conditions Flashcards by Emma Sutcliffe

pathophysiology behind Parkinson’s

loss of dopaminergic neurons in substantia nigra

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if someone presents with Parkinson’s and autonomic dysfunction eg pissing themselves or postural hypotension what is diagnosis

multi system atrophy

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is the tremor in Parkinsons symmetrical or asymmetrical

asymmetrical

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how is rigidity distinguished from spascity

rigidity is velocity dependent

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what test is used to identify bradykinesia in Parkinson

tap index finger and thumb together should have decreased amplitude

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what scan helps to distinguish Parkinson’s from dystonia

DAT scan

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what test should be done in a younger patient presenting with Parkinson’s symptoms

DAT, MRI , bloods as Wilsons disease can cause Parkinsonism

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what is motor neurone disease

cluster of degenerative diseases assoc with selective loss of motor neurons in either motor cortex, CN nuclei and anterior horn of spinal cord

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what kind of MND is most common

Amyotrophic lateral sclerosis ALS or Lou Gehrig

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median survival after onset of MND

3 years

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average age of diagnosis of MND

64 years

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how is MND most likely to present

muscle weakness most commonly upper limb. may be bulbar onset

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describe ALS and classic symptoms

mixed upper and lower motor neurone deficit 
weak grip and arm abduction 
stumbling gait 
foot drop 
drooling and dysarthria

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what drug can be given in MND to prolong life

riluzole

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what criteria system is used in MND

EL ESCORIAL

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what additional medication is commonly given in MND

anticholinergic for drosling and baclofen for muscle spasms and cramps

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what kind of dementia is MND associated with

frontotemporal dementia

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what would distinguish MND from myasthenia graves

and doesn’t affect the eyes

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what would distinguish MS from MND

no sensory or sphincter involvement

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what is syndenhams chorea

chorea seen In children after infection (strep throat )

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what is a stroke defined as

sudden disturbance of cerebral function of vascular origin that causes death or lasts 24 hours

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whats more likely a haemorrhage or thrombosis embolic stroke

thrombosis embolic

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what artery is most commonly affected in thrombotic cerebral infarction

MCA

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where is atheroma most likely to originate from in emboli cerebral infarction

ICA or aortic arch

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what is charcot Marie foot also known as

hereditary sensory motor neuropathy

high arched foot, champagne bottle deformity and lower limb distal muscle weakness

charcot marie tooth

early viral exposure to what may predispose to MS

EBV

when does MS present

30-40s

F:M ratio of MS

3:1

describe progressive relapsing form of MS

slowly gets worse and has flair ups. After flair up is worse than prior to it

clinical features of MS

optic neuritis , pyramidal dysfunction (weakness) , sensory symptoms, lower urinary tract dysfunction, cerebella r and brain stem features, cognitive impairment

symptoms of optic neuritis

painful eye movements and visual loss that resolves

how many episodes have to have occurred for diagnosis of MS

minimum 2 episodes

what is seen in CSF in MS and not in serum

IgG oligoclonal bands

what test may be used to diagnose MS

MRI, CSF, neurophysiology and bloods - PV, FBC CRp should all be normal

what is first line treatment for remitting relapsing MS

tefidera and interferons and Glitiramer Acetate

what is second line treatment for MS

fingolimed/cadrabine and monoclonal antibodies

what is seen macroscopically in the brain in MS

plaques of inflammation - well demaricated- ill defined if active

a GCS of less than what on initial assessment would indicate CT within an hour

<13

a CT within 1 hour of head injury would be indicated if how many episode of vomiting

what traumatic haematoma would be suspected if they present with a lucid interval

extradural haematoma

what neurotransmitter is released in excitotoxicity and subsequently what ion

glutamate and calcium

who can certify brainstem death

2 doctors one must be a consultant

what immune cells are activated in MS

t-cells

are gliosis seen in MND

yes

what protein does CAG code for

glutamine

below what age is Alzheimers classed as early onset

<65

what genes are implicated in Alzheimers

Amyloid precursor protein (APP) | presnilin 1 and 2

what dementia is seen in downs syndrome

alzheimers

what are neuritic plauques formed of in Alzheimers

A-beta amyloid core and astrocyte peripherally

what protein is dysregulated in Alzheimers

tau

what is seen microscopically in Alzheimers

neurofibrillary tangles and neuritic plaques

what does amyloid precursor protein cleave ?

a-beta (aka b-amyloid protein)

what chromosome is the APP gene found on

what apoliipoportine is associated with Alzheimers

what area of the brain atrophies 1st in Alzheimers

hippocampus found in temporal lobe

what is a Lewy body

intracytoplsmic eosinophilic inclusion with dense core surrounded by alpha-synuclei fibrils

describe features of Lewy body dementia

progressive dementia along with hallucinations and fluctuating levels of attention and cognition

what neurotransmitter is release at NMJ

ACh

name 2 pre-synaptic disorders of the NMJ

botulism and Lambert eaton myasthenia syndrome

describe pathophysiology of myasthenia gravis

autoimmune antibodies against post synaptic Each receptor

conditions of what other organ are seen in myasthenia graves

thymus abnormalities

describe Lambert eaton

antibodies to pe-synpatic calcium channel

what carcinoma is associated with Lambert eaton syndrome

small cell carcinoma

treatment of Lambert eaton

3,4, diaminopyridine

treatment of myasthenia graves

pyridostigmine IV Ig thymectomy

diagnosis of myasthenia graves

nerve conduction with repetitive stimulation

what drug should be avoided in myasthenia graves

gentamicin

marker of polymyositis and treatment

increased CK and steroids

what drugs can cause myopathies

statins, amiodarone, diuretics and steroids

what spills from muscle into plasma in rhabdomyolysis

potassium , PO4, myoglobin

describe transiten global amnesia

abrupt onset anterograde >retrograde amnesia repetition transit 4-6 hours generally a one off

describe sporadic CJD

rapid onset dementia , neurological signs and myoclonus

prognosis for sporadic CJD

4 months

what atypical kind of Alzheimers did Terry prachett have

posterior cortical atrophy

symptoms of posterior cortical atrophy

visuospatial disturbances, visual agnosia

what type of Alzheimers results in loss of language first

primary progressive aphasia