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MSRA 2023 > Neurology > Flashcards

Neurology Flashcards

1
Q

Wernicke’s Encephalopathy triad

A

ophthalmoplegia: nystagmus/ lta rectus palsy, conjugate gaze palsy

ataxia, encephalopathy

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2
Q

Korsakoff’s syndrome

A

IRREVERSIBLE

ophthalmoplegia, ataxa, encephalopathy, antero/retrograde amnesia, confabulation

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3
Q

Mx Generalised Toni-clonic

A

M: sodium valporate
F: lamotrigine/levetiracetam

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4
Q

Focal seizure 1st line

A

lamotrigine/ levetiracetam

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5
Q

Focal seizure 2nd line

A

cabamazepine/ oxcarbazepine/ zonisamide

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6
Q

abscence seizure 1 st line

A

ethosuxide

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7
Q

abscence seizure 2nd line

A

M: sodium valporate
F: lamotrigine/ levetiracetam

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8
Q

myoclonic seizure Tx

A

M: sodium valporate
F: levetiracetam

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9
Q

Tonic/ Atonic seizures Tx

A

M: sodium valporate
F: lamotrigine

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10
Q

migraine prophylaxis

A

propranolol
topiramate avoid in women of childbearing ge
amitriptyline

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11
Q

Acute mx cluster headache

A

O2 100%
sc triptan

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12
Q

TIA mx

A

300mg aspirin stat unless taking low dose aspirin already

If more than 1 episode tia/ suspected cardio emboli’s or severe stenosis- referral for admission

If 1 tia within 7 days assessment within 24 hours

If tia >7d days refer r/v within 7d

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13
Q

Ix Parkinsons

A

I123-FP-CIT-SPECT=> DatScan

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14
Q

1st line Parkinsons tx

A

Levodopa

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15
Q

Parkinsons mx

A

1st line: Levodopa

2nd line: Levodopa + Dopamine AG/ MAO-Bi/ COMTi

DA-R AG: bromocriptine, ropinirole, cabergoline, apomorphine: younger pt/ mild sx

MAOB-i: selegiline

COMTi: entacapone, tolcapone

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16
Q

SE Dopamine R AG

A

ergot- derived DA-R AG: bromocriptine, cabergoline-> pulmonary/ retroperitoneal/ cardiac fibrosis

elderly pt: increased risk hallucinations

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17
Q

TACI (total anterior circulation infarcts)

A

involves middle and ant cerebral arteries
unilat hemiparesis +/- hemisensory loss face, arm, leg. Homonymous hemianopia, increased cognitive dysfunction

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18
Q

PACI (partial naterior circulation infarcts)

A

2 of the criteria
unilat hemiparesis +/- hemisensoryloss face/ arm/ leg. homonymous hemianopia. increased cognitive dysunfctionction

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19
Q

LACI (lcunar infarcts)

A

involves perforating arteries around internal capsule, thalamus and basal ganglia. 1 of follwing present. Unilateral weekness +/- sensory deficit of face and arm, arm and leg or all three. Pure sensory stroke. Ataxic hemiparesis

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20
Q

Posterior circulation infarcts (POCI)

A

vertebrobasilar arteries. Presens with 1 of following. Cerebellar or brainstem syndromes. Loss of consciousness. Isolated homonymous hemianopia. (Lateral medullary stndrome aka Wallenberg’s syndrome)

21
Q

Ischaemic stroke timing of thrombolysis + Mx
Mx stroke related to AFib when to start DOAC

A

4.5 hr
Aspirin 300mg ASAP
if DOAC- not started until r/o haemorrhage not until 14d passed from onset of ischaemicc stroke

22
Q

When to consider thrombectomy

A

Pre stroke functional status <3, modified rakin scale and score >5 NIHSS

Offer thrombectomy ASAP within 6hrs of onset with iv thrombolysis 4.5hr to pts with acute ischaemia.

Thrombectomy ASAP last known to be well 6-24hrs previously

23
Q

how long to give aspirin or clopidogrel in stroke

A

life long

24
Q

GCS

A

EVM

E: spontaneous, command, pain, nil
V: orientate, confused, words non sense, incomprehensible sound

M: command, localises pain, withdraw from pain, flexion, extension, no motor response

25
Q

Cranial nerve: which Sensory, motor, both

A

Some say marry money but my brother says big brain matters most

26
Q

Central vs peripheral VII nerve palsy

A

Central contralateral droop of lower half of mouth to lesion as other half also innervated by ontralateral side

Peripheral inability to wrinkle forehead and drop of half mouth on ipsilateral side of lesion

