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Finals Studying - Condensed > Neuro > Flashcards

Neuro Flashcards

1
Q

presentation extradural haemorrhage

A

young person, Hx of injury with lucid interval

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2
Q

appearance extradural haemorrhage CT

A

umbrella shape

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3
Q

presentation subdural haemorrhage

A

old person, Hx of falls

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4
Q

appearance subdural haemorrhage CT

A

convex shape

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5
Q

parkinsonism triad

A
  1. akinesia
  2. tremor
  3. rigidity
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6
Q

Mx Parkinsons

A
  1. MAO-inhibitor (Rasigiline, Selegiline) OR Dopamine Agonist (pramiprexole, bromocriptine)
  2. Add Levodopa
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7
Q

what is levodopa combined with and why

A

Carbidopa - prevent peripheral conversion of Levodopa

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8
Q

s/e of Levodopa

A 
reduced efficacy w time 
postural hypotension
n+v 
dyskinesias
psychosis 
visual hallucinations 
red colour of urine on standing
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9
Q

Mx of n+v due to Levodopa

A

domperidone

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10
Q

Man with parkinsons disease, started on new med and has falls - Dx and due to what med

A

postural hypotension

caused by Levodopa

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11
Q

MAO-inhibitors

A

rasigiline
selegine
cabergoline

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12
Q

dopamine agonists

A

bromocriptine
pramiprexole
ropinorole

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13
Q

drugs causing parkinsonism

A 
chlorpromazine (typical antipsychotic) 
haloperidol  (typical antipsychotic) 
prochlorperazine 
lithium 
metoclopramide 
valproic acid
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14
Q

multisystem atrophy

A

parkinsons + syndrome
- early autonomic stuff (impotence/incontinence, postural hypo)

(ANS involvement + cerebellar)

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15
Q

progressive supranuclear palsy

A

parkinsons + syndrome

  • vertical gaze palsy - diplopia
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16
Q

cortico-basal degeneration

A

parkinsons + syndrome

  • akinetic rigidity of one limb
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17
Q

cushings reflex triad

A
  1. HTN
  2. Bradycardia
  3. Irregular breathing
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18
Q

what is cushings reflex a sign of

A

imminent coning/brain herniation (usually pre-terminal)

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19
Q

pt in a coma after motorbike crash - Dx?

A

diffuse axonal injury (mechanical shearing)

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20
Q

eqn for CPP

A

CPP = MAP - ICP

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21
Q

normal CPP

A

70-100 mmHg

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22
Q

normal MAP

A

70-110 mmHg

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23
Q

normal ICP

A

0-20 mmHg

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24
Q

aiming CPP after head injury

A

> 60 mmHg

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25
Q

aiming MAP after head injury

A

> 80 mmHg

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26
Q

aiming ICP after head injury

A

< 20 mmHg

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27
Q

criteria for brainstem death testing

A
  • Deep coma of known aetiology.
  • Reversible causes excluded
  • No sedation
  • Normal electrolytes
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28
Q

6 tests to confirm brainstem death

A 
corneal reflex
oculovestibular reflex
pupillary reflex
cough reflex
absent response to supraorbital pressure
no spontaneous ventilation
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29
Q

RTA hit on R side of head, lucid period and then deteriorated in A&E - Dx?

A

Extradural haematoma

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30
Q

pt has had a SAH and normal CT and no RF for coning - next best Ix?

A

LP (1`2h after onset of symp)

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31
Q

alcoholic person is confused and drowsy - Dx?

A

subdural haemorrhage

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32
Q

pt has papilloedema, headache and hemi paresis - Ix?

