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Medicine Phase 2a Neuro > Peer-Teaching 3 > Flashcards

Peer-Teaching 3 Flashcards

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1
Q

Example of descending spinal tract

A

Corticospinal

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2
Q

Example of ascending sensory tracts

A

Dorsal column

Spinothalamic

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3
Q

Where do each of these tracts decussate:
Corticospinal
Dorsal column
Spinothalamic

A

Corticospinal - medulla
Dorsal column - medulla
Spinothalamic - almost immediately in spinal cord

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4
Q

What sensation is carried by dorsal column

A

Proprioception, vibration and 2 point discrimination

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5
Q

What sensation is carried by spinothalamic tract

A

Pain and temperature (see other cards for anterior vs lateral)

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6
Q

At what vertebrae do you find the spinal cord

A

Cord extends for C1 (junction with medulla) to L1/2 (conus medullaris)

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7
Q

Where do you take a lumbar puncture

A

L4 (around)

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8
Q

Below L1, the lumbar and sacral nerve roots are grouped together to form what?

A

Cauda equina

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9
Q

What is paraplegia

A

Paralysis of BOTH legs always caused by spinal cord lesion

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10
Q

What is hemiplegia

A

Paralysis of one side of body caused by lesion of the brain

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11
Q

True or False:

Sensory loss usually means spinal cord disease

A

True

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12
Q

What is myelopathy

A

Compression of the spinal cord resulting in upper neuron signs and specific symptoms dependent on where compression is

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13
Q

Causes of myelopathy/spinal cord compression

A

Osteophytes, Disc prolapse (slower onset), Tumour (slow onset)

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14
Q

Signs of spinal cord compression

A

UMN signs

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15
Q

Ix of myelopathy

A

urgent MRI

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16
Q

Tx of myelopathy

A

Surgical decompression and dexamethasone

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17
Q

*Brown-sequard syndrome:

Clinical presentation at level of and below the lesion

A

Below lesion

  • Ipsilateral corticospinal dysfunction
  • Ipsilateral dorsal column dysfunction
  • Contralateral spinothalamic dysfunction

Level of lesion
-Ipsilateral spinothalamic dysfunction (localising sign)

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18
Q

Examples of peripheral neuropathies

A

Radiculopathy
Mononeuropathy
Polyneuropathy

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19
Q

What glial cells are found on cranial nerves

A

Schwann cells as they are peripheral

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20
Q

Describe radiculopathy

A

Compression of nerve root of a LMN

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21
Q

Risk factors of peripheral neuropathy

A 
DAVID:
Diabetes
Alcohol
Vitamin deficiency (B12) 
Infective (GB)
Drugs (isoniazid)
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22
Q

Example of polyneuropathy

A

Multiple/Systemic: diabetes, MS, Guillain Barre etc

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23
Q

Causes of peripheral neuropathies

A

compression, infarction, demyelination, axonal degeneration (lead), infiltration (leprosy)

