Neuro Flashcards
(248 cards)
1
Q
What is the definition of a TIA?
A
Ischaemia caused by temporary blockage of the blood supply to the brain
Lasts less than 24hours, usually 5-15mins.
2
Q
Risk factors for TIA?
A
Age, hypertension, smoking, diabetes, AF and combined oral contraceptive pill
3
Q
What percentage of first strokes are preceeded by a TIA?
A
15%
4
Q
What type of people are TIA’s more common in?
A
Males and black people
5
Q
Where are atherothromboembolism’s from usually in TIA?
A
Carotid artery
6
Q
What might be the cause of a cardioembolism?
A
Atrial fibrillation
7
Q
Differential diagnoses for TIA?
A
Hypoglycaemia, Migraine aura, focal epilepsy, vasculitis
8
Q
What are the presentations of a carotid territory TIA?
A
Amaurosis fugax, aphasia (speech difficulty), Hemiparesis, Hemisensory loss, Hemianopia visual loss
9
Q
What types of symptoms would you see in a vertebrobasilar artery TIA?
A
Cerebellar symptoms (as vertebral supply mostly cerebellum) Vertigo, vomiting, choking, ataxia, hemisensory loss, hemi visual loss
10
Q
What is Amaurosis fugax?
A
Unilateral sudden vision loss
11
Q
What is usually the cause of amaurosis fugax?
A
Temporary occlusion of the retinal artery
12
Q
What might a patient describe during amaurosis fugax?
A
Like a curtain descending
13
Q
What risk score is used to predict a stroke after TIA?
A
ABCD2
14
Q
What does ABCD2 stand for?
A
Age Blood pressure Clinical features (unilateral weakness, speech disturbance) Duration of TIA DM
15
Q
How to diagnose a TIA?
A
Symptoms description Blood tests (glucose, FBC, ESR vasculaitis etc) Brain imaging Carotid imaging (doppler ultrasound ECG Echo
16
Q
Immediate management of TIA?
A
Aspirin, refer to a specialist
17
Q
What would you do to control CV risk factors in TIA?
A
BP control, smoking cessation, statins, no driving for a month
18
Q
Longterm management of TIA?
A
Aspirin, clopidogrel, warfarin Carotid endartectomy (to reduce carotid stenosis)
19
Q
What is a stroke?
A
Rapid onset neurological deficit lasting over 24 hours. Caused by infarction of cells.
20
Q
What are the 2 types of stroke?
A
Ischaemia (blood clot)
Haemorrhagic (bleed in small vessel in the brain)
21
Q
Risk factors for ischaemic stroke?
A
Age, male, HTN, smoking, diabetes, past TIA
22
Q
General symptoms for ischaemic stroke
A
Contralateral sensory loss, contralateral hemiplegia, Facial weakness forehead sparing, dysphasia
23
Q
What symptoms are you more likely to get with a stroke of the ACA?
A
Leg symptoms
24
Q
What symptoms are you more likely to get with a stroke of the MCA?
A
Arm and face symptoms
25
What symptoms are you more likely to have if there is a brainstem infarct?
Quadriplegia, cerebellar signs, vertigo, N+V, locked in syndrome
26
What is a lacunar infarct?
Infarction of a small artery supplying a deep brain structure.
27
What investigations would you do for an ischaemic stroke?
CT scan (distinguish types), MRI scan (more sensitive), blood tests, ECG
28
What is the management of an ischaemic stroke?
Aspirin, warfarin
29
WHat should aspirin be swapped for long term in ischaemic stroke?
Clopidogrel
30
What drugs are used in thrombolysis?
IV alteplase
31
Within what time should you do thrombolysis in stroke?
4.5 hours
32
What is mechanical thrombectomy?
Endovascular removal of thrombus
33
What is an intracerebral haemorrhage?
Sudden bleeding into brain tissue due to rupture of a blood vessel within the brain
34
Risk factors for intracerebral haemorrhage?
HTN, age, anticoagulation, thrombolysis
35
How does hypertension cause intracerebral haemorrhage?
stiff brittle vessels more likely to rupture and cause microaneurysms.
