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Neurology Flashcards

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1
Q

What is the onset time for Bell’s Palsy?

A

Sudden (hours to overnight)

Bell’s Palsy is characterized by a rapid onset of symptoms.

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2
Q

What type of facial weakness is associated with Bell’s Palsy?

A

Lower Motor Neuron (LMN) - affects upper and lower face

This type of weakness results from damage to the facial nerve.

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3
Q

How does forehead wrinkling present in Bell’s Palsy?

A

Absent (unable to wrinkle forehead)

Patients with Bell’s Palsy cannot wrinkle their forehead due to muscle paralysis.

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4
Q

What is the status of eyebrow elevation in Bell’s Palsy?

A

Impaired

Eyebrow elevation is affected due to facial muscle weakness.

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5
Q

What is the status of eye closure in Bell’s Palsy?

A

Impaired - may need eye protection

Patients may require measures to protect the eye from dryness or injury.

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6
Q

Is mouth drooping present in Bell’s Palsy?

A

Present

Mouth drooping is a common symptom due to facial muscle weakness.

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7
Q

What type of pain may occur with Bell’s Palsy?

A

May have retroauricular pain

This pain can occur in the area behind the ear.

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8
Q

What is the common age range for Bell’s Palsy onset?

A

Common in younger adults (20-50 years)

Bell’s Palsy is most frequently diagnosed in this age group.

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9
Q

What is the cause of Bell’s Palsy?

A

Idiopathic (often viral, e.g., HSV-1)

The exact cause is unknown, but viral infections are often implicated.

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10
Q

What is the typical recovery time for Bell’s Palsy?

A

Usually improves over weeks to months (often complete)

Many patients experience significant recovery within this timeframe.

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11
Q

What management is recommended for Bell’s Palsy?

A

Prednisolone (within 72 hours), eye care

Early administration of steroids can help reduce inflammation and improve recovery.

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12
Q

What is the onset time for a stroke involving facial nerve involvement?

A

Sudden (seconds to minutes)

Stroke symptoms can appear very quickly and without warning.

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13
Q

What type of facial weakness is associated with a stroke?

A

Upper Motor Neuron (UMN) - spares the forehead (upper face)

In strokes, the forehead muscles are typically spared due to bilateral innervation.

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14
Q

How does forehead wrinkling present in a stroke?

A

Present (forehead muscles spared)

Patients can still wrinkle their forehead due to the preservation of upper face function.

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15
Q

What is the status of eyebrow elevation in a stroke?

A

Preserved

Eyebrow elevation remains intact in stroke cases affecting the facial nerve.

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16
Q

What is the status of eye closure in a stroke?

A

Normal

Eye closure is typically not affected in strokes involving the facial nerve.

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17
Q

Is mouth drooping present in a stroke?

A

Present

Similar to Bell’s Palsy, mouth drooping is observed due to lower facial weakness.

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18
Q

What other neurological signs may be present in a stroke?

A

Often present - e.g. limb weakness, dysphasia

Strokes often present with additional neurological deficits depending on the affected area.

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19
Q

What is the pain status in a stroke?

A

Usually painless

Strokes often do not cause pain, unlike Bell’s Palsy.

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20
Q

What is the common age range for stroke onset?

A

More common in older adults or those with vascular risk

Age and pre-existing conditions increase the risk of stroke.

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21
Q

What is the cause of stroke?

A

Vascular (e.g., ischaemic stroke)

Strokes are often caused by issues related to blood supply to the brain.

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22
Q

What is Erectile Dysfunction (ED)?

A

Persistent ability to attain/maintain an erection

ED can affect men of all ages but has different underlying causes.

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23
Q

What percentage of younger men with ED have organic causes?

A

20%

The majority are psychogenic in younger men.

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24
Q

List the categories of causes for Erectile Dysfunction.

A
  • Organic (vascular, neurological, anatomical, hormonal)
  • Psychogenic
  • Drugs
  • Lifestyle (long distance lifestyle, alcohol excess, recreational drugs)

Each category can have various contributing factors.

