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Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

What drug is used for B12 supplementation?

A

Hydroxycobalamin

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2
Q

Name two drugs used to treat Myasthenia Gravis and their MOA

A

Pyridostigmine, Neostigmine

reversible AChE inhibitors

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3
Q

What is the main medication for MND management?

A

Riluzole

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4
Q

How would you treat Wernicke’s Encephalopathy?

A

Thiamine

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5
Q

What is carbamazepine used for?

A

2nd line for focal seizures
trigeminal neuralgia

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6
Q

What is the MOA of lorazepam?

What is it used for?

A

Benzodiazepine

Status epilepticus

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7
Q

What is phenytoin used for?

A

status epilepticus

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8
Q

How do you treat status epilepticus?

A

IV lorazepam 4mg, repeat after 10 mins if it doesn’t work

If persists then IV phenobarbital or phenytoin

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9
Q

What is ceftriaxone used for?
When would you add dexamethasone?

A

Meningitis, add dex if showing signs of meningism

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10
Q

What is ciprofloxacin used for?

A

Used for contacts of meningitis

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11
Q

What is cephalosporin used for?

A

Used in conjunction with metronidazole for brain abscesses

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12
Q

What is the MOA of Aspirin?

A

Irreversibly inhibits COX-1 which is required to form thromboxane within platelets.

Hence it prevents platelet aggregation

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13
Q

What is the MOA of Nimodipine?

What is it used for in Neurology?

A

CCB

Sometimes used in SAH to prevent vasospasm

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14
Q

What is the MOA of Triptans?

What are they used for?

A

Bind vascular 5-HT1B receptors, leading to vasoconstriction of cranial arteries

Used acutely for migraines and cluster headaches

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15
Q

What is Topiramate used for?

A

Increase GABA activity and inhibits glutamate activity, blocking neuronal excitability, also causes weight loss

IIH, migraine prophylaxis

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16
Q

What is the MOA of Verapamil?

What is it used for?

A

CCB

Cluster headache prophylaxis

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17
Q

How would you manage encephalitis?

A

IV Aciclovir (it’s HSV-1 in like 95% of cases in adults)

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18
Q

Which 3 agents would you give for a brain abscess?

A

IV cephalosporin + metronidazole

Dexamethasone for the swelling

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19
Q

What are the first line options for Alzheimer’s disease, and what is their MOA?

A

AChEi’s

Donepezil, galantamine, rivastigmine

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20
Q

What is the 2nd line option for Alzheimer’s disease and what is its’ MOA?

A

Memantine

NMDA R antagonist

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21
Q

Donepezil: name one contraindication and one adverse effect

A

Contraindication - bradycardia

Adverse effect - insomnia

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22
Q

What is the MOA of Levodopa?

What is it often combined with and why?

A

Synthetic dopamine

Combined with peripheral decarboxylase inhibitors like carbidopa and benserazide. This is to prevent the breakdown of dopamine

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23
Q

What problems are associated with Levodopa?

A

Becomes less effective over time

SE profile of dyskinesias (XS motor activity such as dystonia, chorea, and athetosis)

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24
Q

What is the role of Dopamine agonists in treating Parkinson’s dementia?

Name one SE

A

Used to delay the use of levodopa and are then often used in combination with levodopa to reduce the dose required

pulmonary fibrosis

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25
Q

Name two examples of MAOIs

A

Selegiline
Rasagiline

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26
Q

What agent is used to treat Huntington’s disease?

A

Tetrabenazine

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27
Q

How do you treat trigeminal neuralgia?

A

Carbamazepine

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28
Q

How do you treat migraines?

A

Triptans

Prophylaxis - propranolol, amitriptyline, topiramate

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29
Q

How do you treat cluster headaches?

A

Triptans + high flow O2

Prophylactic verapamil

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30
Q

How do you treat IIH?

A

Acetazolamide
Consider Topiramate

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31
Q

What is the MOA of Acetazolamide?

A

carbonoic anhydrase inhibitor, decreases CSF production

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32
Q

How do you treat venous sinus thrombosis?

A

Anticoagulate with warfarin and heparin

If infective cause then obviously consider Abx

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33
Q

How do you treat relapses of MS?

A

Methylprednisolone

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34
Q

How do you manage an acute stroke?

A

Send for CT/MRI within 1 hour

Ischaemic -> Aspirin 300mg

If symptom onset within 4.5 hrs then thrombolyse with alteplase

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35
Q

How do you treat pituitary apoplexy?

A

Urgent steroid replacement due to loss of ACTH

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36
Q

How would you manage Guillain Barre syndrome?