36
What are the complications with increasing ICP?
Healthy tissue can die, CSF obstruction causing hydrocephalus, midline shift, herniation (putting pressure on your breathing centre and causing death)
37
Clinical presentation of an intracerebral haemorrhage than differentiate it from ischaemic?
Sudden loss of consciousness, severe headache, meningism, coma
38
Management of intracerebral haemorrhage?
Stop anticoagulants, control of BP, IV mannitol to reduce ICP
39
What is a subarachnoid haemorrhage?
Spontaneous bleeding into the subarachnoid space between pia and subarachnoid
40
Which arteries lie in the subarachnoid space?
Circle of Willis
41
Which blood vessels lie in the subdural space?
Bridging veins
42
Which arteries lie in the extradural space?
Middle meningeal artery
43
Epidemiology of SAH?
35-65, 50% of people die straight away
44
Risk factors for SAH?
HTN, Berry anneurysm, PKD, coarctation of aorta, EDS
45
What is the most common place for a berry aneurysm to occur?
Anterior communicating artery.
46
Pathophysiology of SAH?
Tissue ischaemia (from bleeding)
Raised ICP
Puts pressure on the brain
Irritates the meninges causing inflam
47
What are the clinical presentations of SAH?
THUNDERCLAP HEADACHE,
| nausea, vomiting, collapse, loss of consciousness, seizures
48
Signs of SAH?
Neck stiffness, Kernig's and Bridinskis sign
49
Differential diagnoses for SAH?
Migraine, meningitis
50
Investigations for a SAH?
Brain CT, LP (if ICP is normal), Xanthochromia (CSF looks yellow)
51
What would you see on CT in SAH?
A star shape sign on the CT
52
Management of SAH?
Refer to neurosurgeon, Nimodipine (reduces vasospasm), surgery to stop bleeding is the main treatment.
53
What is a subdural haematoma?
A big clot of blood in the subdural space
54
What is the cause of a subdural haematoma?
Rupture of a bridging vein
55
WHo is subdural haematoma most commonly seen in?
Babies (shaking baby syndrome), people with brain atrophy (dementia, elderly, alcoholics)
56
How long can the latent interval be in subdural haematoma?
Weeks/months as bleeding is slow and there is a gradual rise in ICP.
57
why do symptoms of subdural haematoma occur?
Haematoma starts to autolyse increasing oncotic pressure, drawing water in and therefore increasing ICP, leading to symptoms.
58
What are the symptoms of subdural haematoma?
Fluctuating levels of consciousness, drowsiness , headache, confusion.
Often cannot remember hitting head as it was months ago
59
Signs of subdural haematoma?
raised ICP, seizures
60
What does a subdural haematoma look like on CT?
Crescent shaped, looks like a banana
61
What is the management of subdural haematoma?
IV mannitol, surgery, address cause
62
What is an extradural haematoma?
Bleeding into extradral space caused by trauma to the temporal
63
Which artery is ruptured in extradural haematoma?
Middle meningeal artery
64
What is the latent interval in extradural haematoma?
a few hours
65
Epidemiology for extradural haematoma?
Young people, males, rare in children
66
Clinical presentation of extradural haematoma?
trauma then short episode of drowsiness, lucid interval for hours to days, rapid deterioration follows
Rapidly declinign GCS, headache, vomiting, seiures
67
What does an extradural haematoma look like on a CT scan?
Lemon, with midline shift
68
Management of extradural haematoma?
IV manitol, stabilise patient, Urgent surgery for clot evacuation
69
What is a migraine?
Recurrent throbbing headache often preceded by an aura and associated with nausea, vomiting and visual changes
70
What is the epidemiology of migraines?
More common in females, onset before 40
71
What are risk factors for migraines?
Genetics and family history, female, age (adolescence)
72
What mneumonic is used to remember the aetiology of migraines?
CHOCOLATE
73
What does chocolate stand for?
```
Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie-ins
Alcohol
Tumult
Exercise
```
74
What is prodrome?
