Neuro part 1 Flashcards
1
Q
trio of parkinsons
A
tremor - resting, pill rolling
rigidity - cog wheel
bradykinesia
2
Q
tx parkinsons if motor symptoms are affecting QoL
A
levodopa
3
Q
what drug classes are used in parkinsons if motor symptoms not affecting QoL/ mild symptoms
A
dopamine agonists
MOA-B
COMT inhibitors
4
Q
examples of parkinson drugs:
dopamine agonists
A
ropinirole
pramipexole, apomorphine
bromocriptine, cabergoline
5
Q
examples of parkinson drugs:
MOA-B
A
selegeline
rasagiline
6
Q
examples of parkinson drugs:
COMT inhibitors
A
entacapone
tolcapone
7
Q
examples of parkinson drugs:
Antimuscarinics
A
procyclidine
benzotropine
trihexyphenidyl
8
Q
gold standard in parkinsons treatment
A
sinemet - levodopa + carbidopa
9
Q
is levodopa useful in neuroleptic induced parkinsonism
A
no
10
Q
2 important things to remember in prescription of levodopa
A
same time every day
needs to be continued e.g. if patient admitted to hospital
11
Q
major side effect of dopamine agonists (3)
A
impulse control disorders
hallucinations
excessive daytime somnolence - shouldnt drive
12
Q
when are antimuscarinics used in parkinsons treatment
A
drug induced, not idiopathic
13
Q
tx sudden off states in levodopa using patients
A
amantadine
14
Q
tx levodopa associated nausea
A
domperidone
15
Q
which drugs are most likely to cause impulse control disorders, hallucinations and excessive daytime somnolence in parkinsons treatment
A
can occur with any dopaminergic therapy but most likely with dopamine agonists
- ropinirole
pramipexole, apomorphine
bromocriptine, cabergoline
16
Q
parkinsonism syndrome:
- vertical gaze palsy (down gaze worse than up gaze)
- lack of tremor
- poor response to levodopa
A
progressive supranuclear palsy
17
Q
parkinsonism syndrome:
- ataxia and cerebellar signs
- postural hypotension, erectile dysfunction, bladder disfunction
- poor response to levodopa
A
multisystem atrophy
18
Q
parkinsonism syndrome:
- rigidity and weakness in one limb
- apraxia
- sensory disturbance
A
cortico-basilar degeneration
19
Q
cognitive decline with visual hallucinations
fluctuating symptoms
onset of cognitive decline before onset of parkinson features
A
dementia with lewy bodies
20
Q
drugs that cause drug induced parkinsons
A
anti-psychotics
amiodarone
metoclopramide
21
Q
tx of tremor in drug induced parkinsons
A
procyclidine
22
Q
inheritance of wilsons disease
A
AR
23
Q
ix wilsons disease: serum cearuloplasmin total serum copper free serum copper 24 hour urinary copper excretion
A
main ix: reduced serum cearuloplasmin
reduced total serum copper
increased free serum copper
increased 24 hour urinary copper excretion
24
Q
tx wilsons disease
A
penicillamine
25
1st line treatment of benign essential tremor
propranolol
26
inheritance of benign essential tremor
AD
27
2 causes of intention tremor
wilsons disease
| cerebellar disease
28
drug causes of acute dystonia
typical antipsychotics - haloperidol, chlorpromazine
metoclopramide
suddenly stopping levodopa
29
fasciculations
absence of sensory symptoms
mixed upper and lower motor neuron symptoms
MND
30
primary symptom in MND is
muscle weakness
31
what type of dementia has MND been linked to
fronto-temporal
32
what muscles can be seen to waste in MND
tibialis anterior and small muscles of hands
33
which of the following are present in MND
- extraocular/eye involvement
- sensory loss
- sphincter dysfunction
- cerebellar signs
none
34
typical picture of ALS (MND)
mixed upper and lower MN
LMN in arms and UMN in legs
starts in hands
35
typical picture of progressive bulbar/psuedobulbar palsy
progressive bulbar muscle weakness with subsequent limb involvement - worst prognosis
36
MND that is purely lower motor neuron
progressive spinal muscle atrophy
37
