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MSRA > neurology > Flashcards

neurology Flashcards

1
Q

raised ICP presentation: (7)

A

Cushing’s triad:
1. bradycardia
2. wide pulse pressure
3. irregular respirations

+ raised BP
vomiting
papilloedema
reduced GCS
CN III palsy

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2
Q

CN most commonly affected by raised ICP

A

CN III

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3
Q

CN III (opthalmic n.) palsy signs

A

eye deviated “down & out”
ptosis
pupillary dilation (mydriasis)

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4
Q

internuclear ophthalmoplegia
what is it?

A

occular movement disorder caused from a lesion in the medical longitudinal fasciculus (MLF)

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5
Q

internuclear ophthalmoplegia presentation:

A

failure to ADDUCT eye on affected side

CONTRALATERAL NYSTAGMUS

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6
Q

EDH
i. blood vessel most commonly affected

A

middle meningeal a.

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7
Q

EDH typical hx

A

acceleration/ deceleration trauma
or trauma to side of head
LOC followed by lucid interval

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8
Q

SDH
i. vessels most commonly affected

A

i. bridging veins

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9
Q

SDH
ii. RF
iii. presentation

A

ii. alcoholism
old age
anticoagulation

iii. fluctuating confusion/ consciosness especially for chronic

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10
Q

SAH non-traumatic causes

A
  1. ruptured berry aneurysms
    ^^ most commonly on posterior communicating artery

arteriovenoius malformations
arterial dissection

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11
Q

diffuse axonal injury

i. what causes it
ii. 2 components

A

i. rapid head acceleration/ deceleration

ii.
1. mulitple haemorrhages
2. diffuse axonal damage in white matter

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12
Q

triptan CI:

A

IHD/ cerebrovascular disease

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13
Q

triptans adverse effects:

A

“triptan sensations”
–> tingling, heat, tightness (e.g. throat and chest), heaviness, pressure

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14
Q

generalised tonic clonic seizures

mgt in males

A

sodium valproate

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15
Q

generalised tonic clonic seizures

mgt in females

A

lamotrigene or leviteracetam

may also offer sodium valproate if <10 and unlikely require rx when child bearing age

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16
Q

focal seizures:

i. 1st line mgt
ii. 2nd line

A

i. lamotrigine/ leviteracetam

ii. carbamazepine, oxcabapazepine or zonisamide

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17
Q

absence seizures:

i. 1st line

ii. 2nd line

A

i. ethosuximide

ii. in M: sodium valproate

in F: lamotrigene/ leviteracetam

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18
Q

which anti-epileptic can exacerbate absence seizures?

A

carbemazapine

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19
Q

myoclonic seizures mgt

A

in M: Na valproate

in F: levetiracetam

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20
Q

tonic/ atonic seizures mgt

A

in M: sodium valproate

in F: lamotrigene

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21
Q

sodium valproate SE:

A

Valproate SE:
Appetite increase & weight gain
Liver failure
Pancreatitis
Reversible alopecia
Oedema
Ataxia
Teratogenic, tremor, thrombocytopenia
Encephalopathy (due to increased Na+)

p450 INHIBITOR

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22
Q

phenytoin SE:

A

dizziness, diplopia, slurred speech, nystagmus, ataxia

confusion, seizures
gingical hyperplasia

megaloblastic anaemia
peripheral neuropathy

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23
Q

carbamazepine SE:

A

SIADH
Agranulocytosis
Dizziness
Diplopia
Drowsiness

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24
Q

lamotrigine SE:

A

SJS

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25
Q

cyctochrome p450
enzyme inducers

A

reduce concentration of drugs i.e. make drug work less

CRAP GPS

Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin

Grisefu;uin (antifungal)
Phenobarbitones
Sulphonylureas

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26
Q

cyctochrome p450
enzyme inhibitors

A

increase concentration of drugs (i.e. increase risk of toxicity)

SICK FACES.COM

Sodium valpraite
Izoniazid
Cimetidine
Ketokonazole

Fluconazole
Alcohol (acute)
Chloramphenicol
Erythromycin
Sulfonamides

Ciprofloxacin
Omeprazole
Metronidazole

27
Q

common drugs affected by enzyme inducers/ inhibitors:

A

COCP
warfarin
theophyline
steroids
TCAs
pethidine
statins

28
Q

status mgt:

A

PR diazepam: -
5mg if 1 month-1yr
10mg 12+yrs

29
Q

features of temporal lobe seizure:

A

with or without impairment of consciousness or awareness

aura:
- epigastric rising
- dejà vu / jamais vu
- less commonly hallucinations (auditory/gustatory/olfactory)

typically last approx 1 min
- automatisms

30
Q

features of frontal lobe seizure:

A

MOTOR

Head/leg movements
posturing
post-ictal weakness
Jacksonian march

31
Q

features of parietal lobe seizure:

A

SENSORY

paraesthesia

32
Q

features of occipital lobe seizure:

A

floaters/ flashes

33
Q

GCS

A

Mo6 V5 E4

motor response:

  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None

verbal response:

  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None

eye opening:

  1. Spontaneous
  2. To speech
  3. To pain
  4. None
34
Q

anti-hypertensives are required for stroke mgt if BP > what?

