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Neuro Flashcards

1
Q

Why do chest CT myasthenia gravis

A

Associated with thymic hyperplasia and tumours- common in elderly men

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2
Q

Management bells palsy

A

Oral corticosteroids and anti-virals

Option for surgical decompression

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3
Q

Typical presentation of myasthenia gravis

A 
Muscle weakness that easily tires and improves on exercise 
Ptosis
Diplopia 
Dysphagia 
SOB
Flattened smile
Dysarthria
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4
Q

What can cause bells palsy

A

Post viral infection

Unknown generally

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5
Q

What is a myasthenic snarl

A

Smile looks like a snarl with drooping side of mouth

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6
Q

Symptoms of bells palsy

A

Unilateral facial droop normally either eye or face
Isolated incident
Recent viral infection
No other symtoms

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7
Q

Define myasthenia gravis

A

An uncommon autoimmune condition where antibodies produced against ach receptors on post synaptic membrane of skeletal muscle. Associated with easy fatiguing

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8
Q

What are risk factors for myasthenia gravis

A 
Reduced potassium
Pregnancy
Women OCBA
Elderly men
Certain drugs
Other automimmune conditions
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9
Q

How long does it take blood to appear in CSF post SAH

A

A few hours, only reliably after 12

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10
Q

Investigations for bells palsy

A

Lyme disease test

In cases where complete paralysis of nerve evoked EMG and electroneuronography indicated

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11
Q

What is result of EMG in myasthenia gravis

A

Decremental muscle response over time

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12
Q

Extra symptom of horners

A

Retraction of eyeball into socket

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13
Q

What is xanthochromia

A

Yellow tinge to CSF indicatie of RBC breakdown in CS from a subarach bleed

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14
Q

Signs on examination of myasthenia gravis

A

Ptosis
Extraocular issues
Counting to 50 voice tires
Myasthenic snarl

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15
Q

Risk factors bells palsy

A 
Age 15-45
Nasal flu vaccine
Usual Htn T2DM etc
Cold climate
Hispanic
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16
Q

Differential for bells palsy

A

Lyme disease

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17
Q

What triad of symptoms for horners syndrome

A

Miosis- constriction of pupil
Ptosis- droopy upper eyelid
Anhidrosis- no sweat production on one side of face

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18
Q

What happens if Horners syndrome presents before age of 2

A

If the onset of Horner syndrome is before two years of age, the colored portions of the eyes (irises) may be different colors (heterochromia iridis). In most cases, the iris of the affected side lacks color (hypopigmentation).

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19
Q

What is bells palsy

A

Acute unilateral peripheral facial nerve palsy in patients for whom physical examination and history are otherwise unremarkable

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20
Q

Diagnosis for bells palsy

A

Clinical diagnosis based on absence of any other symptoms and examination signs

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21
Q

Triad of symptoms for horners syndrome

A

Miosis
Ptosis
Anhidrosis

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22
Q

Define horners syndrome

A

Damage to sympathetic supply of one side of face

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23
Q

Tests for myasthenia gravis

A 
Anti ACh-R antibodies
MUSK antibodies- muscle specific tyrosine kinase
Tensilon
EMG
Chest CT
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24
Q

