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medicine phase 2 a > neuro > Flashcards

neuro Flashcards

1
Q

What is the immediate management of stroke?

A

rule out hypoglycaemia
CT scan to rule out haemorrhage

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2
Q

What is immediately given if haemorrhagic stroke is ruled out?

A

aspirin 300mg stat
and continued for 2 weeks

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3
Q

What other medication can be given post CT scan in stroke?

A

alteplase if administered <4.5hrs

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4
Q

What is the management of a TIA?

A

aspirin 300mg daily, secondary prevention of CVD

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5
Q

What is the gold standard imaging tool for stroke?

A

diffusion-weighted MRI

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6
Q

What medications can be used for the secondary prevention of stroke?

A

clopidogrel
atorvastatin - not immediately

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7
Q

What surgical intervention can be used to prevent stroke?

A

carotid endarterectomy or stenting in patients with carotid artery disease

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8
Q

What are the typical presentations of intracranial bleeds?

A

sudden onset headache
seizures
weakness
vomiting
reduced consciousness

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9
Q

What score is used to assess level of consiousness?

A

glasgow coma scale (GCS)

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10
Q

What is the score in GCS based on?

A

eyes, verbal and motor response /15 points

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11
Q

How do subdural haemorrhages present on CT scan?

A

crescent shape, not limited by cranial sutures

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12
Q

What is the typical patient in which a subdural haemorrhage would occur?

A

elderly and alcoholic

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13
Q

What veins rupture to cause a subdural haemorrhage?

A

bridging veins in the outermost meningeal layer

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14
Q

What artery ruptures to cause an extra dural haemorrhage?

A

middle meningeal artery (in temporo-parietal region)

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15
Q

How does an extradural haemorrhage present on CT scan?

A

bi-convex shape (cant cross over sutures)

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16
Q

What is the typical patient to have an extradural haemorrhage?

A

young patient with traumatic brain injury

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17
Q

How does an intracerebral haemorrhage present?

A

similar to ischaemic stroke

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18
Q

What is the usual cause of a subarachnoid haemorrhage?

A

ruptured cerebral aneurysm

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19
Q

What are the typical presentations of a subarachnoid haemorrhage?

A

thunderclap headache (occipital region) during strenuous activity

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20
Q

What are subarachnoid haemorrhages associated with?

A

cocaine and sickle cell anaemia

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21
Q

What is a common complication of subarachnoid bleeds?

A

vasospasm

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22
Q

What medication is used to treat vasospasm?

A

CCB - nimodipine

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23
Q

What are the principles of management for intracranial bleeds?

A

CT head
FBCs and clotting factors
intubation, ventilation, ICU
correct hypertension but avoid hypotension

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24
Q

What are some of the causes of epilepsy?

A

idiopathic
cortical scarring
tumours
strokes alzheimers
alcohol withdrawal

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25
Q

when should patients be referred after their first suspected seizure?

A

within 2 weeks

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26
Q

What are the types of seizure?

A

tonic-clonic
focal
atonic
myoclonic
absence

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27
Q

What are the typical symptoms of a focal seizure?

A

halluncinations
deja vu
memory flashbacks

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28
Q

What are the post-ictal symptoms?

A

confusion, headache, drowsiness, irritability, sore tongue

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29
Q

What is the main diagnostic tool for epilepsy?

A

EEG

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30
Q

What are the criteria for status epilepticus?

A

seizure that lasts longer than 5 mins or more than 3 in 1 hour

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31
Q

What medication should be given in status epilepticus in the community?

A

benzodiazepines - buccal midazolam or rectal diazepam

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32
Q

What should be given for status epilepticus in the hospital?

A

IV lorazepam 4mg

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33
Q

What is the first line treatment for tonic-clonic seizures, atonic and myoclonic?

A

sodium valproate

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34
Q

What is the first line treatment for tonic-clonic seizures in women of child-bearing age?

A

lamotrigine

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35
Q

What is the first line treatment for focal seizures?

A

lamotrigine

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36
Q

What is the first line management for absence seizures?

A

ethosuximide

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37
Q

What is the classic triad of features of parkinsons?

A

resting tremor
rigidity
bradykinesia

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38
Q

Explain the pathophysiology of parkinsons

A

the substantia nigra progressively fails to produce enough dopamine

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39
Q

What are the features of the parkinsons tremor?

A

asymmetrical
4-6Hz
worse at rest
improves with intentional movement
no change with alcohol

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40
Q

Which synthetic dopamine medicine is given in parkinsons and is normally first line in patients with motor symptoms that impact QAL?

A

levodopa

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41
Q

What type of medications are given in parkinsons patients with motor symptoms that do not impede on their life?

A

dopamine agonists

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42
Q

Give an example of a dopamine agonist

A

bromocriptine, pergolide, carbergoline

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43
Q

What is levodopa given with to prevent its destruction before reaching the brain?

