Neurology - done Flashcards

Question

Neuropathic pain mx

Answer 1

Amitriptyline (TCA) duloxetine (SNRI) gabapentin pregabalin

Answer 2

Severe unilateral paroxysmal electric shock like facial pain only in the distribution of the trigeminal nerve (not scalp, mandible or ear). Paroxysms of pain (few seconds to 2 minutes). Allodynia. Usually 50-70YO Most patients get good pain relief with carbamazipine. No other options. Often the underlying cause is compression of the trigeminal nerve by a normal blood vessel in the cranium (85%). 5-15% due to secondary causes - MS - Vascular abnormalities - Tumour of cerebellar pontine angle. Secondary causes more likely if younger, associated facial sensory loss, or bilateral pain.

Answer 3

Headache jaw claudication visual disturbance scalp tenderness

Answer 4

Raised ESR (gp can do) Temporal artery biopsy show multinucleated giant cells Duplex US shows halo sign of temporal artery (these only done by secondary care) If new visual loss - same day assessment by ophthalmologist For all others suspected GCA - Urgent discussion with rheum usually. Ideally same day or within 3 days, specialist review. If strongly suspected GCA, start high dose steroids immediately. 40-60mg oral pred Steroids for 1-2 years or longer!

Answer 5

Single episode of dense amnesia lasting less than 8 hrs with complete recovery and without features of epileptic sezirue. Recurrence rate is low. If recurrent episodes, patient should be referred for assessment for epileptic amnesia.

Answer 6

ALS (amyotropic lateral sclerosis) is the most common type of MNS. Causes mixed upper and lower motor neurone disease. Primary lateral sclerosis is rate and characterised by ascending spastic tetraparesis. Progressive bulbar Palsy, usually women, typically progresses to anarthria in 6-12m with normal limb strength. Progressive muscular atrophy is least well defined, presents with asymmetrical weakness and wasting often in legs

Answer 7

48hrs rest Return to work when feel able No contact sport for 3 weeks

Answer 8

Migraine. Use of triptsns, ergots, combination analgesics for 10d or simple analgesics for 15d is expected to cause a medication overuse headache Need to safely withdraw overused medication. This is done abruptly - withdraw for at least a month. Warn patient other pain condition may get worse.

Answer 9

Clopidogrel first line Second line if allergic or intolerant - aspirin + dipyridamole Aspirin alone if also intolerant of dipyridamole

Answer 10

CHA2DS2VASc

Answer 11

Bilateral symmetrical intention tremor First line mx propranolol or primidone Refer if not tolerate or if other neuro features

Answer 12

Localised pain around the eye associated with lacrimation. Usually once or twice daily for several weeks before resolving. May recur months or years later

Answer 13

Haemorrhagic - consider rapid BP lowering if SBP >150 and presents within 6hrs. - consider rapid BP lowering if SBP>220 and presenting >6hrs of onset. If rapid BP lowering, aim to reach SBP <140 but avoid drop of >60 within 1hr of starting treatment. (Not BP lowering if structural cause, GCS6 or less, early neurosurgery, or massive haematoma with poor prognosis) In ischameic stroke- early hypertension mx does not help unless hypertensive emergency! But if thrombolysis, need BP <185t /110 f ischaemic -

Answer 14

Start statin after 48hrs or as soon as swallow is safe.

Answer 15

Treat with aspirin for 2 weeks before switching back to DOAC. This is because of risk of haemorrhagic transformation. (Little evidence for this)

Answer 16

Clot busting with an IV drug (alteplase or tenectoplase) given within a window of opportunity. Risk of intracerebral haemorrhage.

