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Neuro Flashcards

1
Q 
ddx for adolescent syncope
metabolic disturbance (3)
neuro (4)
cvd (1)
tox (1)
A

metabolic disturbance

  • hypoglycaemia
  • hypotension secondary to dehydration
  • hyponatraemia

neuro

  • epilepsy
  • head trauma
  • subarachnoid haemorrhage
  • meningitis

cardiac arrhythmia
recreational drug use

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2
Q 
key features of history for adolescent syncope
personal (3)
neuro (6)
CVD (3)
vitals (1)
A

personal

  • fhx epilepsy
  • food intake that day, water intake that day
  • recreational drug use

fever

neuro sx.

  • tongue biting during syncope
  • post ictal confusion following period of unconsciousness
  • urinary incontinence during syncope
  • neurological weaknesses or sensation changes
  • recent head trauma
  • headache

CVD

  • chest pain immediately prior
  • sob immediately prior
  • palpitations
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3
Q

peripheral neuropathy - ddx

‘DAMIT BITCH’

A

diabetic neuropathy
alcohol abuse
medication SE - amiodarone, nitrofurantoin, phenytoin, CTX, levodopa
Inflammatory - Guilliane barre syndrome
Tumours - paraneoplastic syndrome
B12 deficiency - alcoholics, pernicious anaemia, coeliacs, sleeve gastrectomy
Infection - HIV, Hep C, leprosy
Trauma
Connective tissue disorders - SLE, polyarteritis nodosa
Hereditary - Charcot marie tooth

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4
Q

diabetic autonomic neuropathy - key features
CVD (2)
GI (2)
urology(2)

A

CVD

  • orthostatic hypotension
  • cardiac autonomic neuropathy - resting tachycardia, bradycardia

GI

  • gastroparesis
  • diarrhoea

urology

  • erectile dysfunction
  • urinary retention
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5
Q

Rx for painful diabetic peripheral neuropathy

A

amitriptyline 25mg nocte increase to 150mg
duloxetine 60mg mane, increase to 60mg bd
gabapentin 300mg up to 1200mg per day
pregabalin 75mg bd, increase to 300mg bd

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6
Q

fits, faints, funny turns - key features on hx

A

any preceding symptoms - sob, headache, recent illness, heart palps, recent head trauma, auras
onset - sudden, slow
does patient remember event
did they lose consciousness
events after episode - urine incontinence, tongue biting, post ictal drowsiness or confusion
PMHx - epilepsy fainting, cvd, dmt, CVD, previous TIA/CVA
Fhx epilepsy

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7
Q

ddx for epilepsy
psych (2)
gen med (2)
neuro (3)

A

psych

  • vasovagal
  • pseudoseizure

cardiac arrhythmia
metabolic disturbance

neuro

  • TIA
  • migraine
  • narcolepsy
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8
Q 
causes of provoked seizures
brain (3)
systemic (3)
tox (2)
wildcard (1)
A 
brain
- CVA
- trauma
- meningitis (infection)
systemic
- hyponatramia
- hypoglycaemia
- hypercalcaemia
tox
- ETOH withdrawal
- synthetic cannabinoids (and probably other drugs)

pregnancy - eclampsia

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9
Q

things to look for in examination post fit faint funny turn

  • general (3)
  • neuro (3)
  • CVD (4)
A 
general
- fever
- cervical spine tenderness on examination
neuro
- neck stiffness
- papillodema
- CN exam abnormalities
CVD
- carotid bruit
- orthostatic hypotension (BP, sitting/standing)
- irregular pulse
- murmurs (heart sounds)
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10
Q

Initial ix for fit faint funny turns

A 
BSL
FBC
UEC
\+/- ECG
CT head
MRI brain
EEG
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11
Q

nonmedication management advice following seizure (7)

A 
no driving until 6/12 episode free
no driving 12/12 if dx epilepsy
no bathe or swimming alone
no working at heights
no abseiling, water sports, operating heavy machinery
seizure 1st aid education
mx of status epilepticus
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12
Q 
Multiple sclerosis - key features examination
optic (3)
general neuro (2)
motor neuron (4)
brainstem (2)
A 
optic
- reduced monoocular blurred vision VA 
- central scotomata
- loss of red color vision
general
- unilateral neuro SOS
- unilateral numbness parasthesia

