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Neurology Flashcards

1
Q

Signs of Parkinsons

A
  • Resting tremor
  • Micrographia
  • Mask life facies
  • Limb bradykinesia
  • Asymmetrical reduced arm swing
  • Reduced step height
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2
Q

Classes of drugs for parkinsons

A

1st line
Levodopa (and dopa-decarboxylase inhibitors
= Levodopa/carvidopa

2nd line
Dopamine agonists
= Pramipexole
= Rotigotine (patch)

Other
MAO-B inhibitors
= Rasgiline
Consider in mild symptoms

Anticholinergics
=Benztropine
Good for resting tremor

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3
Q

Dose of Levodopa/carbidopa
or Levodopa/benserazide

A

50+12.5mg TDS

Increasing to 100mg+25mg TDS

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4
Q

Dose of Pramipexole (modified release)

A

Once day dosing!!

0.375mg

(Max 4.5mg)

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5
Q

Benefit of dopamine agonists in parkinsons

Cautions

A

Once day dosing!

Careful for impulse control issues: gambling, etOH, hypersexual

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6
Q

Side effects of parkinson’s medications

A
  • Nausea
  • Orthostatic dizziness
  • Somlonence

Dopamine agonists: impulse control, hallucinations

Anticholinergics: confusion, dry mouth, urine retention, dry eye, constipation

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7
Q

Dementia pharmacology:
1st line:

A

Donepezil 5mg nocte (max 10mg)

Galatamine 8mg mane

Rivastigmine patch 4.6mg

OR for SEVERE /not tolerating Acetylcholinesterase inhibitors

Memantine 5mg daily (max 20mg)

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8
Q

Trigeminal neuralgia pharmacology

A

Carbamazepine MR 100mg BD

Up to 400mg BD

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9
Q

TIA investigations

A

CT angiography
Carotid artery doppler US
or MR angiography

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10
Q

Painful peripheral neuropathy pharmacology

A

1st line:
Amitriptyline 25mg nocte (up to 150mg)

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11
Q

Complex partial seizure features

A

Temporal lobe epilepsy

  • Slight perceptual disturbance ( could still do simple task or drive a car)
  • Hallucination: smell, sound, visual
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12
Q

Simple partial seizure features

A

NO loss of consciousness

Jerking movements at angle of mouth or in the thumb and finger- then become bigger to involve the rest of the body.

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13
Q

Narcolepsy treatment

A

Modafinil 200mg mane
Or mane 100mg, midday 100mg

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14
Q

Distinguishing between labyrinthitis and vestibular neuronitis

A

Labyrinthitis affects whole inner ear & would have tinitis and hearing loss also

Not just vertigo (and n/v)

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15
Q

Parietal lobe tumour features

A

Seizures
Impaired: handwriting, numbers, maths
Certain movements
Smell and touch issues

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16
Q

Frontal lobe tumour features

A

Personality change
Intellectual impairment
urinary incontinence
Hemiparesis

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17
Q

Occipital lobe tumour

A

Visual field defect
Visuospatial defect

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18
Q

Bell’s Palsy treatment

A

Prednisolone 75mg 5 days

add Valaciclovir if vesicles present

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19
Q

Definition/features of Mononeuritis Multiplex

A
  • Painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving 2 separate nerve areas
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20
Q

Idiopathic intercranial hypertension investgiations

A

MRI (to exclude SOL)
Lumbar puncture (opening pressure raised >25cmH20)

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21
Q

Idiopathic intercranial hypertension treatment

A
  • Acetazolamide 250mg BD
    Increase to 500mg QID as tolerated
  • Weight loss
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22
Q

Idiopathic intercranial hypertension DDx to rule out

A
  • Space occupying lesion
  • Venous sinus thrombosis/obstruction
  • Medication induced: Isotretinoin and tetracyclines
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23
Q

Cerebellar signs

A
  • Wide based gait
  • Intention tremor
  • Dysdiadochokinesis
  • Imbalance
  • Coordination of complex tasks
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24
Q

Dementia work up (routine (8) and recommended (7))

A

Routine
- FBC
- ESR
- LFTs
- EUC (ca)
- TSH
- B12,
- Folate
- CTB

Recommended
- CXR
- Fasting BSL
- Fasting lipids
- Fasting homocystine level
- ECG
- MSU
- Serology; HIV & syphilis

