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C Symposium Flashcards

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1
Q

What are the unique signs of an anterior circulation stroke?

A

Amaurosis fugax (vision loss)
Dysphagia
Apraxia (can’t perform purposeful actions)
Inattention

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2
Q

What are the unique signs of a posterior circulation stroke?

A

Ataxia (loss of control of full body movements)
Diplopia
Vertigo
Bilateral Symptoms

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3
Q

What is the ABCD2 score used for?

A

TIA

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4
Q

What is the polypill?

A 
Combination of:
Statin
Aspirin
Antihypertensive
Folic acid
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5
Q

Name a secondary vascular prevention of stroke?

A

Carotid Endarterectomy

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6
Q

What is negative and positive phenomena?

A

Decreased and increased sensation respectively

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7
Q

What type of stroke has feature known as neglect (not eating half a plate of food)?

A

Right hemisphere stroke

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8
Q

What is visual agnosia?

A

Inability to access semantic knowledge of an object

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9
Q

What is dyspraxia?

A

Loss of ability to plan, conceptualise and execute complex sequence of motor actions

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10
Q

What is spasticity?

A

Hyper excitability of the stretch reflex

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11
Q

Different pain onsets of headache?

A

Acute - seconds to minutes
Evolving - hours to days
Chronic - weeks to months

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12
Q

What are the causes of raised intracranial pressure?

A 
Mass effect
Brain swelling - hypertensive encephalopathy
Increased venous pressure
CSF outflow obstruction - hydrocephalus
Increased CSF production - meningitis
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13
Q

Who is temporal arteritis likely to affect and what is the treatment?

A

Older female patient

High dose steroids - prednisolone

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14
Q

Preventative migraine treatments?

A

Propanolol

Valproate

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15
Q

What are trigeminal autonomic cephalgias?

A 
Pain one side of head in trigeminal area
Activation of trigeminal parasympathetic  system
- cluster headache
- paroxysmal hemicranias
- SUNCT headache
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16
Q

What is the pain relief for trigeminal autonomic cephalgias and what is the prevention?

A

Pain relief - sumatriptan

Prevention - prednisolone, verapamil

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17
Q

What is the presentation of intracranial tumours?

A 
Raised intracranial pressure
Epilepsy
Neurological Deficit
Endocrine dysfunction
Incidental
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18
Q

What is the management of intracranial tumours?

A

Medical: steroids, anti-convulsants, hormonal replacement
Surgical
Adjuvant Therapy

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19
Q

What intracranial tumour are males and females most likely to get?

A

Males - Gliomas

Females - Meningiomas

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20
Q

What are the different types of astrocytoma and what are their grades?

A 
Astrocytic tumours - grade 1
Diffuse astrocytoma - grade 2
Anaplastic astrocytoma - grade 3
Glioblastoma - grade 4
Pilocytic astrocytoma - grade 1 - children and cerebellum
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21
Q

What is classic histological appearance of nuclei and capillaries in Oligodendroglioma?

A

Fried egg nuclei

Arborising Capillaries - chicken wire

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22
Q

What are the features of a meningioma?

A

Grade 1
Whorls
Psamomma bodies

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23
Q

What are the features of a medulloblastoma?

A

In children in the cerebellum
Grade 4
Anaplastic hyperchromatic cells
Rosette formation

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24
Q

Name nerve sheath tumours and nerves affected?

A

Schwannoma - vestibulocochlear nerve
Neurofibroma - spinal nerves - collagen rich
Spindle cell tumours - no specifics

