Neuro

Question 1

Dermatome = ?

Answer 1

= area of skin supplied by a single spinal nerve/root

Question 2

Myotome = ?

Answer 2

= volume of muscle supplied by a single spinal motor nerve

most muscles have more than one myotome

Question 3

What does the lateral corticospinal tract control

Answer 3

rapid, skilled, voluntary movement

Question 4

what does the anterior corticospinal tract control

Answer 4

rapid skilled voluntary movement

Question 5

vestibulospinal tract role?

Answer 5

facilitates extensors, inhibits flexors (controls dizziness) and balance

Question 6

rubrospinal tract role

Answer 6

facilitates flexors and and inhibits extensors

Question 7

tectospinal tract role

Answer 7

truncal reflexes from sigths

Question 8

Define TIA

Answer 8

= transient and reversible episode of sudden onset neurological dysfunction caused by ischaemia without acute infarction
symps usually resolve within 24 hours

Question 9

Where do most TIAs occur

Answer 9

in the anterior circulation (carotid territory)

Question 10

what are the most rapid acting antihypertensives used in acute BP lowering after stroke/haemorrhage

Answer 10

• IV labetamol (BB)

- IV GTN

Question 11

define syncope attack

Answer 11

= paroxysmal event where changes in behaviour, sensation and cognitive processes are caused by insufficient blood/oxygen supply to the brain

Question 12

3 causes of blackouts

Answer 12

syncope
epilepsy
non-epileptic seizures

Question 13

precipitating factors for status epilepticus

Answer 13

alcohol abuse
abruptly stopping AEDs
intercurrent illness
poor compliance with tx

Question 14

define myotonia

Answer 14

= delayed relaxation of muscle after contraction

Question 15

characteristic pathology/general symptoms of MG

Answer 15

weakness and fatiguability of occular, bulbar and proximal limb muscles

Question 16

4 conditions assoc w MG

Answer 16

RA
thyroid disease
pernicious anaemia
SLE

Question 17

Ab involved in MG

Answer 17

anti-AChR and anti-MuSK

Question 18

histology of MG

Answer 18

See AChR Ig and complement deposited at post synaptic membranes

Question 19

occular symptoms of MG

Answer 19

diplopia, ptosis

Question 20

What worsens the weakness experienced in MG

Answer 20

pregnancy
hypokalaemia
emotion
infection
exercise
drugs

Question 21

Mx of MG

Answer 21

PYRIDOSTIGMINE (= acetyl-cholinesterase inhibitor)
if not controlled, add steroids, gradually decrease prednis dose
if not controlled still, add MTX/azathioprine
thymectomy if difficult to control
plasmapharesis in severe exacerbation

Question 22

what is the most common form of MND and what neurones are involved

Answer 22

Amyotrophic lateral sclerosis (ALS) - UMN & LMN

Question 23

different patterns of onset in MND

Answer 23

limb onset (most common)
bulbar onset (worse prognosis - 20%)
resp onset (least common)

Question 24

how would you distinguish MND from MS, MG and GBS

Answer 24

in MND:

• bladder and rectal sphincters usually spared
• no sensory symps

Question 25

MND (ALS) general symps

Answer 25

eventually weakness and atrophy of all 4 extremities, trunk and bulbar muscles

Question 26

characteristic sign in MND

Answer 26

fasciculations

Question 27

what is Guillain barre syndrome (GBS)

Answer 27

= acute inflammatory demyelinating ascending polyneuropathy of PNS

Question 28

what is GBS normally triggered by

Answer 28

an upper respt tract/GIT infection

Question 29

common causative agents of GBS

Answer 29

CAMPYLOBACTER JEJUNI, CMV, | others: mycoplasma, zoster, EBV, HIV - 40% no infectious cause found

Question 30

clinical presentation of GBS

Answer 30

1-3 wks post-inf: ascending symmetrical weakness, starting in distal muscles and progressing to more proximal ones over ~4wks followed by recovery see: loss of reflexes, neuropathic pain and autonomic dysfunction

Question 31

signs of autonomic dysfunction

Answer 31

sweating, tachycardia, arrhythmias

Question 32

what may lead to an ITU admission with GBS

Answer 32

involvement of resp muscles, | therefore must monitor FVC regularly in these pts

Question 33

Mx of GBS

Answer 33

IV Ig plasmapharesis (effective but rarely used) MONITOR VENTILATION

Question 34

3 cardinal symptoms/signs of brain tumour

Answer 34

symps of raised ICP progressive neurological deficit epilepsy

Question 35

signs of raised ICP

Answer 35

headache, drowsiness, N&V

Question 36

cardinal physical sign of brain tumour

Answer 36

papilloedema

Question 37

cell origin of most primary brain tumours

Answer 37

glial cell (mainly astrocytomas)

Question 38

what is dexamethasomes action

Answer 38

decreases cerebral oedema

Question 39

Mx of GBM

Answer 39

TEMOZOLOMIDE = chemo has radically improved survival in pts with MGMT mutant other mx: surgical resection (w. post-op chemo), RT,

Question 40

mx of secondary brain tumours

Answer 40

surgery not often poss but surgery and chemo have best outcome BSC often as effective as RT and prolongs QOL

Question 41

causes of meningitis in neonates

Answer 41

E coli, group B B-haemolytic strep

Question 42

causes of meningitis in adults

Answer 42

n. meningitidis, strep. pneumoniae, (h. influenzae)

Question 43

causes of meningitis in eldery

Answer 43

n. meningitidis, strep. pneumoniae, listeria

Question 44

causes of meningitis in immunocompromised

Answer 44

CMV, cryptococcus (stains with INDIA INK), TB

Question 45

S&S of meningitis

Answer 45

``` headache meningism = neck stiffness and photophobia Kernig's and Brudinski sign Non-blanching petechial rash altered mental state (oedema) fever seizures ```

Question 46

Mx of meningitis

Answer 46

if suspect bacterial - start ABX immediately IV cefotaxime (if community benzylpenicillin) if >50 add ampicillin to cover for listeria dexamethasome - decrease cerebral oedema Notify PHE!!

Question 47

prophylaxis of meningitis

Answer 47

rifampicin/ciprofloxacin

Question 48

what is encephalitis

Answer 48

inflam of brain parenchyma | affects frontal and temporal lobes --> decreased consciousness, confusion and focal signs

Question 49

what causes encephalitis

Answer 49

viral infection - most commonly HSV1 and 2 others: varicella zoster, EBV, mumps, measles, CMV, HIV non-viral - secondary to bacterial meningitis, TB, toxoplasma

Question 50

S&S of encephalitis

Answer 50

features of viral inf DECREASED CONSCIOUSNESS behavioural change, focal neurological deficit, coma, seizures

Question 51

mx of encephalitis

Answer 51

if viral URGENT ACYCLOVIR | if meningitis suspected, emergency IM benzylpenicillin