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neurology Flashcards

1
Q

features of generalised epilepsy

A
  • Lack of aura
  • Young age of onset
  • Photosensitivity and myoclonus
  • Seizures within 24hr of awakening
  • History of alcohol or sleep deprivation
  • Family history of IGS
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2
Q

features of focal epilepsy

A 
focal aura
automatisms - lip smacking, tongue biting, finger rolling
post attack confusion
nocturnal events
history of perinatal injury
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3
Q

types of generalised seizures

A

absence - brief pause the carries on as normal
tonic clonic - LOC. limbs stiffen (tonic) then jerks (clonic)
myoclonic -sudden jerking of limb/face/truck
atonic - sudden loss of muscle tone causing fall, no LOC

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4
Q

types of focal seizures

A

simple - awareness unimpaired, no postictal symptoms
complex - awareness is impaired, aura
evolving to bilateral convulsive - starts focalliy but spreads and becomes convulsive (2/3 of all focal seizures)

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5
Q

treatment for epilepsy

A

focal - lamotrigine, levetiracetam, carbamazepine

generalised - valproate, lamotrigine, levetiracetam

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6
Q

define status epilepticus

A

repeated/prolonged seizure activity

defined as 2 or more seizures without full recovery in between or continuous activity for > 30 min

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7
Q

investigation of epilepsy

A 
clinical history + eye witness
ct head
EEG
glucose
electrolytes
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8
Q

management of Status epilepticus

A

maintain airway
oxygen
IV access and bloods (FBC, U&Es, LFTs, glucose, Tox screen, anticonvulsant levels)
IV fluids
Lorazepam bolus (second dose if no response)
in seizures continue = IV phenytoin infusion

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9
Q

define MS

A

an inflammatory demyelinating disease characterised by the presence of episodic neurological dysfunction in at least 2 areas of the CNS separated in time and space

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10
Q

Risk factors of MS

A

genetics - HLA A3
Fhx
smoking
EBV infection

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11
Q

how might someone with MS present

A 
optic neuritis
transverse myelitis
sensory changes (burning or wet sensation)
leg weakness
increased tone
ataxia
diplopia
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12
Q

define transverse myelitis

A

inflammation of the spinal cord most commonly in the thoracic (T1-12) region

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13
Q

features of transverse myelitis

A

weakness and sensory loss below the level affected

urinary incontinence

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14
Q

diagnosis of MS

A

MRI gadolinium brain
LP - CSF oligoclonal bands, raised IgG
rule out other causes (B12, lyme serology, TSH)

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15
Q

management of MS

A

IV methylprednisolone for relapses
Beta interferon to decrease frequency of relapses
biologics - natalizumab, alemtuzumab
fingolimod, dimethyl fumarate
symptom relief - muscle relaxants, anticholinergics

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16
Q

define myasthenia gravis

A

autoantibodies against ACh receptors causing destruction of post synaptic membrane therefore decreasing muscle fibre A.P

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17
Q

presentation of myasthenia gravis

A

muscle fatigue, worse with activity
limb weakness - difficulty standing up from chair, using stairs
ocular muscle weakness - squints and diplopia
dyspnoea

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18
Q

investigations for myasthenia gravis

A

ACh receptor antibodies
muscle specific tyrosine kinase antibodies
CT to look for thymoma

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19
Q

management of myasthenia gravis

A

cholinesterase inhibitor - pyridostigmine
corticosteroids for ocular symptoms
plasma exchange and IV IG
thymectomy

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20
Q

define a myasthenic crisis

A

development of respiratory failure due to weakness of respiratory muscles

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21
Q

what should be monitored in a myasthenic crisis

A

serial FVC and NIF

both low is an indication for ventilation

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22
Q

clinical features of TACS

A

hemiparesis + higher cortical dysfunction + homonymous hemianopia

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23
Q

clinical features of PACS

A

isolated higher cortical dysfunction
or
2 of hemiparesis, hemianopia, higher cortical dysfunction

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24
Q

clinical features of POCS

A

isolated hemianopia

cerebellar/brainstem symptoms (nystagmus, ataxia)

