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YEAR 3 NICE > last min > Flashcards

last min Flashcards

1
Q

GCS

A

used to diagnose coma

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2
Q

what tracts are affected in dcroticate posurimng

A

lateral corticospinal tracts are affected so rubrospinal tract takes over causing abnormal flexion of upper limbs and reticulpspinal tradct takes over causing extension of legs

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3
Q

in decerbrate both teh alteral corticospinal and rubro spinal tract are affected so what tract takes over

A

reticulospinal

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4
Q

what is generally spared in decorticate as opposed to decerebrate

A

midbrain

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5
Q

total volume of csf

A

150ml and about 450 ml is produced daily

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6
Q

as ICP rises what decreases to compensate (autoregulation)

A

cerebral blood flow and cerebral perfusion pressure

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7
Q

crus cerebri causes

A

contralateral hemiparesis

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8
Q

tonsillar herniation causes

A

neck stiffness, abnormal neck posture and cheyne stokes breathing ( periods of tachypnoea and tachycardia followed by periods of bradycardia and bradypnea)

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9
Q

central herniation of brainstem can cause

A

diplopia due to 6th nerve palsy

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10
Q

subfalcine

A

weaknes in legs

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11
Q

dural venous sinus is between

A

periosteal and meningeal layers of dura

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12
Q

in the spine what layer of dura only exxists

A

the meningeal layer

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13
Q

what meninges is highly vascualrised

A

pia

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14
Q

temporoparietal skull fracture

A

extradural

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15
Q

in extradural haematoma what is tehn compressed to cause headahce, vomitting and contralateral hemiparesis

A

cerebral peduncle

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16
Q

bilateral subdural haematoms are more common in

A

chidlren due to absence of adhesions in subdural space

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17
Q

in chronic subdural what is considered the driving factor

A

brain atrophy

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18
Q

aspirin is a predisposing factor for subdural

A
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19
Q

most comnonpresentation for chronic subdural

A

headhace and confusions but can also have urianry incontince

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20
Q

gait in normal pressure hydrocephalus

A

shuffling

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21
Q

clue that suggests a obstructive hyrocephalus

A

4th ventricle is small in comparison the to lateral and third

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22
Q

congenital hydrocephalus is aminly due to

A

aqueductal stenossi

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23
Q

dialted scalp veins, setting sun appearance (downward devaition of the globe on lid retraction), Macewen sign (cracked pot sound on head percusiion)

A

congenital hydrocephalus

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24
Q

MRI best for

A

hydorcephalus however ct can confirm in acute situation

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25
Q

endoscopic third ventrculostomy is a type of VP shunt opnly likely to be successful in

A

obstructive hydrocephlaus

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26
Q

chaiiri 1 malformation- more common -

A

suboccipital pain
headache borugh on by neck extension
cape like loss of paina nd temp (due to synringomyelia)
downbeat nystagmus

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27
Q

chairi 2 malformation associated with

A

more frequnelty in children and clear associated with myelomeningococele (spina bifida) - there is also hernaition of the 4th ventricle

  • causes dysphasia, apnoea stridor in kids
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28
Q

IIH headache is relieved on

A

standing

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29
Q

after weight loss what drug for IIH

A

diuretics such as acetazolamide

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30
Q

slit like ventricles can be seen in

A

IIH

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31
Q

lateral horns contain

A

autonomic neurons

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32
Q

contraletal sematosensry cortex

A

DCLM and spinothalamic whereas spinocerebellar is ipsilateral

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33
Q

anterior and posterior spinocerebellar si aminly to lower limbs and which is to upper limbs

A

Cuneocerebellar

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34
Q

anterior corticospinal decusaate at levvel via

A

anterior white comissure

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35
Q

hypoglossal and lower facial are innervated

A

contralateral only

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36
Q

what tract innervates anti gravity

A

vestibuspinal - extensors for legs and oppsite for arms

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37
Q

vesitublo - think anti gravity
reticulo - think voluntary response and tone and takes over in decerbrate

A
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38
Q

— reticulospinal incrases tone and facilatates response

A

pontine

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39
Q

medial malleous - L4
dorsum of foot and toes 1-3 = L5
toes 4 and 5 and lateral malleolis = S1

A

perineal = s3,4,5

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40
Q

facet joint- inferior articualr processes fo teh vertebra above artiucalte with the superior articualr processes fo the vertebra below

