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Neurology Flashcards

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1
Q

Name 3 common sites for metastases to the brain

A

Lung
Breast
Prostate

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2
Q

Risk factors for brain tumours

A

Family syndromes
Ionising radiation
X - Ray exposure
MEN - 1

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3
Q

Signs of ICP

A

Headache
Nausea
vomitting
Papilloedema

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4
Q

Warning signs for a headache

A

worse on:

  • waking
  • bending over
  • lying down
  • coughing
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5
Q

Cerebllar signs

A 
DANISH 
D - Dydiadochockinesis 
A - Ataxia 
N - Nystagmus 
I - Intention tremor
S - Slurred speech
H - hypotonia
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6
Q

Clinical presentation of brain tumour

A 
Paresis of limbs 
Speech disorder
Dysphasia 
Seizures
Personality changes 
Coma
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7
Q

Brain tumour investigations

A
  • MRI with gadolinium contrast

- Biopsy + Histology

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8
Q

Causes of Cauda equina syndrome

A

Lumbar disc herniation

  • L4/5
  • L5/S1

Spinal verterbral fractures

Malignancy

Spinal infection

Spinal stenosis
- AS

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9
Q

CES red flags

A
  • Reduced anal tone
  • Bilateral sciatica
  • Saddle anaesthesia
  • Bowel dysfunction
  • Bladder dysfunction
    Urinary retention
  • Sexual dysfunction
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10
Q

Causes of cranial nerve lesions

A 
Trauma 
Tumour
SLE
Herpes zoster
Palsy
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11
Q

CN3 palsy presentation

A
  • Eye down and out
  • Ptosis
  • Mydriasis
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12
Q

CN4 palsy presentation

A
  • Eye down and In
  • Diplopia when looking down
  • Head tilt
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13
Q

CN7 palsy - UMN presentation

A
  • Contralateral paralysis of facial muscles
  • Forhead sparing
  • Lip drooping
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14
Q

CN7 Palsy - LMN presentation

A
  • Ipsialteral paralysis of facial muscles
  • NO forhead sparing
  • Loss of anterior 2/3 of taste
  • Dry eyes
  • Hyperacusis
  • Lip droop
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15
Q

Causes of CN7 palsy

A

Inflammation of parotid

Middle ear infections

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16
Q

CN9 palsy presentation

A

Uvular deviation

decreased gag reflex

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17
Q

Risk factors for dementia

A 
Age > 65
Family Hx
Downs syndrome 
Smoking 
DM
Head trauma
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18
Q

Genetic RF for dementia

A

Apolipoprotein E-E4

Deterministic gene - APP

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19
Q

Alzehimers

  • Onset
  • Sx and signs
  • pathology/imaging
A
  • gradual
- sx
Aphasia 
Agnosia 
Apraxia 
Loss of STM + LTM
Cognitive impairement 
Disorientated
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20
Q

Vascular

  • Onset
  • Sx and signs
  • pathology/imaging
A
  • Abrupt / gradual
  • Sx
    Stepwise deterioration
    periods of stability
  • Areas of ischaemia present on imaging from previous CVA
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21
Q

Lewy body

  • Onset
  • Sx and signs
  • pathology/imaging
A
  • Insidious
- Sx
Hallucinations 
Parkinsoism 
- Tremor 
- SLowing 
- Rigidity
  • Deposition of abnormal proteins
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22
Q

Charecterisitc features of Alzehimers

A
  • Neurofibrillary tangles

- Beta amyloid plaques

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23
Q

Alzehimers mangement

A 
Cholinesterase inhibitors 
- Donepezil 
- Rivastigime 
- Galantamine 
Improves memeory and cognitive function

