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Flashcards in Week 5 Deck (99):
1

Are febrile fits epilepsy risk factors?

Yes

2

What can opiods, anti-emetics, antibiotics, analgesics (tramadol), amphetamines and aminophylline/theophylline all cause?

Epilepsy

3

What investigation is mandatory when approaching the fallen?

ECG

4

What investigation classifies epilespy, confirms non-epileptic attacks, surgical evaluation and confirms non-convulsive status?

EEG - electroencephalogram - recording brain activity

5

if you have had one seizure how long can you not drive a caqr for?

6 months

6

What is the definition of epileptic seizures?

Abnormal synchronisation of neuronal activity

7

In epiletpic seizures - why does abnornal synchronisation of neuronal activity happen?

Too much excitation
Too little inhibition
Changes

8

What is a partial simple epileptic seizure?

Without impaired consciousness

9

What is a partial complex epileptic seizure?

With impaired consciousness

10

What sensory semiology can partial seizures have?

Olfactory, gustatory, visual and auditory

11

Can generalised seizures start from a focal point?

Yes

12

What type of epilepsy: most have genetic predisposition, present in childhood and adolescence, generelaised spike wave abnormalities on EEG, tonic clonic, absence, myoclonic, clonic, tonic and atonic?

Generalised epilepsy

13

Wake up in morning and are stumbling and clumsy, dropping things?

Generalisd seizures

14

When does primary generalised epilepsy present?

Childhood or teens

15

What is treatment of choice for primary generalised epilepsy?

Sodium valproate - lamotrigine as alternative

16

Give a side effect of sodium valproate?

Teratogenic

17

What is juvenile myoclonic epilepsy an example of?

primary generalised epilepsy

18

Early morning jerks, generalised seizures, risk factosr are sleep deprivation, flashing lights?

Juvenile myoclonic epilepsy

19

When is the onset of focal onset epilepsy?

Any age - underlying structural cause

20

What is treatment for focal onset epilepsy?

Carbamazepine or lamotrigine

21

What can focal onset epilepsy frequently cause?

Complex partial seizures with hippocampal sclerosis

22

What do AEDs target?

Presynaptic excitability and neurotransmitter release

23

What do these drugs inhibit - carbamazepine, lamotrigine, oxcarbazepine, phenytoin?

Voltage gated sodium channels - influx increases excitability

24

K+ efflux reduces neuronal excitability, what increases channel activity?

Retigabine

25

What two drugs inhibit Ca2+ channel influx?

Pregablin and gabapentin

26

What AED binds to SV2A, interfering with synaptic vesicles and inhibiting neurotransmitter release?

Levetiracetam

27

What AED enhances GABA synthesis?

Sodium valproate

28

What AEDs target the GABAA receptor, reduce neuronal excitability and increases GABAA receptor activity?

Benzodiazepines, barbiturates, felbamate, topiramate

29

What drug targets GABA transaminase to stop degradation of GABA?

Vigabatrin (elevates GABA levels)

30

What does tiagabine target?

GABA transporter, removes GABA from synapse

31

What two AED should not be prescribed together?

Sodium valproate and lamotrigine

32

Give the initial treatment for partial seizures?

Carbamazepine
Lamotrigine

33

What treatment is for generalised seizures (absence)?

1. Sodium valproate
2. Ethosuximide

34

What treatment is for generalised seizures (myoclonic)?

1. Sodium valproate
2. Levetiracetam
3. Clonazepam

35

What treatment is for generalsied seizures (atonic, tonic, generalised tonic clonic)?

Soidum valproate

36

What AED causes gum hyperrophy?

Phenytoin

37

What drug should never bebn given in generalised epilepsy?

Carbamazepine

38

Give four side effects of sodium valproate?

1. Weight gain
2. Teratogenic
3. Har loss
4. Fatigue

39

What AED is for acute management only, rapid loading possible, enzyme enducer?

Phenytoin

40

What does levetiracetam cause?

Mood swings

41

What AED causes sedation, dysphasia and weight loss?

Topiramate

42

What do carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primidone, topiramate all induce?

Hepatic enzymes
COT3P

43

What do carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primidone, topiramate all alter the efficacy of?

Combined oral contraceptive pill
COT3P

44

What is not adequate if taking enzyme inducing AEDs (COT3P) and dose should be increased?

Morning after pill

45

What is the term for recurrent epileptic seizures without full recovery of consciousness?

Status epilepticus - continuous seizure activity lasting more than 30 minutes

46

Epilepsia partialis continua is a type of status epilepticus - what is it?

Continual focal seizures, consciousness preserved

47

Sudden onset severe headache, collapse, vomiting, neck pain, photophobia?

SAH

48

What focal neurological deficits are present in SAH?

1. dysphasia
2. hemiparesis
3. 3rd nerve palsy

49

What investigation is safe in alert patients with no neurological focal deficit and no papilloedema?

Lumbar puncture

50

SAH lumbar puncture- what does it show?

Blood stained or xanthochromic CSF

51

What is the gold standard for SAH?

Cerebral angiographt

52

Give five complications of SAH?

1. Re-bleeding
2. Delayed ischaemic deficit
3. Hydrocephalus
4. Hyponatraemia
5. Seizures

53

Delayed ischaemic neurological deficit is a complication of SAH. How is it treated?