A
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41
Q

intervertebral disc is a

A

secondary cartilaginous

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42
Q

nucleus pulposus is maily

A

water

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43
Q

– helps maintain an upright posture and assists in straightening the spine after felxion

A

ligamnetum flavum

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44
Q

mornign stiffness whcih resolves with movement and pain made worse by prolonged sitting

A

mechanical

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45
Q

when facet joints are hypertrophies in mechanical back pain can get referred pain that mimics sciatica - however it does not radiate below the knee

A
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46
Q

most common locations for lumbar disc herniation

A

L4/5 and L5/S1

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47
Q

paramedian hernaited disc at L4/5 affects L5 - more common (posterolateral)( nerve root that exists below the level fo the prolapsed disc

A

far lateral herniated disc at L4/5 affects L4 - nerve root that exits at the level of the prolapse (extraforaminal)

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48
Q

radiculopathy - sensory deficit with weakness of the muscle

A
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49
Q

straight leg raise is postive in

A

sciatica

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50
Q

l4/5 root is l5 causes paraesthesia

A

in big toe
l3/4 - pain in anterior thigh (root is L4)

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51
Q

bilateral disc prolapse suggested by

A

bilateral sciatica and sphincter disturbance and dimished perineal sensation

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52
Q

prolapsed disc causing cauda equina is normally at

A

L4/5

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53
Q

if what is present it is highly unlikely to be cauda equina

A

ankle refexes

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54
Q

cauda equina caused by hernaited disc- discectomy
fracture- decompression and fixation
hematoma- evacuation

A
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55
Q

even doing surgery for cauda equina within 24-48hrs there is still

A

10% chance of permanent incontinece

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56
Q

complete effacement of CSF can be due to

A

cauda equina

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57
Q

what leads to neurogenci claudication

A

compression of nerve roots

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58
Q

symptoamtic lumbar stenossi most common at

A

L4/5 level

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59
Q

hypertrophy of facets joints and ligamentum flavum
protruding intervertebral discs
spondylolisthesis

A

aetiology of lumbar stenossi

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60
Q

what can precipitate pain in lumbar stenossi

A

stnading or back extension

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61
Q

what can relieve pain in lumbar stenossi sitting, lumbar flexion or wlaking uphill

A

patients can develop an anthropoid psutre which is exagerrated flexion of the waist

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62
Q

difference of neurological claudication via vascualr

A

neurological - normal pulses, burning as opposed to cramping

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63
Q

what provides immediate relief in vascualr claudication

A

resting

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64
Q

MRI lumbosacral spine for

A

neurogenic claudication

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65
Q

only thing that relieves vascualr is rest. posture has no effect. In neurogenci however posture can releif. eg wlaking uphill, sitting, waist flexion

A
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66
Q

cervical spondylosis affects

A

intervertebral disc adn zygapophyseal joints

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67
Q

cervical spondylosis can either present with degenrate cervical myelpathy which has UMN signs or radiculopath ywhich has

A

LMNS signs

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68
Q

radiculpathy casues

A

LMN signs in the upper and lower limbs and can also cause neck pain

69
Q

radiological findings in cervical spondylosis

A

narrowing of disc space and osteophyte formation

70
Q

degenrative cervical myelopathy

A

causes UMN signs more promiennt in lower limbs

71
Q

clumsy hands with tingling sensation in finger tips

A

DCM

72
Q

cord transection

A

initally flaccid arrecflexic then UMN signs appear later

73
Q

ipsialteral loss of what in brown

A

UMN paralysis and loss of proprioception
contralteral loss of pain and temp is 1-2 segments belwo lesion

74
Q

in central cord syndrome why is bilateral upper limb weakness more than lower limb

A

upper limb fibres in lateral corticospianl tract are more medial
- cape like pain and temp loss

