Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurology > Clinical Neurology > Flashcards

Clinical Neurology Flashcards

1
Q

what immune cells are abundant in the subarachnoid space in pyogenic meningitis?

A

neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is encephalitis?

A

inflammation of the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is meningitis?

A

inflammation of the meninges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is meningoencephalitis?

A

inflammation of the brain and meninges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is myelitis?

A

inflammation of the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what time of year is viral meningitis most common?

A

late summer/autumn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how could you diagnose suspected viral meningitis?

A

viral stool culture
throat swab
CSF PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the treatment for viral meningitis?

A

generally self limiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the most common type of virus to cause viral meningitis?

A

enteroviruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the treatment for viral encephalitis caused by herpex simplex?

A

IV high dose aciclovir

within 6 hours of admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the treatment for viral encephalitis?

A

IV high dose aciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is meningismus?

A

a triad of photophobia, headache and neck stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why does meningismus occur?

A

caused by irritation of the meninges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the 3 main investigations you would do for suspected viral encephalitis?

A

lumbar puncture
electroencephalogram
MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what pre-emptive treatment should you start for suspected viral encephalitis? (even before investigations)

A

IV aciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the 3 most common bacterial causes of meningitis in neonates?

A

listeria
group B strep
E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the most common bacterial cause of meningitis in children?

A

Haemophilus influena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the most common bacterial cause of meningitis in 10-21 year olds?

A

meningococcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the most common bacterial causes of meningitis in the 21+ age group?

A

pneumococcal (top)

meningococcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the most common bacterial causes of meningitis in the the elderly?

A

pneumococcal (top)

listeria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the most common causes of bacterial meningitis in immunocompromised patients?

A

listeria
pneumococcal
meningococcal
gram negative rods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the most common causes of bacterial meningitis in patients with neurosurgery or opened head trauma?

A

staph

gram negative rods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the most common cause of bacterial meningitis in patients with a fracture of the cribriform plate?

A

pneumococcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the most common causes of bacterial meningitis in patients with a basilar skull fracutre?

A

pneumococcal
haemophilus influenza
group A strep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the most common causes of bacterial meningitis in patients with a CSF shunt?

A

staph
gram negative rods
P. acnes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the 3 main potential origins of the bacteria causing meningitis?

A
  1. nasopharyngeal colonisation
  2. direct spread (ie parameningeal foci or skull fracture)
  3. remote foci of infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what cause of meningitis occurs specifically in patients with AIDS?

A

cryptococcus neoformans (fungal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how does bacteria from the nasopharynx gain access to the brain?

A

via bloodstream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what bacteria causes meningococcal meningitis?

A

neisseria meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what causes the symptoms of meningococcal meningitis?

A

endotoxin from the bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the most common cause of meningitis in children under 4 years old?

A

H. influenzae B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

how many types of haemophilus influenza are there?

A

6

A-F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what type of vaccine is available against haemophilus influenza B?

A

conjugated vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what bacterial causes pneumococcal pneumonia?

A

Strep. pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what kind of bacteria is listeria?

A

gram positive bacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the antibiotic of choice for listeria meningitis?

A

IV ampicillin/amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are the 3 main clinical signs of bacterial meningitis?

A

fever
stiff neck
alteration on consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is CSF pleocytosis?

A

increased cell count in the CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is CSF leukocytosis?

A

increased white blood cell count in the CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what are the 4 investigations you should do for suspected bacterial meningitis?

A

blood cultures
throat swab
blood EDTA for PCR
lumbar puncture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what cells are found in the CSF in viral, bacterial and TB causes of meningitis?

A

viral and TB- lymphocytes

bacterial- polymorphs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

will you be able to find a gram stain in the CSF in viral, bacterial and TB causes of meningitis?

A

viral- no
bacterial- yes
TB- yes or no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

will you be able to find a bacterial antigen in the CSF in viral, bacterial and TB meningitis?

A

viral- no
bacterial- yes
TB- yes or no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is the protein within the CSF like in viral, bacterial and TB meningitis?

A

viral- normal or slightly high
bacterial- high
TB- high or very high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what is the glucose within the CSF like in viral, bacterial and TB meningitis?

A

viral- normal
bacterial- less than 70% of blood glucose
TB- less than 60% of blood glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

describe the CSF of ‘aseptic meningitis’?

A

low number of WBC
minimally elevated protein
normal glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what imaging should be performed on all patients with suspected bacterial meningitis with papilloedema or focal neurological signs?

A

CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what are the 6 criteria to undergo a CT prior to lumbar puncture?

A
  • immunocompromised
  • history of CNS disease
  • new onset seizure
  • papilloedema
  • abnormal level of consciousness
  • focal neurological deficit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

when is a lumbar puncture not indicated for a patient with suspected bacterial meningitis?

A
  • clear contraindication

- confident clinical diagnosis of meningococcal infection with a typical meningococcal rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what is the empiric antibiotic therapy for suspected bacterial meningitis?

A
  • IV ceftriaxone

- add IV ampicillin/amoxicillin if listeria suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what is the empiric antibiotic therapy for suspected bacterial meningitis in a patient with a penicillin allergy?

A
  • IV chloamphenicol and IV vancomycin

- IV co-trimoxazole alone if listeria suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

in addition to antibiotics, what other medication should you give to all patients with suspected bacterial meningitis?

A

IV corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what are the contraindications to giving steroids in suspected bacterial meningitis?

A

post-surgical meningitis
severe immunocompromise
meningococcal or septic shock
patients who are hypersensitive to steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are the 3 options for contact prophylaxis for bacterial meningitis?

A

rifampicin
or ciprofloxacin (not in children)
or ceftraixone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what is the pathological hallmark of parkinsons disease?

A

dopaminergic neuron loss in the substantia nigra of the basal ganglia and Lewy body pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what are the 4 main classes of movement disorders?

A

pyramidal/UMN features
hyperkinetic
hypokinetic
ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

where within the brain is the injury if there are pyramidal/UMN features?

