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Neuro last min stuff Flashcards

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1
Q

Treatment of Absence seizures?

A

1st - Valproate or Ethosuximide

2nd - topiramate or levetiracetam

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2
Q

Treatment of Atonic/Tonic-Clonic seizures?

A

1st - Valproate
Levetiracetam
Lamotrigine
Topiramate

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3
Q

Treatment of Myoclonic seizures?

A

1st - Valproate, Levetiracetam or Clonazepam

2nd - Lamotrigine, topiramate

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4
Q

Treatment for focal seizures?

A

1st - carbamazepine

2nd - Lamotrigine, valproate, topiramate

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5
Q

Parkinson’s treatment:

  • gold standard?
  • dopamine agonists?
  • COMT inhibitors?
  • MOAI?
  • Why is apomorphine used?
A

Sinemet (levodopa + carbidopa)

D anon - Pramipexole, apomorphine, roprinirole

COMT - Entacapone

MOAI - Selegeline, rasageline

Apomorphine - sudden ‘off’ states

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6
Q

5 parkinson plus syndromes?

A

Progressive supra nuclear palsy:
- vertical gaze palsy, speech and swallowing problems

Multi-system atrophy:

  • Autonomic dysfunction, cerebellar dysfunction
  • MRI - hot cross bun sign due to pontine & cerebellar atrophy

Corticobasal degeneration:
- One limb is prominent, apraxia, alien-limb phenomenon

LBD:
- cognitive decline, hallucinations

Vascular parkinsonsim:
- predominantly lower limbs with gait disturbance, pyramidal signs and cognitive dysfunction

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7
Q

Wilson’s disease presentation?

A

Young, parkinsonism, behavioural change & cognitive decline, hepatic and renal failure, keyser-fleischer rings in eyes

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8
Q

Treatment of dystonia:

  • general?
  • Focal?
  • acute?
A

general - Baclofen

focal - botulinum toxin

acute - procyclidine

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9
Q

How to differentiate MND from myasthenia graves and MS/neuropathy?

A

myasthenia - it doesn’t affect eyes

MS/neuropathy - no sensory involvement

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10
Q

4 types of MND and features?

A

ALS: most common
- UMN in legs, LMN in arms

PLS:
- UMN only - loss of benz cells in motor cortex

Spinal muscular atrophy:
- purely LMN - loss of anterior horn cells

Progressive bulbar palsy:
- LMN - Affects CN IX, X and XII first - drooling, dysphagia, aspiration

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11
Q

What is pseudo bulbar palsy?

What is it seen in?

A

UMN lesions affecting CNIX, X and XII

Can be seen as part of PLS, parkinson’s etc

(if mix or UMN and LMN then likely bulbar onset ALS)

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12
Q

Myasthenia Gravis:

  • Rx?
  • Crisis treatment?
A

Rx - pyridostigmine

Crisis - IV Ig or plasmapheresis

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13
Q

Neurophysiology for:

  • myasthenia gravis?
  • lambert eaton?
A

MG - single fibre jitter, low amplitude potentials, decreased twitches with repeated stimulation

LEMS - low frequency AP’s, increase in twitch amplitude with exercise, increase in fasciculation with exercise

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14
Q

Rx for lambert eaton?

A

3,4 - diaminopyradine

If acute: IV Ig

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15
Q

What is botulism?

A

Infection with clostridium botulinum

Toxin blocks Each presyaptic terminals

Present with flaccid paralysis - afebrile

Rx: anti-toxin

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16
Q

Stokes adams attack?
Pre-attack?
Attack?
Recovery?

A

Transient arrhythmia causing by reduced cardiac output and loss of consciousness - multiple times per day in any posture

pre: palpitations
attack: fall with LOC, pallor, slow/absent pulse
post: within seconds, flushing

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17
Q

Diagnosis of epilepsy?

A

Largely clinical

CT/MRI to rule out structural abnormality

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18
Q

Investigations for MS?

A

MRI - plaques of demyelination

LP - oligoclonal bands of IgG

Evoked potentials - delayed

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19
Q

MS symptom management:

  • spasticity?
  • Sensory? (numbness, tingling, pain)
  • Bladder dysfunction?
  • Fatigue?
A

spas - Baclofen, physio, OT

sens - amitriptyline, gabapentin, TENS, acupuncture

Bladder dysfunction - bladder training, oxybutynin

Fatigue - hyperbaric oxygen, modafinil

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20
Q

Relapse management in MS?

A

IV Methylprednisolone

Plasma exchange

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21
Q

Disease modifying drugs in MS:
- 1st line?
- 2nd line?
3rd line?

A

1st: Tecfedira, B interferon, Capaxone

2nd - Tysabari, Fingolimod

3rd - Mitoxantrone

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22
Q

Tecfedira/Tysbari SE?

A

reactivation of JC virus causing progressive multifocal leukoencephalopathy

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23
Q

5 causes of mono neuritis multiplex?

Study These Flashcards
A 
Diabetes
Rheumatoid
Carcinomatosis
Vasculitis (Wegners, PAN)
Infection (HIV, leprosy)
24
Q

Difference between polyneuropathy and mononeuritis multiplex?

