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Year 3 > Neurology > Flashcards

Neurology Flashcards

1
Q

Cluster headache features

A

Eye swelling, redness, nasal stiffness, severe pain

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2
Q

Cluster headache prophylaxis

A

Verapamil

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3
Q

Cluster headache management

A

Oxygen and triptan

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4
Q

What antinausea medication is CI in parkinsonism

A

Metoclopramide

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5
Q

unprovoked 1st seizure and driving

A

6 months

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6
Q

unprovoked 1st seizure and driving

A

6 months

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7
Q

Prodrome before Syncope

A

Reflex or neurally mediated syncope

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8
Q

Benign positional Vertigo

A

Movement of head

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9
Q

Meniere

A

Attacks of vertigo + tinnitus + progressive hearing loss

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10
Q

treating MG crisis

A

Plasmapheresis and IV immunoglobulin

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11
Q

treating MG crisis

A

Plasmapheresis and IV immunoglobulin

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12
Q

Treatment of Neuropathic pain

A

Amitriptyline, Duloxetine, gabapentin and pregabalin

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13
Q

Autonomic Dysreflexia

A

Spinal cord injury patients, trigger fecal impaction or urinary retention; extreme hypertension, flushing and sweating.

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14
Q

Asymmetrical features, resting tremor, increased tone

A

parkinson’s disease

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15
Q

Bilateral symptoms, antidopaminergic drugs

A

Drug induced parkinson

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16
Q

Supranuclear palsy

A

Plus syndrome; vertical gaze palsy, Axial rigidity

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17
Q

Lewy body dementia

A

Parkinsonism + dementia near onset of symptoms + nocturnal wandering

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18
Q

Lewy body dementia

A

Parkinsonism + dementia near onset of symptoms + nocturnal wandering

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19
Q

Todd’s Paralysis

A

focal weakness after a focal seizure

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20
Q

Chronic presentation after head injury

A

Subdural hepatoma

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21
Q

Diagnosis of GBS

A

Nerve conduction study

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22
Q

Motor deficit but eye movements spared

A

MND

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23
Q

1st line for PD if affected motor symptoms

A

Levodopa

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24
Q

Hallucinations, epigastric rising, emotions, Automatisms such as lip smacking, grabbing and plucking, deja vu and dysphasia

A

Temporal lobe epilepsy

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25
Q

Head/leg movements, posturing, post-octal weakness and Jacksonian march

A

Frontal lobe epilepsy

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26
Q

Visual flashes and floater during seizure

A

Occipital lobe

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27
Q

Contraindications to triptans

A

CAD as cause vasospasm

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28
Q

Treating Spasticity in MS

A

Gabapentin and Baclofen

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29
Q

History of sinusitis, headache, fever, and focal neurology

A

BRAIN abscess

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30
Q

unilateral facial edema, photophobia, proposes and CN palsy

A

cavernous sinus thrombosis

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31
Q

Pain, opthalmoplegia, proposes, CN5 lesion (ophthalmic ) and Horner’s Syndrome

A

Cavernous sinus syndrome

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32
Q

VF and VT pulseless - ALS

A

CPR + 1 shock

Adrenaline after 3rd shock

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33
Q

GCS - Important

A

EVM
E: eye movement- Spontaneous (4), to voice (3), to pain (2)
V: Verbal response: Oriented (5), Confused (4), inappropriate words (3), inappropriate sounds (2) and no (1)
M: Follows command (6), localizes to pain (5), Withdrawal from pain (4), Inappropriate flexion (3), inappropriate extension (2) and no (1)

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34
Q

Describe Lhermitte’s sign and associated diseases

A

Tingling in hands with flexion of neck

Associated disease - MS and Subacute degeneration of cord

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35
Q

What is Uhtoff’s Phenomenon; where is it seen

A

Worse vision with rise in temperature

MS

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36
Q

Encephalitis cause mostly*

A

HSV-1; use acyclovir drug

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37
Q

Lucid interval

A

Extra-dural hematoma

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38
Q

Biconvex hematoma

A

Extradural

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39
Q

Crescent shaped hematoma

A

Subdural hematoma

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40
Q

Acoustic neuroma best diagnostic test

A

Cerebellopontine angle MRI

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41
Q

Chronic subdural Hematoma - Symptomatic patient - management

A

Burr hole evacuation

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42
Q

Chronic subdural hematoma - Asymptomatic management

A

Conservative management or high dose steroids

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43
Q

Management of acute subdural hematoma

A

Decompressive surgery

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44
Q

What is Nimodipine used for in the management of Hematomas

A

Prevents secondary cerebral ischemia; increases cerebral vasodilation.

