Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Week 22 - Brain metastasis, epilepsy, meningitis, migraine > Flashcards

Week 22 - Brain metastasis, epilepsy, meningitis, migraine Flashcards

1
Q

what are the four main types of migraines

A

migraine without aura
migraine with aura
silent migraine
hemiplegic migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the five stages of a migraine

A

premonitory or prodromal
aura (lasts for up to 60mins)
headache (lasts 4-72hrs)
resolution
postdromal or recovery phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what may the prodromal phase involve

A

subtle symptoms such as yawning, fatigue or mood change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the typical features of a migraine headache

A

usually unilateral
moderate-severe intensity
pounding or throbbing
photophobia
phonophobia
osmophobia
aura (visial changes)
nausea or vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what can migraine aura affect

A

vision, sensation or language

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the visual symptoms associated with aura

A

sparks in the vision
blurred vision
lines across the vision
loss of visual fields (scotoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what do sensation aura changes include

A

tingling or numbnessw

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what language aura symptoms may be found in migraine

A

dysphasia - difficulty speaking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the main features of hemiplegic migraines

A

hemiplegia - unilateral limb weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what other symptoms may be seen in hemiplegic migraines

A

ataxia - loss of coordination
impaired consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is familial hemiplegic migraine

A

an autosomal genetic condition characterised by hemiplegic migraines that run in families. however, they may occur without any genetic link or family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what can hemiplegic migraines mimic

A

can mimic a stroke or a TIA - it is essential to exclude a stroke with sudden-onset hemiplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the common triggers for the onset of migraines

A

Stress
Bright lights
Strong smells
Certain foods (e.g., chocolate, cheese and caffeine)
Dehydration
Menstruation
Disrupted sleep
Trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the acute medical management of migraines

A

NSAIDs (naproxen or ibuprofen)
paracetamol
triptans - sumatriptan
antiemetics if vomiting occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is NOT used in the treatment of migraines and why

A

opiates are NOT used to treat migraines and may make the condition worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when are triptans used

A

used to abort migraines when they start to develop.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the mechanism of action of triptans

A

They are 5-HT receptor agonists (they bind to and stimulate serotonin receptors), specifically 5-HT1B and 5-HT1D. They have various mechanisms of action, including:
- Cranial vasoconstriction
- Inhibiting the transmission
of pain signals
- Inhibiting the release of inflammatory neuropeptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the main contraindications related to triptans

A

vasoconstriction for example, hypertension, coronary artery disease, or previous stroke, TIA, or MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the usual prophylactic medications used to reduce the frequency and severity of migraine attacks

A

Propranolol (a non-selective beta blocker)
Amitriptyline (a tricyclic antidepressant)
Topiramate (teratogenic and very effective contraception is needed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

give two names of prophylactic triptans

A

frovatriptan or zolmitriptan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

when are prophylactic triptans used

A

for menstrual migraines

symptoms tend to occur two days before until three days after the start of menstruation

regular triprans may be used at this time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the risks associated with migraines

A

migraines are assoiated with a slightly increased risk of stroke, particularly when associated with aura.

the risk of stroke is further increased with the combined pill, making them a contraindication to the combined pill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is epilepsy characterised by

A

seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are seizures

A

transient episodes of abnormal electrical activity in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the common 5 types of seizures seen in adults

A

Generalised tonic-clonic seizures
Partial seizures (or focal seizures)
Myoclonic seizures
Tonic seizures
Atonic seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the types of seizures more commonly seen in children

A

absence seizures
infantile spasms
febrile convulsions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what do generalised tonic-clonic seizures involve

A

tonic (muscle tensing) and clonic (muscle jerking) movements associated with a complete loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are generalised tonic-clonic seizures also called

A

grand mal seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what may patients experience before a generalised tonic-clonic seizure

A

aura, an abnormal sensation that gives a warning that a seizure will occur.

there may be tongue biting, incontinence, groaning or irregular breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what happens after the seizure

A

there is a prolonged post-ictal period, where the person is confused, tired and irritable or low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

where do partial seizures/focal seizures occur

A

in an isolated brain area, often in the temporal lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what do partial seizures affect

A

hearing, speech, memory and emotions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the common state of the patient during a partial seizure

A

patients remain awake during partial seizures

they remain aware during simple partial seizures but lose awareness during complex partial seixures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what are the various symptoms associated with partial seizures, depending on the location of the abnormal electrical activity

A

Déjà vu
Strange smells, tastes, sight or sound sensations
Unusual emotions
Abnormal behaviours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

how do myoclonic seizures present

A

with sudden, brief muscle contractions like an abrupt jump or jolt. they remain awake.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what do tonic seizures involve

A

a sudden onset of increased muscle tone, where the entire body stiffens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what do tonic seizures usually result in and how long do they last

A

usually result in a fall if the patient is standing, usually backwards

they last only a few seconds, or at most a few minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what do atonic seizures involve

A

sudden loss of muscle tone, often resulting in a fallh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

how long do atonic seizures last and are patients awake during them?