Answer 17

This is endovascular physical removal of the clot by inserting device via femoral artery which can pull out the clot. Only suitable for large vessels. Usually only done after thrombolysis. (Doesn't work well on its own)

Answer 18

ABCS Antiplatelets - clopdigrel 75mg daily for stroke and most TIAs. NCGS recommends DAPT for 1m if TIA presents within 24hrs. (Aspirin and dipyridamole in clopi allergy). Blood pressure- biggest medically treatable factor! Treat as normal BP guidelines. Aim for clinic BP <140/90 (150/90 if >80YO). AntiCoag - if AF Statins - high intensity, normally atorvastatin 80mg. Treat to target LDL <2 or non-HDL <2.6. Add ezetimibe also to lower CV risk further.

Answer 19

Nice says avoid

Answer 20

Antiplatelets are generally used to reduce arterial thrombotic risk, anticoagulants reduce venous thrombotic risk.

Answer 21

Assuming embolic risk is high enough, anticoagulant for stroke prevention (not antiplatelet). (Secondary care may put patient on both).

Answer 22

Dizzy Dysarthric Diplopia Dysphagia Dystaxia

Answer 23

First line - amitriptyline, duloxetine, gabapentin or pregabalin. Tramadol can be used if acute rescue therapy is needed.

Answer 24

CBT and acceptance and commitment therapy

Answer 25

occur in up to 10% those on oral up to 50% those with IV up to 100% those with intrathecal or epidural use. Can be managed with ondansetron, diclofenac, antihistamines.

Answer 26

Rare but serious idiosyncratic drug reaction. Usually presents with triad of fever, muscle rigidity and autonomic instability, as well as mental status changes. CK is markedly increased, usually 1000-10,000. Also impaired LFTs and U&Es, and ECG abnormalities. Most common cause is exposure to dopamine receptor antagonists eg metoclopramide, prochlorperazine, chlorpromazine, also haloperidol, risperidone, quetiapine. Can also be due to rapid withdrawal from dopamine agonists pramipexole, ropinirole, rotigotine, cabergoline.

Answer 27

ALS - 60% cases. Most commonly presents with limb features. PBP is the second most common - difficulties with speech, swallowing.

Answer 28

6 months fit free if isolated single seizure 12 months seizure free if epilepsy T2 licences 5 years and neuro assessment for single seizure without epilepsy medication. 10 years seizure free without epilepsy medication and neuro assessment if epilepsy.

Answer 29

Better is lamotrigine and levetiracetam. Need drug monitoring either therapeutic drug monitoring or clinical monitoring. Sodium valproate, carbamazipine, phenobarbital, phenytoin, topiramate have increased risk of major congenital malformations.

Answer 30

Amitriptyline (TCA) Pregabalin/gabapentin Second line if above doesn't work: Duloxetine

Answer 31

If progressing over less than 4 weeks, may signify potentially life threatening neuromuscular disorder, cervical myelopathy. If progressing within hours to days, consider guillain barre syndrome or transverse myelitis. Needs immediate referal to neurology, for neurological assessment and assessment of bulbar and respiratory function.

Answer 32

Most commonly presents as progressive ascending muscle weakness and tingling sensations often starting in the legs and spreading to the arms and upper body. Will progress to problems breathing and swallowing if not caught early. If fever think of alternative causes. It is an acute inflammatory neuropathy affecting peripheral nervous system. 66% cases follow URTI or GI infection (triggered by virus or bacteria) Treatment is supportive, some will need respiratory support. IVIg improves outcomes if given within 2 weeks of symptom onset. Mortality 3-10%. 80% regain ability to walk within 6 months. Bimodal distribution of young adults and elderly.

Answer 33

Based on characteristic clinical symptoms and signs of upper and lower motor neurone degeneration supportive by neurophysiological evidence of motor neurone involvement and exclusion of structural lesions with appropriate MRI. More common in men than women. MND does not cause sensory disturbance.

Answer 34

Common. Can diagnose if bilateral upper limn action tremor, with or without tremor in other locations (head, larynx voice tremor, or lower limbs). Should be present for 3 or more years to diagnose. No associated neurological symptoms. Often family history as genetic component. Assess for factors which may worsen tremor before diagnosing essential tremor (such as metabolic or hormonal conditions and drug causes).

