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Main diseases for each system > Neuro > Flashcards

Neuro Flashcards

1
Q

How does Parkinson’s disease present?

A

TRAP

Tremor; asymmetrical at presentation, pill rolling, high frequency, at rest

Rigidity; stiffness, cogwheel, across whole range of joint movement

Akinesia/Bradykinesia; slowed movement esp fine motor movement, facial expression, blinking, less hand gesturing etc.

Postural instability; Shuffling gait, reduced arm swing, problems with feet

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2
Q

What are atypical parkinsonian syndromes?

A

Multiple systems atrophy
Progressive Supranuclear palsy
Corticobasal syndrome

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3
Q

What is the histology of Parkinson’s?

A

Loss of dopaminergic neurones in substantia nigra
excess cholinergic activity
lewy bodies

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4
Q

What is the treatment for Parkinson’s?

A

MAO-B inhibitors; selegeline
Dopaminergic agents; Ldopa+carbidopa and dopamine agonists
Amantadine

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5
Q

What is the pharmacological treatment for Alzheimer’s?

A

Anticholinesterase; donepezil, galantamine, rivastagmine
NMDA receptor blocker; memantine

Antidepressants and antipsychotics

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6
Q

Treatment for vascular dementia

A

Reduce high blood pressure and cholesterol

Control risk factors i.e. obesity and quit smoking

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7
Q

Investigations for vascular dementia

A

FBC, ESR, blood glucose, renal and LFTs

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8
Q

How does fronto-temporal dementia present?

A

Behavioural changes
Personality alteration
Language difficulty

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9
Q

Tests for fronto-temporal dementia

A

CT/MRI to assess damage, FBC, mental testing

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10
Q

Treatment for fronto-temporal dementia

A

Supportive care + benzodiazepene or neuroleptic

SSRIs to reduce impulsive behaviour

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11
Q

How is Lewy Body dementia diagnosed?

A

Doctor’s best judgement based on symptom onset

May order; FBC, metabolic panel, serum TSH, serum vit b12

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12
Q

How is lewy body dementia treated?

A

If behavioural disturbance; benzodiazepene

If not behavioural disturbance; cholinesterase inhibitors, SSRI if depression, clonazepam to help REM sleep disorder, carbidopa/levodopa for motor symptoms

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13
Q

Describe progressive supranuclear palsy presentation

A

problems with walking, balance and eye movements
altered behaviour
muscle stiffness
dysphagia and speech problems

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14
Q

how is PSP diagnosed?

A

rule out similar conditions

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15
Q

How is PSP treated?

A

Levodopa
Antidepressants
walking aids
special glasses

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16
Q

Describe MS presentation

A

Multiple Sclerosis

fatigue, difficulty walking
vision problems
problems controlling bladder
muscle stiffness/spasms

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17
Q

Describe MS treatment

A

Relapses with corticosteroids; methylprednisolone

Beta interferons; glatiramir acetate, dimethyl fumarate, fingolimod, alemtuzumab, natalizumab

Lifestyle mod i.e. physiotherapy

Low dose anticonvulsants

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18
Q

How is MS diagnosed?

A

MRI brain and spinal cord
FBC
Met panel

CSF evaluation
evoked potentials
anti-neuromyelitis antibody

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19
Q

How does cauda equina syndrome present?

A

Lower back pain into legs, perianal numbness, faecal/urine incontinence

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20
Q

How is cauda equina syndrome diagnosed?

A

MRI spinal cord

CT myelography

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21
Q

How is cauda equina syndrome treated?

A

Decompression of spinal nerves; lumbar decompression surgery

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22
Q

How does myaesthenia gravis present?

A

muscle weakness and fatigue progressive through day

Eyelid drooping, facial expression, chewing, swallowing affected

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23
Q

Myaesthenia gravis investigations

A 
serum ACh receptor antibody analysis
muscle specific tyrosine kinase antibodies
serum pulm function tests
CT chest
Single fibre EMG
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24
Q

How is myasethenia gravis treated?

A

Pyridostigmine
Immunosuppressant
thymectomy

Plasma exchange, IV Ig

25
Q

How does DMD present?

A

Genetic condition against dystrophin gene
Usually boys under 5yo

Difficulty standing from floor, running, walking

26
Q

Diagnosis of DMD

A

Genetic testing
Creatine kinase

EMG

27
Q

Treatment of DMD

A

Corticosteroids

Physiotherapy

Swallowing, spinal and heart problem treatment

28
Q

How does Bell’s Palsy present?

