NEUROLOGY (ADULT) Flashcards
(230 cards)
1
Q
WHAT ARE THE CAUSES OF UNILATERAL VISUAL LOSS
A
VASCULA
OPTIC NEURITIS OR PAPILLITIS
RETINAL DETACHEMENT
VITREOUS HAEMORRAGE
RETINOPATHY AND MACULAR DEGENERATION
2
Q
WHAT ARE SOME EXAMPLES OF VASCULAR CAUSES OF UNILATERAL VISUAL LOSS
A
OCCLUSION OF CENTRAL RETINAL ARTERY
OCCLUSION OF CENTRAL RETINAL VEIN
TEMPORAAL ARTERITIS (GIANT CELL)
3
Q
WHAT IS ANTERIOS ISCHEMIC OPTIC NEUOPATHY
A
OCCLUSION OF POSTERIOS CILLARY ARTERY SUPPLYING THE OPTIC NERVE HEAD
4
Q
WHAT IS ANTERIOS ISCHEMIC OPTIC NEUOPATHY ASSOCIATED WITH
A
GIANT CELL ARTERITIS
5
Q
WHAT WOULD YOU FIND ON FUNDOSCOPY FOR ANTERIOR ISCHEMIC OPTIC NEUOPATHY
A
SWOLLEN OPTIC DISK
6
Q
WHAT ARE THE FINDINGS ON FUNDOSCOPY OF CENTRAL RETINAL ARTERY OCCLUSION
A
A PALE RETINAL DISK W CHERRY SPOTS ON THE MACULA
7
Q
WHAT DOES THE CENTRAL RETINAL ARTERY SUPPLY
A
THE WHOLE RETINA
8
Q
WHAT WOULD YOU FIND ON FUNDOSCOPY OF CENTRAL RETINAL VEIN OCCLUSION
A
DILATATION OF BRANCH VEINS
COTTON WOOL PATCHES
MULTIPLE HAEMORRAGES
9
Q
WHAT TESTS WOULD YOU USE TO DIAGNOSE UNILATERAL VISUAL LOSS
A
MRI
VISUAL EVOKED POTENTIAL
FLUORESCEIN ANGIOGRAPHY
TONOMETRY
USS
10
Q
WHAT WOULD YOU USE TO DIAGNOSE OPTIC NEURITIS
A
MRI
VISUAL EVOKED POTENTIAL
11
Q
WHAT WOULD YOU USE TO DIAGNOSE CENTRAL RETINAL VEIN/ARTERY OCCLUSION
A
FLUORESCEIN ANGIOGRAPHY
12
Q
WHAT WOULD YOU USE TO MEASURE INTRAOCCULAR PRESSURE FOR GLAUCOMA
A
TONOMETRY
13
Q
WHAT WOULD YOU USE USS TO DIAGNOSE FOR
A
VITREOUS HAEMORRAGES
RETINAL DETACHEMENT
14
Q
WHAT IS OPTIC NEURITIS
A
INFLAMMATION OF THE OPTIC NERVE CAUSING DAMAGE AND SUBSEQUENT VISUAL LOSS
15
Q
WHAT IS OPTIC NEURITIS ASSOCIATED WITH
A
MS
TEMPORAL ARTERITIS
SLE
LYME
SYPHILLIS
B12 DEFICIENCE
16
Q
HOW DOES OPTIC NEURITIS PRESENT
A
DECREASED VISUAL ACUITY OVER DAYS
PAIN MOVING EYE
VISION LOSS EXACERBATED BY HEAT OR EXCERSISE
AFFERENT PUPILLARY DEFECT
INABILITY TO DISTINGUISH COULOR HUES (DYSCHROMATOPSIA)
17
Q
HOW WOULD YOU MANAGE OPTIC NEURITIS
A
STEROIDS TO SPEED UP RECOVERY
RESOLVES ON ITS OVER AFTER AOUND 6W