MND that is purely upper motor neuron
primary lateral sclerosis
38
drug treatment in MND that prolongs life
riluzole
39
tx drooling in MND
anti-cholinergic
40
EMG of MND
reduced number of action potentials with increased amplitude
41
```
Lower motor neuron limb and bulbar weakness
ED
infertility
gynaecomastia
atrophic testes
X linked
```
Kennedy's disease
42
antibodies in myasthenia gravis
Anti-AchR / Anti-MuSK
| against nicotinic receptors at NMJ
43
2 key features of myasthenia gravis
muscle weakness and fatigability
44
describe the pattern of myasthenia gravis throughout the day and with exercise
worse throughout the day and with exercise
| improves after period of rest
45
common muscles involved in myasthenia gravis
extraocular - double vision
| bulbar
46
describe sensation, muscle appearance tone and reflexes in myasthenia gravis
normal tone appearance and reflexes
| normal sensation
47
tx myasthenia gravis
Pyrostigmine (LA anticholinesterase inhibitor)
48
tx myasthenia gravis relapse
prednisolone
49
tx myasthenia gravis crisis
IV Ig or plasmapheresis
50
drugs that can precipitate a myasthenia gravis crisis
beta blocker
51
what is affects in lambert eaton (LEMS)
pre-synaptic calcium channels in the PNS
52
2 causes of lambert eaton (LEMS)
paraneoplastic - small cell lung cancer, breast, ovarian
| autoimmune - anti P/Q CGCC antibodies
53
primary symptom in lambert eaton (LEMS)
muscle weakness
54
describe the course of lambert eaton (LEMS) with exercise
improves with exercise
55
key symptoms in lambert eaton (LEMS)
muscle weakness that improves with exercise
limb symptoms --> gait disturbance
limb girdle weakness
autonomic involvement
56
reflexes in lambert eaton (LEMS)
hyporeflexia - improves with exercise
57
tx lambert eaton (LEMS)
prenisolone and/or azathioprine
58
is there tongue biting or incontinence in syncope
no
59
is there movement in syncope
either no movement or sometimes brief symmetrical clonic jerks in absence of tonic contraction
60
3 types of syncope
reflex
orthostatic
cardiac
61
reflex syncope: when the body overreacts to certain triggers
vasovagal
62
how many seizures do you need to have before diagnosis of epilepsy
2
63
typical age for febrile seizures
6m to 5 years
64
what is classed as febrile status epilepticus
> 30 mins
65
after what time should parents call an ambulance in a febrile seizure
if it lasts over 5 minutes - give them rectal diazepam or buccal midazolam to use in event
66
when do alcohol withdrawal seizures usually occur
36 hours after drinking
67
what drug can reduce the risk of alcohol withdrawal seizures
benzodiazepine
68
raised serum prolactin implies what kind of seizure
true epileptic
69
what is an aura
individualized and stereotypes symptoms that proceed the seizure by minutes
70
describe the tonic phase of tonic-clonic
```
falls to ground
rigid and cyanosed
stops breathing
tongue biting and incontinence
lasts about 1 minute
```
71
describe the clonic phase of tonic-clonic
asymmetrical convulsive jerks
eyes roll to back of head
breathing starts again
few minutes
72
seizure with brief lapses of awareness in which the patients stops what they are doing and stares blankly
absence seizure
73
Seizures that manifests as sudden loss of all muscle tone with maintenance of consciousness
atonic
74
seizure in first few months of life with Flexion of head, trunk, limbs → extension of arms (Salaam attack); last 1-2 secs, repeat up to 50 times
infantile spasm (west's syndrome)
75
seizure in childhood with paraesthesia (e.g. unilateral face), usually on waking up/at night
benign rolandic epilepsy
76
Infrequent generalized seizures, often in morning or following sleep deprivation, Daytime absences and Sudden, shock like myoclonic seizure with usually good response to sodium valproate
