Neurology Brief Flashcards
Describe trigeminal neuralgia.
Paroxysmal attacks of severe intense burning pain in the trigeminal distribution.
What is the first-line medical treatment for trigeminal neuralgia?
Carbamazepine.
What is the second-line medical treatment for trigeminal neuralgia?
. 1st line: Carbamazepine
2nd line: Gabapentin and amitriptyline
What is the most common virus causing trigeminal neuralgia?
Herpes Zoster Virus (HZV or varicella).
Do you know two important case scenarios related to trigeminal neuralgia?
1. Paroxysmal attacks of pain at face + redness
- Paroxysmal attacks of pain at face + history of redness at face
- Paroxysmal attacks of pain at face + redness = varicella neuralgia.
- Paroxysmal attacks of pain at face + history of redness at face = post-herpetic neuralgia.
1st line of TTT of trigeminal neuralgia……………….
1st line of TTT of bipolar in pregnancy………….…..
1st line of TTT of epilepdy in pregnancy…..………..
1st line of TTT of complex partial seizure…………..
1st line of TTT of trigeminal neuralgia………………. carbamazipine
1st line of TTT of bipolar in pregnancy………….….. carbamazipine
1st line of TTT of epilepdy in pregnancy…..……….. carbamazipine
1st line of TTT of complex partial seizure………….. carbamazipine
Carbamazepine is also linked to fetal abnormalities, but not with intellectual impairment, and should not be used during pregnancy.4
Lamotrigine poses a lower risk during pregnancy and can be prescribed to breastfeeding mothers, with 2.7% of babies having congenital abnormalities; however, it has limited efficacy in preventing mania.
Lithium is the most effective mood stabiliser,6 with demonstrated efficacy in the prophylaxis of postpartum relapse,7 and should be considered for women with seveare bipolar disorder. RACGP
MCC/ MC RF of intra-cranial Hge…
HTN
A condition where weakness starts at lower limbs and ascends upward, often associated with a history of gastrointestinal infection or vaccination.
Guillain-Barre Syndrome (GBS).
CSF findings in GB$……………………………………..
cyto- albuminous dissociation
How is Guillain-Barre Syndrome (GBS) treated?
Plasmapheresis or IVIG.
enzypenicilin for propholayxis
TTT of GB$ with affected respiratory ms………….
plasmapheresis
Most imp monitoring of pt with GB$ ………………..
Most imp monitoring of pt with GB$ ……………….. lung vital capacity (spirometry)
Pt with ptosis, diplopia & muscle weakness after periods of activity which improves with rest………
Dx: myasthenia gravis
What is the most important sign in a patient with Guillain-Barre Syndrome (GBS)?
Areflexia.
Describe Myasthenia Gravis.
A condition characterized by ptosis, diplopia, and muscle weakness that improves with rest.
Most common cp………MG
drooping eyelid
Most common tumour associated ……MG
thymoma
Most imp inv……..MG NO longer done
Most imp inv……..edrophonium test
Drug of choice……MG
physostigmine and neostigmine
pt with prolonged use of cortisone develops ms weakness…
pt with prolonged use of cortisone develops ms weakness… Dx: steroid- induced myopathy
Pt with sudden severe headache then develops nausea& vomiting…
Dx: Sub-Arachnoid Hge (SAH)
What is the most common association with Myasthenia Gravis?
Thyrotoxicosis.
What is the most common complication of Myasthenia Gravis?
Respiratory impairment.
How is Subarachnoid Hemorrhage (SAH) managed?
Coiling or restenting (Endovascular therapy).
What is the first step in managing Subarachnoid Hemorrhage (SAH)?
CT without contrast.
If CT finding in equivocal/ best diagnostic test:SAH
lumbar puncture (CSF analysis)
CSF findings in SAH: ++RBCs and
xanthochromia
Pt with bilateral renal mass develops sudden severe headache…
Dx: SAH DT berry aneurysm rupture
After TTT of SAH, pt develops hypo-natremia…
Dx: SIADH
Young female with acute onset blindness, no H/O ophthalmological disorder=
Young female with acute onset blindness, no H/O ophthalmological disorder= multiple sclerosis (MS) until proven otherwise
Young female with patchy neurological manifestations …
DD: multiple sclerosis OR conversion disorder
What is the important medication given to patients with SAH to decrease vasospasm?
Nimodipine.
Describe the presentation in a young female with optic neuritis.
Multiple sclerosis (MS) until proven otherwise.
What is the first step in diagnosing multiple sclerosis (MS)?
Brain MRI (demyelination) with or without gadolinium.
