Neuro and eyes Flashcards
Menstrual migraine prophylaxis medication
Zoltriptan or frovatriptan
(unlicensed taken around time of menstruation)
Dementia screen bloods
FBC, u&e, LFT, TFT, calcium, glucose, folate, b12
steroid dose in children
The recommended dosage of prednisone for asthma exacerbation is 10 mg of prednisolone for children under two years of age, a dose of
2-5 is 20 mg for children aged
> 5 of 30–40 mg for children
psedomonus sputum treatment
cipro 7-14 days
Acute severe asthma episode is
Peak expiratory flow (PEF) 33–50% best or predicted
respiratory rate ≥ 25 breaths per minute
heart rate ≥ 110 beats per minute
inability to complete sentences in one breath
A 60 year-old retired man who has a sudden onset of slurring of speech and unilateral weakness. He has a complete recovery within 24 hours, and there are no neurological abnormalities at this time. He has not had any similar episodes in the past. DVLA guidance TIA
Cannot drive until 1month
TIA
The DVLA only need be informed if there are neurological abnormalities present four weeks after the episode.
Group 2 driver 1 year
Werneckes triad
Ataxia, confusion and ophthalmoplegia
Korsacoff psychosis
Amnesia, confabulation and disorientation of time
Delirium tremens
Present uptp 7 days of alcohol withdrawal
Autonomic dysfunction- sweating, htn and tachycardia with confusion
Motor neurone disease good presdictive factor
Onset at young age(i.e. 20s or 30s)
female sex
relapsing-remitting disease
sensory symptoms only
long interval between first two relapses
complete recovery between relapses
Horners syndrome
Ptosis, mitosis (constricted pupils), anhidrosis
herpes zoster ophthalmicus tx
Oral acovlovir
acute angle closure glaucoma risk factors
hypermetropia (long-sightedness)
pupillary dilatation
lens growth associated with age
medications - amitriptyline, topiramate, mirtazapine, ssri
Holmes-Adie pupil
dilated pupils
slowly reactive to accommodation
associated with absent knee and ankle reflexes
Stye - infection of the glands on eye lids tx
warm compress for 5-10mins 3-4 times a day
Acute angle closure management if delay in hospital admission
Lie facing front without pillow
Pilocarpine 2% in blue eyes, 4% in green eyes
acetazolamide 500 mg
prostaglandin analogues e.g lantoprost side effects
Brown pigmentation around eyes
Thickened eye lash
Pilocarpine side effects
Small pupils, headaches and blurred vision
Anticholinergic medication licensed for dementia in Parkinson’s disease
Rivadigistimine
Ergotic Dopamine receptor agonists
e.g. bromocriptine cabergoline, side effects
impulsiveness
cardiac/ pulmonary fibrosis
the only anti-emetic that should be used in patients with Parkinson’s disease
Domperidone
Levodopa side effects
Dyskinesia
Motor fluctuations
Hypotension
anorexia
dry mouth
lethargy/drowsiness
psychosis
drugs that can cause peripheral neuropathy
nitrofurantoin
metronidazole
phenytoin
Parkinsons first line medications
- levodopa
- non ergonotic dopamine agonists e.g ropinirolone, apomorphine, pamprixiole
- MAOI
Which migraine prophylaxis medication can precipitate acute angle closure glaucoma
topiramate
Drugs that precipitate acute angle closure glaucoma
antihistamines, antiparkinsonian medications, antipsychotics, benzos, botox, cocaine, H2RAs, mefenamic acid, SSRIs, topiramate, tricyclics
Motor neurone disease facts
Mixed upper and lower motor neurone signs
fasciculations
sensation not affected
don’t affect eye muscles
Risk factors for dementia
Parkinsons
downs’ syndrome
cvd risk factors - htn, cholesterol, smoking
FH
severe psychiatric disease
low IQ
head injury
low physical activity
Dementia MMSE scoring
>26
21- 26
10-20
<10
Normal
mild
Moderate
Severe
Three Dementia acetylcholnisterase inhibitors
donepezil, galantamine and rivastigmine
Huntingtons disease
Autominal dominant disease
anticipation
chorea, dystonia, saccadic eye movements, personality changes
After having a seizure, what is the risk of having another seizure in the next 1 year
30%
If patient has been seizure free for how long can we consider stopping/ reducing their seizure medications?
2yrs
NICE states that the lifetime risk of SUDEP (sudden unexplained death I epilepsy in a patient with epilepsy is how much?
7-12 %
Cause of secondary glaucoma
Uveitis, eye trauma, cataracts, medications especially steroid
Bell’s palsy poor prognosis
Complete palsy
Severe pain
No recovery by 6 weeks
Age >60
Glaucoma vs anterior uveitis
Glaucoma causes visual loss
Anterior uveitis don’t. Includes iritis - redness around the sclera
1.Migraine prophylaxis in children >12
2. Under 12
- Propanol
- Pizotifen
Tension headaches prophylaxis
Acupuncture, CBT, amitriptyline
