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Phase 2a Medicine > Neurology > Flashcards

Neurology Flashcards

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1
Q

What is a dermatome?

A

Area of skin supplied by a single spinal nerve

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2
Q

What is a myotome?

A

Volume of muscle supplied by a single spinal nerve

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3
Q

Where does light touch travel in the brain to?

A

Fasciculus gracilis and cuneatus on both sides

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4
Q

What % of strokes are embolic?

A

85%

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5
Q

What can embolus at a vertebral artery cause?

A
  1. Deafness
  2. Dizziness
  3. Cerebral disease
  4. Problems with motor coordination
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6
Q

What are the types of intercranial haemorrhage?

A
  1. Extradural
  2. Subdural
  3. Subarachnoid
  4. Intracerebral
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7
Q

What layer of the meninges forms part of the BBB?

A

Pia mater

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8
Q

Where does the circle of Willis lie?

A

Subarachnoid space

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9
Q

What can cause extradural haemorrhage?

A
  1. Trauma
  2. Fractured skull
  3. Bleeding from middle meningeal artery
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10
Q

What are the signs of extradural haemorrhage?

A
  1. Lucid period
  2. Rapid rise in ICP
  3. Coma
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11
Q

What is the pathophysiology of subdural haemorrhage?

A
  1. Bleeding from bridging veins, low pressure so stops soon
  2. Days later haematoma starts to autolyse
  3. Increase in oncotic and osmotic pressure sucks water into haematoma
  4. Gradual rise in ICP
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12
Q

Who is at risk of subdural haemorrhage?

A
  1. Alcoholics
  2. Dementia
  3. Shaken babies
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13
Q

What can cause subarachnoid haemorrhage?

A

Berry aneurysms

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14
Q

What is the pathophysiology of subarachnoid haemorrhage?

A

Rupture of arteries forming circle of Willis

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15
Q

What are the symptoms of subarachnoid haemorrhage?

A
  1. Sudden onset severe headache
  2. Photophobia
  3. Reduced consciousness
  4. Thunderclap headache
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16
Q

What methods can be used to investigate vessels?

A
  1. Angiogram
  2. CT
  3. MRI
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17
Q

What level do common carotid arteries bifurcate?

A

C3-C4

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18
Q

Where does the cervical ICA run?

A

Behind and then medial to ECA

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19
Q

Where does the petrous ICA run?

A

Penetrates temporal bone and runs horizontally in carotid canal

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20
Q

Where does the cavernous ICA run?

A

In cavernous sinus

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21
Q

What does cavernous ICA supply?

A
  1. Dura mater
  2. CN 3-6
  3. Posterior pituitary
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22
Q

What are the key branches of the supraclinoid ICA?

A
  1. Ophthalmic artery
  2. Superior hypophyseal arteries
  3. Posterior communicating artery
  4. Anterior choroidal artery
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23
Q

Which MCA branches run laterally to limen insulae?

A

Lateral lenticulostriate branches (M1)

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24
Q

Why are the lateral lenticulostriate branches a key territory for infarct?