Order of muscles affected in myasthenia gravis

A

Extraocular
Bulbar
Face
Neck

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25
What things do you want to rule out in rapid onset headaches
Sub arach Meningitis Encephalitis
26
What can cause rapid onset headaches
Sub arach Meningitis Encephalitis Post coital headache
27
Presentation of sub arach bleed
``` Sudden onset Worst headache ever Often occipital Focal signs Decreasing consciousness Stiff neck ```
28
Presentation of meningitis
Stiff neck Photophobia Fever Purpuric rash
29
Main investigation for meningitis
LP
30
Presentation of encephalitis
Fever Strange behaviour Fits Reduced consciouness
31
Urgent investigations for encephalitis
Head CT | LP
32
Causes of subacute/gradual onset headaches
``` Venous sinus thrombosis Sinusitis Intracranial headache Tropical illness GCA ```
33
Sign on examination of VST
Papilloedema
34
Where is pain in sinusitis
Over frontal or maxillary sinuses
35
How is pain described in sinusitis
Dull and constant ache
36
When is pain worse in sinusitis
When bending over or pressure on sinuses
37
Examples of tropical illnesses causing subacute headache
Malaria Flu like illness Typhus
38
When is headache worst in intracranial hypertension
When standing up
39
How are tension headaches described
Tight band around head
40
Are tension headaches pulsatile
No
41
Do tension headaches localise
No bilateral
42
What can accompany tension headaches
Scalp tenderness
43
Would you think malignancy with recurrent headache
No
44
What can cause recurrent headaches
Cluster headaches Migraines Recurrent meningitis Trigeminal neuralgia
45
Causes of recurrent mengingitis
HSV | Access to subarach space like skull fracture
46
What do chronic and progressive headaches indicate
Raised ICP
47
When are raised ICP headaches worse
Bending forward Coughing Walking Lying down
48
Signs of ICP headaches
``` Vomiting Papilloedema Seizures Odd behaviour Focalising signs ```
49
Things to ask about that precipitate headaches
``` Sex Trauma Drugs on Foods Analgesia ```
50
What signs indicate sub or epidural bleed
Drowsiness | Lucid signs
51
When to consider idiopathic intracranial hypertension
When imaging rules out SOL in ICP headache
52
What does pain when chewing suggest
Giant cell artheritis
53
What are signs of giant cell arthritis
Palpable pulseless temporal arteries Jaw claudication tenderness Subacute headache Visual difficulties
54
Where to palpate temporal arteries
They run up side of head in front of head and then branches over forehead
55
Why are temporal arteries pulseless in GCA
Temporal arteritis which thickens the arteries
56
Features of head trauma headache
Localised but can be widespread | Can be resistant to analgesia
57
Extra things to ask about in headache history
Drugs- analgesia rebound | Social- recent stress?
58
How to do headache history
``` SOCRATES Drugs Stress How often When in day ```
59
What are cluster headaches
Attack of severe pain localised to the unilateral orbital, supra-orbital, and/or temporal areas; lasts from 15 minutes to 3 hours
60
RIsk factors for cluster headaches
Male Smoker Drinker Head injury
61
What can precipitate a cluster headache
Alcohol
62
How long do cluster headache episodes last
15-180mins
63
How often do people get cluster headaches a day
once or twice a day- can get nocturnally
64
How long do clusters of cluster headaches last
4-12wks
65
How long is there between clusters
month- 2 years
66
How to differentiate between clusters and migraines
Migraines feel nauseous and dizzy | Cluster get hyperactivity of parasympathetic nervous system and feel agitated
67
Are cluster headaches unilateral or bilateral
Unilateral
68
Associated signs of cluster headaches
``` Miosis Ptosis Bloodshot eyes Lacrimation Rhinorrhoea Facial flushing ```
69
Laboratory finding in GCA
Raised ESR
70
Investigations for cluster headache
CT/MRI to rule out other neuro problems ESR to rule out GCA Pituitary function
71
3 cardinal features of cluster headaches
Ipsilateral cranial autonomic neuropathy Trigeminal distribution of pain Circadian pattern to pain
72
Signs of hypertension on examinations
CXR enlarged heart Papilloedema Nephropathy
73
3 classical migraine presentations
An aura for 15-30mins then followed by an unilateral throbbing headache Isolated aura without headache Episodic headaches without aura
74
What can be in prodrome for migraines
Yawning Cravings Mood changes Sleep changes
75
What types of auras can you get with migraines
Visual Motor Somatosensory Speech
76
What can symptoms be in visual auras
Jumbling of lines, dots and zigzags Distorting and melting of surroundings- chaotic vision Hemianopia
77
What symptoms tend to accompany episodic headaches
Nausea | Photophobia
78
Acronym for migraine triggers
CHOCOLATE
79
Chocolate triggers for migraines
``` Chocolate Hangovers Orgasm Cheese and caffeine Oral contraceptives Lie ins Alcohol Travel Exercise ```
80
How are migraines diagnosed
Clinically
81
If no aura is present how are migraines diagnosed
Episodic headches of 4-72 hours with nausea or photophobia Then 2 of - pulsatile - unilateral - impairs or worsened by routine activity
82
How does trigemial neuralgia present
Sudden stabbing pain in trigeminal areas that can be brief and recurrent Worse when doing anything that involves moving theit mouth Can get numbness
83
Triggers for trigeminal neuralgia
Shaving Chewing Cleaning teeth Washing
84
Define trigeminal neuralgia
Trigeminal neuralgia (TN) is a facial pain syndrome in the distribution of ≥1 divisions of the trigeminal nerve without any other neurological deficit.
85
Investigations for trigeminal neuralgia
Oral X-ray- check if problem is from dental cause MRI- rule out any other pathologies impinging upon trigeminal nerve Trigeminal reflexes- ask to clench teeth and open mouth against resistance- may deviate to side if muscle weak
86
Causes of trigeminal neuralgia
Any compression on trigeminal nerve Demylenation- extremely common in MS Tumours in brain stem or infarcts
87
Main investigations in acute stroke treatment
CXR ECG Head CT
88
When are carotid dopplers done in suspected strokes
Not acutely In TIAs When has recovered from a stroke nearly Anterior circulatory stroke
89
Why do you get aspiration pneumonias post stroke
Lack of gag relfex causing aspiration of salvic and gastric contents
90
Why do you check ESR post TIA
Vasculitis can cause TIAs
91
What test must always be done in case of suspected symptomatic carotid stenosis
Carotid doppler
92
What tests can be done to further evaluate carotid stenosis
CT/MRI angiography- convential angiography very rarely used now due to risk of stroke
93
Investigations for TIAs
Carotid doppler CT/MRI angiography Echo
94
Why are echos done for TIAs
To look for valvular disease, atrial tumours which can all cause TIAs Check for LVF as sign of end organ failure secondary to hypertension
95
Who do we do carotid endartectomy on
Patients who are fit and have had a TIA or recovered from a stroke well in the past 6 months
96
What is cut off level of stenosis for endartectomy
Has to be over 70% stenosed
97
Can you get absence of bruits in severe stenosis
Yes
98
Management principles for TIAs
Lifestyle Hypertension management Prophylactic anti-platelet agent such as aspirin, clopidogrel
99
Are reflexes normal in myasthenia gravis
Yes
100
What is the tensilon test
Used in suspected myasthenia gravis. A short acting acetylcholinesterase inhibitor is given aswell as saline, in positive myasthenia cases weakness temporarily subsides within a minute
101
What is danger of tensilon test
Can set off a myasthenic crisis
102
What can happen in myasthenic crisis
Arrythmia | Breathing difficulty- can get apnoea
103
What endocrine organ is associated with myasthenia gravis
Thyroid
104
What can precipitate myasthenic crises
Opiates some antibiotics β-blockers Tensilon test
105
What is amaurosis fugax
Sudden onset blindness that can resolve
106
What artery does GCA tend to affect
Branches of external carotid
107
Important thing to ask about in GCA
Pain and aches in muscles
108
What is name given to constant aches and pains in various muscles
Polymyalgia rheumatica
109
Investigations for GCA
ESR and CRP FBC Temporal artery biopsy Temporal artery US
110
Presentation of MS
Attacks of monosymptomatic episodes which can include visual, bladder, cognitive and sensory problems
111
Common symptoms of MS
Bladder- incontinence, urine retention Sexual- ED Sensory- tingling and numbness Cognitive- amnesia, reduced executive functioning Cerebellum- ataxia, intention tremor, scanning speech Eye- diplopia, optic neuritis, hemianopia GI- swallowing and constipation
112
What can trigger symptoms of MS
Heat | Exercise
113
What is scanning speech
Sentences spoken by syllable and with varying tones
114
What is optic neuritis
When optic nerve gets inflammed by any inflammation causing condition such as MS, sarcoid and lyme disease
115
What is ataxia
Inability to coordinate bodys movements
116
Symptoms of optic neuritis
Blurry vision Painful to move eyes Loss of colour seen
117
What is thunderclap headache
Very sudden onset headache that reaches max intensity within 10-15 mins
118
Presentation of sub arach
``` Thunderclap headache Drowsiness Confusion Nausea Neck stiffness Fever ```
119
What must always do if reduced GCS in ED
Medical emergency so urgent investigations
120
Investigations for subarach ED in order
CT | LP- LOOK FOR XANTHACHROMIA
121
Most common causes of subarach
Berry aneurysms AV Malformations Hypertensive haemorrhages Trauma
122
Rarer causes of subarach
Infection Anticoagulants Tumours Vasculopathy
123
Investigation for SAH when confirmed
Angiogram
124
Where do SAH tend to affect
Circle of willis most commonly anterior and posterior communicating arteries
125
Treatment plan for SAH
Neurosurgery
126
Investigations for MS
MRI | CSF electrophoresis
127
Findings of MS investigations
MRI- white sclerotic plaques | CSF electrophoresis- oligoclonal bands
128
CSF feature of Guillain Barre syndrome
High protein | Normal cell and glucose
129
What does headache that affects sleeping indicative of
Raised ICP
130
What is fluctuating consciousness indicative of
Subdural haematomas
131
What must be considered in elderly patients with neuro symptoms
Frail so susceptible to falls- consider bleeds
132
How are subdural haematomas classified
Based on onset of symptoms Acute- up to 72 hours Subacute- 72hours- 20 days Chronic- over 20 days
133
How to diagnose subdural bleed
Crescent or sickle shaped bleed
134
What is complication of GBS
Respiratory muscle weakness leading to T2 muscle RF
135
What is GBS
Acute demyelinating polyneuropathy that often occurs after an infection
136
Presentation of GBS
``` Muscle weakness in legs that ascends with bilateral symptoms Ascending bilateral parasthesia Speech difficulties CN palsys Autonomic dysfunction Recent infection Respiratory difficulty ```
137
Management of GBS priority
Must monitor FVC
138
Presentation of anterior cerebral artery stroke
Behavioural changes Weakness of contralateral leg > arm Mild sensory deficit
139
Presentation of MCA stroke
Contralateral hemiparesis of face > arm > leg Aphasia Hemisensory deficits Loss of contralateral half of visual field
