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neurology Flashcards

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1
Q

raised ICP presentation: (7)

A

Cushing’s triad:
1. bradycardia
2. wide pulse pressure
3. irregular respirations

+ raised BP
vomiting
papilloedema
reduced GCS
CN III palsy

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2
Q

CN most commonly affected by raised ICP

A

CN III

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3
Q

CN III (opthalmic n.) palsy signs

A

eye deviated “down & out”
ptosis
pupillary dilation (mydriasis)

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4
Q

internuclear ophthalmoplegia
what is it?

A

occular movement disorder caused from a lesion in the medical longitudinal fasciculus (MLF)

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5
Q

internuclear ophthalmoplegia presentation:

A

failure to ADDUCT eye on affected side

CONTRALATERAL NYSTAGMUS

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6
Q

EDH
i. blood vessel most commonly affected

A

middle meningeal a.

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7
Q

EDH typical hx

A

acceleration/ deceleration trauma
or trauma to side of head
LOC followed by lucid interval

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8
Q

SDH
i. vessels most commonly affected

A

i. bridging veins

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9
Q

SDH
ii. RF
iii. presentation

A

ii. alcoholism
old age
anticoagulation

iii. fluctuating confusion/ consciosness especially for chronic

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10
Q

SAH non-traumatic causes

A
  1. ruptured berry aneurysms
    ^^ most commonly on posterior communicating artery

arteriovenoius malformations
arterial dissection

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11
Q

diffuse axonal injury

i. what causes it
ii. 2 components

A

i. rapid head acceleration/ deceleration

ii.
1. mulitple haemorrhages
2. diffuse axonal damage in white matter

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12
Q

triptan CI:

A

IHD/ cerebrovascular disease

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13
Q

triptans adverse effects:

A

“triptan sensations”
–> tingling, heat, tightness (e.g. throat and chest), heaviness, pressure

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14
Q

generalised tonic clonic seizures

mgt in males

A

sodium valproate

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15
Q

generalised tonic clonic seizures

mgt in females

A

lamotrigene or leviteracetam

may also offer sodium valproate if <10 and unlikely require rx when child bearing age

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16
Q

focal seizures:

i. 1st line mgt
ii. 2nd line

A

i. lamotrigine/ leviteracetam

ii. carbamazepine, oxcabapazepine or zonisamide

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17
Q

absence seizures:

i. 1st line

ii. 2nd line

A

i. ethosuximide

ii. in M: sodium valproate

in F: lamotrigene/ leviteracetam

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18
Q

which anti-epileptic can exacerbate absence seizures?

A

carbemazapine

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19
Q

myoclonic seizures mgt

A

in M: Na valproate

in F: levetiracetam

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20
Q

tonic/ atonic seizures mgt

A

in M: sodium valproate

in F: lamotrigene

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21
Q

sodium valproate SE:

A

Valproate SE:
Appetite increase & weight gain
Liver failure
Pancreatitis
Reversible alopecia
Oedema
Ataxia
Teratogenic, tremor, thrombocytopenia
Encephalopathy (due to increased Na+)

p450 INHIBITOR

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22
Q

phenytoin SE:

A

dizziness, diplopia, slurred speech, nystagmus, ataxia

confusion, seizures
gingical hyperplasia

megaloblastic anaemia
peripheral neuropathy

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23
Q

carbamazepine SE:

A

SIADH
Agranulocytosis
Dizziness
Diplopia
Drowsiness

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24
Q

lamotrigine SE:

