Neurology Flashcards
(197 cards)
1
Q
Cranial n nucleus
1,2
A
Cerebral cortex
2
Q
Cranial n nucleus
3,4
A
Midbrain
3
Q
Cranial n nucleus
5 6 7 8
A
Pons
4
Q
Cranial n nucleus
9 10 11 12
A
Medulla
5
Q
Poorly controlled DM + severe leg/thigh pain
Followed by proximal muscle wasting (shoulder, thighs , quadriceps)
Dx?
A
Diabetic amyotrophy
6
Q
Chronic alcholic + confusion + ataxia + squint
Dx?
Treatment
A
Wernicke’s encephalopathy
Give thiamine IV
7
Q
Chronic alcoholism c+-CAS+ amnesia + confabulation
A
Korsakoff psychosis
8
Q
Old man + gait abnormality and dementia like behaviour changes
+- urinary urgency and incontinence
CT shows enlarged ventricles
A
Normal pressure hydrocephalus
“Wet wobbly wacky grandpa”
9
Q
Old man + gait abnormality and dementia like behaviour changes
+- urinary urgency and incontinence
+ hx of HTN smoking TIA
MRI shoes multiple lacunar infarcts
A
Vascular dementia
10
Q
Old pt + sexual or inappropriate comments , urinates on sofa
Loss of social interest and acts inappropriately or impulsively
Over eats and struggles with word choices
A
Frontotemporal dementia - Picks disease
11
Q
Forgetful elderly, easily gets lost and is unable to do simple tasks
Dx?
A
Alzheimer’s
12
Q
Acute onset behavioural changes + hallucinations
A
Delirium
13
Q
Old age + bradykinesia + resting tremors + rigidity +postural instability +- expressionless face
A
Parkinson’s
14
Q
Shy drager syndrome - features
A
Parkinsonism - bradykinesia, ataxia, resting tremors
Urinary incontinence
Erectile dysfunction
+- postural hypotension - frequent falls
15
Q
Lewy body dementia
A
Parkinsonism
Dementia
Visual hallucinations
+- delusions
16
Q
Progressive supranuclear palsy
A
Stiff -frozen posture, axial rigidity - falls backwards, shuffling and freezing gait
Restricted downward gaze
17
Q
Tremors - absent @ rest and don’t resolve with distraction
Dx
Treatment
A
Essential tremors
Give propanolol
18
Q
Tremors - absent @ rest , resolve with distraction
A
Psychogenic tremors
19
Q
Intentional tremors + ataxia + dysarthria + nystagmus
Affected part of brain -
A
Cerebellum
=limb ataxia - cerebellar lobe.
= turn all ataxia - cerebellar vermis
20
Q
Mechanism of Guillain Barre syndrome
Dx?
A
Autoimmune degeneration of myelin sheets
of the PERIPHERAL neurons
Dx - nerve conduction study
21
Q
Investigation to confirm myasthenia Gravis
A
Serum skeletal muscle nicotine ach receptor antibody
22
Q
Features similar to MG but + hyperreflexia +ve for upper neutron signs + normal autoimmune panel
Dx?
A
Amyotrophic lateral sclerosis
23
Q
Motor sensory and reflexes affected + typical loss of pain and temperature (spinothalamic tract affected)
Dx?
A
Syringomyelia
24
Q
Syringomyelia+ CN involvement - facial palsy
A
Syringobulbia
25
Ocular condition associated with multiple sclerosis
Optic neuritis
26
Epidural hematoma
| - injury to
Middle meningeal a.
