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Neuro Flashcards

1
Q

3 of the main epilepsy subtypes

A

(a) Focal (partial) seizures - one side of brain
- focal aware (simple partial)
- focal impaired awareness (complex partial)
- motor - Jacksonian march
- non-motor - deja vu, aura

(b) Generalised seizures - both sides of brain
- all of these have LOC
- motor - tonic clonic
- non-motor - absence

(c) Focal to bilateral seizures - on one side of brain and spreads to both lobes

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2
Q

Treatment for typical (petit mal) absence seizures

Onset 4-8years

A

1st line: ethosuximide
2nd line: sodium valproate (or lamotrigine/ levetiracetam if child bearing age)

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3
Q

Treatment for generalised tonic-clonic seizures, myoclonic, tonic/atonic seizures

A

Sodium valproate

Child bearing women are likely to have: lamotrigine or levetiracetam

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4
Q

Treatment for focal seizures

A

1st line: lamotrigine or levetiracetam

2nd line: carbamazepine, oxcarbazepine or zonisamide

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5
Q

What anti-epileptic medication can exacerbate absence seizures

A

Carbamazepine

n.b. carbamazepine is used to treat partial seizures, trigeminal neuralgia and bipolar disorder

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6
Q

Anti-epileptic that is associated with:
(a) neural tube defects
(b) cleft palate

A

(a) sodium valproate
(b) phenytoin

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7
Q

For women with epilepsy, if a COCP is chosen, it should contain a minimum of how much ethinylestradiol

A

30 µg

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8
Q

For women taking phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine, which contraceptives are UKMEC 1-3?

A

UKMEC 3: COCP, POP
UKMEC 2: implant
UKMEC 1: Depo-provera, IUD, IUS

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9
Q

For lamotrigine, which contraceptives are UKMEC 3 and UKMEC 1?

A

UKMEC 3: COCP
UKMEC 1: POP, implant, Depo-Provera, IUD, IUS

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10
Q

Medications that worsen seizure control are alcohol, drugs, theo/aminophylline, bupropion, methlpenidate, mefanamic acid.

What 2 antibiotics can worsen seizure control in patients with epilepsy?

A

ciprofloxacin
levofloxacin

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11
Q

Infantile spasms, or West syndrome, is a type of childhood epilepsy which typically presents in the first 4-8 months of life in M>F.

Prognosis is poor but what is the management?

A

1st line = vigabatrin and high dose prednisolone

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12
Q

Donepezil (ACh-esterase inhibitor) side effects

A

Sleep disorders - insomnia
Bradycardia

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13
Q

What are the most important anti-epileptic drugs to prescribe by brand

A

Phenytoin
Carbamazepine

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14
Q

Hoover’s sign

A

pressure is felt under paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension

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15
Q

Lhermitte’s sign

A

sudden electric shock sensation that occurs when bending the head forward towards the chest in patients with multiple sclerosis

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16
Q

Uhthoff’s sign

A

multiple sclerosis where the patient’s symptoms can be worsened with heat

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17
Q

Treatment of cluster headaches (acute and prophylactic)

A

Acute:
1. 100% oxygen
2. Subcutaenous triptans

Prophylaxis:
1. Verapamil

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18
Q

4 main features of PTSD symptoms

A
  1. Hypervigiliance
  2. Flashbacks
  3. Avoidance
  4. Emotional numbing
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19
Q

If taking warfarin / heparin, what SSRIs should be considered

A

NICE guidelines recommend avoiding SSRIs and considering mirtazapine

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20
Q

Reed-Sternberg cells are associated with what cancer

A

Hodgkin’s lymphoma

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21
Q

What type of lyphoma has alcohol induced lymph node pain

A

Hodgkin’s lymphoma

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22
Q

What haem cancer is likely to cause:

Painless, non-tender, asymmetrical lymph nodes in the neck (cervical/supraclavicular) > axillary > inguinal
Pel-Ebstein fever