A

They are terminal branches with no anastomoses

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25
What do lateral lenticulostriate arteries supply?
1. Lentiform nucleus 2. Caudate nucleus 3. Internal capsule
26
Where do most strokes occur?
Middle cerebral artery
27
What does the posterior inferior cerebellar artery (PICA) supply?
Medulla and inferiore cerebellum
28
What artery is usually blocked in strokes of young people?
Basilar artery
29
What supplies primary visual cortex?
Posterior cerebral artery
30
What are the primary headache types?
1. Migraine 2. Cluster 3. Tension type
31
What are the secondary headache types?
1. Meningitis 2. SAH 3. GCA 4. Idiopathic intracranial HTN 5. Medication overuse headache
32
What are the risk factors for secondary headache?
1. >50 2. Hx of HIV/cancer 3. Changing personality or cognitive dysfunction 4. Vomiting without other obvious cause
33
What is seen on examination for secondary headache?
1. Fever 2. Altered consciousness 3. Neck stiffness 4. Other abnormal neurological exam e.g. weakness
34
What are the red flags for brain tumours?
1. New headache with Hx cancer 2. Cluster headache 3. Seizure 4. Significantly altered consciousness, confusion 5. Papilloedema 6. Other abnormal nerve exam
35
How long do migraines last?
4-72hr
36
Describe a migraine
1. Unilateral 2. Pulsing 3. Moderate/severe 4. Aggravation by routine physical activity
37
What other symptoms can occur during a migraine?
1. Nausea and/or vomiting 2. Photophobia 3. Phonophobia
38
How many migraine pt. have auras?
20%
39
What can auras consist of?
1. Fully reversible visual symptoms with positive +/- negative features 2. Fully reversible dysphasic speech disturbance
40
How long do tension headaches last?
30 mins to 7 days
41
Describe a tension headache
1. Bilateral 2. Pressing/tightening quality 3. Mild or moderate intensity 4. Not aggravated by routine physical activity
42
What other symptoms are present with a tension headache?
1. Anorexia | 2. Photophobia OR phonophobia
43
Describe a cluster headache
1. Severe or very severe 2. Unilateral 3. Orbital, supraorbital and/or temporal pain 4. 15-180 min if untreated
44
What are the accompanying features of cluster headaches?
1. Ipsilateral cranial autonomic features | 2. Sense of restlessness or agitation
45
What happens in episodic cluster headaches?
>2 cluster periods lasting 7 days to 1 year separated by pain free periods lasting >1 month
46
What happens in chronic cluster headaches?
Attacks occur for >1 year without remission or with remission lasting <1 month
47
What are the characteristics of trigeminal neuralgia?
1. Recurring in paroxysmal attacks from a fraction of a second to 2 mins 2. Severe intensity 3. Electric shock like, shooting, stabbing or sharp 4. Precipitated by innocuous stimuli to affected side of face
48
What is the Rx for primary headache?
1. Oral triptan and NSAID/paracetamol 2. Anti-emetic 3. Topiramate 4. Propranolol 5. Amitriptyline
49
What are the symptoms of meningitis?
1. Headache 2. Pyraxial 3. Photophobia 4. Neck stiffness + pyrexia 5. Rash
50
What is the Ix for SAH?
1. CT 2. LP 3. Angiography
51
What is the Rx for SAH?
1. Resuscitation 2. Nimodipine 3. Intervention to prevent re-bleeding
52
What are the symptoms of raised ICP?
1. Worse on waking 2. Worse coughing, sneezing 3. Worse lying down 4. N&V 5. Papilloedema
53
What are the risk factors for idiopathic intracranial HTN?
1. Obesity | 2. Drugs e.g. tetracycline
54
What is the symptoms for idiopathic intracranial HT?
1. Raised ICP headache 2. Visual disturbance 3. Papilloedema
55
What are the Ix for idiopathic intracranial HTN?
1. CT 2. LP (high opening pressure) 3. MRI
56
What is the Rx for idiopathic intracranial HTN?
Acetazolamide, topiramate, diuretics
57
What are the criteria for giant cell arteritis (GCA)?
1. >50 2. New headache 3. Temporal artery abnormality (tender, decreased pulsation) 4. ESR >50 5. Biopsy abnormality
58
What are the red flags for GCA?
1. >50 | 2. Jaw claudication
59
What are the main causes of a chronic daily headache?
1. Chronic migraine | 2. Medication overuse headache
60
How often does medication overuse headache occur?
>15 days/month
61
Describe medication overuse headache