Study These Flashcards
A

Polyneuropathy - symmetrical and widespread, usually glove & stocking, weakness, autonomic/cranial nerves can be affected too

Mono multi - 2 mononeuroopathies in distinct locations at same time

25
11 Causes of polyneuropathy? | metabolic, nutritional, vascular, infectious, drugs, malignancy
``` Diabetes Hypothyroidism Renal failure B12 deficiency Vasculitis (weighers, PAN) Rheumatoid Infection (HIV, Lyme, syphilis) Alcohol Isoniazid Chemo Paraneoplastic syndrome ```
26
Nerve conduction of neuropathy?
reduced response at peripheral and distal locations
27
Ix for guillian barre?
nerve conduction: slowed | LP: increased protein with normal WCC
28
Management of guillian barre?
IV Ig Plasmapheresis +/- ventilatory support
29
Inheritance of charcot marie tooth? Presentation? Nerve conduction? Management?
AD Around puberty Progressive muscle weakness - inverted champagne bottle - foot drop/high stepping gait May be sensory loss and loss of reflexes Nerve: temporal dispersion with stimuli arriving at different times - if severe complete conduction block Rx: physio
30
3 most common viral causes of meningitis?
Echo virus - most common Enterovirus: coxsackie Herpes simplex More insidious onset
31
Who gets cryptococcal meningitis?
HIV/immunosuppression (think hookers)
32
Most common bacterial meningitis if: - immunocompromised? - Skull fracture? - Surgery/open head wound? - CSF shunt?
Pneumo, Meningo, listeria, TB, Gm -ve rods (+cryptococcal) Pneumococcal, HiB, B-haemolytic GAS Staph aureus/epidermidis, aerobic Gm -ve rods Staph epidermidis/aureus, Gm -ve rods, proprionibacterium acnes
33
Kernig's sign?
pain and resistance on passive extension of knee with flexed hip --> meningitis
34
Prophylaxis of meningitis?
Single dose Ciprofloxacin OR 4 doses Rifampicin
35
How to differentiate meningitis from encephalitis?
Quick onset psychosis, odd behaviour, speech and memory problems May be with/without meningism (neck stiffness, headache, photophobia)
36
Causes of encephalitis?
Herpes simplex Varicella zoster CMV/HIV
37
Bilateral temporal lobe enhancement?
HSV encephalitis
38
Management of viral meningitis? | Encephalitis?
meningitis - supportive encephalitis - IV aciclovir
39
Presentation of brain abscess?
Raised ICP: headache, drowsiness Focal neurological signs Fever Preceding skull fracture, endocarditis, sinusitis, dental abscess etc
40
``` Who gets progressive multifocal leukoencephalopathy? Cause? Presentation? Imaging/LP? Rx? ```
immunocompromised, MS drugs tysibari/tecfedira Reactivation of JC virus Demyelination symptoms, similar to MS LP - JC DNA imaging - multifocal enhancing lesions No effective treatment
41
Acute relief of migraine? | Prophylaxis?
Paracetamol + NSAID or Triptan Prophylaxis of >3 attacks per month: 1st - propanolol 2nd - amitriptyline/topiramate/gabapentin/valproate
42
Management of tension headache?
paracetamol/NSAID discourage chronic use of analgesia Relaxation therapy
43
Management of acute tension headache? | Prophylaxis?
1st - high flow oxygen 2nd - sc triptan Prophylaxis - Verapamil (topiramate 2nd)
44
Difference between paroxysmal hemicrania and cluster headache?
Both assoc w autonomic features CH comes in clusters were will get most days for 1-3 months, PH doesn't Paroxysmal shorter (5-30 mins) cluster longer (30 mins-3 hours) PH shows definitive response to Indomethacin (if PH present for >3 months with attacks of greater intensity then hemicrania continua)
45
SUNCT?
attacks last seconds-10 mins Numerous per day (up to 50-60) Lamotrigine/Gabapentin
46
Treatment for Bells Palsy?
Prednisolone for 5 days if present within 72 hours
47
4 features of narcolepsy? | Treatment?
``` daytime somnolence cataplexy hypnagogic hallucinations sleep paralysis (also assoc w REM sleep disorders) ``` Modafinil - reduces daytime somnolence Sodium oxybate - reduces cataplexy
48
Watershed stroke?
caused by sudden drop in BP - hypoperfusion to watershed zones
49
TACS? | PACS?
3 of: - unilateral weakness +/- sensory loss - homonymous hemianopia - higher cerebral dysfunction e.g. dysphasia PACS if 2 present - blockage of middle OR ant cerebral
50
POCS?
One of the following: - isolated homonymous hemianopia - cerebellar/brainstem syndromes, decreased consciousness (ataxia, facial weakness, nystagmus, diplopia) - Confusion/mood changes
51
LACS?
- Purely sensory loss - Ataxic hemiparesis - Unilateral weakness +/- sensory symptoms in face, arms or legs
52
Presentation of intracranial venous thrombosis? - saggital - transverse - cavernous sinus
saggital: headache, vomiting, seizure, reduced vision, papilloedema transverse: headache +/- mastoid pain, seizures, focal signs, papilloedema Cavernous sinus: CN III IV, V1, VI, sympathetic palsy, ophthalmoplegia, swollen conjunctiva/eyelids, proptosis, photophobia, raised ICP - commonly from spread of facial infection
53
How to acutely manage raised ICP?
- elevate head to 30-40 degrees - mannitol - hypertonic saline - intubate and hyperventilate (reduce pCO2 so cerebral vasoconstriction so lower ICP)
54
Symptoms of hernia: - subfalcine? - Uncal? - Tonsillar?
- lower limb weakness - Ipsilateral CN III palsy - ataxia, CNVI palsy, babinski sign, potentially life threatening due to brainstem compression
55
Management of restless leg syndrome?
Ropinirole (dopaminergic agent) | OR clonazepam
56
Neurotransmitter change in Huntington's?
low GABA low ACh High Dopamine
57
Contraindications of forceps/ventouse?
mal-presentation i.e. breech | Absolute cephalopelvic disproportion

Year 3 (19 decks)

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