140
Presentation of PCA stroke
Loss of contralateral half of visual field Sensory deficit Visual agnosia Prosopagnosia
141
Which artery supplies subcortical structures like basal ganglia
MCA
142
What are major features of Lewy body dementia (DLB)
Resting tremor Fluctuating confusion Hallucinations
143
What form of dementia presesnts with parkinsonism
DLB
144
Features of parkinsonism
resting tremor postural instability bradykinesia rigidity
145
Alzheimers typical symptoms
anterograde amnesia confusion changes in personality and mood difficulty planning
146
Anterograde amnesia
Inability to form new memories
147
What does frontotemporal dementia with
Change in personality or behaviour
148
What is depresssive pseudodemntia
Dementia like symptoms caused by an underlying depression
149
What in SBA text suggests depressive pseudodementia
Recent bereavement or trauma
150
With GBS what happens to reflexes
Reduced as LMN
151
What are alternative non neurological diagnoses for tingling
Hyperventilation | Hypocalcaemia
152
What does inability to lie flat in GBS suggest
T2 RF
153
Signs of autonomic dysfunction in GBS
Palpitations BP fluctuations Constipation Incontinence
154
How to differentiate between migraine and raised ICP when headache worsened on coughing and exertion
For raised ICP they are precipitated by it
155
What does headache worse when standing up suggest
Low ICP
156
What does headache worse when lying down suggest
High ICP
157
What are common transient visual obscurations seen secondary to increased ICP
Black dots appearing in vision in both eyes
158
What can provoke visual obscurations secondary to raised ICP
Bending down or straining
159
What is amaurosis fugax
Transient visual loss that normally only occurs in one eye
160
Which eyes does optic neuritis normally affect
Monocular however can be both sequentially or simultaneously
161
What are visual signs in migraines
Normally positive signs such as zig zags | Evolves over a few minutes
162
What does optic disc swelling indicate
Papilloedema
163
What are early signs of optic disc swelling
Enlarged blind spots | Peripheral constriction of visual fields
164
What are advanced signs of optic disc swelling
Loss of central vision and visual acuity
165
Pathologies in optic chiasm produce
Bitemporal hemianopia
166
Pathologies posterior to optic chiasm produce
Hemianopia
167
Pathologies in optic nerve produce
Monocular visual loss
168
Risk factors for idiopathic intracranial hypertension
Raised BMI Female Tetracycline
169
Cardinal features of parkinsons
Unilateral upper limb tremor | Increased tone in all limbs and trunk
170
When is tremor worse in parkinsons
Not being used | Anxious
171
What is drug treatment for parkinsons
Levodopa with dopa decarboxylase inhibitor such as benserazide and carbidopa
172
What are some causes of parkinsonism
Vascular Psycotic drugs Depressive states
173
Which nerve is affected in Ptosis
3
174
Damage to which parts of the nervous system can cause ptosis?
CN3 Midbrain Cervical spine
175
How to differentiate causes of ptosis
Looking at pupil changes Horners- constricted NMJ- normal Cranial nerve palsy- dilated
176
Name of tumour that causes horners syndrome
Pancoast
177
Features of pancoast tumours
Horners Cough Weight loss Wasting of hands in muscle
178
Sign on examination of neuromuscular weakness causing SOB
Raised diaphragm
179
Is the brain sensitive to pain
No it is insensate so all pain felt is by other tissues in skull such as dura, vessels and nerves
180
Purpose of headache assessment
Diagnose headache subtype Determine cause by excluding secondary cause Explain diagnosis and rational for treatment Optimise treatment
181
Important examinations to always be done with headache
``` Full neuro exam Fundoscopy Meningism Systemic examns Temperature BP ```
182
Differentiation between secondary and primary headache
Secondary has known causative disorder whereas primary has no causative disorder
183
Examples of primary headache
Cluster headache Tension headache Migraine
184
Examples of secondary headaches
``` Infection Vascular Trauma ENT causes Metabolic ICP Drug withdrawal Headache psychiatric disorder ```
185
3 headache classifications
Primary Secondary Cranial neuralgia
186
Examples of metabolic causes of headache
Hyoglycaemia | Hypercalcaemia
187
Drugs that can cause rebound headaches
ETOH Opiods Anti-depressants Tramadol
188
Headache red flags age
Middle aged to elderly
189
Headache red flags type of onset
Abrupt and severe
190
Headache red flags site
Temporal- increasing severity
191
Headache red flags pattern
Alteration in frequency or severity
192
Headache red flags systemic signs
Abnormal examination Fever Weight loss
193
Headache red flags neurological signs
LOC Meningism Confusion Focal signs
194
Headache red flags triggers
Posture Valsalvar Coughing Exertion
195
Headache red flags secondary RFx
``` Systemic disease Cancer HIV 3rd trimester pregnancy Trauma recently ```
196
What is SAH commonly mistaken for
Migraine
197
What proportion of SAH present with only headache
1/3
198
How does CT sensitivity for SAH change over time
Over time becomes harder and harder to detect
199
Investigations for SAH
CT within 4 hours ideally | LP after 12 hours to be sure its xanthochromia
200
When is xanthochromia reliable after onset of headache
12 hours-2 weeks
201
What is name of test used to determine if xanthochromia present
Spectrophotometry
202
Causes of thunderclap headaches
``` Any stroke Venous thrombosis Cervical artery dissection Meningitis Vasculitis Pituitary Apoplexy SIH Hypertensive crisis ```
203
What is SIH
Spontaneous intracranial HTN
204
Important thing to remember with imaging in thunderclap headache
Many of the causes will have normal appearances
205
Important thing when doing vertigo or dizziness headache
Ask patient to tell you what they mean | Dont put words in their mouth
206
Description of vertigo
You feel like the world is moving arounf you and you are moving too in the world
207
Description of pre-syncope
Light headness and visual changes
208
What is a nystagmus
Eye twitching that gives impression of world moving
209
Areas of brain associated with vertigo
Cerebellum | Brain stem
210
Common peripheral causes of vertigo
BPPV Meniers Vestibular neuritis
211
Test for BPPV
Dix Hallpike manoeuvre
212
Problem with Dix Hallpike test
Must be done by someone trained in it
213
How to differentiate between papilloedema and papillitis
Papillitis will be associated with pain when moving eyes
214
Important history qs for diplopia
``` Onset Character- what plane? Dutation Associated Sx Triggers/alleviated ```
215
Difference between surgical and medical third nerve palsy in terms of cause
Medical- ischaemia of nerve | Surgical- pressure on nerve
216
Difference between surgical and medical third nerve palsy in terms of presentation
In surgical you see mydriasis before down and out palsy as parasympathic supply on outside of nerve bundle which will be seen first however in ischaemia it affects centre of bundle first so there is muscle problem before mydriasis
217
What do you see in third nerve palsy
Mydriasis Down and out eye Ptosis
218
Investigations for third nerve palsy
Must do brain angiogram to see for aneurysms ischaemia etc
219
Difference in whats affected between horners and third nerve palsy
CN III is Para | Horners is symp
220
How to diagnose MG
Nerve conduction studies Tensilon AChR and MUSK ABs CXR then CT
221
Tx for MG
``` ACh inhibitors Immunosuppression Plasmapharesis IVIG Potential thymectomy ```
222
How does MG present
Diplopia Ptosis Dysphagia Hyophonia
223
O/E seen in MG
Fatiguability so for example if see when ask to look up struggle to maintain it
224
How to determine if someone has binocular diplopia
Resolved by covering one eye
225
What causes physiologically binocular diplopia
Misalignment between ocular signals
226
When is EEG only really useful
If having a seizure or they just did
227
What is a seizure
Paroxysmal motor, sensory or autonomic event caused by abnormal, excessive and synchronous electrical discharges
228
What makes a seizure status elipticus
Last over 5 minutes, a seizure will normally last less than 5
229
Whats a convulsion
Motor seizure
230
What is epilepsy
Chronic disease of brain predisposing you to recurrent unprovoked seizures
231
What is normal criteria for epilepsy
- 2 or more unprovoked seizures 24 hours apart OR - 1 seizure with strong likelihood of another
232
First classification of seizures
General vs focal
233
Difference between general and focal seizures
General affects both hemispheres simultaneously and focal arises from one specific area in one hemisphere or a whole lobe
234
How are genrealised seizures classified
Motor or non motor
235
What is common in all general seizures
LOC
236
What is classification of motor seizures
``` Tonic Clonic Tonic-clonic Atonic Myoclonic ```
237
What happens in tonic seizure
Stiffening of muscles
238
What happens in clonic seizures
Twitching of muscles
239
What happens in tonic clonic seizure
Stiffening of muscles with twitching
240
Common other Sx of tonic-clonic seizures
``` Involuntary scream or cry Uprolling of eye Respiration secretions deposited in oropharynx so scream Tongue biting Incontinence ```
241
What happens after a seizure
Patient can be very confused and conciousness impaired- post ictal phase
242
What is name given to phase after seizure where sleepy
Post-ictal phase | NOTE- if unwitnessed can be only sign of seizure
243
What happens in atonic seizure
Sudden loss of tone so collapse
244
What happens in myoclonic seizure
Sudden rapid contractions of muscles often when waking up
245
Other name for non-motor seizures
Absence seizures
246
Who are absence seizures common in
Children and teenagers
247
What happens in absence seizure
Sudden loss of consciouness where no change in postural muscle tone
248
What can absence seizures be confused with
ADHD as teachers think they are just staring into space
249
How are focal seizures classified
Simple partial | Complex partial
250
Difference between simple and complex partial seizures
Simple doesnt impair consciousness
251
What are complex partial seizures followed by
Post ictal phase
252
What can focal seizures be
Motor, sensory or autonomic
253
What can often precede focal seizure
Auras
254
Common Sx of auras seizures
``` Chewing Lipsmacking Eyeblinking Weird smells Feelings of fear or deja vu Rising sensations in abdo ```
255
What seizure can precede the other
Focal can have secondary general ones
256
Common symptoms of focal seizures
Unilateral shaking | Turning head to one side
257
What is todds paresis
After a focal seizure you can have a focal weakness on a side of the body
258
Pnemonic for causes of seizures
VITMAINS
259
Causes of seizure
``` Vascular Infectious Trauma and toxins Autoimmune Metabolic Idiopathic- epilepsy Neoplasm Psycogenic seizures ```
260
Common toxins causing seizure
Cocaine OD Ampthetamine OD Alcohol withdrawal
261
Which medications can cause seizures
Isoniazid- TB | Bupropion
262
Infectious causes of neurological pathology
Menigitis Encephalopathy Abcess
263
Autoimmune causes of seizure
SLE | Vasculitis
264