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25
clinical features of LACS
``` pure motor stroke or pure sensory stroke or sensorimotor stroke or ataxic hemiparesis or clumsy hand dysarthria ```
26
vessel affected in TACS
proximal middle cerebral or internal carotid
27
vessel affected in PACS
MCA
28
vessel affected in POCS
vertebral/basilar artery | or posterior cerebral artery
29
vessel affected in LACS
small perforating arteries
30
list some investigations for a person presenting with stroke
``` CT head - rule out haemorrhagic stroke ECG - AF PT ant aPTT - coagulopathy carotid ultrasound glucose and serum electrolytes ```
31
management of ischaemic stroke
if presented <4.5hrs ago = thrombolysis (alteplase) aspirin endovascular stent thrombectomy
32
secondary prevention of stroke
``` atorvastatin antihypertensive - Ramipril, thiazide, CCB antiplatelets - clopidogrel, aspirin warfarin if AF smoking cessation ```
33
management of TIA
control risk factors (smoking cessation, statins antihypertensive, aspirin) clopidagrel or aspirin carotid endarterectomy if >50% stenosed and symptomatic or >70% and aasymptomatic
34
what is the ABCD2 score
risk score for predicting stroke after a TIA
35
what makes up the ABCD2 score
a = age>60 (1) b = BP>140/90 (1) c = clinical feature - unilateral weakness (2), speech problems w/o weakness (1) d = duration - >59min (2), <1hr (1) d = diabetes (1) score of 6 = high risk so >4 requires specialist review
36
Presentation of a subarachnoid haemorrhage
thunderclap headache LOC photophobia nausea and vomiting
37
investigations for a subarachnoid haemorrhage
``` CT head ( confirms diagnosis, hydrocephalus, infarction) CT/MR angiogram (find bleeding source) LP (xanthochromia) electrolytes glucose ECG troponin ```
38
management of subarachnoid haemorrhage
aneurysm repair ( interventional radiology preferred to open) nimodipine - prevents vasospasms sodium replacement if needed
39
Presentation of Parkinson's
non motor - loss of smell, constipation, erectile dysfunction, depression TRAPS (tremor, rigidity, akinesia, postural/gait, speech and swallowing)
40
treatment for parkinson's
``` encourage physical activity carbidopa (levedopa +dopa decarboxylase inhibitor) dopamine agonist (ropinirole) MAOB inhibitor (selegiline) COMT inhibitor (entacapone) deep brain stimulation ```
41
what is cervical spondylosis
OA of the cervical spine leading to MSK symptoms | osteophyte formation can irritate/damage/compress the spinal cord and/or nerve roots resulting in neurological symptoms
42
signs and symptoms of cervical spondylosis
``` neck pain, stiffness, crepitations stabbing/dull pain in UL decrease reflexes leg weakness, foot drop cervical muscle spasms ```
43
management of cervical spondylosis
``` physiotherapy NSAIDs muscle relaxants dexamethasone injections surgical nerve decompression ```
44
UMN signs
``` increase tone hyperreflexia spasticity positive babinski clonus ```
45
LMN signs
``` decrease tone hyporeflexia flaccid muscle weakness fasciculations muscle wasting ```
46
Management of MND
riluzole | symptom management - NG tube/blended food for dysphagia, antidepressant, muscle relaxants for spasticity,
47
types of MND
amyothrophic lateral sclerosis (cortex and ant. horn. UMN + LMN) progressive bulbar palsy (CN 9-12. LMN) progressive muscular atrophy (ant. horn. LMN) primary lateral sclerosis (betz cells in motor cortex. UMN)
48
symptoms of hyper active delirium
``` heightened arousal hallucinations inappropriate behaviour agitation restlessness ```
49
symptoms of hypoactive delirium
lethargy reduced motor activity incoherent speech lack of interest
50
what 4 features are required for a diagnosis of delirium
disturbance in attention change in cognition acute onset evidence of a known cause
51
management of delirium
identify and manage precipitating cause calm environment haloperidol
52
symptoms of alzheimer's
memory loss personality change speech and motor deficit nominal dysphasia
53
symptoms of frontotemporal dementia
``` memory loss personality change language impairment change in social behaviour self neglect ```
54
symptoms of dementia with LB
parkinsonism visual hallucinations cognitive impairment REM sleep disturbance
55
symptoms of vascular dementia
impaired executive functions mood changes disinhibition poor attention
56
disadvantages of the MMSE
not sensitive to mild changes unable to detect deficiency cause by a focal neurological lesion insensitive in measuring progression in severe dementia
57
management of Alzheimer's
cholinesterase inhibitor - donepezil antidepressant - sertraline antipsychotic - olanzapine
58
management of vascular dementia
aspirin warfarin if embolic cause BP. glycaemic, statin control carotid endarterectomy
59
presentation of migraine
unilateral throbbing headache aura (nausea, scotomas, flashing lights, limb sensory/motor disturbance) photo/phono/osmophobia
60
treatment of migrains
NSAIDs/aspirin anti emetic (metoclopramide) sumatriptan prophylaxis propranolol amitriptyline valproate
61
what medications commonly cause headaches from overuse
NSAIDs triptans opioids
62
presentation of cluster headaches
``` severe unilateral ipsilateral autonomic features: red watery eye, constricted pupiil drooping eyelid absence of nausea, photophobia ```
63
management of cluster headaches
s/c sumatriptan | prophylaxis = verapamil
64
presentation of EDH
``` lucid period headache vomiting confusion if left untreated - ipsilateral pupil dilation. hemiparesis, coma, death ```
65
CT finding of EDH
lens shaped haemorrhage
66
presentation of SDH
``` elderly/alcoholics fluctuating consciousness headache seizures unsteadiness ```
67
CT finding of SDH
midline shift | crescent shaped haemorrhage
68
presentation of idiopathic intracranial hypertension
overweight high pressure headache visual disturbances (decrease acuity, loss of field, photophobia) optic disc swelling
69
medications that may trgger idiopathic intracranial hypertension
``` tetracycline antibiotics isotretinoin contraceptives steroids levothyroxine ```

finals (13 decks)

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