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IK6 - Exams > Neurology > Flashcards

Neurology Flashcards

1
Q

Describe the GCS scoring system of consciousness

A

max = 15, minimum = 3
< 8 consider intubation

eyes = 4 
verbal = 5 
motor = 6
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2
Q

What functions are associated with the frontal lobe?

A

higher intellectual function
personality, mood
social conduct + behavior

motor areas (post. frontal)

conjugate eye movements + frontal eye fields

language

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3
Q

what functions are associated with the temporal lobe?

A

memory
language
visual pathway (optic radiation)

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4
Q

what functions are associated with the parietal lobe?

A

DOMINANT HEMISPHERE
language, reading, writing
calculation
praxis

NON-DOMINANT HEMISPHERE
visuo-spatial function

BOTH
higher sensory function
visual pathway

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5
Q

what functions are associated with the occipital lobe?

A

visual cortex and visual association areas

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6
Q

What visual field defect would a patient present with if they have a lesion in the optic chiasm?

A

bitemporal hemianopia

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7
Q

What might cause an enlargement of a physiological blind spot?

A

papilloedema

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8
Q

what is tunnel vision?

A

loss of peripheral fields but preservation of central region

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9
Q

what are some causes of tunnel vision?

A

chronic glaucoma
retinitis pigmentosa
cortical disease
may be functional meaning no disease

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10
Q

which eye muscles does CN III supply?

A

superior rectus muscle, medial rectus muscle, inferior rectus muscle, inferior oblique muscle

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11
Q

which eye muscles does CN IV supply?

A

superior oblique muscle

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12
Q

which eye muscles does CN VI supply?

A

lateral rectus muscle

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13
Q

what are the features of CN III palsy?

A

ptosis
eye points down and out

if PNS fibres involved pupil fixed and usually dilated

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14
Q

What are causes of a third nerve (CN III) palsy?

A

compression:
- brainstem by tumour or basilar aneurysm
- tentorial herniation (coning)
- posterior communicating artery aneurysm
- cavernous sinus: tumous, aneurysm, thrombosis
- superior orbital fissure SOL (tumour, granuloma)

infarction:
brainstem or at nerve trunk (DM, HTN, GCA, SLE)

inflammation or infiltration of basal meninges involving nerve

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15
Q

features of fourth nerve palsy

A

isolated unilateral paralysis of superior oblique

diplopia doing down stairs

may hold head tilted to normal side

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16
Q

features of sixth nerve palsy

A

unable to abduct affected eye

diplopia looking to affected side

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17
Q

features of Horner’s syndrome

A

partial ptosis
miosis (pupil constriction)
anhydrosis

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18
Q

what are upper motor neurones?

A

neurons whose cell bodies are in the motor cortex and their axons are in the corticospinal tract synapsing with anterior horn cells

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19
Q

what are lower motor neurons?

A

motor neurons with axons extending from anterior horn cells of the spinal cord to voluntary muscles.

one supplies one motor unit

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20
Q

are fasciculations LMN or UMN signs?

A

LMN

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21
Q

what kind of gait may UMN lesions lead to?

A

spastic, scissoring, circumduction

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22
Q

what modalities of sensation are transmitted via the dorsal columns?

A

position
vibration sense

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23
Q

what modalities of sensation are transmitted via the spinothalamic tracts?

A

pain
temperature

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24
Q

what is the dorsal column pathway?

A

Ascending pathway (from PNS to CNS)

info from preceptors -> primary sensory neurone -> enter dorsal root -> cord -> ascends in dorsal columns (same side) -> brainstem (medulla) -> desiccates (crosses sides) -> third neurone -> thalamus to cerebral cortex (parietal lobe)

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25
Q

what is the spinothalamic column pathway?

A

primary sensory neurone -> enters cord via dorsal root -> desiccates -> ascends in contralateral spinothalamic tract (crosses over within a few segments) -> thalamus -> third neurone -> cortex.

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26
Q

what bodily functions and systems are affected by autonomic dysfunction?

A

pupils
BP and HR
bladder, bowel, sexual function
sweating, lacrimation, salivation

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27
Q

indications for a diagnostic LP?

