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Internal Medicine > Neuro > Flashcards

Neuro Flashcards

1
Q

CVA stands for

A

Cerebrovascular accident - stroke

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2
Q

Types of CVA

A

Ischaemic, haemorrhagic

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3
Q

TIA management

A

Aspirin 300 mg daily
Specialist referral
Diffusion-weighted MRI scan

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4
Q

Stroke differentials

A

TIA, seizure, hypoglycaemia

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5
Q

Stroke management acute

A

immediate CT brain

Alteplase within 4.5 hrs if no haemorrhage

Thrombectomy cansidered within 24 hrs

Ischaemic stroke - keep high BP
Haemorrhagic - treat high BP

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6
Q

Stroke management long term

A

Assess for underlying cause e.g. Afib
Anticoagulation after finishing two weeks of aspirin, with Afib.

MDT rehab

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7
Q

Presentation intracranial haemorrhage

A

Sudden onset headache, seizure, vomiting, reduced LOC, focal neurological symptoms

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8
Q

GCS

A

Eyes, verbal, motor

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9
Q

Extradural haemorrhage blood vessel

A

MMA, often temporal bone fracture.

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10
Q

Subdural haemorrhage blood vessel

A

Bridging veins, elderly & alcoholic

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11
Q

Intracerebral Haemorrhage

A

Bleeding in the brain tissue, similar presentation to ischaemic stroke.
Aneurysm rupture, secondary to ischaemic stroke, tumours.

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12
Q

Subarachnoid haemorrhage bleed into

A

Subarachnoid space where CSF is - thunder clap headache

Usually cerebral aneurysm rupture

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13
Q

Intracerebral haemorrhage management

A

CT head
Bloods - include coagulation screen - correct any clotting abnormality
Correct severe hypertension but avoid hypotension

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14
Q

Presentation subarachnoid haemorrhage

A

Thunderclap headache - often when strenuous activity.
Neck stiffness, photophobia, vomiting, neurological symptoms

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15
Q

Subarachnoid haemorrhage investigations

A

CT head (less reliable after 6 hrs from symptoms starting)
Lumbar puncture if normal CT head - red cells in CSF
CT angiography - locate source of bleeding

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16
Q

Subarachnoid haemorrhage management

A

surgical intervention - endovascular coiling
Intubation & ventilation

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17
Q

MS pathology

A

Autoimmune demyelination of CNS

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18
Q

MS caused by

A

Low vit D, ebstein barr virus, smoking, obesity

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19
Q

optic neuritis

A

most common presentation of MS.
Unilateral reduced vision, developing over hours to days

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20
Q

Most common presentation MS

A

Optic neuritis

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21
Q

Ataxia can be (2)

A

Problem with coordinated movement
- Sensory - loss of proprioception
- Cerebellar

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22
Q

MS management

A

Disease modifying therapy - target immune system

Relapses - steroids

MDT

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23
Q

Motor neurone disease

A

Progressive disease affecting motor neurons. Eventually fatal. No effect on sensation.

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24
Q

Motor neurone disease presentation

A

Insidious progressive weakness of muscles throughout body. Often first noticed upper limbs. Dysarthria.

Diagnosis carefully after excluding other conditions - no effective treatments.

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25
Q

Parkinsons pathology

A

reduction in dopamine in the basal ganglia

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26
Q

Parkinsons presentation

A

Resting tremor
Rigidity
Bradykinesia
Shuffling gait
Gradual onset symptoms - asymmetrical one side affected more

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27
Q

Dementia associated with parkinsons

A

Lewy body
Also has visual hallucinations, delusions, REM sleep disorders, fluctuating consciousness

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28
Q

Parkinsons management

A

Levodopa + carbidopa, Dopamine agonists

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29
Q

Levodopa side effect

A

Dyskinesia - abnormal movements
- chorea
- athetosis
- dystonia

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30
Q

Benign essential tremor

A

Fine tremor, mostly in hands but can also head, jaw and vocal. Worse when tired, stressed or caffeine.

31
Q

Tremor differentials

A

Parkinson’s
MS
Huntingtons chorea
Hyperthyroid
Fever
Dopamine antagonists (antipsychotics)

32
Q

Epilepsy types of seizure

A

Absence
Generalised tonic-clonic
Focal

33
Q

Prior to seizure patient might experience

A

aura

34
Q

Seizure history check

A

Tongue biting, aura, urinary incontinence, LOC, post-ictal period of confusion, tired, irritable.

35
Q

Seizure differentials

A

Vasovagal syncope
Pseudoseizures
Cardiac syncope
Hypoglycaemia
Hemiplegic migraine
TIA

36
Q

Seizure investigations

A

EEG
MRI brain - structural pathology

ECG, serum electrolytes, blood glucose, blood cultures if suspect sepsis.

