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Year 3 > neurology qs > Flashcards

neurology qs Flashcards

1
Q

Medication to reduce migraine FREQUENCY
ACUTE MANAGEMENT

A

Frequency - like prophylaxis - give propranolol or topiramate (propranolol preferred for women childbearing age, topiramate preferred for astmatics)

Acute - triptans, NSAIDs or paracetamol

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2
Q

How long do symptoms need to be present for chronic fatigue syndrome?

A

3 months

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3
Q

Medication for ACUTE cluster headache symptoms and LONG TERM PROPHYLAXIS?

A

Acute - subcutaneous sumatriptan + 100% oxygen

Prophylaxis - verapamil

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4
Q

contraindication of sumatriptan?

A

CAD

So patents with cluster headache should only be given oxygen not the triptan

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5
Q

What migraine medicine may cause extrapyramidal side effects, what is it used for?

A

Metoclopramide ANTI EMETIC

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6
Q

1st line for focal seizure?

A

carbemazepine
(S/E = SIAD, SJS)

Lamotrigine

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7
Q

1st line for generalised seizure?

A

sodium valproate

lamotrigine (use this for pregnant/childbearing females)

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8
Q

2nd line for generalised seizure? + absence seizure 1st line?

A

ethosuximide

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9
Q

manage status epileptica?

A

in hospital = IV lorazepam

not in hospital = PR diazepam

if not working = IV phenytoin

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10
Q

why can vasocagal syncope be hard to distinguish from seizures?

A

ppl with syncope also move!

can present with a sudden fall and immobility (known as akinetic syncope) in 10% of patients but the remaining 90% of patients will demonstrate myoclonic syncope which presents with jerking movements. There is usually a trigger, such as dehydration, hypoglycaemia or intense emotion and the patient is likely to experience a prodrome of nausea, sweats and tunnel vision.

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11
Q

if someone with epilepsy keeps having seizures which do resolve with medication, what should be investigated?

A

rule out hypoglycaemia and hypoxia so do oxygen + cap glucose

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12
Q

When can someone be considered seizure free?

A

> 2 years with anti-epileptics being stopped over 2-3 months

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13
Q

Levodopa is given for parkinsonism

dopamine receptor agonists may also be given, what side effect may they cause?

A

inhibition disorders
(bromociptine, ropinirole, pramipexole, apomorphine)

e.g. more gambling

and - pulmonary fibrosis

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14
Q

1st line drug for moderate / mild Alzheimers dementia?

A

Donapezil
C/I = long QT

(rivastigmine also)
(galantamine if hallucinating)

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15
Q

2nd Line drug or if severe alzheimers?

A

Memantine

NDMA receptor antagonist decreasing glutamate activity

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16
Q

Diagnostic Lewy body dementia test?

A

SPECT scan / DaTscan

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17
Q

Management of trigeminal neuralgia? 1st line

A

New diagnosis - (anticonvulsant) carbamezepine

S/E = SIADH

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18
Q

Management of trigeminal neuralgia is 1st line is not working well?

A

refer to neurologist for microvascular decompression (surgical option)

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19
Q

What conditions are associated with trigeminal neuralgia?

A

Multiple sclerosis mainly

HSV virus

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20
Q

If a person has trigeminal neuralgia, which symptoms would be red flags for an underlying condition?

A
  • sensory changes
  • deafness
  • optic neuritis
  • bilateral symptoms
  • only opathalmic division affected
  • FX of MS
  • age <40
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21
Q

What may precipitate a cluster headache attack?

A

warm temperature
sleep habits
alcohol loads of it
volatile smells

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22
Q

in what headache may you see partial horners?

A

cluster headache

may get miosis and ptosis alongside the redness, lacrimation, swelling, rhinitis

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23
Q

cluster headache is common in males and ?

A

smokers

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24
Q

What is the most common side effect of migraines and how to manage this?

A

Nausea + vomiting

  • IV fluids if needed
  • metoclopramide
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25
Q

do not give prophylactic what drug for migraine in women of child bearing age?

A

Topiramate = teratogenic

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26
Q

patients who take painkillers a lot e.g. have migraines can get medication overdose headaches which are constant.

if this patient is overdoing codeine and paracetamol how to manage?

A

stop simple analgesia or triptans immediately is fine

Opioids need to be weaned off slowly

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27
Q

What is a contraindication for the combined oral contraceptive pill?

A

Migraine with aura

significant increased risk of ischaemic stroke

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28
Q

if both propranolol and topirmate is contraindicated in a patient what to give for prophylaxis of migraine? (asthma + childbearing age)

A

amitryptiline

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29
Q

how should sumatriptan for migraines be taken?

