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Flashcards in Clinical stuff Deck (253)
1

What are the 5 causes of blackouts?

  1. No blood
  2. Blood no good
  3. Brainstem
  4. Cerebral
  5. Psychological

2

What are the causes of "no blood" black outs?

Vasovagal syncope

Postural Hypotension

Hyperventilation

Cardiac Dysrhythmia

3

What are the causes of "blood no good" blackouts?

Hypoxia

Hypoglycaemia

4

What is Vasovagal Syncope?

Fainting

5

What causes Vasovagal snycope?

Vagal activity increaces will symapthetic activity decreses

 

As a result the heart slows and blood pools in the peripheries.

 

Cardiac output decreases resulting in inadequate perfusion to the brain.

 

The patient then collapses, venous return improves and cardiac output goes back to normal

6

What is postural hypotension?

Patient feels dizzy upon standing, blacks out and collapses

7

Why does postural hypotension occour?

Decreased symapthetic activity affecting the heart and peripheral circulation

 

Normal cardio-acceleration and peripheral vasoconstriction in response to standing does not occour.

 

Cardiac output is no sufficiant resulting in loss of consciousness

8

What is usually the cause of postural hypotension?

Decreased sympathetic activity due to anti-hypertensive drugs

 

occasionally due to a physical lesion of the sympathetic pathways

9

What kind of person experiances postural hypotension

middle aged or elderly

Parkinson's disease

Peripheral neuropathy

10

What happens during hyperventilation?

Patients overbeath and wash out CO2 from their blood.

 

Arterial hypocapnia is a potent cerebral vasocontrictive stimulus.

 

Inadequate perfusion to the brain resulting in loss of consciousness

11

How can you prevent hyperventialtion?

Rebreathing into a paper bag.

 

Stops hypocapnia as you are rebreathing air which has more CO2 in it

12

What signs and symptoms are suggestive of cardiac dysrhytmia being the cause of blackouts?

  • Older patient
  • attacks unrelated to posture
  • Hx of Ischaemic heart disease
  • Palpatations
    • Dizziness and colour change prior to collapse

13

What are Vertebro-basilar transient iscaemic attacks?

Thrombo-embolic material from the heart of proximal large arteries occlude arteries supllying the brainstem.

 

Cause ischemia of the brainstem tissue untill they are dislodged

14

what are the symptoms of Vertebro-basilar transient ischaemic attack?

Lasting about 8 minutes

 

Vertigo

Visual field defects (diplopia, hemianopia)

Auditory phenomena (sudden sensorineural hearing loss)

Facial numbness or paresthesias

Dysphagia, dysarthria, hoarseness

Syncope (drop attacks)

Hemisensory extremity symptoms (eg, contralateral to facial component

15

What factors make Vertebro-basilar transient ischaemic attacks more likely in a patient?

Older patient

know arteriopathic history

 

Presence of a source of emboli - MI, atrial fibrilation, neck bruits etc

16

What is a "hysterical attack"

Some patients attract attention to themselves, at a conscious or unconscious level by having blackouts.

 

Attacks consist of apparent loss of conciousness with falling and sometimes simulated convulsive movements.

17

What is narcolepsy?

episodes of sleep of unatural duration and stength occouring at unsual times.

 

Sufferers may also experiance

  • Cataplexy
  • Sleep paralysis
    • Hypnogogic Hallucintions

18

What is transient global amensia?

For a few hours the patient acts normally but afterwards they cant remember anything that happened

 

usually ony happens a couple times in a patients life

19

What are the layers of the meinges?

Dura mater

Arachnoid mater

Pia mater

20

What causes Viral Meningitis?

Enteroviruses like ECHO virus

21

How do you diagnose viral meningitis?

Viral stool culture

Throat swab

CSF PCR

22

How do you treat viral meningitis?

Supportive - Self limiting

23

What is the most common cause of community aquired bacterial meningitis in children?

H. influenza

24

What is the most common cause of community acquired bacterial meningitis in ages 10-21?

Neisseria meningitidis

25

What is the most common cause of community acquired bacterial meningitis in adults

streptococcus pneumoniae

26

What is a major risk factor for streptococcus pneumoniae meningitis?

Fracture of the cribiform plate

27

What type of meningitis does " decreased cell mediated immunity" increase the risk for?

Listeria monocytogenes

28

What type of meningitis does head trauma or neurosurgery put you at higher risk off?

S. aureus

S. epidermidis

29

What type of meningitis does a basilar skull fracture put you at higher risk of?

S.pneumoniae

H. influenzae

beta-hemolytic strep group A

30

What causes meningococcal meningitis?

Neisseria meningitis

31

How does Neisseria meningitis cause symptoms?

Endotoxins

32

Who gets memingococcal meningitis?

Young children

33

What is characterisitic of Tuberculous Meningitis?

Reactivaion:- Elderly

Previous TB on CXR

Non specific ill health

 

34

How do you treat Tuberculous Meningitis?

Isoniazid + rifampicin

35

What is cryptococcal meningitis?

Fungal meningitis presenting mainly in HIV disease

36

What is Chorea?

Fragments of movements flowing irregulary from one body segment to the next

37

What is ballismus?

Extreme chorea

38

What are the two broad subtypes of parkinson's disease?

Tremor dominant Parkinson's Disease

Non-tremor dominant Parkinson's Disease

39

What sub type of parkinsons disease is associated with a slower rate of progression and less functional disability

Tremor-dominant subtype

40

What are the non-motor features of parkinson's disease?

Olfactory dysfunction

cognitive impairment

psychiatric symptoms

sleep disorders

autonomic dysfunction

pain

fatigue

41

What is the classic disease progression of parkinson's disease?

Diagnosed made with motor symptoms but non motor symptoms have been around for a while

 

Initally motor features are well controlled

 

at 17 years 80% report gait freezing and falls while 50% report choking

 

At 20 years 83% have dementia

42

What does the disease progression graph look like for Parkinson's disease

43

What are the pathological hall marks of parkinsons disease?

Loss of dopaminergic neurons within the substania nigra and lewy body pathology

44

What are Lewy bodies?

Build ups of insoluble misfolded alpha-synuclien

45

Does having parents with parkinson disease increase your risk of parkinson's disease?

Yes

46

What mutations are the most common causes of parkinsons disesae?

LRRK2

Parkin

47

What is the most common cause of meningitis in children under the age of 4 ?

H. influenzae

48

How do you treat parkinson's disease ?

Increase dopamine in the brain

49

What are the adverse side affects of dopamine treatment in parkinsons?

Impulse control disorders made worse

Hallucinations - Carefull in the elderly

Nausea

Oedema

Daytime somnolence

50

What are the long term complications of dopaminergic therapy in parkinson's disease?

Motor flucations:- on time/off time

Dyskinesia and chorea (corrolates with levodopa conc)

Hallucinations

 

51

What are the motor symptoms of parkinsonisim?

Bradykinesia

Rest tremor

Rigidity

Postural and gait impariment

52

What is typical with Vascular Parkinsonism?

Predominantly affects lower limbs

Poor levodopa response

Resting tremor uncommon

53

What is Duchenne muscular dystrophy?

X linked genetic disease resulting in progressive muscle weakness

54

What is huntington disease?

Progressive neurodegenerative disorder

 

onsent between 30-50 yrs

 

55

How is huntington disease inherited ?

Autosomal Dominant

56

What is the most common cause of dementia?

Alzheimer's disease (50-70%)

57

What are the 5 things measured in the cerebral spinal fluid when ivestigating meningitis?

WBC count

Neutrophils

Protein

Glucose

 

58

What would you expect the WBC count to be in the CSF during bacterial meningitis?

WBC count >2000

59

What would you expect the neutophil count to be in the CSF of expected bacterial meningitis?

Neutrophils >1180

60

What would you expect of the protein content in the CSF of expected bacterial meningitis?

Protein >220 mg/dl

61

What would you expect the glucose level to be in the CSF of expected bacterial meningitis?

Glucose <34mg/dl

62

What CSF findings are 99% perdictive of bacerial meningitis?

WBC >2000

Neutrophils >1180

Protein >220mg/dl

Glucose <34 mg/dl

63

What should you do when a patient is addmitted to hospital with acute adult bacterial meningitis 

  • Take blood for culture and coagulation screen
  • Take throat swab
  • Swab any skin lesions
  • Start "intial therapy before pathogens are identified" treatment

64

What types of patients which acute adult bacterial meningitis need a CT prior to lumbar puncture?

  • Immunocompromised patients
  • History of CNS disease
  • New onset of seizure
  • Papilloedema
  • Abnormal levels of consciousness
    • Focal neurological deficit
    •  

65

What is the empiracal antibiotic for acute adult bacterial meningitis?

IV ceftriaxone 2g bd 

if listeria is suspected add

Amoxicillin 2g qds

66

What is the empiric antibiotic for acute adult bacterial meningitis for someone with a penicillin allergy?

Chloramphenicol IV 25 mg/kg every 6hrs

plus

Vancomycin IV 500 mg every 6 hours

67

Whats the deal with steriods and bacterial meningitis?

Give to all patients suspected of bacterial meningitis before or with the first dose of antibiotics and then every 6 hours

68

When are the only times you wouldnt give steriods in adult acute baterial meningitis ?

  • Post surgical meningitis
  • Severe immunocompromise
  • septic shock

69

What must you remeber to do when you have a paient with meningitis?

Call Public Health

70

Explain the concept of Cerebral Perfusion Pressre?

Cerebral perfusion pressure = mean arterial pressure --- intracranial pressure

71

What are the ideal CPP = MAP --- ICP pressures that you want to keep

Cerebral perfussion pressure = Mean arterial pressure --- Intracranial pressure

 

>60mmHg = >80mmHg --- < 20mmHg

72

What is normal adult Intercrainial Pressure?

9-11mmHg

73

How can you spot an anteior cranial fossa fracture?

Panda eyes

74

How can you spot a middle crania fossa fracture?

"battle sign"

75

What kills patients with head injuries?

Hypoxia

Hypotension

Raised Intracranial Pressure

76

When should you request a CT scan of the head in patients with head trauma?

Any patient with :

  • Skull fracture
  • GCS <15
  • Focal neurological signs
    • Taking anti-coagulants

 

77

What are the types of traumatic intracranial bleeding from outside to inside?

Extradural haematoma

Subural haematoma

Traumatic subarachnoid haemorrhage

Intracerebral contusion

Intracerebral haematoma

Intraventricular haemorrhage

78

Why is sedation useful in the management of head injuries?

Reduces cerebral metabolic rate

Reduces cerebral blood flow

Reduces ICP

79

What is the most common cause of spontaneous subarachnoid haemorrhage?

Ruptured aneursym

80

What is a saccular aneurysms?

True aneurysms with involvement of all layers of the vessle

81

What is classic in Lower motor neurone disorders?

  • Weak
  • Low tone
    • Fasiculations

82

What causes botulism?

Clostridium botulinum - PWID

83

How does botulinum toxin work?

Cleaves presynaptic protiens involved in vesicle formation and block vesicle docking

84

What is Lambert Eaton Myasthenic Syndrome?

Antibodies to presynaptic calcium channels leading to less vesicle release.

85

What is strongly associated with Lambert Eaton Myasthenic Syndrome?

Small cell carcinoma

86

What is the most common disorder of the neuromuscular junction?

Myasthenia Gravis

87

What is Myasthenia Gravis?

Autoimmune antibodies to acetyl choline receptors

 

Reduced number of functioning receptors leads to muscle weakness and fatiguability

88

When do you first start to experiance symptoms in myasthenia gravis?

When ACh receptors are reduced to 30% of normal

89

When are the two peaks of indcidence in myasthenia gravis?

Females:  30 - 40

Males: 60 - 80

90

What are the common clincial features of myasthenia gravis?

Weakness typically fluctuating

 

Extraocular weakness, facial and bulbar weakness

 

proximal limb weakness

91

How do you treat myasthenia gravis?

Immunomodulating

Steriods/azathioprine

 

emergency treatment wih plasma exchange or immunoglobulin

92

How does myasthenia gravis cause death?

Respiratory failure (diaphram)

and

Aspiration pneumonia

93

What are fasiculations?

Visible, fast, fine and spontaneous muscle twitch

94

What is myotonia?

Failure of muscle channel relaxation after use

95

What does myalgia mean?

Muscle weakness

96

What cause myotonia?

Problem with the cholride channel

97

What is Rhabdomyolysis?

"Dissolution of muscle"


Damage to skeletal muscle causes leakage of large quantities of toxic intracellular contents into the plasma

98

What is multiple sclerosis?

An inflammatory demyelinating disorder of the central nervous system

99

When do people with multiple sclerosis usually present?

30s and 40s

100

What are the 6 clincial features of Multiple Sclerosis?

Pyramidal dysfunction

Optic neuritis

Sensory Symptoms

Lr Urinary tract dysfunction

Cerebellar and brain stem features

Cognitive impairment

101

What does pyramidal dysfunction in MS cause?

Increased tone

Spasticity

Weakness

Extensors of upper limbs

Flexors of lower limbs

102

What is Optic neuritis?

Painful visual loss lasting 1-2 weeks

 

common in Multiple Sclerosis

103

What causes Diplopia in MS?

Abducens nerve palsy

104

What causes facial weakness in multiple sclerosis?

Facial nerve

105

What is internuclear ophthalmoplegia?

Medial longitudinal fasciculus resulting in distortion of binocular vision due to failure of adduction

106

What urinary symptoms do people with multiple sclerosis get?

Frequency

nocturia

urgency

urge incontinence

retention

107

What is required to diagnose MS?

At least 2 episodes suggestive of demyelination

 

dissemination in time and place

108

What should be on your differential diagnosis list for multiple sclerosis?

Vasculitis

Granulomatous disorder

vascular disease

structural lesion

infection

metabolic disorder

109

What are the three principes to treating multiple sclerosis?

  1. Acute exacerbations
  2. Symptomatic treatment
    1. Disease modifying therapy
      1.  

110

How do you treat a mild , moderate and severe acute exacerbation of multiple sclerosis?

Mild - symptomatic treatment

Moderate - Oral steriods

Severe - IV steriods

111

What are the treatment options for spasticity in multiple sclerosis?

Physio

Oral medication - Baclofen and tizanidine

Botulinum toxin

Intrathecal baclofen

112

What does intrathecal mean?

Via the CSF

113

How can you manage the sensory symptoms of Multiple sclerosis?

Anti-convulsant

Anti-depressant

Tens machine

Acupunture 

Lignocaine infusion

114

What anti-convulsant is appropriate in multiple sclerosis?

Gabapentin

115

What antidepressant drug is usefull in multiple sclerosis?

Amitriptyline

116

What three problems do people with multiple sclerosis get with regards to their bladder?

Increased tone at bladder neck

Detruser hypersensitivity

Detruser sphyncteric dyssenergia

117

What is detruser sphyncteric dyssenergia?

Dyscoordination of the detruser muscles and external sphincter muscles

118

How do you treat unrinary tract dysfunction in multiple sclerosis?

  • Bladder drill / diary
  • anti-cholinergics - oxybutynin
  • Desmopressin
    • Catherterisation
    •  

119

How do you treat fatigue in patients with Multiple sclerosis?

Amantadine 

or if sleepy Modafinil

120

What is the first line disease modifying therapy in multiple sclerosis

Interferon beta

Glitiramer acetate

Tecfedira

121

What are there second line disease modifying drugs for multiple sclerosis 

Monoclonal antibody 

 

Fingolimod

122

What is the third line therapy for multiple sclerosis?

Mitoxantrone

123

What are interferon Beta and Copaxone?

Injectable disease modifying drugs for multiple sclerosis (first line)

124

What effect does interferon Beta and Copaxone on multiple sclerosis?

Decrease relapse rate by 1/3

 

Decrease severity of relapses by 50%

 

has an effect on disability

125

What is Tecfidera ?

Oral agent used in multiple sclerosis

126

What affect does Tecfidera have on Multiple Sclerosis?

44 % reduction in relapse rate

127

How does Fingolimod work in the treatment of multiple sclerosis?

Sphingosine-1-phosphate modulator

128

What affect does Fingolimond have on multiple sclerosis?

>50% reduction in relapse rate

129

What are the features of a large motor fibre nerve damage?

 

Symptoms

Power

Sensation

Reflexes

Symptoms - Weakness, unsteadiness, wasting

Power- reduced

Sensation - normal

Reflexes - Absent

130

What are the features of a large sensory fibre nerve damage?

 

Symptoms

Power

Sensation

Reflexes

 

Symptoms - Numbness, paraesthesia, unsteadiness

Power - Normal

Sensation - Vibration and joint posistion sense

Reflexes - Absent

131

What are the symptoms of small fibre nerve damage?

Symptoms

Power

Sensation

Reflexes

 

Symptoms - Pain, Dyesthesia

Power - Normal

Sensation - Pin prick and termperature reduced

Reflexes - Present

132

What are the features of autonomic nerve damage?

Symptoms

Power

Sensation

Reflexes

 

Symptoms - Dizziness, Impotence and nausea

Power - Normal

Sensation - Normal

Reflexes - Present

133

What does Radiculopathy mean?

Problem with the anterior or posterioir rami

134

How would you describe this pattern of loss?

Glove and stocking 

135

What is an acute cause of Demyelinating neuropathy?

Guillaine Barre Syndrome

136

What is characterisitc of Guillain-Barre Syndrome?

Progressive paraplegia over days up to 4 weeks

137

What are the sequence of events during an exacerbation of Guillian-Barre Syndrome?

Sensory symptoms

 

Parapelgia, weakness and pain

138

What are the 6 broad families of axonal neuropathies?

Idiopathic

Vaculitic

Paraneoplastic

Infections

Drugs/toxins

Metabolic

139

What infections can cause axonal neuropathies?

HIV

Syphillis

Lyme

Hepatitis B/C

140

What drugs/toxins can cause Axonal Neuropathies?

Alcohol

Amiodarone

Phenytoin

Chemotherapy

141

What are the metabolic causes of Axonal Neuropathies?

Diabetes

B12 folate deficiencies

Hypothyroidism

Chronic Uremia

Porphyria

142

What are the (a) chronic and (b) acute causes of autonomic neuropathy?

Chronic - Diabetes, Amyloidosis, Hereditary

 

Acute - GBS, Porphyria

143

How can you treat Vasculitic axonal peropheral neuropathy?

Pulsed IV methylprednisolone + cyclophosphamide

144

Do cases on Peripheral lecture 

DO IT

145

What is characterisitc of Non REM sleep?

Partial muscle relaxation

Reduced cardiac output

Snychronised rythmic EEG

 

Non-narrative dreams

146

What is characterisitc of REM sleep?

Mostly at the end of the night

EEG shows fast activity similar to being awake

Atonic muscles

 

Cerebral blood flow increased

Impaired thermal regulation

 

Narrative dreaming 

147

How do you investigate narcolepsy?

Overnight polysomnography

148

What can you measure in the CSF to help with a diagnosis of Narcolepsy?

CSF hypocretin

149

What CSF hypocretin level is suggestive of narcolepsy?

less than 110pg/ml

150

What is nociceptive pain?

An appropriate physiological response to painful stimuli via an intact nervous system

151

What is neuropathic pain?

An inappropriate response caused by dysfunction in the nervous system

152

What does allodynia mean?

Pain from stimulus that is not normally painful

153

What does hyperalgesia mean?

More pain than expected from a painful stimulus

154

How do topical analgesics affect pain? 

Reduce pain impusles transmitted by A-Delta-fibres and C-fibres

155

How do brain tumours commonly present?

Progerssive neurolgical deficit 70%

Motor weakness 50%

headache 50%

sexiures 25%

 

156

What is classical for a headache caused by a brain tumour ?

Worse in the morning 

Wakes them up when they are asleep

Worse with coughing and leaning forward

157

Learn this

158

What are the four grades of Astrocytic tumors?

I Pilocytic

II Low grade astrocytoma

III Anaplastic astrocytoma

IV Glioblastoma

159

What is a Grade 1 astrocytoma?

Truly benign low growing legion

160

Who gets grade 1 astrocytomas?

Children and young adults

161

How do you treat grade 1 astrocytomas?

Surgery - Curative

162

What is this ?

Pilocytic Astrocytoma grade 1

163

Where do people normally get "low Grade" astrocytomas?

Temporal Lobe

Posterior Frontal lobe

Anterior Parietal lobe

164

How do low grade astrocytomas nomrally present ?

Seizures

165

What are the treatment options for grade II astrocytomas?

No treatment

Raidation

Chemotherapy

Combined Radiation and Chemotherapy

 

Plus or minus surgery

166

What factors suggest a poor prognosis in Grade II astrocyomas?

  • Age >45
  • Low performance score
  • tumor >6cm
  • Tumour crossing midline
    • Incomplete resection
      •  

167

What is Glioblastoma Multiform?

Stage 3 / 4 astrocytoma

Most common primary tumor

median survival < 1yr

168

What is an Anaplastic astrocytoma?

Grade III/IV malignant astrocytoma

 

Median survival 2 years

169

How do you treat grade 3 and 4 astrocytomas?

Surgery - not curative but can help symptoms

 

Post operative radiotherapy 

170

Where do people get olidodendroglial tumors and at what age?

Frontal lobes

Adults 25-45 yrs old

171

How do people with Oligodendroglial tumors present ?

With seizures

172

How do you treat Oligodendroglial tumors ?

Chemothrapy + surgery

 

 

173

What is the median surivial for Oligodendroglial tumors?

10 years

174

What are the brain tumor red flags for adults and children?

Adults

Headaches that wake you +/- vomiting 

New neurological deficit incl seizures

 

Children

Tiptoeing, ataxia and vomiting

175

What are the red flags for headaches?

  • New onset headache over aged 55
  • Known/previous malignancy
  • Immuno-suppressed
  • Early morning headache
  • Exacerbated by valsalva

176

What exaerbating symptoms should you ask about in headaches

Posture

Valsalva

 

177

How do you diagnose a migraine?

Pain that is 2 Of:

  • Moderate/severe
  • Unilateral
  • Throbing
  • Worst on movement

 

And 1 of:

  • Photophobia
    • Phonophobia

 

178

What is the pathophysiology of Migraines?

Stress triggers changes in the brain releasing serotonin 

 

Blood vessels constrict and dilate

 

Chemicals including substance P irritate the nerves and blood vessels

179

What is an Aura when refering to a migraine?

Fully reversible visual, sensory , motor or language symptom

180

What are common triggers for migraines ?

Sleep

Dietary

Stress

Hormonal

Physical exertion

 

Headache diary can help identify triggers

181

How do you treat a migraine?

Aspirin

Naproxen 

Ibuporfen

ASAP ( sooner the better)

182

What are Triptans?

5HT agonist used to treat migraines

 

Take at the start of the headache

 

Sublingual

183

Whats the problem with triptans?

Not sure if they are really that great and they are pretty expensive

184

When would you consider prophylaxic treatment for migraines ?

More than 3 attacks per month

 

Very severe attacks

185

What can be used as prophylaxis for migraines?

Propanolol

 

Topiramate

186

What prophylatic affect does propanolol have on migraines?

Reduces frequency by 60-80%

187

What are the contraindications for  propanolol?

Contraindicated in asthma and heart failure

188

What is the downside to using Topiramate as a prohylaxis for migraines

It takes a while to start working

 

Many side effects:- weight loss, paraesthesia, impaired concentration enzyme inducer

189

What are trigeminal autonomic cephalgias? 

Group of primary headache disorders characterised by unilateral trigeminal distribution pain that occurs with prominent ipsilateral cranial autonomic features.

190

Give examples of Ipsilateral cranial autonomic features

Ptosis 
Miosis

Nasal stuffiness

Nausea/vomiting

Tearing 

Eye lid oedema

191

What are the 4 types of trigeminal autonomic cephalgias?

Cluster 

Paroxsymal hemicrania

Hemicrania continua

SUNCT

192

Who gets cluster headaches?

People in their 30s and 40s

193

When do people usually get cluster headaches?

Around sleep time 

194

What are the features of cluster headaches

 

How long do they last and how frequent are they

Severe unilateral headache

 

Lasting 45-90 mins 

1-8 time a day for weeks to months

195

How do you treat cluster headaches?

High flow Oxygen for 20 mins


Sub cut sumatriptan 6mg


Steroids reducing course over 2 weeks

 

 

196

What can be used as a prophylaxis for Cluster headaches?

Verapamil

197

Who gets paroxysmal hemicrania?

Elderly 50s-60s

198

What are the features of paroxysmal hemicrania?

How long does it last?

How frequent ?

Severe unilateral headache with unilateral autonomic features

 

10-30 mins

 

1-40 times a day

 

199

How do you treat paroxysmal hemicrania?

Responds well Indomethicin 

200

What are the main differences between Paroxysmal Hemicrania and cluster headaches?

Paroxysmal Hemmicranias have a shorter duration and are more frequent than cluster headaches 

 

They also respond really well to Indomethicin

201

What does SNUCT stand for?

S - short lied (15-120 seconds)

U - unilateral

N - neuralgiaform headache

C - conjunctival injections

T - tearing

202

How do you treat SUNCT?

Lamotrigine 

or

Gabapentin

203

What investigations would you do for someone with new onset unilateral cranial autonomic features?

MRI brain 

MR angiogram

204

Who gets trigeminal neuralgia?

Older people >60

Woman

205

What triggers trigeminal neuralgia ?

Touch - usually V2/3

206

What are the features of trigeminal neuralgia?

 

Duration ?

 

Frequency?

Severe stabbing unilateral pain

 

1-90seconds

 

10 - 100 times a day

 

few weeks to months before remission 

 

207

how do you treat trigeminal neuralgia?

Carbamazepine

Gabapentin

Phenytoin

Baclofen

 

Surgical - Abalation vs decompression

208

When is a CT scan appropriate in someone who presents with falls/seziures ?

  • Suspected skull fracture
  • Deterioratting GCS
  • Focal signs
  • Head injury with seizure
    • Failure to be GCS 15/15 4hrs after arrival

209

If it is your 1st seziure how long must you wait before you can drive again?

6 months

210

If you have epilepsy how long must you wait before driving again?

1 year 

or 

3 years during sleep

211

What conditions are commonly confused with eplilepsy ?

 

(i.e should be on your differential diagnosis list)

Syncope

Non-epilepti attack disorder

Panic attacks/Hyperventilation

Sleep phenomena

212

What is Epilepsy?

A tendency to recurrent, usually spontaneous eplieptic seizures

213

What is a an eplieptic seizure?

Abnormal synchronisation of neuronal activity

 

Usually excitaory with high frequency action potentials

214

What are the 7 types of eplileptic seizures?

Partial

Simple

Complex

 

Generalised

Absence

Myoclonic

Atonic

Tonic

Tonic Clonic

215

When does primary generalized epilepsy usually present ?

Childhood or early teens

216

How do you treat primary generalized epilepsy?

Sodium Valproate 

 

or

 

Lamotrigine

217

What is important to remember about Sodium Valproate?

Its teratogenic

218

What is focal onsent epilepsy?

Epilepsy with an underlying stuctural cause

219

How do you treat Focal onset epilepsy?

Carbamazepine

 

Iamotrigine

220

What are the symptoms of Focal onset epilepsy?

Complex partial seizures with hippocampal sclerosis

221

How effective are Anti-epiletic drugs (AEDs)

55% seizure free on monotherapy

 

222

What can be used as an anticonvulsant during an acute seizure?

Phenytoin

223

What are the two best anti-convulsant?

Lamotrigine

 

Levetiracetam

224

What is important to remeber about anti-convulsants?

Interfere with the oral contraceptive pill

225

What are the the three types of spontaneous intracranial haemorrhage?

Subarachnoid haemorrhage

Intracerebral haemorrhage

Intraventricular haemorrhage

226

What is a subarachnoid haemorrhage?

Bleeding into the subarachnoid space

227

What is the mortality of subarachnoid haemorrhages?

45% at 1 month

228

How does a subarachnoid heamorrhage present?

Sudden onset:

  • Severe headache 
  • Collapse
  • Vomiting
  • Neck pain
    • Photophobia

229

What is a good investigation for looking for brian aneurisims?

Cerebral Angiography

230

What is the risk of a subarachnoid heamorrage re-bleeding at 

(a) 2 weeks

(b) 6 months

2 weeks - 20%

6 months - 50%

231

After someone has a subarachnoid heamorrage what 3 things do you have to look out for ?

Delayed Ischaemia

Hydrocephalus

Hyponaturaemia

232

How do you treat delayed ischaemia ?

Nimodipine

233

How do you treat hydrocephalus?

CSF draingage

234

What is an intracerebral haemorrhage?

Bleeding into the brain parenchyma

235

What is the most common cause of Intracerebral haemorrhages?

Hypertension - 50%

236

How do intracerebral haemorrhages present?

Headache 

Focal neurological deficit

Decreased conscious level

237

How do you treat intracerebral haemorrahge?

Surgical evacuation of haematoma

238

What is a Intraventricular haemorrhage and how does it happen?

Bleeding into a ventricle

 

Occurs with rupture of a subarachnoid or intracerebral bleed into a ventricle

239

What are the clincial features of a upper motor neurone lesion?

Increased tone

Hyper reflexia

Muscle wasting 

No fasiculation 
 

240

What are the clinical features of a lower motor neurone lesion?

Decreased tone

Muscle wasting

Fasciculation

Diminished reflexes

241

What do the spinothalamic tracts do?

Pain

temperature

crude touch

242

Do the spinothalamic trats govern the ipsilateral or contralateral side of the body?

Contralateral

243

What do the Dorsal columns of the spinal cord do?

Fine touch

Proprioception

Vibration

244

What is motor neuron disease?

untreatable and rapidly progressive neurodegenerative condition 

245

How does motor neurone disease progress?

Starts focal and then spreads continously untill generalzed paresis 

246

What is the average survival time of Motor Neuron disease?

 3 years 

247

Is motor neuron disease familial or sporadic?

10% familial , 90% sporadic

248

What is Amyotrophic lateral sclerosis?

It is the most common subtype of motor neuron disease

249

What is the most common age range for motor neuron disease?

50-75 year

250

Where does Motor Neuron Disease usually start?

Normally extremeties ( mostly upper)

251

What things must you warm someone with parkisnons about when they are first starting on Levodopa?

Impulse control disorders made worse

Sleepiness

 

Psychotic symptoms

252

What is the  frist lime pharmacological treatment for alzehmiers ?


Acetlylholinesterase inhibitors 

 

Donepezil

Galantamine

Rivastigmine

253

What is the second line pharmacological treatment for alzehimers?

Memantine

 

NMDA antagois