Term
| benign intracranial HTN mx |
|
Definition
repeated LP and acetazolamide
can be caused by a number of drugs e.g tetracyclines
occurs in overweight women
other drugs implicated:-
COCP
lithium
levothyroxine |
|
|
Term
| which drug can be used to treat neuroleptic malignant syndrome? |
|
Definition
| bromocriptine. it is a DA agonist |
|
|
Term
what does ABCD2 stand for
what does it mean? |
|
Definition
Age > 60
BP > 140/90
Clinical : unilateral weakness =2, speech disturbance =1
Duration: 10-59=1 and >60min =2
Diabetes =1
total score of 0-7 |
|
|
Term
| how would you used the ABCD2 score to manage your pt? |
|
Definition
the socre is from 0-7.
4 or more means you should
aspirin 300mg stat
seen by specialis within 24hour symptom onset
secondary prevention measures introduced as soon as diagnosis is made. |
|
|
Term
| ABCD2 score is 3 or less how do you proceed? |
|
Definition
specialist assessment within 1 week of symptom onset
consider brain imaging |
|
|
Term
| a pt has a ABCD2 score of 3 but are experiencing crescendo TIAs how would you treat them> |
|
Definition
|
|
Term
1st line antithrombotic for people who have had a stroke?
what if they cant tolerate it? |
|
Definition
1st line: clopidogrel
if not tolerated then aspirin and dipyridamole |
|
|
Term
| features of migraine without aura |
|
Definition
typical unilateral
photo or phonophobia
last 4-72hours
nausea or vomiting
pulsatile quality, throbbing
not attributed to any other cause |
|
|
Term
| which nerve and nerve root is elicited in triceps reflex? |
|
Definition
|
|
Term
which nerve is injured in brachial plexus injuries?
clue C5-C7 |
|
Definition
|
|
Term
a person has a humeral neck fracture (NOT SHAFT #)
which nerve is like to be injured?
clue C5 -6 |
|
Definition
|
|
Term
person presents with wrist drop. which nerve is affected?
a fracture where in upper arm can affect radial nerve? |
|
Definition
Radial nerve
fracture of the mid shaft of humerus can affect radial nerve. C5-C8 |
|
|
Term
| which nerve supplies intrinsic hand muscles except LOAF? |
|
Definition
|
|
Term
medial epicondyle # affects which nerve?
damage to which nerve results in partial claw hand? |
|
Definition
ulnar nerve
also damage to this nerve results in partial claw hand. the ring and pinky be clawed |
|
|
Term
| C5, 6 7 bells of heaven. which nerve am I talking about? |
|
Definition
|
|
Term
| C5 6 palsy from shoulder dystocia AKA? |
|
Definition
| erbs palsy, due to damage to upper trunk of brachial plexus |
|
|
Term
| what palsy results from damage to lower trunk of brachial plexus? |
|
Definition
Klumpkes injury
C8, T1
associated with Horners syndrome |
|
|
Term
| what are the LOAF muscles? |
|
Definition
Lateral 2 lumbrical
Opponens pollis
Abductor pollic brevis
Flexor pollis brevis |
|
|
Term
| benserazide or carbidopa would be combined with which drug to rx parkinsons? |
|
Definition
|
|
Term
| which MAO-b inhibitor is used in Parkinsons disease and its MOA is to inhibit the breakdown of DA secreted by dopaminergic receptors |
|
Definition
|
|
Term
| features of cluster headaches |
|
Definition
more common in men
more common in smokers
positive FHx
usually non throbbing
autonomic symptoms
partial ptosis is also common
mx: 100%, SC or nasal triptan
prophylaxis: verapamil or prednisolone |
|
|
Term
| dermatomes: posterior half of skull cap? |
|
Definition
|
|
Term
| you wear a high turtleneck shirt to cover which dermatome? |
|
Definition
|
|
Term
| ring and little finger makes which dermatome? |
|
Definition
|
|
Term
| xiphoid process is which dermatome? |
|
Definition
|
|
Term
|
Definition
L1
l for ligament
1 for 1nguinal |
|
|
Term
|
Definition
L5
also supplies dorsum of foot except lateral aspect |
|
|
Term
L5 and S1 supply different parts of the foot
what are they and how do you remember it? |
|
Definition
L5 supplies big toe and dorsum of foot except lateral aspect.
remember L = largest of 5 toes.
