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Julia PCP2 > Neurology > Flashcards

Neurology Flashcards

1
Q

What investigation should be urgently ordered in suspected sub-arachnoid haemorrhage?

A

Plain CT brain

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2
Q

What are the features of a headache associated with raised ICP?

A
  • Diffuse headache of variable severity
  • Often progressive
  • Nausea ++
  • Worse with increases in ICP (cough, straining, morning)
  • Papilloedema (peripheral vision loss)
  • Diplopia (6th cranial nerve palsy)
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3
Q

What is Todd’s paresis?

A

A focal weakness in a part of the body after a seizure

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4
Q

Besides with headache, how many a subarachnoid haemorrhage present?

A
  • Reduced conscious state
  • Coma
  • Meningism
  • Focal neurological signs
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5
Q

What are the main causes of sub-arachnoid haemorrhage?

A
  • Ruptured cerebral aneurysm (70%)
  • Ruptured AV malformation (10%)
  • Undiscovered (15%)
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6
Q

If a CT is negative in suspected SAH, what test would you do next?

A

Lumbar puncture - looking for blood in the CSF that does not clear on 3 consecutive tubes

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7
Q

What is xanthochromia?

A

Yellow staining of the CSF due to breakdown of haemoglobin that occurs 6-8 hours after the SAH

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8
Q

What are the 2 management priorities in SAH?

A
  1. Monitor & treat the symptoms & complications of SAH
  2. Prevent re-bleeding
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9
Q

What investigations can be used to find the source of the bleed in a sub-arachnoid haemorrhage?

A
  1. CT angiogram
  2. MR angiogram
  3. Digital subtraction angiography
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10
Q

What are the options for treatment of an aneurysm?

A
  • Surgical clipping of the aneurysm neck

- Endovascular coiling

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11
Q

What is normal intracranial pressure?

A

10-15mmHg

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12
Q

What are the signs of transtentorial herniation?

A
  • Unilateral dilated pupil (3rd nerve palsy)
  • Contralateral hemiparesis (midbrain)
  • Hypertension/bradycardia (Cushing response)
  • Respiratory failure
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13
Q

What is the treatment of raised ICP?

A
  • Elevate head of bed
  • Diuresis (mannitol)
  • Hyperventilate/avoid hypoventilation
  • Sedate/paralyse
  • Remove mass
  • Drain hydrocephalus
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14
Q

What is a seizure?

A

Abnormal, hypersynchronous neural activity

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15
Q

What is an ictus?

A

A sudden neurological event

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16
Q

What is epilepsy?

A

The tendency to repeated, spontaneous seizures

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17
Q

What are the 3 main generalised seizure types?

A
  • Generalised tonic-clonic
  • Absence
  • Myoclonic
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18
Q

What are the features of a generalised tonic-clonic seizure?

A
  • Tonic phase: arms down, eyes open, ictal cry
  • Clonic phase: initially low amplitude & high frequency, progressing to high amplitude but low frequency movements
  • Apnoea may occur
  • Generally last 1-5 minutes
  • Minor injury is common (tongue biting)
  • Aftergoing confusion
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19
Q

What are the features of an absence seizure?

A
  • Alteration of consciousness only
  • No loss of postural tone
  • No warning
  • Facial twitching might occur
  • Last 2-10 seconds
  • Present almost exclusively in children or teenagers
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20
Q

What are the features of a myoclonic seizure?

A
  • Sudden, involuntary muscle twitch

- Appear as a prodrome to GTCS

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21
Q

What are the features of a focal dyscognitive seizure?

A
  • Localised region
  • Affects consciousness
  • Similar to absence, but: longer, less distinct offset, automatisms, less frequent, preceding simple seizure
22
Q

Which is more reliable for distinguishing between GTCS and syncope - tongue-biting or urinary incontinence?

A

Tongue-biting - more specific to GTCS

Urinary incontinence may occur in both

23
Q

What are the features of a psychogenic pseudoseizure?

A
  • Fluctuating intensity
  • Very long
  • Eyes closed
  • Non-anatomical tremor
  • Reactive
  • Consciousness retained (but usually denied)
24
Q

What % of people who have a had a single seizure have another?