Developed or markedly worse during drug use
62
Give 3 types of drugs that can cause medication overuse headache
1. Ergotamine 2. Opioids 3. Triptans
63
What is the pathophysiology of meningitis?
1. Bacteria enter CSF and replicate as no immune system 2. Leaky blood vessels let WBC into CSF 3. Inflammation causes brain swelling
64
What are the symptoms of meningitis?
1. Headache 2. Neck stiffness 3. Photophobia 4. Fever 5. Altered consciousness
65
Which age is most at risk of bacterial meningitis?
Children <5 years
66
What are the complications of bacterial meningitis?
1. Skin scars 2. Amputation 3. Hearing loss 4. Seizures 5. Brain damage
67
What is the Rx for bacterial meningitis in primary care?
Benzylpenicillin
68
What is the immediate management for bacterial meningitis in hospital?
1. Stabilise ABCs 2. Assess Glasgow coma score 3. Blood cultures 4. Broad spectrum Abx 5. Steroids (dexamethasone)
69
What Abx are given for bacterial meningitis?
1. Ceftriaxone | 2. Cefotaxime
70
What are the indications for neuroimaging before LP?
1. Focal neurological signs 2. Presence of papilloedema 3. Continuous or uncontrolled seizures 4. GCS <12
71
What are the contraindications to LP?
1. Respiratory or cardiac compromise 2. Abnormal clotting 3. Severe sepsis or rapidly evolving rash 4. Raised ICP 5. Infection at site of LP
72
What is the most common meningitis bug?
Neisseria meningitidis
73
Describe neisseria meningitidis
Gram negative diplococci (N for Negative)
74
What is the Dx if Neisseria meningitidis is found in blood culture?
Meningococcal septicaemia
75
Give 3 other common causes of bacterial meningitis
1. Strep. pneumonia 2. Listeria spp. 3. Group B strep
76
What viruses can cause acute meningitis?
1. Herpes simplex virus 2. Varicella zoster virus 3. Enterovirus
77
What can cause chronic meningitis?
1. Mycobacterium tuberculosis 2. Syphilis 3. Cryptococcal
78
What are the risk factors for bacterial meningitis?
1. Students 2. Travel 3. Immunosuppressed
79
What is the CSF appearance in bacterial meningitis?
Cloudy
80
What is the DDx for meningitis?
1. SAH 2. Primary headache 3. Flu/viral illness 4. Sinusitis 5. Brain abscess
81
What is given to close contacts of a meningitis pt.?
Ciprofloxacin
82
What is encephalitis?
Inflammation of brain parenchyma
83
What is the most common cause of encephalitis?
Herpes simplex virus
84
What are the early symptoms of encephalitis?
1. Flu like illness 2. Headache 3. Fever 4. Confusion 5. N&V
85
What are the late symptoms of encephalitis?
1. Altered GCS (confusion, coma) 2. Fever 3. Cognitive impairment 4. Seizures
86
What are the Ix for encephalitis?
1. MRI head 2. EEG 3. LP 4. HIV test
87
What is the Rx for encephalitis?
1. Physio and neuro rehab | 2. Aciclovir
88
What are the long term effects of encephalitis?
1. Severe amnesic syndrome 2. Neurological deficit 3. Personality change 4. Speech problems
89
What causes tetanus infection?
Inoculation through skin with Clostridium tetani spores
90
What toxins are produced by Clostridium tetani?
1. Tetanolysin | 2. Tetanospasmin
91
What is the pathophysiology of tetanus?
1. Tetanospasmin travels up axons via retrograde flow 2. Interferes with inhibitory NT release 3. Excitatory neurons act unopposed (more firing) 4. Continuous muscle contraction/spasm
92
What is the incubation period of tetanus?
3 to 21 days
93
What are the signs of generalised tetanus?
1. Risus sardonicus (Satanic smile) | 2. Opisthotonos (whole body spasm)
94
What is the management of tetanus?
1. Vaccine 2. Muscle relaxants 3. Paracetamol 4. Immunoglobulin 5. Metronidazole
95
What are the symptom of rabies?
1. Flu-like symptoms 2. Paraesthesia at bite site 3. Cerebral dysfunction 4. Anxiety 5. Confusion 6. Agitation 7. Hydrophobia 8. Insomnia
96
What is the Rx for rabies?
1. Supportive | 2. Prophylaxis (vaccine, immunoglobulin)
97
What is the key sign of 3rd nerve palsy?
Fixed dilated pupil
98
What type of thrombosis is OCP a risk for in the venous sinuses?
Sagittal sinus thrombosis
99
What are the names of the holes that allow CSF from ventricles into subarachnoid space?
Magendie (midline) and Luschka (lateral)
100
What is the result of the Magendie and Luschka holes being blocked?
Obstructive hydrocephalus
101
What are the symptoms of cerebellar syndrome?