18
Q
WHAT IS OPTIC NEURITIS OFTEN A FIRST PRESENTATION FOR
A
MULTIPLE SCLEROSIS
19
Q
WHAT IS MULTIPLE SCLEROSIS
A
A CHRONIC DEMYLENATING DISEASE WHICH IS AUTOIMMUNE AND MAY CAUSE NEURODEGENERATIVE AXONIAL LOSS
20
Q
WHERE DO MULTIPLE SCLEROSIS LESIONS OFTEN OCCUR
A
OPTIC NERVE
BRAIN STEM
BASAL GANGLIA
SPINAL CORD
21
Q
WHAT ARE THE OPTIC NERVE SYMPTOMS OF MULTIPLE SCLEROSIS
A
REDUCED VISUAL ACUITY OVER DAYS
22
Q
WHAT ARE THE BASAL GANGLIA SYMPTOMS OF MULTIPLE SCLEROSIS
A
NYSTAGMUS (OFTEN CONTRALATERAL TO AFFECTED EYE)
TREMOUR
SLOWED MOVEMENTS
ATAXIA
23
Q
WHAT ARE THE SPINAL CORD SYMPTOMS OF MULTIPLE SCLEROSIS
A
PINS AND NEEDLES
MUSCLE SPASM AND MUSCLE WEAKNESS
24
Q
WHAT ARE THE BRAIN STEM SYMPTOMS OF MULTIPLE SCLEROSIS
A
PYRAMIDAL WEAKNESS ie muscle weakness and spastic parapesis
25
WHAT ARE SIGNS THAT ARE ASSOCIATED W MULTIPLE SCLEROSIS
UMN LESION SIGNS
* BRISK REFLEXES
* SPASTIC HYPERTONIA
* MUSCLE WEAKNESS
* BABINKKI SIGN AND OTHER PRIMATIVE SIGNS
ALSO
OPTIC ATROPHY
AND CEREBELLAR SIGNS IE ATAXIA AND NYSTAGMUS
26
WHAT ARE THE CRITERIA REQUIRED TO DIAGNOSE MULTIPLE SCLEROSIS
MULTIPLE CNS LESIONS
PLUS
1. LESIONS ARE DISSEMINATED IN SPACE EITHER CLINICALLY OR ON MRI
2. ARE DISSEMINATED IN TIME (OVER 1 MONTHS)
3. SYMPTOMS LAST LONGER THAN 24HRS
27
WHAT IS THE INVESTIGATION OF MULTIPLE SCLEROSIS
MRI
LP
EVOKED POTENTIALS (VISUAL)
28
IN MULTIPLE SCLEROSIS WHAT WOULD YOU FIND ON LP
OLIGOCLONAL BANDS
29
WHAT ARE THEY TYPES OF MULTIPLE SCLEROSIS
1. BENIGN
2. RELAPSING REMITTING
3. SECONDARY CHRONIC PROGRESSIVE
4. PRIMARY PROGRESSIVE
30
DESCRIBE BENIGN MULTIPLE SCLEROSIS COURSE
NOT NEURODEGENERATIVE. HAS FLARES BUT THEN THERE WILL BE FULL RECOVERY BACK TO NORMAL LEVELS OF ABILITY
31
DESCRIBE RELAPSING REMITTING CAUSE OF MULTIPLE SCLEROSIS
SLOW STEPWISE DECLINE IN ABILITY WITH EACH FLARE.
THERE IS PARTIAL RECOVERY AFTER EACH FLARE
32
DESCRIBE SECONDARY PROGRESSIVE COURSE OF MULTIPLE SCLEROSIS
AT THE START THERE IS STEPWISE DECLINE OF ABILITY WITH PARTIAL RECOVERY AFTER EACH FLARE.
