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BPT Clinical Exam > Neuro Long > Flashcards

Neuro Long Flashcards

1
Q

DDx for MS

A 
Paraneoplastic syndromes
CNS neoplasm
Vit B12 deficiency
CNS vasculitis
SLE 
Sarcoidosis
HIV and syphilis
Migraine
Somatoform disorders
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2
Q

MS Symptoms to ask about

A
  1. Spastic paraparesis, hemiparesis, tetraparesis
  2. Limb parasthesia
  3. Visual disturbance - loss of acuity, pain or eye movement, loss of central visual field (optic neuritis), diplopia
  4. Ataxia, dysarthria, and tremor - Charcot’s triad (cerebellar or posterior column involvement)
  5. Band sensations around trunk or limbs
  6. Urinary urgency, incontinence of faeces
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3
Q

Ask about Factors that worsen MS symptoms

A 
heat
infection
fever
pregnancy - post partum mainly
exercise
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4
Q

DDX for multiple CNS lesions

A 
MS
SLE
Sjogrens
Behcet's 
Small vessel ischemia
Acue disseminated encephalomyelitis
meningovascular syphilis
paraneoplastic effects of sarcoid
Lyme disease
Multiple emboli from any source
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5
Q

Ix for MS

A

MRI
Visual evoked responses
CSF: oligoclonal bands and altered IgG: albumin ratio

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6
Q

Tx approach to MS

A
  1. Supportive and symptomatic
    - Bladder dysfunction, severe spasticity (Baclofen)
    - URgency (Amitriptylline)
    - Tic douloureux, facial spasm (Carbamazepine and physio)
  2. Immunomodulation/immunosuppression
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7
Q

Interferon Beta SE

A 
Hepatotoxicity 
Cytopenia
Injection site reaction
Flu like Sx
Depression

Monitor:
LFT and FBE 1, 3 months then annually

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8
Q

Glatiramer Acetate SE

A

Hepatotoxicity
cytopenia
Injection site reaction
Lipoatrophy

Monitoring
LFT and FBE at start and annually

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9
Q

Teriflunamide SE

A 
Hepatotoxicity 
cytopenia
Infections
Nausea and diarrhea
Loss of hair

Monitoring
LFT and FBE

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10
Q

Fingolimod SE

A 
Hepatotoxicity
macular oedema
lymphoedema
Bradycardia
Herpes zoster and simplex
Back pain
Headache

Monitoring:
6 hour cardiac monitoring post first dose

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11
Q

Dimethyl fumerate side effects

A 
Lymphopenia
Proteinuria
PML
Flushing
GIT Sx

Monitoring
Urine protein, FBE

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12
Q

Natalizumab SE

A

PML
Hepatotoxicity
Headache
Infusion reaction

Monitoring
MRIB 6 monthly, LFTs and FBE

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13
Q

Alemtuzimab SE

A

Autoimmune thyroid disease
Goodpastures
ITP
Infusion reation

Monitoring
Serial MRI, bloods including TFTs

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14
Q

Symptoms for Hx of MG

A
  1. Ocular - diplopia, drooping eyelids
  2. Bulbar - choking (weakness of pharyngeal muscles), dysarthria, difficulty with chewing and swallowing
  3. Neck - dropped head
  4. Limb girdle -prox muscle weakness

Ask about:

  • Difficult anasethesia - prolonged muscle relaxation
  • Pneumonia due to aspriation
  • OTher organ specific autoimmune disease
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15
Q

IX for MG

A

Bloods:

  • Anti AChR
  • MuSK antibodies (muscle specific kinase antibodies)

Other

  • Electromyogram
  • Thymoma Ix: CXR, CT chest, MRI chest
  • Lung function tests

Associated conditions:
-TFTs, RF, ANA

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16
Q

Key Features of Lambert Eaton Syndrome to differentiate MG

A
  • Prox muscle weakness and pain that may improve with repeated stimulation; reflexes absent or reduced
  • Ocular and bulbar muscles spared usually
  • EMG: High Freq: increment; Low Freq: decrement in AP amplitudes
17
Q

Mx of MG

A
  1. Symptomatic
    - Anticholinergics - Pyridostigmine
    - Potassium supplements/ K+ sparing diuretics
    - Avoid precipitants: Gentamycin, procainamide etc.
    - Myasthenic crisis - often triggered by infection, Resp support, PLEX
  2. Disease Suppression
    - Steroids (can make Sx worse in first week)
    - AZA, Cyclosporin, MMF are added if needed
    - Thymectomy - 70% show improvement and 25% have remission; Failed response usually due to incomplete removal, ectopic, and fulminant disease
18
Q

