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Congition, Movement and Senses > Cognition Movement and Senses > Flashcards

Cognition Movement and Senses Flashcards

1
Q

Give three causes of acute neurological lesion

A

Vascular
Epileptic seizure
Trauma

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2
Q

Give three causes of a subacute (days to week onset) neuro lesion

A

Inflammation
Infection
Expanding mass/tumor

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3
Q

Give two causes of chronic onset neuro lesion

A

Alzheimer’s

Parkinson’s

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4
Q

Wasting: UMN or LMN lesion?

A

LMN

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5
Q

Fasiculation: UMN or LMN lesion?

A

LMN

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6
Q

Increased tone: UMN or LMN lesion?

A

UMN

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7
Q

Increased reflexes: UMN or LMN lesion?

A

UMN

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8
Q

Babinski (upwards plantar reflex): UMN or LMN lesion?

A

UMN

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9
Q

Give 5 signs of LMN lesion

A 
Wasting
Fasiculations
Decreased tone
Decreased reflexes
Down going plantar reflex
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10
Q

Give 3 signs of UMN lesion

A

Increased tone
Increased reflex
Babinski sign

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11
Q

What is key feature of cerebellar lesions?

A

Incoordination - dysdiadochokinasia: unable to do rapid alternating movements eg. Flipping one hand on the other

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12
Q

Give 7 signs of cortical lesions

A 
Aphasia
Apraxia
Agnosia 
Hemianopia (blind in half of vision)
Decreased memory
Changes in executive function/cognition
Loss of smell
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13
Q

Give three signs of anterior chord syndrome

A

Loss of ascending pain and temp
Loss of decending motor
Vibration and propriception sense preserved

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14
Q

Give three signs of post chord syndrome

A

Loss of ascending vibration and proprioception sense
Temp and pain sensation preserved
Motor preserved

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15
Q

What are the three signs of lateral chord syndrome (Brown-Sequard syndrome)?

A

Loss of:
Ipsilateral motor
Ipsilateral ascending vibrations and proprioception
Contralateral pain and temp sensation

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16
Q

What is the classic reported symptom of lateral chord syndrome (Brown-Sequard)?

A

‘One leg weak, one leg numb’

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17
Q

Give two symptoms of central chord syndrome

A

Bilateral loss of pain and temp sensation
Bit of loss of bilateral motor
cape like distribution

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18
Q

Give three classic symptoms/signs of MS

A

Optic neuritis
Internuclear Ophthalmoplegia
Lhermitte’s sign

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19
Q

What is Lhermitte’s sign?

A

Electric shock like sensation at back of neck when Pt puts chin on chest

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20
Q

What’s the classic triad on Ménière’s disease?

A

Vertigo
Hearing loss
Low frequency roaring tinnitus

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21
Q

Give four features of vestibular nystagmus

A

Horizontal oscillations
Increased when looking in direction of fast phase
Jerk with linear slow phase
Optic fixation suppresses it

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22
Q

What is the main symptom differentiating vestibular neuritis and Ménière’s disease?

A

Hearing loss in meneries

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23
Q

Give two treatments to prevent meneries attacks

A

Low salt diet

Thiazide diuretics

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24
Q

Give four permanant treatment options for meneries

A

Intratympanic gentamycin and coritcosteroid
Endolynphatic sac decompression
Vestibular neurectomy
Labyrinthectomy

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25
Q

Give three classic symptoms/signs of Giant cell arthritis you should rule out in sudden vision loss pts

A

Sudden severe painful vision loss
Jaw claudication
Non pulsatile, tender temporal arteries

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26
Q

What are the features of Guiilain Barre syndrome?

A

Motor loss
Loss of deep tendon reflexes
Pareasthesia without objective sensory loss

Often precipitated by gasteroenteritis

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27
Q

Give 4 symptoms of acute angle closure glaucoma

A

Unilateral loss of vision
Painful eye
Unilateral red eye
Halos around lights

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28
Q

What is papilloedema?

