Each one of the following drugs may be used to prevent migraine attacks, except:
Correct Answer E:
Migraine: management:
It should be noted that as a general rule 5-HT receptor agonists are used in the acute treatment of migraine whilst 5-HT receptor antagonists are used in prophylaxis. NICE produced guidelines in 2012 on the management of headache, including migraines.
Acute treatment:
Prophylaxis:
*Caution should be exercised with young patients as acute dystonic reactions may develop.
Each of the following are causes of peripheral neuropathy.
Which one is associated with predominately sensory loss?
Peripheral neuropathy:
Peripheral neuropathy may be divided into conditions which predominately cause a motor or sensory loss.
Predominately motor loss:
Predominately sensory loss:
Alcoholic neuropathy:
Vitamin B12 deficiency:
Which one of the following causes of peripheral neuropathy is most associated with an axonal, rather than demyelinating, pathology?
Correct Answer E: The other causes are associated with a demyelinating pathology: Peripheral neuropathy: demyelinating vs. axonal:
Demyelinating pathology:
Axonal pathology:
*May also cause a demyelinating picture.
A 67-year-old woman comes for review with her husband. Her husband complains that she is constantly getting up from bed at night and pacing around the bedroom. She complains of 'antsy' legs and a 'horrible, creeping sensation'. Her symptoms generally come on in the evening and are only relieved by moving round.
Given the likely diagnosis, what is the most appropriate treatment?
Correct Answer A: Restless leg syndrome - management includes dopamine agonists such as ropinirole.
Restless legs syndrome:
Restless legs syndrome (RLS) is a syndrome of spontaneous, continuous lower limb movements that may be associated with paraesthesia. It is extremely common, affecting between 2-10% of the general population. Males and females are equally affected and a family history may be present.
Clinical features:
Causes and associations:
The diagnosis is clinical although bloods to exclude iron deficiency anaemia may be appropriate.
Management:
A 45-year-old female with a past medical history of asthma is diagnosed as having essential tremor.
What is the most suitable management?
Correct Answer E: Essential tremor is an AD condition that is made worse when arms are outstretched, made better by alcohol and propranolol.
Propranolol is generally considered first-line in essential but given the history of asthma primidone should be used.
Essential tremor: Essential tremor (previously called benign essential tremor) is an autosomal dominant condition which usually affects both upper limbs.
Features:
Click to expand