A

corticospinal/pyramidal tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

where within the brain is the injury if there are hyperkinetic features?

A

basal ganglia (extrapyramidal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

where within the brain is the injury if there are hypokinetic features?

A

basal ganglia (extrapyramidal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

where within the brain is the injury if there is ataxia?

A

cerebellum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what are the 3 main features of parkinsonian syndrome?

A
  • rigidity
  • bradykinesia/akinesia
  • resting tremor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what is dystonia?

A

prolonged muscle spasms and abnormal postures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what is chorea?

A

movements flowing irregularly fro one body segment to another- looks like dancing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what is ballismus?

A

chorea but the movements have a larger amplitude

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what are the broad 2 subtypes of parkinsons disease?

A

tremor dominant PD

non-tremor dominant PD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

compare tremor dominant and non-tremor dominant PD in terms of motor symptoms?

A

tremor dominant PD has a relative absence of other motor symptoms
non-tremor dominant has other motor symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

compare tremor dominant and non-tremor dominant PD in terms of rate of progression and functional disability?

A

tremor dominant PD has a slower rate of progression and less functional disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what special sense can be affected in parkinsons disease?

A

smell

-hyposmia or anosmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what sleep disorder can occur in parkinsons disease?

A

rapid eye movement sleep behaviour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what investigation is needed to diagnose rapid eye movement sleep behaviour?

A

overnight polysomnography with electromyogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what is the requirement for the diagnosis of parkinsonian syndrome?

A

muscular rigidity
4-6Hz resting tremor
postural instability (not caused by primary visual, vestibular, cerebellar or proprioceptive dysfunction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what are lewy bodies?

A

misfolded alpha-synuclein, which aggregate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what is the greatest risk factor for parkinsons disease?

A

age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what is the classic type of rigidity seen in parkinsons?

A

cogwheel rigidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what can happen to the voice of a patient with parkinsons?

A

hypophonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what can happen to the handwriting of a patient with parkinsons?

A

progressively smaller handwriting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

during active movement what happens to a parkinsons tremor?

A

goes away

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what is the difference between rigidity and spasticity?

A

spasticity is velocity dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

describe the gait of a patient with parkinsons?

A

slow, short shuffling steps

slow turns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what is asthenia?

A

abnormal weakness or lack of energy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what are the 3 investigations for parkinsons disease?

A
  • structural brain imaging
  • possibly dopamine functional imaging
  • levodopa challenge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

compare an essential tremor to a parkinsons tremor?

A

essential tremor is symmetrical, postural or kinetic with a higher frequency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

how does an essential tremor respond to alcohol?

A

goes away

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what is the core triad of features which make up multi system atrophy?

A

dysautonomia
cerebellar features
parkinsonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what is the most common cause of degenerative parkinsonism?

A

multi-system atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

when is the onset of fragile X-tremor ataxia syndrome?

A

late onset, above 50 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

how do you calculate the cerebral perfusion pressure?

A

mean arterial pressure - intracranial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

after head injury what should you aim to keep the cerebral perfusion pressure?

A

above 60mmHg

ie MAP needs to be above 80mHg and ICP needs to be below 20mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

what is the normal adult intracranial pressure?

A

9-11 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

what physical finding can be seen in an anterior cranial fossa fracture?

A

panda eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what physical finding can be seen in a middle cranial fossa fracture?

A

battle sign over mastoid area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

what is the name for the cerebellum herniating through the foramen magnum?

A

tonsillar herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what can happen to the pupil when the ICP increases enough to compress the third cranial nerve?

A

dilated pupil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what is the lowest GCS you can get?

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

what is the highest GCS you can get?

A

15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

how do you elicit pain to calculate the GCS?

A

press on medial eyebrow or supraorbital nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

when calculating the GCS, if the patient flexes to pain, what can you assume is working?

A

basal ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

when calculating the GCS if the patient extends to pain, where is the damage?

A

midbrain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

what 3 things must be true for the definition of a coma?

A

patient does not open eyes
patient does not obey comands
patient does not speak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what is the GCS of a patient in a coma?

A

8 or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

in trauma, when should you request a CT scan?

A

1) skull fracture

2) not orientated (GCS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

what is the normal pO2?

A

13-15kPa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

what is the normal pCO2?

A

4-4.5kPa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

what osmotic drug can be given to reduce ICP?

A

mannitol or hypertonic saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

what are the 3 main late effects of head injury?

A

epilepsy
CSF leak (nose, middle ear)
cognitive problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

if there is CSF leak into the middle ear, what type of hearing loss might occur?

A

conductive hearing loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

what are the 4 primary brain tumours which commonly metastasise to the brain?

A

breast
lung
melanoma
kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

what grade of astrocytoma is a glioblastoma?

A

glioblastoma equal astrocytoma grade IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

what is another name for tonsillar herniation through the foramen magnum onto the brain stem?

A

coning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

what causes tonsillar herniation or coning?

A

increased intracranial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

why must you avoid taking a lumbar puncture in patients with increased intracranial pressure?

A

reduces the pressure below the brainstem -might cause herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

the loss of what particular nerves causes failure of breathing after a tonsillar herniation/coning?

A

loss of C3,4,5 - diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

what is the most common tumour in the cerebellum of a child?

A

medulloblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

why might hydrocephalus occur due to reduces CSF absorption?

A

scarring of arachnoid granulations secondary to inflammation (meningitis etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what is hydrocephalus?

A

increased intracranial pressure due to build up of CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what is the difference between missile and non-missile head injury?

A

missile- penetrating foreign object

non-missile- non-penetrating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

why is it important to determine whether the missile head injury was low or high velocity?

A

with high velocity injuries there is also a pressure wave which radiates out causing damage in a further radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what causes injury in a non-missile head injury?

A

sudden acceleration or deceleration of the head causing brain to move within the cranial cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

what is a coup injury and what is a contracoup injury?

A

coup injury- at point of impact

contracoup injury- diametrically opposite point of impact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

which is more serious- coup or contracoup injury?

