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SAQ for finals > Neurology > Flashcards

Neurology Flashcards

1
Q

Other than occipital headache, name 4 symptoms or signs of SAH

A

Neck stiffness
Photophobia
Vomiting
Collapse
Seizures
Focal neurological signs e.g. hemiplegia, dysphagia

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1
Q

What is Kernig’s sign and what does it demonstrate?

A

The hip and knee is bent to 90 degrees, it is positive if pain is caused by straightening the knee = meningeal irritation

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2
Q

What would a CT head show in SAH

A

Blood appears white, mixed in with the CSF lying within the interhemispheric fissure, basal cisterns and ventricles

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3
Q

What further test would you perform if CT head doesn’t demonstrate any abnormality in SAH and what would it show?

A

LP
Xanthochromia (bilirubin)
RBC may also be present

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4
Q

GCS score eyes

A

nothing = 1
pain = 2
verbal command = 3
spontaneous = 4

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5
Q

GCS score verbal

A

nothing = 1
incomprehensible = 2
inappropriate = 3
confused = 4
orientated = 5

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6
Q

GCS score motor

A

nothing = 1
extension = 2
flexion = 3
withdrawal = 4
localisation = 5
obeys command = 6

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7
Q

What 4 bones meet at the pterion in the skull?

A

temporal, parietal, sphenoid, frontal

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8
Q

Is the bleed arterial or venous in an extradural haemorrhage?

A

arterial (middle meningeal)

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9
Q

Is the bleed arterial or venous in a subdural haemorrhage?

A

venous

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10
Q

What are the differences in the shape of haematoma on CT head scan between extradural and subdural?

A

extradural: biconvex
subdural: crescent

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11
Q

What other changes can be identified on a CT scan in a haemorrhage?

A

midline shift, compression of the ventricles

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12
Q

Other than hypertension and smoking, name 4 risk factors for ischaemic stroke

A

diabetes
atrial fibrillation
excess alcohol
COCP
previous TIA

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13
Q

Definition of a TIA

A

A period of neurological deficit resulting from ischaemia (but not infarction) lasting less than 24 hours

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14
Q

Other than hemiplegia, give 2 other signs of ischaemic stroke

A

Hemi sensory loss
Dysphagia
Homonymous hemianopia

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15
Q

What is the commonest cause of cerebral infarct and what surgical technique can be considered?

A

carotid artery atherosclerosis

carotid endarterectomy for severe stenosis

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16
Q

Name 3 other professionals other than doctor or nurse involved in stroke care

A

SALT
Physiotherapy
OT

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17
Q

What is epilepsy

A

transient occurrence of intermittent, abnormal electrical activity of part of the brain

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18
Q

What is Todd’s palsy

A

Temporary weakness after seizure - usually of affected limb(s)

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19
Q

Name 4 types of seizure

A

Generalised tonic clonic
Absence
Focal (partial)
Partial with secondary generalised - starts focal then spreads to general

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20
Q

Name 2 metabolic causes of seizures

A

Hypoglycaemia
Hyponatraemia
Hypernatraemia
Hypocalcaemia

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21
Q

What airway adjunct could you use in a patient not maintaining their airway during a seizure

A

nasopharyngeal airway

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22
Q

What are the 6 routinely performed tests to assess CN II, III, IV and VI

A

Visual acuity
Visual fields
Fundoscopy
Pupillary light response
Pupillary accomodation
Eye movements