Answer 35

Propranolol or primidone depending on patient comorbidities (eg B blockers CI in asthma). Refer if medications do not help.

Answer 36

Need to have episodes occurring in different places at different times. Therefore history very important. Optic neuritis (unilateral vision loss rapidly worsening over hours to days, often with pain on eye movements, colour vision disturbance and central blind spot scotoma) is a very common presentation. If more than 3 plaques on MRI with optic neuritis, change of MS in future is 75%.

Answer 37

Refer to neurology - this diagnosis should be made by specialists.

Answer 38

Propranolol Amitriptyline or Topiramate. chose one based on patients preferences, comorbidities.

Answer 39

On average 1hr to max intensity and lasts 24hrs. Unilateral or can be bilateral, throbbing, worse with activity, can change sides during attack or at next episode. Associated photophobia or phonophobia, allodynia, or N&V. Aggravated by routine ADL, causes activity avoidance. May get premonitory symptoms for hrs-days before (yawning, light sensitivity, nausea, diarrhoea, neck pain, mood changes, tiredness). May get aura usually lasting 60mins, before headache (visual, sensory, speech, motor, or vertigo, or retinal symptoms) - may be positive or negative symptom. May get prodromal period of 12hrs or so after headache before feeling better. Similar to premonitory phase. NB: if strange symptoms in migraine aura, may be something else (TIA, GCA, raised ICP, occipital seizures, retinal detatchment) - if in doubt, refer same day if needed.

Answer 40

Pharma - NICE recommends oral triptan PLUS NSAID/paracetamol for every headache. or monotherapy with oral triptan or aspirin or paracetamol or NSAID if people don't want duel. Add metaclopramide/prochlorperazine if early or persistent vomiting, and can use nasal or SC triptan in these people Non pharma - good hydration, regular meals, sleep, exercise, avoid known triggers. - avoid meds that can make migraine worse - oral contraceptives, HRT, nasap decongestants, SSRIs, PPIs, opioids.

Answer 41

Start when affecting QOL/frequency of attacks at least weekly, or prolonged severe attacks. Aim to reduce severity and frequency by 50%. Use each treatment at max tolerated dose for 3m before deciding if effective or not. First line options are propranolol, topiramate, amitriptyline. Candesartan unlicensed. Propranolol not in asthma. Topiramate not in pregnancy, B blockers and candesartan also not in pregnancy. Topiramate can cause depression. Non drug options: NICE recommends accupuncture. CBT also recommended. Refer if >3 prophylactic treatments have failed.

Answer 42

Can take triptans off licence for 2 days before until 3 days after bleeding starts. 5 days total. there can be risk of medication overuse headache with triptans especially if used at other times in the month too.

Answer 43

Acute treatment - paracetamol first line. Ibuprofen can be used until 28 weeks but not after 28 weeks. - triptans are the treatment of choice if simple analgesia fails. Can be used throughout pregnancy. be mindful of acute headache in pregnancy - may be pre eclampsia, or cerebral venous thrombosis. Check neuro exam, fundoscopy, and BP and urinalysis.

Answer 44

If AURA present - COCP if MEC4. Other hormonal contraception MEC2. If no AURA - COCP MEC2 for initiation, MEC3 if develops a new history of migraine whilst taking COCP. This is because migraine is associated with increased risk of ischaemic stroke (2-4 times increase) and this is highest if aura. transdermal HRT fine with migraine.

Answer 45

HEAD CRISIS C Head trauma last 3 months Exacerbated by cough/valsalva/ sneezing/exercise/change in posture Acute narrow angle glaucoma /GCA Deficit (neurological), cognitive impairment or change in personality. Change in character of headache Roasting hot (fever with worsening headache) Impaired consciousness Sudden onset (max intensity within 5 minutes) - immediate ref to exclude SAH. Immunocompromised Sick (vomiting) without an obvious cause Cancer - previous cancer known to metastasise to the brain, or <20YO with cancer history.