A

Hodgkin’s lymphoma

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23
Q

Depression (variable appetite, poor sleep) with excess alcohol use may benefit from which antidepressant

A

Mirtazapine

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24
Q

Difference between viral labyrinthitis vs vestibular neuronitis

A

viral labyrinthitis = hearing loss and tinnitus are more likely to be present in
vestibular neuronitis = only vestibular nerve is involved so hearing is fine

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25
Q

what medications are used as prophylaxis for contacts of patients with meningococcal meningitis

A

Oral ciprofloxacin or rifampicin

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26
Q

what is the treatment for meningitis
Initial empirical therapy aged < 3 months or >50 years

A

IV cefotaxime + amoxicillin (or ampicillin)

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27
Q

what is the treatment for meningitis
Initial empirical therapy aged 3 months - 50 years

A

IV cefotaxime (or ceftriaxone)

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28
Q

what is the treatment for meningitis
Meningococcal meningitis

A

IV benzylpenicillin or cefotaxime (or ceftriaxone)

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29
Q

what is the treatment for meningitis
Meningitis caused by Haemophilus influenzae or Pneumococcal meningitis

A

Intravenous cefotaxime (or ceftriaxone)

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30
Q

what is the treatment for meningitis caused by Listeria

A

IV amoxicillin or ampicillin

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31
Q

Conditions that cause both UMN and LMN signs
e.g. hyporeflexia (LMN) and positive Babinski sign - extensor plantars (UMN)

A

Motor neuron disease
Subacute combined degeneration of the cord
Friedreich’s ataxia
Syringomyelia
Taboparesis (syphilis)
Conus medullaris lesion

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32
Q

When are triptans taken during headache

A

At the onset of HEADACHE (not aura)

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33
Q

What is the only antiemetic that should be used in parkinson’s disease

A

Domperidone

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34
Q

For parkinsons disease patients, if postural hypotension occurs then what medication can be given

A

midodrine

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35
Q

selegiline for parkinsons disease is what type of drug

A

MAO-B (Monoamine Oxidase-B) inhibitor

  • these inhibit breakdown of DA
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36
Q

What is this sign called and what neuro condition is it seen in?

Gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.

A

Hoffman’s sign

Seen in degenerative cervical myelopathy

And other UMN diseases e.g. MS

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37
Q

What is the gold standard investigation for degenerative cervical myelopathy

A

MRI of cervical spine

Rx: neurosurgery/ ortho spinal surgery to perform decompressive surgery

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38
Q

Two investigations done for Guillain barre syndrome

A
  1. Lumbar puncture - high protein, normal WCC (albuminocytologic dissociation)
  2. Nerve conduction studies - decreased motor nerve conduction velocity, increased F wave and distal motor latency
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39
Q

Sodium valproate effects on P450 system

A

INHIBITOR of the P450 system

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40
Q

Suspected TIA in the past 7 days requires an urgent assessment by stroke doctor within how long

A

urgent assessment (within 24 hours) by a specialist stroke physician

(if longer than a week, then to be referred to be seen within 7 days)

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41
Q

According to the NICE guidelines for neuropathic pain management (2013), first-line treatment options include what 4 drugs

A

amitriptyline
duloxetine
gabapentin
pregabalin

these are used as monotherapy. if one is not working, switch to another.
+ tramadol for rescue therapy
+ topical capsaicin

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42
Q

treatment for trigeminal neuralgia

A

carbamazepine

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43
Q

Topiramate (antiepileptic with risk of foetal malformation) reduces the efficacy of which contraceptives

A

COCP
POP
Implant - ukmec 2

The injection and IUS are not affected

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44
Q

Common peroneal nerve lesion

what features

A

Weakness of foot dorsiflexion and eversion
Sensory loss over foot dorsum + lower lateral part of leg
Wasting of anterior tibial and peroneal muscles
Foot drop unilaterally