A

Facial nerve palsy

Eyelid drooping, facial droop, corner mouth droop, dry mouth, loss of taste

29
Q

Diagnosis Bell’s palsy

A

clinical diagnosis
EMG if unsure
serology for borrelia burgdorferi

30
Q

Treatment Bell’s palsy

A

Prednisolone within 72hours
Eye drops
Surgical tape to close eye at night

31
Q

Describe trigeminal neuralgia diagnosis

A

Based on exclusion possibly MRI

32
Q

Trigeminal neuralgia treatment

A

Avoid triggers

Anticonvulsant; carbamazepine

Surgery; microvascular decompression
Stereotactic surgery

33
Q

How does SAH present?

A 
Thunderclap headache
stiff neck
nausea and vom
photophobia
blurred/double vision
34
Q

Diagnosis of SAH

A

CT scan head, FBC, clotting profile, electrolytes
Lumbar puncture
CT angiography

35
Q

Treatment of SAH

A

CCB Nimodipine; reduce risk secondary cerebral ischaemia
Surgical clipping or endovascular coil embolisation
Pain relief
Anticonvulsants
Antiemetics
Stool softeners reduce re-bleed risk

36
Q

Describe extradural haematoma presentation

A

Convex lens shape on CT

37
Q

Describe brain haematoma treatment

A

Burr hole decompression
Craniectomy and ligation

Pharmacological; anticonvulsants, diuretics, prophylactic ABs, barbiturates

38
Q

Describe subdural haematoma presentation

A

CT concave lens shape

39
Q

How is ischaemic stroke treated?

A

Confirm ischaemic

Alteplase <4.5hrs
Thrombectomy
Antiplatelets
Anticoagulants
Carotid endarcterectomy
40
Q

What are preventative migraine treatments?

A

Topiramate
Propranolol
Botox type A (need 3 previous failed meds)
accupuncture

41
Q

How is motor neurone disease treated?

A

Riluzole slows progression
meds to relieve muscle stiffness
SLT, dietician, OT
physiotherapy

42
Q

Describe investigation of motor neurone disease

A

EMG
nerve conduction studies
MRI brain and spinal cord

43
Q

Describe epilepsy

A

Tendency to recurrent unprovoked seizures

44
Q

Seizure classification

A

Generalised

  • absence
  • tonic-clonic
  • myoclonic
  • atonic

Focal

  • simple partial
  • complex partial
  • secondary generalised
45
Q

Difference between primary generalised and focal seizures

A

Primary no warning, <25, history absence and myoclonic jerks and GTCS, general abnormal ECG, FHx

Focal may have aura, any age, focal abnormality on ECG, MRI may show cause

46
Q

Describe generalised tonic clonic seizures

A

History preceding; unpredictable, PMH complications at birth, trauma, meningitis, brain injuries

Event history; vague warning irritability

Afterwards; tongue biting, incontinence, first recollection in ambulance or hospital, muscle pain

47
Q

Describe witness account GTCS

A 
groaning
rigid phase then limb jerking
Eyes open; staring or rolling up
Foaming at mouth
Groggy for 15-30mins
48
Q

Describe absence seizures

A

Often in children

Sudden arrest activity for few seconds; brief staring, eyelid fluttering

49
Q

Describe complex partial seizures

A

History preceding; rising feeling stomach, funny smell/taste, deja vu

History of event; no recollection

After; disoriented for spell

50
Q

Witness account complex partial seizures

A

Sudden arrest activity
Staring blankly into space
Automatisms; lip smacking, repetitive picking at clothes

May be disoriented afterwards

51
Q

Clinical assessment of seizures

A

ECG
Routine bloods; glucose
CT/MRI
EEG

52
Q

First line treatment of epilepsy

A

Primary generalised; sodium valproate, lamotrigine, levetiracetam

Focal and secondary generalised; lamotrigine, carbamazepine, levetiracetam

Absence; ethosuximide

ACUTELY: diazepam, lorazepam

53
Q

Side effects of phenytoin

A

arrythmia
hepatitis
medication interactions

54
Q

Side effects of sodium valproate

A 
tremor
weight gain
ataxia
nausea
drowsiness
hepatitis
55
Q

Side effects of carbamazepine

A 
ataxia
drowsiness
nystagmus
blurred vision
low serum Na
skin rash
56
Q

Status elipticus

A

prolonged or recurretn tonic clonic seizures >30mins no recovery period

FIRST LINE; diazepam 10-20mg IV or rectally repeated after 10mins if necessary

Midazolam 10mg buccal or intranasal repeated after 10mins if necessary

Lorazepam 0.07mg/kg usually 4mg bolus repeated once after 10mins

SECOND LINE; phenytoin slow infusion, valproate

57
Q

Symptoms of Guillain Barre syndrome

A 
muscle weakness 
respiratory distress
speech problems
absence deep tendon reflexes
ptosis
paraesthesia
58
Q

Diagnosis of Guillain Barre syndrome

A

nerve conduction studies
lumbar puncture
LFTs
spirometry

59
Q

treatment of Guillain barre syndrome

A

plasma exchange

IV immunoglobulin

Main diseases for each system (12 decks)

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