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Flashcards in conditions Deck (558):
1

what investigations may be done after a seizure

EEG, MRI
video - telemetry (camera, EEG and ECG)

2

what are causes of small pupils

old age
bright light
opiate overdose
horner's syndrome
mitotic eye drops

3

what do UMN signs below the level of affected root suggest

spinal cord compression

4

what distinguishes MND from MS and myasthenia gravis

from MS - no sensory loss or sphincter disturbance
from MG - no eye involvement

5

where is the pathology in parkinsonsim

basal ganglia - dopamine loss

6

what drives are given to control cerebeal oedema

dexamethasone
mannitol

7

what infections may lead to a CN VII palsy

ramsay hunt syndrome
lyme disease
meningitis
TB
viruses - HIV , polio

8

what things may lead to a generalised reduction in blood supply or hypoxia

low O2 in blood (hypoxia)
inadequate supply of blood eg cardiac arrest - cortical necrosis
inability to use O2 eg cyanide poisoning

9

what GCS describes a coma

<8
fail to show eye opening in response to voice (<2), perform no better than weak flexion in response to pain (<4) and make unrecognisable grunting (<2)

10

what are the most common malignant brain tumours

medullablastoma, glioma

11

what are the main causes of seizures

2/3 are idiopathic
tumour, stroke, vascular
developmental

12

what blood samples would you want for someone in a coma

glucose, blood gas, toxicology screen

13

what may cause a brain abscess

head injury
adjacent infection - dental. sinusitis, otitis media
neurosurgical procedure

14

what tests may you do to investigate gait

spinal Xray
MRI
muscle biopsy/ EMG
lumpar puncture
Bloods - B12, U&E

15

what are symptoms of a pathology on an individual nerve

wasting and weakness of innervated muscle
special sensory change
very focal

16

how is clostridium botulinum a neuro toxin

binds to presynaptic membrane of NMJ, blocking Ach release

17

what are complications of parkinsons (non drug induced)

depression
dementia (50& after 10 years)
speech, swallow, balance, bladder, bowel

18

what microorganism- nerve conduction studies causes syphillis

treponema pallidum

19

how is a benign essential tremor treated

alcohol, B blocker

20

what is the most common benign brain tumour

menigioma

21

which diseases cause hypertrophy of the calf muscles

Becker's MD
Duchennes MD
(both x linked)

22

what is experienced during a migraine

unilateral headaches, nausea, photophobia. photophonia, functional disability

23

list some types of secondary headcahes

tumour
meningitis
vascular disorders
space occupying lesions
subarachnoid haemorrhage
head injury
drug induced

24

what do rare cases of polio cause

placid paralysis (infect anterior horn cells)

25

is syncope or seizure roe likely to have a precipitant

syncope

26

what are differentials for a rapid onset headache

subarachnoid haemorrhage
meningitis
enecephalitis

27

what are the 3 main causes of a localised interruption to blood supply

1 atheroma + thrombosis of an artery
2 thromboembolism - eg from LA
3 ruptured aneurysm (haemorrhage)

28

how does dermatomyositis present (connective tissue disorder)

pink/ purple skin rash on scalp, eyes, neck, knuckles
muscle weakness (quads, fingers, pharyngeal)
biopsy is key

29

what are symptoms of a spinal cord compression

bilateral leg weakness
back pain
bladder involvement late

30

what is the commonest form of muscular dystrophy

Duchenne's - present at 4

31

what is the myotome of C5

elbow flexor

32

what is the differential diagnosis of cervical spondylosis

MS
nerve root neurofibroma
low B12
compression by tumour

33

what is the difference in daily attack frequency for a cluster headache, paroxysmal hemicranial and SUNCT

cluster headache- 1-8
paroxysmal hemicrania - 1-40
SUNCT - 3-200

34

what is migraine aura

fully reversible and focal neurological changes
usually begins at occipital lobe, causing visual disturbance then spreads to cause tingling, dysphagia, motor symptoms (dysarthria, ataxia, hemiparesis)
only 1/3 experience

35

what are secondary prevention medications for a stroke

anti- hypertensives
aspirin - antiplatelete
lipid lowering (Statin)
warfarin for AF

36

describe the eye opening component of the GCS (1-4)

1- none
2 - to pain
3- to speech
4- spontaneous

37

what percentage of cancer patients will get cerebral metastases

15-30%
(15% as cerebral met symptoms)

38

which skeletal muscles weaken first

proximal arms and legs then distal toes and fingers

39

what is the difference in the protein between bacterial meningitis and encephalitis/ viral meningitis

men - high
en - slightly increased

40

what is apraxia

inability to do a motor task that is not due to a loss of motor function

41

what is hydrocephalus

a condition where excess cerebrospinal fluid within the intracranial space causes dilation of the ventricles and a wide range of symptoms

42

what is the urgent treatment for an epidural abscess

urgent disc removal + 6-8 weeks IV antibiotics

43

what is epilepsy

condition with a recurrent tendency to spontaneous intermittent, abnormal electrical activity in parts of the brain, manifesting as seizures

44

what tumour is associated with myasthenia gravis

thymoma - tumour of thymus (do CXR)

45

what is the differential diagnosis of a subarachnoid haemorrhage

meningitis
migraine
cortical vein thrombosis
dissection or carotid/ vertebral artery

46

how may you investigate a coma without focal or lateralising signs

toxicology screen
blood sugar, blood pressure and blood gas
assess hepatic and renal function

47

which structure do pituitary adenoma commonly compress

optic chasm - bitemporal hemianopia

48

what is parkinsonism

clinical syndrome with 2 or more of ;
tremor
bradykinesia - slowness of movement
rigidity - stiffness, hypertonia
postural instability - unsteadiness/ falls

49

what are pre-syncopal symptoms

light headed, nausea, hot, sweating, tinnitus, tunnel vision

50

how is pernicious anaemia treated

intramuscular B12 injections
(if low with symptoms treat)

51

what are symptoms of a cavernous sinus thrombosis

headache
swollen eyes
proptosis
fever
painful ophthalmoplegia

52

what is the onset of bells palsy

abrupt - over night, after a nap
complete ipsilateral facial weakness in 24-72 days

53

what is a brain tumour

abnormal multiplication of brain cells - any tumorous swelling tends to compress/ destroy healthy cells

54

what are clinical presentations of damage to CN II

papilloedema
chasm bitemporal hemianopia
right optic tract - left homonymous hemianopia
right optic nerve - blindness in right eye

55

what are risk factors for delerium

>65 years
hip fracture
acute illness
dementia/ previous cognitive impairment

56

how does MND present

median age 60
stumbling spastic gait, foot drop
weak grip and shoulder abduction
aspiration pneumonia

57

what is the difference in pain intensity for a cluster headache, paroxysmal hemicranial and SUNCT

cluster headache- very severe
paroxysmal hemicrania - very severe
SUNCT - very severe

58

what is the differential diagnossis of a brain abscess

tumour
subdural haematoma

59

what is the point of investigating Bells palsy

rule out possible causes

60

what is the vegetive state

unawareness of self or the environment - breathes spontaneously, has stable circulation and sleep/ wake cycle

61

what are clinical features of a brain abscess

fever, headache, raised ICP symptoms
focal signs - seizures, dysphasia, hemiparesis

62

how does an atonic seizure typically present

sudden loss of muscle tone causing a fall

63

what is synkinesis

phenomenon seen after damage to a nerve - voluntary contraction of muscles accompanies involuntary contractions of other muscles supplied by that nerve

64

what is the prognosis of each classification of stroke

TACS - 96%
PACS - 45%
LACS - 39%
POCS - 38%

65

what are side effects of sodium valproate

tremor, weight gain, ataxia, nausea, hair loss
TERATOGENIC

66

what is the difference between MS and guillian barre

in guillain barre the demyelinating is acute and precedes from an infection whereas in MS it is chronic

67

what is the triad for an epidural abscess

back pain, pyrexia, focal neurology

68

what is the treatment of a brain abscess

surgical drainage of pus
penicillin (strep) + metronidazole (anaerobes)

69

where is the bleeding in a subdural haematoma

bridging veins between the cortex and venous sinuses resulting in an accumulating heamatoma between dura and arachnoid space

