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clinical 1 Flashcards

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1
Q

first line treatment for migraines prophylaxis

A

propranolol or topiramate

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2
Q

first line migraine prophylaxis for woman of child baring age

A

Propranolol

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3
Q

what is contraindicated in woman with migraine history

A
  • combination contraceptive pill

- topiramate

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4
Q

used to treat migraine attacks

A

Zolmitriptan (triptan) + NSAID or paracetamol

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5
Q

what condition is relieved by “shacking hands”

A

carpal tunnel syndrome

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6
Q

C6 entrapment will have what features

A

proximal weakness: e.g. weakness of the biceps muscle or reduced biceps reflex.

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7
Q

what is xanthochromia

A

yellowing of CSF from bilirubin, indicating subarachnoid haemorrhage

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8
Q

when will xanthochromia appear

A

minimum of 12 hours after onset

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9
Q

Guillain-Barre syndrome weakness has what pattern

A
  • all 4 limbs (peripheral nerves)
  • ascending i.e. the lower extremities are affected first, however it tends to affect proximal muscles earlier than the distal ones
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10
Q

features of migraine (6)

A 
unilateral 
throbbing 
aura 
nausea
photosensitivity 
associated with menstruation
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11
Q

headache described as ‘tight band’

A

tension headache

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12
Q

bilateral headache indicates what type

A

tension

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13
Q

unilateral headache

A

migraine, temporal arteritis or cluster

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14
Q

headaches with intense pain around eyes

A

cluster

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15
Q

cluster headache time scales

A

twice a day 15min-2hrs

cluster lasts 4-12 weeks

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16
Q

eye features associated with cluster headache

A

lacrimation, lid swelling, redness

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17
Q

most likely person to suffer a cluster headache

A

male who smokes

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18
Q

features of temporal arteritis

A

Typically patient > 60 years old

Usually rapid onset

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19
Q

who is most likely to get a medication overuse headache

A

those using opioids and triptans, may have psychiatric co-morbidity

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20
Q

Which type of motor neuron disease carries the worst prognosis?

A

Progressive bulbar palsy

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21
Q

what happens in progressive bulbar palsy

A

palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei

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22
Q

Which type of motor neuron disease carries the BEST prognosis?

Study These Flashcards
A

Progressive muscular atrophy

23
Q

motor neurone disease occurs at what age

24
Q

motor neurone disease presents with what features

Study These Flashcards
A

both upper and lower motor neuron signs

25
4 types of motor neurone disease
amyotrophic lateral sclerosis primary lateral sclerosis progressive muscular atrophy progressive bulbar palsy
26
most common form of motor neurone disease
Amyotrophic lateral sclerosis (50% of patients)
27
gene and enzyme associated with Amyotrophic lateral sclerosis
chromosome 21 and codes for superoxide dismutase
28
signs of progressive muscular atrophy
LMN signs only | affects distal muscles before proximal
29
signs of primary lateral sclerosis
UMN signs only
30
signs of amyotrophic lateral sclerosis
typically LMN signs in arms and UMN signs in legs | ** familial association**
31
when do you give aspirin to someone having a stroke
only once a hemorrhagic stroke has been excluded
32
when do you give thrombolysis in stroke
- it is administered within 4.5 hours of onset of stroke symptoms - haemorrhage has been definitively excluded (i.e. Imaging has been performed)
33
Contraindications to thrombolysis (11)
- Previous intracranial haemorrhage - Seizure at onset of stroke - Intracranial neoplasm - Suspected subarachnoid haemorrhage - Stroke or traumatic brain injury in preceding 3 months - Lumbar puncture in preceding 7 days - Gastrointestinal haemorrhage in preceding 3 weeks - Active bleeding - Pregnancy - Oesophageal varices - Uncontrolled hypertension >200/120mmHg
34
signs of normal pressure hydrocephalus
Urinary incontinence + gait abnormality + dementia
35
how do you treat normal pressure hydrocephalus
ventriculoperitoneal shunting
36
what will imaging of normal pressure hydrocephalus show
enlarged 4th ventricle
37
what is thought to be the cause of normal pressure hydrocephalus
thought to be secondary to reduced CSF absorption at the arachnoid villi
38
management of cluster headaches
acute: 100% oxygen, subcutaneous or a nasal triptan prophylaxis: verapamil, prednisolone
39
Painful third nerve palsy =
posterior communicating artery aneurysm
40
features of 3rd nerve palsy (3)
eye is deviated 'down and out' ptosis pupil may be dilated (sometimes called a 'surgical' third nerve palsy)
41
first line treatment for post-herpetic neuralgia
amitriptyline, duloxetine, gabapentin or pregabalin first-line.
42
most common presentation of MS
optic neuritis
43
appearance, glucose, protein & WBC of bacterial meningitis
appearance - cloudy glucose - low 1g/l WBC - 5-10 thousand polymorphs/mm³
44
appearance, glucose, protein & WBC of viral meningitis
appearance - clear/cloudy glucose - 60-80% plasma protein - normal WBC - 15-1000 lymphocytes/mm³
45
appearance, glucose, protein & WBC of tuberculous meninigits
appearance - Slight cloudy, fibrin web glucose - low ( 1 g/l) WBC -10 - 1,000 lymphocytes/mm³
46
WBC's seen in bacterial meningitis
polymorphs
47
WBC's seen in viral meningitis
lymphocytes
48
motor response for GCS
6. Obeys commands 5. Localises to pain 4. Withdraws from pain 3. Abnormal flexion to pain (decorticate posture) 2. Extending to pain 1. None
49
visual response for GCS
5. Orientated 4. Confused 3. Words 2. Sounds 1. None
50
eye opening for GCS
4. Spontaneous 3. To speech 2. To pain 1. None
51
appearance - cloudy glucose - low 1g/l WBC - 5-10 thousand polymorphs/mm³
viral
52
appearance - cloudy glucose - low 1g/l WBC - 5-10 thousand polymorphs/mm³
bacterial
53
appearance - Slight cloudy, fibrin web glucose - low ( 1 g/l) WBC -10 - 1,000 lymphocytes/mm³
TB

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