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Finals > Neurology Medicine 🧠✅ > Flashcards

Neurology Medicine 🧠✅ Flashcards

1
Q

High stepping gait is a sign of which ataxia?

A

Sensory ataxia

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2
Q

Wide based gait is a sign of which ataxia

A

Cerebellar ataxia

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3
Q

GCS, eyes: spontaneous opening

A

Scores 4

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4
Q

GCS, eyes: opening to verbal command

A

Scores 3

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5
Q

GCS, eyes: opening to pain

A

Scores 2

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6
Q

GCS, eyes: no opening

A

1

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7
Q

GCS, voice: Elegant/appropriate speech

A

Scores 5

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8
Q

GCS, voice: confused speech

A

Scores 4

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9
Q

GCS, voice: inappropriate words

A

Scores 3

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10
Q

GCS, voice: incomprehensible sound

A

Scores 2

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11
Q

GCS, voice: voiceless

A

Scores 1

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12
Q

GCS, motor: obeys command

A

Scores 6

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13
Q

GCS, motor: localises to pain

A

Scores 5

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14
Q

GCS, motor: withdraws from pain

A

Scores 4

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15
Q

GCS, motor: decorticate

A

Scores 3

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16
Q

GCS, motor: decerebrate

A

Scores 2

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17
Q

GCS, motor: none

A

Scores 1

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18
Q

Mneumoic to remember GCS, Motor

A
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19
Q

Mneumoic to remember GCS, verbal

A
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20
Q

Mneumoic to remember GCS, Eyes

A
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21
Q

GCS 13-15… how to Mx

A

CT only if LOC, amnestic, disorientated

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22
Q

GCS 9-12 Mx

A

Need CT

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23
Q

GCS <= 12, Mx

A

CT

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24
Q

Specific clinical findings for HSV enceph?

A

Altered smell, vision, aphasia, memory changes, Kluver Bucy (rest are general)

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25
Q

Approach to Mx of suspected HSV enceph

A

Start immediate Tx if high suspicion. IV acyclovir (2-3 weeks)

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26
Q

Gold standard Invx for HSV encephalitis

A

CSF PCR

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27
Q

Best imaging for HSV enceph

A

MRI

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28
Q

Acute Tx of cluster headaches

A

Hyperbaric O2, triptans,

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29
Q

First line prevention of cluster headaches

A

Verapamil (2nd is Li or topiramate)
Cluster = CCB

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30
Q

Prophylactic therapy for migraine

A

Lifestyle, Topiramate (good!), or valproate, or BB.

2nd lines: TCA, NSAID

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31
Q

Indication for pharmacological intervention in migraines

A

> = 2 attacks a month, severe disability, >= 2 attacks a week regardless of severity

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32
Q

Migraine abortive therapy

A

Triptan best

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33
Q

When not to give triptans for migraine abortive therapy

A

If more than 10 a month, since can cause overuse headaches. Not for CAD, HTN, CVD, PVD,

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34
Q

Status migrainus Mx

A

IV fluids, antiemetic, NSAID, ergotamine, CS

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35
Q

Therapy for acute tension headaches

A

NSAID

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36
Q

Therapy for chronic/prophylaxis of tension headaches

A

Amitriptyline (TCA for Tension)

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37
Q

When to start Abx in suspected meningitis

A

As soon as taken CSF results

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38
Q

When to give CSs in meningitis

A

In children to prevent deafness?

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39
Q

Empiric Abx for meningitis in 3mo-50yrs

A

Ceftriaxone +- vanco

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40
Q

Empiric Abx for meningitis in >-50yrs

A

Ceftriaxone and amoxicillin +- vanco

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41
Q

Abx for meningitis (meningiococci)

A

Ceftriaxone/benzylpenicillin

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42
Q

Abx for meningitis (pneumococci)

A

Ceftriaxone/benzylpenicillin or vanco if severe

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43
Q

Abx for HiB meningitis

A

Ceftriaxone

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44
Q

Tx of viral meningitis

A

Supportive unless HSV (acyclovir)

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45
Q

Mx outlines for IC haemorrhage

A

Mx conservatively
- screen and prevent complications
- rarely Sx
- do cardiac telemetry and BP monitoring

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46
Q

Nerve conduction studies in ALS

A

Normal …. i think might be incorrect

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47
Q

EMG in ALS

A

Positive sharp waves and large amplitudes. Signs of fasciculation

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48
Q

What bedside test should be done in all patients with ALS

A

Swallow test

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49
Q

If ALS patient has positive swallow test, do what?

