Passmed Flashcards
What drug is used as migraine prophylaxis if a patient has asthma
Topiramate
What drugs can be used as migraine prophylaxis?
- Propranolol
- Topiramate
- Amitriptyline
What are the teratogenic effects of topiramate (CA inhibitor)
Cleft lip/palate
- Cartilage formation
What drugs are used to arrest a migraine?
Triptan (sumitriptan) + [NSAID or paracetmaol]
What is the treatment of acute cluster headache?
O2 + Sumitriptan
What drug is used for prophylaxis of cluster headaches?
Verapamil
What are the symptoms of a pontine hemorrhage?
- Reduced GCS
- Paralysis
- Bilateral pin point pupils
What is the acute emergency management of Myasthenia gravis?
Plasmapheresis + IV immunoglobulin
What nerve supplies the palmer aspect of the thumb and nail bed of the index finger?
Median nerve
What nerve supplies lateral dorsal aspect of the hand (base of the thumb)?
Radial nerve
What nerve supplies sensation to the dorsal and palmar aspect of the pinky?
Ulnar
What is Ramsey Hunt syndrome a complication of?
Shingles
What does Alzheimer’s mainly affect in the brain?
Cortex and hippocampus
What drugs are used to treat Lewy body dementia and Alzheimer’s?
- Acetylcholinesterase inhibitors - donepezil, galantamine and rivastigmine
- Memantine (NMDA / glutamate receptor antagonist)
What Alzheimer’s drug is contraindicated in patients with bradycardia (adverse effects include insomnia)?
Donepezil (acetylcholinesterase inhibitor)
Progressive supranuclear palsy has what symptoms to differentiate from Parkinson’s?
- Early falls
- Possib;y symmetric symtoms
- Possibly early dementia
- Does not have tremor
- Degeneration of frontal lobe
Multi-system atrophy has what additional symptoms which can differentiate it from Parkinson’s?
- Postural hypotension
- No tremor
- Atonic bladder, ED
What are the symptoms of degenerative cervical myelopathy?
- Pain in neck, upper or lower limbs
- Loss of motor function, especially digital dexterity, or impaired gait and imbalance
- Loss of sensory function (numbness)
- Loss of autonomic function (urinary/fecal incontinence, impotence)
- +ve Hoffman’s sign
What may degenerative cervical myelopathy caused by / what will be seen on MRI?
Disc degeneration and ligament hypertrophy, with accompanying cord signal change
What drugs are massively linked to intracranial hypertension?
Tetracyclines
What opioid may be used in neuropathic pain?
Tramadol
What Parkinson’s drug may cause cardiac fibrosis?
Bromocriptine (dopamine receptor agonist)
What may be a contraindication to triptans?
Cerebrovascular disease
Adverse effects of Carbamezipine?
- Diplopia
- Headache, drowziness, ataxia
- SJS
- SIADH, hyponatremia
- Leucopenia and agranulocytosis
- P450 enzyme inducer
What channels does carbamezipine bind to?
Na+ channels incr refractory period
What is the 1st line medication for partial seizures?
Carbamezipine (also used in trigeminal neuralgia and bipolar)
What is the 1st line medication for partial seizures?
Carbamazepine (also used in trigeminal neuralgia and bipolar)
What drug can be used to treat idiopathic intracranial hypertension?
Acetazolamide
What does a cerebellar vermis vs cerebellar hemisphere lesion affect?
- Cerebellar vermis = gait ataxia
- Cerebellar hemisphere = finger-nose ataxia
A supracondylar fracture with a subsequent loss of pronation will be caused by damage to what nerve?
Median
After 2 doses of IV lorazepam what medication is given to arrest a seizure?
IV phenytoin
How does exercise affect Lambert-Eaton syndrome vs MG?
Lambert Eaton improves after exercise unlike MG which worsens
Colle’s fracture is an injury to what nerve?
Median
Patient is unable to abduct thumb what nerve is affected?
Median (thenar muscles)
What are the 4 signs of Cushing’s reflex? (ICH)
- Bradycardia
- HTN
- Wide pulse pressure
- Respiratory depression
Motor neuron disease is linked to what type of dementia?
Frontotemporal
What are oligoclonal bands a sign of?
MS
Bilateral vestibular schwannomas are a sign of what syndrome?
NF 2
What drug is given for restless leg syndrome?
Ropinirole (dopamine agonist)
What type of aneurysm may cause CNIII palsy?
PCA berry aneurysm
What are the feautures of Neuroleptic malignant syndrome?
- AKI (elevated CPK)
- Altered mental status
- Incr temp
- Lead pipe rigidity
- Autonomic instability
- ## Tachycardia
What are the causes of Neuroleptic malignant syndrome?
- Dopamine receptor antagonists (antipsychotic)
- Abrupt cessation of dopamine agonists
What anti-epileptic can cause weight gain?
Sodium valproate
What neurocutaneous syndrome has ash leaf spots and shagreen patches?
Tuberous sclerosis
What are Jacksonian movements?
Clonic movements travelling proximally
- Feature of frontal lobe epilepsy
What drugs should be avoided with MG?
- Flouroquinolones (ciprofloxacin)
- Beta blockers
- CCBs
- Botox
- Muscle relaxants
- Lithium
- Magnesium
Brain abcess is treated with what?
Ceftraixone and metronidazole
When are triptans contraindicated?
Cardiovascular disease
Injury to the surgical neck of the humerus affects what nerve?
Axillary nerve
Hemangioblastomas are associated with what syndrome?
Von Hippel-Lindau
Lambert-Eaton syndrome has antiBs against what?
Voltage gated calcium channels
Ondanestron (anti-emetic in chemo) affects what receptor?
5HT-3-receptor antagonist
A craniopharyngioma is derived from what tissue?
Embryonic pituitary tissue
What is Lhermitte’s sign?
Flexion of the neck -> tingling of hands
- active inflammation or impingement on a disc, caused by many conditions (SCDC, MS, spondylosis)
What is used to treat cerebral oedema in brain tumours?
Dexamethasone
Phenytoin can cause what anemia?
Megaloblastic through altering folate metabolism
What vasculitis is associated with polymyalgia rheumatica?
Temporal arteritis
If the patient is moving around in pain due to a headache is it more likely a migraine or cluster headache?
Cluster
How is charcot-marie tooth disease inherited?
Aut Dom
What specifically will GBS show on lumbar puncture?
High protein
Cervical spondylosis has what symptoms?
- Degeneration of cervical spine
- Neck pain
- Shooting pains down arm
What is the 1st line treatment of MG?
Pyridostigmine (blocks activity of acetylcholinesterase)
What is the main symptom of open angle glaucoma?
Unilateral peripheral visual field loss
How does CO2 affect cerebral blood flow?
Increased CO2 = increased cerebral blood flow
-> increased ICP
How does hyperventilation affect cerebral blood flow and ICP?
Decreased CO2 therefore vasonstriction -> Less cerebral blood flow -> decreased ICP
How does CO2 affect the blood vessels in the brain?
Increased PCO2 causes vasoconstriction
Give examples of acetylcholinesterase inhibitors
- Rivastigmine
- Donepazil
- Galantamine
