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clinical 6 Flashcards

1
Q

uses iodine as contrast

A

CT

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2
Q

better for bone

A

CT

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3
Q

Better for soft tissue

A

MRI

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4
Q

T1 hyper intense MRI shows up what

A

fat and 4 ‘M’s’:

  • Methemoglobin (subacute hematoma)
  • Mineral deposition (Ca, Mg, Mn, etc.)
  • Melanin (melanoma)
  • “Mush” (highly proteinaceous fluid)
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5
Q

different types of T1

A

hyperintense (bright)

hyopintense (dark)

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6
Q

contrast in T1 hyperintense

A

gadolinium

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7
Q

T1 hypo intense will show what

A

air
cortical bone
high flow: arterial ‘flow voids’

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8
Q

T2 hyperintense will show up what

A

water (so more water than tissue)

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9
Q

what pathology willa T2 hyper intense show up

A

oedema, demyelination, fluid collection, some tumours

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10
Q

where do you get muscle weakness in duchesses

A

pelvic and shoulder girdle

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11
Q

milder form of duchennes

A

beckers

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12
Q

gene affected in duchennes

A

dystrophin (deficiency)

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13
Q

what has happened to dystrophin gene in duchennes

A

large scale deletion

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14
Q

what will bloods show in duchenes

A

raise creatine kinase

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15
Q

2 signs of duchenes

A

towers sign

toe walking

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16
Q

what will be seen on biopsy of huntinftons brain (macroscopic)

A

caudate atrophy

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17
Q

CAG encodes for what

A

glutamate

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18
Q

chromosome involved in alzheimers that

A

21

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19
Q

plaques in alzheimers had up of what

A

amyloid beta proteins

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20
Q

what other genetic condition associated with alzhimers and why

A

down syndrome coz gene that encodes for Amyloid precursor protein in on chromo 21 r

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21
Q

other than APP mutation, what other genes and chromosomes can cause alzheimers

A 
presenilin 1 (chromo 14)
presenilin 2 (chromos 1)
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22
Q

2 chromosomes invloed in alzheimers

A

1, 14, 21

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23
Q

what are triptans

A

5-HT (1B/1D) agonists

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24
Q

what do triptans do

A
  • constrict arteries
  • inhibit release of substance P and pro inflamm neuropeptides
  • blocks transmission of trigeminal nerve to 2nd order neurones
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25
Q

triptans are used to treat

A

migraine, cluster headaches, subarchnoid heammorhages

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26
Q

dorsal column senses

A

vibration, fine touch and proprioception

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27
Q

what is ‘dissociated sensory loss’

A

pattern of neurological damage caused by lesion to a single tract in spinal cord which involves loss of fine touch and proprioception but with out loss of pain and temperature (or vice versa)

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28
Q

loss of pain and temperature indicates lesion where

A

lateral spinothlamic tract

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29
Q

in lateral spinothalamic lesions why will you lose sensation of pain and temperature at level of spine but not sensory loss to dermatome

A

tract of lissauer transmits one or two levels up from lesion, thus bypassing lesion

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30
Q

cord hemisection is called

A

brown-sequard syndrome

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31
Q

pyramidal tract include

A

lateral and anterior corticospinal tracts

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32
Q

dorsal column also called

A

medial lemniscus system

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33
Q

2 parts of dorsal column

A

gracile (most medial)

cuneate (more lateral)

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34
Q

what will cause both UMN and LMN symptoms (be specific with answer)

A

Amyotrophic lateral sclerosis (motor neuron disease)

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35
Q

poliomyelitis affect which part of CNS

A

anterior horn = LMN signs

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36
Q

UMN or LMN in polio

A

LMN

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37
Q

Brown-Sequard syndrome: tracts affected

A
  1. Lateral corticospinal tract
  2. Dorsal columns
  3. Lateral spinothalamic tract
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38
Q

Brown-Sequard syndrome will show

A
  1. Ipsilateral spastic paresis below lesion (lateral corticospinal tract)
  2. Ipsilateral loss of proprioception and vibration sensation (dorsal column)
  3. Contralateral loss of pain and temperature sensation (lateral spinothlamic tract)
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39
Q

Combination of motor, sensory and ataxia symptoms

A

MS

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40
Q

neurosyphilis is called

A

tabes dorsalis

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41
Q

tabes dorsalis affects what tract

A

dorsal column

42
Q

tabes dorsalis symptoms

A

Loss of proprioception and vibration sensation (dorsal column)

43
Q

faciculatiosn think?