LATER IN THE DISEASE CAURSE THERE IS A STEADY PROGRESSIVE DECLINE IN ABILITY WITHOUT FLARES
33
DESCRIBE PRIMARY PROGRESSIVE COURSE OF MULTIPLE SCLEROSIS
A SLOW AND STEADY DECLINE IN ABILITY WITHOUT FLARES
34
WHAT IS GIANT CELL ARTERITIS
IN INFLAMMATORY DISEASE OF THE LARGE BLOOD VESSELS OF THE HEAD
35
WHAT IS THE PRESENTATION OF GIANT CELL ARTERITIS
HEADACHE
JAW AND TONGUE CLAUDICATION (+POSSIBLE TONGUE NECROSIS)
DECREASED VISUAL ACUITY (OPTIC NEURITIS)
SUDDEN VISUAL LOSS (OPTHALMIC ARTERY OCCLUSION)
PAIN AND TENDERNESS BRUSHING HAIR OR TOUCHING SCALP
36
WHAT IS GIANT CELL ARTERITIS ASSOCIATED WITH
SLE
POLYMYALGIA RHEUMATICS
VARICELLA
RHEUMATOID ARTERITIS
37
WHAT IS THE DIAGNOSIS OF GIANT CELL ARTERITIS
BRUITS
BLOODS: INCREASE IN - CRP - ALP - ESR
BIOPSY OF TEMORAL ARTERY = GOLD STANDARD
38
HOW DO YOU TREAT GIANT CELL ARTERITIS
PREDNISOLONE ASAP TO AVOID BLINDNESS
ALSO CAN ADD IMMUNOSUPPRESSIVE TOCILIZUMAB
39
what is the Px of proximal myopathy
struggle going up and down stairs/hills
crabman syndrome
proximal muscle weakness
40
what is the commonest causes of proximal myopathy
steriods
in inflammatory diseases (SLE)
alcohol
renal/liver failure
bone marrow transplants/chemo/resp diseases
41
Myesthic syndromes presentation
repeated movements causing fatigueability
partial ptosis
42
treatment of myesthenic syndromes
Pyridostigmine
an acetylcolinesterase inhibitor
43
what do mononeuropathies commonly affect
upper limbs
44
what is a mononeuropathy
a disease process of a named nerve
45
what are common mononeuropathies
carpel tunnel syndrome
ulnar nerve palsey
46
pt reports having pain in their thumb,index and middle finger.
The pain radiates down to the wrist,
worse in the morning
struggles to open jars, texting/taking selfies
what is the diagnosis
carpel tunnel syndrome
47
what is the presentation of an ulnar nerve palsey
trouble with fine movements
doing up buttons
paying with coins
makeup
48
what does the ulnar nerve supply
small muscles of the hands
49
how do oyu check the axillary nerve
deltoid for sensation and movement
50
when does the radial nerve usually get damaged
humerous fracture
51
what is the function of the radial nerve
flexion of the wrist
52
what nerve causes foot drop
common perineal nerve
53
what pathology usually causes a foot drop
rediculopathy
54
what are common causes of peripheral neuropathies
diabetes
leprosy
55
what is the difference between ridiculopathy and neuropathy
rediculopathy is a pinched nerve.
Neuropathy is a damaged nerve for whatever reason and can present similarly to a rediculopathy
56
what are the two types of symptom groups of periferal neuropathy
small fibre (C fibre)
early onset symptomsburning pain, numbness
Large fibres (A fibres)
loss of motor function
57
what is a classic presentation of a diabeteic neuropathies
thin, dry, shiny skin,
pigmented skin
hair loss
callusus+ulcers
aka trophic changes
58
what is the presentation of vertebral pain syndrome
pain in neck, radiating to shoulder
ache and discomfort
decreased ROM
no sensory loss or muscle weakness
59
what is vertebral pain syndrome
a myelopathy commonly caused by osteoarthritis of the neck
60
what would vertebral pain syndrome in the thoracic spine be indicative of
cancer mets
wedge fracture
RED FLAG!
61
what is the presentation of a rediculopathy
sharp shooting painful joins in dermatomal pattern
worse on coughing or sneezing
sudden onset usually after doing something manual
not many neurological symptoms
62
what rediculopathy would cause bicep, thumb and index finger presentations of
pins and needles, weakness
6
(biceps has 6 letters, thumb is sixth finger )
63
what nerve root would cause tricep and middle finger weakness
C7
tricep has 7 letters
middle finger (8th finger) = fuck you = 8 letters
64
what rediculopathy would cause foot drop
L5
for dorsi flexion (nnervates dorsum of food)
65
what rediculopathy would cause innability to raise on tip toes
s1
innability to plantar flex
s1 innervates, small toes, side of foot
sole of foot
66
what normally causes rediculopathies
disc prolapse
67
what would occipital lobe disorder present as
contralateral visual disturbances
68
what would parietal lobe disorder present as
contralateral
disturded sensations (not pain)
impared higher sensory processes ie dysgarthia, feeling 3D of objects Dyslexia (reading)
69
what would frontal (back of) lobe disorder present as
hemiparesis
70
what would frontal (front) lobe disorder present as
personality and executive function disorders
must be bilateral for Sx
71
what would basal ganglia disorders cause
if decreased Dopamine (paskinsonianism) there too high control = ridgidity
if increased dopamine = dereased control causing chorea + dystonia (ie hontingtons)
72
what can cause meningism
blood (subarachnoid haemorrage)
pus (infection0
73
what is the Px of meningism
headaches, photophobia, neck stiffness, N+V, systemic Sx
74
What are causes of raised IC pressure
headaches worse in morning, decreased conciousness, N+V,blurred vision (papilloedema), Double visison (paralytic squint).
