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1. 4th year > Neuro part 1 > Flashcards

Neuro part 1 Flashcards

1
Q

trio of parkinsons

A

tremor - resting, pill rolling
rigidity - cog wheel
bradykinesia

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2
Q

tx parkinsons if motor symptoms are affecting QoL

A

levodopa

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3
Q

what drug classes are used in parkinsons if motor symptoms not affecting QoL/ mild symptoms

A

dopamine agonists
MOA-B
COMT inhibitors

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4
Q

examples of parkinson drugs:

dopamine agonists

A

ropinirole
pramipexole, apomorphine
bromocriptine, cabergoline

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5
Q

examples of parkinson drugs:

MOA-B

A

selegeline

rasagiline

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6
Q

examples of parkinson drugs:

COMT inhibitors

A

entacapone

tolcapone

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7
Q

examples of parkinson drugs:

Antimuscarinics

A

procyclidine
benzotropine
trihexyphenidyl

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8
Q

gold standard in parkinsons treatment

A

sinemet - levodopa + carbidopa

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9
Q

is levodopa useful in neuroleptic induced parkinsonism

A

no

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10
Q

2 important things to remember in prescription of levodopa

A

same time every day

needs to be continued e.g. if patient admitted to hospital

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11
Q

major side effect of dopamine agonists (3)

A

impulse control disorders
hallucinations
excessive daytime somnolence - shouldnt drive

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12
Q

when are antimuscarinics used in parkinsons treatment

A

drug induced, not idiopathic

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13
Q

tx sudden off states in levodopa using patients

A

amantadine

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14
Q

tx levodopa associated nausea

A

domperidone

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15
Q

which drugs are most likely to cause impulse control disorders, hallucinations and excessive daytime somnolence in parkinsons treatment

A

can occur with any dopaminergic therapy but most likely with dopamine agonists
- ropinirole
pramipexole, apomorphine
bromocriptine, cabergoline

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16
Q

parkinsonism syndrome:

  • vertical gaze palsy (down gaze worse than up gaze)
  • lack of tremor
  • poor response to levodopa
A

progressive supranuclear palsy

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17
Q

parkinsonism syndrome:

  • ataxia and cerebellar signs
  • postural hypotension, erectile dysfunction, bladder disfunction
  • poor response to levodopa
A

multisystem atrophy

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18
Q

parkinsonism syndrome:

  • rigidity and weakness in one limb
  • apraxia
  • sensory disturbance
A

cortico-basilar degeneration

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19
Q

cognitive decline with visual hallucinations
fluctuating symptoms
onset of cognitive decline before onset of parkinson features

A

dementia with lewy bodies

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20
Q

drugs that cause drug induced parkinsons

A

anti-psychotics
amiodarone
metoclopramide

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21
Q

tx of tremor in drug induced parkinsons

A

procyclidine

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22
Q

inheritance of wilsons disease

A

AR

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23
Q 
ix wilsons disease:
serum cearuloplasmin
total serum copper 
free serum copper 
24 hour urinary copper excretion
A

main ix: reduced serum cearuloplasmin
reduced total serum copper
increased free serum copper
increased 24 hour urinary copper excretion

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24
Q

tx wilsons disease

A

penicillamine

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25
Q

1st line treatment of benign essential tremor

A

propranolol

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26
Q

inheritance of benign essential tremor

A

AD

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27
Q

2 causes of intention tremor

A

wilsons disease

cerebellar disease

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28
Q

drug causes of acute dystonia

A

typical antipsychotics - haloperidol, chlorpromazine
metoclopramide
suddenly stopping levodopa

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29
Q

fasciculations
absence of sensory symptoms
mixed upper and lower motor neuron symptoms

A

MND

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30
Q

primary symptom in MND is

A

muscle weakness

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31
Q

what type of dementia has MND been linked to

A

fronto-temporal

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32
Q

what muscles can be seen to waste in MND

A

tibialis anterior and small muscles of hands

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33
Q

which of the following are present in MND

  • extraocular/eye involvement
  • sensory loss
  • sphincter dysfunction
  • cerebellar signs
A

none

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34
Q

typical picture of ALS (MND)

A

mixed upper and lower MN
LMN in arms and UMN in legs
starts in hands

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35
Q

typical picture of progressive bulbar/psuedobulbar palsy

A

progressive bulbar muscle weakness with subsequent limb involvement - worst prognosis

