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Phase 2 - Neurology > Almostadoctor topics > Flashcards

Almostadoctor topics Flashcards

1
Q

Define a cerebral aneurysm

A

A localised dilation of an artery within the brain

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2
Q

Give some risk factors for cerebral aneurysm development

A

Arteriosclerosis
HTN
Hereditary CT disorders
Septic emboli

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3
Q

Why are cerebral aneurysms called berry aneurysms?

A

Made up of many small sacs which bulge out from the vessel wall

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4
Q

What are the different surgical treatment options for cerebral aneurysms?

A

Clipping
Platinum coiling
Stenting

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5
Q

At what diameter are cerebral aneurysms operated on?

A

7mm or more

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6
Q

Define an ateriovenous malformation

A

An abnormal connection between arteries and veins which bypasses the capillary circulation

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7
Q

Where do AVMs usually occur?

A

Junction of cerebral arteries.

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8
Q

What investigation determines if the cerebral ANM is operable or not?

A

Arteriography

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9
Q

What are the treatment option for AVMs?

A

Watch and wait
Treat symptom only (epilepsy)
Radiotherapy (<3cm in size)
Surgery (larger, more superficial lesions) such as embolisation

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10
Q

What symptoms can AVMs cause?

A

88% are asymptomatic
Headache
Epilepsy
Specific symptoms can give an idea of the location

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11
Q

What can cause AVMs?

A

Hereditary Haemorrhagic telangiectasia (autosomal dominant)

Von Hippel-Lindau Disease

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12
Q

Describe Bulbar palsy

A

Lesion in the motor nuclei of the medulla which causes LMN signs in the facial, glossopharyngeal, vagus and hypoglossal nerve regions

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13
Q

What are the symptoms of bulbar palsy?

A 
Tongue palsy
Facial muscle palsy
Swallowing palsy 
Flacid and fasciculating tongue 
Normal jaw jerk (CN5 intact)
May have quiet, hoarse or nasal speech
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14
Q

What conditions can cause bulbar palsy?

A 
MND
Guillan-Barre
Polio
Syringobulbia 
Brainstem tumours
Myasthenia gravis
Myotonic dystrophy
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15
Q

Describe pseudobulbar palsy

A

Bilateral lesions of UMNs of muscles of regions for facial, vagus, glossopharyngeal and hypoglossal nerves. The lesion commonly occurs inthe corticobulbar tracts.

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16
Q

What are some symptoms of pseudobulbar palsy?

A 
Spastic tongue (cannot protrude)
"Donald Duck" speech 
Increased jaw jerk 
Reduced rate of blinking
Emotional lability
17
Q

What are some causes of pseudobulbar palsy?

A 
Bilateral cerebral vascular accident affecting the internal capsule
Multiple sclerosis
Motor neuron disease
Stroke 
Vascular dementia
18
Q

Define Charcot Marie Tooth diesease

A

An inherited peripheral neuropathy, commonly autosomal dominant

19
Q

What is the pathology of Charcot Marie Tooth disease?

A

Type 1 - gene mutations for myelin sheath growth

Type 2 - Mutations for mitochondria found in the nerves lead to improper nerve conduction

20
Q

What are the symptoms of Charcot Marie Tooth disease?

A
  • Progressive distal muscle weakness and wasting which causes gait changes
  • Loss of reflexes and sensation
  • Normal tone, slight reduction in power
  • Champagne bottle legs appearance (peroneal muscle wasting)
  • Pes cavus
  • Hammer toe
21
Q

What is the management of Charcot Marie Tooth disease?

A 
Incurable
Encourage activity 
Hydrotherapy 
Keep weigth low 
Genetic testing 
Surgery can reduce deformities e.g. clawed toes, pes cavus
22
Q

Define encephalitis

A

Inflammation of the brain parenchyma usually due to a viral infection.

23
Q

What are the most commonly implicated organisms for encephalitis?

A 
Herpes simplex virus 
Rabies 
Measles 
Epstein Barr virus 
Poliovirus 
Coxsackievirus
24
Q

What are the clinical features of encephalitis?

A 
Headache
Drowsiness
Pyrexia
Malaise 
Meningeal signs
25
Q

Give some parenchymal signs

A 
Seizures
Confusion
Dysphasia
Cranial nerve palsies
Ataxia 
Hemiparesis
May have sings of underlying cause e.g. cold sore for herpes simplex, parotid gland swelling for mumps
26
Q

What are the investigations you should do if you suspect encephalitis?

A

Viral serology
PCR of blood
Lumbar puncture (only if intracranial mass has been excluded on scan)
CT scan
MRI scan - shows more subtle changes
EEG
Test for cause e.g. HIV serology, Mantoux test

27
Q

What is the management of someone with encephalitis?

A

HDU/ICU care
IV aciclovir for 2-3 weeks
Anticonvulsants if seizures are present
Dexamethasone for raised ICP

28
Q

Describe Friedreichs ataxia

A

Autosomal recessive disorder due to repeating nucleotide sequence (GAA) in the frataxin gene which codes for the mitochondrial protein frataxin. This cause mitochondrial iron overload, impairing mitochondrial function.

29
Q

What are the signs and symptoms of friedreichs ataxia?

A
  • Wide based ataxic gait
  • Upper limb weakness
  • Nystagmus
  • Lower limb paresis
  • Reduced/absent reflexes
  • Loss of vibration and proprioception
30
Q

What is the treatment for Friedreich’s ataxia?

A

No cure
Life expectancy is 50 years
Treat associated conditions
Surgery to improve symptoms (pes cavus)

31
Q

What conditions is Friedreichs ataxia associated with?

A

Diabetes
Heart disorders e..g AF and hypertrophic cardiomyopathy
Scoliosis
Pes cavus

32
Q

What is Guillain Barre syndrome?

A

An acute inflammatory demyelinating polyneuropathy which tends to occur several weeks after a viral infection (GI or URTI).

33
Q

Describe the clinical course of Guillain Barre

A

Symmetrical muscle weakness which begins in the legs and moves to the arms. Progresses over 4 weeks then resolves. Tend to affect proximal muscles more.
No sensory involvement
Autonomic signs include tachycardia, dysrhythmias and sweating.
Can involve respiratory muscles and cranial nerves/

34
Q

Describe the pathology of Guillain Barre syndrome

A

Viral infection leads to the production of auto-antibodies which attack peripheral nerve, damaging the myelin sheaths. This reduces or block nerve transmission.

35
Q

What investigations do you do for Guillain Barre syndrome?

A

Lumbar puncture will show increase CSF protein with a normal white cell count
Nerve conduction studies will show a decrease speed of conduction

36
Q

What is the prognosis for Guillain Barre?

A

85% - complete/almost complete recovery
10% - unable to walk at 1 year
10% mortality

37
Q

What is the treatment for Guillain Barre?

A

Ventilation
IV immunogloblin
Plasmapheresis

Phase 2 - Neurology (1 decks)

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