just not quite right
75
what can the presentation of pituitary tumour be in males
bilateral hemienopia
ED
less body hair
gynecomastia
fatgiue
76
what can the presentation of pituitary tumour be in females
bilateral hemienopia
irregular periods
fatigue
77
what is a migrane
a headache causing moderate to svere pain lasting from hours to days and if often preceeded by an 'aura'
78
what is the pain description of a migrane
moderate/severe
throbbing + pulsating
worse on moving, photophobia and aversion to sound
79
what causes an aura
unregulated neuron (electic) activity on surface on the brain causing altered perceptions of sensation
often lasting less than an hour
80
what associated symptoms are there with migranes
N+V
tingling in arm or face
speech difficulties
difficulty moving limbs
81
triggers for migranes
bright lights
strong smells
weather changes
stress
lack of sleep
missed meals
alcohol
82
what parts of a migrain history would you ask
date of attach
severiy
duration
treatment used
deatils of associated sx
83
Ix fir migranes
MRI/CT
84
Mx of migranes
PROFYLAXIS:
propranolol
topiramate (antiepileptic)
Amitriptyline (TCA)
ACUTE:
analgesia : paracetamol/aprin/ibruprofen
triptans: sumatriptan (taken at onset)
anti emetics: metoclopramide
85
what is a cluster headache
a severe headache which occurs on one side of the head typically around the eye. PAin lasting for 15mins to 3hrs
pain tends to occur daily for a few weeks then there will be a pain free period
86
sympoms of cluster headache
severely paunful one sided headache with pain ususally behind one eye/temple
lasting form 15min-3hrs
cranial autonomic sx
agitation and restlessness
1-4 attacks every day
pain usually at same times daily
87
what are cranial autonomic Sx
reddening and tearing of eye
drooping of eyelid
smaller pupil o one eye
blocking/running on nose
facial sweating or flushing
88
who typically gets cluster headaches
male
20-40
smoker/drinkier
89
what are RF for cluster headaches
poor sleep
smoking
alcohol
90
what causes cluster heaaches
abnormal activity of the hypothalamus
91
Mx of cluster headaches
oxygen (12-15l/min) for 15-20 min
sumatriptan injections
sumptriptan nasal spray
92
profylactic Mx of cluster headaches
verapamil (CCB)
lithium
corticosteroids
GABApentin
93
what is a tension headache
constant ache that affects both sides of the head mild/moderate pain
usually lasts for 30 minutes to several hours, but can last for several days.
94
triggers for tension headaches
stress and anxiety
squinting
poor posture
tiredness
dehydration
missing meals
lack of physical activity
bright sunlight
noise
certain smells
95
Mx of tension headaches
Painkillers such as paracetamol or ibuprofen can be used
96
profylactic Mx of tension headaches
Regular exercise and relaxation
Maintaining good posture
hydrated
good sleep
up to 10 sessions of acupuncture over a 5- to 8-week period
amitriptyline
97
what is medication overuse headache
one of the most common daily headache disorders in the world
taking painkillers or triptans for as little as for 10 consecutive days a month can cause it
98
what medicines can cause MOH
caffiene
paracetamol
codiene
triptans (eg. sumatriptan)
ibruprofen and other NSAID
99
who is at risk of MOH
those with preexisting headaches such as tension/migraine
100
what are the Sx of MOH
stopping painkillers and getting headaches +
poor sleep
anxiety
nausea
101
what is a subarachnoid haemorrhage
an uncommon type of stroke
caused by bleed under the arachnoid mater (surface of the brain)
102
what is the Px of a subarachnoid haemorrhage
a sudden severe headache unlike anything you’ve experienced before
a stiff neck
N+V
photophobia
blurred vision/diplopia
stroke-like symptoms
* such as slurred speech and weakness on one side of the body
loss of consciousness
convulsions
103
what can osnet a subaracnoid haemorrage
physical effort or straining
* coughing,
* going to the toilet,
* lifting something heavy
* or having sex.
