neurology_20231205142311 Flashcards
1
Q
How would an old subdural haemorrhage show on CT?
A
Hypodense crescent shaped lesion
2
Q
How would a new subdural haemorrhage show on CT?
A
Hyperdense crescent shaped lesion
3
Q
Where is a subdural haemorrhage?
A
Between the dura and arachnoid mater
4
Q
What are the risk factors for subdural haemorrhage?
A
Historic head trauma Anticoagulant use Alcoholism Old age
5
Q
What kind of patient does a subdural haemorrhage tend to occur in?
A
Older patient > 65
6
Q
What are the symptoms of a subdural haemorrhage?
A
Gradually increasing headache and confusion
7
Q
Where is an extra dural haemorrhage?
A
Between the skull and the dura mater
8
Q
What is the commonest cause of extradural haemorrhage?
A
Trauma to the pterion which tears the middle meningeal artery
9
Q
What is the pterion?
A
where the frontal, parietal, sphenoidal and temporal bones meet
10
Q
How does an extradural haemorrhage present?
A
Severe headache
Contralateral hemiplegia
Rapid deterioration in GCS following a lucid period
11
Q
How is an extradural haemorrhage seen on CT?
A
Lemon shaped haematomaShift of the ventricles
12
Q
Where is a subarachnoid haemorrhage?
A
Between the arachnoid and pia mater
13
Q
What is the presentation of a subarachnoid haemorrhage?
A
Severe sudden onset of headache - worst headache of their lifeOften in the occipital region
14
Q
What are subarachnoid haemorrhages caused by?
A
Trauma Spontaneous haemorrhage - most commonly due to the rupture of a berry aneurysm
15
Q
What are the investigations used to diagnose SAH?
A
Non-contrast CT brain Lumbar puncture
16
Q
What would be seen on CT in a SAH?
A
A white area in the centre of the brain, expanding bilaterally
17
Q
What would be seen on lumbar puncture in a SAH?
A
Blood in the CSF or xanthacromia
18
Q
What is the preferred surgical intervention for SAH?
A
Endovascular coiling
19
Q
What other surgical intervention can be performed for SAH?
A
Surgical clipping
20
Q
What condition is associated with subarachnoid haemorrhage?
A
Polycystic kidney disease (patients with PCKD can develop berry aneurysms)
21
Q
When would a lumbar puncture be performed to diagnose SAH?
A
If a CT head is inconclusive
22
Q
When should a lumbar puncture be performed to diagnose SAH if a CT is inconclusive?
A
12 hours after SAH (+onwards)
23
Q
What is the criteria for a CT in one hour after a head injury?
A
More than one episode of vomiting Clinical evidence of a skull fractureMore than 30 minutes of retrograde amnesiaGCS <13GCS < 15 after 2 hours Any sign of basal skull fracture - panda eyes, haemotympanum, CSF leakage from ear or nose Focal neurological deficit Post-trauma seizure
24
Q
What is the criteria for a CT in one hour after head injury in children?
A
Suspicion of non-accidental injury Post-traumatic seizure GCS < 14 or GCS < 15 if infant Evidence of skull fractureTense fontanelle Signs of a basal skull fracture Focal neurological deficits
25
What is the immediate treatment of a SAH?
IV nimodipine or IV mannitol Immediate neurosurgical referral
26
What is motor neuron disease?
A group of progressive and fatal conditions where motor neurons stop functioning.
27
Is sensation affected in MND?
No - only motor is affected
28
What is the most common form of MND?
ALS - amyotrophic lateral sclerosis
29
What are the other forms of MND?
Progressive bulbar palsyProgressive muscular atrophyPrimary lateral scleorosis
30
Which motor neurons does ALS affect?
Upper and lower motor neurons
31
What is the aetiology of MND?
Most cases are sporadic but there are genetic components.
32
What are 3 risk factors for developing MND?
Smoking PesticidesHeavy metal exposure
33
Which motor neurons does progessive bulbar palsy affect?
Upper and lower motor neurons
34
Which motor neurons does progressive muscular atrophy affect?
Only lower motor neurons
35
Which motor neurons does primary lateral sclerosis affect?
Only upper motor neurons
36
What type of patient typically presents with MND?
Middle to late middle aged male patient
37
What are the classical symptoms of MND at presentation?
Asymmetrical weakness - typically in the upper limb first Slurred speech Fatiguability Tripping overClumsinessWasting of muscles
38
What are the UMN signs?
Hypertonia Hyperreflexia SpasticityPositive babinski sign
39
What are the LMN signs?
HypotoniaHyporeflexia FasciculationsMuscle atrophy
40
What investigations can be performed in the diagnosis of MND?
EEGEMG MRI brain and spine ACh and MuSK antibodiesLumbar punctureBlood tests
41
What types of cells die in ALS?
Anterior horn cells and motor cortex neuronal cells
42
What features on history would point away from MND?
Sensory loss
Involvement of ocular muscles
43
What is the only disease modifying treatment for MND?
Riluzole
44
What does riluzole do?
Slows down the progression of ALS and prolongs life by a few months
45
What other management options are involved in MND?
Analgesia Botox injections Baclofen injections Anticholinergics for drooling NG/PEG tube Advance care planningPsychological supportCough assist machinesVoice banking
46
What are the differentials of MND?
Myasthenia Gravis Malignancy Stroke Motor neuropathy MSDisc prolapse
47
Which type of MND has the best prognosis?
Progressive muscular atrophy
48
Which type of MND has the worst prognosis?
Progressive bulbar palsy
49
What type of dementia is associated with motor neuron disease?
Fronto-temporal dementia
50
What is multiple sclerosis?
A cell-mediated autoimmune disorder characterised by demyelination in the CNS
51
Who is MS most common in?
MS is 3 times more common in women
52
When does MS typically present?
In people under 50
53
What are the three sub-types of MS?
Primary progressive Secondary progressive Relapsing-remitting
54
What is the most common subtype of MS?
Relapsing-remitting
55
What is the pathophysiology of MS?
The myelin sheath of oligodendrocytes becomes inflamed, and is infiltrated by immune cells
56
What are some risk factors for developing MS?
Genetics EBVLow vitamin DSmoking Obesity
57
What is the most common initial presentation of MS?
Optic neuritis
58
What is relapsing-remitting MS?
Periods of neurological disease and illness followed by recovery.
59
What is primary progressive MS?
MS that progressively worsens, without relapsing and remitting episodes
60
What is secondary progressive MS?
Progressive worsening of the disease with relapses that have incomplete remissions
61
What is required for a diagnosis of MS?
Lesions disseminated in space and time
62
What investigations can be carried out to confirm MS?
Contrast MRI Lumbar puncture
63
What would be seen on MRI?