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45
Q

Bilateral foot drop / high stepping gait causes with:
Motor loss
Sensory loss

A

Motor loss
- GBS, Charcot Marie Tooth, porphyria

Sensory loss
- Diabetes, uraemia, vit B12 def, alcoholism, amyloidosis, leprosy

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46
Q

Treatment for myasthenia gravis (antibodies against ACh receptors)

A

Pyridostigmine
(ACh-esterase inhibitor)

(+ Prednisolone
+ Azathioprine/ cyclosporin, mycophenolate + thymectomy)

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47
Q

Management of myasthenic gravis crisis
(maintainence Rx is Pyridostigmine)

A

Plasmaphresis
IV Ig

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48
Q

What two meds are used for migraine prophylaxis

A

Propranolol
Topiramate - bad for foetus

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49
Q

Drugs that can worsen myasthenia gravis

A

Penicillamine
Beta blockers
Lithum
Phenytoin
Quinidine, procainamide
Antibiotics (gent, macrolites, tetreacyclines)

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50
Q

What 2 medications are recommended for menstrual migraine prophylaxis

A

frovatriptan (2.5 mg twice a day)
zolmitriptan (2.5 mg twice or three times a day)

Acutely: mefanamic acid, aspirin, paracetamol, caffeine, triptans

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51
Q

What happens to gastric emptying with migraine

A

DELAYED gastric emptying with acute migraine attacks

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52
Q

Two meds that are first-line for spasticity in multiple sclerosis

A

Baclofen
Gabapentin (also useful for oscillopsia)

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53
Q

Treatment for acute relapse of multiple sclerosis

A

oral or IV methylprednisolone

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54
Q

5 drug options for multiple sclerosis maintenance

A
  1. Natalizumab
  2. Ocrelizumab
  3. Fingolimod
  4. B-interferon
  5. Glatiramer acetate
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55
Q

Meniere’s disease triad

A

vertigo
tinnitus (episodic)
sensorineural hearing loss

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56
Q

What cranial nerves and effects occur with acoustic neuroma (vestibular schwannoma)

A

CN 8: vertigo, unilateral SNHL, unilateral tinnitus
CN 10: absent corneal reflex
CN 12: facial palsy

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57
Q

Investigation for acoustic neuroma

A

MRI of the cerebellopontine angle

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58
Q

Complex regional pain management

A
  1. Physio
  2. Neuropathic analgesia (amitryptilline, pregabalin, gabapentin, duloxetine)
  3. Pain team
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59
Q

Which scoring system is most appropriate to use to evaluate whether a patient has had a stroke?

A

ROSIER score

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60
Q

DVLA rules for:
1. Seizure
2. 2nd seizure
3. TIA
4. Multiple TIAs
5. Craniotomy
6. Narcoplexy/cataplexy

A
  1. 1st seizure = 6 months
  2. 2nd seizure =12 months
  3. T1A = 1 month
  4. Multiple TIAs = multiple months = 3 months
  5. CraniotomYEAR = 1 year
  6. NOrcoplexy / CEAtaplexy = No/cease driving (until controlled)
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61
Q

autonomic dysreflexia most common triggers

A

faecal impaction
urinary retention

occurs with Hx of traumatic spinal cord (above T6) injury, bedbound

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62
Q

hypertension
flushing
sweating

above the level of the cord lesion

this is called…?

A

autonomic dysreflexia

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63
Q

What is the dose of rectal diazepam for seizures in:
Simplified to:
Neonate
<12yo
>12yo

A

Neonate = 1.25-2.5mg
<12yo = 5mg
>12yo = 10mg-20mg

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64
Q

What is the dose of midazolam oromucosal solution for seizures in:
1 year
1-4 years
5-9 years
>10 years

A

1 year = 2.5mg
1-4 years = 5mg
5-9 years = 7.5mg
>10 years = 10mg

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65
Q

Tremor difference in parkinson’s versus essential

A

Parkinson’s disease - resting tremor, goes away on movement

Essential - no resting tremor, occurs on movement/outstretch. Can affect voice.

