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Year 4 Medical specialties > Neurology > Flashcards

Neurology Flashcards

1
Q

what should you look for on inspection in a neuro exam

A 
SWIFT
scars 
wasting of muscle 
involuntary movements: dystonia, tics, chorea
fasciculations 
tremor
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2
Q

what signs indicate an UMN lesion

A 
hypertonia - spasticity 
hyperreflexia 
pyramidal weakness: UL extensors, LL flexors 
clonus 
\+ve Babinski (extensor response)
pronator drift
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3
Q

causes of UMN lesions

A 
stroke 
tumours 
MS 
CP 
MND
pseudobulbar palsy
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4
Q

what signs indicate an LMN lesion

A 
hypotonia - flaccid 
hypo/arreflexia 
weakness, wasting, fasciculations 
no clonus 
-ve Babinski (flexor response)
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5
Q

causes of LMN lesions

A 
Peripheral neuropathy - ABCDEE
GBS 
Charcot Marie Tooth disease 
MND 
Bulbar palsy 
mononeuritis multiplex 
Bell's palsy 
Polio
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6
Q

signs of extra pyramidal disease (hypokinetic)

A

bradykinesia - slow to think, respond, loss of finger tap amplitude
rigidity - hypertonicity
resting tremor - highlighted when counting backwards
hypomimia, hypophonia
shuffling gait
loss of arm swing

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7
Q

causes of hypokinetic extra pyramidal disease

A

Parkinsonism - drugs

Idiopathic Parkinsons disease

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8
Q

Parkinsonism is a/symmetrical and PD is a/symmetrical

A 
Parkinsonism = symmetrical 
PD = asymmetrical
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9
Q

signs of cerebellar disease on examination

A 
DANISH 
dysdiadichokinesia 
ataxia 
nystagmus 
intention tremor 
slurred speech 
hypotonia / heel to toe test
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10
Q

bulbar palsy is UMN/LMN?

A

bulbar palsy = LMN

pseudobulbar palsy = UMN

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11
Q

MRI with/out contrast is used for imaging MS

A

WITH contrast

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12
Q

what drug do you give in SAH to prevent cerebral vasospasm

A

nimodipine

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13
Q

what is the triad in Wernicke’s encephalopathy

A

ophthalmoplegia/nystagmus
ataxia
confusion

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14
Q

what are the features of Korsakoff’s syndrome

A

antero/retrograde amnesia

confabulation

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15
Q

causes of cerebellar disease

A 
MAVIS 
MS 
Alcohol 
Vascular (stroke)
Inherited (Freidreich's ataxia)
Space occupying lesion SOL
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16
Q

where does the spinal cord end?

A

L1/2

therefore spinal anaesthesia is at L3/4

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17
Q

Broca’s aphasia?

A

expressive aphasia

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18
Q

Wernicke’s aphasia?

A

receptive aphasia

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19
Q

red flags for headache

A 
>55
worse in the morning / wakes them up 
worse with valsalva 
vomiting 
immunosuppression 
history of malignancy
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20
Q

what emergency conditions would you want to rule out in someone with a headache

A 
meningitis 
SAH 
temporal arteritis 
closed angle glaucoma 
SOL 
IIH
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21
Q

list causes of peripheral neuropathy

A 
ABCDEE 
Alcohol
B12 deficiency 
Cancer / CKD 
DM 
Every vasculitis 
Especially ANCA and RA
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22
Q

Hypoventilation causes raised/low CO2 and therefore vasoconstriction/dilatation of cerebral vessels

A

hypoventilation causes raised CO2

therefore cerebral vasoDILATATION

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23
Q

Hyperventilation causes raised/low CO2 and therefore vasoconstriction/dilatation of cerebral vessels