Before the migraine
75
What are symptoms of prodrome?
Yawning, cravings, mood sleep changes
76
What symptoms do people get in a migraine aura?
Visual disturbances (lines, dots, zigzags, somatosensory (pins and needles)
77
Clinical presentation of a migraine?
Unilateral pain, throbbing type pain, moderate to severe intensity, nausea, vomiting, photophobia
78
How to diagnose migraines?
Usually just made clinically, does not need extra tests unless red flags
79
What are the red flag symptoms for migraines?
Worst/ severe headache, change in pattern of migraine, abnormal neurological exam, onset older than 50, epilepsy, posterior located headache.
80
What tests would you do if there were red flags for migraines?
CRP/ESR, CT/MRI, LP
81
WHat is the first line treatment for migraines?
Triptans e.g. sumatriptan
82
How do triptans work?
Works on 5-HT receptors in the brain leads to vasoconstriction of the cranial vasculature
83
Other treatment options for migraines?
High dose NSAIDS (naproxen), antiemetics,
| AVOID OPIOIDS
84
What can be used for the prevention of migraines?
Beta blockers (propranolol) , TCA's such as amitriptyline
85
What is a cluster headache?
Episodic headaches lasting from 7days up to 1 year. HEadaches are extremely painful./
86
Clinical presentation of cluster headaches?
Rapid onset of excruciating pain, especially around the eye. Pain is localised to 1 area. crescendo of pain that lasts for around 30mins
87
Other features of cluster headaches
```
Ipsilateral autonomic features:
Watery bloodshot eye
Facial flushing
Rhinorrhoea
Miosis (pupillary constriction) and ptosis (droopy eyelid)
```
88
Acute management of cluster headaches?
Analgesics are unhelpful.
| Oxygen is really helpful, triptans
89
Prevention of cluster headaches?
Verapmil (CCB) 1st line prophylaxis, reduce alcohol consumption and stop smoking.
90
Triggers of tension headache?
Stress, sleep deprivation, bad posture, hunger, anxiety, eyestrain, noise
91
Clinical presentation of tension headache?
Bilateral, pressing tight, non pulsatile like an elastic band.
mild/moderate intensity
no aura
92
Symptomatic treatment of a tension headache?
Aspirin, paracetamol, ibuprofen
| AVOID OPIOIDS
93
What is a secondary headache?
Has an underlying pathology
94
What might be the cause of a one sided headache in the temporal area?
Giant cell arteritis
95
What is the criteria for a diagnosis of epilepsy?
At least 2 unprovoked seizures occurring more than 24 hours apart.
96
When is it most common for people to have seizures?
At the extremes of age , so in young people or old people
97
Causes of epilespy?
2/3 idiopathic, cortical scarring, tumours or space occupying lesions, family history
98
What do patients experience in an aura befroe a seizure?
Deja vu, strange smells, flashing lights, strange feelings in gut
99
What is a post ictal period?
The period after a seizure, headache, confusion, myalgia, sore tongue.
100
What are the main 2 types of seizure?
Primary generalized, partial (focal)
101
WHat is a primary generalised seizure?
Spreads throughout the whole cortex, not just one part.
Always associated with loss of consciousness
bilateral and symmetrical motor manifestations.
102
What is a partial seizure?
One single area in a singls lobe is affected. can progress to become generalised.
103
What does tonic mean in a seizure?
tight, stiff rigid limbs
104
What does clonic mean in a seizure?
Rhythmic muscle jerking
105
What is a tonic-clonic seizure?
Mixture of tonic and clonic seizures, leads to characteristic shaking symptoms of a seizure.
106
What is a myoclonic seizure?
Isolated jerking of a limb
107
WHat is an atonic seizure?
Loss of muscle tone, go floppy
108
What is a absence seizure>
Common in childhood, will go pale and stare blankly for a few seconds.
109
What is a simple partial seizure?
No affect on consciousness or memory
110
What is a complex partial seizure?
Patient has symptoms of a seizure and is not aware they are having them
111
How to diagnose epilepsy?