Metabolic causes of seizures
``` Hyponatraemia Hypocalcaemia Glycaemic Hyperthyroid Thiamine deficiency ```
265
Why should seizures be considered in females
Pre-eclampsia
266
DDx of seizure
TIA Migraine Syncope Vertigo
267
When diagnosing seizure what would procede syncope
Light headedness | Sweating
268
Who has psycogenic seizures
History of trauma or abuse
269
What differentiates psycogenic seizures
Retained awareness | Plevic thrusting
270
What differentiates TIA from seizure
TIA lasts a long time with Sx of stroke
271
What makes you think vertigo over seizure
Position they were in | Lasts minutes to days
272
When taking seizure history what is first thing must consider
First time? | If not first then epilepsy so check if medication adequate
273
Workup for first time seizure
``` FBC Electrolytes LFT Glucose Tox screen Pregnancy test ECG for syncope DDx Head CT LP if infection ```
274
Imporant 2 questions to ask when doing a neuro history
Where is the pathology? | What is the type of problem?
275
Possibilities for location of neuro problem
``` Brain Spinal chord Nerve root Peripheral nerve NMJ ```
276
What are possibilities for causes of neuro problems
``` Vascular Infection Inflammation Toxic Tumour ```
277
What will make you think of a brain pathology
Contralateral loss Hypertonia Hyperreflexia
278
What will make you think of a spinal chord pathology
Bilateral sensory or motor loss | Sensory loss up to a certain point
279
What will make you think of radiculopathy
Loss of sensation in a dermatome | Loss of power in all movements supplied by one nerve
280
What will make you think of a mononeuropathy
Sensory or motor loss in specific distribution of one nerve
281
What will make you think of a polyneuropathy causing sensory loss
Glove and stocking distribution
282
Cerebellar signs
``` Ataxia Coordination Dysdiadochokinesia Intention tremor Speech slurred and scanning ```
283
Way to remember cerebellar signs
DANISH
284
Causes of infectious peripheral neuropathy
HIV
285
Causes of metabolic peripheral neuropathy
Diabetes B12 deficiency Uaraemia Hypothyroidism
286
Causes of toxic peripheral neuropathy
Alcohol | Drugs
287
Causes of malignant peripheral neuropathy
Paraneoplastic
288
Peripheral neuropathy with macrocytic anaemia
B12 deficiency
289
Peripheral neuropathy with raised GGT | and MCV
Alcohol
290
Peripheral neuropathy with high TSH
Hypothyroidism
291
Peripheral neuropathy with elevated urea
Uraemia
292
Peripheral neuropathy with chronic infection/ inflammation or myeloma
Amyloidosis
293
How can myelomas cause peripheral neuropathies
Producing many Ig
294
Inflammatory causes of peripheral neuropathy
Vasculitis CTD Inflammatory demyelinating neuropathy
295
Hereditary cause of peripheral neuropathy
Hereditary motor sensory neuropathy
296
Fundoscopy finding MS
Papillitis
297
Presentation of papillitis
Blurred vision | Pain on eye movement
298
What is paraparesis
Partial weakness of legs
299
Causes of vascular spastic paraparesis
Blockage of anterior spinal arteries
300
Causes of infective paraparesis
HIV | Tuberculoma
301
Metabolic cause of spastic paraparesis
B12 deficiency
302
Inflammatory cause of spastic paraparesis
Transverse myelitis
303
What is meralgia parasthetica
Compression of lateral femoral cutaneous nerve
304
Presentaion of meralgia parasthetica
Pain on anterolateal thigh | Parasthesia there too
305
Common radiculopathy example
Sciatica
306
What is sciatica
Compression of lumbosacral nerve
307
Presentation of sciatica
Pain in buttock that radiates down the leg below the knee
308
What can cause nerve root compressions
Disc herniation | Spinal canal stenosis
309
Treatment of meralgia parasthetica originally
Reassuring the pt Advising to avoid tight garments Lose weight
310
Tx of meralgia parasthetica if worsens
Carbamezapine
311
Triad of parkinsons
Tremor Rigidity Bradykinesia
312
Lewy body dementia Sx
Parkinsons Dementia Hallucinations
313
What would cause confusion after moving to a new house
CO poisoning
314
Ddx confusion
``` Degenerative Hypoglycaemia Vascular- bleeds Infection- pneumonia Inflammatory Malignancy Metabolic- drugs, LFTs, UandEs, ```
315
Metabolic causes confusion
``` Encephalopathy Hypocalcaemia Hygolycaemia Hyponatraemia Vitamin defiecencies Endocrinopathies ```
316
AMTS
``` DOB Age Time Year Place Address Who am I Prime minister Second WW Count back from 20 ```
317
Signs of meningitis
Fever Menigism Kernigs sign
318
What is kernigs sign
Flex knee and hip to 90 degrees from trunk and try to straighten leg
319
What is GCA associated with extra skull
Polymyalgia rheumatica Shoulder girdle pain Stiffness around trunk
320
What is polymyalgia rheumaica
Pain in stiffness in muscles around the trunk so shoulders hips etc
321
What must do immediately with GCA
Steroids ESR check Biopsy
322
Immediate management of someone who had stroke over 4.5 hours ago
Aspirin 300mg Swallow screen Maintain hydration and oxygenation etc
323
Treatment for TIA
Aspirin ECG, Echo Doppler
324
Long term TIA management
RF management
325
What dont you do in TIA tx
Treat BP acutely unless severe
326
Management of GBS
Cardiac monitor FVC checked IVIG
327
Simple criteria for collpase
Glucose Cardiac- arryhtmia, outflow obstruction, postural hypotension, vasovagal Seizure
328
What can cause brain abcess in frontal lobe
Sinusitis compication
329
Things to rule out after nasal trauma
Skull fracture can lead to blood behind ear and under eyes Septal haematoma
330
What can be complication of EBV in nose
Cancer especially in south east asians
331
Things to look out for inspection of neck examination
Voice changes Scars Lumps Systemic signs such as exopthalmos or chachexia
332
What to do in palpation of examination of neck
Lymph nodes Feel thyroid- get them to swallow water looking for movements of lumps. Also stick tongue out Feel neck lumps if present and exmaine them
333
How to examine a neck lump
3s - site, size, skin 3c- colour, contour, consistency 3t- tenderness, temperature, transillumination 2f- fluuctuance, fixed Pulsatile? Expansile? Auscultation for bruits
334
How does lymphadenopathy feel in infective causes
``` Firm Tender Mobile Warm Red ```
335
How does lymphadenopathy feel in invasive causes
Firm Non-tender Tethered
336
Investigations for invasive lymphadenopathy
FBC, ESR, CRP Virology, Mantoux CXR and other imaging Fine needle aspiration
337
What bacteria normally invade ascites
Gram neg
338
What condition are antimitochondrial abs elevated in
Primary billiary cirrhosis
339
On biospy what are steatosis and mallorys hyaline indicative of
Alcoholic steatosis
340
Some causes of travellers diarrorhoea
Giardia | Amoebiasis
341
How does crohns appear on CT
Thickened bowel
342
Management of crohns
Steroids | Enteral feeding
343
Blood indicators of UC
CRP | Albumin
344
What happens to albumin in UC flare ups
Down
345
Treatment for acute UC
High dose IV corticosteroids | Heparin prophylaxis
346
Why is heparin given in UC treatment
UC very prothrombotic
347
Tx for toxic megacolon
IV ABx | Urgent surgery referral
348
Extra colonic features UC
``` Arthralgia Erythema nodosum Pyoderma gangrenosum Uveitis Episcleritis Heaptic inflammatory associations ```
349
What is Pyoderma gangrenosum
Skin pustules and nodules that appear all over
350
What is vertical transmission
Mother to foetus
351
What Hep is hep D transmitted with
Hep B
352
Transmission of hep A
Faeco-oral
353
Transmission of hep B
Blood borne so transfusions, vertical and needles from tattoos, injection etc
354
Transmission of hep C
Blood borne so transfusions, vertical and needles from tattoos, injection etc
355
Transmission of hep D
Co-infection with B so blood borne
356
Transmission of hep E
Faeco-oral
357
Complications of Hep C
Cirrhosis Hepatocellular carcinoma Mesangiocapillary glomerulonephritis
358
What is used to monitor Hep C treatment response
RNA level
359
What should be measured prior to Hep C treatment
Viral load | Virus genotype
360
Causes of bitemporal hemianopia
Neoplastic Pituitary adenoma Cranipharyngioma Glioma of chiasm Non neoplastic Cysts of dermoid and epidermoid Sarcoid Aneurysm
361
Where is lesion if unilateral eye loss of vision
Optic nerve of that eye
362
Where are homonymous hemianopia lesions
Optic tract
363
Where can quadrantopia lesions be
Optic radiation
364
Where does optic tract run from
Optic chiasm to geniculate nucleus
365
Caues of intra cerebral bleed
HTN Rupture of aneurysm or AVM Necrosis of vessel from tumour of infection Cerebral venous thrombosis
366
Causes of intracerebral haemorrhage in young ppl
AVM | Aneurysm
367
What is an AVM
Arterio venous malformation- goes straight from artery to vein without going through arterioles from venules going from high to low pressure
368
What is indicated when have no awareness of any stimulus or neglect
Right side- parietal
369
What is a dysconjugate gaze
Diplopia
370
What is used to as thrombolysis in stroke
Alteplase
371
What condition are cafe au lait spots seen in
Neurofibromatosis
372
What arteries are affected in GCA jaw claudication
Mandibular branch of external carotid
373
What arteries are affected in GCA scalp tenderness and headache
Superficial temporal of EC
374
What arteries are affected in GCA in diplopia and visual field loss
Posterior ciliary arteries Diplopia- optic muscles nerves VIsual field loss- retinal arteries
375
5 diagnostic criteria GCA
``` Over 50 New onset headache ESR over 50 Pulsatile or tender temporal artery Biopsy finding granuloma or mononuclear cell infiltration ```
376
What does mixture of upper and lower signs suggest
MND
377
What is brown sequard syndrome
Hemisection of spinal chord
378
Presentation of brown sequard syndrome
Ipsilateral paralysis and loss of fine touch | Contralateral temp and pain loss
379
Tx for MS
Steroid course
380
What are better prognostic factors for MS
``` Onset under 25 Initial presentation of optic neuritis or sensory- ataxia very bad prognosis Long interval between relapses Fewer lesions on MRI Male ```
381
What sex is cluster headache more common
Male
382
Difference in mood during cluster headache and migraine
Cluster headache feel anxious so up and about | Migraine want to curl up in ball
383
Meningitis investigations
CT LP blood cultures
384
Primary care meningitis treatment
IV benzylpenicillin
385
Secondary care meningitis tx
IV ceftriaxone and IV amoxicillin
386
Acute management of migraine
Simple analgesia | Triptans
387
Migraine prevention medications
Trigger avoidance Propanolol Topiramate Amitriptyline
388
Immediate stroke management
300mg aspirin and stop anticoagulants | CT head
389
Investigationsf or cause of stroke
Echo ECG Carotid doppler
390
Difference in decline between alzheimers and vascular dementia
Alzheimers is progressive decline whereas vascular is stepwise
391
Drug treatments for alzheimers
Donepezil | Memantine
392
Triad of LBD
Dementia Hallucinations Parkinsonism
393
Features of depressive pseudodementia
Low mood | Disinterested
394
Features of frontotemporal dementia
Personality changes
395
Cardinal symptoms of parkinsons
Bradykinesia Tremor at rest Rigidity Postural instability
396
Some common symptoms seen in parkinsons (other than cardinal)
Insomnia Hypomimia Depression Autonomic dysfunction