Periventricular white matter lesions
64
What would be found on lumbar puncture in the CSF?
Oligoclonal bandsMildly raised protein Lymphocytes
65
What is the first line management of an MS relapse?
1g IV methylprednisolone for 3 days
66
What is the second line management of an MS relapse?
Plasma exchange
67
What is the long term treatment of MS?
Disease modifying therapies- Natalizumab- Interferon beta - Glatiramer- Dimethyl fumarate- Diroximel fumarate
68
What are the symptoms of MS?
Fatigue Difficulty walking Vision problems NumbnessTingling Muscle spasms Muscle stiffnessWeakness
69
What factors are associated with a worse prognosis in MS?
Male Motor signs at onsetEarly relapsesMany MRI lesions Axonal loss
70
Why is a contrast MRI performed to diagnose MS?
You can age the different lesions on a contrast MRI (to see lesions disseminated in space and time)
71
What contrast is used in a contrast MRI scan?
Gadolinium
72
What medication is first line for muscle spasticity in MS?
BaclofenGabapentin
73
What is a surgical third nerve palsy?
A third nerve palsy with a fixed and dilated pupil
74
What is a medical third nerve palsy?
A third nerve palsy that is pupil sparing
75
What are the symptoms of a third nerve palsy?
PtosisDown and out eye
76
What is the most common cause of a surgical third nerve palsy?
Posterior communicating artery aneurysm
77
What is Lambert-Eaton syndrome?
Autoimmune condition characterised by antibodies against the pre-synaptic voltage gated calcium channels
78
What conditions are associated with Lambert-Eton syndrome?
Small cell lung cancer
Other autoimmune diseases
79
What is myotonic dystrophy?
A trinucleotide repeat disorder affecting muscle-specific chloride channels
80
What is the inheritance of myotonic dystrohpy?
Autosomal dominant
81
What are the features of myotonic dystrophy?
Patient presents in their 20sFrontal balding Distal wasting and weaknessSlow relaxing gripDysarthria
82
What is NMO?
Neuromyelitis optica
83
What is the triad of NMO?
Optic neuritis Transverse myelitis Positive NMO-IgG - an antibody that targets aquaporin 4
84
Which damaged nerve can lead to foot drop?
Common peroneal nerve
85
What is Cushing's triad?
Labile breathing BradycardiaHypertension
86
What are the most common causes of peripheral neuropathy?
ABCDE- Alcohol - B12/folate- Chronic renal failure - Diabetes- Everything else - vasculitis, paraneoplastic
87
What is the distribution of peripheral neuropathy?
Glove and stocking
88
Where is the lesion in a superior quadrantanopia?
Temporal optic radiations
89
Where is the lesion in an inferior quadrantantopia?
Parietal optic radiations
90
What are the symptoms of increased ICP?
Headache worse in the morning Vomiting (can relieve symptoms)Blurred vision Behavioural changes Reduced consciousness levels
91
What investigation is contraindicated in increased ICP?
Lumbar puncture
92
Why is lumbar puncture contraindicated in increased ICP?
Brainstem herniation
93
What is a positive Romberg's sign?
When a patient becomes unsteady upon closure of their eyes when standing upright
94
What kind of ataxia does a positive Romberg's sign suggest?
Sensory ataxia
95
What is the first line preventative treatment of migraine?
Amitryptyline or a beta blocker
96
What is modafinil used for?
To treat drowsiness in narcolepsy (and other conditions)
97
On what side does ischaemia to the cerebellum cause symptoms?
Ipsilateral side
98
Where does the PICA supply?
Inferior cerebellum
99
What is the gold standard investigation for stroke?
Diffusion weighted MRI
100
What features are caused by an anterior inferior cerebellar artery infarct?
Ipsilateral deafness and facial paralysis
Sudden onset of vertigo and vomiting
101
What features are caused by a posterior inferior cerebellar artery infarct?
Ipsilateral facial pain and temperature loss
Contralateral limb/torso pain and temperature loss
Ataxia and nystagmus
102
What are the risk factors for haemorrhagic stroke?
Anticoagulation therapy
Age
Hypertension
Arteriovenous malformation
Drugs that mimic sympathetic nervous system
103
What are the risk factors for ischaemic stroke?
AgeHypertension Smoking Hyperlipidaemia DiabetesAtrial fibrillationHRTOral contraceptive
104
What symptoms are seen in a total anterior circulation infarct?
Unilateral hemiparesis, or unilateral hemisensory loss of upper or lower limb Homonymous hemianopia Higher cognitive dysfunction e.g dyphasia
105
Which limbs are more typically affected in anterior circulation infarcts?
Lower limbs
106
Which limbs are more typically affected in middle cerebral artery infarcts?
Upper limbs
107
What kind of symptoms would be seen with an ophthalmic artery stroke?
Amaurosis fugax
108
What is the first line investigation for a suspected stroke?
Non-contrast CT head
109
What is the difference between stroke and Bell's palsy?
Strokes are forehead sparing, whereas Bell's palsy involves the forehead
110
What is the Bamford classification?
A system of classifying and diagnosing ischaemic stroke
111
What is the Bamford classification of a total anterior circulation infarct?
All three symptoms: - Homonymous hemianopia- Unilateral weakness or sensory deficit of the face, arm and leg- Higher cerebral dysfunction
112
What is the Bamford classification of a partial anterior circulation infarct?
Two out of three symptoms: - Homonymous hemianopia- Unilateral weakness or sensory deficit of the face, arm and leg- Higher cerebral dysfunction
113
What is the Bamford classification of a posterior circulation stroke?
One of the following symptoms?- Cranial nerve palsy and contralateral motor/sensory deficit- Cerebellar dysfunction - Bilateral sensory or motor deficit- Conjugate eye movement disorder- Isolated homonymous hemianopia
114
What is the Bamford classification of a lacunar stroke?
One of the following symptoms:- Pure sensory stroke - Pure motor stroke - Sensori-motor stroke- Ataxic hemiparesis
115
What is the initial management of an ischaemic stroke?
300mg aspirin Thrombolysis if presented within 4.5 hours Thrombectomy if between 4.5-6 hours
116
What drug is used in thrombolysis?
Alteplase
117
What secondary prevention will be given after an ischaemic stroke?
Clopidogrel 75mg daily
Statin
Anti hypertensives
Carotid endarterectomy
118
What is the initial management of a haemorrhagic stroke?
Aim for BP 140/90Stop anticoagulants and antithromboticsReverse any anticoagulationRefer to neurosurgery
119
What tools can be used to assess stroke?
FASTROSIERABCD2
120
What is a TIA?
A sudden onset of a focal neurological deficit (of vascular origin) that resolves in 24 hours
121
What are crescendo TIAs?
More than 1 TIA in 7 daysTIAs that are increasing in frequency and severity
122
What is the definition of a stroke?