37
Q

Anti-epileptic

A

Valproate, levetiracetam, ethosuximide

Carbamazapine, phenytoin

38
Q

Status epilepticus

A

Seizure more than 5 minutes
Benzos first line

39
Q

Opioid reversal

A

Naloxone

40
Q

Bell’s palsy presentation and treatment

A

Bell’s palsy - LMN, unilateral face weakness

Steroids
Lubricating eye drops
most patients fully recover over several weeks

Rule out trauma, tumour, DM, GB, infection

41
Q

Benign brain tumour

A

Meningioma

42
Q

Presentation brain tumour

A

Progressive focal neurological symptoms

43
Q

Intracranial hypertension causes

A

Brain tumours, intracranial haemorrhage, idiopathic, abscesses or infection

44
Q

Headache concerns for intracranial hypertension

A

Constant headache, nocturnal, worse on waking, worse on coughing, vomiting, papilloedema on fundoscopy

45
Q

Worst glioma

A

Glioblastoma

46
Q

Pituitary tumour symptoms

A

Tend to be benign - bitemporal hemianopia
Hormone deficiencies or excesses
Acromegaly, hyperprolactinaemia, cushing’s, thyrotoxicosis

47
Q

Acoustic neuroma

A

Benign tumours of schwann cells that surround the auditory nerve
Unilateral sensorineural hearing loss, tinnitus, dizzines, facial nerve palsy

48
Q

Huntingtons inheritance

A

Autosomal dominant - huntingtin protein build up

49
Q

Hungtinton’s presentation

A

Chorea, dystonia, rigidity, eye movement disorders, dysarthria, dysphagia

Cognitive, psychiatric or mood problems

50
Q

Huntington’s chorea is a progressive condition

A

Life expectance 10-20 yrs

51
Q

Huntington’s treatment and diagnosis

A

Diagnose via genetic testing, no treatments

52
Q

Myasthenia gravis pathology

A

Autoimmune condition - acetylcholine receptor antibodies - neuromuscular junction

53
Q

Myasthenia gravis presentation

A

Vary dramatically between patients
Ptosis, diplopia
Difficulty climbing stairs
Weakness in facial movements
Difficulty swallowing
Slurred speech

54
Q

Investigations myasthenia gravis

A

AChR antibodies
Edrophonium test?

55
Q

Treatment options myasthenia gravis

A

Pyridostigmine - cholinesterase inhibitor - prolongs the action of acetyl choline

56
Q

Charcot marie tooth disease

A

Peripheral motor and sensory neurons - heriditary

57
Q

GB Syndrome presentation

A

Ascending paralysis autoimmune
Following EBV CMV campylobacter jejuni infection.
Reduced reflexes

58
Q

GB syndrome diagnosis

A

Nerve conduction study

59
Q

GB syndrome management

A

Supportive care, VTE prophylaxis, Respiratory failure - intubation, ventilation, IV immunoglobulins

60
Q

Cervical spondylosis

A

Degenerative changes in cervical spine

61
Q

Eye afferent

A

optic nerve pathology

62
Q

fasciculations upper or lower motor neuron

A

Lower

63
Q

Spasticity upper or lower motor neuron

A

Upper

64
Q

Chorea seen in

A

Huntingtons

65
Q

Myoclonus seen in

A

MS, dementia, parkinson

66
Q

Causes of delirium

Chimps phoned

A

infection, drugs, dehydration

Constipation
Hypoxia
Infection
Metabolic disturbance
Pain
Sleeplessness
Prescriptions
Hypothermia/pyrexia
Organ dysfunction (hepatic or renal impairment)
Nutrition
Environmental changes
Drugs (over the counter, illicit, alcohol and smoking)

67
Q

Hyperactive delirium symptoms

A

Clinical features of hyperactive delirium include:

Agitation
Delusions
Hallucinations
Wandering
Aggression

68
Q

Hypoactive delirium symptoms

A

Lethargy
Slowness with everyday tasks
Excessive sleeping
Inattention

69
Q

Delirium management - confusion screen

A

Blood tests:

FBC (e.g. infection, anaemia, malignancy)
U&Es (e.g. hyponatraemia, hypernatraemia)
LFTs (e.g. liver failure with secondary encephalopathy)
Coagulation/INR (e.g. intracranial bleeding)
TFTs (e.g. hypothyroidism)
Calcium (e.g. hypercalcaemia)
B12 + folate/haematinics (e.g. B12/folate deficiency)
Glucose (e.g. hypoglycaemia/hyperglycaemia)
Blood cultures (e.g. sepsis)
Urinalysis:

UTI is a very common cause of delirium in the elderly.
A positive urine dipstick without clinical signs is NOT satisfactory to diagnose urinary tract infection as a cause of delirium.2, 3
Look for other evidence supporting the diagnosis (WCC↑/supra-pubic tenderness/dysuria/offensive urine/positive urine culture).
Imaging:

CT head: if there is concern about intracranial pathology (bleeding, ischaemic stroke, abscess)
Chest X-ray: may be performed if there is concern about lung pathology (e.g. pneumonia, pulmonary oedema)

70
Q

Meds for delirium

A

Haloperidol

Benzos can worsen - lorazepam if need

71
Q

Postural hypotension management

A

Midrodrine, cease antihypertensive, IV fluids

72
Q

Causes of afferent papillary defect

A

Optic nerve damage - MS, glaucoma, retinal detachment, trauma

73
Q
A

Internal Medicine (6 decks)

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