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UKMLA > Neurology > Flashcards

Neurology Flashcards

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1
Q

Symptoms of Charcot - Maries Foot

A

high arch foot
sharp shooting pain of feet

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2
Q

what infection precedes Gillian barre?

A

campylobacter jejuni

(gastroenteritis symptoms)

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3
Q

presentation of Gillian barre

A

reduced reflexes
cranial nerve 7 palsy and diplopia
respiratory muscle weakness

SYMMETRICAL ASCENDING WEAKNESS BEGINS FEET PROGRESSES UPWARDS

4 weeks of trigger

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3
Q

investigation for Gillian barre?

A
  1. nerve conduction studies
  2. lumbar puncture ++protein normal cell count and glucose
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3
Q

DAVID acronym for peripheral neuropath causes?

A

D - Diabetes
A - alcoholic peripheral neuropathy
V -

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4
Q

management for Guilian barre?

A
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5
Q

vitamin deficiencies

A

B12

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6
Q

Infections

A

shingles
HIV
herpes

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7
Q

types of seizures

A

tonic clonic
partial focal (focal aware)
myoclonic
focal impaired seizure
tonic seizure
atonic seizure

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7
Q

Diseases - autoimmune

A

charcot maries
guillian barre

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8
Q

tonic clonic seizure explained?

A
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9
Q

investigations for seizures

A

EEG
MRI brain = structural pathology
blood glucose (HbA1c)
U&E = electrolyte imbalance
blood culture
urine dip
lumbar puncture (sepsis, encephalitis or meningitis)
ECG = cardiac syncope

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10
Q

advice for patients?

A

showers not bath
12 month seizure free before can drive

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10
Q

what is teratogenic in anti epileptics?

A

sodium valproate

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11
Q

what is given to child bearing patents with seizures?

A

lamotrigine, levetiracetam

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12
Q

what is given for absent seizures?

A

ethosuxamide

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13
Q

myoclonic women who are able to have children?

A

levetiracetam

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14
Q

essential tremor what it is?

A

fine tremor affecting all voluntary muscles

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15
Q

what is an action tremor?

A

essential tremor

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15
Q

what tremor is absent at sleep?

A

essential tremor

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16
Q

when is an essential tremor better?

A

alcohol

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17
Q

is essential tremor asymmetrical or symmetrical?

A

symmetrical

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18
Q

location of essential tremor?

A

hands and head usually

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19
Q

What is MND?

