Opthal + Neurology + ENT Flashcards
What is the antidote for an Acetylcholinesterase inhibitor overdose e.g. taking too many tablets to treat Myasthenia gravis?
atropine- an anticholinergic
What is lateral medullary syndrome/Wallenberg?
occlusion of the PICA (posterior inferior cerebellar artery) due to a stroke
Symptoms include:
-contralateral loss of pain and temperature on body
-ipsilateral loss of pain and temperature on face
-dysphagia, hoarseness and loss of gag reflex
-ipsilateral Horner’s syndrome: miosis, ptosis, absence of sweating
-vertigo to fall to ipsilateral side and double vision (diplopia)
-ipsilateral ataxia
What is the difference between: glaucoma, cataracts, amblyopia, age-related macular degeneration (AMD), retinal detachment and retinoblastoma?
glaucoma: Eye pain or high pressure, headaches, Rainbow-coloured halos around lights, tunnel vision, AFFECTS PERIPHERAL VISION, nausea and vomiting
cataracts: Cloudy/blurry vision, Trouble seeing at night, Changes to the way you see colour, red lights in photos
amblyopia: “lazy eye”-reduced vision in the non-favored eye. This is the most common cause of SQUINT (if left untreated)/vision impairment in children
AMD: Blurred central vision, Black or dark spots in the center part of your field of vision, Wavy or curved appearance to straight lines
retinal detachment: floaters, flashes of light in one or both eyes (photopsia), blurred vision, Gradually reduced side (peripheral) vision, A curtain-like shadow over your field of vision, red eyes in photos
retinoblastoma: in children under 5, pupil is covered with white reflex
What is the definition of a chronic migraine/tension-type headache?
At least 15 days per month for >3 months in the absence of medication overuse
What is the difference between lesions in the broca’s and wernicke’s area?
B: short words/sentences: frontal lobe: expressive
W: what they say doesn’t make sense: temporal lobe: receptive
What is the first line long-term and short-term treatment for CLUSTER headaches?
Short-term = oxygen and triptan
long-term = Verapamil
Explain Weber and Rinne’s tests.
512 Hz
Weber’s
-Sound louder in bad ear= conductive loss
-sound louder in good ear=sensorineural hearing loss
LATERALISED TO UNAFFECTED EAR
Rinne’s
-hear noise better from ear rather than bone = no conductive hearing loss
Where is long term memory controlled in the brain?
The hippocampus in the middle temporal lobe
What is the acute and long-term (prophylactic) treatment for migraines?
acute = paracetamol + triptans (even in pregnancy)
for nausea: metoclopramide
prophylactic = propranolol (not in asthma) OR topiramate, amitriptyline, acupuncture (triptans can be used as prophylaxis for menstrual migraines)
avoid CHOCOLATE:
Chocolate
cHeese
cOCP
Caffeine
alcohOl
anxiety
travel
exercise
What information does the spinothalamic tract carry?
Pain
Temperature
Simple touch
What is heschl’s gyrus?
Primary auditory cortex
What is phenylephrine?
Sympathetic agonist used in the eyecauses dilation (mydriasis) and vasoconstriction in the Sclera (very white eyes)
What is Parkinson’s disease and what are the symptoms, diagnostic criteria, investigations and management?
Death of dopamine in the substantia nigra (basal ganglia)
Brain Bank Criteria
-unilateral tremor that occurs at rest and disappears with use of limbs: pill rolling
-bradykinesia (slow movement)
-shuffling gate
-rigid: cogwheel
-depression
-mask like expression
-REM sleep behaviour disorder
-postural hypotension
treatments:
-MR scan of brain: hummingbird, hot cross bun
-DAT scan
-SPECT scan
-Levodopa drug-dopamine agonists e.g. Ropinirole
-Monoamine oxidase inhibitors e.g. rasagaline
(Can give drugs as a patch too)
-ropinirol
-MDT: salt, ot
-falls assessent
-be aware of NMS
How is the frontal lobe assessed?