104
Ix of subarachnoid haemorrage
CT + CTA (computed tomography angiography)
LP (RBC)
105
RF for subarachnoid haemorrages
known brain aneurysm
smoking
high blood pressure
excessive alcohol consumption
Severe head injurys (traumatic subarachnoid haemorrhage)
106
what is the cause of most subarachnoid haemorrages
a ruptured brain aneurysm
107
Mx of Subarachoid haemorrage
nimodipine (reduces risk of ischemia, taken for 3 weeks)
morphine + combination of codeine and paracetamol.
+/-
anticonvulsants(phenytoin) and antiemetics (promethazine)
**surgery**
108
Side effects of Nimodipine
flushing
feeling sick
increased heart rate
headaches
a rash
109
what complications can occur due to SAH
Hydrocephalus
ischemia (leading to cog impairement)
110
what is myesthenia gravis
a muscular disease ausing fatiguability due to the immune system attacking neuromuscular junctions
111
Px of Myesthenia gravis
ptosis
impaired swallow
slurred speech (dysarthia)
repetative movements causing fatiguability
SOB
112
what is the staging of Myesthenia gravis
1. occular muscle weakness
2. difficulty talking + swallowing
3. resp difficulties
113
how do you Ix Myesthenia gravis
nerve conduction studies
anti Ach receptor antibodies
114
how do you Mx Myesthenia gravis
galantamine (anticholinesterases)
pyridostigmine (cholinesterase inhibitor)
Methotrexate, rutiximab (immunosuppressants)
Prednisolone (corticosteroids)
Plasmaphoresis - IVIg
Thyrectomy (removal of thymus)
115
what is motor neurone disease
a neurodegenerative disorder affecting motor neurons
116
name the types of MND
* ALS
* amyotropic lateral sclerosis
* PBP
* progressive bulbar palsey
* PP
* pseudobulbar palsey
* PMA
* progressibe muscular atrophy
* PLS
* primary lateralising sclerosis
* MMA
* Monomelic amyotrophy
117
what is the pathophysiology of ALS
death of voluntary muscle neurons
118
what is the pathophysiology of PBP
neurone death of bulbar muscles (head and neck)
119
what is the pathophysiology of PP
no neuronal death but inability to control facial muscles
120
what are Sx of ALS
spastic tetraparesis
wasting
fasiculations
muscle weakness - trouble swallowing/speakingbeing dexterous
121
what is the common cause of mortality of ALS
death usually after 3 years due to resp failure, bulbar Sx and pneumonai
122
how do you Ix MND/ALS
clinical
EMG supporting evidence
123
How do you manage MND/ALS
Riluzole
* inhibits glutamate release and slows progression
124
what is Guillian-Barre syndrome
an acute neuropathy
125
what is the cause of Guillian-Barre syndrome
post infections with EBV, campylobacter jejuni, CMV
126
what is the pathophysiology of Guillian-Barre syndrome
demyelination causing resp failure via molecular mimicary
127
what is the Px/natural progression of Guillian-Barre syndrome
START
* numbness and tingling in arms and legs
* arm and leg weakness
* ptosis and swallowing difficulties
* muscle pain
* resp failure (1/4 of cases)
END
128
how do yox Ix Guillian-Barre syndrome
LP
* ++proteins
nerve conduction studies
serium antibodies
Bloods
* -Na -K (due to innapropriate secretion of antidiuretic hormone
MRI
129
how do you treat Guillian-Barre syndrome
IvIg
plasmaphoresis
intubation
daltaparin
rehab phisio
130
what does the cerebellum do
controls coordination and movement
131
what can cause cerebellar disorders
Tumours / Space occupying lesions
genetic disorders such as wilsons disease
ataxias:
* genetic/alcohol/periferal neuropathies/ gluten/ vitamin D deficiency/ auoimmune
degeneration disorders ie parkinsons
132
what is the presentation of cerebellar disorders
dysdidokinesis