27
Q

Hand position when damage to ulnar & radial nerve

A

Radial nerve: wrist drop
Ulnar: claw hand

28
Q

AFib related stroke when to start DoAC

A

14 days passed from ischaemic stroke due to high risk of haemorrhage

29
Q

Timing of thombolysis and thrombectomy

A

Thrombolysis 4.5 hrs
Thrombectomy 6hrs

30
Q

Causes of SAH

A

Traumatic cause

Spontaneous

31
Q

Dx of SAH timing of LP

A

CT head within 6 hours of sx onset: if negative then Lp not needed

If more than 6 hours sx onset & normal: do LP, needs to be perform at least 12 hours following sx onset as checking for xanthochromia. Norma, or high opening pressure

32
Q

Mx of SAH

A

Supportive
Vasospasm: po nifedipine
Intracranial aneurysm: coil

Can develop hyponatraemia: due to SIaDH

33
Q

Acute to of migraine

A

Po triptan and NSAIDS or po triptan and paracetamol

34
Q

Cluster headache mx and prophylactic

A

Acute oxygen 100%
Subcutaneous triptan

Prophylactic:verapamil , tapering dose of prednisone

35
Q

Inheritance of essential tremor and mx

A

AD

Propranolol 1st line
Primidone sometimes used

36
Q

Motor neuron investigation

A

Clinical but nerve conduction can help exclude neuropathy

EMG: decreased number of action potential with increased amplitude

MRI: exclude diff dx of cervical cord compression and myelopathy

37
Q

Motor neuron disease mx

A

riluzol: prevents activation of glutamate receptor n-invasive bipap

38
Q

GBS cause, Ix, is it ascending or descending

A

Peripheral nervous system demyelination, ascending paralysis.

Campylobacter jejuni

LP: increased protein with normal WBC
Nerve conduction decreased motor nerve conduction velocity due to demyelination, prolonged distal motor latency, f wave latency increased

39
Q

Miller fisher syndrome

A

Ophthalmoplegia, areflexia, ataxia: eye muscle affected first.

Variant of GBS
Anti GQ1b Ab

40
Q

Huntington genetics

A

AD triculeitide repeat disorder CaG on chromosome 4

Anticipatory

41
Q

Neuropathic pain mx

A

1St line: amitriptyline, duloxetine, gabapentin, pregabalin

Reduce: tramadol- rescue tx

42
Q

Causes of neuroleptic malignant syndrome

A

Pt taking antipsychotics
Slower onset- hours to days

43
Q

Mx of neuroleptic malignant syndrome

A

Stop antipsychotics
Ivi
Dantrolene decreases excitation contraction skim binding to ryanodine receptor. Decreases release of calcium from sarcoplasmic reticulum

44
Q

Multiple sclerosis classification

A
  1. Relapsing remitting
  2. Secondary progressive
  3. Primary progressive
45
Q

Uhthoff’s phenomenon, most common findings in MS, Lhermitles syndrome, what kind of muscle weakness

A

Uhthoff: worsening vision after increased body temp in Ms
Lhermitles : paraesthesia in limbs on neck flexion

Most common eye signs: optic neuritis
Motor spastic weakness due to demyelination along nerves of brain and spine

46
Q

Dx of Ms

A

Demonstration of lesion disseminated in time and space

MRI: initial test- increased signal T2 lesion, periventricular plaque, Dawson fingers often seen on FLAIR images hyperintense lesion perpendicular to corpus callous.

  1. csf: oligoclonal bands and not in serum , increased intrathecal synthesis of IgG

Visual field: visual evoked potential delayed but well preserved waveform

47
Q

Dystrophies types, inheritance, classic findings

A

XR dystrophin xp21

Duchenne frameshit, severe form- calf pseudohypertrophy, growers sign

Becker insertion less severe form

48
Q

Herpes simplex encephalitis ix

A

CSF: lymphocytosis, increased protein
Pcr for hsv
Ct: medial temporal and inferior frontal changes
MRI

49
Q

Mx of migraine in children and adults and prophylaxis

A

Children: acute mx- ibuprofen more effective than paracetamol. >12 years triptan may be used but follow up needed. Sumatriptan nasal spray is the only proven triptan. Prophylaxis pizotifen + propranolol 1st line. 2nd line- valporate/ topiramate/ amitriptyline

Adult: 1st line- oral triptan + nsaid OR po triptan + paracetamol
If not effective than offer n-oral pre metoclopramide/ prochooperazine with or without n-oral nsaids. Triptan

Prophylaxis- propranolol, topiramate not in female in childbearing age, amitriptyline

MSRA 2023 (22 decks)

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