juvenile myoclonic epilepsy
77
what investigation is done to rule out structural abnormality in epilepsy
MRI
78
investigation to classify epilepsy
EEG
79
when should antiepileptics be started
after 2nd seizure
or after 1 if neurological deficit, brain imaging shows structural abnormality, EEG shows unequivocal epileptic activity or the patient/family consider the risk of another seizure unacceptable
80
1st line focal seizure
carbamazepine
81
2nd line focal seizure
lamotrigine
levetiracetam
sodium valproate
82
1st line absence seizure
sodium valproate
| ethosuximide
83
1st line atonic or tonic clonic seizure
sodium valproate
84
2nd line atonic or tonic clonic seizure
lamotrigine
| carbamazepine
85
1st line myoclonic seizure
sodium valproate
86
2nd line myoclonic seizure
lamotrigine
| clonazepam
87
antiepileptic of choice in pregnancy
lamotrigine
88
main side effects of valproate
teratogeniticity
weight gain
P450 inhibitor
89
major side effect of lamotrigine
steven johnson syndrome
90
carbamazepine is first line for what type of seizures
focal
91
main side effect of carbamazepine
agranulocytosis
92
what factors increase risk of SUDEP
poorly controlled epilepsy
smoking
alcohol
illicit drugs
93
how long can you not drive after 1st seizure
- car
- HGV
car : 6 months
| HGV: 5 years
94
how long can you not drive with epilepsy
- car
- HGV
car - fit free for 12 months
| HGV - off medication for 10 years and seizure free
95
what do P450 enzyme inducers do
reduce efficacy of certain drugs - contraceptive pill - suggest switch to IUS
96
examples of P450 enzyme inducers
carbamazepine
| phenytoin
97
are anti-convulsants safe in breast feeding
yes mostly
98
what should be taken in pregnancy if taking phenytoin
vitamin K in last month to prevent clotting disorder in new born
99
dose of folic acid for pregnant women on antiepileptics
5mg before birth and during 1st trim
100
1st line tx status epilepticus in hospital
IV lorazepam
101
1st line tx status epilepticus in primary care
buccal midazolam or rectal diazepam
102
2nd line tx status epileptics
phenytoin, phenobarbital, levetiracetum
103
3rd line tx status epilepticus
GA
104
how often can lorazapam be repeated in status epilepticus
max 2 times (2-4mg)
| give 10-20 mins after first dose
105
motor disturbance in MS
spastic weakness
106
MS: Lehermittes phenomenon
electrical shock down spine and arms/paraesthesia in limbs when head is bent forward/flexed
107
MS: uhtoffs phenomenon
worsening of symptoms with heat and exercise
108
s/s of MS
```
FATIGUE
spastic weakness, brisk reflexes and +ve babinski
sensory disturbance
ataxia and tremor
optic neuritis and RAPD
incontinence
```
109
ix MS
MRI with contrast
110
what is seen on LP of MS
oligoclonal bands of IgG
111
MS treatment: spasticity
baclofen or gabapentin
112
MS treatment: sensory symptoms
amitriptyline or gabapentin
113
MS treatment: bladder dysfunction
bladder training, oxybutinin
114
MS treatment: fatigue (if all other causes ruled out)
amantadine
115
MS treatment: relapse
IV steroids - methylprednisolone (5 days)
| plasma exchange
116
MS treatment: 1st line
B interferon
Capaxone (glitramer acetate)
tecfidera
117
MS treatment: 2nd line
Tysabri
| fingolimod
118
MS treatment: 3rd line
Mitoxantrone
119
presentation: Vitamin B12 deficiency
dorsal column affected first - joint position and vibration
120
nerve involved: weakness of wrist flexion
ulnar
121
nerve involved: humeral shaft fracture
radial nerve
122
nerve involved: burning thigh pain
lateral cutaneous nerve of the thigh - meralgia paraesthetica
123
wrist drop
radial
124
foot drop
| loss of sensation over dorsum of foot
common peroneal
125
nerve involved: weak plantar flexion
| sensory loss over sole of foot
