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Helena's finals > Neurology > Flashcards

Neurology Flashcards

1
Q

Ascending vs descending spinal cord tracts

A

Ascending - sensory
Descending - motor

Ascending tracts include: dorsal columns, lateral spinothalamic tracts, ventral spinothalamic tract

Descending tracts include: lateral corticospinal tract and the ventral corticospinal tract

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2
Q

What do the ascending tracts do? Name each one with its function

A

Dorsal column-medial lemniscus - deep touch, proprioception, vibration

Lateral spinothalamic tract - pain, temperature

Ventral spinothalamic tract - crude touch

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3
Q

What do the descending tracts do? Name each one with its function

A

Lateral corticospinal tract is for voluntary motor of contra lateral limbs

Ventral/anterior corticospinal tract is for movement of trunk, neck and shoulders

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4
Q

conditions to inform the DVLA

A
  • cataplexy
  • first seizure no driving for 6 months
  • epilepsy can’t drive unless free from seizure for 12 months or withdrawing from treatment
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5
Q

triptans (migrains and headaches) are contraindicated for which disease?

A

coronary artery disease because they cause coronary vasospasm

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6
Q

symptoms of cluster headache

A

sudden onset retro-orbital pain with excessive lacrimation and redness
+ autonomic symptoms ( ptosis, miosis, conjunctival injection and excessive lacrimation)

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7
Q

Mx of cluster headache

A

treatment: high flow oxygen + Sub cut sumatriptan
prophylaxis: verapamil

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8
Q

Mx TIA

A

Patients presenting with a suspected TIA whilst taking anticoagulants or who have a bleeding disorder should have urgent imaging to exclude haemorrhage.

Other patients should be given 300mg of aspirin immediately then assessed by a specialist within 24 hours.

First-line secondary prevention is clopidogrel 75mg once daily.

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9
Q

what do you give to patients that cannot tolerate clopidogrel?

A

aspirin + dipyridamole

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10
Q

conditions for aspirin immediately following TIA/ ischaemic stroke

A

Immediate antithrombotic therapy:
give aspirin 300 mg immediately, unless
1. the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)
2. the patient is already taking low-dose aspirin regularly: continue the current dose of aspirin until reviewed by a specialist
3. Aspirin is contraindicated: discuss management urgently with the specialist team

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11
Q

vertigo, hearing loss, tinnitus and an absent corneal reflex, facial weakness

A

vestibular schwannoma aka acoustic neuroma
absent corneal reflex - CN 5
facial palsy - CN7
vertigo, hearing loss, tinnitis - CN8

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12
Q

CN5 vs CN7

A

5 - trigeminal: sensation V1,2,3, motor muscles of mastication
7 - facial: taste, bell’s palsy stuff

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13
Q

which lesions spare forehead? why?

A

upper motor neuron lesion eg strokes ‘spares’ upper face

the forehead receives motor innervation from both hemispheres of the cerebral cortex. A stroke that compromised motor innervation of the face would therefore only result in paralysis of the lower half of the face - the forehead still receiving innervation from the unaffected hemisphere.

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14
Q

comprension + speech production impaired

A

global aphasia

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15
Q

aphasia (aka dysphasia) subtypes

A

can comprehend but speech not fluent - Broca’s (inferior frontal gyrus)

can speak fluently (+neologisms and words dont make sense) but no comprehension - Wernicke’s (superior frontal gyrus)

B before W
comprehend before speak

global - both impaired

conduction aphasia (supramarginal gyrus) = can comprehend and can speak but with neologisms and words dont make sense and can’t repeat

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16
Q

spasticity in multiple sclerosis

A

baclofen

gabapentin

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17
Q

intternuclear opthalmoplegia

A

brainstem problem
affected eye cannot adduct when asked to look in the contralateral direction
classic multiple sclerosis sign

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18
Q

management MS

A

vitamin B, steroids, IV immunoglobulin, plasmapheresis, immunosuppressants (Recombinant beta-IFN), manage symptoms with physical and cognitive therapy. spasticity (baclofen, gabapentin)

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19
Q

normal pressure hydrocephalus

A

Ataxia, urinary incontinence and dementia

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20
Q

bitemporal hemianopia. where is the lesion?

