Neurology Flashcards

1
Q

Name some of the treatable causes/mimics of dementia

A
  • Vitamin deficiency
  • Thyroid disease
  • Infective: HIV, syphilis etc.
  • Hydrocephalus
  • Tumour
  • Depression
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2
Q

Name some of the key features of Alzheimer’s disease

A
  • Early memory disturbance
  • Language and visuospatial problems
  • Preserved personality
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3
Q

Name some of the key features of frontotemporal dementia

A
  • Early changes in personality/behaviour
  • Changes in eating habits
  • Early dysphasia
  • Preserved memory and visouspatial
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4
Q

How can the symptoms of dementia be managed?

A
  • Non pharmalogical (OT, social work etc.)
  • Insomnia treatment
  • Behaviour treatment
  • Depression treatment
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5
Q

Name the specific treatments for Alzheimers and Lewy body dementia

A
  • Cholinesterase inhibitors (Donepezil, rivastigmine, galantamine)
  • NMDA antagonist (memantine)
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6
Q

How does parkinsonism present?

A
  • Bradykinesia
  • Rigidity
  • Tremor
  • Postural instability
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7
Q

How can Parkinson’s disease be treated?

A
  • Levodopa
  • COMT inhibitors
  • Dopamine agonists (e.g. ropinirole)
  • MAO-B inhibitors (selegiline etc.)
  • Deep brain stimulation
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8
Q

Name the cognitive features of dementia

A
  • Memory
  • Dysphasia
  • Dyspraxia
  • Dysgnosia (not recognising objects)
  • Dysexecutive functioning
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9
Q

How does a tension headache present?

A
  • Mild
  • Bilateral headache
  • Pressing or tightening
  • No associated features
  • Not aggravated by routine physical activity
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10
Q

How can a tension headache be managed?

A
  • Abortive: paracetamol, NSAIDs or aspirin

- Preventative: TCAs

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11
Q

How can a migraine be treated?

A
  • Abortive: aspirin, NSAIDs and triptans

- Prophylactic: propranolol, candersartan, anti-epiletics, TCAs and venlafaxine

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12
Q

Which type of headache has an absolute response to indometacin?

A

Paroxysmal hemicrania

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13
Q

How can cluster headaches be managed?

A
  • Abortive: SC sumatriptan, nasal zolmatriptan, oxygen and occipital depomedrone injection or oral prednisolone
  • Preventative: verapamil, lithium, methysergide and topiramate
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14
Q

How can SUNCT/SUNA be managed?

A

Prophylaxis: lamotrigine, topiramate, gabapentin, carbamazepine/ oxcarbazepine

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15
Q

How can trigeminal neuralgia be managed?

A

Prophylaxis: carbamazepine and oxcarbazepine
Surgical: glycerol ganglion injection, steriotactic radiosurgery and decompressive surgery

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16
Q

How can paroxysmal hemicrania be managed?

A

Prophylaxis: indometacin, COX-II inhibitors and topiramate

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17
Q

What are the “sinister” features of headaches?

A
  • Associated head trauma
  • First or worst
  • Thunderclap
  • New daily headache
  • Change in headache pattern
  • Returning patient
  • Focal neurological symptoms
  • Abnormal examination
  • Neck stiffness
  • Headache worse on lying down/ waking up/exertion
  • Jaw claudication or visual disturbance
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18
Q

Name the three categories of syncope

A
  • Reflex: medical situations, cough etc.
  • Orthostatic: dehydration,anti-hypertensives, endocrine etc.
  • Cardiogenic: arrhythmias, aortic stenosis etc.
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19
Q

Which investigations would you do for someone presenting with epilepsy?

A
  • EEG
  • MRI for <50yrs
  • CT for >50 yrs
  • Video-telemetry
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20
Q

Name the first line treatments for primary generalised epilepsies

A
  • Sodium Valproate
  • Lamotrigine
  • Levetiracetam
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21
Q

Name the first line treatments for focal and secondary generalised seizures

A
  • Lamotrigine
  • Carbamazepine
  • Levetiracetam
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22
Q

Name the first line treatment for absence seizures

A

Ethosuximide

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23
Q

Name the treatment options for status epilepticus

A
  • First line: midazolam/ lorazepam/ diazepam
  • Second line: phenytoin and valproate
  • Third line: propofol or thiopentone
24
Q

How can an ischaemic stroke be managed acutely?

