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CP3 Medicine > NEURO - Epilepsy, MS + Parkinsons > Flashcards

NEURO - Epilepsy, MS + Parkinsons Flashcards

1
Q

Def Syncope

A

Transient LOC due to cerebral hypoperfusion

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2
Q

What are the 3 main types of syncope

A

Vaso-vagal
Postural HoTN
Post-prandial HoTN

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3
Q

What is Vasovagal syncope

A

Fainting due to a sudden reflex bradycardia and peripheral vasodilation

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4
Q

What is vasovagal syncope in response to? (4)

A

Standing
Fear
Venesection
Pain

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5
Q

LOC time vasovagal syncope

A

<2mins

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6
Q

Recovery - vasovagal syncope

A

Rapid

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7
Q

Mx vasovagal syncope

A

None req

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8
Q

What is postural HoTN

A

Drop in SBP by >2-+ on standing

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9
Q

Ix postural HoTN

A

Measure sitting + standing BP at 1,5,10mins

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10
Q

What is post-prandial HoTN

A

Drop in 20+ SBP after eating

B/c pooling blood in splanchnic vasculature

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11
Q

Other types of syncope (4)

A

Carotid sinus
Anaemia
Micturition
Exertion

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12
Q

Ix recurrent syncope (5)

A 
Bloods - FBC/U+E/glucose 
Lying/standing BP
ECG/24h tape
EEG
CT head
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13
Q

Advise to pt w/ recurrent syncope pre-Ix

A

NO DRIVING until cause is found

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14
Q

Classic features of a generalised seizure (4)

A

Aura
LOC
Tonic/Clonic
Post ictal phase (drowsiness)

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15
Q

Def focal seizure

A

Originating from within the networks of 1 hemisphere

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16
Q

Do you lose consciousness in a simple focal seizure?

A

No

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17
Q

Types of generalised seizures (6)

A 
Abscence 
TC
Clonic 
Tonic 
Myoclonic 
Atonic
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18
Q

Temporal seizure classic Sx

A

LIp smacking/chewing

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19
Q

Frontal seizure classic Sx

A

MOtor movements

Speech

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20
Q

Parietal seizure classic Sx

A

Sensory changes

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21
Q

Occipital seizure classic changes

A

Vision changes

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22
Q

What is Todds paresis?

A

Temporary paralysis of affected limb, post focal seizure

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23
Q

Causes of seizures (7)

A 
Idiopathic mostly 
Cerebrovascular 
Head injury
CNS infection 
SOL 
Neurodegen disease 
Metabolic - GI/Na/K
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24
Q

Anti-epileptics - 1st line for generalised

A

Na valporate

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25
Q

Anti-epileptics - 2nd line for generalised

A

Lamotrigine

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26
Q

Anti-epileptics - 1st line for absence seizures

A

Ethosuximide

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27
Q

Anti-epileptics - 1st line for focal seizures (2)

A

Carbamazepine

Lamotrigine

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28
Q

Mode of action - Na valporate

A

Potentiates GABA

Blocks NA channels

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29
Q

SE Na Valporate (5)

A 
Rash 
Sedation 
Weight gain 
Hair loss 
Tremor
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30
Q

Who cannot take Na Valporate (3)

A

Pregnant F
Thrombocytopenia
Liver damage

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31
Q

Mode of action - Lamotrigine

A

Blocks Na channel

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32
Q

What is there a risk of when taking Lamotrigine?

A

BM toxicity

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33
Q

Mode of action carbamazepine

A

Na channel blocker

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34
Q

SE carbamazepine (4)

A

Rash
Dizzy
Double vision
AGRANULOCYTOSIS

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35
Q

drug interactions carbamazepine

A

P450 pathway

Inducer

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36
Q

SE Phenytoin (2)

A

Gum hypertrophy

Nystagmus

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37
Q

Why must phenytoin be monitored?

A

Zero order kinetics :/

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38
Q

Which medication must be prescribed in caution w/ phenytoin

A

COC

can lead to failure of COC as is enzyme inducer

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39
Q

Driving rules (CAR) - epileptic

A

Can’t drive
After 1 y can reapply for licence
This is 10 years for a lorry driver

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40
Q

Driving rules (CAR) - 1st unprovoked seizure

A

No driving for 6 months at least

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41
Q

Driving rules (CAR) - provoked seizure

A

Epilepsy regulations apply

Possible exemption if seizure @ time of head injury

42
Q

Def MS

A

Relapsing episodes of immunologically mediated demyelination of CNS –> neuro degeneration

43
Q

M:F MS

A

1:2

44
Q

Classic age of onset MS

A

200-45

45
Q

What is the genetic predisposition to MS

A

HLA-DR2

46
Q

Where are areas of demyelination classically seen in MS? (5)

A 
Optic nn 
Angles of lateral ventricles 
cerebellar peduncles 
Brainstem 
Dorsal/CCS tracts
47
Q

What are the 3 patterns of MS

A

Primary progressive MS (10-20%)
Relapsing/remitting MS (80%)
Fulminating MS (<10%)

48
Q

Features of primary progressive MS

A

No clear cut relapses/remissions

49
Q

When is primary progressive MS diagnosed?