Answer 46

Exclude red flags Then headache diary for 8 weeks

Answer 47

Unilateral only! around the eye and along side of face severe/very severe lasts 15mins- 3hrs. Can get many episodes within a day. May get automonic features on same side eg sweating/red watery eye/constricted pupil/swollen or drooping eyelid, nasal congestion. May be restless/agitated. Refer to confirm diagnosis May occur once every 2 days or up to 8 times daily. If episodic, get pain free periods more than 1 month. If chronic, don't get the pain free periods.

Answer 48

Bilateral, pressing/tightening, not pulsatile. Mild to mod severity, can last anywhere from 30mins to continuous. No associated symptoms. Not aggravated by ADLs. Can be episodic or chronic. Treat with paracet/nsaid or asprin (not if under 16YO due to risk of reye syndrome). Not opioids. Warn of medication overuse headaches. Can use acupuncture for prophylaxis.

Answer 49

Location, severity and duration all variable. Consider if frequent use of acute treatment for headache for more than 3 months of: - paracet, NSAID or aspirin >15d/m - triptan, opioid, ergot or combination analgesia >10d/month. Not aggrevated by ADL.

Answer 50

Acute treatment 100% oxygen NRB mask OR subcut or nasal triptans Paracetamol/NSAIDs/oral triptans/opioids/ergots all do not work! Warn about risk of medication overuse headache Prophylaxis Verapamil may help. Refer for diagnostic clarification. May need imaging. Non invasive vagus nerve stimulators may be initiated in secondary care.

Answer 51

Headache due to neck problem. Needs to have neck problem and at least 2 of onset of headache related to onset of neck problem, headache improves/resolves with improvement of neck problem, ROM is reduced and headache worse with certain neck movements. Headache will resolve with nerve block of cervical structure.

Answer 52

Headache 15d/month while taking regular acute headache treatment for more than 3 months (more than 15 days per month if simple analgesia, more than 10 days per month if triptans, combined analgesia, opioids or ergots). triptans and opioids most common cause. It only occurs if acute analgesia meds is used for underlying headache disorder, not if using for another painful condition. RF is frequent headache, frequent acute medication, pain from another cause, mental health condition. Self perpetuating as more headache then takes more analgesia.

Answer 53

Prevention better than cure, advise not to use any medication for more than 2 days per week. Discuss overuse headache with anyone taking regular acute medication for headache disorder. Stopping overused medication can reduce headache freq and severity but headaches may worsen before they get better (1-2weeks). NICE advise to stop all overused drugs for at least 1 month, abruptly. Warn of short term deterioration likely. Offer support/FU through this period. Then review at 4-8 weeks and consider prophylactic management of underlying headache disorder.

Answer 54

Raised ICP is medical emergency (and symptom of something else going on). Consider if any of: 1. new onset headache/near constant headache, severe headache or change in headache pattern. 2. Visual disturbance 3. Papilloedema 4. Pulsatile tinnitus Refer that day if headache and papilloedema/visual disturbance. Untreated raised ICP can cause permanent sight loss/neurological deficits and death. May also have neck or back pain, lethargy, weakness, behaviour changes, vomiting, reduced consciousness, seizures, sepsis, headinjury, history of cancer.

Answer 55

Good history blood pressure Full neuro exam including cranial nerves and visual fields. Fundoscopy.

Answer 56

Headache with papilloedema - needs neuroimaging Headache and visual disturbance - need formal visual field testing.

Answer 57

Acquired chronic inflammatory condition of CNS. Commonest age of presentation 20-30YO. Most common serious physical disability of working aged adults.

Answer 58

Relapsing remitting - most common, 85% have this initially. Secondary progressive - over time, half people with RR MS develop secondary progressive. Gradually worsening of disability Primary progressive - rare, 15%, gradually worsen with no relapses or remissions.

