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Psychiatry and Neurology > Neuro- MS, Epilepsy and Parkinson's > Flashcards

Neuro- MS, Epilepsy and Parkinson's Flashcards

1
Q

What is MS?

A

Chronic inflammatory demyelinating disease of the brain and CNS

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2
Q

Where are white matter lesions most common in MS?

A 
Periventricular areas
Corpus callosum
Optic nerve
Brainstem
Cerebellum
Cervical spine
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3
Q

What is the most common type of optic neuritis?

A

Posterior (retrobulbar)

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4
Q

What are the features of optic neuritis?

A 
Pain on moving eyes
Decreased visual field
Decreased visual acuity
Loss of colour vision
RAPD
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5
Q

How does the optic disc appear in anterior optic neuritis?

A

Optic disc is….
Red
Swollen
Exudates and haemorrhages

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6
Q

How does the optic disc appear in the most common type of optic neuritis (posterior)?

A

Optic disc appears normal

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7
Q

What are the possible brainstem/ cerebellar features of optic neuritis?

A 
Diplopia
Vertigo
Dizzyness
Ataxia
Dysarthria
INO
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8
Q

What is the most common subtype of MS?

A

Relapsing remitting MS

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9
Q

Other than RRMS, what are the subtypes of MS?

A

Primary progressive MS
Secondary progressive MS
Progressive relapsing MS

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10
Q

Which 2 main tests are used to diagnose MS?

A

MRI

LP

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11
Q

Which 3 differential diagnoses of MS can also have CNS lesions on MRI which are disseminated in space and time?

A
  1. Vasculitis
  2. Ischemia
  3. Neurosarcoid
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12
Q

Which 2 differential diagnoses of MS can also have oligoclonal bands on LP?

A
  1. Neurosarcoid

2. Autoimmune conditions

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13
Q

What are the criteria for patients to be prescribed DMTs?

A
  1. Aged >18 years
  2. RRMS
  3. 2 or more relapses in 2 years
  4. Can walk 100 metres or more with no assistance
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14
Q

Baclofen and Tizanidine can be prescribed to treat which symptom of MS?

A

Spasticity

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15
Q

Gabapentin and Amitryptiline can be prescribed to treat which symptom of MS?

A

Pain

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16
Q

Fluoxetine and Amantadine can be prescribed to treat which symptom of MS?

A

Fatigue

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17
Q

Oxybutynin is an anticholinergic used to treat which symptom of MS?

A

Bladder instability

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18
Q

IV _______________ is prescribed 1g/day for 3 days to shorten relapses of MS.

A

Methylprednisolone

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19
Q

Which factors worsen the prognosis of MS?

A

Male gender
Increased number of relapses
Progressive subtypes
Motor and cerebellar features

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20
Q

There is a ___% chance that MS patients will be unable to walk unaided after 15 years

A

50%

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21
Q

Which 2 demyelinating disorders are differentials for MS?

A

ADEM- Acute demyelinating encephalomyelitis

NMO- Neuromyelitis optica

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22
Q

Acute Demyelinating Encephalomyelitis is a monophasic inflammation which often proedes infection and is most common in which age category?

A

Children

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23
Q

What are the 3 main types of generalised seizures?

A
  1. Tonic clonic
  2. Myoclonic
  3. Absence
24
Q

Partial (focal) seizures involve seizure discharge from a __________ part of one cerebral hemisphere.

25
Q

An aura is a type of which seizure?

A

Simple partial

26
Q

60% of complex partial seizures involve which lobe?

A

Temporal lobe

27
Q

30% of complex partial seizures involve which lobe?

A

Parietal lobe

28
Q

Odd epigastric sensations, auras, automatism and higher cortical function changes are signs of which type of complex partial seizures?

29
Q

25% of epilepsy patients have an underlying structural pathology such as…

A 
Brain tumour
Arterovenous malformation
Cerebral infarct/ haemorrhage
Cerebral VST
Head injury
30
Q

__________ absence seizures involve brief (seconds) loss of contact with surroundings and eyelid jerkings, and may present as learning difficulties.