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45
Q

1st line for Trigeminal neuralgia

A

Carbamazepine

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46
Q

Loss of ability to produce language, comprehension is intact.

A

Broca’s Aphasia

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47
Q

Wernicke’s Aphasia / receptive aphasia

A

Impaired comprehension but retained speech, cannot repeat words

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48
Q

Both comprehension and language production impaired

A

Global aphasia

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49
Q

Primary progressive aphasia

A

Gradual loss of language, dementia related

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50
Q

CHA2DS2VAS

A 
CHF 1
Hypertension 1
Age >75 2
Diabetes 1
Stroke/TIA 2
Vascular disease 1
Age 65-74 1
Female 1
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51
Q

Management of Status Epilepticus

A

1st line: Benzodiazepines (rectal diazepam); IV lorazepam (can be repeated after 10-20 minutes

2nd line: Phenytoin or phenobarbital infusion

Refractory status: General anaesthesia

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52
Q

IVF increases the risk of what placental abnormality

A

Placenta previa

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53
Q

what risk factor is associated with Vasa previa

A

Previous C-section

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54
Q

Multiple episodes of TLC with quick recovery time; Investigation of choice

A

24 hour ECG

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55
Q

Steven-Johnson syndrome is a side effect of what antiepileptic

A

lamotrigine

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56
Q

Hemonymous hemianopia with macula sparing - stroke

A

Posterior cerebral artery

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57
Q

Ipsilateral ataxia, nystagmus, dysphagia, facial numbness, CN palsy, with contralateral hemisensory loss indicates

A

Lateral Medullary syndrome

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58
Q

Isolated hemisensory loss

A

Lacunar infarct

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59
Q

Post-ictal weakness in a focal seizure is Called

A

Todd’s paresis

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60
Q

Urinary incontinence + Gait abnormality + dementia

A

Normal pressure hydrocephalus

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61
Q

Tumour arising from falx cerebri and pushes on the brain; well defined border between the tumour and brain parenchyma

A

Meningiomas

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62
Q

What is oligoclonal bands most associated with

A

Multiple Sclerosis

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63
Q

Autonomic dysreflexia occurs above what level of spinal cord

A

Above T6 level

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64
Q

Gold standard for Cauda equina syndrome

A

MRI spine

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65
Q

BP management in stroke

A

> 180 mmHG

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66
Q

Distended neck veins in Myasthenia may be caused by

A

Thymomas

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67
Q

management of idiopathic intracranial hypertension

A

Acetazolamide

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68
Q

Antipsychotics are 1st line for delirium however they are CI in what condition

A

Parkinson’s Disease

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69
Q

Autosomal Polycystic kidney is associated with what hemorrhage

A

SAH

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70
Q

What is used to treat cerebral edema in patients with brain tumours

A

Dexamethasone

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71
Q

Myasthenia crisis respiratory test

A

FVC

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72
Q

Choice of investigation in GBS

A

Lumbar puncture

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73
Q

Ipsilateral face and contralateral limbs - affected

A

Lateral medullary syndrome PICA

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74
Q

Wernicke’s aphasia (receptive)

A

Affects the superior temporal gurus; speech is fluent comprehension is impaired

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75
Q

Broca’s aphasia

A

Inferior frontal gurus

Non-fluent speech, laboured, repitition is impaired and comprehension is normal

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76
Q

Patient with lung cancer; high BP + Vomiting and severe headaches

A

Cerebral metastasis

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77
Q

1st line Neuropathic pain

A

Amitriptyline, Pregabalin, duloxetine and gabapentin

78
Q

Unilateral sensorineural hearing loss- Investigation

A

MRI - rule out vestibular schwannoma

79
Q

Pituitary tumour in Optic chiasm causes

A

Bitemporal hemianopia

80
Q

What is Cataplexy

A

Loss of skeletal muscle tone with strong (usually) positive emotions

81
Q

Double vision, ptosis, dysphagia and slurring speech with day progressing

82
Q

common origin of brain Metastasis

A

Breast, lung, kidney, thyroid, stomach, prostate and skin

83
Q

Most common primary brain tumour

A

Glioblastoma

84
Q

Hearing loss, vertigo, tinnitus and absent corneal reflex, Associated to neurofibromatosis type 2