70

where does the spinal cord end

C1 - L2
ends at conus medlars, nerve roots continue as caudate equina

71

are cancers of arachnocytes malignant

benign - but can be locally aggressive and invade skull

72

what are clinical presentations of damage to CN VIII

tinnitus
deafness
vertigo - loss of balance
nystagmus - involuntary rapid eye movements

73

what is myeltiis

inflammation of the spinal cord

74

what shape is a regional cerebral infarct normally

wedge shaped - reflect arterial perfusion

75

what fraction of patients die within 1 year of a stroke

1 in 3w

76

how does a subarachnoid haemorrhage typically present

thunderclap headache - sudden onset/ excruciating
vomiting, neck stiffness
collapse, coma
focal neurology may indicate site

77

what is the emergency treatment for caudate equine syndrome

urgent MRI anf lumbar discectomy

78

what defines a chronic cluster headaches

bouts last > 1 year without remission

79

how may giant cell arteritis present

jaw claudication with thickened, pulseless temporal arteries
subacute onset with high ESR

80

what are signs of a parasympathetic nerve neuropathy

constipation, nocturnal diarrhoea, urine retention, erectile dysfunction

81

who should giant cell arteritis be considered in

>50 with new headaches and systemically unwell

82

how would you investigate intracranial hypotension

MRI brain and spine

83

how would you treat intracranial hypotension

bed rest, fluid, analgesics, caffeine
epidural blood patch (painkiller)

84

what is creutzfeldt jakob disease

rapidly progressive, rare form of encephalopathy in which dementia progressed to death in 3-12 months

85

what is functional neurological disorder

change in function rather than structure leading to blackouts, paralysis and abnormal movement

86

what is associated with a headache in acute glaucoma

eye pain and reduced vision
typically elderly, long sighted people

87

when can an ultrasound detect spina bifida

16-20 weeks

88

what is a tumour of a lymphoid cell called

lymphoma

89

what are the layers you go through in a lumbar puncture

skin
subcutaneous tissue
supraspinous ligament
interspinal ligaments
ligamentum flavum (1st pop)
dura (2nd pop)

90

what are myopathies

primary disorders of the muscle with gradual onset symmetrical weakness

91

what is the treatment for absence seizures

sodium valproate
ethosuximide

92

what is the most severe form of spina bifida

SB cystica myeloschisis
muscle paralysis and no sensation

93

what is the prophylactic treatment of migraines

hypotensives - propanolol
anti- epileptics - topiramate, sodium valproate
tricyclic antidepressants - amitriptyline, nortiptyline

94

what causes spina bifida

defective closure of the caudal neural tube/ vertebral arches

95

what cranial nerves are responsible for pupillary reactions

II and III

96

what is the difference between a bulbar palsy and pseudobulbar palsy

bulbar - bilateral LMN affecting CN IX - XII
pseudo bulbar - bilateral UMN lesion of swallowing/ talking muscles

97

which virus commonly causes encephalitis

herpes simplex virus (type 1)

98

what symptoms may a cerebellar stroke present with

ataxia, vertigo, nystagmus

99

what is a common cause of a radiculopathy

herniated disc

100

what history may someone who has focal seizures have

de ja vu, butterflies in abdomen, episodes of looking blank

101

what are localising features of a cerebellopontine pathology (acoustic neuroma/ vestibular schwannoma)

ipsilateral deafness
nystagus
reduced corneal reflex
papilloedema

102

what are symptoms of bells palsy

sagging of mouth
drooling of saliva
speech difficulty
failure of eye closure - watery eye, conjunctivitis

103

what is the diagnostic criteria for a functional neurological deficit

A - more than one symptom of altered function
B- evidence of incompatibility between symptom and medical conditions
C - symptom cant be explained by another medical disorder
D- distress or impairment in social, occupational or other functioning areas

104

what is the posers criteria for a clinical diagnosis of MS

2 attacks with 2 objective clinical lesions

105

where is pain mainly felt in a paraoxysmal hemicrania

mainly orbital/ temporal, strictly lateral
(rapid onset - last 2-30 mins - rapid cessation)

106

what CN are affected in jugular foramen syndrome

CN IX, X, XI

107

how do pituitary adenomas typically present

hormonal imbalance - cushings, acromegaly
visual disturbance - bitemporal hemianopia

108

what is a tumour of a brain capillary vessel called

haemangioblastoma

109

what are risk factors of a subarachnoid haemorrhage

previous SAH
family history - 3-5x risk if close relatives
smoking, alcohol, high BP
bleeding disorders

110

what is the difference between primary progressive and secondary progressive MS

primary - gets worse form onset
secondary - worse after 1st relapse

111

if there was a lesion of the nerve root at L4, what would you expect to see (radiculopathy)

pain down ipsilateral leg
numbness in L4 dermatome (medial malleolus)
weakness in ankle dorsiflexion
reduced knee jerk
(pain in dermatome, numbness in dermatome, weak myotome, loss of reflex)

112

do gliomas metastasise outside the CNS

no - most common and most malignant in CNS by spreading through white matter and CSF pathways

113

what sensory symptoms may be seen in a myelitirelapse of MS

hisotry of pins and needles, paralysis and numbness below level

114

how may you investigate delirium

urine dipstick
bloods - FBE , U&E, LFT, glucose, septic screen
ECG / CXR

115

how would you treat a TIA

control CV risk factors
antiplatelets + anticoagulants
carotid endarterectomy within 2 weeks if 70-99% stenos

116

what is a common site of atheroma and thrombosis leading to ischaemia

bifurcation of carotids - ischaemia of MCA

117

what routine test does every dementia patent get at diagnosis

CT/ MRI to rule out tumour
bloods

118

what history may someone who has generalised seizures have

myoclonic jerks (1st thing in morning)
absences
photosenstitive

119

what is a thunderclap headache

high intensity headache reaching maximum intensity in less than 1 minute

120

what is a differential diagnosis for delerium

dementia
anxiety
epilepsy (non convulsive status)
primary mental illness eg schizophrenia

121

what is the most malignant form of gliomas and why

glioblastoma multiforme
grow rapidly, large cellular growth

122

what are clinical presentations of damage to CN VII

can't purse lips, bare teeth, shut eyes, wrinkle forehead
commonly damaged due to long pathway through bone

123

what is the urgent investigation of a subarachnoid haemorrhage

CT scan

124

what components are used to classify the severity of head injury

GCS, length of loss of consciousness, post traumatic amnesia

125

what is locked in syndrome

patient has total paralysis below the level of the III nerve in the midbrain so is able to open, elevate and depress the eye but no horizontal movement
patient is conscious but unable to speak

126

what is SUDEP

Suden onset death - 1/ 1000

127

what toxins may cause nystagmus

phenytoin (medication)
alcohol
anti- epileptic

128

what are complications of a subarachnoid haemorrhage

rebleeding - commonest cause of death
cerebral ischaemia
hydrocephalus - blocking of arachnoid granulations

129

how is normal pressure hydrocephalus diagnosed

communicating hydrocephalus on CT
lumbar puncture - symptoms improve, normal opening pressure

130

what is amaurosis fugax (TIA)

when the retinal artery is occluded - unilateral progressive visual loss (like a curtain descending)

131

what is status epilepticus

tonic clonic seizures lasting for more than 30 mins

132

what is the difference in duration of attack for a cluster headache, paroxysmal hemicranial and SUNCT

cluster headache- 15-180 mins
paroxysmal hemicrania - 2-30 mins
SUNCT - 5-240 secs

133

what may cause carpal tunnel syndrome

local tumours
acromegaly
prolonged flexion
myeloma
rheumatoid arthritis

134

how are meningitis and encephalitis investigated

blood culture
lumbar puncture - CSF culture/ microscopy
encephalitis - CT/ MRI

135

what is the hospital and at home treatment for status epilepticus

home - midazolam
hospital - lorazepam, diazepam

136

what is a coma

a state of unarousable psychological unresponsiveness in which the subjects lie with eyes closed and show no psychologically understandable response to external stimuli or inner need

137

what is the treatment for primary generalised seizures

sodium valproate, lamotrigine, levetiracetam

138

what is the treatment of a SAH

surgery - endovascular coning or surgical clipping

139

what are the main 4 causes of raised ICP

haemorrhage
tumour
abscess oedema post trauma

140

what is the disease modifying 2nd line treatment of MS

natalizumab
alemtuzumab
fingolimad

141

what is the glove and stocking distribution

worst distally - polyneuropathies (symmetrical, widespread)

