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Year 3 > Neurology > Flashcards

Neurology Flashcards

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1
Q

What is the most common type of stroke?

A

Ischaemic

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2
Q

List mechanisms of ischaemic stroke

A

Embolism
Thrombosis
Systemic hypoperfusion
Cerebral venous sinus thrombosis

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3
Q

What area of the brain does the anterior cerebral artery supply?

A

Anteromedial area of cerebrum

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4
Q

What area of the brain does the middle cerebral artery supply?

A

Lateral cerebrum

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5
Q

What area of the brain does the posterior cerebral arteries supply?

A

Medial and lateral areas of the posterior cerebrum

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6
Q

List the Oxford classification criteria for a Total anterior circulation stroke (TACS)

A

All 3 of the following:
Unilateral weakness of face arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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7
Q

List the Oxford classification for a Partial anterior circulation stroke (PACS)

A

Two of the following:
Unilateral weakness of face arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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8
Q

List the Oxford classification for Posterior circulation syndrome (POCS)

A

One of the following
Cranial nerve palsy and contralateral motor/sensory deficit
bilateral motor/sensory deficit
Conjugate eye movement disorder
Cerebellar dysfunction ( vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia

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9
Q

List the Oxford classification for a Lacunar stroke (LACS)

A

One of the following
Pure sensory stroke
Pure motor stroke
Sensori-motor stroke
Ataxic hemiparesis

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10
Q

common presentation of extradural haemorrhage

A

lucid intervals followed by unconsciousness - (they’re being EXTRA)

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11
Q

CT scan of extradural haemorrhage

A

hyperdense biconvex lens appearance

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12
Q

IgG oligoclonal bands in cerebrospinal fluid

A

Multiple Sclerosis

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13
Q

early clinical signs of huntington’s disease

A

clumsiness, agitation, abnormal eye movements

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14
Q

What amino acid is overly expressed in Huntington’s disease?

A

Glutamate

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15
Q

classification of a lacunar stroke

A

one of the following:
pure sensory
pure motor
ataxic hemiparesis

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16
Q

Main job of vestibulospinal tract

A

activate anti-gravity extensor muscles

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17
Q

Main job of tectospinal tract

A

reflex to visual and auditory stimulus
-head automatically moving to watch cool ‘tech’ car go past

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18
Q

main job of the reticulospinal tract

A

breathing and cardiac control

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19
Q

main job of lateral and ventral corticospinal tract

A

majority of motor function

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20
Q

what is spasticity?

A

a stretch reflex disorder that is apparent on repetitive stretching of muscle causing increased tone

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21
Q

is spasticity an upper or lower motor neuron manifestation?

A

UPPER motor neuron disorder- muscle is in tact but descending controls from brain not working

