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1. 4th year > Neuro part 2 > Flashcards

Neuro part 2 Flashcards

1
Q

describe a migraine

A 
unilateral
throbbing 
worse with movement
at least 2 of photophobia, phobophobia, osmophobia or nausea
4-72 hours
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2
Q

acute migraine treatment

A

NSAIDs/paracetamol + oral triptan

consider nasal triptan in aged 12-17

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3
Q

acute migraine treatment in pregnancy

A

paracetamol 1st line (NSAIDs can be used 2nd line in 1st and 2nd trim)

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4
Q

treatment acute migraine if 1st line not working

A

non-oral preparation of metoclopramide or prochlorperazine + non-oral NSAID or triptan

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5
Q

side effect of metoclopramide

A

acute dystonic reaction

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6
Q

when are triptans CI

A

CVD

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7
Q

1st line migraine prophylaxis

A

propranolol

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8
Q

2nd line migraine prophylaxis

A

topiramate - teratogenic and reduces efficacy of hormonal contraceptive

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9
Q

tx menstrual migraine

A

triptan in acute setting

mefenamic acid or aspirin + paracetamol + caffeine

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10
Q

tension headache treatment

A

paracetamol / NSAID / aspirin

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11
Q

how many cluster headahce for diagnosis

A

at least 5 attacks for diagnosis

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12
Q

describe cluster headache

A

severe unilateral headache around the orbit with ipsilateral autonomic symptoms
multiple attacks most days over 1-3 month period

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13
Q

tx acute attack cluster headache

A

100% O2 + triptan SC

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14
Q

cluster headache prophylaxis

A

verapamil

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15
Q

tx paroxysmal hemicrania continua

A

indomethacin

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16
Q

describe medication overuse headache

A

someone who was experiencing episodic headaches so began regularly using analgesics and headache has now become chronic

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17
Q

tx medication overuse headache caused by simple analgesia/triptans

A

stop abruptly

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18
Q

tx medication overuse headache cause by opioid

A

withdraw gradually

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19
Q

tx trigeminal neuralgia

A

carbamazepine

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20
Q

facial nerve palsy UMN vs LMN

A

UMN: preservation of forehead wrinkling.
LMN: loss of forehead wrinkling on affected side. (forehead affected)

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21
Q

bells palsy UMN or LMN

A

LMN

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22
Q

tx bells palsy

A

if < 72 hours - 60mg prednisolone for 5 days

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23
Q

dx of sleep disorders

A

history and overnight sleep studies

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24
Q

non-REM sleep disorder - sleep paralysis - treatment if troublesome

A

clonazepam

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25
Q

dx of narcolepsy

A

multiple sleep latency test EEG

+ overnight sleep studies

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26
Q

tx day time somnolence in narcolepsy and night time cataplexy

A

modafinil

sodium oxybate

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27
Q

short term treatment insomnia

A

zopiclone

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28
Q

stroke: TACI

A

All three of the following:
• Unilateral weakness +/- sensory loss of face, arm or leg.
• Homonymous hemianopia.
• Higher cerebral dysfunction: dysphasia, visuospatial problems.

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29
Q

stroke: PACI

A

Two of the following present:
• Unilateral weakness +/- sensory loss of face, arm of leg.
• Homonymous hemianopia.
• Higher cerebral dysfunction: dysphasia, visuospatial problems

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30
Q

stroke: POCI

A 
One of the following is present: 
•	Isolated homonymous hemianopia. 
•	Cerebellar or brainstem syndromes
(ataxia, facial weakness, Nystagmus, diplopia). 
•	Loss of consciousness
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31
Q

stroke: LACI

A 
One of the following:
•	Purely sensory stroke. 
•	Ataxic hemiparesis. 
•	Unilateral weakness +/- sensory symptoms in face, arms or legs. 
High association with hypertension
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32
Q

vessels involved in TACI

A

anterior and middle cerebral

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33
Q

vessels involved in PACI

A

anterior or middle cerebral

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34
Q

vessels involved in POCI

A

vertebral basilar arteries

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35
Q

vessels involved in LACI

A

multiple small vessel infarcts in basal ganglia and thalamus and internal capsule

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36
Q

All three of the following:
• Unilateral weakness +/- sensory loss of face, arm or leg.
• Homonymous hemianopia.
• Higher cerebral dysfunction: dysphasia, visuospatial problems.