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25
How does organic ED typically present?
Gradual onset, lack of morning erections, normal libido, cardiovascular risk factors ## Footnote Organic causes often relate to physical health issues.
26
How does psychogenic ED typically present?
Sudden onset, early morning erections, reduced libido, spontaneous/stimulated erections, major life changes, previous psychological problems ## Footnote This type is often related to mental health or situational factors.
27
What factors can lead to drug/lifestyle-related ED?
* New medication * New activity (e.g., cycling) * New illicit drug/alcohol excess ## Footnote Lifestyle changes can significantly impact erectile function.
28
What tool can be used to assess sexual health in men?
SHIM (Sexual Health Inventory for Men) ## Footnote This inventory helps in understanding the severity of ED.
29
What investigations are recommended for ED?
* FBC * HbA1c * Lipid profile * Morning sample of total testosterone * PSA (if appropriate) ## Footnote These tests help identify underlying health issues contributing to ED.
30
What is the first-line treatment for ED?
PDE-5 inhibitors ## Footnote These medications are effective regardless of the underlying cause of ED.
31
What should be done if PDE-5 inhibitors are ineffective?
Start low and titrate if ineffective. Arrange follow-up in 6-8 weeks. ## Footnote Patients should also be advised to try the medication with sexual activity.
32
What are contraindications for using PDE-5 inhibitors?
* Taking nitrates * Guanylate cyclase stimulators * Alpha blockers * Hypotension * Unstable angina * Loss of vision in one eye (due to non-arteritic anterior ischaemic optic neuropathy) ## Footnote Each of these conditions poses specific risks when using PDE-5 inhibitors.
33
What are common adverse effects of PDE-5 inhibitors?
* Back ache * Flushing * Migraine * Dizziness * Nausea and vomiting * Visual/hearing disturbance * Priapism (urgent medical advice if >4 hours) ## Footnote Patients should be informed of these potential side effects.
34
When should a patient be referred to Urology?
* Young men who have always had ED * Trauma * Anatomical abnormality * No response to 2x PDE-5 inhibitors ## Footnote These cases may require specialized evaluation.
35
When should a patient be referred to Endocrinology?
If hypogonadism is suspected ## Footnote Hormonal issues can significantly impact erectile function.
36
When should a patient be referred to Mental Health Services?
* If psychogenic cause is suspected * Men with severe mental distress ## Footnote Psychological factors can play a crucial role in ED.
37
What alternative treatment options may be available after referral?
* Vacuum erection devices * Alprostadil ## Footnote These options can be explored if first-line treatments are ineffective.
38
What are some options for managing chronic primary pain?
* Exercise programmes/physical activity * Psychological therapy (ACT or CBT) * Acupuncture (up to 5 hours in community delivered by band 7 clinician or lower or cost equivalent) * Consider an antidepressant even in the absence of depression (off-label use) ## Footnote ACT stands for Acceptance and Commitment Therapy, and CBT stands for Cognitive Behavioral Therapy.
39
True or False. Local anaesthetic trigger point injections can be helpful in chronic pain.
False Do NOT offer: * Opioids * NSAIDs * Paracetamol * Antiepileptics (including gabapentinoids) * Antipsychotics * Benzodiazepines * Steroid +/- local anaesthetic trigger point injections * Ketamine * Local anaesthetics * TENS * Ultrasound * Biofeedback ## Footnote TENS stands for Transcutaneous Electrical Nerve Stimulation.
40
If a patient is already taking drugs that are not recommended for chronic pain, what should be explained to them?
Explain lack of evidence in chronic pain ## Footnote This refers to the insufficient scientific support for the effectiveness of these medications in managing chronic pain.
41
What plan should be agreed upon if a patient is taking non-recommended medications and reports benefit?
Agree a plan to continue safely if they report benefit/few harms and are on a safe dose ## Footnote Safety measures should be taken to monitor the patient's condition and medication effects.
42
What should be encouraged if a patient taking non-recommended medications experiences little benefit or significant harm?
Encourage and support them to reduce and stop ## Footnote This involves guiding the patient through a tapering process to discontinue the medication safely.
43
How long does pain have to be happened for it to be chronic
3 months
44
Neuroplastic pain
Pain processing and modulation issues
45
Neuropathic pain
Nerve damage
46
Nocioceptive pain
Tissue damage
47
What is the most effective treatment for persistent physical symptoms