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25
Name some of the causes of dementia?
``` Alzheimer's Lewy Body Vascular Fronto-temporal Huntington's Prion disease ```
26
What are the mutated proteins in dementia?
Amyloid proteins - inappropriate folded versions - form insoluble fibrils Tau proteins - no longer stabilise microtubules Ubiquitin - no longer direct proteins to compartments in cells
27
What are the neurodegenerative dementias?
Alzheimer's Lewy Body Fronto-temporal
28
What are neurogenerative movment disorders?
Parkinson's Huntingtons MND
29
What is the triad of effects caused by normal pressure hydrocephalus?
Dementia Gait disturbance Urinary incontinence
30
Classification of seizures?
Generalised - both hemispheres Partial - one hemisphere Secondary generalised - one and then the second
31
What is status epilepticus?
When the brain is in a permanent state of persistent seizure - medical emergency
32
Mutations in which receptors can cause epilepsies?
GABA receptor
33
What is dravet syndrome?
Rare genetic epileptic encephalopathy - nonsense mutation
34
What do antiepileptic drugs do?
Decrease frequency and severity of seizures
35
How to antiepileptic drugs work?
Suppress action potential Enhance GABA transmission Suppression of excitatory transmission
36
What can be used as an alternative to valproate?
Clonazepam
37
What enhances the action of GABAA receptors?
Barbiturates
38
What decreases GABA uptake
Tiagabine
39
What increases the action of GABA?
Benzodiazepines
40
How do benzodiazepines work?
Increase affinity of GABA to receptor
41
What inhibits sodium channels?
Carbamazepine
42
What is valproate effective against and how does it work?
Good against tonic-clonic seizures and absences | Decreased GABA turnover
43
What is foetal hydantoin syndrome
Mother takes phenytoin/carbamazepine during pregnancy Intrauterine growth restriction Microcephaly Growth problems
44
What is epilepsia partialis continua
Motor epileptic seizures
45
How can tetanus help suppress seizures?
Toxin injected into mother cortex - decrease neurotransmitter release Therefore affects GABAergic synapses Seizure activity controlled by light (certain lights can hyperpolarise neurons) - Halorhodopsin
46
What is optic neuritis and its link to MS?
Inflammation of optic nerve Pain and loss of vision Can return to normal visual acuity 50% develop MS
47
What is transverse myelitis, a feature it causes and its link to MS?
Inflammation inside the spinal chord Lhermittes phenomenon (resembles electric shock passing down neck) 50% develop MS
48
MS definite diagnosis?
When transverse myelitis and optic neuritis occur at different times
49
What is multiple sclerosis (MS)?
Disease of the CNS | Inflammatory reaction - loss of myelin - slow nerve conduction
50
What is used in the treatment of MS and how does it work?
Natalizumab - prevents migration of immune cells across blood-brain barrier Fingolimod - oral treatment - takes lymphocytes away from blood and susceptible target organs e.g. CNS
51
Disease progression of MS?
Relapsing - remitting MS Primary progressive MS Secondary progressive MS Progressive relapsing MS
52
What type of lesion leads to tetraplegia and what is it?
Cervical lesion | Partial/total loss of four limbs
53
What type of lesion leads to paraplegia and what is it?
Thoracic lesion | Impairment of lower extremities - legs
54
What is Brown-Sequard Syndrome?
Incomplete spinal cord lesion (one side) | Ipsilateral paralysis
55
Excessive vagal stimulation?
Lesion is above T6 | Loss of parasympathetic control - overwhelming vagal output
56
What are the classes of somatosensory disorders and which receptors are involved?
Tactile - think skin receptors Proprioception - Golgi tendon and muscle spindles Thermal sensation - thermoreceptors Nociceptine sensations - nociceptors
57
Features and location of Meissner's corpuscles?
Looping axonal terminals that inter-twine supporting cells Below epidermis Rapidly adapting small receptor Feels flutter motion
58
Features and location of Merkel's?
Dome structure atop axon terminals Epidermal-dermal border Slow adapting small receptor Pressure, form, texture
59
Features and location of Pacinian's?
Onion shaped appearance Deep dermis Rapid acting large receptor Vibration
60
Features and location of Ruffini?
Terminals interwined with collagen Deep dermis Slow acting large receptor Skin stretch
61
What receptor feels Braille?
Merkel
62
Where does the Herpes Zoster virus live in the infected?
Primary sensory neurons
63
What does damage to the posterior parietal cortex cause?
Astereognosia - inability to identify objects based on touch alone
64
How can a pure sensory stroke occur?
Thalamic infarct
65
What is the distribution of sensation in peripheral neuropathy?
Glove + stocking distribution - no sensation here
66
What are nociceptors?
Pain receptors - simple free nerve endings
67
What substances released in inflammation and tissue damage sensitise peripheral nociception?
Prostaglandins Bradykinin Histamine
68
Where are the nociceptive cell bodies?