A

CT brain

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33
Q

pt with supratentorial haemorrhage and on warfarin - INR 3.3. Given IV Vit K, what is next best thing to give

A

Prothrombin Complex

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34
Q

common conseqence of SAH

A

SIADH

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35
Q

why is LP performed 12h after symptom onset in SAH

A

allow time for xanthochromia (result of RBC breakdown). Helps to distinguish between bleed and traumatic LP

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36
Q

prevention of vasospasm in SAH

A

21d course of nimodipine

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37
Q

thrombolytic window for stroke

A

<4.5h after symptom onset AND exclusion of haemorrhagic stroke

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38
Q

locked in syndrome

A

basilar artery infarct

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39
Q

Mx stroke

A

Ix - non contrast CT - need to rule out haemorrhage first

then PR aspirin 300mg
thrombolyse (alteplase) if <4.5h after symptom onset and haemorrhage ruled out

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40
Q

2 prevention for stroke

A

clopidogrel + dipyridamole

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41
Q

brachioradialis reflex

A

C6

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42
Q

biceps brachii reflex

A

C5,,6

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43
Q

triceps reflex

A

C71

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44
Q

knee jerk reflex

A

L4

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45
Q

ankle jerk reflex

A

S1

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46
Q

Mx idiopathic intracranial HTN

A

AcetozolamiDE

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47
Q

site of lesion in inferior quadrantanopia

A

Parietal lobe (PITS mneumonic)

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48
Q

site of lesion in superior quadrantanopia

A

Temporal lobe (PITS mneumonic)

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49
Q

site of lesion in homonymous hemianopia

A

optic tract

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50
Q

site of lesion in homonymous hemianopia with macula sparing

A

Occipital cortex

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51
Q

site of lesion in bitemporal hemianopia

A

optic chiasm

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52
Q

Mx tremor in Parkinsons

A

anti-cholinergic e.g. procyclidine

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53
Q

Parkinsons drug that has been ass. with pulmonary fibrosis

A

cabergoline

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54
Q

role of DCML

A

vibration, fine touch & proprioception

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55
Q

where do fibres in DCML cross - lesion results in what symptoms

A

medulla

ipsilateral symptoms

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56
Q

where do fibres in spinothalamic cross - lesion results in what symptoms

A

1 or 2 above entry point

contralateral symptoms

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57
Q

where do fibres in corticospinal tract - lesion results in what symptoms

A

medulla

contralateral symptoms

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58
Q

L2 dermatome

A

ant thigh

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59
Q

L3 dermatome

A

ant knee

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60
Q

L4 dermatome

A

medial malleolus

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61
Q

L5 dermatome

A

dorsum of foot

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62
Q

S1 dermatome

A

heel

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63
Q

S2 dermatome

A

back of knee

64
Q

S3 dermatome

A

buttock

65
Q

S4 dermatome

A

perineum

66
Q

S5 dermatome

A

perianal skin

67
Q

myotome lateral leg

A

superficial branch of common fibular

68
Q

myotome anterior leg

A

deep branch of common fibular

69
Q

mnemonic of cerebellar lesion causes

A

MAVIS

MS 
Alcohol 
Vascular 
Inherited ataxias 
Space occupying lesion
70
Q

Mx migraine

A

Triptan (5HT agonist) +/- NSAID

71
Q

contraindications to triptans

A

CVS disease

72
Q

cluster headache

A

headache around 1 eye
+ autonomic features (nasal stuffiness, lacrimation)
clusters last 4-12w then few m headache free
1-8x day

73
Q

Mx cluster headache

A

100% O2 + sumitriptan

74
Q

prophylaxis cluster headache

A

verapamil

75
Q

Mx paroxysmal hemicrania

A

indomethacin

76
Q

SUNCT

A 
short lived 
unilateral 
neuralgiform headache with 
conjunctival injection and 
tearing
77
Q

Mx SUNCT

A

lamotrigine or gabapentin

78
Q

Mx trigeminal neuralgia

A

carbamazepine

79
Q

what groups into trigeminal autonomic cephalgia (TAC)

