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Finals > Neuro guidelines > Flashcards

Neuro guidelines Flashcards

1
Q

investigations following first seizure

A

EEG and brain MRI

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2
Q

investigation to determine true from pseudoseizure

A

raised serum prolactin for a couple hours

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3
Q

when do you NORMALLY start AEDs?

A

After second seizurE

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4
Q

what would make you start AEDs after a first seizure

A

EEG shows unequivocal epileptiform activity
There is a structural abnormality on brain MRI
There is a persisting neurological deficit
Family or family considers risk of second seizure unacceptable

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5
Q

driving ban after 1st seizure

A

6 months

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6
Q

how long do you need to be seizure free for to drive if you have epilepsy

A

12 months

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7
Q

1st line epilepsy meds:

  • generalised
  • absence
  • partial
  • pregnancy
A 
generalised = valproate
absence = valproate or ethosuximide
partial = carbamazepine
pregnancy = lamotrigine (usually 2nd line as well)
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8
Q

status epilepticus and timing

A 
0m = O2 and ABCDE
5m = buccal midaz or IV loraz
10m = IV lorazepam
15m = escalate + phenytoin
45m = intubate
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9
Q

Parkinson’s investigations

A

clinical diagnosis

Use DaT scan (SPECT) and MRI brian to exclude P+ syndromes and to ensure diagnosis if unsure

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10
Q

1st line for PD and SE

A

if motor Sx = levodopa and carbidopa/benserazide
if no motor Sx predominate = can chose from any
SE = dyskinesia

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11
Q

2nd line PD and SE

A

non-ergot derived dopamine agonists (bromocriptine, cabergoline, pergolide, ropinorole) SE = impulse, hallucinations
MAO-Bi = seleginine. SE = ?
COMTi = entacapone. SE = orange urine and diarrhoea

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12
Q

Mx for drug induced parkinsonism

A

procyclidine

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13
Q

investigations that help MS diagnosis

A

contrast brain MRI shows dawson fingers and periventricular plaques. McDonald criteria.
CSF shows oligoclonal bands (doesn’t NEED to be present for diagnosis)

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14
Q

Acute relapse of MS Mx

A

IV methylprednisolone for 5d, shortens flares

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15
Q

1st line DMARD for MS and criteria to get it

A

beta interferon

need 2 relapses in past 2 years and also be able to walk 10-100m unaided

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16
Q

2nd line drugs for MS

  • glatiramer
  • natalizumab
  • fingolimod
A 
glatiramer = immune decoy
natalizumab = alpha4beta1 inhibitor preventing leucocyte transmission through the BBB
fingolimod = sphingosine receptor modulator preventing lymphocytes leaving the lymph nodes
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17
Q

Symptom treatment for MS:

  • fatigue
  • spasticity
  • bladder dysfunction
  • ossciloscopia
A
  • fatigue = amantadine + CBT
  • spasticity = baclofen + gabapentin
  • bladder dysfunction
  • -> residual volume = self catherisation
  • -> no residual volume = anticholinergics
  • ossciloscopia = gabapentin
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18
Q

when are anticholinesterses CI in alzheimers

A

DONEPEZIL is CI bradycardia. not the others

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19
Q

name 3 anticholinesterases for AD

A

galantaine
rivastigmine
donepezil

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20
Q

what is 1st and 2nd line in AD

A 
1st = anticholinesterases
2nd = memantine
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21
Q

How do you treat FTD

A

You cant really. acetylcholinesterases/memantine don’t work because those systems aren’t affected the same way as AD and LBD

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22
Q

Lewy body dementia Tx

A

same as AD

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23
Q

ROSIER score

A

rule out of stroke in the emergency room
any score of >0 means stroke is likely
+1 = speech problem, face/arm/leg weakness, vision problem
-1 = TLOC, seizure, syncope

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24
Q

Immediate Mx of ischaemic stroke

A

Always = 300mg aspirin for 2 weeks
within 4.5 hours = thrombolyse
within 6 hours (or 24 if have done scan and ischaemic bit is still small) if MCA/ACA proximal = thrombectomy ALONGSIDE thrombolysis

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25
Q

Immediate Mx of haemorhagic stroke

A

control BP to 100-120 with labetolol and consult neurosurgery

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26
Q

Ongoing Mx of ischaemic stroke

A

After 2w, stop aspirin and give clopidogrel lifelong 75mg

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27
Q

What is clopidogrel is CI, what do you give for long term secondary preventions

A

aspirin + dipyridamole

28
Q

DVT prophylaxis of stroke in hospital

A

intermitten pneumatic calf devices

29
Q

when do you do a carotid endarterectomy after a stroke

A

if stenosis >50%

30
Q

when do you start a statin after a stroke

A

if cholesterol >3.5

31
Q

ABCD2 score

A 
for TIA
age >60
BP 140>90
clinical features = speech 1p, unilateral weakness 2p
duration (10-59m, 60+m) = 1 and 2 points
diabetes
32
Q

immediate management of TIA

A

300mg aspirin

33
Q

when do you NOT give 300mg aspirin in a TIA and what do you do in those cases

A

anti coagulated/bleeding disorder –> admit for head CT

already on low dose aspirin –> just continue at same dose until TIA appointment

34
Q

when do you arrange TIA appointment

A

crescendo TIA = discuss admission now
TIA in last 7d = assessment within 24 hours
TIA >7d ago = assessment within 7d

35
Q

drug for life in TIA?