A

peripheral decarboxylase inhibitors

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44
Q

Give an example of a peripheral decarboxylase inhibitor

A

benserazide
carbidopa

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45
Q

What are the two main levodopa combination drugs?

A

co-benyldopa (beserazide)
co-careldopa (carbidopa)

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46
Q

what are the main side effects of levodopa?

A

dyskinesias:
dystonia
chorea
athetosis

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47
Q

What are the side effects of dopamine agonists?

A

pulmonary fibrosis
adverse events: hallucinations, sleepiness, control/impulse disorder

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48
Q

What does monoamine oxidase do?

A

breaks down dopamine, serotonin and adrenaline

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49
Q

What are the two examples of a monoamine oxidase-B inhibitors?

A

seregiline
rasagiline

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50
Q

What is the pathophysiology of Huntingtons?

A

loss of GABA so no inhibition of dopamine, thalamic stimulation, chorea

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51
Q

What genetic abnormality is present in Huntingtons?

A

expansion of CAG repeats >35 in HTT gene in chromosome 4

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52
Q

What are the typical symptoms of Huntingtons?

A

chorea
dysarthria
dysphagia
incoordination
dystonia
cognitive decline

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53
Q

when do symptoms typically show in Huntingtons disease?

A

30-50 yrs

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54
Q

What feature of genetic inheritance can be present in Huntingtons?

A

anticipation

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55
Q

What medications may be used to manage chorea in Huntingtons?

A

benzodiazepines

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56
Q

What other medications may be used to manage symptoms of Huntingtons?

A

antipsychotics (olanzapine)
SSRIs
dopamine depleting agents (tetrabenzamine)

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57
Q

What is the most common cause of death in Huntingtons patients?

A

pneumonia

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58
Q

What is alzheimers associates with?

A

B-amyloid plaques (clump between neurones and effect function)

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59
Q

What is the main investigation for dementia?

A

MRI

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60
Q

What is the onset pattern of alzheimers?

A

progressive

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61
Q

What medications can be used to manage symptoms of alzheimer?

A

cholinesterase inhibitor

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62
Q

What is the onset pattern of vascular dementia?

A

sudden, stepwise deterioration caused by multiple infarcts

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63
Q

What area of the brain does lewy-body dementia effect?

A

occipito-parietal region

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64
Q

What are the typical presentations of dementia with lewy bodies?

A

fluctuating cognitive dysfunction, visual hallucinations, parkinsonism

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65
Q

What type of medication can be used in lewy body dementia?

A

cholinesterase inhibitors

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66
Q

What are of the brain does Pick’s dementia effect?

A

frontotemporal

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67
Q

what are could be the cause of headache with photophobia, fever or neck pain?

A

encephalitis, meningitis

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68
Q

what could be the cause of headache that is worse when coughing/straining/standing?

A

raised ICP

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69
Q

What could be the cause of headache with new neuro symptoms, sudden onset or trauma?

A

haemorrhage

70
Q

What could be the cause of headache with visual disturbances?

A

temporal arteritis, glaucoma

71
Q

What examination can be used forICP?

A

fundoscopy - papilloedema

72
Q

What are the normal features of a tension headache?

A

gradual onset and offset, no vision changes

73
Q

What can cause secondary headaches?

A

infection, obstructive sleep apnoea, pre-eclampsia
alcohol
head injury
CO poisoning

74
Q

What is the usual cause of sinusitis?

A

viral infection

75
Q

What can long term analgesic use cause?

A

analgesic headache

76
Q

What causes a hormonal headache?

A

low oestrogen dues to: menopause, pregnancy, menstrual period

77
Q

what are the symptoms of cervical spondylosis?

A

neck pain and headache, more severe with movement

78
Q

What is trigeminal neuralgia associated with?

A

multiple sclerosis

79
Q

What treatment may be used to manage symptoms of trigem neuralgia?

A

carbemazepine

80
Q

What are the 4 types of migraine?

A

with aura
without aura
silent
hemiplegic

81
Q

what can trigger migraines?

A

chocolate
hangovers
orgasms
cheese
oral contraceptives
lie ins
alcohol
tumult
exercise

82
Q

What are the 5 stages of migraines?

A

prodromal
aura
headache
resolution
postdromal

83
Q

What medications can be used in the acute management of migraines?

A

NSAIDs/paracetamol
triptans - sumatriptan
antiemetic

84
Q

What is the main recommended prophylaxis for migraines?

A

acupuncture

85
Q

What medications can be used as prophylaxis for migraines?

A

propranolol, topiramate, amitriptylin

86
Q

what supplementation may prevent migraines?

A

B2 - riboflavin

87
Q

What are the typical presentations of cluster headaches?