NDMA receptor antagonist
- Memantine

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24
Q

Viral causes of encephilitis

A
  • Herpes simplex
  • Varicella zoster
  • CMV
  • EBV
  • MMR
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25
Encephilits presentation
``` Fever Headache Odd behaviour Seizure Focal neurological deficits - Hemiparesis - Dysphasia ```
26
Encephalitis Investigations
1st - LP 2nd - MRI 3rd - swabs
27
What is recommended in all encephalitis patients
HIV testing
28
Ecepahlitis management
- Aciclovir
29
Metabolic causes of seizures
hypoglycaemia hyponatraemia hypoxia
30
What is the prodrome
not part of the seizure - changes in mood and behaviour - lasts hours to days
31
what is aura
part of a seizure - patient is aware - strange gut feeling - De-javu - strange smells
32
Where is a seizure with aura typically located
temporal lobe
33
What are localising features to a temporal lobe seizure
- automatisms - dysphasia - dejavu - emotional disturbance - hallucination of smell/taste
34
What are localising features to a frontal lobe seizure
- posturing - pedalling leg movements - jacksonian march - motor arrest - todds palsy
35
What are localising features to a parietal lobe seizure
- tingling - numbess - motor sx
36
Charecterisitc of a generalsied seizure
- LOC | - bilateral symmetrical motor movements
37
Features of tonic clonic seizure
- LOC - limbs stiffen then jerk - eyes open - tongue bitten - incontinence - post ictal confusion
38
Features of myoclonic seizure
Sudden jerk of limb/trunk/face
39
Causes of status epilepticus
- abruptly stopping anti-epileptic medication - alcohol use - poor compliance to therapy
40
Status epilepticus tx
1st - Lorazepam 2nd - Phenytoin 3rd - Phenobarbital
41
Focal seizures tx
1st - Carbamazepine / Lamotrigrine 2nd - Sodium valporate
42
Adverse effects of Sodium valporate
Teratogenic drug induced liver injury pancreatitis
43
Adverse effects of carbamezapine
Teratogenic Agranulocytosis SIADH Hyponatraemia
44
Adverse effects of lamotrigrine
severe skin reactions
45
Adverse effects of phenytoin
cardiac arrhythmias
46
What is GCA astrongly linked to
Polymyalgia rheumatica
47
GCA presentation
``` Unilateral headache scalp tenderness jaw claudication blurred vision fever vision loss - painless peripheral oedema ```
48
GCA investigations
Clinical presentation bloods - LFTs - Raised ALP - FBC - Anaemia Duplex US of temporal.A Temporal.A biopsy
49
Findings from temporal artery biopsy in GCA
Multinucleated giant cells
50
GCA management
Prednisolone - 60mg Asprin - 75mg Omeprazole
51
What can occur if patients with GCA stop taking theor steroids
Adrenal crisis
52
What is Guillian barre syndrome
Progressive weakness of proximal muscles due to Ab against myselin sheath
53
GBS aetiology
Infection - Campylobacter jejuni - CMV - EBV
54
GBS presentation
- Symmetrical ascending muscle weakness - Pain in back - Areflexia - Parasthesia - Flaccid paralysis
55
Criteria for diagnosing GBS
Brighton
56
GBS investigations
LP - Raised protein but normal WCC Nerve conduction studies
57
GBS differentials
Other causes of acute paralyis - Stroke - Encephalitis - S.C compression
58
GBS managment
- IV immunoglobulins - Plasma exchange - Enoxaparin
59
What should you do prior to GBS tx
Screen for IgA deficiency
60
Causes of SAH
Aneurysmal - ADPKD - Atherosclerosis - HTN - Ruptured berry aneurysm Non aneurysmal - Trauma - AV malformations - Coagulopathies
61
SAH presntation - sx
``` thunderclap headache - occipital nausea vomitting collpase reduced consciousness seizure ```
62
SAH signs
Mengism - photophobia - stiff neck - pain on neck flexion +VE kernigs sign
63
What is kernigs sign
inability to straighten the leg when the hip is flexed to 90 degrees.
64
SAH investigations
- Non contrast CT - LP negative CT but hx is suggestive
65
SAH findings and timings for LP
- 12hrs post sx CSF analysis - elevated red cell count - Xanthochromia
66
SAH management
- ABCDE - Fluids - Analgesia - Anti emetics
67
What should patients with SAH started on
Nimodipine | - reduces vasospasm
68
SAH complications
