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2A - Stuff i just cannot remember > Neuro > Flashcards

Neuro Flashcards

1
Q

When do we prescribe Gabapentin?

A

Epilepsy. For seizures/ neuropathic pain.

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2
Q

What drug should you prescribe for aggression/ chorea?

A

Dopamine receptor Antagonist

eg Risperidone

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3
Q

Bacterial Meningitis causes

A

1 Streptococcus pneumoniae - most common overall

Listeria monocytogenes - pregnant

Neisseria meningitidis

Streptococcus agalactiae - neonates

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4
Q

Migraine Mx:

A

Prophylactic: Topiramate/ propanolol

1L: NSAID, paracetamol, TRIPTAN

2L:

3L: Amitriptyline

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5
Q

Viral Meningitis causes

A

= more common than bacterial

Enteroviruses

  • Echovirus
  • Coxsackievirus
  • Poliovirus

Herpes Simplex Virus

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6
Q

Management of viral meningitis

A

Nowt specific

Supportive.

Acyclovir for HSV

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7
Q

How to tell the difference between bacterial and viral meningitis?

A

Lumbar puncture:

  • Viral: lymphocytosis, normal protein/ glucose
  • Bacterial: low glucose, raised protein

Also bacterial: Kernig’s + Brudzinski’s signs

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8
Q

Management of bacterial meningitis

  • in primary setting
  • secondary setting
    • > 3months age
    • <3months age
  • prophylaxis
A

GP + non-blanching rash: IM Benzylpenicillin

Hospital:
IV 2g Ceftriaxone

or IV Cefotaxime + amoxicillin/ampicillin if <3months (listeria)
+
IV Dexamethasone if purulent CSF/ >3months with bacteria)

Prophylaxis: Ciprofloxacin or Rifampicin

Strep-resistant -Vancomycin

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9
Q

Define haemorrhagic stroke

A

Rupture of cerebrospinal artery

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10
Q

Management of an Ischaemic Stroke

A

ABCDE

IV Alteplase WITHIN 4.5hr onset - Thrombolysis

CT Head - new stroke?

Aspirin 24hr after tx

(Do not lower BP acutely UNLESS malignant; may impair cerebral perfusion)

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11
Q

Contraindications to Thrombolysis for Stroke

A

> 4.5 hr since onset

Recent head trauma, GI/ intracranial haemorrhage, recent surgery. acceptable BP, platelet count/ INR/BP

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12
Q

When can a Mechanical Thrombectomy be formed in Ischaemic Stroke patients?

A

Anterior: within 6hr onset

Posterior: within 12hr onset

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13
Q

Stroke prevention/ Chronic stroke management?

A

HALTSS

Hypertension 2wk AFTER stroke
Antiplatelet: Clopidogrel/ Warfarin (AF)/ rivaroxaban
Lipid-lowering: Atorvastatin
Tobacco: stop smoking
Sugar: Diabetes screening
Surgery: Carotid endarterectomy IF carotid stenosis >50%

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14
Q

How are anterior strokes classified?

A

Anterior:

a) Contralateral hemiplegia/paresis AND
b) Contralateral homonymous hemianopia AND
c) Higher cerebral dysfunction (aphasia, neglect)

  1. TACI = ACA + MCA
  2. PACI = a+b OR c = ACA or MCA

LACI = pure motor/ pure sensory/ sensorimotor/ ataxic hemiparesis. NO higher dysfunction.

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15
Q

How are posterior strokes classified?

A

Posterior:

a) Cerebellar dysfunction OR
b) Conjugate eye movement disorder OR
c) Bilateral motor/sensory deficit OR
d) Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit OR
e) cortical blindness/ isolated hemianopia

= POCI

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16
Q

Which arteries do POCIs involve?

A

Vertebrobasilar arteries + associated branches

> cerebellum, brainstem, occipital lobe

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17
Q

Define haemorrhagic stroke

A

Weakened cerebral vessels lead to rupture and haematoma formation.

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18
Q

What are the two types of haemorrhagic stroke?

A

Intracerebral haemorrhage - 75%

Subarachnoid haemorrhage - 25%

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19
Q

Strong risk factors for haemorrhagic stroke

A

Age, male, FHx, haemophilia, anticoagulation therapy, hypertension, vascular malformations.

Cocaine, amphetamines

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20
Q

Acute management of haemorrhagic stroke

A

Decompressive hemicraniectomy

BP Control <140/80

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21
Q

Pt presents with Lower back pain, saddle parasthesia and are incontinent.