tibial nerve
126
antibodies in guillian barre
anti - GBM1 antibodies
127
common cause of GBS
campylobacter
128
presentation of GBS
ascending symmetrical muscle weakness starting in lower limbs and spreading
back/leg pain initially
129
LP of GBS
isolated rise in protein
130
nerve conduction in GBS
slowed conduction
131
tx GBS
IV IG
| plasmapheresis
132
what is miller fisher syndrome
variant of GBS - ophthalmoplegia, areflexia and ataxia
eye muscles involved first
descending paralysis
anti-GQ1b antibodies
133
```
begins around puberty
distal muscle wasting in legs
mainly motor loss
foot drop
loss of reflexes
```
charcot-marie tooth disease (hereditary peripheral neuropathy)
134
inheritance of charcot marie tooth
AD
135
most common viral cause meningitis
enteroviruses - echovirus
136
if any doubt over bacterial meningitis and RFs for what should patient be started on
antibiotics + IV aciclovir
137
most common meningitis in 0-3 months
Group BS
138
causes of meningitis in 0-3 months
group BS
e coli
listeria
139
most common cause of meningitis in 6 - 60 year olds (< 40)
N meningitidis - most common
| also strep pneumoniae
140
causes of meningitis in 3m - 6 years
n meningitidis
strep pneumonia
h influenzae
141
causes meningitis over 60
strep pneumoniae
n meningitidis
listeria
142
meningitis in immunocompromised
listeria
143
meningitis and skull fracture
pneumococcal
144
meningitis and surgery or open head wound
staph aureus
145
meningitis and CSF shunt
staph epidermidis
146
meningitis and severely immunocompromised e.g. HIV
cryptococcal (fungal)
147
most common complication of meningitis
sensorineural hearing loss
148
what is - Waterhouse-Friderichsen syndrome
adrenal insufficiency secondary to adrenal haemorrhage
149
ix for meningitis
LP
150
ix for meningitis if LP contraindicated
CT to investigate raised ICP
if there is:
whole blood PCR and culture
151
when is LP contraindicated
```
meningococcal septicaemia
increased ICP
immunosuppressed
FND
altered consciousness
```
152
bacterial meningitis CSF
low glucose
high protein
neutrophils - polymorphs
153
what can be done in GP if meningococcal disease suspected
IM benzylpenicillin
154
meningitis treatment: < 3 months
IV cefotaxime + amoxicillin or ampicillin
155
meningitis treatment: 3 months - 50 years
IV cefotaxime or ceftriazone
156
meningitis treatment: > 50 years
IV cefotaxime or ceftriaxone + amoxicillin or ampicillin
157
meningitis treatment: meningococcal
IV benzylpenicillin or cefotaxime or ceftriaxone
158
meningitis treatment: pneumococcal
IV cefotaxime or ceftriaxone
159
meningitis treatment: H influenzae
IV cefotaxime or ceftriaxone
160
meningitis treatment: listeria
IV amoxicillin or ampicillin + gentamicin
161
meningitis treatment: penicillin allergy
chloramphenicol
162
when should dexamethasone be given in meningitis treatment
just before or with first dose of abx
163
when is dexamethasone CI in meningitis treatment:
septic shock
meningococcal septicaemia
immunocompromised or following surgery
< 3 months old
164
what happens when viral infection confirmed
stop abx
| supportive treatment
165
contact prophylaxis for meningitis
ciprofloxacin - single dose
if < 12 - rifampicin 4 doses
166
main cause of encephalitis
HSV 1
167
differentiate encephalitis from meningitis
encephalitis has psychiatric symptoms - psychosis, odd behaviour, speech and memory problems
168
MRI HSV encephalitis
bilateral focal temporal lobe enhancement
169
tx HSV encephalitis
IV aciclovir
170
ix for HSV encephalitis
LP
171
ix brain abscess
CT
172
tx brain abscess
IV metronidazole and ceftriaxone
dexamethason
urgent drainage
173
Tysabri is a risk factor for what neurological condition
progressive multifocal leukoencephalopathy in JCV positive patients