A

contracup injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

in the timeline of a head injury, when does diffuse axonal injury occur?

A

at moment of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

what scale represents the extent of diffuse axonal injury?

A

glasgow coma scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

what protein accumulates in diffuse axonal injury?

A

amyloid precursor protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

what are the 5 main causes for diffuse axonal injury?

A 
trauma
raised ICP
hypoxia
progression of dementia
progression of inflammatory disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

what can you do to prevent extensive diffuse axonal injury following traumatic head injury?

A

medically induce a coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what artery is usually involved in a traumatic extradural haematoma?

A

middle meningeal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what is a traumatic extradural haematoma usually associated with?

A

fracture of temporal or parietal bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

in an extradural haematoma, what kind of herniation can occur?

A

subfalcine herniation

under falx cerebri

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

what is the normal ICP value?

A

5-13 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

what is a tentorial herniation?

A

where the medial aspect of temporal lobes herniate over the tentorium cerebelli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

what cranial nerve is particularly susceptible to tentorial herniation?

A

CN III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

what is a transcalvarium herniation?

A

when brain herniates through any defect in the dura and skull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

what are the 4 main clinical signs of rasied intracranial pressure?

A

papilloedema
nausea and vomiting
headache
neck stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

why do patients with a brain tumour often have a headache in the morning which gets better of the course of the day?

A

CO2 retention in the night causes brain to increase in size and so pushes against meninges, throughout the day the CO2 is blown off and so size of brain decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

what patient group is most susceptible to brain abscesses?

A

IVDUs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

what is the cause of vasogenic cerebral oedema?

A

defect in blood brain barrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

what is the most common type of cerebral oedema?

A

cytotoxic oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

what is the cause of cytotoxic cerebral oedema?

A

ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

what is the cause of hydrostatic cerebral oedema?

A

hypertension within cerebral blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

what is the cause of interstitial cerebral oedema?

A

acute obstructive hydrocephalus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

what is the cause of hypo-osmotic cerebral oedema?

A

large reduction in serum osmolality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

what type of oedema is seen in hypertensive encephalopathy?

A

hydrostatic cerebral oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

which part of the temporal bone does the middle meningeal artery course under?

A

squamous part of temporal bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

nontreated, nonfatal subdural haematomas are demarcated from the underlying brain by what?

A

neomembrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

what blood vessels cause subdural haemorrhages- arteries or veins?

A

veins (bridging veins that extend from brain into subdural space)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

why is there progressive focal neurological signs/symptoms in a chronic subdural haemorrhage?

A

because venous blood leaks out slowly eventually building up pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

what is he most common cause of bradykinesia?

A

parkinsons disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

if dementia procedes the motor symptoms of parkinsons disease or is present within the first year, what is the disease termed instead?

A

dementia with Lewy bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

what is multiple sclerosis?

A

an inflammatory demyelinating disorder of the central nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

what are the 4 types of MS?

A
  1. relapsing and remitting
  2. secondary progressive
  3. progressive relapsing
  4. primary progressive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

what happens to tone in pyramidal dysfunction?

A

increased tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

in pyramidal dysfunction do muscles become rigid or spastic?

A

spastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

in pyramidal dysfunction, are the flexors or extensors weak in the upper limbs?

A

extensors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

in pyramidal dysfunction, are the flexors or extensors weak in the lower limbs?

A

flexors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

what is dysarthria?

A

unclear articulation of speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

where is the problem in internuclear ophthalmoplegia?

A

medial longitudinal fasciculus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

in internuclear ophthalmoplegia, is there a failure of abduction of adduction?

A

adduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

in internuclear ophthalmoplegia, is there nystagmus in the abducting or adducting eye?

A

abduction eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

what is the main symptoms of internuclear ophthalmoplegia?

A

diplopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

what 3 things can be used for fatigue/sleepiness in MS?

A

amantadine
modafinil (if sleepy)
hyperbaric oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

what is the name of the criteria for diagnosing MS?

A

McDonald criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

what may be found in the CSF of a patient with MS?

A

oligoclonal bands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

what is the treatment for an acute exacerbation of MS if mild?

A

symptomatic treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

what is the treatment for an acute exacerbation of MS if moderate?

A

PO steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

what is the treatment for an acute exacerbation of MS if severe?

A

IV steroids/ admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

what are the treatment options for spasticity in MS?

A

physiotherapy
oral baclofen or tizanidine
botulinum toxin
intrathecal baclofen/phenol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

what are the treatment options for sensory symptoms in MS?

A 
anti-convulsant eg gabapentin
anti-depressant eg amitriptyline
tens machine
acupuncture
lignocaine infusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

what can be used for detrusor hypersensitivity in MS?

A

anticholinergic eg oxybutynin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

what type of MS does relapsing and remitting MS usually turn into?

A

secondary progressive MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

what are the first line disease modifying agents for MS?

A

interferon beta
copaxone
tecedria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

what is the first line agent for relapsing and remitting MS?

A

tecfidera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

what is the main side effect of tecfidera?

A

bowel disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

what are the second line disease modifying agents for MS?

A

monocloncal sntibody

fingolimod

174
Q

what are the major side effects of fingolimod?

A

cardiac problems

175
Q

what severe side effect is associated with tysabri? (a drug use in severe relapsing and remitting MS)

A

progressive multifocal leukoencephalopathy

176
Q

what is muscle tone like in REM sleep?

A

low muscle tone

177
Q

do you tend to dream in REM or non-REM sleep?

A

non-REM

178
Q

what is the length of a normal circadian rhythm?

A

25 hours

179
Q

what is seasonal affective disorder?

A

when people have normal mental health throughout most of the year but experience depressive symptoms at the same time each year, usually winter

180
Q

what is the most common REM parsomnia?

A

Rapid eye movement Behaviour Disorder (RBD)

181
Q

what happens in RBD? (rapid eye movement behaviour disorder)

A

atonia is absent so sleeper can act out dreams, often violently and injuring themselves and bed partner

182
Q

are sleep terrors a REM or non-REM parasomnia?

