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Medicine year 4 - finals prep > Neuro revision > Flashcards

Neuro revision Flashcards

(65 cards)

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1
Q

What is syringomyelia?

A

Collection of cerebrospinal fluid within spinal cord

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2
Q

Causes of syringomyelia?

A

Chiari malformation
Trauma
Tumours
Idiopathic

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3
Q

In syringomyelia which sensation is affected?

A

Cape- like loss of temperature sensation, preservation of light touch, proprioception and vibration

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4
Q

Clinical features of syringomyelia?

A

Cape- like loss of temperature sensation
Spastic weakness
Neuropathic pain
Upgoing plantars
autonomic features
Horner’s syndrome
Scoliosis

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5
Q

Treatment for generalised tonic clonic seizures?

A

Males - sodium valproate
Females - lamotrigine or levetiracetam

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6
Q

Treatment for absence seizures?

A

1st line = ethosuximide
2nd = male - sodium valproate
female - lamotrigine/ levetiracetam

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7
Q

Treatment for focal seizures?

A

First line = lamotrigine or levetiracetam
Second line = carbamexapine, oxycarbazepine

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8
Q

Which medication may exacerbate absence seizures?

A

Carbamezapine

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9
Q

What is another name for absence seizures?

A

Petit mal

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10
Q

Treatment for myoclonic seizures?

A

Males - sodium valproate
Females - levetiracetam

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11
Q

Treatment for tonic or atonic seizures?

A

Males - sodium valproate
Females - lamotrigine

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12
Q

What nerves does the sciatic nerve divide into?

A

Tibial and common peroneal nerves

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13
Q

Where does injury often occur in common peroneal nerve lesion?

A

Neck of fibula

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14
Q

Characteristics of common peroneal nerve lesion?

A

Foot drop
Weak foot dorsiflexion, foot eversion
Weak extensor hallucis longus
Sensory loss over dorsum of foot, and lower lateral leg
Wasting of anterior tibial and peroneal muscles

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15
Q

Factors suggesting true epileptic seizure?

A

Tongue biting
Raises serum prolactin

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16
Q

Factors suggesting pseudoseizure?

A

Pelvic thrusting
Family member with epilepsy
Female&raquo_space;
Crying after seizure
Don’t occur when alone
Gradual onset

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17
Q

Classic history - vestibular schwannoma/ acoustic neuroma?

A

Vertigo
Unilateral SNHL
Tinnitus
Absent corneal reflex

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17
Q

Interpretation of Webers?

A

Normal - midline
Conductive - bad ear
SNHL - good ear

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18
Q

Which artery occluded in lateral medullary syndrome/ Wallenberg’s?

A

Posterior inferior cerebellar artery

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19
Q

Cerebellar features of posterior inferior cerebellar artery occlusion/ lateral medullary syndrome?

A

Cerebellar: ataxia, nystagmus

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20
Q

Brainstem features of posterior inferior cerebellar artery occlusion/ lateral medullary syndrome?

A

Ipsilateral: Dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
Contralateral: limb sensory loss

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21
Q

What is Guillain- Barre syndrome?

A

Immune mediated demyelination of peripheral nervous system, often triggered by infection

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22
Q

Which infection often causes GBS?

A

Campylobacter jejuni

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23
Q

What is the characteristic feature of GBS?

A

Progressive, symmetrical weakness of all limbs
Classically ascending weakness
Reduced/ absent reflexes
Few sensory signs/ symptoms