Often associated with skull fracture
Lucid interval
27
Chronic subdural hematoma
Features
What imaging modality is diagnostic
Usually elderly +- on anticoagulant or alcoholic
Hx of minor fall +- minor head injury
Slow onset of sx
CT - diagnostic
Surgical evacuation - dramatic improvement
28
Affected vessel in chronic subdural hematoma
Bridging vein - Cerebral vein
29
Most common cause of SAH
Cerebral aneurysm
30
Common associations of SAH
Ehler danlos
ADPKD - association berry aneurysm ; SIADH = HypOnatremia
Excessive alcohol intake - important RF
31
Dx of SAH
Ct w/o contrast , if inconclusive
| LP - xanthochromia
32
Management SAH
Nimodipine 5-14 day s
| = to diminish anticipated cerebral vasospasm
33
Unilateral dilated pupil
Space occupying lesion
| - abscess tumour hematoma
34
Bilaterally constricted pupil
Opiate overdose - morphine, heroin
| CVA Affecting brainstem
35
Bilaterally dilated pupils
TCA overdose
| Cocaine overdose
36
Crescent shaped hematoma is characteristic for
Subdural hematoma
37
To identify origin/ site of SAH —>
Cerebral angio / CT angio
38
Likely involved blood vessel in subdural haemorrhage
Cerebral vein - rupture of bridging vein
39
CSF findings in bacterial meningitis
Low glucose
High proteins
WBCs - mainly neutrophils
40
CSF findings - viral meningitis
Low glucose
Normal/high protein
WBCs- mainly lymphocytes
41
CSF findings - TB meningitis
Low glucose
High protein
WBCS = early - neutrophils ; later - lymphocytes
42
Organism causing meningitis
```
Gram + diplococci - s.pneumonia
-ve diplococci - neisseria meningitidis
Staph aureus
Gram + bacilli - listeria mono
-ve coccobacilli - h. Influenza
```
43
Turbid/purulent CSF + no rash
- strept pneumoniae
44
Turbid/purulent CSF + rash
Neisseria meningitidis
45
Tension headache
Duration
Prophylaxis
Treatment
Around 30 mins , bilateral
Proph - acupuncture
Tx - pain killer
46
Migraine
Duration
Management
4-72 hrs
1. Sumatriptan
= >17 YO - oral , 12-17 = nasal
2. NSAIDs
Combo therapy
- oral sumatriptan + NSAIDs or
Oral sumatriptan + paracetamol
Transcutaneous vagus n stimulation
Avoid triggers
47
Migraine prophylaxis
Beta blockers or topiramate
48
Cluster headache
Location
Duration
Management
```
Always unilateral
15 min - 3 hrs
100% O2 10 -20 mins
Sumatriptan - nasal or subcutaneous
If 1st time attack - refer to specialist , may require CT
```
49
Cluster headache prophylaxis
CCB - verapamil
50
Treatment migraine vs cluster
Migraine - oral sumatriptan
= <17 nasal >17 oral
Cluster - nasal / subcutaneous
51
Fortification spectra
More complicated images that can float in your vision
- aura
Migraine
52
What medications cant be used in acute phase treatment of migraine
Topimarate and propanolol
| - they are PREVENTATIVE
53
Multiple sclerosis
Age
Gender
Chronic cell mediated autoimmune disorder
- demyelination in CNS
F>M 3:1
20-40 yo
Acute attacks last 1-2 month followed by remission periods
54
Most common type of multiple sclerosis
Relapsing- remitting MS >85%
55
Features of MS
Visual - optic neuritis
Sensory - trigeminal neuralgia, numbness , pins and needles, paresthesia in limbs on neck flexion
Motor - spastic weakness = legs commonly
Cerbellar - ataxia, dysarthria , nystagmus , tremors
56
MS features
Cerebellum + brainstem + transverse myelitis
Cerebellum - ataxia dysarthria , nystagmus
Brainstem - optic problems , facial numbness, ataxia , dysarthria
TM - weakness, spastic quadriparesis/paraparesis , urgency/retention , stiffness , increased tone and brisk reflexes
57
Definitive dx test of MS
MRI _ demyelination, lesions disseminate in time and place
58
Treatment of MS
Acute
Long term
Acute cases - initial or during relapse
= oral or IV methyl prednisolone
Long term = glatiramer acetate or interferon beta
59
Dizziness/vertigo + hx of viral URTI
Vestibular neuritis
60
Dizziness/vertigo + hearing loss or tinnitus + hx of vital URTI
Labryinthitis
61
Deafness + vertigo+ tinnitus + pressure/fullness in one ear
Dx
Finding on imagine
Ménière’s disease
| MRI - normal
62
Deafness + vertigo + tinnitus
+ cranial n palsy + fullness/pressure
Dx?
What imaging to be done ?
