Neuro Flashcards
(193 cards)
1
Q
Two signs in meningism
A
Kernigs
Brudzinskis
2
Q
Clinical picture of optic neuritis
A
Uhthoffs phenomenon Pain with eye movements Other MS signs Loss of monocular vision RAPD
3
Q
What does RAPD stand for?
A
Relative afferent pupillary defect
4
Q
Differentials of weakness
A
MS - optic neuritis ? RR pattern? Uhthoffs?
GB - post GI infection, ascending
MND - upper and lower MN signs
B12 deficiency - distal weakness
Myopathy - proximal weakness
Mononeuropathy - Saturday night palsy (radial)
Stroke (ask about and coats+ heart probs)
5
Q
Management of encephalitis
A
If viral - acyclovir + nutrition &physio
6
Q
Acute management of meningitis
A
Assess consciousness
Blood cultures
Abx - vancomycin + cefalosporin
Steroids- dexamethasone
7
Q
Triad of meningitis Symps
A
Neck stiffness
Fever
Headache
8
Q
Two viral causes of encephalitis
A
Herpes simplex virus HSV
Varicella zoster virus -VSV
9
Q
Clinical picture of encephalitis
A
Preceding flu like illness
Memory loss
Fever
Seizures
10
Q
Contraindications to LP
A
If suspect mass lesion/ RICP
Purpuric/ peticial rash
Anticoagulants
11
Q
What would LP show in Guillian Barre syndrome
A
Raised protein
12
Q
What would LP show in bacterial meningitis
A
Raised cell count
Decreased glucose
13
Q
What are the two types of rash seen in meningococcal (Nisseria meningitidis ) meningitis ?
A
Pupuric
Pecticial
- non blanching purple spots
14
Q
Red flag diagnoses of RED EYE
A
Corneal ulcer Contact lens related red eye Acute angle glaucoma Scleritis Neonatal conjunctivitis
15
Q
Three ophthalmoscope findings that require urgent attention
A
Retinal detachment
Papilloedema
GCA
16
Q
5 red flag causes of ptosis
A
Myasthenia gravis Horners syndrome Stroke 3rd nerve palsy GCA
17
Q
Define Bell’s palsy
A
Acute ipsilateral hemiparalysis of the face due to inflammation and swelling of the facial nerve in the facial canal
18
Q
What is Ramsay hunt syndrome
A
Facial pain (major) and weakness due to herpes zoster virus in the geniculate ganglion. Vesicular eruption in the external auditory meatus.
19
Q
Describe the pyramidal pattern of weakness
A
Flexors are stronger than extensors in the upper limbs and opposite is true in lower limbs
Pyramidal lesion presents w/
+spasticity
+ hypereflexia
+weakness
20
Q
What is the extra pyramidal system responsible for ?
A
Balance and posture
21
Q
What is the main structures involved in the extra pyramidal system
A
Basal ganglia
22
Q
Give 3 extra pyramidal system disorders
A
PD
Huntington’s
Wilson’s disease
23
Q
What is dystonia
A
Involuntary painful muscle movements / spasms
24
Q
Give examples of drugs responsible for drug induced dystonia
A
Antipsychotics
Neuroepilieptics
Levodopa
25
What is meant by a non organic finding and give examples of potentially non organic diseases
A finding that doesn’t have a direct anatomical cause
```
Lower back pain
Dizziness
Vomiting
Chest pain
Headache
Weakness
Visual disturbance
Sensory disturbance
```
26
Headache differentials
Tension / migraine / cluster/ med-overuse
GCA
Meningitis - neck stiffness / fever
RICP - worse in morning +bending/ sneezing
Haemorrhage
27
What is a myotome
Muscles innervated by a spinal root
28
Define dermatome
Area of skin supplied by a nerve root
29
What movement is C5 responsible for
Shoulder abduction.
30
Where would you test C7 dermatome?
Middle finger
31
Where would you test T1 innervation
Inner arm
32
Where would you test c8 dermatome
Little finger
33
Where would you test c6 dermatome
Index finger
34
What nerve root is responsible for arm flexion
C6= elbow flexion
35
What nerve root is responsible for finger abduction and suggest which nerve and which cord
T1
Ulnar
Medial cord
36
Which nerve root is responsible for elbow extension
C7
37
What myotome is responsible for finger flexion
C8
38
What muscle is responsible for elbow extension ? What nerve innervates this
```
Biceps
Musculocutaneous nerve (lateral cord therefore c5/c6)
```
39
What muscle is responsible for thumb abduction
Abductor pollicis brevis
40
Three tests for cortical sensation.
