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FRCEM SBA > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the frequency of triptans/opiods/ergots that is needed to diagnose medication overuse headache?

A

> 10 days a month

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2
Q

What is the frequency of paracetamol/aspirin/NSAIDs that is needed to diagnose medication overuse headache?

A

> 15 days a month

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3
Q

Describe the features of a cluster headache? (7)

A
  1. Unilateral around eye
  2. Constricted pupils
  3. Red/watery eye
  4. Swollen/drooping eyelid
  5. Forehead/facial swelling
  6. Restless/agitated
  7. Lasts 15-180mins
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4
Q

What is the cut off for episodic/chronic migraine/tension headache in terms of number per month?

A

< 15 = episodic
> 15 = chronic

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5
Q

What is c/i in migraine?

A

OCP

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6
Q

What are the first line treatments for migraine according to NICE? (4)

A
  1. Triptan (consider nasal if 12-17)
  2. Paracetamol/ibuprofen
  3. IV metoclopramide
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7
Q

What 3 agents can be used in prophx migraines and which one should be avoiding in women of child bearing age?

A
  1. Topiromate (affects contraception and can lead to fetal malformation)
  2. Amitryptylline
  3. Propanolol

TAP

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8
Q

What is the tx for a cluster headache? (2)

A
  1. High flow o2
  2. SC or nasal triptan
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9
Q

What is used for prophx of cluster headaches?

A

Verapamil

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10
Q

What a cardinal feature of trigeminal neurolagia?

A

Touching area increases pain

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11
Q

What is used in the tx of trigeminal neuralgia? (1)

A

Carbamazepine

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12
Q

What are 2 risk factors for cerebral venous thromobisis? (2)

A

1 Pregnancy/PP
2. Sinusitis

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13
Q

How do we treat cerebral venous thrombosis?

A

Heparinisation

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14
Q

Give 4 features of idiopathic IC HTN?

A
  1. Headache worse on coughing/sneezing
  2. CN palsies
  3. Papiloedema
  4. Can lead to blindness
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15
Q

Who is more likely to suffer from idiopathic IC HTN?

A

Women with large BMI

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16
Q

How is idiopathic IC HTN diagnosed?

A

Increased opening pressure (>20cm) on LP and normal CTH

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17
Q

In young adults what are the 2 most common types of meningitis?

A
  1. Viral
  2. Second peak of meningococcal disease in 20s
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18
Q

What are 2 common organisms leading to meningitis in older adults?

A
  1. Pneumococcal (>50s)
  2. Listeria (>60s)
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19
Q

Skull #s are a risk factor for contracting what type of organism causing meningitis?

A

Pneumococcal

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20
Q

What 3 organisms are increased risk of causing meningitis in patients with HIV?

A
  1. Cryptococcal if CD4 <200
  2. Pneumococcal
  3. TB
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21
Q

What is the expected findings in LP with bacterial meningitis? (5)
(opening pressure/appearance/cell type/protein/glucose)

A
  1. Increased opening pressure
  2. Turbid appearance
  3. Neutrophils
  4. Protein
  5. V low glucose?
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22
Q

What is the expected findings in LP with viral meningitis? (5)
(opening pressure/appearance/cell type/protein/glucose)

A
  1. Normal or mildly increased opening pressure (normal 12-25cm)
  2. Clear appearance
  3. Lymphocytes
  4. Mild increase in protein
  5. Normal of mildly decreased glucose
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23
Q

What is the expected findings in LP with TB meningitis? (5)
(opening pressure/appearance/cell type/protein/glucose)

A
  1. Increased opening pressure (>25cm H20)
  2. Clear/cloudy appearance
  3. Lymphocytes
  4. Very increased protein
  5. Very low glucose
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24
Q

What is the expected findings in LP with fungal meningitis? (5)
(opening pressure/appearance/cell type/protein/glucose)

A
  1. Increased opening pressure
  2. Clear or cloudy
  3. Lymphocytes
  4. Increased protein
  5. Low glucose
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25
Q

What does NICE say is the maximum an LP should delay giving abx?

A

1 hour

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26
Q

What 3 contraindications are there to doing an LP without CTH?

