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PA- FCM > Neurology > Flashcards

Neurology Flashcards

1
Q

What is Alzheimer’s disease

A

it is the most common cause of dementia in the uk
has a slowly progressive memory loss and other cognitive decline

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2
Q

Some signs and symptoms of Alzheimer’s

A

progressive memory loss
inattention
sundowning - symptoms worse at night
language difficulties
inability to solve problems of daily life through abstract reasoning

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3
Q

how is Alzheimer’s diagnosed

A

clinically diagnosed by history and ruling out other potential causes
its also important to look at other reversible causes of the dementia

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4
Q

what types of medication should be avoided in Alzheimer’s disease

A

Sedatives

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5
Q

what medication is used to manage Alzheimer

A

acetylcholinesterase inhibitor

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6
Q

what are some non pharmacological treatment options for Alzheimer’s

A

caregiver education and support
maximizing treatment for other health problems
memory clinic
physical and occupational therapy

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7
Q

What is ALS

A

is a progressive neurodegenerative disease that attacks both the upper and lower motor neurons resulting in muscle weakness and atrophy

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8
Q

Who are at risk from suffering from blow-induced dementia

A

football players -heading the ball
boxers
domestic violence survivors with repeated head trauma

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9
Q

what is one key difference in how stroke and bells palsy present

A

stroke only affects eyebrows down but in bells palsy it will affect forehead aswell

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10
Q

Risk factor for bells palsy

A

diabetes and pregnancy

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11
Q

SS for bells palsy

A

facial muscle weakness over days -weeks
decreased taste or lacrimation, hyperacusis
facial tingling or pain near ear

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12
Q

treatment for bell’s palsy

A

steroids + acyclovir if pt presents early
symptom control- eye patch and pain control

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13
Q

2 causative pathogen for bacterial meningitis

A

S.pneumoniae and N.menigitidis

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14
Q

SS for bacterial meningitis

A

rapidly developing fever
stiff neck
headache
altered mental status
Seizures
Photophobia
Non blanching rash - late sign

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15
Q

Ix for bacterial meningitis

A

Lumbar puncture
FBC
Blood culture

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16
Q

Finding of ix in bacterial meningitis

A

Low glucose, high protein
WBC>5 mm3

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17
Q

Management for bacterial meningitis

A

get blood cultures and start IV antibiotics immediately - usually ceftriaxone
add ampicillin in patients older than 65
steroids - IV dexamethasone

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18
Q

What type of headache is cluster headache

A

primary headache

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19
Q

what group of headaches do cluster headache fall into

A

trigeminal autonomic cephalalgias

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20
Q

RF for cluster headaches

A

common in males
common in 30s to 40s
genetics

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21
Q

name some triggers for cluster headache

A

alcohol
smoking
histamine
nitrate- containing food
smell of volatile substance like petrol, paint nail varnish

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22
Q

Diagnostic criteria for cluster headache

A

at least 5 attacks of severe or very severe unilateral orbital, supraorbital and/ or temporal pain lasting 15 minutes to 3 hours and either or both of the following:
- one of: conjunctival injection, rhinorrhoea, eyelid swelling, forehead/ facial sweating , fullness in ear
- sense of restlessness or agitation

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23
Q

Ix for cluster headache

A

if first time and presenting with signs of Horner’s syndrome then do angiogram

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24
Q

Management for acute cluster headache

A

Oxygen
subcut sumatriptan

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25
Q

Preventative management for cluster headaches

A

verapamil - after ecg
greater occipital nerve block
prednisolone
Topiramate or sodium valproate
Lithium but rarely used
GammaCore - non -invasive vagal nerve stimulation

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26
Q

What is cauda equina syndrome

A

radiculopathy in which the cauda equina is compressed
surgical emergency

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27
Q

SS of cauda equina syndrome

A

saddle anaesthesia
associated with loss of bowel or bladder control
severe back pain
bilateral sciatica

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28
Q

what are some causes of cauda equina

A

Lumbar disc herniation
spinal vertebral fractures
Malignancy
Spinal infection
Iatrogenic

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29
Q

examination finding in cauda equina

A

lower limb neuro exam :
- hypotonia
- weakness
-areflexia
-abnormal sensory changes
Rectal exam:
- recued sensation and anal tone
Abdo: palpable bladder

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30
Q

Ix for cauda equina

A

MRI spine

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31
Q

Management for cauda equina

A

ABCDE approach, then once stable:
Analgesia
Urinary retention- catheter
surgery to fix any reversible cause of decompression

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32
Q

what is Creutzfeldt- Jakob disease

A

rare, progressive and fatal cause of dementia
it is caused by prions which are mis-shaped proteins

