Neurology Flashcards
A common mnemonic for decreased GCS is AEIOU TIPS. Which of the following is one of the following is included in the mnemonic?
a) Toxicity
b) Ethanol
c) Epilepsy
d) Anion gap
e) Stress
C.
AEIOU TIPS
Alcohol/Acidosis
Epilepsy
Infection
Oxygen (hypoxia)/opiates
Uraemia
Temperature/Trauma (especially head)
Insulin (too little or too much)
Psychogenic / Poisoning
Stroke
For patients in a coma, which one of the following is a universal antidote?
a) Thiamine 100 mg IV
b) Flumazenil 0.2 mg IV
c) Dextrose 100ml 10%
d) Naloxone 0.4 - 2 mg SC
e) Physostigmine 1 mg IV
A.
Flumazenil should only be used in select patients with a benzodiazepine overdose (i.e. children with accidental ingestion).
Dextrose is a universal antidote but at 50ml of 50%.
Naloxone is also a universal antidote but is given IM or IV. Beaware with newer drugs being mixed with fentanyl higher doses maybe needed.
Physostigmine is a reversible acetylcholinesterase inhibitor useful in the treatment of central anticholinergic delirium but has multiple side effects if used in the wrong patient.
Which of the following in overdose cause constricted pupils?
a) Tricyclic antidepressants
b) Organophosphates
c) Amphetamines
d) Barbituates
e) Quetiapine
B.
Contricted pupils occur from cholinergic agents like organophosphates and opiates.
Normal or dilated occur in hypothermia, barbiturates and antipsychotics (except olanzapine - constricted)
Dilated occurs with anoxia, anticholinergic agents (TCAs, atropine), Methanol, cocaine, opioid withdrawal, amphetamines and hallucinogens.
Which of the following is effective for migraine treatment?
a) Codeine
b) Metoclopramide
c) Magnesium
d) IV fluids
e) Oxygen
B.
Antidopinergic treatment in the form of Metoclopramide, prochlorperizine and diphenhydramine are very effective. Usually given as an infusion with IV fluids. Opiates including codeine have minimal benefit and can cause rebound headaches. Oxygen can be used in cluster headaches.
Other effective treatment include antiinflammatories such as ketorolac 30mg IV and 10mg of dexamethasone IV.
Which of the following statements is correct regarding the Ottawa SAH rule?
a) It can be used in any age group.
b) Previous headache history is not important.
c) Patients should be investigated if over the age of 50 years.
d) Patients should be investigated if the headache occured during exertion.
e) Patients should be investigated if they have limited neck rotation.
D.
Inclusion criteria: The rule is for patients older than 15 years with a new severe non-traumatic headache reaching maximal intensity within 1 hour.
Exclusion criteria: new neurologic deficits, previous aneurysms, SAH, brain tumours or history of recurrent headaches (>/= 3 episodes over the course of >/= 6 months).
Investigate if any of the following are present:
Age over 40 years
Neck pain or stiffness
Witnessed LOC
Onset during exertion
Thunderclap headache (instantly peaking pain)
Limited neck flexion on examintion
In regards to back pain which one of the following is deemed a ‘red flag’?
a) Steroid use
b) Age over 40
c) History of an SCC
d) Weight loss while on a diet
e) Family history of sciatica
A.
You can use the mnemonic TUNAFISH for red flag symptoms:
Trauma
Unexplained weight loss
Neurological symptoms (don’t forget to ask about symptoms of cauda equina)
Age over 50
Fever
IVDU
Steroid Use
History of Cancer (Prostate, Renal, Breast, Lung)
The San Fransisco Syncope Rule is used to identify high risk patients. Which of the following is included in the rule?
a) Cardiomyopathy
b) High Haematocrit
c) Abnormal EEG
d) SBP <100 at triage
e) Shortness of breath
E.
