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finals > neurology > Flashcards

neurology Flashcards

1
Q

features of generalised epilepsy

A
  • Lack of aura
  • Young age of onset
  • Photosensitivity and myoclonus
  • Seizures within 24hr of awakening
  • History of alcohol or sleep deprivation
  • Family history of IGS
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2
Q

features of focal epilepsy

A 
focal aura
automatisms - lip smacking, tongue biting, finger rolling
post attack confusion
nocturnal events
history of perinatal injury
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3
Q

types of generalised seizures

A

absence - brief pause the carries on as normal
tonic clonic - LOC. limbs stiffen (tonic) then jerks (clonic)
myoclonic -sudden jerking of limb/face/truck
atonic - sudden loss of muscle tone causing fall, no LOC

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4
Q

types of focal seizures

A

simple - awareness unimpaired, no postictal symptoms
complex - awareness is impaired, aura
evolving to bilateral convulsive - starts focalliy but spreads and becomes convulsive (2/3 of all focal seizures)

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5
Q

treatment for epilepsy

A

focal - lamotrigine, levetiracetam, carbamazepine

generalised - valproate, lamotrigine, levetiracetam

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6
Q

define status epilepticus

A

repeated/prolonged seizure activity

defined as 2 or more seizures without full recovery in between or continuous activity for > 30 min

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7
Q

investigation of epilepsy

A 
clinical history + eye witness
ct head
EEG
glucose
electrolytes
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8
Q

management of Status epilepticus

A

maintain airway
oxygen
IV access and bloods (FBC, U&Es, LFTs, glucose, Tox screen, anticonvulsant levels)
IV fluids
Lorazepam bolus (second dose if no response)
in seizures continue = IV phenytoin infusion

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9
Q

define MS

A

an inflammatory demyelinating disease characterised by the presence of episodic neurological dysfunction in at least 2 areas of the CNS separated in time and space

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10
Q

Risk factors of MS

A

genetics - HLA A3
Fhx
smoking
EBV infection

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11
Q

how might someone with MS present

A 
optic neuritis
transverse myelitis
sensory changes (burning or wet sensation)
leg weakness
increased tone
ataxia
diplopia
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12
Q

define transverse myelitis

A

inflammation of the spinal cord most commonly in the thoracic (T1-12) region

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13
Q

features of transverse myelitis

A

weakness and sensory loss below the level affected

urinary incontinence

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14
Q

diagnosis of MS

A

MRI gadolinium brain
LP - CSF oligoclonal bands, raised IgG
rule out other causes (B12, lyme serology, TSH)

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15
Q

management of MS

A

IV methylprednisolone for relapses
Beta interferon to decrease frequency of relapses
biologics - natalizumab, alemtuzumab
fingolimod, dimethyl fumarate
symptom relief - muscle relaxants, anticholinergics

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16
Q

define myasthenia gravis

A

autoantibodies against ACh receptors causing destruction of post synaptic membrane therefore decreasing muscle fibre A.P

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17
Q

presentation of myasthenia gravis

A

muscle fatigue, worse with activity
limb weakness - difficulty standing up from chair, using stairs
ocular muscle weakness - squints and diplopia
dyspnoea

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18
Q

investigations for myasthenia gravis

A

ACh receptor antibodies
muscle specific tyrosine kinase antibodies
CT to look for thymoma

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19
Q

management of myasthenia gravis

A

cholinesterase inhibitor - pyridostigmine
corticosteroids for ocular symptoms
plasma exchange and IV IG
thymectomy

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20
Q

define a myasthenic crisis

A

development of respiratory failure due to weakness of respiratory muscles

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21
Q

what should be monitored in a myasthenic crisis

A

serial FVC and NIF

both low is an indication for ventilation

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22
Q

clinical features of TACS

A

hemiparesis + higher cortical dysfunction + homonymous hemianopia

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23
Q

clinical features of PACS

A

isolated higher cortical dysfunction
or
2 of hemiparesis, hemianopia, higher cortical dysfunction

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24
Q

clinical features of POCS

A

isolated hemianopia

cerebellar/brainstem symptoms (nystagmus, ataxia)

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25
Q

clinical features of LACS

A 
pure motor stroke
or
pure sensory stroke
or
sensorimotor stroke
or
ataxic hemiparesis
or
clumsy hand dysarthria
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26
Q

vessel affected in TACS

A

proximal middle cerebral or internal carotid

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27
Q

vessel affected in PACS

A

MCA

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28
Q

vessel affected in POCS

A

vertebral/basilar artery

or posterior cerebral artery

29
Q

vessel affected in LACS

A

small perforating arteries

30
Q

list some investigations for a person presenting with stroke

A 
CT head - rule out haemorrhagic stroke
ECG - AF
PT ant aPTT - coagulopathy
carotid ultrasound
glucose and serum electrolytes
31
Q

management of ischaemic stroke

A

if presented <4.5hrs ago = thrombolysis (alteplase)
aspirin
endovascular stent
thrombectomy

32
Q

secondary prevention of stroke

A 
atorvastatin
antihypertensive - Ramipril, thiazide, CCB
antiplatelets - clopidogrel, aspirin
warfarin if AF
smoking cessation
33
Q

management of TIA

A

control risk factors (smoking cessation, statins antihypertensive, aspirin)
clopidagrel or aspirin
carotid endarterectomy if >50% stenosed and symptomatic or >70% and aasymptomatic

