clinical 6 Flashcards
(100 cards)
1
Q
uses iodine as contrast
A
CT
2
Q
better for bone
A
CT
3
Q
Better for soft tissue
A
MRI
4
Q
T1 hyper intense MRI shows up what
A
fat and 4 ‘M’s’:
- Methemoglobin (subacute hematoma)
- Mineral deposition (Ca, Mg, Mn, etc.)
- Melanin (melanoma)
- “Mush” (highly proteinaceous fluid)
5
Q
different types of T1
A
hyperintense (bright)
hyopintense (dark)
6
Q
contrast in T1 hyperintense
A
gadolinium
7
Q
T1 hypo intense will show what
A
air
cortical bone
high flow: arterial ‘flow voids’
8
Q
T2 hyperintense will show up what
A
water (so more water than tissue)
9
Q
what pathology willa T2 hyper intense show up
A
oedema, demyelination, fluid collection, some tumours
10
Q
where do you get muscle weakness in duchesses
A
pelvic and shoulder girdle
11
Q
milder form of duchennes
A
beckers
12
Q
gene affected in duchennes
A
dystrophin (deficiency)
13
Q
what has happened to dystrophin gene in duchennes
A
large scale deletion
14
Q
what will bloods show in duchenes
A
raise creatine kinase
15
Q
2 signs of duchenes
A
towers sign
toe walking
16
Q
what will be seen on biopsy of huntinftons brain (macroscopic)
A
caudate atrophy
17
Q
CAG encodes for what
A
glutamate
18
Q
chromosome involved in alzheimers that
A
21
19
Q
plaques in alzheimers had up of what
A
amyloid beta proteins
20
Q
what other genetic condition associated with alzhimers and why
A
down syndrome coz gene that encodes for Amyloid precursor protein in on chromo 21 r
21
Q
other than APP mutation, what other genes and chromosomes can cause alzheimers
A
presenilin 1 (chromo 14) presenilin 2 (chromos 1)
22
Q
2 chromosomes invloed in alzheimers
A
1, 14, 21
23
Q
what are triptans
A
5-HT (1B/1D) agonists
24
Q
what do triptans do
A
- constrict arteries
- inhibit release of substance P and pro inflamm neuropeptides
- blocks transmission of trigeminal nerve to 2nd order neurones
25
triptans are used to treat
migraine, cluster headaches, subarchnoid heammorhages
26
dorsal column senses
vibration, fine touch and proprioception
27
what is 'dissociated sensory loss'
pattern of neurological damage caused by lesion to a single tract in spinal cord which involves loss of fine touch and proprioception but with out loss of pain and temperature (or vice versa)
28
loss of pain and temperature indicates lesion where
lateral spinothlamic tract
29
in lateral spinothalamic lesions why will you lose sensation of pain and temperature at level of spine but not sensory loss to dermatome
tract of lissauer transmits one or two levels up from lesion, thus bypassing lesion
30
cord hemisection is called
brown-sequard syndrome
31
pyramidal tract include
lateral and anterior corticospinal tracts
32
dorsal column also called
medial lemniscus system
33
2 parts of dorsal column
gracile (most medial)
| cuneate (more lateral)
34
what will cause both UMN and LMN symptoms (be specific with answer)
Amyotrophic lateral sclerosis (motor neuron disease)
35
poliomyelitis affect which part of CNS
anterior horn = LMN signs
36
UMN or LMN in polio
LMN
37
Brown-Sequard syndrome: tracts affected
1. Lateral corticospinal tract
2. Dorsal columns
3. Lateral spinothalamic tract
38
Brown-Sequard syndrome will show
1. Ipsilateral spastic paresis below lesion (lateral corticospinal tract)
2. Ipsilateral loss of proprioception and vibration sensation (dorsal column)
3. Contralateral loss of pain and temperature sensation (lateral spinothlamic tract)
39
Combination of motor, sensory and ataxia symptoms
MS
40
neurosyphilis is called
tabes dorsalis
41
tabes dorsalis affects what tract
dorsal column
42
tabes dorsalis symptoms
Loss of proprioception and vibration sensation (dorsal column)
43
faciculatiosn think?