The stroop effect (words are in their colours)
What nerves supply the muscles of mastication and then tensor tympanum?
Mandibular division of the trigeminal.
What would a “hummingbird sign” and “hot cross bun sign” mean on an MRI?
It signifies Parkinson’s but there are different causes of Parksion’s.
two of which are below:
supranuclear palsy = hummingbird sign
multisystem atrophy = hot cross bun
this condition is just parkinsons but with autonomic features e.g. erectile dysfunction, postural hypotension, atonic bladder
What is the difference between a migraine, tension type headahce and a cluster headache?
migraine = unilateral + bilateral, pulsing, nausea/vomiting, photophobia, phonophobia, lasts hours-days
tension type = bilateral, none of the above features
cluster = unilateral, conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, eyelid swelling/drooping, lasts 15mins-3hours
What cranial is affected if there are problems with vision when going down the stairs?
4th cranial nerve- trochlear
if it is affected it cause the eye to be drawn upwards
patient can compensate by when giving them something to read they might tilt their head
What are the different types of seizures and the first line treatment for them?
-febrile convulsions = no specific treatment
-focal seizures: one part of the brain: hearing, speech, taste, memory, emotions, hallucinations and flashbacks —> lamotrigine or levetiracetam
-absence seizures: also called petit mal, rapid blinking of a few seconds of staring into space —> ethosuximide, sodium valproate
-generalised tonic-clonic seizures: fall to ground, muscle jerks, lose consciousness —> sodium valproate. Since this medication is contraindicated in pregnancy or women of child bearing age the next most appropriate drug is lamotrigine.
-Status epileptics - a seizure lasting 5 or more minutes or 2 or more seizures within a 5 minute period without the patient returning to normal between them = CHECK BLOOD GLUCOSE =
If IV access is available 1st line is lorazepam and if IV not possible then 1st line is either buccal midazolam or PR diazepamno recovery after 5mins —> 2nd dose of the above no recovery after 10mins —> IV levetiracetam or phenytoinno recovery 25-30mins —> anaesthetise and intubate
What is the difference between multiple sclerosis and motor neurone disease?
MS - autoimmune, can affect bladder control, can relapse, 20-40y/o
Treatment - aimed at reducing levels of inflammation. Corticosteroids, plasmapheresis, IV immunoglobulin.
MND - neurogenerative, only affects movement, gets worse, eye movements are SPARED, 40-70y/o
different types most common is Amyotrophic lateral sclerosis
What side does the tongue, jaw and uvula deviate to if there is a lesion?
Jaw + tongue = same side as lesion
uvula = opposite
What does the facial nerve do?
Lachryml glands and saliva glands
facial expression
anterior 2/3 tongue taste
stapedius muscle (stapes bone can undergoes osteogenesis?)
What cranial nerves innervate the eye muscles?
Oculomotor: classically “DILATED, FIXED pupil” medial, superior and inferior rectus + inferior oblique (DOWN and OUT)
trochlear: superior oblique
abducens: lateral rectus
What information does the dorsal column pathway carry?
Discriminative touch
conscious proprioception
vibration
What are the ADRs for cholinergics?
Diarrhoea
Urination
Miosis
Bradycardia
Emesis
Lethargy
Lacrimation
Salivation
What is Waardenburg syndrome?
Cells that control potassium secretion fail to migrate into the tissue leading to deafness.
Explain GCS.
3-15
8 or less intubate
TAKE BEST RESPONSE FROM BOTH SIDES
Eyes (4): normal, asked, pain, shut
Visual (5): normal, confused but able to answer, makes no sense, sounds, no voice
Motor (6): normal, defend pain (loaclises), flinches away (wihdraws), decorticate (abnormla flexion), decerebrate, no movement
What are Grommets?
used to treat glue ear: the empty middle part of the ear canal fills up with fluid. This can cause temporary hearing loss/tinnitus/pain.
It usually clears up within 3 months
a small tube placed in your child’s ear during surgery. It drains fluid away and keeps the eardrum open.The grommet should fall out naturally within 6 to 12 months as your child’s ear gets better.
