Clinical Disorders Flashcards
1
Q
What are some of the risk factors of Parkinson’s disease?
A
Male sex
Antipsychotics
Genetics
Stroke
Old age
2
Q
What three symptoms make up the general symptom of Parkinsonism?
A
Bradykinesia
Rigidity
Tremor
3
Q
What symptoms are associated with Parkinson’s Disease?
A
Parkinsonism
Psychiatric/cognitive
Physical e.g. balance/dizziness
4
Q
What are the two hypotheses for the development of Parkinson’s Disease?
A
Loss of dopamine in the basal ganglia
Lewy bodies blocking dopamine in the brain
5
Q
What symptom, along with one of the following is needed for a Parkinson’s Disease diagnosis?
Tremor
Stiffness/rigidity
Balance issues/falls
A
Bradykinesia (slow movements)
6
Q
What would functional imaging show, when scanning patients with Parkinson’s Disease?
A
Decreased dopamine uptake
7
Q
What pharmacological treatment is available for Parkinson’s patients, and what does it do?
A
Dopamine agonists
e.g. Carbidopa and Levodopa
Also may be prescribed MAO-inhibitors (anti-depressants)
8
Q
What non-pharmacological treatment may be offered to Parkinson’s patients?
A
Deep brain stimulation to control movements
9
Q
What two areas might DBS be inserted into, in Parkinson’s patients?
A
Subthalamic nucleus or the globes pallidus interna
10
Q
What symptoms might show, when a patient has a brain tumour?
A
Headache
Raised intercranial pressure
Eye problems
Seizures
Dizziness
Different presentation depending on where the tumour is
11
Q
What might cause brain tumour symptoms?
A
Extra pressure, due to the mass
12
Q
How are brain tumours graded?
A
1-4
1 - benign and cured easily
4 - malignant and not cured very easily
13
Q
What is chemotherapy, and what risks are associated?
A
Kills the cancer cells
Can lead to hair loss, infection, etc…
14
Q
What are immune checkpoint inhibitors in brain tumour management?
A
Allow T cells to kill the cancer cells
15
Q
What do targeted therapies target, in brain tumour management?
A
Targets specific chemical in the tumour
16
Q
What non-pharmacological approaches are used for the management of brain tumours?
A
Surgery to remove the tumour
Radiation to kill cancer cells
Radiation surgery
17
Q
What risk factors are associated with the development of Alzheimer’s disease?
A
Age over 40
Social factors e.g. poorer education and social isolation
Hypertension
Diabetes
18
Q
What three deficits are associated with Alzheimer’s disease?
A
Memory (episodic)
Visuospatial (disorientation)
Language (no fluidity in speech)
19
Q
What two pathophysiological causes are associated with Alzheimer’s disease?
A
Amyloid plaques and Tau tangles
20
Q
How can amyloid cause Alzheimer’s disease?
A
Overproduction of plaques building up in memory areas
21
Q
How can tau cause Alzheimer’s disease?
A
Clumps of tau builds up in neurones
22
Q
What pharmacological therapies are associated with Alzheimer’s?
A
Amyloid lowering therapy
Anti-tau therapies
23
Q
What non-pharmacological management strategies are used in Alzheimer’s disease?
A
Supportive therapy and environmental controls
24
Q
How does vascular dementia present?
A
Cognitive issues e.g. slowing and planning issues
25
What causes vascular dementia?
Blood flow reduction, potentially due to small vessel disease or stroke, etc...
26
How does frontotemporal dementia present?
Behaviour changes
Language issues
Cognitive problems
Physical and social isolation
27
What causes frontotemporal dementia?
Neurodegeneration of the temporal/frontal lobes, potentially due to tau build up
Genetics
28
What percentage of frontotemporal dementia is genetic?
30%
29
How does dementia with Lewy bodies present?
Fluctuations in symptoms e.g. memory and cognitive
Hallucinations
Motor symptoms e.g. parkinsonism
30
What causes Lewy body dementia?
Lewy bodies build up in the brain cells
31
What symptoms are shown in delirium?
Cognitive problems
Hallucinations (auditory)
Physical issues
Social withdrawal and lack of cooperation
32
What are the two types of delirium?
Hypo and hyperactive delirium
33
What risk factors are associated with delirium?
Old age, neurocognitive deficit, ICU, psychosocial drugs
34
What 5 criteria are needed for a diagnosis of delirium?
Disturbed attention or awareness
Rapid development
Cognitive disturbance
No better explanation
Evidence of a general medical condition
35
What may cause encephalopathy?
