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Clinical Flashcards

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1
Q

Some organisms that commonly cause meningitis?

A

Viruses: Herpes, EBV

Bacteria

Fungi e.g. Toxoplasma

Helminths

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2
Q

Fatality rate for bacterial meningitis?

A

10-30%

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3
Q

Main types of bacterial meningitis?

A

Meningococci, Hib, pneumococcus

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4
Q

Signs of meningitis? (get some)

A

Severe headache, neck stiffness, fever, vomiting, confusion, brudzinski’s sign, rash, bruising

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5
Q

Difference in the analysis of CSF in bacterial and viral meningitis?

A

Bacterial has neutrophils and viral lymphocytes

Glucose in bacterial is low, in viral it is normal

Protein is higher in bacterial too

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6
Q

Steps of meningococcal infection?

A

Colonise nasopharynx

Invade epithelial cells

Enter circulation and either/both the CSF and the bloodstream (septicaemia)

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7
Q

Treatment for ALS? How effective?

A

Riluzole, 3 month increase in survival

non-invasive ventilation improves quality of life

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8
Q

How might an axonal injury arise?

A

Traumatic brain injury - direct cut of the axon

MS - inflammatory lesion

Stroke - ischaemic injury

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9
Q

How is regeneration different in the PNS to the CNS?

A

Schwann cells in PNS produce high levels of growth factors, and a permissive environment for repair is created

An inhibitory environment is created in the CNS, by the glia

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10
Q

What is basilar invagination?

A

Upwards herniation of the margins of the foramen magnum into the posterior cranial fossa

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11
Q

What is cephaloceles?

A

Extracranila extensions of the parenchyma or meninges through skull defect

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12
Q

What protein aggregates in many neurodegenerative disorder most naotably in lewy bodies in AD?

A

Aβ (amyloid beta)

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13
Q

How does Aβ contribute to age determined macular degeneration?

A

Induces complement activation and this recruits inflammatory factors

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14
Q

Types of neurotransmission?

Which are dysfunctional?

A

Classical

Spillover - activation of adjacent receptors (dysfunction)

Exocytosis occuring away from membranes defined as active zones (dysfuntion)

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15
Q

What three things often contribute to neurodegeneration?

A

BBB dysfunction

Neuroinflammation (Abeta)

Neurotransmission dysfunction

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16
Q

Viruses that cause meningitis?

A 
Herpes
Mumps
Polio
Japanese encephalitis
HIV
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17
Q

Viruses that cause encephalitis?

A

Herpes
Rabies
west nile virus
Japanese encephalitis

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18
Q

Common 5 types of Herpes viruses?

A

HHV - 1 + 2
HHV 3 - chicken pox/shingles

HHV 4 - EBV (glandular fever)
HHV 5 - cytomegalovirus

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19
Q

What is herpes Zoster?

A

When the virus establishes a life-long latent infection in the dorsal root ganglia, and can be reactivated

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20
Q

How and where do HHV 1 and 2 often infect, anatomically

A

They travel from peripheral nerves to the dorsal root ganglia, can travel back down peripheral nerves to reactivate

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21
Q

What commonly causes sporadic encephalitis?

A

HHV1 (95%)

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22
Q

What can be used to treat Herpes, especially in encephalitis?

A

Acyclovir

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23
Q

What is osteomyelitis?

A

Infection of bone tissue

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24
Q

Main three mechanisms of osteomyelitis infection?