A
  • Thrombolysis
  • Thrombectomy (anterior only)
  • Aspirin 300mg
25
How can a haemorrhagic stroke be managed acutely?
- Manage hydrocephalus - Blood pressure control - Reverse anticoagulation
26
How can a TIA be managed acutely?
Aspirin 300mg
27
What medications should be used for stroke prevention after a TIA?
- Aspirin | - Dipyridamole
28
Name the types of skull fractures
- Linear - Depressed - Comminuted - Ring fracture - Contre-coup (orbital plates)
29
How does raised ICP present?
- Headaches (worse in the morning and coughing/straining) - Papilloedema - Visual disturbance - Loss of upgaze - Impaired consciousness
30
How can hydrocephalus be managed?
- Acetazolamide - External ventricular drain (in emergencies) - 3rd ventriculostomy - Shunt insertion
31
How does normal pressure hydrocephalus present?
- Dementia - Gait disturbance - Urinary incontinence
32
How can raised ICP be managed?
- Avoid pyrexia - Manage seizures - CSF drainage - Elevated head of bed - Analgesia and sedation - Mannitol - Hypertonic saline - Hyperventilation - Hypothermia - Decompressive craniectomy
33
How does Bell's Palsy present?
- Facial sag - Asymmetrical smiling - Voluntary eye closure not possible - No forehead sparing
34
What is Ramsay Hunt Syndrome?
LMN facial nerve palsy due to Herpes Zoster
35
How can Bell's Palsy be managed?
- Eye care (lubricating eye drops) - Steroids - Surgery if no response to medical treatment
36
How can Ramsay Hunt Syndrome be managed?
- Aciclovir | - Steroids
37
How does an essential tremor present?
- Distal symmetrical tremor of the upper limbs | - Can sometimes effect the neck muscles
38
How can an essential tremor be managed?
- Propranolol or primidone | - Deep brain stimulation
39
How does Guillian-Barre syndrome present?
- Progressive ascending symmetrical weaknesss starting in the lower extremities - Facial weakness, dysphasia or dysarthria - Neuropathic pain - Reduced or absent reflexes - Parasthesiae or sensory loss - Autonomic symptoms
40
How can Guillian-Barre be investigated?
- Electrolytes - Lumbar puncture - Antibody screen - Spirometry - Nerve conduction studes - ECG
41
How can Guillian-Barre be managed?
- Plasma exchange - IV immunoglobulin - Steroids - DVT prophylaxis - Pain relief - Admission to ITU may be required
42
How does MS present?
- Optic neuritis - Sensory symptoms - Limb weakness - Diplopia/vertigo/ataxia - Bladder symptoms - Brainstem involvement
43
Name the 1st line disease modifying treatments for MS
- Beta-interferons - Glatiramer acetate - Teriflunomide - Dimethyl fumarate
44
How does peripheral neuropathy present?
- Parasthesiae - Neuropathic pain - Loss of vibration sense and position sense - Muscle wasting - Autonomic: Incontinence and orthostatic hypotension
45
Name the causes of peripheral neuropathy
- Guillian Barre, Charcot-Marie-Tooth - Alcohol - Diabetes - Vitamin - Thiamine or B12 deficiency - Carcinoma
46
How can peripheral neuropathy be managed?
- Foot care, weight reduction and sensible footwear - Glucose and blood pressure control - Steroids - IV immunoglobulins - Amitriptyline, pregabalin or gabapentin
47
What causes a radiculopathy?
- Intervertebral disc prolapse - Degenerative diseases of the spine - Fracture - Malignancy - Infection
48
How does a radiculopathy present?
- Paraesthesia - Numbness - Weakness
49
How can a radiculopathy be managed?
- Analgesia - Amitriptyline - BZDs - Baclofen - Physiotherapy - Surgery
50
How does Wernicke's Encephalopathy present?
- Visual changes - Loss of co-ordination - Profound memory loss - Hallucinations - Polyneuropathy - Muscle atrophy - Confabulation
51
How can Wernicke's encephalopathy be managed?
- Thiamine - Rehydration and diet - OT assessment - Assess capacity and insight
52
How can brain metastases be managed?
- Steroids - Surgery - Radiosurgery - Chemotherapies
53
Name the types of brain tumours
- High grade: gliomas, glioblastoma multiforme , primary cerebral lymphomas and medulloblastomas - Low grade: meningiomas, acoustic neuromas, neurofibromas, pituitary tumours, pineal tumours and craniopharyngiomas - Metastases
54
How can brain tumours be managed?
- Resection - Radiotherapy - Chemotherapy (particularly in CNS lymphoma) - Analgesics, anticonvulsants, anticoagulants and steroids
55
How do lumbosacral disc prolapses present?
- Unilateral leg pain - Numbness, parasthesia and weakness in one nerve root distribution - A positive straight leg test - Pain relieved by lying down
56
How can disc prolapses be managed?
- Analgesia - Keeping active - Heat and massage - Physiotherapy - Discectomy