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24
Investigations in GBS?
Lumbar puncture - rise in protein, normal WBC count Nerve conduction studies - dec motor nerve conduction velocity (demyelination)
25
Parietal lobe lesions?
Sensory inattention Apraxia Tactile agnosia Inferior homonymous quadrantanopia
26
Occipital lobe lesion?
Homonymous hemianopia (with macular sparing) Cortical blindness Visual agnosia
27
Temporal lobe lesion?
Wernicke's aphasia Superior homonymous quadrantanopia Auditory agnosia Prosopagnosia (difficulty recognising faces)
28
Frontal lobe lesion?
Broca's aphasia (expressive) Disinhibition Perseveration Anosmia Inability to generate list
29
Cerebellum lesions?
Midline - gait and truncal ataxia Hemisphere lesion - intention tremor, past pointing, dysdiadokinesia, nystagmus
30
Dysdiadochokinesia?
Inability to perform rapid alternating muscle movements
31
Cause of brown sequard syndrome?
Lateral hemisection of the spinal cord
32
Features of brown squared syndrome?
Ipsilateral weakness below lesion Ipsilateral loss of proprioception and vibration sensation Contralateral loss of pain and temperature sensation
33
Does unilateral cerebellar lesion cause contra or ipsi- lateral signs?
Ipsilateral
34
Symptoms of cerebellar disease?
DANISH D- dysdiadochokinesia,, dysmetria (past- pointing), 'drunk' A- ataxia N- nystagmus I- intention tremor S- slurred staccato speech, scanning dysarthria H - hypotonia
35
GCS - motor response?
6. Obeys commands 5. Localises to pain 4. Withdraws from pain/ normal flexion 3. Abnormal flexion to pain (decorticate posture) 2. Extending to pain 1. None
36
GCS - verbal?
5. Orientated 4. Confused 3. Words 2. Sounds 1. None
37
GCS - eye opening?
4. Spontaneous 3. To speech 2. To pain 1. None
38
What can Lambert- Eaton syndrome be associated with?
Small cell lung cancer >>> Breast, ovarian cancer Independent autoimmune disorder
39
Cause of Lambert- Eaton syndrome?
Antibody against presynaptic voltage- gated calcium channels in PNS
40
Features of Lambert- Eaton syndrome?
Repeated muscle contractions lead to inc muscle strength Limb- girdle weakness Hyporeflexia Autonomic symptoms
41
EMG in Lambert- Eaton syndrome?
Incremental response to repetitive electrical stimulation
42
Management of Lambert- Eaton syndrome?
Treat underlying Immunosuppression e.g. prednisolone +/- azathioprine
43
What is myasthenia gravis?
Autoimmune disorder resulting in insufficient functioning acetylcholine receptors
44
What causes myasthenia gravis?
Antibodies to acetylcholine receptors seen in 85-90%
45
Key features of myasthenia gravis?
Muscle fatigability Extraocular muscle weakness: diplopia Proximal muscle weakness Ptosis Dysphagia
46
Associations with myasthenia gravis?
Thymomas AI disorders e.g. pernicious anaemia, AI thyroid disorders, rheumatoid, SLE Thymic hyperplasia
47
Investigations for myasthenia gravis?
Single fibre EMG CK normal Antibodies to acetylcholine receptors, some + for anti- muscle- specific tyrosine kinase AB's
48
Management of myasthenia gravis?
Long- acting acetylcholinesterase inhibitors - pyridostigmine Eventually require immunosuppression - prednisolone, azathioprine Thmectomy
49
Management of myasthenia crisis?
Plasmapharesis IV immunoglobulins
50
Ankle reflex?
S1-S2
51
Knee reflex?
L3-L4
52
Biceps reflex?
C5-C6
53
Triceps reflex?
C7-C8
54
What causes subacute combined degeneration of the spinal cord?
Vitamin B12 deficiency resulting in impairment of dorsal columns, lateral corticospinal tracts and spinocerebellar tracts
55
Features of subacute combined degeneration of the spinal cord - dorsal column?
Distal tingling/burning/sensory loss is symmetrical and tends to affect the legs more than the arms Impaired proprioception and vibration sens
56
Features of subacute combined degeneration of the spinal cord - lateral corticospinal tract?
Muscle weakness, hyperreflexia, and spasticity upper motor neuron signs typically develop in the legs first Brisk knee reflexes absent ankle jerks extensor plantars
57
Features of subacute combined degeneration of the spinal cord - spinocerebellar tracts?
Sensory ataxia - gait abnormalities Positive Romberg's sign
58
Anterior cerebral artery stroke?
Contralateral hemiparesis and sensory loss, lower extremity > upper
59
Middle cerebral artery stroke?
Contralateral hemiparesis and sensory loss, upper extremity > lower Contralateral homonymous hemianopia Aphasia
60
Posterior cerebral artery stroke?
Contralateral homonymous hemianopia with macular sparing Visual agnosia
61
Weber's syndrome/ branches of posterior cerebral artery that supply midbrain?
Ipsilateral CN III palsy Contralateral weakness of upper and lower extremity
62
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg's syndrome)
Ipsilateral: facial pain and temperature loss Contralateral: limb/torso pain and temperature loss Ataxia, nystagmus
63
Anterior inferior cerebellar artery (lateral pontine syndrome)?
Similar to Wallenberg's Ipsilateral: facial paralysis and deafness
64
Lacunar stroke?
Isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia Strong assoc. w/ hypertension Basal ganglia, thalamus, internal capsule

Medicine year 4 - finals prep (2 decks)

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