A

Video fluoroscopy to confirm dysphagia

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50
Q

Mx of ALS

A

Riluzole (3 mo survival)
MDT team to give care

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51
Q

Lewy body dementia vs Parkinson’s

A

LBD the dementia aspect of before or same time as movement signs

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52
Q

Clinically probable PD criteria

A

Max two red flags balanced with equal or more supportive criteria , and absence of absolute exclusions criteria

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53
Q

Clinically established PD criteria

A

Two or more supportive criteria and no red flags, and absence of absolute exclusions criteria

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54
Q

Parkinson’s diagnosis supportive criteria

A
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55
Q

Parkinson’s exclusion criteria for diagnosis

A
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56
Q

Parkinson’s patients younger than 65 should be started on which medication

A

DA agonist (rarely first though), or MAOi (not often levodopa due to late motor complications)

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57
Q

Less than 65 years old, Parkinson’s, tremor is the chief concern. Best Mx

A

Antimuscarininc

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58
Q

parkinsons Patient less than 65 years old and has multiple co morbs (Mx?)

A

Levodopa and carbdopa

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59
Q

Patient above 65 with Parkinson’s. Mx?

A

Levodopa and carbdopa

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60
Q

Main Parkinson’s drug to decrease off periods of L dopa

A

COMTi

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61
Q

When do we do deep brain stimulation in Parkinson’s

A

Severe symptoms, respond to L-dopa but not controlled by the meds

62
Q

Suspect Huntington’s… how to invx/dx

A

CT or MRI, then genetic testing

63
Q

Medical therapy for huntingtons. 3 things, and consider why we give each one

A

Clozapine, NMDA antagonists, SSRI

64
Q

Diagnostic idea for MS

A

Clinical and MRI. CSF only if cannot diagnose

65
Q

Invx of choice for MS

A

MRI

66
Q

McDonalds criteria

A

For MS.

67
Q

MS acute flare Tx

A

IV methylprednisolone

68
Q

3 options for long term Mx of MS

A

Natalizumab, Glatiramer, IFN

69
Q

Risk associated with Natalizumab Tx (in MS)

A

PML reactivation

70
Q

Second line for acute MS flare

A

Plasmapheresis

71
Q

Diagnostic test for MG

A

Edrophonium test (Tensilon). Give edrophonium, which rapidly improves symptoms

72
Q

Once diagnosed MG, need to do what!

A

Chest CT (for thymoma)

73
Q

First line Tx for MG

A

Pyridostigmine

74
Q

Other than meds, consider what in MG Tx ?

A

Thymectomy

75
Q

Mx of Myasthenic crisis

A

Intubate, plasma exchange/IVIg, and long term GCs

Makes sense (remove ABs, prevent apnoea, anti inflam to prevent)

76
Q

What is Lambert sign?

A

Diagnostic sign for lambert Eaton. Muscle strength improved with repetitive use/stimulation.

77
Q

Tx for severe LEMS

A

IvIg

78
Q

Definitive Tx for LEMS

A

Remove CA

79
Q

Mx for alcoholic cerebellar degen

A

Remove booze and provide nutrition (gait ≠ improve)

80
Q

Post infx cerebellitis signs

A

Child, has VZV/measles/EBV few days ago, rapid onset ataxia

81
Q

Tx for essential tremor

A

Propanolol (or booze!)

82
Q

Status E Mx

A

ABC, IV lorazepam, (recall more)

83
Q

Generalised clinic tonic seizure Tx

A

Valproate (lamotrigine/Lev if chance of pregnancy)

84
Q

Focal seizure first line (Savvas)

A

Carbamazepine

85
Q

Absence seizure first line

A

Ethosuxomide

86
Q

Myoclonic epilepsy first line

A

Valproate (Lam/Lev if preg chance)

87
Q

Atonic seizure Mx

A

Valproate (Lam/Lev if preg chance)

88
Q

SJS causers (from anti seizure meds)

A

carbamazepine lamotrigine phenytoin

89
Q

First line invx for all suspected epidural cases

A

CT head no IV contrast

90
Q

Tx Approach to patient with epidural

A

Craniotomy (unless very small and asymptomatic)

91
Q

If epidural small and assymp… what to do?

A

Cereal CTs to monitor

92
Q

If neurosurgeon not available, and epidural Dx’d… what to do?

A

Burr hole

93
Q

Signs that patient 100% needs craniotomy for Epidural

A

More than 30ml of EDH vol, more than 5 mum midline shift, focal Neuro, GCS <8, clinical deteriation

94
Q

First invx for ICP

A

Imaging

95
Q

Confirmation test for elevated ICP

A

Intraventricular catheter and CSF drawings drainage (no CI)

96
Q

Mx for high ICP (temporarily)

A

Controlled hyperventilating, mannitol, consider sedation

97
Q

Mx for high ICP (definitively)

A

Surgery/remove cause, CSF drain. Once done, so mannitol

98
Q

Mx for glioblastoma M

A

Resect and radio/chemo, and GCs

99
Q

Mx of medulloblastoma (depending if above or below 3 yo)

A

Children >= 3: chemo and craniospinal radiotherapy

Children < 3: chemo

100
Q

First line Tx for meningioma

A

Surgical resection

101
Q

When to do radiotherapy in mengiomas

A

If inoperable, as adjuvant for grade II And III, very small tumours.

102
Q

When to do active surveillance in meningioma

A

Slow growing and elderly patient

103
Q

Best initial test for SAH

A

CT without contrast

104
Q

Confirmation test for SAH (if CT was positive)

A

Angiography

105
Q

If suspect SAH, yet CT negative?

