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Flashcards in clinical 1 Deck (53)
1

first line treatment for migraines prophylaxis

propranolol or topiramate

2

first line migraine prophylaxis for woman of child baring age

Propranolol

3

what is contraindicated in woman with migraine history

- combination contraceptive pill
- topiramate

4

used to treat migraine attacks

Zolmitriptan (triptan) + NSAID or paracetamol

5

what condition is relieved by "shacking hands"

carpal tunnel syndrome

6

C6 entrapment will have what features

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

7

what is xanthochromia

yellowing of CSF from bilirubin, indicating subarachnoid haemorrhage

8

when will xanthochromia appear

minimum of 12 hours after onset

9

Guillain-Barre syndrome weakness has what pattern

- 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

10

features of migraine (6)

unilateral
throbbing
aura
nausea
photosensitivity
associated with menstruation

11

headache described as 'tight band'

tension headache

12

bilateral headache indicates what type

tension

13

unilateral headache

migraine, temporal arteritis or cluster

14

headaches with intense pain around eyes

cluster

15

cluster headache time scales

twice a day 15min-2hrs
cluster lasts 4-12 weeks

16

eye features associated with cluster headache

lacrimation, lid swelling, redness

17

most likely person to suffer a cluster headache

male who smokes

18

features of temporal arteritis

Typically patient > 60 years old
Usually rapid onset

19

who is most likely to get a medication overuse headache

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

20

Which type of motor neuron disease carries the worst prognosis?

Progressive bulbar palsy

21

what happens in progressive bulbar palsy

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

22

Which type of motor neuron disease carries the BEST prognosis?

Progressive muscular atrophy

23

motor neurone disease occurs at what age

>40

24

motor neurone disease presents with what features

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