Precipitants of GBS to ask about

A
  • Resp infection
  • Campylobacter diarrheal illness
  • Mycoplasma
  • EBV
  • Influenza

Precipitating event
-Surgical operations, vaccinations, Malignant disease, SLE, HIV

19
Q

IX for GBS

A

Immune stimulus
-Monospot, cold agglutinins, CMV, HIV, Campylobacter

CSF Fluid
-Raised protein

Lung function tests
-FEVx, FVC

EMG
-Takes 10 days to 3 weeks for evidence to appear

Antibodies if indicated

20
Q

DDX for acute ascending motor paralysis

A 
GBS
Diptheria
Polio
PAN
Acute intermittant porphyria
Botulism
21
Q

DDX for autonomic neuropathy

A 
GBS
Diabetes
Alcoholism
Acute intermittant porphyria
Amyloidosis
22
Q

Tx of GBS

A
  1. PT to prevent contractures
    - Resp support in ICU if FVC <1 L
  2. Steriods, immunosuppression, IVIG, and PLEX
    - IVIG and PLEX shorten recovery time from resp pparalysis and hasten return to mobility, PLEX has less relapse rates than IVIG
23
Q

Causes of Presyncope

A
  1. Cardiac
    - AS, HOCM
    - Arrhythmia
  2. Autonomic
    - Vasovagal
    - Autonomic neuropathy
    - MSA, e.g. associated with Parkinsons
  3. Drugs
    - Antihypertensives, antipsychotics
  4. Hypovolemia
    - Hemorrhage, dehydration, addisonian crisis
  5. Cerebrovascular
    - Vertebrobasilar insufficiency
24
Q

Ix for syncope

A

-FBE, ESR, glucose, cholesterol, urinalysis -?renovascular disease
ECG/Holter/Implanted cardiac loop
CTB
MRI - Cerebral tumor/vascular malformation/stroke
EEG

25
Q

Carbamazepine SE

A 
Dizziness
Sedation
Hyponatremia
Aplastic anaemia
Steven Johnsons Syndrome 
Rash
26
Q

Gabapentin SE

A

Sedation
Oedema
Weight gain

27
Q

Lamotrigine SE

A 
Acne
Insomnia
Headache
Dizziness
Diplopia
Steven Johnsons
Rash
Hepatic Failure
28
Q

Phenytoin SE

A 
Sedation
OEdema
WEight gain
Steven Johnsons
Rash
Hepatic Syndrome
Lupus like syndrome
Cardiac conduction abnormalities
Gingivial hyperplasia
29
Q

Sodium Valproate SE

A 
Hirsuitism
WEight gain 
Tremor
Hepatic failure
Pancreatitis
Thrombocytopenia
30
Q

CAuses of ischemic stroke

A
  1. Embolus from heart
  2. Large artery disease
  3. Subcortical (Lacunar)
  4. Cryptogenic
  5. Vasculitis, genetic, Venous sinus thrombosis
31
Q

Stroke DDx

A
  • Large vessel ischemia: atherosclerosis risk factors
    • Small vessel ischemia: HTN (lacunar infarcts)
    • Cardio-embolic: AF, IE, LV thrombus
    • Young: consider vasculopathies, thrombophilia, PFO, venous infarct
      Haemorrhagic: HTN, aneurysm, amyloid, trauma, anticoagulation
32
Q

Stroke Ix

A
  • CTB + CTA + CT Perfusion acutely - Ischemic vs Hemorrhagic
    • MRI DWI - Ischemic stroke
    • Identify cause:
      ○ Assess BP on arrival to ED and as inpatient
      ○ ECG/Holter monitor - for AF
      ○ TTE - IE, LV Thrombus, PFO
      ○ Carotid US - ICA stenosis
      ○ CTD/Vasculitis Screen and ESR
      Thrombophilia screen
33
Q

PFO Closure indication

A

Age <60 with no other cause found for stroke apart from PFO who have associated atrial septal aneurysm or moderate to large right to left shunt
Note transient increased risk of AF post closure for 4-6 weeks

34
Q

DDx for Cognitive impairment and their presentations

A
  • Symptoms suggestive of a particular aetiology:
    ○ Alzheimer’s: early STML, language problems, insidious onset
    ○ Lewy Body: Visual hallucinations, frequent falls, Parkinsonism features
    ○ Vascular: history of strokes
    ○ Alcohol history
    Consider mimics for cognitive impairment: Mood disturbance, stroke, infection (delerium)

BPT Clinical Exam (11 decks)

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