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23
Q

Damage to what two visual structures can lead to homonymous hemianopia

A

optic radiation
visual cortex

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24
Clinical test to decide whether dorsal column is intact (in the lower limbs)
proprioception and pressure
25
Does the dorsal column run anteriorly or posteriorly in the spinal cord
posteriorly
26
Where does the dorsal column decussate
medulla
27
What sensory modalities does the spinothalamic tract carry
pain and temperature
28
hemiplegia of both legs - what part of the spine has been affected
anterior
29
anterior cord syndrome
spinal artery occlusion causes ischaemia and hemiplegia
30
Describe the distribution signs found for a patient with a left-sided Brown-Sequard syndrome affecting the lumbar region
ipsilateral (left) spastic paralysis and loss of vibration and proprioception contralateral loss of pain and temperature
31
Give the 2 organisms which most commonly cause meningitis in a 22 year old
Neisseria meningitidis Streptococcus pneumoniae
32
Prior to performing a lumbar puncture, why might a CT head scan be performed?
To rule out raised intracranial pressure
33
Once a suspected meningitis patient is admitted to hospital, what group of antibiotics are the empirical treatment of choice?
cephalosporins (cefotaxime, ceftriaxone)
34
In query meningitis, what antibiotic will the GP give intramuscularly prior to A&E
Benzylpenicillin
35
Which nerve is compressed in carpal tunnel syndrome
median nerve
36
Which muscles in the hand are supplied by the median nerve
two lateral lumbricals opponens pollicis, abductor pollicis brevis, flexor policis brevis
37
What is a positive Phalen's test?
wrist flexion for 1 minute elicits paraesthesia in the median nerve distribution
38
What is a positive Tinel's test?
tapping over the median nerve at the wrist elicits paraesthesia in the median nerve distribution
39
GIve 2 risk factors for carpal tunnel syndrome
pregnancy COCP obesity trauma DM RA acromegaly repetitive activities
40
One investigation for carpal tunnel syndrome
electromyography
41
What 2 management options can you do for carpal tunnel syndrome
Splinting local corticosteroid injection carpal tunnel release surgery
42
Give the 3 hallmark features of Parkinson's disease
pill rolling tremor bradykinesia / shuffling gait cog wheel rigidity
43
what is the name given to lesions seen microscopically in the brain of a parkinson's disease patient
Lewy bodies
44
what medication should be commenced with levodopa and why
peripheral dopa-decarboxylase inhibitor (CARBIDOPA) reduces peripheral breakdown, leading to decreased dose of levodopa required for symptom control and reduced risk of side effects
45
give 2 complications associated with long-term levodopa treatment
on-off fluctuations end of dose dyskinesia dyskinesias postural hypotension
46
apart from levodopa, give 2 management options of parkinsons
MOAB e.g. selegiline dopamine agonist e.g. bromocriptine
47
at what time of day is the headache in raised intracranial pressure typically worse
morning
48
what may patients report exacerbates an intracranial pressure headache
bending forward, lying down, coughing
49
give 2 clinical features other than headache in intracranial pressure
nausea/vomiting papilloedema seizures focal neurology
50
Give 2 examples of a space-occupying lesion
neoplasm haematoma abscess
51
Give 2 medical managements which may be used to decrease intracranial pressure
Dexamethasone Mannitol
52
2 investigations to perform after seizure
EEG MRI BM FBC U&E
53
Other than epilepsy, 3 possible causes of seizure
Meningitis Tumour Head injury Haemorrhage Alcohol withdrawal Pseudoseizures
54
2 pieces of advice for epileptic patient
Avoid dangerous work/leisure activities (e.g. working heavy machinery or at heights, swimming) Be mindful of safety at home (take showers instead of baths) Advise about lifestyle factors that may lower seizure threshold (e.g. alcohol, recreational drugs, sleep deprivation) Take a witness of the seizure to the specialist appointment if possible
55
Treatment if status epilepticus does not stop after 2 doses of benzo
Levetiracetam Phenytoin
56
Shooting electric shock pain down spine and legs when moving neck
Lhermitte's sign
57
Criteria to confirm diagnosis of MS
McDonald criteria (dissemination in time and space)
58
1 absolute contraindication to performing a lumbar puncture
Infected skin over puncture site Increased intracranial pressure Trauma to lumbar vertebrae
59
Complications of meningococcal septicaemia
Septic shock Hearing loss Seizures Intellectual impairment Death
60
Other than idiopathic parkinson's, name 3 other causes of parkinsonism
Progressive supranuclear palsy Drug induced (AP) Dementia with lewy body
61
Vertical gaze palsy + parkinsonism
Progressive supranuclear palsy
62
Where is the CSF located
Subarachnoid space
63
RFs for subarachnoid haemorrhage
PCKD Cocaine use HTN Smoking Excess alcohol
64
Healthcare professionals involved in stroke care
Nurse SALT Dietician Physiotherapist OT
65
Trigeminal neuralgia features
electricity-like, shooting, stabbing or burning pain triggered by touch, taking, eating, shaving or cold Attacks may worsen over time
66
1st line treatment trigeminal neuralgia and another treatment option
1st - Carbamazepine Trigeminal nerve block
67
Investigation to arrange for trigeminal neuralgia
MRI head

SAQ for finals (20 decks)

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