hydrocephalus vasospasm - cerebral infarction hyponatraemia rebleeding
69
Subdural haemorrhage pathophsiology
Tearing of bridging veins - deceleration injury - blood accumulates - raised ICP - brain herniation
70
SDH risk factors
``` alcohol excess epileptics old age trauma clotting disorders ```
71
EDH clinical presentation
``` Initial LOC Lucid period headache nausea vomitting drowsiness ```
72
EDH presentation - signs
- drop in GCS - Positive babinski sign - Hypereflexia - Blown pupil - ipsilateral
73
Causes of tension headache
``` MC SCOLD M- missed meals C - Conflict S - stress C - clenched jaw O - Over exertion L - Lack of sleep D - Depression ```
74
Causes of migraine
``` CHOCOLATE C - chcoclate H - hangovers O - Orgasma C - Cheese O - Oral pill L - Lie ins A - Alcohol T E - excercise ```
75
Migraines presentation
Aura - cravings / mood changes Unilateral - pulsating Worse on movement With one of the following Photophobia/ phonophobia Nausea / vomiting
76
Migranes tx
Mild - NSAIDs - Anti emetics Severe - Sumitriptan
77
Migraine prophlaxis
1st - Propranolol / Topirmate 2nd - Acupuncture 3rd - Amitriptyline
78
Cluster headache presnetation
``` Rapid onset excrutitating pain (15-180mins) Lacriamtion bloodshot eye rhinorrhea Miosis Ptosis lid swelling nocturnal pain vomitting ```
79
Cluster headache acute tx
- 100% O2 | - Sumitriptan
80
Cluster headache prophylaxis
Avoid triggers - alcohol | 1st - CCB
81
Trigeminal neuralgia presentation
unilateral pain | - electryfying/burning/lighting
82
Trigeminal neurlagia causes
CN 5 compression - cyst - tumour - MS
83
Trigeminal neuralgia Tx
Avoid triggers Meds 1st - Carbamezapine 2nd - Pheytoin/gabapentin surgical - Microvascualr decompression
84
Shingles presentation
``` Pain + tingling - dermatome malaise myalgia fever headache rash - papules + vesicles pruritus ```
85
Shingles investigations
- Clincal dx | - confirmes with PCR testing
86
Shingles differential dx
atopic eczema impetigo contact dermatitis migraine
87
shingles risk for reactivation
``` old age immunocompromised HIV Hodgkins BM transplant ```
88
Shingles tx
IV aciclovir
89
Shingles complications
Post herpetic neuralgia - burning intracable pain - poor response to analgesics tx: - Amitryptyline
90
What is Huntingtons disease
AD condition charecterised by progressive neurodegeneration
91
Huntingtons disease risk factors
Family Hx | Longer CAG repeat
92
Huntingtons disease pathophysiology
30-40 year olds ``` Triple CAG disorder - > 36 Anticipation Mutation on chromosome 4 Polyglutamine disorder Glutamine accumulates in striatum causing cell death Chorea ```
93
What forms the striatum
caudate | putamen
94
HD net effect
Decreased - GABA Decreased - Ach Increased - dopamine
95
HD clincial presentation
``` behavioural changes personality chnages chorea poor cordiantion 'dysarthria dysphagia jerky eye movements aggression ```
96
HD investigations
genetic testing CT / MRI - Atrophy of caudate nucleus
97
HD differential dx
other causes of chorea | - stroke of basal ganglia
98
HD - chorea tx
Tetrabenazine - dopamine depeting agent Sulpride - Dopamine receptor antagonist
99
HD - depression tx
Sertraline
100
HD - aggression tx
Risperidone | - Anti psychotic
101
What is mengingitis
Inflammation of meningies - Arachnoid + Pia Notifiable disease
102
Common organsims causing menigitis in children
Neisseris meningitides - Gram -ve Diplococci Strep peneumonia Haemophilius influnzae
103
Common organsims causing menigitis in neonates
E.Coli Strep. Agalactiae - Group B haemolytic strep
104
Common organsims causing menigitis in pregnancy
Listeria monocytogenes
105
Meningitis presentation
``` Heacdache neck stiffness Fever Photophobia Kernigs sign Petechial rash vomitting ```
106
What is Brudzinski's sign and when is it present
Hip and knees flex when the neck is flexed | - Meningitis
107
Meingitis investigations
Bloods - FBC/U+E/Glucose/Coag screen - Blood cultures Imaging - CXR - CT LP - Protein - glucose - M&S - Cell count
108
Meningococcal septicaemia tx - community - hospital
- IM Benzylpenicillin | - Cefotaxime
109
Bacterial meningitis tx