A

meningitis, encephalitis
SAH
MS
Huntington’s disease
inflammatory disorders = syphilis, sarcoid, GBS
idiopathic intracranial HTN
myelography

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28
Q

indications for a therapeutic LP?

A

intrathecal chemo
removing CSF in IIH or post-op
spinal anaesthesia

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29
Q

Contraindications for LP

A

suspect or actual intracranial mass (risk of coning)
bleeding disorder
significant spinal deformity

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30
Q

what antibodies should be tested for if you suspect myasthenia gravis?

A

anti-acetylcholine receptor antibodies

anti-MuSK antibodies

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31
Q

What is a myasthenic crisis and how do you treat?

A

weakness of respiratory muscles during a relapse

ventilate if < 20mL/kg
plasma or IV Ig
treat any trigger for relapse

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32
Q

What are the causes of lamber-eaton myasthenic syndrome?

A

disorder of NM transmission due to impaired presynaptic release of ACh

causes: paraneoplastic (small cell lung CA) or autoimmune

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33
Q

how is lambert-eaton different to myasthenia gravis?

A

in lambert eaton:

  • gait affected before eyes
  • autonomic involvement
  • hyporeflexia and weakness which improves with exercise
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34
Q

what criteria is used for MS?

A

Mcdonald criteria

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35
Q

what is the triad of parkinsonism?

A

tremor (worse at rest, pill-rolling, 4-6 cycles per second)
rigidity
bradykinesia/hypokinesia

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36
Q

what sort of a gait do parkinson’s patients have?

A

reduced arm swing, short shuffling steps with flexed trunk, freezing at obstacles/doors

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37
Q

what might pale optic discs indicate?

A

previous subclinical optic neuritis

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38
Q

Which is forehead sparing?

a) UMN
b) LMN

A

UMN

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39
Q

describe a spastic gait

A

stiff movement of legt in an arc

might be post stroke

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40
Q

describe the walk of a patient with sciatic nerve injury

A

drop foot + high stepping gait

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41
Q

describe sensory ataxia

A

board based high-stepping gait

this is due to peripheral neuropathy leading to deficits in proprioception

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42
Q

tender pulseless temporal arteries, jaw claudication

A

GCA

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43
Q

signs of parkinsons

A

lead-pipe rigidity, cog-wheel rigidity, pill rolling tremor, festinant gait with poor arm swing

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44
Q

onset of chorea in middle age with dementia onset later on

A

Huntington’s disease

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45
Q

gait apraxia, confusion, incontinence

A

normal pressure hydrocephalus

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46
Q

cauda equina syndrome signs

A

saddle anaesthesia, bowel/bladder dysfunction

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47
Q

triad of nystagmus + opthalmoplegia + ataxia

A

wernicke’s encephalopathy

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48
Q

nerves responsible for the supinator reflex

A

C5 and C6

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49
Q

nerves causing biceps reflex

A

C5 and C6

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50
Q

nerves causing triceps reflex

A

C7

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51
Q

unilateral weakness/sensory deficit, homonymous hemianopia, higher cerebral dysfunction (dysphasia, neglect)

A

anterior circulation stroke

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52
Q

CN palsies, cerebellar signs (vertigo, dysarthria, ataxia, choking)
isolated homonymous hemianopia

A

posterior circulation stroke

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53
Q

which cancers commonly metastasis to the brain?

A

thyroid
lung
breast
stomach
colorectal
prostate

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54
Q

what are features of SOL in the brain?

A

headache - worst in the morning and on lying down
nausea + vomiting
seizures
progressive focal neurological deficits
cognitive + behavioural changes
papilloedema + vision changes

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55
Q

what are the cardinal features of cluster headaches?

A

trigeminal distribution of pain
same-sided cranial autonomic symptoms
pattern to the attacks

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56
Q

what is the main causative organism of encephalitis?

A

most common is HERPES VIRUS

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57
Q

what is the primary bacterial cause of meningoencephalitis?

A

neisseria meningitides

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58
Q

what organisms are important to consider in an immunocompromised patient presenting with encephalitis?

A

CMV
toxoplasmosis
listeria

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59
Q

what are the signs of a raised ICP on examination?

A

reduced GCS
hypertension
bradycardia
irregular breathing pattern
papilloedema

60
Q

what are the types of focal seizure?