Illness, vitamin B1 deficiency, or hepatic insufficiency
36
What risk factors are associated with Huntington's disease?
Ages 35-45
Genetics
37
What symptoms are shown in Huntington's disease?
Movement issues
Cognitive issues
Emotional issues
Metabolic issues e.g. weight loss and speech problems
38
What two things cause Huntington's disease?
Genetics
Neurodegeneration
39
What mode of inheritance is Huntington's disease?
Autosomal dominant
40
How many CAG repeats are needed for Huntington's disease to be present?
Over 40 CAG repeats
41
What area is particularly impacted by neurodegeneration in Huntington's disease?
The striatum
42
What two investigations can be done to diagnose Huntington's disease?
CAG repeat testing
Imaging showing striatal atrophy
43
In Huntington's disease management, what is Tetravebazine's mechanism of action?
Inhibits dopamine 2, serotonin and norepinephrine
44
What non-pharmacological management can be used to treat Huntington's disease?
Physiotherapy
Occupational therapy
Social support
Cognitive and behavioural support
45
What risk factors may lead to stroke?
Hypertension, smoking, diabetes, lifestyle, old age
46
What symptoms can a cortical stroke lead to?
Cognitive problems
47
What symptoms can a sub-cortical stroke lead to?
Patient is alert, but paralysed
48
What symptoms can a brainstem stroke lead to?
Unsteady, complications e.g. locked in syndrome, quadriplegic
49
What is the cause of an ischemic stroke?
Blocked artery, leading to reduced blood flow and oxygen to the brain
50
What four things may lead to blocked arteries, causing an ischemic stroke?
Atheroma
Thrombosis
Embolism
Heart attack
51
What is an embolism?
Clot breaks off and blocks another area
52
What is atheroma?
Fatty material build up in the arteries
53
What causes a brain haemorrhage?
Vessels rupture, leading to a brain blood, due to high blood pressure
54
Where would an intracerebral haemorrhage be?
Bleeding in or around the brain
55
Where would a subarachnoid haemorrhage be?
Bleeding in the space around the brain
56
How can a cerebral vein lead to a haemorrhage?
Blocked vein leads to back pressure and no blood flow, may also lead to seeping
57
What causes an aneurysm?
High blood pressure means vessels burst
58
What are the two types of aneurysm?
Fistula and cavanova
59
What is a fistula aneurysm?
When blood goes from high to low pressure
60
What is a cavanova aneurysm?
Vessel seep slightly
61
What is a lacunar syndrome?
Small subcortical lesion caused by a blocked artery
62
What may cause lacunar syndromes?
Small vessel disease
Stroke
Ataxia
Pure motor
Dyatheria clumsy hand syndrome
63
What three things might cause a cardiogenic stroke?
Heart doesn't beat properly
Patent foramen ovale (hole in heart doesn't close and clot travels to other side of the heart)
Myocardial infarction (heart attack leads to decreased blood flow)
64
What three tests are used in the investigation of stroke?
NIH stroke score
Modified Rankin score
Imaging
65
What pharmacological management is used for the treatment of stroke?
Thrombosis (alteplase)
66
How does thrombosis work?
Dissolves blood clots and prevents new clots, plasminogen to plasmin
67
When is the use of thrombosis suitable?
Up to 9 hours after the stroke
Strokes with a small core and large perfusion lesion
68
What is an MR tissue clock in stroke investigation?
If the stroke is seen on diffusion, but not FLAIR or T2 MRI, the stroke happened under 4 hours before
69
What is the main drug used for thrombolysis in stroke management?
Alteplase
70
What is a thrombectomy in stroke management?
Catheter is used to pull the clot out from the groin
71
When is thromobectomy suitable for stroke management?
When the stroke happened up to 24 hours before, with a small/medium core, and a large perfusion area
72
What symptoms are show in coma patients?
Unresponsiveness and unarousableness
73
When symptoms are show when a patient is in a vegetative state?
Wakefulness, but no awareness
74
What symptoms are show when a patient is in a minimally conscious state?
Very altered consciousness, some awareness, and some interaction with the environment
75
What might cause altered levels of consciousness?
Sleep wake cycle nuclei damage
Reticular activating system damage
The cortex damage
76
On the JFK coma recovery scale, what score suggests a patient is in a minimally conscious state?
A score of above 10
77
What does the Wessex head injury scale measure?
Responsiveness and interaction with the environment providing a scale outcome of different sensory modalities
78
What three responses does the Glasgow coma score measure?
