Firms: Neuro Flashcards
(121 cards)
1
Q
When would you aim for lower O2 sats around 88-92%?
A
Pts at risk of hypercapnic resp failure
2
Q
What should you always know when analysing the ABG?
A
How much oxygen the pt is on and also compare to prev gas results
3
Q
What does a narrow pulse pressure suggest?
A
Arterial vasoconstriction - cardiogenic shock or hypovolaemia
4
Q
What does a low diastolic blood pressure suggest?
A
Arterial vasodilation - anaphylaxis or sepsis
5
Q
UMN Signs
A
Hypertonic
Weakness
Clonus
Brisk Reflexes
Pos Babibski’s
6
Q
LMN Signs
A
Hypotonic
Weakness
Fasciculations
Dec Reflexes
Neg Babibski’s
7
Q
Presenting query stroke
A
Acute onset, time critical, urgent CT as a potential candidate for thrombolysis within 4.5hrs, CIs to thrombolysis, contact stroke team, CTA target for thrombectomy
8
Q
Does a normal CT scan exclude a stroke?
A
It only excludes a bleed and hence able to thromblyse
9
Q
Absolute CIs to thrombolysis
A
Uncertain onset, GCS <8, SBP >185 or DBP >110, BM <2.7 or >22, pl <100k, INR >1.7, LMWH within 48h, advanced liver disease
10
Q
Presenting query meningitis
A
Conscious level, signs of meningism, focal neuro, rash, fundoscopy
11
Q
What can you give before abx when treating bacterial meningitis?
A
Dexamethasone 15-20mins before abx to reduce hearing loss
12
Q
After stabilising meningitic pts where do they go?
A
HDU
13
Q
Spinothalamic Tracts (3)
A
Ant: Crude Touch
Lateral: Pain + Temp
14
Q
Dorsal Columns (3)
A
Light Touch, Vibration, Proprioception
15
Q
Spasicity vs Rigidity
A
Spasicity - unidirectional, velocity dependent, clasp knife phenomenon, umn lesion
Rigidity - all directions, velocity independent, cog wheel and lead pipe, parkinsons
16
Q
How can you elicit receptive vs expressive dysphasia?
A
Receptive - ask them to do something
Expressive - what is this, repeat this sentence after me, make your own sentence up about
17
Q
Where is the damage in receptive + expressive dysphasia?
A
Receptive: Wernicke’s area in the dominant temporal lobe
Expressive: Broca’s area in the dominant frontal lobe
18
Q
What can interfere w dx of receptive dysphasia?
A
Deaf, confused, different language
19
Q
What is the best way to elicit a cerebellar lesion?
A
Ask the pt to tap out a rhythm
20
Q
What can interfere w testing dysdiadochokinesia?
A
Parkinson’s
21
Q
Cerebellar Signs in H+N (3)
A
Over/undershooting saccades, nystagmus, slurred staccato speech
22
Q
Cerebellar Signs in Limbs (7)
A
Ataxia, difficulty tapping out rhythm, past pointing of nose to finger + knee to toe, dysdiadochokinesia, intention tremor, hypotonia, slow to dampen reflexes due to rebound oscillation
23
Q
What does the EMG show in cerebellar dysfunction?
A
Triphasic EMG w phases: high first, delayed second, rebound third
24
Q
How do you differentiate b/w sensory and cerebellar ataxia?
A
Check for toe proprioception to inc/exc sensory
25
What are the nerve roots for each reflex?
S1/2 - Ankle
L3/4 - Knee
C5 - Biceps
C6 - Supinator
C7 - Triceps
26
How do you test for the knee jerk if the pt is in an above knee cast?
Test by hitting above the knee or anterolateral thigh
27
If you have umn signs in the leg, but normal function of the intrinsic muscles of the hands, where is the lesion confined to?
The thoracic spine as C8+T1 must be in tact for hand function and a lesion below L1 would result in LMN signs
28
When you say a certain part of the neuro exam was normal what do you mean?
Normal for those patient demographics
29
What are the four broad categories of neuropathy?
Motor, Sensory, Motor Sensory, Autonomic
30
What should you get the pt to do after gait to exacerbate problems?