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24
Q

Risk factors of carpal tunnel syndrome

A

Pregnancy, obesity, hypothyroidism, rheumatoid arthritis, acromegaly, gout

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25
Aetiology of carpal tunnel syndrome
NOT repetitive strain injury, idiopathic
26
Presentation of carpal tunnel syndrome
Pain and paresthesia in hand (wake and shake-worse at night) Loss of sensation Median nerve distribution (palm radial 3) Wasting of abductor pollicis brevis – wasting of thenar eminence
27
Investigations of carpal tunnel syndrome
PHALENS and TINENLS
28
Treatment of carpal tunnel syndrome
1. conservative: pain relief, split at night 2. hydrocortisone injection 3. surgical decompression
29
What is sciatica
L5/S1 lesion = S1 NERVE ROOT COMPRESSION = SCIATICA
30
Presentation of sciatica
Sensory loss/pain in back of thigh/leg/lateral aspect of little toe (essentially in the sciatic nerve distribution)
31
Causes of sciatica
Disc prolapse, Osteoarthritis | treatment is conservative
32
Ix of sciatica
MRI urgent
33
What is cauda equina syndrome
Lesion at or below L1
34
Causes of cauda equina syndrome
Tumours, disc herniation, trauma can cause the compression
35
Signs of cauda equina syndrome
Lumbosacral pain (early), Saddle anesthesia (Do PR), areflexia, fasciculations, Loss of bowel / bladder control, urinary retention (late)
36
Ix of cauda equina syndrome
MRI Spine
37
Tx of cauda equina syndrome
Surgical decompression, high dose dexamethasone
38
Red flags of cauda equina syndrome
``` Bilateral sciatica Bilateral flaccid leg weakness Saddle anesthesia Bladder and bowel dysfunction Erectile dysfunction Areflexia ```
39
Quantitive value of raised ICP
>15mmHg
40
Signs of raised ICP
headache, reduces GCS, vomiting, Pupillary changes, Seizures
41
Features of presentation of ICP
Worse in the morning Made worse by coughing, straining/ bending forward If prolonged ICP= papilledema, falaring around the optic disc due to obstruction of the venous return form the retina
42
Why is pain in morning from raised ICP worse in morning
CSF redistribution when laying flat= increased pressure around the brain
43
Ix of raised ICP
Do a head CT and ophthalmology review
44
Tx of raised ICP
Mannitol Surgical (shunt/decompression) Dexamethasone (tumour)
45
Aetiology of Myasthentia gravis
AUTOIMMUNE IgG autoantibodies attach postsynaptic acetylcholine nicotinic receptors at NMJ Associated with a thymic tumour in 10%
46
Presentation of myasthetia gravis
– Characterized by Muscle WEAKNESS AND FATIGABILITY of ocular, bulbar and proximal limb muscles –Ptosis, talking and chewing problems, swallowing (worse at the end of the day) (can affect any muscle variably) (Lots of drugs can aggravate Myasthenia Gravis: BBs, Lithium, Some antibiotics)
47
Ix of myasthentia gravis
Bedside– count to 50 / keep your arm outstretched Anti-AChR antibodies in blood (Can also have Anti-MuSK antibodies) Electromyography – fatigability CT/MRI – thymus hyperplasia (thymoma) Tensilon test (rarely performed)
48
Tx of myasthentia gravis
1st= Pyridostigmine (acetylcholinesterase inhibitor) + Prednisolone/ azathioprine (Immunosuppression) 2nd= methotrexate/ cyclosporine etc In crises – IV immunoglobulin, Plasmapheresis Thymectomy
49
Signs of Duchene Muscular Dystrophy
Awkward manner of running with frequent falls & more easily fatigued- Difficulty with motor skills e.g. running & jumping
50
Most common bacterial cause of meningitis
Strep pneumoniae
51
Bacteria causing meningitis with worst prognosis
Neisseria meningitis
52
Presentation of meningitis (bacterial)
Meningisms: fever, headache, stiff neck, photophobia Fever , +ve kernig’s sign, Brudzinski’s Non-blanching plupurent rash = meningococcal septicaemia TREAT FIRST, INVESTIGATE LATER
53
Ix of bacterial meningitis
LP and CSF analysis (protein, colour, glucose) Head CT (If other signs such as papilledema or seizures Bloods (FBC, culture ect…)
54
Tx of bacterial meningitis
GP/community – IM Benzylpenicillin Hospital – IV cefotaxime (add amoxicillin for listeria cover) Contacts - Rifampicin, men C vaccine
55
What is Kernigs sign
Patient supine with hip flexed 90 degrees | Knee cannot be fully extended
56
What is Brudzinskis sign
Neck rigidity | Passive flexion of neck causes flexion of both legs and thighs
57
What is encephalitis
Infection of the actual brain parenchyma | Cerebral fluid is often altered (unlike meningitis)
58
Presentation of encephalitis
Tends to affect immunocompromised Can be viral or bacterial (Herpes Simplex Virus is dangerous) Early symptoms: fever, headache, lethergy, behavoral change Late symptoms: focal signs, seizures, coma
59
Ix of encephalitis
LP (lumbar puncture) = raised lymphocytes, Bloods, Blood Culture, Viral PCR, CT Head
60
Tx of encephalitis
immediate high dose I.V acyclovir
61
Risk factors for reactivation of herpes zoster
Old age, poor immune system, chickenpox < 18 months age
62
