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3C week 4 - fits, faints and funny turns > extra + secondary care (neuro) > Flashcards

extra + secondary care (neuro) Flashcards

1
Q

features of a temporal lobe seizure (3)

A

Motionless staring, automatisms (such as lip-smacking) and post-ictal dysphasia

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2
Q

what is the traid of wernicke’s encephalopathy

A
  1. ophthalmoparesis with nystagmus;
  2. ataxia;
  3. confusion
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3
Q

what causes wernicke’s enephalopathy

A

subacute deficiency of thiamine (vitamin B1)

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4
Q

where do M1 neurons decussate

A

in the medulla-spinal chord

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5
Q

why is hyper-reflexia seen in pts w UMN lesions

A

lack of inhibitory modulation of the reflexes from the brain

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6
Q

if Hx of peripheral sensory involvement (e.g. numb feet) what else should be asked about and why

A

autonomic involvement e.g. bladder, bowel, sexual function -> the sympathetic chain may be involved in SC lesions but not usually in peripheral neuropathy

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7
Q

why are abnormal smells often seen in auras of those with mesial temporal lobe epilepsy

A

the primary rhinal cortex (smell) is situated close to the hippocampus (the site of seizure generation) -> smells are often associated with memory

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8
Q

occipital -> temporal lobe pathway (what does it encode)

A

‘what’ pathway i.e. what objects are, semantic memory

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9
Q

occipital -> parietal lobe pathway (what does it encode)

A

‘where’ pathway i.e. where in space objects are, spatial awareness

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10
Q

what is the fastest onset NDD

A

motor neuron disease

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11
Q

what is the commonest genetic neurological conditoin

A

charcot-marie-tooth disease

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12
Q

characterisitic history of progression of someone with charcot-marie-tooth

A

normal at primary school but gradual onset throughout life -> gradually get worse at sport etc.

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13
Q

what can cause brown-sequard syndrome

A

MS is the commonest cause but can also be caused by other inflammatory conditions

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14
Q

what DH tracts are supplied but the anterior spinal artery (2)

A

spinothalamic + motor

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15
Q

if there is a stroke in the anterior spinal artery what sensations remain intact

A

proprioceptions + fine touch + vibrations (i.e. whatever is in the dorsal column)

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16
Q

lead pipe vs clasp knife rigidity

A

lead pipe - persists throughout the range of movement of a particular joint, seen in PD
clasp knife - after an initial resistance to passive movement of a joint, there is a sudden reduction in tone and the limb moves quite freely through the rest of the range of the particular movement, seen in spasticity

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17
Q

what is Pseudoathetosis

A

movement disorder that is characterized by involuntary, slow, and writhing movements -> proprioceptive defect, can be seen when testing pronator drift

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18
Q

what is dysmetria

A

the inability to control the distance, speed, and range of motion necessary to perform smoothly coordinated movements - as sign of cerebellar damage

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19
Q

what muscle has pure C6 innervation

A

brachoradialis

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20
Q

what is hoffman’s sign

A

an involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail of the middle finger down -> this is an abnormal sign and indicated UMN damage

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21
Q

what condition is pes cavus seen in

A

charcot-marie-tooth

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22
Q

how many beats is abnormal in clonus test

A

3-5 beats

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23
Q

what is a CT scan good for picking up (2)

A
  1. blood
  2. bone injuries (fractures)

i.e. trauma

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24
Q

what area of the brain/skull may have high numbers of artifacts in CT scans

A

posterior fossa

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25
Q

what gland may normal calcification be seen (on a CT head scan)

A

pineal gland

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26
Q

what does T1 vs T2 MRI show

A

T1 - anatomy;
T2 - pathology (fluid appears white)

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27
Q

what is malignant MCA syndrome

A

and increase in pressure due to massive MCA infarct in a young pt leading to mass effect (as less brain atrophy so no space for the swelling in the skull)

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28
Q

malignant MCA syndrome mgx

A

surgery - hemicraniotomy

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29
Q

what usually surrounds a haemorrhage in the brain and why

A

a haemorrhage is usually surrounded by oedema as blood is very irritable to the brain leading to inflammation

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30
Q

SAH CT presentation (not star sign)

A

may look like the sulci/gyri are “coloured in” (star sign not always present)

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31
Q

subdural vs extra dural blood supply (vein/artery)

A

subdural - venous => low pressure
extradural - arterial +> high pressure

32
Q

what is a ring enhancing lesion (CT/MRI head)

A

an abnormal radiological sign where there is a lesion with area of hypodensity surrounded by a bright rim from contrast -> must be in a contrast scan

33
Q

what can cause ring enhancing lesions (3)

A
  1. abcess;
  2. secondary tumour
  3. inflammation (e.g. demyelinating, but this is usually a ‘c’ shape)
34
Q

why should a pt w a brain haemorrhage be rescanned at 6 weeks

A

to look for metastesis -> melanoma often metastesises to the brain and can cause tumours that haemorrhage

35
Q

what 3 brain areas are demyelinating plaques commonly found in MS

A
  1. periventricular
  2. posterior fossa
  3. juxtacortical
36
Q

how can symptoms arising from the commonly demyelinated areas (in MS) be distinguished from vascular disease

A

they are vascularly protected areas

37
Q

meningiomas presentation (CT)

A

hyperdense region with areas of calcification and a tail coming out of it

38
Q

encephalitis vs differntials - how to distinguish from a scan

A

encephalitis usually occurs bilaterally, if unilateral then consider a differential