CHESS:
CHF or hx of CHF
Hct: Low
ECG: Abnormal
SOB: Hx of dyspnoea
SBP: <90 at triage
Which one of the following corresponds to a stroke in the anterior cerebral artery?
a) Contralateral hemianaesthesia and hemiparesis (legs > arms), gait apraxia, altered mental status and imapired judgement.
b) Contralateral hemianaesthesia and hemiparesis (arms/face > legs), contralateral homonymous hemianopsia, ipsilateral gaze.
c) Contralateral homonymous hemianopsia, cortical blindness, impaired memory.
d) Wide variety of cranial nerve, cerebellar, and brainstem defeicits, vertigo, nystagmus, visual field deficits, dysphagia, dysarthria, facial hypoesthesia, syncope, ataxia. Loss of pain and temerpature sensation in ipsilateral face and contralateral body.
e) Upper limb weakness bilaterally worse than lower limbs.
A.
Which one of the following corresponds to a stroke in the middle cerebral artery?
a) Contralateral hemianaesthesia and hemiparesis (legs > arms), gait apraxia, altered mental status and imapired judgement.
b) Contralateral hemianaesthesia and hemiparesis (arms/face > legs), contralateral homonymous hemianopsia, ipsilateral gaze.
c) Contralateral homonymous hemianopsia, cortical blindness, impaired memory.
d) Wide variety of cranial nerve, cerebellar, and brainstem defeicits, vertigo, nystagmus, visual field deficits, dysphagia, dysarthria, facial hypoesthesia, syncope, ataxia. Loss of pain and temerpature sensation in ipsilateral face and contralateral body.
e) Upper limb weakness bilaterally worse than lower limbs.
B.
Which one of the following corresponds to a stroke in the posterior cerebral artery?
a) Contralateral hemianaesthesia and hemiparesis (legs > arms), gait apraxia, altered mental status and imapired judgement.
b) Contralateral hemianaesthesia and hemiparesis (arms/face > legs), contralateral homonymous hemianopsia, ipsilateral gaze.
c) Contralateral homonymous hemianopsia, cortical blindness, impaired memory.
d) Wide variety of cranial nerve, cerebellar, and brainstem defeicits, vertigo, nystagmus, visual field deficits, dysphagia, dysarthria, facial hypoesthesia, syncope, ataxia. Loss of pain and temerpature sensation in ipsilateral face and contralateral body.
e) Upper limb weakness bilaterally worse than lower limbs.
C.
Which one of the following corresponds to a stroke in the vertebral/basilary artery?
a) Contralateral hemianaesthesia and hemiparesis (legs > arms), gait apraxia, altered mental status and imapired judgement.
b) Contralateral hemianaesthesia and hemiparesis (arms/face > legs), contralateral homonymous hemianopsia, ipsilateral gaze.
c) Contralateral homonymous hemianopsia, cortical blindness, impaired memory.
d) Wide variety of cranial nerve, cerebellar, and brainstem defeicits, vertigo, nystagmus, visual field deficits, dysphagia, dysarthria, facial hypoesthesia, syncope, ataxia. Loss of pain and temerpature sensation in ipsilateral face and contralateral body.
e) Upper limb weakness bilaterally worse than lower limbs.
D.
Which of the following is a relative contraindication to tPA for stroke?
a) Recent LP
b) Brain tumour
c) INR > 1.7
d) Platelet count <100,000
e) Major surgery within the past 14 days
E.
Relative exclusion criteria for tPA:
Only minor or repidly improving symptoms
Very severe symptoms NIHSS>22 or coma
Major surgery within the past 14 days
GI or urinary haemorrhage within the past 21 days
Which of the following is an absolute contraindication to tPA for stroke?
a) Only minor or repidly improving symptoms
b) Very severe symptoms NIHSS>22 or coma
c) Major surgery within the past 14 days
d) GI or urinary haemorrhage within the past 21 days
e) Blood glucose <2.8 or >22 mmol/L
E.
Absolute exclusion criteria for tPA:
Suspected SAH
Previous intracranial haemorrhage
Cerebral infarct or severe HI within the past 3 months
Recent LP or rterial puncture at a non-compressible site
Brain tumour
Metastatic cancer diagnosis
BP >185 mmHg systolic, or >110 mmHg diastolic
Bleeding diathesis
Prolonged PT >15s or INR >1.7
Platelet count <100,000
Blood glucose <2.8 or >22 mmol/L
Seizures at onset with postictal impairments
