Passmedicine Flashcards
What is Weber’s syndrome?
Ipsilateral third nerve palsy with contralateral hemiplegia -caused by midbrain strokes
Brocas area
Involved in producing coherent speech
Wernickes area
Involved in speech processing and understanding language
Driving rules if you are withdrawing from epilepsy medication?
Cannot drive till 6 months after last dose (ie stop meds and wait six months)
Driving and fainting
No restriction
Driving and syncope? (explained and non-explained)
Explained - 4 weeks off
Non-explained - 6 months off
Two or more episodes - 12 months off
Stroke/TIA and driving?
1 month off driving, may not need to inform DVLA if no neurological deficit
Multiple TIAs - 3 months off driving and inform DVLA
Gold standard marker for CSF?
Beta-2 transferrin
If not, then just check for glucose :)
How does phenytoin work?
Binds to sodium channels and increases the refractory period
What do you need to be careful of when starting a phenytoin infusion?
Need to monitor heart because it is unpredictable and can cause arrhythmias
Which muscles are likely to waste in motor neurone disease?
Small hand muscles
Tibialis anterior
When might the symptoms of carpal tunnel syndrome be worse?
At night e.g. “might wake patient during the night”
Which hand muscles are supplied by the median nerve?
LOAF muscles
Someone has a painful third nerve palsy, what should you be worried about?
Posterior communicating artery aneurysm
(pupil dilated)
What is Weber’s syndrome? Which part of the brain does it occur in?
Caused by midbrain stroke
Ipsilateral third nerve palsy with contralateral hemiplegia
Treatment for cluster headache? and prophylaxis?
100% oxygen and triptan
Prophylaxis: verapamil
Which nerve wraps around the humerus and may be damaged in shoulder dislocation?
The axillary nerve
Which level is affected in Klumpkes palsy, and which other syndrome might occur?
Klumpke’s palsy is C8-T1
Involvement of T1 may also cause Horner’s syndrome
In Klumpke’s paralysis, there is typically weakness of the hand intrinsic muscles
Which level is affected in Erb’s palsy?
C5 and C6
(brachial trunks)
Obese young females with headaches/blurred vision, what should you think
Idiopathic intracranial hypertension
Which nerve palsy might be present in idiopathic intracranial hypertension?
Sixth nerve palsy
Which medications can increase risk of idiopathic intracranial hypertension?
Tetracyclines
Isotretinoin
Contraceptive pill
Steroids
Levothyroxine
Lithium
Management of idiopathic intracranial hypertension?
Weight loss
Repeated lumbar puncture
Acetazolomide
(might need to do optic nerve sheath decompression and fenestration to prevent damage to the optic nerve)
-remember idiopathic intracranial hypertension can cause blindness if not treated promptly
Which nerve supplies the extensors of the arm/hand
The radial nerve
Which muscle supplies the interosseous muscles of the hand?
The ulnar nerve
Which rami make up the brachial plexus?
C5 - T1
Real Teenagers Drink Cold Beer
Roots
Trunks
Divisions
Cords
Branches
Normal pressure hydrocephalus triad
Incontinence
Dementia
Gait
Why do you have to be careful when combining sodium valproate and lamotrigine?
Combining sodium valproate and lamotrigine can cause serious skin rashes, such as Steven-Johnson’s syndrome
Which test should you perform if you suspect degenerative cervical myelopathy?
You should perform Hoffman’s test (flick the patients middle finger, and you are looking for abnormal flexion in the thumb)
A positive Hoffman’s sign is a sign of motor neurone dysfunction and points to a disease of the CNS
When should you give someone migraine prophylaxis?
When someone is experiencing more than 2 migraines per month
Migraine prophylaxis for pregnant women?
Give them propanolol
(acute treatment - paracetamol)
Why should you avoid using topiramate as migraine prophylaxis in pregnant women?
Associated with cleft lip and palate if used in the first trimester of pregnancy
(although used in migraine prophylaxis, topiramate is an anticonvulsant)
Not much evidence about triptans in pregnancy so usually avoided
Medication particularly useful for prophylaxis of menstrual migraines?
Triptans
What is CADASIL syndrome?
Cerebral autosomal dominant ateriopathy with subcortical infarcts
(type of genetic condition where you get strokes)
Someone develops a foot drop, which nerve might be involved?
Common peroneal
Someone develops a foot drop and then a wrist drop, which condition should you consider?
Mononeuritis multiplex
What arteries are involved in a posterior circulation infarct?
The vertebrobasilar arteries
When is essential tremor more noticeable?
When arms are stretched out
What makes essential tremor better?
Propanol and alcohol
(i guess remember the “ol’s”)
A 69 year old woman presents with a 3 week history of headache, which is worse on the right side. She is generally unwell and feels “weak”, noting particular difficulty in getting up from a chiar
Temporal arteritis
What type of seizure is Carbamazepine of no use in?
Absence seizure
Most common presenting feature of MS
Optic neuritis
A 32 year-old female presents with a 3 day history of altered sensation on her left foot and right forearm. On examination she has clonus in both legs and has hyperreflexia in all limbs.
Multiple sclerosis
First line treatment for trigeminal neuralgia
Carbamazepine
Migraines and hormone replacement therapy?
Safe to prescribe hormone replacement therapy however might make migraines worse
Which nerve is associated with a wrist drop
Radial nerve