Acoustic neuroma - vestibular schwannoma
| MRI of cerebellar-pontine angle
63
Treatment of BPPV
Epley’s manoeuvre
| Mostly resolves spontaneously
64
What structure does BPPV involve
Semicircular canal - usually
| Posterior semi-circular canal
65
Features of wernicke’s encephalopathy
| Causes
Confusion + ataxia + squint
Chronic alcoholism
Can be caused by hyperemesis gravidarum, stomach ca
= vitamin B1 deficiency
66
What happens if wernicke’s encephalopathy not treated
Can develop wernicke’s korsakoff syndrome = korsakoff psychosis
CAS+ amnesia + confabulation
67
2ry prevention of ischemic stroke, TIA
Control BP , statins - all patients,
Antiplatelet or anticoagulants - depends on presence of AFib
AFIB —> warfarin or DOAC
No AFIB —> clopidogrel 75 mg OD
68
Ischemic stroke pt - presents <45 hrs
| Management
Give thrombolytic therapy
= alteplase
Then
Aspirin 300. Mg 2 weeks + clopidogrel 75mg for life
69
Acute ischemic stroke mgmt
Maintain O2 temp and blood glucose
CT scan head
Thrombolytic therapy if in window ; if > 4.5 hrs or time not given just give aspirin 300mg stat
Aspirin + clopidogrel
70
Broca vs wernicke’s aphasia
Broca - inferior frontal lobe - usually left
- broken speech but they undertsand
Wernicke’s - superior temporal lobe - mostly left
- problem w/ speech comprehension , fluent speech
71
Antiepileptic drugs in pregnancy
- before pregnancy
- established pregnancy
B4 -
carbamazepine or lamotrigine
+ folic acid 5mg until 12 weeks
Est. - don’t change drug - even if its sodium valproate
If seizure free for >= 2 years - consider stopping antiepileptics
72
Cauda equina syndrome
Features
Investigation
Mgmt
```
Saddle paresthesia
Inability to initiate voiding
Back pain
MRI spine - urgent
Urgent referral to orth / surgical decompression
```
73
Commonest cause of cauda equina
Central disc prolapse
74
Parkinson’s disease
- pathology
- features
Progressive neuro degeneration of dopaminergic neurons in substantia nigra
= low levels of dopamine
Triad - bradykinesia + resting tremors+ rigidity
Asymmetrical
75
Main drugs in treatment of Parkinson’s
- general
- for tremors and dystonia
3- nocturnal and early morning hypokinesia and rigidity
General
- levodopa, co-careldopa, Cabergoline
= dopamine D2 agonists
Tremors + dystonia
- Benzhexol, orphenadrine
(Anti-cholinergics)
3- controlled release preparations
76
Sudden cessation of. Co-careldopa can cause
Akinesia - inability to move muscles voluntarily
77
What 2 drugs cant be used in Parkinson patients
Haloperidol ,
| Metoclopramide
78
Antiemetic used in Parkinson
Levomepromazine
79
Rapid tranquilliser used in Parkinson’s
Lorazepam - IM
80
Delirium vs dementia
```
Delirium - acute w/ fluctuating sx
Cause - infection , intoxication ,dehydration etc
It’s reversible
Hallucinations and mood changes
Attention/consciousness - impaired
```
Dementia - chronic, irreversible , hallucination not common except Lewy body - visual , attention and consciousness normals
81
Huntington’s disease
Jerky random uncontrolled movement - chorea
| Appear b/w ages 35-45 YO
82
Dx of epilepsy
2 unprovoked seizures with > 24 hrs apart
83
Initial dx of obstructive sleep apnoea
| Most appropriate/ gold standard investigation
Pulse oximetry, overnight breathing pattern study
Gold - polysomnography
84
Treatment of OSA
Conservative - weight loss, stop alcohol
CPAP
Rarely - surgical
85
Guillian Barre vs Myasthenia Gravis
GBS
- weakness, absent or decreased reflexes, often has pain, no fasciculations
Young age , ascending polyneuropathy , happens after trigger - infection
MG -
Fatigue is hallmark, weakness , no pain or fasciculations , tire easily
D features - droopy eyelid (ptosis), diplopia, dysphoni , dysphagia, dysarthria
86
D features of myasthenia gravis (5)
```
droopy eyelid (ptosis),
diplopia,
dysphonia,
dysphagia,
