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Main diseases for each system > Neuro > Flashcards

Neuro Flashcards

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1
Q

How does Parkinson’s disease present?

A

TRAP

Tremor; asymmetrical at presentation, pill rolling, high frequency, at rest

Rigidity; stiffness, cogwheel, across whole range of joint movement

Akinesia/Bradykinesia; slowed movement esp fine motor movement, facial expression, blinking, less hand gesturing etc.

Postural instability; Shuffling gait, reduced arm swing, problems with feet

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2
Q

What are atypical parkinsonian syndromes?

A

Multiple systems atrophy
Progressive Supranuclear palsy
Corticobasal syndrome

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3
Q

What is the histology of Parkinson’s?

A

Loss of dopaminergic neurones in substantia nigra
excess cholinergic activity
lewy bodies

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4
Q

What is the treatment for Parkinson’s?

A

MAO-B inhibitors; selegeline
Dopaminergic agents; Ldopa+carbidopa and dopamine agonists
Amantadine

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5
Q

What is the pharmacological treatment for Alzheimer’s?

A

Anticholinesterase; donepezil, galantamine, rivastagmine
NMDA receptor blocker; memantine

Antidepressants and antipsychotics

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6
Q

Treatment for vascular dementia

A

Reduce high blood pressure and cholesterol

Control risk factors i.e. obesity and quit smoking

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7
Q

Investigations for vascular dementia

A

FBC, ESR, blood glucose, renal and LFTs

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8
Q

How does fronto-temporal dementia present?

A

Behavioural changes
Personality alteration
Language difficulty

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9
Q

Tests for fronto-temporal dementia

A

CT/MRI to assess damage, FBC, mental testing

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10
Q

Treatment for fronto-temporal dementia

A

Supportive care + benzodiazepene or neuroleptic

SSRIs to reduce impulsive behaviour

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11
Q

How is Lewy Body dementia diagnosed?

A

Doctor’s best judgement based on symptom onset

May order; FBC, metabolic panel, serum TSH, serum vit b12

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12
Q

How is lewy body dementia treated?

A

If behavioural disturbance; benzodiazepene

If not behavioural disturbance; cholinesterase inhibitors, SSRI if depression, clonazepam to help REM sleep disorder, carbidopa/levodopa for motor symptoms

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13
Q

Describe progressive supranuclear palsy presentation

A

problems with walking, balance and eye movements
altered behaviour
muscle stiffness
dysphagia and speech problems

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14
Q

how is PSP diagnosed?

A

rule out similar conditions

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15
Q

How is PSP treated?

A

Levodopa
Antidepressants
walking aids
special glasses

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16
Q

Describe MS presentation

A

Multiple Sclerosis

fatigue, difficulty walking
vision problems
problems controlling bladder
muscle stiffness/spasms

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17
Q

Describe MS treatment

A

Relapses with corticosteroids; methylprednisolone

Beta interferons; glatiramir acetate, dimethyl fumarate, fingolimod, alemtuzumab, natalizumab

Lifestyle mod i.e. physiotherapy

Low dose anticonvulsants

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18
Q

How is MS diagnosed?

A

MRI brain and spinal cord
FBC
Met panel

CSF evaluation
evoked potentials
anti-neuromyelitis antibody

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19
Q

How does cauda equina syndrome present?

A

Lower back pain into legs, perianal numbness, faecal/urine incontinence

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20
Q

How is cauda equina syndrome diagnosed?

A

MRI spinal cord

CT myelography

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21
Q

How is cauda equina syndrome treated?

A

Decompression of spinal nerves; lumbar decompression surgery

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22
Q

How does myaesthenia gravis present?

A

muscle weakness and fatigue progressive through day

Eyelid drooping, facial expression, chewing, swallowing affected

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23
Q

Myaesthenia gravis investigations

A 
serum ACh receptor antibody analysis
muscle specific tyrosine kinase antibodies
serum pulm function tests
CT chest
Single fibre EMG
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24
Q

How is myasethenia gravis treated?