A

complex partial seizure (reduced consciousness)
simple partial seizure (consciousness not affected)

focal seizures may progress to generalised seizures

61
Q

what are the types of generalised seizure?

A

tonic (stiffening of body)
myoclonic (limb jerking)
tonic-clonic (reduced consciousness, muscle stiffening, convulsions)
absence seizures
atonic seizures (sudden loss of muscle tone -> collapse)

62
Q

what are some secondary causes of seizures?

A

brain = tumours, infection, inflammation, haemorrhage, trauma, neurodegenerative diseases

toxic/metabolic = sodium imbalances, alcohol withdrawal

systemic = malignant HTN, eclampsia

63
Q

what is todd’s paralysis?

A

this is a post-ictal state where the patient has flaccid muscle tone

typical of a frontal lobe, focal or motor seizure

64
Q

how do you treat status epilepticus?

A
  1. ABC, check glucose, ABG for electrolytes
  2. IV lorazepam or PR diazepam or buccal midazolam. can repeat step 2 up to 2 times
  3. IV phenytoin infusion + ECG monitoring
  4. diazepam infusion + close respiratory monitoring
  5. general anaesthesia + intubation + ICU
65
Q

what anti-convulsant is commonly used to treat focal seizures?

A

lamotrigine or carbamazepine

66
Q

what anti-convulsant is commonly used to treat general seizures?

A

sodium valproate

67
Q

what is the inheritance pattern of huntington’s?

A

autosomal dominant

68
Q

what is the genetic mutation responsible for huntington’s?

A

expanded CAG repeat in the gene for the huntingtin protein

more than 40 repeats indicates huntington’s. < 28 is normal

69
Q

what are the types of hydrocephalus?

A

non-communicating/obstructive = flow of CSF is blocked causing build up

communicating - communication between ventricles and subarachnoid space causing reduced absorption or venous drainage

normal pressure hydrocephalus = idiopathic chronic ventricular enlargement. may lead to white matter tract damage over time

70
Q

what is the triad of features seen in normal pressure hydrocephalus?

A

dementia
gait disturbance
urinary incontinence

71
Q

what are common viral causes of meningitis?

A

enteroviruses
mumps
herpes
VZV
HIV

72
Q

what are common causes of meningitis in neonates?

A

group B streptococci
E. coli
listeria

73
Q

what are common causes of meningitis in children?

A

H. influenza
N. meningitides
strep. pneumoniae

74
Q

what are common causes of meningitis in adults?

A

N. meningitides
S. pneumoniae
TB

75
Q

what are common causes of meningitis in elderly?

A

s. pneumoniae
listeria

76
Q

what is the commonest cause of fungal meningitis and who does it affect?

A

cryptococcus

immunocompromised patients

77
Q

what are some common auras experienced by migraine patients?

A

VISUAL - chaotic cascading, distortions, dots, ZIGZAG lines, jumbling of lines, defects in visual field

SENSORY - parasthesia

MOTOR - dysarthria, ataxia, opthalmoplegia, hemiparesis

78
Q

what are some triggers for migraines?

A

CHOCOLATE

CHOCOLATE
HANGOVERS
Orgasims
CHEESE
ORAL CONTRACEPTIVE PILL [very important]
Lie-ins
ALCOHOL
Tumult
Exercise

79
Q

what are neurological abnormalities do not occur in MND?

A

patients have NO sensory loss or sphincter disturbance

80
Q

what is the most common type of MND?

A

amyotophic lateral sclerosis

81
Q

what is the MRC scale?

A

0 - no constraction
1 - flicker or trace contraction
2 - active movement in the plane of gravity
3 - active movement against gravity, but not resistance
4 - active movement against gravity + resistance but WEAK
5 - normal power

82
Q

what sort of an immune response causes MS?

A

t cell response

83
Q

what condition is lambert eaton associated with?

A

small cell lung carcinoma

84
Q

which antibodies are commonly implicated in MG?

A

anti-acetylcholine receptor antibodies (90%)
MUSK antibodies

85
Q

difference between neurofibromatosis 1 and 2?

A

1 - presents with skin symptoms (e.g. cafe au lait) + other issues + increased CA risk. most common type

2 - CNS tumours rather than skin lesions. schwannomas, meningiomas, gliomas, cataracts

86
Q

what is the urine test for multiple myeloma?