A

lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour

lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

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21
Q

epiepsy treatment

A

Generalised tonic-clonic seizures
sodium valproate
second line: lamotrigine, carbamazepine

Absence seizures* (Petit mal)
sodium valproate or ethosuximide
sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy

Myoclonic seizures**
sodium valproate
second line: clonazepam, lamotrigine

Focal seizures
carbamazepine or lamotrigine
second line: levetiracetam, oxcarbazepine or sodium valproate

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22
Q

carbmazepine contraindictions

A

absence and myoclonic seizures

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23
Q

status epilepticus treatment

A

Benzo: IV 4mg lorazepam/IV/PR 10mg diazepam, buccal 10mg midazolam repeat after 10mins if seizure does not terminate

if seizure still recurs after 2nd dose, IV phenytoin/ sodium valproate — consult specialists for dose

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24
Q

Subarachnoid haemorrhage management

A

ABC + OXYGEN
Isotonic/normal saline to resuscitate
arterial line (monitor BP specifically) - stop anti-hypertensives
Nimodipine - cerebral vasodilator to stop cerebral ischaemia and improve outcomes
reverse anticoagulation - we want clotting
neurosurgery: surgical clipping, endovascular coil embolization
reduce high ICP: lumbar drainage or ventriculostomy, mannitol