Two point discrimination
Stereognosis
Graphasthesia
41
Where do the lateral cerebrospinal neurones decussate?
At the medulla
42
Where do the ventral cerebrospinal neurones decussate?
In the ventral horn at the level of exit
43
What sensory modalities are Carried in the DCML system
Fine touch , vibration, proprioception
44
Where do the neurones of the DCML system decussate ?
At the medulla (they ascend ipsilaterally)
45
What fasiculus does S info from the upper limb travel in
Upper limb = cuneate fasciculus
46
What sensory modalities are carried in the lateral spinothalamic tract?
Pain and temperature
47
What sensory modalities are carried in the anterior spinothalamic tract
Crude touch and pressure
48
At what level do the neurones of the spinothalamic tract cross over ?
Level of entry
49
If a lesion occurs on the R side of the SC which side is proprioception lost on?
R side
50
Injury to the R side of the SC will cause pain and temp loss on which side of the body
Left
| will lead to loss of pain and temp sensation on the contra lateral side
51
Classic feature of myasthenia gravis
Fatigue-ability or face and neck
52
What disorders affect the UMN?
MS, stroke, MND
53
In a real bulbar palsy is it the UMN or LMN affected and name a condition where this may happen? How will the jaw jerk reflex present ?
LMN
GBS
Absent JJR
54
In a pseudo- bulbar palsy which neurone is affected upper or lower? And what condition might this occur in? How will the Jaw jerk reflex present
Upper
MS
Brisk JJR
55
What is verbal apraxia
Struggle to make movements of speech
56
A lesion in the DCML can be due to a deficiency in what substance?
B12
57
What is the difference between rigidity and spasticity
Spasticity is velocity dependent
58
4 causes for causes of both UMN & LMN signs
Subacute degen of SC due to B12 deficiency
Syphilis
MND
2 diff pathologies
59
Does polio effect UMN or LMN?
LMN
60
3 signs in horners syndrome
Partial ptosis
Miosis
Anhydrosis
61
What nerve can be compressed at the elbow
Ulnar
62
What nerve commonly causes wrist drop?
Radial nerve
63
In NMJ pathologies what modalities are affected
Motor only
Sensory only
Motor and sensory
Motor only
64
Give the clinical syndrome name for pins and needles caused by nerve root compression I.e. cauda equina
Radiculopathy
65
Give the clinical syndrome name for any disease of the spinal cord
Myelopathy
66
What neuro clinical syndrome could cause visual disturbances and no periods
Parasellar syndrome
67
What conditions would you see when the basal ganglia has
A- too much control
B- too little control
A- Parkinson’s
| B- chorea
68
What GCS score would someone who opens their eyes to pain, localises to pain and says inappropriate words achieve
10
| = moderate brain injury 12-9
69
What is a lateralising sign a sign of -
Inner tension
70
What sign would you see with a 3rd nerve palsy
Fixed dilated pupil
71
What is the differential of a 3rd nerve palsy
A blind eye (here will get contralateral construction w/ pen torch
72
What activities might a patient report struggling with if they have a myelopathy
Zips
Buttons
Keyboards
Phones
Fine hand movements
73
What myotome / movement is c6 responsible for
Biceps (elbow flexion)
74
What myotome is c7 responsible for
Triceps
75
What dermatome is c7 responsible for?
Middle finger
76
What dermatome is T1 responsible for ?
Little finger
77
What dermatome is c6 responsible for
Thumb and index finger
78
What dermatome is c5 responsible for
Skin over deltoid
79
What muscle movement is c5 responsible for
Shoulder abduction
80
What movement is c8 responsible for
Finger flexion
81
Where would you expect to find a tumour that causes L unsteadyness and hearing loss
L cerebellopontine angle
82
How many mls of CFS is produced in 24hours
500mls
83
How many music csf can the ventricular system hold
20mls
84
What is the total csf volume
120mls
85
What is normal pressure of the csf
5-15cm
86
3 upper motor neurone signs
Hoffmanns
Babinskis
Ankle clonus
87
The median nerve is responsible for thumb abduction. What trunk does the median nerve receive it’s motor innervation from ?
Inferior trunk
(Medial cord)
C8/T1
88
What cord does the median nerve receive it’s sensory innervation from ?
Superior trunk
| Lateral cord
89
What trunk might be damaged if shoulder abduction is not possible
Superior trunk
90
What is different about the optic nerve compared to other cranial nerves
It is part of the CNS (Hence affected in MS- blurred vision) all other cranial nerves are part of the PNS
91
What does distal weakness suggest?