Sudden onset of a focal neurological deficit of vascular cause, with symptoms lasting more than 24 hours.
123
What are the contraindications to thrombolysis?
BP > 180/110Recent head traumaGI or intracranial haemorrhageRecent surgery - 2 weeks Platelet count INR > 1.7
124
What are the symptoms of a basilar artery stroke?
Locked in syndrome - Complete loss of movement with preserved consciousness and ocular movements
125
What are the symptoms of an anterior spinal artery stroke?
Loss of pain, temperature and motor function below the level of infarction
126
What is the management of a TIA?
300mg of aspirin Clopidogrel long term StatinsArrange urgent carotid doppler
127
What are the symptoms of a basilar artery stroke?
Locked in syndrome - Where the muscles of the body and face are paralysed but consciousness and eye movements are preserved
128
What is myasthenia gravis?
An autoimmune disease characterised by antibodies to the nicotinic acetylcholine receptors
129
What are the symptoms of myasthenia gravis?
Weakness of limbsDrooping eyelidsDiplopiaDifficulty smiling or chewing Difficulty swallowing Change in speech
130
When are symptoms typically worst in MG?
At the end of the day
131
What condition is myasthenia gravis associated with most commonly?
Thymic hyperplasia
132
What investigations are carried out in myasthenia gravis?
ACh receptor antibodiesCT chest (for thymoma)Single fibre elecetromyography (EMG for single muscle fibres)
133
What is the first line medical management of MG?
Long acting cetylcholinesterase inhibitors
134
What is the first line long acting acetylcholinesterase inhibitor used in MG?
Pyridostigmine (neostigmine may also be used)
135
What other management options are available?
Immunosuppression - prednisolone or azathioprineThymectomy
136
What other antibodies can cause MG?
MuSK antibodiesLRP4
137
What is the treatment of a myasthenic crisis?
IV immunoglobulins Plasma exchange
138
What condition is myasthenia gravis a paraneoplastic syndrome of?
Thymoma
139
What is lambert-eaton syndrome?
A myasthenic syndrome that is a paraneoplastic syndrome of small cell lung cancer
140
What is the difference between myasthenia gravis and lambert-eaton syndrome?
MG worsens with exercise and activity, whereas lambert-eaton syndrome improves with exercise
141
What is epilepsy?
Tendency to have seizures due to abnormal electrical activity in the brain
142
What are the features of tonic-clonic seizures?
Loss of consciousnessMuscle jerking (clonic)Muscle tensing (tonic)Tongue biting Incontinence
143
Which phase usually comes first in a tonic-clonic seizure?
Tonic phase
144
What is the first line treatment of tonic-clonic seizures?
Sodium valproate for males Lamotrigine or levetiracetam for females
145
What is the second line treatment of tonic-clonic seizures?
Lamotrigine or carbamezapine
146
How does an absence seizure present?
Usually children Stare into space for a few secondsAbruptly returns to normal Lasts around 20 seconds
147
What is the first line management of absence seizures?
Ethosuximide
148
When is sodium valproate contraindicated?
In females of fertile age
149
What are the side effects of sodium valproate?
Teratogenic Liver damageHair lossTremorWeight gain Oedema Ataxia
150
What is the first line medication for focal seizures?
Lamotrigine or leveteracitam
151
What is the second line medication for focal seizures?
Carbamezapine
152
What are the features of a frontal focal seizure?
Jacksonian features - numbness of tingling starts isolated, and then moves to the other limbs on the same side of the body Dysphasia Todd's paresis
153
What is Todd's paresis?
When a seizure is followed by a brief period of paralysis
154
What are the features of a temporal lobe focal seizure?
Deja vu Lip smacking Emotional disturbance - sudden onset of fearHallucinations - auditory, gustatory or olfactory
155
What are the features of a parietal lobe focal seizure?
Sensory symptoms - tingling and numbnessMotor symptoms - from spread of seizure into pre-frontal gyrus where motor cortex is
156
What are the features of an occipital focal seizure?
Visual symptoms - dots and lines in the vision
157
What are the features of a myoclonic seizure?
Sudden jerking of the limbs, face or trunk
158
What is the first line medication for a myoclonic seizure?
Sodium valproate for males Levetiracetam for females
159
What drug worsens myoclonic seizures?
Carbamezapine
160
What is the first line medication in hospital for status?
IV lorazepam
161
What is status epilepticus?
5 or more minutes of continuous seizure
162
What is the driving guidance for patients with epilepsy?
1 seizure - 6 months seizure freeMore than 1 seizure - one year seizure free
163
What are the features of an atonic seizure?
Sudden loss of muscle tone, which leads to a fallNo loss of consciousness
164
What is the first line management of status epilepticus in the community?
Buccal medazolam or rectal diazepamRepeat 15 minutes later
165
What medication can worsen absence seizures?
Carbamezapine
166
What investigations are performed to diagnose epilepsy?
EEG (after 2 seizures)MRI brain ECGElectrolytes Blood glucose Blood cultures, urine culturesLumbar puncture
167
What is juvenile myoclonic epilepsy?
An epilepsy syndrome characteristed by infrequent generalised seizures (often in the morning), absence seizures and sudden shock like myoclonic jerks
168
When is the typical onset of juvenile myoclonic epilepsy?
In teenage years
169
Who is juvenile myoclonic epilepsy more common in?
Girls
170
What is benign rolandic epilepsy?
An epileptic syndrome characterised by either tonic-clonic seizures, or focal seizures with abnormal sensation in the face - These seizures typically occur during sleep
171
When can medication be started for seizures?
After a patient has had 2 seizures, and has been investigated with an EEG
172
What are the fetal complications of antiepileptics in pregnancy?
Orofacial defects Haemorrhagic disease of the newborn Congenital heart defects Spina bifida
173
What are the complications of sudden withdrawal of antiepileptics?
Status epilepticus Suddent unexpected death in epilepsy
174
Do antiepileptic levels increase or decrease in pregnancy?
Decreased due to increased hepatic metabolism and increased renal clearance
175
Can breastfeeding women take antiepileptics?
Yes
176
What investigation can be used to distinguish between a true seizure and a pseudoseizure?
Prolactin - prolactin will be raised in a true eplipetic seizure
177
What is the definition of a seizure?
A transient episode of abnormal electrical activity in the brain
178
What general advice should be offered to parents of children with epilepsy?
Take caution when swimming
Take caution with heights
Shower rather than have a bath
Record any further episodes
Call 999 if a seizure lasts more than 5 minutes, or more than 2 minutes with LOC
179
What is a bulbar palsy?
A lower motor neuron lesion affecting cranial nerves 9, 10 and 12
180
What are the causes of bulbar palsy?