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33
Q

what are the 2 types of Creutzfeldt-Jakob Disease

A

sporadic and variant
Variant CJD is caused by eating meat infected by bovine spongiform encephalopathy through eating infected cattle meat

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34
Q

symptoms of Creutzfeldt-Jakob disease

A

may not have symptoms for a while but once symptoms starts showing then pt will only have few years left

the symptoms are abnormalities in almost every area of the neurologic system

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35
Q

Ix for Creutzfeldt-Jakob disease

A

tissue biopsy
EEG
MRI
Lumbar puncture

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36
Q

Management for Creutzfeldt-Jakob disease

A

none. Symptomatic, supportive and psychological care for patient and family.

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37
Q

what neurotransmitter is known to be involved in delirium

A

acetylcholine

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38
Q

Risk factors for delirium

A

advanced age
serious illness
dehydration
polypharmacy
pre-existing dementia
electrolyte imbalance
sleep deprivation
infection -very common cause

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39
Q

Signs and symptoms of delirium

A

reduced awareness of the environment t
drowsy or lethargic
distractable
new memory impairment
hallucination
delusions

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40
Q

Ix for delirium

A

Look for signs of infection
neuro exam
FBC, U&E, Renal and kidney functions
urinalysis
CXR
ECG
ct/mri

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41
Q

Management for delirium

A

treat the cause

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42
Q

what is diabetic peripheral neuropathy

A

a prevalent complication of diabetes

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43
Q

Ss of diabetic peripheral neuropathy

A

pain, loss of sensation

44
Q

Ix for diabetic neuropathy

A

clinical diagnosis
fasting glucose
HbA1C
nerve conduction studies

45
Q

What is extradural haemorrhage

A

collection of blood between the outer dura mater and the inner surface of the skull

46
Q

which artery tear us commonly associated in an extradural haemorrhage

A

middle meningeal artery

47
Q

presentation of an extradural haemorrhage

A

brief LOC
subsequent deterioration of consciousness and headache

48
Q

Ix and findings for an extradural haemorrhage

A

CT head
“lens” or “balloon” shaped mass over surface of brain
usually has a mass effect with midline shift

49
Q

Management for an extradural haemorrhage

A

evacuation of the blood by a neurosurgeon
if unable to do neurosurgery then may attempt burr holes

50
Q

ss for essential tremor

A

noticeable tremor when arms are outstretched
difficulty in writing, eating, and holding objects and doing fine motor tasks
but do not have bradykinesia, rigidity, balance difficulties or cog impairment

51
Q

non medical, medical and surgical management for essential tremor

A

behavioural techniques and physical therapy
propranolol, primidone, topiramate
deep brain stimulation, focused ultrasound thalamotomy

52
Q

what is epilepsy

A

umbrella term for a condition where there is a tendency to have seizures.
seizures are transient episodes of abnormal electrical activity in the brain

53
Q

ix for epilepsy

A

eeg
mri

54
Q

what is generalised tonic clonic seizures

A

loss of consciousness
tonic (muscle tensing )
clonic (muscle jerking)

may have tongue biting, incontinence, groaning

after the seizure there is a prolonged post-ictal period where the person is confused, drowsy and feels irritable or depressed

55
Q

management for tonic clonic seizures

A

sodium valproate

56
Q

what is focal seizures

A

start in temporal lobes
affect hearing, speech, memory and emotions

57
Q

some ways focal seizures can present

A

hallucination
memory flashbacks
deja vu
doing strange things on autopilot

58
Q

Management for focal seizures

A

carbamazepine or lamotrigine

59
Q

what is absence seizures

A

typically happen in children
becomes blank, stares into space and then abruptly returns to normal
typically last 10-20 seconds

60
Q

Management for absence seizures

A

sodium valproate
ethosuximide

61
Q

what is atonic seizures

A

aka drop attacks
brief lapses in muscle tone
don’t usually last more than 3 minutes

62
Q

Management for atonic seizures

A

sodium valproate

63
Q

what is myoclonic seizures

A

present as sudden brief muscle contractions like sudden “jump”
usually remains awake during the episode

64
Q

Management for myoclonic seizures

A

sodium valproate

65
Q

what is infantile spasm

A

aka west syndrome
starts in infancy around 6 months of age
clusters of full body spasms
poor prognosis

66
Q

Management for infantile spasm

A

prednisolone or vigabatrin

67
Q

what is status epilepticus

A

medical emergency
defined by seizures lasting more than 5 minutes or more than 3 seizures in one hour