142

what is the difference between a simple and a complex focal/ partial seizure

simple has no impairment of consciousness
complex has post ictal symptoms

143

how does temporo-parietal dementia present

early memory disturbance
language and visuospatial problems

144

what is the triad of horners syndrome

ptosis
hydrosis
facial sweating

145

what is the prognosis of a meningioma

commonly cured by surgery

146

what is the urgent test for cervical spondylosis

MRI

147

what myopathies may occur with pain on exercise

ischaemic, metabolic

148

what is the myotome and dermatome of C8

M - finger extensor
d - pinky

149

which part of the face is trigeminal neuralgia present in and what may trigger it

unilateral maxillary or mandibular divison of trigeminal causing stabbing pain in lower face
washing, shaving, cold/ wind. talking, chewing

150

where are medullablastomas normally located

primitive neural cells in posterior fossa, especially brainstem

151

what may be a differential diagnosis for a seizure

trauma, stroke, haemorrhage, raised ICP, alcohol/ drug withdrawal, metabolic disturbance, infection, drugs (cocaine)

152

what are side effects of carbamazepine

ataxia, drowsiness, nystagmus, blurred vision, leucopenia
allergic skin rash (erythematous)

153

what is the difference in glucose between bacterial meningitis and encephalitis/ viral meningitis

men - reduced
en - normal (60% of blood glucose)
(take paired blood sample and compare it)

154

what % of inpatients does delerium affect

50% of inpatients > 65
associated with longer admission, more complications and a higher mortality

155

what is a tumour of an arachnoid cell called

meningioma

156

what nervous infection can be caused by a mosquito or tick

arbovirus encephalitis

157

what percentage of strokes occur in people over 65

75%

158

describe a tension headache

tight band - bilateral, non pulsatile headache +/- scalp muscle tenderness
no associated features / not aggravated by physical activity

159

what is the treatment for a glioblastoma multiforme

complete surgical removal then steroids and anticonvulsant

160

what cranial nerve does the jaw jerk test

V

161

what are localising features of a parietal lobe pathology

hemisensory loss
sensory innatetnion
dysphagia
stereognosis - unable to recognise object by touch

162

if a tumour is close to a CSF pathway, how may it present

hydrocephalus

163

what are specific features of giant cell arteritis

scalp tenderness
jaw claudication (exercise induced)
visual disturbance
elevated ESR - >50 , CRP+ platelet count

164

are anencephaly/ exencaphaly compatible with life

no

165

what is a muscular dystrophy

group of genetic diseases with progressive degeneration and weakness of specific muscle groups
confirmed by EMG and biopsy

166

what may cause a bulbar or pseudo bulbar palsy

MND
guillain barre
MS
stroke
myasthenia gravis

167

how does encephalitis present

fever, odd behaviour, fits, reduced consciousness

168

what would you expect to see in a lumbar puncture of MS

oligoclonal bands of IgG present in CSF but not serum (CNS inflammation)
if glucose low but protein high it is not MS

169

what are the most common subtypes in young onset dementia (<65)

alzheimers (33%)
vascular (15%)
frontotemporal (15%) - loss of neurones in these zones

170

how would you treat a brain tumour with hydrocephalus but is inaccessible for surgery

ventriculo-peritoneal shunt

171

what is the differntial diagnossi for meningitis

other infections
sarcoidosis
drug induced - NSAIDs
malignancy

172

what is the incidence of VP shunts failing

40% in 1st year, 5% per year after first year
50% fail in 5 years
(from occlusions, disconnection, migration, over/ under drainage, infection, skin erosion)

173

what is dementia

progressive impairment of multiple domains of higher intellectual function and deteritration in behaviour, marked by memory disorders, changes in personality, deterioration in personal care, impaired reasoning ability and disorientation

174

what is an intracranial venous thrombosis

thrombosis of cerebral sinus or veins causes infarction
seizures are common and focal

175

what is a myasthenia crisis

life threatening weakness of respiratory muscles during a relapse
monitor forced vital capacity

176

when does diffuse axonal injury occur

big acceleration force with a rotation and all the neurones become disrupted in the corpus callosum, grey matter, basal ganglia etc.

177

what are the main differences between a primary generalised and focal/ partial epileptic seizure

primary generalised - affect whole brain, no warning, <25, may have family history
focal/ partial - structural problem, preceding aura, any age, focal abnormality on EEG

178

what are causes of lowering GCS

drug intoxication
metabolic - hypoxia, hypercapnia, sepsis, hypotension
renal/ liver failure
ketoacidosis
seizures
raised ICP - tumour, stroke, haemorrhage, hydrocephalus

179

what is the diagnosis of migraine based on

history
>5 headaches lasting 4-72 hrs + nausea/ vomiting/ phono/photphobia + any 2 of unilateral, pulsating, impairs routine activity

180

what is a clinical presentation of damage to CN XI

weakness in turning head and shrugging shoulders

181

what is the difference in location of tumours in the CNS between adults and children

adults - above tentorium
children - below tenotrium

182

what is the prognosis of a high grade atrocytoma/ Glioblastoma multiform

1 year survival

183

what domains are affected in alzheimers disease

visuospatial skill
memory
verbal abilities
executive function (planning)

184

what is a depressed skull fracture

little pieces of bone pushed inwards by the force to the localised area

185

what is the most common mononeuropathy

carpal tunnel syndrome (median nerve + tendons)

186

which nerve commonly grows a schwannoma

CN VII - vestibulocochlear shwannoma at angle between pons and cerebellum (unilateral deafness)

187

why is direct injury to the eye uncommon to cause a black eye (periorbital contusion)

eye is protected by supraorbital ridge and nose

188

what is a clinical presentations of damage to CN I

anosmia

189

how is herpes simplex encephalitis diagnosed and treated

PCR in virology of the CSF from a lumbar puncture
treat - acyclovir

190

how would you investigate a TIA

bloods - FBC, U&E, glucose, lipids, ESR
ECG/ echo
carotid doppler +/- angiography

191

how would a motor neuropathy present

progressive weak of clumsy hands, difficulty in walking, difficult breathing (reduced vital capacity)

192

which tumours commonly metastasise to the spinal cord

lung, breast, prostate

193

what is the myotome of S1

ankle plantar flexor

194

is there muscle atrophy in LMN or UMN pathologies

LMN

195

what is a haematoma

accumulation of blood within the tissue that clots to form a solid swelling.
injury, disease of blood vessels or clotting disorders are common causes

196

what is the triad for meningitis presentation

fever, neck stiffness, altered mental state
rash
photophobia , nausea, vomiting also

197

where do focal seizures originate from

within networks linked to one hemisphere and often seen with underlying history of structural disease

198

what gait appears is there is an UMN lesion

spastic - stiff, circumduction of legs + scuffing of toes

199

what supplement should be taken in pregnancy to avoid congenital malformations

400g folic acid
(avoid vit A - retonic acid in lever)

200

what may precipitate a paroxysmal hemicrania attack or a SUNCT

ph- bending or rotating the head
SUNCT - wind/cold, touch and chewing

201

what are localising features of a occipital lobe pathology

contralateral visual field defects
polyopia (seeing multiple images)
palinopsia - image persists

202

what are watershed infarcts

zonal pattern of ischaemia and infarction at interface of territories (central part has better perfusion)

203

what are side effects of MS treatment

flu like symptoms
abnormal blood count/ liver function
injection site reaction

204

what is agnosis

inability to put meaning to sensory information eg faces, hand object

205

what are differentials for a thunderclap headache

subarachnoid haemorrhage (1 in 10)
TIA/ stroke
intracerebral haemorrhage
venous sinus thrombosis
carotid/ vertebral dissection
meningitis/ encephalitis
spontaneous intracranial hypotension

206

what is ischaemia

a relative or complete lack of blood supply in a tissue or organ

207

how does thrombolysis work

dissolves the clot in the blood vessel to restore perfusion - tissue already dead

208

what is encephalitis

inflammation of the brain substance

209

what are the 3 stages of lyme disease

1 - rash at tick bite (erythema migrans) + flu/ menignism
2 - early disseminated infection weeks to months (MSK and neuro most common)
3 - chronic infection in years