dysarthria
```
87
Mechanism of guillian barre syndrome
Autoimmune degeneration of myelin sheets of PERIPHERAL neurons
88
Dx test for guillian barre
Nerve conduction study
89
Test to confirm dx of myasthenia gravis
Serum skeletal muscle nicotine Ach receptor antibody
90
Bell’s palsy
| Features
Facial n palsy
Loss of forehead and brow movement,
Inability yo close eyes + drooping lid
Loss of nasolabial fold and drooping lower lip
In severe cases - dysarthria and difficulty eating
91
Cause of Bell’s palsy
| Treatment
Viral infection
Prednisolone
92
N that inner ages voluntary muscles of face
Facial
| Muscles of facial expression
93
N that inner ages involuntary muscles of face
Trigeminal
| Muscles of mastication and cornea
94
Horners syndrome
Cause
Features
Unilateral ptosis miosis and anhydrosis
Caused by. Compression of Ipsilateral sympathetic chain
95
Trigeminal neuralgia
| Treatment
Meds - carbamazepine = 1st line
Other - lamotrigine, phenytoin, Gabapentin
Surgery - micro vascular decompression
*corneal reflexes intact usually
96
Status epilepticus - def
Seizure > 5 mins or
| 2 or more seizures in a 5 min period w/o person returning to normal in between
97
Management of status epilepticus
1- 2 separate doses of (10-20 mins in between)
IV lorazepam - if IV access or in hospital or
Buccal midazolam to rectal diazepam - community
2. IV phenytoin
3. Refer to ICU - intubation , IV phenobarbital
98
In suspected stroke
- initial investigation
- most appropriate investigation
Initial - CT brain
Most appropriate - MRI brain
Ataxia and slurred speech - MRI much better than CT ( lesions of posterior fossa)
99
Hakims triad
= normal pressure hydrocephalus
GDU
Gait abnormality - ataxia, waddling gait, imbalance walking
Dementia - behavioural and cognitive changes, forgetful
- reversible
Urinary urgency +- incontinence
ELDERLY
100
Dx of normal pressure hydrocephalus
Hakims triad + CT/MRI brain
= enlarged lateral and third ventricles
Lumber infusion test ( nitrate cal infusion test) - new NICE option
101
Treatment of NPH
CSF shunt
| Ventriculoperitoneal or ventriculopleural or ventriculoatrial
102
Epilepsy vs Non -epileptic attack disorder
Epilepsy
- genetic factors , lasts < 2mins, eyes open - if closed easy to open manually , tongue biting , drooling, self injury , incontinence, post octal confusion, slow post ictal EEG
NEAD -
> 2 mins, eye closed and difficult to open manually y, hx of child abuse sexual or physical , post ictal EEG normal
103
If in doubt of a NEAD dx what should be done
Dx of NEAXD - video EEG
Video EEG can rule out epilepsy in a patient w/ conversion disorder (attacks of inability to talk + no LOC)
104
```
Differentiating tremors
Parkinson’s
Essential
Psychogenic
Cerebellar
```
Parkinsons - present at rest
Essential - absent @ rest , doesn’t resolve w. Distraction
Psychogenic - absent @ rest, resolves w/ distraction
Cerebellar - intentional (tries to touch nose catch something) + other cerebellar features
105
The likely site of mets to brain
Diencephalon
| - diabetes insipidus (polyuria, polydipsia)
106
Diabetes insipidus vs SIADH
| Location
DI - diencephalon
= thalamus, hypothalamus, epithalamus, subthalamus and posterior pituitary
SIADH - cerebrum/cerebellum
107
Diabetes insipidus
Cranial - hypothalamus
Not enough ADH produced
Nephrogenic - kidneys fail to respond to ADH
108
Bulbar palsy
10,11,12, sometimes 7 n disturbance Rather than corticobulbar tracts (LMN)
```
LMN signs present
Gag reflex reduced - bovine cough
Nasal speech
Jaw jerk - normal
Wasted tongue, fasciculations
Signs in limbs
Normal emotions
```
109
Pseudobulbar palsy
```
Degeneration of corticobulbar pathways
- 5 7 10 11 12 - UMN
LMN signs absent
Gag reflex increased/normal
Spastic tongue
Increased jaw jerk
Kabila emotions
Bilateral UMN
```
110
What is the bulbar area?