A

motor neurone disease

44
Q

role of nerve conduction studies in motor neurone disease

A

results will show normal conduction, therefore ruling out neuropathy and suggesting MND

45
Q

Electromyography in motor neurone disease will show what

A

reduced number of action potentials with an increased amplitude

46
Q

which features do you NOT get in motor neurone disease that differentiate if from poly neuropathy, MS and myasthenia gravis

A
  • no ocular involvement
  • no spinster involvement
  • no sensory loss
47
Q

which features will suggest motor neurone disease

A
  • wasting of small muscle of hand
  • UMN signs in legs
  • LMN signs in arms
48
Q

UMN lesion features

A

weakness
increased tone (velocity dependent)
hyperreflexia

49
Q

LMN lesion features

A

wasting
fasciculations
hypotonia/flaccidity
reduced reflexes

50
Q

what do fat ladies get that can cause headache and visual defect

A

idiopathic intracranial hypertension

51
Q

drugs that can cause idiopathic intracranial hypertension (4)

A

steroids
tetracycline antibiotics
contraceptives
lithium

52
Q

tuberous sclerosis inheritance

A

autosomal dominant

53
Q

tuberous sclerosis or neurofibromatosis may present with seizures

A

tuberous sclerosis

54
Q

axillary and groin freckles seen in

A

neurofibromatosis

55
Q

ash leaf macule seen in

A

tuberous sclerosis

56
Q

curtain descending over eye

A

amaurosis fugal

57
Q

protocol if ABCD2 score 4+

A

300mg aspirin immediately

investigations within 24 hrs

58
Q

protocol if ABCD2 score 3 or less

A
  • specialist assessment within 1 week of symptom onset, including decision on brain imaging
  • if vascular territory or pathology is uncertain, refer for brain imaging
59
Q

given to patients who cannot tolerate clopidogrel

A

aspirin + dipyridamole

60
Q

antithrombotic drug given post stroke

A

clopidogrel

61
Q

how may “attacks” required to diagnose migraine

A

at least 5

62
Q

criteria for migraine diagnosis

A
  • Minimum of 5 attacks
  • Headache attacks lasting 4-72 hours with nausea/vomitong or photophobia/phonophobia
  • Plus at least 2 of:
    1. unilateral location*
    2. pulsating quality (i.e., varying with the heartbeat)
    3. moderate or severe pain intensity
    4. aggravation by or causing avoidance of routine physical activity
63
Q

nerve an nerve root in tricep reflex

A

radial and C7

64
Q

radial nerve arises from which levels

A

C5 - C8

65
Q

waiters tip (erbs palsy) is due to damage where

A

upper brachial plexus C5-C6

66
Q

when is waiters tip (erb palsy) common

A

shoulder dystocia in babies

67
Q

internal rotation and extension of upper limb and

A

waiter tip (erb palsy)

68
Q

Bromocriptine, ropinirole, cabergoline, apomorphine are

A

dopamine agonists

69
Q

what must be given with L-dopa

A

decarboxylase inhibitor (e.g. carbidopa)

70
Q

decarboxylase inhibitor (e.g. carbidopa) do what

A

prevent peripheral metabolism of levodopa to dopamine

71
Q

dopamine agonist side effects

A

pulmonary, retroperitoneal and cardiac fibrosis

72
Q

what is Selegiline

A

MAO-B (Monoamine Oxidase-B) inhibitors

73
Q

MAO-B (Monoamine Oxidase-B) inhibitors do what

A

inhibits the breakdown of dopamine secreted by the dopaminergic neurons

74
Q

what are Entacapone, tolcapone

A

COMT (Catechol-O-Methyl Transferase) inhibitors

75
Q

COMT (Catechol-O-Methyl Transferase) inhibitors do what

A

COMT is an enzyme involved in the breakdown of dopamine, and hence may be used as an adjunct to levodopa therapy

76
Q

Antimuscarinics block ______ receptors

A

cholinergic

77
Q

nerve root for small toe

A

S1 = S for small one

78
Q

nerve root for big toe

A

L5 = Largest of the 5 toes

79
Q

nerve root for middle finger + palm of hand

A

C7

80
Q

nerve root ring finger + pinky

A

C8

81
Q

nerve root for knee caps

A

L4

82
Q

nerv root for thumb and index

A

C5, C6

83
Q

time off driving for TIA

A

1 month

84
Q

time off driving for multiple TIAs over short period of time

A

3 months

85
Q

time off driving for a single seizure without an epilepsy diagnosis

A

6 months

86
Q

seizure with lip smacking

A

complex partial seizure

87
Q

how do simple and complex partial seizure differ

A

in complex you lose consciousness/awareness

88
Q

who can’t you give triptans to

A

heart conditions

89
Q

triptan are

A

5-HT agonists, vaso construction and reduce inflammatory peptide release

90
Q

triptans used to treat what

A

migrane and cluster headaches

91
Q

dose of diazepam give PR in adult having a prolonged fit

A

10 - 20mg max 30

92
Q

Stroke: Contralateral hemiparesis and sensory loss, lower extremity > upper

A

Anterior cerebral artery

93
Q

Stroke: Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

A

Middle cerebral artery

94
Q

Stroke: Contralateral homonymous hemianopia with macular sparing

A

Posterior cerebral artery

95
Q

Stroke: Amaurosis fugax

A

retinal/opthalmic artery

96
Q

Stroke: locked in syndrome

A

basillary artery

97
Q

what is cataplexy

A

sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)

98
Q

bells palsy: forehead affected? UMN or LMN

A

yes forehead affected, LMN

99
Q

treatment for bells palsy

A

prednisolone within 72 hours of onset, for 10 days

100
Q

what nerve in unilateral ‘high stepping gait’

A

peroneal nerve

Neuro (20 decks)

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