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
2
Q
How long do symptoms need to be present for chronic fatigue syndrome?
A
3 months
3
Q
Medication for ACUTE cluster headache symptoms and LONG TERM PROPHYLAXIS?
A
Acute - subcutaneous sumatriptan + 100% oxygen
Prophylaxis - verapamil
4
Q
contraindication of sumatriptan?
A
CAD
So patents with cluster headache should only be given oxygen not the triptan
5
Q
What migraine medicine may cause extrapyramidal side effects, what is it used for?
A
Metoclopramide ANTI EMETIC
6
Q
1st line for focal seizure?
A
carbemazepine
(S/E = SIAD, SJS)
Lamotrigine
7
Q
1st line for generalised seizure?
A
sodium valproate
lamotrigine (use this for pregnant/childbearing females)
8
Q
2nd line for generalised seizure? + absence seizure 1st line?
A
ethosuximide
9
Q
manage status epileptica?
A
in hospital = IV lorazepam
not in hospital = PR diazepam
if not working = IV phenytoin
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.
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
12
Q
When can someone be considered seizure free?
A
> 2 years with anti-epileptics being stopped over 2-3 months
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
14
Q
1st line drug for moderate / mild Alzheimers dementia?
A
Donapezil
C/I = long QT
(rivastigmine also)
(galantamine if hallucinating)
15
Q
2nd Line drug or if severe alzheimers?
A
Memantine
NDMA receptor antagonist decreasing glutamate activity
16
Q
Diagnostic Lewy body dementia test?
A
SPECT scan / DaTscan
17
Q
Management of trigeminal neuralgia? 1st line
A
New diagnosis - (anticonvulsant) carbamezepine
S/E = SIADH
18
Q
Management of trigeminal neuralgia is 1st line is not working well?
A
refer to neurologist for microvascular decompression (surgical option)
19
Q
What conditions are associated with trigeminal neuralgia?
A
Multiple sclerosis mainly
HSV virus
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
21
Q
What may precipitate a cluster headache attack?
A
warm temperature
sleep habits
alcohol loads of it
volatile smells
22
Q
in what headache may you see partial horners?
A
cluster headache
may get miosis and ptosis alongside the redness, lacrimation, swelling, rhinitis
23
Q
cluster headache is common in males and ?
A
smokers
24
Q
What is the most common side effect of migraines and how to manage this?
A
Nausea + vomiting
- IV fluids if needed
- metoclopramide
25
do not give prophylactic what drug for migraine in women of child bearing age?
Topiramate = teratogenic
26
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?
stop simple analgesia or triptans immediately is fine
Opioids need to be weaned off slowly
27
What is a contraindication for the combined oral contraceptive pill?
Migraine with aura
significant increased risk of ischaemic stroke
28
if both propranolol and topirmate is contraindicated in a patient what to give for prophylaxis of migraine? (asthma + childbearing age)
amitryptiline
29
how should sumatriptan for migraines be taken?
Sumatriptan should be taken once the headache starts, but not during the aura phase
30
what can you give instead of IV mannitol in raised ICP?
A hypertonic saline
works similarly, draws out water from brain
31
pathophysio of controlled hyperventilation in raised ICP?
Hyperventilation -> reduced CO2 -> vasoconstriction of cerebral arteries -> reduced ICP
32
Patients with myasthenia gravis can be given too much acetycholinesterase inhibitors and = cholinergic crisis
how to treat this?
Plasmapheresis
+
IV immunoglobulins
33
Which patients get wernickes?
B1def
Alcoholics
AIDs
bone marrow transplant
34
Treat hallucination in wernickes?
chlordiazepoxide
35
anterograde and retrograde amnesia seen in?
Korsakoff syndrome
36
Bedside investigation to reveal myasthenia gravis
ice pack test - apply ice pack, patient will lose their ptosis is it is due to MG
37
why would you want to do a chest CT in a patient with myasthenia gravis
to check for thymus abnormalities e.g. hyperplasia
38
why might a pregnant lady get wernikes encephalopathy
B1 def due to excessive vomiting = hyperemesis gavidarum
39
Who is interferon beta liscenced treatment for
relapsing remitting multiple sclerosis
40
SOD1 mutation?
genetic cause for familial ALS
41
LMN signs only in a patient?
Progressive muscular atrophy
* a type of MND
42
which glucocortioid is preferred in MS (1st line acute symptoms relief)
methylprednisolone
43
factors associated with worse prognosis in MS?
