Neurology Flashcards
TIA - how quickly should they be referred?
If < 7 days ago:
- Aspirin 300mg and review within 24 hours
If > 7 days ago:
- Review within 7 days
3 options for migraine prophylaxis:
Propanolol
Amitriptyline
Topimerate (CI in pregnancy)
What is the only licensed treatment for motor neurone disease in the UK?
Riluzole
Cauda equina syndrome is MOST commonly caused by herniation of an intervertebral disc at which nerve root level?
L4/L5 (60%)
Only 2% of all herniated discs will cause CES
What is the diagnostic criteria for trigeminal neuralgia?
A. At least three attacks of unilateral facial pain
B. Pain in one or more divisions of the trigeminal nerve with no radiation beyond this
C. At least three of the following four characteristics:
- recurring in paroxysmal attacks lasting from a fraction of a second to two minutes
- severe intensity
- electric-shock-like, shooting, stabbing or sharp in quality
- precipitated by innocuous stimuli to the affected side of the face
Extensor plantar responses - upper or lower sign?
UMN
Name three possible features of LMN problems?
Atrophy
Fasiculations
Absent reflexes
Hypotonia
Amitriptyline - name 3 contraindications?
Arrythmia
Heart block
Severe liver disease
Manic phase of bipolar
Name two things that can precipitate neuroleptic malignant syndrome?>
Sudden abrupt withdrawal of antiparkinsonian medication due to compliance issues or malabsorption (e.g. due to gastroenteritis) may precipitate
What are the 4 core symptoms of neuroleptic malignant syndrome?
fever, altered mental state, muscle rigidity and autonomic dysfunction
What is the 1st line antiepileptic for children, young people and adults with generalised tonic clonic seizures?
Sodium valproate
Don’t use in pregnancy, contraception in all girls child bearing age
Medication overuse headache is usually a complication of which other condition?
Migraine
(migraine, tension and then MOH are most common headache causes)
Name 3 ways to distinguish stroke vs. Bells?
What is the most common acute mononeuropathy?
Bells palsy: Whole side, comes on in hours/ days, may also have disturbed taste
Stroke: Forehead spared, comes on in minutes
In children, after how long with no seizures would you consider withdrawal of epilepsy medication?
2 years
(60-70% will remain seizure free if withdrawn after no seizsures at 2 years)
What imaging helps when benign resting tremor cannot be clinically differentiated from a Parkinsonian tremor?
Single photon emission computerised tomography (SPECT)
Parkinsons clinical diagnosis but where need scan use above
1st line treatment for trigeminal neuralgia?
Carbamazepine
What are the CTH rules for fall on apixaban?
All CTH within 8 hours if no other indications
Name 3 classic guillian barre symptoms, which is most specific/ requires urgent referral?
weakness, paraesthesiae, and reduced or absent reflexes
- Absent reflexes are most specific
(Often preceeding viral URTI/ GI infection)
What 3 management options are first line for tension headache?
Aspirin, paracetamol or an a non-steroidal anti-inflammatory (NSAID) - ibuprofen or naproxen
MND survival rates at:
a) 5yrs
b) 10yrs
a) 25%
b) 5-10%
Most die within 2-3 years
MND, 1st and second most common types?
Most common ALS (60%)
2nd most common PBP (Progressive bulbar palsy)
Trigeminal neuralgia, Carbamazapine not tolerated. What is next step in primary care?
Seek specialist advice
Do not start other drugs w/o specialist input
What is the classic triad of parkinsons?
Bradykinesia (slow movements)
Tremor
Rigidity
Bell’s palsy - management and timing of this?
Steroids should be started within 72 hours
50mg for 10/7 or 60mg for 5/7 then reducing 10mg daily over 5/7
No evidence for steroids after 72hrs or aciclovir
How may diabetic amyotrophy present clasically?
Diabetic amyotrophy is a subacute, painful and mainly motor mononeuropathy which commonly involves the femoral nerve producing wasting and weakness of the quadriceps muscle with loss of the knee jerk.