1. Ataxia 2. Nystagmus 3. Drunken feeling
102
What are the structures associated with the brainstem?
1. CN III-XII 2. Descending motor tracts (pyramidal) 3. Ascending sensory tracts (Lemnisci) 4. Reticular activation 5. Cerebellar peduncles
103
What does the reticular activating system control?
1. Alertness 2. Sleep/wake 3. REM/non REM sleep 4. Respiratory centre 5. Cardiovascular drive
104
What are the sights of cavernous sinus syndrome?
1. Facial numbness 2. Paralytic squint 3. Fixed dilated pupil
105
What are the consequences of middle ear infection?
1. Deafness | 2. Facial palsy
106
What is the condition associated with rapid changes in serum Na?
Central pontine myelonecrosis
107
What are the criteria for brainstem death?
1. Pupils 2. Corneal reflex 3. Caloric vestibular reflex 4. Cough reflex 5. Gag reflex 6. Respirations 7. Response to pain
108
What part of the NS is affected in MS?
CNS
109
What is the common age of onset for MS?
20-40
110
What are the risk factors for MS?
1. Caucasian 2. Female 3. Latitude 4. Low Vit D 5. Genetics
111
What is the pathophysiology of MS?
Exposure to antigen which drives system to produce auto reactive lymphocytes which are detrimental and cause demyelination and inflammation
112
What is Eutoph's phenomenon?
Remyelinated cells will have thin myelin and pt. never fully recover
113
What are the most common patterns of MS?
1. Macrophage mediated | 2. Antibody mediated
114
What are the typical symptoms of MS?
1. Optic neuritis 2. Spasticity 3. Sensory symptoms 4. Lhermitte's sign 5. Nystagmus, double vision 6. Bladder and sexual dysfunction
115
What are the diagnostic criteria for MS?
1. 2+ CNS lesions disseminated in time and space | 2. Exclusion of conditions giving a similar clinical picture
116
What are the Ix for MS?
1. MRI | 2. CSF - inflammatory proteins
117
What is the DDx for MS?
1. SLE 2. Syphilis 3. Lyme disease 4. Sjogren's syndrome
118
What are the Rx for MS?
1. Steroids - betaferon 2. Methylprednisolone 3. Nataluzimab 4. Diazepam 5. Treat symptoms
119
Describe fatigue in MS
1. Exacerbated by heat 2. Improved by cool temperatures 3. Makes other symptoms appear worse
120
What is the DDx for epilepsy?
1. Hypoglycaemia 2. Migraine 3. Postural syncope 4. TIA
121
What are the main reasons for loss of consciousness?
1. Cardiac/BP related 2. Epileptic seizures 3. Dissociative seizures
122
What is epilepsy?
Recurrent, unprovoked epileptic seizures
123
What is an epileptic seizure?
A paroxysmal event in which changes of behaviour, sensation or cognitive processes are caused by excessive, hyper synchronous neuronal discharges in brain
124
How long does a seizure last?
30-120s
125
What are positive ictal symptoms?
Excessive e.g. seeing, hearing, feeling that isn't there
126
What are postictal symptoms?
Follow positive ictal symptoms e.g. weakness, loss of function
127
Give 2 examples of typical seizure phenomena?
1. Lateral tongue bite | 2. Deja vu
128
What is syncope?
Paroxysmal event in which changes in behaviour, sensation and cognitive processes are caused by an insufficient blood or oxygen supply to brain
129
How long does a syncope last?
5-30s
130
What are pre syncopal symptoms?
1. Stars over whole visual field 2. Noises distorted 3. Dizzy 4. Light headed 5. Vision goes black
131
What is a non-epileptic seizure (NES)?
Paroxysmal event in which changes in behaviour, sensation and cognitive function caused by mental processes associated with psychosocial distress
132
What are the factors suggestive of epilepsy?
1. Tongue biting 2. Head turning 3. Muscle pain 4. LOC >5 min 5. Cyanosis 6. Postictal confusion
133
What are the factors suggestive of syncope?
1. Prolonged upright position 2. Sweating prior to LOC 3. Nausea 4. Pallor
134
What are 5 factors suggestive of NES?
1. Pelvic thrusting 2. Long duration 3. Closed eyes 4. Ictal crying 5. No cyanosis
135
What is the first line Rx for structural epilepsy?
Carbamazepine or lamotrigine
136
When is genetic generalised epilepsy most common?
Childhood
137
What is first line treatment for genetic generalised epilepsy?
Valproate or lamotrigine
138
What seizure types are associated with structural epilepsy?
1. Partial seizure with(out) LOC | 2. Secondary generalised seizures
