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Neurology Flashcards

1
Q

What is Alzheimer’s disease

A

it is the most common cause of dementia in the uk
has a slowly progressive memory loss and other cognitive decline

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2
Q

Some signs and symptoms of Alzheimer’s

A

progressive memory loss
inattention
sundowning - symptoms worse at night
language difficulties
inability to solve problems of daily life through abstract reasoning

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3
Q

how is Alzheimer’s diagnosed

A

clinically diagnosed by history and ruling out other potential causes
its also important to look at other reversible causes of the dementia

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4
Q

what types of medication should be avoided in Alzheimer’s disease

A

Sedatives

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5
Q

what medication is used to manage Alzheimer

A

acetylcholinesterase inhibitor

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6
Q

what are some non pharmacological treatment options for Alzheimer’s

A

caregiver education and support
maximizing treatment for other health problems
memory clinic
physical and occupational therapy

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7
Q

What is ALS

A

is a progressive neurodegenerative disease that attacks both the upper and lower motor neurons resulting in muscle weakness and atrophy

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8
Q

Who are at risk from suffering from blow-induced dementia

A

football players -heading the ball
boxers
domestic violence survivors with repeated head trauma

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9
Q

what is one key difference in how stroke and bells palsy present

A

stroke only affects eyebrows down but in bells palsy it will affect forehead aswell

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10
Q

Risk factor for bells palsy

A

diabetes and pregnancy

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11
Q

SS for bells palsy

A

facial muscle weakness over days -weeks
decreased taste or lacrimation, hyperacusis
facial tingling or pain near ear

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12
Q

treatment for bell’s palsy

A

steroids + acyclovir if pt presents early
symptom control- eye patch and pain control

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13
Q

2 causative pathogen for bacterial meningitis

A

S.pneumoniae and N.menigitidis

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14
Q

SS for bacterial meningitis

A

rapidly developing fever
stiff neck
headache
altered mental status
Seizures
Photophobia
Non blanching rash - late sign

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15
Q

Ix for bacterial meningitis

A

Lumbar puncture
FBC
Blood culture

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16
Q

Finding of ix in bacterial meningitis

A

Low glucose, high protein
WBC>5 mm3

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17
Q

Management for bacterial meningitis

A

get blood cultures and start IV antibiotics immediately - usually ceftriaxone
add ampicillin in patients older than 65
steroids - IV dexamethasone

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18
Q

What type of headache is cluster headache

A

primary headache

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19
Q

what group of headaches do cluster headache fall into

A

trigeminal autonomic cephalalgias

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20
Q

RF for cluster headaches

A

common in males
common in 30s to 40s
genetics

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21
Q

name some triggers for cluster headache

A

alcohol
smoking
histamine
nitrate- containing food
smell of volatile substance like petrol, paint nail varnish

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22
Q

Diagnostic criteria for cluster headache

A

at least 5 attacks of severe or very severe unilateral orbital, supraorbital and/ or temporal pain lasting 15 minutes to 3 hours and either or both of the following:
- one of: conjunctival injection, rhinorrhoea, eyelid swelling, forehead/ facial sweating , fullness in ear
- sense of restlessness or agitation