ataxia
nystagmus
intention tremour
scanning and speech (dysarthia)
hypotonia
133
what Ix are required ffor cerebellum disorders
Bloods
Mri
134
What is the management of cerbellar disorders
underlying cause :
lifestyle or medication changes
vit D, thymine, B12 supplments
rutiximab if autoimmune
135
what is Parkinsons Disease
a common neurodegenerative disease most commonly in the elderly
136
what is the pathophysiology of Parkinsons Disease
depletion of dopamine secreting cells in substancia nigra
leading to altered neural networks and +++ control from basal ganglia
137
what is the Px of Parkinsons Disease
tremour - pill rolling resting tremour
ridgidity - + tone in limbs and trunk
akinesia (difficulty tsarting movement)
expressionless + unblinking, slow monotenous speech, micrographia
postural changes - stooped gait, shuffling gait, poor blaance
138
what is the natural progression of Parkinsons Disease
neuropsychiatric Sx
sleep disorders
XS saliva and sweat and GI disturbances
Fatigue and weightloss
death (bronchopneumonia)
139
how do you Ix parkinsons disease
clinical
absence of disease on MRI
140
how do you Mx Parkinsons Disease
levodopa (dopamine precurser)
Ropinirole (Dopamine agonists)
Seleqine (monoamine oxidase B inhibitor)
Physio
SSRI
stereotatic neurosurgery
141
what are SE of dopamine agonists
-- impulse control
142
how do monoamine oxidase B inhibiors work
inhibit catacbolism of dopamine in brain
143
what is narcolepsy
Narcolepsy is a rare long-term brain condition that causes a person to suddenly fall asleep at inappropriate times.
The brain is unable to regulate sleeping and waking patterns normally
144
what is the Px of Narcolepsy
excessive daytime sleepiness – feeling very drowsy throughout the day and finding it difficult to concentrate and stay awake
sleep attacks – falling asleep suddenly and without warning
cataplexy – temporary loss of muscle control, often in response to emotions such as laughter and anger
sleep paralysis – a temporary inability to move or speak when waking up or falling asleep
excessive dreaming and waking in the night
145
what are the DD of narcolepsy
sleep apnoea
epilepsy
depression
hypothyroidism
a previous head injury
146
how do you Dx Narcolepsy
eliminate other DD (MRI, EEG)
sleep analysis
Epworth sleepiness scale
Polysomnography
multiple sleep latency tests
147
what is polysomnography
electroencephalography (EEG), which monitors brain waves
electrooculography, which monitors eye movements
EMG
recordings of movements in your chest and abdomen
recordings of airflow through your mouth and nose
pulse oximetry,
ECG
148
what is the The Epworth sleepiness scale
The Epworth sleepiness scale is a questionnaire used to assess how likely it is you'll fall asleep while doing different activities.
undertaken by GP to see if refferal to specialist services is necessary
149
Mx of Narcolepsy
sleep hygiene
stimulants: dexamphetamine
Sodium oxybate (helps control loss of muscle control)
antidepressants
150
what is wernicke encephalitis
presence of neurological symptoms caused by depletion of B-vitamin reserves, in particular thiamine (vitamin B1)
151
what is the presentation of wernicke encephalitis
triad of
* ophthalmoplegia usually lateral rectus palsy
* ataxia
* confusion
152
causes of wernecke encephalitis
alcoholics
but it is also in chronically malnusrished
153
Mx of werneckes
Thiamine IM/IV until clinically better then suppliment further PO
(+ B12 and other B vitamins)
154
what is korsicoff syndrome
wernicke's encephalopathy if untreated is followed by Korsakoff's syndrome.