Generally: heel toe walking to remove gait base, hopping, squatting
Specifically: Stand on toes (S1/2 weakness), stand on heels (L4 weakness), great toe dorsiflexion (L5 weakness)
NB: looking to see if they’re the same height on both sides
31
What should you always ask before any sensory examination?
The pt to outline any areas of sensory abnormality
32
The three dys of speech
Dysphasia (language), dysphonia (voice), dysarthria (articulation)
33
What are the two types of dysphonia?
NB: the pt isn’t breathless
Vocal Cord:
aDduction - strained
aBduction - breathy
34
What should you test next after eliciting a hemiparesis of the face, arm and leg? (2)
Speech + Sensory
35
What is the premise of the Romberg’s test?
You require two of the following to maintain balance whilst standing: proprioception, vestibular function, vision
36
How do you elicit the spastic catch in the upper limb?
Start distally and attempt: wrist extension, supination, elbow extension
37
What could give a false neg fhx?
Disputed paternity, estrangement, suicide
38
How do you test the motor function of the radial, ulnar and median nerves?
Wrist extension, finger aBduction, breaking okay sign
39
How do you test the sensory function of the radial, ulnar and median nerves?
Dorsal thumb web space, ulnar palmar aspect, median palmar aspect
40
At which point on the legs would you expect sx of peripheral neuropathy on the arms?
Just above the knees as it is length dependent
41
CNS Anatomy
Cerebral hemispheres, basal ganglia, cerebellum, spinal cord
42
PNS Anatomy
Anterior horn cells, nerve roots inc cauda equina, brachial and lumbosacral plexi, peripheral nerves, NMJ, muscle
43
What you say T8 what three different levels can this be referring to?
Vertebrae, canal, cord
44
What signs do you usually pick up in a pt w MND?
UMN: brisk reflexes
LMN: fasciculations
45
Why do you get wasting in both UMN and LMN lesions?
UMN: disuse trophy - not sig
LMN: lack of supply - significant
46
What is the distribution of weakness in the limbs due to an UMN lesion?
Upper Limbs: extension > weaker > flexion
Plus weak shoulder aBductors
Lower Limbs: flexion > weaker > extension
Plus weak hip aBductors and foot eversion
47
What are important findings from a neuro exam to document?
Alert, Oriented, GCS
Facial droop, speaking in full sentences, gait assessment
T - N; P - 5/5; R - equal bilaterally w downgoing plantars; C - N; S - grossly intact in modalities tested
48
Which muscle raises the forehead?
Frontalis
49
Which muscles are spared in UMN facial weakness?
Frontalis + Orbicularis Oculi
50
Are the CN nuclei UMN or LMN?
LMN
51
Where on the brainstem does each CN nuclei originate?
Midbrain: 3+4
Pons: 567
Junction: 8
Medulla: 9-12 and either above/below decussation
52
Cribriform Plate
CN1 + ant ethmoidal nerves
53
Optic Canal
CN2 + ophthalmic artery
54
Superior Orbital Fissure
CNs 3-6 + lacrimal nerve, superior ophthalmic vein, branch of the inferior ophthalmic vein
55
Foramen Rotundum
CN5 - Maxillary Branch
56
Foramen Ovale
CN5 - Mandibular Branch
57
Foramen Spinosum
Middle meningeal artery + vein
58
Internal Acoustic Meatus
CN7+8, vestibular ganglion, labyrinthine artery
59
Jugular Foramen
CN9-11, jugular bulb, inferior petrosal and sigmoid sinuses
60
Hypoglossal Canal
CN12
61
Foramen Magnum
CN11, medulla and meninges, vertebral arteries, anterior and posterior spinal arteries, dural veins
62
Which foramen goes through the ethmoid bone?
Cribriform Plate
63
Which foramen go through the sphenoid bone?
Optic Canal
Superior Orbital Fissure
Foramen Rotundum
Foramen Ovale
Foramen Spinosum
64
Which foramen go through the petrous part of temporal bone?
Internal acoustic meatus and anterior aspect of jugular foramen
65
Which foramen go through the occipital bone?
Posterior aspect of jugular foramen, hypoglossal canal, foramen magnum
66
What are the afferent + efferent nerves of the light reflex?