210

which areas of the brain are most vulnerable to neuronal loss

hippocampus, amygdala, temporal neocortex, subcortical nuclei

211

what is the difference between infrequent episodic tension type headaches, frequent episodic tension type headaches and chronic tension type headaches

IETTH - <1 day/ month
FETTH - 1-14 days/ month
CTTH - >15 days a month

212

what are the 3 red flags for cause equina syndrome

bilateral sciatica
saddle anaesthesia - numb around bottom
urinary dysfunction

213

what is nystagmus

rapid, involuntary movements fo the eye, associated with balance

214

what is a Stokes Adam attack

transient arrhythmias - fall to ground and are pale, with a slow ascent pulse
recovery in seconds

215

where do generalised seizes originate from

somewhere in the brain but rapidly engage bilaterally leading to simultaneous onset of widespread electrical discharge with no localising features

216

why is it hard to define where a gliomas is

NOT encapsulated - diffuse edges

217

what is the difference in progression between vascular and CJD dementia

CJD - rapid
vascular - stepwise

218

what is guillain barre syndrome

disease of peripheral nerves in which there is numbness and weakness in the limbs
antibodies against pathogen attack antigens of the host's myelin sheath on peripheral nerves

219

what is the treatment for focal partial seizures

carbamezapine or lamotrigine
2nd levetiracetam

220

what is the myotome of L3

knee extensors

221

what type of character does a migraine headache have

throbbing, pulsatile, lateralising

222

how is guillain barre syndrome treated

IV immunoglobulins or plasma exchange

223

Is babinskis sign present in UMN or LMN lesions (upping plantar)

UMN

224

what is the most common symptom of parkinsons

tremor - affecting one hadn't , spreading first to leg on same side then to other limb
most pronounced when resting

225

what is assessed for in maternal blood screening at 16-20 weeks

high levels of alpha fetoprotein

226

what percentage of spinal cord tumours are extradural, intramural, intramedullary

extra - 55%
intramural - 40%
intramedullary - 5%

227

what may you do to investigate cerebral metastases

CT chest/ abdo/ pelvis
mammography
biopsy skin leasion/ lymph node

228

what is the treatment for lyme disease

prolonged antibiotics - IV ceftriaxone

229

how does demyelination of white matter occur

activated T cells cross the blood brain barrier with acute inflammation of the myelin sheath and loss of function
sheath repairs poorly
appears as lesions or plaques on MRI scan

230

what are modifiable risk factors for having a stroke

hypertension
DM
smoking/ alcohol
hyperlipidaemia
obesity
hyper coagulability

231

what are the main causes of an ischaemic stroke

large artery atherosclerosois
cardioembolic (thromboembolism from heart)
small artery occlusion
thrombosis in situ

232

what is the treatment for an acute relapse of MS

oral prednisone - big dose
symptomatic treatment

233

what heart arrhythmia do seizures cause

tachycardia mostly
(bradycardia with long pauses common in temporal lobe seizures)

234

what is vascular dementia

cumulative effect of many strokes

235

what is the hakim adams triad of normal pressure hydrocephalus (preventable cause of dementia)

wet , wobbly, wacky
(urinary incontinence, gait disturbance, quick memory loss)

236

what is the difference in pain quality for a cluster headache, paroxysmal hemicranial and SUNCT

cluster headache- sharp, throbbing
paroxysmal hemicrania - sharp throbbing
SUNCT - stabbing, burning

237

what is the initial management of a head injury

ABC + stabilse cervical spine
if GCS <8 - intubation and ventilation

238

how may a cranial nerve neuropathy present

swallowing/ speaking difficulty
diplopia

239

what is Lhermittes signs

neck flexion produces tingling down spine

240

which head trauma causes a subarachnoid haemorrhage

head is rotates and accelerated eg blow to the chin/ struck from behind

241

what is a tumour of a glial cell called

gliomas - malignant
including - glioblastoma, astrocytoma, oligodendroglioma, ependymoma

242

what are clinical presentations of damage to CN X

pharyngeal branches - difficulty swallowing
laryngeal branches - quiet, hoarse voice

243

what questions may you ask someone who has had a seizure

account from witness
tongue biting, urinary incontience
loss of consciousness
previous episodes
any triggers - alcohol, stress, flickering lights/ TV

244

what cranial nerves are responsible for the corneal response

V and VII

245

what is the difference in onset between a seizure and syncope

seizure sudden onset (no warning)
syncope gradual onset

246

is there muscle fascultations in LMN or UMN pathologies

LMN

247

how does WHO classify brain tumours

by location;
tumours of neuroepitheal tissue
tumours of cranial and spinal nerves
tumours of meninges
ferm cell tumours
haematopoietic tumours
cysts and tumour like lesion
tumours of cellar region

248

what is the prophylactic and surgical treatment for trigeminal neuralgia

carbamazepine
surgical - decopressive surgery

249

what causes an analgesic rebound headache

mixed analgesic overuse - paracetamol, opiates, codeine
withdraw (no more than 6d per month)

250

what is cervical spondylosis

degenertaion of the cervical spine

251

what are localising features of a pathology in the cerebellum

DANISH
dyskinesia
ataxia
nystagmus
intension tremore
slurred speech
hypotonia

252

what is the number 1 cause of disability/ nursing home admissions

strokes

253

if a patient has a middle cerebral artery occlusion on their non dominant side what may they present with

unilateral neglect and agnosia (lack of awareness)
(if dominant - apahasia (wernickes))

254

what is a pituitray adenoma

benign tumour of epithelial origin derived from glandular tissue in pituitary fossa

255

what is the definition of a stroke

the sudden onset of focal or global neurological symptoms caused by ischaemia or haemorrhage and lasting more than 24 hours

256

what is the treatment for a medullablastoma

surgical removal and restore CSF flow
radiotherpay

257

what is the difference between communicating and non communicating hydrocephalus

communicating - CSF flows freely from chord plexus to arachnoid granulations
non communicating - obstruction where CSF can't travel freely

258

what senses are lost in Brown- squared syndrome (hemicord lesion)

ipsilateral - loss of vibration and joint position
contralateral - loss of pain and temperature

259

how is MND treated

supportive - PED, non invasive ventilation
multidisciplinary
riluzole (anti-glutamate)

260

how may a brain tumour present

Fit
headache
vomiting
falling GCS
cognitive impairment
papilloedema

261

what is osteomyelitis

infection within a vertebral body
(severe pain, tenderness and redness over the involved bone + general illness and fever)

262

which age group are malignant brain tumour more common in

children

263

what are 2 common sites of ruptured vessels causing haemorrhage strokes

basal ganglia - micro aneurysms
circle of willis - berry anurysms
(hypertension + weak vessel wall)

264

what is the lifetime prevalence of migraines in men and women

men - 10 %
women 22%

265

how do you diagnose locked in syndrome

recognise that patient can open their eyes voluntarily and signal numerically by eye closure

266

if you suspect meningitis what should you do

treat!!!!!!

267

wat are tumours of nerve sheath celled

shwannoma, neurofibroma

268

how are the reflexes in UMN and LMN lesions

UMN - increased
LMN - decreased

269

what does rabies encephalitis cause

paralysis and encephalitis

270

what defines a chronic migraine

headaches on > 15 days per month, of which >8 are migraines, for more than 3 months

271

what is the headaches of sinusitis like

dull, constant ache over frontal/ maxillary sinus with tenderness - worse on bending over
ethmoid or sphenoid sinus pain is felt deep in the midline at the root of the nose

272

what is the prognosis of a spinal stroke

change of full recovery low unless significant in first 24 hours
20% mortality, 35-40% minimal recovery

273

what are the phases of a migraine

prodrome
aura
early headache
advanced headache
postdrome - fatigue, muscle pain

274

what are clinical presentations of damage to CN VI

diplopia
medial deviation of affected eye

275

what do all people with recurrent syncope or falls need

cardiac assessment

276

what factors predispose to a migraine
(chocolate)

Chocolate
hangovers
orgasms
cheese/ caffeine
oral contraceptive
lie ins
alcohol
exercise
dehydration/ hunger
stress

277

what age group does alzheimers present in

>40 s

278

why does hydrocephalus make the head enlarge in a child

sutures haven't fused
(frontal bossing, venous scalp distension, sunset eyes (struggle to look upwards)