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66
Q

Essential tremor is an autosomal dominant condition which affects both upper limbs:
1. postural tremor - worse if outstretched
2. improved by alcohol and rest
3. can affect the head

Treatment of essential tremor is…?

A

Propanolol
Primidone

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67
Q

Eye deviates down and out
Ptosis
Pupil may be dilated

What palsy

A

CN3 palsy

(same side CN lesion as the eye down and out)

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68
Q

Absence seizures - good prognosis: what percentage become seizure free in adolescence

A

90-95%

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69
Q

absence seizures are also called

A

petit mal

Rx sodium valproate and ethosuximide

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70
Q

Does a lower motor neurone facial nerve palsy (Bell’s palsy) affect the forehead or spare the forehead

A

LMN lesion AFFECTS the forehead (as facial nerve innervating both forehead and face sits more peripherally)

UMN lesion spares the upper face

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71
Q

Bell’s palsy - when to refer urgently to ENT if no improvement after what timeframe

A

If no improvement in paralysis AFTER 3 WEEKS

(plastic surgery referral after a 6-9 months)

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72
Q

Migraine and hormone replacement therapy (HRT) - what is recommendations

A

safe to prescribe HRT for patients with a history of migraine but it may make migraines worse

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73
Q

A 72-year-old man develops visual problems. He is noted to have a left homonymous hemianopia with some macula sparing.
Where is the lesion

A

Occipital cortex

Macula sparing lesions are in the occipital cortex!

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74
Q

Bitemporal hemianopia
(a) upper quadrant defect cause
(b) lower quadrant defect cause

A

(a) upper quadrant defect - pituitary tumour (inferior compression)
(b) lower quadrant defect - craniopharyngioma (superior compression)

75
Q

Adenoma sebaceum (angiofibromas) butterfly distribution over nose is seen in which autosomal domninant neuro disease

A

Neurofibromatosis

76
Q

Patient who has had an extensive stroke with right-sided hemiplegia, what side is the homonymous hemianopia

A

RIGHT SIDE

Remember: the homonymous hemianopia is always on the same side as the paresis.

77
Q

what antibiotic can cause peripheral neuropathy

A

nitrofurantoin

78
Q

Peripheral neuropathy is a known adverse effect of which antiepileptic

A

phenytoin

79
Q

left homonymous hemianopia means visual field defect to the left has a lesion where?

A

LESION OF RIGHT OPTIC TRACT

80
Q

Inferior homonymous quadrantanopia has a lesion in which lobe

A

Parietal lobe

81
Q

Superior homonymous quadrantanopia has a lesion in which lobe

A

Temporal lobe

82
Q

If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, when should they be admitted /seen by stroke

A

IMMEDIATELY to exclude a haemorrhage

Without warfarin/DOAC, suspected TIA should be seen in 24 hours

83
Q

What antiepileptic can cause megaloblastic anaemia

A

Phenytoin

as it alters folate metabolism

84
Q

Acute treatment for tension headaches (3 drugs)

A

Aspirin
Paracetamol
Or NSAIDs

85
Q

Prophylaxis for tension headaches if medications fail

A

Acupuncture - up to 10 sessions over 5-8 weeks

86
Q

Paroxysmal hemicrania - headaches like cluster but more frequent episodes throughout the day. <30 mins episode.
What is the treatment

A

indomethacin

87
Q

What % of patients with migraine have aura

A

25%

88
Q

Restless legs syndrome - what is the most important blood test

A

Ferritin

Can be low

89
Q

Restless leg syndrome treatment

A
  1. DA agonists e.g. pramipexole, ropinirole
  2. Gabapentin or pregabalin
  3. If sleep issues - use z-drugs or benzos short course
  4. Treat IDA, walk, stretch
90
Q

Medication overuse headache - when to stop:
1. Simple analgesia + triptans
2. Opioid analgesia

A
  1. Simple analgesia + triptans - stop immediately
  2. Opioid analgesia - stop gradually
91
Q

Eye palsy cranial nerves
LR6 SO4 R3

A

lateral rectus CN6 - inwards
Superior oblique CN4 - up and out
Rest CN3 - down and out

92
Q

When can you stop anti-epileptics and how long should they be stopped over

A

Consider stopping if seizure free for >2 years, and stop the anti-epileptics over 2-3 months

93
Q

A 14-year-old-girl attends along with her parents. They report that for the last month they have noticed occasional ‘twitches’ of her arms. These are more common early in the morning.