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25
subdural haemorrhage management
haematoma <10mm without significant neurological dysfunction conservative prophylactic anti epileptics stop and reverse anticoagulants ICP lowering regimen: raise head, hyperventilate, sedation (lower anxiety), hyperosmolar therapy (hypertonic saline, mannitol), cooling, decompressive hemicraniectomy haematoma >10mm or expansile or significant dysfunction 1. ventriculoperitoneal shunt chronic haematoma --- craniotomy
26
Cushing's triad
Increased ICP --> Cushing’s triad of hypertension, bradycardia, irregular respiration (+ altered mental status, compression of cranial nerves)
27
indication for emergency intubation
A Glasgow coma scale score of 8 or less is in indication for emergency intubation
28
rhinorrhoea + halo sign
CSF!!!!
29
basilar skull fracture symptoms
Basilar skull fracture can lead to injury of any structures at the skull base The middle meningeal vessels are particularly at risk because they run underneath the relatively thin pterion.--> extradural haematoma raised ICP racoon eye bruising + battle sign (behind ear) bruising rhinorrhoea
30
Urthoff’s phenomenon
Multiple sclerosis | Symptoms worse in heat
31
Parkinson's key symptoms
Tremor Rigidity (cog wheeling) Akinesia (bradykinesia) Postural instability (falls, hypotension) dementia, depression, insomnia, hallucinations mask like facial expression, monotonous speech, poor swallow, aspiration pneumonias, autonomic (multiple system atrophy) --- gastric reflux, constipation, postural hypotension, urinary incontinence, erectile dysfunction, cerebellar signs
32
Parkinsons plus syndromes
lewy body - fluctuating cognition, visual hallucinations, early dementia progressive supranuclear palsy - limited vertical gaze, can't look down corticobasal syndrome - unilateral parkinsonism, non-fluent aphasia multiple system atrophy - autonomic symptoms vascular parkinsonism - multi-infarcts, lower body
33
gold standard diagnosis of parkinson's
brain histology (death) is definitive: staining for alpha synuclein which indicates cell death Braak stages in practice: 2/3 TRAP symptoms + reversibility with levodopa
34
Parkinson's conservative treatment
physio - muscle stiffness occupational health - practical solutions to things you might find hard like dressing yourself or getting around your house, shower SALT - dysphagia, speech diet advice: fibre, higher salt (postural instability)
35
parkinsons surgical option
deep brain stimulation therapy
36
Parkinsons medical treatments
1. levodopa + carbidopa 2. dopamine agonists 3. MAO-B inhibitors 4. COMT inhibitors
37
Side effects of levodopa
dizzy, lethargy uncontrollable, jerky muscle movements (dyskinesias) and "on-off" effects, where the person rapidly switches between being able to move (on) and being immobile (off
38
dopamine agonists side effects
hallucinations increased confusion compulsive behaviour - gambling, shopping, excessive sexual interest so they need to be used with caution, particularly in elderly patients, who are more susceptible. + family members watch out for any odd behaviours
39
how do the parkinsons medications work?
1. levodopa + carbidopa levodopa is turned into dopamine carbidopa acts to reduce peripheral conversion 2. dopamine agonists 3. MAO-B inhibitors monoamine oxidase B inhibitors prevent dopamine breakdown 4. COMT inhibitors inhibit Catechol-O-methyltransferase (COMT) prevent dopamine breakdown
40
which tuning fork for rinnie and webers?
512 Hz
41
what is rinnie's test
512 tuning fork on mastoid process vs in front of pinna bone vs air conduction air conduction should be better Think: telephone rings (ear)
42
what would be an abnormal rinnie's test?
bone conduction is louder | suggests a conductive problem in the same ear
43
what is weber's test?
512 tuning fork on the centre of the forehead. Patient asked if sound is heard louder on one side or not? normal is when sound does not lateralise
44
conductive hearing loss findings
rinnie's air < bone in affected air OR normal (air>bone) | weber's localises to affected ear
45
sensorineural hearing loss findings
rinnie's normal air > bone | weber's localises to UNaffected ear
46
weber's test mneumonic
Sun Caffe sensorineural - unaffected ear Conductive - affected ear
47
menier's disease symptoms
sensorineural hearing loss tinnitis vertigo minutes to hours
48
bilateral vestibular schwannomas are seen in which familial disease?
neurofibromatosis 2
49
what test to look at patients diability? following what disease?
Barthel index -- used particularly after stroke 10 tasks and the patient is scored based on the amount of time and assistance needed - presence of faecal/ urinary incontinence - help with feeding, transfer, dressing etc scored 0 to 100. 0 is completeld dependent, 100 is completely independent
50
brain tumours management
dexamethasone - oedema surgery post-op chemotherapy radiotherapy
51
migraine prophylaxis - what do you give and when do you
topiramate (asthmatics but teratogenic, cleft palate) or propanolol (better for women of childbrearing age) riboflavin is also effective >2 attacks per month
52
ischaemic stroke Mx time for definitive mx
thrombolysis (4.5hrs) & thrombectomy (6hrs) from symptom onset
53
investigations for acoustic neuroma/ vestibular schwannoma
audiogram | gadalinium-enhanced MRI head
54
where are most acoustic neuroma/ vestibular schwannoma in the brain
cerebellopontine angle
55
wrist drop - which nerve effected
radial nerve palsy
56
which neurology drug is highly associated with steven johnson syndrome and how do you treat it? after how long of treatment to SJS symptoms typically start to develop?
lamotrigine <2 months of starting it prodrome of a viral URTI for 2 weeks then rapid onset painful rash on face and limbs Mx. stop drug, admit, ICU, fluids, IV and NG
57
prophylaxis of cluster headaches
verapamil
58
anti-nausea drug for raised ICP causes of nausea
haloperidol
59
anti-nausea drug for GI causes of nausea
metoclopramide
60
types of motor neurone disease and key points