A

bence-jones proteins

87
Q

what is the pharmacological management of tension headaches?

A

ibuprofen 400mg
TCA such as amitriptyline for chronic tension headaches

88
Q

does a stroke to the middle cerebral artery affect the upper limbs or lower limbs more?

A

upper limbs + trunk

89
Q

do strokes involving the anterior cerebral artery affect the upper limb or lower limbs more?

A

lower limbs

90
Q

what are cardiac sources of emboli?

A

AF
post MI (mural thrombus is dislodged/broken up)
valve disease or prosthesis
venous clot passing through PDA or VSD

91
Q

what are the components of the ABCD2 score and what is the scores significance?

A

Age > 60
BP > 140/90
clinical features (weakness, speech disturbance no weakness)
duration > 1hr = 2, 10-59 = 1
diabetes

maximum = 7
over 6 = very high risk of stroke
all over 4 to be assessed within 24 hours by specialist
used for TIA

92
Q

what is the management of TIA?

A

is a suspected TIA has occurred in the last 24 hours load with 300mg aspirin

once confirmed load with 300mg clopidogrel and give high intensity statin therapy (atorvastatin 20-80mg)

93
Q

what is the triad for wernicke’s encephalopathy?

A

mental status change
opthalmoplegia
gait dysfunction

94
Q

what deficiency causes wernicke’s encephalopathy?

A

thiamine deficiency

95
Q

describe the motor component of the GCS score?

A 
1 = no movement 
2 = abnormal extension to pain - decerebrate 
3 = abnormal flexion to pain - decorticate 
4 = withdraws from pain 
5 = localises to pain 
6 = obeys commands
96
Q

what are signs of an UMN lesion?

A

increase tone (spasticity)
reduced power
hyperreflexia
upgoing plantar reflex

97
Q

what are the signs of a LMN lesion?

A

reduced tone (flaccid)
reduced power
hyporeflexia

98
Q

What are signs of cerebellar pathology?

A

DANISH

Dysdiadochokinesia (tested with rapid alternating movements)
Ataxia
Nystagmus
Intention tremor
Speech - slurred, scanning
Hypotonia

99
Q

How would you manage a stroke?

A

< 4.5 hours - CT if no haemorrhage THROMBOLYSIS

> 4.5hrs - CT head to exclude haemorrhage, aspirin, swallow assessment, maintain hydration + oxygenation + monitor glucose

100
Q

How would you manage a TIA?

A

aspirin
ECG, echocardiogram
Carotid doppler
Risk factor modification

101
Q

what are the features of a third nerve palsy?

A
  • eye deviated down and out
  • dilated pupil
  • unilateral complete ptosis
102
Q

causes of 3rd nerve palsy?

A
  • Posterior communicating artery aneurysm (painful)
    • Neurosurgical emergency
  • Hypertension
  • Diabetes
  • MS
  • Others - trauma, bleed, tumour

surgical vs medical

  • surgical - extrinsic compression
  • medical - affecting nerve directly in some way
103
Q

how does pupil dilation help determine cause of 3rd nerve palsy?

A
  • Surgical causes - early pupil dilation, PNS nerves are on the outside so are compressed early when there is an extrinsic cause
  • Medical - pupil dilation is a late sign, damage to 3rd nerve occurs from inside to outside
  • Other investigations - excluding chronic medical issues
104
Q

causes of ptosis

A
  • Unilateral
    • Horner’s syndrome
    • 3rd nerve palsy
    • Congenital
  • Bilateral
    • Myasthenia gravis
    • Myotonic dystrophy
    • Oculopharyngeal muscular dystrophy
    • Mitochondrial disease (e.g. Kearns-Sayres)
105
Q

how does pupil size and ptosis help differentiate the issue?

