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Y3 > Neuro > Flashcards

Neuro Flashcards

1
Q

Tension headache signs and symptoms

A

Bilateral dull pressure-like headache
Pericardial/neck muscle tenderness

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2
Q

Tension headache management

A

NSAIDs(ibuprofen, naproxen, diclofenac)
Paracetamol

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3
Q

Cluster headache signs and symptoms

A

Male
Heavy smoking/drinking
Severe unilateral pain at night
Headache comes in clusters
Sweating
Miosis ± ptosis
Conjunctival redness ± lacrimation
Nasal congestion ± rhinorrhoea
Eyelid oedema

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4
Q

Cluster headache management

A

Subcutaneous/nasal sumatriptan
Inhaled O2

Verapamil(CCB)

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5
Q

Migraine signs and symptoms

A

Unilateral throbbing headache
Nausea
Photophobia
Female
Triggers e.g. stress

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6
Q

Migraine management

A

Acute:
1. NSAIDs/paracetamol
2. Sumatriptans

Prophylaxis:
1. Propranolol
2. Topiramate
3. Amitriptyline

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7
Q

Trigeminal neuralgia signs and symptoms

A

Electric shock like pain
Unilateral

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8
Q

Trigeminal neuralgia management

A

Carbamazepine
Posterior fossa decompression

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9
Q

Raised ICP signs and symptoms

A

Cushing’s triad: high systolic BP, irregular breathing, bradycardia
Bilateral throbbing headache
Worse when lying down
Early morning N+V

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10
Q

Raised ICP investigations

A

Urgent CT head
NEVER do lumbar puncture
Ophthalmoscope: papilloedema

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11
Q

Meningitis signs and symptoms

A

Headache
Malaise
Fever
Stiff neck
Photophobia
Confusion

Non blanching rash

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12
Q

Meningitis investigations

A

Lumbar puncture: cloudy if bacterial
VBG
CT head

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13
Q

Meningitis management

A

Primary care: Benzylpenicillin IM
Hib: ceftriaxone IV 10/7
Strep: ceftriaxone IV 2/52
Meningococcal: ceftriaxone IV 1/52
Consider dexamethasone

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14
Q

Meningitis complications

A

Hearing loss
Sepsis
Impaired mental status

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15
Q

Pre-chiasmal visual field defect causes

A

Optic neuritis
Amaurosis fugax
Optic atrophy
Retrobulbar optic neuropathy
Trauma

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16
Q

Bell’s palsy signs and symptoms

A

Unilateral face drooping
Non forehead sparing
Dry eye
Sound hypersensitivity
Bell’s phenomenon
Idiopathic, 60% preceded by ARI

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17
Q

Ramsay-hunt syndrome signs and symptoms

A

Unilateral LMN facial palsy due to varicella zoster reactivation
Painful blisters in ear/hard palate/tongue

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18
Q

Horner’s syndrome signs and symptoms

A

Triad: miosis, ptosis, anhydrosis
Enophthalmos

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19
Q

Horner’s syndrome investigations

A

CXR: pancoast tumour
CT head: stroke/tumour
MRI angiography: carotid artery dissection

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20
Q

Type 1 Neurofibromatosis signs and symptoms

A

More common
Painful skin lesions
Cafe au lait macules
Lisch nodules(eyes)
Armpit freckling

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21
Q

Type 2 neurofibromatosis signs and symptoms

A

Hearing loss
Tinnitus
Vertigo

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22
Q

Neurofibromatosis investigations

A

Full body examination
Ophthalmological assessment
Hearing test
CT/MRI

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23
Q

MS signs and symptoms

A

Optic neuritis
Sensory loss
Muscle weakness
Fatigue
ataxia
Lhermitte’s(barber chair) sign

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24
Q

MS investigations

A

Absence of alternative diagnosis
Dissemination in time
Dissemination in space

Clinical history/examination
MRI: focal white matter lesions
CSF: inflammation
Electrophysiology

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25
Q

Myasthenia gravis signs and symptoms

A

Muscle fatigue with use
Ptosis
Diplopia
Dysarthria
Dysphagia
±SOB
Fatiguable muscles
NORMAL reflexes

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26
Q

Myasthenia gravis investigations

A

Bloods: anti-AChR & anti-MuSK antibodies(could be -ve, thymic hyperplasia)
EMG
CT upper thorax: thymic hyperplasia
Tensilon(Ch-ase inhibitor)/pyridostigmine(long acting Ch-ase inhibitor)->improve symptoms
TFT

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27
Q

Lambert Eaton myasthenia syndrome signs and symptoms

A

Associated with SCLC
Muscle weakness improving with use
Hyporeflexia

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28
Q

Motor neuron disease signs and symptoms

A

Progressive muscle weakness
Dysphagia
SOB
Sparing oculomotor, autonomic function
Thenar & hypoglossus wasting

29
Q

Parkinson’s signs and symptoms

A

S - shuffling gait
M - hypomimic face
A - akinesia (+bradykinesia)
R - rigidity
T - tremor (asymmetrical)

30
Q

Huntington’s signs and symptoms

A

Choreic movements(rapid jerky involuntary)
Speech impairment
Unsteady gait
Cognitive decline, dementia

31
Q

Alzheimer’s signs and symptoms

A

Amnesia
Anomia
Apraxia
Agnosia
Aphasia

32
Q

Alzheimer’s investigations

A

CSF: high tau, low beta amyloid
Mini mental state exam(MMSE)
Montreal cognitive assessment(MOCA)