Usually clinical, EEG (determine the type), Bloods to rule out underlying cause
112
How to manage a seizure lasting over 5 mins?
Give benzodiazepines, either rectally or IV
113
Drugs to manage epileps?
Sodium valproate unless female of childbearing potential.
| Give lamotrigine
114
Types of primary brain tumours?
Gliomas (astrocytoma)
115
What are the most common origins for secondary brain tumours?
Non-small cell lung cancer
116
What is Wernicke's encephalopathy?
Depletion of vitamin B1
117
What is the triad in Wernicke's encephalopathy?
Confusion, ataxia, opthalmoplegia
118
Who does Wernicke's encephalopathy occur in?
Chronic alcoholism
119
How to manage wernickes encephalopathy?
Pabrinex (IV b vitamins)
120
What is the most common type of dementia?
Alzheimers
121
Risk factors for alzheimers?
Down's syndrome, over 65, depression and low mood, reduced cognitive activity
122
What are the key pathological hallmarks for alzheimers?
Beta-amyloid plagues, tau tangles, atrophy of the centre of the brain
123
Signs and symptoms for alzheimers?
Memory loss, particularly short term memory,
Difficulty understanding and finding words
Attention and concentration difficulties
Psychiatric changes
Disorientation
124
Investigations and diagnosis of dementia?
MMSE (mini mental state exam), Bloods to check for other causes, memory clinic assessment, MRI
125
Treatment for alzheimers?
No cure, supportive therapy with carers ar home,
| Acetylcholinesterase inhibitors can help manage symptoms
126
WHat is FT dementia?
More common in under 65, atrophy of the frontal and temporal lobes
127
Signs and symptoms of FT dementia?
```
Behavioural issues (loss of inhibition/empathy and compulsive behaviours)
Progressive aphasia
Semantic dementia (loss of vocab and problems understanding)
```
128
Treatment of FT dementia?
SSRI's can help with behaviour symptoms, Levodopa if Parkinsons symptoms
129
What is vascular dementia?
The result of multiple small infarcts over time
130
Signs and symptoms for vascular dementia?
Characterised by stepwise progression (stable followed by jump in progression),
Visual disturbances, UMN signs, muscle weakness etc
131
Investigations and diagnosis for vascular dementia ?
Full history, ask about previous stroke/TIA, Cognitive impairment screen, medication review , MRI to look for previous infarcts
132
How to treat vascular dementia?
Supportive therapy, SSRI's or anti-psychotics to control symptoms.
133
What is dementia with Lewy bodies?
Lewy bodies found in the brainstem and neocortex
| On a spectrum with dementia and Parkinsons
134
Signs and symptoms of Lewy body dementia?
Dementia presented initially, may also present with parkinsonism (tremor, rigidity, change in gait)
135
How to diagnose Lewy body dementia?
Presence of dementia with 2 of : fluctuating attention and concentration, hallucinations, spontaneous parkinsonism
136
How to treat dementia with Lewy bodies?
Refer to a specialist, supportive therapy, cholinesterase inhibitors to treat cognitive decline
137
Typical age of onset of parkinsons?
55-65 years
138
Aetiology of parkinsons?
Too little dopamine,
139
What is the Parkinson's triad?
Bradykinesia, rigidity, resting tremor
140
What are common clinical signs of parkinsons?
Impaired dexterity, fixed facial expressions, foot drag
141
Associated symptoms of parkinsons?
Dementia, depression, urinary frequency, constipation, sleep disturbances
142
How is Parkinson's diagnosed?
1. diagnosis of parkinsonian syndrome
2. exclusion criteria
3. supportive criteria (unilateral onset, rest tremor present)
143
How to treat parkinsons?
MDT care, Levodopa, COMT inhibitor,
144
What is huntingtons?
neurodegenrative disease causing hyperkinesia, lots of uncontrolled movement.
145
What penetrance does huntingtons have?
100%
146
What is the classical triad in huntingtons?
Chorea, dystonia and incoordination
147
Other symptoms of huntingtons?
psychiatric issues, depression, cognitive impairment
148
Investigations for huntingtons?