A
  • Ptosis + large pupil → 3rd nerve
  • Ptosis + small pupil → Horner’s syndrome
  • Ptosis + normal pupil → myasthenia and other
106
Q

causes of 6th nerve palsy + finding

A

failure of eye abduction

  • Hypertension, DM, MS, raised ICP
107
Q

signs of raised ICP

A
  • Papilledema (late sign usually)
  • Loss of retinal vein pulsation in fundus (early)
  • Hypertension, bradycardia and abnormal breathing pattern - Cushing’s triad
  • Focal neurology
    • Including other CN palsies
  • seizure
  • ↓ GCS
108
Q

causes of wasting of small muscle of the hands

A

unilateral

  • Pancoast’s tumour
  • brachial plexus trauma
  • cervical rib

bilateral

  • RA
  • cervical spondylosis
  • MND
  • CMT
  • syringomyelia
  • bilateral cervical ribs
109
Q

how to localise site of lesion causing a 7CN palsy?

A
  • assess CN 6, 5 and 8
  • if 6 has defects too → pons lesion
  • if 5 and 8 have defects too → cerebello-pontine angle
110
Q

features of 3rd nerve palsy

A
  • Eye deviated “down and out”
  • Ptosis
  • Dilated pupil
    • Early in surgical, late in medical as PNS on periphery of CN3 nerve bundle
111
Q

causes of 3rd nerve palsy

A
  • Medical
    • DM
    • MS
    • Vasculitis
    • SOL
    • Weber’s syndrome - midbrain stroke
    • Cavernous sinus thrombus
  • Surgical
    • Trauma
    • Posterior communicating artery aneurysm
    • Uncal herniation due to ↑ ICP giving false “localising sign”
112
Q

what does the facial nerve supply (CN7) ?

A
  • Muscles of facial expression
  • Stapedius of ear
  • Anterior 2/3 of tongue sensory
  • PNS fibres to lacrimal and salivary glands
113
Q

causes of bilateral facial nerve palsy

A
  • Sarcoidosis
  • GBS
  • Bilateral acoustic neuroma - NF type 2
114
Q

causes of unilateral facial nerve palsy (CN 7)

A
  • LMN
    • MS
    • Bell’s palsy
    • Ramsey Hunt
    • Acoustic neuroma
    • Parotid tumours
    • HIV
    • DM
  • UMN
    • MS
    • Stroke
115
Q

features of 4th nerve palsy

A

trochlear nerve

  • Innervates superior oblique (moves eye out and down)
  • Features
    • Vertical diplopia
      • Going down stairs or reading book
    • Subjective tilting of objects
    • Head tilt
    • Eye up and rotated out
116
Q

what is lateral medullary syndrome and it’s features

A
  • After posterior inferior cerebellar artery
  • Features
    • Ataxia
    • Nystagmus
    • Brainstem features
      • Ipsilateral: dysphagia, facial numbness, CN palsy (e.g. Horner’s)
      • Contralateral: limb sensory loss
117
Q

Oxford stroke classification

total anterior circulation stroke

A
  • requires 3 criteria:
    1. Unilateral weakness (and/or sensory deficit) of face, arm and leg
    2. Homonymous hemianopia
    3. Higher cerebral dysfunction - dysphasia, visuospatial disorder
  • Most common site of occlusion for TACS is the MCA, due to complete blockage of vessels
118
Q

Oxford stroke classification

partial anterior circulation stroke

A
  • requires 2 of the 3
    1. Unilateral weakness (and/or sensory deficit) of face, arm and leg
    2. Homonymous hemianopia
    3. Higher cerebral dysfunction - dysphasia, visuospatial disorder
  • Involves smaller arteries in the anterior circulation e.g. upper or lower division of the MCA
119
Q

Oxford stroke classification

lacunar stroke syndrome

A
  • arises from smaller vessels being affected and has no loss of cortical function.
  • Infarcts in perforating arteries around the basal ganglia, internal capsule, thalamus or pons
  • 1 of the following:
    • Pure sensory stroke
    • Pure motor stroke
    • Sensori-motor stroke
    • Ataxic hemiparesis
120
Q

oxford stroke classification

posterior stroke syndrome

A
  • different presentation. May have a varied clinical picture.
  • Involves the vertebrobasilar arteries
  • Need 1 of the following for diagnosis:
    • CN palsy and contralateral motor/sensory deficit
    • Bilateral motor/sensory deficit
    • Conjugate eye movement disorder e.g. horizontal gaze palsy
    • Cerebellar dysfunction e.g. vertigo, nystagmus, ataxia
    • Isolated homonymous hemianopia
121
Q