A

Swollen optic nerve head secondary to raised ICP - usually bilateral

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29
Q

Give three causes of bilateral optic disc swelling

A

Raised ICP (papilloedema)
Malignant hypertension
Optic disc drusen (calcium deposits)

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30
Q

Give 5 features of ALS presentation

A

Upper exreamity weakness
stiffness with poor coordination and balence
unsteady gait
Drooling
Emotional lability (inappropriate outbursts of laughing or crying)

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31
Q

Signs of chylamidia conjunctivitis of newborn?

A

Creamy white discharge

5-12 days after birth

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32
Q

Signs of Gonorrhoea conjunctivitis in newborn

A

D 2-5

Rapid progressing

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33
Q

Signs of staphylococcus conjunctivitis in newborn?

A

Yellow discharge

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34
Q

Triad of shaken baby syndrome

A

Encephalopathy
Subdural heamhorrage
Retinal heamhorrage

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35
Q

What is leucocoria?

A

White pupil

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36
Q

What is phoria?

A

Eye misalignment but corrected through subconscious effort

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37
Q

What is trophia?

A

Eye deviation that cannot be controlled

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38
Q

What is retinopathy of prematurity?

A

Abnormal retinal changes that may occur in preterm babies

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39
Q

Give 5 chronic causes of blurred vision

A 
Diabetic retinopathy 
Diabetic maculopathy
Glaucoma
Cataract
Age related macular degeneration
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40
Q

Give 3 ddx of acute blurred vision with painful red eye

A

Corneal ulcer
Uveitis
Acute angle closure glaucoma

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41
Q

Give three signs of primary open angle glaucoma

A

Optic disk cupping (cup:disk ratio of >0.6 is suspicious)
Raised IOP
Progressive visual field defect

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42
Q

How do you measure IOP?

A

Tonometry

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43
Q

How do you lower IOP in glaucoma?

A

Suppress humor production

  • beta blocker
  • alpha agonists
  • carbonic anhydrase inhibitor

Increase outflow
- prostaglandin analogues

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44
Q

Give three symptoms of cateract

A

Gradual decrease in acuity and blurred vision
Myopia
Glare

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45
Q

Give three examinations to test for cataracts

A

Measure acuity
Check red reflex (reduced in cataracts)
Obscured view of fundus on ophthalmoscopy

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46
Q

Give 2 antimuscarinics

A

Oxybutynin

Atropine

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47
Q

What investigation is used to examine micro vascular leakage in wet age related macular degeneration?

A

Fluorescein angiography

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48
Q

Give 5 signs of Uveitis

A 
Circumcorneal injection (red around cornea)
Hypopynon
Keratic precipitates
Watery discharge
Small and irregular pupil
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49
Q

Give 5 ddx of chronic blurred vision

A 
Diabetic retinopathy
Age related macular degeneration (dry)
Cataract
Glaucoma
Diabetetic maculopathy
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50
Q

Give three ddx of acute painful red eye causing blurry vision

A

Acute closed angle glaucoma
Uveitis
Corneal ulcer

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51
Q

Give 6 ddx of acute painless white eye blurred vision

A 
Central retinal artery occlusion
Central retinal vein occlusion
Wet age related macular degeneration 
Non arteritic anterior is chewing optic neuropathy 
Giant cell arteritis
Retinal detachment
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52
Q

Give 5 ddx of chronic blurred vision

A 
Diabetic retinopathy
Age related macular degeneration (dry)
Cataract
Glaucoma
Diabetetic maculopathy
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53
Q

Give three ddx of acute painful red eye causing blurry vision

A

Acute closed angle glaucoma
Uveitis
Corneal ulcer

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54
Q

Give 6 ddx of acute painless white eye blurred vision

A 
Central retinal artery occlusion
Central retinal vein occlusion
Wet age related macular degeneration 
Non arteritic anterior is chewing optic neuropathy 
Giant cell arteritis
Retinal detachment
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55
Q

Give two symptoms of tension headache

A

Right band around head

No aura

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56
Q

what microbe causes Tracheoma?

A

Chylamydia Trachomatis

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57
Q

What are 2 complication of repeated tracheoma conjuctivitis

A 
conjuctival scarring (cicatrisation)
Corneal scarring/opacity
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58
Q

what 3 regions are onchoceriasis endemic to

A

equatorial africa
Central america
south america

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59
Q

What antiparasitic drug is used to treat onchoceriasis?