397
What is hypomimia
Reduced showing of facial expressions
398
2 treatment paths for parkinsons
Overall aim is to increase dopamine at substantia nigra - L Dopa and peripheral DOPA-decarboxylase inhibitor (co-beneldopa) - dopamine agonists
399
Examples of dopamine agonists
Ropinirole Pramipexole Apomorphine
400
How to tell difference between rigidity and spasticity
- In spasticity there is only resistance to movement in one direction such as in arm will be only stiff in flexion but easier in other direction - rigidity wont be affected by speed of movement but in spasticity will be more noticable when move arm faster
401
Difference in site of lesion for spasticity and rigidity
Spasticity in corticospinal tract whereas rigidity in extrapyramidal tract
402
Causes of spasticity
Anyhting affecting corticospinal tract - Stroke - Spinal chord compression - MND
403
Causes of rigidity
Anything affect extrapyramidal tracts like basal ganglia | - mainly parkinsons
404
Anatomy of meninges surrounding brain and location of vessels
``` Skull Artery Dura Arachnoid mater Pia mater ```
405
What happens in extradural bleeds physiologically
Trauma causes tearing of middle meningeal artery, blood collects between dura and skull
406
Clinical presentation of extradural bleed
History of trauma Transiet LOC Lucid interval Ongoing headache and reduced consciousness
407
What happens in subdrual bleeds physiological
Tearing of bridging veins between subdural space and subarach space- venous blood accumulates between dura and arachnoid mater
408
Clinical presentation of acute subdural bleed
Reduced consciousness | Severe focal neurology
409
Clinical presentation of chronic subdural bleed
Little or no history of head trauma | Reduced consciousness and severe focal neurology
410
Which groups of people are very susceptible to subdural bleeds
Elderly | Alcoholics as their bridging veins become very weak
411
What type of lesion is upgoing plantars
UMN
412
What type of lesion is pronator drift
UMN
413
What type of lesion is fasiculations and fibrillations
LMN
414
LMN causes of lesion
MND Trauma Polio
415
UMN causes of lesion
MND MS SOL Stroke
416
What medical syndromes could confused be
``` Delirium Dementia Mental impairment Psychosis Receptive dysphasia Expressive dysphasia ```
417
What is delirium
Acute impairment in cognitive ability with impaired consciousness
418
What is dementia
A chronic progressive impairment in cognitive ability with intact consciousness
419
What is psychosis
Disorder of thought and perception
420
Where is damage in receptive dysphasia
Wernickes area
421
Where is damage in expressive dysphasia
Brocas area
422
If patient has confusion what should you do first
Assess ABC then do AMTS. Can also differentiate between expressive and receptive dysphasia Check if in any pain
423
How would you differentiate between expressive and receptive dysphasia
Get them to follow a 3 step command- receptive | Can they name 3 common objects- expressive
424
Questions for AMTS
``` Give them an address Orientation in time 1. What time is it 2. What year is it 3. How old are you Orientation in space 4. Where are you Long term memory 5. What is your DOB 6. When did WW2 end 7. Who is PM Orientation in person 8. Who am I Short term memory 9. count back from 20 10. Can you remember address i gave you ```
425
Qs for collateral confusion history
Normal state? Time course of confusion Drug history
426
Surgical sieve for confusion
``` Infection Neoplastic Vascular Immune Trauma Endocrine Drugs Metabolic Degenerative ```
427
Infective causes of confusion
``` Chest infection UTI Encephalitis Brain abscess Sepsis ```
428
Vascular causes of confusion
Stroke | MI causing hypoperfusion
429
Trauma causes of confusion
Extradural | Subdural
430
Endocrine causes of confusion
HHS DKA Any thyroid problem
431
Drug causes of confusion
Intoxication or withdrawal from opioates, alcohol or psych meds Overuse of diuretics, digoxin and thyroid meds
432
What accounts for 30% of confusion cases
Drug toxicity
433
Metabolic causes of confusion
``` hypoxia Hypercapnia Hypercalcaemia Sodium or any electrolyte imbalances Hypoglycaemia Vit B12 or folate deficiencies ```
434
"Other" causes of confusion
Hypothermia | First time presentation of dementia
435
Vital signs to look out for in confusion assessment
``` Pulse and RR- tachypnoea and tachycardia infection BP- hypoperfusion, cushing reponse Fever- underlying infection, sepsis? Sats- hypoxia can cause confusion Blood glucose- HHS, DKA or hypo? ```
436
What is cushing repsonse
Occurs in raised ICP- bradycardia with HTN
437
Examination of confused patient
``` Obvs going to be difficult but look out for these Consciousness- GCS Septic focus Pupils Focal neurology Needle tracks Asterixis Bitten tongue or shoulder dislocation Breath for alcohol ```
438
When confused what will you look for in spetic screen
Chest- crackles UTI- tenderness, urinalysis Cellulitis Meningitis- neck stiffness, photophobia
439
What will dilated pupils in confusion suggest
Cocaine or TCA OD Hypoxia Hypothermia Post ictal
440
What will pinpoint pupils in confusion suggest
Opiates or barbiturate OD
441
What does asterixis in confusion suggest
Hypercapnia Hepatic encephalopathy Uraemia
442
What to smell for in breath
Alcohol Fetor hepaticus Uraemic fetor Fruity- DKA
443
What is fetor hepaticus
Musty smelling breath from breakdown failure of liver
444
What is uraemic fetor
Urine smelling breath from renal failure due to excretion failure
445
Septic screen investigations for confusion
``` FBC CRP Blood cultures Urinalysis Mid stream urine sample for urine cultures CXR ```
446
Metabolic screen investigations for confusion
``` ABG U&Es TFTs LFTs Thiamine Haemitinics ```
447
What to look for in FBC confusion
WCC confusion | Anaemia may contribute to hypoxia
448
What to look for in urinalysis confusion
Leukocyte esterase Nitrites **Positive predictor for UTI is only if both are raised Glucose or ketones may suggest diabetic complications
449
Important thing to remember in urinalysis obtaining method
Should be midstream, in and out catheter sample or suprapubic catheter Important as first part of micturition normally contaminated
450
What to look for CXR confusion
Infection sign | Cardiomegaly- HF causing hypoperfusion
451
What to look for in ABG confusion
Uraemia, DKA and some toxins cause metabolic acidosis | Hypercapnia
452
Main investigations for confusion
Spetic screen Metabolic screen ECG Tox screen
453
Why does infection not always present with fever in old people
Temperature regulation is poor
454
What are two main risk factors for MS
Smoking | Vit D deficiency
455
What are 3 causes of sudden onset eye pain
Acute glaucoma Anterior uveitis Optic neuritis
456
Typical MS patient in SBAs
White female 20-40
457
What is uthoffs phenomena
MS symptoms worse after exercise or in the heat
458
In what condition do you see scanning dysarthria
MS
459
Examinations findngs MS
``` Nystagmus INO Facial parasthesia Intention tremor UMN signs Scanning dysarthria ```
460
Is radiology needed for MS diagnosis
No just need two separate attacks lasting more than 24hours at least 1 month apart
461
Good differentials for MS
B12 deficiency Transverse myelitis SLE
462
Common infections that precede GBS
``` HIV EBV CMV Mycoplasma Campylobacter **** important in history to ask about recent infections sx like diarrorhoea fever cough etc ```
463
What type of signs do you get in MS
UMN
464
What type of signs do you get in MS
LMN
465
Important investigations for GBS to do admission
ECG- autonomic dysfunction leads to arrythmias Assess postural BP FVC NCS
466
Presentation of cauda equina syndrome
``` Bilateral sciatica Saddle anaesthesia Bowel bladder dysfunction Sexual dysfunction Back pain Parasthesia in sacral and lumbar deramtomes ```
467
What does pain eased by leaning forward in cauda equina syndrome suggest
Spinal chord stenosis is cause
468
Investigations for Cauda equina
Urgent MRI | Do DRE
469
What are examination findings of cauda equina syndrome
``` LMN signs DRE - saddle anaesthesia - reduced sphincter tone Palpable bladder ```
470
If patient with CES has bladder dysfunction what should you immediately do
Catheterise
471
What is progression of alcohol withdrawal
Agitation(6hrs)-->hallucinations(12hrs)-->seizures(36hrs)-->delirium tremens(48hrs)
472
What is delirium tremens
State of complete altered mental state following alcohol withdrawal
473
Presentation of delirium tremens
``` Seizures Agitated Hallucinations Sweating Tremor ```
474
What should do if believe patient is an alcoholic or is suffering from alcohol withdrawal
Ask CAGE questions
475
What are questions should ask in CAGE questionnaire
Have you ever felt if should Cut down on drinking Does it Annoy you if people tell you you drink too much Have you ever felt Guilty about your drinking Have you ever had an Eye opener when wake up to ease hangover or settle nerves
476
Further questions for suspected alcoholics
DSM-V
477
Blood findings in alcohol withdrawal
VBG- resp alkalosis from agitated hyperventilation FBC-low plts, increase in MCV (very common blood findings of alcos) U&Es LFTS and clotting
478
Management of alcohol withdrawal
``` Oral diazepam-> IV lorezapam If that doesnt work propofol or phenolbarbital Pabrinex Glucose Supportive care ```
479
What can be used on ward to sedate patient
Haloperidol- 30-60mins | Lorezapam- 5-10mins
480
Post operaition confusion DDx
Sepsis from infection Hypoxia- anaemia from blood loss, PE, atelectasis, opiates depress resp center Electrolyte imbalances- AKI, intra and postoperative fluid replacement Alcohol withdrawal
481
What functions are tested in MMSE
``` Language expression and reception Orientation in time and space Calculation Long and short term memory Visuospatial ability ```
482
What is acute confusion state defined as
Observable impaired attention, awarenss and cognition of sudden onset. Is interchangeable with delirium
483
Features of korsakoffs syndrome
Amnesia | Confabulation
484
Indications for immediate CT
``` GCS<13 on admission GCS<15 2 hrs after admission Post traumatic seizure Focal neurological deficit Vomiting more than once Suspected skull fracture ```
485
Why dont we give everyone a CT
Large dose of radiation
486
In UMN lesions which muscle groups tend to be affected more
Extensors in arms | Flexors in legs
487
Inspection signs of UMN lesions
Contractures | Disuse atrophy
488
Inspection signs of LMN lesions
Wasting Fasiculations Fibrillations
489
What does a pronator drift suggest about lesion
Contralateral pyramidal lesions
490
Nerve root for shoulder abduction and specific nerve
C5 | Axillary
491
Nerve root for shoulder adduction and specific nerve
C6/7 | Thoracodorsal
492
Muscle | involved in shoulder abduction
Deltoid primarily
493
Muscle involved in shoulder adduction
Teres major Lat dorsi Pec major
494
Nerve root for elbow flexion and specific nerves
C5/6 Musculocutaneous Radial
495
Nerve root for elbow extension and specific nerve
C7 | Radial
496
Specific muscles used in elbow flexion
Biceps brachii Coracobrachialis Brachialis
497
Specific muscles used in extension of elbow
Triceps brachii
498