UMN

  • unilateral spastic paresis - weakness, no muscle atrophy
  • increased tone no fasiculations or fibrillations
  • hyperreflexia - deep tendon reflexes
  • positive babinski/upgoing plantar reflex

brainstem

  • ataxic gait
  • internuclear opthalmoplegia
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13
Q

multiple sclerosis - key investigations

A

MRI brain + spine with contrast - MS lesions
CSF electrophoresis - oligoclonal bands raised IgG
Evoked vision potential studies

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14
Q

Multiple sclerosis - McDonald dx criteria (4)

A

objective evidence of 2 or more lesions
disseminated in time and space
with no better explanation for cause
2 x separate episodes, 2 separate CNS regions

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15
Q

Multiple sclerosis - ddx for clinically isolated syndrome (acute demyelination)

neuro (3)
nutritional (1)
infection (2)
other (2)

A

neuro

  • migraine
  • cerebral tumour
  • spinal cord compression
nutritional
- b12 deficiency
infection
- HIV
- syphilis

other

  • paraneoplastic syndromes
  • psychiatric distress/somatisation
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16
Q

myasthenia gravis - key investigations (3)

A

anti-acetylcholine receptor antibodies +ve
CT scan chest/thorax - detect thyoma or thyroid tumour
Electromyography - EMG

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17
Q

myasthenia gravis - key features Hx

A

painless fatigue with exercise
weakness precipitated by stress - cyesis, infection, surgery, emotional
fluctuating symptoms
variable severity of muscle weakness
variable distribution of muscle weakness:
ocular - diplopia,
dysphagia, difficulty chewing, dysphonia/speech, difficulty whistling
limbs proximal to distal, generalised weakness
resp - sob, breathlessness
a/w other autoimmune diseases - SLE, RA, thyroid, pernicious anaemia
FHx
PMHx

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18
Q

myasthenia gravis - nonmedical management

A

referral to consultant neurologist
detect thyoma with ct chest
exclude associated autoimmune disease

19
Q

myasthenia gravis - treatment

A

anticholinesterase inhibitors - pyridostigmine 30mg tds, titrate weekly up to 120mg 4hrly
prednisolone 5mg od, titrate up to 1mg/kg/day max 75mg mane
azathioprine 1.5-2.5mg/kg po od

20
Q

multiple sclerosis - key features history

A 
onset of symptoms over days to weeks of:
blurred vision, diplopia
painful eye movement
motor weakness
sensory weakness/parasthesia
unsteady gait
bowel or bladder dysfunction
FHx MS
previous episodes
head trauma
headache
vertigo
21
Q

Vertigo - central causes (3):

A

CVA
cerebral tumour
MS

22
Q

Vertigo - peripheral causes (4):

A

Meniere’s diease
labyrinthitis
Benign paroxsymal postional vertigo
vestibular neuronitis

23
Q

Vertigo - key features Hx

A 
any associated tinnitus or hearing loss
preceding viral illness
provoked from change in position
duration of episode
any associated neurological symptoms - weakness, ataxia, confusion, paraesthesia
any associated N+V
medications - ototoxic drugs, antihypertensives
stress/panic attacks
recent head trauma
24
Q

Headaches red flags

A

Age >50yrs
pmhx active or past malignancy
thunderclap headache
1st ever headache with focal neurology
hx recent head trauma
increasing severity or frequency of headache
positional - increases when lying, bending, coughing, straining, valsalva
associated systemic illness - fever, neck stiffness, rash
PMHx - HIV, cancer, immunocompromise
Papilodema
FHX berry aneurysm

25
Q

headache - history

A 
is this worse than previous headaches?
severity of headache?
where is the pain? does it radiate anywhere?
onset - sudden, slowly?
any prodromal symptoms?
is it made worse by coughing bending straining 
any fevers, rashes, neck stiffness
any vomiting
any vertigo or dizziness 
any vision changes
any photophobia
PMhx
medications 
any recent trauma
26
Q

