Neuro 5 Flashcards
MG anesthetic drugs which are less successful?
suxamethonium
Rocuronium
neuromuscular blocking drugs
non depolarising
ppl w MG will be more sensitive to this drug
what is the treatment of choice for an essential tremor?
propranolol
skin on palmar aspect of thumb nerve innervation?
median
ulnar nerve provide sensation to?
medial aspect of the palm
is sodium valproate an inducer of p450?
No it is an inhibitor
Sodium valproate causes inhibition of the P450 system
sodium valproate s/e
A - Appetite increase –> weight gain
L - Liver failure
P - Pancreatitis
R - Reversible hair loss (alopecia)
O - Oedema
A - Ataxia
T - Teratogenic, tremor, thrombocytopaenia
E - Enzyme inducer (p450), encephalopathy (due to high ammonia)
MND is associated with which dementia?
frontotemporal dementia
partial strokes
2/3 criteria
complete / total anterior circulation stroke?
middle and anterior cerebral arteries
hemiparesis / hemisensory loss
homonymous hemianopia
higher cognitive dysfunction
what is the difference between multiple system atrophy and normal pressure hydrocephalus ?
MSA is parkinson plus condition
tremor/rigidity and bradykinesia
NPH
> gait
>urinary incontinence
>confusion
which abx class increases risk of Intracranial hypertension
lymecycline
drugs which increase risk of Intracranila htn?
COMAAR
ciclosporin
ocp
mineralocorticoids
amiodarone
antibiotics
> tetracyclines
> sulphonamides
colles fracture which nerve?
The median nerve may be injured in a Colle’s fracture
distal radius > outstretched hand
raised ICP mx?
head elevation 30 degrees
diuretic use > mannitol > osmotic diuretic
controlled hyperventilation
why is metoclopramide contraindicated in patients with parkinsons?
dopamine antagonist
crosses BBB
> worsene extrapyramidal side effects of PD
Domperidone
blocks dopamine receptors in the chemoreceptor trigger zone
does not cross BBB
anti emetics contraindicated in PD?
metoclopramide
haloperidol
prochlorperazine
which Parkinson drug is associated with pulmonary fibrosis?
cabergoline
Myasthenia gravis
exarcebating drugs?
why?
beta blockers
> not sure / look up
Painful third nerve palsy
where would lesion / occlusion be?
posterior communicating artery
carpal tunnel syndrome
sensory loss where?
motor function where?
median nerve
lateral 3.5 digits
flexor muscles of the forearm
flexion, abduction, opposition, and extension of the thumb.
Cubital tunnel syndrome
what nerve
what sign?
ulnar nerve pathology
froments test
adductor pollicis muscle
> ulnar neuropathy
what is in pabrinex?
IV b/c
includes b12
replace thiamine
C8/T1 radiculopathy
similar to ulnar nerve neuropathy but forearm is impacted
What can happen if you give folate before b12?
worsen b12 deficiency
> subacute combined degeneration of the spinal cord
what is wernickes triad?
confusion
ataxia
opthalmoplegia
Ix signs from wernickes encephalopathy?
decreased red cell transketolase
MRI
Acute seizure management?
ABC approach
ensure airway and o2
give benzodiazepines
Rectal Diazepam dose?
adult
10-20mg
focal seizure first line?
lamotrigine / levetiracetam
focal seizures involve?
inappropriate electrical activity on one side of the brain
post suspected TIA mx?
investigations
aspirin 300mg unless contraindicated
assessed urgently <24hours
diffusion MRI
urgent carotid doppler imaging
post suspected TIA mx?
medical
antiplatelet therapy
DAPT
> clopidogrel 300mg
> aspirin 300mg
75mg for 21 days
PPI considered
long term secondary prevention TIA?
clopidogrel
how is carotid imaging conducted?
carotid duplex USS
CT angiography / MR angiography
webers syndrome is characterised by?
ipsilateral ?
contralateral?
midbrain stroke
ipsilateral CN 3
contralateral hemiparesis
sarcoidosis facial nerve palsy
lethargy
bilateral CN 7 palsy
bilateral parotid gland enlargement
shagreen patch
tuberous sclerosis
rough skin over lumbar spine
Homocystinuria
methionine metabolism
when would you not be appropriate for DAPT?
if previous GI bleed risk
monothrerpay and ppi
Clopidogrel moa
inhibits platelet aggregation
reduces risk of clot formation
sumatriptan MOA
5-HT1 receptor agonist
constriction of blood vessels in the brain
> relieve headache
radial nerve supplies what muscle group?
extensor muscle group
interossei are supplied
ulnar nerve
what is jacksonian movement?
clonic movement moving proximally
> frontal
which antiepileptic can cause peripheral neuropathy as a side effect?
phenytoin
main s/e of soidum valproate
GI
tremor
weight gain
hair loss
levetiracetam main s/e
mood swings
aggression
most common bleeding site in extradural haemorrhage
middle meningeal artery
> pterion: weakest part of the cranium
uncal herniation causes?
oculamotor nerve palsy
dilated and fixed pupil
to count as localising how high should the movement be?
upto clavicle
in GBS there is decreased ______ nerve conduction velocity
decreased motor nerve conduction velocity
secondary to demyelination
carotid endartectomy should be done on side?
contralateral to the symptoms
miller fischer syndrome?
subtype of GBS
areflexia
opthalomoplegia
ataxia