A

Ivermectin

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60
Q

Xerophthalmia is a deficeincy in which nutrient?

A

Vitamin A

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61
Q

Give 4 complications of xerophthalmia (vit a deficency)

A

Nightblindness
Corneal/conjunctival driness and keratinisation
corneal ulcers which may lead to perforation
corneal necrosis

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62
Q

What three drug classes can you give for acute migraine treatment?

A

NSAIDS
Tryptans
Antiemetic

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63
Q

What antiepileptic can be used to treat migraines and cluster headaches acutely?

A

Topiramate

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64
Q

What drug abolishes paroxysmal hemicrania and hemicrania continua? And is used for diagnosis?

A

Indomethacin

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65
Q

Give a symptom to differentiate a headache as cerebreal venous thrombosis

A

altered conciousness

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66
Q

what is the pattern of pain in a headache causes by arterial dissection

A

Thunderclap and on neck and radiates to side of head

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67
Q

Give four eye symptoms/signs in idiopathic intracranial hypertension

A

gradual decrease in visual acuity
visual feild defects
papilloedema
diplopia (if abducens palsy)

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68
Q

What vitamin deficiency is associated with MS

A

D (supplement should be given in management)

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69
Q

What antiepileptic is generally best for generalised seizures?

A

Valporate

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70
Q

Which antiepileptic is best for focal seizures?

A

Lamotrigine

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71
Q

Give four antiepileptic drugs

A

valporate
lamotrigine
phenytoin
carbamyazapine

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72
Q

What is the diagnosis criteria for epilepsy (and thus the indication antiepileptic treratment)

A

2 unprovoked seizures >24 hours apart

not from brain injury, ischemia, encephalitis

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73
Q

What antiepileptic carries the highest risk of teratogenesis?

A

valporate (exclude pregnancy before starting)

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74
Q

Give one eye sign of uncal herniation

A

fixed dilated pupil

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75
Q

Give 6 criteria that must all be fullfilled to confirm brain death

A 
Absence of all brain stem reflexes
Apnoea (w pCO2 >60)
No response to deep central pain
core temp >34C
Systolic BP >90mmHg
No drugs that could simulate brain death
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76
Q

Give four lacuna syndromes (showing a subcortical lacuna stroke)

A

Pure motor stroke (hemiparesis)
Pure Sensory Stoke (paraesthesia)
Ataxic hemiparesis (incoordination)
Clumsy hand - dysarthria (severe dysarthria)

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77
Q

What imaging finding would make you suspicous of a lacuna stroke?

A

No lesion or deep infarct in location inconsistent with clinical picture

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78
Q

What is the IV thrombolysis drug given in ischeamic stroke?

A

Tissue Plasminogen Activator

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79
Q

What is the maxmimum time after stroke that you can give IV thrombolysis?

A

<4.5 hours

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80
Q

What drug should be given as a prophylactic adjunct in stroke thrombolysis?

A

Asprin (300mg)

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81
Q

Give two indications for decompressive surgury after a stroke

A

Malignant MCA syndrome (increasing pressure after MCA occlusion in young people)
Large Cerebellar infarct

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82
Q

Give two primary causes of haemhorragic stroke

A

hypertension

Amyloid angiography

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83
Q

Give four situations where seizures may occur

A

Epilepesy
Alchohol withdrawl
Psychogenic/functional
febrile convulsions

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84
Q

What two forms of epilepsy affecting under 5s causes moderate mental handicap and poor prognosis?

A 
Infantile spams (west's syndrome)
Lennox-Gastaut Syndrome
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85
Q

What peadiatric epilepsey causes symptoms of facial pareasthesia on waking?

A

Benign Rolandic

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86
Q

Give three presentations of juvenille myoclonic epilepsey

A

infrequent morning generalised seizures
Daytime absence seizures
Sudden chocklike myoclonicic seizures

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87
Q

What demographic is affected by juvenille myoclonic epilepsey?

A

teenage girls

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88
Q

Give four possible complications of cataract surgury

A

Endophthalmitis
Post. capsule rupture
Suprachoroidal heamhorrage
post. capsule opacification

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89
Q

What type of glioma has the worst prognosis?