Headache - examination

A 
vital signs
face and scalp - masses, neck stiffness
neuro exam - perrla, cn exam, RAPD, 
fundoscopy for papilloedema
CVS exam - HS, carotid bruits
27
Q

headache Ix

A

CT/MRI for chronic heaache with ?intracranial pathology

CT head/mri for chronic headache with associated neuro SOS

28
Q

Headache - indication for neurology referral

A 
dx uncertain
inadequate or no response to treatment
condition or disability worsens
irretractable or daily headaches
urgent t/f to ED if ?CVA/TIA, head trauma, meningitis
29
Q

Ramsay hunt syndrome - key features

A

Typically presents with a triad of otalgia, cutaneous
vesicles in a dermatomal distribution and
unilateral facial nerve palsy.
cutaneous vesicles in external auditory canal
diffuse otitis externa, crusting
preauricular ln swelling
Pmhx - chicken pox as child

30
Q

Ramsay hunt syndrome - mx

A

‘facial nerve recovery’ - aciclovir 800mg 5 times per day for 7-10days
prednisolone - 1mg/kg <75mg po mane for 7-14days
‘management of postherpetic neuralgia’ - pregabalin 75mg - 300mg po bd, gabapentin 100-300mg po tds
‘eye care’ - regular lubricating eye drops throughut day, taping eye shut at night
clinical review at 7 days to check response to treatment
educate on sos of opthalmic complications

31
Q

facial weakness - ddx

A 
Stroke/TIA
multiple sclerosis
otitis media, schwannoma
Bells palsy(idiopathic)
Ramsay Hunt Syndrome
Myasthenia gravis
head trauma
temporal bone fracture
cerebral tumour, parotid tumour, lymphoma
neurofibromatosis
32
Q

facial weakness - Peripheral nerve palsy - key features examination

A 
weakness of forehead, eye and mouth
weakness in raising and furrowing brow
smooth forehead/no wrinkles
weakness in blinking/closing eye
weakness in grimacing and smiling
flattening of nasolabial fold
33
Q

facial weakness - upper motor neuron/CNS - CVA key features examination

A

lower face only
nasolabial fold flattening
weakness in smiling and grimacing
sparing forehead, brows and eyes

34
Q

Bells palsy - mx

A

Advise patients that facial nerve recovery can take several weeks or months.
eye care - drops and tape shut eyelid at night
cover and protect eye in windy and dusty conditions
prednisolone 1mg/kg <75mg po mane for 5 days
educate on sos corneal abrasion/ulcer

35
Q

Stroke risk assessment after suspected TIA (ABCD2)

A

age> 60 (1)
bp >140/90 (1)
Clinical features - unilat weakness (2) speech disturbance only (1)
duration <10min (0), 10-59mins (1), >60mins (2)
diabetes mellitus (1)

36
Q

Management of chillblains

A 
betamethsone 0.05% topically bd
keep warm and dry peripheries
exercise indoors
avoid cold exposure
nifedipine CR 20mg od
37
Q

Raynaud’s phenomenon management

A 
avoid cold exposure
keep warm and dry peripheries
quit smoking
avoid b-blockers
of if severe trial nifedepine 20-30mg
38
Q

DEMENTIA mnemonic - causes of cognitive decline

A

Drugs
Eyes and Ears (cant see/hear properly)
Metabolic - hypo/hyper - Na, Ca, Thyroid, UEC
Emotion - depression
Nutrition - vit b12 def
Trauma or Tumour - Intracranial bleed or mass
Infection - uti, pneumonia
Alcohol, Alzheimers, atherosclerosis(CVA)

39
Q

Indication for geris referral

A

unclear diagnosis
atypical presentation
psychotic or severe behavioural issues
commencement of anti dementia medications

40
Q

Dementia - ddx (4 Ds)

A

depression
delerium
drugs

41
Q

Dementia/cognitive decline - Ix

A 
FBC
ESR
LFT
Calcium
TFT
B12 
CT brain
42
Q

HINTS exam

A

Head impulse test - positive = eyes saccade to refocus = peripheral
nystagmus = unilateral, horizontal - peripheral
test of skew = cover/uncover = eye remains motionless after uncover = peripheral

43
Q

oligoclonal bands + raised IgG in CSF electrophoresis suggests what disease

A

multiple sclerosis

44
Q

myasthenia gravis - pathohysiology

A

autoimmune disease, destroys nicotiniv acetylcholine receptors

kfp (14 decks)

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