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GP FELLOWSHIP RNZGP > Neurology > Flashcards

Neurology Flashcards

1
Q

Signs of Parkinsons

A
  • Resting tremor
  • Micrographia
  • Mask life facies
  • Limb bradykinesia
  • Asymmetrical reduced arm swing
  • Reduced step height
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2
Q

Classes of drugs for parkinsons

A

1st line
Levodopa (and dopa-decarboxylase inhibitors
= Levodopa/carvidopa

2nd line
Dopamine agonists
= Pramipexole
= Rotigotine (patch)

Other
MAO-B inhibitors
= Rasgiline
Consider in mild symptoms

Anticholinergics
=Benztropine
Good for resting tremor

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3
Q

Dose of Levodopa/carbidopa
or Levodopa/benserazide

A

50+12.5mg TDS

Increasing to 100mg+25mg TDS

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4
Q

Dose of Pramipexole (modified release)

A

Once day dosing!!

0.375mg

(Max 4.5mg)

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5
Q

Benefit of dopamine agonists in parkinsons

Cautions

A

Once day dosing!

Careful for impulse control issues: gambling, etOH, hypersexual

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6
Q

Side effects of parkinson’s medications

A
  • Nausea
  • Orthostatic dizziness
  • Somlonence

Dopamine agonists: impulse control, hallucinations

Anticholinergics: confusion, dry mouth, urine retention, dry eye, constipation

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7
Q

Dementia pharmacology:
1st line:

A

Donepezil 5mg nocte (max 10mg)

Galatamine 8mg mane

Rivastigmine patch 4.6mg

OR for SEVERE /not tolerating Acetylcholinesterase inhibitors

Memantine 5mg daily (max 20mg)

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8
Q

Trigeminal neuralgia pharmacology

A

Carbamazepine MR 100mg BD

Up to 400mg BD

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9
Q

TIA investigations

A

CT angiography
Carotid artery doppler US
or MR angiography

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10
Q

Painful peripheral neuropathy pharmacology

A

1st line:
Amitriptyline 25mg nocte (up to 150mg)

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11
Q

Complex partial seizure features

A

Temporal lobe epilepsy

  • Slight perceptual disturbance ( could still do simple task or drive a car)
  • Hallucination: smell, sound, visual
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12
Q

Simple partial seizure features

A

NO loss of consciousness

Jerking movements at angle of mouth or in the thumb and finger- then become bigger to involve the rest of the body.

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13
Q

Narcolepsy treatment

A

Modafinil 200mg mane
Or mane 100mg, midday 100mg

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14
Q

Distinguishing between labyrinthitis and vestibular neuronitis

A

Labyrinthitis affects whole inner ear & would have tinitis and hearing loss also

Not just vertigo (and n/v)

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15
Q

Parietal lobe tumour features

A

Seizures
Impaired: handwriting, numbers, maths
Certain movements
Smell and touch issues

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16
Q

Frontal lobe tumour features

A

Personality change
Intellectual impairment
urinary incontinence
Hemiparesis

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17
Q

Occipital lobe tumour

A

Visual field defect
Visuospatial defect

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18
Q

Bell’s Palsy treatment

A

Prednisolone 75mg 5 days

add Valaciclovir if vesicles present

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19
Q

Definition/features of Mononeuritis Multiplex

A
  • Painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving 2 separate nerve areas
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20
Q

Idiopathic intercranial hypertension investgiations

A

MRI (to exclude SOL)
Lumbar puncture (opening pressure raised >25cmH20)

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21
Q

Idiopathic intercranial hypertension treatment

A
  • Acetazolamide 250mg BD
    Increase to 500mg QID as tolerated
  • Weight loss
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22
Q

Idiopathic intercranial hypertension DDx to rule out

A
  • Space occupying lesion
  • Venous sinus thrombosis/obstruction
  • Medication induced: Isotretinoin and tetracyclines
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23
Q

Cerebellar signs

A
  • Wide based gait
  • Intention tremor
  • Dysdiadochokinesis
  • Imbalance
  • Coordination of complex tasks
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24
Q