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25
Pre-hospital management of suspected meningitis
Obtain blood cultures if possible ABX: 1) Ceftriaxone 2g (50mg/kg) IV or IM 1) Benzylpenicillin 2.4g (60mg/kg) IV or IM
26
Features suggestive of Multiple Sclerosis
- Optic neuritis - Lhermitte sign (shooting pain with neck flexion) - Internuclear ophthalmoplegia (diplopia) - Fatigue - Heat sensitivity (Uhthoff phenomenon) - Unilateral facial or limb sensory loss - Subacute motor weakness
27
Triad for Wernicke's Encephalopathy
Encephalopahthy Occulomotor dysfunction Gait ataxia
28
Essential tremor management
Propanolol 10mg BD up to 160mg in 2 divided doses
29
Damage /tumour in Temporal lobe
- Receptive aphasia - Difficulty recognising faces - Emotional disturbance (aggressive behaviour) - Difficulty identifying objects
30
Acute migraine treatment (first line agents)
NSAID: - Aspirin 900mg - Ibuprofen 400mg TRIPTAN - Sumatriptan 50 to 100 mg. Wait 2 hours before repeating dose
31
Non- pharmacological migraine management
- Cool packs to forehead or back of head - Heat pack to neck - Quite dark room - Regular sleep schedule - Avoid triggers (chocolate, citrus, MSG) - Hydration (1.5-2L) - Limit caffeine
32
Migraine prophylaxis
- Amitriptyline 10mg - Candesartan 4mg - propanolol 20mg (avoid in asthma) - Topiramate 25mg
33
Medication overuse headache management
- Gradually wean opioids and triptans - Bridge with Naproxen MR 750mg daily for 5 days in first week then wean
34
Trigeminal neuralgia pharmacological management
Carbamazepine 100mg BD
35
Trigeminal neuralgia clinical features
- Trigeminal distribution: V2 V3 more common - Paroxysmal electric shock /stabbing nature of pain - Unilateral - Tigger zones - Brought on by innocuous stimuli (wind, light touch) - Autonomic symptoms: unilateral lacrimation, conjunctival injection, rhinorrhoea
36
Agitation in aged care pharmacology
Risperidone 0.25mg BD PRN
37
Acute dystonia management HINT: Single agent
Benztropine 1mg IM or IV
38
Childhood Absence Epilepsy features 1. Onset age 2. How long seizures for 3, EEG findings
1. 4-10yrs 2. 2-20 secs (tens per day) 3. Generalised rhythmic spikes or double spike wave discharges ~3Hz
39
Cluster headache features (gender predominance, frequency & duration of attack, etOH trigger) Also other features
- M> F - up to 8 daily - 15-180 minutes - SEVERE (called suicide headache) - yes etOH Trigger Tearing, conjunctival injection, Fullness of the ear, tinnitus Agitation, restless
40
First line agent for PREVENTION of cluster headache management and caution for this
Verapamil IR 80mg TDS for 2 weeks titrate up to 160mg TDS HEART BLOCK must do ECG before every dose increase - PR interval & severe bradycardia **increase dose every 2 weeks
41
First line agent for ACUTE treatment of cluster headache (2 agents)
Sumatriptan 6mg subcut High flow oxygen 100% 15L tight fitting non-rebreather 15-20mins then stop
42
3 questions for assessing falls risk
1. More than 2 falls in last 12 months 2. Presenting following a fall? 3. Difficulty with walking or balance?
43
Causes for muscle weakness (and fatigue) in upper limbs
- MND - Cervical myelopathy - MS - Inclusion body myositis (distal weakness) - Thyrotoxicosis - B12 deficiency - Myasthenia gravis (more proximal weakness)
44
Exam findings in MND/ALS
- Brisk reflexes in a wasted limb - Split hand sign - Fasciculation - Dysarthria/dysphagia
45
Peripheral neuropathy differentials
- Diabetic neuropathy - B12 Deficiency - Paraproteinuria - Peripheral vascular disease - Idiopathic - Restless leg syndrome - Hypothyroidism - Alcohol related peripheral neuropathy - Medication: Amiodarone, metronidazole
46
Post TIA/CVA carotid artery stenosis cut off for end arterectomy?
>70% (ipsilateral) Marginal for 50-69%
47
Post stroke: antiplatelet therapy
Aspirin 100mg daily OR Clopidogrel 75mg daily OR Dipyriamole MR + Aspirin 200 + 25mg BD ** DAPT could be good 3 weeks -3 months post but not strictly in guidelines
48
Status Migrainosus
Sumatriptan 6mg subcut
49
Tension headache prophylaxis
Amitriptyline 10mg nocte increasing up to 75mg
50
Bell's Palsy exam findings
- Decreased tearing from eye - Vesicles - Loss of taste anterior 2/3 tongue - Hyperacusis - Drooling
51
Bell's Palsy treatment
- Pred 75mg (1mg/kg) - artifical tears - review 3-4 weeks - MRI if not improved in 4 months - Valaciclovir 1g 8hourly 7d
52
TIA driving exclusion period (private and commercial)
- 2 weeks - 4 weeks
53
Peripheral neuropathy 'Burning foot" differentials
- Peripheral vascular disease - B12 deficiency - Tarsal tunnel syndrome - Reynauds - Diabetic nephropathy - Chilblains - hypothyroidism - etoH - Complex regional pain syndrome - Chemotherapy
54
3Hz wave and spike EEG - type of seizure
Absence seizure
55
What medications can you NOT use in parkinsons (cautions)
Metoclopramide Prochlorperazine
56
Migraine in children pharmacology
1st line: ibuprofen 10mg/kg up to 400mg TRIPTAN 1st line: Sumatriptan 10-20mg IN (repeat 2 hrs) if nausea: Ondansetron: 0.1mg/kg up to 8mg orally
57
Cluster headache prevention (pharmacology)
Verapamil IR 80mg TDS increasing to 160mg TDS
58
Dementia NON-pharmacological considerations
- My aged care assessment - Enduring guardian - Advanced care directive - Legally needs to inform RMS of diagnosis - Home medication review - Dementia australia website - Maintain social activities - Exercise for 30 mins most days
59
Differentials for limb weakness
- MND - MS - Chronic inflammaotry demyelinating neuropathy (CIDP) - Radiculopathy (myeloradiculopathy) - Myositis - B12 deficiency - Thyrotoxicosis - Lead poisoning - Myesthenia gravis - Space occupying lesion - Bulbar palsy
60
Post stroke use of DAPT? Time frame
- Endorsed by stroke foundation for 3 weeks of DAPT

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