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36
Q

MND that is purely lower motor neuron

A

progressive spinal muscle atrophy

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37
Q

MND that is purely upper motor neuron

A

primary lateral sclerosis

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38
Q

drug treatment in MND that prolongs life

A

riluzole

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39
Q

tx drooling in MND

A

anti-cholinergic

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40
Q

EMG of MND

A

reduced number of action potentials with increased amplitude

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41
Q 
Lower motor neuron limb and bulbar weakness
ED
infertility 
gynaecomastia 
atrophic testes
X linked
A

Kennedy’s disease

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42
Q

antibodies in myasthenia gravis

A

Anti-AchR / Anti-MuSK

against nicotinic receptors at NMJ

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43
Q

2 key features of myasthenia gravis

A

muscle weakness and fatigability

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44
Q

describe the pattern of myasthenia gravis throughout the day and with exercise

A

worse throughout the day and with exercise

improves after period of rest

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45
Q

common muscles involved in myasthenia gravis

A

extraocular - double vision

bulbar

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46
Q

describe sensation, muscle appearance tone and reflexes in myasthenia gravis

A

normal tone appearance and reflexes

normal sensation

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47
Q

tx myasthenia gravis

A

Pyrostigmine (LA anticholinesterase inhibitor)

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48
Q

tx myasthenia gravis relapse

A

prednisolone

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49
Q

tx myasthenia gravis crisis

A

IV Ig or plasmapheresis

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50
Q

drugs that can precipitate a myasthenia gravis crisis

A

beta blocker

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51
Q

what is affects in lambert eaton (LEMS)

A

pre-synaptic calcium channels in the PNS

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52
Q

2 causes of lambert eaton (LEMS)

A

paraneoplastic - small cell lung cancer, breast, ovarian

autoimmune - anti P/Q CGCC antibodies

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53
Q

primary symptom in lambert eaton (LEMS)

A

muscle weakness

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54
Q

describe the course of lambert eaton (LEMS) with exercise

A

improves with exercise

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55
Q

key symptoms in lambert eaton (LEMS)

A

muscle weakness that improves with exercise
limb symptoms –> gait disturbance
limb girdle weakness
autonomic involvement

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56
Q

reflexes in lambert eaton (LEMS)

A

hyporeflexia - improves with exercise

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57
Q

tx lambert eaton (LEMS)

A

prenisolone and/or azathioprine

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58
Q

is there tongue biting or incontinence in syncope

A

no

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59
Q

is there movement in syncope

A

either no movement or sometimes brief symmetrical clonic jerks in absence of tonic contraction

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60
Q

3 types of syncope

A

reflex
orthostatic
cardiac

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61
Q

reflex syncope: when the body overreacts to certain triggers

A

vasovagal

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62
Q

how many seizures do you need to have before diagnosis of epilepsy

A

2

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63
Q

typical age for febrile seizures

A

6m to 5 years

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64
Q

what is classed as febrile status epilepticus

A

> 30 mins

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65
Q

after what time should parents call an ambulance in a febrile seizure

A

if it lasts over 5 minutes - give them rectal diazepam or buccal midazolam to use in event

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66
Q

when do alcohol withdrawal seizures usually occur

A

36 hours after drinking

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67
Q

what drug can reduce the risk of alcohol withdrawal seizures

A

benzodiazepine

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68
Q

raised serum prolactin implies what kind of seizure

A

true epileptic

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69
Q

what is an aura

A

individualized and stereotypes symptoms that proceed the seizure by minutes

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70
Q

describe the tonic phase of tonic-clonic

A 
falls to ground
rigid and cyanosed
stops breathing
tongue biting and incontinence
lasts about 1 minute
71
Q

describe the clonic phase of tonic-clonic

A

asymmetrical convulsive jerks
eyes roll to back of head
breathing starts again
few minutes

72
Q

seizure with brief lapses of awareness in which the patients stops what they are doing and stares blankly

A

absence seizure

73
Q

Seizures that manifests as sudden loss of all muscle tone with maintenance of consciousness

A

atonic

74
Q

seizure in first few months of life with Flexion of head, trunk, limbs → extension of arms (Salaam attack); last 1-2 secs, repeat up to 50 times

A

infantile spasm (west’s syndrome)

75
Q

seizure in childhood with paraesthesia (e.g. unilateral face), usually on waking up/at night

A

benign rolandic epilepsy

76
Q

Infrequent generalized seizures, often in morning or following sleep deprivation, Daytime absences and Sudden, shock like myoclonic seizure with usually good response to sodium valproate