Dementia work up (routine (8) and recommended (7))

A

Routine
- FBC
- ESR
- LFTs
- EUC (ca)
- TSH
- B12,
- Folate
- CTB

Recommended
- CXR
- Fasting BSL
- Fasting lipids
- Fasting homocystine level
- ECG
- MSU
- Serology; HIV & syphilis

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25
Q

Pre-hospital management of suspected meningitis

A

Obtain blood cultures if possible
ABX:
1) Ceftriaxone 2g (50mg/kg) IV or IM
1) Benzylpenicillin 2.4g (60mg/kg) IV or IM

26
Q

Features suggestive of Multiple Sclerosis

A
  • Optic neuritis
  • Lhermitte sign (shooting pain with neck flexion)
  • Internuclear ophthalmoplegia (diplopia)
  • Fatigue
  • Heat sensitivity (Uhthoff phenomenon)
  • Unilateral facial or limb sensory loss
  • Subacute motor weakness
27
Q

Triad for Wernicke’s Encephalopathy

A

Encephalopahthy
Occulomotor dysfunction
Gait ataxia

28
Q

Essential tremor management

A

Propanolol 10mg BD

up to 160mg in 2 divided doses

29
Q

Damage /tumour in Temporal lobe

A
  • Receptive aphasia
  • Difficulty recognising faces
  • Emotional disturbance (aggressive behaviour)
  • Difficulty identifying objects
30
Q

Acute migraine treatment (first line agents)

A

NSAID:
- Aspirin 900mg
- Ibuprofen 400mg

TRIPTAN
- Sumatriptan 50 to 100 mg. Wait 2 hours before repeating dose

31
Q

Non- pharmacological migraine management

A
  • Cool packs to forehead or back of head
  • Heat pack to neck
  • Quite dark room
  • Regular sleep schedule
  • Avoid triggers (chocolate, citrus, MSG)
  • Hydration (1.5-2L)
  • Limit caffeine
32
Q

Migraine prophylaxis

A
  • Amitriptyline 10mg
  • Candesartan 4mg
  • propanolol 20mg (avoid in asthma)
  • Topiramate 25mg
33
Q

Medication overuse headache management

A
  • Gradually wean opioids and triptans
  • Bridge with Naproxen MR 750mg daily for 5 days in first week then wean
34
Q

Trigeminal neuralgia pharmacological management

A

Carbamazepine 100mg BD

35
Q

Trigeminal neuralgia clinical features

A
  • Trigeminal distribution: V2 V3 more common
  • Paroxysmal electric shock /stabbing nature of pain
  • Unilateral
  • Tigger zones
  • Brought on by innocuous stimuli (wind, light touch)
  • Autonomic symptoms: unilateral lacrimation, conjunctival injection, rhinorrhoea
36
Q

Agitation in aged care pharmacology

A

Risperidone 0.25mg BD PRN

37
Q

Acute dystonia management
HINT: Single agent

A

Benztropine 1mg IM or IV

38
Q

Childhood Absence Epilepsy features
1. Onset age
2. How long seizures for
3, EEG findings

A
  1. 4-10yrs
  2. 2-20 secs (tens per day)
  3. Generalised rhythmic spikes or double spike wave discharges ~3Hz
39
Q

Cluster headache features
(gender predominance, frequency & duration of attack, etOH trigger)

Also other features

A
  • M> F
  • up to 8 daily
  • 15-180 minutes
  • SEVERE (called suicide headache)
  • yes etOH Trigger

Tearing, conjunctival injection, Fullness of the ear, tinnitus
Agitation, restless

40
Q

First line agent for PREVENTION of cluster headache management and caution for this

A

Verapamil IR 80mg TDS
for 2 weeks titrate up to 160mg TDS

HEART BLOCK
must do ECG before every dose increase
- PR interval & severe bradycardia

**increase dose every 2 weeks

41
Q

First line agent for ACUTE treatment of cluster headache (2 agents)

