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Flashcards in clinical 3 Deck (51)
1

2 main categories of seizures

generalised and partial

2

general seizures include (4)

grand mal (tonic-clonic)
petit mal (absence seizures)
myoclonic: brief, rapid muscle jerks
partial seizures progressing to generalised seizures

3

types of partial seizure

simple (no disturbance of consciousness or awareness)
complex (consciousness is disturbed)
temporal lobe → aura, déjà vu, jamais vu; motor → Jacksonian

4

type of tremor improved by alcohol

essential tremor

5

which tremor has a strong family history

essential tremor (autosomal dominant)

6

in what position is essential tremor worse

outstretched arms

7

which features would suggest a tremor is caused by thyrotoxicosis

hyperthyroid signs: Weight loss, tachycardia, feeling hot

8

3 common signs of cerebellar disease

intention tremur
past pointing
nystagmus

9

in what gender is parkinsons more common

males 2:1

10

what is pathophysiology of parkinsons

degeneration of dopaminergic neurons in the substantia nigra

11

classic triad of features in parkinsons

tremor, bradykinesia, rigidity

12

type of rigidity in parkinsons

leap pipe
cog wheel: due to superimposed tremor

13

what are triptans

specific 5-HT1 agonists used in the acute treatment of migraine

14

contraindications of triptans

history of/risk of: ischaemic heart disease or cerebrovascular disease

15

what drug do you give in a prolonged seizure

rectal benzodiazapine (diazepam) usually 10mg in >12yrs, can give up to 30mg

16

site of stroke: Contralateral hemiparesis and sensory loss, lower extremity > upper

Anterior cerebral artery

17

site of stroke: Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

Middle cerebral artery

18

site of stroke: Contralateral homonymous hemianopia with macular sparing
Visual agnosia

Posterior cerebral artery

19

site of stroke: Ipsilateral CN III palsy
Contralateral weakness

Weber's syndrome (branches of the posterior cerebral artery that supply the midbrain)

20

site of stroke: Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

21

site of stroke: Symptoms are similar to Wallenberg's, but:
Ipsilateral: facial paralysis and deafness

Anterior inferior cerebellar artery (lateral pontine syndrome)

22

site of stroke: Amaurosis fugax

retinal artery

23

site of stroke: 'Locked-in' syndrome

Basilar artery

24

in ABCD2 score which 2 factors give highest risk of having a stroke

- unilateral weakness
- TIA >60 mins ** 2 points each **

25

what is cataplexy

describes the sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)

26

cataplexy is strongly associated with which other condition

narcolepsy

27

high stepping gait suggests what

foot drop from neuropathy

28

if high stepping gait (indicting foot drop) is unilateral, where is the most likely site of lesion

a common peroneal nerve

29

if foot drop is bilateral this indicates what type of neuropathy

peripheral

30

in regards to facial palsy, how do UMN and LMN features differ

upper motor neurone lesion spares upper face (forehead) where lower affects all of face

31

what 4 conditions can cause bilateral facial palsy

sarcoidosis
Guillain-Barre syndrome
polio
Lyme disease

32

way to remember what the facial nerve innervates

face (expression), ear (tapedius), taste (anterior 2/3), tear

33

first line treatment for generalised seizures

sodium valproate

34

how does sodium valproate work

by increasing GABA activity

35

which anti epileptic drug causes weight gain

sodium valproate

36

type of 5-HT drug used in:

acute:
prophylaxis:

acute: 5-HT receptor agonist
prophylaxis: 5-HT receptor antagonist

37

who should get migraine prophylaxis

if 2+ migraines a month

38

low CSF glucose indicates what

TB meningitis or bacterial

39

CSF glucose in viral meningitis is usually

60-80% plasma glucose

40

which 2 anti epileptic drugs should not be given together due to skin reactions

sodium valproate and lamotrigine

41

at what point should anti seizure medication be started

after 2nd seizure - unless meets other criteria that suggest to start after 1st seizure

42

criteria for starting anti seizure medication after 1st seizure

- the patient has a neurological deficit
- brain imaging shows a structural abnormality
- the EEG shows unequivocal epileptic activity
- the patient or their family or carers consider the risk of having a further seizure unacceptable

43

first line treatment for partial seizures

carbamazepine

44

first line treatment for generalised seizures

Sodium valproate

45

which drug may actually exacerbate absence seizure

carbamazepine

46

propanolol is a prophylaxis for migrane, but who shouldn't get this

those with asthma

47

migraine prophylaxis for those with asthma

topiramate

48

preferred drug deliver method for triptans in:

12-17yrs
> 17yrs

12-17 yrs = nasal
> 17 yrs = oral

49

if first line acute treatment of migraine doesn't work, what is then used

non-oral preparation of metoclopramide or prochlorperazine and consider adding a non-oral NSAID or triptan

50

woman of child baring age should receive which migraine prophylaxis

propanolol (topiramate may be teratogenic and it can reduce the effectiveness of hormonal contraceptives)

51

if first line migraine prophylaxis fails what is recommended

10 sessions of acupuncture over 5-8 weeks' or gabapentin