over 2 weeks
77
clusters prophylaxis
verapamil or pred
78
paroxysmal hemicrania
elderly 50-60 w>m | short and more frequent than others
79
treatment for paroxysmal hermicrania
indomethian
80
SUNCT
``` short lived 15-20s unilateral neuralgia from headache conjunctival injections tearing ```
81
treatment SUNCT
lamotrigene | gabapentin
82
new onset unilateral cranial autonomic features
MRI brain MRI angio
83
trigmenal neuralgia treatment
``` carb gabapentin phenytoin baclofen surgical - ablation/decompression ```
84
MRI in trigmenal neuralgia
atypical features, poor response to medical treatment or surgery being considered
85
treatment for tension headaches
relaxation therapies | small doses of amitriptyline

THIRD YEAR (27 decks)

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