MRI/CT loss of striatal volume
Genetic testing,
Tests for SLE, thyroid disease, WIlsons and dementia
149
Treatment of huntingtons?
Can only manage, no effect on the progression of the condition.
Benzodiazepines for chorea, SSRI for depression, haloperidol for psychosis
150
Causes of spinal cord compression?
Trauma, tumours, central disc protrusion, epidural haematoma, infection,
151
Signs and symptoms of spinal cord compression?
Loss of bladder or bowel function, UMN signs in the lower limbs, LMN signs in the upper limbs
Dependant on injury site, paraplegia, pain, paasthesia etc.
152
Investigations for spinal cord compression?
X ray wole spine, MRI, renal function, haemoglobin to monitor blood loss
153
How to treat spinal cord compression?
Dexamethasone until treatment plan confirmed, catheterisation, analgesia, surgical decompression
154
What is brown-sequard syndrome?
Hemi section of the spinal cord, ipsilateral hemiplegia
155
Signs and symptoms of brown sequard?
Ipsilateral loss of position, light touch and vibration sensation at the level of the lesion.
Contralateral loss of pain and temparature below the level of the lesion.
156
Investigations and diagnosis for brown sequard?
Plain radiographs for penetrating or blunt trauma, MRI to determine extent of injury
157
Treatment of brown sequard
Spine immobilisation, steroids to decrease swelling, physical therapy and occupational therapy
158
What is the cauda equina?
The nerve roots caudal to the spinal cord termination
159
Causes of cauda equina syndrome?
Herniation at L4/5 or L5/S1 levels, tumours, trauma, infection, AS
160
Signs and symptoms of cauda equina syndrome>
Sudden onset, saddle paraesthesia, bladder/bowel dysfunction, sexual dysfunction, motor problems, lower back pain,
161
Investigations for cauda equina syndrome?
Rectal exam, loss of anal tone and sensation,
MRI spine
This is a medical emergency
162
WHat is the treatment for cauda equina syndrome?
Surgical decompression, immobilise spine, give anti inflammatories, antibiotics if infection, chemo if indicated.
163
What is carpal tunnel syndrome?
Compression of the median nerve within the carpal tunnel
164
Which areas of the hand does the median nerve supply?
Thumb, index finger, middle finger and half of the ring finger
165
Who most commonly presents with carpal tunnel?
people in their late 50's and 70's; pregnant women
166
Signs and symptoms of carpal tunnel?
Pins and needles (middle and index fingers tend to be affected first.
Pain in fingers that can reach to the shoulder, numbness in the same areas, weakness and loss of grip of the fingers, symptoms typically worse at night
167
What investigations for carpal tunnel?
Clinical diagnosis based on symptom presentation.
| Nerve conduction test if unclear, USS or MRI if nerve damage suspected.
168
How to treat carpal tunnel?
Most cases will resolve, rest the wrist and try to avoid gripping, squeezing actions.
Steroid injections and surgery if severe.
169
What is foot drop?
Difficulty in lifting the front part of the foot resulting in dragging of the toes. This can be permeant or temporary
170
What is foot drop caused by?
Damage to the common peroneal nerve.
171
What causes of foot drop?
Injury, tumour, hip replacement, cauda equina, MS
172
Signs and symptoms of foot drop
Unilateral symptoms, complaint of one foot dragging across the floor when walking, tripping, numbness and weakness in the same side
173
Investigations for foot drop?
Find underlying cause:
X-ray, USS, CT, MRI
Nerve conduction study.
174
Treatment for foot drop?
Brace or splint, physio, specialised shoes, surgery, nerve stimulation.
175
What is Charcot Marie Tooth?
An inherited peripheral neuropathy.
176
What is Duchenne's muscular dystrophy?
X-linked recessive condition, progressive muscle wasting and weakness, damage to the dystrophin gene.
177
What is the function of dystrophin?
Strengthen muscle fibres and protect from injury.
178
Signs and symptoms of duchennes muscular dystrophy?