33
Q

Frontotemporal dementia signs and symptoms

A

Personality change
Emotion, behaviour affected

34
Q

Vascular dementia signs and symptoms

A

Similar to Alzheimer’s but step wise progression

35
Q

Wernicke’s encephalopathy signs and symptoms

A

Alcohol abuse

Triad:
Confusion
Ataxia
Ophthalmoplegia

36
Q

Wernicke’s encephalopathy investigations

A

Bloods: albumin, vit B1, LFT
ECG
CT scan
Neuropsychology

37
Q

Myasthenia gravis management

A

Initial:
Corticosteroids

Long term:
1. ACh-ase inhibitor(pyridostigmine)
2. Azathioprine
3. Thymectomy

Crisis:
IV immunoglobulin
Plasmapheresis

38
Q

Parkinson’s management

A

Levodopa

Dopamine agonist
MAO-B inhibitor

39
Q

MS management

A

Bolus methylprednisolone shortens relapses
Baclofen treats spasticity
Beta interferon reduces frequency of relapses

40
Q

Guillain-Barre syndrome signs and symptoms

A

Acute LMN weakness
starts with hands & feet, ascending
Numbness/tingling in limbs(polyneuropathy)
Preceding infection

41
Q

Bell’s palsy management

A

Prednisolone 40mg OD 7/7
Acyclovir 200mg 5x 5/7
Eyedrops, eye shield

42
Q

Guillain-Barre syndrome investigations

A

Lumbar puncture: high protein
Spirometry: type 2 resp failure
Monitor vital capacity
Nerve conduction studies

43
Q

Parkinson’s investigations

A

DaTscan
Bloods: rule out hyperthyroidism, anaemia

44
Q

Varicella zoster signs and symptoms

A

Painful facial rash that stops at midline

45
Q

Varicella zoster management

A

Acyclovir 800mg oral 5x a day 1/52
Topical lidocaine

46
Q

Brain abscess signs and symptoms

A

Triad:
Fever
Headache
Neurological symptoms

47
Q

Brain abscess investigations

A

CT brain contrast: Ring enhancing lesion

48
Q

Brain abscess management

A

Hyperbaric oxygen therapy
Antibiotics
Surgical drainage or aspiration

49
Q

Radiculopathy signs and symptoms

A

Pinched nerve root:
Pain
Paraesthesia
Numbness
Weakness

50
Q

Radiculopathy investigations

A

MRI at spinal level
Nerve conduction studies

51
Q

Radiculopathy management

A

Medical:
Pregabalin
Amitriptyline
Duloxetine
Gabapentin

Tramadol
Capsaicin cream if localised/oral not tolerated

Physical therapy e.g. Weight loss

Surgery e.g. discectomy

52
Q

Epilepsy signs and symptoms

A

Absence seizure:
LOC for 10 seconds

Focal seizure:
Auras precede
Lip smacking

Generalised tonic-clonic:
Limb flexion followed by extension
Tongue biting

Myoclonic seizure:
Brief muscle spasm -> fall

Atonic seizure:
Bilateral loss of muscle activity >1s

53
Q

Epilepsy management

A

tonic clonic:
male - sodium valproate
female - lamotrigine/levetiracetam

focal:
1st - lamotrigine/levetiracetam
2nd - carbamazepine

absence:
1st - ethosuximide
2nd - valproate(M) or lamotrigine/levetiracetam(F)

myoclonic:
male - sodium valproate
female - levetiracetam

tonic or atonic:
male - sodium valproate
female - lamotrigine

54
Q

Extradural haemorrhage signs and symptoms

A

Lucid period
Headache
3rd nerve palsy
LOC
Head trauma

55
Q

Extradural haemorrhage investigations

A

CT head: convex shape

56
Q

Extradural haemorrhage management

A

Burr hole/craniotomy
Post surgery: anti-epileptics, hyperosmotics

57
Q

Spinal cord compression signs and symptoms

A

Back pain at spinal level
Paraesthesia/anaesthesia of dermatome
Weakness below spinal level
Urinary/stool incontinence/retention
Hyperreflexia

58
Q

Spinal cord compression investigations

A

X ray spine
MRI spine (gold standard)

59
Q

Spinal cord compression management

A

Dexamethasone 16mg/day
NSAIDs/opiates
Bisphosphonate (myeloma/prostate/breast cancer)

Surgical decompression
Radiotherapy

60
Q

SAH signs and symptoms

A

Sudden onset thunderclap headache
Meningism

61
Q

SAH investigations

A

Non-contrast CT head (within 6h)

+ve: CT angiography
-ve: lumbar puncture 12h after

MR angiography

62
Q

SAH management

A

Intubation + mechanical ventilation
NG tube
Codeine + anti-emetics

Initial:
Nimodipine (CCB)
Bed rest at 45 degrees

Surgery:
Coiling (preferred over clipping)

63
Q

Subdural haemorrhage sign and symptoms

A

Head trauma
Confusion
Gradually increasing headache

64
Q

Subdural haemorrhage investigations

A

CT head: crescent shape

65
Q

Subdural haemorrhage management

A

Small:
Reabsorb naturally
Small catheter to suck out haematoma

Large:
Craniotomy -> suction and irrigation

Chronic:
Atorvastatin

66
Q

Stroke/TIA signs and symptoms

A

FAST:
Face, arm, speech test

ACA: hemiplegia -> legs
MCA: aphasia, hemiplegia -> arms/face
PCA: homonymous hemianopia

TIA resolves within 24h

67
Q

Stroke/TIA investigations

A

TIA:
MRI brain

Stroke:
Non-enhanced CT head

68
Q

Stroke/TIA management

A

Initial: 300mg aspirin

Haemorrhage excluded:
Alteplase within 4.5h of symptom onset
Or
Thrombectomy within 6h of symptom onset with IV thrombolysis after confirmation by CT/MR angiogram

clopidogrel + statin
Oxygen if needed, maintain glucose

Y3 (9 decks)

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