Specific nerve root for wrist extension and nerve
C6 | Radial
499
Specific nerve root for wrist flexion and nerve
C6/7 | Median
500
Specific nerve root for finger extension and nerve
C7 | Radial
501
Specific nerve root for finger abduction and nerve
T1 | Ulnar
502
Nerve root and nerve used for thumb abduction
T1 | Median
503
Muscles used finger extension
Extensor digitorum
504
Muscles used finger abduction
First dorsal interosseous | Abductor digiti minimus
505
Muscle used for thumb abduction
Abductor policis brevis
506
What does pendular reflex indicate
Cerebellar disease
507
Nerve root tested in biceps reflex
C5/6
508
Nerve root tested triceps reflex
C7
509
Nerve root tested supinator reflex
C5/6
510
What is dysmetria
Poor coordination
511
What does positive rombergs suggest
Sensory dysfunction- proprioceptive/vestibular problem
512
What does positive trendelenburg test show
Myopathy of gluteus medius or gluteus minimus
513
What is a positive trendelenburg test
If raise leg and the hip on that side drops it suggests myopathy of muscles on standing leg
514
Nerve root and specific nerve tested for in hip flexion
L1/2 | Iliofemoral
515
Nerve root and specific nerve tested for in hip extension
L5/S1 | Sciatic
516
Muscle tested for in hip flexion
Iliopsoas
517
Muscle tested for in hip extension
Gluteus maximus
518
Muscle tested for in leg extension
Quadriceps
519
Muscle tested for in leg flexion
Hamstring
520
Nerve root and specific nerve tested for in leg extension
L3/4 | Femoral
521
Nerve root and specific nerve tested for in leg flexion
S1 | Sciatic
522
Nerve root and specific nerve tested for in foot dorsiflexion
L4/5 | Deep peroneal
523
Nerve root and specific nerve tested for in foot plantarflexion
S1/2 | Tibial
524
Muscle tested for in ankle dorsiflexion
Tibialis anterior
525
Muscle tested for in ankle plantarflexion
Gastrocnemius | Soleus
526
Muscle tested for in BIG TOE EXTENSION
Extensor hallucis longus
527
Nerve root and specific nerve tested for in big toe extension
L5 | Deep peroneal
528
What does broad stance suggest
MS lesion | Cerbellar vermis damage
529
What does instability of stance when walking suggest
Cerebellar dysfunction- will lean towards side of lesion
530
What does reduced and absent arm movements suggest when walking
Parkinsons
531
What does small short shuffling steps suggest
Parkinsons
532
What does high stepping foot suggest
Weakness of dorsiflexors- damage to peroneal nerve
533
What is term for high stepping foot
Foot drop
534
What does difficulty doing heel to toe test suggest
Sensory ataxia Cerebellar problems Weakness of flexors
535
DANISH
``` Dysdiadochokinesia Ataxia Nystagmus Intention tremor Scanning speech Hypotonia ```
536
Pnemonic to remember parkinsons main symptoms
TRAP
537
How to examine bradykinesia
Finger tapping- force decreases over time | Writing on page- text shrinks across page called mircographia
538
Signs of bradykinesia
Hypomimia Hypophonia Micrographia
539
Signs of tremor in parkinsons
Pin-rolling tremor where are rolling pin in hand
540
Signs of rigidity in parkinsons
Cogwheel tremor
541
What do you find on examination of spasticity
Initial resistance but then after becomes easy- clasp knife phenomena
542
What is difference between cog wheel and lead pipe rigidity
In lead pipe rigidity there will be resistance for the duration of flexion Whereas in cogwheel rigidity there is resistance at certain points for the duration of flexion
543
What do you see leadpipe rigidity in
Neuroleptic malignant syndrome
544
When patient presents with weakness what is important to ascertain
Whether is actually sensory, ataxia or too painful
545
When patient presents with weakness what is first way to classify symptoms
Onset- acute, subacute or chronic
546
What is likely to cause acute limb weakness
Trauma or vascular causes
547
What is likely to cause subacute limb weakness
Progressive demyelination or SOL
548
What is likely to cause chronic onset limb weakness
Slow growing tumour or MND
549
What is likely to cause sudden onset weakness
Ischaemia- stroke, spinal chord infarction, acute limb ischaemia Spinal chord- prolapse, fracture, transection Non-ischaemia brain- todds paresis, hypoglycaemia, migraine
550
What is likely to cause subacute onset weakness
Brain- SOL, MS(can also affect spinal chord) Inflammatory- MS, GBS, TM Infective/toxic- poliomyelitis, botulism, tetanus
551
Gradual onset weakness causes
Spinal chord- spinal canal stenosis, Vit B12 deficiency Peripheral nerve- DM, vasculitis, alcohol, B12, uraemia, hypothyroidism, myeloma NMJ- MG, Lambert eaton syndrome MND
552
How to differentiate between disc prolapse and spinal canal stenosis as cause for CES
Disc prolapse acute onset | Stenosis- chronic
553
Important questions to ask about with limb weakness
``` Exact time of onset Speech or visual disturbances Headache Back pain Seizure or LOC Trauma or fall recently Risk factors for stroke ```
554
Limb weakness with back pain
Spinal chord prolapse, infarct, abscess or trauma GBS Transverse myelitis
555
Risk factors to ask with stroke
AF Previous stroke SLE Atherosclerotic factors
556
What percent of brocas and wernickes area of left handers are on left side
80%
557
What lobe is wernickes and brocas area in
Brocas is in frontal | Wernickes is in temporal
558
What does eye deviation show about side of lesion in weakness
If eyes deviate towards side of weaknesss lesion is in brainstem If eyes deviate away suggests that lesion is in cortical area
559
What is further support for alcohol withdrawal
Drug and Alcohol Liaison Specialist (DALS) Community services (e.g alcoholics anonymous) Therapy
560
How to investigate severity of alcohol withdrawal
CIWA-Ar scale (Clinical Institute Withdrawal Assessment from Alcohol Revised scale)
561
Physiologically what causes alcohol withdrawal
Glutamate upregulation
562
If patient has LMN motor signs but sensory pathways intact what does this suggest
Probably either a NMJ problem or muscular lesion
563
If patient has LMN motor signs but sensory pathways are not intact what does this suggest
Probably either peripheral nerve damage or nerve root
564
If there are UMN signs what does intact spinothalamic suggest
Just the dorsal columsn that have been affected
565
If there are UMN signs but only pain and temperature pathways are affected what does this suggest
That dorsal columns are intact and only anterior spine is affected- probable spinal artery infarct
566
What is carried in dorsal columns
Light touch and proprioception
567
What is carried in spinothalamic
Pain and temperature
568
What are motor signals carried in
Corticospinal
569
What are only anterior pathways affected in anterior spinal artery infarction
Pain and temperature
570
What are causes of brown sequard syndrome
trauma ischaemic Infective- TB Inflammatory- MS
571
What are causes of transverse myelitis
Inflammatory- MS, NOSD, SLE, Sjogrens, Sarcoid Infective- post viral or bacterial infection Post vaccine
572
2 most common causes of transverse myelitis
MS | NOSD
573
What is NOSD
Neuromyelitis optic spectrum disorders
574
Presentation of transverse myelitis
Ascending distal weakness and parasthesia Toilet dysfunction Back pain
575
What are signs on examination of transverse myelitis
UMN bilateral | Bilateral parasthesia
576
What is L'hermitte sign
Neck flexion leads to tingling in limbs- sign of TM
577
What is McArdles sign
Neck flexion leads to increase in limb weakness
578
Investigations for TM and results
MRI to look for chord lesions MS tests LP- increased WCC (increased neutrophil for NOSD)
579
Where to look for scars in CN exam
Behind the ear
580
What test can be used to test for spatial neglect
Hold hands out to side and ask which hands are moving
581
What should happen in accommadation reflex
Eyes should converge and constrict
582
What is abnormal RAPD test
Abnormal eye will look dilated compared to normal eye
583
What does abnormal RAPD show
Optic nerve problem- normally optic neuritis
584
What affects the blind spots in eyes
Swollen optic disc either from optic neuritis, papilloedema
585
What can cause medical 3rd nerve palsy
Iscahemia DM Vasculitis
586
What does spatial neglect on one side suggest
Parietal lobe issue
587
If there is complete blindness in one eye what does this suggest about lesion site
Optic nerve problem
588
Muscles supplied in eyebrow raising
Frontalis | Orbicularis
589
With facial weakness what does this suggest about stroke location
MCA
590
When do most TIAs resolve within
1 hour
591
What could FBC show in suspected stroke
Polycythaemia- ischaemic Thrombocytosis- ischaemic Thrombocytopenia- haemorrhage
592
Blood tests for suspected stroke
FBC- platelets, polycythaemia Glucose Cotting- coagulopathy, haemophilia
593
In strokes what is important in blood clotting results
Looking for coagulopathies, haemophilias
594
How long after thrombolysis should patient be given antiplatelet therapy
24 hours
595
In acute setting of strkoe what are risks you are worried about and how would they be managed
Recurrent stroke- LMWH can be used DVT- stockings, trying to get to mobilise, LMWH Pressure ulcers management
596
How should stroke patient be assessed over days following on from stroke
``` GCS Swallow- ?NG Speech and language Visual fields as prone to falls if affected Gait- safe to walk or not? ```
597
Drug treatment long term for stroke
Clopidogrel Statin ACEi if HTN
598
What should BP target be in diabetics
120/80
599
What happens physiologically in TIAs
Clots form but plasmin system able to dissolve them
600
What scoring system is done on TIA patients to determine when go to TIA clinic
ABCD2
601
What is most important part of TIA management
Identify cause and sort that out
602
Main things done in TIA clinic
Assess whether stroke has properly resolved Then assess RFx- HTN, diabetes, hyperlipidaemia, smoking, AF Carotid artery stenosis
603
Post any occlusive episode in brain of AF nature in origin what drug should patient be started on
Anticoagulation
604
When prescribing an anticoagulation what must be considered
The risk of bleeding especially in the elderly | Therefore need to do chadvasc and hasbled
605
Is there any point in givng an aspirin for someone who had a TIA of AF origin
No as is an antiplatelet
606
What can cause chord compression
Disc herniation | SOL including tumour, abscess, cyst or haematoma
607
If lost sensation from belly button downwards what is spinal chord lesion and vertebral level
T10 is chord level but then vertebral level will be higher up at T6
608
What is INO
Internuclear opthalmoplegia
609
Where is INO lesion
Medial longtitudal fasiculus
610
Most likely cause of INO
MS especially in younger people but in older people think of stroke
611
What happens in INO on examination
Assuming is right sided lesion When look to left (adducting right eye), right eye movement is slowed and saccadic nystagmus seen however when converge eyes there is no problem
612
If had optic neuritis then how will optic nerve function in future
RAPD will be seen in future due to damage
613
What happens physiologically in MS
T cells destroy myelin sheath
614
3 main investigations for MS and what they will show
