Neurology Flashcards
1
Q
What is the frequency of triptans/opiods/ergots that is needed to diagnose medication overuse headache?
A
> 10 days a month
2
Q
What is the frequency of paracetamol/aspirin/NSAIDs that is needed to diagnose medication overuse headache?
A
> 15 days a month
3
Q
Describe the features of a cluster headache? (7)
A
- Unilateral around eye
- Constricted pupils
- Red/watery eye
- Swollen/drooping eyelid
- Forehead/facial swelling
- Restless/agitated
- Lasts 15-180mins
4
Q
What is the cut off for episodic/chronic migraine/tension headache in terms of number per month?
A
< 15 = episodic
> 15 = chronic
5
Q
What is c/i in migraine?
A
OCP
6
Q
What are the first line treatments for migraine according to NICE? (4)
A
- Triptan (consider nasal if 12-17)
- Paracetamol/ibuprofen
- IV metoclopramide
7
Q
What 3 agents can be used in prophx migraines and which one should be avoiding in women of child bearing age?
A
- Topiromate (affects contraception and can lead to fetal malformation)
- Amitryptylline
- Propanolol
TAP
8
Q
What is the tx for a cluster headache? (2)
A
- High flow o2
- SC or nasal triptan
9
Q
What is used for prophx of cluster headaches?
A
Verapamil
10
Q
What a cardinal feature of trigeminal neurolagia?
A
Touching area increases pain
11
Q
What is used in the tx of trigeminal neuralgia? (1)
A
Carbamazepine
12
Q
What are 2 risk factors for cerebral venous thromobisis? (2)
A
1 Pregnancy/PP
2. Sinusitis
13
Q
How do we treat cerebral venous thrombosis?
A
Heparinisation
14
Q
Give 4 features of idiopathic IC HTN?
A
- Headache worse on coughing/sneezing
- CN palsies
- Papiloedema
- Can lead to blindness
15
Q
Who is more likely to suffer from idiopathic IC HTN?
A
Women with large BMI
16
Q
How is idiopathic IC HTN diagnosed?
A
Increased opening pressure (>20cm) on LP and normal CTH
17
Q
In young adults what are the 2 most common types of meningitis?
A
- Viral
- Second peak of meningococcal disease in 20s
18
Q
What are 2 common organisms leading to meningitis in older adults?
A
- Pneumococcal (>50s)
- Listeria (>60s)
19
Q
Skull #s are a risk factor for contracting what type of organism causing meningitis?
A
Pneumococcal
20
Q
What 3 organisms are increased risk of causing meningitis in patients with HIV?
A
- Cryptococcal if CD4 <200
- Pneumococcal
- TB
21
Q
What is the expected findings in LP with bacterial meningitis? (5)
(opening pressure/appearance/cell type/protein/glucose)
A
- Increased opening pressure
- Turbid appearance
- Neutrophils
- Protein
- V low glucose?
22
Q
What is the expected findings in LP with viral meningitis? (5)
(opening pressure/appearance/cell type/protein/glucose)
A
- Normal or mildly increased opening pressure (normal 12-25cm)
- Clear appearance
- Lymphocytes
- Mild increase in protein
- Normal of mildly decreased glucose
23
Q
What is the expected findings in LP with TB meningitis? (5)
(opening pressure/appearance/cell type/protein/glucose)
A
- Increased opening pressure (>25cm H20)
- Clear/cloudy appearance
- Lymphocytes
- Very increased protein
- Very low glucose
24
Q
What is the expected findings in LP with fungal meningitis? (5)
(opening pressure/appearance/cell type/protein/glucose)
A
- Increased opening pressure
- Clear or cloudy
- Lymphocytes
- Increased protein
- Low glucose
25
What does NICE say is the maximum an LP should delay giving abx?
1 hour
26
What 3 contraindications are there to doing an LP without CTH?
1. Signs increased ICP
2. Severe sepsis
3. Rapidly evolving rash
27
What additional investigations to identify the organism should be performed in a patient being investigated to meningitis aside from LP? (3)
1. Meningococcal/pneumococcal PCR
2. Meningococcal throat swab
3. BC
28
What two treatments are first line for suspected meningitis according to NICE?
1. 10mg IV dexamethasone
2. 3rd generation cephalosporin
29
What does NICE recommend for initial abx treatment of meningitis in penicillin/cephalosporin anaphx?
25mg/kg chloramphenicol IV
30
What antibiotic should be given in adults > 60 years or immunocompromised in suspected meningitis?
2g Amoxicillin IV
(co-trimoxazole if pen anaphx)
31
What antibiotic should be given as prophx for close contacts of patients with suspected meningococcal meningitis?
PO ciprofloxacin
32
In children with a petechial rash what 4 things should trigger IV abx?
1. Petechiae start to spread
2. Rash becomes purpuric
3 Signs of bacterial meningitis
4. Signs sepsis
33
If there are no increased risk factors in invx of petechial rash what is the next invx?
Bloods - if raised inflam markers give IV abx
34
Why don't we use cefriaxone in neonates?
Can lead to increased bilirubin
35
What is first line treatment for suspected meningitis in under 3 month olds?
IV cefotaxime
+
IV amoxicillin/ampocillin
36
What is the treatment for suspected meningitis in children > 3months?
IV ceftriaxone
37
If children being managed for suspected meningitis have had recent travel or prolonged abx use in the last 3 months which abx should be added to ceftriaxone?
IV vancomycin
38
Which abx in particular is effective against Group B strep meningitis?
Cefotaxime
39
Which IV antibiotics are used to treated listeria meningitis?
IV amoxicillin or ampicillin
40
When should steroids be used in children with suspected meningitis (1) and when should it not be given (2)?
