Neuro/psych Flashcards
Varenicline
- MoA?
- Cautions and contraindications?
NIcotinic receptor partial agonist
Caution in depression
Contraindicated in pregnancy and breastfeeding
Buproprion
- MoA?
- Contraindications?
Noradrenaline and dopamine reuptake inhibitor
Nicotinic receptor antagonist
Contraindicated in pregnancy and breastfeeding
When commencing medication for depression, what would you recommend in someone who also takes a triptan?
NOT an SSRI (risk of serotonin syndrome)
- recommended:
- Mirtazapine, ruboxetine
When commencing medication for depression, which one would you recommend in someone who also takes an NSAID/aspirin/anticoagulation?
Recommend Mirtazapine (risk of PUD with SSRIs)
In elderly, coprescribe a PPI
Recommended antidepressant medication for a pt with epilepsy?
Sertraline is first line
CT findings in idiopathic intracranial hypertension
normal/small ventricles
Symptoms of idiopathic intracranial hypertension?
overweight woman
- headache worse in mornings and at night
- blurred vision
- nausea
Positive lupus anticoagulant
likely diagnosis?
antiphospholipid syndrome
Investigations for suspected myasthenia gravis
anti acetylcholine receptor antibodies (serum)
repetitie nerve stimulation studies
CT THORAX - for ?thymoma
Fundoscopy finding suggestive of SAH?
subhyaloid haemorrhage
2 common forms of TB Infection of CNS
Meningitis
Tuberculoma (slowly growing focal lesion)
1st rank symptoms of schizophrenia
- Delusions
- Thought insertion/withdrawal/broadcasting
- Auditory hallucination
- Passivity
Signs of TCA overdose
Tachycardia
Dilated pupils
Dry eyes
Urinary retention
Hyperreflexia
symptoms of normal pressure hydrocephalus
Wet wacky wobbly
Urinary incontinence
Dementia
Ataxia - mimics parkinsons
What is dissociative fugue
Purposeful travel ++
Dissociative amnesia
lower limb restlessness after commencing an antipsychotic
diagnosis?
Akathisia
Friedrichs ataxia
- what systems does it affect?
- what age and population does it tend to affect
- ‘structural’ manifestations of disease?
Autosomal recessive
Affects CNS and heart
often presents in young men.
Never in east asian and native americans.
Can be preceded by pes cavus and scoliosis
Initial test used in suspected duchennes?
CK
De clerembaults
Believing someone is in love with you of superior status
Fregoli syndrome
Believing you’re seeing someone you know as many strangers
Most common cause of death in duchennes
respiratory and cardiac complications
Resp: resp muscle weakness –> increased LRTIs
Cardiac: DCM, arrhythmia, heart failure
Muscular dystrophy
Inheritance pattern?
Features?
Autosomal dominant
- muscular weakness
- ptosis, cataracts
- ## frontal balding
Diabetic amyotrophy
How does it present?
Reflexes?
Reversibility?
- Excruciating pain in hips/buttocks/thighs
- Absent reflexes
- Resolves with good diabetic control
Baby blues
- when does it peak? when does it tend to improve?
Peaks day 3-5
resolves by day 10
Worsening neurological symptoms in hot environment
- what is the name of this sign?
- cause?
Uthoffs
MS
Lhermittes sign - describe
electric shock sensation on neck flexion
loss of pain and temp sensation over shoulders and upper body ?cause
syringomyelia
1st line treatment for gtc seizure prophylaxis
sodium valproate
but if woman of child bearing age –> lamotrigine/levetiracetam
1st line treatment for absence seizures
ethosuximide
section 5(2) what is it and how long does it last for
allows a patient already in hospital to detained for mental health assessment - 72 hours
section 2 - what is it, who is required, and how long does it last for
detains for metnal health ASSESSMENT - reqested by 2 doctors (1 is usually a consultant psychiatrist) to be performed by AMHP
lasts for 28 days
section 135 vs 136
135 in private property
136 in public place
Which bloods to monitor in pts taking lithium?
TFTs
calcium (affects PTH glands)
U&Es (can cause K derangement)
difference in CSF findings with viral vs TB meningitis?
both cause raised monocytes
viral = normal glucose
TB = low glucose
important bloods to monitor if taking CBZ? why?
FBC
- risk of aplastic anaemia
timing of CT Brain for suspected SAH - why does it matter
if taken within 6 hours of headache starting - can rule out SAH
If done at >6hrs post - do an LP?
diagnostic investigations for MS
MRI brain - high signal T2 lesions
CSF - oligoclonal bands
Visual evoked potentials
signs of valproate toxicity
increased GABA
- reduced GCS
- hypoglycemia
- low BP
- high Na
serotonin syndrome vs neuroleptic malignant syndrome
Serotonin syndrome -
- hypERreflexia
- clonus
- dilated pupils
Neuroleptic malignant syndrome
- hypOreflexia
- lead pipe rigidity
- normal pupils
what hospital treatment can often precipitate wernickes encephalopathy
IV glucose can worsen wernicke’s
tremor, hyperreflexia, ataxia, flattened T waves –> which drug has been OD’d?
Lithium
what blood test should be monitored in pts taking carbemazepine
FBC - risk of aplastic anaemia
1st line tx of myoclonic seizures
men: valproate
women: levetiracetam