A

Glioblastoma multiforme

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90
Q

Give a prostaglandin analougue used to increased uveosclero outflow in open angle glaucoma

A

Latanoprost

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91
Q

Give a carbonic anhydrase inhibitor used to decrease aqueous humor production in open angle glaucoma

A

acetazolamide

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92
Q

give four drugs / drug classes that can cause hypokalemia

A

Sulphonylurea
SSRI
Tricyclic

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93
Q

Give three functions of CN3

A 
eye movement (failiure results in down and out eye)
parasympathetic innervation (failiure results in fixed dilation)
Levator muscle innervation (failiure results in ptosis)
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94
Q

Give two conditions that would give a +ve RAPD test?

A 
Retinal detatchment
Optic neuritis (eg. in MS)
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95
Q

Give 2 symptoms of a ACA stroke

A

contralateral hemiparesis and sensory loss

lower limb more affected than upper

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96
Q

Give 4 symptoms of MCA stroke

A

contralateral hemiparesis and sensory loss
lower limb more affected than upper
Contralateral homonymous hemianopia
aphasia

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97
Q

Give two symptoms of PCA stroke

A

Contralateral homonymous hemianopia (macular sparing)

Visual agnosia

98
Q

Give two symptoms of stroke effecting PCA branches supplying midbrain (Weber’s syndrome)

A

Contralateral upper and lower limb weakness

ipsilateral CN3 palsy (down and out eye ect.)

99
Q

Give four symptoms/signs of post inferior cerebellar artery infarct - lateral medulla affected
(Lateral medullary/wallenberg syndrome)

A

ipsilateral facial pain and temp loss
contralateral tosa + limb pain and temp loss
ataxia
nystagmus

100
Q

Give four signs/ symptoms of ant. inf. cerebellar artery infarct - lateral pons affected
(lateral pontine syndrome)

A

Ipsilateral facial paralysis and deafness
contralateral torso+limb pain and temp loss
ataxia
nystagmus

101
Q

What is the classic sign of basillar artery infarction

A

Locked in syndrome

102
Q

What is the only focal seizure that can cause loss of conciousness?

A

Temporal lobe (complex partial seizure)

103
Q

Give 5 auras of temporal lobe seizures

A 
Epigastric sensation
Fear/elation
autonomic (flushing, salivation, palpitations)
De ja vu
olfactory hallucination
104
Q

what spinal tract is most likely affected in B12 deficiency?

A

Doral columns (vibration and proprioception)

105
Q

Give 2 blood findings in B12 deficeincy

A

Lowered Hb
Increased MCV
(megaloblastic aneamia)

106
Q

Give 4 causes of posterior cord syndrome

A

B12 deficiency
Syphylis
HIV Myelopathy
Demylination

107
Q

Which tract crosses over at the level in lateral cord syndrome and what is its function

A

spinalthalamic (pain and temp sensation)

108
Q

What is the typical pattern of distribution of sensory loss in central cord syndrome?

A

Cape like distribution

109
Q

Give 4 causes of central cord syndrome

A

Syringiomyelia (expansion of central canal)
Intrinsic cord tumor
Demyelinationn disease
Trauma

110
Q

What are the nerve roots of the bicep reflex?

A

C5-C6

111
Q

what are the nerve roots of Tricep reflex

A

c6-C7

112
Q

What are the nerve roots of Knee reflex

A

L2-L4

113
Q

What are the roots of the ankle reflex?

A

S1-S2

114
Q

Give two symptoms of focal nerve compression

A

Tempory pareasthesia

Loss of sensation

115
Q

What is the typical pattern of sensory loss in generalised periferal neuropathy eg. diabetic neuropathy

A

Glove and Stocking

116
Q

Give four symptoms of generalised periferal neuropathy (eg. diabetic neuropathy)

A

Glove and stocking distribution
Gradual onset
Affecting distal limbs (decreased weakness and sensation)
Loss of reflexes

117
Q

How do you test median nerve?

A

Thumb abduction (away from palm)

118
Q

How do you test ulnar nerve?

A

Finger abduction and aduction (interossei)

119
Q

How do you test common peroneal nerve?