Afferent - 2nd
Efferent - 3rd
67
What are the respective actions produced from C5-T1?
aBduction C5
aDduction C7
Biceps C5-6
Triceps C7-8
Extensor Carpi Radialis C6
Extensor Carpi Ulnaris C7
Fingers + Thumb C8-T1
68
What causes a mixed UMN and LMN picture? (2)
MND + spinal cord pathology that also affects the anterior horn cells i.e. UMN below and LMN at level
69
When does vertebrae pathology switch from UMN -> LMN signs in the legs?
L1
70
What are the sinister causes of a headache?
VIVID: vascular, infection, vision threatening, raised ICP, carotid dissection
71
What examination can you do to distinguish central vs peripheral vertigo?
HiNTs: head impulse, nystagmus, skew
72
How is BPPV dx + tx?
Dx: Dix-Hallpike Test
Tx: Epley Manoeuvre
73
What ix can you carry out for a suspected TIA w/o delaying transport to hosp? (2)
Glucose + ECG
74
Tx for a suspected TIA
If within last week give aspirin 300mg immediately and arrange urgent assessment by specialist unless: contraindicated, on low dose regularly, bleeding disorder
75
Raised ICP: Cushing’s Reflex
Inc BP
Dec HR
Irregular Breathing
76
Ddx for Raised ICP (5)
Meningitis/Encephalitis/Abscess, Cerebral Oedema, Hydrocephalus, Haemorrhage, Tumour
77
What are the different types of jerking?
Chorea, Myoclonic, Tics
78
What is the early sign of papilloedema?
Loss of venous pulsation at the optic disc
79
What makes back pain an emergency?
Loss of bladder function
80
What should you always measure whilst performing a LP?
Opening Pressure
81
Ddx of Foot Drop
Common peroneal, sciatic, L5, CMT, MND, glioblastoma
82
Cauda Equina vs Conus Medullaris
CE: dec tone, dec reflexes, downgoing plantars
CM: inc tone, dec reflexes, upgoing plantars
Both have saddle anaesthesia, bladder/bowel dysfunction, erectile dysfunction
83
Ddx of Parkinson’s Disease
Depression + Essential Tremor
Plus Syndromes: MSA (autonomic insufficiency), PSP (loss of vertical gaze), CBD (alien limb), LBD (fluctuating cognition)
Secondary: vascular, drug induced, toxins, trauma, CNS infection
Young Pts: Wilsons, Huntingtons, dopa-responsive dystonia
84
What can a DaT scan be helpful in distinguishing between?
PD vs essential tremor, vascular, drug induced
85
Mx of PD
Consrv: MDT and carers, postural exercises and wt lifting, monitor mood and BP
Medical: predominantly used for sx control, start levodopa and carbidopa early, dopamine agonists if <70yrs as it has more non-motor SEs, MAO-BI/COMT inhibitors
Surgical: ablation and deep brain stimulation are only short term solutions and don’t prevent disease progression
86
What are CIs for taking levodopa? (3)
Psychosis, Glaucoma, MAO-AI
87
How can you give parkinson’s medications if the pt is NBM?
Use a NGT with L-dopa dose in dispersible form OR rotigotine patch at equivalent dose
88
What is the genetic basis of Huntington’s disease?
Expansion of CAG repeat on chr4
89
Headache Red Flags
Papilledema
Seizures
Focal Neuro
Cancer/HIV
Visual Disturbance
Postural Change
Pregnancy
N+V
Vasculitis
Diabetes
Worsening
AM Sx
90
What is the typical pt w idiopathic intracranial hypertension?
Obese female in her 3rd decade who presents with: signs of raised ICP, narrowed visual fields, blurred vision, sixth nerve palsy, enlarged blind spot
91
Mx of IIH
Consrv: neuro-ophthalmology input + optimise wt
Medical: acetazolamide/topiramate, loop diuretics, prednisolone
Surgical: optic nerve decompression + CSF shunting
92
What are the triggers for a migraine?
Chocolate
Hangovers
Orgasms
Cheese/Caffeine
Oral Contraceptives
Lie Ins
Alcohol
Travel
Exercise
93
What is the diagnostic criteria for a migraine w/o aura?
