Neurology Medicine 🧠✅ Flashcards
1
Q
High stepping gait is a sign of which ataxia?
A
Sensory ataxia
2
Q
Wide based gait is a sign of which ataxia
A
Cerebellar ataxia
3
Q
GCS, eyes: spontaneous opening
A
Scores 4
4
Q
GCS, eyes: opening to verbal command
A
Scores 3
5
Q
GCS, eyes: opening to pain
A
Scores 2
6
Q
GCS, eyes: no opening
A
1
7
Q
GCS, voice: Elegant/appropriate speech
A
Scores 5
8
Q
GCS, voice: confused speech
A
Scores 4
9
Q
GCS, voice: inappropriate words
A
Scores 3
10
Q
GCS, voice: incomprehensible sound
A
Scores 2
11
Q
GCS, voice: voiceless
A
Scores 1
12
Q
GCS, motor: obeys command
A
Scores 6
13
Q
GCS, motor: localises to pain
A
Scores 5
14
Q
GCS, motor: withdraws from pain
A
Scores 4
15
Q
GCS, motor: decorticate
A
Scores 3
16
Q
GCS, motor: decerebrate
A
Scores 2
17
Q
GCS, motor: none
A
Scores 1
18
Q
Mneumoic to remember GCS, Motor
A
19
Q
Mneumoic to remember GCS, verbal
A
20
Q
Mneumoic to remember GCS, Eyes
A
21
Q
GCS 13-15… how to Mx
A
CT only if LOC, amnestic, disorientated
22
Q
GCS 9-12 Mx
A
Need CT
23
Q
GCS <= 12, Mx
A
CT
24
Q
Specific clinical findings for HSV enceph?
A
Altered smell, vision, aphasia, memory changes, Kluver Bucy (rest are general)
25
Approach to Mx of suspected HSV enceph
Start immediate Tx if high suspicion. IV acyclovir (2-3 weeks)
26
Gold standard Invx for HSV encephalitis
CSF PCR
27
Best imaging for HSV enceph
MRI
28
Acute Tx of cluster headaches
Hyperbaric O2, triptans,
29
First line prevention of cluster headaches
Verapamil (2nd is Li or topiramate)
Cluster = CCB
30
Prophylactic therapy for migraine
Lifestyle, Topiramate (good!), or valproate, or BB.
2nd lines: TCA, NSAID
31
Indication for pharmacological intervention in migraines
>= 2 attacks a month, severe disability, >= 2 attacks a week regardless of severity
32
Migraine abortive therapy
Triptan best
33
When not to give triptans for migraine abortive therapy
If more than 10 a month, since can cause overuse headaches. Not for CAD, HTN, CVD, PVD,
34
Status migrainus Mx
IV fluids, antiemetic, NSAID, ergotamine, CS
35
Therapy for acute tension headaches
NSAID
36
Therapy for chronic/prophylaxis of tension headaches
Amitriptyline (TCA for Tension)
37
When to start Abx in suspected meningitis
As soon as taken CSF results
38
When to give CSs in meningitis
In children to prevent deafness?
39
Empiric Abx for meningitis in 3mo-50yrs
Ceftriaxone +- vanco
40
Empiric Abx for meningitis in >-50yrs
Ceftriaxone and amoxicillin +- vanco
41
Abx for meningitis (meningiococci)
Ceftriaxone/benzylpenicillin
42
Abx for meningitis (pneumococci)
Ceftriaxone/benzylpenicillin or vanco if severe
43
Abx for HiB meningitis
Ceftriaxone
44
Tx of viral meningitis
Supportive unless HSV (acyclovir)
45
Mx outlines for IC haemorrhage
Mx conservatively
- screen and prevent complications
- rarely Sx
- do cardiac telemetry and BP monitoring
46
Nerve conduction studies in ALS
Normal .... i think might be incorrect
47
EMG in ALS
Positive sharp waves and large amplitudes. Signs of fasciculation
48
What bedside test should be done in all patients with ALS
Swallow test
49
If ALS patient has positive swallow test, do what?
