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Neurology Y3 JC > Conditions > Flashcards

Conditions Flashcards

1
Q

You want to visual the bone structure of the skull, do you use a CT or MRI?

A

CT it has better bone visual than MRI but not good for soft tissue

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2
Q

You’re doing an MRI and want to visualise a potential occlusion of a cerebral artery. Which mode would you use? T1 or T2?

A

T1- good for fat and 4M’s methemoglobin ( haematoma), mineral deposition (Ca, mg, mn), melanin, musch (proteinaceous fluid)

T2 is more for looking for fluid likein oedema

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3
Q

Patient has an acoustic schwannoma. What classic picture will be obesrved on their CT?

A

Ice cream cone from internal acoustic meatus

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4
Q

Patient presents with a blown pupil what is the a likely pathology ?

A

Uncal transtentorial herniation that causes 3rd cranial nerve palsy

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5
Q

Patient has been diagnosed with a grade 1 astrocytoma. What is the prognosis of this?

A

Benign and also known as pilocytic. With resection full recovery

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6
Q

Patient has been diagnosed with a grade 2 astrocytoma. What is the prognosis of this?

A

NOT benign, gets worse with time, treat with surgery and radiotherpaoy and chemo. This is likely to recur. And carries a poorer prognosis if >50yrs. With added radio and chemo there is increased progression free survivial

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7
Q

Patient has been diagnosed with a grade 3/4 astrocytoma. What is the prognosis of this?

A

This is malignant and regardless of treatment there will be death within 14months.
If want to get to 14months then need radio and TMZ is an oral chemo that increases survival by 2 months

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8
Q

You suspect a brain tumour and do bloods to look for specific proteins that would indicate this. What are these?

A

AFP
HCG
LDH

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9
Q

Man presents with painful headache that woke them up that gets worse with coughing, difficulty walking, and slurred speech. On examination they have nystagmus, hyptonia, inability to supinate/pronate his hands and tap them together quickly. What is the likely diagnosis

A

Tumour of the brain

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10
Q

Patient has undergone neurosurgery to remove a tumour. There has been associated seizures with his tumour. What must you advise him post surgery?

A

He CANNOT DRIVE for 1 year and must inform the DVLA

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11
Q

Women with a previous breast cancer presents with seizures and headaches. You suspect a brain tumour. Which type is most common in this group of people?

A

Meningiomas

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12
Q

Patient presents with rotatory nystagmus, lack of ability to upgaze, you ask him to follow your finger and when you bring it closer for accomodation the patients eyes bulge out at you. What is his likely diagnosis

A

Pineal tumour

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13
Q

Patient presents with cafe au lait patches, axillary freckling, and fleshy nodules of the skin. He on examination has tachycardia, sweating and headaches. What is the likely diagnosis?

A

Neurofibromatosis type 1 with complication of phaeochromocytoma

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14
Q

What is the genetic makeup of duchenne muscular dystrophy?

A

X-linked recessive with a mutation in the protein for dystrophin

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15
Q

Young boy of 4 years presents as he was unable to walk until 18months and is now toe walking, and when asking him to get up from sitting he has to walk up his hands. What is the likely diagnosis?

A

Duchenne muscular dystrophy

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16
Q

What are the investigations for a patient with potential duchenne muscular dystrophy?

A

Bloods for CK
Electromyography, molecular genetic testing
Muscle biopsy

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17
Q

What are the odds of a brother of duchenne muscular dystrophy to develop the condition?

A

50%

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18
Q

What is the genetic defect that causes Huntington’s disease?

A

It is an autosomal dominant trait causing repeating code of CAG (which codes for glutamine)

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19
Q

What is the age group that is likely to develop huntingtons dease

A

30-50yrs

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20
Q

35 year old presents with a low mood and has been finding he’s become more irritated with things. It has lasted the past few months, now he also has been experiencing some uncontrolled movements of his arms and legs that some of his friends have referred to as dancing. What is thelikely diagnosis?

A

Huntingtons disease

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21
Q

What is the treatment for huntington disease?

A

There is no treatment it is progressive until death

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22
Q

What is the inheritance pattern of spinal muscular atrophy?

A

Autosomal recessive

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23
Q

What is the pathology behind spinal muscular atrophy

A

Progressive loss of anterior horn cells in the spinal cord and brainstem nuclei due to mutation in the SMN1 gene on chromosome 5

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24
Q

Mutation of what gene makes it more likely to develop alzheimers disease?

A

Apolipoprotein E people with this mtuation have a 55% chance of developing this condition by the time they are 80

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25
Q

What epidemiological group is most likely to develop alzheimers

A

Downsyndrome

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26
Q

What epidemiological group is likely to get a streptococcus pneumoniae infection leading to pyogenic meningitis?