If MRI findings are inconclusive, what is the next step in diagnosing multiple sclerosis (MS)? second
CSF analysis (Oligoclonal IgG bands).
Describe the next step for a young female with optic neuritis I vestogation
MRI (not visual evoked response)
3rd choice…………… Multiple sclerosis
Investigation
Visual evoked response
What is the treatment of choice for multiple sclerosis?
IV cortisone high dose
Corticosteroids are the mainstay treatment for acute relapses. Intravenous methylprednisolone is generally used, although oral methylprednisolone has been shown to have similar efficacy.14 Other options include adrenocorticotropic hormone or plasma exchange. Medical treatment is only necessary if the relapse symptoms have a significant impact on quality of life, as treatment may hasten the recovery from a relapse but not the likelihood of recovery or permanent disability.14
What is the diagnosis when patient shaves only one side of their face and combs hair on the other side only?
Hemi-neglect
How do you diagnose hemi-neglect?
Ask the patient to fill in the numbers of a clock
What is the cause of hemi-neglect?
Lesion of the non-dominant (Right) parietal lobe
What is the treatment for heat stroke?
Pt came with T> 40. He worked for prolonged time under sun rays in a hot day.heat stroke…. ……… Dx:
Evaporation cooling
What is the most important way to prevent decubitus ulcers?
Patient repositioning every 2 hours
What is the second most important way to prevent decubitus ulcers?
Air mattress
What is the diagnosis for a patient with an irresistible urge to move legs before or during sleep?
Restless leg syndrome
What is the treatment for restless leg syndrome?
Levodopa
The treatment for restless leg syndrome (RLS) according to RACGP guidelines includes:
- Lifestyle Modifications: Regular exercise, good sleep hygiene, and avoiding caffeine and alcohol.
-
Medications:
- Dopamine Agonists: Pramipexole or ropinirole.
- Alpha-2-delta Ligands: Gabapentin or pregabalin for patients with painful RLS or comorbid insomnia.
- Iron Supplementation: For patients with low ferritin levels.
- Non-Pharmacological Therapies: Leg massages, hot baths, and pneumatic compression devices.
For more detailed information, refer to the RACGP guidelines.
What is the most common association of restless leg syndrome?
Iron deficiency anemia
What is the diagnosis for a patient with hand tremor only?
Essential tremor
What is the first-line treatment for essential tremor?
Beta blockers (DOC)
Pt with rapid progressive dementia+ myoclonus…
Dx: CJD… CO: prion.
What must be confirmed by two physicians to diagnose brain death?
Brain death
What is the diagnosis for weakness and loss of pain and temperature affecting only the upper limb?
Syringomyelia (cord cavitation)
What is the investigation of choice for syringomyelia?
MRI (cavity in the spinal cord)
What is the diagnosis for a diabetic patient with ptosis and down and out gaze?
Oculomotor neuropathy
What is the cause of neuropathy in diabetic patients?
Ischemic
What is the diagnosis for a young female with unilateral pulsating headache with or without aura?
Migraine
What is the first-line treatment for migraines?
NSAIDs
What is the treatment if NSAIDs fail for migraines?
Sumatriptan
What is the treatment if Sumatriptan fail for migraines?
ergotamine
1st line of TTT in pregnant & children: Migraine
paracetamol
1st line of prevention: Migraine
BB
2nd line of prevention: Migraine
amitryptiline
MCC of headache in children: migraine
migraine headache
OCPs is contra-indicated in
pts with migraine with aura
Pt complains of severe band-like headache…
Dx: tension headache
TTT: 1st line…….. massage & relaxation & 2nd line…….. tension
TTT: 1st line…….. massage & relaxation & 2nd line…….. NSAIDs
Headache + severe unilateral retro-orbital pain…
cluster headache
What is the treatment for cluster headaches during an acute attack?
100% O2
What is the diagnosis for a young female with a history of OCPs or vitamin A intake, presenting with severe headache, diplopia, and papilledema?
Pseudotumor cerebri (IIH)
What is the first step investigation in managing pseudotumor cerebri (IIH)?
CT normal
Describe the 2nd step in the diagnosis process mentioned in the content.Pseudotumor cerebri (IIH)
Increase opening pressure and check for normal cerebrospinal fluid.
2nd step: LP… increase opening pressure& normal Cs
What is the most common complication mentioned in the content that can occur with the condition described?
Blindness.
How should the treatment be approached for the condition described in the content?
Stop offending medication and focus on weight loss.
Define the condition characterized by resting tremor, bradykinesia, rigidity, narrow-based shuffling gait, and postural instability.
Parkinsonism.