Cerebellum medulla pons
| Responsible for involuntary functions that keep us alive
111
Bovine cough
Non explosive cough - someone unable to close glottis
Seen in vagus n (10) lesions
May be associated with dysphonia
112
Webers syndrome
MIDBRAIN infarct - PCA block - post cerebral a.
Ipsilateral oculi motor n palsy
- ptosis , mydriasis, deviated outwards downwards
+ contralateral hemiparesis
113
Wallenberg / lateral medullary syndrome
PICA block - post inferior cerebellar a
Ipsilateral horners + loss of pain and temp in FACE
+ contralateral loss of pain and temp LIMBS
114
Sx of cerebellar lesion
Ataxia
Intentional tremors
Dysarthria
Nystagmus
115
Most appropriate treatment of alcohol withdrawal
Chlordiazepoxide i.e benzos
Next add thiamine vit B1
116
Alcohol withdrawal seizures
| Treatment
IV lorazepam
| Or diazepam
117
Drug to promote alcohol abstinence
Disulfiram
118
Drug to reduce alcohol craving
Acamprosate
119
Weakness + increased reflexes + fasciculations
Motor neurone disease
120
Tumour lysis syndrome
Raised urate , K+, phosphate
Low Ca ++
After chemo
121
Important side effects of vincristine (chemo)
Chemo induced peripheral neuropathy
| SIADH - dilutional hyponatremia
122
Fever + low neutrophils after chemo
Febrile neutropenia
| Immediate IV ABx
123
Stroke of cerebellum/brainstem
| Site :
Posterior circulation
| - do MRI head
124
Cavernous sinus thrombosis
| Features
```
Chemosis - conjunctival oedema
Proptosis
6th CN palsy - diplopia on lateral gaze
Pain over medial canthus
Severe headache , fever chills hx of sinusitis
```
125
Pick’s disease
| Features
Frontotemporal dementia
```
Disinhibition - frontal lobe
Struggles w/ word choices - temporal lobe
Disengagement
Inappropriate/impulsive
Personality and behaviour changes
Neglects personal hygiene
```
126
What is characteristic of picks disease
Focal gyral atrophy w/ knife blade appearance
| Macroscopic changes - atrophy of frontal and temporal lobes
127
Contralateral paralysis + sensory loss (face + arm)
+ Ipsilateral gaze preference
What is affected?
Middle cerebra a. - supplies lateral hemisphere
Other features
Aphasia
Homonymous hemianopia
128
What does middle cerebra a. Supply?
Lateral part of hemisphere
129
Anterior cerebral a. Supplies
Frontal and medial cerebrum
130
Occipital lobe supplied by
Posterior cerebral a.
131
Basilar a. Supplies
Cerebellum
Brainstem
Occipital
132
Strongest genetic RF for Alzheimer’s
APOEE e$ gene
133
Features of Alzheimer’s
Elderly
Short term memory loss
After some time - confusion, inability to make decisions, progressive language deficits
Late - disorientation , behavioural changes , death
134
Dx of Alzheimer’s
MRI
Single photon emission CT - differentiates from FTD
MMSE - assess cognitive impairment
135
MMSE score
25-30 normal
21-24 mild
10-29 moderate
<10 - severe
136
Management of Alzheimer’s
Ruvastigmine - 1st line ( mild to mod)
Others - donepezil, galantamine
2nd line
Memantine - NMDA receptor antagonist
Or in severe cases
Suitable for patients with bradycardia , heart block
137
Best advice for mechanical lower back pain
Continue or increase mobilisation
| Regular analgesia
138
Back pain elicited after repeated contraction
| Relieved my movement and changing position
Myofascial pain syndrome
139
Parkinsonism + erectile dysfunction + postural hypotension
Shy drager syndrome
140
Lewy body dementia
Features
Imaging
Dementia
Fluctuating levels of awareness
Mild Parkinsonism
Visual hallucination**
Imaging - MRI brain
141
Presentation similar to myasthenia gravis but w/ increased reflexes (+UMN) + normal autoimmune panel
Amyotrophic lateral sclerosis = motor neurone disease