```
Presents in childhood, proximal muscular dystrophy, pseudohypertrophy of the calves
Major milestones delayed
Can't hop, run or jump,
recurrent falls
speech delay
fatigue
```
179
Investigations for duchennes?
Serum creatinine kinase very high, genetic analysis, muscle biopsy with assay for dystrophin protein, muscle strength test, gait assessment.
180
Complications of Duchennes?
Joint contractures, resp failure , cardiomyopathies and HF, gastric dillation, learning difficulties, constipation, osteoporosis and hypertension
181
How to treat Duchennes?
MDT care, Immunisations, physio, vit D and bisphosphonates, corticosteroids, mobility help , nutritional care.
182
What is the most common form of MND?
ALS
183
What is Riluzole?
A life prolonging MND drug
184
How does ALS present?
signs of degeneration of upper and lower motor neurons, asymmetric onset, positive babinski sign, fasiculations of the tonuge.
185
What is the Babinski sign>
Stroking the sole of the foot, causing your big toe to move upwards and your toes to spread out.
186
What age should you have a positive Babinski sign?
Under the age of 2
187
Is it normal to have a positive Babinski sign in adulthood?
No, this indicates neurological issues.
188
What are the corticobulbar signs that indicate a worse prognosis in ALS?
Brisk jaw reflex, dysarthria, dysphagia, sialorrhoea (excess salivation)
189
Investigations for ALS?
```
Diagnosis via the El escorial criteria
Nerve condiction studies
EMG
CT/MRI of the brain
Bloods
Muscle biopsy
```
190
Treatment for ALS?
MDT care
Quinine/baclofen for cramps
Hyoscine for sialorrhoea
PEG tube for nutrition
191
What is progressive bulbar palsy?
Involves the brain stem, the part of the brain required for swallowing, speaking, chewing and other functions
192
Pathophysiology of PBP?
Its in the origin of the cranial nerves 9-12 and so this can lead to a much worse prognosis than ALS
193
signs and symptoms of PBP?
First affected muscles are those used for talking, chewing and swallowing
Palsy of the tongue, difficulty swallowing and palsy of facial muscles
194
Diagnosis of PBP?
The same as ALS
195
Treatment of PBP?
Same as ALS
196
What does Primary lateral scelrosis involve?
UMN of the arms legs and face
197
What does progressive muscular atrophy involve?
Progressive degeneration of only the LMNs
198
Which form of MND involves genes?
ALS
199
What is MS?>
An autoimmune condition resulting in the loss of the myelin sheath in the CNS
200
Which cells produce myelin in the CNS>
Oligodendrocytes
201
Which cells produce myelin in the peripheries?
Schwann cells
202
What happens in MS?
SLows or blocks transmisson to the CNS
203
What people are more commonly affected with MS?
Females more common than males, younger 20-30
204
What is relapsing and remitting MS?
Symptoms come and go, periods of good health followed by sudden symptoms>
205
What is secondary progressive MS?
Follows relaxing remitting, gradually worsening symptoms with fewer remissions
206
WHat is primary progressive MS?
From the beginning of the disease symptoms gradually get worse, has the worst prognosis.
207
Pathophysiology of the remission in MS?
Remyelinating of nerve cells in-between relapses
208
Symptoms of MS/
Upper limb extensions and lower limb flexors are weaker, spastic paraparesis, changes in sensation causing numbness and tingling, fatigue
209
Signs of MS?
Symptoms worse with heat, Lhermitte sign (electric jolt down the neck when flexing spine), UMN signs, loss of colour vision, optic neuritis
210
What is optic neuritis?
Damage to the optic nerve causing pain with eye movement and temporary vision loss in one eye
211
What are the investigations for MS>
Symptoms must be spaced apart, MRI gold standard, LP,
Use Macdonald criteria
Bloods to rule out other causes
212
How to treat MS?
MDT care, notify DVLA,
Steroids in acute
Interferon beta, fingolimod and Natalizumab
213
What is Guillain Barre syndrome?
Acute polyneuropathy caused by rapid damage of the peripheral nerves. Demyelination and axonal degeneration.
214
How does GBS most commonly present?