75
Q

anterior cord - paralysis and loss of pain and temp below level of injury

A

lumbar stenosis can cause legs to feel heavy and become numb when walks

76
Q

nominal aphasia where is affected

A

supramarginal gyrus and angular gyrus of parietal lobe

77
Q

cerebellum derived from

A

metencephalon

78
Q

cerebrocerebelllum

A

corrects errors

79
Q

scanning dysarthria

A

patients speak slowly with poor articualtion of speech

80
Q

hypothalamus

A
  • body temp
  • release of hormones
  • synthesises ADH and oxytocin
  • feeding and starvation
    -mamillary nucleus
81
Q

subthalamus causes

A

contraletal hemiballism- flinging movements of one side of the body

82
Q

resting tremor in parkisnosn between what HZ

A

4-6

83
Q

cag repeats

A

Huntingotns

84
Q

gerstamnn syndrome is what brain lobe

A

parietal

85
Q

brain tumours most common

A

grde 3 or 4 - glioblastoma more so

86
Q

what can progress to glioblatomas mulitforme

A

anaplastic astrocytoma

87
Q

butterfly appearnace

A

glioblastoma multiforme

88
Q

after mRI - do molecular analysis to look for MGMT promoter methylation as is predictive for response of

A

alkylating agents ( temozolamide)

89
Q

stupp prptocol for

A

glioblastomas

90
Q

diffuse astrocytoma and ologodendrogliomas are grade

A

2

91
Q

bipolar cells with long hair like projections

A

pilocytsic astrocytoma

92
Q

pilocystic astrocytomas can affect

A

cerebellum or midline structres egg thalamis or optic chiasm

93
Q

optic pathway gliomas are commonly seen in

A

NF1

94
Q

tumours that carries the best prognosis

A

oligodendrogliomas

95
Q

oligodendroglial affects what lobe

A

frontal

96
Q

who is at risk of developing multiple meningiomas

A

those with NF type 2 and those who experienced radiation in childhood

97
Q

foster kennedy

A

optic atrophy in ipsilateral eye and papilloedema in contralateral eye

98
Q

microadenoma if smaller than

A

10mm

99
Q

acth tumour

A

do low dose dexamethasone compression test then high dose to differentiate between adrenal and pituitary. causes

100
Q

prolactinomas are mamaged exlusivelu medically with cabergoline. if fails then quinagolide

A
101
Q

Take home message: always preform a prolactin and early morning cortisol for anyone who you suspect to have a pituitary tumour before referring to a neurosurgeon or an endocrinologist.

A
102
Q

verocay bodies in acoustin neuroma - palisading nuceli against a fibrillary background

A
103
Q

how is surgery done for vestibular schwanoma

A

retrosigmoid approach in prone psoition

104
Q

haemangioblastomas develop where

A

posterior fossa

105
Q

number of surrounds black flow voids indicating blood vessels suggesst

A

haemangioblastomas

106
Q

arteries that comes off internal carotid

A

opthalamic and anterior choriodal

107
Q

main branch of the vertebral artery is the

A

posterior inferior cerebellar arteries

108
Q

basillary artery branches

A

anterior inferior cerebellar and superior cerebellar

109
Q

AVM creates a shunt with no

A

capillary bed present

110
Q

AV malformations are

A

common cause of haemorrhage in under 40

111
Q

AVM tend to be asymptoamtic until haemorrhage

A
112
Q

intracerebral haemorrhages are the most common as a result of

A

AVM

113
Q

patients may experience symptoms such as slowly progressive hemiparesis due to the local ischaemic effect of AVMs. It had been shown that AVM ‘steals’ or decreases the cerebral blood flow of the tissue surrounding the nidus leading to ischaemia (steal phenomenon).

A
114
Q

CATHETER ANGIPGRAPHY IS prefered for

A

AVMS

115
Q

angiohraphy - of avm

A

tangle of vessels
large feeding artery
large draining veins

116
Q

most common cause of sah

A

head trauma!!! berry aneurysm is most common non traumatic cause

117
Q

aneurysm where has a higher risk of rupturing

A

posterior compared with anterior

118
Q

CT angio done after lumabr(if done) puncture to to indentify lcoation in

A

SAH

119
Q

most commn electrolyte abnormaility in SAH

A

hyponatraemai

120
Q

cavernous malforamtion are

A

benign vascualr lesions encompassing sinusoidal spaces and separated by elastin

121
Q

pathology resembles a mulberry

A

cavernous malformation

122
Q

what has a rim of haemoside laiden macrophages surrounding it

A

cavenrous malformaitn

123
Q

unlike AVM, cavernous malformation are hard to visualise on angiopgraphy

A
124
Q

KRIT1 gene linked to

A

cavernous malformation

125
Q

MRI with popcorn - has ring of hypo- intensity consistent with hemosiderin desposition