Glue ear in Down’s syndrome/cleft palate in children or ADULTS in general should be referred to ENT
What is tropicamide?
Parasympathetic acetylcholine antagonist used in the eye
stops constricting of pupiltreated eye becomes very dilated
What drugs have affects on hearing (ototoxicity)?
Gentamicin
Loop diuretics e.g. furosemide
What is Ramsay-Hunt Syndrome?
AKA–> herpes zoster oticus (chickenpox)
-shingles outbreak affects the facial nerve near one of your ears
-painful shingles rash with blisters on the ear, facial paralysis, hearing loss in affected ear
Treatment: acyclovir or famciclovir AND corticosteroids like prednisone
What condition is most commonly seen in contact lens users that causes red, painful, light sensitive, gritty eyes?
keratitis —> same day referral to an eye specialist, stop wearing contacts, ab
Caused by pseudomonas
What affected nerve would cause the appearance of a “claw-like” hand?
ulnar nerve
2nd and 3rd finger bent
What is the difference between entropion and ectropion?
entropion: in-turning of the eyelids
ectropion: out-turning of the eyelids
What is fluorescein eye drops used for?
orange dye (fluorescein) and a blue light is used to detect: SEIDEL’s sign-foreign bodies in the eye to see how deep it is!!!!-can show corneal ulcers: caused by CONTACT LENSES or vitA deficiency
corneal ulcers are usually due to herpes simplex virus keratitis and can cause REDUCED corneal sensation —> topical aciclovir
you would also see HYPOPYON (white blood cells in eye)
How do you treat epistaxis?
haemodynamically stable = pinch nose for 10-15 mins and Sit with their upper body tilted forward and their mouth open.
–> topical antiseptic preparation to reduce crusting and vestibulitis: prescribe Naseptin–> is allergic to neomycin, peanut, or soya prescribe mupirocin
admission or referral to secondary care –> under 2 years of age or have a comorbidity (coronary artery disease) bleeding hasn’t stopped in 10-15mins = cautery with silver nitrate, packing or clipping of the sphenopalatine artery
What is acute viral labrynthitis and what is the difference between that and vestibular neuronitis?
sudden onset horizontal nystagmus, sensorineural hearing loss, nausea, vomiting and vertigo
Management:
-episodes are usually self-limiting
-prochlorperazine or antihistamines may help reduce the sensation of dizziness
vestibular neuronitis has NO hearing loss, but has horizontal nystagmus
HiNTs exam used—> prochlorperazine
What is the diagnosis of a patient with diabetes presenting with sudden appearance of floaters and sudden blurring of vision?
Vitreous haemorrhage
What is the difference between then anterior, posterior, central and Brown-Sequard cord syndrome?
anterior = loss of pain, temp, light touch and pressure, Sacral sparing
posterior = loss of proprioception, vibration, 2-point discrimination. Motor preservation
central = bilateral spastic paralysis and sacral sparing. Upper limbs affected more than lower
BS = -ipsilateral paralysis
-loss of ipsilateral proprioception and vibration
-loss of contralateral pain, temperature, light touch and pressure
What is the difference between Hutchinson’s pupil and Argyll-Robertson pupil?
Hutchinson’s = Unilaterally dilated pupil, unresponsive to light –> compression of the occulomotor nerve of the same side, by an intracranial mass (e.g. tumour, haematoma)
AR = Bilaterally small pupils that accommodate but don’t react to bright light –> neurosyphilis and diabetes mellitus
What drugs can cause tinnitis?