Eye opening
Verbal
Motor
79
What score is the worst on the Glasgow coma scale?
A score of 3
80
What is imaging used to find in patients with a disorder of consciousness
Regional changes in blood flow and metabolism
Rule out seizures and look for a sleep wake cycle
81
What is a mild TBI defined as on the mayo criteria?
Unconsciousness for 0-30 mins
Anterograde amnesia
GCS 13-15
82
What is a moderate TBI defined as on the mayo criteria?
Unconscious for 30mins to 24 hours, GCS of 9-12
83
What is a severe TBI defined as on the mayo criteria?
Unconscious for over 24 hours, GCS of 9 or under
84
What is a symptomatic TBI?
Shows some symptoms of a TBI e.g. visual issues and confusion
85
What two urgent assessments are needed when treating a TBI?
Check for swelling
Check for intercranial haemorrhage
86
When would you need to do a head CT on a TBI patient?
If they lost consciousness, are old, have vomited more than once, have had seizures or lost sensorium
87
If a TBI patient doesn't need a head CT, high GCS, and no focal neurology, how long should they be observed for?
6-8 hours
88
What two non-pharmacological treatments are used for TBI management?
Craniotomy or Burr holes
89
How can a craniotomy treat a TBI?
Sucks out the haematoma/blood
90
How can burr holes treat a TBI?
Small holes are made in the skull to relieve pressure
91
What are the signs of raised inter cranial pressure?
Headache
Nausea/vomiting
Vision issues
Cushing reflex
92
What is the Cushing reflex?
A sign of raised inter cranial pressure
High blood pressure
Decreased respiration
Bradycardia
93
What theory suggests that raised pressure in the skull is due to one of the contents of there brain pushing into an area?
Monroe-Kellie doctrine
94
What might cause an intraparenchymal haemorrhage?
Hypertension or tumour
95
What symptoms may be caused by an intraparenchymal haemorrhage?
Headache
Nausea/vomiting
Reduced conscious level
Agitation
96
What symptoms are shown when a patient has a subarachnoid haemorrhage?
Sudden onset of a 'thunderclap headache'
Meningism (nausea, photophobia)
Reduced consciousness
3rd/6th nerve palsy
Vasospasm
97
What type of brain injury might cause a subarachnoid haemorrhage?
Traumatic or non-traumatic head injury
98
When investigating a subarachnoid haemorrhage, what will CSF fluid look like, if this is what the patient has suffered with?
Blood in the CSF
Yellow CSF after 12 hours (blood breakdown products)
99
What might cause a subdural haemorrhage?
Ruptured bridging veins
100
What might cause an epidural haemorrhage?
Ruptured meningeal artery
101
What symptoms might show after diffuse axonal injury?
Coma/vegetive state
Agitation
Varied cognitive dysfunction
102
What causes diffuse axonal injury?
Shearing injury due to an acceleration, deceleration insult
103
What symptoms does post traumatic amnesia lead to?
Psychiatric problems
Disruption of normal conscious level
Disorientation
Anterograde amnesia
104
What test is done on TBI patients to test if they have post-traumatic amnesia?
The Westmead scale
105
What amplitude would a normal awake adult's EEG show?
10-100
106
Interictal epileptic discharges suggest what diagnosis?
Epilepsy
107
What causes epileptic activity on an EEG?
Paroxysmal depolarising shift, leading to neurones firing in bursts of action potentials caused by a large shift of membrane potential
108
How do generalised seizures show on an EEG?
Bilateral, symmetrical and synchronised, spike/polyspike-and-wave discharges
109
What is bipolar EEG?
Localisation by phase reversal
110
What is referential EEG?
Localisation by highest amplitude
111
What is epileptogenesis?
Changes in brain regions, leading tissue to generate spontaneous seizures
112
What main differences are there between an epileptic and syncope seizure?
Confused after an epileptic seizure
Syncope lasts seconds, not minuets
Sheldon questionnaire (below 1 = epilepsy, above 1 = syncope)
113
What three things are needed for a diagnosis of epilepsy?
2 unprovoked seizures, 24 hours apart
Or, 1 seizure, but have had a stroke/EEG activity shows epilepsy changes
Or certain symptoms, leading to a syndromic diagnosis
114
What is vagal nerve stimulation, as a treatment for epilepsy?
Stimulate the vagal nerve with electrical impulses to prevent irregular brain activity
115
What causes syncope seizures?