139
What seizure types are associated with genetic generalised epilepsy?
1. Absence seizures 2. Myoclonic seizures 3. Primary generalised tonic clonic seizures
140
Give 3 drugs that can treat focal seizures
1. Carbamazepine 2. Phenytoin 3. Vigabatrin
141
Give 3 drugs that can treat focal and generalised seizures
1. Valproate 2. Lamotrigine 3. Topiramate
142
Give 2 drugs that can treat generalised seizures
1. Ethosuximide | 2. Rufinamide
143
What are the mechanisms of action of AEDs?
1. Inhibit excitatory cells 2. Increase activity of inhibitory interneurons 3. Inhibit post-synaptic cells so it is less sensitive to excitatory NT
144
What are the Rx for refractory epilepsy?
1. Resective surgery 2. Hemispherectomy 3. Tractotomy 4. Electrostimulation 5. Vagus nerve stimulation
145
What are the symptoms of lateral medullary syndrome on ipsilateral side?
1. Horner's syndrome 2. Limb ataxia 3. Loss of facial sensation 4. Dysarthria 5. Dysphagia
146
What are the symptoms of lateral medullary syndrome on contralateral side?
Loss of pain and temperature sensation
147
Where is sense lost if there is a lesion to dorsal column?
Ipsilateral side
148
What are the symptoms of Brown Squared syndrome at level of lesion?
Ipsilateral spinothalamic
149
What are the symptoms of Brown Squared syndrome below lesion?
1. Ipsilateral corticospinal tract dysfunction 2. Ipsilateral dorsal column dysfunction 3. Contralateral spinothalamic tract dysfunction
150
What are the causes of secondary damage as a result of head injury?
1. Physiological response to trauma 2. Effects of hypoxia/ischaemia 3. Infection
151
What does skull fracture increase risk of?
1. Haematoma 2. Infection 3. Aerocele
152
How do extradural haematoma cause death?
1. Brain displacement 2. Raised ICP 3. Herniation
153
What is the pathophysiology of subdural haematoma?
Tear to bridging veins
154
What are the risk factors for subdural haematoma?
1. Age 2. Dementia 3. Alcohol
155
What are the causes of traumatic SAH?
1. Contusion/laceration 2. Base of skull fracture 3. Vertebral artery rupture/dissection 4. Intraventricular haemorrhage
156
What causes superficial cerebral haemorrhage?
Severe contusion
157
What causes deep cerebral haemorrhage?
Diffuse axonal injury
158
What are the long term effects of diffuse traumatic axonal injury?
1. Thinning of corpus callosum | 2. Gliding contusions
159
What are the causes of brain swelling?
1. Congestive brain swelling 2. Vasogenic oedema 3. Cytotoxic oedema
160
What are the complications of hypoxia ischaemia (HI)?
1. Infarction | 2. Hypoxic ischaemic damage
161
Which brain part is most susceptible to HI?
Hippocampus
162
What are the symptoms of chronic traumatic encephalopathy (CTE)?
1. Personality change 2. Memory problems 3. Epilepsy 4. Parkinsonism 5. Gait problems
163
What is the pathophysiology of CTE?
1. Atrophy 2. Enlarged ventricles with fenestrated cavuum septum 3. Tau-positive neurofibrillary and astrocytic tangles
164
What is the diagnostic criteria for CTE?
Both neurons and astrocytes effected
165
What innervates muscle spindles?
Gamma motor neurones
166
What happens when a muscle is stretched?
1. Afferent impulses from muscle spindles | 2. Reflex partial contraction of muscle
167
What are the potential sites of damage to motor neurons?
1. Motor nuclei 2. Motor neurons 3. Spinal ventral roots 4. Peripheral nerves 5. NMJ 6. Muscle
168
What are the clinical features of LMN lesions?
1. Muscle tone reduced 2. Muscle wasting 3. Fasciculation 4. Depressed reflexes
169
What is the pathophysiology of MND?
1. Motor neuron damaged 2. Muscle loses electrical supply 3. Muscle wastage
170
What are the investigations for LMN conditions?
1. Neurophysiology nerve conduction 2. MRI head/spine 3. Bloods e.g. muscle enzymes, peripheral neuropathy screen 4. LP
171
What are the neural inputs into the final common pathway?
1. Reflex arc 2. Corticospinal pathway 3. Extrapyramidal system 4. Cerebellum
172
What is the corticospinal tract?
A major descending pathway connecting LMN and UMN, important in control of voluntary movements
173
Where do most corticospinal tract fibres crossover?
Medullary pyramid
174
What are the clinical features of upper motor neuron pathology?