What is the treatment of choice for Parkinsonism according to the content?
Levodopa.
Describe the condition that can develop in a patient with Parkinsonism leading to symptoms like nausea, vomiting, abdominal distension, and constipation.
Pseudo-obstruction.
What is the diagnosis for a child experiencing recurrent episodes of staring that last 5-15 seconds and then resumes normal activity?
Absence seizure.
How should absence seizures be treated according to the content?
Ethosuximide is the treatment of choice.
Describe the type of seizure that occurs in a child with the first attack of generalized convulsion with fever and evidence of extracranial infection.
Febrile seizure (benign seizure).
What is the recommended treatment for febrile seizures in children according to the content?
Control fever; first-line: paracetamol. If very high: ice packs then paracetamol.
Define the risk of future epilepsy in a patient who has experienced febrile seizures compared to the normal population.
Higher risk.
Risk of future epilepsy in pt with febrile seizure is> normal population
What is the increased risk of future bronchiolitis in a patient who has had bronchiolitis compared to the normal population according to the content?
Higher risk.
Risk of future BA in pt with bronchiolitis is> normal population
Describe the crucial step to take when dealing with a patient experiencing their first seizure.
Ask a witness; very important.
What is the initial investigation recommended for a patient after experiencing their first seizure according to the content?
CT without contrast.
If normal ct for febrile seizure ……
do EEG
Most imp questions to kid with seizure ….
is this 1st attack???
Seizures and driving .…the most recent updates:….vvvvvv imp
Isolated seizures…….
Single seizure on withdrawal of the medication……
Non-compliant patient, Chronic seizure or Recurrent seizure….
Seizures and driving .…the most recent updates:….vvvvvv imp
Isolated seizures…….6 months
Single seizure on withdrawal of the medication……3 months
Non-compliant patient, Chronic seizure or Recurrent seizure….2 years
How should seizures and driving be managed based on the most recent updates mentioned in the content?
Isolated seizures: 6 months; single seizure on withdrawal of medication: 3 months; non-compliant patient, chronic seizure, or recurrent seizure: 2 years.
Other illness and driving:
Hemianopia……
TIA or stroke……..
When to stop anti-epileptic medication…
Other illness and driving:
Hemianopia……never drive
TIA or stroke……..1 month
When to stop anti-epileptic medication… pt free of seizure for 2 Ys
Female on anti-epileptic medication decided to be pregnant…
next step: stop medication (even if cabamazipine is found in choices)
Most safe drug in pregnancy………….
Carbamazipine
Single attack of seizure lasting> 30 min…
status epilepticus
Define the condition characterized by sudden onset vertigo without any other manifestations.
Vestibular neuritis.
Describe the condition characterized by sudden onset vertigo and hearing loss.
Labyrinthitis.
What is the treatment approach for status epilepticus as mentioned in the content?
ABC (airway, breathing, circulation) then IV diazepam.
Paroxysmal attacks of vertigo, tinnitus, ear fullness…..
minier’s disease
Vertigo related to position……………………………………..…
BPPV
Vertigo, tinnitus, neurological manifestation…………..
Acoustic neuroma
What is the most common cause of status epilepticus or recurrent seizures according to the content?
Non-compliance.
Describe Benign Paroxysmal Positional Vertigo (BPPV)
Vertigo related to position, commonly diagnosed using Dix-Hallpike maneuver.
Define Acoustic Neuroma
A condition characterized by vertigo, tinnitus, and neurological manifestations, typically diagnosed with MRI.
How is BPPV diagnosed?
Through the Dix-Hallpike maneuver.
What is the first step in managing suspected stroke cases?
Administration of aspirin.
1st step in management of suspected stroke in PUD pt…..
aspirin
Pt with ischemic stroke presented in the 1st 3 hs………….…..
TPA (best outcome)
What is the most important medication in hemorrhagic stroke?
Anti-hypertensive drugs, particularly oral ACE inhibitors.
Long term management of stroke…………………………..
aspirin & dipyridamole
1st inv in suspected stroke………………………………….……………….
CT
Best inv of stroke……………………………………………….……………….
MRI
Inv on choice in embolic stroke ……………………………………….
Echo, EKG
MC RF of stroke…………………………………..………..
HTN
Stroke pt with hemiplegia affecting LL>UL with marked personality changes…
ACA
Stroke pt with hemiplegia affecting UL>LL with homonymous hemianopia….
MCA
Stroke pt with deep coma/OR/ fall attacks……………..
Vertebra – basilar artery
Stroke pt with contralateral hemiplegia, ipsilateral blindness………..
