4. Neurology Flashcards
CNIII controls most of the muscles of the eye. Which 2 does it not control?
Lateral Rectus
Superior Oblique
CNIII controls muscles of the eye. What is it’s other function?
Parasympathetic innervation of the pupil which keeps it constricted.
What is the classical clinical signs of a CNIII palsy?
Ipsilateral eye ‘down and out’ with fixed, dilated pupil.
(Only controlled by lateral rectus and superior oblique, and loss of parasympathetic innervation)
Causes of CNIII palsies (inner & outer fibre causes):
Inner (pupil remains normal):
Diabetes
High blood pressure
Inflammatory diseases
Outer (damage to sphincter pupillae/ciliary muscle / pupil affected):
Aneurysm
Herniation
Meningitis
Tumour
TBI
Where does the spinal cord terminate?
L1/2
(paediatrics = lower)
What is the scan of choice when there is clinical suspicion of CES?
Non-contrast CT of lumbosacral spine
Where is the primary motor cortex located in the brain?
Posterior frontal lobe
Which 3 systems are involved in motor control, and which is the most important?
Corticospinal (No1!)
Basal ganglia
Cerbellum
Patient with bulbar onset MND can have problems with sialorrhoea. Name 2 drugs that can help with this.
Hyoscine butylbromide
Glycopyrronium bromide
3 potential benefits of NIV (other than improved breathlessness) in MND patients.
Better sleep
Improve fatigue
Improve early morning headache
What scoring system is used to measure disease severity in MND, and how is it calculated?
ALSFRS-R score.
12 aspects of physical function, each scored 4-0 (4 normal, 0 no ability).
Medications relieve pain in 1/3 of patients with MND. Name a specific drug for each of the following 3 specific problems; muscle stiffness, muscle cramps and joint pains.
Stiffness = baclofen
Cramps = quinine
Joint pains = long acting NSAIDs
Is Future Care Planning legally binding in Scotland?
No
Is an Advance Directive legally binding in Scotland? What is it, and what can it NOT include?
It is a written statement of somebody’s wishes to refuse certain medical treatments e.g. IV Abx, NIV and gastrostomy tube feeding.
It cannot include a request for specific treatments, or for euthanasia.
State the 4 anticipatory drugs / drug class.
Hyoscine butylbromide
Midazolam
Levomepromazine
Opioids
What does CSCI stand for and what is it for?
Continuous subcutaneous infusion
More consistent symptom control
Give 3 bulbar features of MND.
Dysarthria
Tongue fasciculations
Dysphagia