Aspirin and other NSAIDs
What is the difference between:
scleritis
episcleritis
pre-septal cellulitis
orbital cellulitis
optic neuritis?
scleritis = inflammation of the sclera, red, painful, watering, decrease in vision –> ophthalmologist, NSAIDs, steroids
episcleritis = red, NOT painful, watering, photophobia, phenylephrine blanches the episcleral vessels but NOT the scleral vessels –> conservative, artificial tears
pre-septal/peri-orbital cellulitis = children, red, swollen, painful eye of acute onset, symptoms associated with fever, ptosis, NO PAIN on moving eye –> referred to secondary care for assessment, oral antibiotics (co-amoxiclav)
orbital cellulitis = red, painful, proptosis (bulging), ptosis, reduced vision, PAIN ON EYE MOVEMENT –> admission to hospital for IV antibiotics, septic screen, CT head
optic neuritis = commonly associated with MS, unilateral decrease in vision, colour vision affected, pain on eye movement, Relative Afferent Pupillary Defect (RAPD), central scotoma –> MRI and steroids
What is anterior uveitis ALSO KNOWN AS iritis?
Associated with autoimmune conditions e.g. ankylosing spondylitis, crohn’s
anterior chamber cells seen on slip lamp exam
red eye
pain
photophobia
Management:
-urgent review by ophthalmology
-cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
-steroid eye drops
How do you treat bleeding after a tonsillectomy?
Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.
Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics.
How do you treat Chronic rhinosinusitis and what’re the symptoms?
facial pain: typically frontal pressure pain which is worse on bending forwardnasal discharge: usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infectionnasal obstruction: e.g. ‘mouth breathing’
post-nasal drip: may produce chronic cough
Management of recurrent or chronic sinusitis:
-avoid allergen
-intranasal corticosteroids
-nasal irrigation with saline solution
Red flags symptoms (IF ANY –> URGENT ENT REFERRAL)
unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis
What is the difference, clinically, between:
Otosclerosis
Presbyacusis
Noise damage
Acoustic neuromas
Otitis media
Otosclerosis = genetic condition- runs in families, irregular bony formation in the middle ear, progressive conductive deafness, which typically presents in middle age. Tinnitus and vertigo may also be present, but are less common.
Presbyacusis = sensorineural gradual hearing loss in both ears and NO dizziness
Noise damage = sensorineural hearing loss
Acoustic neuromas = unilateral sensorineural hearing loss with DIZZINESS
Otitis media = NOT normal otoscopy
What is the treatment for a nosal/septal haematoma, not bleeding, just swollen and red?
urgent referral to ENT for drainage
What does retinal detachment present like and how do you treat it?
-Sudden painless loss of vision
-Dense shadow that starts peripherally progresses towards the central vision
-A veil or curtain over the field of vision
-Straight lines appear curved
-Central visual loss
-relative afferent pupillary defect
management:
-urgently referred to ophthalmologist for assessment with a slit lamp and ophthalmoscopy
-if caused by diabetes then treat this
What is a Cholesteatoma?
non-cancerous growth of squamous epithelium. Most common in patients aged 10-20 years. Being born with a cleft palate increases the risk of cholesteatoma around 100 fold.
Main features:
chronic ear infections
FOUL-smelling
non-resolving
discharge
hearing loss
Other features are determined by local invasion:
-vertigo
-facial nerve palsy
-cerebellopontine angle syndrome
-Otoscopy ‘attic crust’ - seen in the uppermost part of the ear drum
Management:
patients are referred to ENT for consideration of surgical removal
What is the first line abx for tonsilitis and what causes it?
Caused by strep progenies
CENTOR 3 or 4:
exudate, lymph nodes, fever, absence of cough —> Phenoxymethylpenicillin–> Clarithromycin if allergic
Fever can be recorded at any point not just the one at the consultation
What visual changes do digoxin and viagra have?
digoxin = yellow-green vision (dig for gold)
viagra = blue vision (‘the blue pill’)
What is a vestibular/acoustic schwannoma?
benign tumor–> overproduction of Schwann cells
unilateral hearing loss
tinnitus (ringing in the ear)
dizziness/loss of balance
facial numbness/weakness or paralysis on the side of the tumor
MRI to diagnose
urgent referral to ENT surgical removal
radiation
observation
What is acute epiglottitis?
emergency
Caused by h. influenzas B
Do not examine child’s mouth
chin is lifted and pushed forward with hands on floor (tripod position)
DDDD: dysphagia, drooling, dysphonia, distress
—> ceftriaxone, oxygen, endotracheal intubation potentially
What is mastoiditis?
