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47 Cards in this Set
- Front
- Back
Head Injury - Immediate CT Head |
GCS < 13 on initial assessment CGS < 15 2 hours post injury Suspected open or depressed skull fracture Any sign of basal skull fracture Post-traumatic seizure Focal neurological deficit > 1 episode of vomiting |
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Head Injury - CT Head within 8 hours |
>= 65 years History of bleeding/clotting disorders Taking warfarin Dangerous mechanism of injury > 30 mins of retrograde amnesia of events prior to injury |
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Migraine Prophylaxis |
1) Propanolol or topiramate. 2) 10 sessions of acupuncture over 5-8 weeks 3) Gabapentin 4) Riboflavin 5) Menstrual migraine - frovatriptan or zolmitriptan - mini-prophylaxis |
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Migraine Treatment |
1) Oral triptan and NSAID or Oral triptan and paracetamol 2) Aged 12-17 years - nasal triptan 3) Non-oral preparation of metoclopramide or prochlorperazine + non-oral NSAID/triptan |
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Migraine without aura |
A) At least 5 attacks fulfilling B-D B) Headache attacks lasting 4-72 hours C) >= 2 of: unilateral, pulsating, moderate/severe pain intensity, aggravated by movement. D) >= 1 of: nausea +/- vomiting, photophobia and phonophobia. E) Not attributed to anything else. |
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Parkinson's Disease |
Degeneration of dopaminergic neurons in basal ganglia Mean age 65 years, 2x men Resting tremor - 3-5 hz, worsens with tiredness, pill-rolling Bradykinesia - difficulty initiating, short shuffling steps, poverty of movement Rigidity - cog-wheel, lead-pipe Mask-like, flexed, micrographia, drooling, depression, dementia, reduced smell, sleep disorder |
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Essential tremor |
Autosomal dominant Bilateral Worse with arms outstretched Improved by alcohol and rest Most common cause of titubation - head tremor Mx - propanolol, primidone |
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MS Features |
Visual - optic neuritis (most common), optic atrophy, worsening of vision following rise in temp, internuclear opthalmoplegia. Sensory - pin/needles, numbness, trigeminal neuralgia, parasthesia in limbs on neck extension. Motor - spastic weakness. Cerebellar - ataxia. Urinary incontinence, erectile dysfunction, intellectual deterioration |
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Neuropathic pain |
1) Amitriptyline, duloxetine, gabapentin, pregabalin 2) If first doesn't work try the others 3) Tramadol for breakthrough pain 4) Capsaicin cream if localised |
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Restless Leg Syndrome |
Spontaneous, continuous lower leg movements. May be associated paraesthesia. 2-10 % population, M=F, FHx. Uncontrollable urge to move legs - symptoms worse at night, crawling or throbbing sensation. Causes - FHx, low ferritin, uraemia, DM, pregnancy. Mx - stretching, iron replacement, dopamine agonists, benzodiazepines, gabapentin. |
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Dopamine Receptor Agonists |
Bromocriptine, ropinerole, cabergoline, apomorphine. If ergot derived - cabergoline, bromocriptine - pulmonary, retroperitoneal and cardiac fibrosis - ECHO, ESR, creatinine and CXR prior to starting treatment. Impulse control disorders and daytime somnelence. Postural hypotension, hallucinations, nasal congestion. |
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Levodopa |
Combined with decarboxylase inhibitor to prevent peripheral metabolism of levodopa to dopamine. Reduced effectiveness with time - 2 years. Dyskinesia, on-off effect, dry mouth, anorexia, psychosis, postural hypotension, drowsiness. |
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Monamine Oxidase B Inhibitors |
Selegiline Inhibits the breakdown of dopamine secreted by dopaminergic neurons |
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Amantadine |
Probably increases dopamine secretion and inhibits its uptake at dopaminergic receptors. Ataxia, slurred speech, confusion, dizziness, livedo reticularis. |
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COMT Inhibitors |
Entacapone, tolcapone. COMT is an enzyme involved in the breakdown of dopamine - used as an adjunct to levodopa. |
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Antimuscarinics |
Block cholinergic receptors. Used in drug-induced PD. Help tremor and rigidity. |
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Epilepsy Mx |
Started after 2nd seizure, unless neurological defect, structural brain abnormality, EEG shows unequivocal epileptic activity, high risk. |
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Generalised tonic-clonic Seizures |
1) Sodium Valproate 2) Carbamazepine or lamotrigene (young/pregnant girls) |
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Partial Seizures |
1) Carbamazepine 2) Lamotrigene, Sodium valproate |
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Absence Seizures |
Sodium valproate Ethosuximide |
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Myoclonic Seizures |
1) Sodium Valproate 2) Clonazapam, Lamotrigine |
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Triptans Adverse Effects and CI |
Adverse effects - tingling, heat, tightness, heaviness, pressure. CI - Hx of or singificant risk factors for IHD/cardiovascular disease. |
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Epilepsy Classification |
1) Generalised - tonic-clonic, absence, myoclonic (brief, rapid muscle jerks). 2) Partial - simple (preserved consciousness, memory + awareness), complex (loss of consciousness or awareness or memory), temporal lobe. |
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MND |