A

Haematogenous - from blood

Direct inoculation

Contiguous - from adjacent soft tissue infection

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25
Clinical features of septic arthritis?
Acute (mostly) Pain Fever Movement limited
26
Two types of Septic arthritis? Causes?
Chronic: - TB - Fungi - Lyme disease Acute/viral - Rubella/vaccine - mumps - Hep B
27
What is a prion? (in prion disease)
An infection that is solely protein based, encoded by your own disease
28
Is there an infammatory response in prion disease?
Nope
29
What does prion disease cause?
Rapid neurodegeneration and death in avg. 1 year, due to accumulation of prion proteins in the brain
30
Three main types of primary headaches?
Tension-headache Migraine Cluster headaches
31
Who normally gets tension-headaches?
All ages
32
Who normally gets migraines?
Teen - young adult | Female
33
Who normally gets cluster headaches?
Female over 30
34
Common causes of raised Intracranial pressure?
Space occupying lesions CSF blockage leading to hydrocephalus Idiopathic intracranial hypertension
35
Causes of secondary headaches?
Raised ICP Vascular Meningitis/encephalitis Giant cell arteritis
36
Types of hearing loss?
Conductive Sensorialneural
37
Common causes of conductive hearing loss?
Otitis media Otosclerosis Trauma
38
Types of otitis media? causes?
Supprative (pus-producing) - Viral (90%) non-supprative - glue ear
39
What is cholesteatoma?
Erosion/rotting of middle ear/mastoid
40
Treatment for otoslerosis?
- hearing aid | - stapedectomy
41
What is acoustic neuroma?
Benign tumour of vestibular nerve?
42
two types of vestibular disorders?
Central = brainstem + cerebellum Peripheral = inner ear or vestibulocochlear nerve
43
What is BPPV?
Benign paroxysmal positional vertigo Caused by substances in the vestibular apparatus cured through a epley movement
44
Three main causes of recurrent vertigo?
BPPV Vestibular migraine Movement provoked pathologies
45
What do NK cells recognise on cell surface membranes?
Glycoproteins
46
Raised intracranial pressure symptoms?
Headache Nausea and Vomiting Pupilloedema reduced consciousness
47
Common causes of raised intracranial pressure?
Expanding mass increase in CSF/water content/blood volume
48
What can lead to cerebral vasodilatation?
Increased PaCO2 Decreased PaO2 Decreased pH Decreased cerebral perfusion pressure
49
Types of hydrocephalus?
Communicative (absorption issue) non-communicative (blockage)
50
Types of cerebral drains?
Subarachnoid Intraventricular Intraparenchymal Epidural
51
Treatment options for raised intracranial pressure?
Heads up Venous drainage (e.g. central line) Sedation Hyperventilation CSF drainage Mannitol
52
Roles of the parietal, temporal, frontal and occipital association cortexes?
Parietal AC: attending to stimuli Temporal AC: recognising stimuli Frontal AC: planning responses Occipital AC: recognising visual stimuli
53
What is neglect syndrome, what area of the brain is damaged?
When the left visual field is completely ignored by patients Damage to the right parietal lobe
54
Why is neglect syndrome always caused by damage to the right parietal lobe and not the left?
The left visual field only has connections to the right parietal lobe, but the right visual field has connections to left and right
55
What is agnosia? Two types?
Agnosia: inability to recognise things Somatosensory: The inability to recognise objects by touch Prosopagnosia: Inability to recognise faces
56
What is apraxia, two categories?
Conditions involving damage to the prefrontal cortex Ideomotor: - inability to execute learned purposeful movements Conceptual apraxia: - inability to complete multistep actions in the correct order
57
What is aphasia, the two categories, and where is damaged in those categories?
Aphasia is damage to areas of speech Expressive is inability to produce the correct speech = motor (broca's area) Receptive aphasia = sensory (wernicke's area)
58
Three types of learning/conditioning?
Classical conditioning - association of one thing with another causing one response to be linked to a new stimulus Operant conditioning - Using both positive and negative reinforcement (negative reinforcement is NOT punishment but the removal of a negative thing, e.g. less hunger) Social learning theory - complex learning requiring high amounts of cortical functioning
59
Two types of long-term memory?
Procedural - cognitive perceptual and motor skills Declarative - facts
60
Three levels of encoding of memories?