A

Ankle dorsiflexion

120
Q

How do you test sciatic nerve?

A

Knee flexion

121
Q

How do you test tibeal nerve?

A

Ankle plantar flexion

122
Q

How do you test femoral nerve?

A

Knee extension/hip flexion

123
Q

What is the hallmark symptoms of myesthenia gravis?

A

Fatiguability

no sensory loss

124
Q

What are the two hallmark signs of ALS?

A

Mix of upper and lower MN symptoms

No sensory loss

125
Q

What ALS subtype has the fastest progression?

A

Bulbar onset

126
Q

Give 5 symptoms of behavioral variant frontotemporal dementia?

A 
v early loss of insight
disinhibition
loss of empathy and reactivity
sterotyped/conpulsive behavior
becomes completely self centered
127
Q

Give two disgnosing features of semantic dementia variatn of language variant frontotemporallobe dementia

A

Loss of single word meaning

Repetition is preserved

128
Q

GIve two features of non fluent aphasia variant of frontotemporal lobe dementia

A

Effortful, hesitant speech

Preserved single word meaning

129
Q

Give four symptoms of hyperureamia

A

Asterixis
confusion
incoherence
hallucination

130
Q

What drugs is used to treat organophosphate poisoning

A

Atropine

131
Q

What is the triad of Wernikes-Korsakoffs syndrome?

A

Ataxia
Ophthalmoplegia
Confusion

132
Q

What are you looking for on blood test for limbic encephalitis?

A

Anti-NMDA receptor antibodies

133
Q

What condition is limbic encephalitis commonly associated with?

A

Ovarian Teratoma

134
Q

What type of episodes are typical of vestibular neuritis (labyrinthitis)

A

Single, intense lasting a few days

135
Q

Give three vestibular suppressants

A

Benzodaizepines
Meclonide
Proclorperazine

136
Q

Give three antiemetics

A

Promethazine
Metoclopramide
Prochlorperazine

137
Q

What are the episodes like in BPPV

A

seconds to mins, provokes by specific head movements

138
Q

What are the episodes like in Meniere’s

A

Occur in clusters, each episode lasting 30 min to 1hr

139
Q

How do you treat BPPV?

A

Epley Maneuver

140
Q

What is the classic prodrome of meniere’s?

A

Aural fullness

141
Q

What are the diagnosic criteria for MS

A

Two more more episodes plus objective clinical evidence of two or more lesions

142
Q

Are MS symptoms UMN or LMN lesions

A

UMN

143
Q

Give 7 signs / symptoms of optic neuritis

A 
Loss of colour vision (particularly red)
Smudge across vision
decreased acuity
Central scotoma
RAPD
pain on movement
Swollen optic disk on fundoscopy
144
Q

Give 2 signs/ symptoms of internuclear ophthalmoplegia

A

When Pt looks away from affected side, the inward movement of the affected eye is impaired
Pt reports double/blurry vision when this happens

145
Q

How do you acutely manage MS relapse (2 steps)

A

treat any concomittant infection that may have triggered it (if applicable)
Oral Methyprednisolone

146
Q

Give three symptoms of keratitis

A

Unilateral painful reed eye
Photophobia
Forign body sensation

147
Q

Give three signs of keratitis

A

conjuctival injection
white corneal infiltrate (over the ulcer)
hyponon

148
Q

What topical Abx should you give for keratitis?

A

Ofloxacin

149
Q

What is the cut off time for TIA to be classified as a stroke

A

24hr

150
Q

How do you differentiate migraine aura from epilepsey?

A

Both have positive symptoms
Epilepsey spreads (eg. visual to language) over seconds
Migraine Aura spreads over mins (spreads slower)

151
Q

Give three signs of parietal lobe lesion

A

Apraxia (contra hemiparaesis)
Inf. homonymous quadrantanopia
Sensory inattention

152
Q

Give symptoms of temporal lobe lesion

A

Neologism w fluent speech
sup. honomymous quadrant anopia
auditory agnosia

153
Q

Give one symptom of occiptal lobe lesion

A

vision changes (homonynous hemianopia)

154
Q

Give three symptoms of frontal lobe lesion

A

Non fluent speech
Disinhibition
anosmia

155
Q

Inn which lobes do the optic radiations from the sup and inf quadrants of the visual feild run?

