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5th year countdown > Neurology > Flashcards

Neurology Flashcards

1
Q

Main features of lewy body dementia

A

Pschiactric/memory before movement disorder.

Episodic
Visual hallucinations → pleasant
Progressive memory loss
Mobility problems

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2
Q

CJD

A 
Prion disease - rapidly worsening symptoms over few months
Sporadic - rare
Varient - mad cow disease
Familail/inherited
Iatrogenic
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3
Q

Cause Parkinson

A

↓ dominergic neurones in substantia nigra in nigrostriatrial pathway - important for initiating and facilitate movement

  • lose 80% of neurones before clinical symptoms
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4
Q

Parkinson Triad

A

Bradykinesia
Rigidity
Tremor - pill rolling

Micographoa, ↓ blink, hypomimic face, cogwheel, ↓ postural reflexes

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5
Q

Mgmt of tremor in PD

A

anticholinergic - benzhexol

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6
Q

Mgmt of nausea & vomiting in PD

A

Domperidone - doesn’t cross BBB

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7
Q

Cannot tolerate levodopa

A

Dopamine agonist - bromocriptine

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8
Q

Acute psychosis in PD

A

reduce the parkinson medication they are on that could be causing psychotic symptoms

May need antipsychotic - atypical e.g. clozapine (typicals could add in more parkinson symptoms)

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9
Q

Uncontrolled despite maximum oral therapy

A

Apomorphine - give domperidone prophylactic

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10
Q

Tx of restless leg syndtome

A

Ropinirol, pramipexole, levodopa, gabapentin

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11
Q

What should you consider in someone presenting with parkinson’s before mgmt?

A

Cause of parkinson’s

Is this parkinson’s disease? Parkinsonism? Or parkinson’s plus

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12
Q

Mgmt of parkinsons

A
  1. Replace dopamine - L-DOPA (levodopa or carbidopa)
  2. Dopamine agonist (bromocriptine, cabergoline, pramipexole, ropiniroel)
  3. Stop breakdown of dopamine
    a) MAO-B inhibitors (Selegine)
    b) COMT inhibitors
    c) dopamine decarboxylase inhibitors
  4. Tremors: anticholinergic - benzhexol
  5. Glutamate antagnost - amantadine
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13
Q

Parkinson plus syndrome

Multiple system atrophy

A 
Parkinsoniam
Autonmic disturbance 
Cerebellar signs
Lean to side on walking - pisa signs  
3 subtypes

→ parkinson or cerebella dominant

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14
Q

Progressive supra nuclear palsy

A

Parkinsonism
Vertical gaze palsy
Cognitive deterioration

  • Doesn’t response well to L-dopa → dopamine agonist
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15
Q

Corticobasal degeneration

A

Parkinsonism
Cerebellar signs
Poor executive function - alien limb - clumsiness, jerking

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16
Q

Facial grimacing, writhing movements of arms + Fhx

A

Huntingdon’s disease

17
Q

Tremor both arms, worse outstretch (positional), no present at rest, improves with alcohol

A

Essential tremor - BB

18
Q

Rapidly progressive memory over last few months + jerking

A

CKD

19
Q

Tremor worse at rest, unilateral stiffness, moving slowly

A

Idiopathic parkinson’s disease

20
Q

Difficulty walking, falls backwards, rigidity, difficult looking downwards

A

Progressive supra nuclear palsy

21
Q

Walks slowly, leans to left, fainted, urge incontinencem BP drops when standing

A

Multisystem atrophy

22
Q

Multiple sclerosis

Background

A 
Chronic, inflammatory, multifocal, demyelinating disease of CNS
• UMN 
• W>M, 20-50
• Northern european + N america 
• genetic
23
Q

Multiple sclerosis
CF
Signs on exam

A 
Hours - days - depends where lesion is 
Optic neuritis
Diplopia
Weakness
Spasiticy 
Paraesthesia 
↓ co-ordination

UMN
Lhermittes sign

24
Q

What is Lhermittes sign

A

Bend head forward get shooting pains in limbs

25
Q

3 subtypes

A

Relapsing remitting - most common (80% become secondary progressive)
primary progressive
secondary progressive

26
Q

Diagnosis of MS

Criteria

A

Bloods: vasculitic screen
Imaging: > 2 lesions on MRI
CSF analysis: ↑IgG

McDonald’s criteria - dissemination in space and time of CNS lesions

27
Q

Mgmt of MS

A
  • Education + counselling
  • Acute attack - high dose steroids - methylpred
  • Prevention of relapse - immunomodulators - interferon beta
  • Symptom mgmt - analgesis for neuropathic pain, Tx depression
  • Physiotherapy
28
Q

Myaesthenia Gravis

  • who does it commonly effect
  • CF
  • does it effect eyes
  • what makes it worse
  • what happens if they count to 50
A

Young women with muscle weakness
Autoimmune condition (other conditions?)
Antibody to Each receptor on post-synaptic membrane
Progressie weakness, swallowing, eye involvement (bilateral ptosis, diplopia)
Worse in pregnancy
Sensation, tone & reflexes normal
Voice will tail off when count to 50

29
Q

Gold standard test for MG

A

Tensillon test

30
Q

What happens on EMG

A

↓ muscle action after continuous stimulation

31
Q

Lambert-Eaton Syndrome - what cancer is associated with

A

Small cell lung cancer

32
Q

Cause

A

Pre-synapri membrane antibody to Ca receptor

33
Q

Any eye signs

A

no

34
Q

LES + exercise

A

Improves

35
Q

EMG for lambert-eaton

A

↑ muscle action after continuous stimulation

36
Q

24 female, unilateral ↓vision, painful

A

Optic neuritis

37
Q

pregnant lady, ↑ muscle weekness + double vision and dropping eyelids, can’t keep her head up

A

Myaesthenia gravis

38
Q

↑ muscle weakness, ↑ after walking dog, clothing baggy, hoarse voice, cough

A

Lambert-Eaton syndrome with SC lung cancer

39
Q

Pain in L eye, weakness on R leg, 2 months earlier had pain and double vision

A

Multiple sclerosis - 2 lesions, separated in time.

5th year countdown (17 decks)

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