A

They last only briefly, and patients are usually aware during the episodes. They often begin in childhood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what kind of syndrome may atonic seizures be indicative of

A

Lennox-Gastaut Syndrome

41
Q

what are absence seizures and in who are they usually found

A

usually seen in children.

the patient becomes blank, stares into space and then abruptly returns to normal

42
Q

what are infantile spasms also known as

A

West syndrome

43
Q

when do infantile spasms start

A

rare, start at around six months of age

44
Q

how does West syndrome present

A

with clusters of full-body spasms.

45
Q

what is the characteristic ECG finding in West syndrome

A

Hypsarrhythmia

46
Q

what is the treatment of West syndrome and what is the prognosis like

A

it is associated with developmental regression and has a very poor prognosis

treatment is with ACTH and vigabatrin

47
Q

what are febrile convulsions

A

tonic-clonic seizures that occur in children due to a high fever

48
Q

are febrile convulsions caused by epilepsy

A

no.
may occur in children between 6 months and 5 years

49
Q

what are the differential diagnoses for epilepsy

A

Vasovagal syncope (fainting)
Pseudoseizures (non-epileptic attacks)
Cardiac syncope (e.g., arrhythmias or structural heart disease)
Hypoglycaemia
Hemiplegic migraine
Transient ischaemic attack

50
Q

what will happen with the DVLA regarding epilepsy

A

the DVLA will remove their driving license until a specific criteria is met - e.g being seizure free for one year

51
Q

what are the safety precautions taken with epilepsy

A

Taking showers rather than baths (drowning is a major risk in epilepsy)
Particular caution with swimming, heights, traffic and dangerous equipment

52
Q

what does epilepsy treatment aim for

A

aim to be seizure free on the minimum anti-epilelptic medications

53
Q

what is given to men and women who cannot have children with generalised tonic-clonic seizures

A

sodium valrpoate

54
Q

what is given for generalised tonic-clonic seizures in women able to have children

A

lamotrigine or levetiracetam

55
Q

what is given for partial/focal seizures in all men and women

A

lamotrigine or levetracetam

56
Q

what is given for myoclonic and tonic/aclonic seizures in men and women who cannot have children

A

sodium valporate

57
Q

what is given for myoclonic seizures in women who can have children

A

Levetiracetam

58
Q

what is given for tonic and aclonic seizures in women who are able to have children

A

lamotrigine

59
Q

what is given in all men and women with absence seizures

A

ethosuximide

60
Q

how does sodium valporate work

A

increasing the activity of the GABA which has a calming effect on the brain

61
Q

what are the notable side effects of sodium valporate

A

teratogenic
liver damage and hepatitis
hair loss
tremor
reduce fertitilty

62
Q

what may sodium valporate cause in pregnancy

A

cause neural tube defects and developmental delay

63
Q

what is in place to ensure effective contraception and an annual risk acknowledgement form

A

the Valproate pregnancy prevention programme

64
Q

what is status epilepticus

A

a medical emergency defined as either:
- a seizure lasting more than 5 mins
- multiple seizures without regaining consciousness in the interim

65
Q

what does management of status epilepticus involve

A

an ABCDE approach, including;
Securing the airway
Giving high-concentration oxygen
Checking blood glucose levels
Gaining intravenous access (inserting a cannula)

66
Q

what is first line treatment for status epilepticus

A

a benzodiazepine first line, repeated after 5-10 mins if the seizure continues

67
Q

what are second and third line treatments for status epilepticus

A

Second-line options (after two doses of benzodiazepine) are IV levetiracetam, phenytoin or sodium valproate

Third-line options are phenobarbital or general anaesthesia

68
Q

what are the options for benzodiazepines

A

Buccal midazolam (10mg)
Rectal diazepam (10mg)
Intravenous lorazepam (4mg)

69
Q

what is meningitis

A

inflammation of the meninges due to infection.

70
Q

what are the meninges

A

are the lining of the brain and spinal cord.