She should be referred to paediatric neurology urgently to investigate for

A

Juvenile myoclonic epilepsy

can present with absences and/or myoclonus (in upper limbs) before progressing to generalised seizures

94
Q

Obese, young female with headaches / blurred vision

A

idiopathic intracranial hypertension

(papilloedema, CN6 palsy, headache)

95
Q

Treatment for idiopathic intracranial hypertension (3 drugs)

A

Acetazolamide
Topiramate
Semaglitide

+ repeated lumbar puncture /surgery

96
Q

5 medications that increase risk of idiopathic intracranial hypertension

A
  1. COCP
  2. Steroids
  3. Tetracyclines
  4. Retinoids
  5. Lithium
97
Q

GCS scoring - score ranges
Motor
Verbal
Eye

A

Motor 1-6
Verbal 1-5
Eyes 1-4

98
Q

A 75-year-old female presents with sensory loss to the little finger and wasting of the hypothenar eminence. What nerve has the likely lesion?

A

Ulnar nerve

Claw hand can occur with damage at wrist. Damage at elbow may not show claw.

99
Q

Ulnar nerve is motor to

A
  1. Medial two lumbricals
  2. aDductor pollicis
    interossei
  3. hypothenar muscles
  4. flexor carpi ulnaris
100
Q

Treatment for maintenance after stroke/TIA occurs

A

Clopidogrel 75mg OD + statin (after aspirin 300mg)

If not tolerated, give aspirin 75mg OD + dipyridamole MR 200mg BD (or separately if unable to tolerate one)

101
Q

Laughter with fall/collapse is called

A

Cataplexy

typically triggered by strong emotions such as laughter, anger or surprise. usually a/w narcolepsy

102
Q

Post-herpetic neuralgia treatment

A
  1. Amitriptyline

OR chronic neuropathic pain meds:
Duloxetine/ gabapentin / pregabalin

103
Q

A rare but recognised adverse effect of lamotrigine therapy is

A

Stevens Johnsons syndrome

104
Q

Reflex roots for
Ankle
Knee
Biceps
Triceps

A

Ankle - S1-S2
Knee - L3-L4
Biceps - C5-C6
Triceps - C7-C8

105
Q

What do NICE recommend for migraine prevention if both topiramate and propranolol have been ineffective after 2 months or are unsuitable

A

Offer 10-sessions of acupuncture over 5-8 weeks

Riboflavin 400mg OD

106
Q

Consider what medication to manage drooling of saliva in people with Parkinsons

A

glycopyrronium bromide

107
Q

What medication is useful for managing tremor in drug-induced parkinsonism

A

Procyclidine

108
Q

What parkinsons drugs are associated with pulmonary fibrosis

A

Dopamine agonists (first generation)

e.g. cabergoline, bromocriptine

109
Q

For multiple sclerosis, does the typical (female, young age, relapsing remitting) or atypical patient (male, old, short interval between relapses) carry the worse prognosis

A

Atypical patient
(male etc)

carries the worse prognosis

110
Q

What muscles are often spared in motor neurone disease

A

Extraocular eye muscles

No cerebellar or sensory signs in motor neuron disease!

111
Q

What vitamin do NICE advocate as being useful in the prophylaxis against migraine?