Infection from middle ear to mastoid bone
ear pain behind ear
history of otitis media
fever
swelling
red and tender over mastoid
external ear protrudes forwards
ear discharge if eardrum perforates
give IV abx- vanc or cef
complications —> meningitis
What is the difference between Non-proliferative and proliferative diabetic retinopathy and how do you treat it?
SUDDEN VISION LOSS
Seen in photo is TREATED diabetic retinopathy
Non-proliferative = microaneurysms, blot haemorrhages, hard exudates, cotton wool spots –> observation and if severe panretinal laser photocoagulation
proliferative = neovascularisation –> Intravitreal VEGF inhibitors and pan-retinal photocoagulation laserboth –> glycaemic control
What can cause stridor?
viral croup (treated with dexamethasone)
Airway blockage (cancer, foreign body)Trauma –> potentially tracheostomy
Swelling (tonsillitis epiglottitis)
Smoke or chemical inhalation
Neck surgery
What would be the fundoscopy findings of central retinal artery occlusion and central retinal vein occlusion and how do you treat it?
Artery:
-sudden unilateral vision loss
-‘cherry spot’ on retina
-pale retina
—> IV acetazolamide, IV mannitol, ocular massage, intraarterial thrombolysis
Vein:
-sudden painless unilateral vision loss
-severe retinal haemorrhages ‘stormy sunset’
—>managed conservatively unless underlying condition, anti-VEGF, laser photocoagulation
What are the symptoms of acute sinusitis and how is it treated?
facial paintypically frontal pressure pain which is worse on bending forward
nasal discharge: usually thick and purulent
nasal obstruction
paracetamol/ibuprofen if symptoms for more than 10 days –> steroids –> mometasone 200 micrograms twice a day
What is age-related macular degeneration and the different types?
Most common cause of blindness
usually elderly women
symptoms:
-reduced vision acuity
-worse in dark
-flashing lights
-wavy lines: Amsler grid testing
investigations:
-fundoscopy: dry or wet?
-slit lamp microscopy
types: WET = subacute presentation, presence of neovascularisation —> anti-VEGF
DRY = gradual onset, Drusen —>give beta-carotene, vit C and E, zinc
What is the difference between viral and bacterial conjunctivitis? How do you treat and in pregnancy too?
viral = serous discharge, recent URTI
bacterial = purulent discharge, eyes may be ‘stuck together’ in the morning, itchy –> chloramphenicol eye drops but in pregnant woman use fusidic acid eye drops
BOTH = Do not wear contact lenses until symptoms have resolved. Clean the eyelids with a wet cloth and apply a cold compress
What is the difference between otitis media and otitis externa?
otitis media due to haemophilus = pain, ear tugging, BULGING of the tympanic membrane, otorrhoea, erythema tympanic membrane, fever, hearing loss, recent virus usually influenza –> -Paracetamol or ibuprofen
-nasal decongestants
-antibiotics: 5-7 day course of amoxicillin or erythromycin if allergic to penicillin ONLY if perforation, symptoms >4 days, systemically unwell, younger than 2 or immunocompromised-admit if children are younger than 3 months or have a high temperature
otitis externa due to CANDIDA= “Swimmers ear” (surfers get it), seen in eczema patients, pain, intense itching, debris in the ear canal, external canal/tympanic membrane may be erythematous–> topical abx +/- steroids
-if continues to spread = flucloxacillin
-if recurrent = antifungal
use ciprofloxacin if they have diabetes!!
What is Neuroleptic malignant syndrome (NMS)?
seen in patients taking antipsychotic medication OR dopaminergic drugs (such as levodopa) for Parkinson’s disease, usually when the drug is suddenly stopped or the dose reduced
occurs within hours to days of starting an antipsychotic
-raised creatine kinase
-Acute kidney injury (secondary to rhabdomyolysis) and leukocytosis
-pyrexia
-muscle rigidity
-hypertension
-tachycardia and tachypnoea
-agitated delirium with confusion
management:
stop antipsychotics
IV fluids
give dantrolene or bromocriptine in selected cases
What is Samter’s trio?
