Peer-Teaching Flashcards by James Reilly

75yr old male
Sudden onset weakness in left arm, slurred speech and L sided facial droop
Resolved in 15 minutes
Smokes 10/day for 30 years
Most likely diagnosis

Transient Ischaemic Attack

How well did you know this?

Not at all

Perfectly

Define Transient Ischaemic Attack

focal, sudden onset, neurological deficit lasting <24hrs, with complete clinical recovery

How well did you know this?

Not at all

Perfectly

Causes of TIA

Thromboembolism from carotids
Cardioembolism
Hyperviscosity e.g. polycythaemia

How well did you know this?

Not at all

Perfectly

What is amaurosis fugax

Emboli passes into retinal artery

A curtain descending over my field of vision’

How well did you know this?

Not at all

Perfectly

Investigations of TIA

ABCD2- Risk score of a stroke
Carotid Doppler- stenosis
CT angiography- stenosis

How well did you know this?

Not at all

Perfectly

Treatment of TIA

Modifiable Risk Factors- stop smoking/alcohol, exercise, diet
Aspirin immediately
Clopidogrel
Statin- simvastatin 
Treat BP- Beta Blocker or ARB

How well did you know this?

Not at all

Perfectly

80yr old female
Sudden onset R arm weakness, sensory loss in R arm, difficulty speaking and swallowing
Present for >5hrs with no improvement
PMH: AF, Hypertension, Diabetes
Diagnosis?

Stroke

How well did you know this?

Not at all

Perfectly

Define stroke

Rapid onset of neurological deﬁcit caused by focal, cerebral, spinal or retinal INFARCTION

Rapidly developing signs of focal or global disturbance of cerebral functions, lasting for more than 24HRS or leading to death

How well did you know this?

Not at all

Perfectly

Signs and symptoms of MCA stroke

Motor Weakness, Hemiplegia
Sensory disturbances
Receptive and Affective Aphasia

How well did you know this?

Not at all

Perfectly

Signs and symptoms of ACA stroke

Frontal Lobe
Drowsiness
Logical thinking
Personality

How well did you know this?

Not at all

Perfectly

Signs and symptoms of PCA stroke

Contralateral Hemianopia

How well did you know this?

Not at all

Perfectly

Initial investigation of stroke

CT scan

How well did you know this?

Not at all

Perfectly

Medical Treatment of ischaemic stroke

Throbolysis- IV Altepase

Aspirin for 2 wks then clopidogerol

How well did you know this?

Not at all

Perfectly

Medical treatment of haemorrhagic stroke

Control BP- Beta Blocker/ ARB
Beriplex if warfarin related
Surgery- Clot evation

How well did you know this?

Not at all

Perfectly

Conservative treatment of stroke

Rehabilitation- Physio, OT

Modifiable Risk Factors- Stop smoking/alcohol, exercise

How well did you know this?

Not at all

Perfectly

50 Year old male
Local shopping
Sudden sharp pain- ‘Feels like he has been kicked in the back of the head’
Neck stiffness
Feels systemically fine
Diagnosis

Subarachnoid Haemorrhage

How well did you know this?

Not at all

Perfectly

Give example of BV in extradural layer

Middle Meningeal Artery

How well did you know this?

Not at all

Perfectly

Give example of BV in subdural layer

Bridging veins

How well did you know this?

Not at all

Perfectly

Give example if BVs in subarachnoid layer

Circle of Willis

How well did you know this?

Not at all

Perfectly

Main cause of subarachnoid haemorrhage

Berry aneurysm

How well did you know this?

Not at all

Perfectly

What is a subarachnoid haemorrhage

Spontaneous bleed in subarachnoid space

Rupture of artery so raised ICP

How well did you know this?

Not at all

Perfectly

What is result of raised ICP

Lower consciousness

How well did you know this?

Not at all

Perfectly

Signs of subarachnoid haemorrhage

Kernigs and Bradzini sign

How well did you know this?

Not at all

Perfectly

Ix of SAH

CT scan

How well did you know this?