A

cavernous malformation

126
Q

most common location of aneurysm

A

between anter and ant comm
between poster comm and internal carotid

127
Q

fusiform - hyeptension
berry - saccular
mycotic - septic emboli

A
128
Q

aneurysm on posterior communciating artery

A

third nerve palsy

129
Q

if anterior communicating aneurysm is large enough it can compress the

A

optic chiasm

130
Q

elderly, multiple comorbodieties and posterior circualtion favours

A

coiling over clippign

131
Q

abcd2 greater than 4

A

stroke specialist within 24hrs

132
Q

carotid stenosis ix

A

carotid doppler

133
Q

glutamte and enxymes causes

A

cerebral oedeam

134
Q

conductive

A

arcuate fasiculis - connects brocas to wernickes

135
Q

Visual inattention: patients with inattention fail to detect visual stimulus in one half of the visual field when both are tested together. However, when each half is tested alone then they can detect the visual stimulus.

A
136
Q

Patients with ischaemic stroke presenting within 4.5 hours of definitive onset of symptoms can be treated with intravenous thrombolysis (alteplase). Stroke affecting the carotid territory should be evaluated for carotid endarterectomy.

A
137
Q

(patients who are not suitable for clopidegrol can be put on low dose aspirin (75 mg)+dipyridamole)

A
138
Q

– 300 mg daily should be commenced within hours of ischaemic stroke and continued for two weeks then patients should be transferred to clopidegrol for lie

A

aspirin

139
Q

edinger wesstphal innervates

A

sphincter pupillae and ciliary muscles

140
Q

nerve that travels through the cavernous sinus

A

abducens

141
Q

accomodation reflex - increase lens curvature, constriction of pupils and eye convergence

A
142
Q

chalky white disc

A

GCA

143
Q

enlarged blind spot can be seen in

A

papilloedema

144
Q

ptosis is due to dysfunction of what muscle

A

muller

145
Q

anhydrosis means lesion is below where

A

superior cervical ganglion

146
Q

painful horners syndrome should raise possibiloty of

A

carotid artery dissection

147
Q

what is used to confirm a Horners pupil

A

Apraclonidine - causes horners pupil to dialte whereas normal pupil remaines unaffected

148
Q

what is posterior inferior cerebellar artery affected in

A

LAteral medullary syndrome

149
Q

adies pupil presents as

A

one pupil is larger and there is blurring on near vision

150
Q

holmes adie syndrome

A

absent tendon reflex of lower limb, adie pupil and orthostatic hypotension

151
Q

what causes adies pupil to constrict

A

pilocarpine

152
Q

most common cause of arygll robertson pupil

A

diabetes

153
Q

how is arygll robertson pupil different to adies

A

arygll robertson - pilocarpine does not cause constriction of pupils

154
Q

tuberculum sellae meningioma has

A

ipisilateral central scotoma with contralateral superotemporal defects

155
Q

lesion where causes contralateral homonymous hemianopia

A

optic tract

156
Q

what artery affected in contralateral homonymous hemianopia with macualr sparing

A

calcarine artery

157
Q

surgical as opposed to medical problems causing 3rd nerve palsy cause what

A

affect the pupil as pupillomotor fibres are damaged

158
Q

webers has

A

ipsilateal 3rd nerve palsy adn contralateral hemiparesis

159
Q

contralateral hemiparesis affects

A

cerebral peduncle

160
Q

benedikts syndrom has ipsilateral 3rd nerve palsy with contralateral

A

tremor, ataxia or chorea (red nucleus)

161
Q

what makes trochlear nerve palsy worse

A

tilting head to the ipsialteral shoulder

162
Q

affected eye in 4th nerve palsy is

A

higher than the contrlateral eye

163
Q

what double vision is seen in abducens nerve palsy

A

horizontal - worse on looking at distant targets

164
Q

NF is

A

autosomal dom

165
Q

bag of worm senstion on eyelid

A

NF1

166
Q

what is treated with botulinum toxin injection and has bilateral involuntary contraction of the orbicualris oculi msucle

A

benign essential blepharospasm

167
Q

what 2 thigns pass through the cavernous sinus

A

internal carotid and abducens

168
Q

cavernous sinus sydnrome can affect what cn

A

3,4,5(1)(2),6- maxillary sensory loss

YEAR 3 NICE (14 decks)

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