Neurology Flashcards

1
Q

Name some causes of cerebellar lesions?

A

MS, tumour, abscess, haemorrhage, chronic alcohol use

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2
Q

What is bells palsy?

A

LMN lesion affecting facial nerve (usually caused by HSV)

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3
Q

Features of bells palsy?

A

LMN weakness of the face, loss of taste on anterior 2/3 tongue, hyperacusis, decreased tear production

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4
Q

Mx of bells palsy?

A

close eyelids with tape, prednisolone

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5
Q

What causes a stroke?

A

cerebral infarction due to embolism or thrombosis (at site of atheromatous plaque)

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6
Q

What is a TIA?

A

transient episode of neurological deficit caused by brain/SC/retinal infarction. This is usually caused by microemboli

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7
Q

Symptoms of a stroke by anatomy?

A

ACA: leg > arm
MCA: arm > leg, facial weakness, controlateral homonymous hemianopia
PCA: visual agnosia

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8
Q

Ix for a TIA/stroke

A

imaging: head CT, doppler US of the carotid
Bloods: FBC, UE, LFT, ESR, CRP, glucose, lipids
ECG

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9
Q

What is the risk score for Rx of a stroke following a TIA?

A

ABCD2

Age >60, BP > 140/90, clinical features, duration of TIA, T2DM

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10
Q

RF prevention following a stroke/TIA?

A

statin, aspirin 75mg daily, control BP

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11
Q

Mx of a patient presenting with a TIA/stroke?

A
  1. Aspirin 300mg (continue then as 75mg daily)
  2. Thrombolysis (IV alteplase) given within 4.5hrs of onset of a stroke
  3. control HTN
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12
Q

What causes a SAH?

A

rupture of berry aneurysm, congenital AVM

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13
Q

Features of SAH rupture?

A

thunderclap headache in the occipital region, vomiting, meningial irritation, loss of consciousness, focal neuro signs, pappilodoema

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14
Q

Ix of a SAH?

A

CT head, LP (shows increased oxybilirubin released from lysis), MR angiography

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15
Q

Mx of a SAH?

A

bed rest, supportive measures, Nimodipine, give IV normal saline

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16
Q

What is a SDH and what causes it?

A

blood in the subdural space following the rupture of a saggital vein due to a minor head trauma. increased Rx in the elderly and alcoholics (atrophic brains)

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17
Q

What is epilepsy?

A

the tendancy to have seizures (seizures are convulsions or transient abnormal events caused by paroxysmal discharge of cerebral neurones

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18
Q

What is a simple and complex partial seizure?

A

simple - only affect one part of the brain, and do not affect consciousness or memory

Complex - affect awareness or memory during/immediately after seizure

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19
Q

Ix for epilepsy?

A

CT head, determine seizure type, EEG with camera footage.

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20
Q

How do you manage status epilepticus?

A

General: O2, IV access, IV thiamine, monitor sats

  1. Lorazepam IV (repeat after 10 minutes) - monitor respiratory rate (causes depression)
  2. Phenytoin IV - ECG monitoring due to arrhythmias
  3. Phenobarbitol
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21
Q

Name some anti-epilpetic drugs and their side effects

A

Sodium Valproate - weight gain, hair loss, liver damage
Lamotrigine - TEN
Carbamezepine - rashes, leucopenia, TEN

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22
Q

Pathological process in Parkinson’s disease?

A

depletion of dopamine-secreting cells in the substantia nigra. These neurones project to striatum and neural circuits in the basal ganglia movement pathways.

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23
Q

Name the main features of Parkinson’s?

A
  1. TREMOR - 4-7Hz resting tremor (pin rolling of the thumb), improves with voluntary movement
  2. RIGIDITY - increased tone in limbs and trunk, limbs resist passive extension (lead pipe rigidity)
  3. AKINESIA - difficulty initiating movement, face expressionless, speech slow
  4. SHUFFLING GAIT - characteristic stoop, poor balance .

Non motor - depression, hallucinations, dementia, impulsive behaviours, insomnia, drooling saliva, dysphagia

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24
Q

Ix for Parkinson’s?