Study These Flashcards
A

Pyridostigmine
Immunosuppressant
thymectomy

Plasma exchange, IV Ig

25
How does DMD present?
Genetic condition against dystrophin gene Usually boys under 5yo Difficulty standing from floor, running, walking
26
Diagnosis of DMD
Genetic testing Creatine kinase EMG
27
Treatment of DMD
Corticosteroids Physiotherapy Swallowing, spinal and heart problem treatment
28
How does Bell's Palsy present?
Facial nerve palsy Eyelid drooping, facial droop, corner mouth droop, dry mouth, loss of taste
29
Diagnosis Bell's palsy
clinical diagnosis EMG if unsure serology for borrelia burgdorferi
30
Treatment Bell's palsy
Prednisolone within 72hours Eye drops Surgical tape to close eye at night
31
Describe trigeminal neuralgia diagnosis
Based on exclusion possibly MRI
32
Trigeminal neuralgia treatment
Avoid triggers Anticonvulsant; carbamazepine Surgery; microvascular decompression Stereotactic surgery
33
How does SAH present?
``` Thunderclap headache stiff neck nausea and vom photophobia blurred/double vision ```
34
Diagnosis of SAH
CT scan head, FBC, clotting profile, electrolytes Lumbar puncture CT angiography
35
Treatment of SAH
CCB Nimodipine; reduce risk secondary cerebral ischaemia Surgical clipping or endovascular coil embolisation Pain relief Anticonvulsants Antiemetics Stool softeners reduce re-bleed risk
36
Describe extradural haematoma presentation
Convex lens shape on CT
37
Describe brain haematoma treatment
Burr hole decompression Craniectomy and ligation Pharmacological; anticonvulsants, diuretics, prophylactic ABs, barbiturates
38
Describe subdural haematoma presentation
CT concave lens shape
39
How is ischaemic stroke treated?
Confirm ischaemic ``` Alteplase <4.5hrs Thrombectomy Antiplatelets Anticoagulants Carotid endarcterectomy ```
40
What are preventative migraine treatments?
Topiramate Propranolol Botox type A (need 3 previous failed meds) accupuncture
41
How is motor neurone disease treated?
Riluzole slows progression meds to relieve muscle stiffness SLT, dietician, OT physiotherapy
42
Describe investigation of motor neurone disease
EMG nerve conduction studies MRI brain and spinal cord
43
Describe epilepsy
Tendency to recurrent unprovoked seizures
44
Seizure classification
Generalised - absence - tonic-clonic - myoclonic - atonic Focal - simple partial - complex partial - secondary generalised
45
Difference between primary generalised and focal seizures
Primary no warning, <25, history absence and myoclonic jerks and GTCS, general abnormal ECG, FHx Focal may have aura, any age, focal abnormality on ECG, MRI may show cause
46
Describe generalised tonic clonic seizures
History preceding; unpredictable, PMH complications at birth, trauma, meningitis, brain injuries Event history; vague warning irritability Afterwards; tongue biting, incontinence, first recollection in ambulance or hospital, muscle pain
47
Describe witness account GTCS
``` groaning rigid phase then limb jerking Eyes open; staring or rolling up Foaming at mouth Groggy for 15-30mins ```
48
Describe absence seizures
Often in children | Sudden arrest activity for few seconds; brief staring, eyelid fluttering
49
Describe complex partial seizures
History preceding; rising feeling stomach, funny smell/taste, deja vu History of event; no recollection After; disoriented for spell
50
Witness account complex partial seizures
Sudden arrest activity Staring blankly into space Automatisms; lip smacking, repetitive picking at clothes May be disoriented afterwards
51
Clinical assessment of seizures
ECG Routine bloods; glucose CT/MRI EEG
52
First line treatment of epilepsy
Primary generalised; sodium valproate, lamotrigine, levetiracetam Focal and secondary generalised; lamotrigine, carbamazepine, levetiracetam Absence; ethosuximide ACUTELY: diazepam, lorazepam
53
Side effects of phenytoin
arrythmia hepatitis medication interactions
54
Side effects of sodium valproate
``` tremor weight gain ataxia nausea drowsiness hepatitis ```
55
Side effects of carbamazepine
``` ataxia drowsiness nystagmus blurred vision low serum Na skin rash ```
56
Status elipticus
prolonged or recurretn tonic clonic seizures >30mins no recovery period FIRST LINE; diazepam 10-20mg IV or rectally repeated after 10mins if necessary Midazolam 10mg buccal or intranasal repeated after 10mins if necessary Lorazepam 0.07mg/kg usually 4mg bolus repeated once after 10mins SECOND LINE; phenytoin slow infusion, valproate
57
Symptoms of Guillain Barre syndrome
``` muscle weakness respiratory distress speech problems absence deep tendon reflexes ptosis paraesthesia ```
58
Diagnosis of Guillain Barre syndrome
nerve conduction studies lumbar puncture LFTs spirometry
59
treatment of Guillain barre syndrome
plasma exchange | IV immunoglobulin

Main diseases for each system (12 decks)

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