The association of asthma, aspirin sensitivity and nasal polyposis:
-nasal obstruction
-rhinorrhoea, sneezing
-poor sense of taste and smell
Management:
-all patients with suspected nasal polyps should be referred to ENT for a full examination
-topical corticosteroids shrink polyp size in around 80% of patients
In patients with asthma, aspirin and other NSAIDs should be avoided as these may precipitate an asthma exacerbation
How do you treat a perforated ear drum?
no treatment and review the patient in 2 weeks and then 6 weeks.
In the majority of cases the tympanic membrane will heal without treatment in 6-8 weeks
Myringoplasty may be performed if the tympanic membrane does not heal by itself.
What is Weber’s syndrome?
midbrain stroke
left pupil- dilated and light reflexes are absent
Power is 3/5 bilaterally in both upper and low limbs.
What is blepharitis?
Inflammation of the eyelid margins
bilateral grittiness
sticky eyes
erythematous eyelid margins
worse in warm weather
hot compresses, removal of debris with cotton buds dipped in cooled boiled water, and artificial tears if patients report dry eyes
What would be the diagnosis of a patient getting dizzy on extending neck?
vertebrobasilar ischaemia
What is Reye’s syndrome?
DO NOT GIVE ASPIRIN - as this can cause Reye’s
rare disorder that can cause liver and brain damage affecting children and young adults under 20 years of age
symptoms:
-usually begin a few days after a viral infection, such as a cold, flu or chickenpox
-repeatedly being sick
-tiredness and lack of interest or enthusiasm
-rapid breathing
-seizures (fits)
What CSF findings would suggest bacteria, virus, TB and fungi?
-bacteria: increased neutrophils and protein, decreased glucose
-virus: increased lymphocytes
-TB: increased lymphocytes, very high protein and decreased glucose
-fungi: increased lymphocytes
What is the treatment for gingivitis?
simple gingivitis (painless, bleeds, red):
-review by a dentist
acute necrotizing ulcerative gingivitis (painful, punched-out gums, halitosis (bad breath):
-refer the patient to a dentist
-oral metronidazole for 3 days
-chlorhexidine mouth wash
-analgesia
What is black hairy tongue?
desquamation of the filiform papillae –> tongue may be brown, green, pink or another colour
Predisposing factors:
poor oral hygienea
ntibiotics
head and neck radiation
HIV
intravenous drug use
** The tongue should be swabbed to exclude Candida and if recurrent Candida test for diabetes **
Management:
tongue scraping
topical antifungals if Candida
What is the treatment for squints in children?
-corrective glasses
-occlusion therapy OR penalization therapy -(atropine drops) - for amblyopia
-eye exercises
-surgery
-botox
What is the management of a subarachnoid haemorrhage and how does it present?
thunderclap headache with occipital headache with nausea
-non-contrast CT
-only lumbar puncture 12hrs from onset if CT was done MORE than 6hrs of onset and CT was normal: Xanthochromia
-refer to neurosurgery
-oral nimodipine
-coil to treat intracranial aneurysms
When could you not do a lumbar puncture and what would you do instead?
if there is raised ICP (bradycardia, irregular resps, widened pulse pressure, papilloedema, low GCS) for example in meningitis
also cannot do a LP in non-communicating (obstructive) hydrocephalus
if cannot do an LP then do a blood PCR instead
What symptoms are common in Ménière’s disease and how do you treat?
Feeling of ‘fullness’ and ‘pressure’—> betahistine
What is benign paroxysmal positional vertigo (BPPV)?
vertigo and dizziness caused by changes in head position (rolling over in bed)
DIAGNOSED with Dix-Hallpike manoeuvre
-resolves spontaneously after a few weeks to months
-Symptomatic relief may be gained by Epley manoeuvre
What are the complications of an aneurysmal subarachnoid haemorrhage?
