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1. Fellowship Written - SAQ > Neurology > Flashcards

Neurology Flashcards

(62 cards)

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1
Q

Why would you perform a lateral canthotomy?
What are 3 signs it is needed in unconscious and conscious patient?

A

Ocular compartment syndrome

Unconscious
RAPD
Raised intra ocular pressure
Dilated puptil suggesting retrobulbar haematoma

Conscious
Decreased acuity, pain, opthalmoplgeia

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2
Q

what are the poor prognosticating factors on SAH CT

A
  1. loss of white gray matter differentiaiton
  2. obstructive hydrocephalus
  3. tonsiller herniation
  4. loss of sulci
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3
Q

GBS v spinal cord lesion

A
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4
Q

what is the relevance of FVC and its interpreation in monitoring GBS?

A
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5
Q

what are the differentials for acute bilateral leg weakness?

A
  • GBS
  • lambert Eaton
  • spinal cord compression/cauda equina
  • hypokalaemia paralysis
  • myasthenia gravis
  • traumatic spinal cord injury
  • spinal cord infarct
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6
Q

Classical triad of GBS

A
  • symmetrical ascending weakness
  • areflexia
  • minimal sensory loss
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7
Q

what investigations are useful in ?GBS

A
  • LP - raised protein and normal/low WCC
  • anti ganglioside antibodies
  • nerve conduction studes suggesting peripheral demyelination
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8
Q

what are the life threatening complications of GBS

A
  1. Resp - hypoventilation and respiratory arrest
  2. autonomic - labile BP and tachycardia
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9
Q

what are the clinical features of facial nerve palsy?

A
  • weakness of upper and lower facial musculature
  • decreased taste anterior 2/3 ipsalateral tongue
  • ipsalateral hyperacuisis
  • ipsalateal reduced tear production
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10
Q

what are the peripheral causes of an isolated facial nerve palsy??

A

meningioma/cholesteatoma
temporal bone fracture
parotid neoplasm
mastoid surgery
facial laceration
lyme
sarcoid
amyloid
GBS
diabetes
botulism
HIV
syphillis

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11
Q

what is the treatment for idiopathic bells palsy

What is the prognosis and what factors are associated with poorer income?

A

Treatment:

*eye care to prevent corneal exposure eg patch, lubricant
* pred 60mg 5/7 then taper
* ?need for antivirals

Prognosis
85% complete recovery 2 months
partial recovery
less chance of recovery in:
* pregnancy
* older age
* diabetes
* taste affected

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12
Q

what are the typical examination findings of third nerve palsy

A
  • eye looks down and out (loss of adduction, elevation)
  • ptosis
  • mydriasis
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13
Q
A
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14
Q

in a third nerve palsy how does ipsalateral pupil dilation help distinguish aetiology?

A

Pupil constriction is mediated by parasympathetic fibres that accompany CN III they travel peripherally & are more susceptible to compression resulting in pupil dilation.
symptom not there in vascular cause

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15
Q

What are the causes of aniscoria?

A
  • 3rd nerve palsy
  • physiologica
  • trauma
  • horners
  • acute close angle glaucoma
  • drugs eg tropicamide
  • Adies pupil
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16
Q
A
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17
Q

positive and negatives on scan

Diagnosis

A

positives
* hyperdensity in midbrain consistent with acute bleed
* dilatation of lateral horns consistent wth hydrocephalus

negatives
* no tonsiler herniation
* no midline shifft
* no intraventriclar blood
* no sign of trauma

Diagnosis
acute intracranial haemorrhage

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18
Q

what are the PRN end of life meds?

A
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19
Q

What are the components of OTTAWA SAH rule?

A
  • age over 40
  • neck stiffness
  • witness LOC
  • onset during extertion
  • thunderclap
  • limited neck flexion on examination

if any is a yes it cant be ruled out

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20
Q

what are the investigsations and pros and cons for ?sah 6 hours post presentation

What is the best scan within 6 hours?

A

**LP **

Pros - high sensitivy and specificty
cons - risks of infection, tine consuming, operator dependent

CTA

Pros - can diagnose aneurysms, pain free
Cons - 1-2% aneurysmic and may be asymptomatic

within 6 hours - CT

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21
Q

what are the ways to minimise post LP headache?

A
  • atraumatic needle
  • small needle calibre
  • early mobilisation
  • replace stylet before removal of needle
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22
Q

what can cause a headache and visual symptoms?

A

SAH
migraine
GCA
acute angle close glaucoma
CVA
SOL

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23
Q

what features of hx suggest migraine

A

prior migraines
FH
parasthesia
scotoma
nausea
photophobia

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24
Q

what is the first line medical treatment for migraine?