Answer 59

Most commonly visual/sensory disturbance, limb weakness, gait problems, bladder or bowel dysfunction. Visual disturbance may be loss or reduced vision in one eye, with painful eye movements, loss of red discrimination (optic neuritis), or double vision. Sensory symptoms is ascending sensory disturbance or weakness. More likely to be MS with neurological symp/signs if aged under 50, no fever/infection, symptoms evolving over more than 24hrs, persist over several days/weeks and then improve, and may have history of previous neurological symptoms. Need to rule out alternative causes depending on the presentation.

Answer 60

Rapidly progressive unsteady gait - urgent neurology referral. Progressive memory problems in young adult with multiple cognitive functions - routine referral. Persistent distally predominant altered sensation in limbs with brisk deep tendon reflexes - routine referral. Things not suggestive of MS - fatigue, depression, dizziness, vague sensory symptoms without focal neurological signs or symptoms, headache.

Answer 61

In 10 years before diagnosis, those with MS often have non specific consultations to the GP - with GI and urinary symptoms, depression, anxiety, insomnia, pain. This is prodrome when looking with hindsight but cannot tell at time.

Answer 62

Inflammation of the optic nerve. Partial or total unilateral visual loss developing over a few days, eye pain (in particular on eye movement) and/or loss of colour vision (particularly reds). May be bilateral. Need to ensure not neuromyelitis optica (rare alternative demyelinating disorder, high mortality rate if not treated with immunosuppression). If thinking about optic neuritis, refer to neurology.

Answer 63

Secondary care done. Based on history, examination, MRI and laboratory findings. Not diagnosed on MRI again.

Answer 64

Must notify DVLA and can drive as long as safe vehicle control maintained. Licence for 1 2 3 or 5 yrs may be issued provided medical enquiries by DVLA confirm driving performance is not impaired. May need specific controls. Same for group 2.

Answer 65

All under secondary care. Yearly review. Including symptoms and functional impact, MS disease course, general health including smoking/weight/exercise etc, medication review, bone health. Risk of contractures and pressure ulcers. Care and carer needs.

Answer 66

DMARD treatments - reduce relapses. They can be associated with blood abnormalities, increased risk of infection, cardiac arrhythmias, macula oedema, secondary autoimmunity, and in some cases increased risk of cancer. If women of childbearing age - need contraception. Avoid live vaccines.

Answer 67

Fatigue, mobility problems, spasticity, oscillopsia, emotional lability, pain, cognitive and memory problems, ataxia, dystonia and tremor.

Answer 68

May use spasticity to maintain posture and using medication may impair this. First line - baclofen Second line - gabapentin Third line - both together.

Answer 69

May get overactive bladder or stress incontinence For overactive bladder - antimuscarinics (however, may worsen CI in MS) - bladder wall botox injection if antimusarinics not tolerated or not effective. Stress incontinence - PFME

Answer 70

If person with stable disease then develops new symptoms or worsening of existing symptoms and these last more than 24hrs. Need to exclude infection eg chest infection, UTI. Commonest symptoms of relapse include optic neuritis (loss of visual acuity), sensory alterations, weakness, imbalance, and fatigue and cognitive dysfunction. Usually relapse occurs over hours to days then reaches plateau which may last days to weeks. Recovery may be complete or incomplete, and may take months. refer to secondary care if suspected relapse, they will usually give oral or IV methylprednisolone.

Answer 71

DMARDs exercise is beneficial not smoking. immunisations

Answer 72

Antidepressants, lithium, valproate, theophylline, thyroid hormones, immunosuppressants, caffiene, nicotine, glucocorticoids, sympatheticomimetics (adrenaline, salbutamol, cocaine, MDMA, amphetamines).

Answer 73

Postural or kinetic tremor. Usually upper limbs, bilateral, may also have tremor in head, larynx or lower limbs. Medium fast

Answer 74

devices such as weighted pens or computer mice can help tremor. other devices can help with buttons, drinking and eating. pharma mx with propranolol or primidone. Can use together.