A

Sup = temporal
inf = parietal lobe
(up is down!)

156
Q

What visual feild defect is a paretal lobe lesion likely to cause?

A

Homonymous inf. quadrantanopia

157
Q

What type of visual field defect is a temporal lobe lesion likely to cause?

A

Homnymous superiorquadrantanopia

158
Q

Where is brocas and Wernickes areas found and an what is their blood supply

A

Brocas = frontal lobe
Wernickes = temporal lobe
Both supplied by MCA

159
Q

Give four features of Wernickes Aphasia

A

Fluent speech
Neologism/word substituion
impaired comprehension (Receptve aphasia)
preserved repetition

160
Q

Give three features of Brocas aphasia

A

Non fluent, laboured speech
Preserved comprehension
Impaired repetition

161
Q

What is conduction aphasia

A

lesion of arcuate fasiculus connecting Wernickes to Brocas area
only presenting feature is impaired repetition (commprehension preserved and speech is fluent)

162
Q

Give two features of proliferative diabetic retinopathy

A

Neovascularisation at disk

Tractional retinal detachment

163
Q

Give three features of nonproliferative diabetic retinopathy

A

Microanursysms
Dot heamhorrages
Cotton wool spots

164
Q

Give two aneasthetics that may be given as eyedrops if examination of a forign body is painful

A

Proymetacaine

tetracaine

165
Q

What may white corneal infiltrate in corneal forign body pt be a sign of?

A

Bacterial Keratitis -> refer to ophthalmology

166
Q

How do you manage superfiscial corneal FB?

A

Topical aneastheisa (Promethacaine, Tetracaine)
Remove w moist cotton bud
1 week of chloamphenicol drops (Abx)

167
Q

What can missed ferous intraoccular FB cause as a complication

A

Siderosis (retinotoxic ions leak into eye) - irreverside retinal function loss

168
Q

Give 4 signs of penetrating eye injury

A

visible entry would on cornea or sclera
reduced red reflex
ocular inflammation
distorted pupil

169
Q

What imaging modality is contraindicated if metal intraoccular FB is suspected

A

MRI (magnetic feild may move FB through eye)

Use XR or CT if high index of suspicion

170
Q

What is commitio Retinae

A

Retinal odema as a result of blunt trauma

171
Q

What type of chemical injury is most destructive to the eye

A

alkali

172
Q

What is the management for chemical eye injury

A

immediate copius irrigation for 30 mins

check pH after 10 mins then continue irrigating

173
Q

What is the conjunctival presentation in alkalli eye injury

A

Appears deceptively white and uninflammed as alkali closes the conjunctival vessles

174
Q

What is the first line immediate management for traumatic opticneuropathy

A

Urgent CT to rule out displaced orbital fracture and intracranial heamhorrage

175
Q

What is the most common orbital fracture

A

Blowout fracture (orbital floor)

176
Q

Give 5 signs of an orbital floor (blowout) fracture

A 
sunken orbits
vertical diplopia (restricted eye movement)
eyelid swelling
nose bleed
loss of cheek and upper gum sensation
177
Q

What is the most common cause of an orbital fracture

A

punch!

178
Q

What is enophthalmos?

A

Herniation of the orbit downward into maxially sinus

179
Q

What xray findings will be seen in a orbital blowout fracture

A

Fluid level (blood) in maxillary sinus

180
Q

What 2 situations would you refer an eyelid lacteration to ophthalmology?

A

lid margin involvement

Nasolacrimal duct involvement

181
Q

In an orbital fracture, pain is worst looking in which direction?

A

Upwards

182
Q

How do you manage B12 deficincey

A

IM hydroxocobalamin if no neuroinvolement

give B12/folate first to prevent precipitating spinal cord degeneration

183
Q

What Investigation can be used to confirm difference between AION and Giant Cell Arteritis

A

ESR: Only giant cell has raised

184
Q

What is the characteristic finding of retinal artery occlusion on fundoscopy?