A

Sumatriptan 6mg subcut

High flow oxygen 100% 15L tight fitting non-rebreather 15-20mins then stop

42
Q

3 questions for assessing falls risk

A
  1. More than 2 falls in last 12 months
  2. Presenting following a fall?
  3. Difficulty with walking or balance?
43
Q

Causes for muscle weakness (and fatigue) in upper limbs

A
  • MND
  • Cervical myelopathy
  • MS
  • Inclusion body myositis (distal weakness)
  • Thyrotoxicosis
  • B12 deficiency
  • Myasthenia gravis (more proximal weakness)
44
Q

Exam findings in MND/ALS

A
  • Brisk reflexes in a wasted limb
  • Split hand sign
  • Fasciculation
  • Dysarthria/dysphagia
45
Q

Peripheral neuropathy differentials

A
  • Diabetic neuropathy
  • B12 Deficiency
  • Paraproteinuria
  • Peripheral vascular disease
  • Idiopathic
  • Restless leg syndrome
  • Hypothyroidism
  • Alcohol related peripheral neuropathy
  • Medication: Amiodarone, metronidazole
46
Q

Post TIA/CVA carotid artery stenosis cut off for end arterectomy?

A

> 70% (ipsilateral)

Marginal for 50-69%

47
Q

Post stroke: antiplatelet therapy

A

Aspirin 100mg daily
OR
Clopidogrel 75mg daily
OR
Dipyriamole MR + Aspirin 200 + 25mg BD

**
DAPT could be good 3 weeks -3 months post but not strictly in guidelines

48
Q

Status Migrainosus

A

Sumatriptan 6mg subcut

49
Q

Tension headache prophylaxis

A

Amitriptyline 10mg nocte increasing up to 75mg

50
Q

Bell’s Palsy exam findings

A
  • Decreased tearing from eye
  • Vesicles
  • Loss of taste anterior 2/3 tongue
  • Hyperacusis
  • Drooling
51
Q

Bell’s Palsy treatment

A
  • Pred 75mg (1mg/kg)
  • artifical tears
  • review 3-4 weeks
  • MRI if not improved in 4 months
  • Valaciclovir 1g 8hourly 7d
52
Q

TIA driving exclusion period (private and commercial)

A
  • 2 weeks
  • 4 weeks
53
Q

Peripheral neuropathy ‘Burning foot” differentials

A
  • Peripheral vascular disease
  • B12 deficiency
  • Tarsal tunnel syndrome
  • Reynauds
  • Diabetic nephropathy
  • Chilblains
  • hypothyroidism
  • etoH
  • Complex regional pain syndrome
  • Chemotherapy
54
Q

3Hz wave and spike EEG - type of seizure

A

Absence seizure

55
Q

What medications can you NOT use in parkinsons (cautions)

A

Metoclopramide
Prochlorperazine

56
Q

Migraine in children pharmacology

A

1st line: ibuprofen 10mg/kg up to 400mg

TRIPTAN
1st line: Sumatriptan 10-20mg IN (repeat 2 hrs)

if nausea:
Ondansetron: 0.1mg/kg up to 8mg orally

57
Q

Cluster headache prevention (pharmacology)

A

Verapamil IR 80mg TDS increasing to 160mg TDS

58
Q

Dementia NON-pharmacological considerations

A
  • My aged care assessment
  • Enduring guardian
  • Advanced care directive
  • Legally needs to inform RMS of diagnosis
  • Home medication review
  • Dementia australia website
  • Maintain social activities
  • Exercise for 30 mins most days
59
Q

Differentials for limb weakness

A
  • MND
  • MS
  • Chronic inflammaotry demyelinating neuropathy (CIDP)
  • Radiculopathy (myeloradiculopathy)
  • Myositis
  • B12 deficiency
  • Thyrotoxicosis
  • Lead poisoning
  • Myesthenia gravis
  • Space occupying lesion
  • Bulbar palsy
60
Q

Post stroke use of DAPT? Time frame

A
  • Endorsed by stroke foundation for 3 weeks of DAPT

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