Answer 75

Compression of median nerve at the wrist. Most common compression neuropathy in primary care. Distribution is palm and lateral 3.5 digits. Pain and paresthesia. Median nerve also supplies motor fibres to thenar eminence so CTS can cause wasting of this. Symptoms often intermittent. Pressure on the median nerve can cause demyelination too. Pain and tingling wakes at night, more pronounced first thing in the morning. Often people have movements to make the tingling go away.

Answer 76

twice as common in women. increases over age 30 Obesity, diabetes, RA, previous wrist fracture, use of walking stick. Weaker risk factors include smoking, hypothyroidism, keyboard use, and racquet sports.

Answer 77

Gold standard would be nerve conduction studies. However in primary care can do Kamath and Stothard scored questionnaire - clinician administered. This asks about about symptoms, pattern, affect of pregnancy and of wearing splint. Need score of 5 for CTS. Special tests Phanels, Tinnels, Durkans, have poor sensitivity and specificity and should not be used. Nerve conduction studies generally only done if considering surgery. Blood tests only required if possible secondary cause eg thyroid disease or RA.

Answer 78

Cervical radiculopathy (especially if bilateral). Cubital tunnel syndrome - ulcer nerve compression usually at elbow (this causes little finger symptoms). Less commonly peripheral neuropathy, cervical cord disease (MS), raynauds. Could also be MND, acute stroke. NB: de quervains tenosynovitis causes pain in the hand or wrist but not usually sensory disturbance.

Answer 79

Conservative management options 1. Wrist splint at night - limited effectiveness 2. Single corticosteroid injection (evidence that this is more effective than splints). Should get improvement within 6 weeks. refer to secondary care if persisting symptoms or disability not responding to 6 weeks of conservative mx. Don't delay secondary care referral as surgical outcomes poorer if longer period of symptoms.

Answer 80

Open or endoscopic decompression. Most respond well, only minority require rehab post op. Recurrence rate up to 10%.

Answer 81

This is entrapment of the ulnar nerve in the cubital tunnel (funny bone). Affects ring finger and little finger. This is second most common mononeuropathy. Left untreated will progress to motor symptoms due to atrophy of small intrinsic muscles of the hands. Must less commonly the ulnar nerve can be trapped at the wrist which is called Guyon canal syndrome .

Answer 82

Clinical diagnosis (but no validated scoring system like we have for carpal tunnel). may be confirmed by US or nerve conduction studies.

Answer 83

Education Avoiding aggrevating activities (prolonged resting on elbows). Elbow splinting, braces and nerve gliding exercises have been suggested. All lack supporting evidence. Surgical decompression in refractory cases.

Answer 84

Metoclopramide Prochlorperazine Perphenazine Flupentixol Chlorpromazine Fluphenazine Haloperidol Pimozide Sulpiride Trifluoperazine

Answer 85

More likely to have underlying organic cause eg tumour stroke Alzheimer's More likely to start medication after single seizure due to increased risk of future seizure. Levetiracetam or lamotrigine usually first line.

Answer 86

Weakness of muscles of dorsiflexion of the ankle, causing problems with walking. Commonest cause peroneal neuropathy, mostly due to external pressure on the nerve eg cast wearing, leg crossing, prolonged kneeling or squatting. Can also be due to nerve root disease (ask about back pain) or nerve disease, or myopathy, or stroke, musclular dystropy (but latter two are rare and would present with other things too). Differentiate based on pattern on neuro exam. EMG or nerve conduction studies to confirm working diagnosis of peroneal neuropathy. Behaviour modification as management. Consider orthosis to help support foot, maybe PT. Refer if not improving in primary care. If bilateral foot drop - refer - ?CAS.

