clinical

Question 1

what is neurology

Answer 1

Diseases of Brain, Spinal Cord, Peripheral Nerves and Muscle

Question 2

stuff studied in neurology

Answer 2

Incidence in General Practice Stroke Carpal Tunnel Syndrome Epilepsy Bells Palsy Tremor Parkinsons Disease Brain Tumour Multiple Sclerosis

Question 3

where could the problem be

Answer 3

Muscle Neuromuscular Junction Peripheral Nerve Spinal Cord Brain

Question 4

what could the underlying cause be

Answer 4

Traumatic Vascular Toxic/Metabolic Infectious Inflammatory/Autoimmune Genetic-congenital Neoplastic Degenerative

Question 5

how do you test cognitive/thinking abilities

Answer 5

‘Mini Mental State Examination’

Question 6

what is a mini mental state exam

Answer 6

orientation - year, date etc
registration - name 3 objects one second to say each, ask patient to name them - count trials and record
TRIALS - attention and calculation: - serial 7s, spell world backwards / recall - ask for the 3 repeated before / language - name a pencil and watch, repeat no ifs ands or buts, 3 stage command, read and obey 3 things

Question 7

how do you assess cranial nerves

Answer 7

smell, vision, eye movements, facial sensation and movements

Question 8

how do you assess the limbs

Answer 8

power, coordination, reflexes and sensation

Question 9

how do you test CSF

Answer 9

lumbar puncture

Question 10

investigations for neurological problems

Answer 10

Brain Scans – CT and MRI Cerebrospinal fluid (CSF) – Lumbar puncture Nerve Conduction Studies and Electromyography (EMG) Electroencephalogram (EEG) and Evoked Potentials Brain Pathology – Damage to Cells or Larger Structures

Question 11

role of the neurologist

Answer 11

diagnose, treat and manage disorders that affect the central nervous system (the brain and spinal cord) and the peripheral nervous system (nerves and muscles which activate movement and transmit sensation from all parts of the body to the brain).

Question 12

syndromic formulation in a neurological exam

Answer 12

Clinical Facts – History and Examination Interpretation in terms of Physiology/Anatomy Syndromic Formulation and Lesion Localisation Anatomic Diagnosis + Mode of Onset Use Investigations to Confirm or Refute Clinical Judgement

Question 13

CT

Answer 13

x-ray

3d

Question 14

Pathology

Answer 14

gold standard diagnosis
10 brain a year - biopsy
stain for different cells
plaques and tangles - Alzheimer’s

Question 15

MRI

Answer 15

big magnet
different tissue respond to different magnetic fields
mad cow disease - young people, protein ingest conform to same shapes - signal change

Question 16

Lumbar puncture

Answer 16

take fluid that bathes CNS - see infection, tumour, inflammation, neurodegenerative
clear fluid
infection - yellow

Question 17

EEG

Answer 17

electrodes

spikes - epilepsy - lots of neurons firing at the same time

Question 18

nerve conduction studies

Answer 18

individual nerves - see how many have died

Question 19

electromyography

Answer 19

it is the recording of AP in muscle fibres
extracellular/intracellular recording
extracellular measures the changes in difference between internal and external V at 2 electrodes
voluntary stimulation - transducer on hand measures force and turns it into an electrical signal - physical representation of electrical events. force line mirrors the EMG
experimental stimulation - if there is a signal electrical signal there is a twitch in the force line
if the signal increases strength from 5-9mA the twitch increases
twitches last .2 seconds
if freq increases to 5/s then there are many twitches - each one is distinct
if freq increases to 10/s there is summation - the force twitches don’t finish before the next one starts so they add up
if the freq increases to 20/s it is tetanic - can’t see individual twitch because they’re so close together
can make max force with voluntary and experimental - nervous system send signals at correct freq to create tetanic/fused contraction.

Question 20

neuroanatomical location stroke

Answer 20

cause problems on other side of brain to lesion - contralateral
stroke I left side responsible for language - cause aphasia
middle cerebral artery - most commonly affected, weakness and loss of sensation
posterior cerebral artery - stroke affect occipital lobe - result in visual loss
anterior cerebral artery - contralateral leg weakness
brainstem - problems with balance, eye movement, speech and swallowing, breathing

Question 21

using a history to diagnose problems

Answer 21

look at nature of symptoms, onset, previous medical problems, family history, social history, other symptoms