Commonly, 6 weeks post GI infection. Increased incidence in males, peak ages 15-35 and 50-75
215
What are the signs and symptoms of GBS?
Toes to nose weakness, starts at the feet and works its way up.
Absent reflexes, sensory loss in the lower extremities.
216
Investigations of GBS?
Bloods, LP (raised protein, normal white cells), Spirometry to monitor lung function, ECG to identify abnormalities and monitor
217
Treatment for GBS?
IV ig for 5 days, plasmapheresis, DVT prophylaxis (low molecular weight heparin)
AVOID CORTICOSTEROIDS
218
What is lambert eaton syndrome?
Impaired presynaptic release of acetyl choline, caused by an autoimmune attack of voltage gated calcium channels
219
Symptoms of Lambert eaton?
Proximal muscle weakness, depressed tendon reflexes , gait changs, dry mouth, impotence in males, eyelid ptosis,
220
How to differentiate Lambert Eaton from myasthenia gravis?
Detection of ACh receptor antibodies indicate MG
221
Investigations for lambert eaton?
Nerve stimulation, serum test for VGCC
222
Which cancer is associated with lambert eaton?
Small cell lung cancer.
223
How to treat lambert eaton?
Treat any cancers, acetylcholinesterase inhibitors, amifampridine for muscle strength, immunosuppression in severe cases.
224
What is myastenia gravis?
Binding of autoantibodies to the neuromuscular junction
225
When do women commonly present with MG?
30's
226
Signs and symptoms of MG?
Muscle weakness that is worse on exertion and gets better with rest, occular manifestations (drooping eyelid etc)
No muscle weakness
can be seizures
227
Investigations of MG?
Diagnosis is mostly clinical , thyroid function tests, detection of ACH receptor antibodies.
228
What is the crushed ice test for MG?
Ice is applied to the ptosis for 3 mins, if it improves its likely to be MG
229
How to treat MG?
ACh esterase inhibitors, pyridostigmine can control symptoms
230
What is amaurosis fugax usually a complication of?
Giant cell arteritis
231
What is the most common cause of peripheral neuropathy?
Diabetes
232
Sensory symptoms for peripheral neuropathy?
```
Loss of touch, proprioception, temperature/pain sensation, paraesthesia
Romberg test (cannot stand with feet together and eyes closed)
```
233
What are the motor symptoms for peripheral neuropathy?
Tripping, difficulty opening jars, difficulty climbing stairs, muscle wasting
234
How to treat peripheral neuropathy?
Treat cause
| Can give pregabalin, gabapentin for pain
235
What is meningitis?
Inflammation of the meninges
236
What can bacterial meningitis be caused by?
E.coli, listeria, HIB, s.pneumoniae, klebsiella. TB
237
Viral causes of meningitis?
HIV, influenza, measles, enteroviruses
238
Risk factors for meningitis?
Immunosuppression, smoking, CSF shunts, DM, IVDU,
239
Symptoms for meningitis?
```
Stiff neck
Photophobia
Non-blanching rash
Kernigs sign
Raised ICP
Fever, headache, vomiting, nausea, lethargy, irritability, muscle pain, chills, sore throat
```
240
Investigations for meningitis?
Bloods (cultures) ABG, LP (contraindicated in ICP and shock)
241
Treatment for meningitis?
Antibiotics (IV cefotaxime or IV benzyl penicillin)
242
What is encephalitis?
Inflammation of the brain parenchyma due to a viral infection.
243
Triad of symptoms in encephalaitis?
Fever , headache, and altered mental status
244
Treatment for encephalitis?
Aciclovir ASAP, IV benzylpenicilin immediately.
245
What is herpes zoster?
More commonly known as shingles, painful rash caused by the reactivation of a nerve infection caused by the varicella zoster virus
246
How does herpes zoster present?
Red, painful rash, stabbing or burning pain, fever, headache, fatigue and itching.
247
Investigations for herpes zoster?
PCR test, CSF analysis, bloods
248
Treatment for herpes zoster?
Antiviral therapy (Acyclovir) analgesia and antipyretics