***Amyotrophic Lateral Sclerosis: UMN legs + LMN arms Primary Lateral Sclerosis Variant: UMN Progressive Muscular Atrophy Variant: LMN, distal → proximal, best prognosis progressive bulbar palsy: palsy of tongue, chewing, swallowing, facial muscles due to loss of function of brainstem motor nuclei. worst prognosis. LMN signs only
61
myasthenia gravis medical management
mild disease: pyridostigmine prednisolone (titrate up as intiail worsening of symptoms) steroid-sparing agents (azathioprine) to avoid side effects life-threatening exacerbations: IV immunoglobulin/ plasma exchange malignant thymomas excised
62
most likely dominant hemisphere
left
63
global aphasia, which blood supply affected
left middle cerebral artery
64
signs of essential tremor
tremor arises with sustained muscle tone eg. outstretching arms, improved by alcohol and rest can also effect the vocal cords autosomal dominant condition
65
Mx. of essential tremor
propanolol
66
explain the cushing's triad feature of hypertension and bradycardia with raised ICP
cerebral perfusion pressure = mean arterial pressure - intracranial pressure so if ICP rises, to maintain adequate cerebral perfusion, the MAP rises too by a sympathetic reflex this HTN is then detected by baroreceptors to decrease HR
67
migrains with aura and COCP
absolute contradication due to increased stroke risk | migraine with aura type only
68
migraine with menstruation mx
mefanamic acid Or aspirin, paracetamol, caffeine
69
migraine and HRT
it is safe to prescribe HRT for people with history of migraines but HRT might make the migraines worse
70
electomyography findings
neuropathy: increased duration and amplitude of action potentials myopathy: decreased duration and amplitude of action potentials
71
mx. post lumbar puncture headache
1. analgesia, rest | 2. >72 hours -- IV caffeine, epidural saline, blood patch
72
what happens if you suddenly stop parkinson's drugs
acute akinesia or neuroleptic malignant syndrome
73
DVLA and seizures
first seizure - 6 month seizure seizure free + no findings on brain imaging or epileptiform EEG epilepsy - 12 month seizure free withdrawing drugs - no driving for 6 months until last dose bus driver - 10 year seizure fee
74
secondary prevention after stroke
clopidogrel alone is first line or aspirin and dipyridamole
75
at what point do you start IV phenytoin in status epilepticus
2 doses of benzos
76
at what point do you intubate and GA in status epilepticus?
45 mins from onset
77
stroke/TIA and DVLA?
don't need to inform DVLA if no residual neurological defect (or if just 1 episode) 1 month off driving
78
which is single biggest risk factor for bell's palsy?
pregnancy
79
signs and symptoms of neuroleptic malignant syndrome
pyrexia, muscle ragidity, hypertension, tachycardia, tachypnoea, delirium, confusion
80
trigeminal neuralgia signs and treatment
unilateral electric shock like pain in one/more divisions of trigerminal nerve provoked by light touch, brushing teeth, combing hair Mx. carbamazepine refer to neuro if under 50y/o
81
how soon do you start anticoagulation following an ischaemic stroke?
14 days | earlier may exacerbate secondary haemorrhage
82
dysarthria vs aphasia
dysarthria = motor disorder and find difficult to pronounce and speak words aphasia = compression, repetition or production of speech
83
Ix for myasthenia gravis
single fibre electromyography CT thorax to exclude thymoma CK normal autoantibodies against acetylcholine receptors and anti-muscle-specific tyrosine kinase
84
antibodies in myasthenia gravis
autoantibodies against acetylcholine receptors and anti-muscle-specific tyrosine kinase
85
Mx. myasthenia gravis
1. long acting acetylcholinesterase inhibitors eg. pyridostigmine 2. immunosuppression prednisolone 3. thymectomy
86
blood test to distinguish between pseudoseizure and actual seizure
serum prolactin 10-20 minutes after seizure
87
homonoymous quadrantopias - where is the lesion?
contralateral side PITS Parietal inferior Temporal superior
88
craniopharyngiomas symptoms
lower bitemporal hemianopia | diabetes inspidus
89
why do you get oedema with brain tumours
disruprtion of the blood-brain barrier | give dexamethasone to treat oedema
90
most common primary brain tumour in children
pilocytic astrocytoma
91
Total anterior circulation stroke
3 Unilateral sensory/motor loss (face, arm and leg) Higher cerebral function eg. Dysphasia, visuospatial Homonymous hemianopia
92
Partial anterior circulation stroke
2 of: Unilateral sensory/motor loss (face, arm and leg) Higher cerebral function eg. Dysphasia, visuospatial Homonymous hemianopia
93
Lacunar syndrome
``` 1 of: ***of face and arm, arm and leg or all three. Pure sensory Pure motor Sensory-motor stroke Ataxic hemiparesis ```
94
Posterior circulation syndrome
1 of Cranial nerve palsy and contra lateral motor or sensory deficit Bilateral motor or sensory deficit Cerebellum dysfunction: ataxia, nystagmus, vertigo Isolated homonymous hemianopia or cortical blindness Loss of conscious, brain stem problems
95
Which stroke syndrome, no loss of higher cerebral functions
Lacunar syndrome
96
lateral medullary syndrome
the combination of facial and contralateral body loss of pain sensation along with nystagmus and ataxia Posterior circulation syndrome subtype
97
What score to assess risk of repeat TIA?
ABCD2 score
98
Signs of Alzheimer’s
``` 5 As Amnesia Anomia naming Apraxia doing, calculation, dressing Agnosia recognising people Aphasia speaking ```
99
Csf analysis in dementia
Tau high as it leaks into csf | Beta amyloid low as it deposits into plaque
100
Neuroleptic malignant syndrome cause, key symptoms and treatment
2 weeks after new antipsychotic (Dopamine antagonist) ie. excessive dopamine blockade FEVER Fever Encephalopathy confusion, restless Vital sign dysregulation - BP up or down, high Hr, RR Enzymes elevated creatinine kinase, myoglobin as muscle breaks down Rigid and Hyperreflexia, dilated pupils, diaphoresis Mx. stop cause. Benzodiazepines (lorazepam), Dantrolene (fever) and bromocriptine (d2 agonists)
101
signs of optic neuritis
inflammation of optic nerve - pain on eye movents - unilateral decrease in visual acuity - poor discrimination of colours "red desaturaation" - RAPD - central scotoma

Helena's finals (22 decks)

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