279

what is the main problem in communicating hydrocephalus

resorption problem where it can't keep up the pace of CSF production - causing dilation and raising ICP

280

what is the difference between spina bifida cystic meningocele, meningomyelocele and myeloschisis

meningocele - fluid filled sac outside spine, underlying tissue fine
meningomyelocele - nerve roots and spinal cord in sac
myeloschisis - spinal cord in sac

281

how does carpal tunnel syndrome present

aching pain in hand and wrist (especially at night)
paraesthesia in thumb, index and middle fingers - relieved by dangling and shaking

282

what are the DVLA rules for epileptics to hold a group 1 and HGV/ PSV license

group 1 - seizure free for 1 year (can arise from sleep)
HGV/ PSV - seizure free for 10 years, no medication

283

what are non modifiable risk factors for having a stroke

previous stroke
age
family history
male

284

what are differentials for a TIA

hypoglycaemia
migraine aura
hyperventilation
focal epilepsy

285

what is sciatica

shooting pain down leg to ankle

286

what is the myotome and dermatome of L4

M - ankle dorsiflexors
D - big toe

287

what are channelopathies characterised by

episodic periods of weakness - fully recover
(influx of Ca, Na, Cl)

288

what test is necessary in trigeminal neuralgia

MRI to exclude all secondary causes - tumour, MS etc

289

what are the domains of examining cognitive function

memory
attention
language
behaviout
emotion
visuspatial

290

what is a brain abscess

localised area of pus within the brain (polymicrobial)

291

what are children immunised against to prevent meningitis

haemophilus, neisseria menignitides C, pneumococcla meningitis

292

what is the differential diagnosis for a spinal cord compression

MS
trauma
Guillain barre syndrome
transverse myelitis
carcinomatous meningitis

293

what is the cause of idiopathic Parkinsons disease

dementia with lewy bodies

294

what are the characteristics of a headache due to raised ICP

worse in morning, lying down, bending forward or coughing

295

what is the statistics for having a stroke after a TIA

1 in 12

296

describe a migraine disorder

chronic disorder with complex changes in the brain that can't be localised and episodic attacks which are recurrent and reversible pain associated symptoms

297

what is the difference between a myelopathy and a radiculopathy

myelopathy - UMN -neurological deficit due to compression of spinal cord at a sensory level
radiculopathy - LMN - compression of nerve root leading to single dermatomal and myotomal deficits

298

what is delerium

acute disorder of the mental processes, which can manifest as delusions, disorientation, hallucinations or extreme excitement

299

how is normal pressure hydrocephalus treated

programmable VP shunt - can change settings of drainage

300

what is the rash and test for meningococcal meningitis

purple hemorrhagic petechial skin rash
tumbler test - non blanching - doesn't disappear on pressure

301

what type of intracranial haemorrhage occurs in babies if they are shaken too much

subdural

302

what is Alzheimers disease characterised by

memory impairment
as the disease progresses, language difficultires, apraxia and visuospatial problems, leading to a loss of judgement and inability to carry out basic functions

303

what microorganism causes lyme disease

borrelia burgoferi from ticks in wooded areas

304

what blood tests would you do to investigate a stroke

FBC, glucose, lipids, ESR (giant cell arteritis)

305

what investigations may you do to investigate HIV brain infections

lumbar puncture - india ink , cryptococcal antigen test
toxoplasmosis serology
PCR - JC virus, CMV, HIV

306

what is preventative medication for tension type headache

tricyclic antidepressants - amitriptyline, notriptyline

307

is there weakness in LMN or UMN pathologies

both

308

when may you consider creutzfeldt jakob disease

any rapidly progressive dementia (weeks/ months)

309

what test can be done to detect neuropathies

neurophysiology

310

what are characteristic of lewy body dementia

fluctuating cognitive impairment
detailed visual hallucinations
parkisons

311

how is a disc prolapse managed

nerve root injection - temporary relief
discectomy

312

what bacteria commonly cause a brain abscess

streptococci
step miller (caramel smell)

313

how would you investigate myasthenia gravis

Ach receptor antibody
Anti MuSK antibody
Neurophysiology - jitter
CXR

314

what is the disease modifying 1st line treatment of MS

S/c or I/m injections of beta- interferons or glatiramer acetate

315

what is bell's palsy

idiopathic facial nerve palsy - paralysis of the facial nerve causing weakness in the muscles of one side of the face and inability to close the eye, bare teeth or wrinkle forehead

316

what are cranial autonomic symptoms of trigeminal autonomic cephalagias

tearing (lacrimation)
nasal congestion/ rhinnorhea
eyelid oedema
horners -miosis, ptosis, facial sweating

317

what is the differential diagnosis of a extradural haematoma

epilepsy
carotid dissection
CO poisoning

318

what microorganism causes tetanus

clostridium tetani - acts at NMJ causing righty and spasm

319

what is the differetnial diagnosis of a brain tumour

stroke
aneurysm
head injury
venous sinus thrombosis
haematome
encephalitis
MS
post - octal

320

what is the differential diagnosis of a stroke

head injury
subdural haemorrhage
hypo/ hyperglycaemia
intracranial tumour/ mass
psot ictal
hepatic encephalopathy
bells palsy
drug overdose
encephalitis

321

what is the differential diagnosis of a migraine

cluster/ tension headache
cervical spondylosis
sinusists/ otitis media
intracranial pathology
TIA

322

how does meningitis present

fever, stiff neck, photophobia, purpuric rash

323

how does hydrocephalus present in adults

symptoms of raised ICP - headache, nausea, vomiting, drowsiness, papilloeadema, 6th nerve palsy

324

how do tonic clonic seizure typically present

loss of consciousness and fall to the ground
limbs stiffen (tonic) and then jerk (clonic)
tongue biting may occur or urinary incontinence

325

what is the presentation of an extradural haematoma

falling GCS from rising ICP
severe headache, vomiting, confusion, seizures

326

what drugs are used to treat neuropathic pain

amitriptyline
duloxetine
gabapentin

327

describe the best motor response component of the GCS (1-6)

1- none
2- extending to pain
3- flexing to pain
4- withdrawing from pain
5- localising to pain
6 - obeying commands

328

what is levy body dementia characterised by

lewy bodies in brain stem/ cortex

329

when are epileptic drugs allowed to be stopped

seizure free for 2 years

330

how may a baby with a muscular myopathy present

poor suck
failure to thrive (no weight gain)
floppy (no muscle tone)

331

which arteries are involved in a lacunar stroke

small arteries to basal ganglia

332

what is the treatment of parkinsons

levodopa - dopamine prescursor
(prolonged 1/2 life by COMT and MAO-B inhibitors)

333

what autoimmune diseases can cause encephalitis

anti VGKC - frequent seizures
anti NMDA - flu like, psych features

334

what are signs of a sympathetic nerve neuropathy

postural hypertension, reduced sweating, ejaculatory failure, horners syndrome

335

what are the 4 main management goals of brain tumours

accurate tissue diagnosis
improve quality of life
aid effect of adjuvant therapy
prolong life expectancy

336

when does guillain barre syndrome develop

1-28 days after a respiratory/ GI infection (campylobacter)

337

what factors affect the outcome of a coma

age, cause, depth, duration , brain stem signs

338

what is the problem with a hairline fracture

if impinges on ear it creates a portal for infection to reach the brain

339

what is the treatment for proaoxysmal hemicrania

indomethacin

340

how do 80% of MS cases present

as a relapse
optic neuritis, sensory symptoms (pins and needles, dysaesthesia), limb weakness, sphincter disturbances, brainstem - nystagmus, ataxia, vertigo

341

what is the finding of myasthenia gravis on neurophysiology

jitter - variation in fibre firing in motor unit

342

what is L'hermittes sign (B12 myelopathy)

flex neck --> electric shock down back

343

what kind of tremor disappears with distraction

functional neurological disorder

344

are injury and incontinence more common in syncope or seizure

seizure (unless syncope at night)

345

what type of headache may indicate a raised ICP

chronic, progressive headaches worse on waking, lying, bending forward, coughing
+ vomiting, papillloedema = do imaging

346

what is Hoovers sign of functional weakness

hip extension is weak if tested directly but normal if asked to flex the opposite hip