A

Sumatriptan should be taken once the headache starts, but not during the aura phase

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30
Q

what can you give instead of IV mannitol in raised ICP?

A

A hypertonic saline

works similarly, draws out water from brain

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31
Q

pathophysio of controlled hyperventilation in raised ICP?

A

Hyperventilation -> reduced CO2 -> vasoconstriction of cerebral arteries -> reduced ICP

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32
Q

Patients with myasthenia gravis can be given too much acetycholinesterase inhibitors and = cholinergic crisis

how to treat this?

A

Plasmapheresis
+
IV immunoglobulins

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33
Q

Which patients get wernickes?

A

B1def

Alcoholics
AIDs
bone marrow transplant

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34
Q

Treat hallucination in wernickes?

A

chlordiazepoxide

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35
Q

anterograde and retrograde amnesia seen in?

A

Korsakoff syndrome

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36
Q

Bedside investigation to reveal myasthenia gravis

A

ice pack test - apply ice pack, patient will lose their ptosis is it is due to MG

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37
Q

why would you want to do a chest CT in a patient with myasthenia gravis

A

to check for thymus abnormalities e.g. hyperplasia

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38
Q

why might a pregnant lady get wernikes encephalopathy

A

B1 def due to excessive vomiting = hyperemesis gavidarum

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39
Q

Who is interferon beta liscenced treatment for

A

relapsing remitting multiple sclerosis

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40
Q

SOD1 mutation?

A

genetic cause for familial ALS

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41
Q

LMN signs only in a patient?

A

Progressive muscular atrophy

  • a type of MND
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42
Q

which glucocortioid is preferred in MS (1st line acute symptoms relief)

A

methylprednisolone

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43
Q

factors associated with worse prognosis in MS?

A

Male sex

Older onset

Motor signs on onset

Many MRI lesions

Early relapses

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44
Q

Types of nerve damage

neuropraxia

axonotmesis

neurotmesis

traumatic neuroma

A

compression injury (conduction block)

axon damages but perineurium remains

complete nerve division

benign painful nodular thickening caused by nerve regeneration at site of nerve injury

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45
Q

wasting of thenar eminence + loss of sensation in lateral palmar surface of 3.5 digits

test weakness in abductor pollic brevis

which nerve affected by peripheral nerve injury?

A

Median nerve C6-T1

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46
Q

wasting of hypothenar eminence
sensory loss over medial 1.5 digits
“claw hand”

which nerve affected by peripheral nerve injury?

A

Ulnar nerve C8-T1

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47
Q

wrist drop (weakness of wrist extension)

which nerve affected by peripheral nerve injury?

A

Radial nerve C5-T1

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48
Q

weakness of dorsiflexion and eversion of foot?

which nerve affected by peripheral nerve injury?

A

common peroneal nerve L4-S1

49
Q

inability to invert foot or stand on tip toe
sensory loss on sole of food

which nerve affected by peripheral nerve injury?

A

tibial nerve L4 - S3

50
Q

carpal tunnel syndrome (peripheral nerve injury)

A

median nerve compression
(pregnancy, RA)

weakness + wasting

tinel’s sign = paraesthesia
phalens sign = wrist flexion -> symptoms

tx = steroids + splints at night

51
Q

Gullian barre syndrome? (peripheral nerve injury)

A

immune mediated
demyelination of PNS triggered (camylobacterJ)

back/leg pain
symmetrical weakness of all limbs (ascending pattern)

absent reflexes

LP = rise in protein with normal WCC

52
Q

Foot drop + weakness of hip abduction?

A

peroneal nerve lesion = foot drop

if just foot drop = peripheral injury
hip weakness = L5 radiculopathy

53
Q

what symptoms indicates that late stage potentially irreversible cauda equina

A

urinary incontinence

54
Q

meningitis key signs?

A

kernig = inability to straighten leg when hip is 90 degrees flexed

brudzinski sign - forced flexion of neck elicits flexion of hips

55
Q

most common complication meningitis?

A

deafness = sensourineal hearing loss

56
Q

when is dexamethasone not given alongside IV fluids and abx for meningitis?

A

With suspected meningococcal septicaemia (rash, pale, cold)

57
Q

prophylaxis for contacts of patients with meningococcal meningitis?

A

oral ciprofloxacin

58
Q

when is LP not performed for meningitis diasgnosis?

A

if severe sepsis(rash) signs = can caused DIC

if raised ICP

59
Q

encephalitis MRI findings

A

bilateral medial temporal lobe involvement

60
Q

brain abscess like meningitis has headache, fever, brudzinski + kernig sign so how to differentiate?

