pathology Flashcards
(169 cards)
1
Q
examples of neurological compression in the spine?
A
cauda equina syndrome and disc prolapse
2
Q
contraindications for MRI?
A
implanted electronics
claustrophobia
pregnant
tattoos
3
Q
PET SCAN shows what?
A
used to map out glucose usage
can see tumours, inflammation, infection
4
Q
how ct of brain appears?
A
black csf
white skull
grey brain - subtle white and grey matter difference
5
Q
how MRI of brain appears?
A
white csf
better grey-white matter difference
6
Q
MRI good for?
A
good for soft tissue
7
Q
US advantage and disadvantages?
A
no radiation
less expensive
moveable
image and interpretation quality based on operator skill
8
Q
X-rays advantage and disadvantages?
A
highly available
fast
lacks soft tissue detail
9
Q
ct advantages and disadvantages?
A
rapid
metal and pacemaker tolerance
radiation
expensive
10
Q
MRI advantage and disadvantages?
A
no radiation
sofft tissue seen
can get physiological info form images
poor metalwork tolerance
slow
expensive
not movement tolerant
11
Q
radionuclide radiology advantages and disadvantages?
A
can get physio info - perfusion metabolism etc
radio tracer expensive
12
Q
3 main causes of localised interrupted blood supply? 3
A
atheroma and thrombus
thromboembolism
ruptured aneurysm
13
Q
TIA ? EXPLAIN
A
transient symptoms - reversible ischameia
tissue still viable
less than 24 hrs
14
Q
fibrosis in cns referred as?
A
gliosis
15
Q
thromboembolism in stroke classically from where?
A
left atrium with AF
16
Q
CAUSES of cerebral artery to have an aneurysm?
A
due to its thin walls - hypertension and weakening of wall aneurysm forms
17
Q
what is happening in body during cardiac arrest?
A
period of no perfusion and no oxygen
18
Q
common treatment for intracranial aneurysm?
A
end embolism
surgical clipping
treating complications - infection, infarcts etc
19
Q
posterior cerebral artery supplies what?
A
perception and visual field
20
Q
middle cerebral artery supplies what?
A
supplies sensation, strength and language - frontal lob, temporal and parietal etc
21
Q
what arteries supply cerebellum?
A
- posterior inferior
- anterior inferior
- superior
22
Q
ataxia is?
damage where?
A
disease - like being drunk - stumbling, slurred speech
damaged cerebellum
23
Q
foramen munro?
A
inter ventricular foramina - connect lateral with 3rd vent.
24
Q
what are the names of holes I roof of fourth vent?
A
1 medial - formane magendie
2 lateral - foramen luschka
25
Parkinson's disease what is it and what does it involve?
disease of basal ganglia
degeneration of neurons in substantial migration and dopaminergic inputs
lack of dopamine
26
hypokinesia?
slowness, difficult to make voluntary movements - increased tone and tremors
27
huntingtons disease?
cortex loss
| loss of caudate, putamen and globus paalidus
28
what part of brain can alcohol affect?
cerebellum and cerebellar circuits
29
amnesia?
memory loss
30
anterograde amnesia?
inability to form new memories
anything that happen after injury - unable to recall
31
retrograde amnesia?
cannot access MORE RECENT old memories
leading up to injury
longtime ago events are fine - as better rehearsed and more deeply imbedded
32
spinal cord tumours split into? 3 explain each
extra dural = outside dura
intra-dural - extra medullary = below termination of sc&above termination of dura mater
intra-medullary = within sc substance
33
cerebral perfusion = ?
MAP - ICP
34
creatine kinase tested in bloods means?
elevated if damaged muscle
35
muscle disease causes? 2
congenital - defects in different things
acquired - electrolyte disturbance/endocrine/autoimmune
36
inflam muscle disease?
autoimmune group of diseases
37
what does cholinesterase do?
break down ACH at nmj
38
what does Ash receptor antibody do?
blocks Each receptor and prevents ACH activating receptor and causing contraction at nmj
39
myasthenia gravis?
neuromuscular disorder causing weakness in VOLUNTARY skeletal muscles - defect in contracting etc
40
MYASTHENIA GRAVIS physiology cause?
autoimmune - where ACH receptor antibody prevents nt ach to carry out function and cause contraction
41
why remove thymus gland in MG?
as thymus gland part of immune system - will reduce immunity and ACH receptor antibody
42
Guillain barre syndrome?
autoimmune condition that affects nerves
43
LMN Lesions signs?5
```
muscle atrophy/wasting
muscle weakness
fasciculations
no reflexes
loss of tone - flacid
```
44
plantar response - extensor and flexor means UMN/LMN?