Loss of blood/oxygen to the brain temporarily
116
What are generalised convulsive status epilepticus?
Last over 30 mins
Or, continuous seizures for 30 mins or more, without regained consciousness between seizures
117
What might cause generalised convulsive status epilepticus?
Fever (between 6 months and 6 years old)
Meningitis
118
What pharmacological treatment is used to treat epilepsy?
Anticonvulsants e.g. sodium valporate
119
What is the mechanism of action of sodium valporate?
Alters electrical activity by affecting ion channels/neurotransmission (GABA/glutamate)
120
What should be given to stop a seizure that has lasted over 5 mins?
Benzodiazapines e.g. buccal midazolam to increase GABA
121
What ages are susceptible to infective encephalitis?
Below 1 and about 65
122
What symptoms might be caused by infective encephalitis?
Fever
Headache
Neck stiffness
Cognitive issues
Seizures
123
What virus is most likely to cause encephalitis?
HSV (usually HSV 1)
124
How does the HSV virus lead to encephalitis?
Migrates to either the trigeminal ganglia or the olfactory bulb, replicates again and stays latent until it reactivates and causes an acute infection of the brain
125
If a patient has infective encephalitis, what would they lumbar puncture show?
Increased white blood cell count
126
What pharmacological treatment is given to patients with infective encephalitis?
Antivirals e.g. acyclovir to prevent the spread of infection
127
What symptoms can autoimmune encephalitis lead to?
Neuropsychiatric problems
Limbic issues
128
What is a common symptom of LGI-1 encephalitis?
Faciobrachial dystonic seizures
129
What are common symptoms of NMDA encephalitis?
Hallucinations, delusions, and flu symptoms
130
What is paraneoplastic encephalitis?
Antibodies causing encephalitis, due to T cells attacking cancer, leading to neuronal loss/prevention of signalling
131
How does the breakdown of LGI-1 lead to encephalitis?
Antibodies break the connection between ADAM22 and ADAM23 molecules
132
How does the breakdown of NMDA receptors lead to encephalitis?
Leads to irregular signalling between the pre and post synaptic neurones
133
How do corticoid steroids treat autoimmune encephalitis?
Anti-inflammatories that bind to and reduce glucocorticoid
134
What is plasma exchange?
Purified plasma is taken from donors and transferred into autoimmune patients
135
What is intravenous immunoglobin?
A patient's own blood is taken and purified and transferred back into themselves
136
What symptoms may be caused by guillian-barre syndrome?
Progressive weakness of the arms or legs
Loss of reflexes
137
What causes autoimmune neuropathies?
Antibodies bind to myeline and injure the nerves, causing weakness
138
What is conduction block usually caused by?
Disruption to the myeline sheath
139
What causes vasculitis neuropathy?
Inflammatory destruction of nerve blood vessels
140
What symptoms can vasculitis neuropathy lead to?
Motor and sensory pain and progressive weakness
141
How does myasthenia gravis present?
Weakness and fatigue of muscles
Visual issues
Slurred speech and swallowing problems
Fluctuating symptoms throughout the day
142
What causes myasthenia gravis?
B cell mediated antibodies attack the acetylcholine receptor or cancer
143
What symptoms does Lambert-Eaton lead to?
Weakness of proximal muscles
Autonomic symptoms
Absent tendon reflexes
144
What causes Lambert-Eaton?
Antibodies attack voltage gated calcium channels at the neuromuscular junction or cancer
145
What pharmacological treatment is given to patients with Lambert-Eaton, and what does it do?
Amifampridine to increase the release of acetylcholine at nerve endings
146
What are the risk factors of multiple sclerosis?
Female sex, age 20-40, family history, northern latitude
147
What symptoms does multiple sclerosis lead to?
Dysfunction, fatigue, numbness, balance issues, relapses, progression
148
What causes multiple sclerosis?
Inflammation leading to loss of nerve cells (T and B cells)
149
What does gadolinium enhancement show in multiple sclerosis patients?
Identifies blood brain barrier disturbance
150
What does the McDonald criteria state is needed for a multiple sclerosis diagnosis?
1 year of disease progression
plus either, DIS in the brain, spinal cord, or positive CSF
151
How many oligological bands are present in multiple sclerosis patient's CSF?
Two or more
152
What do beta-interferons do for multiple sclerosis?
Prevent T cells, and reduce inflammation by binding to interferon alpha/beta receptor 1
153
What can cause neuropathic pain?
Lesion of the somatosensory system, neurological disorders, diabetes, chemo
154
What is the visual analogue scale?