A

progressive and eventually fatal condition where motor neurones stop functioning

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19
presenting symptoms of MND
usually late middle aged man, increased fatigue of muscles and fatigue after exercise e.g., foot drop usually first noticed in upper limbs 1. trips and clumsiness are first sign 2. increased tone and spasticity 3. upping plantar reflex 4. muscle wasting reduced tone 5. reduced reflexes 6. slurred speech and dysarthria (UMN AND LMN SIGNS)
19
management of essential tremor?
propanolol
19
what is the second most common MND type?
progressive bulbar palsy - affects muscle of talking and swelling (most severe)
19
investigations to diagnose MND
clinical diagnosis made by specialists
20
what is the management of MND
no cure Riluzole can slow progression if they have ALS and extend life over months NIV for respiratory weakness management for maintaining quality of life. usually die from respiratory failure and pneumonia
20
What is the most common type of MND
ALS
20
multiple sclerosis?
chronic progressive condition where immune system attacks myeline sheath, impacts oligodendrocytes
20
what other types of MS are there?
secondary progressive (elongated periods of relapse) primary progressive (symptoms for a year without disease free period)
21
most common MS type?
relapsing-remitting
21
nutrition method preferred for MND?
PEG
21
symptoms of MS
1. optic neuritis (demyelination of optic nerve, unilateral impaired vision, pain moving eyes, colour differences) - central scatoma 2. diplopia 3. focal weakness (corners, facial nerve palsy, paralysis, incontinence) 4. focal sensory numbness (electric shock sensation on neck flexion) 5. ataxia
21
what is lhermittes sign?
electric shock on flexion of neck if positive = MS
22
investigations for MS?
1. MRI scan to see lesions 2. neurologist clinical picture 3. lumbar puncture (oligoclonal bands in lumbar puncture in the CSF)
23
management for MS?
Flare up treatment: STEROIDS - high dose oral steroids - IV steroids 3-5 days if eye involvement natalizumab ocrelizumab = used to induce long term remission
24
What is myasthenia gravis
autoimmune condition for muscle weakness worse activity better at rest usually women <40 men >60 associated with thymoma - motor neurone communicate with neuromuscular junction. ACH antibodies are produced and block the AcH receptors
25
most common antibodies to be seen in myasthenia graves?
ACh receptor antibodies 1. Muscle specific Kinase (MUSK) 2. LRP4 (low density lipoprotein)
26
presenting symptoms of Myasthenia Gravis?
- eyelid weakness (drooping eyelid) - double vision - worsening with activities - climbing stairs, raising hands up head - jaw fatigue and swallowing issue - weakness in facial movements and slurred speech?
27
investigations of myasthenia gravis
blood AcH, MuSK and LRP4 CT or MRI thymoma
28
management for myasthenia gravis
pyridostigmine is mangat treatment for myasthenia graves prednisolone for immunosuppression thymectomy rituximab
29
what is parkinson's disease
reduction of dopamine from basal ganglia
30
3 and more cardinal symptoms of Parkinson's
1. resting tremor (unilateral) - pill rolling, worse when distracted 2.cogwheel rigidity 3. bradykinesia (slowing of movements) 4. stoop posture 5.lack of arm swing 6. shuffling gait 7. hypomania (no facial expression)
31
parkinson + sydromes?
4 main ones - multi system atrophy - dementia with lewy bodies (dementia with parkinsonian features, visual hallucinations, fluctuating consciousness) - progressive supranuclear palsy - cortical basal degeneration
32
management for Parkinson's
refer to neurologist and give levodopa co-beneldopa (peripheral decarboxylase inhibitor) given to prevent breakdown MOAI (selegiline) prevent breakdown COMT (entcapone) prevent breakdown Cabergoline (dopamine agonist)
33
cabergoline can develop into what?
pulmonary fibrosis
34
what will spinal cord injury present with?
1. motor symptoms - weakness or paralysis - UMN signs 2. sensory symptoms - shock burning - loss or alteration 3. Pain - neuropathic 4. autonomic - HTN and bradycardia - bladder and bowel dysfunction (IF BELOW T11/12) - Sexual dysfunction
35
anterior cord syndrome
loss of motor and pain/temp preserved proprioception anterior spinal artery occlusion
35
investigations for since cord injury?
CT spine MRI for soft tissue
35
central cord syndrome ?
impacts the upper>lower usually elderly patients with hyperextension injuries of neck
35
brown squared syndrome?
usually penetrating trauma -ipsilateral motor function loss -contralateral temp and pain loss
36
subarachnoid haemorrhage presentation ?
usually ruptured cerebral aneurysm in the brain between pia and arachnoid membrane 1. thunder clap headache which reaches max intensity 30s-1min 2. usually in sex or heavy lifting 3. neck stiffness, vomiting and photophobia 4. visual changes, dyshagia and lack of consciousness, week of headaches LACK OF FEVER = NO MENINGITIS
36
management of spinal cord lesions
IV methylprednisolone surgical decompression or referral
37
risk factors for subarachnoid haemorrhage
family history PCOS HTN Smoking Excessive alcohol cocaine use sickle cells
37
investigations for subarachnoid haemorrhage?
CT head first line WITHIN 6 HOURS OF SYMPTOMS ONSET lumbar puncture otherwise = look for yellow colour (xanthochromia , increased bilirubin) ECG CT angio to locate
37
medical management for subarachnoid haemorrhage
Nimodipine used to prevent vasospasm which cause brain ischaemia
38
subdural haemorrhage cause?
shearing of bridging vein - whiplash high impact injuries
38
surgical management for subarachnoid
coiling
39
investigation for subdural haemorrhage?
CT scan show crescent shape
40
management of subdural haemorrhage
41
where does bleeding present on CT in subarachnoid?
ventricles and cystines (middle of brain)
42
extradural haemorrhage causes?
middle meningeal in temporparietal region
42
biconvex CT scan what is it?
extradural
43
what is subarachnoid?
rupture of aneurysm
44
dilated pupil is indicated of what haemorrhage
extradural haemorrhage
45
trigeminal neuralgia impacts what nerve?
46
what triggers trigemnial neuralgia what is the cause?
pinprick sharp feelings over the face small muscle movements usually cause pain (washing, shaving, smoking, talking) unilateral
46
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47
management for trigeminal neuralgia?
carbamazepine failure to respond then referral

UKMLA (14 decks)

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