A

head CT, diagnosis is clinical

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25
Name some treatments for parkinson's plus drug names and side effets?
1. Levodopa (L dopa = dopamine agonist, peripheral decarboxylase inhibitor = carbidopa) - SE = nausea 2. Dopamine agonist - Ropinirole SE = impulse issues 3. Monoamine oxidase B inhibitor e.g Selegiline
26
What are the chemical changes in the brain in Hungington's?
reduced GABA and ACh, dopamine is spared
27
What is MS?
autoimmune disorder of the CNS creating plaques of demyelination within the brain in SC which are disseminated in time and place. there are 2+ distinct clinical episodes of CNS dysfunction with periods of remission. Inflammation mediated by CD4 cells
28
Name some features of MS based on where the demyelination occurs?
Optic neuropathy - optic neuritis, pain, optic atrophy Brainstem - diplopia, vertigo, dysphagia, nystagmus SC - numbness, pins and needles, spastic paraparesis, incontinence
29
Ix for MS?
MRI brain/SC - show the plaques EMG - shows electrical potentials are prolonged CSF - raised protein count, electrophoresis shows oligoclonal IgG bands
30
Management for acute attack of MS and maintaining remission?
Acute - methylprednisolone | Maintaining relapse - B interferon, Natalizumab
31
Features of acute bacterial meningitis?
headache, neck stiffness, fever, photophobia, vomiting. Positive Kernig and Brudunski sign. Consciousness not normally impaired. Meningococcal = non-blanching petichial and purpuric rash
32
DD of bacterial meningitis?
SAH, migraine
33
Ix for meningitis?
Head CT LP - CSF microscopy (bacterial has low glucose and high protein and looks purulent) blood cultures, blood glucose, chest x ray,
34
Mx for meningitis?
* if suspect meningococcal - immediate Benpen IM - IV fluids if depleted - ABx = Cefotaxime
35
Features of acute viral encephalitis?
mild fever, headache, drowsy, focal neuro signs, drowsy coma
36
Ix for encephalitis?
MRI brain, CSF analysis, EEG
37
3 main features of a brain tumour?
focal neuro deficit, new onset epilepsy, raised ICP
38
Features of a raised ICP headache?
headache worse with coughing/sneezing/straining, vomiting, pappilodoema Downward displacement of the brain = resp depression, bradycardia, coma and death
39
What is hydrocephalus? how does it occur?
excessive CSF in cranium. Normally due to obstructed outflow of CSF through the ventricles (e.g. due to tumour or congenital malformation
40
Features of hydrocephalus?
headache, vomiting, pappilodoema
41
How do you manage a tension headache?
1. Reassure and explain to the patient. Avoid medication overuse. 2. Tricyclic antidepressants
42
What is a migraine?
recurrent headache associated with visual and GI disturbance. Common in women <40
43
Name some precipitating factors of migraines
cheese, wine, chocolate, menstruation, lights
44
features of migraines?
headache lasting 4 - 72 hours. Associated nausea and vomiting, photophobia. Worse with exertion. Aura (visual flashing lights, unilateral blindness, weakness.
45
Management of migraines pathway?
general: avoid precipitants, do not use COCP if get migraines 1. MILD - paracetamol/NSAIDS + metoclopromide (antiemetic) 2. SEV - triptan PREVENT - B blocker/TCA
46
What is a cluster headache?
severe orbital headaches lasting 1-2hrs which occur in clusters. Have autonomic features (lacrimation, red eye, rhinorrhea)
47
How do you manage an acute cluster headache?
100% oxygen and a triptan
48
Features of GCA?
headache, scalp tenderness, pain in jaw and jaw claudication. Superficial temporal artery is tender and firm. AION
49
Ix of GCA?
ESR, FBC, temporal artery biopsy
50
Mx of GCA?
high dose prednisolone (reduce guided by ESR)
51
Name some causes of SCC?
metastasis, myeloma, degeneration, trauma, osteoporosis, neurofibroma
52
Features of SCC?
UMN progressive leg weakness and eventual paralysis. there is sensory involvement and loss sphincter control and urinary incontinence/retention and constipation
53
Ix of SCC?
XRay/MRI spine
54
What is MND?
relentless and unexplained destruction of upper motor neurons an anterior horn cells in the brain and SC.
55
Presentation of MND?
2 main presentations - bulbar palsy/ALS. wasting/fasciculations with UMN signs simultaneously.
56
Ix for MND?
clinical diagnosis. EMG might show muscle denervation
57
Mx of MND?
Riluzole (Na channel blocker.) ventilation and PEG
58
What is carpal tunnel?
entrapment neuropathy of the median nerve travelling to the hand through the carpal tunnel.
59
Name some RF of carpal tunnel?
RA, acromegaly, pregnancy, hypothyroid, DM, obesity
60
What sign is positive when testing for carpal tunnel?
Tinnels sign - tapping on the carpal tunnel reproduces the pain
61
Name 3 infections which can trigger GBS? which epitope do they share?
C.jejuni, EBV, campylobacter - they share the GM1 and GQ1b antigens on peripheral nerves
62
Features of GBS?
Progressive limb weakness, reflexes lost, respiratory and cardiac involvement + eye involvement (miller fischer)
63
Ix of GBS?
nerve conduction studies, GQ1b antibodies, CSF normal
64
Mx of GBS?
IVIG, measure tidal volume, ECG monitoring, DVT prophylaxis
65
What is MG?
weakness and fatiguability of the ocular, bulbar and proximal limb muscles. it is due to autoantibodies to the acetylcholine receptors (anti-AChR Abs) at the postsynaptic membrane of the NMJ.
66
Features of MG?
fatiguability of muscles on sustained use. ocular muscles, bulbar muscles = difficulty talking and cheswing and swallowing
67
Ix for MG?
Anti-AChr and Anti-MUSK antibodies nerve stimulation tests CT/MRI mediastinum - thymoma? tensillon test - IV anticholinesterase results in rapid improvement of symptoms
68
Mx of MG?
anticholinesterase - Pyridostigmine PO corticosteroides (Azathioprine) IVIG Thymectomy