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Year 3 medicine > Neurological disease > Flashcards

Neurological disease Flashcards

1
Q

What is the difference between primary and secondary headaches?

A

Secondary is caused by underlying condition e.g. infection, neoplasm, stroke

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2
Q

What are the different types of primary headache disorders?

A

Tension type headache
Migraine
Trigeminal autonomic cephalalgias (e.g. cluster headache).

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3
Q

What are the red flags in the history of headaches?

A

Worsens with valsalva
Wakes out of sleep
Change in character
Age of onset
Sudden onset (Thunderclap)
Focal neurological deficits
Constitutional symptoms (fever, meningism, rash, weight loss)

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3
Q

What red flags for headaches might you see on examination?

A

Sick appearing, skin changes, trauma
Altered cognition
Occular: Hyphema, pupil non-reactivity, optic disc swelling, proptosis, restricted eye movements
Meningism
Focal neurological findings

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4
Q

How quickly do thunderclap headaches peak?

A

Within 60 seconds

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5
Q

What investigations might you consider for a headache?

A

Bloods - FBC, U+E’s, ESR, CRP, Glucose
Imaging - CT Head (acute), CT Venogram Head, MRI Brain
Lumbar puncture

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6
Q

What is SNNOOP10?

A
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7
Q

How do you treat secondary headaches?

A

Treat underlying cause
Consider medication overuse

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8
Q

How do you treat primary headaches?

A
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9
Q

What type of primary headache is most prevalent?

A

Tension type

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10
Q

Describe tension type headache

A
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11
Q

Describe migraine headache

A
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12
Q

Describe cluster headache

A
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13
Q

In which type of headache is agitation more common

A

Cluster (Trigeminal Autonomic Cephalalgia)

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14
Q

Frequency of episodic and chronic tension type headache?

A
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15
Q

Frequency of episodic and chronic migraines?

A
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16
Q

What is status migrainosus?

A

Migraine attack lasting longer than 72 hours

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17
Q

What is the trigeminocervical complex?

A

Physiological complex of how head and neck sensory information combine.

Nerves come together and pathway loops up into ventralposteriormedial thalamic nucleus (VPM), then goes to other sensory components in the brain.

Explains why people with migraine get neck pain etc.

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18
Q

When would you give high flow O2 in a headache?

A

For cluster

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19
Q

What medications should you not give for the acute treatment of tension type and migraine headaches?

A

opiods

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20
Q

To prevent medication overuse headaches, you should limit monthly use of triptans, non-opioid analgesics and opioids to how much?

A
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21
Q

When would you start using preventative headache medication?

A

If someone get’s a headache 15 days in the month

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22
Q

What preventative treatment is used for tension type headache?

A
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23
Q

What preventative treatment is used for migraines?

A
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24
Q

What preventative treatment is used for cluster headaches?

A
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25
Q

How long do preventative treatments for headache stake to work?

A

Up to three months

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26
Q

Trigeminal neuralgia sx?

A
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27
Q

What is trigeminal neuralgia also known as?

A

Tic Doloreux

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28
Q

What are the secondary causes of trigeminal neuralgia?

A

Tumour at cerebellopontine angle, arteriovenous malformation or multiple sclerosis

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29
Q

What is classical trigeminal neuralgia?

A

Nerve root atrophy or displacement due to neurovascular compression

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30
Q

What is idiopathic trigeminal neuralgia?

A

No cause identified

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31
Q

What imaging would you get in tigeminal neuralgia?

A

MRI + MRA with thin cuts through the trigeminal nerve to look for compression.
MRA to look at blood vessels.

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32
Q

First line treatment for trigeminal neuralgia?

A

Carbamazepine
2nd line - Other anticonvulsants (gabapentin, pregabalin, lamotrigine)

Used as they stabalise neuronal firing

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33
Q

What are the surgical options for trigeminal neuralgia?

A

Percutaneous procedures
Stereotactic radiosurgery
Microvascular decompression

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34
Q

What is a seizure?

