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Year 3 > Neuro last min stuff > Flashcards

Neuro last min stuff Flashcards

1
Q

Treatment of Absence seizures?

A

1st - Valproate or Ethosuximide

2nd - topiramate or levetiracetam

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2
Q

Treatment of Atonic/Tonic-Clonic seizures?

A

1st - Valproate
Levetiracetam
Lamotrigine
Topiramate

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3
Q

Treatment of Myoclonic seizures?

A

1st - Valproate, Levetiracetam or Clonazepam

2nd - Lamotrigine, topiramate

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4
Q

Treatment for focal seizures?

A

1st - carbamazepine

2nd - Lamotrigine, valproate, topiramate

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5
Q

Parkinson’s treatment:

  • gold standard?
  • dopamine agonists?
  • COMT inhibitors?
  • MOAI?
  • Why is apomorphine used?
A

Sinemet (levodopa + carbidopa)

D anon - Pramipexole, apomorphine, roprinirole

COMT - Entacapone

MOAI - Selegeline, rasageline

Apomorphine - sudden ‘off’ states

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6
Q

5 parkinson plus syndromes?

A

Progressive supra nuclear palsy:
- vertical gaze palsy, speech and swallowing problems

Multi-system atrophy:

  • Autonomic dysfunction, cerebellar dysfunction
  • MRI - hot cross bun sign due to pontine & cerebellar atrophy

Corticobasal degeneration:
- One limb is prominent, apraxia, alien-limb phenomenon

LBD:
- cognitive decline, hallucinations

Vascular parkinsonsim:
- predominantly lower limbs with gait disturbance, pyramidal signs and cognitive dysfunction

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7
Q

Wilson’s disease presentation?

A

Young, parkinsonism, behavioural change & cognitive decline, hepatic and renal failure, keyser-fleischer rings in eyes

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8
Q

Treatment of dystonia:

  • general?
  • Focal?
  • acute?
A

general - Baclofen

focal - botulinum toxin

acute - procyclidine

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9
Q

How to differentiate MND from myasthenia graves and MS/neuropathy?

A

myasthenia - it doesn’t affect eyes

MS/neuropathy - no sensory involvement

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10
Q

4 types of MND and features?

A

ALS: most common
- UMN in legs, LMN in arms

PLS:
- UMN only - loss of benz cells in motor cortex

Spinal muscular atrophy:
- purely LMN - loss of anterior horn cells

Progressive bulbar palsy:
- LMN - Affects CN IX, X and XII first - drooling, dysphagia, aspiration

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11
Q

What is pseudo bulbar palsy?

What is it seen in?

A

UMN lesions affecting CNIX, X and XII

Can be seen as part of PLS, parkinson’s etc

(if mix or UMN and LMN then likely bulbar onset ALS)

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12
Q

Myasthenia Gravis:

  • Rx?
  • Crisis treatment?
A

Rx - pyridostigmine

Crisis - IV Ig or plasmapheresis

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13
Q

Neurophysiology for:

  • myasthenia gravis?
  • lambert eaton?
A

MG - single fibre jitter, low amplitude potentials, decreased twitches with repeated stimulation

LEMS - low frequency AP’s, increase in twitch amplitude with exercise, increase in fasciculation with exercise

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14
Q

Rx for lambert eaton?

A

3,4 - diaminopyradine

If acute: IV Ig

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15
Q

What is botulism?

A

Infection with clostridium botulinum

Toxin blocks Each presyaptic terminals

Present with flaccid paralysis - afebrile

Rx: anti-toxin

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16
Q

Stokes adams attack?
Pre-attack?
Attack?
Recovery?

A

Transient arrhythmia causing by reduced cardiac output and loss of consciousness - multiple times per day in any posture

pre: palpitations
attack: fall with LOC, pallor, slow/absent pulse
post: within seconds, flushing

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17
Q

Diagnosis of epilepsy?

A

Largely clinical

CT/MRI to rule out structural abnormality

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18
Q

Investigations for MS?

