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Specialty Blocks > 4. Neurology > Flashcards

4. Neurology Flashcards

1
Q

CNIII controls most of the muscles of the eye. Which 2 does it not control?

A

Lateral Rectus
Superior Oblique

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2
Q

CNIII controls muscles of the eye. What is it’s other function?

A

Parasympathetic innervation of the pupil which keeps it constricted.

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3
Q

What is the classical clinical signs of a CNIII palsy?

A

Ipsilateral eye ‘down and out’ with fixed, dilated pupil.
(Only controlled by lateral rectus and superior oblique, and loss of parasympathetic innervation)

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4
Q

Causes of CNIII palsies (inner & outer fibre causes):

A

Inner (pupil remains normal):
Diabetes
High blood pressure
Inflammatory diseases

Outer (damage to sphincter pupillae/ciliary muscle / pupil affected):
Aneurysm
Herniation
Meningitis
Tumour
TBI

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5
Q

Where does the spinal cord terminate?

A

L1/2
(paediatrics = lower)

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6
Q

What is the scan of choice when there is clinical suspicion of CES?

A

Non-contrast CT of lumbosacral spine

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7
Q

Where is the primary motor cortex located in the brain?

A

Posterior frontal lobe

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8
Q

Which 3 systems are involved in motor control, and which is the most important?

A

Corticospinal (No1!)
Basal ganglia
Cerbellum

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9
Q

Patient with bulbar onset MND can have problems with sialorrhoea. Name 2 drugs that can help with this.

A

Hyoscine butylbromide
Glycopyrronium bromide

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10
Q

3 potential benefits of NIV (other than improved breathlessness) in MND patients.

A

Better sleep
Improve fatigue
Improve early morning headache

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11
Q

What scoring system is used to measure disease severity in MND, and how is it calculated?

A

ALSFRS-R score.

12 aspects of physical function, each scored 4-0 (4 normal, 0 no ability).

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12
Q

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.

A

Stiffness = baclofen

Cramps = quinine

Joint pains = long acting NSAIDs

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13
Q

Is Future Care Planning legally binding in Scotland?

A

No

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14
Q

Is an Advance Directive legally binding in Scotland? What is it, and what can it NOT include?

A

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.

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15
Q

State the 4 anticipatory drugs / drug class.

A

Hyoscine butylbromide
Midazolam
Levomepromazine
Opioids

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16
Q

What does CSCI stand for and what is it for?

A

Continuous subcutaneous infusion

More consistent symptom control

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17
Q

Give 3 bulbar features of MND.

A

Dysarthria
Tongue fasciculations
Dysphagia

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18
Q

Give 5 respiratory features of MND.

A

SOB on exertion
Daytime somnolence
Fatigue
Early morning headache
Orthopnoea

19
Q

Give 3 cognitive features of MND (these are rare).

A

Emotional lability
Behavioural change
Fronto-temporal dementia

20
Q

Give 6 limb features of MND.

A

Focal weakness
Falls / trips from foot drop
Loss of dexterity
Muscle wasting
No sensory symptoms
Muscle fasciculations

21
Q

Give 4 neurological symptoms that would not be supportive of an MND diagnosis.

A

Bladder / bowel involvement

Improving symptoms

Prominent sensory symptoms

Double vision / ptosis

22
Q

What would nerve conduction studies and electromyography show in MND?

A

Normal motor conduction on nerve studies (excludes neuropathy)

Electromyography would show reduced number of action potentials with increased amplitude

23
Q

The diagnosis of MND is clinical, but what kind of scan is usually performed to rule out differentials, and what are they?

A

MRI

Cervical cord compression
Myelopathy

24
Q

What is the typical distribution of upper and lower motor signs in ALS?

A

Upper limbs = lower signs e.g. muscle wasting esp small hand muscles, weakness

Lower limbs = upper signs e.g. spasticity, increased tone

25
Q

What is the first line management for trigeminal neuralgia?

A

Carbamazepine

26
Q

What should prompt a neurology referral when considering trigeminal neuralgia?

A

Failure to respond to treatment
Atypical features

27
Q

Trigeminal neuralgia is a pain syndrome that causes severe pain. Is it bi or unilateral generally?

A

Unilateral

28
Q

Define trigeminal neuralgia (4 point).

A

Unilateral disorder

Electric shock like pains

Sudden onset and termination

Pain remits for variable periods

29
Q

Trigeminal neuralgia often is evoked by ‘trigger factors’. Give 3 examples of a trigger factor.

A

Washing
Shaving
Smoking
Brushing teeth

Trigger areas can also arise e.g. nasolabial folds

30
Q

The vast majority of cases of trigeminal neuralgia are idiopathic, but can be due to a serious underlying cause in some cases. Give some red flag symptoms that would suggest this, and warrant a neurology referral.

A

Sensory changes
Only ophthalmic division involvement, or bilateral symptoms
Deafness / other ear problems
Optic neuritis
FHx of MS
Age onset < 40 years
Herpes simplex infection

31
Q

What are the 3 divisions of the trigeminal nerve?

A

Ophthalmic
Maxillary
Mandibular

32
Q

What age is the peak incidence of trigeminal neuralgia, and what is the distribution between sexes?

A

Age 60-70

F:M = 2:1

33
Q

What is the age distribution in Myasthenia Gravis?

A

Women are affected younger, typically under 40

Men are affected older, typically over 60

34
Q

What type of tumour is commonly associated with MG?

A

Thymoma

35
Q

Which muscle groups are most affected in MG, and give some symptoms that arise due to this?

A

Proximal limb muscles; difficulty up stairs, standing up, lifting above head

Small muscles of head and neck; extraocular muscles causing diplopia, eyelids causing ptosis, swallowing difficulties and slurred speech

36
Q

Give 3 tests that may be indicated when investigating for MG.

A

Antibody testing; Ach, MuSK, LRP4

CT/MRI for thymoma

Edrophonium test (cholinesterase enzyme blocker)

37
Q

Give 4 management strategies for MG.

A

Pyridostigmine (Achesterase blocker)

Immunosuppression via prednisolone / azathioprine

Thymectomy

Rituximab as last line (mab against B cells)

38
Q

What triggers a myasthenic crisis, and what is one of the most worrying symptoms?

A

Often triggered by intercurrent illness.

Respiratory muscle weakness can lead to respiratory failure.

39
Q

Give 3 management options for a myasthenic crisis.

A

Iv Ig

Plasmapharesis

NIV or mechanical ventilation for respiratory support

40
Q

4 good prognostic factors in Bell’s Palsy:

A

Improvement in symptoms in first 2 weeks

Partial > complete paralysis at onset

Younger patients do better

Initiation of steroids within 72 hours

41
Q

Give 3 exacerbating factors of essential tremor:

A

Stress
Tiredness
Caffeine

42
Q

Give 2 things that improve an essential tremor.

A

Rest
Alcohol

43
Q

What inheritance pattern does essential tremor have?

A

Autosomal dominant

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