Medicine/Neuro Flashcards
(32 cards)
1
Q
Cerebellar signs
A
- (Truncal ataxia)
- Broad based ataxic gait
- Rhomberg positive
- Nystagmus
- (Saccades)
- Past pointing
- Dysphonia/Sticato (british constitution)
- Dysdiadochokinesia
- Rebound phenonemon
- (Pronator drift)
- Hyperreflexia
- Hypotonia
- Heel to shin coordination impairement
2
Q
Brief causes of cerebellar disease
A
- MS
- Alcohol
- Vascular
- Inherited
- Space occupying lesion
(MAVIS)
3
Q
Summary of TACI, PACI, Lacunar, POCI (Full NCs under Medicine/Stroke)
A
- TACI
- Hemiplegia
- Homonymous hemianopia
- Higher corticol dysfunction
- PACI
- 2 of 3
- Lacunar
- Hemi-motor or hemi-sensory deficit only
* POCI - Visual fields affected
4
Q
Define: hemiparesthesia, Hemiparesis and hemiplegia
A
Hemiparesthesia - altered sensation on one half of the body
Hemiparesis - weakness on one half of the body
Hemiplegia - paralysis of one half of the body
5
Q
Explaining MS to a patient
A
- Multiple sclerosis (MS) is a condition that can affect the brain and/or spinal cord, causing a wide range of potential symptoms, including problems with vision, arm or leg movement, sensation or balance.
- Autoimmune condition where the body attacks the coating of nerves
- It’s a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild.
- In many cases, it’s possible to treat symptoms. Average life expectancy is slightly reduced for people with MS.
6
Q
Risk factors for MS
A
- 20-30 years old
- Female
- FHx
- Infections such as EBV
- Caucasian
- Autoimmune PMHx e.g. hypothyroid, DM I etc.
7
Q
Common presentations of MS
A
- double or blurred vision
- numbness, weakness in one or two extremities
- instability in walking
- tremor
- problems with bladder control
- heat intolerance
8
Q
Types and brief definition
A
- Relapsing remitting
- 80% of cases
- Episodes/attacks of MS lasting days or weeks that may fully recover or leave patient with permanent problems
- May turn into 2ary progressive
- Primary progressive
- 10% of cases
- Slow progression of sx without remission, though may have ‘stable’ phases
- 2ary progressive
- Half of people with relapsing and remiting will develop this
- Starts as relapsing and remiting then turns into a progressive picture
9
Q
Investigations of suspected MS
A
- Refer to neuro
- 2 attacks - soft
- Full neuro exam
- MRI
- Evoked potential test (EEG with eye test)
- Lumber puncture looking for auto-immune antibodies
- Bloods - to rule out other things
10
Q
Differentials of MS
A
- Stroke
- Toxins
- B-12 deficiency
- Space occuping lesion
- Other inflammatory disorders like lupus
- HIV
- Vasculitis
11
Q
Treatment of MS
A
- LEMONS (lifestyle, education, monitor for complications, nutrition)
- Treat relapses
- Steriods (pred) reduce length
- Baclofen for mm spasms
- Prevent relapses
- Disease modifying drugs e.g. interferon beta, alemtuzumab
- Treat symptoms
- MDT
12
Q
Circle of willis
A
13
Q
Bells palsy features, causes, treatment
A
Bell’s Palsy (LMN) - temporary palsy of facial nn
Features - same side as lesion
- Unilateral facial weakness incl forehead
- Bell’s sign (eye rolls upward when trying to close eyelids)
Causes
- Herpes (Ramsay-hunt syndrome vesicles in ear)
- HIV
- Sarciod
- EBV
- Lymes disease
Treatment
- Eye protection - drops, patch
- Prednisone
14
Q
Other LMN CN7 palsy causes and associated features
A
Acoustic neuroma - CN5,6+8 involvement
Parotid tumour/ectomy - parotid lump/scar
Cholesteatoma - CN8 involvement
All features will be same side as lesion
15
Q
UMN CN7 palsy features, causes and associated sx
A
Features
- Forhead sparing
- Opposite side to lesion
Causes
- Stroke - hemianopia, hemiparasis/stesia, high cortical dysfunction
- MS - multiple neuro foci e.g. vision problems, sensory and motor issues, bladder problems
16
Q
Horners syndrome causes, sx, investigation
A
Horners syndrome - Damage to sympathetic chain that supplies face
Causes
- Tumours (thyroid, brain, pancoast)
- MS
- Trauma e.g. thyriodectomy
- Cervical rib
- Migraine
- Carotid aneursym/dissection
- Otitis media
Features - all on same side as lesion
- Ptosis
- Anhydrosis (no sweating)
- Miosis (contracted pupil)
Diagnosis
- No reaction to cocaine eye drops, normally dilates
Investigation
- Identify cause
- MRI - Ca
- Carotid USS - carotid pathology
- CXR - pancoast
17
Q
Motor neurone disease: presenting sx/ RF
A
MN disease - degeneration of motor neurones
Presenting sx
- Limb weakness
- Slurred speech
- Weak grip
- MM cramps and fasiculations
- Wgt loss
- Laughing and crying at inappropriate times
- FHx
- Age <70
18
Q
Parkinsons: Triad
A
Parkinsons - Death of dopinergic nerves in basal ganglia
Triad (assymetrical)
- Bradykinesia
- Resting tremor
- Cog wheel rigidity
19
Q
PD B symptoms
A
ASSYMETRICAL
- Shuffling gait, limited arm swing, hesitation when starting and turning
- Expressionless face
- Slurred/slow/monotonous speech
- Positive glabellar tap
- Anosmia
- Balance problems
- Urinary/sexual dysfunction
- Visual problems
- Swallowing issues