Nimodipine - CCB
High fluid intake tripe H therapy

54

How do you treat hydrocephalus?

CSF drainage- LP, EVD, shunt

55

How do you treat hyponatraemia caused by SAH?

Fludrocortisone

56

What is bleeding into brain parenchyma?

Intracerebral haemorrhage

57

What are 50% of intracerebral haemorrahges due to and what are 30% due to?

50% - hypertension
30% - aneurysm or AV malformation

58

What shows Charcot Bouchard microaneurysms arising on small perforating arteries and basal ganglia haematoma?

Hypertensive Intracerebral Haemorrhage

59

What are two investigations ofr ICH?

CT
Angiography

60

What occurs with rupture of a subarachnoid or intracerebral bleed into a ventricle?

Intraventricular haemorrhage

61

What can cause intraventricular haemorrhage?

AV malformations - steal syndrome, headache

62

What gies from motor cortex to anterior grey horn and decussates at medullary level?

Upper motor neurone

63

What is the anterrior horn cell of corticospinal tract?

Lower motor neurone

64

Is the corticospinal tract ipsilateral or contralateral?

Ipsilateral

65

Give four features of Upper Motor Neurone Lesion?

1. Increased tone
2. Muscle wasting NOT marked
3. No fasciculation
4. Hyper - reflexia

66

Give four features of Lower Motor Neurone Lesion?

1. Decreased tone
2. Muscle wasting
3. Fasciculation
4. Diminished reflexes

67

Ipsilateral motor level
Ipsilateral dorsal column sensory level
Contralateral spinothalamic sensory level

Brown sequard syndrome
cord hemisection

68

What causes central cord syndrome?

Hyperflexion or extension injury to already stenotic neck

69

What gets weakness in central cord sybndrome?

Distal upper limb weakness - wrists and elbows

70

Cape like spinothalamic sensory loss?

Central cord syndrome

71

What colums are preserved in central cord syndrome?

dORSAL

72

how do you treat spinal cord metastatic tumours?

Dexamethasone
Radiotherapy
Surgery

73

What part of brain is affected in ataxia?

Cerebellum

74

In upper motor neuron pattern there is pyramidal/corticospinal patter nof weakness - whjat does it involve?

Weak extensors of arm
Weak flexors of leg

75

What lobe enables self critisism and trying again?

Frontal lobe

76

What lobe is affected in brocos dysphasia?

Dominant frontal lobe

77

Memory dysfunction nad difficulty recognising things?

Temporal lobe lesion

78

What lobe is affected iun Wernickes disorder?

Temporal

79

What lobe in congruous upper homonymous quadrantanopia?

Temporal lobe

80

Visual field defect (congruous lower homonymous quadrantanopia)

parietal lobe

81

Gerstmann’s syndrome (disease of the dominant angular gyrus, part of the inferior parietal lobe): Dysgraphia, left-right disorientation, finger agnosia, acalculia

Parietal lobe

82

What lobe in inattention and denial?

Parietal

83

What condition are COMT inhibitors such as entacapone and tocapone used for?

Parkinsons

84

The mainstay treatment of PD is levodopa which can lead to what?

Dyskinesias

85

Visual compromise, stiffness and weakness ?

MS

86

nAME A Pure upper motor neurone syndrome of MND?

Primary lateral sclerosis

87

What stroke related syndrome - no visual field defect, pure motor hemiparesis, or pure sensory deficit on one side of body, clumsy hand syndrome?

Lacunar syndromes

88

Cranial nerve palsy
Unilateral or bilateral motor or sensory deficit
Disorder of conjugate eye movements
Cerebellar dysfunction
Homonymous hemianopia
Cortical blindness

posterior circulation syndrome

89

where is stroke lesion?
Hemiplegia and homonymous hemianopia contralateral to the lesion, and
Either aphasia or visuospatial disturbances
+/- sensory deficit contralateral to the lesion

Total anterior circulation syndromes

90

where is stroke lesion?
One or more of unilateral motor or sensory deficit, aphasia or visuospatial neglect (with or without homonymous hemianopia)
Motor or sensory deficit may be less extensive than in lacunar syndromes

Partial anterior circulation syndromes

91

What term is given to glove and stocking type peripheral neuropathy with weakness and or loss of sesnation?

Length dependant peripheral neuropathy

92

Name an acute condition of demyelinating neuropathy?

Guillaine barre syndrome

93

Name a chronic demyelinating neuropathy?

CIDP
Hereditary sensory motor neuropathy = charcot marie tooth disease

94

Progressive paraplegia over days, pain common, post infection campylobacter?

Guillain Barre Syndrome

95

Pure motor, sensory, sensorimotor, small fibre (congenital insensitivity to pain syndrome) and autonomic variants.
Demyelinating and axonal varieties.
Genetic testing available for the most common mutations (eg CMT1a)

Hereditary neuropathy

96

Treatment of peripheral neuropathy - axonal vasculitic?

Pulsed IV methylprednisolone and cyclophosphamide

97

Treatment of peripheral neuropathy demyelinating?

IVIg pooled immunoglobulin
Steroids
Azathioprine, mycophenalate and cyclophosphamide

98

What nerve fibres are damaged in muscle control, touch vibration, position, perception?

Large

99

What nerve fibres are damaged in cold, perception and pain?

Small