Myasthenia Gravis MND - progressive bulbar palsyGuillain Barre syndrome Brainstem stroke
181
What are the symptoms of a bulbar palsy?
Speech difficultyDysphagiaDrooling
182
What are the signs of a bulbar palsy on examination?
Quiet nasal speech Absent or normal jaw jerk reflexAbsent gag reflex Flaccid fasciculating tongue
183
What is the management of a bulbar palsy?
Speech and language therapy Medication for drooling NG tube - swallowing difficulties
184
What is pseudobulbar palsy?
An upper motor neuron lesion affecting cranial nerves 9, 10 and 12
185
What are the signs of psuedobulbar palsy on examination?
Quiet speech Spastic tongue Brisk jaw jerk reflexEmotional lability
186
What is Bell's Palsy?
An idiopathic syndrome affecting the facial nerve
187
What are the symptoms of Bell's Palsy?
Acute onset of unilateral facial weaknessEar pain - postauricular otalgia Hyperacusis - finding loud noises unbearable Drooling Drooping eyelid or corner of mouth Altered tasteDry eyes or mouth
188
Does Bell's palsy involve the forehead?
Yes (stroke is forehead sparing)
189
What is the main treatment of Bell's palsy?
Oral steroids - 50mg OD for 10 days
190
What other management options are involved in Bell's palsy?
Supportive treatments - artificial saliva/tears, eye patch/tape
191
What is Ramsay Hunt syndrome?
A facial nerve palsy caused by shingles near the ear
192
How is Ramsay-Hunt syndrome differentiated from Bell's Palsy?
Patients with Ramsay-Hunt syndrome will have profound ear pain, and a rash in the ear
193
What extra treatment would be given to someone with Ramsay-Hunt syndrome?
Acyclovir
194
What is the classic triad of Parkinson's?
BradykinesiaResting tremorRigidity
195
What is the pathophysiology of Parkinson's?
A reduction in the amount of dopaminergic neurons in the substantia nigra
196
What are some other common symptoms of Parkinson's?
Stooped postureFacial maskingReduced arm swing Shuffling gaitSmall handwriting Difficulty initiating movement
197
What kind of tremor can be seen in Parkinson's?
Pill rolling tremor
198
What is the difference between Parkinson's and benign essential tremor?
Parkinson's- Worsens with rest- Asymmetrical- Improves with intentional movement - No change with alcohol Benign essential tremor - Improves with rest- Symmetrical - Worsens with intentional movement - Improves with alcohol
199
What are the differential diagnoses of Parkinson's?
Lewy body dementia Benign essential tremor Drug-induced Parkinsonism Progressive supranuclear palsyMultiple system atrophy
200
What is the first line treatment of Parkinson's?
Levodopa/carbidopa
201
What is levodopa?
L-dopa is a precursor to dopamine
202
What is carbidopa?
Carbidopa prevents levodopa from being broken down before reaching the brain - leads to a lower dose of levodopa needed, and fewer side effects
203
What is the second line treatment of Parkinson's?
Dopamine agonists, COMT inhibitors, MAO-B inhibitors
204
When might a dopamine agonist be considered for initial therapy?
To delay starting levodopa, as levodopa's effectiveness reduces overtime
205
What are the signs of multiple system atrophy?
Parkinsonism Autonomic dysfunctionCerebellar signs
206
What is multiple system atrophy?
A rare neurodegenerative disorder that causes gradual damage to neurons
207
What are the common side effects of levodopa?
Dry mouth Palpitations Psychosis Anorexia Postural hypotension
208
Give an example of a dopamine receptor antagonist.
Cabergoline
209
What medications are contraindicated in Parkinson's?
Haloperidol - it promotes dopamine blockadeDopamine antagonists such as olanzapine
210
What medication can be used to sedate Parkinson's patients?
Lorazepam
211
What is the most important side effect of dopamine agonists?
Impulsivity
212
What is cortico-basal degeneration?
A parkinson-plus syndrome where there is spontaneous uncontrolled movements of the affected limbs (in addition to the Parkinsonian triad)
213
What is progressive supranuclear palsy?
A parkinson-plus syndrome characterised by the parkinsonian triad + a vertical gaze palsy
214
What is multiple system atrophy?
A parkinson-plus syndrome characterised by Parkinsonianism and early autonomic features - postural hypotension, impotence and incontinence
215
Give examples of MAO-B inhibitors.
RasagilineSelegiline
216
Give examples of COMT inhibitors.
EntacaponeTolcapone
217
What are the differences between idiopathic and drug induced parkinson's?
Drug induced parkinsons tends to be symmetrical Rigidity and resting tremor are uncommon in drug induced parkinsonism
218
What are the most common bacterial causes of meningitis?
Streptococcus pneumoniae Neisseria meningitidisHaemophilus influenzaeListeria monocytogenes
219
What are the most common viral causes of meningitis?
EchovirusesCoxsackie A and B Poliovirus Herpes viruses
220
What are the most common fungal causes of meningitis?
Cryptococcus neoformans Mycobacterial meningitis
221
What are the non-infective causes of meningitis?
MalignancyChemical meningitis Drugs - NSAIDs, trimethoprimSarcoidosisSLE
222
What are the clinical features of meningitis?
HeadachePyrexia Neck stiffnessPhotophobia Nausea and vomiting Focal neurology SeizuresNon-blanching rash
223
What is Kernig's sign?
Patient is supine with hips flexed at 90 degrees- Positive test if there is pain on passive extension of the knee
224
What is Brudzinski's sign?
Positive sign - reflexive hip and knee extension when a patient's neck is flexed
225
What is the acute management of suspected bacterial meningitis?
2g IV ceftriaxone BD
226
What is the acute management of suspected bacterial meningitis in very young and old patients?
IV ceftriaxone + IV amoxicillin ( to cover for listeria)
227
What is the management of patients with a non-blanching rash in community?
IM benzylpenicillin and immediate transfer to hospital
228
What are the investigations for meningitis?
Lumbar puncture Bloods - FBC, U&E, glucose, clotting ABGBlood culturesCT head
229
What are the features of CSF in bacterial meningitis?
Cloudy appearanceWBC - 1000-2000Predominantly neutrophils Protein raised Low glucose Elevated opening pressure
230
What are the features of CSF in viral meningitis?
Clear appearance WBC - <300Predominantly lymphocytesProtein normal or elevatedGlucose normalNormal or elevated opening pressure
231
What are the features of CSF in fungal meningitis?
Cloudy appearance WBC <500Predominantly lymphocytes Protein rasiedLow glucose Elevated opening pressure
232
What medication may be given to those with meningitis to reduce the chance of long term neurological deficit?
IV dexamethasone
233
What prophylactic antibiotic is given to close contacts of those with meningitis?