motor neurone disease
44
role of nerve conduction studies in motor neurone disease
results will show normal conduction, therefore ruling out neuropathy and suggesting MND
45
Electromyography in motor neurone disease will show what
reduced number of action potentials with an increased amplitude
46
which features do you NOT get in motor neurone disease that differentiate if from poly neuropathy, MS and myasthenia gravis
- no ocular involvement
- no spinster involvement
- no sensory loss
47
which features will suggest motor neurone disease
- wasting of small muscle of hand
- UMN signs in legs
- LMN signs in arms
48
UMN lesion features
weakness
increased tone (velocity dependent)
hyperreflexia
49
LMN lesion features
wasting
fasciculations
hypotonia/flaccidity
reduced reflexes
50
what do fat ladies get that can cause headache and visual defect
idiopathic intracranial hypertension
51
drugs that can cause idiopathic intracranial hypertension (4)
steroids
tetracycline antibiotics
contraceptives
lithium
52
tuberous sclerosis inheritance
autosomal dominant
53
tuberous sclerosis or neurofibromatosis may present with seizures
tuberous sclerosis
54
axillary and groin freckles seen in
neurofibromatosis
55
ash leaf macule seen in
tuberous sclerosis
56
curtain descending over eye
amaurosis fugal
57
protocol if ABCD2 score 4+
300mg aspirin immediately
| investigations within 24 hrs
58
protocol if ABCD2 score 3 or less
- specialist assessment within 1 week of symptom onset, including decision on brain imaging
- if vascular territory or pathology is uncertain, refer for brain imaging
59
given to patients who cannot tolerate clopidogrel
aspirin + dipyridamole
60
antithrombotic drug given post stroke
clopidogrel
61
how may "attacks" required to diagnose migraine
at least 5
62
criteria for migraine diagnosis
- Minimum of 5 attacks
- Headache attacks lasting 4-72 hours with nausea/vomitong or photophobia/phonophobia
- Plus at least 2 of:
1. unilateral location*
2. pulsating quality (i.e., varying with the heartbeat)
3. moderate or severe pain intensity
4. aggravation by or causing avoidance of routine physical activity
63
nerve an nerve root in tricep reflex
radial and C7
64
radial nerve arises from which levels
C5 - C8
65
waiters tip (erbs palsy) is due to damage where
upper brachial plexus C5-C6
66
when is waiters tip (erb palsy) common
shoulder dystocia in babies
67
internal rotation and extension of upper limb and
waiter tip (erb palsy)
68
Bromocriptine, ropinirole, cabergoline, apomorphine are
dopamine agonists
69
what must be given with L-dopa
decarboxylase inhibitor (e.g. carbidopa)
70
decarboxylase inhibitor (e.g. carbidopa) do what
prevent peripheral metabolism of levodopa to dopamine
71
dopamine agonist side effects
pulmonary, retroperitoneal and cardiac fibrosis
72
what is Selegiline
MAO-B (Monoamine Oxidase-B) inhibitors
73
MAO-B (Monoamine Oxidase-B) inhibitors do what
inhibits the breakdown of dopamine secreted by the dopaminergic neurons
74
what are Entacapone, tolcapone
COMT (Catechol-O-Methyl Transferase) inhibitors
75
COMT (Catechol-O-Methyl Transferase) inhibitors do what
COMT is an enzyme involved in the breakdown of dopamine, and hence may be used as an adjunct to levodopa therapy
76
Antimuscarinics block ______ receptors
cholinergic
77
nerve root for small toe
S1 = S for small one
78
nerve root for big toe
L5 = Largest of the 5 toes
79
nerve root for middle finger + palm of hand
C7
80
nerve root ring finger + pinky
C8
81
nerve root for knee caps
L4
82
nerv root for thumb and index
C5, C6
83
time off driving for TIA
1 month
84
time off driving for multiple TIAs over short period of time
3 months
85
time off driving for a single seizure without an epilepsy diagnosis
6 months
86
seizure with lip smacking
complex partial seizure
87
how do simple and complex partial seizure differ
in complex you lose consciousness/awareness
88
who can't you give triptans to
heart conditions
89
triptan are
5-HT agonists, vaso construction and reduce inflammatory peptide release
90
triptans used to treat what
migrane and cluster headaches
91
dose of diazepam give PR in adult having a prolonged fit
10 - 20mg max 30
92
Stroke: Contralateral hemiparesis and sensory loss, lower extremity > upper
Anterior cerebral artery
93
Stroke: Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
Middle cerebral artery
94
Stroke: Contralateral homonymous hemianopia with macular sparing
Posterior cerebral artery
95
Stroke: Amaurosis fugax
retinal/opthalmic artery
96
Stroke: locked in syndrome
basillary artery
97
what is cataplexy
sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)
98
bells palsy: forehead affected? UMN or LMN
yes forehead affected, LMN
99
treatment for bells palsy
prednisolone within 72 hours of onset, for 10 days
100
what nerve in unilateral 'high stepping gait'
peroneal nerve
