more neuro

Question 1

pre-synaptic NMJ disorders (2)

Answer 1

lambert eaton
botulism

Question 2

pathophysiology of lambert eaton

Answer 2

antibodies against pre-synaptic calcium channels

Question 3

treatment of lambert eaton

Answer 3

treat underlying cancer
immunosuppress eg steroids and azathioprine
3,4 diaminopyridine

Question 4

how to distinguish lambert eaton from myasthenia

Answer 4

strength increases with use in lambert
fatigues in use in myasthenia

Question 5

pathophysiology of myasthenia

Answer 5

antibodies against post synaptic Ach receptors

Question 6

main feature of lambert eaton

Answer 6

repeated muscle use leads to increased muscle strength

Question 7

cancer assoc with myasthenia

Answer 7

thymoma

Question 8

eye symptoms in myasthenia

Answer 8

diplopia- double vision
ptosis

Question 9

in myasthenia if negative for anti- acetylcholine receptor antibodies what antibody should be checked for

Answer 9

anti-muscle-specific tyrosine kinase antibodies

Question 10

investigation for myasthenia

Answer 10

EMG + ct to exclude thymoma

Question 11

treatment of myathenia

Answer 11

pyridostigmine - anticholinesterase inhibitor

Question 12

what antibiotic is contr-indicated in myasthenia and why

Answer 12

Gentamicin as it can reduce the effectiveness of neuromuscular transmission and exacerbate symptoms of the disease.

Question 13

what drugs can make myastheni aworse

Answer 13

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

Question 14

treatment of HTn in CKD

Answer 14

first lin e= ACEi
seocnd - furosemide

Question 15

what part of sleep has increased cerebral blood flow w

Answer 15

REM Sleep

Question 16

what type of sleep is the majority

Answer 16

non rem sleep

Question 17

what is parasomnia

Answer 17

acting out dreams

Question 18

when is parasomnia seen

Answer 18

parkinsons

Question 19

what is sleep walking an example of

Answer 19

parasomnia

Question 20

investigation for narcolepsy

Answer 20

overnight polysomnopgraphy

Question 21

what is the criteria to diagnose chronic insomnia

Answer 21

trouble falling asleep or staying asleep at least three nights per week for 3 months or longer.

Question 22

what medications can cause insomnia

Answer 22

steroids

Question 23

treatment of short term insomnia

Answer 23

hort-acting benzodiazepines or non-benzodiazepines (zopiclone, zolpidem and zaleplon).

Question 24

time fram for subacute headache

Answer 24

mins to hours

Question 25

criteria fro migraine

Answer 25

min 5 attacks lasting 4-72 hours 2 of : severe unilat, throbbing , worse on movement and 1 of - n&v or photo/phonophobia

Question 26

examples of auras

Answer 26

hemianopic loss central scotoma

Question 27

what neurotransmitter is invloved with migrains

Answer 27

serotonin

Question 28

first line treatment for migraine

Answer 28

triptan and NSAID triptan and paracetamol

Question 29

what type of drugs are triptans

Answer 29

5-ht receptor agonist

Question 30

prophylaxis of migraine , 1st, 2nd and 3rd line

Answer 30

1st - amitriptyline 2nd - propanalol 3rd - topiramate

Question 31

what patient group should topiramate be avoided in and why

Answer 31

women of child bearing age - teratogenic and reduces effectiveness of contraception

Question 32

when should prophylaxis be offered in migraine

Answer 32

more than 3 attacks in a month

Question 33

chronic tension headache defined as

Answer 33

tension headache occur on 15 or more days per month.

Question 34

acute treatment of tension headache

Answer 34

NSAID, aspirin or paracetamol

Question 35

prophylaxis of tension headache

Answer 35

amirtiptyline or acupuncture - 10 sessions over 5-8 weeks

Question 36

what are the 4 type of trigeminal autonomic cephalgias

Answer 36

1. cluster 2. paroxysmal hemicrania 3. hemicrania continua SUNCT

Question 37

who tends to get cluuster headaches

Answer 37

young men 30-40

Question 38

how long do clusters tend to last in cluster headaches

Answer 38

4-12 weeks

Question 39

how long does an apisode of lcuster headache last

Answer 39

15mins- 2hours

Question 40

what can trigger a cluster headache

Answer 40

alcohol

Question 41

what autonomic features are seen in all the trigeminal autonomic cephalgias

Answer 41

- nasal stuffiness - ptosis -miosis - small pupils - tearing -puffy eyelid - N&V

Question 42

what investigation is done in those with trigeminal cephalgias

Answer 42

MRI with gadalinium contrast

Question 43

management of acute cluster headache

Answer 43

high flow oxygen for 20 mins s/c sumatriptan

Question 44

prophylaxis for cluster headach

Answer 44

verapamil

Question 45

features of paroxysmal hemicranis

Answer 45

severe unilateral headache- usually orbital or temporal region with unilat autonomic features

Question 46

duration and frequency of episodes in paroxysmal hemicranis

Answer 46

<30 mins 1-40 times a day

Question 47

treatment for paroxsymal hemicranis

Answer 47

indomethicine

Question 48

what is a SUNCT headache

Answer 48

short - 15-120 seconds unilateral nearalgiform headache conjunctival injections tearing

Question 49

treatment for a SUNCT headache

Answer 49

lamotrigene or gabapentin

Question 50

risk factors for idiopathic intracranial hypertension

Answer 50

female obesity pregancy drugs - COCP, steroids, tetracyclines, lithium , retinoids

Question 51

management of intercranial hypertension

Answer 51

acetazolamide and weight loss

Question 52

LP pressure in IIH

Answer 52

increased opening pressure

Question 53

management of trigeminal neuralgia

Answer 53

carbamazapine

Question 54

gold strandard for treating brain aneurysms

Answer 54

DSA - digital subtraction angiography

Question 55

normal ICP

Answer 55

7-15mmHg

Question 56

most common cause of cauda equina

Answer 56

the most common cause is a central disc prolapse this typically occurs at L4/5 or L5/S1

Question 57

investigation for cauda equina

Answer 57

MRI

Question 58

first line treatment options for neuropathic pain

Answer 58

amitriptyline duloxetine, gabapentin or pregabalin

Question 59

what should be used for rescue therapy in neuropathic pain

Answer 59

tramadol

Question 60

what can be used for localised neuropathc pain

Answer 60

topical capsaicin

Question 61

symptoms in wernickes

Answer 61

opthalmoplegia/ nystagmus ataxia encephalopathy (+ peripheral neuropathy)

Question 62

investigations in werniceks

Answer 62

MRI decreased red cell transketolase

Question 63

symptoms in korsakoffs

Answer 63

wernickes - opthal/nystag, atax, enceph PLUS - antero/retrograde amnesia and confabulation

Question 64

how long after alcohol withdrawal does delirium tremens kick in

Answer 64

48-72 hrs

Question 65

where is the lesion in wernickes aphasia (receptive)

Answer 65

superior temporala gyrus

Question 66

where is lesion in brocas apahasi

Answer 66

inferior frontal gyrus

Question 67

what type of aphasia auses word salad

Answer 67

wernickes

Question 68

where is the lesion in coductive aphasia

Answer 68

arcuate fasiculus - the connection between wernickes and brocas

Question 69

what type pf aphasia results in poor repitiion

Answer 69

conductive aphasia

Question 70

where is the lesion in erbs palsy

Answer 70

C5, 6

Question 71

where is the lesion in trunkal ataxia/ gait ataxia

Answer 71

cerebellar midline

Question 72

where is the lesion in past pointing

Answer 72

cerebellar hemisphere