Measures pain intensity
155
What is the main investigation for neuropathic pain?
History and examination
156
What is the brief pain inventory?
Measures how much pain interferes with everyday life
157
What pharmacological treatments can be used for the management of neuropathic pain?
Amitriptyline, duloxetine, gabapentin or pregabalin
158
What are the risk factors for migraine?
Female sex
Obesity
Family history
Stressful life events
159
What symptoms might be caused by migraine?
Headache (throbbing)
Nausea
Movement aggravated
Aura
Pre or post-dromal phases
160
What causes trigeminal nerve pain?
Inflammation of the trigeminal nerve leads to the innovation of large vessels and meninges in the brain
leads to the release of peptides and non painful stimuli appearing painful
161
What is the cause of aura in a migraine?
A depressed wave of cortical activity over the cortex
162
What defines episodic and chronic migraines?
Episodic - fewer than 15 days of attacks a month
Chronic - headaches for 15 days or more a month
163
What pharmacological treatment can be used for the management of migraines?
Triptins to prevent nociceptive neurotransmission
164
What non-pharmacological treatments are suggested for patients with migraines?
Lifestyle e.g. good sleep, exercise, and stress reduction
Botox
165
How do TAC headaches present?
One sided headaches
Red eyes, sweating, pain around the eyes
Pain doesn't spread
166
How do tension type headaches present?
Pressing pain
Bilateral
167
How do cluster headaches present?
Severe unilateral pain
Restlessness
Pain in bouts or clusters
168
How do paroxysmal hemicranias present?
Sudden onset
Unilateral attacks
169
What symptoms might inter cranial pressure disorder lead to?
Headache (worse in the morning)
Aggravated by coughing or sneezing
Visual issues
Pulsatile tinnitus
170
What might cause inter cranial pressure disorder?
Raised inter cranial pressure
171
What would be shown on an MRI in a patient with raised inter cranial pressure disorder?
Sagging or a collection of subdural haemorrhage
172
What non-pharmacological management might be given to patients with inter cranial pressure disorder?
Surgery to drain CSF
Weight loss
173
What makes functional seizures different to epileptic seizures?
Last longer
Seizure changes as you observe it
Asynchronous movements
Pelvic thrusting
Head movements
Able to recall/responsive afterwards
174
How do functional seizures show on EEG?
Don't have epileptic activity
175
What are the biopsychosocial causes of FND?
Biological - illness, disease, hyper mobility, physical event
Psychological issues
Social neglect
176
How does predictive processing lead to FND?
Bottom up processing is overridden by background knowledge, so symptoms dampen when attention is redirected
177
What treatment is offered to patients with FND?
Botox for jerking movements
MDC
Physio
CBT
178
What is the DSM-5 criteria for depression?
Depressive mood
5 or more symptoms
Most of the day, everyday for 2 weeks or more
Impaired functioning
179
What is psychotic depression?
Distortion of reality and delsuions/hallucinations
180
What might cause mania?
Genetics
Immune dysregulation
White matter abnormalities
Limbic network damage
Neurotransmitter signal changes
181
What defines bipolar disorders 1 and 2?
BP1 - at least 1 manic episode
BP2 - hypomania and depression
182
What is cyclothymic disorder?
Continuous mood disorder for over 2 years, but not severe enough to be depression or BP
183
What defines primary and secondary psychosis?
Primary - schizophrenia and mood disorders
Secondary - developmental, degenerative, and acquired conditions
184
What is the cause of positive and negative symptoms in schizophrenia?
Positive - excess of dopamine
Negative - shortage of dopamine
185
How do tricyclic acids work?
Block the reuptake of serotonin, norepinephrine, and dopamine
186
What symptoms might be caused by myotonic dystrophy?
Foot drop, weak grip, cognition, frontal balding, high testosterone, cataracts
187
What causes myotonic dystrophy?
Genetics (CGT repeats)
188
What is the genetic inheritance of Duchenne's?
X-linked
189
What three things might cause neuropathies?
Hereditory
Metabolism/toxins
Autoimmune
190
What symptoms are caused by motor neurone disease?
Bulbar, limb, respiratory, cognitive, progression, upper and lower motor dysfunction
191
What three things might cause motor neurone disease?
Genetics
Glutamate
Neuroinflammation
192
What is the Goldcoast criteria for motor neurone disease?
Progressive
Upper and lower motor neurone involvement (or 2 lower regions)
Exclusion of other disorders