A

Cherry red spot at center of Macula

185
Q

What is the characteristic finding of retinal vein occlusion

A

cotton wool spots

186
Q

What are the three symptoms of retinal detatchment?

A

Flashing lights
Floaters
Visual Field loss

187
Q

What part of Hx in acute painful red eye vision loss may ake you suspect acute closed angle glaucoma?

A

Halos around lights

188
Q

What is the subtype of diabetic retinopathy with neovascularisation at the disk?

A

Proliferative (the worse one! May result in vision loss through vitreous heamhorrage from the new vessles)

189
Q

What is the typical pattern of visual field loss in open angle glaucoma?

A

Starts at periferal vision

Later gets Arcuate Scotoma (around macula)

190
Q

Give 4 post operative risks of cataract surgury

A

Endophthalmitis
Posterior capsule rupture
Suprachoroidal heamhorrage
Post capsule opacification (residual lens cells proliferate and opacify the new lens)

191
Q

Give the 2 differentiating factors of age related macular degeneration as seen on fundoscopy

A

Drusen (yellow spots on retina)

Mottled appearing retina (due to areas of hyper and hypopigmentation)

192
Q

Give three signs of wet age related macular degeneration not found on dry

A

grey/green lesion
yellow exudates
retinal heamhorrage

193
Q

What invesetigation do you do for wet age related macular degeneration

A

Flourescein angiography (to identify areas of microvascular leakage)

194
Q

What two investigations can be used to spot a corneal lesion/defect in diagnosing bacterial keratitis?

A

Flourscein staining

Slit lamp

195
Q

How may you differentiate Keratitis with uveitis

A

Keratitis may have a corneal lesion as seen on flourscein staining ( as its a corneal problem)
Uveitis may have a small and irregularly shaped pupil (as its an iris problem)

196
Q

How do you differentiate bacterial and viral conjunctivitis?

A

Bacterail : mucopurulent discharge

Viral : Watery discharge (also has follicular conjunctivitis)

197
Q

What do you consider chylamydial conjunctivtis?

A

Bacterial conjunctivits (mucopurulent discharge) lasting >3 weeks

198
Q

How do you differentiate subconjunctival heamhorrage with episcleritis (both have localsied eye redness)

A

Episcleritis has acute onset grittiness

199
Q

What is chalazion?

A

chronic painless, mildly tender, round eyelid swelling

common with acne or ecsema (seborrheic dermatitis)

200
Q

What is tonic pupil (holmes adie pupil)

A

abnormally large due to parasympathetic denervation. ‘near’ constriction is better than light constriction

201
Q

Give 4 causes of pathologically dilated pupil

A

Tonic pupil (holmes-adie pupil)
CN3 palsy
Traumatic mydriasis
Iris rubeosis

202
Q

Which cranial nerve innervates levator muscle

A

CN3

203
Q

what is presbyopia?

A

Age related loss of accomdation ability of the eye

204
Q

+ve or -ve lens needed for hypermetropia (long sighted)?

A

+ve

205
Q

+ve or -ve lens needed for myopia?

A

-ve

206
Q

What is the main sign of keratocornus?

A

Cornea becomes cone shaped

207
Q

What is a tropia strabismus?

A

Eyes misallgined and cant be corrected by effort

208
Q

What is a phoria strabismus?

A

eyes misalligned but can be corrected through concious effort

209
Q

Give 4 symptoms/ signs of ideopathic intracranial HTN

and state the demographic it typically affects

A

Head ache
Blurred vision
Papilloedema
CN 6 palsy (Pt cant look outwards toward affected side)

210
Q

What is the tinnel test for carpel tunnel syndrome

A

Tap at palmar crease and it causes pareasthesia

211
Q

What is the Phalens test for carpel tunnel syndrome

A

Hand held flexed under gravity. Produces pareasthesia

212
Q

Give 4 signs/ exam findings in carpel tunnel syndrome

A

Index sensation decreased more than little finger
sensory impariment splits ring finger
weak thumb abduction
thenar wasting

213
Q

Give 3 symptoms of carpel tunnel syndrome

A

pareasthesia for a few mins when waking at night or gripping
weakness of thumb or hand
wrist pain

214
Q

How do you test radial nerve motor function

A

Extend thumb IP joint under resistence

215
Q

How do you test median nerve motor function

A

thumb abduction

216
Q

How do you test the ulnar nerve motor

A

abduct fingers against resistence

217
Q

If Bells palsy Pt can frown, is it upper or lower motor neurone?

