Y3 Questions/buzzwords Flashcards
What is Cushing’s triad?
widened pulse pressure (due to increased cortisol production), bradycardia and irregular breathing
Which diuretic is used in managing raised ICP?
Mannitol, it is an osmotic diuretic
Managing which type of brain-related emergency involves use of lactulose?
Hepatic encephalopathy
Clear gut to reduce colonic transit time, so that there is less chance for bacteria to produce nitrogenous waste
Which parts of the spinal cord can be affected in subacute combined degeneration of the spinal cord? How would these present clinically?
Dorsal Columns - distal symmetrical impaired sensation (more commonly in legs), impaired proprioception & vibration
Lateral cortical spinal tracts - muscle weakness, hyperreflexia, and spasticity (UMN signs), brisk knee jerks, absent ankle jerks, extensor plantar
Spinocerebellar tract involvement - sensory ataxia leading to gait abnormality, +ve Romberg’s sign
What causes subacute combined degeneration of the spinal cord?
Vitamin B12 deficiency (can be caused by recreational nitrous oxide inhalation)
What are the four drugs listed as first-line for managing neuropathic pain?
Amitriptyline, duloxetine, gabapentin or pregabalin
If one isn’t working very well, SWITCH to another instead of ADDING them
How does chronic subdural haematoma classically present?
It comes on insidiously, developing over weeks to months, with a lucid interval followed by gradual decline in consciousness
Dull headache, confusion, and lethargy
How would extradural haematoma usually present?
EDH typically results from significant head trauma associated with a skull fracture and presents acutely with a lucid interval followed by rapid neurological decline.
What is the one key feature of multiple sclerosis compared to other similar neurological conditions?
The dissemination of symptoms in time and space
Patients typically experience different neurological symptoms affecting different parts of the central nervous system at different times
What is the key feature of myasthenia gravis and what are some presentations?
Muscle fatigability
Diplopia (extraocular muscle weakness), Proximal muscle weakness, ptosis, dysphagia
What is the preferred medication for secondary prevention following a stroke?
Clopidogrel
In what condition are DOACs used for prevention?
preventing strokes in non-valvular atrial fibrillation or venous thromboembolism
Which is preferred for secondary stroke prevention - anti-coagulants or anti-platelets?
Anti-platelets
When is tissue plasminogen activator (like Alteplase) indicated following an acute stroke?
It is indicated in patients presenting within 4.5 hours of symptom onset and with no contraindications to thrombolysis
What are things that can lead to contraindications of thrombolysis?
INR >1.7
Past history of intracranial haemorrhage
Major surgery in the last 14 days
GI or urinary tract bleeding in the last 21 days
Suspicion of subarachnoid haemorrhage, even if CT normal
Uncontrolled blood pressure >185 systolic and/or >110 diastolic
How to manage crescendo TIA?
Aspirin 300mg and review within 24h
First line treatment in optic neuritis?
Intravenous methylprednisolone
What is the main purpose in performing a non-contrast CT Head in acute ischaemic stroke?
To exclude the presence of an intracranial haemorrhage
What imaging should be undertaken following an ischaemic stroke?
This is done to figure out potential cause of the emboli
Carotid ultrasound (to identify critical carotid artery stenosis)
CT/MR angiography (to identify intracranial and extracranial stenosis)
Echocardiogram (if a cardio-embolic source is suspected)
Main risk factor for haemorrhagic stroke?
Hypertension, cerebral amyloid angiopathy, anticoagulation
Three cardinal signs of middle cerebral artery stroke
Contralateral hemiplegia, contralateral homonymous hemianopia, (if in dominant hemisphere) dysphasia
NB: not to confuse dysphasia with dysphagia
What is the Oxford-Bamford criteria for a total anterior circulation stroke?
All three of:
- Unilateral weakness and/or sensory deficit in the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
What are the causes of ischaemic stroke (including % of cases for each cause)?
25% of ischaemic strokes are caused by intracranial small vessel atherosclerosis
50% of ischaemic strokes are caused by large vessel atherosclerosis e.g. carotid artery stenosis
20% of ischaemic strokes are cardio-embolic e.g. in atrial fibrillation there is stasis of blood flow in the left atrium, predisposing to thrombus formation in the left atrium, and subsequent embolisation to the brain.
Rare causes of ischaemic stroke include primary vascular causes (such as vasculitis and arterial dissection) and haematological causes (prothrombotic states).
Should aspirin 300mg be given to patients who are candidates for thrombolysis?
No, aspirin should be withheld until 24hrs after thrombolysis when a repeat CT head is done to avoid bleeding risk
What is the clinical presentation of Bell’s palsy?
Unilateral facial droop with eyebrow involvement
Only involves cranial nerves
What is the clinical presentation of a lacunar stroke?
Hemiparesis/contralateral changes in sensation/ataxia
There should be NO eye signs or involvement
What is the clinical presentation of lateral pontine syndrome?
Unilateral facial paralysis and deafness due to respective CN nuclei involvement
Hemiparesis
How would rhabdomyolysis typically feature in an exam question?
As a patient who has had a fall or prolonged epileptic seizure and is found to have an acute kidney injury on admission
Creatinine kinase would be above 5 times raised than normal
What conditions can give a positive Hoffmann’s sign?
Any upper motor neurone lesion (eg. MS) or cervical myelopathy that affects the motor reflex in the hand
What are the urinary findings in a clinical picture of acute tubular necrosis and what are causes for this condition?
High sodium (impaired sodium reabsorption) and low or normal urinary osmolality (impaired water reabsorption)
Prolonged ischaemia to the kidney tubular cells (eg an endurance event like ultra-marathon) or nephrotoxins (eg NSAIDs)
What is the acute medical management of migraine?
NSAIDs - take as early as possible
Triptans - asap when headache starts, but NOT during aura
What are adverse effects of triptans?
tingling, heat, tightness (e.g. throat and chest), heaviness, pressure