Not at all

Perfectly

Tx of SAH

Neurosurgeon

Causes of subdural haemorrhage

RTA | Metastasis cause rupture

Pathophysiology of subdural haemorrhage

Rupture of bridging veins Few weeks/months later Haematoma formation -> Hyperosmotic so draws water from the brain Raised ICP and midline shift

Clinical presentation of SDH

Fluctuating consciousness | Headache

Ix of SDH

CT scan - Sickle shaped, crescent shaped collection of blood

Tx of SDH

Neurosurgeon - Irrigation | IV Mannitol

True or False: | Extradural haemorrhage is a medical emergency

True

Cause and pathology of extra dural haemorrhage

Head injury -> Fracture in temporal/parietal bone -> Rupture of the middle meningeal artery Rapid collection of blood in extradural space

Signs of extradural haemorrhage

Decrease consciousness, Signs of raised ICP

Complication of EDH

Tentornial herniation - death of respiratory arrest

Ix of EDH

CT scan- biconvex hypodense haematoma

Tx of EDH

Neurosurgery- irrigation, IV Mannitol

Clinical diagnosis of epilepsy

2 or more unprovoked seizures with >24hrs apart

Define seizure

The recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain due caused by excessive, hypersynchronous neuronal discharges

Type of epilepsy seizures

Generalised | Partial/focal

What is Generalised seizure

Affects whole cortex with no localising features to one hemisphere

What is partial seizure

Focal onset with features referred to a lobe

Types of generalised seizures

``` Tonic-clonic Absence seizure Myoclonic Tonic Atonic ```

Describe generalised tonic-clonic seizure

No prodrome or aura. Tonic Phase- Rigidity -> Clonic Phase- Rhythmic muscle jerking (seconds to minutes). Post-ictal- Drowsiness, confusion and coma

Describe generalised absence seizure

Typically childhood, stops talking mid-sentence- carry on where left off

Describe generalised myoclonic seizure

Sudden isolated jerk of limb, face or trunk. May be thrown to the ground

Describe generalised tonic seizure

Sudden sustained stiffening of the body. | Not followed by jerking

Describe generalised atonic seizure

Sudden loss of muscle tone and cessation. Fall

Types of partial seizures

Depends on lobe affected

Purpose of temporal lobe

Memory, Emotion and Receptive speech

Describe partial seizure of temporal lobe

Aura- Deja-vu, auditory hallucinations, funny smells | Out of body experience, automatisms e.g. lip smacking, chewing, ﬁddling

Purpose of frontal lobe

Motor and Thought Processing

Describe partial seizure of frontal lobe

Jacksonian march - seizure “marches” up or down the motor homunculus starting in face or thumb Post-ictal Todd’s palsy - paralysis of limbs involved in seizure for several hour

Purpose of parietal lobe

Sensory disturbances

Describe partial seizure of parietal lobe

Tingling/numbness

What is Todd's palsy

Paralysis of limbs involved in seizure for several hour | Due to focal seizure of temporal lobe

Investigations of Epilepsy

EEG (electroencephalogram)

Tx of epilepsy: Emergency Generalised Partial

Emergency (Status Epilepticus)- IV Lorazepam Generalised- Sodium Valporate, Lamotrigine Partial/Focal- Carbamezapine

List the differences between dementia or delirium

``` Dementia: Onset - Insidious (months to years) Course - Progressive Duration - months to years Consciousness - Normal unless severe Causes - Disorder ``` ``` Delirium: Onset - Acute (hours to days) Course - Fluctuating Duration - hours to weeks Consciousness - Altered Causes - Stroke, Metabolic, Infective etc ```

What is dementia

A syndrome that causes memory loss, difficulties with thinking, problem-solving, language and ADL’s

Diagnosis of dementia

Clinical diagnosis | MMSE- <17/30 serious cognitive impairment

Treatment of dementia

Healthier Lifestyle Social Support Acetylcholinesterase Inhibitor (e.g Rivastigmine) Control CV Risk Factors

Peer-Teaching Flashcards

(61 cards)