A

non-REM parasomnia

183
Q

are restless legs or periodic limb movement syndrome REM or non-REM parasomnias?

A

non-REM parasomnias

184
Q

what is sleep paralysis?

A

a phenomenon where the brain holds the body in paralysis but we are returning to conscious

185
Q

what is a common vision which accompanies sleep paralysis?

A

an old hag at the edge of the bed

186
Q

what is narcolepsy?

A

a neurological disorder with a decreased ability to regulate sleep cycles

187
Q

what are the 5 main symptoms of narcolepsy?

A 
excessive daytime sleepiness
cataplexy
sleep paralysis
REM behavioural disorder
hypnagogic hallucinations
188
Q

what is cataplexy?

A

loss of muscle tone giving appearance of fainting, though patient is completely conscious

189
Q

what is cataplexy usually brought on by?

A

strong emotion

190
Q

what is the name for hallucinations which occur before you go to sleep? (abnormal)

A

hypnagogic hallucinations

191
Q

what is the name for hallucinations which occur as you wake up? (normal)

A

hypnapompic hallucinations

192
Q

what 3 investigations can help with diagnosing narcolepsy?

A
  • overnight sleep study
  • multiple sleep latency test
  • lumbar puncture
193
Q

what can be seen on lumbar puncture of a patient with narcolepsy?

A

low levels of hypocretin (a neuropeptide which regulates wakefulness)

194
Q

what is a multiple sleep latency test?

A

measures time elapsed from the start of a daytime nap to first signs of sleep (sleep latency)

195
Q

what are the 2 classes of insomnia?

A

reactive

psychophysiological

196
Q

why does reactive insomnia occur?

A

during a time of stress/anxiety

197
Q

why does psychophysiological occur?

A

loss of ability to fall asleep easily- beds are no longer associated with only sleep

198
Q

what is the most common subtype of motor neurone disease?

A

amylotrophic lateral sclerosis (ALS)

199
Q

is increased tone an upper or lower motor sign?

A

upper

200
Q

is weakness an upper or lower motor sign?

A

lower

201
Q

is babinski’s sign an upper or lower motor sign?

A

upper

202
Q

is a spastic gait an upper or lower motor sign?

A

upper

203
Q

is hyperreflexia an upper or lower motor sign?

A

upper

204
Q

are fasciculations an upper or lower motor sign?

A

lower

205
Q

are absent or reduced deep tendon reflexes an upper or lower motor sign?

A

lower

206
Q

does amylotrophic lateral sclerosis have upper and motor lower neurone features?

A

both upper and lower motor neurone features

207
Q

does primary lateral sclerosis have upper and lower motor lower neurone features?

A

upper motor neurone features

no lower

208
Q

does progressive muscular atrophy have upper and lower motor neurone features?

A

lower motor neurone features

upper motor neurone feautres can be sublinical

209
Q

does ALS-frontotemporal dementia have upper and lower motor neurone features?

A

both upper and lower motor neurone features

210
Q

what is the prognosis for amylotrophic lateral sclerosis and ALS-frontotemporal dementia

A

poor

211
Q

what is the prognosis for primary lateral sclerosis (a subtype of MND)?

A

good

212
Q

what is the prognosis of progressive musclar atrophy (a subtype of MND)?

A

variable

213
Q

what pattern of atrophy is typically seen in ALS?

A

split hand syndrome

wasting of thenar muscle group, relative preservation of hypothenar muscle group

214
Q

what is the hoffmann reflex?

is this normal?

A

tapping of the distal phalynx of the 3/4th finger, causing the distal phalynx of the thumb to flex (can be normal)

215
Q

what is the snout reflex?

A

tapping the midline of closed lips, causing lips to purse (abnormal)

216
Q

what is pseudobulbar affect?

A

uncontrollable episodes of crying/laughing in response to something which should not cause that much emotion
may be mood-incongruent

217
Q

is pseudobulbar affect an upper or lower motor sign?

A

upper

218
Q

what bacteria produces botulinum toxin?

A

clostridium botulinum

219
Q

how does botulinum toxin cause muscle weakness?

A

breaksdown proteins involved in vesicle formation, so reduces neurotranmitter release

220
Q

what is lambert eaton myasthenic syndrome?

A

autoantibodies to voltage gated calcium channels on presynaptic membrane, reduced neurotransmitter release

221
Q

what underling cancer is strongly associated with lambert eaton myasthenic syndrome?

A

small cell carcinoma

222
Q

what is the most comon disorder of the neuromuscular junction?

A

myasthenia gravis

223
Q

what is myasthenia gravis?

A

autoantibodies to acetyl choline receptors on the post-synaptic membrane, leads to reduced functioning of receptors causing muscle weakness and fatigue

224
Q

75% of patients with myasthenia gravis have what underlying condition?

A

thymus hyperplasia or thymoma

225
Q

at what age do women an men tend to get myasthenia gravis?

A

F- 20-30 years old

M- 50-70 years old

226
Q

the weakness in myasthenia gravis tends to fluctuate, as the day progresses does it generally get better or worse?

A

worse

227
Q

what are the 3 most common weakness presentations of myasthenia gravis?

A

extraocular weakness
facial weakness
bulbar weakness
(fatiguable weakness)

228
Q

in myasthenia gravis, is weakness usually proximal or distal?

A

proximal

229
Q

what are the treatment options for myasthenia gravis?

A

acetylcholinesterase inhibitor
thmectomy
steroids/azathioprine
plasma exchange/immunoglobuline (n emergency)

230
Q

why do people with myasthenia gravis tend to die?

A
  • respiratory failure and aspiration pneumonia

- side effects of immunosuppression

231
Q

what is myotonia?

A

failure of muscle relaxation after use

232
Q

what disease has progressive weakness with characteristic thumb sparing?

A

inclusion body myositis

233
Q

what is the rhabdomyolysis triad?

A

myalgia
muscle weakness
myoglobinuria

234
Q

what are the 2 main complications of rhabdomyolysis?