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22
Q

first line management of status epilepticus

A

benzodiazepines

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23
Q

common cause of communicating hydrocephalus

A

subarachnoid haemorrhage and meningitis

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24
Q

common cause of non-communicating hydrocephalus

A

tumours and lesions

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25
pathophysiology of communicating hydrocephalus
CSF able to exit but absorption into venous system is impeded
26
what kind of stroke shows hyper attenuation on CT
haemorrhagic stroke (hyper-attenuation = formation of acute blood clot )
27
what are the causes of haemorrhagic stroke
vasculitis or vessel wall abnormalities
28
what is the acute management to reduce severity of Multiple Sclerosis attacks?
methylprednisolone
29
what is the chronic management of multiple sclerosis?
disease modifying drugs- interferon beta, glatiramer acetate, natalizumab symptom control- cannabinoids, symptom basis
30
where is broca's area located?
frontal lobe
31
where is wernicke's area located?
temporal lobe
32
what is symptom of Broca's aphasia
Broken speech
33
what is symptom of Wernicke's aphasia?
Word scramble/ Weird speech
34
worsening back pain and leg weakness with walking, with relief on forward bending is a common presentation of what?
spinal claudication
35
role of the hippocampus?
important in moving stuff from short term to long term memory
36
location of the hippocampus
deep brain in temporal lobe
37
what nerve is responsible for afferent limb or corneal reflex?
ophthalmic nerve - CNVi
38
what is the mechanism of action of baclofen?
agonist of GABA receptors - upregulates inhibition of muscle contraction -> decreases muscle spasms and spasticity
39
role of the amygdala?
processing of memory and emotional reactions
40
what artery supplies the amygdala? and what symptoms occur if this becomes damaged?
Kluver-Bucy syndrome - hyperphagia, hypersexuality, pica and docility
41
anatomical course of the optic radiations from the retina? (parietal and temporal lobes)
parietal lobe carries information from inferior quadrant of retina temporal lobe carries information from superior quadrant of retina
42
are cranial nerve lesions ipsilateral or contralateral?
all are ipsilateral (except trochlear)
43
what is the rule of 4 when it comes to origins of nuclei?
1st 4 (except I and II) = midbrain 2nd 4 (V, VI, VII and VIII) = pons 3rd 4 (IX, X, XI and XII) = medulla oblongata
44
what are the different types of MS?
relapsing remitting, secondary progressive, primary progressive
45
what is the medical management for fatigue in MS patients?
Amantadine
46
47
what gene is most likely mutated in early onset familiar Alzheimer's disease?
presenilin 1 gene (also APP or presenilin 2)
48
what gene is most likely mutated in sporadic Alzheimer's disease
APOE e4
49
what mode of inheritance is Huntington's disease?
autosomal dominant (CAG trinucleotide repeat)
50
symptoms of cerebellar syndrome
DANISH dysdiadochokinesia ataxia nystagmus intention tremor slurred speech hypotonia
51
what are some causes of cerebellar syndrome
alcohol Multiple sclerosis stroke cerebellar haemangioma
52
management of motor fluctuations in parkinson's patients
MAO-B inhibitor - e.g. Risagiline
53
what should be prescribed alongside Levodopa to increase the bioavailability of it in Parkinson's patients?
Carbidopa or Benserazide
54
what class of medications should be avoided in Parkinson's patients?
anti-psychotics e.g. Haloperidol -- blocks dopamine- worsens motor function
55
short term side effects of ECT
headache, nausea, memory impairment and cardiac arrythmias
56
Management of acute confusional state
if treatment of underlying cause and environmental modification not working then medication = haloperidol (unless Parkinson's then use Lorazepam)
57
First line investigation if vascular dementia is suspected
MRI head
58
Neuroleptic malignant syndrome presentation
adverse reaction to antipsychotics - e.g. haloperidol symptoms - sweating, fever, rigidity, confusion, fluctuating blood pressure and tachycardia signs- increase creatinine kinase diagnostic
59
lumbar puncture findings for viral meningitis
pleomorphic lymphocytosis, normal glucose and moderately raised protein clear appearance
60
lumbar puncture for bacterial meningitis
neutrophilic pleocytosis, decreased glucose and increased protein cloudy appearance
61
what are the myelin producing cells in the CNS
oligodendrocytes
62
what are the myelin producing cells in the PNS
schwann cells (swans float down the Ponds)
63
neuropathic pain management
Don't Get Pain Again duloxetine gabapentin pregabalin amitriptyline
64
organism most associated with Guillain Barre syndrome
campylobacter jejuni
65
hypodense vs hyperdense on CT
hypodense bleeding = dark => chronic hyperdense bleeding = white => acute
66
drug used to prevent vasospasm in subarachnoid haemorrhages
nimodipine - calcium channel blocker
67