A

MRI - plaques of demyelination

LP - oligoclonal bands of IgG

Evoked potentials - delayed

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19
Q

MS symptom management:

  • spasticity?
  • Sensory? (numbness, tingling, pain)
  • Bladder dysfunction?
  • Fatigue?
A

spas - Baclofen, physio, OT

sens - amitriptyline, gabapentin, TENS, acupuncture

Bladder dysfunction - bladder training, oxybutynin

Fatigue - hyperbaric oxygen, modafinil

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20
Q

Relapse management in MS?

A

IV Methylprednisolone

Plasma exchange

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21
Q

Disease modifying drugs in MS:
- 1st line?
- 2nd line?
3rd line?

A

1st: Tecfedira, B interferon, Capaxone

2nd - Tysabari, Fingolimod

3rd - Mitoxantrone

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22
Q

Tecfedira/Tysbari SE?

A

reactivation of JC virus causing progressive multifocal leukoencephalopathy

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23
Q

5 causes of mono neuritis multiplex?

A 
Diabetes
Rheumatoid
Carcinomatosis
Vasculitis (Wegners, PAN)
Infection (HIV, leprosy)
24
Q

Difference between polyneuropathy and mononeuritis multiplex?

A

Polyneuropathy - symmetrical and widespread, usually glove & stocking, weakness, autonomic/cranial nerves can be affected too

Mono multi - 2 mononeuroopathies in distinct locations at same time

25
Q

11 Causes of polyneuropathy?

metabolic, nutritional, vascular, infectious, drugs, malignancy

A 
Diabetes
Hypothyroidism
Renal failure
B12 deficiency
Vasculitis (weighers, PAN)
Rheumatoid 
Infection (HIV, Lyme, syphilis)
Alcohol
Isoniazid
Chemo
Paraneoplastic syndrome
26
Q

Nerve conduction of neuropathy?

A

reduced response at peripheral and distal locations

27
Q

Ix for guillian barre?

A

nerve conduction: slowed

LP: increased protein with normal WCC

28
Q

Management of guillian barre?

A

IV Ig
Plasmapheresis
+/- ventilatory support

29
Q

Inheritance of charcot marie tooth?
Presentation?
Nerve conduction?
Management?

A

AD

Around puberty
Progressive muscle weakness - inverted champagne bottle - foot drop/high stepping gait
May be sensory loss and loss of reflexes

Nerve: temporal dispersion with stimuli arriving at different times - if severe complete conduction block

Rx: physio

30
Q

3 most common viral causes of meningitis?

A

Echo virus - most common
Enterovirus: coxsackie
Herpes simplex

More insidious onset

31
Q

Who gets cryptococcal meningitis?

A

HIV/immunosuppression (think hookers)

32
Q

Most common bacterial meningitis if:

  • immunocompromised?
  • Skull fracture?
  • Surgery/open head wound?
  • CSF shunt?
A

Pneumo, Meningo, listeria, TB, Gm -ve rods (+cryptococcal)

Pneumococcal, HiB, B-haemolytic GAS

Staph aureus/epidermidis, aerobic Gm -ve rods

Staph epidermidis/aureus, Gm -ve rods, proprionibacterium acnes

33
Q

Kernig’s sign?

A

pain and resistance on passive extension of knee with flexed hip –> meningitis

34
Q

Prophylaxis of meningitis?

A

Single dose Ciprofloxacin
OR
4 doses Rifampicin

35
Q

How to differentiate meningitis from encephalitis?

A

Quick onset psychosis, odd behaviour, speech and memory problems

May be with/without meningism (neck stiffness, headache, photophobia)

36
Q

Causes of encephalitis?

A

Herpes simplex
Varicella zoster
CMV/HIV

37
Q

Bilateral temporal lobe enhancement?

A

HSV encephalitis

38
Q

Management of viral meningitis?

Encephalitis?

A

meningitis - supportive

encephalitis - IV aciclovir

39
Q

Presentation of brain abscess?