1. Spasticity 2. Tendon reflexes are brisk 3. + Babinski sign 4. Limb muscle weakness 5. Emotional lability
175
What is the pattern of limb muscle weakness in UMN pathology?
1. Upper limbs extensors weaker than flexors 2. Low limbs flexors weaker than extensors 3. Finer movements severely impaired
176
What are the common causes of UMN pathology?
1. Stroke 2. MS 3. Spinal compression 4. Tumour 5. MND
177
What are the Ix for UMN pathologies?
1. MRI brain/spine 2. Blood tests for metabolic disorder 3. CSF examination e.g. oligoclonal bands
178
What are the cardinal symptoms of brain tumour?
1. Raised ICP symptoms 2. Progressive neurological deficit 3. Epilepsy
179
What are the symptoms of raised ICP?
1. Headache 2. Reduced conscious level 3. N+V
180
Where are the commonest brain metastases from?
1. Lung 2. Breast 3. Colorectal 4. Testicular 5. Renal cell
181
What is the most common primary brain tumour type?
High grade glioma (HGG)
182
What distinguishes stage of brain tumours?
1. Cellularity 2. Mitotic activity 3. Vascular proliferation 4. Necrosis
183
Describe a low grade glioma (LGG)
Slow growing but will undergo anapaestic transformation
184
When is LGG most often diagnosed?
Age 35
185
Give 4 prognostic factors for LGG
1. Histology type 2. Age 3. Size of tumour 4. Location
186
What is the median age of onset for HGG?
45-60
187
What are the causes of HGG?
1. Ionising radiation 2. FHx 3. Immunosuppression
188
What are the symptoms of brain tumours?
1. Headache 2. Seizures 3. Focal neurological symptoms 4. Behavioural changes
189
Describe a typical brain tumour headache
1. Woken by headache 2. Worse in morning 3. Postural 4. N&V associated
190
What are the focal symptoms of brain tumour?
1. Weakness 2. Sensory loss 3. Visual/speech disturbance 4. Ataxia
191
What are the non-focal symptoms of brain tumour?
1. Personality change 2. Memory disturbance 3. Confusion
192
What are the signs of brain tumour?
1. Papilloedema 2. Hemiparesis 3. Hemisensory loss 4. Visual field defect 5. Dysphagia
193
What are the investigations for brain tumour?
1. CT contrast 2. MRI 3. Brain biopsy 4. Molecular markers
194
What are the Rx for HGG?
1. Steroids 2. Surgery 3. Radiotherapy 4. Chemo - temozolomide
195
What are the Rx for LGG?
1. Surgery 2. Radiotherapy 3. Chemotherapy
196
What are the symptoms of pituitary tumour?
1. Excessive hormone production 2. Visual field problems 3. Inadequate hormone production
197
What are the Rx for secondary brain tumour?
1. Surgery 2. Radiotherapy 3. Chemo 4. Supportive care
198
What form is used in primary care the assess cognitive function?
6CIT
199
What are the symptoms of dementia?
1. Memory loss 2. Problem solving 3. Language
200
What is seen on the brain of Alzheimer's (AD) pt.?
1. EX amyloid plaques | 2. IC neurofibrillary tangles
201
What are the features seen in AD?
1. Gradual and progressive change in memory function >6m | 2. Impaired performance on episodic memory test
202
What lobes tend to be affected in AD?
Temporal and parietal lobes
203
What is the DDx for AD?
1. Vascular dementia 2. Mixed dementia 3. Dementia with Lewy bodies 4. Depressive pseudo dementia
204
What are the psychiatric changes in AD?
1. Social withdrawal 2. Apathy 3. Delusions 4. Agitation
205
What are the Ix for dementia?
1. Memory tests 2. MRI 3. PET scan 4. LP (more amyloid)
206
What is seen on a dementia MRI?
Atrophy
207
What is the Rx for dementia?
1. Support 2. Ach inhibitors 3. Carers 4. Prevention 5. Memantine
208
What are functional symptoms?
Disorder of function of body, rather than structure
209
What are organic symptoms?
Structural problem with body which can be detected by examination or investigation
210
What is depleted in AD?
Acetyl choline
211
What is depleted in PD?
Serotonin, NA, DA
212
What causes psychosis in PD Rx?
Excess DA
213
What are acute neurological pathologies associated with?
Delirium or confusional states with prominent impairment of attention
214
What individual factors can affect psychiatric presentation?
1. Age 2. Sex 3. Education 4. Prior psychiatric Hx
215
What are the psychiatric symptoms of Wilson's disease?
1. Personality change 2. Mood disturbance 3. Psychosis 4. Cognitive impairment
216
What are the psychiatric symptoms of Huntington's?