-rebleeding
-hydrocephalus
-vasospasm
-HYPONATRAEMIA
-seizures
-SIADH
What are the facial bones–> need to know incase of a facial fracture?
What is Hutchinson’s sign?
rash on the tip or side of the nose.strong risk factor for ocular involvement –> Herpes Zoster Ophthalmicus (HZO)
What is an ataxic gate?
loss of heel to toe walking
What is the difference between a thyroglossal cyst and a brachial cyst?
thyroglossal = moves with swallowing and protrusion of tongue, seen in children
brachial = mobile cyst lateral to midline, usually presents after a URTI
How do you withdraw from drugs after them causing medication overuse headaches?
simple analgesia + triptans: stop abruptly
opioid analgesia: withdraw gradually
When would you perform a CT head within 1hr/immediately?
-GCS < 13 on initial assessment
-GCS < 15 at 2 hours post-injury
-suspected open or depressed skull fracture (laceration)
-any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)
-post-traumatic seizure
-focal neurological deficit
-more than 1 episode of vomiting
What artery is affected in ‘locked-in’ syndrome?
basilar artery
What is Erb-Duchenne palsy (‘waiter’s tip’)?
due to damage of the upper trunk of the brachial plexus (C5,C6)
may be secondary to shoulder dystocia during birth
the arm hangs by the side and is internally rotated, elbow extended
—> supportive management as usually resolves 6-12 months, physio
What is gliobastoma multiforme?
Most common primary brain tumour in adults and is associated with a poor prognosis (~ 1yr).
-solid tumours with central necrosis and a rim that enhances with contrast
-vasogenic oedema
-Treatment is surgical with postoperative chemotherapy and/or radiotherapy
-Dexamethasone is used to treat the oedema
What is Klumpke’s paralysis?
Damage to T1 due to traction/trauma
ALL FINGERS ARE BENT
loss of intrinsic hand muscles
clawed hand
What is allergic conjunctivitis?
Usually seen with hayfever and may be seasonal
bilateral symptoms:
itchy
swollen erythema
—> 1st: topical or systemic antihistamines 2nd: sodium cromiglicate
What would you suspect if you were examining a back with a tuff of hair on it or a birth mark?
Spina bifida- non fusion of vertebral arches during development
three types:
-myelomeningocele: most severe and neurological defects
-occulta: birth mark or hair patch
-meningocele
risk can be reduced by taking of folic acid supplements during pregnancy
Where do the cranial nerves exit at the skull base?
it may say what is jugular foramen syndrome? And then whatever nerves pass through this are affected and cause those specific symptoms!
Learn what a normal fundus looks like.
THIS IS OF THE LEFT EYE AND THE OPTIC DISC IS ON THE LEFT SIDE
What does papilloedema look like?
Blurred disc margins
What is shown in the CT and what would it cause?
Middle cerebral artery bleed
contralateral hemiparesis (weakness on one side of body)
facial droop
aphasia/dysphagia
contralateral hemiparesis (weakness on one side of body)
What is the difference between subdural and an extradural haematoma?
Extra: due to trauma, loses then regains then loses consciousness I.E. lucid interval, craniotomy and evacuation of haematoma
sub: CT, observe conservatively, surgical decompression, monitor ICP, stop or reverse anticoagulants
**remember if there is another bleed opposite to the haematoma this might be a contracoup injury
What is a pituitary adenoma?
common benign tumours but usually never found
symptoms can be:
-excess of a hormone (e.g. Cushing’s disease, acromegaly (too much growth hormone: big hands and jaw, CARPAL TUNNEL), amenorrhea and galactorrhea due to excess prolactin)
-depletion of a hormones
–> hypopituitarism
-headaches
-bitemporal hemianopia–> compression of the optic chiasm
treatment:
-bromocriptine
-TRANSSPHENOIDAL surgery
-radiotherapy
What is pituitary apoplexy?