Investigation? Other presentations Cause? Likely diagnosis? Mx?

A

Cauda Equina Syndrome

  • sudden loss of sphincter control

Urgent MRI + Surgical decompression < 48hr

Cause: lumbar disc herniation L4-S1

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22
Q

Young pt presents with sudden severe back pain following a gymnastics competition.

Likely diagnosis?

A

Vertebral disc degeneration

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23
Q

Pt presents with severe pain and stiffness of their shoulder and neck.

Likely diagnosis? Where else could they be stiff?

A

Polymyalgia rheumatica

Affected areas: neck, shoulders, hips, lumbar spine

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24
Q

Management of Acute Cord Compression

A

Steroids - dexamethasone (if malignancy)

Surgical decompression

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25
Q

Cord compression presentations

A

Acute UMN signs + sensory disturbance below the lesion

Bladder/ bowel incontinence

“weak, hyperreflexive legs + paraesthesia “

26
Q

Management of all seizures

A

Lamotrigine, Levetiracetam, Valproate

27
Q

Mx of Focal Seizures

A

Carbamazepine, Gabapentin, Phenytoin

28
Q

Mx of Absence seizures

A

Ethosuximide

29
Q

Mx of epilepsy + heart problems

A

Digoxin (inhibits Na/K/ATPase)

30
Q

Which epilepsy drug is CI in pregnancy

A

Valproate = teratogenic

31
Q

Pt presents with rigidity, bradykinesia and postural instability. Tremor is worse at rest.

Likely diagnosis? Management? Associations?

A

Parkinson’s

LEVODOPA + Co-careldopa (SE n, hallucinations)

DA agonist - ropinirole
MAO-Bi - Selegline
COMTi - Entacaopone

Assoc with Lewy-Body dementia

32
Q

Pt presents with sudden painless vision loss and a stiff neck/shoulders.

Likely diagnosis? Management?

A

Giant Cell Arteritis
(jaw claudication, tender scalp)

Prednisolone + protective bisphosphonate
(lansoprazole, alenronate)

33
Q

Causes of peripheral neuropathy

A

Diabetes
HIV
B12 deficiency

34
Q

MND is associated with which dementia?

A

Fronto-temporal (Pick’s) Dementia

35
Q

Most common cause of meningitis

A

VIRAL - enteroviruses

  • echovirus
  • Coxsackie
36
Q

Viral causes of meningitis

A

Enteroviruses (echo, coxsackie)
Herpes Simplex Virus
Varicella zoster

37
Q

What are the main causes of Bacterial Meningitis?

A

Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenza b

Listeria monocytogenes (bimodal age)

38
Q

Immunocompetent Patient under 60 presents in the hospital with bacterial meningitis.

Treatment?

A

1L IV Ceftriaxone +
Dexamethasone

2L Chloramphenicol +
Dexamethasone

If suspected penicillin-resistant pathogen use 3rd-gen Vancomycin cover

39
Q

Immunocompetent Patient under 60 presents in the hospital with bacterial meningitis.

After empirical tx, they are found to have Listeria monocytogenes. Tx?

A

IV amoxicillin

or IV Trimethoprim

40
Q

Immunocompetent Patient under 60 presents in the hospital with bacterial meningitis.

After empirical tx, they are found to have Staphylococcus aureus. Tx?

A

IV Flucloxacillin + Rifampicin

2L IV Vancomycin + Rifampicin

41
Q

Immunocompetent Patient under 60 presents in the COMMUNITY with bacterial meningitis.

Tx IF they have a rash?

A

IV Benzylpenicillin/ chloramphenicol

Urgent referral

42
Q

Baby presents in the hospital with bacterial meningitis.

Empirical treatment?

A

2g IV Ceftriaxone + IV Ampicillin

43
Q

Most common cause of encephalitis?

A

HSV-1

44
Q

Inflammation of brain parenchyma

A

Encephalitis

45
Q

Pt presents with fever, headache and altered mental status.

CSF shows normal plasma:glucose ration.

Likely diagnosis? Tx?

A

Encephalitis

IV Aciclovir
IV Benzylpenicillin

46
Q

Pt presents with a red, painful rash across her cervical dermatome.

The rash is fluid-filled blisters and is “burning”. She is febrile and fatigued.

Likely diagnosis? Investigations? Tx?

A

Herpez zoster - Shingles (reactivated varicella zoster)

Inv: PCR, CSF, Blood culture

Tx:

  • Acyclovir
  • analgesia
  • antipyretics
47
Q

Pt presents with parasthesia of the peripheries and describe a tingling shooting pain in the feet. They show distal weakness and fasciculations on the legs.

