neuro Flashcards
(157 cards)
1
Q
types if brain herniation
A
uncal (transtentorial)
subfalcine
tonsillar
central
2
Q
what typ eof brain herniation causes a blown pupil
A
uncal - presses on CN III
3
Q
what type of brain herniation causes contralateral leg weakness and how
A
subfalcine herniation
catches the anterior cerebral arteries
4
Q
if someone has extreme HTN and bradycardia whta type of brain herniation is suspected
A
tonsillar
5
Q
what is done in a cerebellar examination
A
D- dysdiadokinesia
A- ataxia
N- nystagmus
I - intention tremours
S- slurred or staccato speech
H - hypotonia /heel shin test
6
Q
most common primary adult brain tumour
A
glioblastoma
7
Q
most common childhood brain tumour
A
GRADE 1 ASTROCYTOMA
8
Q
how would a grade 1 pilocytic astrocytoma present in children
A
evidence of raised ICP - falling behind in school
walking on tiptoes
9
Q
brain biopsy showing rosenthal fibres- corkscrew eosinophilic bundle
A
grade 1 astrocytoma (pilocytic)
10
Q
treatment of grade 1 astrocytoma
A
surgery is curative
11
Q
grade III astrocytoma called
A
anaplastic astrocytoma
12
Q
GRade III astrocytoma prognosis
A
2 year median survivial
13
Q
solid tumours with central necrosis and a rim that enhances with contrast
A
gliobastoma multiforme
14
Q
treatment of gliobalastoma and med surviala
what i sused to treat oedema
A
1 year
tx - surgical with postoperative chemotherapy and/or radiotherapy. Dexamethasone is used to treat the oedema.
15
Q
hypermethylation of what gene has been linked to improved glioblastoma prognosis
A
MGMT
16
Q
what type of surgery is performed on gliobastomas
A
fluorescence-guided surgery using 5-ALA
17
Q
what colou rdoes tumour show up after usign 5-ALA
A
pink
18
Q
how often is radio given in glioblastoma post -op
A
5 dyas a week for 6 weeks
19
Q
side effects of radiotherapy
A
drops IQ by 10
skin
hair
tired
20
Q
what chemo agent is used first line in glioblastoma
what it is then switched to
A
temozolamide - if not respondin after 6 months switch to PCV
21
Q
where are oligodendromas found
A
frontal lobe
22
Q
calcifications with ‘fried egg appearance brain biopsy
A
oligodendroma
23
Q
cancers that most commonly spread to the brain
A
lung
breast
skin. (melanoma)
bowel idney
24
Q
where do meningiomas originate from
A
arachmoid cap cells
25
psmammoma bodies on brain biopsy
meningioma
26
what cancer is seen in kids post chemo
meningiomas
27
bilateral acoustic neuromas/vestibular schwannoma assoc with what condition
neurofibromatosis II
28
what three blood tests shoul dbe done for any children with a midline tumour
B-HCG
AFP
LDH
will determine if germinoma
29
Small, blue cells. Rosette pattern of cells with many mitotic figures
medulloblastoma
30
duchennes inheritance pattern
x-linked recessive
31
pathophysiology of Huntingtons
- what protein is toxic
progressive degen of basla ganglia due to abnormally long GLUTAMINE protein that are toxic
32
in huntingtons what repeats code for gllutamine and how many are seen in a normla unaffected individual
CAG - norm 20 repeats
33
what number of repeats is diagnostic of huntingtons
36 CAG repeats
34
prognosis of huntingtons
15-20 years
35
pathophysiology of duchennes - what type of mutation
dystophin deficiency - most commonly deletion
36
diagnosis of duchennes
increased CK
genetics
37
what type of cardiomyopathy is assoc with duchennes
dilated
38
pathophysiology of spinal muscular atrophy
SMN1 deficiency - single nucleotide splices out exon & of SMN1 which is essential for prevention of motor neuron loss
39
inheritance pattern of spinal muscular atrophy
auto recessive
40
symptoms o fspinal muscular atrophy
proximal muscle weakness and wasting
repisratory muscles
41
what is lost in Spinal muscular atrophy
loss of anterior horn cells
42
what genetic mutations and corresponding chromosomes are implicated in alzheimers
Amyloid precurosr protein (APP) - chromo 21
presenilin 1 - chromo 14
presenilin 2 - chromo 1
43
what apopprotein is linked to susceptiability to alzheimer and what does it encode for
apoprotein E allele E4 - encodes a cholesterol transport protein
44
macroscopic pathological changes in alzheimer
wide spread cerebral atrophy - partic cortex and hippocampus
45
microscopic changes in alzheimers
type A Beta- amyloid plaques and intraneuronal neurofibrillary tangles cause by abnormal aggregation of the tau protein
hyperphosphorylation of the tau protein has been linked to AD
46
what neurotrasnmitter is there a deficit of in alzheimers
acetylcholine
47
non-parma management of alzheimers
-'a range of activities to promote wellbeing that are tailored to the person's preference'
- group cognitive stimulation therapy for patients with mild and moderate dementia
48
pharma management of alzheimers
mild - mod
cholinesterase inhibitors - e.g donepezil, rivastigmine and galantamine