LP- oligoclonal bands MRI- white lesions Visually evoked potentials- can measure activation of visual cortices after visual stimulus so will see delayed activation on eye that has been affected by optic neuritis
615
Are oligoclonal bands specific to MS
No
616
What are some contraindications for thrombolysis
``` Haemorrhage on CT After 4.5 hours Seizure on onset of stroke Stroke or head injury recently Major surgery or trauma within 2 weeks Thrombocytopenia INR above 1.7 ```
617
What is froments sign indicative of
Ulnar nerve palsy
618
What does para- prefix mean
Lower limbs
619
What does mono- prefix mean
One limb
620
What does tetra and quadra- prefix mean
All 4 limbs
621
What is difference between limb hemiparesis and full body hemiparesis
Full body affects the face aswell
622
What can cause a limb hemiparesis
Smt affecting all of cerebral motor cortex Smt affecting the corona radiata, internal capsule or pons Cervical vertebral prolapse
623
What could cause a paraparesis
Brain- parasagittal meningioma Bilateral motor spinal tracts- chord compression Cauda equina Bilateral lumbosacral plexus- GBS
624
What could cause a tetraplegia
Traumatic injury to cervical spine | Demyelinating disease such as GBS
625
What tends to cause proximal muscle weakness
NMJ- MG, eaton lambert syndrome Muscle problems- polymyositis Hyperparathyroidism Drugs such as statins
626
Physiologically what happens in polymyositis
Muscle cells are attacked by CD8 cells due to molecular mimicry mechanism
627
What conditions are associated with polymyositis
RA | Sjogrens
628
Which muscles does polymyositis tend to affect
Proximal- hips and shoulders
629
What can polymyositis present with difficulty doing
Walking Combing hair Lifting off of chair Swallowing
630
Diagnosis of polymyositis
Measure muscle enzymes like aldolase and creatine kinase Muscle specific antibodies- anti Jo 1 EMG Muscle biopsy
631
Endocrine causes of proximal myopathy
COT | Cushings, osteomalacia, thyrotoxicosis
632
If ataxic what must consider as 3 possible sites of lesion
Vestibular system Cerebelleum or brain stem Proprioception pathways
633
How do problems with vestibular system present
Unilateral unsteadiness and disequilibrium with associated nausea and vomiting
634
Most common causes of vestibular system ataxia
Drugs and alcohol | Must consider meniers
635
What is somatotrophic distribution of cerebellum
Trunk controlled centrally and limbs more peripherally
636
What is central part of cerebellum
Vermis
637
What do lesions to vermis cause
Lead to truncal or gait ataxia- wide stance appearing drunk
638
What happens in lesions of cerebellar hemispheres
Dysmetria Dysdiadokochinesia Scanning dysarthria
639
What is dysmetria
Difficulty judging distance
640
What is vestibulocerebellum knowns as
Flocculondular lobe
641
What do problems with flocculondular lobe lead to
Postural instability | Impaired eye movement
642
Common pathologies affecting cerebellum
``` Stroke Tumour Alcohol Demyelination Genetic disorders ```
643
What is sensory ataxia
Problem with proprioceptiom
644
What is inability to stand still with eyes closed a sign of
Sensory ataxia
645
How do people with sensory ataxia walk
Stomping feet as dont know how high to lift feet | Stumble when in dark as lose sensory input
646
Some causes of sensory ataxia
B12 defic MS Diabetes Anything causing neuropathy of proprioception
647
Top causes of seizure in young person- metabolic
Hypocalcaemia Hyponatraemia Hypoglycaemia Hypokalaemia
648
What happens in brain SOL on CT
Cerebral oedema leading to midline shift
649
Most common tumour in brain
Metastases In men from lung In women from breast
650
Cauda equina syndrome
When tail of spinal chord is affected
651
What is reflex can do for bulbar presentation to determine if UMN or LMN
Jaw jerk
652
Who does MG normally present in
Younger women or older people | In older people tend to present less with opthalmoplegia and ptosis
653
Symptoms worse late in evenings
MG
654
What is the tensilon test
Give Achesterase inhibitor | In MG sx will improve
655
What comes first in progression of alzheimers
Language and memory then personality
656
Extra pyramidal signs on examination
Pronator drift Rigidity Resting tremor
657
Causes of mixed UMN and LMN signs
Compresssion of spinal chord Subacute spinal chord degeneration MND
658
What causes subacute spinal chord degneration
B12 degeneration
659
Who are stomping gaits seen in
Diabetics
660
Who is high stepping gait seen in
Peroneal nerve damage
661
Who is hemiplegic gait seen in
UMN damage
662
What is seen in hemiplegic gait
Person circumducts their foot as cant flex hip Arm on that side may also be damaged with flexed arm and hand Flexors in arm and extensors in leg the strongest
663
Pathophysiology of BPPV
Calcium carbonate crystals in semicircular canals gets dislodged sending misinformation about heads position leading to vertigo
664
Presentation of BPPV
Vertigo triggered by movement | In history must elicit when started
665
What is important thing to bear in mind with brainstem
Wont just be one pathology as is so smalled
666
What is presentation of Menieres
Tinnitus Hearing loss Sensation of increased pressure in ear Vertigo lasting mins to hours
667
Presentation of vestibular neuritis
Vertigo Tinnitus Sensation of increased pressure in ear
668
Difference between vestibular neuritis and Menieres
Only in menieres hearing loss
669
Vertigo in migraine sufferes
Have an increased incidence that can occur with or without
670
Where is the blood in SAH
In the sulci and fissures
671
What signs on CT are indicative of severe bleed
Midline shift | Intraventricular bleeding
672
Where are lesions in memory loss
Temporal lobe but has to be bilateral lesion
673
Symptoms of posterior circulation stroke
Ataxia Nystagmus Hemianopia
674
CSF finding of viral meningitis
High protein | Lymphocytosis
675
CSF finding of bacterial meningitis
Low glucose Neutropenia Slightly high protein
676
CSF finding of TB meningitis
Slightly high protein Low glucose Lymphocytosis
677
CSF finding of fungal meningitis
Slightly high protein Low glucose Lymphocytosis
678
Difference between bacterial and viral meningitis
Bacterial much worse that can lead to sepsis
679
What are neurofibromas
Fibrinous tumours growing from nerves
680
What is neurofibromatosis
A genetic condition leading to non-cancerous growths
681
What are faulty genes in neurofbromatosis
In type 1 NF1- Chr 17 | In type 2 NF2- Chr 22
682
What is inheritance of neurofibromatosis
Autosomal dominant
683
Which nerves does neurofibromatosis affect
Those in extremeties and skin but can be along peripheral nerves and spinal nerves
684
Where are cafe au lait spots seen
Back, buttocks and thighs- normally appear in first year of life
685
In lower limb where does wasting occur first
Medial thigh
686
What does tender muscles suggest
Myositosis
687
What tends to be pathognomonic for MND
Bulbar involvement
688
What can mimic limb claudication
Spinal canal stenosis
689
When is spinal canal stenosis easier
Flexing | Easier sitting
690
When is only time pred can be given in bells palsy
First 72 hrs
691
What is it called when herpes zoster causes bells palsy
Ramsay hunt syndrome
692
What is ramsay hunt syndrome
Herpes zoster virus causes shingles
693
Symptoms of ramsay hunt syndrome
7th nerve palsy Loss of earing in ear Painful rash on face
694
Management of bells palsy
Tape eyes shut due to risk of corneal ulceration
695
How is amaurosis fugax described
Painless closing of eye
696
Differentials for amaurosis fugax
TIA- retinal artery occlusion | GCA
697
How does retinal artery occlusion present on fundoscopy
Oedema | Cherry red macula
698
Retinal vein occlusion on fundoscopy
Retinal haemorrhages | Cotten wool spots
699
How is acute glaucoma described
See haloes around everything
700
What causes spinal canal stenosis
Spondylosis
701
What makes spinal canal stenosis worse
Walking downhill- anything that extends spine
702
Which nerves does MG only affect
Motor
703
Which sensory pathways are most commonly affected in diabetic neuropathy
Pain | Vibration
704
What are some common infective neuropathies
Lyme disease | Leprosy
705
What happens to sleep in parkinsons
REM sleep affected means muscles arent paralysed
706
What do parkinsons patients do in sleep
Act it out | Scream
707
Neuro causes of collapse
Seizure | Parkinsons->postural hypotension
708
Autonomic dysfunctions of parkinsons
Post hypotensions Sexual dysfunction Constipation
709
Whoa re medication overuse headaches common in
Migraine sufferers
710
Main danger of epilepsy
Status ellipticus
711
What is phenytoin used routinely for
Epilepsy
712
What is protocol when patient seizing
``` Diazepam/lorezapam Diazepam Phenytoin Phenobarbital Intubate and give general anaesthetic ```
713
What does someone do in a complex partial seizure
Automatisms of useless activities like chewing, lipsmacking, picking things up or fumblinf around Will have no recognition as starts in temporal lobe generally
714
What is rough guidance for C4 dermatome
Above shoulders
715
What is rough guidance for T4 dermatome
Nipples
716
What is rough guidance for T10 dermatome
Umbilicus
717
What is rough guidance for L1 dermatome
Pockets
718
What is rough guidance for L3 dermatome
Knees
719
How to determine between a myopathy and MG
Test for fatiguability Count down from 100 Squat repeatedly Abduct and adduct shoulders
720
What is lambert eaton syndrome
Paraneoplastic syndrome where ABs formed against K+ channels
721
What is weird about LEMS
Strength improves on exercise
722
How to differnetite MG from LEMS
EMG
723
What conditions are associated with MG- will be in history potentially
``` CTD T1DM Graves Hahimotos Pernicious anaemia ```
724
What is tinels sign
Tap a nerve and it will tingle- indicative of a compressed nerve
725
What is hoffmans sign
Flick middle finger and thumb will contract in an UMN disease
726
How is dementia diagnosed truly
On biopsy
727
What can be signs on imaging of dementia
Infarcts | Atrophy
728
5 most common sources of brain mets
``` Melanoma Colon Lung Breast Kidney ```
729
How can primary brain tumours be classified
Axial or extra-axial
730
What are axial brain tumours
Tumours of the brain matter itself
731
Examples of axial brain tumours
Astrocytoma Oligodendrogliomas Ependymomas Medulloblastomas
732
What are glioblastomas
Grade 4 astrocytoma
733
What are ependymomas tumours of
Cells lining ventricles
734
What are extra axial brain tumour examples
Meningioma Vestibular schwannoma Pituitary adenoma Haemangioma
735
What do vestibular schwannomas compress
CN 7 and 8
736
What level does spinal chord end in adults vs children
Adults L1/2 | Children L2/3
737
Procedure for an LP
Trace line between 2 PSIS called tuffiers line
738
Indications of an LP
Diagnostic- infection, MS, GBS, SAH | Therapeutic- IIH, intrathecal drugs
739
Which intra thecal drugs are often fiven
Haematological drugs in children
740
Contraindications of LP
Raised ICP Increased bleeding risk Infection at site Cardiorespiratory distress
741
Risks of LPs
Headache due to intracranial hypotension Infection at site Nerve root pain
742
Raised ICP signs
``` Headache worse when lying down Nausea in am Blurry vision Fundoscopy Cushings peptic ulcer Cushing reflex ```
743