347

what is contrecoup

cortical contusion that happens directly on the opposite side as the momentum of the brain is different to the skull

348

what is the myotome of T1

intrinsic muscles of the hand

349

what may cause a coma with menigism

subarachnoid haemorrhage
meningitis
encephalitis

350

list some generalised seizures

tonic - clonic
myoclonic
absence
atonic

351

what may you want to find out about from a witness of syncope

activity at time/ night before
any warning feelings
feeling after
any similar symptoms before
any injury - tongue biting or incontinence
loss of consciousness - how much they remember
colour

352

what is myasthenia gravis

autoimmune disease against receptors of the NMJ, decreasing effectiveness of Each

353

describe the best verbal response component of the GCS (1-5)

1- none
2- unrecognisabel sounds
3- inappropriate words
4- confused
5- orientated

354

how does botulism present

4-14 days - descending symmetrical flaccid paralysis
diagnosed on EMG or culture from wound

355

what type of gait is caused by cerebellar lesions

ataxic - can't walk heel to toe, wide based, falls

356

what is the difference between a primary and secondary headache

primary have no underlying medical cause (disruption of normal brain pathways) whereas secondary have an identifiable structural or biochemical cause

357

what length of time of ischaemia will cause irreversible brain damage

3 minutes (neurones don't regenerate)

358

when is the diagnosis of epilepsy normally made

2nd unprovocked attack

359

how is the tone in LMN pathologies

decreased - floppy

360

what percentage of the population will experience at least one seizure in their life

3-5%

361

how does papilloedema occur if CN II is damaged

increase in CSF pressure stops venous drainage but artery still supplies

362

what are clinical presentations of damage to CN XII

paralysis and wasting of ipsilateral half of tongue (tip deviates to affected side)
vulnerable during tonsillectomy

363

what is the character of pain felt in SUNCT

unilateral, orbital or temporal pain that is stabbing and pulsating in the forehead and can be accompanied by conjunctival infection/ lacrimation

364

how does cortical contusion occur

brain is injured by striking inner aspects of skull and sustains bruising

365

what is a tumour of the pituitary gland called

adenoma

366

what is the differential of a subdural haematoma

stroke
dementia
CNS mass - tumour, abscess

367

what symptosm/ signs may be seen in a brainstem relapse of optic neuritis

cerebellum - nystagmus, vertigo, ataxia
cranial nerve - eye III, IV, VI
UMN limbs

368

what are side effects of topiramate

weight loss, difficulty finding words, tingling hands and feet

369

what is the preventative treatment of a cluster headache

veramapril high dose
lithium, topirimate

370

who/ where is multiple sclerosis more common

females
colder climates - further from equator
lack of vit D

371

what type of injury does a knife cause

incision - sharp force to small area, easily stitched

372

what are side effects or levetiracetam

irritability, depression, drowsiness

373

what is the clinical diagnosis of parkinsons bases on

tremor, dyskinesia, postural instability, rigidity
slowly progressive >5-10 years
good response to dopamine treatment

374

wha drug is used to treat a facial nerve palsy

prednisolone

375

what is the best way to manage a hypoxic seizure

lie person down with legs up

376

what ay cause a cranial nerve palsy

infection
raised ICP
tumour
ischaemia/ stroke
aneurysm
systemic - diabetes, sarcoidosisn, guillain barre

377

what cranial nerves are responsible for oculovestibular responses

III, IV, VI, VIII

378

what is the MRI finding of a subdural haematoma

clot + midline shift
cresent shaped collection of blood over 1 hemisphere

379

how may myasthenia gravis present

limb weakness
extreme fatiguability (better in morning/ rest)
eyelids - ptosis, diplopia
weak mastication, swallowing, respiratory , talking

380

what are symptoms of a subdural haematoma

fluctuating levels of consciousness
sleepiness, headaches, personality change
increasing ICP , seizure

381

which type of hydrocephalus is more likely to cause rapid deterioration

non communicating

382

what cranial nerves are responsible for spontaneous eye movements

III, IV, VI

383

what may cause a spinal stroke

atheromatous disease
thromboembolic disease
vasculitis
systemic hypotension

384

why are CNS lymphomas difficult to treat

drugs don't cross blood brain barrier

385

what is persistent negative state defined as

vegetive state > 4 weeks - regarded as permanent with little chance of recovery

386

what are abrasians

injury to the superficial skin - scratches and grazes
no scarring

387

what are warning signs for raised ICP

headache worse in morning/ waking people up, lying flat, coughing, stooping, straining
focal symptoms or signs
cognitive/ personality change
seizures
visual disturbances

388

why should be aware of feeding patients with bulbar pasly

risk of aspiration and chest infection

389

what signs would a muscular myopathy present with

muscle wasting
large muscle hypertrophy (not relaxing)
normal/ reduced tone
normal reflexes

390

how is a extradural haemorrhage likely to occur from a skull fracture

cross a meningeal artery and bleed out (commonly middle)

391

what are clinical presentations of damage to CN IX

loss of gag reflex
loss of test form back of tongue

392

what are causes of a coma without focal or lateralising signs

ischaemic conditions
metabolic disturbances
intoxications
infections
hypo/hyperthermia

393

what are the main causes of a haemorrhagic stroke

primary intracebral haemorrhage
secondary haemorrhage - subarachnoid, venous sinus thrombosis

394

how long do the majority of cluster headaches last

45- 90 mins (15 - 3 hours)

395

what is the non pharmacological treatment of dementia

dementia support services
occupational therapy
social work

396

what are clinical presentations of damage to CN III

ptosis - upper eyelid droops
eyeball abducted and pointing down
no accomodation of lens

397

what are causes of congenital hydrocephalus

genetic
prenatal viral infection
intraventricular haemorrhage
spina bifida cystica

398

in a coma, what areas of the brain are damaged and undamaged

damaged - cerebral cortex and thalamus
undamaged - brainstem and hypothalamus

399

what features are seen in myopathies

gradual onset of symmetric proximal weakness
preserved tendon refelxes
specific muscle groups affected
no paraesthesia or bladder problems
no fasciculatons

400

what are the main types of MS

relapsing remixing - 85%
primary progressive - 10-15%
secondary progressive
sensory 5% - only mild sensory episodes
malignant

401

what is the myotome and dermatome of C6

M - wrist extensor
D - thumb

402

what drug can be given to treat alzheimers

cholinesterase inhibitors - donepezil, rivastigmine, galantamine

403

why do more women suffer from migraines than men

female hormone cycle - in reproductive age 20-50

404

what UMN and LMN are seen in MND

UMN - increased tone, spasticity, brisk reflexes, upping plantars
LMS - muscle wasting/ fasciculation (tongue, abdomen, thigh)

405

what does the public awareness of a stroke - BE FAST stand for

balance
eyes
facial weakness
arm weakness
speech disturbance
time to call 999

406

what is vestibular neuronitis

inflammation of the vestibular nerve with sudden onset, disabling vertigo and committing, with hearing symptoms
lasts days - weeks with gradual recovery

407

what is anosognosia (alzheimers)

a lack of insight into problems of the disease

408

what is executive function

how you plan what you are going to do / switch plans

409

what is the 2nd most common cancer in children

medullablastomas

410

what imaging would you do for a spinal cord compression

MRI

411

what is the definitive diagnosistic test of dementia

post mortem

412

what are symptoms of a pathology of a nerve root

myotomal wasting and weakness
reflex change

413

what may lead to delerium

post surgery
infections - pneumonia, UTI
head injury
metabolic disorder
drug/ drug withdrawal
hypoxia (pulmonary or cardia)

414

if there was a lesion of the spinal cord at C6, what would you expect to see (myelopathy)

sensory level at thumb
increased tone in legs
brisk reflexes
Babinski +ve
(UMN below lesion)

415

how does facioscapulohumeral MD present

weakness in face, scalp and biceps from 12-14 with the inability to puff out cheeks or raise hands above head
(AD) 20% need wheelchair by 40

416

what is a clinical presentation of damage to CN IV

diplopia when looking down and inwards

417

what is a laceration

tear/ split in skin by a BLUNT force - don't heal very well

418

what is the difference between metabolic disorders of carb metabolism and fat metabolism

carb occur on short exertion
lipid on prolonged exertion - glycogen stores run out and need FA (McArdle's)