A

acute renal failure

disseminated intravascular coagulation

235
Q

what is the treatment of polymyositis/dermatomyositis?

A

steroids

236
Q

what is the most common extra-axial brain tumour?

A

meningioma

237
Q

what are the 4 most common symptoms of a brain tumour in an adult?

A

progressive neurological deficit
motor weakness
headache
seizures

238
Q

what is the onset of a headache caused by a brain tumour?

A

slow onset

239
Q

what usually exacerbates a headache caused by a brain tumour?

A

worse in the morning
coughing
leaning forward

240
Q

what is cushings triad and what is it in response to?

A

increase blood pressure, decreased heart rate, irregular breathing

in response to very high IC{

241
Q

who tends to get grade 1 astrocytic tumors?

A

children

242
Q

where do children tend to get grade 1 astrocytic tumours?

A

in the cerebellum

243
Q

what is the treatment of choice for a grade 1 astrocytoma?

A

surgery (Curative)

244
Q

are grade 1 astrocytomas benign or malignant?

A

benign

245
Q

if there is a grade 1 astrocytoma of the optic nerve, what diagnosis should be considered?

A

neurofibromatosis

246
Q

why are grade 2 astrocytomas considered to be malignant even though they are technically low grade?

A

because they become grade 3 and 4 tumours with time

247
Q

compare grade 1 and grade 2 tumours in terms of enhancement on contrast?

A

grade 1 enhance, grade 2 dont tend to

248
Q

what is the treatment of a grade 2 astrocytoma?

A

surgery +/- radiation/chemotherapy

249
Q

what is a glioblastoma?

A

grade 4 astrocytoma

250
Q

why do you still do surgery in cases of grade 3 and 4 astrocytomas even though it is non-curative?

A

to improve quality of life

251
Q

where do oligodendroglial tumours tend to occur?

A

frontal lobes

252
Q

what is the main presentation of oligodendroglial tumours?

A

seizures (due to calcification)

253
Q

what is the treatment for oligodendroglial tumours?

A

surgery + chemo/radiotherapy

254
Q

what condition should you think of if a patient has multiple meningiomas?

A

neurofibromatosis 2

255
Q

what are the 4 types of meningiomas? (classified by location)

A

parasagittal
convexity]sphenoid
intraventricular

256
Q

if a meningioma is found incidentally why may you choose to do nothing about it?

A

most are benign and very slow growing

257
Q

when is angiography of a brain tumour indicated?

A

if embolisation is planned

258
Q

what is the name of a benign peripheral nerve sheath tumours?

A

shwannomas

259
Q

what is the name of a malignant peripheral nerve sheath tumour?

A

malignant peripheral nevre sheath tumour

260
Q

what does bilateral vestibular schwannomas indicate?

A

NF 2

261
Q

what are the 3 major symptoms of vestibular schwannomas?

A

hearing loss
tinnitus
balance problems

262
Q

what are the 4 major post-op complications of surgery on a vestibular schwannoma?

A

facial nerve palsy
corneal reflex
nystagmus
abnormal eye movement

263
Q

if a patient wakes up in the morning with a headache that gets better as the day goes on what should you be thinking of?

A

raised ICP

264
Q

if a patients headache is worse when they lie down what should you be thinking of?

A

raised ICP

265
Q

what are the 5 main red flags of a headache?

A

new onset over 55 years old
known/prev malignancy
early morning headache
eacerbation by valsalva (eg coughing, sneezing etc)

266
Q

are migraines usualy colourful or colourless?

A

colourles

267
Q

if a visual disturbance is bright, what should you be thinking about instead of a migraine?

A

occipital lobe seizure

268
Q

what is more common- migraine with or without aura?

A

without aura

269
Q

what is the criteria for diagnosing a migraines?

A

at least 5 attacks lasting from 4 -72 hours
2 from: moderate/severe, unilateral, throbbing pain, worse on movement
1 from: autonomic features, photophobia, phonophobia

270
Q

what is the pathophysiology of a migraine?

A

depolarisation somewhere in the cortex excites the trigeminal nerve causing it to release substances
-these dcause dilation of cranial blood vessels causing pain
(trigeminal vascular headache)

271
Q

how long does an aura in association with migraine last?

A

20-60 mins, usually before the headache

272
Q

what is the most common type of aura?

A

visual

273
Q

what is the symptomatic treatment of migraines?

A
  1. NSAIDs
    +/- antiemetic
  2. triptans
274
Q

when should you give prophylaxis for migraines?

A

if there are more than 3 attackes per month or migrains are very severe

275
Q

how long must you trial a prophylaxis drug for migraines for?

A

4 months to see benefit

276
Q

what drugs are used for migrain prophylaxis?

A 
propanolol
topiramate
amitriptyline
gapapentin
pizotifen
sodium valproate
277
Q

what are the side effects of topieramate?

A

weight loss
paraesthesia
impaired concentration

278
Q

what lifestyle advice should you give someone with migraines?

A 
diet- avoid triggers, healthyh balanced diet
hydration
decrease caffeine
decrease stress
regular exercise
279
Q

what are trigeminal autonomic cephalgias?

A

primary headaches characterised by unilateral trigeminal distribution pain with ipsilateral autonomic features

280
Q

what are the 4 main types of trigeinal autonomic cephalgias?

A

cluster
paroxsymal hemicrania
hemicrania continua
SUNCT

281
Q

what is a cluster headache?

A

severe unilateral headache that lasts 45-90 mins, up to 8 times per day
cluster bout may last up to a few months

282
Q

what is the treatment for a cluster headaches?

A

high flow ozygen for 20 mins
subcut sumatriptan
steroids (reduce over 2 weeks)
verapamil (prophylaxis)

283
Q

what is the differnece between paroxysmal hemicranias and cluster headaches?

A

paroxysmal hemicranias are shorter in duration and more frequent

284
Q

compare age and sex of patients who get paroxysmal hemicranias and cluster headaches?