68
Q

management of status epilepticus

A

ABCDE approach
IV lorazepam

69
Q

what is encephalitis

A

inflammation of the encephalon

70
Q

ss of encephalitis

A

altered mental status
fever
flu-like prodromal illness
early seizure

71
Q

common virus that cause encephalitis

A

herpes simplex virus type 1

72
Q

IX for encephalitis

A

Routine blood test, blood cultures, viral PCR, CSF
CNS imaging

73
Q

Treatment fir encephalitis

A

iv ceftriaxone and iv acyclovir
other supportive management

74
Q

what does frontotemporal dementia cause

A

causes extreme disinhibition and markedly inappropriate behaviour which quickly alienates family, spouses, co workers and can lead to arrest by police for inappropriate activities

75
Q

key motor findings in foot drop

A

weakness or paralysis of dorsiflexion and eversion

76
Q

what does gullian barre syndrome often present after

A

often presents after a URTI or gastroenteritis

77
Q

what is guillain barre sydnrome

A

demyelination of peripheral nerves

78
Q

what pathogen is commonly associated with Guillain barre syndrome

A

campylobacter jejuni

79
Q

SS of guillain barre syndrome

A

progressive weakness in arms and legs
areflexia
elevated CSF proteins
symmetrical symptoms
progression of symptoms over days to weeks

80
Q

Ix for guillain barre syndrome

A

FBC
LP
EMG/NCV

81
Q

Management for guillian barre syndrome

A

IV immunoglobulin
pain control
physical therapy

82
Q

what are the triad for Huntington’s disease

A

Dominant inheritance
choreoathetosis
dementia

83
Q

Ix for Huntington’s and what it shows

A

MRI and CT scans in moderate to severe disease can show loss of striatal volume and increased size of the frontal horns of the lateral ventricles.

Genetic testing is required to make a diagnosis and genetic counselling in a specialist unit is required.

84
Q

Management for Huntington’s

A

chorea - managed with a number of med e.g tetrabenazine
depression treated with SSRI
psychosis- antipsychotics

85
Q

management for meningitis in GP and second line

A

benzylpenicillin
second line -chloramphenicol

86
Q

glucose and protein levels in viral meningitis

A

glucose - normal
proteins - normal/high

87
Q

some complication of meningitis

A

septic shock
DIC
coma
Seizures
hearing loss
hydrocephalus
death

88
Q

common causative agent in viral meningitis

A

enteroviruses such as echoviruses, coxsackie viruses A&B , polio virus

89
Q

some causes of non-infective meningitis

A

Malignancy
chemical meningitis
DRUGS ( NSAIDS and Trimethoprim)
Sarcoidosis
SLE
Behcet’s disease

90
Q

what is migraine

A

complex neuro condition that cause headaches and other associated symptoms

91
Q

name the 4 types of migraine

A

migraine without aura
migraine with aura
silent migraine
hemiplegic migraine

92
Q

what are the typical headaches symptoms

A

pounding/throbbing
usually unilateral
discomfort with light(photophobia)
discomfort with loud noises
with or without aura
nausea and vomiting

93
Q

how long can migraine headaches last between

A

4 to 72 hours

94
Q

what does aura mean and name some examples of how it presents

A

term used to describe visual changes associated with migraine
sparks in vision
blurring vision
line across vision
loss of of different visual fields

95
Q

what is hemiplegic migraine

A

can mimic stroke

96
Q

symptoms of hemiplegic migraine

A

typical migraine symptoms
sudden or gradual onset
unilateral weakness of the limbs
ataxia
change in consciousness

97
Q

some triggers for migraine

A

stress
bright lights
strong smells
certain foods
dehydration
menstruation
abnormal sleep patterns
trauma

98
Q

5 stages of migraine

A

prodromal
aura
headache
resolution
postdrome

99
Q

acute management for migraines

A

paracetamol
triptans
NSAIDS
Antiemetics

100
Q

Medication used for migraine

A

Tripatans

101
Q

Migraine prophylaxis

A

headache diary
avoid triggers
propranolol
topiramate
amitriptyline

102
Q

injectable preventative for migraine

A

greater occipital nerve blocks for HFEM or CM
Botulinum toxin therapy for chronic migraine

103
Q

Buzzword for multiple sclerosis

A

separated in time and space

104
Q

what is the leading cause of multiple sclerosis

A

EBV

105
Q

pathophysiology of multiple sclerosis

A

autoimmune destruction of the CNS myelin sheath causing demyelination in the CNS white

106
Q

RF for multiple sclerosis

A

smoking
ebv
low vit D
Genetics

PA- FCM (10 decks)

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