A

rapid onset
unilateral pain around eye
watery/bloodshot eye
facial flushing

88
Q

what are the medicinal treatments of cluster headaches?

A

vaptans - sumatriptan

89
Q

What are some of the preventative treatments for cluster headaches?

A

CCB - verapamil

90
Q

What part of the CNS is demyelinated in MS?

A

CNS - oligodendrocytes

91
Q

What is the inflammation mediated by in MS?

A

T cell mediated (type 4)

92
Q

What are the potential causes of MS?

A

multiple genes
EBV
low vit D
smoking
obesity

93
Q

What are the typical symptoms of MS?

A

Tingling
Eyes - optic neuritis
Ataxia - cerebellar and sensory
Motor - paraparesis

94
Q

What are the different disease patterns of MS?

A

clinically isolated syndrome
relapsing remitting
secondary progression (after relpasing/remitting)
primary progression

95
Q

how is MS diagnosed?

A

with clinical presentations

96
Q

What imaging/invasive investigations can be done for MS?

A

MRI - identify lesions
lumbar puncture - oligoclonal bands in CSF

97
Q

What medication can be used to treat relapses in MS?

A

Methyl prednisolone

98
Q

What medication can be used to help with neuropathic pain in MS?

A

amitriptyline

99
Q

What medication can be used to treat urge incontinence in MS?

A

tolterodine (anticholinergic)

100
Q

What medications can be used to treat spasticity in MS?

A

baclofen/gabapentin

101
Q

What types of medications can be used to modify disease in MS?

A

biological therapies - target interleukins/cytokines/inflammation

102
Q

What is the most common type of MND?

A

amyotrophic lateral sclerosis (ALS)

103
Q

What is the second most common type of MND?

A

progressive bulbar palsy

104
Q

What are the potential causes/risk factors of MND?

A

FH
smoking
exposure to heavy metals/pesticides

105
Q

What are the signs of LMND?

A

muscle wasting
reduced tone
fasciculations
reduced reflexes

106
Q

What are the signs of UMND?

A

increased tone/spasticity
brisk reflexes
upgoing plantar reflexes

107
Q

How is MND diagnoses?

A

by exclusion

108
Q

What is one medicinal treatment that may extend life by a few months in ALS?

A

riluzole

109
Q

What may be used at home to support breathing at night in MND?

A

Non-invasive ventilation (NIV)

110
Q

What are some of the presentations of progressive bulbar palsy?

A

LMND + UMND
dysphagia
dysarthria

111
Q

What autoantibody is responsible for 85% of cases of myasthenia gravis?

A

acetylcholine receptor antibodies

112
Q

What are the other two antibodies responsible for myasthenia gravis?

A

muscle specific kinase (MuSK)
low density lipoprotein receptor related protein (LRP4)

113
Q

What do the antibodies do in myasthenia gravis?

A

block ACh receptors or interfere with production of them leading to inadequate ACh receptors

114
Q

How do symptoms of myasthenia gravis change throughout the day?

A

worsen as the day goes on
improve with rest

115
Q

what muscles does myasthenia gravis typically effect?

A

proximal muscles and small muscles of the face and neck

116
Q

What are the signs of myasthenia gravis?

A

diplopia
ptosis
dysphagia
dysarthria
weakness with repetitive movements

117
Q

What examinations can be done to diagnose myasthenia gravis?

A

repeated abduction of arm will then show unilateral weakness

118
Q

What is Myasthenia gravis associated with?

A

thymoma - look for thymectomy scar

119
Q

What are the investigations for myasthenia gravis?

A

antibody testing
MRI thymus gland
edrophonium test

120
Q

How does the edrophonium test work?

A

edrophonium chloride given (blocks cholinesterase enzymes) should temporarily relieve weakness

121
Q

What are the typical medicinal treatments for myasthenia gravis?

A

reversible acetylcholinesterase inhibitors
immunosuppressives
monoclonal antibodies

122
Q

Give and example of a reversible acetylcholinesterase inhibitors used for myasthenia gravis

A

pyridostigmine
neostigmine

123
Q

What immunosuppressives can be given in myasthenia gravis?

A

prednisolone/azathioprine

124
Q

What can trigger a myasthenic crisis?

A

respiratory tract infection

125
Q

How is a myasthenic crisis managed?

A

non-invasive ventilation (BiPAP)
IV immunoglobulins and plasma exchange

126
Q

What is the most common bacteria to cause meningitis?

A

Neisseria meningitidis

127
Q

What type of bacteria is N. meningitidis?

A

gram-negative diplococcus

128
Q

What is the other common bacteria to cause meningitis?

A

streptococcus pneumoniae

129
Q

What is the most common bacteria to cause meningitis in neonates?

A

group B strep

130
Q

what is meningococcal septicaemia?

A

infection in the blood

131
Q

what is a sign of meningococcal septicaemia?