A
  1. Signs increased ICP
  2. Severe sepsis
  3. Rapidly evolving rash
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27
Q

What additional investigations to identify the organism should be performed in a patient being investigated to meningitis aside from LP? (3)

A
  1. Meningococcal/pneumococcal PCR
  2. Meningococcal throat swab
  3. BC
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28
Q

What two treatments are first line for suspected meningitis according to NICE?

A
  1. 10mg IV dexamethasone
  2. 3rd generation cephalosporin
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29
Q

What does NICE recommend for initial abx treatment of meningitis in penicillin/cephalosporin anaphx?

A

25mg/kg chloramphenicol IV

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30
Q

What antibiotic should be given in adults > 60 years or immunocompromised in suspected meningitis?

A

2g Amoxicillin IV
(co-trimoxazole if pen anaphx)

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31
Q

What antibiotic should be given as prophx for close contacts of patients with suspected meningococcal meningitis?

A

PO ciprofloxacin

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32
Q

In children with a petechial rash what 4 things should trigger IV abx?

A
  1. Petechiae start to spread
  2. Rash becomes purpuric
    3 Signs of bacterial meningitis
  3. Signs sepsis
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33
Q

If there are no increased risk factors in invx of petechial rash what is the next invx?

A

Bloods - if raised inflam markers give IV abx

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34
Q

Why don’t we use cefriaxone in neonates?

A

Can lead to increased bilirubin

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35
Q

What is first line treatment for suspected meningitis in under 3 month olds?

A

IV cefotaxime
+
IV amoxicillin/ampocillin

36
Q

What is the treatment for suspected meningitis in children > 3months?

A

IV ceftriaxone

37
Q

If children being managed for suspected meningitis have had recent travel or prolonged abx use in the last 3 months which abx should be added to ceftriaxone?

A

IV vancomycin

38
Q

Which abx in particular is effective against Group B strep meningitis?

A

Cefotaxime

39
Q

Which IV antibiotics are used to treated listeria meningitis?

A

IV amoxicillin or ampicillin

40
Q

When should steroids be used in children with suspected meningitis (1) and when should it not be given (2)?

A
  1. Bacterial meningitis
  2. < 3 months old and meningococcal meningitis
41
Q

Which inotropes are recommended in children with meningitis? (2)

A

Dopamine
Dobutamine

42
Q

What dose of IV glucose should be given in children with low glucose and meningitis?

A

2ml/kg 10% boluse

43
Q

List 4 drugs that should be avoided in Parkinsons disease?

A
  1. Metoclopramide
  2. Stemetil
    3 Haloperidol
  3. Chlorpromazine
44
Q

If PD patients can’t take their medication orally what should be first and then second line?

A
  1. NG/NJ/PEG
  2. Rotigotine patch
45
Q

If PD medications are missed what is the most significant complication?

A

Neuroleptic malignancy syndrome

46
Q

How quickly does NICE recommend a patient with a first fit should be seen by?

A

< 2 weeks

This is the same amount if patient has had a seizure following a period of relapse

47
Q

What makes a complicated febrile convulsion? (3)

A
  1. > 10 mins
  2. Weakness
  3. Focal
48
Q

What does NICE recommend for invx of epilepsy re: EEG (4)

A
  1. Photon/hyperventilations EEG
  2. If fails - sleep deprivation EEG
  3. If fails ambulatory EEG

Does not rule out epilepsy

49
Q

How quickly does NICE recommend patients have an MRI following their first seizure?

A

6 weeks

50
Q

What is first line maintenance anti-epileptic according to NICE in patients who are not able to have children?

A

Sodium valporate

51
Q

What is first line maintenance treatment for epilepsy in patients able to have children?

A

Keppra or lamotrigine

52
Q

What is first line for prevention of focal seizures? (2)

A

Keppra or lamotrigine

53
Q

What is first line prophx for absence seizures?

A

Ethosuximide

54
Q

When does NICE suggest to give bolus of patients regular anti-epileptic in the status algorithim?

A

If there is suspicion of poor adherence

55
Q

What are the doses of the recommended first line anti-epileptics in status? (3)

A
  1. Phenytoin 20mg/kg
  2. Valporate 30mg/kg
  3. Keppra 40mg/kg
56
Q

What are the two treatment options 3rd line for status according to NICE? (2)

A

Phenobarbital
I+V

57
Q

What does NICE recommend with regards to ABCD2 and using to decide management of TIA?