A

paroxysmal hemicranias-50-60s (F more then M)

30-40s (M more than F)

285
Q

what is a SUNCT headache?

A 
Short lived (less than 2 minutes)
Unilateral
Neuralgiaform headache
Conjunctival injections
Tearing
286
Q

what is the treatment for paroxysmal hemicranias?

A

indomethicin

287
Q

what is the treatment for SUNCT headaches?

A

lamotrigine

gabapentin

288
Q

what investigation can be done for those with new onset ipsilateral cranial autonomic features?

A

MRI brain and MR angiogram

289
Q

who tends to get trigeminal neuralgias?

A

over 60 years old

F more than M

290
Q

what triggers trigeminal neuralgias?

A

touching face (usually V2/3 area)

291
Q

what is the character of trigeminal neuralgia pain?

A

severe stabbing unilateral pain

292
Q

how long does the pain of trigeminal neuralgia last?

A

1- 90 seconds but can occur up to 100 times per day (occurs in bouts before remission)

293
Q

what is the treatment for trigeminal neuralgia?

A

carbamazepine, gabapentin, pheytoin, baclofen

surgery (rare): ablation or decompression

294
Q

what is the major difference between trigeminal autonomic cephalgias and trigeminal neuralgias?

A

trigeminal neuralgias dont have autonomic features

295
Q

what tends to happen to the limbs and head in an epileptic fit?

A

posturing of limbs

head turning

296
Q

what is a tonic clonic seizure?

A 
first tonic (stiff) phase
then clonic (jerky) phase
297
Q

what are corpopedal spasms?

A

severly painful muscle cramps of hands and feet

298
Q

why should you always do an ECG on a patient presenting with a new seizure?

A

might not be a seizure, could have a cardiac cause for collapse

299
Q

why would you choose to get a CT scan of a patient presenting acutely with a new seizure?

A
  • clinical or radiological skull fracture
  • deteriorating GCS
  • GCS not 15 after 14 hours
  • head injury with seizure
  • focal signs
  • suggestion of other intracranial pathology
300
Q

what are the 4 uses of an electroencephalogram? (EEG)

A
  • classification of epilepsy
  • confirmation of non-epileptic attacks
  • surgical evaluation
  • confirmation of non-convulsive status
301
Q

how long should you stop driving if you have a seizure? (not epilepsy, first fit)

A

car- 6 months

HGV- 5 years

302
Q

how long should you stop driving if you have an epileptic seizure?

A

car- 1 years (3 years if you also get fits during sleep)

HGV- 10 years

303
Q

what decreases the risk of SUDEP in an epileptic patient?

A

taking medication
bed partner
mild epilepsy

304
Q

what is an epileptic seizure?

A

abnormal synchronisation of neuronal activity

305
Q

do older people or young people tend to have focal epilepsy?

A

older people

306
Q

do older people or young people tend to have generalised epilepsy?

A

young people

307
Q

can generalised epilepsy cause focal or generalised seizures?

A

generalised

308
Q

can focal epilepsy cause focal or generalised seizures?

A

focal and generalised seizures

309
Q

what is the difference between a simplex= and complex seizure?

A

simple- no loss of consciousness

complex- loss of consciousness

310
Q

what is the treatment of choice for primary generalised epilepsy?

A

sodium valproate

lamotrigine in women of childbearing age

311
Q

what kind of epilepsy is juvenile myoclonic epilepsy?

A

primary generalised epilepsy

312
Q

what time of day does juvenile myoclonic epilepsy tend to have symptoms?

A

morning

313
Q

what are the main 2 risk factors for seizures in generalised myoclonic epilepsy?

A

flashing lights

sleep deprivaion

314
Q

what is the treatment of choice for focal onset epilepsy?

A

carbamazepine

or lamotrigine

315
Q

what kind of epilepsy is complex partial seizures with hippocampal sclerosis?

A

focal epilepsy

316
Q

why does complex partial seizures with hippocampal sclerosis occur?

A

brain doesnt fold properly during development, hippocampus is affected

317
Q

when would you add on anti-convulsant drugs in epilepsy?

A

tried 3 anti-epileptic drugs, not suitable for surgery

318
Q

what anti-epileptic drugs affect women’s contraception?

A

hepatic-enzyme inducing drugs (eg carbamazepine)

319
Q

describe how womens contraception is altered by hepatic-enyzme inducing drugs?

A
  • OCP efficacy altered
  • progesterone only pill doenst work
  • progesterone implant doesnt work
  • depot progesterone needs more frequent dosing
  • morning after pill needs increased dose
320
Q

what does the oral contraceptive pill do to lamotrigine?

A

reduces lamotrigines efficacy

321
Q

why should sodium valproate not be given to women of childbearing age?

A

teratogenic

322
Q

where do berry aneurysms/saccular aneurysms occur?

A

circle of willis (tend to be where vessels branch)

323
Q

what is the name of the headache which happens just before you orgasm?

A

benign coital cephalgia

324
Q

what is a traumatic tap on LP?

A

when you get blood in the needle from piercing arteries while doing a LP

325
Q

what artery do you use to do cerebral angiography?

A

femoral artery

326
Q

what is the gold standard for locating the artery which has caused subarachnoid haemorrhage?

A

cerebral angiography

327
Q

what is the mainstay of treatment of an aneurysm that has previously caused a subarachnoid haemorrhage?

A

endovascular treatment

328
Q

how long does it take for delayed ischaemia from a subarachnoid haemorrhage?

A

3-12 days

329
Q

what drugs is used post-subarachnoid haemrrhages to stop vasospasm?

A

nimodipine (calcium channel blcker)

330
Q

why is nimodipine given for 3 weeks after a subarachnoid haemorrhage?

A

to reduce vasospasm to reduce delayed ischaemia

331
Q

if the headache from a subarahcnoid has not got better after a few days, what complication should you be thinking of?

A

hydrocephalus

332
Q

what salt imbalance can occur as a complication of subarachnoid haemorrhage?

A

hyponatramia

333
Q

why can hyponatraemia occur as a complication of subarachnoid haemorrhage?