Amyotrophic lateral sclerosis, progressive muscular atrophy, bulbar palsy. Fasciculation, no sensory signs, upper limb - LMN lesion, lower limb - UMN, wasting of small hand muscles and tibialis anterior. Doesn't effect external occular muscles. No cerebellar dysfunction. Abdominal reflexes preserved. |
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GCS |
M6: Obeys commands, localises to pain, withdraws from pain, flexion to pain, extension to pain, nothing. V5: Normal speech, confused, words, sound, nothing. E4: Spontaneous, voice, pain, nothing. |
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Migraine |
Last up to 72 hours - usually unilateral headache. Third have associated aura. 3x women - 18 %. Triggers - tiredness, stress, alcohol, COCP, dehydration, lack of food, cheese, chocolate, wine, citrus fruits, menstruation, bright lights. |
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Phenytoin Side-effects |
Acute - dizziness, diplopia, nystagmus, slurred speech, ataxia, confusion, seizures. Chronic - gingical hyperplasia, hirsutism, coarsening of facial features, tiredness, megaloblastic anaemia, osteomalacia, lymphadenopathy, dyskinesia. Idiosyncratic - fever, rashes, hepatitis, dupuytrens contracture, aplastic anaemia, lupus. Teratogenic - cleft palate, congenital heart disease. |
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Sodium Valproate Adverse Effects |
Nausea, weight gain, increased appetite, alopecia, ataxia, tremor, pancreatitis, hepatitis, teratogenic, thrombocytopenia, hyponatraemia. Inhibits P450 system. |
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Stopping Antiepileptics |
Seizure free for > 2 years - do over 2-3 months |
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Diabetic Gastroparesis |
Erratic BM control, bloating, vomiting. Mx - Metoclopramide, domperidone, erythromycin. |
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Causes Motor Peripheral Neuropathy |
Guillain-Barre Syndrome Porphyria Lead poisoning Charcot-Marie-Tooth Chronic Inflammatory Demyelinating Polyneuropathy Diphtheria |
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Causes Sensory Peripheral Neuropathy |
DM Alcohol Vitamin B12 Deficiency Uraemia Leprosy Amyloidosis |
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Pre-hospital Management of Seizures |
Rectal diazepam. Neonates - 1.25-2.5mg 1 month - 2 years - 5mg 2 years - 12 years - 5-10mg 12-18 years - 10mg Adult - 10-20mg (max 30mg) Elderly - 10mg (max 15mg) |
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Wilson's Disease |
Excessive copper deposition in the tissues. Onset 10-25 years. Children present with liver disease, adults with neurological symptoms. Hepatitis, cirrhosis, basal ganglia degeneration, speech disturbance, chorea, dementia, kayser-Fleischer rings, renal tubular acidosis, blue nails, haemolysis. Diagnosis - reduced serum caeruloplasmin, raised 24 hr urinary copper. Mx - penicillamine - copper chelation. |
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ABCD2 |
A - Age >= 60 years B - Blood pressure >= 140/90 C - Clinical features - unilateral weakness = 2, speech disturbance + no weakness = 1 D - Diabetes D - Duration - > 60 mins = 2, 10-50 mins =1 |
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Rosier Score |
> 0 = stroke likely. Loss of consciousness/syncope = -1 Seizure activity = -1 Asymmetrical facial weakness = 1 Asymmetrical arm weakness = 1 Asymmetrical leg weakness = 1 Speech disturbance = 1 Visual field disturbance = 1 |
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Good prognostic factors for MS |
Female Young at diagnosis Sensory symptoms Remitting-relapsing course Long time between first two relapses |
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Pizotifen Side-effects |
Weight gain Drowsiness |
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Lhermitte's Sign |
Paraesthesiae in limbs on neck flexion Seen in MS, subacute combined degeneration of the cord and cervical stenosis |
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Uhthoff's Phenomenon |
Worsening of vision following a rise in body temperature Seen in MS. |
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Cluster Headache Management |
Treatment - Subcutaneous sumatriptan and 100 % oxygen. Prophylaxis - prednisolone, verapamil. |
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Medication overuse headache |
1 in 50. Present for >= 15 days of a month, developed or worsened whilst taking analgesia, opiods and triptans are most risky. Mx - triptans and simple analgesia - stop abruptly, opioids - withdraw gradually. |
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Drugs that worsen seizure control with epilepsy |
Alcohol, cocaine, amphetamines Ciprofloxacin, levofloxacin Aminophylline, theophylline Buproprion Methylphenidate Mefenmic acid |
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Oculogyric Crisis |
Dystonic reaction to certain drugs or medical conditions. Restlessness, agitation. Involuntary upward deviation of the eyes. Causes - metoclopramide, phenothiazines, haloperidol, postencephalitic Parkinsons disease Mx - procyclidine |
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Idiopathic Intracranial Hypertension |
Features - headache, papilloedema, blurred vision, enlarged blind spot, 6th nerve palsy. Risk factors - female, fat, pregnancy, COCP, steroids, tetracycline, vitamin A. Mx - weight loss, acetazolamide, topiramte, lumbar puncture, surgery. |
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MS Management |
Acute - IV methylprednisolone. Disease modifying - beta-interferon. Spasticity - baclofen, gabapentin, diazepam, dantrolene, tizanidine. Bladder dysfunction - if no residual volume - anticholinergics. |
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Normal Pressure Hydrocephalus |
Urinary incontinence + gait abnormality + dementia. Reversible. Reduced CSF absorption at the arachnoid villi. Also occurs with head injury, subarachnoid haemorrhage and meningitis. Enlarged 4th ventricle. Shunting. |