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MIND AND MOVEMENT > Neurology > Flashcards

Neurology Flashcards

1
Q

Tests to do if query myasthenia gravis

A

Short acting anticholinesterase agent in MG would transiently improve symptoms.
Do chest imaging to rule out thymoma
Do CT brain
Blood as,pale for anti acetylcholinesterase antibodies

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2
Q

Problems with MG

A

Progressive fatiguable weakness
They also have problems with mastication, talking, drinking, swallowing. Aspiration pneumonia and resp failure can result as unable to clear secretions

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3
Q

Neuro systems review

A 
Headaches
 Altered vision
Fits, faints, funny turns
Hearing difficulties 
Memory problems
Speech and swallowing difficulties 
Weakness
Numbness or tingling
Incontince or retention
Erectile dysfunction
Balance or coordination difficulties 
How is it affecting ADLs
FH
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4
Q

Progressive weakness without sensory loss. Arm twitching. Legs giving way. Change in speech. Father died when in 30s.

A

Amyotrophic lateral sclerosis- UMN AND LMN lesions. Some genetic component but sporadic mutations more common

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5
Q

Severe painful unilateral headaches. No warning. Eye watering, nasal stuffiness. No symptoms between headaches. Usually at night.

A

Cluster headache

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6
Q

Tight band like headache precipitated by stress

A

Tension headache

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7
Q

Brief stabbing pain when chewing or brushing teeth

A

Trigeminal neuralgia

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8
Q

Photophobia, neck stiffness, fever, headache

A

Meningitis

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9
Q

Sudden onset excruciating headache. Reaches climax within minutes

A

Subarachnoid haemorrhage

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10
Q

Unilateral landing headshcem multiple triggers, lasts for hours, aversion to bright lights, can be preceded by aura

A

Migraine

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11
Q

20 minute unilateral debilitating headache p. Retro orbital pain with red eye and watering

A

Cluster headache

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12
Q

Headache triggered by changes in position or exertion. Changes in vision or headache with leaning forward, coughing, sneezing

A

Raised Icp- SOL- tumour, abscess. Hydrocephalus

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13
Q

Pain around eyes with blurred vision and halos around lights

A

Acute angle closure glaucoma

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14
Q

Scalp tenderness, unilateral. Jaw claudication .

A

Temporal arteritis

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15
Q

Red flags for headaches

A 
Sudden onset 
High severity
Fever
New onset neurological deficit 
New onset cognitive dysfunction 
Change in personality
Impaired GCS
recent head trauma
Headache triggered by cough, sneeze, exercise or change in posture
Headache with halls around lights 
Headache with jaw claudication
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16
Q

LOC triggered you vigorous exercise in a young person

A

Hypertrophic cardiomyopathy or cardiogenic syncope

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17
Q

Triggered by pain, fear, prolonged standing. Preceded by pallor, nausea, sweating, no confusion afterwards

A

Vaso vagal

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18
Q

Triggered when standing up

A

Postural hypotension

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19
Q

Collapse on shaving or turning head

A

Carotid sinus sensitivity

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20
Q

Crying out, falling to floor, period of stiffness followed by rhythmic jerking that gradually decreases in amplitude and frequency, period of confusion after

A

Generalised tonic clinic seizure

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21
Q

LOC, pale and sweaty beforehand, jerking of limbs, eye rolled back short duration, no confusion

A

Vaso vagal

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22
Q

Violent shaking, head moving side to side , arching back, episodes of stillness before starting again, forced eye closure

A

Psychogenic non epileptic struck

23
Q

Facial weakness on right side, motor weakness on left

A

Right side brainstem lesion

24
Q

Left weakness and sensory changes

A

Right hemisphere lesion

25
Q

Lower motor neurone weakness in all four limbs and loss of sensation

A

Peripheral neuropathy

26
Q

UMN signs in all four limbs and loss of sensation

A

Spinal cord lesion

27
Q

Loss of vision and pain in eye. Incontinence. Leg weakness

A

Think MS

Do MRI brain and spine

28
Q

Elderly patient, head trauma, worsening lethargy, confusion

A

Subdural haematoma

Do CT

29
Q

Progressive weakness, cannot walk unaided, started off at numbness and tingling in hands and feet. Now SOB. Had food poisoning three weeks ago
Absent reflexes , glove and sticking sensory loss