Video fluoroscopy to confirm dysphagia
50
Mx of ALS
Riluzole (3 mo survival)
MDT team to give care
51
Lewy body dementia vs Parkinson’s
LBD the dementia aspect of before or same time as movement signs
52
Clinically probable PD criteria
Max two red flags balanced with equal or more supportive criteria , and absence of absolute exclusions criteria
53
Clinically established PD criteria
Two or more supportive criteria and no red flags, and absence of absolute exclusions criteria
54
Parkinson’s diagnosis supportive criteria
55
Parkinson’s exclusion criteria for diagnosis
56
Parkinson’s patients younger than 65 should be started on which medication
DA agonist (rarely first though), or MAOi (not often levodopa due to late motor complications)
57
Less than 65 years old, Parkinson’s, tremor is the chief concern. Best Mx
Antimuscarininc
58
parkinsons Patient less than 65 years old and has multiple co morbs (Mx?)
Levodopa and carbdopa
59
Patient above 65 with Parkinson’s. Mx?
Levodopa and carbdopa
60
Main Parkinson’s drug to decrease off periods of L dopa
COMTi
61
When do we do deep brain stimulation in Parkinson’s
Severe symptoms, respond to L-dopa but not controlled by the meds
62
Suspect Huntington’s… how to invx/dx
CT or MRI, then genetic testing
63
Medical therapy for huntingtons. 3 things, and consider why we give each one
Clozapine, NMDA antagonists, SSRI
64
Diagnostic idea for MS
Clinical and MRI. CSF only if cannot diagnose
65
Invx of choice for MS
MRI
66
McDonalds criteria
For MS.
67
MS acute flare Tx
IV methylprednisolone
68
3 options for long term Mx of MS
Natalizumab, Glatiramer, IFN
69
Risk associated with Natalizumab Tx (in MS)
PML reactivation
70
Second line for acute MS flare
Plasmapheresis
71
Diagnostic test for MG
Edrophonium test (Tensilon). Give edrophonium, which rapidly improves symptoms
72
Once diagnosed MG, need to do what!
Chest CT (for thymoma)
73
First line Tx for MG
Pyridostigmine
74
Other than meds, consider what in MG Tx ?
Thymectomy
75
Mx of Myasthenic crisis
Intubate, plasma exchange/IVIg, and long term GCs
Makes sense (remove ABs, prevent apnoea, anti inflam to prevent)
76
What is Lambert sign?
Diagnostic sign for lambert Eaton. Muscle strength improved with repetitive use/stimulation.
77
Tx for severe LEMS
IvIg
78
Definitive Tx for LEMS
Remove CA
79
Mx for alcoholic cerebellar degen
Remove booze and provide nutrition (gait ≠ improve)
80
Post infx cerebellitis signs
Child, has VZV/measles/EBV few days ago, rapid onset ataxia
81
Tx for essential tremor
Propanolol (or booze!)
82
Status E Mx
ABC, IV lorazepam, (recall more)
83
Generalised clinic tonic seizure Tx
Valproate (lamotrigine/Lev if chance of pregnancy)
84
Focal seizure first line (Savvas)
Carbamazepine
85
Absence seizure first line
Ethosuxomide
86
Myoclonic epilepsy first line
Valproate (Lam/Lev if preg chance)
87
Atonic seizure Mx
Valproate (Lam/Lev if preg chance)
88
SJS causers (from anti seizure meds)
carbamazepine lamotrigine phenytoin
89
First line invx for all suspected epidural cases
CT head no IV contrast
90
Tx Approach to patient with epidural
Craniotomy (unless very small and asymptomatic)
91
If epidural small and assymp… what to do?
Cereal CTs to monitor
92
If neurosurgeon not available, and epidural Dx’d… what to do?
Burr hole
93
Signs that patient 100% needs craniotomy for Epidural
More than 30ml of EDH vol, more than 5 mum midline shift, focal Neuro, GCS <8, clinical deteriation
94
First invx for ICP
Imaging
95
Confirmation test for elevated ICP
Intraventricular catheter and CSF drawings drainage (no CI)
96
Mx for high ICP (temporarily)
Controlled hyperventilating, mannitol, consider sedation
97
Mx for high ICP (definitively)
Surgery/remove cause, CSF drain. Once done, so mannitol
98
Mx for glioblastoma M
Resect and radio/chemo, and GCs
99
Mx of medulloblastoma (depending if above or below 3 yo)
Children >= 3: chemo and craniospinal radiotherapy
Children < 3: chemo
100
First line Tx for meningioma
Surgical resection
101
When to do radiotherapy in mengiomas
If inoperable, as adjuvant for grade II And III, very small tumours.
102
When to do active surveillance in meningioma
Slow growing and elderly patient
103
Best initial test for SAH
CT without contrast
104
Confirmation test for SAH (if CT was positive)
Angiography
105
If suspect SAH, yet CT negative?