Male sex
Older onset
Motor signs on onset
Many MRI lesions
Early relapses
44
Types of nerve damage
neuropraxia
axonotmesis
neurotmesis
traumatic neuroma
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
45
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?
Median nerve C6-T1
46
wasting of hypothenar eminence
sensory loss over medial 1.5 digits
"claw hand"
which nerve affected by peripheral nerve injury?
Ulnar nerve C8-T1
47
wrist drop (weakness of wrist extension)
which nerve affected by peripheral nerve injury?
Radial nerve C5-T1
48
weakness of dorsiflexion and eversion of foot?
which nerve affected by peripheral nerve injury?
common peroneal nerve L4-S1
49
inability to invert foot or stand on tip toe
sensory loss on sole of food
which nerve affected by peripheral nerve injury?
tibial nerve L4 - S3
50
carpal tunnel syndrome (peripheral nerve injury)
median nerve compression
(pregnancy, RA)
weakness + wasting
tinel's sign = paraesthesia
phalens sign = wrist flexion -> symptoms
tx = steroids + splints at night
51
Gullian barre syndrome? (peripheral nerve injury)
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
Foot drop + weakness of hip abduction?
peroneal nerve lesion = foot drop
if just foot drop = peripheral injury
hip weakness = L5 radiculopathy
53
what symptoms indicates that late stage potentially irreversible cauda equina
urinary incontinence
54
meningitis key signs?
kernig = inability to straighten leg when hip is 90 degrees flexed
brudzinski sign - forced flexion of neck elicits flexion of hips
55
most common complication meningitis?
deafness = sensourineal hearing loss
56
when is dexamethasone not given alongside IV fluids and abx for meningitis?
With suspected meningococcal septicaemia (rash, pale, cold)
57
prophylaxis for contacts of patients with meningococcal meningitis?
oral ciprofloxacin
58
when is LP not performed for meningitis diasgnosis?
if severe sepsis(rash) signs = can caused DIC
if raised ICP
59
encephalitis MRI findings
bilateral medial temporal lobe involvement
60
brain abscess like meningitis has headache, fever, brudzinski + kernig sign so how to differentiate?
focal neurology e.g. 3rd/6rh nerve palsy
hx of infection
61
manage brain mets ppt?
patients biggest concern - high ICP (persistent headache)
= high dose dexamethasone to reduce oedema
* usually from a lung cancer
62
for anxiety
step 1 = educate and monitor
step 2 = low intensity psychological intervention
step 3 = CBT or DRUGS ???
1 = SSRI, Sertraline
2 = Different SSRI/SNRI, Escitalopram, duloxetine, venlafaxine
3 = pregabalin
63
examples of SSRI?
sertraline
fluoxetine (1st line children)
citalopram
64
how to tx delirium tremens?
chlordiazeproxide + pabrinex
65
how to treat hyperactive delirium (confusion with agitation)
haloperidiol / respiradone
* C/I parkinsons, use lorazepam
66
investigation / manage opiate overdose?
naloxone shows signs of reversal - diagnosis
also used for treatment
--> IV naloxone
67
how to tx paracetamol overdose
ingestion:
- <1 hr
- < 4 hrs
- >15 hrs
- <1 hr = activated charcoal
- < 4 hrs = wait 4 hrs, get serum level, tx with quantified N acetylcysteine
- >15 hrs = IV N acetylcysteine
68
tinnitus + mixed resp alkalosis (hyperventilation), diaphoresis?
Aspirin overdose
69
convulsions + prolonged QT + dry skin, dry mouth?
tricyclic antidepressant overdose
mx with IV sodium bicarbonate
70
what is used for opioid detox-ification?
methadone or buprenorphine
71
if someone is using clopidogrel 75mg post stroke, but bad GI side effects what to give instead?
aspirin 75mg + modified release dipyridamole
72
ABCD2 score?
predicting the occurrence of a stroke in the short term period following a transient ischaemic attack.
73
ROSIER score?
The Recognition of Stroke in the Emergency Room (ROSIER) scale is effective in the initial differentiation of acute stroke from stroke mimics.
74
NIHSS score?
National Institutes of Health Stroke Scale (NIHSS) is a tool used to objectively measure the impairment caused by a stroke.
75
When is thombolysis + thrombectomy both offered post stroke?
if stroke is under 4.5 hrs
AND for thrombectomy - if stroke is in anterior circulation ACA/MCA
76
someone has a stroke, its because of new AF (AF needs anticoag tx) when should the AF tx be commenced?