419

how may a secondary headache present (sinister)

associate head trauma
first or worst - thunderclap
changes in headaches pattern or type

420

what muscular disease is characterised by excess fatiguability

myasthenia gravis (improved by rest and in morning)

421

what is the difference in pallor between a seizure and syncope

seizure - pallor uncommon
syncope - common

422

what are clinical features of delerium

globally impaired cognition, perception and consciousness which develops over hours/ days
reversal of sleep wake cycle
memory deficit
disordered thinking

423

what are symptoms of lumbar spinal stenosis

pain down both legs, worse on walking/standing and relieved on sitting or bending forward

424

what percentage of coma patients will die or remain in vegetative state

85%

425

how is alzheimers managed

specialist memory service
acetylcholinesterase inhibitors
BP control

426

what are localising features of a frontal lobe pathology

hemiparesis
personality change
Brocas dysphasia
executive dysfunction- can't plan tasks

427

what are clinical presentations of damage to CN V

paralysis of mastication muscles
loss of corneal/ sneezing reflexes
loss of sensation in face
trigeminal neuralgia

428

what is the mean survival of alzheimers

7 years from diagnosis

429

what is the myotome and dermatome of C7

M - elbow extensor
D - middle fingers

430

what blood test will be elevated in a degenerative myopathy

creatinine kinase

431

how is the diagnosis of hydrocephalus made

CT - dilation of temporal horns of lateral ventricles

432

what are causes of intellectual impairment

maternal alcohol abuse
genetic - downs
radiation to mum
infection - rubella
birth trauma - lack of O2
post natal insults - head injury, infection, lead

433

what are risk factors of alzheimers disease

1st degree relatives
down's syndrome
genetic
vascular risk factors - high BP, diabetes, dyslipidaemia
low cognitive activity , depression
smoking

434

how would you investigate lyme disease

serological tests
CSF for lymphocytosis
MRI brain/ spine
EMG

435

what posture does syncope and seizure occur in

syncope - upright only
seizure - any posture

436

what is the commonest cause of a spinal cord compression

secondary malignancy - breast, lung, prostate, thyroid, kidney

437

What is a benign essential tremor

postural tremor - abscent at rest, present on maintained posture (AD)

438

list some primary headaches

migraine (most common)
tension headaches
cluster headaches

439

what is the most common form of dementia

Alzheimers disease

440

what is hydrocephalus usually due to

accumulation of CSF from a blocked aqueduct causing a build up in forebrain and preventing CSF passing to 4th ventricle to drain

441

what is the treatment for myasthenia gravis

ACh inhibitor
immunosuppression - prednisone, azathioprine
plasma exchange if severe

442

what ay cause a cranial nerve palsy

infection
raised ICP
tumour
ischaemia
aneurysm

443

how is the tone in UMN pathologies

increased
spasticity (not consistent) and rigidity (stiff)

444

what is the symptomatic treatment of dysaesthesia (unpleasant sensations in the hands and feet)

amitriptyline , gabapentin

445

what is the differetnial diagnosis of dyncope

first seizure
hypoxic seizure
cardiac arrythmia
narcolepsy
migraine

446

what is a transient ischaemic attack

an ischaemic neurological event with symptoms lasting <24 hours

447

what causes a bruise

blunt force to the skin damages the little blood vessels which ooze out into the subcutaneous tissue

448

what is the characteristic appearance of MND on EMG

widespread denervation
no neuropathy as it is an anterior horn cell problem

449

what exacerbates symptoms of myasthenia gravis

pregancy, low K, infection, over treatment
change of climate, emotion, exercise
gentamicin, opiates, B blockers

450

how is neurosyphillis treated

high dose penicillin - tertiary disease years/ decades after

451

what is pernicious anaemia

antibodies to intrinsic factor prevent B12 absorption in terminal ileum

452

what is the treatment for myoclonic seizures

sodium valproate
levetiracetam, topiramate
(avoid carbamezapine)

453

what is the commonest cause of vegetive state

trauma - car accident, cardio-pulmonary arrest
(considerable damage to cerebral cortex and thalamus)

454

what is seen on a lumbar puncture of guillain barre syndrome

high protein

455

list some treatable causes/ mimics of dementia

vitamin B12 deficiency
HIV, syphillis
hypo/hyper thyroid causing cognitive changes
mimics - hydrocephalus, frontal tumour, depression

456

what is the most minor form of spina bifida

SB occulta - L5-6 have small tuft of hair , no clinical symptoms

457

what may cause communicating hydrocephalus

infection - bacterial meningitis
subarachnoid haemorrhage - scarring of arachnoid granulations
head trauma
drugs

458

what is the Macdonald criteria for a MRI diagnosis of MS

approx 10 lesions and 1 relapse

459

what are the 3 components of the GCS

eye opening
best verbal response
best motor response

460

what are the 2 most common myotonic disorders

DM1 - 20-40 with distal weakness, weak sternomastoids, myotonia, facial weakness , most die or respiratory/ cardiac
DM2 - not as severe

461

how is bacterial meningitis treated

antibiotics ASAP - IV ceftriaxone

462

what causes an intention tremmor

cerebellar damage

463

what can cause a phrenic nerve mononeuropathy

(orthopnea + raised hemidiaphragm on CT)
lung cancer, TB, cervical spondylosis, thoracic surgery, muscular dystrophy

464

what is a differential diagnosis for myasthenia gravis

polymtosistis
botulism
Takayasus arteritis
rheumatoid arthritis

465

what are side effects of levodopa

dyskinesia, painful dystonia, psychosis, visual hallucinations
nausea and vomititng

466

what may cause a coma with focal brainstem or lateralsiing cerebral signs

tumour, haemorrhage, infarction, abscess

467

who is most vulnerable to a subdural haematoma

elderly - veins are vulnerable from atrophy

468

what is an epileptic seizure

intermittent stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation - from abnormal neuronal discharges in grey matter

469

what is syncope

collapse +/- loss of consciousness

470

what is a tumour of an embryonic neural cell called

medullablastoma (childhood malignant)

471

how would a glioblastoma multiform typically present

progressive loss of function
headache
vommiting
drowsiness
raised ICP symptoms

472

what is trigeminal neuralgia

paroxysmal attacks of pain felt in the distribution of one or more branches of the trigeminal nerve

473

what drug is helpful in behavioural issues

NMDA agonist

474

how is a spinal cord compression treated

dexamethasone in malignancy
radio/ chemotherapy + decompressive laminectomy

475

what are warning signs for a headaches

change in headache, frequency, character, associated symptoms
focal neurological symptoms
abnormal neurological exam
neck stiffness/ fever - meningitis
jaw claudication or visual disturbance - GCA

476

what is the organisms can cause meningitis

meningococcus - neisseria meningitides B and C
pneumococcus - strep pneumonia, Haemophilus influenzae

477

how may a spinal stoke present

sudden onset, back pain and weakness, numbness and paraesthesia

478

what is the life expectancy of MND

3-5 years from symptom onset (median 3)
2-3 years from diagnosis (50% in 14 months)

479

what are signs of a spinal root compression

pain/ electrical sensation in fingers at level
numbness, dull reflexes, LMN weakness, wasting of muscles

480

how can a head injury lead to focal neurological signs/ epilepsy

diffuse axonal injury
contusion (brusing)
intracerebral haematoma
extra cerebral haematoma

481

which cranial nerves does the gag reflex test

IX, X

482

what are localising features of a temporal lobe pathology

dysphasia
contralateral homonymous hemianopia
amnesia

483

what are the 2 classes of seizure in the ILAE classification

generalised
focal

484

what are causes of dilated pupils

youth
dim lighting
anxiety/ excitement
cocaine/ amphetamine overdose
mydriatic eye drops

485

what is the mean onset age of Alzheimers

70

486

what is motor neurone disease

cluster of neurodegenerative diseases, characterised by selective loss of neurones in motor nuclei of brainstem, corticospinal fibres and anterior horn cells of spinal cord
(gradual wasting of limbs then bulbar (speech/ swallowing ) respiratory onet

487

how would you investigate a coma with menignism

CT head
lumbar puncture

488

what screening tests can be done to examine cognitive function

mini mental MMSE
montreal MOCA

489

what is the most common cause of fainting

vasovagal - reflex bradycardia + peripheral vasodilation provoked by emotion, pain or standing too long (urination)

