DPD: Amir Sam Neuro cases Flashcards Preview

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Flashcards in DPD: Amir Sam Neuro cases Deck (30)
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1

Which sites may a lesion causing a neurological pathology be found?

Brain
Spinal cord
Nerve roots
Peripheral nerves
Neuromuscular junction

2

What may cause neurological pathology broadly speaking?

Vascular
Infection
Inflammation/ AI
Toxic/ Metabolic
Tumour/ malignancy

3

State what would be affected by pathology of each of the cranial nerves

I: sense of smell
II: VA, VF, pupils, fundoscopy
III, IV, VI: diplopia
V: sensation, corneal reflex
VII: facial palsy
VIII: hearing
IX, X: Speech, swallowing
XI: Sternocleidomastoid, trapezius
XII: tongue movements

4

Describe the tone, power and reflexes seen in upper motor neurone lesions

Tone: Increased (spasticity)
Power: Decreased
Reflexes: Increased (brisk), upgoing plantar

5

Describe the tone, power and reflexes seen in lower motor neurone lesions

Tone: Decreased (flaccid)
Power: Decreased
Reflexes: Diminished

6

List 3 examples of UMN conditions

Stroke
Multiple sclerosis
Huntingtons disease

7

Using the acronym, list the cerebellar signs

Dysdiadochokinesa
Ataxia
Nystagmus
Intention tremor
Slurred/ staccato speech
Hypotonia

8

How would you locate the lesion based on the distribution of abnormal sensation?

Cerebral cortex: Hemisensory loss
Spinal cord: reduced up to certain Level
Nerve roots (Radiculopathy): Dermatome
Mononeuropathy: Specific area
Polyneuropathy: Glove + stocking

9

Considering the broad causes of pathology, what can cause peripheral neuropathy?

Vascular: No.
Infection: HIV
Inflammation/ AI: Vasculitis, CTD, inflammatory demyelinating neuropathy
Toxic/ Metabolic: DM, Alcohol, B12 deficiency
Tumour/ Malignancy: Paraneoplastic feature

10

Give 3 features of papillitis (optic neuritis at head of optic nerve)

Blurred vision
Blurred optic disc margins
Pain on eye movement

11

What features are suggestive of MS?

2 lesions
Separated in time + space

12

Give 4 differentials for apparent confusion and decreased AMTS

Post-ictal (post seizure)
Dysphasia
Dementia
Depressive pseudo dementia

13

Describe the GCS

Eyes
4 = Spontaneous
3 = Opens in response to voice
2 = Opens in response to painful stimuli
1 = Does not open

Verbal response
5 = Oriented
4 = Confused
3 = Words
2 = Sounds
1 = No sounds

Motor response
6 = Obeys commands
5 = Localizes pain
4 = Withdraws to painful stimuli
3 = Abnormal flexion
2 = Extension
1 = No movements

14

List the 10 components of AMTS

DOB
Age
Time
Year
Place
Recall (West Register Street)
Recognize doctor + nurse
PM/ Monarch
Date of 2nd WW
Count backwards from 20 to 1

15

Give 3 signs of meningitis

Fever
Neck stiffness
Kernig's sign

16

Give 4 signs of a migraine

Throbbing headache
Vomiting
Photo/ phonophobia
Aura

17

What indicates SAH? What should yo do?

Sudden onset headache
CT
LP (xanthochromia)

18

What makes you suspect GCA as cause of headache? What measurement may be found? What should you do?

> 50s
High ESR
Urgent steroids e.g. prednisolone
Biopsy

19

How do you manage a patient presenting with stroke within 4.5 hours of onset?

CT
If no haemorrhage- Thrombolysis

20

How do you manage a patient presenting with stroke after 4.5 hours of onset?

CT head (exclude haemorrhage)
Aspirin (300mg, swallow assessment)
Maintain hydration, oxygenation

21

How do you manage a patient presenting with TIA?

Aspirin
Don't treat BP acutely (unless >220/120)
ECG
Echo
Carotid doppler
Risk factor modification

22

In the context of reduced pinprick sensation what may Duloxetine be used to treat?

Peripheral neuropathy in diabetics

23

What is Meralgia paraesthetica? What are the symptoms of this?

Compression of lateral femoral cutaneous nerve
Pain + parasthesia on anterolateral thigh

24

How is Meralgia paraesthetica treated?

Reassure
Avoid tight garments
Lose weight
If persistent: Carbamazepine or Gabapentin

25

List 5 risk factors for Meralgia paraesthetica

Obesity
Pregnancy
Trauma
Diabetes
Long lies

26

What symptom would arise from lumbosacral nerve root compression? What is this also known as?

Pain in the buttock radiating down the leg to below the knee
Sciatica

27

Give 2 causes of lumbosacral nerve root compression

Disc herniation
Spinal canal stenosis

28

Give 6 differentials for confusion and decreased consciousness

Hypoglycaemia
Vascular: bleed
Infection
Inflammation
Malignancy
Toxic/ Metabolic: Drugs, LFTs, Vit déficiences, Endocrinopathies

29

What 4 differentials must be excluded for headache presentation in the ED?

Meningitis: Neck stiffness, Kernig's
SAH: Sudden onset
GCA: High ESR, >50
Migraine: Throbbing, photophobia

30

What could cause backache and LMN weakness, with indications for FVC monitoring and IVIG?

Guillain Barre Syndrome