Answer 87

Few potentially reversible causes of dementia so important to consider diagnosis. Will have ventriculomegaly without raised CSF pressure. Can also get normal pressure hydrocephalus with other conditions such as SAH or meningitis. Presents in those over 60 with gait and balance disturbance, cognitive impairment and urinary incontinence. No not all may get all features. Dementia or Parkinson's key differentials. If suspected, refer to neuro for neuroimaging. Treat with VP shunt.

Answer 88

Presentation 50-60YO, commoner in males. 10% genetic. Link with physical activity especially if concussive or cervical trauma. Early diagnosis prolongs survival

Answer 89

Progressive muscle weakness (and wasting) without significant sensory component. 70% present with limb symptoms. asymmetrical, twitching, fasciculations, wasting, cramps, often distally. 25% present with bulbar symptoms (dysarthria quiet hoarse slurred speech, espeically if tired. also dysphagia liquids more than solids). Wasted tongue, excessive saliva, tongue fasciculation. Urgent referral if swallow affected. Also get respiratory features (especially later) and cognition affected. When referring - specifically mention you are considering MND. 50% of those with ALS will develop cognitive impairment, 80% anxiety, 20% psychosis. Not affected in MND: bladder/bowel, sensory, vision. Also any symptoms that improve goes against MND - it is always progressive.

Answer 90

ALS most common 85%. Mixed UMN and LMN. Survival mean 4yr from symptom onset. Primary lateral sclerosis - rare 3%, UMN dysfunction and substantial spasticity but best survival rates. Primary muscular atrophy - LMN with muscle atrophy and flaccid paralysis. Survival between ALS and PLS. Mx to alleviate symptoms, maintain function, ACP. Single drug Riluzole is licenced for ALS - modest benefit at improving survival but doesnt improve symptoms.

Answer 91

Muscle cramps - quinine, baclofen Spasticity - baclofen, dantrolene, tizanidine Drooling - conservative then antimuscarinic or glycopyrronium. Gastrostomy for nutrition. DO SR1 form for fast track benefit support.

Answer 92

Less than 40, bilateral symptoms, opthalmic division only, sensory loss, hearing loss, skin or oral lesions, optic neuritis or FHx of MS, poor response to treatment (consider surgery). If facial pain and persistent facial numbness - refer 2WW for infiltrative/intracranial mass. If facial pain and headache - same day assessment for GCA.

Answer 93

Side effects common - dizziness, diplopia, ataxia, elevated LFTs, hyponatraemia. Enzyme inducer so multiple drug interactions. Bloods at intiation but routine blood monitoring not required. NB some asian populations have allele HLAB1502 that increases risk of SJS with carbamazipine, so do genetic testing before prescribing in these people. If patient does not respond to carbamazipine, refer. They may get radiosurgery.

Answer 94

No, unlike IBS and fibromyalgia, everyone with suspected functional neurological disorder should be referred to secondary care for assessment and diagnosis. Symptoms of FND may include motor or sensory symptoms, sleep disturbance, memory problems, dissociative symptoms, seizures. Often multiple symptoms across multiple body areas. Previous adverse experiences are risk factors. Might have variability. Often co-exist with another neurological condition eg epilepsy, MS.

Answer 95

Communicate diagnosis well Physiotherapy and other rehab Psychological therapy Drug treatments - SSRI if concurrent MH problem but not only for FND. Comorbid conditions - treat actively where possible. If new symptoms or signs - refer back for neurological assessment.

Answer 96

Bidirectional, torsional or vertical nystagmus are bad. Negative head impulse test (Positive test if there is saccade, this means peripheral rather than central, therefore negative HIT indicates more likely central cause). Any skew deviation (corrective movement in uncovered eye) needs urgent referal for possible central cause. Other neurological deficits - one sided deafness, dysarthria, severe gait ataxia. Limp abnormalities such as numbness, weakness, poor coordination.

Answer 97

Neuro - posterior stroke, demyelination Local- cervical dizzness ENT - BPPV labyrinthitis, menieres Other - anaemia, diabetes, hypovolaemia, psychosomatic disorder.

Neurology - done Flashcards

(128 cards)