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23
Q

Ix for cluster headache

A

if first time and presenting with signs of Horner’s syndrome then do angiogram

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24
Q

Management for acute cluster headache

A

Oxygen
subcut sumatriptan

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25
Preventative management for cluster headaches
verapamil - after ecg greater occipital nerve block prednisolone Topiramate or sodium valproate Lithium but rarely used GammaCore - non -invasive vagal nerve stimulation
26
What is cauda equina syndrome
radiculopathy in which the cauda equina is compressed surgical emergency
27
SS of cauda equina syndrome
saddle anaesthesia associated with loss of bowel or bladder control severe back pain bilateral sciatica
28
what are some causes of cauda equina
Lumbar disc herniation spinal vertebral fractures Malignancy Spinal infection Iatrogenic
29
examination finding in cauda equina
lower limb neuro exam : - hypotonia - weakness -areflexia -abnormal sensory changes Rectal exam: - recued sensation and anal tone Abdo: palpable bladder
30
Ix for cauda equina
MRI spine
31
Management for cauda equina
ABCDE approach, then once stable: Analgesia Urinary retention- catheter surgery to fix any reversible cause of decompression
32
what is Creutzfeldt- Jakob disease
rare, progressive and fatal cause of dementia it is caused by prions which are mis-shaped proteins
33
what are the 2 types of Creutzfeldt-Jakob Disease
sporadic and variant Variant CJD is caused by eating meat infected by bovine spongiform encephalopathy through eating infected cattle meat
34
symptoms of Creutzfeldt-Jakob disease
may not have symptoms for a while but once symptoms starts showing then pt will only have few years left the symptoms are abnormalities in almost every area of the neurologic system
35
Ix for Creutzfeldt-Jakob disease
tissue biopsy EEG MRI Lumbar puncture
36
Management for Creutzfeldt-Jakob disease
none. Symptomatic, supportive and psychological care for patient and family.
37
what neurotransmitter is known to be involved in delirium
acetylcholine
38
Risk factors for delirium
advanced age serious illness dehydration polypharmacy pre-existing dementia electrolyte imbalance sleep deprivation infection -very common cause
39
Signs and symptoms of delirium
reduced awareness of the environment t drowsy or lethargic distractable new memory impairment hallucination delusions
40
Ix for delirium
Look for signs of infection neuro exam FBC, U&E, Renal and kidney functions urinalysis CXR ECG ct/mri
41
Management for delirium
treat the cause
42
what is diabetic peripheral neuropathy
a prevalent complication of diabetes
43
Ss of diabetic peripheral neuropathy
pain, loss of sensation
44
Ix for diabetic neuropathy
clinical diagnosis fasting glucose HbA1C nerve conduction studies
45
What is extradural haemorrhage
collection of blood between the outer dura mater and the inner surface of the skull
46
which artery tear us commonly associated in an extradural haemorrhage
middle meningeal artery
47
presentation of an extradural haemorrhage
brief LOC subsequent deterioration of consciousness and headache
48
Ix and findings for an extradural haemorrhage
CT head "lens" or "balloon" shaped mass over surface of brain usually has a mass effect with midline shift
49
Management for an extradural haemorrhage
evacuation of the blood by a neurosurgeon if unable to do neurosurgery then may attempt burr holes
50
ss for essential tremor
noticeable tremor when arms are outstretched difficulty in writing, eating, and holding objects and doing fine motor tasks but do not have bradykinesia, rigidity, balance difficulties or cog impairment
51
non medical, medical and surgical management for essential tremor
behavioural techniques and physical therapy propranolol, primidone, topiramate deep brain stimulation, focused ultrasound thalamotomy
52
what is epilepsy
umbrella term for a condition where there is a tendency to have seizures. seizures are transient episodes of abnormal electrical activity in the brain
53
ix for epilepsy
eeg mri
54
what is generalised tonic clonic seizures
loss of consciousness tonic (muscle tensing ) clonic (muscle jerking) may have tongue biting, incontinence, groaning after the seizure there is a prolonged post-ictal period where the person is confused, drowsy and feels irritable or depressed
55
management for tonic clonic seizures
sodium valproate
56
what is focal seizures
start in temporal lobes affect hearing, speech, memory and emotions
57
some ways focal seizures can present
hallucination memory flashbacks deja vu doing strange things on autopilot
58
Management for focal seizures
carbamazepine or lamotrigine
59
what is absence seizures
typically happen in children becomes blank, stares into space and then abruptly returns to normal typically last 10-20 seconds
60