A

Acoustic neuroma

causes facial numbness, weakness, absent corneal reflex and facial palsy

85
Q

Diagnosis of Acoustic neuroma

A

Gadolinium enhanced MRI

86
Q

Rinne’s Test

A

air conduction > bone conduction is normal

Bone conduction > Air conduction - Conductive hearing loss

87
Q

Webers test

A

Normal = Both ears

Louder in the normal ear and not louder in the ear with the sensorineural loss

88
Q

Stroke and facial palsy -

A

Will cause drooping of the face and not the forehead - Contralateral

89
Q

Bell’s palsy causes what type of facial palsy

A

Forehead + Lower face - ipsilateral

90
Q

management of Bell’s palsy

A

prednisolone + antivirals
eHeaye care

no improvement in 3 weeks: refer to ENT

91
Q

headache, nausea, vomiting, papilledema, increased CSF pressure, WCC and signs of infection (sinus or mastoid)

A

Brain abscess

92
Q

Ring enhancing lesion on CT and signs of infections

A

Brain abscess

93
Q

Management of community acquired Brain abscess

A

3rd generation cephalosporin + Metronidazole

94
Q

what can not be seen on CT in a brain metastasis

A

micrometastasis

95
Q

Unilateral headache of extreme intensity, redness, lid swelling, nasal stiffness, miosis and ptosis, injection of the eyes

A

Cluster headache

96
Q

Acute management of cluster headache

A

Triptan and high flow oxygen therapy

can be aborted using prednisolone

97
Q

Prophylaxis of cluster headache

A

Verapamil or lithium

98
Q

Mixed syndrome affecting the motor, sensory, and autonomic nerves

A

Diabetic neuropathy

99
Q

Management of diabetic neuropathy

A

1st line Amitriptyline, duloxetine, pregabalin, gabapentin

Tramadol for rescue

100
Q

Abrupt onset, short, glazed eyes, and blank stare, normal brain scan, clonus; EEG 3Hz spike and wave

A

Absence seizure or petit mal

101
Q

Sudden jerk of limb, face and trunk

A

Myoclonic seizure

102
Q

Sudden loss of muscle tone and causing fall, No LOC, Seizure type

A

Atonic seizure

103
Q

Clusters of head nodding and arm jerking, EEG shows hypsarrhythmia

A

West syndrome also called infantile spasms

104
Q

Automatisms include

A

lip smacking, chewing

105
Q

Automatism, deja vu, jamias Vu, delusional behaviour, emotional disturbance and taste and smell; ANS, automatic speech

A

Temporal lobe epilepsy

106
Q

Jacksonian march, and todds palsy

A

Frontal lobe epilepsy

107
Q

Visual phenomena such as spots, lines and flashes causing epilepsy

A

Occipital lobe epilepsy

108
Q

somatosensory symptoms such as tingling, pain, numbness, pricking, vertigo, distortion of space

A

Parietal lobe epilepsy

109
Q

Treatment of choice for absence seizures

A

Ethosuximide

110
Q

Steven johnson syndrome is a side effect of this AED

A

Lamotrigine

111
Q

cerebellar syndrome, hirtuism, ataxia, nystagmus, dysarthria, gingival hypertrophy are SE of this AED

112
Q

Manage status epilepticus

A

Lorazepam (2 times)
Phenytoin
Anaesthesia with propofol or thiopental

113
Q

treating partial seizures

A

Lamotrigine or carbamazepine

114
Q

Common cause of encephalitis in immunucompetent

A

HSV, Tb and VZV

Immunocompromised VZV >HSV

115
Q

Personality change, meningeal signs, confusion, low GCS, seizures

A

Encephalitis

116
Q

CT changes in Encephalitis

A

Medial temporal and inferior frontal changes - petechial hemorrhage

117
Q

Management of Encephalitis

118
Q

Fine tremor, worse when arms outstretched, symmetrical, prominent on voluntary movement, worse when tired, absent during sleep and improves with alcohol

A

Benign essential tremor

119
Q

Management of benign essential tremor

A

Propranolol and primidone

120
Q

Where does extradural hematoma take place

A

Between the two layers of dura called periosteal and meningeal layer, causing trauma to middle meningeal artery/Vein.