A

Perform lumbar puncture or CTA

106
Q

When does the CT lose its sensitivity for SAH

A

After 6 hours

107
Q

How to prevent vasospasm in SAH

A

Nimodipine

108
Q

Initial Mx for SAH

A

Stabilise (ABCDE), prevent bleeding (BP, anticoag reversal), pain management, ICP management

109
Q

Aneurysmal SAH Mx

A

Coiling (less invasive) and clipping (less bleeding)

110
Q

First line invx for subdural

A

CT no contrast

111
Q

When to do Hematoma evacuation in subdural

A

Hematoma large, midline shift, herniations, rapid Neuro determination, focal signs, high ICP, failed conservative Tx

112
Q

Medical management for subdural

A

ICP management and Neuro protective measures (recall when to do Sx instead)

113
Q

Diagnosis of Guillaine Barré

A

Clinical. Can see albuminocytologic dissociation on CSF and low nerve conduction. Do ABG and spirometry

114
Q

Mx of Guillaine Barré

A

Supportive, (intubation), IV Ig or exchange plasmaphoresis

115
Q

Dx and Mx of cauda equina

A

MRI to diagnose, then surgical decompression

116
Q

Invx for stroke

A

CT non contrast

117
Q

CT for stroke shows no. Haemorrhage… now what

A

Likely ischemia… so must do rtPA. If else’s than 4 hours since signs

118
Q

When can do tPA for ischemia stroke

A

If less than 3-4.5 hours since signs

119
Q

If ischemia stroke patient cannot have Thrombolysis (> 4.5 hrs), do what

A

Infra arterial Thrombolysis or thrombectomy. For CTA first

120
Q

TIA probable? Do what

A

MRI

121
Q

Post stroke Mx

A

Aspirin within 48 hrs, statin and anticoag. Keep BP low (recall permissive hypertension in non Thrombolysed)

122
Q

BP aims in stroke patient (thombolysed vs non thrombolysed)

A

<185/110 if Thrombolysed
<220/120 if not Thrombolysed (permissive HTN to open collaterals)

123
Q

CIs for tPA

A

Active internal bleeding, BP >185/110, INR > 1.7, IC haemorrhage HX, PLT > 40, stroke over 4.5 hours ago

124
Q

SAH suspicion, but non diagnostic CT… do what

A

LP

125
Q

SAH suspicion, but non diagnostic CT… LP also negative… consider?

A

CTA

126
Q

TIA Mx

A

Aspirin, statin, BP control (2° prevention)

127
Q

Headache better when lying flat?

A

Low pressure headache

128
Q

Tx of low pressure headaches

A

NSAID and an epidural blood patch to clot potential hole

129
Q

Dx and Tx of vestibular neuritis

A

Clinical and give meclizine

130
Q

First line Tx for menrniere

A

Lifestyle changes (low alcohol, salt and caffeine)

131
Q

Central vertigo signs

A

Pure verticle, not fatigueable, gaze fix will inhibit,

132
Q

Peripheral vertigo signs

A

Horizontal/torsional nystagmus, fatigueable, stops with gaze fixation, abrupt onset, more N/V

133
Q

Acute vertigo Mx

A

Meclizine best. Other antiH are ok. Antiemetic, benzos

134
Q

Dx of BPV, Tx

A

Dix Hallpike then Epley

135
Q

Dx of MS? Based on formative Q

A

MRI brain, spinal cord, CSF and wait for another episode

136
Q

Dx for huntingtons

A

clinical, MRI, then genetics

137
Q

abulia?

A

not ABUL to initiate movement…. and is seen in ACA

138
Q

Transcortical motor aphasia = what kind of stroke

A

ACA (Broca’s - but can repeat stuff)

139
Q

apraxia

A

cannot do skilled movements (ACA stroke)

140
Q

lateral thalamic lossed in which stroke

A

PCA

141
Q

Alexia without agraphia

A

can’t read, can write = dominant PCA

142
Q

anomic aphasia

A

cannot name stuff = dominant PCA

143
Q

Agnosia

A

cannot recog sensory stimuli (textures, objects etc.) = dominant PCA

144
Q

prosopgnosia

A

cannot recog faces = non dominant PCA

145
Q

impaired exec function is most prominent in which dementia

A

vascular

146
Q

If new onset seizure… do what Invx

A

imaging = only do EEG if imaging negative

147
Q

M.G., best new test to Dx (according to savvas)

A

single fibre EMG… then your chest xray to rule out thymoma… then find antibodies

148
Q

best place for pain relief admin in palliative care

A

mid chest, or abdomen (esp if cachectic). Buttlefly needle subQ

149
Q

CIs for lumbar puncture

A

ICP high signs (focal neuro, papillo, vom), coag, previous lumbar puncture, spinal joint disease, skin infx

150
Q

MMSE for Alzheimer… what score or lower are we sus

A

24 or less

Finals (11 decks)

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