What is a cushings ulcer
When ICP puts pressure on vagus nerve causing excess acid production
744
Headache with epigastric pain
Raised ICP leading to cushings ulcer
745
Causes of ICP
SOL- haematoma, abscess, tummour or cyst Cerebral oedmea- trauma or lesion Increased blood flow to brain Increased CSF volume
746
Causes of raised ICP due to increased blood flow
Drugs Malignant HTN Superior vena cava obstruction Venous sinus thrombous
747
Which drugs can increase ICP
GTN | Viagra
748
In what modality is CSF white
T2 weighted MRI
749
How to treat cluster headache acutely
High flow oxygen | Nasal or subcut triptans
750
What can give ring-enhancing lesions on CT in brain
Abscess Toxoplasmosis MS Tumour
751
What condition is trigeminal neuralgia commonly seen in
MS
752
Pathophysiology of trigeminal neuralgia
Compression of nerve by artery or vein loop in majority of cases 10% tumours, MS, skull base abnormalities HTN is a risk factor
753
In babies what is likely to cause meningitis
E.coli | Group B strep
754
In children what is likely to cause meningitis
Strep pneumoniae | H. influenzae
755
What causes meningitis in young people
Neisseria meningitidis
756
What causes meningitis in the elderly
Listeria monocytogenes | Strep pneumoniae
757
What viruses cause meningitis
Enteroviruses, HSV, VZV and HIV
758
Which type of organism most commonly causes meningitis
Virus also is less severe
759
How does meningococcal disease present
Rapid onset fever and malaise then signs of sepsis and meningitis with a non blanching rash
760
What causes meningococcal disease
Neisseria meningitides
761
Risk factors for meningitis
Crowded places as spread via resp droplets Extremes of age Infections of head/face including sinusitis and mastoiditis
762
Signs on examination of meningitis
Kernigs sign Brudzinskis sign Petecial non-blanching Fever, sepsis
763
What is brudzinskis sign
Flexion of neck while knees and hips flexed too
764
How does CSF look in bacterial meningitis
Turbid and cloudy
765
How does CSF look in viral meningitis
Clear
766
How does CSF look in TB meningitis
Fibrin web
767
What are WCC described as in CSF neutrophils
Polymorphs
768
What are WCC described as in CSF lymphocytes
Mononuclear
769
What are investigations for meningitis you order
LP is most important but should do CT first if contraindications 2 sets of blood cultures
770
What would make you do a CT before a LP in meningitis
``` Seizures Papilloemeda LOC Immunocompromised Focal neurology ```
771
Complications of meningitis
Hearing loss Sepsis Impaired mental statement Encephalitis
772
Management of meningitis at GP
IM benzylpenicillin
773
Management of meningitis A&E
IV ceftriaxone Acyclovir if viral Then do cultures and target antibiotics Consider IV dexamethasone
774
What is encephalitis
Inflammation of the brain parenchyma
775
What type of organism causes encephalitis typically
Viral
776
Viral causes of encephalitis
``` HSV CMV EBV HIV Measles ```
777
Non viral causes of encephalitis
``` Lyme disease Legionella Bacterial meningitis TB Malaria ```
778
Presentation of encephalitis
``` Viral podrome Fever Headache Altered mental state Seizures Focal neurology ```
779
Altered mental states seen in encephaliitis
Memory disturbances Personality changes Psyciatric manifestations LOC
780
Investigations for encephalitis
MRI LP- look for signs similar to meningitis EEG Blood cultures
781
What is seen on imaging of encephalitis
Oedema and hyperintense lesions
782
What exacerbates ICP headaches
Coughing and sneezing Exercise Lying down
783
What is the cushing reflex
Increased SBP Irregular breathing Bradycardia
784
What is cheyne stokes respiration
Progressively deeper and sometimes faster followed by a gradual decrease that results in apnoea
785
What is cheyne stokes respiration seen in
``` HF Stroke Hyponatraemia TB Brain tumours ```
786
Differnece on non contrast CT between acute and chronic subdurals
In acute the blood appears white
787
Who are acute subdurals normally seen in
Young people after severe trauma
788
Who are chronic subdurals normally seen in
Elderly
789
Surgical management of subdurals
Burr holes or craniotomy
790
Conservative management for small acute subdurals
``` Admit, observe and monitor Prophylactic anti-epileptics ICP monitoring Correct coagulopathies Lower ICP ```
791
Management of subdural
ABCDE Neurosurgery If under 10mm and is no significant dysfunction then observe If large or significant neuro dysfunction surgery
792
RFs for SAH
PCKD Alcohol Smoking HTN
793
What type of CT do you use on the head
Non contrast
794
ECG finding of SAH
Long QT
795
CT sensitivty for SAH in first 12 hours
98
796
Which cells do medulloblastomas arise from
Immature embyonal cells
797
What puts peoples at greater risk of developing meningioma
Neurofibromatosis
798
How would frontal lobe tumour present
Personality changes Apathy Intellect impaired
799
How does a vestibular schwannoma present
Progressive deafness
800
Investigations for brain tumour
CT- quick MRI- better resolution CXR and CT to look for mets Biopsy to be definitive
801
How to do froments sign
Hold piece of paper between thumb and fingers. | Normally the thumb should be flat however in ulnar nerve palsy the PIP is flexed
802
What is cause of epilepsy
Genetic predisposition to seizures commonly genetic deformities in NMDA and GABA channels
803
What is excitatory NT and receptor in brain
Glutamate | NMDA
804
What is inhibitory NT and receptor in brain
GABA | GABA
805
What is method of action of benzos
Enhance GABA transmission
806
Examlpes of anticonvulsants used in epilepsy
Lamotrigine Sodium valproate Carbamezapine
807
In simple partial seizures what often happens
Either jerking | Or strange sensations or weird smells and tastes
808
How can epilepsy be managed
Anti convulsants Surgery to remove area of brain causing damage Nerve stimulation- vagus often Ketogenic diet
809
What diet is often recommended in epilepsy
Keto
810
If epilepsy patient goes into status elipticus what could it be
``` Poor compliance to meds- check levels Metabolic causes- glycaemic, U&Es Drugs- alcohol, amphetamines, cocaine Hypoxia Infection- encephalitis, meningitis SOL- abscess, tumour Vascular- vasculitis, AV malformation ```
811
Anaesthetic often given to terminate seizures
Theopentone
812
What is the triad for normal pressure hydrocephalus
Gait ataxia Urinary incontince that progress to include faeces Dementia
813
Presentation of NPH
Gait ataxia Urinary incontince that progress to include faeces Dementia Can get headache occasionally especially at night (ICP)
814
What is pathophysiology of communicating hydrocephalus
There is problem with reabsorptio of CSF into veins or rarely failure of production of CSF NO OBSTRUCTION
815
What can cause communicating hydrocephalus
Haemorrhage Meningitis Tumours Venous thrombosis
816
Where does fluid accumulate in communicating hydrocephalus
In ventricles | In subarachnoid spcae
817
What happens in non communicating hydrocephalus
CSF flow obstruction from SOL most of time
818
4 types of hydrocephalus
Communicating Non communicating NPH Congenital
819
Presentation of communicating and non communicating hydrocephalus
Blurred vision Unsteady gait 6th nerve palsy
820
Sign on examination of NPH
Babinskis UMN Parkinsonism
821
CT and MRI findings of hydrocephalus
Increased size of ventricles | Tumour
822
Investigations of hydrocephalus
CT/MRI- increased ventricle size, potenital tumour causing obstruction LP- opening pressure increased
823
Who does NPH occur in
Elderly
824
What would cause inceased opening pressure in meningitis LP
Communicating hydrocephalus as impaired reuptake
825
If someone has a facal nerve palsy what are 4 examinations must carry out
Motor function Otoscopy Palpate parotids Schirmers test for lacrimation
826
What are most tumours of the parotid
Benign 80% with 80% pleomorphic adenoma
827
What can cause bells palsy
Ramsey hunt syndrome Parotid tumour Lyme disease Vestibular schwannoma
828
How does a vestibular schwannoma present
Hearing loss | Tinnitus
829
What are breast cysts development most commonly associated with
Hormones- often with start of menopause
830
What are fibroadenomas most commonly associated with
Hormones
831
How does inflammatory breast cancer appear
Mastitis or abscess
832
How is inflammatory breast cancer often diagnosed
Think is abscess or mastitis so give Abx- rash then refractory to these
833
What are key features on examination of inflammatory breast cancer
Warmth Erythema Peau d'orange Early lymph node involvement
834
If cancer is suspected what biopsy technique is preferred
Core biopsy> FNA
835
What is blood marker for breast cancer
Ca 15-3
836
How does breast cancer appear on mammogram
``` Spiculated mass Parenchyma distortion Skin thickening Calcification Axillary lymph nodes ```
837
How does breast cancer appear on US
Ill defined hypoechoic mass Halo from oedema Axillary lymph nodes Acoustic shadowing
838
Management of bells palsy
Prednisolone if within 72 hours | Consider aciclovir
839
How long do do migraines last
2-72 hours in children | 4-72 hours in adults
840
What is a scotoma
Change in vision where see something
841
In chronic tension headaches what is used as prophylaxis
Amitriptyline
842
Causes of tremor
``` Parkinsons Huntingtons Essential tremor Drug induced tremor Hyperthyroidism Enhanced physiological tremor Anxiety Caffeine ```
843
Most common cause of cellulitis
Strep pyogenes | Staph aureus
844
How is cellulitis classified
Class 1- no systemic signs Class 2- pts have comorbid conditions affecting recovery Class 3- pts have accompanying limb threatening illnesses and signs of systemic infection like confusion and tachycardia Class 4- severe sepsis and infection
845
Treatment for class 1 cellulitis
Oral abx in outpatient setting
846
Treatment for class 2 cellulitis
Oral or IV abx in outpatient setting
847
Treatment for class 3 cellulitis
Hospitilisation for IV abx
848
Treatment for class 4 cellulitis
ITU
849
Management of cellulitis at home
Oral abx Simple analgesia Elevate leg Keep it moisturised to prevent infection and help healing
850
When would you do X ray in gout
If chronic disease that is especially untreated
851
What can be seen on x ray of gout
Punched out lytic region
852
Acute mangement of subdural
ALS protocol Watch out for cervical spine injury Osmotic diuresis if raised ICP Burr holes or craniotomy
853
Management of chronic subdural
If symptomatic do burr holes or craniotomy
854
What are complications of subdural
Permenant focal neurology to area affected Raised ICP Cerebral oedema Post op complications- seizures, abscess, meningitis
855
Treatment of peripheral neuropathy in DM
Duloxetine
856
What causes hypotonia
Cerebellar and LMN lesions
857
Cancer causes of peripheral neuropathy
Myeloma | Paraneoplastic syndrome
858
What is papillitis
Optic neuritis
859
TIA management
``` Aspirin Dont treat BP ECG Echo Carotid doppler RF management ```
860
What are global t wave inversion seen in
Brain herniation
861
What are cerebral t waves
T wave inversion seen globally due to brian herniation
862
In MND what muscles are spared
Ocular

Year 3 Conditions (33 decks)

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