Oral ciprofloxacin
234
What is Huntington's?
An autosomal dominant disorder with more than 38 CAG trinucleotide repeats in the gene encoding for the huntingtin protein
235
What is the triad of Huntington's features?
Choreoathetosis
Dominant inheritance
Dementia
236
What is choreoathetosis?
Uncontrollable movements of the arms and legs
237
What other features can be seen in Huntington's?
Saccadic eye movementsPersonality changesDystonia - muscle spasms and contractions
238
What investigations can be performed to diagnose Huntington's?
MRI CT Genetic testing - gold standard
239
What is the most effective medication to control chorea?
Tetrabenazine
240
What are the typical MRI findings in Huntington's?
Atrophy of the caudate nucleus and putamen
241
What are the causes of spinal cord compression?
Trauma Neoplasia Infection Disc prolapseEpidural haematoma
242
What are the features of spinal cord compression?
Acute UMN signs Sensory disturbance below the lesion Deep and localised back pain Bladder and bowel involvement
243
What is the gold standard investigation for spinal cord compression?
URGENT MRI spine
244
What is the first line treatment of spinal cord compression?
Surgical decompression within 48 hours
245
What is added to the treatment in patients where the cause is suspected to be malignant?
Empiric steroids - dexamethasone
246
What is the distribution of peripheral neuropathy?
Glove and stocking
247
What are the causes of peripheral neuropathy?
ABCDE A - alcohol B - B12/folate deficiency C - chronic renal failureD - DiabetesE - everything else - vasculitis, paraneoplastic
248
What nerve does cubital tunnel syndrome affect?
Ulnar nerve
249
Where does cubital tunnel syndrome affect?
Medial one and a half digits
250
How does alcohol contribute to peripheral neuropathy?
Causes thiamine deficiency
251
Which medication for TB may cause a peripheral neuropathy?
Isoniazid
252
Why does isoniazid cause a peripheral neuropathy?
It causes a B6 deficiency
253
What nerve causes carpal tunnel syndrome?
Median nerve
254
Where in the hand does the palmar branch of the median nerve supply?
ThumbIndex and middle fingerLateral half of the ring finger
255
Which thenar muscles does the median nerve supply?
Abductor pollicis brevis Opponens pollicisFlexor pollicis brevis
256
What are the risk factors for carpal tunnel syndrome?
Obesity Repetitive movements DiabetesPerimenopause Rheumatoid arthritis Hypothyroidism Acromegaly Trauma
257
What is the presentation of carpal tunnel syndrome?
NumbnessParaesthesia Burning sensation Pain Weakness of thumb movements Weakness of grip strength Difficulty with fine movements Wasting of thenar muscles
258
What is Phalen's test?
Fully flexing the wrists and holding them in this position - elicits numbness and paraesthesia in the median nerve distribution
259
What is Tinnel's test?
Tapping the wrist at the location where the median nerve passes through the carpal tunnel - elicits numbness and paraesthesia in the median nerve distribution
260
What is the management of carpal tunnel syndrome?
Rest and altered activitiesWrist splints Steroid injections Carpal tunnel release surgery
261
What type of injury causes a common peroneal nerve palsy?
Injury at the neck of the fibula
262
What is the most common presentation of a common peroneal nerve lesion?
Foot drop
263
What are the other presentations of a common peroneal nerve lesion?
Weak dorsiflexion Weak eversion of the foot Weakness of extensor hallucis longis Sensory loss over the dorsum of the foot
264
What drugs commonly cause peripheral neuropathies?
Amiodarone Isoniazid Vincristine Nitrofurantoin Metronidazole
265
What are the other causes of foot drop?
L5 radiculopathy Sciatic nerve lesion Superficial or deep peroneal nerve lesion
266
What symptoms does radial nerve damage cause?
Wrist drop Sensory loss across the dorsal aspect of the 1st and 2nd metacarpals
267
What is Guillain Barre syndrome?
Ascending inflammatory demyelinating polyneuropathy
268
What are the features of GBS?
Ascending symmetrical limb weaknessPreceding paraesthesia May involve respiratory system May present with cranial nerve palsies
269
What signs would be seen on examination of GBS?
LMN signs in the lower limbs Type 2 respiratory failureCranial nerve signs
270
What investigations would be performed in the diagnosis of GBS?
Spirometry - look for reduced FVCABG - type 2 respiratory failureAnti-gangloside antibodiesLumbar puncture
271
What would a lumbar puncture show in GBS?
Raised protein Normal cell counts Normal glucose
272
What is the first line treatment of GBS?
IV immunoglobulins
273
What is the second line treatment of GBS?
Plasmapheresis
274
What is the gold standard investigation in GBS?
Lumbar puncture
275
What is normal pressure hydrocephalus?
CSF buildup in the ventricles of the brain
276
What is the cause of normal pressure hydrocephalus?
Imparied absorption of CSF at the arachnoid granulationsAqueductal stenosis
277
What are the causes of hydrocephalus?
Trauma Brain bleedIdiopathic
278
What is the triad of features in normal pressure hydrocephalus?
Urinary incontinence Dementia Gait abnormality
279
What is the time frame of normal pressure hydrocephalus?
Develops over a few months
280
What is the definitive investigation for normal pressure hydrocephalus?
Walking and cognitive assessments before and after draining a large volume of CSF
281
What other investigation can show evidence of NPH?
MRI head can show enlarged ventricles
282
What is the management of NPH?
CSF drainageVentriculoperitoneal shunt
283
What is a ventriculoperitoneal shunt?
A small catheter that drains CSF from the ventricles into the peritoneal cavity where it is more easily absorbed
284
What are the complications of a ventriculoperitoneal shunt?
Infection
Blockage
Excessive drainage - prevented by a valveIntraventricular haemorrhage during surgery
285
What is encephalitis?
Inflammation of the brain
286
What is the most common cause of encephalitis?
Viral
287
What are the causes of encephalitis?
Viral Bacterial Fungal Autoimmune
288
What age range do people typically get encephalitis?
Under one Over 65
289
What is the msot common viral cause of encephalitis?
HSV-1
290
What other viruses cause encephalitis?
HSV-1
EBV
VZV
Cytomegalovirus
HIV
291
What are the symptoms of encephalitis?
Altered consciousnessAltered cognition Unusual behaviour Acute onset of focal neurological symptoms Acute onset of focal seizuresFever
292
What investigations should be performed in suspected encephalitis?
Lumbar puncture Viral PCR of CSFCT MRIEEG if seizures or vague symptoms HIV testing
293
What is the treatment of encephalitis?
Empirical treatment of IV ceftriaxone and acyclovir
294
What is an acoustic neuroma?
A benign schwann cell tumour surrounding the vestibulocochlear nerve
295
Where in the brain do acoustic neuromas occur?
Cerebellopontine angle
296
Where are schwann cells found?
In the peripheral nervous system
297
What is the typical presentation of an acoustic neuroma?
40-60 years old Gradual onset of:- Unilateral hearing loss- Unilateral tinnitus - Vertigo - Sensation of fullness in the ear
298
What is the presentation of a progressed acoustic neuroma?
Cranial nerve 5, 6, 7, 8, 9 and 10 palsies
299
What condition is associated with a bilateral acoustic neuroma?
Neurofibromatosis type 2
300
What investigations are carried out to diagnose acoustic neuroma?
Audiometry
CT
MRI - provides more detail than CT
301
What is the management of acoustic neuroma?
Conservative management - monitoring if no symptoms Partial or total surgical removal Radiotherapy
302
What cranial nerve palsies does acoustic neuroma typically present with?
5, 7 and 8
303
What is the definitive investigation for acoustic neuroma?
MRI of the cerebellopontine angle
304
What is the presentation of trigeminal neuralgia?
Intense shooting facial pain Lasts a few seconds to a few hoursMostly affects one side of the face
305
What kinds of actions can the pain be triggered by?
Talking Eating Touching the face
306
What is the first line treatment for trigeminal neuralgia?
Carbamezapine
307
What is the clinical triad of Wernicke's encephalopathy?
Ataxia Confusion Nystagmus
308
What is the cause of Wernicke's encephalopathy?
Thiamine deficiency (vitamin B1)
309
What are the causes of thiamine deficiency?
Chronic alcohol abuse Malnutrition Bariatric surgery Hyperemesis gravidarum
310
What is the treatment of Wernicke's encephalopathy?
IV Pabrinex
311
What is IV Pabrinex?
IV high-dose thiamine
312
What can Wernicke's encephalopathy progress to if left untreated?
Korsakoff's syndrome
313
What is the presentation of Korsakoff's syndrome?
Anterograde amnesia Retrograde amnesia Confabulation
314
What is Horner's syndrome?
An interruption of the sympathetic nervous system to the eye
315
What is the classic triad of symptoms in Horner's syndrome?
Ptosis
Miosis
Anhidrosis
316
What are the common causes of Horner's syndrome?
Pancoast tumour Stroke Carotid artery dissection
317
What are the differentials of Horner's syndrome?
Occulomotor nerve palsy Myasthenia gravis Bell's palsy
318
What is the name for not being able to extend the knee when the hip is flexed?
Kernig's sign
319
What condition can Kernig's sign be seen in?
Meningitis
320
What investigations should be ordered in a patient with suspected meningitis?
Blood culture, lumbar puncture, CRP, ESR, head CT, serum meningococcal and pWneumococcal PCR, throat swabs
321
What antibiotic should be given to patients with neisseria meningitidis?
IV cefotaxime
322
Give 7 signs of Parkinson's disease.
Resting tremor, bradykinesia, resting tremor, increased tone/rigidity, stooped posture, decreased arm swing, decreased amplitude or accuracy of repetitive movement
323
How does dopamine normally stimulate movement?
It inhibits the inhibitory pathway of the striatum, allowing movement.
324
What is the first line treatment of Parkinson's disease?
Levodopa
325
How does levodopa work?
Levodopa is a precursor molecule to dopamine. It therefore increases the amount of dopamine available to act upon receptors.
326
What drug is given with levodopa?
Carbidopa
327
Why is carbidopa given with levodopa?
It inhibits peripheral metabolism of levodopa
328
What are the two second line treatments for Parkinson's disease?
Dopamine agonists - pramipexole, ropinirole| MAO/COMT inhibitors
329
How do MAO/COMT inhibitors work?
They reduce the metabolism of dopamine - more available
330
Give 2 conditions that are associated with Parkinson's.
Depression, dementia
331
What symptoms are specific to a MCA stroke?
Contralateral motor weakness of upper limbs
Contralateral loss of sensation of the upper limbs
Hemianopia
Dysphasia
Aphasia
Face drop
332
What symptoms are specific to a ACA stroke?
Contralateral motor weakness of the lower limbs| Contralateral loss of sensation of the lower limbs
333
Which arteries does a total anterior circulation stroke involve?
Anterior and middle cerebral arteries
334
What is the difference between a partial and total anterior stroke?
A partial stroke has two of the following criteria, whereas a total has all 3:- Homonymous hemianopia - Unilateral hemiparesis or hemisensory loss - Higher cognitive dysfunction e.g dysphasia
335
What type of stroke is AF a risk factor for?
Ischaemic stroke
336
Give 6 red flag symptoms associated with headache.
```Altered consciousnessConfusion New headache with a history of cancerPapilloedema Cluster headacheSeizure```
337
What drug is given to reduce ICP?
IV Mannitol
338
Give 4 lower motor neuron signs.
Decreased tone Decreased reflexesMuscle wastingFasciculations
339
Give 4 upper motor neuron signs
Brisk reflexes
Increased tone
Babinski's sign
Minimal muscle atrophy - muscle weakness
340
How does normal pressure hydrocephalus present?
DementiaUrinary incontinenceUnsteady gait
341
What are the pathological findings in normal pressure hydrocephalus?
CSF pressure is normal, but the ventricles are dilated
342
In a right superior homonymous quadrantanopia where would the lesion be?
Meyer's loop - left temporal optic radiation
343
In a right inferior homonymous quadrantanopia, where would the lesion be?
Left parietal optic radiation
344
What is dysarthria?
A motor disorder where the muscles of speech are damaged, paralysed or weakened
345
Where in the brain is affected to cause chorea in Huntington's?
Striatum of the basal ganglia (caudate nucleus)
346
What pattern of inheritance does Huntington's show?
Autosomal dominant
347
What kind of mutation is seen in Huntington's?
A trinucleotide repeat - CAG
348
What are the features of Huntington's disease?
Chorea
Personality changes
Dystonia
Saccadic eye movements
349
After what age do Huntington's symptoms typically start to develop?
35
350
Which neurones are affected in Huntington's disease?
GABAnergic and cholinergic neurons
351
What is the first line medication for chorea in Huntington's disease?
Tetrabenazine
352
What is the first line treatment of behavioural problems in Huntington's?
SSRIs - citalopram or fluoxetine
353
What is the first line treatment of psychosis in Huntington's?
Haloperidol
354
What kind of motor neuron symptoms does Huntington's result in?
UMN
355
What type of hypersensitivity reaction is Guillain-Barre syndrome?
Type 4
356
Which infection classically causes Guillain-Barre syndrome?
Campylobacter jejuni
357
What is the characteristic feature of Guillain-Barre syndrome?
Progressive, symmetrical weakness of all limbs
358
What is the initial presenting feature of Guillain-Barre syndrome in many patients?