121
Q

Lucid interval is associated with

A

Extradural hematoma

122
Q

Cn3 palsy, coma, after a head injury

A

extradural hematoma

123
Q

CT finding of a Extradural hematoma

A

Lens shaped; does not cross fissures but crosses falx cerebrii

124
Q

management of extradural hematoma

A

Craniotoma and evacuation of the clot

125
Q

Bridging veins bleeding causes

A

Subdural hematoma

126
Q

Subdural hematoma location

A

between arachnoid and dura

127
Q

Crescent shaped not limited by suture lines; causing mass effect, hyperdense on CT

A

Acute subdural hematoma

128
Q

Management of acute and chronic subdural hematoma

A

Acute: Decompressive surgery (raised ICP!)
Chronic: conservative or burr hole decompression

129
Q

Rupture of saccular aneurysms, and AV malformations lead to what type of bleed

A

Sub-arachnoid hemorrhage

130
Q

Berry aneurysms occur at

A 
Post communicating and Internal corotid junction 
OR 
Anterior communicating and ACA 
or 
Bifurcation of MCA
131
Q

Adult polycystic kidneys, coarctation of aorta and Ehler-danlos are associated with this cranial bleed

A

SAH

Management surgical: Clipping

132
Q

first line imaging in SAH

A

CT scan - hyperdense basal cisterns, sulci and ventricular system

133
Q

Confirmation of diagnosis in SAH

A

Lumbar puncture at 12 hours - Xanthochromia

134
Q

what is used to decrease the cerebral vasospasms in SAH

A

Nimodipine

135
Q

Headache, fever, photophobia, neck stiffness, CN palsy

A

Meningitis

136
Q

CSF for bacterial meningitis

A 
CSF pressure: raised 
Turbid
WBC: neutrophilia/ PMN  
Raised protein 
Low glucose
137
Q

TB meningitis CSF

A

raised CSF pressure , neutrophilia early and later lymphocytes/ Mononucle
Protein raised and low glucose

138
Q

Viral meningitis CSF

A

Normal or raised CSF pressure
Raised lymphocytes, mononucleosis
Raised protein - Mild
Normal Glucose

139
Q

Define Kernig’s Sign

A

Neck stiff when leg is straightened with hip at 90

140
Q

Define Brudzinski’s sign

A

Lifting head leads to lifting of legs

141
Q

Management of Meningitis

A

community Benzyl penicillin
<50: Ceftriaxone
>50: ceftriaxone + ampicillin
Viral: Aciclovir

142
Q

CI to lumbar puncture in meningitis

A

Thrombocytopenia, unstable - Cardio + resp, coagulation disorder, infection at LP site and neurology such as focal signs

143
Q

what type of meningitis A, C, B causes most cases

A

B as there is no vaccine

144
Q

PNS disease - demyelinating, AI, both motor and sensory; can cause autonomic problems, follows a diarrheal infection; affects lower limbs and ascends upwards over hours to days

A

Guillian Barre Syndrome

145
Q

What is Miller-fisher (GBS syndrome)

A

Opthamoplegia, ataxia and areflexia + GBS signs

146
Q

Common pathogens associated with GBS

A

C. Jejuni; CMV and vaccines - rabies

147
Q

Initial diagnosis of GBS

A

Lumbar puncture: elevated protein and increased albumin

148
Q

Gold standard for GBS

A

EMG and nerve conduction study - slow conduction velocity

149
Q

Management of GBS

A

IV plasmapharesis and immunoglobulines

150
Q

Unilateral headache throbbing in nature, photophobia and phonophobia, headache, prodrome, aura

151
Q

Acute management of migraine

A

Paracetamol + metoclopramide or domperidone
NSAIDs
Triptans for severe

152
Q

Prophylaxis of migraine

A

Topiramate or propanolol

153
Q

Increased tone, reflexed and extensor plantar response

154
Q

Wasting, fasciculations, reduced tone, reduced reflexes, and flexor plantar reflex

155
Q

LMN in arms and UMN in legs

156
Q

UMN signs only - type of MND

A

Primary lateral sclerosis

157
Q

LMN signs only (worst prognosis)