A

IV Ig
VTE prophylaxis

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37
Q

How would you manage Bell’s palsy?

A

Corticosteroids

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38
Q

What agents would you use to manage restless leg syndrome and what is their MOA?

A

Ropinirole or pramipexole

DA agonists

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39
Q

In severe cases of Myasthenia Gravis, conventional management options operating at the NMJ may not be effective.

What would you try next?

A

mAbs like Rituxumab or Eculizumab

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40
Q

How would you manage Lambert-Eaton syndrome?

A

Oral Pyridostigmine

Offer DAP (2,4-diaminopyridine) to increase the release of ACh

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41
Q

How would you differentiate LES and MG?

A

LES - better with use
MG - worse with use

MG also has extraocular muscle weakness

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42
Q

How would you differentiate MG and MND?

A

MG has extraocular muscle weakness

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43
Q

How would you subdivide Myotonic Dystrophy?

A

DM1 - distal
DM2 - proximal

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44
Q

How would you manage GBS acute bad stuff?

A

FVC 4 hourly
IV IG
VTE prophylaxis

45
Q

What 2 variables do Nerve Conduction Studies measure?

A

Conduction Velocity
Distal latency

46
Q

What is the distal latency in Nerve Conduction Studies?

A

Time required to traverse the segment nearest the muscle

47
Q

What are the signs of total anterior ciruclation infarcts?

A

All 3 of the following

1) Unilateral hermiparesis
2) Homonymous hemianopia
3) Higher cognitive dysfunction

48
Q

Describe the 3 signs of Leriche syndrome

Who gets Leriche syndrome?

A

1) Claudication of the buttocks and thighs
2) Atrophy of the musculature of the legs
3) Impotence (due to paralysis of L1)

Men

49
Q

What kind of bleed is associated with fluctuating consciousness?

A

Subdural haemorrhage

50
Q

How would you differentiate a seizure from a psuedoseizure?

A

Prolactin will be raised in a seizure

51
Q

What sign is seen on MRI of a meningioma?

A

Dural tail

52
Q

Name the only type of reversible dementia

A

Normal pressure hydrocephalus

53
Q

How would you differentiate FTD and Huntington’s?

A

Huntington’s shows involuntary movement

54
Q

Describe the GCS

A

EYES
4) Spontaneously
3) To speech
2) To pain
1) No response

Mouth
5) Orientated
4) Confused
3) inappropriate words
2) incomprehensible sounds
1) no response

Motor
6) Obeys commands
5) Localises to pain
4) flex to withdraw from pain
3) abnormal flexion
2) abnormal extension
1) no response

55
Q

Describe the 5 causes of cerebellar pathology

A

MAVIS

MS
Alcohol
Vascular
Inherited (Freidrich’s ataxia, spinocerebellar ataxia, ataxia telangiectasia)
SoL

56
Q

What disease is Lambert Eaton Syndrome associated with?

A

Small Cell Lung Cancer

57
Q

What are the features of GBS on LP?

A

^protein
normall wcc

(albuminocytologic dissociation)

58
Q

What are the features of a PCA infarct?

Why?

A

Homonymous hemianopia w/ macular sparing

This is because th occipital pole (macula) receives a dual blood supply (PCA + MCA)

59
Q

Damage to which spinal levels is associated with autonomic dysreflexia?

A

T6 and above

60
Q

How would you manage medication overuse headaches?

A

Stop abruptly - triptans, simple analgesics

gradually withdraw - codeine

61
Q

Name 1 side effect of Lamotrigine

A

SJS

62
Q

Name 1 side effect of Ethosuximide

A

GI upset :(

63
Q

Name 1 side effect of Levetiracetam

A

Mood swings

64
Q

Give two other names for a PICA infarct

How would it present?

A

Wallenberg syndrome
Lateral medullary syndrome

Ipsilateral facial motor / sensory loss, Horner’s

Contralateral - hermiparesis

65
Q

Give another name for an AICA infarct

How would it present?

A

lateral pontine syndrome

ipsilateral facial paralysis + deafness

66
Q

How would a lacunar infarct present?

A

isolated hemisensory loss

67
Q

Which 2 drugs are 1st line for spasticity in MS?

A

Gabapentin
Baclofen

68
Q

Name a contraindication to the use of Triptans

Why?

A

IHD

May cause coronary artery vasospasm risking MI

69
Q

What is the gold standard investigation for venous sinus thrombosis?

A

MR Venogram

70
Q

What is the function of the spinothalamic tract?

A

Pain and temperature conduction

71
Q

What is the Barthel index for?

A

measures disability or dependence in ADLs in stroke patients

72
Q

What antiplatelet regime is recommended following an acute ischaemic stroke?

A

Aspirin 300mg OD for 2/52

Then clopidogrel 75mg OD long-term

73
Q

For how long does someone need to be seizure free before driving a car?

A

12 months with epilepsy diagnosis

6 months after first seizure

74
Q

How do you treat paroxysmal hemicrania?

A

Indomethacin

75
Q

What sort of haemorrhage will have a lucid interval?

A

Extradural haeamatoma

76
Q

What finding on EEG suggests infantile spasms (West’s syndrome)?

A

Hypsarrhythmia

77
Q

How would you differentiate, central, pre-ganglionic, and post-ganglionic causes of horner’s syndrome?

A

Central - anhidrosis of head, arm, and trunk

Pre-ganglionic - facial anhidrosis

Post-ganglionic - no anhidrosis

78
Q

What is the most common SE associated with Memantine?

A

Constipation

79
Q

How would you differentiate pseudodementia from a true dementia?

A

psuedodementia - global memory loss, potential for improvement

dementia - short term memory loss

79
Q

Which neurological condition is most closely associated with thymoma?

A

Myasthenia Gravis

79
Q

When can you stop anti-epileptic drugs?

A

Seizure free for >2 year

stopped over 2-3 months

79
Q

Which Abx increase the risk of IIH?

A

tetracyclines

79
Q

Which type of MND carries the worst prognosis?

A

Progressive bulbar palsy

80
Q

Describe Lhermitte’s sign

A

Tingling of the hands in neck flexion

Dorsal column disease
SCDSC
Cervical stenosis

81
Q

What neurocutaneous syndrome is associated with bilateral vestibular schwannoma?

A

NF2

82
Q

Why is propranolol the preferred agent for migrain prophylaxis?

A

Topiramate is teratogenic

83
Q

What are the 2 main features of CJD?

A

Rapid onset dementia
Myoclonus

84
Q

Describe the 3 core symptoms of depression

A

Anhedonia
Anergia
Low mood

85
Q

Describe logoclonia

A

Parkinson’s pt get stuch on a word and repeats it

86
Q

Which anti epileptic drug is more associated with weight gain?

A

Sodium valproate

87
Q

Describe Argyll-Robertson pupil

A

ARP

Accomodation Reflex Present (ARP)

Pupillary Reflex Absent (PRA)

Seen in neurosyphillis

88
Q

In trauma, how would you test that a fluid is CSF?

A

Check for glucose

beta-2-transferirn is the gold standard though

89
Q

What drug reduces the number of relapses in MS?

A

Natalizumab

90
Q

What is the investigation of choice for narcolepsy?

A

multiple sleep latency EEG

91
Q

What scoring system would you use to differentiate between stroke and stroke mimics?

A

ROSIER

92
Q

How might you manage tremor in drug-induced Parkinson’s?

A

Procyclidine

(remember antipsychotic drug SEs)

93
Q

How would you manage an essential tremor?

A

Propranolol

94
Q

Which anti-emetic might cause extrapyramidal side effects?

A

Metoclopramide

(Dopamine antagonist)

95
Q

What is the preferred imaging modality for patients suspected of TIA?

A

MRI brain with diffusion-weighted imaging

96
Q

How might you differentiate a cerebellar hemisphere lesion from a cerebellar vermis lesion?

A

Hemisphere - finger-nose ataxia

Vermis - gait ataxia

97
Q

What patterns of deficity would you expect to find in SCDSC?

A

Loss of prioprioception and vibration sensation

Muscle weakness

Hyperreflexia

98
Q

Describe Brown-Sequard syndrome

A

Spinal hemisection

Ipsilateral - weakness, proprioception / vibration loss

Contralateral - pain/temperature loss (spinothalamic)

99
Q

Describe multiple system atrophy

A

Parkinson’s + syndrome

Postural hypotension
Impotence

100
Q

Describe the Cushing reflex

A

Response to ^ICP

HTN
Bradycardia
Wide pulse pressure

101
Q

What dermatological condition is associated with Parkinson’s?

A

Seborrhoeic dermatitis

102
Q

What simple blood test might differentiate a bacterial and non-bacterial meningitis?

A

Procalcitonin

103
Q

How might you manage meningitis in the community?

A

IM Benzylpenicillin

103
Q

Which management option for IIH is teratogenic?

A

Acetazolamide

104
Q

An MI in what region might cause an AV block?

A

Inferior MI

Medicine (22 decks)

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