Back/leg pain
359
What are the first line investigations for Guillain-Barre syndrome?
Lumbar puncture| Nerve conduction studies
360
What will a lumbar puncture in a patient with Guillain-Barre syndrome show?
CSF with raised protein, and normal cell counts
361
What is the first line treatment for Guillain-Barre syndrome?
IV immunglobulins or plasma exchange
362
What features are typical of a temporal lobe seizure?
Lip-smacking, recurrent sense of deja vu, and postictal dyphasia.
363
What kind of features will a lesion below L1 cause?
Lower motor neuron symptoms
364
What are the symptoms of cerebellar disease?
Mnemonic DANISH```D - dysdiadochokinesia A - ataxiaN - nystagmus I - intention tremorS - slurred, stachato speechH - hypotonia```
365
What is the classic history of extra dural haemorrhage?
Brief loss of consciousness, followed by a lucid period ad then a quick deterioration
366
What is an extra dural haemorrhage commonly caused by?
Trauma to the head, which leads to a tear in the middle meningeal artery
367
What is the classic presentation of a subarachnoid haemorrhage?
Sudden onset of thunderclap headacheOcciptal headacheSigns of meningism
368
What is the most common cause of subarachnoid haemorrhage?
Berry aneurysm
369
What is the history of a subdural haemorrhage?
Typically more chronic:- Headache- Cognitive decline - Fluctuating consciousness
370
What is the classic triad of symptoms in Parkinson's disease?
Bradykinesia, rigidity, tremor
371
What is the acute management of cluster headache?
100% high flow oxygen
372
What is the prophylactic treatment of cluster headache?
Verapamil
373
What symptoms other than pain around the eye are seen in cluster headache?
Ipsilateral watering of the eye, red eye, nasal congestion and constricted pupil/drooping eyelid
374
What is the first line medication for patients with focal seizures?
Lamotrigine or levetiracetam
375
What is the first line medication for patients with generalised seizures?
Sodium valproate
376
How long must patients be seizure free before they can drive?
12 months
377
What is the first line acute management to terminate a seizure?
Benzodiazepines
378
What are the first line investigations after a patient first has a seizure?
Electroencephelogram (EEG), MRI
379
What features are typical of a frontal lobe seizure?
Proximal spread of clonic jerking| Affected muscles remain weak after seizure (called post ictal Todd's paralysis)
380
What features are typical of a temporal lobe seizure?
Pre-seizure aura/hallucinationsLip smacking during seizurePost-ictal confusion
381
What features are typical of an occipital lobe seizure?
Flashing and floaters
382
What features are typical of a parietal lobe seizure?
Non-specific sensory symptoms - paraethesia
383
Which limbs does an anterior cerebral artery stroke typically affect?
Lower limbs
384
Which limbs does a middle cerebral artery stroke commonly affect?
Upper limbs
385
What symptoms does a basilar artery stroke cause?
Locked in syndrome - complete paralysis of all muscles apart from the eyes
386
What is the initial management of a suspected TIA?
300mg aspirin daily
387
What is the first line long term anti-thrombotic therapy for patients who have had a confirmed TIA?
75mg clopidogrel daily
388
What are the symptoms of brown-sequard syndrome?
Ipsilateral weakness below the lesion
Ipsilateral loss of proprioception and vibration
Contralateral loss of pain and temperature
389
Where does the cauda equina begin?
L1/L2
390
What kind of symptoms does cauda equina syndrome cause?
Lower motor neuron symptoms
391
What kind of symptoms does a spinal cord compression present with?
UMN symptoms above the lesion| LMN symptoms below the lesion
392
How long after infection does Guillain-Barre syndrome typically develop?
2-3 weeks
393
Which infection classically causes Guillain-Barre syndrome?
Campylobacter jejuni
394
What is the first line investigation for suspected stroke?
CT head
395
Give an example of a benzodiazepine.
Clonazepam
396
What is the first line treatment for temporal arteritis?
Oral prednisolone
397
Give 3 symptoms of cauda equina.
Inability to open bowels/urinateReduced anal tone Saddle anaethesia
398
What is the first line treatment of myasthenia gravis?
Acetylcholinesterase inhibitors
399
Name 2 acetylcholinesterase inhibitors.
Pyridostigmine| Neostigmine
400
How long after the onset of symptoms can IV alteplase be given for acute ischaemic stroke?
4.5 hours
401
Who does Wernicke's encephalopathy typically affect?
Alcoholics
402
What symptoms are seen in Wernicke's encephalopathy?
Ataxia, opthalmoplegia, confusion
403
What is the cause of spina bifida?
Multifactorial
404
What receptors are found in the sympathetic nervous system?
Adrenergic and nicotinic
405
What receptors are found in the somatic nervous system?
Acetylcholine
406
What mutation is found in patients with Huntington's?
36 or more CAG repeats
407
What is the best prognostic treatment of motor neuron disease?
Riluzole
408
What happens in a tonic seizure?
The patient goes tense and stiff
409
What happens in a tonic-clonic seizure?
The patient goes tense and stiff, then has muscle tensing and relaxing
410
What is the first line treatment of tension headache?
Paracetamol
411
What are the CSF findings in bacterial meningitis?
High proteinLow glucoseHigh neutrophil polymorphs
412
What are the CSF findings in viral meningitis?
High or normal protein Normal glucoseHigh lymphocytes
413
What are the CSF findings in fungal meningitis?
High protein Low glucoseHigh lymphocytes
414
What is a complication of temporal arteritis?
Blindness (amaurosis fugax)
415
Why can temporal arteritis cause blindness?
Emboli occluding the retinal artery
416
What type of seizures is Jacksonian march associated with?
Frontal lobe seizure
417
What is Jacksonian march?
Where the seizures 'march' up and down the motor homonculus
418
What is the definition of multiple sclerosis?
An autoimmune demyelinating condition causing lesions disseminated in time and space
419
What is a common initial symptom of multiple sclerosis?
Optic neuritis
420
What is Uhthoff's phenomenon?
When symptoms (of MS) are worse with heat
421
What virus is a risk factor for MS?
EBV
422
What type of symptoms does motor neuron disease present with?
Upper and lower motor neuron symptoms
423
What is the first line for bacterial meningitis in a primary setting?
IM benzylpenicillin
424
What is the first line for bacterial meningitis in a secondary setting?
IV benzylpenicillin or IV ceftriaxone
425
What is the treatment of viral meningitis?
Analgesia, antipyretic and hydration
426
What is the second line treatment of viral meningitis?
Aciclovir
427
What symptoms are seen in Horner's syndrome?
Anhydrosis (reduced sweating), miosis (pupil constriction), ptosis (eyelid droop)
428
Give a cause of Horner's syndrome.