A

TACI

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37
Q

Two of the following present:
• Unilateral weakness +/- sensory loss of face, arm of leg.
• Homonymous hemianopia.
• Higher cerebral dysfunction: dysphasia, visuospatial problems

A

PACI

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38
Q 
One of the following is present: 
•	Isolated homonymous hemianopia. 
•	Cerebellar or brainstem syndromes
(ataxia, facial weakness, Nystagmus, diplopia). 
•	Loss of consciousness
A

POCI

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39
Q 
One of the following:
•	Purely sensory stroke. 
•	Ataxic hemiparesis. 
•	Unilateral weakness +/- sensory symptoms in face, arms or legs. 
High association with hypertension
A

LACI

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40
Q

clinical presentation of a stroke involving the ACA

A

Contra lateral weakness and sensory loss (hemiparesis), lower limb > upper limb

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41
Q

clinical presentation of a stroke involving the MCA

A

Contralateral weakness and sensory loss (hemiparesis), especially of arm and face.
Homonymous hemianopia (contralateral)
Aphasia

42
Q

clinical presentation of a stroke involving the PCA

A

Contralateral homonymous hemianopia with macular sparing

43
Q

clinical presentation of a stroke involving the ophthalmic artery

A

amaurosis fugax

44
Q

clinical presentation of a stroke involving the Branches of the PCA that supply the midbrain (Webers syndrome)

A

Ipsilateral CN III palsy

Contralateral weakness of upper and lower extremities

45
Q

clinical presentation of a stroke involving the Posterior inferior cerebellar artery (PICA) Wallenberg syndrome/lateral medullary syndrome

A

Ipsilateral facial pain and temperature loss
Contralateral limb/torso pain and temperature loss
Ataxia
Nystagmus
Ipsilateral horners

46
Q

clinical presentation of a stroke involving the Anterior inferior cerebellar artery / lateral pontine syndrome

A

Symptoms similar to Wallenberg’s but ipsilateral facial paralysis and deafness

47
Q

basilar artery stroke

A

locked in syndrome

48
Q

most common cause of haemorrhagic stroke

A

uncontrolled hypertension

49
Q

what kind of stroke does sudden drop in BP cause e.g. sepsis

A

watershed

50
Q

1st line investigation for stroke

A

non-contrast CT

51
Q

investigation of stroke if presenting 1 week after or with mild deficits suggesting small lesion

A

MRI

52
Q

time frame for thrombolysis

A

4.5 hours

53
Q

time frame for thrombectomy

A

6 hours (varies)

54
Q

tx stroke if ischaemic confirmed

A

300mg aspirin

thrombolysis + thrombectomy - if within time frame

55
Q

tx stroke > 4.5 hours and confirmed ischaemic

A

300mg aspirin

thrombectomy (under 6 hours)

56
Q

how long is aspirin continued after stroke

A

14 days

57
Q

medication post ischaemic stroke

A
  • aspirin for 14 days
  • clopidogrel + dipyridamole
  • aspirin + dipyridamole if clopidogrel not tolerated
  • statin
  • if patient also has AF - warfarin or a direct thrombin or factor Xa inhibitor
58
Q

tx suspected TIA

A

aspirin 300mg

59
Q

tx suspected TIA if already taking anticoagulant

A

admit for imaging to exclude haemorrhage

60
Q

tx post stroke

A

clopidogrel
dont drink alcohol or drive for 1 months
cant drive bus or lorry for 1 year
if patient also has AF - warfarin or a direct thrombin or factor Xa inhibitor

61
Q

do you need to tell DVLA if you have had a TIA

A

no but need to be symptom free after 1 month/speak to doctor before restarting

62
Q

gold standard IX for intracranial venous thrombosis

A

MRI venography

delta sign

63
Q

Sudden onset, thunderclap headache that is usually occipital, develops within seconds and described as worst headache ever

A

SAH

64
Q

ix SAH

A

CT brain

- Acute blood (hyperdense/bright on CT) distributed in the basal cisterns, sulci and in severe cases the ventricles

65
Q

when is LP done in SAH

A

12 hours post presentation

66
Q

what is seen on LP of SAH

A

xanthochromic CSF - turns yellow due to breakdown of RBC

67
Q

ix to find out cause of SAH

A

CT angiogram

68
Q

tx SAH

A

IV saline
nimodipine for 21 days
may need neurosurgery - coil or clipping

69
Q

what metabolic complication can SAH lead to

A

hyponatraemia due to SIADH

70
Q

minor trauma, fluctuating consciousness, dull headache, can be over weeks to months

A

SDH

71
Q

ix SDH

A

CT brain - crescent shaped haematoma

72
Q

vessels affected in SDH

A

bridging veins

73
Q

vessels affected in EDH

A

middle meningeal

74
Q

presentation of EDH

A

notable trauma
lucid interval
increasingly severe headache with sudden decline in consciousness

75
Q

fixed dilated pupil would be a sign of what in context of EDH

A

brain herniation

76
Q

ix EDH

A

CT brain: lens shaped (biconvex) hematoma

77
Q

EDH is/is not limited by suture lines

A

EDH is restricted by suture lines

78
Q

SDH is/is not limited by suture lines

A

SDH is not limited by suture lines

79
Q

dx brain tumour

A

MRI

80
Q

most common primary brain tumour

A

astrocytoma / glioma

81
Q

most common primary brain tumour in adults

A

glioblastoma multiform

82
Q

benign tumour occuring in frontal lobe, younger patients, chemosensitive and presents with seizures most often

A

oligodendroma

83
Q

aggressive tumours of cerebellum almost exclusively seen in children

A

medulloblastoma

84
Q

how do medulloblastoma spread

A

through CSF - drop down mets

85
Q

extra axial tumours of the arachnoid cap cells

A

meningioma

86
Q

when would bilateral vestibular schwannomas be seen

A

Neurofibromatosis type 2

87
Q

what cranial nerves can be affected in vestibular schwanoma

A

V
VII
VIII

(VEStibular)
V - five
E - eight
S - seven

88
Q

ocular symptom seen in vestibular schwanoma

A

loss of corneal reflex

89
Q

tumour that presents with lower bitemporal hemianopia

A

craniopharyngioma

90
Q

most common type of brain tumour

A

mets

- lung, breast, kidney, colon, melanoma

91
Q

what tumour is sensitive to tenozolomide

A

glioblastoma

92
Q

describe the headache of raised ICP

A

worse in morning
worse on lying down and coughing, bending
associated with N+V

93
Q

what is cushings reflex

A

bradycardia
hypertension
wide pulse pressure
irregular breathing

94
Q

1st line simple tx of raised ICP

A

elevate head to 30-40 degrees

95
Q

treatment of raised ICP - reduce ICP

A

IV mannitol, hypertonic saline, intubate and hyperventilate

96
Q

tx of raised ICP preventing cerebral oedema

A

dexamethasone

97
Q

tx IIH

A

acetazolamide
2nd line - topiramate
repeated LP

98
Q

brown sequard

A

Contralateral: loss of pain, temperature beginning 1-2 levels below the lesion
Ipsilateral: UMN paralysis – weakness, and loss of proprioception, vibration, light touch

99
Q

central cord syndrome

A

Bilateral Upper limb weakness. (more than LL)

Band like loss of pain, temperature and gross touch on the back in cape distribution.

100
Q

anteiror cord syndrome

A

paralysis and loss of pain and temperature below the level of injury with preserved proprioception and vibration sensation

101
Q

common complaints in cervical myelopathy

A

loss of digital dexterity / clumsiness

imbalance and gait disturbance –> falls

102
Q

gold standard IX for cervical myelopathy

A

MRI cervical spine

1. 4th year (23 decks)

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