1. Structural (how it looks) - not encoded very well 2. Phonemic (how it sounds) - encoded intermediately well 3. semantic (what it means) - encoded very well
61
Types of forgetting?
Failure to encode Decay Retrieval failure: can't find memory cue motivated forgetting: repressed memories interference: confusion with other memories
62
Two categories of myelopathies?
Compressive Non-compressive
63
Examples of a compressive myelopathy?
Cervical spondylosis Tumour Epidural abscess Trauma Central cord syndrome
64
Examples of non-compressive myelopathies?
Acute: vascular infarction Sub-acute: MS/HIV, EBV Chronic: ``` hereditary spastic paraperesis MND Tumour Copper/B12 deficiency MS HIV, syphilis ```
65
Process of positive adjustment in patients with a long-term-condition
1. Diagnosis 2. Adjustment process 3. Adjustment outcome
66
Stages of change in a patient?
Precontemplation Contemplation Preperation Action Maintenance/relapse
67
Common classifications of dementia?
Dementia with lewy bodies (15%) Vascular (20%) Alzheimers (60%)
68
Classification of dementia diagnosis?
Progressive decline in memory and other cognitive abilities > 6 months
69
Common features of dementia?
Apraxia/Aphasia Cognitive decline
70
treatment for dementia?
AchEI - Donepezil Memantine - stabilises glutamatergic neurotransmission
71
rare causes of dementia?
FTD - frontotemporal dementia Huntingtons CJD
72
Possible modes of genetics of dementia
1. Autosomal dominant, every generation has it 2. Familial dementia: one or more relative has it 3. Sporadic: out of the blue
73
Details of autosomal dominant genetic inheritance of dementia?
Early onset, APP gene thought to be the cause APOE gene also implicated
74
What are the functions of the reticular formation?
Ascending pain pathways Integrative functions
75
What are the parasympathetic nuclei and their outputs?
Edinger westphal - Ciliary Superior salivatory - Facial - Pterygopalatine ganglion and submandibular gland Inferior salivatory - Glossopharyngeal - Otic
76
How does the corneal reflex work?
The efferent limb from each eye is the facial nerve, they then synapse on the MLF which connects the efferent limb to the afferent limb (trigeminal nerve)
77
If the corneal reflex arc is transected at the afferent limb what is lost?
Both corneal reflexes of the eye are lost
78
If the corneal reflex is transected in the efferent limb on the direct side what is lost?
The direct response is lost but the consensual is still present.
79
What travels in the DLF (dorsal lateral fasciculus)?
The reticulospinal tract.
80
The process of the pupillary light reflex?
Afferent limb - optic nerve Efferent limb - occulomotor nerve Optic nerve - Pretectal nuclues (PAG) - Edinger westphal nucleus (PAG) - Occulomotor nerve - Ciliary ganglion
81
Why do both pupils restrict even when light is shone into only one?
The pretectal nucleus sends fibres to both edinger westphal nuclei
82
When might the pupillary reflex be absent?
MS Uncal herniation Horners syndrome
83
What are the two eye movements transmitted by the MLF?
Circadic movements - one thing to another e.g. words (voluntary) Smooth Pursuit movements - watching a moving object (involuntary)
84
What type of cortex covers most of the human brain, how many layers does it have?
Neocortex - 6 layers
85
What is cell layer 4 and 5 for in the neocortex, what is larger in the PMC and PSC?
Cell layer 4 is for inputs - larger in the PSC Cell layer 5 is for output - larger in the PMC
86
What would a lesion to the right parietal association cortex commonly cause?
Contralateral neglect syndrome (left hemineglect)
87
What is the definition of agnosia/aphasia/ataxia/apraxia/amnesia?
Agnosia - inability to recognise things Aphasia - deficits in speech Ataxia - inability in coordination Apraxia - deficits in planning of motor actions Amnesia - memory deficits
88
Two forms of apraxia?
Ideomotor - can't execute learned movements voluntarily Conceptual - can't execute multistep actions in the right order
89
Two types of aphasia, what is damaged in each?
Expressive - damage to brocas area - slow laboured monotonous speech Receptive - damage to wernickes - fluent speech with the wrong words, unaware of the mistakes being made, unable to read
90
What area is damaged in prosopagnosia?
Fusiform gyrus in the temporal lobe
91
What is a depressive episode defined as?
2 of the following: - Pervasive low mood - reduced energy - Reduced interest and enjoyment For 2 weeks

NLM2 (14 decks)

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