490

how does fronto-temporal dementia present

early changes in personality and behaviour or eating habits
early dysphagia

491

what is the most common cause of a subarachnoid haemorrhage

berry aneurysm rupture

492

why is a greater injury caused by greater velocity

Ek = 1/2 m v^2

493

what kind of gait does Parkinsons present with

extrapyramidal - flexed posture, shuffling feet, slow to start, postural instability

494

what is the myotome of L2

hip flexors

495

what are late stage presentations of alzheimers

irritability, mood changes (depression)
behaviour change - aggression
psychosis - hallucinations
agnosia - not recognise self in mirror

496

what drugs may induce parkinsons

dopamine antagonists, antipsychotics

497

how are tension type headaches treated

aspirin, paracetamol or NSAIDS
limit to 10 days a month

498

which lobe is the most common for focal complex seizures

temporal - post octal confusion, hallucinations of smell, sight, taste and hearing

499

when does a lumbar puncture need to be done after a subarachnoid haemorrhage

> 12 hours after
allow breakdown of RBCs

500

what kind of head trauma is likely to cause a subdural haemorrhage

hit head off floor - skull stops moving but brain accelerates
Little veins stretch, burst and bleed out increasing venous pressure

501

what are symptoms of chorea

non rhythmic, jerky, purposeless movements
(huntington's)

502

what test may you do to investigate dementia <65

genetic

503

what does consciousness depend on

intact reticular activating system (alert)
functioning cerebral cortex (awareness)

504

what is the difference in circadian periodicity for a cluster headache, paroxysmal hemicranial and SUNCT (same time day/ year)

cluster headache- 70%
paroxysmal hemicrania - 45%
SUNCT - absent

505

what is the prophylactic treatment of SUNCT

lamotrigine

506

where are brain metastases commonly from

renal cell, lung, breast, GI tract

507

what indicators is the prognosis of MS bad for

male , old age, many early relapses, motor signs, many MRI lesions/ axonal loss

508

what is the management of a large subdural haematoma

craniotomy or burr hole washout

509

what symptoms are experienced in a cluster headache

suicide headache - strictly unilateral
one eye become watery and bloodshot with lid swelling and facial flushing
+ migraine symptoms

510

how does an absence seizure typically present

brief pauses <10s - suddenly stop then carry on
presents in childhood, posture and balance maintained

511

what symtpoms/ signs may be present in a stroke - loss of;

power
sensation - feels dead
vision
speech - dysarthria , dysphagia
coordination

512

how many people in the UK have dementia

750,000

513

what is a medication overuse headache

headache present on >15 days month which has developed or worsened whilst taking regular symptomatic medication

514

what is the difference in the WCC between bacterial meningitis and encephalitis/ viral meningitis

men - mainly neutrophils
en - mainly lymphocytes

515

what are localising features of a pathology in the midbrain

failure of up or down gaze
light near dissociated pupil epsonses
nystagmus on convergent gaze

516

what is Gerstmann's syndrome

lose recognition of body image, inability to write/ make calculation
(usually left parietal lobe pathology)

517

how does cervical spondylosis present

neck stiffness (common in >50s)
stabbing/ dull arm pain

518

what is the treatment for tonic/ atonic seizures

sodium valproate

519

what is the prognosis of a subarachnoid haemorrhage

50% mortality
4-6% rebelled in first 2 days, 40% in first month

520

what are focal seizures characterised according to

aura, motor features, autonomic features and degree of awareness or responsiveness

521

what is the difference between a ring and a fissure fracture

ring is continuous around the bone and needs a lot of energy eg. a wall
fissures are less complete usually from a blunt force

522

which peptide is though to be a cause of alzheimer's disease

B-amyloid peptide - degradation product of amyloid precursor protein least to loss of Each

523

what are contraindications for a lumbar puncture

new onset seizure
bleeding
papilloedema
abnormal conscious level GCS <10
focal neurological deficit
immunocompromised

524

which percentage of Alzheimers patients have vascular dementia

95%

525

what is cerebellar coning

when ICP raises so much that the cerebellum begins to herniate down foramen magnum leading to death of brain stem

526

which test can be done to assess electrical activity in muscle

EMG

527

what are the most common medical causes of a coma lasting more than 5 hours (in order)

40% drug/ alcohol ingestion
25% hypoxia
20% cerebrovascular - haemorrhage or infarction
15% metabolic - sepsis, hypoxia, hypercapnia, hepatic/ renal failure

528

what is the acute treatment of hydrocephalus

external ventricular drainage
shunt placement (most ventriculo -peritoneal)

529

what events may cause a coma

head injury, sudden collapse, limb twitching, drug/ alcohol abuse

530

what is optic neuritis

subacute (rapid) visual loss in 1 eye with pain on moving and disturbed colour vision . usually resolves over weeks.
optic disc atrophy

531

how would a sensory neuropathy present

numbness, pins and needles, paraesthesia (glove and stocking)
difficulty handling small objects

532

what imaging may you do to investigate a stroke

CT/ MRI - infarct vs haemorrhage
ECG/ echo
carotid doppler ultrasound (carotid artery stenos)
hypercoagulable blood screen

533

how do myoclonic seizures seizure typically present

sudden jerk of a limb, face or trunk

534

what is an encephalocoele

herniation of cerebral tissue through a defect in the skulls the neural tube fails to close (most common in occipital region)
can be treated

535

how many cervical nerve roots are there

8 - 7 vertebrae

536

what are differentials for a gradual onset headcahe

venous sinus thrombosis
sinusists
tropical illness - malaria
intracranial hypotension - worse on standing

537

what is the lifetime prevalence of tension headaches in men and women

men 42%
women 49%

538

what are signs of a spinal cord compression

progressive
UMN legs - spastic weakness, upgoing plantars
LMN arms - wasting, hyporeflexia
incontinence

539

what is multiple sclerosis

inflammatory plaques of demyelination in the CNS disseminated in space and time
disease of white matter

540

what is the management of delerium

treat underlying cause
re-oreintate patient
encourage visitors
monitor NEWS, fluid intake
practice sleep hygiene

541

what are side effects of lamotrigine

skin rash, difficulty sleeping, flu symptoms

542

what are symptoms of tetanus

occur 4-25 days after infection - muscle stiffness, spasm and rigidity of jaw and neck , high fever and pain common

543

what is the abortive treatment of migraine

aspirin or NSAIDs big dose
oral triptans

544

what is a transformed migraine

episodic migraine increasing frequency over weeks/ months/ years but symptoms become less sever

545

what is a common feature of an extradural haematoma

deteriorating consciousness after a head injury that produced no loss of consciousness

546

which arteries supply the hemisphere and the brainstem/ cerebellum

hemispheres - anterior, middle and posterior
brainstem/ cerebellum - vertebral/ basilar

547

what are degenerative causes of spinal cord pathologies

disc prolaps, ligament hypertrophy, osteocyte formation (abnormal bony spurs)

548

what may cause non communicating hydrocephalus

aqueductal stenosis
cysts
haematoma
tumours/ masses
congenital malformations

549

what is the clinical presentation of encephalitis

flu like symptoms for 4-10 days, progressive headache + fever, progressive cerebral dysfunction

550

what is the episodic nature of cluster headaches

bouts last 1-3 months with at least 1 month remission
up to 8 times a day, 2 days a month

551

what is the myotome and dermatome of L5

M - long toe extensors
D - toes

552

what indicators is the prognosis of MS good for

female, optic neuritis, long interval between relapses, few relapses in 1st 5 years

553

if the right optic tract is damaged, what will present

left homonymous hemianopia

554

how long does a migraine aura normally last

15-60 minutes

555

what imaging differentiates between parkinsons and not

dopamine transporter SPECT

556

what is the treatment of giant cell arteritis

high dose prednisolone
arrange temporal artery biopsy

557

what 3 things can interrupt the oxygen supply from a vessel (virchows triad)

vessel wall - atheroma
blood flow - pressure
blood constituents - thrombosis, reduced platelets

558

what are the most common subtypes in late onset dementia (+65)

alzheimer's (55%)
vascular (20%)
levy body (20%) - type of parkinsons