CBT
48
Exercise is recommended for managing chronic pain but not for CSF/ME where an energy management approach is required True or False
True
49
What is the typical occurrence of vestibular neuritis or labyrinthitis?
They tend to happen just once ## Footnote These conditions are characterized by inflammation of the vestibular nerve or labyrinth.
50
What should the information provided in the pages not replace?
Your own good clinical judgement ## Footnote It emphasizes the importance of individual patient circumstances and medical history.
51
What is a suggested consideration before relying on the information provided?
Check drug doses, potential side-effects and interactions with the British National Formulary ## Footnote This is crucial for patient safety and accurate treatment.
52
What are the symptoms associated with prolonged acute vertigo (>24h)?
* Neurological signs or symptoms, e.g. diplopia * Headache * Nausea * Photophobia/phonophobia ## Footnote These symptoms may indicate a posterior stroke.
53
What condition should be considered with sudden, episodic vertigo triggered by head position changes?
Benign paroxysmal positional vertigo (BPPV) ## Footnote The positive Dix-Hallpike manoeuvre is a diagnostic test for this condition.
54
What symptoms are associated with Ménière's disease?
* Hearing loss * Loss of balance * Tinnitus ## Footnote Ménière's disease is a disorder of the inner ear that can affect hearing and balance.
55
What symptoms suggest vestibular neuritis?
* Prolonged acute vertigo (that's not a stroke) * Loss of balance * Vomiting ## Footnote Vestibular neuritis is often characterized by a sudden onset of vertigo.
56
What is the difference between lightheadedness and vertigo?
Lightheadedness refers to a feeling of faintness or dizziness, while vertigo is the sensation of spinning or movement. ## Footnote Lightheadedness may occur alongside palpitations, chest pain, dyspnea, or loss of consciousness.
57
What would make you think of potential cardiac causes of dizziness?
Possible cardiac causes include palpitations, chest pain, dyspnea, and transient loss of consciousness. ## Footnote Cardiac investigations may be warranted in such cases.
58
What symptoms suggest a cerebellopontine angle tumor?
Symptoms may include gradual onset of vertigo, progressive hearing loss May have facial numbness/weakness, and loss of corneal reflex. ## Footnote Referral for imaging is necessary.
59
What characterizes acute vestibular syndrome?
Acute vestibular syndrome is characterized by constant vertigo lasting more than 24 hours and may include diplopia, difficulty standing, and sensory or motor symptoms. ## Footnote It is considered uncommon and may necessitate admission and imaging.
60
What is the commonest cause of vertigo?
BPPV (Benign Paroxysmal Positional Vertigo) is the commonest cause of vertigo. ## Footnote Treatment may include the Epley manoeuvre.
61
What is the duration and frequency of attacks in Ménière's disease?
Attacks in Ménière's disease last more than 20 minutes, usually less than 2 hours, and may occur episodically. ## Footnote Symptoms include vertigo, tinnitus, and fluctuating sensorineural hearing loss.
62
What is a key characteristic of vestibular migraine?
Vestibular migraine is characterized by episodic and recurrent vertigo, often accompanied by nausea, vomiting, headache, or photophobia. ## Footnote Headache may not be as prominent as in other types of migraine.
63
What is persistent postural-perceptual dizziness?
Persistent postural-perceptual dizziness is a chronic functional disorder characterized by non-spinning vertigo or an unsteady feeling, worsening with complex visual stimuli. ## Footnote This condition improves with distraction and may limit activities.
64
What is the recommended approach for vestibular rehabilitation?
Vestibular rehabilitation involves exercises and strategies designed to alleviate dizziness and improve balance. ## Footnote Specific details can be found in the main Vertigo article.
65
What symptoms are associated with labyrinthitis?
Labyrinthitis may present with vertigo, hearing loss, and other vestibular dysfunctions. ## Footnote It is considered even rarer than vestibular neuritis.
66
Fill in the blank: The Dix-Hallpike test is often positive in cases of _______.
BPPV
67
True or False: Ménière's disease is often accurately diagnosed.
False ## Footnote Ménière's disease is often overdiagnosed.
68
What are the potential symptoms of vertigo that occur suddenly?
Symptoms may include immediate onset of vertigo, constant vertigo, older age, and vascular risk factors. ## Footnote Additional symptoms may include diplopia and difficulty standing.
69
What is the classic triad of menieres
Tinnitus Vertigo Sensation of aural fullness

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