Dorsal root ganglion
69
Where does referred pain from each of the following go: a) oesophagus b) heart c) bladder d) ureter e) prostate
``` Oesophagus - chest wall Heart - chest and arm Bladder - perineum Ureter - lower abdomen and back Prostate - lower trunk and legs ```
70
What is the neurotransmitter and neuropeptide for pain?
Glutamate and substance P respectively
71
What is phantom pain?
Sensation without input
72
In which instance will hyperalgesia occur?
When already damaged tissue is present - as it is unusually sensitive
73
Analgesia Ladder (increasing)
Non-Opiod - NSAIDs Weak Opiod Strong Opiod Epidural/spinal/nerve block
74
What is neuropathic pain and in what instances can you get it?
Spontaneous pain and hypersensitivity to pain Painful diabetic neuropathy Post herpetic neuropathy - site of a previous attack of shingles Trigeminal neuralgia
75
What is allodynia?
Pain in response to non painful stimuli
76
What are dysanthesias?
Unpleasant abnormal sensations e.g. ants crawling on skin
77
Which antidepressant can be used for neuropathic pain?
Tricyclic agents
78
Which anticonvulsants reduce pain and how do they work?
Gabapentin - blocks voltage gated calcium channels Pregablin - blocks Calcium N type Carbamazepine - blocks sodium and calcium channels
79
What is the problem with the eye when there is blurred vision?
Refractive problem - cornea, lens, shape of eye | Macular problem
80
What is the problem with the eye when there is difficulty seeing in bright light?
Corneal or lens problem - cataract usually
81
What is the problem with the eye when there is distorted vision and what is the distortment?
Things look wavy and lines aren't straight | Retina problem - wet macular degeneration or retina detachment
82
What is the problem with the eye when things look pale?
Optic nerve disease
83
What is a floater and its causes?
Deposit of various sizes in the vitreous humour of the eye | Posterior vitreous detachment or vitreous haemorrhage
84
What is a cataract?
Opacity of the lens | Common aging change
85
What is the treatment of cataracts?
Surgery - phacoextraction and then lens implant
86
How can giant cell arteritis cause visual loss?
Anterior ischaemic optic neuropathy | Central retinal artery occlusion
87
What is wet ARMD and what is it's pathology?
Blurred vision or loss in visual field Fluid entering macula (on retina) Choroidal neovascular membrane Rapid loss of vision
88
Treatment of wet ARMD?
Anti VEGF
89
What keeps the eye spherical?
Vitreous Humour
90
How does the lens change to accommodate a near and a far point?
Fat lens is near point | Flat lens is far point
91
What is hyperopia and how is it corrected?
Far sightedness - eyeball is too short | Place a convex lens in front of the eye
92
What is myopia and how is it corrected?
Near sightedness - eyeball is too long | Place a concave lens in front of eye
93
Where is the origin of the blood vessels in the eye?
Optic disk
94
What is scotopic and what photoreceptors are used?
Night time and only rods are used
95
What is mesopic and what photoreceptors are used?
Twilight time and both cones and rods
96
What is photopic and what photoreceptors are used?
Day time and only cones
97
What is colour blindness known as?
Dichromat
98
What are the different types of retinal ganglion cells and how do they differ?
M type - large P type - small - most common K type - medium
99
Locked in syndrome vs persistent vegetative state?
Awake and aware but unable to move vs Eyes open - chronic wakefulness
100
What does the basal ganglia consist of?
Corpus Striatum Amygdala Claustram
101
Corpus Striatum consists of?
Paleostriatum which is the globus pallidus | Neostriatum which is caudate nucleus and putamen
102
What is the main function of the substantia nigra?
Initiate movement
103
What gets disrupted in Parkinson's?
Nigrostriatial input
104
What happens in a patellar tap? - which fibre as well
Myostatic stretch reflex Muscle spindle activated 1a
105
Golgi tendon reflex? - which fibre
Inverse myostatic reflex 1b Indirect inhibition via inhibitory neuron
106
Stepping on a pin? - which fibre for sensory afferent
Flexor withdrawal | A-delta, C, Group 3 sensory afferent
107
Likely cause if weakness is non-specific?
Illness
108
Likely causes of UMN weakness?
Stroke, tumour
109
Likely causes of LMN weakness?
`MND Peripheral neuropathy Single nerve damage
110
Where is the lesion when half the body is affected?
Cerebral hemisphere
111
Where is the lesion when all four limbs are affected?
High cervical cord
112
If there is a lower spinal cord lesion what is affected?
`Lower limbs
113
Where is the lesion when one limb is affected?
Spinal root/peripheral nerve
114
Where is the lesion when there is generalised proximal weakness?
Myopathy
115
In myopathy how does an EMG differ from normal?
Smaller waves
116
In denervation how does an EMG differ from normal?
Lower frequency
117
In neuropathic pain how does an EMG differ from normal?
Bigger waves

Control Symposium (1 decks)

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