Neurology & psych Flashcards
Not able to drive for how long after a single TIA?
1 month (no need to tell DVLA)
Not able to drive for how long after multiple TIAs over a short period?
3 months and need to tell DVLA
Section 3 of mental health act =
Compulsory admission for under 6 months for treatment
Section 2 of mental health act =
Compulsory admission for 28 days or less for assessment
Section 4 of mental health act =
Exceptional circumstances
Compulsory admission for 72hrs if unable to get section 2 sorted
Section 5 - 2 =
Doctor holding powers, 72hrs
1st line medical management in delerium
Haloperidol
What Rosier score indicates a potential stroke
1 or greater
Treatment in severe myasthenia gravis crisis
IV immunoglobulin
Pick’s disease
Pick’s disease is a rare neurodegenerative disorder that causes a slowly progressive frontotemporal dementia.
Mild-to-moderate Alzheimer’s disease 1st line medical management
The AChE inhibitors are:
Donepezil (Aricept)
Galantamine
Rivastigmine
Medical tx for normal pressure hydrocephalus
Acetazolamide
Severe Alzheimer’s disease medical management
Memantine acts by blocking NMDA-type glutamate receptors and is recommended for use in patients with moderate Alzheimer’s disease that are intolerant of or have a contraindication to AChE inhibitors, or in patients with severe Alzheimer’s disease.
Korsakoff psychosis, is characterised by:
Retrograde amnesia
An inability to memorise new information
Disordered time appreciation
Confabulation
T-ACE is primarily used to screen for
alcohol abuse in pregnant women
Meadow syndrome
the caregiver fabricates the appearance of health problems in another person, typically their child.
The highest risks for suicide are:
Previous episode of self-harm (5) – 4% of people who attend A&E with self-harm will kill themselves within five years
Previous mental illness (4)
Male sex (3)
Severe depression (2)
Misuse of drugs and alcohol (2)
Gedankenlautwerden
Thought echo occurs when a patient hears their own thoughts as if they are being spoken aloud. When heard simultaneously this is Gedankenlautwerden
The following are considered to be good prognostic factors in schizophrenia:
(10)
Acute onset
Precipitating stressful event
No family history of schizophrenia
Family history of depression
Older age of onset
No history of previous episodes
Normal intelligence
Preponderance of affective symptoms
No loss of emotion
Prompt treatment
SADQ or or LDQ
Severity of alcohol dependence
APQ
for the nature and extent of the problems arising from alcohol misuse.
AUDIT
identification and as a routine outcome measure of alcohol dependency
Lhermitte’s sign
sudden sensation resembling an electric shock experienced by patients with MS
Imaging modality to help diagnose Wernicke’s encephalopathy
MRI brain
Meningococcal meningitis, what abx is given in hospital if there is hx of anaphylaxis to cephalosporins
Chloramphenicol IV
Anterior cerebral artery stroke signs
Contralateral motor weakness (leg/shoulder > arm/hand/face)
Minimal contralateral sensory loss
Dysarthria, aphasia
Left limb apraxia
Urinary incontinence
Behavioural and personality changes
Middle cerebral artery stroke signs
Contralateral hemiparesis (face/arm > leg)
Contralateral hemisensory loss
Expressive or receptive dysphasia (dominant hemisphere)
Contralateral neglect (non-dominant hemisphere)
Posterior cerebral artery stroke signs
Contralateral homonymous hemianopia
Quadrantic visual field defects
Contralateral thalamic syndrome (PCA supplies thalamus)
Wallenberg’s syndrome
Occlusion of the posterior inferior cerebellar artery causes the lateral medullary syndrome
Contralateral loss of pain and temperature sense on the body (damage to spinothalamic tracts)
Ipsilateral loss of pain and temperature sense on the face (damage to CN V)
Vertigo, nystagmus, tinnitus, deafness and vomiting (damage to CN VIII)
Horner’s syndrome (damage to the descending hypothalamospinal tract)
Neisseria meningitidis meningitis contacts, chemoprophylaxis drug
Pregnancy
Rifampicin 600 mg PO BD for two days
OR single dose of ciprofloxacin 500mg
Both contraindicated in pregnancy, so IM ceftriaxone 250mg
In the UK, most cases of meningococcal septicaemia are caused by
Neisseria meningitidis group B
The initial dose of alteplase
0.9 mg/kg (up to a maximum of 90 mg), given intravenously over 60 minutes
Benedikt syndrome
Lateral midbrain syndrome
Weber’s syndrome
Medial midbrain syndrome
Wallenberg’s syndrome
Lateral medullary syndrome
Logorrhoea
pertaining to the overuse of words or excessive talkativeness
Who needs prophylaxis for meningococcal disease
Household members who have had prolonged close contact within 7 days before the onset of illness
Kissing contacts
Healthcare workers who have had direct exposure to droplets or respiratory secretions prior to completion of 24 hours of antibiotics
What abx is used as a prophylaxis in menigococcal disease?
Rifampacin / Ciprofloxacin
IV Cef in pregnant patients
Pathogenesis of MS
MS is a multicentric, multiphasic inflammatory disorder of the central nervous system (CNS) in which focal lymphocytic infiltration leads to damage to myelin and axons.
Uhthoff symptom
a temporary worsening of multiple sclerosis (MS) symptoms that occurs when the body temperature increases
Commonest cause of BPPV
Posterior semicircular canal otoliths (calcium oxalate crystals)
labyrinthitis
When ipsilateral hearing loss is associated with the symptoms of vestibular neuritis
At what % of carotid stenosis is surgery offered?
> 50%
How long after a TIA can patients drive?
4 weeks
The risk for stroke after a TIA is highest during the first:
48hrs
Typical LP result in GBS
A raised CSF protein (>0.4 g/L) with normal white cell count
Treatment for patients with GBS who can’t walk
IVIG or plasma exchange
1st line in mild acute myasthenia gravis
Pyridostigmine
The only medical treatment for vasospasm, due to SAH, with proven clinical benefit is
oral nimodipine 60 mg 4-hourly
Bacteria causing tetanus
Clostridium tetani (bacillus)
Which antibiotics can treat Clostridium tetani
BenPen and Metronidazole
Potential LP findings in cerebral sinus thrombosis?
Many patients have raised protein levels and pleocytosis on CSF analysis
Wernicke’s encephalopathy features (4)
confusion, ataxia, nystagmus and ophthalmoplegia
Chronic tension headache is defined by…
Episodes at least 15 days per month
Meningococcal prophylaxis in pregnancy
IM ceftriaxone 250mg
Dose of initial benzo in SE in children
Lorazepam 0.1 mg/kg
Buccal midazolam 0.5 mg/kg or rectal diazepam 0.5 mg/kg
Dose of levetiracetam in SE in children
40 mg/kg of levetiracetam IV (maximum 3 g) over 5 minutes
Dose of phenytoin in SE in children
20mg/kg over 20 mins
Autonomic involvement in cluster headaches
Ipsilateral conjunctival injection
Ipsilateral rhinorrhoea
Ipsilateral lacrimation
Ipsilateral miosis
Ipsilateral ptosis
Which type of scan shows evidence of Wernicke’s encephalopathy?
MRI
The initial dose of alteplase for stroke is?
0.9mg/kg
In the UK, most cases of meningococcal septicaemia are caused by
N.meningitidis B
Time cut off for thrombectomy
6hrs
What imaging must be confirmed for a patient to be eligible for thrombectomy
CTA or MRA showing occlusion of the proximal anterior circulation
