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Neurology > Step 2 > Flashcards

Step 2 Flashcards

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1
Q

reflex grading

A

0 absent
+1 hypoactive
+2 normal
+3 hyperactive
+4 clonus

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2
Q

function of dorsal column

A

proprioception, fine touch, vibration sense, two-point discrimination

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3
Q

function of spinothalamic tract

A

pain and temperature

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4
Q

function of corticospianl tract

A

motor movement of limbs

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5
Q

preventative medications for migraine

A

propranolol
topiramate
nortryptilline

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6
Q

risk factor for cluster headache

A

smokers

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7
Q

best initial treatment for cluster headache

A

100% 02 or sumatriptan injection

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8
Q

how many attacks are needed for migraine diagnosis

A

5

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9
Q

preventative medication of choice for migraine in pregnancy

A

propranolol

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10
Q

preventative treatment for cluster headache

A

verapamil - often given with prednisolone (10 day course)
other options include Na valproate, topiramate, lithium

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11
Q

what underlying condition should you suspect if bilateral trigeminal neuralgia

A

multiple sclerosis

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12
Q

main risk factors for lacunar stroke and how would this present

A

hypertension, diabetes, smoking

pure motor, pure sensory, ataxic hemiparesis, dysarthria or clumsy hand

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13
Q

stroke involving what artery can cause neglect

A

stroke of the middle cerebral artery in the non-dominant hemisphere

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14
Q

stroke involving what artery can cause aphasia

A

stroke involving the middle cerebral artery of the dominant hemisphere

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15
Q

stroke involving what artery causes homonymous hemianopia with macular sparing

A

posterior cerebral artery
(without macular sparing is middle cerebral artery)

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16
Q

sudden headache, neck pain and horner syndrome

A

carotid artery dissection

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17
Q

weber syndrome

A

occlusion of a branch of the posterior cerebral artery cauing;
- ipsilateral CN III palsy
- contralateral hemiparesis
- parkinsonism rigidity (if susbtantia nigria is involved)

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18
Q

60 yr patient with chronic hypertension presents with extreme pain over his left leg. he was recently discharged from hospital 3 months ago after suffering a stroke. ?diagnosis

A

thalamic pain syndrome from lacunar stroke
often presents a few weeks after the event with a hypersensitive pain response over the contralateral affected area of the body

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19
Q

how would a posterior inferior cerebellar artery stroke present

A

loss of pain and temperature on ipsilateral face and contralateral body
ipsilateral bulbar weakness/dysarthria
ipsilateral horner syndrome
vertigo, nystagmus, hiccups

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20
Q

BP, glucose, platelet and INR counts that are contraindications to TPa therapy for stroke

A

BP >185 or > 110
glucose < 50 or > 400
platelet < 100,000
INR >1.7 or prolonged aPTT

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21
Q

contraindications to tpa therapy for stroke

A

stroke or head trauma in past 3 months
TIA within past 6 months
major surgery past 2 weeks
MI past 3 months
GI or urinary bleeding in the past 21 days
prev intracranial haemorrhage
INR >1.7 or prolonged aptt
glucose < 50 or >400
platelets < 100,000
BP >180 systolic or > 110 diastolic
seizure at onset of symptoms