39
Q

what will an AVM look like on a T2 MRI scan

A

signal void - signal loss occurring within moving fluids, when the fluid is moving at a sufficient velocity relative to the MRI apparatus

40
Q

how can ocular fatigability be checked

A

ask the pt to look up and see how long until they experience double vision (can also look at corneal light sign to tell this)

41
Q

what does “bulblar” mean

A

the medulla oblongata, which looks like a swelling, or bulb, at the top of the spinal cord is known as the bulbar area -> damage to CN IX-XII leads to bulbar involvement

42
Q

what infection causes LMN involvement only

A

polio

43
Q

what is syringomyelia

A

a chronic progressive disease in which longitudinal cavities form in the cervical region of the spinal cord - a collection of cerebrospinal fluid within the spinal cord.;
This characteristically results in wasting of the muscles in the hands and shoulders (cape like distribution) and a loss of sensation

44
Q

basal ganglia function analogy

A

a record player - involved in learned automatic activities e.g. walking, driving

45
Q

what congential malfomation is syringomyelia associated with

A

Arnold-Chiari malformation

46
Q

7 neurological emergencies

A
  1. SAH
  2. status epilepticus
  3. meningitis
  4. myastehnic crisis
  5. cauda equina
  6. stroke
  7. guillian-barre
47
Q

why do learning difficulties increase the chance of status epilepticus

A

ppl are born with abnormal connections in the brain -> more likely to have continuous seizures

48
Q

9 causes of seizure w not hx of epilepsy

A
  1. space occupying lesion
  2. meningitis
  3. CVD
  4. encephalitis
  5. SAH
  6. metabolic deragement (hypoglycaemia/natrurina etc.)
  7. alcohol intoxication
  8. withdrawal
  9. toxins (cocaine, carbon monoxide)
49
Q

if glucose levels are low in someone with status epilepticus what should be done

A
  1. give glucose gel
  2. give buccal medazilone
50
Q

what demographic of people is venous sinus thrombosis prevelent in

A

pregnant women

51
Q

signs of venous sinus thrombus (4)

A
  1. headache
  2. ptosis
  3. increased ICH signs
  4. optic disc swelling
52
Q

what is the normal opening prerssure of a lumbar puncture

A

9-12 mmHg

53
Q

what should be checked in the CSF samples

A
  1. microscopy
  2. biochem
  3. xanthochromia (photosensitive so sample must not be exposed to light)
  4. presence of rbcs (check to see if levels are deceasing or remain the same -> if decreasing then likely just due to traumatic tap, if not then more serious cause)
54
Q

what to look for in the LP of suspected guillian-barre

A

inflammatory features -> high protein but normal WBCs

55
Q

4 key presenting features of gullian-barre

A
  1. ascending pattern
  2. symmetrical
  3. usually motor
  4. loss of deep tendon refelxes
56
Q

what is weber’s syndrome

A

a form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

57
Q

does a RAPD +ve finding indicate a partial or complete defect

A

partial defect pre optic chiasm

58
Q

what infection might result in trigeminal neuralgia arising after it

A

shingles (post herpatic neuralgia)

59
Q

what is the mgx of shingles

A

acylcovir 800mg x5 a day

60
Q

what nerves does the corneal reflex test

A

CN V (afferent) and CN VII (efferent)

61
Q

what is often a warning sign in someone about to have a seizure

A

looking up/away -> if seen help them to the ground

62
Q

what can be done as risk reduction measures in someone having a seizure

A

remove scarves/other dangerous items; place something soft under their head

63
Q

what is the most important thing to do when someone is having a seizure

A

time the length of the seizure

64
Q

what should be done if there are signs of airway comprimise

A

place in recovery position -> otherwise don’t interfere until seizure is over (and then put in recovery position)

65
Q

what might someone with temporal lobe epilepsy do during a seizure

A

wander around - stay with them + move objects out of their way

66
Q

what is pre-eclampsia

A

high blood pressure during pregnancy and after labour -> may develop into eclampsia (fit)

67
Q

what drug is given if someone experiences eclampsia

A

magnesium sulphate

68
Q

what is hypomimea

A

lack of facial expression (parkinson’s)

69
Q

lead pipe vs cogwheel rigidity

A

lead pipe - persists throughout the range of movement of a particular joint, seen in PD;
cogwheel - amalgamation of tremor + lead pipe rigidity simultaneously leading to cog-like movement

70
Q

where is cogwheel rigidity best felt usually

A

at the wrist

71
Q

why might sleep disruption be seen in PD

A

medication wears off at night leading to disordered dreaming

72
Q

what part of normal gait is lost in shuffling gait

A

loss of heel strike (and reduced arm swing)

73
Q

3 principle symptoms of PD

A
  1. tremor
  2. stiffness
  3. small movement impairment
74
Q

11 non-motor PD symptoms

A
  1. sleep disturbances
  2. overproduction of saliva
  3. depression
  4. sweating problem (autonomic dysfunction)
  5. bowel/bladder dysfunction
  6. low BP
  7. loss of smell
  8. impulse control change
  9. seborrheic dermatitis
  10. visual hallucinations
  11. altered speech
75
Q

what test should be done in an emergency situ in someone w Guillian-barre

A

spirometry - may show rapid respiratory depression

76
Q

at what level is a lumbar puncture taken

A

L3-4

77
Q

what is the cushing triad (raised ICP)

A
  1. hypertension (with wide pulse pressure)
  2. bradypnoea
  3. bradycardia
    (opposite of shock)

3C week 4 - fits, faints and funny turns (4 decks)

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