- MG has normal reflexes , assoc with autoimmune
142
Lambert Eaton syndrome
Associated with tumours - e.g lung ca
Same as MG but -
Reflexes absent , elicited after excercise
Increased strength/power of weak muscles after repeating test
143
Syringomyelia
Loss of pain and temp
| Motor sensory reflexes all affected
144
Syringobulbia
Syringomyelia + CN involvement
| Syrinx extends to involve brainstem
145
Organic brain damage
| Features
Memory loss
Agitation
Confusion
146
Willis Ekbom syndrome
| What should be done
Restless leg syndrome
Check iron - ferritin low - give supplements
If normal -
give dopamine agonist = Ropinirole pramipexole rotigotine
Or Gabapentin , pregabalin
Lifestyle change usually enough - alcohol smoking caffeine sleep etc
147
Dopamine agonist
Ropinirole
Pramipexole
Rotigotine
148
Dementia vs depressive pseudodementia
Dementia
= progressive , long term sx , mood variations , concealing amnesia , tries to answer questions
Pseudo =
rapid onset, short term sx, consistently depressed mood , short answer negativism, highlight amnesia, fluctuating cognitive impairment
149
Normal grief response
Stage 1 - hrs to days
= denial disbelief numbness
Stage 2 - wks - 6 mo
Sadness, grief, hallucination , social withdrawal, guilt etc
Stage 3 - wks to months
Symptoms resolve
Social activities resumed
Memories of good times
Denial & isolation - anger - depression - bargaining - acceptance
150
Inattention/neglect in one side + seizure + neurological deficit
Think of
Space occupying lesion - tumour abscess
It’s a feature of parietal lobe lesion
151
Lucid intervals seen in
Epidural / extramural hgx
| = middle meningeal a.
152
Cervical spondylosis
Limited + painful neck movement
| Occipital headaches
153
Treatment of absence seizure
Sodium valproate
154
Intracranial tumour mgmt
High dose dexa - shrink mass
GCS <8 - give mannitol (rapid action)
Intracranial hgx + very low GCS - urgent craniotomy
155
```
Sensory n roots
L1
L2
L3
L4
L5
S1
```
```
L1 - groin , pelvic girdle
L2 - anterior thigh
L3 - inner medial thigh and distal anterior thigh
L4 - inner medial shin
L5 - lateral shin and dorsum of foot
S1 - lateral foot
```
156
Amaurosis fugax
Cause
Features
Transient occlusion of central retinal a.
Painless temporary unilateral recurrent loss of vision
5-15 mins , resolves in <24 hrs
157
RF of amaurosis fugax
Atherosclerosis (neck bruit)
HTN
Giant cell arteritis
158
Tia vs amaurosis fugax
TIA - emboli from heart
| AF - emboli from internal carotid
159
Medication absolutely CI in migraine w/ aura
COCP - increased risk of cardiovascular accident
Best contraception to use - copper IUD
160
Treatment Ménière’s
Buccal or IM - prochlorperazine
161
NF 1
- features
- association
Presents more with skin lesions - cafe au lait
Axillary/ groin freckles, iris hamartoma, scoliosis
Assoc w/ pheochromocytoma
162
NF2
CNS tumours
| Bilateral acoustic neuroma , schwannoma, meningioma
163
Definitive diagnosis for multiple sclerosis
MRI spinal cord and brain
| = demyelination , lesions disseminated in time and place
164
Treatment of acute multiple sclerosis
IV methylprednisolone
165
Myasthenia gravis association
Thyrotoxicosis
166
Lambert Eaton syndrome association
Tumours - small cell lung ca
167
Best next modality in TIA
Carotid doppler scanning
168
When should carotid endarterectomy
Internal carotid a. Stenosis >/= 50% in men
| >/= 70% women
169
Rapid correction of hypernatremia can cause
Cerebral oedema
170
Suspected meningitis
W/ rash -
W/o rash
Investigation
Rash - blood culture
| No rash - LP
171
TIA
| Driving advice
Stop driving at least 1 month
Stop lorry or bus driving 1 year
