Passmed questions Flashcards
Urinary incontinence + gait abnormality + dementia
normal pressure hydrocephalus
a reversible cause of dementia seen in elderly patients ?
normal pressure hydrocephalus
variant of fast score to assess stroke risk?
stROke ROsier score
Obese, young female with headaches and blurred vision, think?
idiopathic, intercranial hypertension.
idiopathic intercranial hypertension treatment?
weight loss and diuretic (acetazolamide)
two drugs that may cause peripheral neuropathy? “feels like walking on cotton wool”
nitrofurentoin and metronidazole
Normal pressure hydrocephalus management?
Normal pressure hydrocephalus
What is the most common presentation of multiple sclerosis?
optic neuritis
worsening of vision following rise in body temperature?
Uhthoff’s phenomenon: worsening of vision following rise in body temperature. Seen in MS
Colours, particularly reds, may appear “washed out” or less bright than usual. Which eye condition?
optic neuritis
Patients with MS can present with non specific symptoms. How do 75% present?
significant lethargy
what can you get in neck flexion in MS?
paraesthesia in limbs (Lhermittes syndrome)
what is paraesthesia?
abnormal sensation such as tingling, tickling or burning of a person’s skin with no apparent physical cause
Progressive degenerative disesase of brain. Accounts for majority of dementia in the UK?
alzheimers disease
what is thought to cause the inherited form?
mutations in amyloid precursor protein
what is apoE4?
class of proteins involved in the metabolism of fats in the body
macroscopic changes in alzheimers>
macroscopic: widespread cerebral atrophy, particularly involving the cortex and hippocampus
microscopic changes in alzheimers?
cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein
biochemically, what is there a deficit of in alzheimers?
acetylcholine
paired helical filaments are partly made from a protein called tau?
neurofibrillary tangles
There is a deficit of acetylcholine in amlzheimers. NICE now recommend the three acetylcholinesterase inhibitors. what are they?
donepezil, galantamine and rivastigmine
if intolerant of first l in drugs, what can be given second line ?
memantine (clementine)
DVLA advice post multiple TIAs: cannot drive for
3 months
if you have a seizure/fit, what must you do?
inform the DVLA
for patients with established epilepsy or those with multiple unprovoked seizures:
→ may qualify for a driving licence if they have been free from any seizure for?
12 months
if there have been no seizures for 5 years (with medication if necessary)
single episode syncope, explained and treated. restriction on driving?
4 weeks
single episode syncope, unexplained?
6 months off driving
stroke or TIA. If not residual neurological deficit. how long do you need to take off driving and do you need to inform DVLA?
1 month off driving. may not need to inform DVLA
craniotomy e.g. For meningioma. How long off driving
1 year
chronic neurological disorders e.g. multiple sclerosis, motor neuron disease: DVLA should be informed, what form is filled out?
PK1 form
levodopa side effects?
!Reduced effectiveness with time! dyskinesia (writhing movements) palpitations psychosis postural hypotension
name 3 dopamine receptor agonists?
dope
bromocriptine, ropinirole, cabergoline
what kind of drug is cabergoline?
dopamine agonist
what should patients being started on dopamine agonists be warned about ?
potential to cause impulse control disorders
side effect of dopamine agonist>
hallucinations
which drugs are associated with pulmonary and cardiac fibrosis?
dopamine agonists
when do most neurologists start ant epileptic treatment ?
following a second epileptic seizure
in what situations would you start an anti epileptic following a first seizure?
the patient has a neurological deficit
brain imaging shows a structural abnormality
the EEG shows unequivocal epileptic activity
the patient or their family or carers consider the risk of having a further seizure unacceptable
first line in generalised seizures?
sodium valpraote (sodium is a general flavouring)
second line?
lamotrigine and carbamazepine
which drug can precipitate absence seizures?
carbamazepine
first line for partial/focal seizures?
carbamazepine or lamotrigine (carbs only part of balanced diet)
2nd line in partial/focal seizures?
levetiracetam, oxcarbazepine or sodium valproate
myoclonic seizure treatment ?
sodium valproate (mayoclinic eating)
2 drugs you can use in absence seizures? (petit mal)
2 drugs that don’t like being absent from each other. sodium valproate and ethoSUXamide
Useful in patients with absence seizures who are intolerant of sodium valproate?
ethosuxamide
A 24-year-old man with focal seizures. He previously developed a rash whilst taking lamotrigine?
carbamazepine
what drug does carbamazepine always go with?
lamotrogine
what is titubation?
head tremor
that is made worse by intentional movement, made better by alcohol and propranolol?
essential tremor
if you see “fasciculations” think of?
motor neurone disease
if you have first seizure and if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG. how long off driving ?
6 months
what is phenytoin used in ?
the management of seizures
side effects of phenytoin?
large list of side effects
Acute
initially: dizziness, diplopia, nystagmus, slurred speech, ataxia
later: confusion, seizures
Chronic
common: gingival hyperplasia (secondary to increased expression of platelet derived growth factor, PDGF), hirsutism, coarsening of facial features, drowsiness
megaloblastic anaemia (secondary to altered folate metabolism)
peripheral neuropathy
enhanced vitamin D metabolism causing osteomalacia
lymphadenopathy
dyskinesia
Idiosyncratic fever rashes, including severe reactions such as toxic epidermal necrolysis hepatitis Dupuytren's contracture* aplastic anaemia drug-induced lupus
Teratogenic
associated with cleft palate and congenital heart disease
what is saturday night palsy?
compression of the radial nerve against the humeral shaft, possibly due to sleeping on a hard chair with his arm draped over the back. cannot extend wrist
Leg crossing, squatting or kneeling may cause a foot drop secondary to a common peroneal neuropathy. women who works in a nursery with foot drop. management?
avoid to stop leg crossing, kneeling and squatting. review in 4 weeks
cluster headache - acute treatment?
subcutaneous sumatriptan + 100% O2
risk factors for developing idiopathic inter cranial hypertension?
obesity
female sex
pregnancy
drugs*: oral contraceptive pill, steroids, tetracycline, vitamin A, lithium
features of tuberous sclerosis?
“ash leaf spots” which fluoresce under UV light
roughened patches of skin over the lumbar spine
adenoma sebaceum (angiofibromas) in butterfly distribution over nose
fibromata beneath nails
café au lait spots may be seen
if you get nausea in parkinson, which anti emetic?
domperidone
reduced sensation in a glove-and-stocking distribution
peripheral neuropathy. hands and feet are affected first, then the reduced sensation travels up the limbs
A positive Hoffmans sign is a sign of?
upper motor neuron dysfunction and points to a disease of the central nervous system
Neuroleptic malignant syndrome is typically seen in patients?
who have just started treatment. its a rare but dangerous condition seen in young males who have just started anti psychotic medication