< 55 y/o - IV Cefotaxime >55y/o or pregnant - IV Cefotaxime + Amoxicillin
110
Bacterial meningitis prophylaxis
Oral ciprofloxacin
111
Viral menignitis tx
Aciclovir - herpes simplex
112
What is MND
Degeneration of Upper and lower motor neurone disease
113
signs of LMN disease
muscle wasting fascicualtions reduced tone reduced reflexes
114
Signs of UMN disease
Increased tone Spactisity Upgoing plantar reflexes
115
ALS presentation
Upper and lower motor neurone signs - focal wasting - fasciculations - spascticity - brisk reflexes - wrist and foot drop
116
Progressive bulbar palsy
Dysarthria Dysphagia Choking Tongue fascicualtions
117
MND management
Riluzole - Slows disease progression and extend survival time
118
UMN Lesions presentation
``` Hypertonia spasticity clasp knife reflex brisk reflexes Positive babinski sign clonus Upper limb - extensors weaker Lower limb - flexors weaker ```
119
LMN lesions presentation
``` Hypotonia Flaccid paralysis absent reflexes fasciculations muscle atophy ```
120
What si multiple sclerosis
Chronic inflammatory Auto-immune mediated demylenation of CNS - Oligodendrocytes
121
Multiple sclerosis classification
- RRMS - Primary progressive - Secondary progressive - Progressive relapsing
122
describe Relapsing remitting MS
Sx occur in attacks | - relpases and remission
123
common sites for demyelination in multiple sclerosis
``` optic nerve spinal cord brianstem cerebellum corpus collosum ```
124
Multiple sclerosis eye presentation
``` Optic neuritis double vision pain Intranuclear opthalmoplegia conjungate lateral gaze disorder ```
125
Multiple scerosis presenation
``` parasthesia pain UMN signs - Spasticity - reduced power - hyper reflexia sexual dysfunction bladder and bowel dysfunction Cerebellar - ataxia ```
126
What is Lhermitte's sign
Elerctic shock down spine when neck is flexed
127
What is Uhthoff's phenomenon
Pre existing sx worsen with increased temp
128
Multiple sclerosis presentation mneumonic
DEMYELINATION ``` D - Diplopia E - eye movements painful optic neuritis M - Motor weakness nY - Nystagmus L - Lhermitte's E - Intention tremor N - Neuropathic pain A - Ataxia T - Talking slurred I - Impotence O - Overactive bladder N - Numbness ```
129
Multiple sclerosis investigations + diagnostic criteria
MRI - demyelination plaques LP + CSF electrophoresis McDonald criteria
130
Multiple sclerosis differential dx
SLE | Sarcoidosis
131
Multiple sclerosis accute attack management
Methylprednisolone
132
Multiple sclerosis - bladder dysfunction tx
Anticholinergics - Oxybutynin - detrusor overactivity
133
Parkinsons disease - mneumonic
``` TRAPS T - Tremor R - cogwheel rigidity A - Akinesia P - Postural instbaility S - Shuffling gait ```
134
Parkinsons disease presentation
``` Resting tremor cogwheel rigidity Bradykinesia - micrographia - speech slow - difficulty initiating movements Stooped posture Shuffling gait reduced arm swing Depression ```
135
Parkinsons disease management
Levodopa | - Imoroves tremor + bradykinesia
136
What are dopamine agonists
used to delay starting L-DOPA | - Ropinirole
137
What are MOA-B inhibitors
Monoamine oxidase B inhibitors Inhibit MOA-B which braks down dopamine Selegline Rasagiline
138
What are COMT inhibitors
Inhibit Catecho-o-methyl transferase inhibitors - Entacapone
139
Causes of peripheral neuropathy
``` DAVID D - DM A - Alcohol V - Vit B12 def I - Ineffective (GB) D - Drugs (Isoniazid) ```
140
what is spinal cord compression
medical emergency spinal cord compression leading to UMN signs + specific sx
141
Spinal cord compression causes
``` spine trauma vertebral tumour disc herniation disc prolapse spinal cord neoplasms ```
142
Spinal cord compression presentation
``` Spasticity Hyperreflexia Hesitancy increased frequency sensory loss at level below lesion ```
143
What leads to paraplegia
spinal cord lesion
144
What leads to hemiplegia
brain lesion
145
Function of corticospinal tracts
Motor | decussation - medulla
146
Function of DCML
Sensory - fine touch propioception vibration Decussation - medulla
147
Function of spinothalamic
Sensory - Temperature Pain Crude touch Lateral - pain and temp Medial - crude touch
148
What is spondylolisthesis
Spillage of vertebrae over the one below
149
What is spondylosis
Degenerative disc disease
150
What is myelopathy
Spinal cord compression - UMN signs
151
What is radiculopathy
Spinal root compression - LMN signs - Pain in dermatome supplied by nerve root - meakness in myotome supplies by nerve root
152
Causes of Ischameic stroke
Thrombosis - Athermomatous plaque Embolic Thromboembloism - Carotid A Cardioembolic - AF Cardiac mural thrombi - MI/IE
153
RF for ischaemic stroke
``` Older age Hypertension Smoking Family hx DM AF Combined pill ```
154
Causes of haemorrhagic stroke
Ruptured cerebral artery Trauma AV malformation Repurfusion injury - ischaemic stroke
155
RF for haemorrhagic stroke
``` Haemophillia Hypertension Ant-coagulation Vasculitits Older age Malignancy ```
156
Presentation of an ACA stroke
- Contralateral limb weakness - Contralateral sunsory disturbance - Incontinence - Apraxia - Drowsiness - Dysarthria
157
Presentation of a MCA stroke
- Contralateral limb and sensory loss - Contralateral homonymous hemianopia (No sparing) - Aphasia - Dysphasia - Facial droop
158
Presentation of PCA stroke
- Contralateral homonymous hemianopia (Macular sparing) - Contralateral sensory loss - Memory defecits - Vertigo - Prospopagnosia - Blindness
159
Presentation of stroke in posterior circulation
Motor defecits - Hemiparesis - Facial paralysis ``` Paraesthesia Ipsilateral cranial nerve defecits Vertigo Nausea Vomitting ```
160
Stroke investigations
``` DW MRI / CT ECG Bloods - Glucose - hypoglycaemia - FBC - polycythaemia - ESR - Vasculitis ```
161
Stroke - Ischameic management
Presents <4.5hrs after sx Thrombolysis - IV ALTEPLASE - clopidogrel after 24hrs If thrombolysis not appropriate - 300mg Asprin (2 weeks) - 75mg Clopidogrel
162
Haemorrhagic stroke management
Anti-hypertensives - Beta blockers - CCB Nimodipine - prevents vasospasm Reverse anti-coag Anticonvulsant
163
Secondary prevention for stroke
``` Clopidogrel - 75mg Atrorvastatin - 80mg Modifiable RF - HTN - DM - Smoking cessation - Alcohol ```
164
Clinical presentation of TIA
- unilateral weakness or paralysis - dysphasia - ataxia - vertigo - loss of balance - Amaurosis fugax Curtain effect Clinical sign of ICA stenosis
165
TIA investigations
Bloods Carotid. A doppler US - Stenosis / atheroma MRI head with diffusion weighted imaging - detect small infarct GOLD STANDARD ECG - Arrhythmias
166
What is the ABCD2 risk score used for
Risk of having a stroke following a TIA
167
Describe the ABCD2 risk score
A - Age > 65 B - BP > 140/90 C - Clincal features Unilateral weakness = 2 Dysphasia w/ no weakness = 1 D - Duration > 60 mins = 2 10-60 mins = 1 D - Diabetes DM = 1 > 3 - refer to specialist (24hrs)
168
TIA management
``` 300mg Asprin (2 weeks) 75mg Clopidogrel ``` Stroke secondary prevention
169
SSRIs MOA
Inhibit seretonin uptake increases availability in synapse
170
SSRIs examples
Citalopram Sertraline Fluxetetine
171
SSRIs S/E
GI upset Hyponatraemia Decrease appetite Citalopram - Increase QT Interval
172
Anti emetics - recetor targets and exmples
D1 - Metclopraminde H1 - Cyclizine 5-HT3 - Odansetron
173
Benzodiazepenes examples and indications
Lorazepam Status epilepticus
174
Most common cause of a haemorrhagic stroke
HTN
175
Cluster headaches prophylaxis
Verapamil
176
Cluster headaches are more common in which group of people?
Smokers | Men
177
Common triggers for migranes
``` Tiredness/stress Alcohol combined pill mensruation bright lights ```
178
Migraines prophylaxis
Topirmate Propanolol Amitryptaline
179
Criteria required for Multiple sclerosis diagnosis
McDonald criteria
180
Red flag sx for raised ICP
Worse on coughing or straining Postural - worse on stnading/lying/bending over Vomitting
181
Trigeminal neuralgia - Presentation - 1st line - Prophlaxis
Facial pain Electric - shooting pain Worsen overtime Carbamazepine CCB
182
Trigeminal neuralgia triggers
cold weather spicy food caffeine citrous fruits

Disease summaries (9 decks)

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