Neurology Flashcards
What are the nerve roots for ankle, knee, brachial and triceps reflexes?
Ankle - S1,2
Knee - L3,4
Brachial - C5,6
Triceps - C7,8
What are the afferent and efferent nerves of the corneal reflex?
Afferent - ophthalmic nerve (CNV1)
Efferent - facial nerve
What does the rubrospinal tract do?
Excites flexors and inhibits extensors of the upper body
What is the innervation of the first dorsal web space?
L5
What do microglia do?
Phagocytes of the CNS (cause reactive gliosis)
What do astrocytes do?
Provide physical support and maintain the BBB
Name frontal lobe functions
- Precentral gyrus – primary somatomotor cortex
- Broca’s area – expressive speech (in dominant hemisphere)
- Executive functioning – personality, decision making, planning
Name parietal lobe functions
- Postcentral gyrus – primary somatosensory cortex
- Reading, writing, R and L orientation
Name temporal lobe functions
- Primary auditory cortex – in superior temporal gyrus
- Wernicke’s area – receptive speech
- Hearing, speech, identity, emotion, memory
Name occipital lobe functions
Primary visual cortex - in calcarine sulcus
Name components of the limbic system and their functions
- Memory, perception, learning
- Cingulate gyrus
- Hippocampus (in medial temporal lobe) – spatial perception
- Amygdala (in medial temporal lobe) – emotion
Name parts of the brainstem and their functions
- Midbrain – auditory and visual reflexes, red nucleus, substantia nigra
- Pons – CN V, VI, VII, VIII, connects to cerebellum
- Medulla oblongata – CN IX, X, XI, XII, respiration, cardiac control, vomiting centre
Describe the basal ganglia pathways
- Direct pathway (excitatory) – cerebrum – striatum (caudate nucleus and putamen) – internal globus pallidus – thalamus – cerebrum
- Indirect pathway (inhibitory) – cerebrum – striatum – external globus pallidus – subthalamic nucleus – thalamus
- Dopamine – produced in substantia nigra – excites direct pathway and inhibits indirect pathway – increases movement
Name side effects of opioids
Apnoea - decreased medullary response to CO2
Orthostatic hypotension - H1-mediated vasodilatation, decreased sympathetic tone
Constipation and increased biliary pressure - increased SM tone, reduced motility via enteric neurones
Name opioids and give indications for each
Heroin - severe post-op pain
Methadone - opioid replacement therapy, chronic cancer pain
Pethidine - labour
Buprenorphine - patient-controlled injection systems
Note - tramadol contraindicated in epilepsy
What are medications used in each type of epilepsy?
Tonic-clonic/atonic/tonic - sodium valproate, lamotrigine
Absence - sodium valproate, ethusoximide
Focal - carbamazepine/lamotrigine
How do triptans work?
Serotonin receptor agonists
Describe Eye Response in the GCS
- 4 – open spontaneously
- 3 – open to voice
- 2 – open to pain
- 1 – do not open
Describe Verbal Response in the GCS
- 5 – orientated
- 4 – confused
- 3 – inappropriate words
- 2 – incomprehensible
- 1 – none
Describe Motor Response in the GCS
- 6- Obeys commands
- 5 - Localises pain
- 4 - Withdraws from pain
- 3 - Flexes to pain
- 2 - Extends to pain
- 1 - No response
Name contraindications to LP
What should be done first?
GCS<12
Papilloedema
Seizure
DIC
Do CT first
Describe Lambert Eaton Myasthenic Syndrome (LEMS)
- Proximal muscle weakness with improvement on movement, dry eyes
- Associated with SSLC
- Antibodies against voltage-gated calcium channels
How may temporal lobe seizures present?
Deja vu
Sensory aura