A
  • paracetamol 1g PO
  • ibuprofen 400mg PO
  • Aspirin 900mg PO
  • Sumitriptan 50mg PO
  • Stemetil 12.5mg slow IV
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25
what drugs can be used in migraine prophylaxis
propranolol amitryptiline verapamil sodium valproate
26
what clinical features of GBS would suggest intubation is needed
**FVC below 15ml/kg** bulbar weakness tachynpnoea hypoxia
27
what are the spinal tracts for movement and what do they control?
corticospinal - skeletal muscle corticobulbar - cranial nerves
28
what part of the nervous system is responsible for involuntary movement damage to what part causes involuntary movement
autonomic damage to basal ganglia causes involuntary
29
30
Rinne 512 tuning fork on mastoid and infront of ear. Which is louder? if louder on mastoid then conductive hearing is better Wever 512hz tuning form in middle and say where louder moves to conductive hearing loss or away from sensorineural
31
what are some atraumatic causes of senosorineural hearing loss?
post viral gentamicin/vancomycin vasculitis sarcoid
32
what are the contraindications to LP
patient refusal raised ICP localised skin infection around site focal neurological signs coagulopathy patient agitation
33
SAH symptoms
headache vomiting collapse photophobia neck stiffness transient LOC focal neuro signs
34
35
what are the break down products that make blood appear yellow
bilirubin oxyhaemoglobin
36
What criteria would suggest a CT is needed before LP for ?SAH
signs if RICP immunosuppression focal deficit new seizure within 6 hours of ?sah headache reduced GCS
37
three non tox causes
heat stroke meningitis hyperthyroid
38
name some tox causes and key examination findings
* serotonin toxicity - rigidity, hyperreflexia, mydriasis * sympathomimetic - mydriases, tachycardia, hypertension * anti-cholinergic - full bladder, tdry skin, flushed, delirium
39
4 drugs and doses for stopping seizure
1. midazolam IV 5mg aliquots 2. leviteracetam 40mg/kg IV 3. phenytoin 20 mg/kg IV 4. sodium valproate 1g
40
differentials for prolonged seizure
* head injury and ICH * eclampsia * primary epilepsy * meningitis * hypoglycaemia
41
5 serious complications of status
1. hypoxic brain injury 2. ICH 3. pulmonary oedema 4. rhabdo and AKI 5. fractures eg spine
42
8 causes for first seizure
hypoglucaemia primary epilepsy meningitis trauma and ICH toxins - sympathomimetic drug withdrawal SOL CVA
43
main side effects of IV phenytoin and management
* sodium channel blockade and widended qrs and VT - sodium bicarm 2mmol/kg IV every 2 mins
44
name some stroke mimics and how you may identify them
1. hypoglycaemia - low bsl/known diabetic 2. SOL - known CA 3. seizure/todds paralysis - known epilepsy, witnssed seizure 4. hemiplegic migraine - migraine sufferer, headache 5. functional - psych hx 6. MS - known hx 7. Bells - LMN facial signs
45
what is the inclusion criteria for CVA thrombolysis
Clinical stroke + * over 18 * clear onset within 4.5 hours * No evidence of ICH on CT * Consent * focal deficit
46
exclusion criteria for CVA thrombolysis
* ICH * no consent * major surgery in last 14 days * SBP over 185 * GI/GU bleed within 21 days * platelets under 100 * on warfarin and INR over 1.5 * resolving neurology
47
48
what scoring system is used post TIA
ABCD2
49
finding
hyperdense MCA sign
50
What are the main causes of dizziness?
Peripheral - BPPV, vestibular neuritis, meinieres Central - CVA, SOL, MS other hypoglycaemia pre syncope sepsis
51
list three history and three exam findings to help differentiate between central and peripheral causes of vertigo
**Peripheral** * History - consitutinal sx, worse on movement, viral prodrome, tinnitus, hearing loss, sudden onset * Exam - dix hallpike +ve, abnormal ENT exam, horizontal nystagmus **Central** * History - other neuro sx, CVS risk fx, gradual onset * Exam - focal neuro deficity, other CN signs, vertical nystagmus, any cerebella sign
52
what investigations and why when looking at central v peripheral vertigo
53
54
What are the components of a HINTS exam and its clinical significance?
**1. nystagmus **- horizontal suggests peripheral. Vertical suggests central **2. head impulse test** - correcrive saccade suggests periphral, none is central **3. Test of skew** - abnormal skew test with ocular tilt suggests central
55
what features of nystagmus suggest central cause?
vertical or rotational change in direction non fatiguable spontaneous
56
what are some differentials for hyperensive encephalopathy
ICH menigoencephalitis toxoplasmosis SOL migraine hypoglycaemia
57
define: hypertensive emergency hypertensive urgency
hypertensive emergency - over180 or 120 with end organ damage or over 200 hypertensive urgency - over 180 or 120 with no end organ damage
58
drugs for hypertensive emergency
59
what is the target for treating hypertensive emergency/urgency
reduce MAP by 15-25% in 2 hours
60
what can cause apnoea post termination of seizure
over medication hypercapnoea hypoglycaemia post ictal coning eg SOL subclinical seizure SDH/EDH menigitis
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1. Fellowship Written - SAQ (30 decks)

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