A

Raised ICP: headache, drowsiness
Focal neurological signs
Fever

Preceding skull fracture, endocarditis, sinusitis, dental abscess etc

40
Q 
Who gets progressive multifocal leukoencephalopathy?
Cause?
Presentation?
Imaging/LP?
Rx?
A

immunocompromised, MS drugs tysibari/tecfedira

Reactivation of JC virus

Demyelination symptoms, similar to MS

LP - JC DNA
imaging - multifocal enhancing lesions

No effective treatment

41
Q

Acute relief of migraine?

Prophylaxis?

A

Paracetamol + NSAID or Triptan

Prophylaxis of >3 attacks per month:
1st - propanolol
2nd - amitriptyline/topiramate/gabapentin/valproate

42
Q

Management of tension headache?

A

paracetamol/NSAID
discourage chronic use of analgesia
Relaxation therapy

43
Q

Management of acute tension headache?

Prophylaxis?

A

1st - high flow oxygen
2nd - sc triptan

Prophylaxis - Verapamil
(topiramate 2nd)

44
Q

Difference between paroxysmal hemicrania and cluster headache?

A

Both assoc w autonomic features

CH comes in clusters were will get most days for 1-3 months, PH doesn’t

Paroxysmal shorter (5-30 mins) cluster longer (30 mins-3 hours)

PH shows definitive response to Indomethacin

(if PH present for >3 months with attacks of greater intensity then hemicrania continua)

45
Q

SUNCT?

A

attacks last seconds-10 mins
Numerous per day (up to 50-60)

Lamotrigine/Gabapentin

46
Q

Treatment for Bells Palsy?

A

Prednisolone for 5 days if present within 72 hours

47
Q

4 features of narcolepsy?

Treatment?

A 
daytime somnolence
cataplexy
hypnagogic hallucinations
sleep paralysis
(also assoc w REM sleep disorders)

Modafinil - reduces daytime somnolence
Sodium oxybate - reduces cataplexy

48
Q

Watershed stroke?

A

caused by sudden drop in BP - hypoperfusion to watershed zones

49
Q

TACS?

PACS?

A

3 of:

  • unilateral weakness +/- sensory loss
  • homonymous hemianopia
  • higher cerebral dysfunction e.g. dysphasia

PACS if 2 present - blockage of middle OR ant cerebral

50
Q

POCS?

A

One of the following:

  • isolated homonymous hemianopia
  • cerebellar/brainstem syndromes, decreased consciousness (ataxia, facial weakness, nystagmus, diplopia)
  • Confusion/mood changes
51
Q

LACS?

A
  • Purely sensory loss
  • Ataxic hemiparesis
  • Unilateral weakness +/- sensory symptoms in face, arms or legs
52
Q

Presentation of intracranial venous thrombosis?

  • saggital
  • transverse
  • cavernous sinus
A

saggital: headache, vomiting, seizure, reduced vision, papilloedema
transverse: headache +/- mastoid pain, seizures, focal signs, papilloedema

Cavernous sinus: CN III IV, V1, VI, sympathetic palsy, ophthalmoplegia, swollen conjunctiva/eyelids, proptosis, photophobia, raised ICP - commonly from spread of facial infection

53
Q

How to acutely manage raised ICP?

A
  • elevate head to 30-40 degrees
  • mannitol
  • hypertonic saline
  • intubate and hyperventilate (reduce pCO2 so cerebral vasoconstriction so lower ICP)
54
Q

Symptoms of hernia:

  • subfalcine?
  • Uncal?
  • Tonsillar?
A
  • lower limb weakness
  • Ipsilateral CN III palsy
  • ataxia, CNVI palsy, babinski sign, potentially life threatening due to brainstem compression
55
Q

Management of restless leg syndrome?

A

Ropinirole (dopaminergic agent)

OR clonazepam

56
Q

Neurotransmitter change in Huntington’s?

A

low GABA
low ACh

High Dopamine

57
Q

Contraindications of forceps/ventouse?

A

mal-presentation i.e. breech

Absolute cephalopelvic disproportion

Year 3 (19 decks)

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