Inform DVLA if multiple TIA in car driver, 1 TIA in bus/lorry driver
172
Seizure
| Driving advice
1 year of being seizure free - car driver
| 5 years seizure free - lorry driver
173
Acute subdural vs SAH
Acute subdural - hx of trauma, rapid deterioration
| SAH - thunderclap
174
Supranuclear palsy
| Features
Stiff frozen posture
Axial rigidity
Falling backwards, shuffling freeing gait
Restricted downward gaze
175
```
Diabetic amytrophy (proximal diabetic neuropathy)
Features
```
Complication of poorly controlled DM
Severe thigh or leg pain —> proximal muscle wasting (shoulders thighs pelvic girdle )
Usually resolve within months
Good DM control is a must
176
Vascular is neuropathy vs diabetic amyotrophy
Similar presentation but w/ raised ESR = vasculitis
177
Treatment of neuropathic pain in diabetics
Amytriptiline - 1st line
| Or Gabapentin Duloxetine or pregabalin
178
Treatment of trigeminal neuralgia
Anticonvulsant - carbamazepine
| Others - lamotrigine phenytoin Gabapentin
179
Vascular dementia
| Features
Dementia +
Hx of HTN smoking TIAs
MRI - multiple lacunar old infarcts
180
Treatment Bell’s palsy
High dose prednisolone - 10 days
181
Treatment of Ramsay hunt syndrome
Acyclovir
182
Types of spina bifida
Occulta - mild. = hairy patch, dimple , dark spot or swelling
Meningocele - sac of fluid
Myelomeningocele - severe “ open spina bifida”
-poor ability to walk , impaired bladder or bowel control , hydrocephalus
-tethered spinal cord and latex allergy
183
Prevention of spina bifida
Folic acid during pregnancy
184
Healed UTI w/ persistent high bladder pressure and urinary retention
Management
Intermittent self catheterisation
If ongoing UTI - urinary incontinence pads preferred
185
Folic acid in pregnancy
0.4 mg / 400ug 1/day for 12 weeks
5mg /day 12 weeks if :
DM , BMI >30 , on antiepileptics, FHx of NTD , prev pregnancy w/ NTD
5 mg whole pregnancy
SCD, thalassemia
186
TIA site of lesion
- leg
- face and arms
- vision and language
Leg = anterior communicating a.
Face and arms = middle cerebral artery
Vision and language - posterior cerebral a.
187
Gerstmann syndrome
Inability to designate or name different fingers of both hands - finger agnostic
Confusion of R/L side of body
Dyscalculia
Dysgraphia
Word blindness , homonymous hemianopia, lower quandrantopia
188
Lesion in Gerstmann syndrome
Inferior *parietal* lobe - angular gurus pr subjacent white matter of left hemisphere
189
Vessels involved in subdural and epidural hematoma
SDH - bridging veins
| EDH - middle meningeal a.
190
Acute delirium causes
Hyponatremia
Infection, Alcohol withdrawal ,acute MI
Head injury ,DM , thyrotoxicosis
191
Transverse myelitis
| Features
```
Weakness
Spastic quadripartite or paraparesis
Urgency/tension
Stiffness
Increased tone + brisk reflexes
```
192
Idiopathic cranial hypertension
| Features
Bilateral throbbing headache
Assoc w/ nausea vomiting , tinnitus , visual disturbance
Occurs daily, worse in morning
Improves with standing
Obesity is RFv
193
When does Parkinson’s disease dementia occur
More than a year after dx of parkinsons
194
Side effects of co-careldopa
Dyskinesia
+- Hallucinations
Focal tremors
195
Migraine w/ aura vs stroke/TIA
Migraine - gradual onset, word salad , mainly visual sx
| Stroke/TIA - sudden , temporary loss of vision , dysarthria
196
Safest anti-epileptic in pregnancy
Lamotrigine
| Carbamazepine
197
Hoover’s sign
Dx of functional weakness of LL
+ve = pt supine , flexion of weak hip against resistance is NOT followed by extension of other normal hip
Normal people or organic cause - flexion of weak hip against resistance - followed by extension of other normal hip
(-ve hoover sign)