A

50%

25
Q

What is the safety advice given to newly diagnosed epileptics?

A
  • Have someone supervising you if swimming
  • Do not work at heights
  • Take showers not baths
  • Alcohol & sleep deprivation can trigger seizures
26
Q

What is the treatment of acute seizures if they are prolonged or recurrent?

A
  • Seizure termination: benzodiazepines

- Acute prophylaxis: benzodiazepines or phenytoin

27
Q

Which hand muscles does the median nerve supply?

A

Opponens pollicis, abductor pollicis brevis, flexor pollicis brevis + lateral 2 lumbricals

28
Q

Diplopia & ptosis are common in which neuromuscular disease?

A

Myasthenia gravis

29
Q

What investigation should be performed for a suspected myopathy?

A

Muscle biopsy (or MRI)

30
Q

What test can distinguish neuropathy from myopathy & axonal from demyelinating?

A

Electrophysiology

31
Q

Which nerves does motor neurone disease affect?

A

Both the upper & lower motor neurons

32
Q

What cognitive impairment is motor neurone disease most commonly associated?

A

Fronto-Temporal Dementia (FTLD)

33
Q

What mutation is linked to 10% of cases of motor neuron disease?

A

SOD1 gene on chromosome 21

34
Q

What are the clinical features of motor neurone disease?

A
  • Muscle wasting including tongue
  • Fasciculations
  • Tone: increased or decreased
  • Generalised weakness
  • Reflexes preserved until late
  • Plantars may be upgoing
  • NO SENSORY LOSS
  • Cranial nerves spared
35
Q

What is Lambert Eaton Myasthenic Syndrome (LEMS)?

A

A loss of pre-synaptic neurons due to antibodies against Ca2+ channels

Often associated with small cell lung cancer

36
Q

What are the clinical features of myasthenia gravis?

A
  • History of fatigueability
  • Early involvement of EOM
  • Dysarthria
  • No muscle wasting
  • Weakness increasing with repetitive exercise
  • Reflexes & sensation unaffected
37
Q

What causes myasthenia gravis?

A

Autoantibodies that cross react with the acetylcholine receptor at the neuromuscular junction

High association with thymic hyperplasia or thymoma

38
Q

What tests should be ordered in suspected myasthenia gravis?

A
  1. Tensilon test
  2. Bloods - for autoantibodies (ACh receptor, MuSK)
  3. CT chect (thymoma)
39
Q

What is the tensilon test?

A

Transient reversal of symptoms using a short-acting acetylcholinesterase antagonist

40
Q

What drug is used in the tensilon test?

A

Edrophonium

41
Q

What is mononeuritis multiplex?

A

Neuropathy involving multiple peripheral nerves - a medical emergency (almost always ischaemic)

42
Q

What are some axonal causes of acute polyneuropathies?

A
  • AMAN, AMSAN
  • Glue sniffers neuropathy
  • Vasculitis
  • Thiamine deficiency
  • Porphyria
43
Q

What are the 4 cardinal features of Parkinson’s disease?

A
  1. Tremor
  2. Bradykinesia
  3. Rigidity
  4. Postural instability
44
Q

What is dyskinesia?

A

A reversible, Levodopa-induced motor complication

45
Q

What is dystonia?

A

Involuntary muscle contraction involving abnormal movements & postures

46
Q

For which PD symptoms if levodopa most effective at treating?

A

Hypokinetic motor symptoms, tremor & rigidity

47
Q

What drug must levodopa be combined with?

A

A peripheral dopa decarboxylase inhibitor (carbidopa or benserazide)

48
Q

What are common adverse effects of levodopa?

A
  • Nausea, abdominal cramping, diarrhoea
  • Somnolence
  • Dizziness & headache
  • Confusion, hallucination, delusions, agitation & psychosis
  • Orthostatic hypotension
49
Q

What medications besides L-DOPA are used in Parkinson’s disease?

A
  • COMT inhibitors
  • Selective Monoamine Oxidase Type B inhibitors
  • Dopamine agonists
  • Anticholinergics
  • Amantadine
50
Q

What are the non-motor features common in Parkinson’s disease?

A
  • Orthostatic hypotension
  • Urine frequency
  • Constipation

Julia PCP2 (21 decks)

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