A

juvenile myoclonic epilepsy

77
Q

what investigation is done to rule out structural abnormality in epilepsy

A

MRI

78
Q

investigation to classify epilepsy

A

EEG

79
Q

when should antiepileptics be started

A

after 2nd seizure

or after 1 if neurological deficit, brain imaging shows structural abnormality, EEG shows unequivocal epileptic activity or the patient/family consider the risk of another seizure unacceptable

80
Q

1st line focal seizure

A

carbamazepine

81
Q

2nd line focal seizure

A

lamotrigine
levetiracetam
sodium valproate

82
Q

1st line absence seizure

A

sodium valproate

ethosuximide

83
Q

1st line atonic or tonic clonic seizure

A

sodium valproate

84
Q

2nd line atonic or tonic clonic seizure

A

lamotrigine

carbamazepine

85
Q

1st line myoclonic seizure

A

sodium valproate

86
Q

2nd line myoclonic seizure

A

lamotrigine

clonazepam

87
Q

antiepileptic of choice in pregnancy

A

lamotrigine

88
Q

main side effects of valproate

A

teratogeniticity
weight gain
P450 inhibitor

89
Q

major side effect of lamotrigine

A

steven johnson syndrome

90
Q

carbamazepine is first line for what type of seizures

A

focal

91
Q

main side effect of carbamazepine

A

agranulocytosis

92
Q

what factors increase risk of SUDEP

A

poorly controlled epilepsy
smoking
alcohol
illicit drugs

93
Q

how long can you not drive after 1st seizure

  • car
  • HGV
A

car : 6 months

HGV: 5 years

94
Q

how long can you not drive with epilepsy

  • car
  • HGV
A

car - fit free for 12 months

HGV - off medication for 10 years and seizure free

95
Q

what do P450 enzyme inducers do

A

reduce efficacy of certain drugs - contraceptive pill - suggest switch to IUS

96
Q

examples of P450 enzyme inducers

A

carbamazepine

phenytoin

97
Q

are anti-convulsants safe in breast feeding

A

yes mostly

98
Q

what should be taken in pregnancy if taking phenytoin

A

vitamin K in last month to prevent clotting disorder in new born

99
Q

dose of folic acid for pregnant women on antiepileptics

A

5mg before birth and during 1st trim

100
Q

1st line tx status epilepticus in hospital

A

IV lorazepam

101
Q

1st line tx status epilepticus in primary care

A

buccal midazolam or rectal diazepam

102
Q

2nd line tx status epileptics

A

phenytoin, phenobarbital, levetiracetum

103
Q

3rd line tx status epilepticus

A

GA

104
Q

how often can lorazapam be repeated in status epilepticus

A

max 2 times (2-4mg)

give 10-20 mins after first dose

105
Q

motor disturbance in MS

A

spastic weakness

106
Q

MS: Lehermittes phenomenon

A

electrical shock down spine and arms/paraesthesia in limbs when head is bent forward/flexed

107
Q

MS: uhtoffs phenomenon

A

worsening of symptoms with heat and exercise

108
Q

s/s of MS

A 
FATIGUE
spastic weakness, brisk reflexes and +ve babinski
sensory disturbance
ataxia and tremor 
optic neuritis and RAPD
incontinence
109
Q

ix MS

A

MRI with contrast

110
Q

what is seen on LP of MS

A

oligoclonal bands of IgG

111
Q

MS treatment: spasticity

A

baclofen or gabapentin

112
Q

MS treatment: sensory symptoms

A

amitriptyline or gabapentin

113
Q

MS treatment: bladder dysfunction

A

bladder training, oxybutinin

114
Q

MS treatment: fatigue (if all other causes ruled out)

A

amantadine

115
Q

MS treatment: relapse

A

IV steroids - methylprednisolone (5 days)

plasma exchange

116
Q

MS treatment: 1st line

A

B interferon
Capaxone (glitramer acetate)
tecfidera

117
Q

MS treatment: 2nd line

A

Tysabri

fingolimod

118
Q

MS treatment: 3rd line

A

Mitoxantrone

119
Q

presentation: Vitamin B12 deficiency

A

dorsal column affected first - joint position and vibration

120
Q

nerve involved: weakness of wrist flexion

A

ulnar

121
Q

nerve involved: humeral shaft fracture

A

radial nerve

122
Q

nerve involved: burning thigh pain

A

lateral cutaneous nerve of the thigh - meralgia paraesthetica

123
Q

wrist drop

A

radial

124
Q

foot drop

loss of sensation over dorsum of foot

A

common peroneal

125
Q

nerve involved: weak plantar flexion

sensory loss over sole of foot

A

tibial nerve

126
Q

antibodies in guillian barre

A

anti - GBM1 antibodies

127
Q

common cause of GBS

A

campylobacter

128
Q

presentation of GBS

A

ascending symmetrical muscle weakness starting in lower limbs and spreading
back/leg pain initially