Perform lumbar puncture or CTA
106
When does the CT lose its sensitivity for SAH
After 6 hours
107
How to prevent vasospasm in SAH
Nimodipine
108
Initial Mx for SAH
Stabilise (ABCDE), prevent bleeding (BP, anticoag reversal), pain management, ICP management
109
Aneurysmal SAH Mx
Coiling (less invasive) and clipping (less bleeding)
110
First line invx for subdural
CT no contrast
111
When to do Hematoma evacuation in subdural
Hematoma large, midline shift, herniations, rapid Neuro determination, focal signs, high ICP, failed conservative Tx
112
Medical management for subdural
ICP management and Neuro protective measures (recall when to do Sx instead)
113
Diagnosis of Guillaine Barré
Clinical. Can see albuminocytologic dissociation on CSF and low nerve conduction. Do ABG and spirometry
114
Mx of Guillaine Barré
Supportive, (intubation), IV Ig or exchange plasmaphoresis
115
Dx and Mx of cauda equina
MRI to diagnose, then surgical decompression
116
Invx for stroke
CT non contrast
117
CT for stroke shows no. Haemorrhage… now what
Likely ischemia… so must do rtPA. If else’s than 4 hours since signs
118
When can do tPA for ischemia stroke
If less than 3-4.5 hours since signs
119
If ischemia stroke patient cannot have Thrombolysis (> 4.5 hrs), do what
Infra arterial Thrombolysis or thrombectomy. For CTA first
120
TIA probable? Do what
MRI
121
Post stroke Mx
Aspirin within 48 hrs, statin and anticoag. Keep BP low (recall permissive hypertension in non Thrombolysed)
122
BP aims in stroke patient (thombolysed vs non thrombolysed)
<185/110 if Thrombolysed
<220/120 if not Thrombolysed (permissive HTN to open collaterals)
123
CIs for tPA
Active internal bleeding, BP >185/110, INR > 1.7, IC haemorrhage HX, PLT > 40, stroke over 4.5 hours ago
124
SAH suspicion, but non diagnostic CT… do what
LP
125
SAH suspicion, but non diagnostic CT… LP also negative… consider?
CTA
126
TIA Mx
Aspirin, statin, BP control (2° prevention)
127
Headache better when lying flat?
Low pressure headache
128
Tx of low pressure headaches
NSAID and an epidural blood patch to clot potential hole
129
Dx and Tx of vestibular neuritis
Clinical and give meclizine
130
First line Tx for menrniere
Lifestyle changes (low alcohol, salt and caffeine)
131
Central vertigo signs
Pure verticle, not fatigueable, gaze fix will inhibit,
132
Peripheral vertigo signs
Horizontal/torsional nystagmus, fatigueable, stops with gaze fixation, abrupt onset, more N/V
133
Acute vertigo Mx
Meclizine best. Other antiH are ok. Antiemetic, benzos
134
Dx of BPV, Tx
Dix Hallpike then Epley
135
Dx of MS? Based on formative Q
MRI brain, spinal cord, CSF and wait for another episode
136
Dx for huntingtons
clinical, MRI, then genetics
137
abulia?
not ABUL to initiate movement.... and is seen in ACA
138
Transcortical motor aphasia = what kind of stroke
ACA (Broca's - but can repeat stuff)
139
apraxia
cannot do skilled movements (ACA stroke)
140
lateral thalamic lossed in which stroke
PCA
141
Alexia without agraphia
can't read, can write = dominant PCA
142
anomic aphasia
cannot name stuff = dominant PCA
143
Agnosia
cannot recog sensory stimuli (textures, objects etc.) = dominant PCA
144
prosopgnosia
cannot recog faces = non dominant PCA
145
impaired exec function is most prominent in which dementia
vascular
146
If new onset seizure... do what Invx
imaging = only do EEG if imaging negative
147
M.G., best new test to Dx (according to savvas)
single fibre EMG... then your chest xray to rule out thymoma... then find antibodies
148
best place for pain relief admin in palliative care
mid chest, or abdomen (esp if cachectic). Buttlefly needle subQ
149
CIs for lumbar puncture
ICP high signs (focal neuro, papillo, vom), coag, previous lumbar puncture, spinal joint disease, skin infx
150
MMSE for Alzheimer... what score or lower are we sus
24 or less