A

SUNCT
cluster headache
paroxysmal hemicrania

80
Q

what must all pt presenting with a TAC headache get

A

MRI brain + MR angiogram

81
Q

risk factors for MS

A

FHx
young female
high latitude
previous EBV infection

82
Q

MS presentation

A 
pyramidal dysfunction (UMN signs) 
ocular symp (optic neuritis) 
sensory symp 
cerebellar signs (DANISH) 
autonomic dysfunction (bladder symp)
83
Q

sensory symptoms in MS

A

sensation of water tricking down skin
DCML tract loss
numbness/paraesthesia

84
Q

Lhermitte’s sign

A

sensory sign in MS

electric shock down upper limb + trunk on neck flexion

85
Q

Uhthoff’s phenomenon

A

sensory sign in MS

exacerbation of symp from hot environments

86
Q

Ix MS

A

MRI and CSF analysis (IgG oligoclonal bands)

87
Q

Mx acute MS relapse

A

moderate - oral pred 5d

severe - IV pred 5d

88
Q

Mx MS

A
  1. Interferon beta

Others:

  • tysabri (natalizumab)
  • fingolomid
89
Q

Mx fatigue in MS

A

amantadine +/- modafinil

90
Q

Mx spasticity in MS

A

baclofen or gabapentin

91
Q

Mx bladder symptoms in MS

A

catheter or oxybutinin

92
Q

pathology MS

A

demyelination of axons in white matter - loss saltatory conduction

93
Q

cause of temporal lobe oedema on MRI

A

HSV

94
Q

Kernig’s sign

A

meningitis sign

resisted knee extension when hip flexed

95
Q

Most common cause meningitis in adult

A
  1. Strep. pneumoniae
96
Q

Most common cause meningitis in child/adolescent

A
  1. Neisseria meningitidis
97
Q

Mx meningitis in community

A

IM benzylpenicillin

98
Q

“fibrin web” appearance of lumbar puncture

A

TB meningitis

99
Q

meningitis prophylaxis

A

ciprofloxacin

100
Q

simple focal seizure

A

awareness intact, specific to lobe it arises

101
Q

presentation of temporal lobe focal seizure

A 
"HEAD" 
hallucinations 
epigastric rising 
automatisms 
deja vu
102
Q

presentation of frontal lobe focal seizure

A

head/leg movements
posturing
jacksonian march

103
Q

presentation of parietal lobe focal seizure

A

paraesthesia

104
Q

presentation of occipital lobe focal seizure

A

flashes/floaters

105
Q

complex focal seizure

A

awareness impaired. temporal lobe most common

106
Q

myoclonic seizure

A

small twitch or severe jerk

107
Q

tonic seizure

A

LOC, fall to ground, extension of neck, back arching

108
Q

clonic seizure

A

flex and relax rapidly

109
Q

MX generalised epilepsy

A
  1. sodium valproate or lamotrigine

2. levetiracetam

110
Q

Mx of absence seizures

A

Ethosuxamide

111
Q

car driver, has an awake seizure - how long no driving

A

1 y

112
Q

car driver, has seizures when asleep - how long no driving

A

can drive - must not have had an awake attack for 3y

113
Q

bus /lorry driver, has one off seizure - how long no driving

A

5 y

114
Q

bus/lorry driver, has Dx of epilepsy - how long no driving

A

must be seizure and medication free for 10 y

115
Q

mononeuritis multiplex

A

2 or more peripheral nerves affecting distinct areas

116
Q

causes of mononeuritis multiplex

A

“WARDS PLC”

Wegeners
Aids 
Rheumatoid 
Diabetes
Sarcoidosis 
pAN
Leprosy 
Carcinomatosis
117
Q

sciatic nerve

A

L4-S3

118
Q

sign of a common peroneal nerve mononeuropathy

A

sensory - loss over dorsum of foot

motor - foot drop, loss of ankle dorsiflexion/eversion

119
Q

sign of a tibial nerve mononeuropathy

A

sensory - loss over sole of foot

motor - loss of plantarflexion/inversion

120
Q

pathology of a polyneuropathy

A

demyelination
or
axonal degeneration
(or both)