UMN LESION = extensor up
LMN lesion = flexor down - normal or none
45
UMN lesions signs? 5
```
increased reflexes
muscle weakness
clonus
extensor plantar response
increase tone - spastic
```
46
anterior horn cell disease affects what?
both upper and lower motor neurone
47
symptoms of motor neurone disease?
pure motor
mix of both UMN AND LMN
48
EMG?
TESTS electrical activity in muscles
49
drug used to slow progress of MND?
riluzole
50
myelopathy?
damage to sc - due to compression - etc due to trauma or herniation etc
51
arteries of sc?
anterior and posterior spinal arteries brnahce sof vertebraal artery
52
B12 deficient myelopathy?
most likely affect what part pf sc?
lack of B12 can lead to damage to SC
dorsal/posterior
53
sc infarction affects what part of sc?
anterior cords
54
subarachnoid haemorrhage gives what type of headache?
thunderclap
55
primary headache pain pathway explain in cortex?
loop structures/pathway
- cortical structures
- brainstem
- trigeminal ganglion
AND
CGRP = a key transmitter in this
56
migraine -primary or secondary headache?
primary headache - no known cause
57
tension-type headache?
band like pressure around head -tightening/pressing quality
primary headache
bilateral
58
migraine?
| feature?
primary headache
episodic attacks - painfree then attack etc etc
59
aura of a migraine?
precedes migraine attack -
spreads and d evolves -- involving visual,sesnory, speech etc
usually visual - blurry vision/spots etc
60
stages of migraine?
prodrome
aura
attack
postdrome
61
chronic migraine is classified as?
as more than 15 days headache per month
62
common cause of chronic migraine? e.g. - 3
medication overuse -
analgesics
caffeine overdose
opioids
63
triptans medication for?
migraines etc
64
new daily persistent headache meaning?
remember onset with pain becoming continuous and unremitting within 24hrs
65
neuralgia?
stabbing pain due to affected nerve - damaged
66
trigeminal neuralgia commonly caused by?
compression from bv
67
trigeminal autonomic cephalalgias?
symptoms 2
examples - 5
are group of primary headaches disorders
- uniateral pain
- ipsliteral cranial autonomic symptoms
```
=clucter headache
=paroxysmal hermicarnia
=SUNCT
-SUNA
-hemicrania continua
```
68
cluster headache?
unilateral/bilateral?
type of TAC -
occur in cluster periods
extreme pain
awakens you In the middle of night with intense pain in and around on eye/ noon side of head
unilateral
69
circadian rhythm?
internal process that controls sleep-wake cycle
70
abortive treatment?
non-specific and migraine specific therapy - include analgesics/triptans - medication fro when you fell migraine arriving or just started
71
greater ocipital nerve block ?
function
inject steroid to the nerve
to treat migraine headaches
72
cluster
paroxysmal hemicrania
SUNCT
- which one most sever pain
cluster
73
indometacin is?
an NSAID
used for headaches
74
treatment for paroxysmal Hemicrania?
indometacin
75
Hemicrania continua? explain path of it
strictly unilateral CONTINUOS headache in background
with superimposed exacerbations of more severe pain
type of TAC
76
paroxysmal hemicrania? explain path of it
type of TAC
| unilateral
77
SUNCT/SUNA?
features?
similar to?
TYPE OF TAC
more frequent - no refractory period
like cranial neuralgia
78
high/low pressure in head features?
high - headache worse lying down/exercise
low - sitting or standing up triggered
79
thunderclap headache means?
high intensity headache reaching max. intensity in less than 1 min- instantaneously
80
hydrocephalus means?
raised CSF in brain - increased ICP
81
HIGH PRESSURE headache symptoms? 3
headache wakens patient up
progressive focal symptoms
drowsiness
82
papiloedmea is?
a result of what?
bilateral disc/optic nerve swelling from pressure from CSF behind eye (as a result of increased ICP)
83
3rd ventricular colloid cyst presents as?
sudden headache(raised icp) and loss of consciousness
84
intracranial hypotension common cause?
the cause this leads to?
post lumbar puncture
leaves hole, fluid leaks out - when standing CSF holds it up - but less fluid means brain sinks down
85
giant cell arteritis? what is it
inflamed large arteries - cranially
86
giant cell arteritis - features to look out for?