A

focal neurology e.g. 3rd/6rh nerve palsy

hx of infection

61
Q

manage brain mets ppt?

A

patients biggest concern - high ICP (persistent headache)

= high dose dexamethasone to reduce oedema

  • usually from a lung cancer
62
Q

for anxiety
step 1 = educate and monitor
step 2 = low intensity psychological intervention
step 3 = CBT or DRUGS ???

A

1 = SSRI, Sertraline

2 = Different SSRI/SNRI, Escitalopram, duloxetine, venlafaxine

3 = pregabalin

63
Q

examples of SSRI?

A

sertraline
fluoxetine (1st line children)
citalopram

64
Q

how to tx delirium tremens?

A

chlordiazeproxide + pabrinex

65
Q

how to treat hyperactive delirium (confusion with agitation)

A

haloperidiol / respiradone

  • C/I parkinsons, use lorazepam
66
Q

investigation / manage opiate overdose?

A

naloxone shows signs of reversal - diagnosis

also used for treatment
–> IV naloxone

67
Q

how to tx paracetamol overdose

ingestion:
- <1 hr
- < 4 hrs
- >15 hrs

A
  • <1 hr = activated charcoal
  • < 4 hrs = wait 4 hrs, get serum level, tx with quantified N acetylcysteine
  • > 15 hrs = IV N acetylcysteine
68
Q

tinnitus + mixed resp alkalosis (hyperventilation), diaphoresis?

A

Aspirin overdose

69
Q

convulsions + prolonged QT + dry skin, dry mouth?

A

tricyclic antidepressant overdose

mx with IV sodium bicarbonate

70
Q

what is used for opioid detox-ification?

A

methadone or buprenorphine

71
Q

if someone is using clopidogrel 75mg post stroke, but bad GI side effects what to give instead?

A

aspirin 75mg + modified release dipyridamole

72
Q

ABCD2 score?

A

predicting the occurrence of a stroke in the short term period following a transient ischaemic attack.

73
Q

ROSIER score?

A

The Recognition of Stroke in the Emergency Room (ROSIER) scale is effective in the initial differentiation of acute stroke from stroke mimics.

74
Q

NIHSS score?

A

National Institutes of Health Stroke Scale (NIHSS) is a tool used to objectively measure the impairment caused by a stroke.

75
Q

When is thombolysis + thrombectomy both offered post stroke?

A

if stroke is under 4.5 hrs

AND for thrombectomy - if stroke is in anterior circulation ACA/MCA

76
Q

someone has a stroke, its because of new AF (AF needs anticoag tx) when should the AF tx be commenced?

A

2 weeks after an acute ischaemic stroke

WOULD GIVE ANTICOAG so apixiban as long term mx (DOAC)

WOULDNT need clopidogrel as that is an antiplatelet and more useful hence for atherosclerosis based strokes

77
Q

you need 3 out of 6 major criteria for anxiety disorder. what are they?

A
  • Muscle tension
  • Sleep disturbance
  • Fatigue
  • Restlessness
  • Irritability
  • Poor concentration
78
Q

What is the anxiety questionnare?

A

GAD 7

79
Q

aetiology of depression?

A

Lack of monoamines e.g. serotonin, noradrenaline, dopamine

80
Q

How to diagnose major depressive disorder?

A

Depression mood or anhedonia +

(4 other sx from)
- insomnia
- guilt
- fatigue
- diminished focus / cognition
- weight change due to appetitie
- agitation
- suicidal ideation

81
Q

Scoring systems for depression?

A

PHQ-9 (patient health questionnare)

+

HAD (hospital anxiety and depression scale)

82
Q

what is the confusion screen?

A

TFTs (hypothyroidism)
B12 + Folate
Glucose (hypoglycaemia)
Bone profile (hypercalcaemia)

do for delirium

83
Q

Cognitive impairment screening for delirum?

A

AMTS ( 6 or less = delirium / dementia )

84
Q

Dilated fixed pupils post head trauma loss and gain and loss of conciousness?

A

Extradural haemorrhage

the pupils are due to oculomotor nerve compression from raised ICP

85
Q

subdural haemorrhage propylactic what given after?

A

Antiepileptics

86
Q

complication of subarachnoid haemorrhage? (leads to hyponatraemia)

A

SIADH

87
Q

Investigation for TIA?

A

Carotid doppler

do CT if patient has bleeding disorder or is on anticoags to be on safe side

exclude hypoglycaemia

88
Q

young stroke bloods in patients U55?

A

thrombophilia and autoimmune screening

89
Q

Parkinsons test / ix

A

DAT scan (dopaminergic agent trial) test, should see improvement on symptoms when dopamine is given

90
Q

drug induced vs idiopathic parkinsons sx?