A

Yes, clopidogrel 75mg as in stroke

36
Q

first line sedative in delerium

A

0.5mg haloperidol

CI in PD so use lorazepam instead

37
Q

investigation for meningitis

A

Serum PCR and blood culture

LP unless CI (meningococcal septicaemia or raised ICP)

38
Q

think its meningitis and you’re a GP?

A

Give IM benzylpenicillin as long as it doesn’t delay transfer to hospital

39
Q

empirical Abx for menignitis in hospital depending on age

A 
<3m = cefotaxime + amoxicillin
3m-50y = ceftriaxone/cefotaxime
>50y = ceftriaxone/cefotaxime + amoxicillin
40
Q

IV antibiotic for specific meningitis bug:

  • meningiococcal
  • pneumococcal/hamophilus
  • listeria

–what else do you give to everyone

A
  • M = benzylpenicillin + cefotaxime
  • P/H = cefotaxime
  • L = amoxicillin + gentamicin

You give dexamethasone alongside first dose of antibiotic to everyone to reduce neuro complication rate

41
Q

how do you confirm a SAH has occurred

A

1st do CT head

if negative, check CSF for xanthchromia at least 12 hours later

42
Q

management for SAH when waiting for surgery

A

strict bed rest, stool softness, no straining, BP control

43
Q

medical management for SAH after surgery

A

21 days nimodipine (CCB) to prevent vasospasm

44
Q

presentation and Mx of vasospasm post SAH

A

presents 4-9d after surgery for SAH with focal deficits +/- reduced cognitive function
triple H therapy
- hypervolaemia, induced hypertension, haemodilution

45
Q

1st line Ix for Lyme disease

A

ELISA for antibodies against burrelia burgdorferi

can diagnose clinically if symptoms present and bull eye erythema migrans present

46
Q

Mx of Lyme:

  • early
  • disseminated
A 
early = doxycycline
disseminated = ceftriaxone

beware of Jarisch-Herxheimer reaction

47
Q

Encephalitis best Ix

two other Ixs

A

Best = MRI shows hyperdensitiy in temporal lobe
EEG shows lateralised periodic discharges at 2Hz
CSF shows lymphocytosis and elevated protein

48
Q

Mx of encephalitis

A

IV aciclovir as most common cause is HSV1

49
Q

trigeminal neuralgia Mx

when do you refer

A

carbamazepine

refer if <50yo or fails to respond to above

50
Q

Bells palsy Mx

time cutoff for Tx

A

1mg/kg 10d prednisolone
eye care
give within 72 hours for best effect

51
Q

Best Ix for myasthenia gravis

other Ix needed

A 
Best = single fibre EMG (trace decreases in amplitude with receptive stimulation)
others = CT chest to exclude thymoma
Tension test (IV edrophinium) NOT used anymore
52
Q

Mx for Myaesthenia gravis

- flare

A

flare = prednisolone

53
Q

Mx for Myaesthenia gravis

  • ongoing
  • how do you monitor respiratory function
A

ongoing = antcholinesterase inhibitor long acting pyridostigmine
Monitor with FVC

54
Q

Mx for Myaesthenia gravis

- crisis

A

plasmapheresis and IVIG

55
Q

Guillain barre syndrome:

  • LP
  • nerve conduction studies
  • antibody
A
  • LP shows isolated protein rise
  • nerve conduction studies (slow response due to demyelination)
  • anti-GM1
56
Q

GBS Mx

A

IVIG

57
Q

MND Ix

A

Normal nerve conduction study

EMG shows few APs with normal amplitude + fibrillation

58
Q

Mx for MND

A

riluzole and BiPAP at night

59
Q

acute Mx of migraine 1st and 2nd line

A

1st = NSAID + oral triptan + paracetamol
——-> if <17yrs old use nasal triptan instead
2nd = non-ral metoclopromide/prochlorperazine (beware of dystonic reaction)

60
Q

cutoff for migraine prophylaxis frequency

A

2+ per month

61
Q

migraine prophylaxis Mx
1st and 2nd line
adjunct?

A

1 = propranolol (or topiramate if not woman of childbearing age)
2 = acupuncture
—> can also use riboflavin as adjunct

62
Q

cluster headache acute Mx

A

100% oxygen and subcut triptan

63
Q

prophylaxis cluster headache

A

verapamil

64
Q

tension headache acute Mx

A

NSAID, paracetamol

65
Q

Tension headache propylaxis

A

acupuncture (NOT amitriptyline which is often used)

66
Q

When do you do a head CT within 1 hour after a head injury

A 
GCS <15 2 hours after injury
GCS <13 on clerking
focal neurological deficit
post-traumatic seizure
2+ episodes of vomiting
open or depressed skull fracture
67
Q

when do you do a head CT within 8 hours after a head injury

A

Need to have some loss of consciousness and:

  • be over 65
  • be on warfarin or have bleeding disorder
  • have 30mins amnesia before event
  • dangerous mechanism of injury (struck by vehicle, ejected from vehicle, fall >1m/5 stairs)

Finals (13 decks)

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