31
Q

Atypical ________ seizures are commoner than typical absence seizures, and involve longer periods of absence, tending to occur in children with prior brain injury.

32
Q

Myoclonic seizures often occur at which time of day in late childhood?

A

First thing in the morning

33
Q

What are the 2 most common differential diagnoses of epilepsy?

A

Syncope

Non epileptic attacks

34
Q

What are the key features of Parkinsonism?

A
  1. Tremor (resting)
  2. Rigidity
  3. Bradykinesia
  4. Postural abnormalities
35
Q

Which part of the brain is affected by Parkinsons?

A

Pars compacta of substantia nigra in basal ganglia

36
Q

Give 4 differential diagnoses for PD?

A
  1. Essential tremor
  2. Drug induced parkinsonism
  3. Vascular parkinsonismm
  4. Parkinsons plus syndromes- PSP or MSA
37
Q

Which drugs can cause Parkinsonism in a patient?

A
  1. Sodium valproate
  2. Salbutamol
  3. Typical antipsychotics
  4. Lithium
  5. Anti emetics
38
Q

How do the symptoms of vascular parkinsonism differ to PD?

A

Only lower limbs and gait affected

39
Q

What are the key features of Progressive Supranuclear Palsy (Parkinsons Plus)?

A

Falls and dementia early
Little tremor
Symmetrical rigidity
Vertical gaze palsy= limited downward eye movement

40
Q

Which Parkinsons Plus syndrome has bladder and autonomic issues, impotence and ataxia?

A

Multiple system atrophy

41
Q

Rasagiline and Selegiline are which class of PD drugs?

A

MAOB inhibitors

42
Q

Entacapone and Tolcapone are which class of PD drugs?

A

COMT inhibitors

43
Q

Pramipexole and Ropinirole are which class of PD drugs?

A

Dopamine agonists

44
Q

Amantidine, Apomorphine and DBS can be used to relieve which SE of Parkinson’s drugs?

A

Dyskinesia

45
Q

Give 4 examples of how essential tremor differs to Parkinsons tremor?

A
  1. Improved by alcohol
  2. Affects head, arms and voice
  3. Symptoms develop over years
  4. Symmetrical
  5. Often has positive family history
  6. Handwriting large and messy
    7, Postural tremor
46
Q

Out of levodopa, dopamine agonists and MAOB inhibitors, which create the most motor complications?

47
Q

Out of levodopa, dopamine agonists and MAOB inhibitors, which has the greatest improvements in motor symptoms and activities of daily living?

48
Q

Give 2 symptoms/ conditions that can occur if anti Parkinson medication is withdrawn suddenly.

A
  1. Acute akinesia

2. Neuroleptic malignant syndrome

49
Q

If a patient with early Parkinsons has motor symptoms which impact on their quality of life, which drug should be given as first line?

50
Q

If a patient with early Parkinsons does not have motor symptoms which impact on their quality of life, which drugs should be considered as first line?

A

Dopamine agonists
Levodopa
MAOB inhibitors

51
Q

Which SEs should patients being started on PD medication be warned about?

A

Psychotic symotoms- delusions, hallucinations
Impulsivity
Dyskinesia
Excessive sleepiness

52
Q

Which PD drug class can cause excessive sleepiness and sudden onset of sleep?

A

Dopamine agonists

53
Q

Amantidine is an antiviral medication used to treat ______ in MS patients and is also used as an adjunct in treating PD.

54
Q

Which class of PD drugs has the greatest risk of hallucinations as a SE?

A

Dopamine agonists

55
Q

What is Lhermitte’s symptom?

A

Brief electric shock sensation down the limbs on flexion of the neck

56
Q

What is Uthoff’s phenomenon?

A

Symptoms of MS tend to get worse with heat

Psychiatry and Neurology (9 decks)

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