A

non-blancing rash - indicates disseminated intravascular coagulopathy

132
Q

What is meningococcal meningitis?

A

infection of the meninges and the CSF

133
Q

What are the typical symptoms of meningitis?

A

fever, neck stiffness, vomiting, photophobia

134
Q

What are the symptoms of meningitis in a neonate?

A

hypotonia, poor feeding, lethargy, hypothermia, bulging fontanelle

135
Q

What investigation is recommended in neonates with a fever?

A

lumbar puncture

136
Q

What two examinations can be used to diagnose meningitis?

A

kernig’s and Brudzinski’s tests

137
Q

what is the initial management of meningitis in the community?

A

IM/IV benzylpenicillin + immediate hospitilisation

138
Q

What investigations should be done in the hospital if meningitis is suspected?

A

lumbar puncture
bloods - meningococcal PCR and glucose

139
Q

where is a lumbar puncture done?

A

L3-L4 space

140
Q

What things are checked for in the CSF in meningitis?

A

cloudiness, glucose, protein, WCC viral PCR

141
Q

What is characteristic of CSF in bacterial infection?

A

cloudy, high protein, low glucose, high neutrophils and positive cultures

142
Q

What is characteristic of CSF in viral infections?

A

clear,normal protein, normal glucose, increased lymphocytes

143
Q

What may cause fungal meningitis?

A

cryptococcus, candida

144
Q

what abx are given to patients under 3 months with menigitis?

A

cefotazime + amoxicillin

145
Q

What abx are given to patinets over 3 months with meningitis?

A

cefotaxime

146
Q

What other antibiotic may be given if there’s a risk of penicillin allergy?

A

vancomycin

147
Q

What might be given to reduce the severity of hearing loss or neuro problems in meningitis?

A

steroids

148
Q

What is the treatment for viral meningitis with HSV or VZV?

A

aciclovir

149
Q

What are some of the complications of meningitis?

A

hearing loss
cerebral palsy
cognitive impairment

150
Q

What triggers guillain-barre syndrome?

A

recent infection

151
Q

What are the normal pathogens to trigger guillain-barre syndrome?

A

campylobacter jejuni, EBV, cytomegalovirus

152
Q

What is the pathophysiology of guillain-barre syndrome?

A

B cells produce antibodies against the pathogen and they attack the myelin sheath on motor nerve cells

153
Q

what is the typical presentation of guillain-barre syndrome?

A

symmetrical ascending weakness
reduced reflexes
peripheral loss of sensation/neuropathic pain
(may progress to facial nerves)

154
Q

How long do symptoms usually start after infection in guillain-barre syndrome?

A

4 weeks

155
Q

What investigations can be done for guillain-barre syndrome?

A

nerve conduction studies (slow nerve conduction)
lumbar puncture

156
Q

What would show on lumbar puncture in guillain-barre syndrome?

A

high protein

157
Q

What is the management for guillain-barre syndrome?

A

IV immunoglobulin
plasma exchange
VTE prophylaxis

158
Q

What is Lamber-Eaton myasthenic syndrome associated with?

A

small cell lung cancer

159
Q

How does Lambert-Eaton myasthenic syndrome present?

A

similar to myasthenia gravis
proximal muscle wasting
ptosis
diplopia
dysphagia
dysarthria

160
Q

What medication is used to treat Lambert-Eaton myasthenic syndrome?

A

amifampridine

161
Q

What is charcot-marie tooth disease?

A

an autosomal dominant condition that effects motor and sensory nerves

162
Q

What are the classic features of charcot-marie tooth disease?

A

high foot arch (pes cavus)
distal muscle wasting
weakness in dorsiflexion
reduced tone/reflexes

163
Q

What are the causes of peripheral neuropathy? (ABCDE)

A

alcohol
B12 deficiency
cancer and CKD
diabetes and drugs (azathioprine)
every vasculitis

164
Q

What is the criteria for neurofibromatosis type 1?

A

two of CRABBING
cafe-au-lait spots
relative with NF1
axillary or inguinal freckles
bony dysplasia or bowing
iris hamartomas
neurofibromas
glioma of optic nerve

165
Q

What is a common feature of neurofibromatosis type 2?

A

bilateral acoustic neuromas

166
Q

What is tuberous sclerosis?

A

genetic condition that causes the development of hamartomas (benign neoplastic growths)

167
Q

what is the classic presentation of tuberous sclerosis?

A

child with epilepsy and skin feature (cafe-au-lait spots/ash leaf spots etc)

168
Q

How is tuberous sclerosis managed?

A

management of complications e.g. epilepsy

169
Q

What are the typical presentations of brain tumours?

A

raised ICP and focal neurological symptoms

170
Q

what are the three main types of glioma?

A

astrocytoma
oligodendrocytoma
ependymoma

medicine phase 2 a (10 decks)

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