S1 supplies little toe and lateral aspect of dorsum of foot
remember S = smallest of toes |
|
|
Term
| a person with epilepsy controlled by medications must be seizure free for how long in order to be able to drive their car? |
|
Definition
|
|
Term
| 1st seizure. how long off driving? |
|
Definition
6 months
established epilepsy? need to be seizure free for 1 year |
|
|
Term
if you have a stroke or TIA how long off driving?
do you need to tell DVLA? |
|
Definition
1 month off driving
do not have to tell DVLA if you have no focal neurological deficits. |
|
|
Term
| if you have multiple TIAs over a short period of time how long off driving? |
|
Definition
| 3 months and also tell DVLA |
|
|
Term
| what type of stroke results when the penetrating arteries to the brains deep structures is blocked? |
|
Definition
lacunar stroke
present with pure motor or pure sensory
or sensorimotor
ataxix hemiparesis
dysarthria/clumsy hand syndrome |
|
|
Term
what doe total anterior circulation infarcts involve?
arteries are middle and anterior |
|
Definition
unilateral hemiparesis of face/arm/leg
homonymous hemianopia
higher cognitive dysfunction.
if only 2/3 are present then it is a partial anterior circulation infarct |
|
|
Term
if a pt presented with any of the following symptoms what type of stroke would you be thinking?
pure sensory stroke
ataxic hemiparesis
unilater weakness +/- sensory loss to face arm, leg or all three |
|
Definition
|
|
Term
how would posterior circulation infarcts present?
which arteries do they involved? |
|
Definition
presentation: cerebellar or brainstem syndromes
LOC
isolated homonymous hemianopia
they invoved vertebrobasilar arteries |
|
|
Term
|
Definition
ipsilateral CN III palsy
contralateral weakness |
|
|
Term
|
Definition
ipsilateral : ataxia, facial numbers, nystagmus, CN palsy e.g horners
contralateral: limb sensory loss |
|
|
Term
Wallenberg's syndrome AKA?
which artery does it affect? |
|
Definition
Lateral Medullary Syndrome
posterior inferior cerebellar artery |
|
|
Term
| how are strokes classified |
|
Definition
| oxford stroke classification AKA Bamford stroke classification |
|
|
Term
| what is the difference between simple and complex partial seizures? |
|
Definition
| with simple ones there is no disturbance of consciousness or awareness |
|
|
Term
| a pt presents with Parkinson's disease plus dysarthria and reduce vertical eye movements. what are you thinking? |
|
Definition
| Progressive supranuclear palsy |
|
|
Term
| which dementia may result from chronic head trauma e.g boxers? |
|
Definition
|
|
Term
| parkinsonian plus syndromes what are they and how would you question read this? |
|
Definition
Multi system atropy
Progressive supra nuclear palsy
if someone in the q has parkinsonism but also symptoms that suggest the cause is not idiopathic then you should consider parkinsonism plus syndrome |
|
|
Term
Parkinsons plus postural hypotension = ataxia
which Parkinson plus syndrome is it most likely? |
|
Definition
|
|
Term
| what classification do you use to asses someone who comes in with a suspected stroke? |
|
Definition
ROSIER
recognition of stroke in emergency room |
|
|
Term
How to use the ROSIER score?
what score suggests a stroke is likely? |
|
Definition
first exclude hypoglycaemia then assess the following
LOC/syncope -1
Seizure -1
new acute onset of:-
asymmetric facial weakness +1
asymmetric leg weakness +1
asymmetric arm weakness +1
speech disturbance +1
visual field defect +1
Stroke is likely is score is >0 |
|
|
Term
| resting pill rolling tremor would be seen in which condition? |
|
Definition
|
|
Term
list features of essential tremor
this is improve by alcohol and rest |
|
Definition
strong FHx
POSTURAL TREMOR: WORSE WHEN ARMS OUTSTRETCHED
titubation: head nodding. |
|
|
Term
| antibodies against pre synaptic voltage gate calcium channels. I am a para neoplastic syndrome. whats my name? |
|
Definition
Lambert-Eaton syndrome
most have underlying malignancy small cell lung cancer
it typically affects muscles of proximal arms and legs
affects |
|
|
Term
|
Definition
Triptan Sensations: tingling, heat, tightness, heaviness, pressure in throat or chest
CI: Hx or significant risk factors for IHD or CVD |
|
|
Term
| Cutaneous features of Tuberous Sclerosis? |
|
Definition
AD condition
Depigmented patches of skin called Ash leaf spots : fluoresce under UV light
Shagreen patches: roughened skin over Lumbar spine
adenoma sebaceum in a butterfly distribution over the nose
Fibromata beneath nails
café au lait spots |
|
|
Term
| what medication and dose would you administer to an alcoholic fitting and who continues to fit 5 mins after oxygen is given? |
|
Definition
Rectal diazepam 10mg
repeat once after 10-15 mins if necessary |
|
|
Term
| if a stroke was in the anterior cerebral artery where would the patient experience greater sensory loss? upper or lower limbs? |
|
Definition
| lower limbs would be more affected than the upper limbs |
|
|
Term
| if a person had sensory loss after a stroke and the upper limbs were more affected than the lower limbs, where would the stroke be? |
|
Definition
|
|
Term
| associated effects of having a middle cerebral artery stroke |
|
Definition
contralateral hemiparesis
sensory loss upper> lower extremities
contralateral homonymous hemianopia
Aphasia |
|
|
Term
| when would you get contralateral homonymous hemianopia with macula sparing? ie where must the stroke be? |
|
Definition
| posterior cerebral artery |
|
|
Term
| stroke in which artery results I locked in syndrome? |
|
Definition
|
|
Term
| what is the term given to the sudden and transient loss of muscular tone caused by strong emotion? |
|
Definition
cataplexy
~ 2/3 of people with narcolepsy have cataplexy |
|
|
Term
| what is the most common cause for a high stepping gait in a bilateral foot drop? |
|
Definition
peripheral neuropathy
if unilateral foot drop then think lesion in common peroneal nerve. |
|
|
Term
what is syringomyelia and when does it become syringobulbia?
what are the typical features? |
|
Definition
syringomyelia is when there is a development of a cavity within the SC.
if this cavity extends to the medulla it is cally syringobulbia.
features of syringe myelia:-
can be asymmetrical initially then progresses slowly in a shawl like pattern
motor: wasting and weakness of arms
sensory: spinothalamic sensory loss (pain and temp)
loss of reflexes: bilateral up going plantars
also seen: Horner's syndrome |
|
|
Term
| causes of bilateral facial nerve pasly? |
|
Definition
Sarcoid
GBS
Lyme disease
Polio |
|
|
Term
| causes of unilateral facial nerve palsy |
|
Definition
Bells
Ramsey Hunt
HIV
Diabetes
Parotid gland tumour
MS
acoustic neuroma |
|
|
Term
if a person has stroke what level of cholesterol would make you initiate a statin?
many people wait to start pt on statin until 48 hours after. why is this? |
|
Definition
levels > 3.5 and you should give statin.
clinicians wait 48 hours before starting statin because there is a risk of hemorrhagic transformation |
|
|
Term
in a stroke when can thrombolysis be given?
what is recommended by NICE? |
|
Definition
if presentation is with in 4.5 hours of symptom onset
if haemorrhagic stroke has been excluded.
Alteplase recommended by NICE. |
|
|
Term
| after stroke which medication is recommended 1st line in pts? |
|
Definition
Clopidogrel
if they cannot take this then
aspirin and MR dipyramidole
if aspirin and clopidrogrel CI then dipyramidole alone. |
|
|
Term
|
Definition
| inhibits phosphodiesterase enzymes and increases cellular cAMP levels. |
|
|
Term
MOA of sodium valproate is to increase GABA activity
what are the side effects? |
|
Definition
increased appetite and weight gain
alopecia: regrowth may be curly
hyponatremia
tremor
pancreatitis
hepatitis |
|
|
Term
in CSF analysis the cells are predominantly lymphocytes and the glucose is more than half the value of the serum glucose.
lymphocytes can mean viral or TB meningitis but how would you use the glucose reading to differentiate the cause? |
|
Definition
the cause is viral because the glucose is > 50% of the serum value.
In TB yes there would be lymphocytes predominating but the glucose would be low. |
|
|
Term
| in which form of meningitis would the appearance of CSF look like a fibrin web? |
|
Definition
|
|
Term
features of MSA
shy-dragger is a subtype of MSA |
|
Definition
parkinsons sign
autonomic signs (atonic bladder, postural hypotension)
cerebellar signs |
|
|
Term
| most clinicians start meds after 2nd seizure. when does NICE recommend starting meds after the first seizure? |
|
Definition
if there is a neuro deficit
brain imaging shows structural abnormality
if pt and their family feel a second seizure is unacceptable
EEG shows unequivocal electrical activity |
|
|
Term
| for partial seizures which medication is 1st line? |
|
Definition
|
|
Term
| for generalised seizures which medication is first line? |
|
Definition
Sodium Valproate
2nd line: lamotrigine , carbamazepine |
|
|
Term
| absence seizures 1st line? |
|
Definition
| ethosuximide or valproate |
|
|
Term
| which type of seizure can carbamazepine exacerbate? |
|
Definition
|
|
Term
| a pt is on parkinsons medication you don't know which one. you take a urine sample and leave it to stand. it turns reddish and this gives you the answer? |
|
Definition
Levodopa.