Signs of herpes zoster
Dermatomal distribution of rash and pain
63
Tx of herpes zoster
Oral acyclovir
64
Pathology of herpes zoster
Viral infection affecting peripheral nerves When latent virus is reactivated in the dorsal root ganglia it travels down theaffected nerve via the sensory root in DERMATOMAL DISTRIBUTION over a period of 3-4 days Resulting in perineural and intramural inflammation
65
In immunocompromised patients, where is the most common site of reactivation of herpes zoster
thoracic nerves followed by the opthalmic division of the trigeminal nerve
66
What is Gullian-Barre syndrome
Inflammatory, demyelinating, polyneuropathy in the peripheral nervous system
67
Aetiology of Gullain-Barre syndrome
Campylobacter jejuni (also EBV, CMV, HIV, mycoplasma)
68
Sx of Gullain-Barre syndrome
Progressive ASCENDING (Distal → Proximal) MUSCLE WEAKNESS FOLLOWING VIRAL ILLNESS (hours/days) Can be motor and sensory! “walking on rubber” Loss of reflexes Vary from mild to severe Severe can cause respiratory depression
69
Ix of Gullain-Barre syndrome
Mainly clinical diagnosis LP (lumbar puncture) - ↑ protein in CSF, WCC normal, nerve conduction studies (Vital capacity should be monitored if suspected Respiratory involvement)
70
Tx of Gullain-Barre syndrome
IV Ig, Ventilation is respiratory muscles involved, NO STEROIDS
71
What is Creutzfeldt-Jakob disease (also pathology)
A neurodegenerative prion disease Spongiform encethaoplthy and extensive prion protein deposition with florid plaques in the cerebrum and cerebellum Protein responsible for copper uptake in neurons misfolded → misfolded protein acts as template and causes others to misfold → apoptosis of neurons → cysts and plaques form in the brain giving it a sponge like appearance.
72
Epidemiology of CJD
Mainly affects 55-75 years old (1 in 1 million) Casus: 85%= idiopathic, 14%= gene mutation, 1%= iatrogenic (via contaminated blood transfusion/ unclean surgical instruments)
73
Sx of CJD
Ataxia, poor memory, behavioral changes, muscle weakness, myoclonus, dementia
74
What is vCJD
Variant Creutzfeldt-Jakob disease (mad cow disease)
75
``` Which of these is NOT a red flag for cauda equina syndrome? Saddle anaesthesia Urinary incontinence Areflexia Loss of bowel control ```
Urinary incontinence
76
``` Which is not characteristic of inflammation of the meninges: Neck stiffness Photophobia Headache Non-blanching rash ```
Non-blanching rash
77
Lesion in left meyers loop, what is the field defect
Superior temporal Hemianopia
78
``` Child comes into GP, has fever, neck stiffness, non-blanching rash, immediate treatment? IM Benzylpenicillin IV Benzylpenicillin IV cefotaxime Oral Rifampicin ```
IM Benzylpenicillin
79
``` Patient has a raised ICP, fever and cough - which is least appropriate Ophthamology review LP Head CT Blood culture ```
LP
80
``` Which of these is not a contraindication for thrombolysis Patient on warfarin Patient cured from brain cancer Knee replacement 2 months ago Patient with DM ```
Patient with Diabetes M
81
``` Which of these is a distinguishing feature of epilepsy to syncope Loss of bladder function Biting tongue Patient experiences an aura Sudden ```
Sudden
82
``` Man, RTA, 3 weeks later presents to A+E, nausea+vomiting+no fever - diagnosis? Subdural Meningitis Normal pressure hydrocephalus Extradural ```
Subdural
83
``` Involuntary, jerky movements, face and hands progressing proximally. Ix + Tx? CT + Thrombolysis EEG + Sodium valproate CT+ Sodium valproate EEG + Carbamazepine ```
EEG + Carbazepine
84
``` Seizure: Whole body becomes rigid, post-ical myalgia - Diagnosis? Tonic-clonic Tonic Myoclonic Frontal lobe ```
Tonic
85
``` Female, unilateral headache 12 hours - most likely diagnosis? Tension Cluster Migraine Trigeminal neuralgia ```
Migraine
86
Number of CAG repeats to be diagnostic of Huntingtons
36
87
Which symptom of Parkinsons is not treated by a dopamine promoting drug
Tremor
88
``` For which of these conditions would baclofen be a useful treatment? Parkinsons Epilepsy Huntingtons MS ```
MS
89
Alert patient with glioma has memory loss and is not responding to commands - where is the tumour (which lobe)?
Temporal lobe
90
``` Which of these primary tumours can metastasise to brain but not bone: Breast Stomach Kidney Thyroid ```
Stomach
91
``` A patients eye movements are slower and jerker than normal, which diagnosis can be excluded? MND MS Myasthentia gravis Myopathy ```
MND
92
``` In acute tension headache, which is the least useful treatment? Ibuprofen Sumatriptan Aspirin Amitriptyline ```
Sumatriptan
93
``` MND patient: has reduced tone in arms and down going planters, where are his lesions? UMN LMN UMN+LMN Cranial nerve nuclei ```
LMN
94
``` Patient presents to A+E with acute epigastric pain - what type of headache could she be suffered from: Tension Cluster SAH Trigeminal neuralgia ```
Tension

Medicine Phase 2a Neuro (28 decks)

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