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Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the difference between stroke and TIA? 2 things

A

Stroke
Lasts more than 24hours
Residual recovery

TIA
Lasts seconds - 24hours
Complete recovery

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2
Q

Give 3 main pathologies underlying Cerebral vascular accidents?

A

Embolism
Thrombosis
Haemorrhage

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3
Q

Give 5 risk factors for stroke?

A 
HEADS
Hypertension/Hyperlipidemia
Elderly
Atrial fibrllation
Diabetes
Smoking & Alcohol
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4
Q

How can you recognise a Total/Partial anterior circulation (TAC/PAC) stroke?

A

TAC:
Higher dysfunction (aphasia, visuospatial disturbance, decreased conscious levels)
Homonymous heminopia
Hemiparesis (2 of arm, face or leg)

PAC:
2/3 of above

Symptoms must be same side or else its not a stroke

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5
Q

How can you recognise a Posterior circulation (POCS) stroke?

A 
VANISH'D
Vertigo
Ataxia
Nystagmus
Intention tremor
Slurred speech (Also in TAC/PAC)
Heel-shin test (+ve)
Dysdiaodochokinesis
Broad based walking gait
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6
Q

How can you recognise a Lacunar (LACS) stroke?

A

Pure motor
Pure sensory
Ataxic hemiparesis

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7
Q

Which investigations will you do when suspecting a stroke? 6 things

A 
CT head (within 24 hrs) - rule out bleed
US carotids - stenosis is risk factor
ECG - AF is risk factor
FBC - polycythamia
Cholesterol - risk factor
Glucose - hypoglycaemia
CRP/ESR - temporal arteritis
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8
Q

What 3 factors need to be in place for thrombolysing a stroke patient?

A

Expert team in place (neuroimaging/clinicians)
Patient seen within 4.5hrs of symptom onset
No contraindications exist

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9
Q

Give 5 contraindications to thrombolysing a stroke patient?

A 
Major infarct or haemorrhage on CT
Mild (non disabling) deficits
Recent surgery/trauma/obstetric delivery
Past CNS haemorrhage
Seizures at presentation
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10
Q

Suggest 4 primary prevention steps for stroke?

A

Control risk factors: hypertension, diabetes, cholesterol, cardiac disease
Exercise
Quit smoking

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11
Q

Suggest 3 secondary prevention steps for stroke?

A

Control risk factors like primary prevention
Aspirin (75mg daily)
Warfarin (if embolic or AF 2 weeks after stroke)

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12
Q

What does the DVLA say about stroke/TIA?

A

No driving for 1 month after episode

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13
Q

If a patient experiences a TIA, how can you assess the risk of getting a stroke?

A 
ABCD2 score
Age > 60y/o
Blood pressure >140/90
Clinical features:
-unilateral weakness (2)
-speech disturbance
Duration of symptoms:
-more than 1hr (2)
-less than 1hr
Diabetes

Score More than 4 = specialist review within 24hrs
Otherwise within 7 days

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14
Q

What is the classical triad of signs in Parkinsonism?

A

Tremor
Rigidity
Bradkinesia/Hypokinesia

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15
Q

Name 4 professionals involved in the management of Parkisons disease?

A 
Neurologist
Physiotherapist
Social worker
GP
OT
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16
Q

What are the risk factors for epilepsy? 4 risk factors

A 
Congenital/developmental disorders (ie migrational disorders)
Infections
Febrile convulsions in early life
Head injury
Brain tumour
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17
Q

Give 4 seizure triggers?

A

Flashing lights
Infection/Fever
Sleep deprivation
Stress

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18
Q

What does the DVLA say about Epilepsy?

A

Need to be seizure free for >1yr to drive

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19
Q

What are partial seizures and describe them?

A

Focal onset of seizures referable to one part of the hemisphere

Simple partial seizure: Awareness unimpaired. No post-ictal symptoms

Complex partial seizure: Awareness impaired. More likely post-ictal symptoms

20
Q

What are the different types of primary generalised seizures? 4 types

A

Absence: Brief <10secs pauses
Tonic-clonic: Loss of consciousness, limb stiffen (tonic) then jerk (clonic). Post-ictal confusion and drowsiness
Myoclonic: Sudden jerk of a limb, face or trunk
Atonic (akinetic): Sudden loss of muscle tone

21
Q

Name 3 drugs which are useful for managing epilepsy?

A

Sodium valproate
Lamotrigine (better tolerated, less teratogenic)
Carbamezapine

22
Q

What is status epilepticus?

A

Condition where the brain is in a constant state of seizure > 5mins

23
Q

Name 4 types of drugs used in treating parkinsons disease?