49
second line alzheimers treatment
memeantine - NMDA inhib
50
when is donepezil contra indicated n alzheimers
if bradycardic
51
where is morphine metabolised
liver by glucorondiation
52
what is morphine excreted by
kidney
53
what is codeine metabolised by
liver
54
what pain medication is safe in severe renal impairement
alfentinil, buprenoprihne and fentanyl
55
1st line management of trigemnal neuralgia
carbamazapine
56
what is the cushings reflex
extreme HTN and bradycardia often pre-terminal event
57
what occurs in a diffuse axonal injury
result of mechanical shearing following deceleration, causing disruption and tearing of axons
58
scar formation of astrocytes is called
gliosis
59
what MAP can autoregulation in brain no longer compensate for
50mmHg
60
what is a watershed area in the brain
area between two arterial territories
61
first line investigation for suspect stroke
non contrast CT
62
scoring system for sctroke
ROSIER score
63
what medication should be given as soon as haemorhaggic stroke ruled out
300mg aspirin
64
what is the criteria for alteplase use in storke
haemorrhagic excluded
less than 4.5 hrs from onset
65
contra indications to thrombylysis in stroke
LP in last 7 days
pregnancy
GI haemorrhage in preceeding 3 weeks
intracranial neoplasm
prev haemorhhagic stroke
oesophageal varices
66
when should thrombectomy be offered
if within 6-24 hrs of stroke involving the PROXIMAL ANTERIOR CIRCULATION
67
when should thrombectomy be offered
if within 6-24 hrs of stroke involving the PROXIMAL ANTERIOR CIRCULATION
OFFER THROMBYLSIS TOO IF <4.5 HRS
68
second prevention medications after ischaemic stroke
clopidogrel
aspirin + MR dypiridamole if clop not tolerated
69
what level of carotid stenosis would warrent an carotid endartectomy following TIA
>70%
70
defitnition of a TIA
a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction. REF
71
most common site of thrombotic cerebral infarct
MCA
72
most common site of orgin in emboli in stroke
ICA or aortic arch
73
what aneurysms can cause haemorhagic stroke
charcot - bouchard aneurysm
74
where do most berry aneurysms occur
ICA
75
most common cause of subarachnoid haemorrhage
head trauma
76
first line investigation for subarachnoid haemorrhag
non contrast CT
77
when should an LP be done in suspect subarachnoid
if a CT that was done more than 6 hrs after presentation is normal do an LP
78
what time perios after onset of sympotoms should LP be done in subarachnoid haemorrhage and wy
min 12 hours to allow xanthochromia (RBC breakdown) to occur
79
what LP findings suggest sub arachnoid haemorrhage
increased or normal opening pressure and xanthchromia
80
what are UMN symptoms
increased tone (spascitiyt)
hyperrelfexia
weakness
81
what are LMN symptoms
decreased tone
muscle wasting
fasiulations
diminished refelxes
82
symptoms of progressive supranuclear palsy
parkinsonism
falls
vertical gaze palsy - patients complain of difficulty reading of descending stairs
83
IX after seizure
EEG and MRI
84
features of parkinsons
bradykinesia, tremor and rigidity
85
are parkinsons symptoms symmetrical
no they are classically asymmetrical
86
autonomic dysfucntion seen in parkinsons
postural hypotension
87
dx of parkinsons
clinically
-if young can do a DAT i.e. under 40
88
what is seen under microscope in parkinsons
lewy bodies
89
first line treatment of parkinsons if motor symptoms predominate
Levodopa
90
what type of drug is levodopa combined with to prevent peripheral metabolisation of levadopa to dopamine outside Brain
decarboxylase inhibitor e.g. cabidopa or benserazide
91
if a patient with parkinsons is admitted to hospital and cannot take their levadopa what should be done
dopamine agonist patch as rescue medication to prevent acute dystonia
92
what should be obtained prior to starting a dopamine agonist and why
echo, ESR, creatinine and chest x-ray
dopamine receptor agonists (bromocriptine, cabergoline) have been associated with pulmonary, retroperitoneal and cardiac fibrosis
93
drug class options in parkinsons
dopamine agonisst
MOA- B inhib
LEVADOPA
COMT - inhibitors
94
examples of dopamine agonsitis used in parkinsons
ropinerole, pramipexole, apomorphine
95
examples of MAO-B inhibitors
selegeline, rasagaline
96
what scan is used to differentiate parkinsonism from dystonia
DAT scan
97
what eye symptoms do kids with hydrocephalus present with
sunsetting eyes - can see alot of whites at the top
98
types of hydrocephalus
communicating
non-communicating (obstructive)
99
causes of obstructive hydrocephalus
tumours,
SAH
developmental abnormalities (e.g. aqueduct stenosis).
100
causes of non obstructive hydrocephalus
choroid plexus tumour (very rare))
failure of reabsorption at the arachnoid granulations (e.g. meningitis or post-haemorrhagic).