155
what is the Px of Korsicoff
permanent:
## Footnote
disorientation, confusion or mild memory loss
undernutrition - for example, the person is very underweight
involuntary, jerky eye movements or paralysis of the muscles that move the eyes
poor balance or unsteadiness, or other signs of damage to a part of the brain called the
156
what would an MRI show of Korsicoff
shrunken cerebellum
157
What is the Mx of Korsicoff
stop alcohol intake
support and care
158
what is huntingtons
is an inherited disorder that results in the death of brain cells. causing too little control over movement coordination causing hyperkinesis
159
Sx of Hyntingtons
Chorea :jerky, random, and uncontrollable movements also causing stumbling and clumsiness
(this will then progess to rigidity, writhing motions or abnormal posturing)
difficulty concentrating and memory lapses
depression/ mood swings and personality changes / progressive cognitive impairement
problems swallowing, speaking and breathing
difficulty moving
160
When does Huntingotns present
25's-50's
161
what genetic mutation causes Huntingtons
Repetition of the CAG gene
162
how do you diagnose huntingtons
genetic testing
163
what is the Mx of Huntingtons
Chlorpromazine /benzos/antipsychotics (chorea- antidopaminergic/ D2 antagosist)
SSRI
164
What drugs induce parkinsonism
antipsychotics (neuroleptic drugs)
CCB namely cinnarizine
165
What is Trigeminal Neuralgia
Compression of CN V (trigeminal) by loops of blood vessels (rarely by tumours or MS)
166
what is the Px of Trigeminal neuralgia
function, sensation and touch affected - usually unilateral
Usually caused by triggers in the trigeminal area ie shaving beards, brushing teeth
Severe pain from face, teeth and mouth - feels like electric shock
pain lasting around 2 minutes with a dull ache afterwards
theres increased production fo saliva and tears
167
how would you investigate trigeminal neuralgia
MRI if the patient is young or the cause/presentation is unclear
(patients affected are usually older women)
168
What is the managment of trigeminal neuralgia
carbamazipine
glucerol injections
deep brain stimulation
surgical deconpression
169
What is epilepsy
recurrent tendancy to have spontaneous, intermittent and abnormal electrical ativity in a part of the brain/generalised accross the brain leading to seizures
170
what are causes of epilepsy
idiopathic
stroke
trauma
malignancy
171
what is the presentation of temporal seizures
smell/taste abnormalities
auditory phenomena
lip smacking
walking w/o purpose
deja-vu
172
what is the Px of Frontal seizures
motor phenomena, repeated movements
may lead to jacksonian march
173
what is the Px of occipital seixures
visual phenomena
174
what is the Px of parietal seizures
sensory disurbances ie tingling and numbness
175
what is the presentation of an Absence seizure
transient LoC \<10s
with abrupt onset and termination
kind of like daydreaming/phasing out
176
what is the Px of a myoclonic seizure
sudden brief jerking of limb/face/trunk
177
what is the Px of a Tonic seizure
sudden increase in tone
often causing fall
178
what is the Px of a tonic -clonic seizure
tonic phase: LoC + increased tone
clonic phase : rythmic jerking of limbs
179
what is the Px of an Atonic Seizure
no LoC
sudden loss of muscle tone ie drop of hand or fall
180
how do you Ix Epilepsy
Video EEG
test lactate to differentiate non - epileptic attacks
181
what is the management of a partial seizure
carbamezipine
lamotragine
182
what is the management of a tonic seizure
sodiu valproate
carbamezipine is wanting children
183
what is the management of an atonic seizure
sodium valproate
184
what is the management of a myoclonic seizure
sodium valproate
185
what is a simple seizure
aware of what happened
186
what is a complex seizure
impaired awareness of what happened
187
what is status epilipticus
a medical emergency
seizures lasting \>5min
188
what is the managment of satus epilipticus
open and maintain airway, gain IV access
Buccal midlazapam/rectal diazapam (community)
IV lorazapam (hospital)
phenytoin if prolonged
189
what are the types of parkinsonism plus
a progressivee supranuclear palsy
corticobasal degeneration
multiple system atrophy
dementia with lewi bodies
190
what is the Px of parkinsons + progressive supranuclear palsy
parkinsonism
+
postural instability and falls with vertical gaze palsy. Is of a symmetrical onset and has truncal rigidity
191