ICA
Stroke pt with ipsilateral horner $, ataxia and contralateral loss of P, T…
PICA
Stroke pt with uncrossed hemiplegia (paralysis of face& body at the same side)………….…
INTERNAL CAPSULE
Lesions of the optic pathway:
Optic nerve…….
Optic chiasma…..
Optic radiation….
Occipital lobe……
Temporal lobe…..
Parietal lobe…….
Lesions of the optic pathway:
Optic nerve…….unilateral blindness
Optic chiasma…..bitemporal hemianopia
Optic radiation….contralateral homononymous hemianopia
Occipital lobe…… contralateral homononymous hemianopia
Temporal lobe…..contralateral upper quadrantic field defect
Parietal lobe……. contralateral lower quadrantic field defect
MC affected reflex in pt with sciatica……
Ankle reflex
Area of lower limb affected by sciatica…
the whole leg except the medial side
Do lesions in the optic pathway affect vision?
Yes, they can cause various visual field defects depending the location of the lesion.
Describe the area affected by sciatica in the lower limb.
Sciatica affects the whole leg except the medial side.
What is the first-line treatment for sciatica?
Paracetamol is commonly used as the initial treatment for sciatica.
How is sciatica typically diagnosed?
MRI is the investigation of choice forosing sciatica.
1st inv in Duchene muscle dystrophy…..
Best inv in Duchene muscle dystrophy….
1st inv in Duchene muscle dystrophy….. CK
Best inv in Duchene muscle dystrophy…. Muscle biopsy
What are the common manifestations of Vitamin A deficiency?
Night blindness and impaired growth are common symptoms of Vitamin A deficiency.
VITAMIN DEFICIENCY:
Vitamin A …………..
Vitamin D ………….
Adult:
Kids:
Vitamin E….
Vitamin K….
Vitamin C ( ascorbic acid)…most common cause of bleeding in elderly (scurvy)
Thiamine(B1)…..
Riboflavin…..
Niacin……
Vitamin B6…..
B12(cyanocobalamines)… megaloblastic anemia, peripheral neuropathy
VITAMIN DEFICIENCY:
Vitamin A ………….. NIGHT blindness and impaired growth
Vitamin D …………. Adult: osteomalacia. Kids: rickets
Vitamin E….anemia
Vitamin K….Bleeding
Vitamin C ( ascorbic acid)…most common cause of bleeding in elderly (scurvy)
Thiamine(B1)…..wernike enceplalopathy and beriberi
Riboflavin…..cheilosis and dermatitis
Niacin……pellagra( dermatitis, diarrhea and dementia)
Vitamin B6…..peripheral neuropathy
Folic acid……megaloblastic anemia
B12(cyanocobalamines)… megaloblastic anemia, peripheral neuropathy
Describe the difference in presentation of osteomalacia in adults versus rickets in children.
Adults present with osteomalacia while kids present with rickets.
What condition is associated with a deficiency in Vitamin E?
Anemia.
What is the main symptom associated with a deficiency in Vitamin K?
Bleeding.
What is the most common cause of bleeding in the elderly due to a deficiency in Vitamin C?
Scurvy.
What conditions are associated with a deficiency in Thiamine (B1)?
Wernicke encephalopathy and beriberi.
What are the symptoms associated with a deficiency in Niacin?
Dermatitis, diarrhea, and dementia (pellagra).
What neurological condition is linked to a deficiency in Vitamin B6?
Peripheral neuropathy.
What type of anemia is associated with a deficiency in Folic acid?
Megaloblastic anemia.
What are the main manifestations of a deficiency in Riboflavin?
Cheilosis and dermatitis.
What are the consequences of a deficiency in Vitamin B12 (cyanocobalamin)?
Megaloblastic anemia and peripheral neuropathy.
Pt with cervical injury develops severe – pulse &– BP…
Dx: Neurogenic shock
Pt on labor receive epidural anathesia develops severe – pulse &– BP…
Dx: Neurogenic shock
Do patients with cervical injury experiencing severe bradycardia and hypotension have what shock?
Yes.
Neurogenic shock
Do patients in labor receiving epidural anesthesia who develop severe bradycardia and hypotension have neurogenic shock?
Yes.
Is bradycardia a common feature of what shock?
Yes, it is the only type of shock causing bradycardia.Neurogenic shock
What is the initial step in the treatment of Neurogenic shock?
IV fluid administration, followed by atropine and vasopressors.
How should an elderly patient with atrial fibrillation requiring anticoagulation be treated?
With Warfarin targeting an INR of 2-3, except for those with prosthetic valves who require a higher target INR.