Nerve pathology
92
What does proximal weakness suggest
Muscle pathology
93
Name 3 mono neuropathies
Ulnar nerve palsy
Radial nerve palsy- Saturday night palsy (compressed at axilla)
Median nerve palsy - carpel tunnel
94
What is carpel tunnel syndrome
Compression of the median nerve by the flexor retinaculum
95
Causes on mononeuritis multiplex
CT disorders
| Vasculitis
96
What is the clinical picture seen in mononeuritis multiplex
Painful
Effects many nerves across the body
Asymmetrical
Subacute presentation
97
Name the immunosuppressant classically used to tx vasculitic neuropathies
Cyclophosphamide
98
What Alzheimer’s medication is used to treat LBD
Rivistigmine
99
What ACEi is used to treat myasthenia gravis
Pyridostigmine
100
Name two immunoSs used in vasculitic disease
Azothiaprine
| Cyclophosphamide
101
Management of GBS resp failure crisis
```
ABCD
ABG
ECG
Early anaesthetic help
?Infection
Supportive autonomic management
IVIG
```
102
What is kernigs sign
Painful to straighten a flexed knee when hips are flexed
103
Brudsinskis sign
Lift neck up when straighten legs
104
How do you treat tachyC
Cardio version
105
How do you treat Bradycardia
Pacing
106
How would you treat a vasculitic neuropathy
ImmunoSS
Aripiprazole
Cyclophosphamide
107
How would you treat inflammatory neuropathies
Steroids - prednisolone
108
What sensation is effected in gluten sensitivity
Proprioception
109
Two anterior horn cell diseases
MND
| Polio
110
Horners presentation
Ptosis
Miosis
Anhydrosis
111
If you can’t planar flex your foot which nerve root is affected
S1
112
How would an L5 radiculopathy present
Foot drop and loss of sensation on big toe and dorsum of foot
113
Commonest cause of cauda equina
Prolapsed disc
114
Features of cauda equina
```
Weak legs
Sexual dysfunction
Compaction
Retention
Pain
Saddle anesthesia
```
115
Rash in dermatomal pattern=?
Shingles
116
Non motor symps of Parkinson’s
```
Sleep disturbances
Constipation
Pain
Fatigue
Anxiety and depression
Psychosis
```
117
Assymetrical features of PD
Arm swing
Tremor
Foot drop
118
Tx of benign essential tremor
Beta blockers
119
Parkinson tx
Levodopa
Co-careldopa
Selegaline
120
Parkinson’s differentials
Normal pressure hydrocephalus - exclude w. CT
Multiple systems atrophy
Benign essential tremor- will scribble all over page
121
Tx pathway for SE
Pre hospital- rectal Diaz, buccal midaz
Hosp- IV loraz , IV phenytoin
?intubate
IV dextrose
Monitor temp and acidosis
Consider causes - infection, intracranial event
Consider complications - renal damage from circ collapse, rhabdomyalisis, aspiration
122
Pathophysiology of Huntington’s
CAG repeats
Huntingtin protein aggregates
Loss of GABA neurones therefore less inhibition of dopamine release
123
What would CT in a Huntington’s pt show
Caudate atrophy
| Enlarged ventricles
124
Huntington’s differentials
BG stroke
Rh fever
Wilson’s disease
SLE
125
What is tetrabenazine
Dopamine depleting agent
126
Causes of morning headache
Sinusitis
RICP
Sleep apnoea
127
Headache differentials
```
RICP
Tension/cluster/migraine
Med over use
Meds in GTN
NPH
IHH
GCA/ trigeminal neuralgia
SAH
Meningitis
```
128
Features of RICP headache
Worse in morning
Wakes in sleep
Worse on coughing and sneezing
+\- papillodema
129
Everything about GCA
```
Scalp tenderness
Amouris fungax- sudden painless vision loss
Posterior ciliary A
Measure ESR/CRP
Jaw Claudication
```
130
Tx of migraine
Propanol -1st line
Amytriptaline 2nd line
Topirimate
Botox injections
131
Red flags for headache
```
New onset
Papillodema
RICP
Seizures
LoC
Abnormal neuro exam
```
132
Headache where you want to rest
Migraine
133
Headache where you are restless
Cluster
134
Bilateral headache
Tension
135
Unilateral headache
Migraine
Cluster
Trugeminal neuralgia
136
How many attacks do you need to have for a diagnosis of trigeminal neuralgia
3
137
Criteria for migraine
```
5 attacks
4-72hours
Unilateral throbbing
Aggravated my physical activity
Phono/photophobia
N&v
```
138
Duration of the tension headache
30mins -7days
139
Which headache is associated with red eye and lacrimation
| Ipsilateral cranial autonomic features
Cluster
