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AKT Prep > Neurology > Flashcards

Neurology Flashcards

1
Q

TIA - how quickly should they be referred?

A

If < 7 days ago:
- Aspirin 300mg and review within 24 hours

If > 7 days ago:
- Review within 7 days

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2
Q

3 options for migraine prophylaxis:

A

Propanolol
Amitriptyline
Topimerate (CI in pregnancy)

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3
Q

What is the only licensed treatment for motor neurone disease in the UK?

A

Riluzole

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4
Q

Cauda equina syndrome is MOST commonly caused by herniation of an intervertebral disc at which nerve root level?

A

L4/L5 (60%)

Only 2% of all herniated discs will cause CES

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5
Q

What is the diagnostic criteria for trigeminal neuralgia?

A

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

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6
Q

Extensor plantar responses - upper or lower sign?

A

UMN

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7
Q

Name three possible features of LMN problems?

A

Atrophy
Fasiculations
Absent reflexes
Hypotonia

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8
Q

Amitriptyline - name 3 contraindications?

A

Arrythmia
Heart block
Severe liver disease
Manic phase of bipolar

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9
Q

Name two things that can precipitate neuroleptic malignant syndrome?>

A

Sudden abrupt withdrawal of antiparkinsonian medication due to compliance issues or malabsorption (e.g. due to gastroenteritis) may precipitate

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10
Q

What are the 4 core symptoms of neuroleptic malignant syndrome?

A

fever, altered mental state, muscle rigidity and autonomic dysfunction

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11
Q

What is the 1st line antiepileptic for children, young people and adults with generalised tonic clonic seizures?

A

Sodium valproate

Don’t use in pregnancy, contraception in all girls child bearing age

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12
Q

Medication overuse headache is usually a complication of which other condition?

A

Migraine

(migraine, tension and then MOH are most common headache causes)

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13
Q

Name 3 ways to distinguish stroke vs. Bells?

A
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14
Q

What is the most common acute mononeuropathy?

A

Bells palsy: Whole side, comes on in hours/ days, may also have disturbed taste

Stroke: Forehead spared, comes on in minutes

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15
Q

In children, after how long with no seizures would you consider withdrawal of epilepsy medication?

A

2 years

(60-70% will remain seizure free if withdrawn after no seizsures at 2 years)

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16
Q

What imaging helps when benign resting tremor cannot be clinically differentiated from a Parkinsonian tremor?

A

Single photon emission computerised tomography (SPECT)

Parkinsons clinical diagnosis but where need scan use above

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17
Q

1st line treatment for trigeminal neuralgia?

A

Carbamazepine

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18
Q

What are the CTH rules for fall on apixaban?

A

All CTH within 8 hours if no other indications

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19
Q

Name 3 classic guillian barre symptoms, which is most specific/ requires urgent referral?

A

weakness, paraesthesiae, and reduced or absent reflexes
- Absent reflexes are most specific

(Often preceeding viral URTI/ GI infection)

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20
Q

What 3 management options are first line for tension headache?

A

Aspirin, paracetamol or an a non-steroidal anti-inflammatory (NSAID) - ibuprofen or naproxen

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21
Q

MND survival rates at:
a) 5yrs
b) 10yrs

A

a) 25%
b) 5-10%

Most die within 2-3 years

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22
Q

MND, 1st and second most common types?

A

Most common ALS (60%)

2nd most common PBP (Progressive bulbar palsy)

23
Q

Trigeminal neuralgia, Carbamazapine not tolerated. What is next step in primary care?

A

Seek specialist advice

Do not start other drugs w/o specialist input

24
Q

What is the classic triad of parkinsons?

A

Bradykinesia (slow movements)
Tremor
Rigidity

25
Q

Bell’s palsy - management and timing of this?

A

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

26
Q

How may diabetic amyotrophy present clasically?

A

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.

27
Q

Name three types of spastic cerebral palsy and common features:

A

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

28
Q

Give 2 examples of DMARDS in MS?

A

Natalizumab reduces the frequency and severity of relapses by about 68%

B interferon only produces a 30% response

29
Q

Which drug is first-line for the relief of muscle spasticity in multiple sclerosis (MS)?

A

Baclofen

30
Q

What are the characteristic features of infantile spasms?

What age does it develop?

A

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.

31
Q

What are the characteristic features of Myoclonic epilepsy?

What age does it develop?

A

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.

32
Q

How should suspected infantile spasms be managed?

A

Refer within 24hrs

33
Q

Name 3 non-organic conditions that can cause memory problems?

A

CFS/ME
fibromyalgia
affective disorder
anxiety

34
Q

1st line treatment for cluster headache?

A

oxygen and/or subcutaneous or nasal triptans

Avoid paracetamol/ NSAID/ aspirin

35
Q

Name three conditions pregabalin is licenced for?

A

Neuropathic pain,
Generalised anxiety disorder Anticonvulsant

36
Q

Mechanism of Entacapone?

A

Entacapone prevents the peripheral breakdown of levodopa, by inhibiting catechol-O-methyltransferase

37
Q

1st line prophylactic for menstrual migraine (if standard tx not worked)?

A

Frovatriptan or
zolmitriptan

38
Q

Selegiline mechanism?

A

Monoamine oxidase-B (MAO-B) inhibitor.

Less good movement improvement but not as many side effects as levodopa

39
Q

Women on enzyme inducing drugs - what contraception is recommended?

A

Mirena IUS/ copper IUD
Depo injection

40
Q

A patient with motor neurone disease develops significant excessive salivation (sialorrhoea). 1st line mx? When would you not use this?

A

Antimuscarinic (hyoscine)

If cognitive impairment- glycopyrrolate

41
Q

NICE recommend which non-pharmacological treatment for chronic tension-type headache?

A

Consider a course of up to 10 sessions of acupuncture over 5–8 weeks for the prophylactic treatment of chronic tension-type headache

42
Q

Acute stroke - if shown to be ischemic when start Aspirin, what dose, how long to continue?

A

Aspirin 300mg
Start within 48hrs
Continue at least 14 days

43
Q

Name 3 CI to using sumitriptan?

A

Previous MI
Previous TIA/ stroke
IHD
Uncontrolled HTN
Peripheral vascular disease

44
Q

What is the first investigation in primary care that should be considered for a possible new diagnosis epilepsy?

A

ECG

(Note imaging like MRI will be carried out in secondary care - NICE recommend ECG for all first seizure)

45
Q

According to NICE guidelines, what is the minimum length of time that a headache diary should be kept for?

A

8 weeks

46
Q

What level of carotid artery stenosis would indicate endartectomy?

A

70%

47
Q

What feature of stroke would be most suggestive of underlying carotid stenosis

A

Hemiplegia

48
Q

What duration over which constitues prolonged seizure?

A

5mins

49
Q

Name 3 presenting features of Progressive supranuclear palsy?

A

Gait disturbance leading to falls,
Fatigue
Subtle personality changes
Vertical gaze palsy

50
Q

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?

A

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.

51
Q

Group 2 driving guidelines after TIA?

A

Don’t drive for 1 year

(1 month for Group 1)

52
Q

What is the NICE cut off for episodic vs. chronic headaches?

A

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

53
Q

Name 3 common comorbid conditions which come with Parkinsons disease?

A

Siallorrhea (drooling)
Depression
Constipation

AKT Prep (22 decks)

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