A

hyperventilation causes low CO2

therefore cerebral vasoCONSTRICTION

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24
Q

what imaging technique is diagnostic of degenerative cervical myelopathy

A

MRI

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25
what type of seizure is carbamazepine used to treat
FOCAL seizures!! | never generalised
26
which antiepileptic drug is considered 'safe' in pregnancy
lamotrigine
27
what is a risk of lamotrigine
SJS | Therefore build up the dose very slowly
28
which antiepileptics are teratogenic
sodium valproate carbamazepine topiramate phenytoin
29
side effects of sodium valproate
``` VALPROATE Appetite increased / weight gain Liver failure Pancreatitis Reversible hair loss Oedema Ataxia Teratogenic, thrombocytopaenia, tremor Encephalopathy ``` also P450 inhibitor
30
if someone has a one off seizure, how long can they not drive for?
6 months if it is one off
31
if someone has a diagnosis of epilepsy what are the driving rules for a car
can only drive after having a full year of not having seizures
32
if someone has a diagnosis of epilepsy what are the driving rules for a bus/lorry
can only drive after being medication free for 10 years
33
management of status epilepticus
ABCDE 1. IV lorazepam / buccal midazolam / PR diazepam 2. after 5 min repeat BZD 3. phenytoin + call anaesthetics/ICU 4. Na valproate 5. Keppra 6. ICU
34
describe obstructive hydrocephalus
aka non-communicating blockage within ventricular system therefore enlargement of lateral and 3rd ventricles and a normal 4th ventricle
35
describe communicating hydrocephalus
no blockage within the system, rather outwith the ventricles all ventricles are enlarged
36
what are consequences of raised ICP
``` herniation midline shift impaired blood flow CN palsies low GCS ```
37
what are the different types of brain herniation
``` supratentorial - subfalcine / cingulate (ACA compression) - uncal (CN3 compression) - central - transcalvarial (skull #) infratentorial - tonsilar (cerebellum) ```
38
drug causes of parkinsonism
``` dopamine antagonists - metaclopramide, haloperidol, chlopromazine lithium amiodarone B blockers Na valproate ```
39
Management of Parkinsons disease
levodopa + carbidopa (co-careldopa) MAOB inhibitors - selegeline, resegiline dopamine agonists - pramiprexole
40
what drugs are used for tremor relief in Parkinsons?
anticholinergics - procyclidine
41
what are the Parkinsons plus syndromes
multisystem atrophy - PD plus autonomic instability | progressive supranuclear palsy - impaired upward gaze
42
features of MS
Pyramidal - weakness, spasticity, hyperreflexia Ophthalmological - optic neuritis, INO Sensory - paraesthesia, trigeminal neuralgia LUTS - frequency, urgency, incontinence Cerebellar - DANISH Fatigue
43
dystonia
abnormal muscle spasm
44
chorea
irregular jerky involuntary movement
45
tics
brief repetitive stereotyped involuntary actions
46
myoclonus
sudden shock like involuntary movement
47
hemiballism
flinging of one arm
48
``` what are the proteinopathies in the following neurodegenerative conditions: Alzheimers Frontotemporal dementia DLB Huntingtons CJD ```
Alzheimers - extracellular amyloid plaques, intracellular neurofibrillary tangles of tau Frontotemporal dementia - tau, Pick's bodies DLB - alpha synuclein Huntingtons - huntington, CAG repeat CJD - prion
49
pupil is spared/involved in PCOM aneurysm
involved | external compression of CN3
50
most common ocular CN lesion
CNVI
51
features of a CN3 palsy
down and out ptosis ± pupillary involvement
52
features of a CN6 palsy
LR palsy | INO
53
features of a CN4 palsy
diplopia exacerbated on down gaze head tilt down away from affected muscle inability to adduct and depress the eye
54
which CN is more vulnerable to traumatic injury
CN4
55
CN involved in RAPD
CN2 Afferent | CN3 Efferent
56
causes of RAPD
``` MS demyelination optic neuritis vitreous haemorrhage ischaemic optic neuropathy ```
57
causes of UMN CN7
stroke tumour demyelination
58
causes of LMN CN7
bell palsy iatrogenic - LA trauma infection - Ramsey hunt
59
Horner's syndrome features
disruption of sympathetics resulting in: partial ptosis miosis hemifacial anhydrosis
60
causes of Horners syndrome
1st: stroke, demyelination, neoplasm, syringomyelia 2nd: cervical rib, Pancoast tumour, brachial plexus injury, trauma, iatrogenic 3rd: trauma, iatrogenic, ICA dissection/aneurysm, tumour, cavernous sinus lesion
61
PBP = UMN lesion, true or false
true
62
BP = LMN lesion, true or false
true
63
BP features
fasciculations | tongue wasting
64
what features in a history make a swallowing problem more likely to be neurological
dysphagia to liquids, then solids
65
LP of GBS
high protein and no cells
66
antibody for GBS
anti ganglioside antibodies
67
differential for papilloedema and loss of vision
SOL cerebral venous sinus thrombosis IIH

Year 4 Medical specialties (3 decks)

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