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Exams :) > Neurology > Flashcards

Neurology Flashcards

1
Q

Parkinsonian tremor speed
Essential tremor speed

A

-Slow - 4-6Hz
-faster - 6-12 Hz

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2
Q

Parkinson’s motor symptoms (5)

A

-Bradykinesia (esp. limbs)
-Mask-liked facies
-Hypophonia
-Micrographia
-Shuffling gait

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3
Q

Parkinsons non-motor sympotms (9)

A

-REM sleep behaviour disorder (dream enactment, vocalisation)
-Constipation
-Mood disorders
-Dementia (40%)
-Restless legs
-Sexual dysfunction
-Daytime fatigue/somnolence
-Dysphagia
-Autonomic features - postural hypotension

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4
Q

Parkinsons disease 1st line management

(?what to be wary about with dopamine agonists)

A
  1. Levodopa(+ carbidopa/benserazide) 300-600mg day in 3-5 doses
  2. MAO-B inhibitors also 1st line for mild symptoms - e.g rasagiline 1mg daily

Dopamine agonists - pramipexole/rotigotine patch - C/I if impulse control disorder e.g gambling/alcohol/hyperseual behaviour)

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5
Q

Migraine non-pharmacological Rx (4)

A

-Cold pack over forehead/back of skull
-Hot pack over neck/shoulders
-Neck stretches & self-mobilisation
-Rest in a quiet dark room

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6
Q

Migraine acute pharm Rx (non-opioid)
(3)

A

1) Aspirin 900mg, rpt dose 4-6 hours
OR ibuprofen 400-600mg

Add metoclopramide 10mg if nauseous

2) Triptans
e.g Sumatriptan 50-100mg oral, rpt dose 2 hours (max does 300mg)
OR naratriptan 2.5mg oral

[Triptans contraindicated in CVS disease]

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7
Q

Carotid artery stenosis clinical features

A

Acute neurological ischaemia (sensory/motor impairment, dysphasia)
Amaurosis fugax (monocular vision loss)

Distribution of symptoms - usually anterior circulation (MCA/ACA) or retinal artery, not usually post. circulation (e.g vertigo/cerebellar signs)

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8
Q

Carotid artery 1st line Ix

A

USS
(CT Angio 2nd line - for surigcal planning)

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9
Q

Carotid artery stenosis Rx

A

Symptomatic - CEA

Asymptomatic - antiplatelet + statin
Refer vasc non-urgent if >80% stenosis
Annual monitoring w/ carotid USS

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10
Q

Pharmacological Rx of Alzheimer’s disease - 2 medication (types)
Contraindications for each

A

Acetylcholinesteriase inhibitors (Donepezil, rivastigmine, galantamine)
-C/I in GI obstruction, active peptic ulcer. Precaution in seizures, heart block/arrhythmia, asthma/COPD
Memantine (NMDA receptor antagonist)
-C/I - seizures

ACEi first –> change to memantine if advanced

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11
Q

Antipsyhotic medication choices for BPSD (2)
Other medicaiton choice

as per eTG

A
  1. Risperidone
  2. Olanzapine

SSRIs (?citalopram)

Increased risk stroke/death/cognitive decline

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11
Q

Antipsyhotic medication choices for BPSD (2)
Other medicaiton choice

as per eTG

A
  1. Risperidone
  2. Olanzapine

SSRIs (?citalopram)

Increased risk stroke/death/cognitive decline

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12
Q

Idiopathic Intracranial Hypertension hx. questions

A

○ Is headache worse on getting up or w/ postural change?
○ Associated tinnitus? (?pulsatile)
○ Associated nausea/vomiting?
○ Is there blurring of vision?
○ Is there horizontal diplopia?

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13
Q

Idiopathic Intracranial Hypertension Rx features (5)

A

○ Reduce CSF pressure
○ Acetazolamide
○ Weight loss
○ Ceasing OCP
- Regular opthal r/v

Sight-threatening condition!

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14
Q

Brain-tumour headache clin. features

A

○ Starts early morning before pt gets up
○ Disappears soon after getting up
○ Focal neuro sx
– Hemiparesis, speech/cognitive deficits, visual disturbances, ataxia, seizures

not fit for unconditional licence!

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15
Q

Multiple Sclerosis risk factors

A

-FHx

15
Q

Multiple Sclerosis risk factors (5)

A

-FHx
-EBV infection
-Low Vit D/sun exposure
-Obesity
-Smoking

16
Q

Causes of facial weakness (6 broad categories)

A

Neurological - stroke, GBS, Multiple sclerosis
Idiopathic - Bell’s palsy
Ear - acute/chronic OM, cholesteatoma, scwannoma
Infection - Herpes zoster, mumps, rubella, EBV
Malignancy - cerebral tumour, cutaneous facial cancer, parotid tumour, lymphoma
Trauma - Temporal bone #, facial nerve damage from surgery

17
Q

Diagnosis?

Asymmetrical onset
Progressive motor weakness
No sensory symptoms
Presence of both UMN and LMN lesions in same region (e.g brisk reflex in wasted area)
Fsaciculations

A

Motor Neurone Disease

ALS most common subtype, both UMN and LMN signs
Dx usually clinical (neurologist), MRI B - degeneration or normal
Rx - no cure, early resp support, advanced care planning

18
Q

UMN signs (5)
LMN signs (4)

A

UMN
-slowed movement/stiffness
-Clonus
-Spasms
-Spasticity
-Hyperreflexia

LMN
-Weakness
-Wasting
-Fasciculations
-Hyporeflexia

19
Q

Seizures DDx (10)

A

○ Cardiac syncope 2ndary to arrythmias, AS, cardiomyopathy
○ Non-cardiac syncope (e.g vasovagal syncope, postural hypotension)
○ Migraine
○ Narcolepsy-cataplexy
○ Tremors/tics
○ Pseudoseizures
○ Hypoglycaemia/hypoxia
○ Head injury
○ CNS infections - meningitis/encephalitis
-Stroke

20
Q

First seizure - referral urgency?
Driving advice?
Avoidance advice?

A
  • Any patient with first seizure –> semi urgent neurology referral 4-6 weeks
    -Not to drive until adequately assessed - must see neurologist
    -Avoid operating heavy machinery, swimming alone, heights, contact sports/recreation, drugs
21
Q

Diabetic foot peripheral neuropathy examination (4)

A

Pinrick sensation
10g monofilament sensation plantar aspect of 1st toes/MT joints
Vibration sensation 128Hz tuning fork at dorsum, great toe
Ankle reflexes

22
Q

Dementia medication options (3)

A

-Oral donepezil
-Oral galantmine
-Rivastigmine (patch > oral)

23
Q

Dementia Ix (8)

A

-FBE
-UEC
-LFT
-BSL
-TFTs
-VIT B12
-?Syphilis/HIV
-?CTB

24
Q

progressive upper limb weakness DDx (10)

A

-Multiple sclerosis
-Peripheral neuropathy
-Myasthenia gravis
-Motor Neurone disease
-Cervical radiculaopthy
-Space occupying lesion
-PMR/polymyosistis/dermatomyositis
-Hyperthyroidism
-B12 deficiency
-Coeliac disease

25
Q

?Diagnosis

-Asymmetrical, focal onset
-Staedily progressive limb weakness
-No sensory involvement/pain
-Mix of UMN and LMN lesions in same area
-Widespread fasciculations
-“split hand sign” (thenar wasting >hyothenar)

A

Motor neurone disease

Exams :) (20 decks)

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