Management for absence seizures
sodium valproate ethosuximide
61
what is atonic seizures
aka drop attacks brief lapses in muscle tone don't usually last more than 3 minutes
62
Management for atonic seizures
sodium valproate
63
what is myoclonic seizures
present as sudden brief muscle contractions like sudden "jump" usually remains awake during the episode
64
Management for myoclonic seizures
sodium valproate
65
what is infantile spasm
aka west syndrome starts in infancy around 6 months of age clusters of full body spasms poor prognosis
66
Management for infantile spasm
prednisolone or vigabatrin
67
what is status epilepticus
medical emergency defined by seizures lasting more than 5 minutes or more than 3 seizures in one hour
68
management of status epilepticus
ABCDE approach IV lorazepam
69
what is encephalitis
inflammation of the encephalon
70
ss of encephalitis
altered mental status fever flu-like prodromal illness early seizure
71
common virus that cause encephalitis
herpes simplex virus type 1
72
IX for encephalitis
Routine blood test, blood cultures, viral PCR, CSF CNS imaging
73
Treatment fir encephalitis
iv ceftriaxone and iv acyclovir other supportive management
74
what does frontotemporal dementia cause
causes extreme disinhibition and markedly inappropriate behaviour which quickly alienates family, spouses, co workers and can lead to arrest by police for inappropriate activities
75
key motor findings in foot drop
weakness or paralysis of dorsiflexion and eversion
76
what does gullian barre syndrome often present after
often presents after a URTI or gastroenteritis
77
what is guillain barre sydnrome
demyelination of peripheral nerves
78
what pathogen is commonly associated with Guillain barre syndrome
campylobacter jejuni
79
SS of guillain barre syndrome
progressive weakness in arms and legs areflexia elevated CSF proteins symmetrical symptoms progression of symptoms over days to weeks
80
Ix for guillain barre syndrome
FBC LP EMG/NCV
81
Management for guillian barre syndrome
IV immunoglobulin pain control physical therapy
82
what are the triad for Huntington's disease
Dominant inheritance choreoathetosis dementia
83
Ix for Huntington's and what it shows
MRI and CT scans in moderate to severe disease can show loss of striatal volume and increased size of the frontal horns of the lateral ventricles. Genetic testing is required to make a diagnosis and genetic counselling in a specialist unit is required.
84
Management for Huntington's
chorea - managed with a number of med e.g tetrabenazine depression treated with SSRI psychosis- antipsychotics
85
management for meningitis in GP and second line
benzylpenicillin second line -chloramphenicol
86
glucose and protein levels in viral meningitis
glucose - normal proteins - normal/high
87
some complication of meningitis
septic shock DIC coma Seizures hearing loss hydrocephalus death
88
common causative agent in viral meningitis
enteroviruses such as echoviruses, coxsackie viruses A&B , polio virus
89
some causes of non-infective meningitis
Malignancy chemical meningitis DRUGS ( NSAIDS and Trimethoprim) Sarcoidosis SLE Behcet's disease
90
what is migraine
complex neuro condition that cause headaches and other associated symptoms
91
name the 4 types of migraine
migraine without aura migraine with aura silent migraine hemiplegic migraine
92
what are the typical headaches symptoms
pounding/throbbing usually unilateral discomfort with light(photophobia) discomfort with loud noises with or without aura nausea and vomiting
93
how long can migraine headaches last between
4 to 72 hours
94
what does aura mean and name some examples of how it presents
term used to describe visual changes associated with migraine sparks in vision blurring vision line across vision loss of of different visual fields
95
what is hemiplegic migraine
can mimic stroke
96
symptoms of hemiplegic migraine
typical migraine symptoms sudden or gradual onset unilateral weakness of the limbs ataxia change in consciousness
97
some triggers for migraine
stress bright lights strong smells certain foods dehydration menstruation abnormal sleep patterns trauma
98
5 stages of migraine
prodromal aura headache resolution postdrome
99
acute management for migraines
paracetamol triptans NSAIDS Antiemetics
100
Medication used for migraine
Tripatans
101
Migraine prophylaxis
headache diary avoid triggers propranolol topiramate amitriptyline
102
injectable preventative for migraine
greater occipital nerve blocks for HFEM or CM Botulinum toxin therapy for chronic migraine
103
Buzzword for multiple sclerosis
separated in time and space
104
what is the leading cause of multiple sclerosis
EBV
105
pathophysiology of multiple sclerosis
autoimmune destruction of the CNS myelin sheath causing demyelination in the CNS white
106
RF for multiple sclerosis
smoking ebv low vit D Genetics

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