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Neuro Flashcards

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1
Q

Type of speech difficulty in MG

A

dysarthria

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2
Q

difference in MS and MG face palsy

A 
MS = pseudobulbar palsy (UMN, spastic tongue, no wasting)
MG = bulbar palsy (LMN, wasted tongue, absent reflexes)
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3
Q

MG tests

A

tensilon test
CT upper thorax for thymoma/thymic hyperplasia
ACh receptor antibodies
TFTs
Ice-pack cooling to affected eyelid resolves ptosis
EMG tests

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4
Q

what is myasthenic crisis?

A

muscle weakness leading to respiratory failure

worsened by anaesthetic and certain drugs (tetracycline)

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5
Q

what are you worried about after tensilon tests?

A

when drug wears off it can precipitate a myasthenic crisis

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6
Q

treatments for MG

A 
steroids
azathioprine
ACh-esterase inhibitors (rivastigmine)
IVIG/plasmaphoresis for crisis
thymectomy
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7
Q

symptoms of giant cell arteritis

A 
frontal headache
pain on palpation
pain brushing hair
jaw claudication on eating
visual loss
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8
Q

symptoms of trigeminal neuralgia

A

intermittent sharp pain
in mandibular/maxillary distribution
worse on eating but episodic and severe

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9
Q

physical examination of giant cell arteritis

A

temporal tenderness
palpable thickened temporal artery
visual loss

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10
Q

3 tests for giant cell arteritis

A

ESR
temporal artery biopsy
USS temporal artery

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11
Q

initial treatment of Giant Cell arteritis

A

high dose steroids (IV if visual problems) until symptoms resolve
commence osteoporosis prophylaxis

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12
Q

associated condition with giant cell arteritis

A

polymyalgia rheumatica

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13
Q

sensitivity of CT head on SAH

A

> 95 if done within 6h

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14
Q

signs of SAH on LP

A

xanthochromia if within 4h

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15
Q

what is Lhermitte’s sign

A

tingling of limbs on neck flexion in MS/cervical spondylosis

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16
Q

investigations for MS

A

LP

MRI brain/cord

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17
Q

features of demyelination

A

IgG oligoclonal bands in CSF
clinical features
MRI features don’t corelate to severity of disease (T2 hyperintense lesions)

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18
Q

most common feature in MS

A

headache

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19
Q

epidemiology of MS

A

F>M
M do worse and more likely to have primary progressive course
worsened by heat, but more common in colder climates

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20
Q

Treatment for MS

A

Bolus pred to shorten relapse
Beta interferon reduces frequency of relapse
baclofen for spasticity

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21
Q

GBS weakness distribution

A

Starts distal, gets proximal

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22
Q

Respiratory failure type in GBS

A

Type 2 (CO2 rises early and O2 falls later)

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23
Q

what FVC would indicate imiment respiratory failure

A

<1.5L with >30% drop lying flat

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24
Q

how does inclusion body myositis present

A

> 50y

slow progressive weakness of proximal and distal muscles, mimicking MND

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25
pattern for MND
LMN and UMN signs dysphagia/dysarthria respiratory involvement normal sensation
26
how to confirm MND
EMG/Nerve Conduction Studies
27
medication for MND
riluzole - doesn't improve symptoms but slows progression
28
respiratory changes in MND
elevated hemidiaphragm on CXR | spiro: reduced FVC/FEV1 with restrictive pattern
29
which recreational drug can cause parkinsonism in young people
heroin. MPTP in synthetic heroin can chemically destroy neurons in the substantia nigra
30
what is a progressive supranuclear palsy?
vertical gaze palsy parkinsonism features axial ridigity
31
how does midbrain stroke present
internuclear ophthalmoplegia and loss of conjugate eye movement
32
how does cortical-basal ganglionic degeneration present
Parkinson + syndrome | apraxia, akinesia, sensory neglect, behavioural change and aphasia
33
what would you see on fundoscopy in reaised ICP
optic disc swelling
34
what visual defect would you see in raised ICP
enlarged blind spots and constricted fields acutely more advanced there will be loss of central vision and visual acuity
35
risk factors for idiopathic intracranial hypertension
F, high BMI, tetracycline use
36
when should pt with SAH undergo LP
12h after pain onset if CT is normal
37
why do we no longer prescribe ergot dopamine agonists
pleural/cardiac fibrosis
38
why do we give COMTi in addition to L-dopa
help with motor complications like 'wearing off'. slows breakdown of levodopa, prolonging effect
39
what is 'wearing off' in parkinson's
symptoms returning before next dose and relieved after
40
what is 'peak dose dyskinesia'
shaking shortly after taking medicine that subsides after
41
characteristics of essential tremor
``` gradual onset over 5 years no other symptoms symmetrical worse on performance of tasks 50% have FH ```
42
treatment for essential tremor
reduce caffeine primidone beta blockers if not asthmatic
43
difference between parkinsons and parkinsonism
parkinsonism = dyskinesia, bilateral rest tremor, levodopa doesn't help
44
how to see dopaminergic neurone loss
DaT scan
45
causes of third nerve palsy
internal carotid artery dissection intracranial aneurysm pressing on nerve thrombotic occlusion of blood supply to nerve
46
where would lesion be in | homonoymous hemianopia
behind chiasm i.e in brain
47
treatment for BPPV
1) epley 2) Cawthorne cooksey exercise 3) watch and wait 4) prochlorperazine
48
what is juvenile myoclonic epilepsy
syndrome of TC seizures and myoclonic jerks, sometimes absence seizures. Begins in childhood and often persists into adulthood
49
what is Jacksonian march
spreading of seizure symptoms from one part of the body to another
50
what is Todd's paresis
temporary weakness in body part after seizure - mimics stroke
51
investigations for seizures
blood glucose | MRI brain
52
diagnostic criteria for RRMS
CNS inflammation not due to alternative cause, in different places in CNS and at different times.
53
treatment for RRMS
acutely: methylprednisolone chronically: beta-interferon, dimethyl fumarate second line natalizumab
54
x-ray view for occiput
Towne's view
55
what vessel is implicated in subdural haematoma
tearing of a bridging vein from cerebral cortex and a draining venous sinus
56
eye signs in raised ICP
venous pulsations later you get papilloedema
57
causes of bilateral ptosis
MG | congenital
58
what's the difference between spasticity and rigidity
``` spasticity = increased tone early on rigidity = increased tone throughout ```
59
pt with weakness down left side. why would you CXR?
aspiration metastasis/lung cancer enlarged heart/heart failure
60
how many cafe au lait spots if pathological
more than 6
61
features of type 1 NF
``` more than 6 CaL spots frecking in axilla/neck/groin dermal neurfibroma nodular neuroibroma optic glioma fundal changes lisch nodules (iris hamartomas) - need a slit lamp ``` Triad of: Neurofibroma, CaL spots, Lisch nodule
62
features of type 2 NF
bilateral 8th nerve palsy | nervous system tumours
63
Complications of NF
hypertension - RAS thoracic kyphosis - resp compromise malignant change - 10% learning difficulty
64
what is Crowe's sign?
freckling of axilla
65
which motor lesions spares the forehead
UMN
66
if facial nerve palsy what else do you look for
ears for Ramsay-Hunt syndrome and acute otitis media (hyperacusis as well) parotids for other nerves anterior 2/3 tongue for taste
67
how to localise lesion in 7th nerve palsy with other nerves
6th = pons lesion | 5th and 8th = cerebello-pontine angle
68
earliest sign for cerebello-pontine lesions
loss of corneal reflex

Capsule notes (8 decks)

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