A

Dopamine - Levodopa with decarboxylase inhibitor
Dopamine agonist
Anticholinergics
MAO-B inhibitors

24
Q

Give 6 possible triggers of migraine?

A 
CHOCOLATE
CHeese
Oral contraceptives
Caffeine
alcohOL
Travel
Exercise
25
Q

How can manage migraines in the acute phase and long term? 5 things

A

Acute:
Simple analgesics
Anti-emetics

Long term:
Avoid triggers
Triptans (sumatriptan)
Prophylaxis if > 2 attacks/month (B-blockers, Seratonin antagonists, Amytriptylline)

26
Q

Give 5 professionals that might be involved in the management of a stroke patients?

A 
Occupational Therapists
Physiotherapists
Speech and Language therapist
Dietician
Counsellors
Social workers
27
Q

State 6 possible complications of a stroke?

A 
Infection (aspiration pneumonia, UTI, septicaemia)
Thromboembolism (PE, DVT)
Hydration and nutritional difficulties
Seizures
Pressure sores
Seizures
Depression
28
Q

Suggest 4 implications of a diagnosis of epilepsy might have on a patient?

A

Driving (only after 1yr of seizure free)
Cannot operate heavy machinery or drive HGVs
Unable to work in armed forces, pilot or train driver
Have showers instead of baths incase of seizure

29
Q

Give 4 presentation symptoms of multiple sclerosis?

A

Usually mono symptomatic:

Unilateral optic neuritis
Numbness/Tingling in limbs
Leg weakness
Brainstem/Cerebellar symptoms - DANISH (Dysdiadochokinesis, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia)

30
Q

Give 3 possible causes of a subarachnoid haemorrhage?

A

Rupture of berry aneurysm
Congenital AV malformations
Trauma

31
Q

State 2 diagnostic investigations for a subarachnoid and what you will see?

A

CT head -Obvious bleed

Lumbar puncture - CSF will be bloody or xanthachromic due to blood breakdown (billirubin)

32
Q

Give the definitive treatment for subarachnoid haemorrhage?

A

Obliteration of aneurysm by surgical clipping OR

insertion of fine wire coil

33
Q

State 4 possible complications of subarachnoid haemorrhage?

A 
Rebleeding
Cerebral ischaemia
Hydrocephalus
Stroke
Death
34
Q

How might a sub dural haemorrhage present?

A

Fluctuating levels of consciousness +/- intellectual slowing, sleepiness, headache, personality change

35
Q

What is the management of a sub dural haemorrhage?

A

Irrigation/evacuation via:
1st - Burr hole craniostomy
2nd - Craniotomy

36
Q

Give 4 causative organisms of meningitis?

A

Neisseria Meningitides
Streptococcus pneumoniae
Enteroviruses
Mycobacterium tuberculosis

37
Q

Apart from blood tests, which investigations can you do in meningitis and what order?

A

CT head to rule out high ICP then lumbar puncture as there is risk of coning

38
Q

Describe 3 differences seen on analysis of the CSF between viral and bacterial meningitis?

A

Appearence: Viral clear vs Bacterial cloudy

Glucose levels: Viral normal vs Bacterial low

Protein levels: Viral low vs Bacterial high

Organisms on stain/culture: Viral non seen vs Bacterial seen

39
Q

Give 4 steps in the immediate management of meningitis?

A

ABC - O2, fluids
Abx - Benzyl penicillin, Cefotaxime, ?Aciclovir
Dexamethasone
Investigations (CT/LP)

40
Q

State 3 possible complications of meningitis?

A

Hydrocephalus
Brain abscess
Epilepsy
Focal neurological deficits

41
Q

State 4 features of myopathic facies?

A 
Snarl
Poor smile
Looks sad
Unable to whistle
Drooping mouth
42
Q

Give 3 ways in which you can manage mysthania gravis?

A

Anticholinesterase medication (neostigmine)
Corticosteroids
Immunosuppressors (azothioprine)
Plasmaphoresis

43
Q

Give 5 possible causes of falls in the elderly?

A 
Postural hypotension
Joint problems/instability (OA)
Muscular weakness (proximal myopathy, hemiparesis, diabetic neuropathy)
Visual problems (macular degeneration)
Balance problems (inner ear disease
Epilepsy
44
Q

In bacterial meningitis what will you have to do for public health measures?

A

Prevention household and other close contacts have to be given abx prophylaxis (rifampicin for 2 days). Also Vaccination against serogroups A and C

45
Q

State 4 possible sideeffects seen in long term L-DOPA treatment of parkinsons disease?

A

End-of-dose deterioration of function
On/off oscillations
Freezing during movement
Dose failure (drug resistance)

46
Q

Where would you perform a lumbar puncture?

A

Plane of iliac crests through the level L3/4

Medicine (17 decks)

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