more brain stuff

Question 1

risk factors for giant cell arteritis

Answer 1

polymyalgia
rheumatica
age

Question 2

pathology of giant cell arteritis

Answer 2

inflammation of temporal artery due to granulomatous build up

Question 3

symptoms of giant cell arteritis

Answer 3

claudication of jaw
scalp sensitivity
temple pain 
sudden unilateral blindness 
headache

Question 4

complications of giant cell arteritis

Answer 4

blindness

Question 5

diagnosis of giant cell arteritis

Answer 5

temporal artery biopsy
ESR and CRP up
ACE up

Question 6

treatment of giant cell arteritis

Answer 6

high dose steroid (prednisolone)

Question 7

risk factors for spinal cord compression

Answer 7

osteoporosis
malignancy
slipped disc

Question 8

treatment of spinal cord compression

Answer 8

treat underlying cause

compression relief surgery

Question 9

diagnosis of spinal cord compression

Answer 9

emergency MRI
biopsy
serum electrophoresis
CXR to check for lung cancer

Question 10

symptoms of a trapped nerve

Answer 10

patient feels pain in the distribution of that nerve because the axon spontaneously fires when irritated

Question 11

lower motor neuron lesion signs

Answer 11

signs at the level of the lesion

Question 12

upper motor neuron signs

Answer 12

signs below the level of the lesion

Question 13

causes of cauda equina syndrome

Answer 13

malignancy

disc herniation

Question 14

signs of cauda equina syndrome

Answer 14

mixed UMN and LMN signs
leg weakness
early urinary retention

Question 15

symptoms of cauda equina syndrome

Answer 15

low back pain
pain that radiates down leg
numbness around anus
loss of bowel or bladder control

Question 16

complications of cauda equina syndrome

Answer 16

ongoing bladder/sexual dysfunction

Question 17

diagnosis of cauda equina syndrome

Answer 17

CT/MRI

Question 18

treatment of cauda equina syndrome

Answer 18

surgical relief

laminectomy

Question 19

risk factors for Brown-Sequard syndrome

Answer 19

trauma

septic emboli

Question 20

pathology of Brown-Sequard syndrome

Answer 20

damage to one half of the spinal cord

Question 21

signs of Brown-Sequard syndrome

Answer 21

loss of two point discrimination
ipsilateral UMN weakness
ataxia
ipsilateral Babinski sign

Question 22

symptoms of Brown-Sequard syndrome

Answer 22

ipsilateral paralysis and loss of proprioception

contralateral loss of pain and temperature sensation

Question 23

diagnosis of Brown-Sequard syndrome

Answer 23

MRI

Question 24

risk factors for accessory nerve disorder

Answer 24

medical procedures to neck - e.g. cervical lymph node biopsy

Question 25

pathology of accessory nerve disorder

Answer 25

palsy of accessory nerve, leading to sternocleidomastoid and trapezius function loss

Question 26

signs of accessory nerve disorder

Answer 26

loss of muscle mass fasciculations partial paralysis winged scapula

Question 27

symptoms of accessory nerve disorder

Answer 27

muscular weakness in trapezius and sternocleidomastoid

Question 28

treatment of accessory nerve disorder

Answer 28

surgical repositioning of muscles | preservation of C2-4

Question 29

risk factors for Bell's palsy

Answer 29

diabetes | pregnancy

Question 30

pathology of Bell's palsy

Answer 30

CN7 palsy, often as a result of a viral infection

Question 31

signs of Bell's palsy

Answer 31

``` unilateral facial weakness numbness/pain around the ear ageusia (loss of taste) sagging of mouth speech difficulty unable to wrinkle forehead ```

Question 32

complications of Bell's palsy

Answer 32

crocodile tears - unilateral lacrimal stimulation

Question 33

diagnosis of Bell's palsy

Answer 33

rule out brainstem lesion, stroke, tumour | bloods - increased Borrelia antibodies in Lyme disease

Question 34

treatment of Bell's palsy

Answer 34

prednisolone (give quickly)

Question 35

symptoms of third nerve palsy

Answer 35

pupils down and out ptosis diplopia

Question 36

what is the most common mononeuropathy?

Answer 36

carpal tunnel syndrome

Question 37

symptoms of carpal tunnel syndrome

Answer 37

aching in hand and arm (esp. at night) paraesthesia in thumb, index, and middle finger relieved by dangling arm over the bed

Question 38

diagnosis of carpal tunnel syndrome

Answer 38

maximal wrist flexion for one minute can induce symptoms | tapping over the nerve can cause tingling

Question 39

treatment of carpal tunnel syndrome

Answer 39

splinting local steroid injection decompression surgery

Question 40

what percentage of patients over 40 with myasthenia gravis have thyme hyperplasia?

Answer 40

70%

Question 41

what percentage of patients with myasthenia gravis have a thymic tumour?

Answer 41

10% they may have antibodies to striated muscle

Question 42

pathology of myasthenia gravis

Answer 42

autoimmune disease and B and T cell mediation antibodies to nicotinic acetylcholine receptors at neuromuscular junctions some pts have anti-MuSK instead (against tyrosine kinase)

Question 43

signs of myasthenia gravis

Answer 43

ptosis diplopia myasthenia snarl symptoms worse at end of day

Question 44

order of muscle fatigue in myasthenia gravis

Answer 44

``` extraoccular bulbar face neck limb girdle trunk ```

Question 45

complications of myasthenia gravis

Answer 45

myasthenia crisis - weakness of respiratory muscle

Question 46

diagnosis of myasthenia gravis

Answer 46

anti-AChR antibodies in 90% EMG - decreasing muscular response to repetitive nerve stimulation single fibre EMG - block and jitter of orbiculares occuli CT to exclude thymoma tensilon test

Question 47

treatment of myasthenia gravis

Answer 47

``` anti cholinesterase (pyridostigmine) immunosuppresion (prednisolone) plasma pharesis IV immunoglobulin thymectomy ```

Question 48

risk factors for peripheral neuropathies

Answer 48

``` infection ischaemia toxins (e.g. vitamin B6 excess) inflammatory disease hereditary ```

Question 49

characteristics of sensorimotor neuropathy

Answer 49

symmetrical | length dependent

Question 50

characteristics of sensory neuropathy

Answer 50

asymmetrical

Question 51

symptoms of peripheral neuropathy

Answer 51

loss of perception of temperature and pressure loss of balance (ataxia - worse in the dark) muscle cramps muscle weakness fasciculations muscle atrophy

Question 52

what should you always check for in patients presenting with asymmetrical sensorimotor neuropathy?

Answer 52

vasculitis

Question 53

treatment of peripheral neuropathies

Answer 53

amitriptyline, pregabalin, or gabapentin for pain quinine for cramps physiotherapy and walking aids to help with balance

Question 54

risk factors for Guillain-Barre syndrome

Answer 54

Campylobacter infection

Question 55

signs of Guillain-Barre syndrome

Answer 55

rapid ascending paralysis and sensory deficits | GI infection might precede the disease

Question 56

treatment of Guillain-Barre syndrome

Answer 56

IVIG - plasma exchange - do immediately | ITU