1. Subcortical dementia 2. Anxiety 3. Personality changes 4. Hallucinations
217
What are the symptoms of fronto-temporal dementia?
1. Apathy 2. Anxiety 3. Egocentricity 4. Elevated mood 5. Neglect personal appearance
218
What psychiatric problems can be caused by a stroke?
1. Personality change 2. Affective disorder 3. Psychosis
219
What are the causes of transient global amnesia?
Migraine-like depression of temporal lobe function
220
What are somatisation disorders?
When physical symptoms are caused by mental or emotional factors
221
What is ataxia
Descriptive term for loss of coordination, clumsiness, tendency to fall
222
What is the output element of the cerebellum?
Purkinje cells
223
What are the symptoms of cerebellar dysfunction?
1. Slurring of speech 2. Unsteadiness 3. Stumbles and falls
224
What are the examinations for cerebellar dysfunction?
1. Gait 2. Limb ataxia 3. Eye movements 4. Speech 5. Sensory ataxia
225
What is the Ix for cerebellar dysfunction?
MRI head
226
What are the signs of cerebellar dysfunction?
1. Nystagmus 2. Dysarthria 3. Action tremor 4. Limb ataxia 5. Gait ataxia
227
What gene is found in 71% of pt. with idiopathic sporadic ataxia?
HLA DQ2
228
What toxins can cause ataxia?
1. Alcohol 2. Phenytoin 3. Lithium
229
What is the main neurodegenerative cerebellar dysfunction?
Multisystem atrophy - C
230
How many strokes are ischaemic?
85%
231
How many strokes are haemorrhagic?
15%
232
What is the main cause of intracerebral haemorrhagic stroke?
High BP
233
What is the DDx for stroke?
1. Hypoglycaemia 2. Migrainous aura 3. Mass lesions 4. Simple partial seizure
234
What is the management for TIA?
1. Assess stroke risk with ACBD2 score 2. Statin e.g. simvastatin 3. Antiplatelet e.g. clopidogrel 4. Treat BP if raised
235
Where do most brain tumours occur in children?
Posterior fossa
236
What is the most common neuroepithelial tumour?
Astrocytoma
237
What is the pathway of progression of astrocytoma?
1. Cell of origin 2. Astrocytoma 3. Anaplastic astrocytoma 4. Glioblastoma
238
When is oligodendroglioma most common?
4th-5th decades
239
Co-deletion of what gene gives a better prognosis of oligodendroglioma?
1p19q
240
What gene is mutated in neuroepithelial tumour?
IDH1
241
What indicates low grade lesions diagnostically?
Rosenthal fibres
242
How do secondary brain tumours often present?
More oedema
243
What is one of the major complications of raised ICP?
Herniation
244
What is the result of no intervention for internal herniation?
Haemorrhage
245
What is the prevalence of PD in >65s?
3%
246
What are the symptoms of PD?
1. Bradykinesia 2. Akinesia 3. Tremor at rest 4. Rigidity
247
What are the signs of PD?
1. Shuffling gait 2. Increased tone 3. Asymmetrical reduced arm swing 4. Rest tremor 5. Decreasing amplitude of repetitive movement
248
What is seen in the brain of a PD pt.?
Reduced substantia nigra
249
How is PD diagnosed?
1. Examination and Hx 2. DaTSCAN - reduced DA 3. CT head
250
What are the Rx for PD?
1. L-DOPA 2. DA agonist e.g. ropinirole 3. COMT inhibitors 4. MAO-B inhibitors e.g. rasagiline 5. Anticholinergics
251
What are the side effects of anticholinergics?
1. Cognition 2. Confusion 3. Systemic
252
What are the complications of PD?
1. Depression 2. Dementia 3. Constipation 4. Anxiety 5. Increased urinary frequency
253
What symptoms are NOT seen in PD at the start?
1. Dementia 2. Incontinence 3. Symmetry 4. Early falls
254
What are the symptoms of normal pressure hydrocephalus?
1. Magnetic gait 2. Incontinence 3. Dementia
255
How is normal pressure hydrocephalus diagnosed?
Enlarged ventricles on CT head
256
What is the Rx for normal pressure hydrocephalus?
Surgical shunt
257
What is the Rx for essential tremor?
1. Beta blockers 2. Primidone 3. Gabapentin
258
What are the cardinal features of Huntington's disease (HD)?
1. Chorea 2. Dementia 3. Psychiatric problems 4. Positive FHx
259
What are the signs of HD?
1. Abnormal eye movement 2. Chorea 3. Ataxia 4. Parkinsonism
260
What is the Rx for HD?
Treat symptoms 1. Sulpride 2. SSRIs 3. Haloperidol 4. Risperidone
261
What is mononeuropathy?
Problem with one nerve
262
What is polyneuropathy?
Problem with many nerves
263
What is the cause of carpal tunnel syndrome?
Median nerve entrapment at wrist
264
What are the symptoms of peripheral neuropathies (PN)?
1. Ataxia 2. Muscle cramp 3. Weakness 4. Fasciculations 5. Atrophy
265
How are axonal PN classified?
1. Symmetrical sensorimotor 2. Asymmetrical sensory 3. Asymmetrical sensorimotor
266
What is the presentation of symmetrical sensorimotor PN?
Tingling in fingers or toes which moves more proximal then motor symptoms start
267
What is affected in asymmetrical sensory PN?
Dorsal root ganglia
268
What is seen on clinical examination in PN?
1. Reduced or absent tendon reflexes 2. Sensory deficit 3. Weakness
269
How are PN diagnosed?
1. Nerve conduction test | 2. Questionnaires
270
What is seen in demyelinating PN on nerve conduction?
Slow conduction velocities
271
What is seen in nerve conduction for PN with axonal problems?
Reduced amplitudes of potentials
272
What are 4 causes of axonal PN?
1. HIV 2. Vasculitis 3. Porphyria 4. Hepatitis
273
What systemic disease are associated with PN?
1. DM 2. Vit B12 deficiency 3. Coeliac disease
274
What are the main types of Guillain Barre syndrome?
1. Demyelinating 2. Axonal motor 3. Axonal sensorimotor
275
What is the presentation of Guillain Barre syndrome?
Rapid ascending paralysis and sensory deficits
276
What is the usual cause of Guillain Barre syndrome?
Campylobacter GI infection
277
What is the Rx for Guillain Barre syndrome?
IVIG plasma exchange
278
What are the Rx for PN?
1. Pain e.g. gabapentin 2. Cramps e.g. quinine 3. Balance e.g. physio
279
What does an anterior circulation stroke block?
Artery from or off circle of Willis
280
What does posterior circulation stroke block?
Basilar or vertebral arteries
281
Stroke to what vessel causes the biggest deficit?
MCA
282
What are the symptoms of ACA stroke?
1. Leg weakness 2. Sensory disturbance in legs 3. Gait apraxia 4. Incontinence 5. Drowsiness
283
How is stroke diagnosed?
CT head
284
What are the symptoms of MCA stroke?
1. Contralateral arm and leg weakness 2. Contralateral sensory loss 3. Hemianopia 4. Aphasia 5. Facial droop
285
What are the symptoms of PCA stroke?
1. Contralateral homonymous hemianopia 2. Cortical blindess 3. Headaches unilateral 4. Prosopagnosia 5. Visual agnosia
286
What are the symptoms of posterior circulation strokes?
1. Motor deficits 2. Dysarthria 3. Vertigo 4. Visual disturbance 5. Altered consciousness
287
What is the Rx for stroke?
1. Acitlyse (thrombolysis) 2. Clot retrieval 3. Interarterial thrombolysis 4. Decompressive craniectomy
288
What is the risk management Rx for stroke?
1. Aspirin 2. Clopidogrel 3. Statins 4. Warfarin 5. Antihypertensives
289
What are the symptoms of SC compression?
1. Pain and stiffness in neck/back 2. Sciatica 3. Numbness in limbs 4. Loss of sensation in feet 5. Foot drop
290
How is SC compression diagnosed?
1. XR spine (spurs) 2. CT spine 3. Bone scan 4. EMG
291
What is the Rx for SC compression?
1. NSAIDs 2. Steroids high dose 3. Radiation therapy 4. Physical therapy
292
What are the symptoms of cauda equina syndrome?
1. Low back pain 2. Sciatica 3. Saddle and perineal hypoesthesia 4. Bowel disturbance
293
What are the Ix of cauda equina syndrome?
1. MRI | 2. Myleogram
294
What is the Rx for cauda equina syndrome?
1. Surgery | 2. Catheterisation
295
What nerve does carpel tunnel compress?
Median nerve
296
What are the symptoms of carpel tunnel syndrome?
1. Numbness in first three fingers and thumb 2. Pain that travels up arm 3. Wrist pain at night 4. Weakness in hand muscles
297
What are the Ix for carpal tunnel syndrome?
1. Physical exam 2. XR 3. Electromyography 4. Nerve conduction study
298
What is the Rx for carpal tunnel syndrome?
1. Wrist splinting 2. NSAIDs 3. Corticosteroids 4. Surgery
299
What is the pathophysiology of myaesthenia gravis?
Breakdown in normal communication between nerves and muscles
300
What are the symptoms are myaesthenia gravis?
1. Ptosis 2. Diplopia 3. Impair speaking 4. Difficulty swallowing 5. Weak neck muscles
301
What is the Dx for myaesthenia gravis?
1. Neurological exam 2. Edrophonium test 3. Ice pack test 4. Nerve stimulation studies 5. CT
302
What is the Rx for myaesthenia gravis?
1. Pyridostigmine 2. Neostigmine 3. Prednisone 4. Azathioprine

Phase 2a Medicine (15 decks)

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