A

SIADH

cerebral salt wasting

334
Q

what is the treatment of hyponatraemia due to subarachnoid haemorrhage? (how is this differnet to the normal treatment)

A

supplement sodium intake
fludrocortison
DO NOT FLUID RESTRICT
(usually you would fluid restrict)

335
Q

why do you not fluid restrict to treat the hyponatraemia that can occur due to subarachnoid haemorrhage?

A

can encourage vasospasm

336
Q

what investigation usually give the diagnosis of subarachnoid haemorrhage?

A

CT brain

if not, then lumbar puncture if safe

337
Q

what are the most common causes of intracerebral haemorrhage?

A

hypertension (50%)
aneurysm
AVM

338
Q

what is the name for the microaneurysms that arise on small arteries within the brain that are secondary to hypertension and can lead to intracerebral haemorrhage?

A

charcot-bouchard microaneurysms

339
Q

is the majority of the corticospinal tract crossed or uncrossed?

A

crossed

340
Q

where does the majority of the corticospinal tract decussate?

A

medullary level

341
Q

is the spinothalamic tract crossed or uncrossed?

A

uncrossed

342
Q

where does the spinothalamic tract decussate?

A

spinal level

343
Q

if there is a spinal cord lesion affecting the corticospinal tract, will it cause ipsilateral or contralateral symptoms?

A

ipsilateral

344
Q

if there is a spinal cord lesion affecting the spinothalamic tract, will it cause ipsilateral or contralateral symptoms?

A

contralateral

345
Q

are the dorsal column tracts crossed or uncrossed?

A

crossed

346
Q

where do the dorsal columns decussate?

A

medullary level

347
Q

if there is a spinal cord lesion affecting the dorsal columns, will it cause ipsilateral or contralateral symptoms?

A

ipsilateral

348
Q

what sensation does the spinothalamic tract deal with?

A

pain and temperature

349
Q

what sensation do the dorsal columns deal with?

A

fine touch, proprioception, vibration

350
Q

what is the most common cause of acute spinal cord compression?

A

metastatic disease of the spine leading to collapse

351
Q

what is spondylosis?

A

degeneration of the intervertebral discs ofthe spine- vey painful

352
Q

what are the 4 main causes of acute spinal cord compression?

A

tumours
trauma
infection
spontaneous haemorrhage

353
Q

what are the 3 main causes of chronic spinal cord compression?

A

degenerative disease- spondylosis
tumours
rheumatoid arthritis

354
Q

what joints in the spine does rheumatoid arthritis affect?

A

the synovial facet joints

355
Q

what kind of spinal cord injury can give you brown-sequard syndrome?

A

cord hemisection

356
Q

what are the symptoms of brown-seqard syndrome?

A

below level of injury

  • ipsilateral motor loss
  • ipsilateral dorsal column loss (fine touch, proprioception, vibration)
  • contralateral spinothalamic loss (pain and temp)
357
Q

what causes central cord syndrome?

A

hyperflexion or extension injury to an already stenotic neck

358
Q

where does the limb weakness occur in central cord syndrome?

A

predominantly distal upper limb weakness

lower limb power preserves

359
Q

where does the sensory loss occur in central cord syndrome?

A

‘cape like’ spinothalamic sensory loss (pain and temp)

dorsal columns preserves (vibration, fine touch and proprioception)

360
Q

compare acute and chronic spinal cord compression in terms of spinal shock?

A

acute compression- spinal shock

chronic compression- no spinal shock

361
Q

in chronic spinal cord compression, do LMN or UMN signs tend to predominate?

A

upper motor neuron signs

362
Q

what are the two classes of intradural tumour within the spine?

A

extramedullary (eg meningioma, schwannoma)

intramedullay (eg astrocytoma, ependymoma)

363
Q

if a tumour that is within the spine is extradural, what kind of tumour is it most likely to be?

A

metastatic

364
Q

why is dexamethasone given to patients with tumours (primary or mets) causing spinal compression?

A

reduces swelling in spinal cord

365
Q

what is the treatment for an infection causing acute spinal compression?

A

antimicrobial therapy
surgical drainage
stabilisation

366
Q

what is the treatment for a haemorrhage causing acute spinal compression?

A 
reverse anticoagulation (ie give clotting factors like vit K)
surgical decompression
367
Q

what is the treatment for degenerative disease causing spinal cord compression?

A

decompression +/- stabilisation

368
Q

where is the location of the cause of a somatosensory aura?

A

parietal lobe (somatosensory cortex on postcentral gyrus)

369
Q

where is the location of the cause of a visual aura?

A

occipital lobe (visual cortex)

370
Q

what are the 3 types of functional attacks?

A
  1. attacks with prominent motor activity
  2. episodes of collapse with no movement
  3. abreactive attacks (Fear, hyperventilationetc)
371
Q

what is the usual duration of a functional attack?

A

10-20mins

372
Q

what is status epilepticus?

A

recurrent epileptic seizures lasting more than 30 mins (no full recovery of consciousness between seizures)

373
Q

what are the 3 kinds of status epilepticus?

A
  • generalised convulsive status epilepticus
  • non convulsive status (altered state)
  • epilepsia partialis continua
374
Q

what metabolic disorders can cause status epilepticus?

A

hyponatraemia, pyridoxine deficiency

375
Q

treating an absent seizure with what drug can cause status epilepticus?

A

carbemazapine

376
Q

what is the drug treatment of status epilepticus for immediate control?

A

lorazepam IV
if delay gaining IV access-
diazepam PR
(give 50ml 50% glucose if any suggestion of hypoglycaemia, give IV thiamine if any suggestion of alcoholism)

if persisting transfer to ITU and control with general anaesthesia

377
Q

compare the difference in symptoms for a large sensory fibre and small sensory fibre peripheral neuropathy?

A

large: numbness, paraesthesia, unsteadiness
small: pain, dysasthesia

378
Q

compare the difference in reflexes for a large sensory fibre and small sensory fibre peripheral neuropathy?

