neurosciences Flashcards
causes of carpal tunnel syndrome
idiopathic
pregnancy
oedema e.g. heart failure
lunate fracture
rheumatoid arthritis
The following drugs may exacerbate myasthenia:
Pills likely to produce bad quality myasthenia gravis
Penicillamine, Lithium, Tetracycline, Procainamide, Beta blockers, Quinolones, Macrolides, Gentamicin
best and worst anaesthetic to use in patients with MG
worst : suxamethonium
best : rocuronium
what test is used in the diagnosis for MG
antibodies to acetylcholine receptors
what cancer is associated with MG
thymoma
what is the pathophysiology of carpal tunnel syndrome
action potential prolongation in both sensory and motor axons
how long do symptoms need to be present for a diagnosis of chronic fatigue syndrome to be made
3m
what is the management of a myasthenic crisis
supportive care
IV immunoglobulin
plasma exchange
what are the features of Wernicke’s encephalopathy
oculomotor dysfunction : nystagmus, ophthalmoplegia ( lateral rectus palsy, conjugate gaze palsy)
ataxia
what additional symptoms are seen in Korsakoff syndrome
amnesia ( retrograde and anterograde)
confabulation
what is the nature of inheritance of essential tremor ?
autosomal dominant
what are the features of essential tremor
postural tremor: worse if arms outstretched
improved by alcohol and rest
most common cause of titubation (head tremor)
which medications are prescribed in Parkinson’s disease ?
quality of life affected : Levodopa
quality of life not affected : dopamine agonist, levodopa or MAO-B
what are some of the side effects of drugs used to manage Parkinson’s
excessive sleepiness
hallucinations
impulse control disorders
what are some of the side effects of levodopa
dry mouth
anorexia
palpitations
postural HTN
psychosis
what are some adverse effects of levodopa ?
end of dose wearing off
on-off phenomenon
dyskinesia’s at peak dose ( involuntary writhing movements)
what other medications can be used to manage parkinsons
dopamine receptor agonists ( bromocriptine)
MAO-B
amantadine
COMT inhibitors ( entacapone)
what is the definition of a TIA
'’tissue based definition’’
transient episode of neurological dysfunction caused by focal brain, spinal cord, retinal ischaemia WITHOUT ACUTE INFARCTION
What type of tremor is seen with voluntary movements ?
Unilateral tremor that improves with movement
Neuroimaging is not normally indicated in suspected bacterial meningitis unless there are signs of:
raised ICP
infantile spasms ( West syndrome)
hypsarrhythmia –> EEG
brief spasms
poor prognosis
lennox gastaut syndrome
extension of infantile spasms
1-5 y
atypical falls and jerks
EEG : slow spike
manage w ketogenic diet
benign rolandic epilepsy
paraesthesia (e.g. unilateral face), seizures characteristically occur at night
juvenile myoclonic epilepsy
Typical onset in the teens, more common in girls
1. Infrequent generalized seizures, often in morning
2. Daytime absences
3. Sudden, shock-like myoclonic seizure
usually good response to sodium valproate
what are the key features of MS
optic neuritis: common presenting feature
optic atrophy
Uhthoff’s phenomenon: worsening of vision following rise in body temperature
internuclear ophthalmoplegia
what are the most common causes of bacterial meningitis in the neonatal period
Group B streptococcus , E.coli , Listeria monocytogenes
what are the main causative agents of bacterial meningitis in kids
Neisseria meningitidis
Streptococcus pneumoniae
what autonomic dysfunction is seen in Parkinson’s
postural Hypotension
what are the symptoms of drug induced Parkinson’s
rapid onset and bilateral
rigidity and rest tremor uncommon
How does bone metastases generally present ?
pathological fractures and bone pain
posterior cerebral artery stroke
macular sparing
visual agnosia
contralateral homonymous hemianopia
what is the first line management for a myoclonic seizure in women
Levetiracetam
what is a PICA infarction also known as ?
Lateral medullary syndrome
Wallenberg syndrome
what is the most common complication of meningitis
Sensorineural hearing loss
what is the pathophysiology of spastic cerebral palsy
Upper motor neurones in the periventricular white matter
what investigation should be used to view demyelinating lesions
MRI with contrast
how do seizures present depending on the lobe they originate from
temporal : automatisms ( lip smacking)
frontal lobe : head/ leg movements, post-ictal weakness, Jacksonian march
parietal lobe : paraesthesia
occipital : floaters and flashers
when should migraine prophylaxis be commenced in patients
2/ more attacks per month
what are the symptoms of ALS
asymmetric limb weakness
mixed LMN and UMN
fasciculations
wasting of the small hand muscles/ tibialis anterior
Absence of sensory signs and symptoms
what remains preserved in MND
ocular muscles not affected
no cerebellar signs
abdo reflexes
what is the management of acute relapse of MS
high dose steroids such as methylprednisolone for 5 days
which drugs reduce the risk of relapse in MS
natalizumab
ocrelizumab
how is spasticity managed in MS
Baclofen and gabapentin
what are the most common causes of viral meningitids
coxsackievirus B
______________is the preferred modality in patients with suspected TIA who require brain imaging
MRI brain with diffusion-weighted imaging
what are the symptoms of Duchenne muscle dystrophy?
progressive proximal muscle weakness from 5 years
Gower sign - child uses arms to stand up from a squatted position
intellectual impairment
calf pseudohypertrophy
Ivx for Duchenne muscular dystrophy
raised ck
genetic testing - definitive
nature of inheritance of Duchenne muscular dystrophy
X linked recessive
what cardiac condition is Duchenne muscular dystrophy ass. with
dilated cardiomyopathy
what is the investigation of a brain abscess
CT scan showing ring enhancing lesion
what is the management of a brain abscess
cephalosporin and metronidazole
what 2 antiepileptics are used in the management of focal seizures
lamotrigine / levetiracetam
kernig’s sign
extension of the knee when