A pancoast tumour (rare tumour in the apex of the lung)
429
What sensory deficits are seen in Brown-sequard syndrome?
Ipsilateral loss of proprioception, vibration and motor function at the level of the lesion
Contralateral loss of pain and temperature sensation 2 levels below the lesion
430
Which vessel are extradural haematomas associated with?
Middle meningeal artery
431
What drug is given after subarachnoid haemorrhage to prevent vasospasm?
Nimodipine
432
What is the most common cause of Guillain-Barre syndrome?
Campylobacter jejuni
433
What symptoms can cluster headache cause other than pain?
Rhinorrhoea, ptosis, red eyes, lacrimation
434
What is the most appropriate first line investigation for MS?
MRI head
435
What is the classic history of an extradural haemorrhage?
Loss of consciousness, followed by a lucid period, then rapid onset of neurological defecits
436
What kind of brain bleeds are common in elderly patients who have fallen?
Subdural
437
Why are elderly patients more susceptible to subdural bleeds?
They have smaller brains and more fragile bridging veins
438
What is the first line acute treatment of migraine?
Sumatriptan
439
What is the first line cluster headache prophylaxis?
Verapamil
440
What type of dementia causes early memory loss?
Alzheimer's
441
What type of dementia causes early personality changes?
Fronto-temporal
442
What type of personality changes are seen in fronto-temporal dementia?
Aggression, disinhibition, hypersexuality
443
What type of progression does vascular dementia cause?
Stepwise progression
444
What is the only life prolonging medication available for MND?
Riluzole
445
What is baclofen used for?
To treat cramps in MND
446
What other investigation should also be ordered in suspected MS?
Lumbar puncture
447
What type of weakness is associated with Charcot-Marie Tooth syndrome?
Champagne bottle weakness - wasting of the muscles in the lower legs
448
What is the first line treatment of generalised seizures in women of child bearing age?
Lamotrigine
449
What symptoms are likely seen in a brain tumour?
```HeadacheBehavioural changesNauseaSpeech problems Weakness```
450
What is the pathophysiology of Alzheimer's disease?
Buildup of extravascular beta amyloid plaques and neurofibrillary triangles in the brain
451
What is the cause of fronto-temporal dementia?
Atrophy of the frontal lobe
452
What is Phalen's test used for?
Carpal tunnel syndrome
453
What is a positive Phalen's test result?
The patient is only able to flex their wrist for a maximum of 1 minute
454
Which receptors are affected in myasthenia gravis?
Nicotinic acetylcholine receptors of the neuromuscular junction
455
Up to a 1/5 of myasthenia gravis patients also have what other condition?
Thymoma
456
What cells predominate in the CSF of someone with bacterial meningitis?
Neutrophils
457
What is the first line prophylaxis of migraine?
Topiramate
458
What other medications can be used for migraine prophylaxis?
Beta blockers| Tricyclic antidepressants - amitriptyline
459
What is the definition of stroke?
Sudden onset of neurological defecits, due to ischaemic or haemorrhagic compromise of blood supply to the brain
460
What tract carries sensation of pain and temperature?
Spinothalamic tract
461
What tract carries sensation of proprioception, vibration and fine touch?
Doral column lemniscus pathway
462
Where does the dorsal column lemniscus pathway decussate?
Medulla oblongata
463
What is the name for a loss of sensation in the genital area?
Saddle anaesthesia
464
Give 4 causes of cauda equina syndrome.
TraumaDisc herniation TumoursSpine metastases
465
What is the first line management of cauda equina?
Lumbar decompression surgery
466
What is the first line investigation of cauda equina?
Emergency MRI spine
467
What distinguishes meningitis from meningococcal septicaemia?
Non-blanching petechial rash + signs of septic shock
468
What two signs will be positive on examination in meningitis?
Kernig's sign| Brudzinski's sign
469
What is Brudzinski's sign?
When the neck is flexed in a patient with meningitis, the hips and knees will also flex
470
What are the two most common causative organisms o bacterial meningitis?
Neisseria meningitidis| Streptococcus pneumoniae
471
What is the gold standard investigation for meningitis?
Lumbar puncture
472
What is the treatment of meningitis in the community?
IM benzylpenicillin
473
What is the treatment of meningitis in hospital?
IV cefotaxime/ceftriaxone (3rd generation cephalosporins)
474
What are the risk factors for folate deficiency?
Alcohol
Crohn's
Age
Diet
475
How long should a patient who has had a single TIA stop driving for?
1 month
476
How long should a patient who has had multiple TIAs stop driving for?
3 months - inform the DVLA
477
How long should a patient who has had a single seizure stop driving for?
6 months - inform the DVLA
478
What is the prophylactic treatment of cluster headache?
Verapamil
479
What is the immediate managment of cauda equina?
Immediate surgical decompression
480
What medications are recommended by NICE for migraine prophylaxis?
TopiramatePropanalolAmitriptyline Acupuncture
481
What is the first line prophylaxis of migraines?
Beta blockers
482
When is topiramate used for prophylaxis of migraines?
When beta blockers are unsuitable e.g in asthma
483
What is the resting tremor seen in Parkinson's often described as?
Pill rolling tremor
484
What is Charcot's neurological triad?
Dysarthria, nystagmus, intension tremor
485
What condition is Charcot's neurological triad seen in?
Multiple sclerosis
486
What is relapsing-remitting MS?
Flare ups are followed by a period of reduced symptoms - this baseline sees progressive disability with each remission.
487
What is progressive relapsing MS?
Progressive increase in disability with intermittent flares that resolve to the increasing baseline
488
What is the prophylactic treatment of meningitis?
Ciprofloxacin
489
What is the pathophysiology of Alzheimer's disease?
Extra-neuronal beta amyloid plaquesIntra-neuronal neurofibrally triangles Cortical atrophy
490
Give 4 risk factors for Alzheimer's disease.
Family history Caucasian Increasing ageDown's syndrome
491
What is the Oxford classification of stroke?
Assesses the following criteria:- Unilateral hemiparesis- Homonymous hemianopia - Higher cognitive dysfunction
492
What is the first line treatment of trigeminal neuralgia?
Carbamezapine
493
What cells are targeted in MS?
Oligodendrocytes
494
What constitutes a complex partial seizure?
The patient is not aware of goings on during the seizure, and is confused afterwards
495
Which nerve opens the fist?
Radial nerve
496
What is giant cell arteritis also called?
Temporal arteritis
497
What is GCA?
GCA is a systemic vasculitis that affets medium to large sized arteries
498
Where does GCA typically affect?
The temporal arteries
499
What age patients does GCA typically affect?
Over 50s Incidence peaks in 70s
500
What is the presentation of GCA?
Scalp tendernessTemporal headache Jaw claudicationBlurred or double vision