A

Riboflavin
Vitamin B2
400mg OD

112
Q

Frozen shoulder has what limited movement of the shoulder

A

external rotation

113
Q

Which is the only cholinesterase inhibitors (out of rivastigmine, donepezil and galantamine) that is licensed for use for Parkinson’s disease and can help cognitive impairment

A

Rivastigmine

114
Q

rare but important adverse effect of topiramate

A

acute myopia and secondary angle-closure glaucoma

115
Q

Carbamazepine is generally ineffective in which type of seizures

A

Absence seizures

116
Q

Cardiovascular disease is a contraindication to which headache medication

A

Triptans

117
Q

normal pressure hydrocephalus triad

A

urinary incontinence
gait abnormality
dementia

118
Q

Muscle wasting of the hands
Numbness and tingling
Painful neck
Headache

What is the likely cause

A

Thoracic outlet syndrome

119
Q

Median nerve (carpal tunnel) injury affects what motor hand muscles (LOAF)

A

Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

Sensory = over thumb and 2nd, 3rd finger

120
Q

multiple sclerosis tingling in hands when neck flexes

What is this an example of?

A

Lhermitte’s sign

also seen in cervical stenosis, subacute degen of cord

121
Q

Saturday night palsy is caused by compression of what nerve

A

Radial nerve against humeral shaft

Hard to extend wrist

122
Q

The dementia specialist commences an elderly lady with a diagnosis of severe Alzheimers dementia on a medication to treat her cognitive impairment. Which drug does NICE recommend for severe Alzheimers disease?

A

memantine

123
Q

mild to moderate Alzheimer’s disease management medication options

A

Acetylcholinesterase (AChE) inhibitors:

donepezil
galantamine
rivastigmine

124
Q

Donepezil is a medication to treat Alzheimers disease. One of the possible side effects of the acetylcholinesterase inhibitors (donepezil, rivastigmine and galantamine) is…

A

bradycardia

125
Q

what are the 4 rotator cuff mucles

SItS

A

Supraspinatus
Infraspinatus
teres minor
Subscapularis

126
Q

What are actions of supraspinatus

A

ABDUCTs arm
most commonly injured

127
Q

What are actions of infraspinatus

A

rotates arm laterally

128
Q

What are actions of teres minor

A

ADDUCTS arm
Rotates arm laterally

129
Q

What are actions of subscapularis

A

ADDUCTs arm
Rotates arm medially

130
Q

what score is used to assess severity of OA of the hip

A

Oxford hip score

131
Q

what investigation is first line for hip osteoarthritis

A

plain x-rays

132
Q

4 peri-operative and 3 post-operative complications of total hip replacement

A

PERI-OPERATIVE:
1. VTE
2. Fracture
3. Nerve injury
4. Infection

POST-OPERATIVE:
1. Leg length discrepancy
2. Posterior dislocation - presents with pain and ‘clunk’, internal rotation + shortening
3. Aseptic loosening with infection

133
Q

What is the most common reason for revision of a hip replacement

A

Aseptic loosening

+/- prosthetic joint infection

134
Q

which patient should receive migraine prophylaxis

A

if migraines are having significant impact on QoL and daily function, or occur frequently (more than once a week) or are prolonged + severe despite optimal acute treatment

135
Q

Sudden-onset intense unilateral pain
Red/watering eyes
Blocked or runny nose
Extreme agitation
Everyday, lasting 4-12 weeks

what type of headache

A

cluster headache

Rx = sumitriptan or inhaled oxygen

136
Q

Lennox-Gastaut syndrome may be an extension of infantile spasms. What dietary treatment can help?

A

Ketogenic diet

137
Q

Juvenile myoclonic epilepsy (Janz syndrome) in teen girls usually has daytime absences, sudden shocks, then seizures.
What is the treatment?