A

Asymmetrical symptoms suggests idiopathic Parkinson’s

91
Q

At which ICP is treatment needed? - invasive intraventricular catheter drainage

A

ICP 20+

92
Q

types of Motor neuron disease?

A

ALS = common, UMN + LMN

Bulbar palsy = tongue + bulbar = worst prognosis

Primary lateral sclerosis - UMN

Progressive muscular atrophy - LMN

93
Q

respiratory care in motor neuron disease?

A

BIPAP for type 2 resp failure

94
Q

Ix for MND?

A

EMG - signs of denervation

Spirometry - monitor resp muscle weakness

95
Q

types of MS?

A

can present as relapsing remitting which may detoriate into secondary progressive after 10-15 years

or Present as primary progressive from the start

96
Q

intranuclear opthalmoplegia in MS?

A

Lesion of medial longitudinal fasciculus - blocks contralateral 6th nerve and ipsilateral 3rd nerve = affects horizontal gaze

–> impaired adduction in the eye and nystagmus in the other abducting eye

97
Q

ABCD2 score system TIA?

A

Age 60+ = 1 score

Blood Pressure 140/90+ = 1 score

Clinical:
- unilateral leg weakness = 2 score
- speech impairment = 1 score

Duration symptoms:
60mins+ = 2 score
10-59mins = 1 score

Diabetes = 1 score

98
Q

risk factor for acute vs chronic subdural haematoma?

A

Acute - trauma
Chronic - anticoag

99
Q

Partial vs total anterior circulation infarct?

A

Partial 2/3 features
total 3/3 features

features:

  • contralateral haemiparesis/sensory loss
  • contralateral homonymous hemianopia
  • higher cerebral dysfunction e.g. aphasia
100
Q

For a pregnant asthmatic women what migraine prophylaxis should be used?

A

amitryptilline

not proranolol, or topiramate

101
Q

What is the most common migraine complication?

A

N + V

102
Q

How to investigate chronic fatigue syndrome?

A

Depaul questionnare

103
Q

Raised ICP = cushings triad?

A

irregular breathing
bradycardia
wide pulse pressure

104
Q

how to treat idiopathic intracranial HTN (fat female post wx loss)

A

acetozolamide

105
Q

How to tx a bad tension headache|?

A

amitryptilline
Accupuncture

106
Q

What medicine worsens Mysasthenia gravis sx?

A

Beta blocker

107
Q

Ix for Myasthenia gravis?

  • specific vs sensitive
A

serum antibody AchR (specific)

EMG showing decremental response (sensitive)

108
Q

What is the tensillon test?

A

For MG - do not user due to risk of cardiac arrest

the IV edrophonium reduces muscle weakness

109
Q

Mx for myasthenia gravis?

A

pyridostigmine

steroid 2nd line

110
Q

What is seen on MS imaging?

A

MRI with contrast in brain/spine shows demyelination in plaques

  • and CSF testing is positive for increased IgG + oligobands
111
Q

MS acute tx?

MS spasticity tx?

A
  • methylprednisolone 2nd line is plasma exchange
  • beclofen + gabapentin
112
Q

Lasegues sign?

A

straight leg test, pain on flexion seen in sciatica

113
Q

Bacterial

Viral

TB

meningitis CSF results?

A

bacterial = cloudy, high neutrophils, high protein, low glucose

viral = clear, high lymphocytes, high protein, normal glucose

TB = cloudy/fibrin, lymphocytes, high protein, normal glucose, high opening LP pressure

114
Q

TIA initial ix steps?

referral rules?

A

all px need an urgent carotid doppler

CT for those px who are on anti-coag / have bleeding disorder

Mx going forward: 80g statin, 300mg aspirin, 75mg clopidogrel

within 7 day ppt = 24 hours
after 7 days ppt = within 7 days

115
Q

manage a haemorrhagic stroke

A

labetalol

116
Q

extradural haemotoma key points?

A

ConveX = lemon shaped seen on CT no contrast used

Have a lucid phase

affects middle meningeal artery

do craniotomy

117
Q

subdural haematoma key points?

A

concave = banana shaped on CT

can be acute or chronic, acute is hyperdense (white) and chronic is hypodense (darker)

bridging vein rupture

if acute and sx = craniectomy
if chronic and sx = burr hole evacuation

118
Q

Subarachnoid haemorrhage key points?

A

aneurysm rupture (polycystic kidney)

do CT head
LP do 12 hrs from sx onset looking for xanthochromia

do CT angio when confirmed to find site to the coiling

give these px nimodipine (CCB) to prevent vasospasm ( SIADH hypoN complication)

Year 3 (14 decks)

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