Name three types of spastic cerebral palsy and common features:
Spastic diplegia, most common, stiffness in the legs with difficulty walking
Spastic quadriplegia, stiffness of all limbs, difficult head control , difficult speech, seizures common
Spastic hemiplegia are the most ambulatory
Give 2 examples of DMARDS in MS?
Natalizumab reduces the frequency and severity of relapses by about 68%
B interferon only produces a 30% response
Which drug is first-line for the relief of muscle spasticity in multiple sclerosis (MS)?
Baclofen
What are the characteristic features of infantile spasms?
What age does it develop?
Infantile spasms usually start in first year of life.
Clusters of tonic spasms which occur every 5–10 seconds, usually just after waking up from sleep.
What are the characteristic features of Myoclonic epilepsy?
What age does it develop?
Myoclonic epilepsy is the sudden involuntary spasm of a muscle or a group of muscles. It usually develops between ages of 5 and 16 years.
How should suspected infantile spasms be managed?
Refer within 24hrs
Name 3 non-organic conditions that can cause memory problems?
CFS/ME
fibromyalgia
affective disorder
anxiety
1st line treatment for cluster headache?
oxygen and/or subcutaneous or nasal triptans
Avoid paracetamol/ NSAID/ aspirin
Name three conditions pregabalin is licenced for?
Neuropathic pain,
Generalised anxiety disorder Anticonvulsant
Mechanism of Entacapone?
Entacapone prevents the peripheral breakdown of levodopa, by inhibiting catechol-O-methyltransferase
1st line prophylactic for menstrual migraine (if standard tx not worked)?
Frovatriptan or
zolmitriptan
Selegiline mechanism?
Monoamine oxidase-B (MAO-B) inhibitor.
Less good movement improvement but not as many side effects as levodopa
Women on enzyme inducing drugs - what contraception is recommended?
Mirena IUS/ copper IUD
Depo injection
A patient with motor neurone disease develops significant excessive salivation (sialorrhoea). 1st line mx? When would you not use this?
Antimuscarinic (hyoscine)
If cognitive impairment- glycopyrrolate
NICE recommend which non-pharmacological treatment for chronic tension-type headache?
Consider a course of up to 10 sessions of acupuncture over 5–8 weeks for the prophylactic treatment of chronic tension-type headache
Acute stroke - if shown to be ischemic when start Aspirin, what dose, how long to continue?
Aspirin 300mg
Start within 48hrs
Continue at least 14 days
Name 3 CI to using sumitriptan?
Previous MI
Previous TIA/ stroke
IHD
Uncontrolled HTN
Peripheral vascular disease
What is the first investigation in primary care that should be considered for a possible new diagnosis epilepsy?
ECG
(Note imaging like MRI will be carried out in secondary care - NICE recommend ECG for all first seizure)
According to NICE guidelines, what is the minimum length of time that a headache diary should be kept for?
8 weeks
What level of carotid artery stenosis would indicate endartectomy?
70%
What feature of stroke would be most suggestive of underlying carotid stenosis
Hemiplegia
What duration over which constitues prolonged seizure?
5mins
Name 3 presenting features of Progressive supranuclear palsy?
Gait disturbance leading to falls,
Fatigue
Subtle personality changes
Vertical gaze palsy
A 78-year-old man with Parkinson’s disease takes regular co-careldopa and ropinirole. His wife is concerned about his sexual disinhibition over the past two months. She has also discovered significant debt on his credit card.
Which is the SINGLE MOST likely diagnosis?
Impulse control disorder can develop at any time during the course of any dopaminergic therapy.
Impulse control disorder can develop at any time during the course of any dopaminergic therapy.
Group 2 driving guidelines after TIA?
Don’t drive for 1 year
(1 month for Group 1)
What is the NICE cut off for episodic vs. chronic headaches?
NICE defines episodic headaches (tension, migraine, cluster) as having a frequency of less than 15 per month.
Chronic is more than 15 days per month for >3 months
Name 3 common comorbid conditions which come with Parkinsons disease?
Siallorrhea (drooling)
Depression
Constipation