A

Do not use it

58
Q

Does NICE recommend routine use of CTH in TIA?

A

No, MRI should be considered in TIA clinic

59
Q

What is the management of TIA according to NICE?

A
  1. 300mg aspirin ASAP
  2. Consider secondary prevention
60
Q

When should a suspected TIA be seen in clinic?

A

< 24 hours

61
Q

What is the current thrombolysis window according to NICE?

A

< 4.5 hours

62
Q

When does NICE recommend thrombectomy < 6 hours of symptoms?

A

Proximal anterior circulation occlusion on CTA/MRA

63
Q

In circumstance does NICE recommend thrombectomy only <24 hours?

A
  1. CT perfusion/ diffusion weighted MRI shows potential tissue salvage and no thrombolysis given
64
Q

What does NICE recommend with basilar/posterior cerebral artery stroke with potential salvage on imagine < 24hours?

A

Thombectomy
+
Thrombolysis

65
Q

What does NICE recommend with regards to anticoagulation post stroke with new AF?

A

300mg aspirin daily for 2 weeks followed by anticoagulation

66
Q

What does NICE recommend if symptoms of PE/DVT and stroke?

A

Anticoagulate over asprin

67
Q

What does NICE recommend in BP control and haemorrhagic stroke? (2)

A
  1. Consider rapid control if < 6 hours and SBP 150-220
  2. Aim for SBP <140 but do not drop by >60mmHg in first hour
68
Q

What does NICE recommend to aim for BP if thrombolysing a stroke?

A

<185/110

69
Q

When does NICE support decompressive hemicraniectomy in ischaemic stroke? (3)

A
  1. MCA infarct (at least 50%)
  2. Reduced GCS
  3. NIHSS score >15
70
Q

What are the 3 P’s NICE says supports a diagnosis of vasovagal?

A

Postural
Provoking factors
Prodrome

71
Q

Who does NICE recommend have cardiology review within 24 hours with regards to TLOC? (6) and who should we consider if in (1)

A
  1. ECG abnormality
  2. FHx SCD
  3. During exertion
  4. Heart failure o/e
  5. Unexplained SOB
  6. New murmur

> 65 and no prodrome

72
Q

What is the recommended investigation for ? cardiac syncope?

A

Ambulatory ECG

73
Q

What is the first line investigation for recurrent vasovagal syncope?

A

Tilt test

74
Q

What is the first line test for exercise induced syncope and when is it c/i?

A

Exercise testing within 7 days but not if suspected AS or HOCM

75
Q

Following a first seizure how long must a category 1 and 2 license holder stopping driving for?

A

Cat 1 - 6 months
Cat 2 - 5 years

76
Q

Following an epileptic seizure how long must a category 1 and 2 license holder stopping driving for?

A
  1. 12 months
  2. 10 years
77
Q

Following a TIA how long must a category 1 and 2 license holder stopping driving for?

A
  1. 1 month
  2. Notify DVLA - 1 year
78
Q

Following angina how long must a category 1 and 2 license holder stopping driving for?

A
  1. Do not drive with symptoms
  2. Contact DVLA
79
Q

Following an episode of hypoglycaemia how long must a category 1 and 2 license holder stopping driving for?

A
  1. > 2 episodes in a year must tell DVLA
  2. Stop driving, notify DVLA
80
Q

In the context of alcohol misuse how long must a category 1 and 2 license holder stopping driving for?

A
  1. 6 months, control of problem and need normal bloods
    2 1 year and control of problem, normal bloods
81
Q

In context of alcohol dependence how long must a category 1 and 2 license holder stopping driving for?

A
  1. 1 year abstinence
  2. 3 years abstinence
82
Q

What is the advice re: dementia and driving

A

Issue is complex, may still be able to drive

83
Q

What antibiotic should be given to close contacts of patients with diagnosed meningococcal disease?

A

1 dose ciprofloxacin

84
Q

What is the treatment of severe GBS? (2)

A

Either plasma exchange of IV immunoglobulin

85
Q

What largely differentiates severe/non severe GBS?

A

Whether a patient can walk

86
Q

What is the treatment for temporal arteritis 1) with and 2) without visual loss?

A
  1. 40-60mg prednisolone OD
  2. 500mg IV methylprednisolone

FRCEM SBA (12 decks)

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