129
Q

LP of GBS

A

isolated rise in protein

130
Q

nerve conduction in GBS

A

slowed conduction

131
Q

tx GBS

A

IV IG

plasmapheresis

132
Q

what is miller fisher syndrome

A

variant of GBS - ophthalmoplegia, areflexia and ataxia
eye muscles involved first
descending paralysis
anti-GQ1b antibodies

133
Q 
begins around puberty 
distal muscle wasting in legs 
mainly motor loss 
foot drop 
loss of reflexes
A

charcot-marie tooth disease (hereditary peripheral neuropathy)

134
Q

inheritance of charcot marie tooth

A

AD

135
Q

most common viral cause meningitis

A

enteroviruses - echovirus

136
Q

if any doubt over bacterial meningitis and RFs for what should patient be started on

A

antibiotics + IV aciclovir

137
Q

most common meningitis in 0-3 months

A

Group BS

138
Q

causes of meningitis in 0-3 months

A

group BS
e coli
listeria

139
Q

most common cause of meningitis in 6 - 60 year olds (< 40)

A

N meningitidis - most common

also strep pneumoniae

140
Q

causes of meningitis in 3m - 6 years

A

n meningitidis
strep pneumonia
h influenzae

141
Q

causes meningitis over 60

A

strep pneumoniae
n meningitidis
listeria

142
Q

meningitis in immunocompromised

A

listeria

143
Q

meningitis and skull fracture

A

pneumococcal

144
Q

meningitis and surgery or open head wound

A

staph aureus

145
Q

meningitis and CSF shunt

A

staph epidermidis

146
Q

meningitis and severely immunocompromised e.g. HIV

A

cryptococcal (fungal)

147
Q

most common complication of meningitis

A

sensorineural hearing loss

148
Q

what is - Waterhouse-Friderichsen syndrome

A

adrenal insufficiency secondary to adrenal haemorrhage

149
Q

ix for meningitis

A

LP

150
Q

ix for meningitis if LP contraindicated

A

CT to investigate raised ICP
if there is:
whole blood PCR and culture

151
Q

when is LP contraindicated

A 
meningococcal septicaemia
increased ICP
immunosuppressed 
FND
altered consciousness
152
Q

bacterial meningitis CSF

A

low glucose
high protein
neutrophils - polymorphs

153
Q

what can be done in GP if meningococcal disease suspected

A

IM benzylpenicillin

154
Q

meningitis treatment: < 3 months

A

IV cefotaxime + amoxicillin or ampicillin

155
Q

meningitis treatment: 3 months - 50 years

A

IV cefotaxime or ceftriazone

156
Q

meningitis treatment: > 50 years

A

IV cefotaxime or ceftriaxone + amoxicillin or ampicillin

157
Q

meningitis treatment: meningococcal

A

IV benzylpenicillin or cefotaxime or ceftriaxone

158
Q

meningitis treatment: pneumococcal

A

IV cefotaxime or ceftriaxone

159
Q

meningitis treatment: H influenzae

A

IV cefotaxime or ceftriaxone

160
Q

meningitis treatment: listeria

A

IV amoxicillin or ampicillin + gentamicin

161
Q

meningitis treatment: penicillin allergy

A

chloramphenicol

162
Q

when should dexamethasone be given in meningitis treatment

A

just before or with first dose of abx

163
Q

when is dexamethasone CI in meningitis treatment:

A

septic shock
meningococcal septicaemia
immunocompromised or following surgery
< 3 months old

164
Q

what happens when viral infection confirmed

A

stop abx

supportive treatment

165
Q

contact prophylaxis for meningitis

A

ciprofloxacin - single dose

if < 12 - rifampicin 4 doses

166
Q

main cause of encephalitis

A

HSV 1

167
Q

differentiate encephalitis from meningitis

A

encephalitis has psychiatric symptoms - psychosis, odd behaviour, speech and memory problems

168
Q

MRI HSV encephalitis

A

bilateral focal temporal lobe enhancement

169
Q

tx HSV encephalitis

A

IV aciclovir

170
Q

ix for HSV encephalitis

A

LP

171
Q

ix brain abscess

A

CT

172
Q

tx brain abscess

A

IV metronidazole and ceftriaxone
dexamethason
urgent drainage

173
Q

Tysabri is a risk factor for what neurological condition

A

progressive multifocal leukoencephalopathy in JCV positive patients

1. 4th year (23 decks)

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