34
Q

what is the ABCD2 score

A

risk score for predicting stroke after a TIA

35
Q

what makes up the ABCD2 score

A

a = age>60 (1)
b = BP>140/90 (1)
c = clinical feature - unilateral weakness (2), speech problems w/o weakness (1)
d = duration - >59min (2), <1hr (1)
d = diabetes (1)
score of 6 = high risk so >4 requires specialist review

36
Q

Presentation of a subarachnoid haemorrhage

A

thunderclap headache
LOC
photophobia
nausea and vomiting

37
Q

investigations for a subarachnoid haemorrhage

A 
CT head ( confirms diagnosis, hydrocephalus, infarction)
CT/MR angiogram (find bleeding source)
LP (xanthochromia)
electrolytes
glucose
ECG 
troponin
38
Q

management of subarachnoid haemorrhage

A

aneurysm repair ( interventional radiology preferred to open)
nimodipine - prevents vasospasms
sodium replacement if needed

39
Q

Presentation of Parkinson’s

A

non motor - loss of smell, constipation, erectile dysfunction, depression
TRAPS (tremor, rigidity, akinesia, postural/gait, speech and swallowing)

40
Q

treatment for parkinson’s

A 
encourage physical activity
carbidopa (levedopa +dopa decarboxylase inhibitor)
dopamine agonist (ropinirole)
MAOB inhibitor (selegiline)
COMT inhibitor (entacapone)
deep brain stimulation
41
Q

what is cervical spondylosis

A

OA of the cervical spine leading to MSK symptoms

osteophyte formation can irritate/damage/compress the spinal cord and/or nerve roots resulting in neurological symptoms

42
Q

signs and symptoms of cervical spondylosis

A 
neck pain, stiffness, crepitations
stabbing/dull pain in UL
decrease reflexes 
leg weakness, foot drop
cervical muscle spasms
43
Q

management of cervical spondylosis

A 
physiotherapy
NSAIDs
muscle relaxants
dexamethasone injections
surgical nerve decompression
44
Q

UMN signs

A 
increase tone
hyperreflexia
spasticity
positive babinski
clonus
45
Q

LMN signs

A 
decrease tone
hyporeflexia
flaccid muscle weakness
fasciculations
muscle wasting
46
Q

Management of MND

A

riluzole

symptom management - NG tube/blended food for dysphagia, antidepressant, muscle relaxants for spasticity,

47
Q

types of MND

A

amyothrophic lateral sclerosis (cortex and ant. horn. UMN + LMN)
progressive bulbar palsy (CN 9-12. LMN)
progressive muscular atrophy (ant. horn. LMN)
primary lateral sclerosis (betz cells in motor cortex. UMN)

48
Q

symptoms of hyper active delirium

A 
heightened arousal
hallucinations
inappropriate behaviour
agitation
restlessness
49
Q

symptoms of hypoactive delirium

A

lethargy
reduced motor activity
incoherent speech
lack of interest

50
Q

what 4 features are required for a diagnosis of delirium

A

disturbance in attention
change in cognition
acute onset
evidence of a known cause

51
Q

management of delirium

A

identify and manage precipitating cause
calm environment
haloperidol

52
Q

symptoms of alzheimer’s

A

memory loss
personality change
speech and motor deficit
nominal dysphasia

53
Q

symptoms of frontotemporal dementia

A 
memory loss
personality change
language impairment
change in social behaviour 
self neglect
54
Q

symptoms of dementia with LB

A

parkinsonism
visual hallucinations
cognitive impairment
REM sleep disturbance

55
Q

symptoms of vascular dementia

A

impaired executive functions
mood changes
disinhibition
poor attention

56
Q

disadvantages of the MMSE

A

not sensitive to mild changes
unable to detect deficiency cause by a focal neurological lesion
insensitive in measuring progression in severe dementia

57
Q

management of Alzheimer’s

A

cholinesterase inhibitor - donepezil
antidepressant - sertraline
antipsychotic - olanzapine

58
Q

management of vascular dementia

A

aspirin
warfarin if embolic cause
BP. glycaemic, statin control
carotid endarterectomy

59
Q

presentation of migraine

A

unilateral throbbing headache
aura (nausea, scotomas, flashing lights, limb sensory/motor disturbance)
photo/phono/osmophobia

60
Q

treatment of migrains

A

NSAIDs/aspirin
anti emetic (metoclopramide)
sumatriptan

prophylaxis
propranolol
amitriptyline
valproate

61
Q

what medications commonly cause headaches from overuse

A

NSAIDs
triptans
opioids

62
Q

presentation of cluster headaches

A 
severe unilateral
ipsilateral autonomic features: 
red watery eye, constricted pupiil
drooping eyelid
absence of nausea, photophobia
63
Q

management of cluster headaches

A

s/c sumatriptan

prophylaxis = verapamil

64
Q

presentation of EDH

A 
lucid period
headache
vomiting
confusion
if left untreated - ipsilateral pupil dilation. hemiparesis, coma, death
65
Q

CT finding of EDH

A

lens shaped haemorrhage

66
Q

presentation of SDH

A 
elderly/alcoholics
fluctuating consciousness 
headache
seizures 
unsteadiness
67
Q

CT finding of SDH

A

midline shift

crescent shaped haemorrhage

68
Q

presentation of idiopathic intracranial hypertension

A

overweight
high pressure headache
visual disturbances (decrease acuity, loss of field, photophobia)
optic disc swelling

69
Q

medications that may trgger idiopathic intracranial hypertension

A 
tetracycline antibiotics
isotretinoin
contraceptives
steroids
levothyroxine

finals (13 decks)

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