the effects of this drug usually wear off in 2 years so this is why clinicians tend to wait until later years to use medication |
|
|
Term
| in CN III palsy how would the eye be resting? |
|
Definition
|
|
Term
| crossed findings are characteristic of brainstem infarcts. what would you see in Webers syndrome? |
|
Definition
ipsilateral CN III palsy
contralateral weakness |
|
|
Term
| man with bad asthma and bad migraine presents to GP. you know NICE says for migraine prophylaxis you can give propranolol or topiramate. which one wold you give him and why? |
|
Definition
Topimarate because he has asthma and beta blockers are not advised in asthma.
but if it was a women of child bearing age you would give propranolol over topiramate because topiramate can be teratogenic and also reduce effectiveness of COCP |
|
|
Term
| when should you start prophylaxis treatment of migraine? |
|
Definition
| when they are having 2 or more attacks per month |
|
|
Term
|
Definition
acute: PO triptan and NSAID
prophylaxis: topiramate or propranolol
2nd line: 5-10 sessions of acupuncture over 5-8 weeks or gabapentin
advice people that riboflavin 400mg OD might be useful in reducing frequency and intensity in some people. |
|
|
Term
|
Definition
rebleeding
obstructive hydrocephalus due to blood in ventricles
vasospasm leading to cerebral ischemia |
|
|
Term
| which medication might you give post op after SAH surgery to reduce severity of neurological deficits? |
|
Definition
Nimodipine 60mg/ 4hourly
calcium channel blocker |
|
|
Term
| which type of MND presents with mainly UMN in lower limbs and LMN in upper limbs? |
|
Definition
amyotrophic lateral sclerosis
familial causes are associated with ch21. disruption on the super oxide dismutase gene |
|
|
Term
| a man has presented with stroke, ECG also shows he has AF. what is the initial management? |
|
Definition
Aspirin is the initial management.
although he is in AF we do not give anticoagulation in the first 14 days after stroke due to the chance it can exacerbate secondary haemorrhage. |
|
|
Term
ptosis and dilated pupil v
ptosis and constricted? |
|
Definition
pptosis and dilated = CN III palsy
ptosis and constricted = Horners |
|
|
Term
| which vitamin deficiencies can cause sub acute combine degeneration of the spinal cord? |
|
Definition
| vitamin B12 and Vitamin E |
|
|
Term
| which 2 strep are linked to bad oral hygene? |
|
Definition
| strep mitis and sanguinis |
|
|
Term
| which heart defect can allow a venous cloth to pass to the left side of the heart and cause a stroke? |
|
Definition
|
|
Term
|
Definition
| if seizure free for > 2 years. the meds are weaned over 2-3 months |
|
|
Term
acute management of stroke dose and length
lt mx? dose and length |
|
Definition
acute: 300mg aspirin after ischemic stroke is confirmed, cx for 14 days
LT: 75mg clopidogrel |
|
|
Term
| which type of haemorrhage occurs as a complication to chronic hypertension and is life threatening? |
|
Definition
Pontine haemorrhage
pts often present with reduced GCS
quadriplegia
miosis
and absent horizontal eye movements. |
|
|
Term
| in median nerve entrapment there is weakness of thumb abduction. which muscle is this? |
|
Definition
|
|
Term
| mx of median nerve entrapment? |
|
Definition
wrist splints at night
corticosteroids
surgery: flexor retinaculum division |
|
|
Term
features of cubital tunnel syndrome.
this is due to compression of the ulnar nerve |
|
Definition
intermittent tingling of 4th and 5th fingers
this may be worse when elbow is rested on a firm surface or is flexed for extended periods
later there is numbness in 4th and 5th fingers with associated weakness.
affects men twice as much as women |
|
|
Term
| mx of cubital tunnel syndrome |
|
Definition
physio
pain killers
surgical transposition of the nerve |
|
|
Term
| a pt has anterior resection rectum surgery. which nerve is at increased risk for damage? |
|
Definition
| hypogastric autonomic nerves |
|
|
Term
| a man has surgery to fix an inguinal hernia, which nerve Is at risk? |
|
Definition
|
|
Term
| carotid endartecomy can damage which nerve? |
|
Definition
|
|