what is the Px of parkinsons + corticobasal degeneration
parkinsons
+
aparxia, aphasia and asterognosis
192
what is the Px of parkinsons + multiple system atrophy
aka Shy-drager syndrome
parkinsonism
+ autonomic dysfunction (postural hypotension, bladder dysfunction)
and cerebellar signs
193
what is the Px of parkinsons + dementia w lewi bodies
commonest form of parkinsons plus
parkinson
+
variation in cognition, visual hallucination, REM sleep disturbance, orthostatic hypotension
194
what is the pathophysiologies of the 4 types of parkinsonism +
progressibe supranuclear: tau tangles
cotricobasal degeneration: tau tangles
multiple system atrophy: cell loss w sunsequent gliosis
lewi body dementia: alpha-synucelin and ubiquitin (lewi bodies)
195
What is Hydrocephalus
abnormal accumulation of CSF in ventricles
196
what are the types of hydrocephalus
obstructive
non-obstructibe
normal pressure
197
describe the pathophysiology of obstructive Hydrocephalus
Impaired outflow due to lesion or stenosis
causing acute drop in conciousness
198
describe the pathophysiology of non-obstructive Hydrocephalus
Impaired reabsorbtion due to tumour or meningitis
199
describe the pathophysiology of normal pressure Hydrocephalus
isopathic chronic ventricular enlargement with damage of long tracts (UMN lesion)
spasticity, hyperreflexia, and abnormal reflexes
usually in elderly
200
what is the Mx of Hydrocephalus
drain
peritoneal shunt
201
What are causes of meningitis in neonates
GBS
E COLI
202
What are causes of meningitis in children
Haemophylis influenza
neisseria meningitidis
strep pneumoniae
203
what are causes of meningitis in adults
neisseria meningitidis
strep pneumoniae
204
what are causes of meningitis in OAP
strep pneumoniae
205
what are viral causes of meningitis
HIV
enterovirus
206
what are fungal causes of meningitis
candida albicans
cryptococcus
207
what is the Px of meningitis
headache + neckstiffness
photophobia and fever
if bacterial - intense malaise and fever +/- petechial rash if meningococcal
208
what Ix would you perform for meningitis
blood and urine cultures
LP
Blood: lactate
209
what is encephalitis
inflammation of the brain
210
what causes encephalitis
mainly viral
Mumps
HSV (most commonly)
Enterovirus
Rabies
211
How do you Ix encephalitis
MRI
LP (monocytes, lymphocytes, protein)
212
What is Horners syndrome
damage to Sympathetic nerves trunk that supplies face
213
what causes horners syndrome
Glioma
infarction
neurofibromatosis
T1 brachial nerve lesion
Dissected internal carotid artery
214
what is the presentation of horners syndrome
miosis
ptosis
anhydrosis
(on half of face)
215
Pt cant Abduct eye (lateral rectus) what Cranial nerve is involved
CN VI
216
Pt cantdepress, rotate or adduct eye (superior oblique) what Cranial nerve is involved
CN IV
217
Pt has deviated jaw and tongue what Cranial nerve is involved
trigeminal (deviate towards lesion)
218
Pt cant
open eye lid fully (ptosis)
One eye always depressed and abducted (down and out)
with reactive pupil
what Cranial nerve is involved
CN III
219
Describe Bells Palsey and the nerve its caused by
forhead, half unresponive to movement (so LMN because UMN are unaffected)
CN VII
220
What is LEMS
=
Lambert- Eaton Myasthenic syndrome
neuromuscular junctions affected
Where functions of pre synaptic voltage gated Ca2+ channels is impaired by autontibodies resulting in impaired ACh release
Similar to MG but with slighly different presentations
221
what is the difference in presentation between MS and LEMS
![]()
222
How do yo mx a myaesthenic crisis
Intubation
IVIg plasma exchange
223
What is a rediculopathy
mechanical compression of a nerve as it leaves the spinal cord
224
What are causes of Rediculopathy
Osteopathic growth
disc degeneration and lateral protrusion
verebral collapse
tumour growth
225
what is the px of rediculopathyPa
Pain!!
sensory disturbances loss of reflexes
tingling and numbness in dermatomal / myotomal distribution
226
what is the Ix of rediculopathy
clinical unless considering surgery then MRI
227
what is the Mx of rediculopathy
Rest and analgesia
surgical decompression
228
what is a myelopathy
Trauma or compression of the spinal cord causing 'muscle problems'
229
what are the symptoms of myelopathy
depends on tracts affected
but loss of fine otor skills
tingling
not associated with nerve like pain
back may hurt
230
what are the differences between a subdural and extradural haemorrage
![]()
