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Flashcards in Extra neuro questions Deck (26)
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1
Q

Absolute CI to thrombolysis x11

A
Previous haemorrhagic stroke 
Suspected SAH 
LP in the last 7 days 
Stroke or traumatic brain injury last 3 months
Seizure at onset of stroke 
Intracranial neoplasm 
Active bleeding
GI haemorrhage last 3 weeks
Oesophageal varices
Pregnancy 
Uncontrolled HTN >200/120
2
Q

Relative CI to thrombolysis

A
Major surgery or trauma last 2 weeks
Concurrent anticoagulation with INR >1.7
Bleeding diathesis (predisposition to bleeding)
Suspected intracardiac thrombus
Active diabetic haemorrhagic retinopathy
3
Q

Features of normal pressure hydrocephalus

A

Dementia, urinary incontinence and gait abnormalities

4
Q

Diagnosis of normal pressure hydrocephalus

A

Diagnostic CSF removal (draining lumbar puncture etc)

Will cause improvement in symptoms

5
Q

Management of normal pressure hydrocephalus

A

Surgical CSF shunting

6
Q

First line for neuropathic pain

A

Amitryptilline
Gabapentin
Pregabalin
Duloxetine

7
Q

First line for trigeminal neuralgia

A

Carbamazepine

8
Q

What is intranuclear opthalmoplegia

A

Cause of horizontal disconjugate eye movement
Due to lesion in medial longitudinal fasciculus
Impaired adduction of eye on same side as lesion
Nystagmus of abduction of eye on other side

9
Q

Causes of intranuclear opthalmoplegia

A

MS

Vascular disease

10
Q

Antibodies in GBS

A

Anti-ganglioside - present in MIller-Fischer

25% of GBS

11
Q

Infective agent in GBS

A

Commonly campylobacter jejuni

12
Q

What causes huntington disease

A

Trinucleotide repeat expansion (CAG) in huntingin gene on chromosome 4p- autosominal dominant inheritance - exhibits anticipation

13
Q

Initial features of HTD

A

Insidious onset in middle-age, fidgeting and clumsiness
Develops into involuntary, jerky, dyskinetic movements
Grunting and dysarthria

14
Q

Late disease features of HTD

A

Rigid

Akinetic and bed-bound

15
Q

Cognitive abilities in HTD

A

Early cognitive, emotional and behavioural changes - lability, dysphoria, anxiety and then dementia

16
Q

Examination signs of HTD

A

Chorea, dysarthria
Slow voluntary saccades and supranuclear gaze restriction
Parkinsonism and dystonia ( especially juvenile onset)

17
Q

How many repeats needed for HTD diagnosis

A

> 39 CAG repeats

27-39 exist with reduced penetrance

18
Q

What is seen on CT/MRI in HTD

A

Symmetrical atrophy of striatum (esp, caudate nuclei)

Butterfly dilation of lateral ventricles

19
Q

Treatment of chorea in HTD

A

Dopamine-depleting drugs (reserpine, tertabenazine)

Benzo’s

20
Q

Prognosis of HTD

A

Most die 15-20years after first onset of symptoms - usually from resp infection

21
Q

How does inclusion body myositis differ from other inflammatory myopathies (dermato and polymyositis)

A

Can cause neck droop (affects erector spinae muscles) and dysphagia
Insidious onset over months-years
Most common in >50 yr old

22
Q

Distinguishing features of CSF on varying meningitis

A

Bacterial - cloudy, high neutrophils, high protein and low glucose
Viral - high lymphocytes and protein and normal glucose
TB - fibrinous CSF, high lymphocytes and protein and low glucose

23
Q

Treatment of meningitis

A

Cefotaxime
Benzylpenicllin good for meningococcus
Amox + gent for listeria
Chloramphenicol if penicillin allergic

Also dexamethasone IV (QDS for 4 days)

24
Q

Prevalence of migraines in men and women

A

Men 6% and women 18% therefore 3x more common in women

25
Q

What is Alport syndrome

A

Genetic condition with sensorineural hearing loss, kidney dysfunction (haematuria and proteinuria) and vision problems

26
Q

What is pendred syndrome

A

Genetic disorder leading to bilateral sensorineural hearing loss and goitre with euthyroid or slightly hypothyroid