- Insomnia
- Micrographia
20
Q
PD investigations and treatment
A
Investigations
- Full neuro exam
- Refer to specialist
Treatment
- MDT
- LEMON
- L-Dopa
21
Q
PD plus syndromes and associated features
A
- Multi-system-atrophy - Low BP/postural hypotension
- Progressive supranuclear palsy (PSP) - Palsy of eye movement
- Corticobasal degeneration - apraxia, acalculia, myoclonus
- Lewy body dementia - dementia
22
Q
Peripheral neuropathy definition and examples
A
Peripheral neuropathy - damage to nns of peripheral nervous system
Examples
- Foot drop - common peroneal nn
- Diabetic - polyneuropathy
- Carpal tunnel syndrome - median nn
- Bell’s palsy - CN7
23
Q
Myopathy definition and examples
A
Myopathy - disease in which mm fibres don’t work properly
Examples
- dermatomyositis - autoimmune condition that attacks skin and mm
- polymyositis - inflammation of mm
- myositis ossificans - mm turns into bone when injured
24
Q
Spinal cord stenosis: signs and sx, investigation, causes, treatment
A
Spinal cord stenosis - narrowing of spinal canal leading to pressure on spinal cord and nn roots. Can lead to cauda equina
Symptoms
- Posterior back and leg (both) pain can also be: numbess, weakness, stiffness or parasthesia (pins and needles)
- Variable exercise tolerance day to day
- Sx relieved by bending forward or sitting down (shopping trolley)
Signs
- Men
- Lumbar
- Variable hyporeflexia
- Normal strength and sensation
Investigation
- CT
Causes
- OA
- Disc degeneration
- Pagets disease
- Thick spinal ligaments
- Previous spinal trauma
Treatment
- Physio - exercise bike
- Surgery if bad - laminectomy
- Analgesia
25
Cauda equina: signs and symptoms, causes, investigation, treatment
Cauda equina - compression of cauda equina L2 down
Signs
* Leg weakness
* Reduced anal tone and sensation
* Urine retention check with catheter
Symptoms
* Saddly anaesthesia
* Severe lower back pain
* Urinary and bowel problems - retention/incontinence of either
* Leg pain/weakness/parasthesia bilateral
Causes
* Central disc herniation
* Spondylosis
* Spinal stenosis
* Tumour
* Trauma
* Infection
Investigation
* Emergency MRI of lumbar spine
Treatment
* Admit
* Decompress - surgery
* Analgesia
26
Disc herniation - signs and symptoms, causes, investigation, treatment
Disc herniation - interverterbral disc prolapse leading to pressure on nerve roots
Signs
* Decreased power, sensation, reflexes
Symptoms
* Lumbar
* Severe back pain, made worse by moving, bending forward, coughing, sitting, lateral flexion
* Radiculopathy
* Parastesia
* Weakness
* Leg pain
* Back mm spasm
Causes
* Age/degeneration
* Lifting excess wgt
* Excessive excerise
* Obesity
Investigation
* Spurlings, femoral nn stretch, straight leg raise
* PNS
Treatment
* Analgesia
* Mm relaxants
* TCA
* Gabapentin
* Rest
27
Cervical myelopathy: signs, symptoms, causes, investigation, treatment
Cervical myelopathy - compression of cervical spinal cord
Signs
* Weakness and wasting of hand mm
* Hypereflexia
* Clonus/Hofmans/Babinskis
* Normal sensation
Symptoms
* Progressive
* Weakness
* Arm, neck and leg pain
* Problems with fine motor
Causes
* Cord compression (tumour, disc herniation etc.)
* Ischaemia from vascular compression
* Osteophytes
Investigation
* C-spine x-ray - osteophytes
* MRI - canal stenosis, cord anomalies
Treatment
* Depends on cause
* Conservative: physio
* Surgery for pain and progressive sx
28
Radiculopathy: signs, symptoms, causes, investigations, treatment
Sciatica
Signs
* Leg pain
* Radiates below ankle
* Positive SLR
Symptoms
* sharp + shooting (worse w/ cough/sneeze)
* altered sensation
* reduced power corresponding myotone
* absent/reduced reflexes
* later muscle wasting/fasiculations
Causes
* Prolapsed Intervertebral disc
* Spinal stenosis
* Cauda equina syndrome
* Facet arthrosis
Investigations
* Differentiate referred pain from nerve root pain
* Referred pain
* Dull Poorly localised
* may affect both legs
* nerve root pain
* sharp well localised
* closely follows dermatone
* paraesthesia may be present
* positive SLR
Treatments
* Physiotherapy and education
* Nerve root block
* Epidural steroid injection
* Foraminal steroid injection
* Surgical decompression
29
What is the difference between myelopathy and radiculopathy
Myelopathy - compression of spinal cord
Radiculopathy - compression of nerve root
30
Define: Osteophytes, spondylosis, spondylolysis and spondylolisthesis
osteophytes - bony projection associated with the degeneration of cartilage at joints
spondylosis - umbrella term for spine degeneration
spondylolysis - stress fracture in pars interarticularis (pointy bit of vertebrae)
spondylolisthesis - Slippage of vertebrae from stress facture above
31
what is the difference between bulbar and pseudobulbar palsy
bulbar palsy is a lower motor neuron lesion of cranial nerves 9, 10 and 12. Apseudobulbar palsy is an upper motor neuron lesion of cranial nerves 9, 10 and 12
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