causes of hemiplegic gait

A
  • spastic flexion of upper, extension of lower
  • circumduct their leg
  • unilateral
    • stroke, SOL, trauma, MS
  • bilateral
    • trauma hemisection of spinal cord
122
Q

diplegic gait

A
  • scissoring gait
  • spine + sensation affected
    • prolapsed disc, spinal spondylosis, spinal tumour, transverse myelitis, spinal infarct, syringomyelia, hereditary spastic paraperesis
  • bilateral brain
    • cerebral palsy, MS, bilat. brain infarcts, midline tumour
  • MND
123
Q

causes of shuffling gait

A

parkinson’s

124
Q

causes of ataxic gait

A
  • cerebellar ataxia
    • cerebellar stroke, SOL, MS, ETOH, B12 def, drugs, Frederich’s ataxia, paraneoplastic
  • sensory
    • peripheral neuropathy (DM)
  • vestibular
    • labyrinthitis
    • Meniere’s disease
    • acoustic neuroma
125
Q

neuropathic/high-stepping gait

A
  • weakness in muscles of distal limb → peripheral nerve damage
  • causes
    • foot drop → common peroneal nerve injury
    • L5 radiculopathy (disc prolapse)
    • generalised polyneuropathy
      • DM, MND, charcot-marie tooth disease
126
Q

myopathic/waddling/Trendelenburg gait

A
  • weakness of hip abductors
  • systemic
    • hyper/hypothyroidism
    • cushing
    • acromegaly
    • PMR
    • polymyositis or dermatomyositis
  • muscular dystrophy
    • DMD, becker’s MD, myotonic dystrophy
127
Q

choreiform gait

A
  • involuntary movements such as grimace/lip-smack and choreic movements
  • basal ganglia disease
    • huntington
    • syndeham’s chorea - rheumatic fever
    • cerebral palsy
    • wilson’s
    • dopaminergic meds (PD)
128
Q

is cerebellar ipsilateral or contralateral innervating?

A

ipsilateral

so nystagmus going left → left cerebellum issue, same for all other signs

129
Q

antalgic gait

A
  • stand phase reduced
  • caused by pain
    • OA
    • inflammatory joint disease
    • lower limb #
    • nerve entrapment e.g. sciatica
130
Q

CSF features of bacteria

A
131
Q

CSF features of virus

A
132
Q

CSF features of GBS

A
133
Q

CSF results of SAH

A
134
Q

CSF results of TB

A
135
Q

key dermatomes

  • C2, C4, C7, T4, T10, L2, L5, S1
A
136
Q

cortical issue → face + limb defect pattern

A

face + limb affected on same side

CNS lesion is on the contralateral

137
Q

brainstem issue - face and limb presentation

A
  • crossing signs
    • contralateral facial weakness to limb weakness
    • e.g. R face, left limbs
  • weakness + ataxia, vertigo and double vision
138
Q

Failure to abduct the eye indicts a contra lateral or ipsilateral defect of what nerves?

A

Ipsilateral Abducens nerve palsy (CN 6)

139
Q

Describe features of Broca’s aphasia

A

Frontal lobe Non-fluent speech + normal comprehension + impaired repetition

140
Q

cauda equina vs cord compression

A
141
Q

describe brown sequard syndrome

A

ipsilateral light tough, vibration and proprioception (at lesion)

contralateral loss of pain and temperature (2-3 levels below)

142
Q

how does gleason score impact prostate CA Tx

A

< 6 - low risk, watch and wait

7 - medium

over 7 - high risk, active treatment

143
Q

what sort of kidney injury do NSAIds cause?

A

interstitial nephritis

144
Q

cavernous sinus pathology

A

combination of unilateral ophthalmoplegia (cranial nerve (CN) III, IV, VI), autonomic dysfunction (Horner syndrome) or sensory CN V1- CN V2 loss.

145
Q

intermittent claudication in calf - which vessel is blocked?

A

right superficial femoral

146
Q

ophthalmoplegia + facial nerve issues

A

think about cavournous sinus issue

147
Q

slice to hand

can’t flex MCP and PIP but can flex DIP

what structure has been damaged?

A

flexor digiti superficialis

IK6 - Exams (24 decks)

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