A

large: absent reflexes
small: present reflexes

379
Q

what is pseudoathetosis?

A

abnormal writhing movements, usually of the fingers

380
Q

what causes pseudoathetosis?

A

loss of proprioception

381
Q

where is the nerve injured in a radiculopathy?

A

nerve root

382
Q

where is the nerve injured in a plexopathy?

A

nerve plexus

383
Q

what is the initial pattern of sensory loss or weakness in peripheral neuropathy?

A

glove and stocking

384
Q

what is guillain barre syndrome?

A

progressively demyelinating condition with progressive paraplegia that occurs over days and lasts up to 4 weeks
sensory symptoms (such as pain) proceed weakness
-association: post infectious

385
Q

why do people with guillain barre syndrome die?

A

autonomic failure- arrhythmias

386
Q

what is the treatment of guillain barre syndrome?

A

immunoglobulin infusion

plasma exchange

387
Q

what causes the neuropathy in hereditary sensory motor neuropathy?

A

demyelination

388
Q

what are the 3 main causes of chronic autonomic neuropathy?

A

diabetes
amyloidosis
hereditary autonomic neuropathy

389
Q

what are the 2 main causes of acute autonomic neuropathy?

A

guillian barre syndrome

porphyria

390
Q

what are the SMART goals for neurological rehab?

A 
specific
motivating
achievable
rational/relevant
time-defined
391
Q

where within the brain is the problem if the movement disorder presents with pyramidal/upper motor neurone features? (such as pyramidal weakness, spasticity)

A

corticospinal tract

392
Q

where within the brain is the problem if the movement disorder presents with hyperkinetic features? (such as dystonia, tics, myoclonus, chorea)

A

basal ganglia

393
Q

where within the brain is the problem if the movement disorder presents with hypokinetic features? (such as rigidity, bradykinesia)

A

basal ganglia

394
Q

where within the brain is the problem if the movement disorder presents with ataxia?

A

cerebellum

395
Q

are increased deep tendon reflexes likely to be caused by an upper motor or lower motor problem?

A

upper motor

396
Q

are decreased deep tendon reflexes likely to be caused by an upper motor or lower motor problem?

A

lower motor

397
Q

are increased pathological reflexes likely to be caused by an upper motor or lower motor problem?

A

upper motor

398
Q

is increased muscle tone likely to be caused by an upper motor or lower motor problem?

A

upper motor

399
Q

is decreased muscle tone likely to be caused by an upper motor or lower motor problem?

A

lower motor

400
Q

is increased muscle bulk likely to be caused by an upper motor or lower motor problem?

A

upper motor

401
Q

is wasting of muscle bulk likely to be caused by an upper motor or lower motor problem?

A

lower motor

402
Q

are fasiculations likely to be caused by an upper motor or lower motor problem?

A

lower motor

403
Q

where anatomically is the location of the disease if there is fatiguable weakness?

A

neuromuscular junctions

404
Q

what is the pattern of weakness that occurs with a parasagittal frontal lobe lesion?

A

paraparesis

405
Q

what is the pattern of weakness that occurs with a cervical spinal cord UMN lesion?

A

pyramidal weakness of arms and legs

406
Q

what is the pattern of weakness that occurs with a thoracolumbar spinal cord UMN lesion?

A

pyramidal weakness of legs

407
Q

is polio a disease of upper or lower motor neurones?

A

lower

408
Q

what is mononeuritis multiplex?

A

an asymmetrical neuropathy of multiple nerves

409
Q

what muscle, named nerve and nerve root causes shoulder abduction? (after 30 degrees)

A

deltoid
axillary nerve
C5

410
Q

what muscle, named nerve and nerve root causes elbow extension?

A

triceps
radial nerve
C7

411
Q

what muscle within the forearm, named nerve and nerve root causes finger extension?

A

extensor digitorum
posterior interossus nerve (radial)
C7

412
Q

what muscle, named nerve and nerve root causes index finger abduction?

A

1st dorsal interosseus
ulnar nerve
T1

413
Q

what muscle (main muscle), named nerve and nerve root cause hip flexion?

A

iliopsoas
femoral nerve
L1,2

414
Q

what muscles, named nerve and nerve root cause knee flexion?

A

hamstrings
sciatic nerve
S1

415
Q

what named nerve and nerve root causes ankle dorsiflexion?

A

common peroneal nerve

L4,5

416
Q

what muscle, named nerve and nerve root causes great toe dorsiflexion?

A

extensor hallucis longus
common peroneal nerve
L5

417
Q

what nerve roots supply the ankle reflex?

A

S1,2

418
Q

what nerve roots supply the knee reflex?

A

L3,4

419
Q

what nerve roots supply the biceps reflex?

A

C5,6

420
Q

what nerve roots supply the triceps reflex?

A

C7,8

421
Q

if there is a problem with the peroneal nerve, what tendon reflex is absent?

A

none

422
Q

describe the cerebellar gait?

A

broad-based and unsteady

423
Q

what is the DANISH mneumonic for remembering cerebellar tests?

A 
Dysdiadochokinesis
Ataxia
Nystagmus
Intention Tremor
Speech
Hypotonia
424
Q

what is dysdiadochokinesis?

A

clumsy fast alternating movements

425
Q

how do you test for an intention tremor?

A

finger-nose test

heel-shin test

426
Q

what is hypomimia?

A

reduced facial expression

427
Q

what is hypophonia?

A

soft speech

428
Q

compare the visual field defect with temporal and parietal lobe lesions?

A

parietal- inferior homonymous quadrantanopia

temporal- superior homonymous quadrantanopia

429
Q

what is levodopa broken down into once in the brain?

A

dopamine

430
Q

what type of drug can be used for tremor in parkinsons disease?

A

anticholinergics

431
Q

why are COMT inhibitors sometimes given in addition to levodopa in parkinsons disease?

A

inhibits enxyme which breaks down levodopa

432
Q

does parkinsons disease tend to be symmetrical or asymmetrical?

A

asymmetrical

Neurology (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions