Flashcards in Revision 2 Deck (198)
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151
what are the features of a stabbing/ icepick headache
more common in females
stabbing pain
severe
anywhere in head
lasts <30 secs
any prequency
autonomic features
no trigger
responds to indomethicin
152
summarise brown sequard syndrome
hemicord lesion
-lateral corticospinal tract damage = ipsilateral UMN weakness
-posterior column= ipsilateral vibration and proprioception loss
-anterolateral system= contralateral pain and temperature loss
153
describe the symptoms seen in central cord syndrome
centre part of spinal cord affected
in small lesions- spinothalamic tract fibres that cross the anterior white matter commisure are interrupted = bilateral pain and temp loss at affected levels, below this cord function intact = cape like distribution
large lesions- corticospinal, spinothalamic and dorsal column may be affected aswell= upper motor neurone pattern of deficit below the level of injury (interrupted corticospinal), with spastic paralysis and urinary retention, and a LMN deficit pattern at level of injury (damage to ant horn cells)
upper extremities more affected than lower as fibres more central
154
which nerve is at risk of injury:
colles fracture
median
155
which nerve is at risk of injury:
ant shoulder dislocation
axillary
156
which nerve is at risk of injury:
humeral shaft #
radial (in spiral groove)
157
which nerve is at risk of injury:
posterior dislocations of hip
sciatic
158
which nerve is at risk of injury:
supracondylar # of the elbow
median (anterior interosseous branch)
159
which nerve is at risk of injury:
bumper injury to the lateral knee
peroneal nerve (fibular)
160
what differentiates back ache from sciatica
back ache can radiate to buttock and thigh but not below the knee like sciatica can
161
what are the symptoms of an L3/4 prolapse
> L4 root entrapment > pain down to medial ankle (L4), loss of quadriceps power, reduced knee jerk
162
what are the symptoms of an L4/5 prolapse
L5 root entrapment > pain down dorsum of foot, reduced power Extensor Hallucis Longus and tibialis anterior
163
what are the symptoms of an L5/S1 prolapse
S1 root entrapment > pain to sole of foot, reduced power planarflexion, reduced ankle jerks
164
what is the role of broca and wernickes areas
brocas- speech production
wernickes- speech comprehension
165
what are the SEs of sodium valporate
increased appetite= massive weight gain
alopecia
teratogenic (neural tube defects, cleft lip and palate, cardiovascular abnormalities, genitourinary defects, developmental delay, endocrinological disorders, limb defects, and autism)
166
what is lamotrigine first line for
focal seizures (carbamazepine is 2nd line)
women with generalised seizures
167
what are the SEs of lamotrigine
rash
HA
dry mouth
168
what is levetiracetam
epilepsy management
2nd line in women of childbearing age
Good 3rd line alternative after sodium valproate and lamotrigine
Quite well tolerated – tiredness apathy weight gain
169
what are the key symptoms of MS
Optic neuritis, Sensory symptoms, Lr urinary tract dysfunction, Pyramidal dysfunction (Tone+, spastcicity, F of UL, E of LL)
At least 2 episodes suggestive of demyelination + Dissemination in time and place
170
what will be seen on blood tests for MS
nothing
171
what for acute Tx for MS flare
steroids
172
what are the treatment options for parkinsons
levodopa (with dopadecarboxylase inhibitor)
monoamine oxidase B inhibitor
dopamine agonist
can add on
catechol-o-methyl transferase inhibitor (prolongs actions of levodopa)
173
what are the symptoms of parkinsons
Gait - shuffling, slow turning with multiple steps, trouble with doorways, stooped over, reduced arm swinging, fenestration
Also non-motor features: EARLY - Hyposmia (reduced smell),
Constipation,
REM sleep disturbance (can act out dreams)
depression – V V common and pronounced generally
LATE - Dementia (it is Lewy body dementia if within the first 2 years, otherwise is parkinsons disease dementia)
Everyone gets some form of cognitive decline over time with parkinsons disease.
cog wheel rigidity
resting tremour)
positive froment's maneuver (rigidity increases in examined body segment by voluntary movement of other parts),
micrographia,
bradykinesia,
hypomimia (decreased facial expression),
hypophonia (quieter voice)
174
which generation of antipsychotic is clozapine
2nd - is an atypical
175
name extrapyramidal drugs
(dopamine antagonists)
all antipsychotics- typicals (haloperidol) worse than atypicals (clozapine)
metoclopramide
domperidone
176
what is the main down fall of atypical antipsychotics
weight gain and metabolic syndrome
177
what causes meningitis in neonates
listeria, group B streptococci, E. coli
178
what causes meningitis in children
H influenza
179
what causes meningitis in ages 10-21
meningococcal
180
