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Flashcards in Passmed questions Deck (63)
1

Urinary incontinence + gait abnormality + dementia

normal pressure hydrocephalus

2

a reversible cause of dementia seen in elderly patients ?

normal pressure hydrocephalus

3

variant of fast score to assess stroke risk?

stROke ROsier score

4

Obese, young female with headaches and blurred vision, think?

idiopathic, intercranial hypertension.

5

idiopathic intercranial hypertension treatment?

weight loss and diuretic (acetazolamide)

6

two drugs that may cause peripheral neuropathy? "feels like walking on cotton wool"

nitrofurentoin and metronidazole

7

Normal pressure hydrocephalus management?

Normal pressure hydrocephalus

8

What is the most common presentation of multiple sclerosis?

optic neuritis

9

worsening of vision following rise in body temperature?

Uhthoff's phenomenon: worsening of vision following rise in body temperature. Seen in MS

10

Colours, particularly reds, may appear "washed out" or less bright than usual. Which eye condition?

optic neuritis

11

Patients with MS can present with non specific symptoms. How do 75% present?

significant lethargy

12

what can you get in neck flexion in MS?

paraesthesia in limbs (Lhermittes syndrome)

13

what is paraesthesia?

abnormal sensation such as tingling, tickling or burning of a person's skin with no apparent physical cause

14

Progressive degenerative disesase of brain. Accounts for majority of dementia in the UK?

alzheimers disease

15

what is thought to cause the inherited form?

mutations in amyloid precursor protein

16

what is apoE4?

class of proteins involved in the metabolism of fats in the body

17

macroscopic changes in alzheimers>

macroscopic: widespread cerebral atrophy, particularly involving the cortex and hippocampus

18

microscopic changes in alzheimers?

cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein

19

biochemically, what is there a deficit of in alzheimers?

acetylcholine

20

paired helical filaments are partly made from a protein called tau?

neurofibrillary tangles

21

There is a deficit of acetylcholine in amlzheimers. NICE now recommend the three acetylcholinesterase inhibitors. what are they?

donepezil, galantamine and rivastigmine

22

if intolerant of first l in drugs, what can be given second line ?

memantine (clementine)

23

DVLA advice post multiple TIAs: cannot drive for

3 months

24

if you have a seizure/fit, what must you do?

inform the DVLA

25

for patients with established epilepsy or those with multiple unprovoked seizures:
→ may qualify for a driving licence if they have been free from any seizure for?

12 months
if there have been no seizures for 5 years (with medication if necessary)

26

single episode syncope, explained and treated. restriction on driving?

4 weeks

27

single episode syncope, unexplained?

6 months off driving

28

stroke or TIA. If not residual neurological deficit. how long do you need to take off driving and do you need to inform DVLA?

1 month off driving. may not need to inform DVLA

29

craniotomy e.g. For meningioma. How long off driving

1 year

30

chronic neurological disorders e.g. multiple sclerosis, motor neuron disease: DVLA should be informed, what form is filled out?

PK1 form

31

levodopa side effects?

!Reduced effectiveness with time!
dyskinesia (writhing movements)
palpitations
psychosis
postural hypotension

32

name 3 dopamine receptor agonists?

dope
bromocriptine, ropinirole, cabergoline

33

what kind of drug is cabergoline?

dopamine agonist

34

what should patients being started on dopamine agonists be warned about ?

potential to cause impulse control disorders

35

side effect of dopamine agonist>

hallucinations

36

which drugs are associated with pulmonary and cardiac fibrosis?

dopamine agonists

37

when do most neurologists start ant epileptic treatment ?

following a second epileptic seizure

38

in what situations would you start an anti epileptic following a first seizure?

the patient has a neurological deficit
brain imaging shows a structural abnormality
the EEG shows unequivocal epileptic activity
the patient or their family or carers consider the risk of having a further seizure unacceptable

39

first line in generalised seizures?

sodium valpraote (sodium is a general flavouring)

40

second line?

lamotrigine and carbamazepine

41

which drug can precipitate absence seizures?

carbamazepine

42

first line for partial/focal seizures?

carbamazepine or lamotrigine (carbs only part of balanced diet)

43

2nd line in partial/focal seizures?

levetiracetam, oxcarbazepine or sodium valproate

44

myoclonic seizure treatment ?

sodium valproate (mayoclinic eating)

45

2 drugs you can use in absence seizures? (petit mal)

2 drugs that don't like being absent from each other. sodium valproate and ethoSUXamide

46

Useful in patients with absence seizures who are intolerant of sodium valproate?

ethosuxamide

47

A 24-year-old man with focal seizures. He previously developed a rash whilst taking lamotrigine?

carbamazepine

48

what drug does carbamazepine always go with?

lamotrogine

49

what is titubation?

head tremor

50

that is made worse by intentional movement, made better by alcohol and propranolol?

essential tremor

51

if you see "fasciculations" think of?

motor neurone disease

52

if you have first seizure and if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG. how long off driving ?

6 months

53

what is phenytoin used in ?

the management of seizures

54

side effects of phenytoin?

large list of side effects
Acute
initially: dizziness, diplopia, nystagmus, slurred speech, ataxia
later: confusion, seizures

Chronic
common: gingival hyperplasia (secondary to increased expression of platelet derived growth factor, PDGF), hirsutism, coarsening of facial features, drowsiness
megaloblastic anaemia (secondary to altered folate metabolism)
peripheral neuropathy
enhanced vitamin D metabolism causing osteomalacia
lymphadenopathy
dyskinesia

Idiosyncratic
fever
rashes, including severe reactions such as toxic epidermal necrolysis
hepatitis
Dupuytren's contracture*
aplastic anaemia
drug-induced lupus

Teratogenic
associated with cleft palate and congenital heart disease

55

what is saturday night palsy?

compression of the radial nerve against the humeral shaft, possibly due to sleeping on a hard chair with his arm draped over the back. cannot extend wrist

56

Leg crossing, squatting or kneeling may cause a foot drop secondary to a common peroneal neuropathy. women who works in a nursery with foot drop. management?

avoid to stop leg crossing, kneeling and squatting. review in 4 weeks

57

cluster headache - acute treatment?

subcutaneous sumatriptan + 100% O2

58

risk factors for developing idiopathic inter cranial hypertension?

obesity
female sex
pregnancy
drugs*: oral contraceptive pill, steroids, tetracycline, vitamin A, lithium

59

features of tuberous sclerosis?

“ash leaf spots” which fluoresce under UV light
roughened patches of skin over the lumbar spine
adenoma sebaceum (angiofibromas) in butterfly distribution over nose

fibromata beneath nails
café au lait spots may be seen

60

if you get nausea in parkinson, which anti emetic?

domperidone

61

reduced sensation in a glove-and-stocking distribution

peripheral neuropathy. hands and feet are affected first, then the reduced sensation travels up the limbs

62

A positive Hoffmans sign is a sign of?

upper motor neuron dysfunction and points to a disease of the central nervous system

63

Neuroleptic malignant syndrome is typically seen in patients?

who have just started treatment. its a rare but dangerous condition seen in young males who have just started anti psychotic medication