A

If progressive deterioration for >1y

50
Q

Features of relapsing/remitting MS

A

Initial eps resolve completely
Subsequent events –> residual disability
Eventually develops 2’ progressive MS

51
Q

Features fulminating MS

A

Debilitating progressive deterioration from early stage

52
Q

Optic Sx MS

A 
Optic neuritis: 
> Sudden painful LOV
> Loss  colour vision (esp red)
> Swollen optic disc 
> Diplopia
53
Q

UMN Sx MS

A

CCS

–> hemi/monoparesis

54
Q

Sensory Sx MS

A

Dorsal tract
Paresthesia
Proprioceptive loss

55
Q

Cerebellar Sx MS

A

Intention tremor

Nystagmus

56
Q

What is Uthoff’s phenomenon

A

Sx of MS being worse in the head

57
Q

1’ care Ix MS

A 
FBC
U+E
LFT
ESR
TFT
Glucose 
Ca
B12
HIV
58
Q

2’ care Ix MS

A

MRI
CSF
Visual evoked response

59
Q

MRI features MS

A

> 10 plaques visible

60
Q

CSF features MS

A

Incr cell count
Incr protein
Oligoclonal IgG bands present

61
Q

Visual evoked response features - MS

A

Delayed EEG reaction in occipital lobe to visual stimuli

62
Q

DDx - R/R MS (3)

A

TIA
SLE
CNS sarcoid

63
Q

DDx - 1’ progressive MS (3)

A

MND
CNS mass
Parkinsons/HD

64
Q

Mx - acute relapse MS

A

Ix - rule out other cause

High dose CCS: PO methylprednisolone 0.5mg/day for 5 days

65
Q

How long does it take for an acute MS relapse episode to recover

A

2-3 months

66
Q

LT Mx MS

A

MDT + annual review
Lifestyle
UTI will exaccerbate
Dimethyl fumuarate/teriflunomide - R/R

67
Q

Mx R/R MS if severe (2+ relapses in 1 y)

A

Natalizumab

68
Q

Complications MS (8)

A 
Fatigue 
Spasticity 
Ataxia/tremor 
Mobility 
Bladder dysfunction 
Sexual dysfunction 
Pressure sores 
Depression
69
Q

LE MS

A

20-30 y

70
Q

Poor prognostic factors MS (3)

A

Incr age of PS
Early cerebellar involvement
Loss mental fct

71
Q

Mx fatigue in MS

A

Amantadine + CBT

72
Q

Mx spasticity in MS

A

Baclofen + physio

Botox injection

73
Q

Mx bladder dysfunction in MS

A

Oxybutynin/toleridine

If >100ml - int self-catheterisation

74
Q

Anatomical changes - Parkinsons

A

Degeneration of the SN pars compacta

–> Decreased dopamine activity

75
Q

Features Parkinsons - BRIT WGM

A 
Bradykinesia 
Rigidity 
Instability 
Tremor 
Writing (micro) 
Gait 
Mask face
76
Q

Classic triad Parkinsons disease

A

Bradykinesia
Rigidity
Tremor

77
Q

Def Bradykinesia

A

Progressive reduction in speed/amplitude

78
Q

Def rigidity

A

Increased tone throughout range of movements

‘lead pipe/cog wheeling’

79
Q

Rigidity vs spasticity

A

Rigidity = increased tone w/ tremor

Spasticity - velocity dependent

80
Q

What type of tremor typically do pt w/ PD get

A

Pill rolling

Occurring at rest + w/ movement

81
Q

Gait changes PD

A

Festinant shuffle
Decreased arm swing
Turning hesitation/freezing

82
Q

Speech changes PD

A

Monotonous pronunciation

83
Q

Non-motor features PD (4)

A

GI - dysphagia/constipation/urinary freq
Vivid dreams
Depression
Cognition/dementia

84
Q

Causes Parksinsons disease (4)

A

Idiopathic
Dx - neuroepileptics/anti-psychotics
Vascular
Toxin - Wilsons

85
Q

What is Parkinsons plus syndrome (3)

A

Progressive supranuclear palsy
Multiple system atrophy
Lewy body dementia

86
Q

Features of supranuclear palsy PD +(3)

A

Symmetrical onset
Postural instability/sleep problems
Limitation in movement down gaze

87
Q

Features of multiple system atrophy PD+ (3)

A 
Autonomic - postural HOTN, bladder dysfunction, sweating 
Cerebellar sins 
Pyramidal signs (incr plantars/hyperreflexia)
88
Q

5 main sets of Meds used in PD Tx

A 
Levodopa/Carbidopa
DA receptor agonists - ropinirole/bromocriptine/cabergoline
MAOI
Anticholinergics (tremor) 
COMT inhibitors - entacapone/tolcapone
89
Q

Levodopa effects - motor Sx:

A

> improvement in motor Sx

90
Q

Levodopa effects - ADL

A

> improvement in ADLs

91
Q

Levodopa effects - motor complications

A

> motor complications

92
Q

Levodopa - adverse events

A

< specified adverse events

93
Q

DA agonists - motor Sx

A

< improvement in motor Sx

94
Q

DA agonists - ADLs

A

< improvement on ADLs

95
Q

DA agonists - Motor complications

A

< motor complications

96
Q

DA agonists - adverse effects

A

> specified adverse events

97
Q

MAO-B-I - motor Sx

A

< improvement in motor Sx

98
Q

MAO-B-I - ADLs

A

< improvements in ADLs

99
Q

MAO-B-I - motor complications

A

< motor complications

100
Q

MAO-B-I - adverse events

A

< specified adverse events

CP3 Medicine (29 decks)

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