CSF is contained within the meninges

71
Q

what are the causes of bacterial meningitis

A

Neisseria meningitidis
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae
Group B streptococcus (GBS) (particularly in neonates as GBS may colonise the vagina)
Listeria monocytogenes (particularly in neonates)

72
Q

what is neisseria meningitidis

A

a gram-negative diplococcus bacteria.

they are circular bacteria that occur in pairs

commonly known as meningococcus

73
Q

what is meningococcal meningitis

A

when the bacteria infects the meninges and the CSF.

74
Q

what does meningococcal septicaemia mean

A

when the meningicoccal bacterial infection is in the blood stream

this is what causes the non-blanching rash

75
Q

what are the most common causes of viral meningitis

A

Enteroviruses (e.g., coxsackievirus)
Herpes simplex virus (HSV)
Varicella zoster virus (VZV)

76
Q

what is used to treat herpes and varicella

A

aciclovir

77
Q

what are the typical symptoms of meningitis

A

Fever
Neck stiffness
Vomiting
Headache
Photophobia
Altered consciousness
Seizures

78
Q

what are the non-specific symptoms that neonates and babies can present with in the case of meningitis

A

hypotonia, poor feeding, lethargy, hypothermia and a bulging fontanelle

79
Q

what do the NICE guidelines on sepsis recommend as part of the investigation in children

A

The NICE guidelines on sepsis recommend lumbar puncture as part of the investigations for children with suspected sepsis who are:
- Under 1 month, presenting with fever
- 1 to 3 months and are unwell or have a low or high white blood cell count

80
Q

what are the two special tests you can perform to look for meningeal irritation

A

Kernig’s test
Brudzinski’s test

81
Q

what is involved in Kernig’s test

A

involves lying the patient on their back, flexing one hip and knee at 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees

this causes a slight stretch in the meninges. Where there is meningitis, it will produce spinal pain or resistance to movement

82
Q

what does Brudzinski’s test involve

A

lying the patient flat on their back and gently using your hands to lift their head and neck off the bed, flexing their chin to their chest

a positive test, indicating meningitis is when this causes the patient to flex their hips and knees involuntarily

83
Q

where is the needle usually inserted for lumbar puncture

A

L3-L4 or L4/L5 intervertebral space

84
Q

what is the appearance of bacterial and viral CSF

A

bacterial - cloudy
viral - clear

85
Q

what is the protein and glucose in bacterial and viral CSF

A

bacterial - protein is high and glucose is low

viral - protein is mildly raised or normal and the glucose is normal

86
Q

what is the white cell count in bacterial and viral CSF

A

bacterial - high WCC (neutrophils)

viral - high WCC (lymphocytes)

87
Q

what is the culture seen in bacterial and viral CSF

A

bacterial - bacteria
viral - negative

88
Q

TOM TIP: Lumbar puncture interpretation is a common exam question. Think about what will happen with bacteria or viruses living in the CSF rather than rote learning the results. Bacteria swimming in the CSF will release proteins and use up glucose. Viruses may release a small amount of protein and do not use up glucose. The immune system releases more neutrophils with bacteria and lymphocytes with viruses.

A
89
Q

which type of meningitis is the most serious

A

bacterial meningitis is the most serious and is a medical emergency

90
Q

what are children seen in primary care given if they have suspected meningitis AND a non-blanching rash

A

urgent dose of benzylpenicillin (IM or IV) while awaiting transfer to hospital

91
Q

what are the blood tests for bacterial meningitis

A

Blood tests should include a meningococcal PCR if meningococcus is suspected. This tests for meningococcal DNA. It can give a result faster than blood cultures (depending on local services) and will still be positive after the bacteria has been treated with antibiotics.

92
Q

what is added to treatment of meningitis if viral meningitis is suspected

A

aciclovir - herpes simple virus

93
Q

when should vancomycin be added to meningitis treatment

A

if there is a risk of penicillin-resistant pneumococcal infection (e.g., recent foreign travel or prolonged antibiotic exposure).

94
Q

why are steroids used in bacterial meningitis treatment

A

to reduce the frequency and severity of hearing loss and neurological complications

95
Q

which types of meningitis are notifiable disease to the UK health security agency

A

Bacterial meningitis and meningococcal infection

96
Q

what is the usual choice for post exposure prophylaxis in the case of meningococcal infection

A

single dose of ciprofloxacin

97
Q

what are the complications of meningitis

A

Seizures and epilepsy
Cognitive impairment and learning disability
Memory loss
hearing loss - A KEY COMPLICATION
Focal neurological deficits, such as limb weakness or spasticity

98
Q
A

Year 3 (63 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions