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Year 4 Placements > Neurology > Flashcards

Neurology Flashcards

1
Q

In cases of raised ICP due to brain haemorrhage, what can be given to patients while waiting for definitive treatment?

A

Mannitol +/- hypertonic saline

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2
Q

Xanthochromia is a sign of what?

A

Subarachnoid haemorrhage

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3
Q

How long should we wait before lumbar puncturing subarachnoid haemorrhage patients and why?

A

12 hours, not reliable

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4
Q

What may be found in the CSF of subarachnoid haemorrhage patients?

A

Xanthochromia - bilirubin in CSF

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5
Q

Acute and chronic cases of subdural haemorrhage can be managed via what?

A

Acute - craniotomy
Chronic - Burr holes

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6
Q

The Cushing’s reflex encompasses which 3 features? What does this indicate?

A

Increased BP + decreased HR + irregular breathing
- indicates increased ICP and immediate need for secondary care, as can precipitate death within seconds or minutes

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7
Q

What breathing pattern can we ask patients to adopt in order to combat raised ICP initially?

A

Hyperventilation
- CO2 causes cerebral vessels to dilate, leading to increased blood flow to brain and hence increased ICP even further; hyperventilation > blow off CO2 > decrease ICP

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8
Q

Respiratory arrest indicates herniation of what brain portion?

A

Cerebellar tonsils through foramen magnum

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9
Q

Down and out eye + ptosis + blown pupil indicates herniation of what?

A

Temporal lobe uncus, leading to oculomotor nerve palsy (CNIII)

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10
Q

Which type of brain haemorrhage may result in a lucid interval before presenting?

A

Extradural

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11
Q

What type of scan is best for multiple sclerosis?

A

MRI + contrast

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12
Q

Wallenberg’s syndrome is due to infarction of which brain area?

A

Lateral medulla
- via posterior inferior cerebellar artery occlusion

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13
Q

Ipsilateral Horner’s syndrome can appear due to infarction of which brain area?

A

Lateral medulla

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14
Q

Down and out eye is a characteristic of which nerve palsy?

A

Oculomotor

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15
Q

Oculomotor nerve palsy is a characteristic of which posterior stroke syndrome?

A

Weber’s

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16
Q

What is the first line treatment for absence seizures?

A

Ethosuximide

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17
Q

Sodium valproate can be used as first line in which type of epilepsy, in which subgroup of patients?

A

Tonic clonic - males and females unable to have children

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18
Q

What is the first line treatment for all types of focal seizure?

A

Lamotrigine or levetiracetam monotherapy

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19
Q

What is second line therapy for focal seizures?

A

Carbamazepine

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20
Q

Which common AED may exacerbate symptoms of myoclonic seizures?

A

Lamotrigine

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21
Q

Which skin complication should be watched out for when using lamotrigine?

A

Steven’s-Johnson syndrome
= widespread blistering skin rash

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22
Q

Spinal stenosis pain can be alleviated by leaning in what direction?

A

Forwards

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23
Q

Lhermitte’s sign is a sign of what disease?

A

Multiple sclerosis

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24
Q

Guillian Barre syndrome is most associated with which infective agent?

A

Campylobacter

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25
Q

Hoover’s sign is indicative of what disorder?

A

Functional neurological disorder

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26
Q

Which class of medications is suitable to give first line in status epilepticus?

A

Benzodiazepines

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27
Q

Which blood marker may be raised after an epileptic seizure?

A

Prolactin

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28
Q

Jacksonian march during an epileptic seizure indicates origin from which cerebral lobe?

A

Frontal

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29
Q

High homocysteine levels may indicate what?

A

Vitamin B12/6/folate deficiency

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30
Q

Chronically elevated homocysteine levels can increase risk of what?

A

Stroke, heart disease, dementia

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31
Q

Myoclonic jerks can be precipitated by impairment in which organ system?

A

Renal
- uraemia irritates brain and causes jerks

32
Q

Which common antibiotic can cause peripheral neuropathy?

A

Nitrofurantoin
- renal impairment can precipitate this due to decreased renal clearance of Nitrofurantoin

33
Q

Which TB medication can cause peripheral neuropathy?

A

Isoniazid
- should be prescribed with concomitant pyridoxine in attempt to prevent precipitation of peripheral neuropathy

34
Q

Which TB medication can cause peripheral neuropathy?

A

Isoniazid
- should be prescribed with concomitant pyridoxine in attempt to prevent precipitation of peripheral neuropathy

35
Q

Fingolimod should be monitored with which blood test and why?

A

FBC, can cause leukopenia/neutropenia

36
Q

Fingolimod is a disease modifying drug for which disease?

A

Multiple sclerosis
- relapse remitting ONLY

37
Q

Epilim is a form of which epileptic medication?

A

Sodium valproate

38
Q

A headache which is worse on standing and improves on lying down indicates what?

A

Intracranial hypotension

39
Q

Behavioural change is more characteristic of which of the following - encephalitis or meningitis?

A

Encephalitis

40
Q

The most common causative organism of encephalitis is what?

A

Herpes simples virus

41
Q

What is first line for chemotherapy induced nausea?

A

Ondansetron (5HT3 serotonin antagonist)

42
Q

Which anti-emetic should be avoided in Parkinson’s patients?

A

Metoclopramide

43
Q

Which Parkinson plus syndrome is characterised by vertical gaze palsy?

A

Progressive supranuclear palsy

44
Q

Autonomic dysfunction (postural hypotension, incontinence, impotence) is suggestive of which Parkinson plus syndrome?

A

Multiple system atrophy

45
Q

Spontaneous activity of a limb is suggestive of which Parkinson plus syndrome?

A

Corticobasal degeneration

46
Q

Which delirium medication should be utilised in agitated Parkinson’s patients?

A

Lorazepam
- haloperidol C/I due to promotion of dopamine blockage

47
Q

Which 2 classes of medication can be utilised in Parkinson’s patients experiencing end of dose effects?

A

MAO-I inhibitors - selegiline, rasagiline
COMT inhibitors - entacapone, tolcapone

48
Q

What is the mechanism of action of carbidopa when given with levedopa?

A

Decreases peripheral breakdown of L-dopa, leaving more for central action and hence better therapeutic effect

49
Q

What is the treatment for brain abscess?

A

IV ceftriaxone 2g BDS + IV metronidazole 500mg TDS

50
Q

What is the most common causative organism for encephalitis?

A

Herpes simples virus type 1

51
Q

Which antibody is associated with autoimmune encephalitis?

A

NMDA receptor antibody

52
Q

Which clinical feature most commonly separates encephalitis and meningitis?

A

Behavioural change - suggests encephalitis over meningitis

53
Q

Which lobe of the brain is most commonly involved in encephalitis?

A

Temporal
- watch for temporal neurological signs e.g. aphasia

54
Q

What is the treatment for encephalitis?

A

Empirical broad spectrum antimicrobial therapy with 2g ceftriaxone IV BDS + 10mg/kg aciclovir TDS for 2 weeks

55
Q

Which 2 examination signs may be seen in meningitis?

A

Kernig’s and Brudzinski’s

56
Q

What may be administered to suspected meningitis patients while awaiting transfer to hospital?

A

IM benzylpenicillin

57
Q

What can be given concomitantly with antibiotics in meningitis that may reduce morbidity and mortality?

A

IV dexamethasone

58
Q

What is the first line treatment for meningitis in a non penicillin allergic patient?

A

2g ceftriaxone IV BDS + IV amoxicillin for listeria coverage

59
Q

What is the first line treatment for meningitis in a penicillin allergic patient?

A

IV chloramphenicol

60
Q

What is the first line treatment in essential tremor?

A

Propranolol

61
Q

What is the first line treatment in essential tremor in patients with asthma?

A

Topiramate
- propranolol first line in those without asthma

62
Q

Failure of 2 doses of IV lorazepam in status epilepticus indicates the need for what next medication?

A

IV infusion of phenytoin
- requires cardiac monitoring
- OR loading with IV levetiracetam, sodium valproate

63
Q

What is the difference between essential tremor and Parkinsonism tremor?

A

Essential - occurs when working/during stress
Parkinsonism - occurs at rest

64
Q

What is the first line treatment for acute cluster headache?

A

100% oxygen via non-rebreathe mask + subcutaneous triptan

65
Q

What is the first line treatment for migraine?

A

Oral triptan + NSAID/paracetamol

66
Q

What is the first line non pharmacological treatment for idiopathic intracranial hypertension?

A

Weight loss

67
Q

What is the first line pharmacological treatment for idiopathic intracranial hypertension?

A

Acetozolamide

68
Q

Which genetic mutation is most commonly associated with motor neurone disease?

A

SOD1

69
Q

Suspected spinal cord compression should be managed immediately with what?

A

Dexamethasone

70
Q

What type of tremor is seen in cerebellar dysfunction?

A

Intention

71
Q

Name the 6 features of cerebellar dysfunction

A

DANISH:
D - dysdiadochokinesia
A - ataxia
N - nystagmus
I - intention tremor
S - slurred speech
H - hypotonia

72
Q

What is a positive Romberg’s test?

A

Unsteadiness on the feet when the patient is asked to close their eyes whilst standing

73
Q

What does a positive Romberg’s test indicate?

A

Sensory ataxia

74
Q

What are the 3 key features of Horner’s syndrome?

A

Ptosis, miosis, anhidrosis

75
Q

What is the first line treatment for intracranial venous thrombosis?

A

Low molecular weight heparin

76
Q

Which class of painkillers are contraindicated after an ischaemic stroke?

A

Triptans

77
Q

Which type of meningitis is most common in immunocompromised patients (e.g. HIV)?

A

Cryptococcal

Year 4 Placements (10 decks)

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