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
you need 3 out of 6 major criteria for anxiety disorder. what are they?
- Muscle tension
- Sleep disturbance
- Fatigue
- Restlessness
- Irritability
- Poor concentration
78
What is the anxiety questionnare?
GAD 7
79
aetiology of depression?
Lack of monoamines e.g. serotonin, noradrenaline, dopamine
80
How to diagnose major depressive disorder?
Depression mood or anhedonia +
(4 other sx from)
- insomnia
- guilt
- fatigue
- diminished focus / cognition
- weight change due to appetitie
- agitation
- suicidal ideation
81
Scoring systems for depression?
PHQ-9 (patient health questionnare)
+
HAD (hospital anxiety and depression scale)
82
what is the confusion screen?
TFTs (hypothyroidism)
B12 + Folate
Glucose (hypoglycaemia)
Bone profile (hypercalcaemia)
do for delirium
83
Cognitive impairment screening for delirum?
AMTS ( 6 or less = delirium / dementia )
84
Dilated fixed pupils post head trauma loss and gain and loss of conciousness?
Extradural haemorrhage
the pupils are due to oculomotor nerve compression from raised ICP
85
subdural haemorrhage propylactic what given after?
Antiepileptics
86
complication of subarachnoid haemorrhage? (leads to hyponatraemia)
SIADH
87
Investigation for TIA?
Carotid doppler
do CT if patient has bleeding disorder or is on anticoags to be on safe side
exclude hypoglycaemia
88
young stroke bloods in patients U55?
thrombophilia and autoimmune screening
89
Parkinsons test / ix
DAT scan (dopaminergic agent trial) test, should see improvement on symptoms when dopamine is given
90
drug induced vs idiopathic parkinsons sx?
Asymmetrical symptoms suggests idiopathic Parkinson's
91
At which ICP is treatment needed? - invasive intraventricular catheter drainage
ICP 20+
92
types of Motor neuron disease?
ALS = common, UMN + LMN
Bulbar palsy = tongue + bulbar = worst prognosis
Primary lateral sclerosis - UMN
Progressive muscular atrophy - LMN
93
respiratory care in motor neuron disease?
BIPAP for type 2 resp failure
94
Ix for MND?
EMG - signs of denervation
Spirometry - monitor resp muscle weakness
95
types of MS?
can present as relapsing remitting which may detoriate into secondary progressive after 10-15 years
or Present as primary progressive from the start
96
intranuclear opthalmoplegia in MS?
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
ABCD2 score system TIA?
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
risk factor for acute vs chronic subdural haematoma?
Acute - trauma
Chronic - anticoag
99
Partial vs total anterior circulation infarct?
Partial 2/3 features
total 3/3 features
features:
- contralateral haemiparesis/sensory loss
- contralateral homonymous hemianopia
- higher cerebral dysfunction e.g. aphasia
100
For a pregnant asthmatic women what migraine prophylaxis should be used?
amitryptilline
not proranolol, or topiramate
101
What is the most common migraine complication?
N + V
102
How to investigate chronic fatigue syndrome?
Depaul questionnare
103
Raised ICP = cushings triad?
irregular breathing
bradycardia
wide pulse pressure
104
how to treat idiopathic intracranial HTN (fat female post wx loss)
acetozolamide
105
How to tx a bad tension headache|?
amitryptilline
Accupuncture
106
What medicine worsens Mysasthenia gravis sx?
Beta blocker
107
Ix for Myasthenia gravis?
- specific vs sensitive
serum antibody AchR (specific)
EMG showing decremental response (sensitive)
108
What is the tensillon test?
For MG - do not user due to risk of cardiac arrest
the IV edrophonium reduces muscle weakness
109
Mx for myasthenia gravis?
pyridostigmine
steroid 2nd line
110
What is seen on MS imaging?
MRI with contrast in brain/spine shows demyelination in plaques
* and CSF testing is positive for increased IgG + oligobands
111
MS acute tx?
MS spasticity tx?
- methylprednisolone 2nd line is plasma exchange
- beclofen + gabapentin
112
Lasegues sign?
straight leg test, pain on flexion seen in sciatica
113
Bacterial
Viral
TB
meningitis CSF results?
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
TIA initial ix steps?
referral rules?
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
manage a haemorrhagic stroke
labetalol
116
extradural haemotoma key points?
ConveX = lemon shaped seen on CT no contrast used
Have a lucid phase
affects middle meningeal artery
do craniotomy
117
subdural haematoma key points?
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
Subarachnoid haemorrhage key points?
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)