A

Upper

218
Q

Give 1 differentiating factors between demylianting and axonal periferal neuropathy

A

Axonal - small amplitude, normal velocity

demylnating - slow velocity

219
Q

What is the main symptom of length dependant poly neuropathy

A

Starts in toes and ends up as glove and stocking distrbution

220
Q

What is the chronic form of Guillian Barre called

A

Chronic Inflammatory Demylinating Polyradiculoneuropathy

221
Q

Give the 3 criteria to diagnose essential tremor

A

isolated bilateral action tremor
>3 years duration
absence of other neurological signs

222
Q

Give the 2 main drugs used to treat severe essential tremor

A 
Propanolol
Primidone (antiepileptic)
223
Q

Give a feature of the tremor in dystonic tremor syndrome

A

V irregular and jerky

224
Q

Give 6 drugs which may be used for migraine prophylaxis

A 
Metoprolol
Topiramate (antiepileptic)
Valporate
Mg
Candesartan (ARB)
Botox
225
Q

When is migraine preventative medication indicated?

A

> 8 migraine days in a month

226
Q

Give 2 forms of acute treatment for cluster headache

A

100% O2

triptans

227
Q

Give three drugs that may be used for preventative treatment of cluster headache

A

Verapamil
topiramate
Lithium

228
Q

give 2 features of conduction aphasia (arcuate fasiculus stroke)

A

Fluent speech
Repetition impaired
(doesnt fit picture of either wernickes or brocas aphasia)

229
Q

Giver the triad of symptoms of korsakoffs amneisa/syndrome

A 
Anterograde amnesia (cant form new memories)
Reterograde amnesia (loss of old memories)
Confabulation (making up new memories)

in addition to the wernickes triad

230
Q

What is monoccular diplopia and give 3 causes?

A

Persists when one eye is closed

Corneal scarring
uncorrected refractive error
cataract

231
Q

What is binocular diplopia and give 5 causes

A

Only exists when both eyes are open

Strabismus
Cranial nerve palsy
eye displacement within socket (eg tumor)
Extraoccular muscle disease
thyroid eye disease
232
Q

Give 3 signs of trochlear nerve palsy?

A

aquired diplopia
eye turns upward as it looks towards nose
head tilted away from lesion side

233
Q

What course of action should be taken in pediatric leucocoria?

A

Urgent Ophthalmolgy referal

234
Q

What preterm babies should be screened for retinopathy of prematurity?

A

<1500g

<32 weeks

235
Q

what is the hallmark symptom of limbic encephalitis?

A

Short term memory loss (but may have seizures ect.)

236
Q

give 6 features of function seizure (to differentiate from epileptic seizure)

A 
trashing with little spasticity
eyes forced closed and resist opening
lasts over 5 mins (epilepsey last <3)
Retains some awareness despite looking like a generalised seizure
fast resp rate (ceases in epilepsy)
side to side head movement
237
Q

Give 4 symptoms/signs of ideopathic intracranial hypertension

A

dull bilateral fronto/retrorbital headache
cough/valsalva/exercise makes it worses (raised pressure headache)
decreased visual acuity and visual field defects
Papilloedema

238
Q

What three drugs can be used for cluster headache prevention

A

Topiramate (antiepileptic)
Verapamil (Ca channel blocker)
lithium

239
Q

What is an ictal syncope?

A

Seizure affecting area of brain contolling blood pressure

syncope superimposed on top of seizure

240
Q

Give 4 features of a temporal lobe focal seizure?

A

Staring

241
Q

Give 2 features of anti epileptic drug hypersensitivity reactio, give a risk factor and what drug is most likely to cause it?

A

multiorgan syndrome and a rash
Han chinese predisposition

Carbamazapine

242
Q

Give three negative consequences to fetus of maternal seizures

A

small for gestational age
Fetal heart rate deccelerations (v serious)
decreased verbal IQ

Congition, Movement and Senses (1 decks)

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