A

> 185/110

35
Q

essential tremor features:

A

postural tremor: worse if arms outstretched
improved by alcohol and rest
most common cause of titubation (head tremor)

AD inheritance

36
Q

essential tremor mgt

A

propranolol is first-line
primidone is sometimes used

37
Q

myasthenia gravis: exacerbating factors

A

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

38
Q

TACI
i. vessels involved
ii. features

A

i. middle and anterior cerebral arteries

ii. all 3 of:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

39
Q

PACI
i. vessels involved
ii. features

A

i. smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery

ii. 2 of:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

40
Q

lacunar infarcts (LACI, c. 25%)

i. vessels involved
ii. features

A

i. perforating arteries around the internal capsule, thalamus and basal ganglia

ii.presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

41
Q

posterior circulation infarct (POCI):
i. vessels involved
ii. features

A

i. vertebrobasilar arteries

ii. presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

42
Q

Lateral medullary syndrome (posterior inferior cerebellar artery)/ Wallenberg’s syndrome
features:

A

ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

43
Q

Weber’s syndrome features:

A

ipsilateral CN III palsy
contralateral weakness

44
Q

cluster headache mgt:
i. acute
ii. prophylaxis

A

i. oxygen
s/c triptan

ii. verapamil
some evidence for tapering dose of prednisolone

45
Q

migraine mgt:

i. acute
ii. prophylaxis

A

i. triptan, NSAID, paracetamol
[or amitriptyline]

ii. topiramate or propranolol
[or valproate]
if age 12-17 consider nasal triptan

iii. pizotifen

topiramate associated with risk of cleft palate so propranolol is preferred in women of child bearing age

46
Q

trigeminal neuralgia mgt:

A

carbamazepine

if fails to respond or atypical features –> refer to neuro

47
Q

hsv encephalitis CT head fetaures

A

temporal lobe changes

48
Q

mgt of spasticity in MS

A

gabapentin and baclofen

49
Q

Bell’s palsy mgt

A

PO prednisolone within 72 hrs of sx onset

50
Q

idiopathic intracranial HTN mgt:

A

weight loss
carbonic anhydrase inhibitors e.g. acetazolamide
repeated LP (temporary measure only)

51
Q

neuroleptic malignant syndrome features:

A

pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

52
Q

neuropathic pain:

A

1st line:

amitryptiline/ duloxetine/ gabapentin/ pregabalin

monotherapy i.e. if one does not work try another

tramadol as ‘rescue therapy’

53
Q

Miller-Fisher syndrome vs GBS:

A

anti- GQ1B antibodies in Miller-Fisher

Miller - Fisher - starts proximally i.e. with eyes

Miller Fisher triad:
ataxia
areflexia
ophthalmoplegia

54
Q

Lambert Eaton syndrome
i. what is it?
ii. association?

A

i. autoimmune disorder characterised by the production of autoantibodies that target pre-synaptic voltage-gated calcium channels, leading to impaired neurotransmission at the neuromuscular junction

ii. small cell lung cancer

55
Q

Lambert Eaton syndrome presentation:

A
  • limb weakness, PROXIMAL and SYMMETRICAL
  • autonomic features: - xerostomia, orthostatic hypotension, impotence
  • reduced/ absent tendon reflexes which can be potentiated by brief muscle contraction

IMPROVED with repeated movements/ repetitive contractions (unlike myaesthenia gravis which = fatiguable weakness)

56
Q

lower brachial plexus (Klumpke’s)injury association:

A

Horner’s syndrome (ipsilateral)
if T1 involvement

57
Q

criteria for CT head within 1 hour of injury:

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
>1x vomiting

58
Q

criteria for CT head within 8 hrs of head injury:

A

any of following RF:
age 65+
hx bleeding/ clotting disorders/ anticoagulants
dangerous mechanism of injury

59
Q

PD mgt

A
  1. levodopa

dopamine agonists e.g. roplinirole, rotigotine, apomorphine
MOA-B inhibitors e.g. selegiline, rasagaline (used + levodopa)
COMT inhibitors e.g. entacapone, tolcapone
amantadine
anti-cholinergics e.g. prochyclidine (not used that often irl)

60
Q

PD ddx:

A

Lewy body dementia
progressive supranuclear palsy
multiple system atrophy
corticoobasal degeneration
Wilson’s
drug induced Parkinsonism
demenuta pugillistica
vascular parkinsonism

61
Q

progressive supranuclear palsy features

A

early instability + frequent falls
vertical gaze impairment
Parkinsonism

62
Q

multiple system atrophy

A

early autonomic dysfunction
poor response to levodopa

63
Q

corticobasal degeneration

A

alien limb phenomenon
apraxia
cortical sensory loss (cannot recognise objects despite normal sensory input)

MSRA (16 decks)

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