They display a + Romberg test (sensory ataxia).

Likely diagnosis? Possible causes? Treament?

A

Peripheral neuropathy

Diabetes, medicine, alcohol, CKD, injury

infection, connective-tissue disorder, inflammation, malnourishment

Tx:

  • underlying
  • Pregabalin/ gabapentin (pain)
  • supportive
48
Q

Pt presents with temporal headache and temporary vision loss. Her jaw hurts intermittently and she has double vision.

Likely diagnosis?
Investigations?
Treatment?

A

Giant Cell Arteritis

American College of Rheumatology:

  • ESR>50
  • abnormal temporal artery biopsy
  • age >50
  • New headache
  • temporal artery abnormality

minimum 3/5

Tx:

  • prednisolone
  • aspirin
  • Tocilizumab
49
Q

What is Tocilizumab used for? Outline pharmacology

A

Giant cell arteritis maintenance

Monoclonal Ab against IL-6 receptor. Helps with GCA remission.

50
Q

Pt presents with muscle weakness of her hands worse on exertion, and eased with rest. She describes double vision. On examination her eyes are drooping (ptosis).

Likely diagnosis? Investigations?
Treatment?
Complications

A

Myasthenia Gravis

1L AChR Ab (85%)
MuSK Ab (10%)
Ice pack - ptosis improves

EMG-Single fibre EMG

CT Chest - thymoma?

Tx:

Acute: Prednisolone

Long-term: Acetylcholinesterase inhibitor - Pyridostigmine
+ methotrexate

Complications: Myasthenia Crisis (resp failure), Thymoma

51
Q

A patient is diagnosed with Myasthenia gravis, What investigation will you also consider?

A

CT Chest - Thymoma?

52
Q

37 yr woman from Sweden presents with a 2 day history of blurry vision and pain the right eye. Her visual acuity is 1/60 and there is some loss of colour vision.

Neuro exam is normal, so no CNS involvement

Fundoscopy reveals a swollen right optic disc.

Likely diagnosis?
Investigations?
Treatment?

A

Multiple Sclerosis
(optic neuritis)

Investigations:

MRI head + SC

  • gadolinium-enhanced lesions of ventricles
  • myelitis

Lumbar Puncture - Oligoclonal banding (IgG)

Treatment: Empirical Methylprednisolone

If relapse-remitting: injectable beta-interferon (long-term)

53
Q

Lorazepam use

A

Acute management of seizures

54
Q

Pt presents with meningism, fever and nausea, as well as confusion and papilledema.

Likely diagnosis? Investigations?

A

Suspected Meningitis with raised ICP.

1L CT Head (quicker than MRI)

Then Lumbar Puncture

55
Q

22yr old M presents to A&E with worsening bilateral headache. He is febrile but otherwise fit and well.

CT Head shows subtle sulcal effacement. LP exudes Frank purulent fluid and a raised opening pressure.

Most likely underlying pathogen?

A

Neisseria meningitidis

56
Q

22yr old M presents to A&E with worsening bilateral headache. His PHx shows he is immunocompromised

CT Head shows subtle sulcal effacement. LP exudes Frank purulent fluid and a raised opening pressure.

Most likely underlying pathogen?

Tests? Treatment?

A

Cryptococcus neoformans

Ag-test + India-Ink stain

Treatment

  • 2wk IV Amphotericin B + Flucystosine
  • 8wk fluconazole
57
Q

Describe the LP of a pt with acute bacterial meningitis

A

Macroscopically purulent, neutrophilic leukocytosis, low glucose, high protein

58
Q

Describe the LP of a pt with acute viral meningitis

A

Lymphocytes, slightly raised protein, normal glucose

59
Q

Pt is suspected to have viral meningitis. There is no signs of encephalitis.

Likely cause? Treatment?

A

Enterovirus (Coxsackie/ Echovirus)

Self-limiting. Give analgesia, antipyretics, nutrition, fluid.

60
Q

Pt is suspected to have viral meningitis. She is irritable, febrile and confused.

Likely cause? Treatment?

A

HSV1/2

IV Acyclovir

61
Q

1 month old Baby presents with 12hr vomiting, crying, irritability. He is pyrexial and cries when his head is moved.

Treatment?

A

Probably bacterial meningitis.

IV Cefotaxime (>1month old) AND Ampicillin (listeria cover)

62
Q

Anti-GD1a

A

Guillain Barre syndrome

2A - Stuff i just cannot remember (19 decks)

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