A

Sodium valproate

138
Q

First line tretament for parkinson’s disease if the motor symptoms are affecting patient’s quality of life

A

Levodopa

139
Q

First line tretament for parkinson’s disease if the motor symptoms are NOT affecting patient’s quality of life

A

DA agonist (non-ergot derived); or
Levodopa; or
Monoamine oxidase B (MAO-B) inhibitor

140
Q

What are the 2 risks if parkinson’s medication is not taken or not absorbed e.g. gastroenteritis

A

Acute akinesia
Neuroleptic malignant syndrome

141
Q

Levodopa is nearly always combined with what

A

Decarboxylase inhibitor
e.g. carbidopa or benserazide

prevents peripheral metabolism of levodopa to DA

142
Q

‘on-off’ phenomenon with levodopa

A

Normal motor in ‘on’ period
Restricted poor mobility in ‘off’ period

143
Q

dyskinesias with levodopa

A

occur at peak dose

dystonia, chorea and athetosis - involuntary writhing movements

144
Q

examples of dopamine receptor agonists used in Parkinson’s disease

A

Bromocriptine
Ropinirole
Cabergoline

145
Q

Dopamine receptor agonists used for parkinson’s disease e.g. bromocriptine, cabergoline have been associated with what adverse effects

A

Pulmonary and cardiac fibrosis

146
Q

Dopamine receptor agonists used for parkinson’s disease e.g. bromocriptine, cabergoline are associated with pulmonary and cardiac fibrosis.

What monitoring needs to be done for these treatment?

A

Echocardiogram
ESR
Creatinine
CXR

Before treatment, then monitor closely

147
Q

What are the options for Parkinson’s treatment medications

A
  1. Levodopa + carbidopa
  2. DA receptor agonist e.g. bromocriptine, cabergoline
  3. MAO-B inhibitor e.g. selegiline
  4. COMT inhibitor
  5. anti-muscarinics
148
Q

what is the longest duration of aura before migraine that is considered normal by NICE and British Association for the Study of Headache (BASH)?

A

5 mins to 1 hour

149
Q

Typical migraine auras include what usually

A

transient hemianopic disturbance or a spreading scintillating scotoma (‘jagged crescent’)

150
Q

NICE states which 5 aura symptoms are atypical and prompt further investigation or referral

A
  1. motor weakness
  2. double vision
  3. visual symptoms affecting only 1 eye
  4. poor balance
  5. decreased consciousness
151
Q

Bell’s palsy symptoms

A

This is a LMN lesion which affects the forehead.

LMN facial nerve palsy
Post-auricular pain
Altered taste
Dry eyes
Hyperacusis

152
Q

Management of Bell’s palsy

A
  1. Prednisolone
  2. Eye care - eyedrops + lubricants
  3. If no improvement after 3 weeks - refer to ENT
153
Q

What does median nerve innervate in the hand for sensory function?

A

Over thumb and lateral 2.5 fingers
Palm

154
Q

Good prognosis features of multiple sclerosis

A

Female sex
Age - young onset
Relapsing-remitting disease
Sensory symptoms ONLY
Long interval between first two relapses
Complete recovery between relapses

155
Q

What analgesia is contraindicated in children

A

Aspirin
- due to risk of Reye’s syndrome (encephalopathy with liver, kidney, pancreases infiltration)

156
Q

What is the most common psychiatric problem with Parkinson’s disease?

A

Depression

157
Q

Parkinson’s disease is due to degeneration of dopaminergic neurons in what region

A

substantia nigra

158
Q

Drug-induced parkinsonism has slightly different features to Parkinson’s disease such as:

A
  • Motor symptoms are rapid onset and bilateral
  • Rigidity and rest tremor are uncommon
159
Q

If there is difficulty differentiating between essential tremor and Parkinson’s disease, NICE recommend considering what investigation

A

SPECT (123 I-FP-CIT single PET CT scan)

160
Q

3rd nerve palsy
What are the 3 main features

A

Eye is down and out
Ptosis
Pupil may be dilated (surgical)

161
Q

Causes of 3rd nerve palsy (down and out, ptosis, dilated if surgical)

A

Diabetes
Vasculitis e.g. GCA, SLE
Aneurysm
Weber’s syndrome

162
Q

Patients with ischaemic stroke are given 300mg aspirin (then maintenance 75mg clopidogrel).