A

Abnormal firing of the brain

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35
Q

60% of seizures are from which lobe in the brain?

A

Temporal

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36
Q

Status epilepticus is a seizure after how long?

A

5 mins

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37
Q

Difference between focal and generalised seizure?

A
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38
Q

Temporal lobe seizure symptoms?

A
39
Q

Frontal lobe seizure symptoms?

A
40
Q

Parietal lobe seizure sx?

A
41
Q

Occipital lobe seizure sx?

A
42
Q

Criteria for epilepsy?

A
43
Q

Criteria for resolves epilepsy?

A
44
Q

Non-epileptic seizure signs?

A
45
Q

What are the common causes for seizures in well controlled epilepsy?

A
46
Q
A
47
Q

What general seizure precautions do you advise patients?

A
48
Q

What is SUDEP?

A
49
Q

What is drug resistant epilepsy?

A
50
Q

What type of diet in childcare can cause remission of epilepsy?

A

Ketogenic

51
Q

Most recurrence of epilepsy occurs within how long of discontinuing drugs?

A

1 year

52
Q

What is a tremor?

A
53
Q

What is akathasia?

A
54
Q

What is asterixis?

A
55
Q

What is a motor tic?

A
56
Q

What is chorea?

A
57
Q

What is dystonia?

A
58
Q

What is myoclonus?

A
59
Q

What is clonus?

A
60
Q

What is asterixis associated with?

A

Metabolic disturbances e.g. hepatic encephalopathy or renal dysfunction

61
Q

What specific bits of history do you want to find out with someone with a tremor?

A
62
Q

How do you assess a tremor at rest?

A
63
Q

How do you assess a tremor on action?

A
64
Q

What do you look for in the finger tap test?

A
65
Q

What investigations do you do for tremor?

A
66
Q

What is a DAT scan?

A

Dopamine transporter scan

Looks for any dopamine deficiency

67
Q

Essential tremor can worsen with what?

A

Caffeine
some medications

68
Q

What improves essential tremor?

A

Alcohol

69
Q

Why does essential tremor happen?

A

Alteration in the cerebello-thalamo-cortical circuit
Thalamus and cortex involved in movement
Cerebellum involved in finessing movement.

70
Q

Dx for essential tremor?

A
71
Q

What is essential tremor plus?

A
72
Q

How does essential tremor and parkinsons differ in history?

A
73
Q

How does essential tremor and parkinsons differ in examination findings?

A
74
Q

What is the treatment for essential tremor?

A
75
Q

What part of the face is affected in an upper motor neuron lesion?

A
76
Q

What part of the face is affected in an lower motor neuron lesion?

A
77
Q

Which conditions present with bilateral lower motor neuron facial nerve palsy?

A
78
Q

How do you assess CN VII?

A
79
Q

What is bells palsy associated with?

A
80
Q

How is bells palsy treated?

A
81
Q

What are the complications of recovery from bells palsy?

A
82
Q

What causes wernicke’s encephalopathy?

A
83
Q

Signs of wernickes encephalopathy?

A
84
Q

What can untreated wernickes encephalopathy lead to?

A
85
Q

Why should you give thiamine before glucose in nutritionally deficient patients?

A

Can precipitate wernickes encephalopathy

86
Q

What would you see on imaging in wernickes encephalopathy?

A
87
Q

Alcohol blocks absorption of thiamine and what?

A

Magnesium

88
Q

You get Wernicke-Korsakoff from damage of the what?

A

Medial dorsal thalamus

89
Q

Thiamine deficiency can present as dry beri beri. What are the sx of this?

A
90
Q

Thiamine deficiency can present as wet beri beri. What are the sx of this?

A
91
Q

Thiamine deficiency can present as gastrointestinal beri beri. What are the sx of this?

A
92
Q

What is Machiafava bignami disease?

A
93
Q

What tool do you use to assess for alcohol withdrawal?

A
94
Q

Why do we give thiamine in alcohol withdrawal?

A
95
Q
A

Year 3 medicine (10 decks)

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