>=5 Headaches lasting 4-72h AND N+V AND any two of: unilateral, pulsating, impairs routine activity
94
Tx of Migraine
Prophylactic: propranolol 40-120mg/12h or topiramate 25-50mg/12h
Attacks: warm/cold pack, rebreathing into paper bag, oral triptan combined w paracetamol/NSAID
95
What considerations must you consider with topiramate?
Teratogenic + Dec Pill Efficacy
96
What is the typical pt w cluster headaches?
Male, Smoker, FHx
97
Tx of Cluster Headaches
Prophylactic: verapamil 360mg
Attacks: 100% O2 + s/c triptan 6mg
98
What are the common triggers for trigeminal neuralgia?
Washing
Shaving
Talking
Eating
Dental
99
Mx of Trigeminal Neuralgia
You must do a MRI to exclude secondary causes: aneurysm, tumour, MS
Start carbamazepine first line and if refractory tertiary referral for surgical options
Screen for depression which can often accompany recurrent headaches
100
What HiNTs results are consistent with peripheral vertigo?
A pos head impulse test, unidirectional and horizontal nystagmus, negative skew test
101
Workup for TIA
Bedside: obs/ABPM + ECG/24h tape/echo
Bloods: FBC, U+Es, LFTs, CRP, ESR, Glucose, Lipids
Imaging: unenhanced CT head if any concern wrt intracranial bleeding, CXR (infection aspiration sarcoidosis), carotid doppler US +/- angiography
102
Mx of TIA
Antipl: 2w aspirin -> long term clopidogrel/ticagrelor
BP: ACEi/CCB +/- diuretic
Cholesterol: atorvastatin
Diabetic: meds if indicated
103
What is the ABCD2 score used for?
Stratifies which pts are at high risk of having a stroke following a suspected TIA: a score of >=4 must be assessed by specialist <24h and <4 are seen within 7d
104
What is the Bamford classification of strokes?
Tbc
105
Sx of GBS
Weakness
Paraesthesia
Autonomic
Pain
106
What is Guillian-Barre syndrome?
An ascending progressive acute inflammatory demyelinating polyradiculopathy usually triggered by an infection
107
Ix for GBS
Bedside: thorough neuro exam, spirometry 4hrly, ECG
Bloods: FBC, U+Es, LFTs, CRP, ESR, Glucose, ABG (T2RF)
Imaging: CXR, LP (inc protein + normal WCC), nerve conduction studies (slow)
108
What will the LP show in GBS?
N/High Protein + N/Low WCC
109
Mx of GBS
Always call for senior support
Supportive: resp, freq turning to prevent pressure sores and contractures, VTE prophylaxis
Medical: IVIG, plasmapheresis, analgesia
Prognostic: involve PT and OT to aid recovery and psychological input support counselling
110
What is the lesion in INO?
Medial Longitudinal Fasciculus
Unilateral: Stroke vs Bilateral: MS
111
What are the examination findings of INO?
Weakness in aDduction of the ipsilateral eye
Nystagmus in aBduction of the contralateral eye
112
What are the eponyms of MS? (6)
Devic’s Syndrome
Lhermitte’s Sign
Uhthoff’s Phenomenon
Charles Bonnet Syndrome
Pulfrich Effect
Argyll Robertson Pupil
113
What diagnostic criteria is used for MS?
McDonald +/- MRI/LP
114
How can MS affect the eyes?
Optic Neuritis
Internuclear Ophthalmoplegia
Argyll Robertson and Marcus Gunn Pupil
115
Where is the stroke if there’s double vision upon look laterally?
Midbrain
116
What is the antiplatelet regime for a stroke/TIA once a haemorrhagic stroke is excluded?
All OD 2wks Aspirin 300mg -> long term Clopidogrel 75mg OR if CI Aspirin 75mg combined w slow release dipyridamole
117
What anticoagulation should the pt receive from 2wks following a stroke if they also have AF?
DOAC/Warfarin
118
What can be used to assess ADL’s following a stroke?
Barthel’s Index
119
What is Miller Fisher syndrome?
Variant of GBS w ophthalmoplegia, ataxia and areflexia
120
What antibody is seen in the serum of pts with Miller Fisher syndrome?
Anti-GQ1b
121
Ddx for Bilateral Ptosis
MG, Dystrophy, Mitochondrial Disease