140
Features of IIH
```
Over 30
Fat
Fertile - oestrogen
Visual disturbance
Headache
Lp= normal contents but high pressure
Tx = diuretics , CSF shunt , lifestyle mods
```
141
Tx of GCA
Steroids
142
Diagnosis for trigeminal neuralgia
```
3 attacks
Unilateral
In the distribution of trigeminal n
Sharp
Preceded by eating/ shaving
```
143
Tx for trigeminal neuralgia
Carbamazepine
None Opiod pain relief
Surgery
144
What does an NIHSS score of 13 indicate
Mild-mod stroke
145
What does an NIHSS score of 22 indicate
Severe stroke
146
What is the cut off score on NIHSS for a very severe stroke
25
147
What is the stroke classification system and what are the 4 classes
```
Bamford
TACS
PACS
LACS
POCS
```
148
Cause of seizure
Hyponatremia
| Trauma
149
Differentials for vertigo+ deafness
Schwannoma
| Cerebellopontine angle syndrome
150
Management of SAH
```
Supportive
Lp
Ct
Nimodipine
Reverse anticoagulant
Endovasc coiling / clipping
```
151
Differentials for cause of coma
```
Epilepsy
Stroke
Drugs/ alcohol
DKA
Addisons crisis
Trauma
```
152
Fever+ confusion should make you query what
Encephalitis
153
Pins and needles suggests what pathology
Nerve root compression
154
Problems with small hand movements might suggest pathology where?
Spinal cord
155
A lateralising sign suggests what
Inner tension
156
Causes of optic neuritis
Diabetes
Syphilis
MS
157
Features of optic neuritis
Pain w’ eye movement
RAPD
Unilateral visual acuity
158
3rd nerve palsy features
Ptosis
Eye down and out
Dilated
159
Fixed Dilated pupil differentiation
Death
Blind eye
3rd nerve palsy
Benzos
160
What is the classical presentation of a myelopathy
Fine hand movements affected i.e phones , keyboard , buttons , zip
161
How much CSF is produced in a day
500ml
162
How much CSF is there at any one time
120ml
163
What is the normal pressure of the CSF
5-15cm H2O
164
How much CSF can the ventricles hold
20ml
165
No corneal reflex = damage to which nerves
5i ,7
166
Afferent nerve of corneal reflex
Ophthalmic nerve
167
Efferent nerve of corneal reflex
Facial
168
Pupillary reflex afferent limb
Optic nerve
169
Pupillary reflex efferent limb
Occular motor
170
Stroke in the visual cortex would give what presentation
Homonymous hemianopia W/ macular sparing
171
Where does the macular receive its blood supply from
PCA and MCA
172
What visual presentation might you see in a stroke to the L temporal love
R sided homonymous congruent Inferior quadrantopia
173
What type of innervation is there into the edinger-Westfiel nucleus
Bilateral
174
Which nerve supplies SO of the eye
Trochlear
175
Which nerve supplies LR of the eye
Abducens
176
Treatment of Bell’s palsy
Corticosteroids
| +\- antivirals
177
A left sided cortical lesion would effect what area of the face
R lower quad
| Bilateral innervation to the forehead
178
What is the biggest feature of Ramsay hunt syndrome
Pain !!!
| Then facial weakness
179
Tx of Ramsay hunt
Acyclovir
180
Causes of whole face weakness
```
GBS
MG
Bilateral supranuclear lesions
Lymes disease
Sarcoidosis
```
181
Tx of trigeminal neuralgia
Carbamazepine
182
What classically causes amaourosis fungax
GCA
183
What is horners syndrome
Damage to the symp nerves that supply the face
184
Causes of B12 deficiency
Veganism
Pregnancy
Pernicious anaemia
Mal absorb- coeliac
185
What test will be positive if there is damage to the dorsal columns
Rhombergs
186
U&LMNS + glove and stocking paraparesis = what condition
Sub acute spinal degen (b12)
187
Investigations to do in epilepsy
MRI
EEG
Video EEG
SPECT
188
Cardiac causes of syncope
```
Long QT- arrhythmia
Scar from pervious MI
WPW
Brugada
Epsilon waves
Heart blocks
Valvular
```
189
Heart block causes of cardiac syncope
Trifascicular block
Mobits T2
3rd degree
190
What is trifascicular heart block
RBBB
LAD
first degree heart block
191
Name a condition where you would see synchronous jerking and one where you would see asynchronous jerking
Synchronous - epilepsy
| Assynchronous - syncope
192
You don’t give AE’s in a first seizure what do you give instead
Benzos (loraz)
193
5 differentials for black out
```
Epilepsy
NEAD
Syncope
HypoG
Hydrocephalus
```