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22
Q

target glucose in management of stroke

23
Q

target BP if haemorrhagic conversion of stroke

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A

systolic < 140

24
Q

target BP after and within 24 hrs of receiving TPa therapy for stroke

Study These Flashcards
A

< 185/105mmHg

25
causes of xanthochromia on LP
SAH HSV encephalitis
26
risk factors for berry aneurysms
hypercholesterolaemia smoking ehlors danlos ADPKD coarctation of aorta marfans syndrome sickle cell
27
CT confirms sub arachnoid haemorrhage, next step in investigations?
non-invasive CT angiography (such as four-vessel angiography or CTA with 3D reconstructions)
28
preventative measures to reduce complications after SAH
maintain BP < 150 systolic to prevent re-bleed nimodipine to prevent vasospasm and subsequent ischaemic stroke watch for raised ICP and hydrocephalus
29
most common causative orgnaism of cavernous sinus thrombosis
septic thrombosis = staph aureus
30
main investigative modality for suspected cavernous sinus thrombosis
MRI with gondolinium and MR angiography
31
patient appears with 3 day onset of left periorbital pain, swelling, diplopia and inability to abduct left eye. pt discloses he popped a spot on his lower forehead last week ?diagnosis ?investigation
cavernous sinus thrombosis MRI with gondolinium and MR angiography treatment = vanc + ceftriaxone/cefepime + heparin/LMWH
32
treatment for cavernous sinus thrombosis
vancomycin + third generation cephalosporin (i.e. ceftriaxone or cefepime) continue for 3-6 weeks heparin or LMWH to reduce mortality antifungals if positive culture metrondiazole if anaerobic
33
if someone is found to be in a coma and cause is unknown, what medications should be prescribed ?
administer DONT to treat the treatable causes of coma; dextrose oxygen naloxone thiamine
34
peristsent vegetative state vs coma
persistent vegetative state - eyes open but not aware, sleep wake cycles coma - eyes closed, not aware, no sleep-wake cycles
35
artery affected in wenickes vs brocas aphasia
wenickes - posterior inferior middle cerebral artery, posterior superior temporal lobe brocas - superior middle cerebral artery, posterior inferior frontal cortex
36
fluent speech with abnormal words with intact cognition
conductive aphasia wernickes present similarly but no comprehension
37
impaired fluency of speech with intact repetition
broca's and wernickes has impaired repetition if repetition is intact = transcortical motor aphasia (damage around either broca's or wernickes areas)
38
imapired consciousness and lip smacking ?type of seizure
complex partial
39
uncontrollable twitching of thumb and intact awareness ?type of seizure
simple partial
40
treatment for status epilepticus not resolving despite IV lorazepam ?next step in management
consider use of IV fosphenytoin, IV leveteracitam or IV valproic acid if still persistent despite this then consider medically induced coma
41
how to differentiate seizure from pseudoseizure on bloods
generalised and complex partial seizures will have high prolactin in immediate post-ictal period but will be normal in pseudoseizure
42
1st line treatment for epilepsy in children
leveteracitam
43
1st and 2nd line option for absence seizure
1st line = ethosuximab 2nd line= valproic acid
44
patient has epilepsy and has been tried on carbamazepine however symptoms not managed on this. ?next step
trial of another medication as monotherapy once x2 trials of monotherapy have failed --> adjunct therapy
45
EEG shows 3 per second spike and wave discharged ?seizure type
absence seizure
46
EEG shows 10Hz activity and alternating slow wave ?seizure type
tonic clonic
47
options for first line medication used in status epilepticus
given after seizure persists for > 5 minutes 1st line - benzodiazepines - IV lorazepam - IV diazepam - phenobarbital - rectal diazepam in children - intranasal midazolam
48
treatment for labrynthitis / vesticular neuritis
steroids given < 72hrs after symptom onset anti-vertigo agents e.g. meclizine anti-emetics
49
treatment for acute attacks in menieres disease
Meclizine or benzodiazepines antiemetics for N&V severe unilateral attacks - gentamicin intra-tympanic injection into middle ear canal
50
treatment for chronic menieres disease
lifestyle changes; reduce salt, nicotine, caffeine and alcohol intake to reduce water retention if persistent despite lifestyle changes; Betahistine or diuretics
51
close contacts to those with confirmed meningococcal meningitis should be treated with what
rifampicin, ceftriaxone (preferred in pregnancy) or ciprofloxacin (avoid in < 18yrs and pregnancy) + pneumococcal vaccine
52
role of dexamethasone in meningitis
dexamethasone can reduce mortality, hearing loss and short term neurological deficits in meningitis caused by strep pneumoniae in adults if given 15-20 BEFORE antibiotics decreases hearing loss in children esp H.influenzae meningitis
53
rostral vermis syndrome
cerebellar ataxia with no other cerebellar signs caused by chronic alcohol use

Neurology (6 decks)

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