101
triad of symptoms in normal pressure hydrocephalus
and treatment
dementia
gait disturbance
incontinenece
weird, wet, wobbly
VP shunt
102
what is hydrocephalus ex vacuo
increase in CSF secondary to brain loss e.g. alzheimers
103
meningitis organisms in neonates
group B strep - from mum
e.coli
listeria
104
causes of viral meningitis
coxsachie
mumps
HSV
HIV
measels
105
treatment of viral meningitis
suppoertive
aciclovir if suspect seocndary to HSV
106
what is Waterhouse-Friderichsen syndrome
adrenal insufficiency secondary to adrenal haemorrhage
107
can patients with meningococcal septicaemia have an LP
no is contraindicated
108
what should be done for investigations for meningococcal septicaemia
cultures and PCR
109
management of children under 3 months with meningitis
IV amoxicillin adn Iv cefotaxime
110
management of children >3months with meningitis
Iv cefotaxime or ceftriazone
111
what shoudl be given in meningits if >50
cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)
112
when shoudl dexamethasone be avoided in meningitis
septic shock, meningococcal septicaemia, or if immunocompromised, or in meningitis following surgery' or children < 3 months
113
what should be given in suspect meningococcal disease in community
IM benpen
114
what is a coup and contra coup injury
coup - injury at point of impact
contra-coup - injury at opposite side of brain
115
what is injured in subdural heamoatoma
bridging veins
116
most common subtype of MND
ALS - amyotrophic lateral sclerosis
117
median survival of MND
3 years after onset
118
most common presentation of ALS
asymmetrical limb weakness
119
symptoms of MND
are the eyes involved
asymmetrical limb weakness
mixed UMN and LMN symps
wastiing of the hands and tibialis
fasiculations
NO SENSORY SYMPTOMS or extra ocular muscle symptoms
120
finidings on nerve conduction studies in MND
Normal motor conduction - excludes neuropathy
121
treatment of MND
Riluzole - extends life by 3 months
122
what is used to treat respiratory weakness in MND
BiPaP at night
123
what dementia is MND associated with
Frontotemporal dementia
124
what tests are done in MND and how is diagnosis achieved
nerve conduction studies - normal
electrophysioloigy - dewer impluses increased amplituted
MRI - exclude cord compresssion
is a Dx of exclusion
125
how to you distinguish rigidity from spascitity
rigidity felt throughout movement
no increase with speed
126
what is ballism
extreme form of chorea that involves swinging movements
127
what is syndenhams chorea
self limiting chorea seen in children following GABHS infection
128
causes of chorea
huntingtons, wilsons, syndenhams, drugs, basal ganglia lesion, anti phospholipid syndrome
129
what is a hypnic jerk and what clinical sign s it an example fo
jump as you fall asleep
myoclonus
130
causes of predom sensory peripheral neuropathy
diabetes
Leprosy
Vit B12 deficiency
alcoholism
uraemia
131
causes of predom motor periph neuropathy
guillane barre
charcot marie tooth
132
what infection often triggers Guillain barre
campylobacteur
133
characteristic feature of guillain barre
progressive, symmetrical weakness of all the limbs.
134
most common inital feature of guillain barre
back and leg pain
135
what direction does weakness tend to progress in guillain barre
ascending - legs first
136
what investigaitions are done in guillain barre
why is one done ?
LP and nerve conduction studies
LP - to rule out infectious mimics e.g. HIV CMV
137
what nerve conduction study results would be expected in guillain barre
decreased motor nerve conduction velocity (due to demyelination)
prolonged distal motor latency
increased F wave latency
138
what type of disease is GBS
autoimmune
139
most common hereditary peripheral neuropathy
charcot marie tooth
140
physical manifestation i charcot marie tooth
high arched foot
champagne bottle calf
141
pathophysiology of MS
autoimmune antibodies agains myelin of CNS
142
most common form of MS
relapsing remitting
143
what vitamin deficiency is linked to MS
vitamin D
144
what is the most significant symptoms in those presenting wiht MS
lethargy
145
visual symptoms in MS
optic neuritis
optic atrophy
Uhthoffs phenomenon
internuclear opthalmoplegia
146
what is Uhthoffs phenomenon and when is it seen
seen in MS
worsening of vision following rise in body temperature
147
what is Lhermitte's syndrome
paraesthesiae in limbs on neck flexion
seen in MS
148
what drug can be used to treat fatigue in MS
amantadine
149
what is seen in CSF in MS
IgG oligoclonal bands
150
what is used to treat acute relapses of MS and duration
IV or oral mthylpred for 5 days
151
treatment of spascity in MS
baclofen
152
example of DMARD in MS
natalizumab, tecfidera
153
what GCS warrants a CT in under 1 hour
<13
154
how many episodes of vomiting warrant a Ct in under 1 hour
>1
155
when should immediate head CT be done
LOC or amnesia with any of
- traumtic injury mechanism
- >65
- coagulopathy
156
what focal head injury presents with a lucid interval
extradural heamatoma
157
if MND presents without bulbar symptoms (dysphagia, brisk jaw refelx, tongue wasting) what test should be doen and why
MRI to exclude spinal cord compression