A

SJS

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25
cyctochrome p450 enzyme inducers
reduce concentration of drugs i.e. make drug work less CRAP GPS Carbamazepine Rifampicin Alcohol (chronic) Phenytoin Grisefu;uin (antifungal) Phenobarbitones Sulphonylureas
26
cyctochrome p450 enzyme inhibitors
increase concentration of drugs (i.e. increase risk of toxicity) SICK FACES.COM Sodium valpraite Izoniazid Cimetidine Ketokonazole Fluconazole Alcohol (acute) Chloramphenicol Erythromycin Sulfonamides Ciprofloxacin Omeprazole Metronidazole
27
common drugs affected by enzyme inducers/ inhibitors:
COCP warfarin theophyline steroids TCAs pethidine statins
28
status mgt:
PR diazepam: - 5mg if 1 month-1yr 10mg 12+yrs
29
features of temporal lobe seizure:
with or without impairment of consciousness or awareness aura: - epigastric rising - dejà vu / jamais vu - less commonly hallucinations (auditory/gustatory/olfactory) typically last approx 1 min - automatisms
30
features of frontal lobe seizure:
MOTOR Head/leg movements posturing post-ictal weakness Jacksonian march
31
features of parietal lobe seizure:
SENSORY paraesthesia
32
features of occipital lobe seizure:
floaters/ flashes
33
GCS
Mo6 V5 E4 motor response: 6. Obeys commands 5. Localises to pain 4. Withdraws from pain 3. Abnormal flexion to pain (decorticate posture) 2. Extending to pain 1. None verbal response: 5. Orientated 4. Confused 3. Words 2. Sounds 1. None eye opening: 4. Spontaneous 3. To speech 2. To pain 1. None
34
anti-hypertensives are required for stroke mgt if BP > what?
>185/110
35
essential tremor features:
postural tremor: worse if arms outstretched improved by alcohol and rest most common cause of titubation (head tremor) AD inheritance
36
essential tremor mgt
propranolol is first-line primidone is sometimes used
37
myasthenia gravis: exacerbating factors
penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines
38
TACI i. vessels involved ii. features
i. middle and anterior cerebral arteries ii. all 3 of: 1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg 2. homonymous hemianopia 3. higher cognitive dysfunction e.g. dysphasia
39
PACI i. vessels involved ii. features
i. smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery ii. 2 of: 1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg 2. homonymous hemianopia 3. higher cognitive dysfunction e.g. dysphasia
40
lacunar infarcts (LACI, c. 25%) i. vessels involved ii. features
i. perforating arteries around the internal capsule, thalamus and basal ganglia ii.presents with 1 of the following: 1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three. 2. pure sensory stroke. 3. ataxic hemiparesis
41
posterior circulation infarct (POCI): i. vessels involved ii. features
i. vertebrobasilar arteries ii. presents with 1 of the following: 1. cerebellar or brainstem syndromes 2. loss of consciousness 3. isolated homonymous hemianopia
42
Lateral medullary syndrome (posterior inferior cerebellar artery)/ Wallenberg's syndrome features:
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's contralateral: limb sensory loss
43
Weber's syndrome features:
ipsilateral CN III palsy contralateral weakness
44
cluster headache mgt: i. acute ii. prophylaxis
i. oxygen s/c triptan ii. verapamil some evidence for tapering dose of prednisolone
45
migraine mgt: i. acute ii. prophylaxis
i. triptan, NSAID, paracetamol [or amitriptyline] ii. topiramate or propranolol [or valproate] if age 12-17 consider nasal triptan iii. pizotifen topiramate associated with risk of cleft palate so propranolol is preferred in women of child bearing age
46
trigeminal neuralgia mgt:
carbamazepine if fails to respond or atypical features --> refer to neuro
47
hsv encephalitis CT head fetaures
temporal lobe changes
48
mgt of spasticity in MS
gabapentin and baclofen
49
Bell's palsy mgt
PO prednisolone within 72 hrs of sx onset
50
idiopathic intracranial HTN mgt:
weight loss carbonic anhydrase inhibitors e.g. acetazolamide repeated LP (temporary measure only)
51
neuroleptic malignant syndrome features:
pyrexia muscle rigidity autonomic lability: typical features include hypertension, tachycardia and tachypnoea agitated delirium with confusion
52
neuropathic pain:
1st line: amitryptiline/ duloxetine/ gabapentin/ pregabalin monotherapy i.e. if one does not work try another tramadol as 'rescue therapy'
53
Miller-Fisher syndrome vs GBS:
anti- GQ1B antibodies in Miller-Fisher Miller - Fisher - starts proximally i.e. with eyes Miller Fisher triad: ataxia areflexia ophthalmoplegia
54
Lambert Eaton syndrome i. what is it? ii. association?
i. autoimmune disorder characterised by the production of autoantibodies that target pre-synaptic voltage-gated calcium channels, leading to impaired neurotransmission at the neuromuscular junction ii. small cell lung cancer
55
Lambert Eaton syndrome presentation:
- limb weakness, PROXIMAL and SYMMETRICAL - autonomic features: - xerostomia, orthostatic hypotension, impotence - reduced/ absent tendon reflexes which can be potentiated by brief muscle contraction IMPROVED with repeated movements/ repetitive contractions (unlike myaesthenia gravis which = fatiguable weakness)
56
lower brachial plexus (Klumpke's)injury association:
Horner's syndrome (ipsilateral) if T1 involvement
57
criteria for CT head within 1 hour of injury:
GCS < 13 on initial assessment GCS < 15 at 2 hours post-injury suspected open or depressed skull fracture any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign). post-traumatic seizure. focal neurological deficit. >1x vomiting
58
criteria for CT head within 8 hrs of head injury:
any of following RF: age 65+ hx bleeding/ clotting disorders/ anticoagulants dangerous mechanism of injury
59
PD mgt
1. levodopa dopamine agonists e.g. roplinirole, rotigotine, apomorphine MOA-B inhibitors e.g. selegiline, rasagaline (used + levodopa) COMT inhibitors e.g. entacapone, tolcapone amantadine anti-cholinergics e.g. prochyclidine (not used that often irl)
60
PD ddx:
Lewy body dementia progressive supranuclear palsy multiple system atrophy corticoobasal degeneration Wilson's drug induced Parkinsonism demenuta pugillistica vascular parkinsonism
61
progressive supranuclear palsy features
early instability + frequent falls vertical gaze impairment Parkinsonism
62
multiple system atrophy
early autonomic dysfunction poor response to levodopa
63
corticobasal degeneration
alien limb phenomenon apraxia cortical sensory loss (cannot recognise objects despite normal sensory input)

MSRA (16 decks)

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