121
Q

metabolic causes of polyneuropathy

A 
diabetes 
B12/folate deficiency 
hypothyroidism 
renal failure 
hypoglycaemia
122
Q

drug causes of polyneuropathy

A 
alcohol
isoniazid 
phenytoin
nitrofurantoin 
amiodarone 
metronidazole 
chemo drugs - vincristine, cisplatin
123
Q

presentation guillain barre syndrome

A

ascending paralysis
CNVII symptoms
post campylobacter syndrome

124
Q

Ix guillain barre

A

LP - increased protein
EMG
monitor FVC (resp muscle)

125
Q

MX guillain barre

A

IVIG

126
Q

brown-sequard syndorme

A

cord hemisection

  • lateral corticospinal
  • lateral spinothalamic
  • dorsal columns
127
Q

pathology alzheimer’s

A 
neurofibrillary tangles (tau protein) 
beta-amyloid plaques 
deficit of Ach
128
Q

Mx alzheimer’s

A
  1. cholinesterase inhibitor - Donepezil, Rivastigmine, Galantamine
  2. n-methyl-d-aspartate antagonist (NDMA) - memantine
129
Q

pathology of LBD

A

lewy body inclusions - alpha synuclein

130
Q

Mx LBD

A

same as Alz

  1. Cholinesterase inhibitors - Rivastigmine, Donepezil, Galantamine
  2. NDMA antagonist - memantin
131
Q

Mx of REM sleep disorder in LBD

A

clonazepam or melatonin

132
Q

“wet wobbly and wacky”

A

normal pressure hydrocephalus

133
Q

picks disease

A

frontotemporal dementia

134
Q

inheritance of huntingtons

A

autosomal dominant

135
Q

subgroups of MND

A

amyotrophic lateral sclerosis
primary lateral sclerosis
progressive muscular atrophy
progressive bulbar palsy

136
Q

amyotrophic lateral sclerosis

A

subgroup of MND (most common)
UMN - legs
LMN - arms

137
Q

primary lateral sclerosis

A

subgroup of MND

UMN signs only

138
Q

progressive muscular atrophy

A

subgroup of MND

LMN signs only

139
Q

progressive bulbar palsy

A

subgroup of MND
affects CN IX - XII
palsy of tongue, chewing muscles and swallowing

140
Q

Mx MND

A

anti-glutamate drugs - Riluzole

141
Q

channel down in lambert eaton syndrome

A

pre-synaptic ca channels

142
Q

receptor down in myasthenia gravis

A

post-synaptic Ach receptors

143
Q

lambert eaton synd - associated with what conditiion?

A

small cell lung ca

paraneoplastic syndrome

144
Q

presentation lamber eaton syndrome

A

limb girdle weakness
hyporeflexia
autonomic symptoms​ (dry mouth, impotence)

145
Q

mneumonic for cerebellar disease

A

DANISH

Dysdiadokinesia 
Ataxia 
Nystagmus 
Intention tremor 
Stacato speech 
Hypotonia
146
Q

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

A

L3 nerve root compression

147
Q

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

A

L4 nerve root compression

148
Q

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

A

L5 nerve root compression

149
Q

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

A

S1 nerve root compression

150
Q

sensory loss dorsum of foot - level of nerve compression?

A

L5

151
Q

sensory loss of lateral foot - level of nerve compression?

A

S1

152
Q

weakness of dorsiflexion of foot - level of nerve compression

A

L5

153
Q

weakness of plantarflexion of foot - level of nerve compression

A

S1

154
Q

ocular symptoms MS

A

optic neuritis

bilateral internuclear ophthalmoplegia

155
Q

tysabri (MS Mx) is associated with what?

A

PML - must test first for JC virus

Finals Studying - Condensed (22 decks)

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