A

Progressive bulbar palsy- palsy of tongue, jaw, swallowing

158
Q

EMG of MND

A

reduced APs and increased amplitude

159
Q

Improves survival in MND

A

Riluzole NMDA inhibitor

160
Q

Multiple plaques of demyelination disseminated in time and space

A

Multiple Sclerosis

161
Q

Commonest type of MS

A

Relapsing and remitting

162
Q

Dawson’s fingers are associated with

A

MS - paraventricular veings in brain stem, SC and optic nerves

163
Q

First symptom in MS

A

optic neuritis
other signs: opthalmoplegia, urinary incontinence, sensory; Lhermitte’s Sign: shock-like sensation with neck flexion
Uthoff’s phenomenon: Worsening of symptoms with rise in temperature

164
Q

MS affects what cells

A

Oligodendrocytes

165
Q

Diagnosis of MS

A

MRI T2 or GD-enhancing

LP: IgG oligoclonal bands

166
Q

Clinical criteria in MS

A

McDonald criteria

167
Q

Management of MS

A 
Acute relapse: High dose IV methylprednisolone 
DMARDs reduces the relapses 
Immunosuppressants 
fatigue: amantadine 
Spasticity- gabapentin or baclofen 
Gabapentin for visual field oscillation
168
Q

DMD inheritance

A

X linked recessive

169
Q

Gowers sign

A

pathpneumonic for muscular dystrophy, where arms are needed to get up from ground

170
Q

Diagnosis of muscular dystrophy

A

Genetic testing, Raused creatinine kinase, increased Aldolase, LFTs may be increased

171
Q

Cause of death in DMD

A

Respiratory failure

172
Q

post-synaptic disease of NMJ and pre-synaptic disease

A

Post-synaptic - MG

Pre-synaptic- Lambert-Eaton syndrome, tick paralysis and botulism

173
Q

Extra-ocular symptoms, bulbar symptoms, face, neck and limb symptoms - weakness, normal reflexes and increased fatigue

174
Q

Diagnosis of MG

A

EMG - decreased response, reduced FVC, thymus CT and TFTs

Anti-AChR abs

175
Q

Treatment of MG

A

Pyridostigmine, steroids, IV and plasmapharesis in crisis

176
Q

Antibodies to presynaptic VG calcium channels at NMH, manifestation of Small cell lung cancer, improves with acitivity, absent reflexes

A

Lambert-eaton

can use aminopyridine

177
Q

Treating optic neuritis

A

High dose steroids

178
Q

Cardinal symptoms of PD

A

Bradykinesia + resting tremor + rigidity + postural instability

179
Q

SE of L-dopa

A 
DOPAMINE 
D: dyskinesia 
On-off phenomena 
Psychosis
low ABP 
Mouth dryness
Insomnia
N/V 
EDS - day time sleep
180
Q

young and fit PD treatment

A

DA agonist + MOA- inhibitor and L dopa

181
Q

Frail and old PD treatment

A

L Dopa and MOA inhibitor

182
Q

Autonomic dysfunction such as hypotension and bladder problems, cerebellar signs and rigidity in PD like patient

A

Multiple system atrophy also called shy drager

183
Q

postural instability - falls, speech + dementia and palsy including vertical gaze in PD like patient

A

Supranuclear palsy

184
Q

Aphasia, dysarthria, apraxia, rigidity in one limb in PD like patient

A

Corticobasilar degeneration

185
Q

Visual hallunication + Dementia in PD

A

Lewy body dementia

186
Q

Radicular pain in the dermatomal distribution and LMN weakness at lesion level
Progressive UMN weakness and sensory loss below the lesion
painless bladder retention

A

Cord compression

187
Q

Mixed UMN/LMN signs, early constipation and retention, back pain, sacral area and ED

A

Conud medullaris

188
Q

Saddle anesthesia, back pain, radicular pain down the legs, bilateral flaccid, areflexic lower limb weakness, poor anal tone and incontinence, retention of feces and urine

A

Cauda equina syndrome

189
Q

Gold standard for Cauda equina investigation

190
Q

Management of cauda equina

A

steroids, decompression

191
Q

Wet, instability/wobbly and whacky/ demented

A

Normal pressure hydrocephalus

Year 3 (11 decks)

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