Neuro - degen and dysfunc without pathol Flashcards
MOTOR NEURONE DISEASE
i) what type of motor neurons does it affect? does it have sensory involvement?
ii) what reflexes are seen? what may be seen when observing muscles? what is this due to?
iii) where is weakness first noticed? how may this present? name three signs of LMN disease? name three signs of UMN diseaase?
iv) what drug may slow progression and extend survival by a few months? what do patients usuallly die of? (2)
i) affects both UMN and LMN and does not have sensory involvement
ii) brisk reflexes due to UMN involve
muscle fasciculation due to LMN involve
iii) first notice weakness in upper limbs - increasaed fatigue when exercising, clumsy, drop things
LMN - muscle wasting, reduced tone, fascic, reduced reflexes
UMN - increased tone, spasticity, brisk reflexes, upgoing plantar response
iv) riluzole can slow progression
usually die of resp failure or pneumonia
PARKINSONS DISEASE
i) what is the classic triad? what is it called if cognitive/neuropysch symptoms present first? name five symptoms? what type of hallucinations may be seen?
ii) what is rem sleep behavioural disorder?
iii) name four ways in which PD tremor is different from benign essential tremor?
i) triaad - resting tremor, cogwheel rigidity, bradykinesia
dementia with lewy bodys of cog symptoms first
hard to initiate movement, shuffling gait, reduced arm swing, difficulty turning in bed, visual hallucinations (non threatening), pill rolling unilateral tremor
ii) loss of REM sleep atonia therefore movement in REM sleep - may be seen as acting out dreams
iii) ET - symmetrical, improves at rest, worse with intentional movement, improves with ETOH
PD TREATMENT
i) what is given to boost own DA levels? is this usually given first line? what is it combined with? what is the main side effect?
ii) give an example of a COMT inhibitor?
iii) how do DA agonists work? what is a side effect of prolonged use? name one
iv) name an MAO B inhibitor? how do they work?
i) levodopa - usually reserved for when other tx arent effective
combine with peripheral decarbox inhibitors eg caribidopa to stop it being broken down before it enters the brain
ii) COMT = entacapone
iii) mimic DA in the basal ganglia to stimulate DA receptors - less effective than levodopa
side effect = pulmonary fibrosis
cabergoline, bromocryptine
iv) selegine, rasagilline
stop MAOs breaking down DA - use to delay need to use levodopa
MIGRAINE
i) how long may they last? name six typical features? name five possible triggers
ii) what is aura? name four types that may be seen in migraine?
iii) what type of migraine can mimic stroke? name four symptoms of this type of migraine
iv) what are the five stages of migraine?
i) last between 4-72 hours
mod/severe intensity, pounding or throbbing, usually unilateral, photphobia, phonophobia, aura, N+V
triggers - stress, lights, smells, certain foods, dehy, menstruation, change in sleep pattern, trauma
ii) aura is visual change associated with migraine
sparks in vision, blurry vision, lines across vision, loss of specific visual fields
iii) hemiplegic migraine can mimic stroke - hemiplegia (unilat weak of limbs), ataxia, change in conciousness
iv) stages: 1) premonitionary/prodromal (can begin three days before headache)
2) aura - up to 60 mins
3) headache - 4-72 hours
4) resolution - fade away or relieve by vomit or sleep
5) post dromal or recovery phsae
MX OF MIGRAINE
i) name four medicines that can be used in acute management?
ii) which drugs are used to abort migraines when they start to develop? what receptor do they work at? name three ways they work
iii) what can help to identify triggers? name three medications that can be used long term as prophylaxis
iv) which NICE recommended alternative therapy may be useful? which vitamin may be supplemented?
v) what can be given as prophylaxis for migraines specifically triggered around menstruation? (2)
i) acute mx - paracetamol, triptans (sumitriptan), NSAIDs, antiemetics if vomiting occurs
ii) triptans can be used to aabort - 5HT receptor agonists
work on sm muscle in arteries > vcons
work on periph pain receptors to inhibit activation
reduce neuronal activity in CNS
iii) headache diary to identify triggers
prophylaxis - propanolol, topiramate (teratogenic), amitriptyline
iv) acupuncture
supp with vitamin B2 (riboflavin)
v) menstruation triggered - give NSAIDs eg mefanamic acid or triptans to prevent
CLUSTER HEADACHES
i) where do they usually occur? what pattern may they follow? how long may an attack last?
ii) what is a typical patient presentation? name two things that can trigger an attack
iii) name five symptoms
iv) what drug can be used in acute mx? what else can be given?
v) name three things that can be given as prophylaxis?
i) usually unilateral around the eye
clusters of attacks then dissapear - may last 15 mins to 3 hours
ii) typical px is 30-50yr old male smoker
triggered by ETOH, strong smells and exercise
iii) intolerable paain, red/swollen/watery eye, pupil constriction (miosis), ptosis, nasal discharge, facial sweating
iv) triptans for acute mx (subcut sumitriptan injection) and high flow 100% oxygen for 15-20 mins at home
v) prophylaxis - verapamil, lithium, prednosiolone
EPILEPSY
i) what investigation can support dx? what scan may be done?
ii) what happens in a tonic clonic seizure? which phase comes first? name three assoc symptoms? what may happen afterwards?
iii) what is first line tx for TC seizures? what is second line? (2)
iv) where do focal seizures start? name three things they may affect? name four ways which they may px?
v) how are focal seizures mx first line? (2) second line? (2) - opposite of TC
i) EEG, MRI brain
ii) loss of conc then tonic (musc tensing) and clonic (muscle jerking) assoc with tongue biting, incontinence, groaning, irregular breathing
iii) sodium valproate 1st line
lamotrigine or carbamazepine second line
iv) focal seizures start in temporal lobes and affect hearing, speech, memory, emotions
can px with hallucinations, memory flashbacks, deja vu, doing strange things on auto pilot
v) first line is carbamaz or lamot
second line is valproate or leviteracetam
STATUS EPILEPTICUS
i) what is it?
ii) what approach should be taken?
iii) what medication should be given? what is given if seizure persists?
iv) what two medications can be given in the community?
i) seizure lasting more than 5 mins or more than 3 seizures in one hour
ii) A-E approach
iii) give IV lorazepam 4mg repeated after 10min if seizure continues
give IV phenobarbital or phenytoin if seizure persists
iv) buccal midazolam or rectal diazepam
