Neurology Flashcards
What are some causes of transient loss of consciousness?
- Cardiac (4)
- Neuro (3)
- Other (2)
- Cardiac - vasovagal, arrhythmias, HOCM, postural hypotension
- Neuro - epilepsy, NEAD, migraines
- Other - hypoglycaemia, vestibular disorders
What are some possible diagnoses for four limb weakness?
GBS Acute cervical cord syndrome Cauda equina Myasthenia gravis Acute myositis
What type of infections can precipitate GBS?
Respiratory or GI infections
What would you expect to see on LP for GBS?
What other test can you order to support your diagnosis?
Raised protein with normal cells and glucose
Nerve conduction studies
What is the general management for GBS? (4)
- Frequent obs - peak flow, standing and lying BP (autonomic dysfunction)
- IV immunoglobulin
- DVT prophylaxis
- Pain relief
What antibodies are there in myasthenia gravis? (2)
What other test is required?
ACh receptor antibodies
MuSK
CT thymus
Which medications are used in myasthenia gravis? (2)
What treatment is available for exacerbations of myasthenia gravis?
Acetylcholinesterase inhibitor e.g. pyridostigmine
Immunosuppression e.g. prednisolone, azathioprine
IV immunoglobulin
How long does it usually take people to recover from Bell’s palsy?
When should steroids be considered?
Differential diagnoses for Bell’s palsy?
3-4 months
If presenting within first 72h
Ramsay-Hunt syndrome, Lyme disease, sarcoidosis, trauma, inner ear (e.g. otitis media, cholesteatoma, acoustic neuroma)
What would you expect to find if these nerves are compressed?
- Common peroneal nerve
- L5 nerve root
- weakness of dorsiflexion and eversion of foot
2. weakness of inversion and eversion of foot
What are the symptoms of optic neuritis? (4)
What can cause optic neuritis? (6)
Pain on eye movements, impaired colour vision, RAPD, scotoma
MS, sarcoidosis, SLE, Lyme, mumps, measles
What are you trying to show when testing for MS?
What are the main tests for MS?
What criteria is used to diagnose MS?
Dissemination in time and space
Time - 2 episodes of neurological symptoms OR presence of oligoclonal bands on LP
Space - MRI brain and spine
McDonald criteria
What lifestyle advice should you give those with MS? (4)
When should disease modifying agents be considered?
What is the treatment for a relapse of MS?
Inform DLVA, stop smoking, avoid stress, regular exercise
More than 2 relapses in 2 years
PO/IV methylprednisolone
What is the management for migraines?
- Acute (3)
- Prophylactic (3)
- NSAIDs, paracetamol or triptans; anti-emetics
2. Propranolol, amitryptiline, topiramate
What is the management for cluster headaches?
- Acute (2)
- Prophylactic (3)
- High flow oxygen, SC triptans
2. Verapamil, lithium, prednisolone (short term)
What are some general measures for managing raised ICP? (4)
Head tilt
Avoid hypotension
Maintain euvolaemia
Maintain normal CO2 (as causes vasodilation)
What is the most common type of malignant brain tumour?
What is the most common type of benign brain tumour?
Glioblastoma multiforme
Meningioma
What are the types of focal seizures?
Which medication is used first-line?
Simple focal, focal dyscognitive, focal to GTC
Carbemazepine or lamotrigine
What are the types of generalised seizures? (4)
What medication is used first-line?
Tonic-clonic, absence, atonic, myoclonic
Sodium valproate for all plus:
- ethosuxamide for absence
- lamotrigine for GTC
What is the criteria for formally diagnosing epilepsy? (3)
- 2 or more unprovoked seizures more than 24h apart
- 1 unprovoked seizure with probability of further seizures similar to (1)
- Diagnosis of epilepsy syndrome
Which investigations can you order after a suspected seizure? (4)
Exclude reversible causes e.g. blood glucose, infection, electrolytes
ECG
EEG
MRI
Which anti-epileptic drug is most likely to cause:
- Rash?
- Agranulocytosis?
- PCOS?
- Lamotrigine
- Carbamazepine
- Sodium valproate
What should people with epilepsy be told to avoid? (4)
Working at height
Cycling in traffic
Working with dangerous machinery
Alone in a bath
What are the driving rules for epilepsy?
Reapply for licence after 1 year (10 years if lorry driver)
One-off seizure, no risk of another seizures - 6 months (5 years if lorry driver)
What conditions are associated with epilepsy?
Neurofibromatosis
Tuberous sclerosis
Can you remember the scoring for GCS? - eyes
Eyes:
- No movement
- Opens eyes in response to pain
- Opens eyes in response to speech
- Spontaneous movements of eyes
Can you remember the scoring for GCS? - verbal
Verbal:
- No verbal response
- Incomprehensible sounds
- Inappropriate words or cannot use language properly
- Confused but able to engage
- Able to engage in conversation
Can you remember the scoring for GCS? - motor
Motor:
- No motor response
- Extension to pain
- Abnormal flexion to pain
- Normal flexion in response to pain
- Localises to pain
- Obeys commands
Which type of intracranial bleeds causes the following on CT?
- Crescent shape
- Biconvex shape
Which blood vessels are most likely to be affected?
- Subdural - bridging veins
2. Extradural - middle meningeal artery