1. Bacterial meningitis
2. < 3 months old and meningococcal meningitis
41
Which inotropes are recommended in children with meningitis? (2)
Dopamine
Dobutamine
42
What dose of IV glucose should be given in children with low glucose and meningitis?
2ml/kg 10% boluse
43
List 4 drugs that should be avoided in Parkinsons disease?
1. Metoclopramide
2. Stemetil
3 Haloperidol
4. Chlorpromazine
44
If PD patients can't take their medication orally what should be first and then second line?
1. NG/NJ/PEG
2. Rotigotine patch
45
If PD medications are missed what is the most significant complication?
Neuroleptic malignancy syndrome
46
How quickly does NICE recommend a patient with a first fit should be seen by?
< 2 weeks
This is the same amount if patient has had a seizure following a period of relapse
47
What makes a complicated febrile convulsion? (3)
1. >10 mins
2. Weakness
3. Focal
48
What does NICE recommend for invx of epilepsy re: EEG (4)
1. Photon/hyperventilations EEG
2. If fails - sleep deprivation EEG
3. If fails ambulatory EEG
Does not rule out epilepsy
49
How quickly does NICE recommend patients have an MRI following their first seizure?
6 weeks
50
What is first line maintenance anti-epileptic according to NICE in patients who are not able to have children?
Sodium valporate
51
What is first line maintenance treatment for epilepsy in patients able to have children?
Keppra or lamotrigine
52
What is first line for prevention of focal seizures? (2)
Keppra or lamotrigine
53
What is first line prophx for absence seizures?
Ethosuximide
54
When does NICE suggest to give bolus of patients regular anti-epileptic in the status algorithim?
If there is suspicion of poor adherence
55
What are the doses of the recommended first line anti-epileptics in status? (3)
1. Phenytoin 20mg/kg
2. Valporate 30mg/kg
3. Keppra 40mg/kg
56
What are the two treatment options 3rd line for status according to NICE? (2)
Phenobarbital
I+V
57
What does NICE recommend with regards to ABCD2 and using to decide management of TIA?
Do not use it
58
Does NICE recommend routine use of CTH in TIA?
No, MRI should be considered in TIA clinic
59
What is the management of TIA according to NICE?
1. 300mg aspirin ASAP
2. Consider secondary prevention
60
When should a suspected TIA be seen in clinic?
< 24 hours
61
What is the current thrombolysis window according to NICE?
< 4.5 hours
62
When does NICE recommend thrombectomy < 6 hours of symptoms?
Proximal anterior circulation occlusion on CTA/MRA
63
In circumstance does NICE recommend thrombectomy only <24 hours?
1. CT perfusion/ diffusion weighted MRI shows potential tissue salvage and no thrombolysis given
64
What does NICE recommend with basilar/posterior cerebral artery stroke with potential salvage on imagine < 24hours?
Thombectomy
+
Thrombolysis
65
What does NICE recommend with regards to anticoagulation post stroke with new AF?
300mg aspirin daily for 2 weeks followed by anticoagulation
66
What does NICE recommend if symptoms of PE/DVT and stroke?
Anticoagulate over asprin
67
What does NICE recommend in BP control and haemorrhagic stroke? (2)
1. Consider rapid control if < 6 hours and SBP 150-220
2. Aim for SBP <140 but do not drop by >60mmHg in first hour
68
What does NICE recommend to aim for BP if thrombolysing a stroke?
<185/110
69
When does NICE support decompressive hemicraniectomy in ischaemic stroke? (3)
1. MCA infarct (at least 50%)
2. Reduced GCS
3. NIHSS score >15
70
What are the 3 P's NICE says supports a diagnosis of vasovagal?
Postural
Provoking factors
Prodrome
71
Who does NICE recommend have cardiology review within 24 hours with regards to TLOC? (6) and who should we consider if in (1)
1. ECG abnormality
2. FHx SCD
3. During exertion
4. Heart failure o/e
5. Unexplained SOB
6. New murmur
>65 and no prodrome
72
What is the recommended investigation for ? cardiac syncope?
Ambulatory ECG
73
What is the first line investigation for recurrent vasovagal syncope?
Tilt test
74
What is the first line test for exercise induced syncope and when is it c/i?
Exercise testing within 7 days but not if suspected AS or HOCM
75
Following a first seizure how long must a category 1 and 2 license holder stopping driving for?
Cat 1 - 6 months
Cat 2 - 5 years
76
Following an epileptic seizure how long must a category 1 and 2 license holder stopping driving for?
1. 12 months
2. 10 years
77
Following a TIA how long must a category 1 and 2 license holder stopping driving for?
1. 1 month
2. Notify DVLA - 1 year
78
Following angina how long must a category 1 and 2 license holder stopping driving for?
1. Do not drive with symptoms
2. Contact DVLA
79
Following an episode of hypoglycaemia how long must a category 1 and 2 license holder stopping driving for?
1. > 2 episodes in a year must tell DVLA
2. Stop driving, notify DVLA
80
In the context of alcohol misuse how long must a category 1 and 2 license holder stopping driving for?
1. 6 months, control of problem and need normal bloods
2 1 year and control of problem, normal bloods
81
In context of alcohol dependence how long must a category 1 and 2 license holder stopping driving for?
1. 1 year abstinence
2. 3 years abstinence
82
What is the advice re: dementia and driving
Issue is complex, may still be able to drive
83
What antibiotic should be given to close contacts of patients with diagnosed meningococcal disease?
1 dose ciprofloxacin
84
What is the treatment of severe GBS? (2)
Either plasma exchange of IV immunoglobulin
85
What largely differentiates severe/non severe GBS?
Whether a patient can walk
86
What is the treatment for temporal arteritis 1) with and 2) without visual loss?
1. 40-60mg prednisolone OD
2. 500mg IV methylprednisolone