A

GBS
Differential of transverse myelitis

Do LP and MRI

30
Q

Treatment of GBS

A

Iv immunoglobulin
Or plasma exchange

DVT prophylaxis, lots of obs

31
Q

LP with high protein but normal white cells

A

GBS

32
Q

Key features of GBS

A 
Peak disability in four weeks 
Antecedent trigger 
Areflexia
CSF- high protein, normal cell count 
Generally spontaneous recovery occurs
33
Q

Differentials of GBS

A 
Acute myelopathies
Botulism
Diphtheria 
Lyme disease 
Vasculitis neuropathy
34
Q

Oligoclonal bands in CSF and not in blood

A

Think MS

35
Q

Four limb symptoms and urinary disturbance

A

Cervical spine

36
Q

Right sided facial weakness. Whole face, no sparing. Sensation normal

A

Right LMN lesion. Bell’s palsy

37
Q

Treatment of Bell’s palsy

A

Steroids
aciclovir
Tape eye closed at night

Can initially worsen before getting better

38
Q

Painful vesicles affecting external ear, palate. Facial weakness. Ear and face pain

A

Ramsay hunt syndrome

Treat with aciclovir within 3 days of onset and steroids

39
Q

Young female with foot slapping when walking after a weekend kneeling

A

Common peroneal nerve palsy. Get nerve conduction studies

Ask about back pain as the palsy could be due to prolapsed disc.

40
Q

Wrist drop

A

Radial nerve palsy. Often due to compression on mid shaft of humerus. Get neurophysiology assessment. Give splint to help with function

41
Q

Young man, blurring in right eye, discomfort and pain in movement of eye. Reduction in vision in right eye. Left eye normal

A

Optic nerve problem. Eg optic neuritis

42
Q

Blood tests following RAPD

A

Serum b12 as deficiency can mimic optic neuropathy
Look for evidence of multi system inflammation
No pun specific inflammatory markers eg CRP, ESR
Specific immunological markers- ANA, ANCA, serum ACE,
Infectious triggers eg HIV, syphillis, hep B and C
Rarer antibodies eg Devics

MRI scan would show high signal in optic nerve

43
Q

Causes of an unsteady gait

A

Cerebellum problems leading to cerebellar ataxia
Dorsal column problem leading to sensory ataxia
Peripheral nerve problems leading to sensory ataxia
Vestibular problems

44
Q

Features of cerebellar disease

A

Vertigo and nausea
Voice changes- staccato
Poor coordination in arms and legs
One side of body affected- ipsilateral lesion

45
Q

Vestibular problems

A

Nausea
Vertigo
Room spinning
Can lead to hearing loss and tinnitus

46
Q

Unsteady gait and sensory loss. Pins and needles. Balance worse in dark. Fall over when eyes closed

A

Sensory ataxia

47
Q

Unsteady gait and bladder disturbance

A

Spinal cord lesion

48
Q

How to treat MS relapse

A

High dose steroids, give PPI alongside this

Try to treat symptoms of the relapse

49
Q

Medications used in MS

A

Steroids to treat relapse

Disease modifying agents eg beta interferons

Baclofen- reduce muscle spasticity. Can be very sedative through
Gabapentin- reduce neuropathic pain
Sertraline- depression often common with chronic disease
Oxybutinin- if urge incontinence a problem but can lead to bladder retention

50
Q

How to treat neuropathic pain

A

Pregablin
Gabapentin
Tricyclic antidepressant eg amitriptylline
Carbamazepine (useful in trigeminal neuralgia)

51
Q

Side effects of beta interferons

A

Injection site reaction or rash
Flu like symptoms for a few days
Reduced immune system

52
Q

Conditions that can mimic MS

A

Devics syndrome- neuromyelitis optics, affects spinal cord and optic nerve. Test for NMO antibodies
Anticsediolipin antibody syndrome
Neurosarcoidosis
Sjogrens

53
Q

Side effects of steroids

A 
Acne 
Blurred vision 
Cataracts 
Glaucoma 
Easy bruising 
Difficulty sleeping 
High blood pressure 
Increased appetite and weight gain 
Increased Body hair 
Ulcers 
Diabetes 
Osteoporosis 
Impaired wound healing

MIND AND MOVEMENT (6 decks)

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