Neuro PassMed Flashcards
treatment of idiopathic inter cranial hypertension
acetazolamide (carbonic anhydrase inhibitor)
which antiemetic can be prescribed to Parkinson’s patients and why is it favoured
domperidone - doesn’t cross the BBB so doesn’t cause EP side effects
is a resting parkinsons tremor bilateral or unilateral
unilateral
bells palsy treatment
prednisolone for 10 days - prescribed within 72hrs of onset
encephalitis treatment
IV acyclovir to cover HSV1
essential tremor- what is its inheritance, when is it worst and how do you treat
AD
worst when arms outstretched
tx = propranolol
what medication is used in thrombolysis if patient presents within 4.5hrs
alteplase
what is used in secondary prevention of stroke
clopidogrel is now preferred over aspirin
name one contraindication to triptan use in migraine management
a history of CVD
name the acute management of migrane
triptan+NSAID+ paracetamol
name the prophylactic management of migrane
topiramate or propranolol
what neurocutaneous syndrome are bilateral vestibuloschwannomas associated with
NFB2
what does the presence of thymoma on CT in a tired girl suggest
myasthenia gravis
which antiepileptic has peripheral neuropathy as a side effect
phenytoin
describe the mechanism of action of phenytoin
binds to Na channels to increase the refractory period
how is the weakness in Lambert eaton syndrome different from MG
weakness in Lambert eaton IMPROVES after exercise
weakness in MG WORSENS after exercise
which antibodies are associated with MG
ACh receptor antibodies
which antibodies are associated with lamber eaton syndrome
voltage gated calcium channel antibodies
what visual field defect will occur if there is a L temporal lobe infarct?
R superior quadranopia (remember PITS)
what visual field defect will occur if there is a L parietal lobe infarct?
R inferior quadranopia (PITS!)
which type of stroke affects the upper limb more than the lower limb
middle cerebral artery infarct
which type of stroke affects the lower limb more than the upper limb
anterior cerebral artery infarct
which stroke presents with 2 of:
- contralateral hemiparesis and sensory loss
- homonyms hemianopia
- aphasia
partial anterior circulation infarct
which type of stroke has all 3 of:
- contralateral hemiparesis +/- sensory loss
- aphasia
- contralateral homonymous hemianopia
total anterior circulation infarcts
what is used for long term prophylaxis of cluster headaches
verapamil
what is used as acute therapy for cluster headaches
sumatriptan and high flow oxygen
what would be signs of a problem in the basal ganglia
hypERkinetic (Huntington’s)
or
hyPOkinetic (Parkinson’s)
what is the acute treatment and prophylactic treatment of an ischaemic stroke
acute- 300mg aspirin. if present within 4.5hrs of symptom onset, thrombolysis (using alteplase)
prophylactic - clopidogrel
what is the Cushing reflex in response to
a physiological response to ICP
what is the Cushing reflex
hypertension and bradycardia
what should you orescribe to patients with N&V associated with chemotherapy
ondansetron (5HT antagonist)
what is required before starting phenytoin and why
cardiac monitoring- it has pro-arrhythmogenic side effects
what is the most common hereditary sensorimotor neuropathy? which nerves does it affect
Charcot-marie-tooth disease
peripheral nerves
name 4 features of Charcot Marie tooth disease
foot drop
high arched feet
distal muscle weakness and atrophy
hyporeflexia
what is the 1st line investigation for suspected stroke
non-contrast CT head
what are contrast-enhanced CT scans more useful for
detecting cerebral mets and abscesses
in detecting ismchaemic changes, is T1 or T2 imaging more sensitive
T2 weighted imaging is more sensitive
where is Broca’s speech area located
inferior frontal gyrus
describe the characteristics of Broca’s aphasia
expressive aphasia
non fluent, laboured and halting speech
comprehension normal
where is wernicke’s area located
superior temporal gyrus
describe the characteristics of wernicke’s aphasia
receptive aphasia
speech remains fluent but sentences make no sense
comprehension is impaired
where does the facial nerve supply sensation to on the tongue
the anterior 2/3
name one of the signs of bulbar onset MND
tongue fasciculations
name 3 areas that are NOT affected in MND
- external ocular muscles (no nystagmus or diplopia) (allows it to be differentiated from MG)
- No cerebellar signs
- sphincter function preserved
when a patient presents with mixed UMN and LMN signs, what else must you consider other than MND?
subacute combined degeneration of the cord
occurs due to vit B12 deficiency
can be precipitated if patients are given folate supplements without B12
which drug is used to manage tremor in drug induced parkisnson’s
procyclizine
which Parkinson’s drug has been associated with pulmonary fibrosis
cabergoline
why is compliance so important in Parkinson’s medication
risk of acute akinesia or neuroleptic malignant syndrome if medication isn’t taken
what is dystonia
involuntary muscle spasms and sustained muscle contractions
name 2 drugs that can cause drug induced dystonia
levodopa and other dopamine agonists used in Parkinson’s treatment
typical antipsychotics - dystonia is one of the EP side effects they can cause
how do you treat drug induced dystonia
procyclidine
treatment for neuroleptic malignant syndrome
bromocriptine
which arteries does a lacunar infarct affects
the perforating arteries around the internal capsule, thalamus and basal ganglia
which arteries does a posterior circulation infarct affect
vertebrobasilar arteries
what are the 3 features of normal pressure hydrocephalus
walking wet, wacky
ataxia
urinary incontinence
dementia
what is the 1st line treatment for neuropathic pain
amitriptyline (TCA)
duloxetine (SNRI)
gabapentin (anticonvulsant)
pathology of Parkinson’s
loss of dopaminergic neurones in substantia nigra
what disorder do antiaprkinsonian medications have a risk of
impulse control disorders
dopamine agonists are the worst for it
a stroke in what area of the brain would cause quadriplegia and ‘locked in’ syndrome
brainstem stroke
which brachial plexus palsy causes a ‘waiters tip’ appearance
erb’s palsy
which nerve roots are damaged in erb’s palsy -
how does it present?
C5, C6
internally rotated shoulder with extended elbow
which brachial nerve palsy causes a ‘claw hand’
klumpke’s palsy
which nerve roots are damaged in klumpke’s palsy
C8, T1