medication of choice for patients with primary chronic pain (chronic pain without an obvious underlying cause)
antidepressants - e.g. amitriptyline, duloxetine or an SSRI
68
first line management of trigeminal neuralgia
carbamazepine
69
management of status epilepticus
First line - give benzodiazepine immediately - buccal or rectal OR give IV lorazepam if IV access and facilities available if not stopping the -> after 5-10 minutes give second dose of benzo/lorazepam if still no response give IV phenytoin / levetiracetam / sodium valproate
70
NICE guidelines for investigating head injury within 1 hour
GCS <13 on initial assessment GCS <15 at 2 hours post injury suspected open or depressed skull fracture any sign of basal skull fracture - 'panda eyes' , cerebrospinal fluid leakage, battle's sign seizure focal neurological deficit > 1 episode of vomiting
71
NICE guidelines for investigating head injury within 8 hours
adults with following who have experienced some loss of consciousness or amnesia since injury: age >65 any history of bleeding or clotting disorders dangerous mechanism of injury >30 mins retrograde amnesia immediately before injury
72
Horner's syndrome presentation
ptosis, miosis and anhydrosis
73
afferent limb of the jaw jerk reflex
CN V3 - mandibular
74
where do the preganglionic neurons of sympathetic nervous system originate from
T1- L2/3
75
mechanism of action of carbamazepine
sodium channel inhibitor - stabilise hyperexcitable neuronal membranes
76
Characteristics of frontal lobe dysfunction
- perseveration = continued behaviour or action e.g. repeating question over and over - executive dysfunction e.g. planning, organising and initiating tasks
77
characteristics of temporal lobe dysfunction
- auditory hallucinations - memory disturbances - language comprehension - emotion changes
78
where does the blood from the dural venous drain
internal jugular vein
79
what areas of spinal cord are affected in subacute combined degeneration of the cord
dorsal - fine touch and vibration lateral - corticospinal tracts -motor
80
Initial non-motor signs of Parkinson's
depression anxiety memory loss olfactory problems sleep disturbance constipation balance issues
81
pharmacological management of idiopathic intracranial hypertension
acetazolamide
82
medication of choice for Parkinson associated delusions
typical antipsychotics - olanzapine, risperidone
83
first line medication for medical assisted detoxification
chlordiazepoxide
84
sensory tracts
dorsal column spinothalamic
85
features of Wernicke's Encephalopathy
CAN OPEN confusion ataxia nystagmus ophthalmoplegia PEripheral neuropathy
86
name the different Parkinson's Plus syndromes
multiple system atrophy cortico-basal degeneration progressive supranuclear palsy lewy body dementia
87
name the different types of Motor Neuron Disease
spinal amytrophic lateral sclerosis- most common - UPPER AND LOWER progressive muscular atrophy - ONLY LOWER progressive bulbar palsy primary lateral sclerosis - ONLY UPPER
88
name different patterns of Multiple Sclerosis
relapsing-remitting secondary progressive primary progressive
89
describe brown sequard syndrome
ipsilateral weakness and loss of fine touch, joint proprioception and vibration contralateral loss of pain and temperature
90
first line treatment for trigeminal neuralgia
carbamazepine
91
prophylaxis medications for migraine
topimarate- contraindicated in females of childbearing age propranolol - contraindicated in asthma amitriptyline
92
what antibiotics are most commonly associated with lowering the seizure threshold
cirpofloxacin - and other quinolones
93
what side will the uvula deviate towards if there is a problem with the left vagus nerve
to the right side
94
cerebellar dysfunction symptoms
D- dysdiadochokinesia A- ataxic gait N- nystagmus (horizontal) I- intention tremor S- slurred staccato speech H- hypotonia
95
what does a lesion in right hypoglossal nerve cause
tongue to deviate to the right 'tongue towards affected side'
96
where does Wernicke's encephalopathy cause neuronal death
mamillary bodies periaqueductal grey matter fourth ventricle thalamus
97
non-proliferative diabetic retinopathy
cotton-wool spots dot-blot haemorrhages venous bleeding
98
proliferative diabetic retinopathy
neovascularisation
99
what receptors do autoimmune antibodies target in lambert eaton syndrome
voltage gated calcium channels pre-synaptic
100
what nerve supplies sensory innervation to the medial aspect of the leg
saphenous nerve
101
main neurotransmitter in parasympathetic
acetylcholine
102
acute management of migraine attack
NSAID and triptans
103
prophylaxis of migraine
1st - propanalol or amitriptyline 2nd - valproate
104
acute management of cluster headache
high flow oxygen and triptan
105
prophylaxis of cluster headache
verapamil
106
management of hemicrania headaches
indomethicin
107
management of trigeminal neuralgia
carbamazepine
108
management of idiopathic intracranial hypertension
weight loss and acetazolamide
109

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