- beaded/enlarged temporal arteries
| - A NEW headache IN OVER 50YRS
87
ENCEPHALITIS?
inflammation/infection of brain substance
88
triad of meningitis symptoms?
and others?
fever
neck stiffness
altered mental status
nausea / vomiting
rash
sensitive to light
89
organisms(bacterial/viral) causing meningitis?
N. meningitides
strept. pneumoniae
enteroviruses
90
common cause of encephalitis?
(e.g.2)
other cause?
viral -
herpes!
entero
autoimmune encephalitis
91
contraindication of lumbar puncture? 3
when impending cerebral herniation - due to abnormal ICP
on anticoagulants
if SOL
92
BRAIN ABCESS
causes?
treatment?
streptococci organism
anaerobes
surgical drain
93
HIV can cause what to brain?
can cause brain infections with patients who have low CD4 cell count
94
microbe cause of Lyme disease?
borrelia. B
95
Lyme disease?
tick spreading/bite
96
neurosyphilis?
| cause?
bacterial infection affecting brain
treponema pallidum
spread by sexual activity
97
streptococci - gram positive or negative?
positive
98
CJD disease?
caused by?
types of CJD?
BRAIN DISORDER CAUSED BY INFECTIOUS prion protein
which build up in level in brain tissue -
SPORADIC - unkown trigger/random
VARIENT - from cattle disease(mad cow) or genetic mutation
99
dementia what is happening physiologically?
damage to nerve cells and loss of connections between
100
causes of dementia? 4
alzheimers disease
vascular - damage to bv supplying brain
frontotemporal - breakdown of nerves in frontal/temporal region
Lewy body
101
Lewy body?
abnormal balloon like protein clumps found in brain
102
pathology of Alzheimers?
beta-amyloid plaques and neurofibrillary tangles in brain cortex -leading to loss of neurones and synapses
103
how is depression and dementia associated?
depression can be a symptom of dementia
104
medication used in Alzheimers? and explain their actions 2
cholinesterase inhibitors - increase nt in synapses
e.g.-donepezil
NMDA ANTAGONIST - memantine - regulates glutamate chemical messenger in brain function
105
main SYMPTOMS OF PARKINSONS? 4
bradykinesia - slowed movements
rigidity -stiff muscles
tremor
postural instability
106
pathology of Parkinson's? 2
in basal ganglia
| lack of dopamine and presence of Lewy bodies
107
unilateral or bilateral -parkinsons?
unilateral -one side then spreads on both sides
108
what scan can be used to see dopamine?
dopamine transport scan - spect
109
medications of PARKINSONS? 4
LEVODOPA - replace dopamine
COMT inhibitor - prevents levodopa breakdown -prolongs action
MAO-B inhibitor - prevent breakdown of dopamine
dopamine agonists - stimulate dopamine receptor
110
later complications of parkinson?
drug induced
```
levodopa wears off
leads to dyskinesias - involuntary muscle movements
and psychiatric (hallucinations)
```
111
way to deal with drug induced complications of levodopa?
use of -
MAO-B inhibitor
COMT inhibitor
slow release levodopa
medications given are time critical - to prevent wear off
112
level of consciousness measured by?
how aware and awake you are
113
reasons for decreased gcs? 3
seizures
raised icp
toxic/metabolic states - hypoxia/hypoglycaemia
114
glasgow coma scale?
3-15
eye opening response
verbal response
motor response
to pain
115
GCS FOR COMA?
less than or equal to 8
116
coma causes? 3
- toxic metabolic - hypoxia/ischameic
- infection - meningitis/encephalitis
- focal cerebral/tumour
117
what is a stroke?
when bv to brain ruptures or bleeds or blockage MORE THAN 24HRS
118
2 types of strokes?
ischaemic - clot stops blood supply to brain
| haemirragic - blood leaks into brain
119
tia?
mini stroke
| less than 24hrs and resolves itself
120
risk factors of stroke? 7
```
AF
SMOKING
DIET
alcohol
diabetes
high bp
genetic
```
121
basilar artery stroke?
ischameia to pons/brianstem
122
hoover sign?
testing for leg muscle weakness etc
123
difference between haemorragic/ischameic stroke treatment?
ischaemic - remove clot
| haemorragic - make blood clot
124
warfarin is what?
anti-coag
| stop blood to clot
125
which layer of meninges does csf sit?
subarachnoid
126
normal levels of protein, glucose, WCC in csf fluid?
protein less than 0.45
glucose around 3
WCC less than 3
127
what things are present in csf?
```
electrolytes - sodium/potassium etc
protein
WCC
glucose
pH neutral
```
128
2 MAIN REASONS OF HYDROCEPHALUS?
- block prior to reabsorption - like obstruction in cerebral aqueduct
- defect in reabsorption by AG
129
ADUEDUCT STENOSIS LEADS TO?
hydrocephalus
130
symptoms of hydrocephalus?
symptoms of raised ICP
papilloedmea
headache
nerve palsy - abducens - diplopia
131
what balance is kept between what in intracranial cavity? 3
balance between
csf
blood venous channels
tissue
132
how to measure ICP?
EVD into cranium
133
is our ICP FIXED level in our bodies?
no it fluctuates based on response and pulse rate and activatty
134
ICP AND MAP what they do to cerebral flow?
MAP - mean arterial pressure pushes blood into brain
ICP - resisting blood into brain
135
CPP?
| =?
CEREBRAL PERFUSION PRESSURE
=MAP-ICP
136
auto regulation of brain means?
how does it do it? 4 mechanisms
ability of brain to maintain constant blood flow in spite pressure fluctuations
- autonomic innervation - para/symp. - vasodiltion/constriction
- endothelial mechanisms - sense pressure in vessel and vasodilation/C
- myogenic auto regulation - muscles in vessels - sense stretch - AND RESPOND
- metabolic - vasodilate/constrict - cause influence on vessels
137
what nerve palsy associated with raised icp?
6th nerve palsy - abducens
| or third nerve palsy oculomotor
138
ataxia is seen - where is lesion?
cerebellum
139
meningioma? benign/malignant? where?
benign
140
mannitol used for?
to reduce ICP/ pressure
141
nystagmus seen - where is lesion in brain?
cerebellum
142
cauda equina syndrome is?
| unilateral/bilateral?
all nerves to lower back are compressed
bilateral
143
radiculopathy means?
pain in single dermatome. -distrubance here
144
head injury leads to what changes biochemically?
amino acid - glutamate increases
which causes increase in Ca influx
this is neurotic which lead to oedema
145
head injury leads to what changes biochemically?
| explain pathway to oedema
amino acid - glutamate increases
which causes increase in Ca influx
this is neurotic which lead to oedema and swelling
146
nitrous oxide in head injury effects?
NO is produced by neurons and cells which have neurotoxic effects - cell injury
147
contusions of brain are associated with areas of what?
WHICH RESULT IN?
haemorrhage and lead to bleeding
| to raised ICP
148
EXTRADURAL HEAMORRAGE SHAPE?
LENS SHAPE - EGG
149
SUBDURAL HAEMORRAGE SHAPE?
MOON SHAPE
150
MOST COMMON CAUSE of intracranial haemorrhage?
hypertension
151
muscle wastinG in UMN?
no only in LMN
152
FASCULITATIONS SEEN IN UMN/LMN?
IN LMN
153
SUBARACHNOID - WHERE IS HAMEORRAGE FROM?
aneurysm anywhere in circle of willis
154
functional neuro disorder?
where there is problem with functioning - like how brain sends/recieves signals - not structural - stroke/ms
DOING PART AFFECTED
155
what is cognition?
what part of brain?
higher level activity - enables us to learn, comprehend, communicate, understand etc
involves a lot of areas of brain working together to bring it about
156
mini mental state examination?
| what is it?
screening tool for cognition checking
not accurate tool - lacks sensitivity and distinguishing etc
157
montreal cogntive assessment?
assess cognition -see if any impairment
bed side
brief screen
158
addenbrookes cognitive assessment?
to assess cognition impairment
long screen
good at distinguishing disorders
most useful screen
159
cognitive screens?
useful tool but limited
160
most common symptom of MS?
then name others
OPTIC NERUTITIS
ophthalmoplegia - weakness of eye muscles
diplopia
tremor etc
161
treatment for MS relapses? 2
disease modifying treatment for reducing number of relapses
or steroid to help recovery from relapse
162
complication of sinusitis?
brain abcess
163
N.meningitidis is what type of organism?
gram negative diplococci
164
meningoencephalitis associated with what condition?
mumps
165
Gillian barre syndrome?
what is it?
what it affects?
immune mediated demyelination of peripheral nerves triggered by infection - motor and sensory affected
peripheral neuropathy
166
what investigations to carry out in Myasthenia gravis?
antibody tests
167
what is reuse from Babinski test in UMN?
POSITIVE
168
cauda equina syndrome?
```
lmn lesion
muscle weakness
lower back pain
bladder disturbance
saddle anaesthesia
```
169
saddle anaesthesia?
loss of sensation in buttons and around that region
