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Misc > Neuro misc > Flashcards

Neuro misc Flashcards

1
Q

treatment for Non-epileptic attacks?

A

rectal benzo/ buccal
midazolam to try and abort the attack.

Ambulance: another dose of
lorazepam?

A-E

If so can give one further dose of lorazepam IV
when reach hospital.

Then move onto IV phenobarbital or phenytoin,

Anaesthetic agents.

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2
Q

Treatment for tonic clonic siezure?

A

Sodium valproate and lamotrigine.

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3
Q

How do you treat focal siexures?

A

Carbamazepine and lamotrigine.

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4
Q

how do you treat an abscent seizure?

A

NOT CARBAMAZEPINE, valproate,

ethosuximide.

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5
Q

Treatment for GCA

A

Prednisolone (45mg) and Aspirin (75mg) with a PPI

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6
Q

Characteristic feature of GCA?

A

Scalp tenderness and palpabale tender and reducded pulsation temporal arteries. temporal loss of vision - maybe in one eye. temporaal artery educed pulsations

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7
Q

Investigations for GCA

A

Raise ESR and CRP
ANCA negative
Raise aLP (alkaline phosphotase)
reduced Hb

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8
Q

Who isGCA most common in?

A

over 50 females. if under 50, suspect takayshu

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9
Q

what is a seizure?

A

A paroxysmal event in which changes in behaviour, sensation or cognition are affected by excessive hypersynchronous neuronal discharges in the brain.

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10
Q

What is epilepsy?

A

A recurrent tendency to seizures:
2 unprovoked seizures
1 seizure and EEG evidence of a tendency towards seizures.

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11
Q

Investigations for seizures?

A

Focal or considering neurosurgery do MRI.
CT if secondary to an injury
EEG to support diagnosis.
ECG
Exclude other causes- glucose, U&E, calcium, LFT.

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12
Q

Alzheimer’s treatments?

A

anticholinesterases (donepazil)

memantine (anti glutamate

control RF
MDT

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13
Q

Signs of meningitis?

A 
Neck stiffness
Headache
Non blanching rash 
Photophobia
Vomiting
Reduction in level of consciousness/ seizures
Signs of shock 
Signs of raised ICP. 
Fever
If evidence of focal neurological deficit, think encephalitis instead.
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14
Q

CSF of viral meningitis

A

decrease WBC and protein
normal glucose
clear

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15
Q

CSF of bacterial meningitis?

A

Increase neutraphils and protein
decrease glucose
cloudy

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16
Q

treat a subarachnoid haemorrhage?

A

Nimodipine CCB to prevent ceberal artery bursting. fluids and rest

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17
Q

Treat GCA?

A

High dose oral prednisolone (40mg) + low dose aspirin (75mg)
+
PPI (both medications associated with gastrointestinal toxicity)

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18
Q

what is a focal seizure with consciousness?

A

jerk,y, seld aware, memory retained

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19
Q

Focal seizure with dysphagia and motor impairment?

A

proble with the frontal lobe

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20
Q

Focal seziure with numbeness, pain, tingling? (sensation impairent)

A

problem in parietal lobe

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21
Q

Wich siezure do u not treat with carbamazepine?

A

Absence - treat with Na Valporate and ethosuximide

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22
Q

Name the dementias?

A

Alzheimers
Vascular
Frontotemporal
Lewy body

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23
Q

What plaques would u find in alzheimers?

A

B amyloid. links to APP gene.

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24
Q

how do you test memory and alzheimers? (cognitive imparirment)

A

6CIT questions

ask about year, time, counting, address, current time etc, month, year and repetition. assess on confidence

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25
Q

Treat Alzheimer’s?

A

MDT, control vascular risk factors, anticholinesterases (donepazil) and memantine (anti glutamate).

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26
Q

What is Kernig’s sign?

A

supine hip flexed. knee cant be fully extended

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27
Q

What is Brudzinski’s sign?

A

neck rigidity. Flextion of nech causes flection of legs and thighs

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28
Q

What are the two signs of meningitis?

A

Kernig’s and Brudzinski’s

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29
Q

LP for TB?

A

clear, raised lymphoctyes, very raised protein, very low glucose

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30
Q

Encephalitis CSF?

A

clear, normal/raised protein and lymphocytes. normal or low gloucose

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31
Q

which meningisitse has cloudy CSF?

A

bacterial

32
Q

Treat meningitis?

A

IV 3rd generation cephalosporin e.g. ceftriaxone

IM ben pen if community

33
Q

Name a cephalosporin?

A

ceftriaxone

34
Q

Features of cauda equina?

A

Urinary retention
Loss of ankle and knee reflexes
Severe radicular pain esp. down backs of legs,
Saddle anaesthesia, perianal numbness
Sexual dysfunction
Areflexic flaccid weakness with fasciculations.
Loss of anal tone- very late.

35
Q

Treat cauda equina?

A

decompression surgery and high dose dex.

36
Q

Cerebellar haemorrhage common features?

A 
nystagmus
gait disorder
headache
vomit
dysarthia
intention tremour - when guided to an object
staccato speech
37
Q

what disease presents with a resting tremour?