Some patients however are eligible for thrombolysis with alteplase instead - what are the 2 criteria for this?

A
  1. Administered within 4.5 hours of stroke symptoms onset
  2. Haemorrhage excluded with imaging
163
Q

Management of acute stroke

A

Imaging to ensure not haemorrhagic, then:
1. 300mg aspirin PO/PR; 2. Thrombolysis with IV alteplase - within 4.5hours
3. Mechanical thrombectomy - within 6-24 hours (+ thrombolysis with alteplase)

then 75mg clopidogrel + statin thereafter when discharged +/- carotid atery endarterectomy

164
Q

NICE recommend that all decisions about thrombectomy of ishcaemic stroke should take into account a patient’s overall clinical status. What scores and thresholds does it recommend?

A

Pre-stroke functional status of less than 3 on modified Rankin scale
and
Score of more than 5 on National Institutes of Health Stroke Scale (NIHSS)

165
Q

When should thrombectomy be offered for patients with stroke?

A
  1. Proximal anterior circ stroke - within 6 hours
  2. Proximal anterior circ stroke with potential to salvage brain tissue - between 6-24 hours
  3. Proximal posterior circ stroke - within 4.5hours
166
Q

Carotid artery endarterectomy is recomended to patients if they have suffered stroke/TIA in carotid territory and are not severely disabled. It should be considered if stenosis is above what?

A

> 70% ECST criteria
50% NASCET criteria

167
Q

degenerative cervical myelopathy gold standard test

A

MRI of cervical spine

168
Q

Guillain-Barre syndrome is an immune-mediated demyelination of peripheral nervous system often triggered by what infection

A

Campylobacter jejuni

169
Q

Weakness in Guillain-Barre syndrome usually has what pattern

A

Ascending
Progressive
Symmetrical

170
Q

What do patients on sodium valproate need to do every year for the valproate pregnancy prevention programme

A

See epilepsy specialist once a year for an Annual Acknowledgement of Risk form

171
Q

What is the strongest risk factor for developing Bell’s palsy

A

Pregnancy

172
Q

What cancer is myasthenia gravis linked to

A

Thymomas

173
Q

What investigations can be done for myasthenia gravis?

A
  1. EMG
  2. CT chest - to rule out thymomas
  3. Bloods - antibodies to ACh receptors, normal CK
  4. Tensilon test
174
Q

Neuroleptic malignant syndrome is usually seen in patients who have just started treatment or who have been taking it for a while?

A

Just started treatment!

Occurs within hours to days (slower onset)

175
Q

Neuroleptic malignant syndrome treatment

A

Stop antipsychotic
IV fluids
Dantrolene
Bromocriptine (DA agonist)

176
Q

Ulnar nerve is sensory to which part of the hand

A

Medial 1.5 fingers
Palmar and dorsal aspects

177
Q

Triptans adverse effects - what are triptan sensations

A

Tingling
Tighteness of throat and chest
Heaviness + pressure

178
Q

In a patient with a Bell’s palsy, severe pain might indicate what..?

A

Ramsay Hunt syndrome

179
Q

What type of Parkinson’s disease medications has been most linked with impulse control disorders?

A

Dopamine receptor agonists

180
Q

4th nerve palsy features

A

Eye is upwards and out
Head tilt
Torsional diplopia

CN4 supplies SO - this depresses eye and moves inwards usually

181
Q

CN4 supplies what eye muscle

A

superior oblique

182
Q

Foot drop
Frequently sprained ankles
High arched feet (pes cavus)
Distal muscle atrophy and weakness
Hyporeflexia
Stork leg deformity

what is the diagnosis

A

Charcot-Marie-Tooth disease

183
Q

4 indications of cannabis based medicinal products

A
  1. chemotherapy nausea
  2. chronic pain
  3. spasticity in MS
  4. severe treatment resistant epilepsy

AKT (25 decks)

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