Sudden enlargement of a pituitary tumour due to haemorrhage or infarction
hypertension, pregnancy, trauma, anticoags –> RISKS
-sudden onset headache
-vomiting
-neck stiffness
-visual field defects: classically bitemporal superior quadrantic –> compressing optic chiasm from BELOW
-features of pituitary insufficiencye.g. hypotension/hyponatraemia secondary to hypoadrenalism
MRI
STEROIDS
surgery
fluid balance
What is a craniopharyngioma?
benign brain tumour ABOVE the pituitary gland
again can present with:
weight gain
struggling to see car wing-mirrors
diabetes insipidus
headaches
vision loss: bitemporal inferior quadrantic –> compressing optic chiasm from ABOVE
vomiting
difficult to conceive
treatment: surgery, radiotherapy
What is Bell’s palsy?
Acute unilateral facial nerve paralysis due to infection, inflammation etc.
-LMN palsy: forehead is affected (opposite for UMN lesion)
-post-auricular pain (behind ear)
-altered taste
-dry eyes
treatment:
-oral prednisolone within 72hrs
-eye care: lubricants and drops as they cannot control eye movements
-refer urgently to ENT if no improvement in 3 weeks
What is acute angle-closure glaucoma (AACG)?
Rise in intraocular pressure (IOP) stops aqueous outflow
risks:
-long sighted (hypermetropia)
symptoms:
-Pain
-eye or head
-semi dilated non-reacting pupil
-decreased acuity
-symptoms worse when in the dark
-hazy cornea
investigations:
-tonimetry to assess raised IOP
gonioscopy
Management:
Emergency:
-combination of eye drops (pilocarpine, beta blocker, alpha-2-agonist)
-IV acetazolamide
-steroids
long term: laser peripheral iridotomy
What are cataracts?
light doesn’t reach retina
symptoms:
-Cloudy/blurred vision
-hard to distinguish colours
-lights appear brighter
-defect in red reflex
investigations:
-opthalmoscopy
-slit lamp exam
risks:
all the usual ones plus hypocalcaemia
Management:
-early stages = stronger glasses
-surgery: complications include endophthalmitis, retinal detachment, posterior capsule opacification
What’s the difference between a stye and chalazion (Meibomian cyst)?
Chalazion = firm, painless lump
What is retinitis pigmentosa?
night blindness
tunnel vision
What is Multiple Sclerosis (MS)?
-no cure-women-20-40 y/o-two types: relapsing-remitting and secondary progressive disease (symptoms between relapses)
-visual: optic neuritis, Uhthoff’s phenomenon (worsening in vision after rise in body temperature)
-sensory: pins and needles, numbness, trigeminal neuralgia
-motor: spastic weakness, ataxic gate, temor
-urinary incontinence, sexual dysfunction
MRI = plaques and Dawson fingers
CSF lumbar puncture = oligoclonal bands
treatment–>
-acute relapse = high dose steroids (methylprednisolone) for 5 days
-prophylaxis = natalizumab (monoclonal antibodies)
-to treat spasticity = gabapentin and baclofen
What is the pterion and what artery is associated with it?
Region of the skull that has easy access to the middle miningeal artery
Learn the field effect scene on different parts of the optic tract.
2 Optic chiasm: bitemporal hemianopia
3 optic tract: right homonymous hemianopia
4 right homonymous superior quadrantanopia
A patient had a stroke and was left with this eye field defect. Where did the stroke occur?
Left parietal lobe
Learn the normal anatomy of the eye.
What are the different types of cataracts?
Nuclear
posterior subcapsular
cortical
What is arteriovenous malformations?
a group of blood vessels form incorrectly and get tangled usually happens in birth but symptoms may never appearcan cause strokes, seizures, buzzing or rushing sound in ears, headache, vision changes, etc
Learn the circle of Willis.
Label the brainstem (midbrain, pons, medulla, cerebellum) on the MRI.
The purple blob is one side of the cerebellum
Learn where the basal ganglia is on a brain MRI.
How can you tell the difference between a haemorrhagic and a ischaemic stroke on a CT?
White: haemorrhagic
Black: ischaemic
