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Yr3/4 and Yr 5Neuro > passmed year 5 > Flashcards

passmed year 5 Flashcards

1
Q

what is the best way to refer someone if they think they have had a TIA

A

refer to TIA clinic and then they will need MRI

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2
Q

MRI findings for someone with MS and where are they found

A

sagital view
dawsons fingers
perpendicular to corpus callosum

also

high signal T2 lesions
periventricular plaques

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3
Q

long-term prophylaxis of cluster headaches

A

verampamil
vasodilatory effects on cerebral arteries

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4
Q

stopping anti epileptic drugs - time frame adn how long do you need to be seizure free

A

Can be considered if seizure free for > 2 years, with AEDs being stopped over 2-3 months

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5
Q

1hou rhisotry of sudden onset headache
vomit and nausea
new onset facila pain over rigth maxilla

A

venus sinus thrombosis

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6
Q

gold standard for venous sinus thrombosis

A

MR venogram

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7
Q

mx of venous sinus thrombosis

A

LMWH

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8
Q

Lateral sinus thrombosis palsy to what nerves

A

6th and 7th

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9
Q

Cavernous sinus thrombosis cx

A

local infection (e.g. sinusitis), neoplasia, trauma
periorbital erythema and oedema

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10
Q

what nerves involved in cavernous sinus thrombosis

A

3,4,6,5

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11
Q

a sagittal sinus thrombosis will also present with seizures and hemiplegia
what is seen on venography

A

empty delta sign

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12
Q

The ‘4Ds’ can be useful in remembering causes of postural hypotension with compensatory tachycardia

A

Deconditioning.
Dysfunctional heart: aortic stenosis.
Dehydration: disease (acute illness, adrenal insufficiency), dialysis, drugs (diuretics, narcotics).
Drugs: anti-anginals, anti-parkinsonian medications (levodopa), antidepressants, antipsychotics, anti-benign prostatic hyperplasia drugs (tamsulosin).

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13
Q

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

A

posterior cerebral a.

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14
Q

difference between bleed in cerebellar vermis and cerebella hemisphere stroke

A

Cerebellar hemisphere lesions cause peripheral (‘finger-nose ataxia’)

Cerebellar vermis lesions cause gait atax

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15
Q

seizures in the morning/following sleep deprivation

A

Juvenile myoclonic epilepsy

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16
Q

most likely operation to be done for symptomatic chronic subdural bleeds

A

subdural bleed symptomatic

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17
Q

If the patient was asymptomatic and the subdural haemorrhage was found incidentally, there may be a preference fo

A

conservative mx

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18
Q

management choice for symptomatic acute subdural haemorrhage

A

decompresssive craniectectmy - useful if reacculuaiton of blood or there is a solid haematoma that cannot be removed via burr hole evacuation

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19
Q

status elipticus at home what can you give

A

in the prehospital setting PR diazepam or buccal midazolam may be given

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20
Q

status elipticus in hosp

A

in hospital IV lorazepam is generally used.

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21
Q

does sulcal widening normal happen as part of ageing and what condition presents with ventriculomegaly out of proportion to sulcal enlargement.

A

normal pressure hydrocephalus

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22
Q

Vitamin B12 deficiency
subacute combined degeneration of spinal cord
dorsal column usually affected first so what happens prior to distal paraesthesia

A

joint position and vibration lost

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23
Q

predom motor loss - peripheral neuropathy

A

Guillain-Barre syndrome
porphyria
lead poisoning
hereditary sensorimotor neuropathies (HSMN) - Charcot-Marie-Tooth
chronic inflammatory demyelinating polyneuropathy (CIDP)
diphtheria

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24
Q

predom sensory loss peripheral neuropathy

A

diabetes
uraemia
leprosy
alcoholism
vitamin B12 deficiency
amyloidosis

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25
Q

If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA what should happen

A

admit immediatley to exclude h

26
Q

neuroleptic malignant syndrome features

A

pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

27
Q

mx of NMS

A

stop antipsychotic
patients should be transferred to a medical - ntensive care units
IV fluids to prevent renal failure
dantrolene - and decreasing the release of calcium from the sarcoplasmic reticulum
bromocriptine, dopamine agonist, may also be used

28
Q

why can yoy not stop parkinsons meds - take L dopa for example

A

it is important not to acutely stop levodopa, for example, if a patient is admitted to hospital
if a patient with Parkinson’s disease cannot take levodopa orally, they can be given a dopamine agonist patch as rescue medication to prevent acute dystonia

29
Q

how do we manage bladder dysfuncction in MS

A

ultrasound KUB - first to assess bladder emptying
if significant residual volume → intermittent self-catheterisation
if no significant residual volume → anticholinergics may improve urinary frequency

30
Q

nystagmus in werncikes encephalopathy caused by what

A

lateral rectus palsy

31
Q

cushing triad in raised ICP

A

widening pulse pressure
bradycardia
irregular breathing

and HTN

32
Q

features of bells palsy

A

forehead affected
post-auricular pain (may precede paralysis)
altered taste - ant two thirds of tongue
dry eyes
hyperacusis

33
Q

anti epileptic drug mos associated with weight gain

A

sodium val po weight

34
Q

diabetes insipidus due to a craniopharyngioma causes what visual field defect

A

lower bitemporal hemianopia

35
Q

definition of a TIA

A

TIA is now tissue-based, not time-based: a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction

36
Q

neuropathic pain caused by

A

diabetic neuropathy
post-herpetic neuralgia
trigeminal neuralgia
prolapsed intervertebral disc

37
Q

neuropathic treatment 1st or 2nd line

what is used for localised neuropathic pain

A

first-line treatment
amitriptyline
duloxetine, gabapentin or pregabalin

2nd line one not tried above

topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia

38
Q

encepahltiis what shoudl u always do

A

start aciclovir

39
Q

most likely cause of encephalitis

A

HSV-1

40
Q

key feature of myasthenia

A

fatiguability

41
Q

medication overuse headahce best - how do you manage opiods and other painkilelrs

A

simple analgesia + triptans: stop abruptly
opioid analgesia: withdraw gradually

42
Q

visual agnosia sign of what artery stroke

A

PCA

43
Q

SO causes eye to do what

A

eye to internally rotate and depress while adducted.- trochelar nerve

44
Q

what is spastic paraparesis

A

Spastic paraparesis describes a upper motor neuron pattern of weakness in the lower limbs

eg - paraesthesia in her lower limbs, both of which have persisted for the past 3 weeks. She recalls experiencing bilateral leg stiffness about a year ago,

45
Q

raised ICP through trans-tendotrial herniation can compress what nerve

A

3rd

46
Q

mx of raised ICP

A

head elevation to 30º
IV mannitol may be used as an osmotic diuretic
controlled hyperventilation
removal of CSF - LP for idiopathic , ventirucloperitoneal shunt for hydrocephalus and drain and montiro

47
Q

how does controlled hyperventialtion reduce ICP

A

Hyperventilation reduces blood carbon dioxide, in turn causing cerebral vasoconstriction and a reduction in intracerebral pressure (ICP). This must be controlled so as to avoid under-perfusion of potentially ischaemic brain regions.

48
Q

when do you treat HTN in a stroke setting

A

Hypertension should not be treated in the initial period following an ischaemic stroke (unless prior to thrombolysis)

49
Q

limbic encephalitis 3 main sx

A

memory loss, confusion, and seizures.

50
Q

radiculopathy(pinched nerves) caused by

A

Degenerative changes: As people age, the discs in their spine can dry out, stiffen, and bulge, which can lead to bone spurs forming around the discs. These bone spurs can narrow the openings where the nerve roots exit the spine, known as foramina, which can pinch the nerve. This process is called foraminal stenosis.
Herniated discs: A herniated disc can occur when the material inside a disc tears and compresses a nerve root.
Trauma: Falls, car accidents, or other trauma can cause radiculopathy.
Bone spurs: Bone spurs can grow on the vertebrae and pinch a nerve root.

51
Q

what is atelectasis

A

the collapse of a lung or part of a lung, also known as a lobe

52
Q

how does sodium bicarbonate reverse the metabolic acidosis caused by tricyclic overdose

A

When administered intravenously, sodium bicarbonate dissociates into sodium (Na+) and bicarbonate (HCO3-) ions.
The bicarbonate ions consume hydrogen ions (H+) and convert to carbonic acid (H2CO3).
Carbonic acid converts to water (H2O) and carbon dioxide (CO2), which are exhaled from the lungs

53
Q

atypical cause of atypical GBS

A

shingles vaccination - small amount of cases linked to infection

54
Q

Antiganglioside antibodies can be used to test for GBS - what are examples of some of those antibodies

A

nti-GM1 (IgM) with multifocal motor neuropathy, GQ1b (IgG) with the Miller-Fisher syndrome and GM1 (IgG) with the Guillain-Barre syndrome

55
Q

inflammatory neuropathies can cause arrhymias - what do you need to monitor this

A

ECG

56
Q

what is the difference between myelopathy vs neuropathy

A

Myelopathy affects the spinal cord, while neuropathy affects the peripheral nervous system

myelopathy sx - pain, decreased balance and coordiantion, difficult walking , bladder and bowel function lost

nueoapthy more particular part

57
Q

GBS MRI findings

A

thickening and thickening and contrast enhancement of the spinal nerve roots, especially in the region of the cauda and conus medullaris contrast enhancement of the spinal nerve roots, especially in the region of the cauda and conus medullaris

normally in the anterior nerve roots

58
Q

why are steriods not used in GBS

A

reduce nerve regeneration delaying recovery so give IV immunoglobulins instead especially if off feet

59
Q

Precursor to lymes disease is a

A

cranial neuropathy such as trigeminal neuralgia or LR palsy

60
Q

Monoclonal means one is going out of control - technically means immunocompromised as not mounting any other response
so what is the diffference between this and polyclonal - Monoclonal antibodies

A

Monoclonal antibodies
Produced from a single clone of cells, which are all identical to each other. This makes monoclonal antibodies extremely specific, as they bind to a single epitope on an antigen.
Polyclonal antibodies
Produced from multiple clones of cells, each producing antibodies to different epitopes on an antigen. This gives polyclonal antibodies a broader range of epitope recognition.

61
Q

ritixumab works on what cell type

A

CD(cluster of differentiation)-20 present on B cell
- for any conditon with b cell pathology such as myasthenia and MS

62
Q

if cannot use IV immunnolgobulins what can you do

when should you do bloods

A

plasma exchange - seperate blood and plasma(water and protein so could be cancer cells in here) then replace the plasma with fluid and add to blood and give back.

This is why you must do all your tests before doign the plasma exchnage

Yr3/4 and Yr 5Neuro (9 decks)

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