A

parkinsons

38
Q

What is the most common cause of cerebellar haemorrhage?

A 
Hypertension
Use of anticoagulants
Coagulopathies
Arteriovenous malformation
Metastatic tumour
Cavernoma
Trauma
39
Q

name a prothrombin complex concentrate?

A

Beriplex

40
Q

How do you treat cerebellar haemorrhage?

A 
CT, rever warfarin
Beriplex (prothrombin complex concentrate)
fresh frozen plasma, vit K
surgery
BP control - BB
41
Q

what makes up 80 percent of strokes?

A

ischaemic. the others are haemorrhagic

42
Q

Signs of SAH?

A

Kernig’s sign
Brudzinski’s sign
sudden onset thunderclap headache
(no nausea or associated symptoms)

43
Q

Most common cause of non-traumatic SAH?

A

Berry aneurysms

AVM rupture

44
Q

Treating SAH?

A

Lifestyle – stop smoking, HTN
Medical – Nimodipine
(reduces vasospasm – lowers risk of cerebral ischaemia)
Surgical – Endovascular coiling/clipping

45
Q

Complications of SAH

A

Hydrocephalus
Cerebral ischaemia
Seizures

46
Q

Causes of sub-dural haemorrhage?

A

Trauma
Dementia / Alcoholism
Anticoagulation
DM

rupture to a bridging vein

47
Q

Sub-duralheamorrage signs/

A

Loss of consciousness
Seizure
Nausea, vomiting
Evolving neurological deficit

48
Q

Treatment of EDH?

A

Burr hol craniotomy (drainage to decompress)

49
Q

Cause of EDH?

A

Trauma to temporal bone and haemorrhage of middle meningeal artery. treated with craniotomy

50
Q

What is GBS

A

Guillain-Barre Syndrome (GBS) . condition where there is a damamged meylin and exposes nerve fibres

51
Q

Symptoms of GBS?

A

Symmetrical, Rapid onset, progressive muscle weakness and Paraesthesia starting at hands and feet and moving upwards.
Autonomic Dysfunction – BP, HR, Sweating
pain common in back, shoulders

52
Q

Complication of GBS?

A

respiratory failure, moniter FVC every 4 hrs

53
Q

CSF of GBS?

A 
raised protein (igG ganglioside antibodies)
Normal WCC
54
Q

What investigations would u find in GBS

A

Nerve conduction studies – slow conduction velocity (demyelination)
Anti-ganglioside antibodies
LP and CSF analysis – raised proteins (IgG anti-ganglioside antibodies), normal WCC

55
Q

What antibodies would u find in GBS?

A

anti-ganglioside antibodies

56
Q

Treating GBS?

A

IVIG -
Plasma exchange
Mechanical Ventilation if respiratory failure

57
Q

What does GBS usually precede?

A

GI or Resp infection like diarrhoea symptoms or sore throat

58
Q

What causes GBS?

A

Campylobacter, CMV, VZV, HIV, EBV

causes an autoimmune respone 1-3 weeks infection

59
Q

Pathophysiology of GBS?

A

Anti-ganglioside IgG due to molecular mimicry, binds to gangliosides in peripheral nerves = destruction of myelin sheath by T cells and macrophages

60
Q

What can sensory loss indicate?

A

MS, myelopathy

61
Q

What can disturbances in eye movements indicate?

A

MG or MS

62
Q

What can disturbances in sphincter indicate?

A

MS not MND

63
Q

What signs arent seen in MND

A

No sensory loss (MS, Myelopathy)
No disturbances in eye movements (MG, MS)
No sphincter disturbances (MS)

64
Q

Mx for MND?

A

RILUZOLE (Anti glutaminergic

65
Q

TReatment for drooling in MND

A

– Amitriptyline

66
Q

Treatment for spasticity in MND

A

Baclofen (GABA agonist) or Dantrolene (Inhibits Ca2+ skeletal muscle contraction

67
Q

treatment for joint pain

A

analgesiac ladder

68
Q

Treatment for meningitis?

A

cefotaxime

69
Q

Treatment for meng. caused by listeria mono.

A

add amoxacillin to cefotaxime

70
Q

4 types of MS?

A

PRMS
SPMS
RRMS
PPMS

71
Q

Would you see nystagmus in MS?

A

yes

72
Q

Demyelination for MS symptoms?

A 
Diplopia
Eye movement painful (Optic Neuritis)
Motor weakness
nYstagmus
Elevated temperature (Uhthoff phenomenon)
Lhermitte’s sign 
Intention tremor
Neuropathic pain
Ataxia
Talking slurred
Impotence
Overactive bladder
Numbness
73
Q

Where would u see an intention tremou?

A

MS and Wilson’s disease

74
Q

What would u se in CSF electrophoresis of MS

A

oligoclonal bands igG. this is CNS infammation

75
Q

What investifations would u do for MS?

A

MRI WITH CONTRAST – active lesions (able to receive appropriate treatment

76
Q

Treatment for neuropathic pain in MS

A

Gabapentin

77
Q

What would u give to treat sexual dysfunction?

A

Sildenafil

Misc (14 decks)

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