A 
Hospitalised patients
CSF skull fructures
Diabetics
Alcoholics
Asplenic
Cochlear implants
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27
Q

What bug that wouldnt cause infection in the healthy populations is likely to cause a meningitis infection in a HIV patient?

A

Cryptococcus neoformans

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28
Q

What group of patients are likely to get listeria infections leading to meningitis?

A

Immunosuppressed

Neonates

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29
Q

A known alcoholic patient has come in with a headache and fever. You do a lumbar puncture and it shows high neutrophils in the CSF. What is the likely diagnosis?

A

Pyogenic meningitis with likley streptococcus pneumoniae or listeria

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30
Q

What are the four symptoms that distinguish a patient with meningitis?

A

Headaches, fever, neck stiffness and change in mental state

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31
Q

Patient has suspected meningitis in the hospital setting. What is your treatment?

A

Ceftriaxone IV 2g BD
&
Dexamethasone IV 10mg qds over 15-20mins

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32
Q

You suspect a meningitis by listeria what is your treatment?

A

If not sure its definitely listeria then give

Ceftriaxone IV 2g BD + amoxicillin IV 2g

The amoxicillin is to treat the listeria

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33
Q

You suspect a patient has meningitis. They have had recent travel to canada. What is your treatment?

A

Ceftriaxone IV 2g BD
Dexamethasone IV 10mg qds over 15-20mins

&&&&&&&&
Vancomycin as pneumococcal resistance is high in canada

34
Q

What is the most common bug to cause aseptic meningitis?

A

Herpes simplex virus

35
Q

Unvaccinated child presents with their mom with sudden onset confusion, agitation, headaches and had a seizure this morning. She has a GCS of 13. What is the likely diagnosis?

A

Encephalitis- sudden onset, non vaccinated

36
Q

What is the treatment for encephalitis by herpes simplex virus?

A

IV aciclovir (dosage depends on age if >12yrs then 10mg/kg for 14days)

37
Q

What are the drug levels on the WHO pain ladder?

A

1- NSAIDs and/or paracetamol
2- weak opiod
3- strong opiod

38
Q

Is codeine a strong opiod, weak opiod or NSAID

A

Codeine is a weak opiod

39
Q

Is oxycodone a strong opiod, weak opiod or NSAID

A

Strong opiod

40
Q

Is indometacin a strong opiod, weak opiod or NSAID

A

Indometacin is a NSAID

41
Q

Is tramadol a strong opiod, weak opiod or NSAID

A

Tramadol is a weak opiod

42
Q

Is hydromorphone a strong opiod, weak opiod or NSAID

A

Hydromorphone is a strong opiod

43
Q

In what condition must you avoid prescribing tramadol?

A

In epilepsy you cant give tramadol

44
Q

What drug would you give to reverse a patient with opiod toxiity?

A

Naloxone

45
Q

What are some of the general side effects of opiod use?

A

Orthostatic hypotension
Nasuea, vomiting, constipation, increased intrabillary pressure
Confusion, euphoria, dysphoria, hallucinations, dizziness

46
Q

What is the treatment for neuropathic pain?

A

Gabapentin and pregabalin
Amitryptline, nortyptiline
Carbamazepine

47
Q

Man presents with a single abscess in the brain what are some preceding conditions/pathologies that could cause this?

A

Chronic otitis media
Mastoiditis
Skull fractures
Other penetrating injury

48
Q

Man presents with shuffling gait, resting tremor and when he starts walking feels it takes a long time to get going. He has just been started on a new drug, what is this likely to be

A

Metoclopramide

Antipsychotic drugs can cause parkinsons features

49
Q

What are some of the classic features of a parkinsons patient on examination?

A

Bradykinesia by crab claws and small amplitude

Increased tone by cogwheel rigidity and leadpipe rigidity.

50
Q

22 year old female presents acutely to the GP with spinning flashes and pain on the right side of her head. She describes it as throbbing and finds the light hurts her eyes. She is approaching her period. What is the likely diagnosis?

A

Migraine

51
Q

What are some of the triggers for migraines

A

Chocolate, cheese, alcohol, stress, lack of sleep, hormones and exercise

52
Q

What are the requirements in a patient for prescribing prophylaxis for migraines?

A

Must have more than 3 attacks a month or very severe attacks.
They must then trial it for a minimum of 3 months before switching to other prophylaxis

53
Q

What is the acute management for migraine?

A

NSAIDS (aspirin 900mg, naproxen 250mg, ibuprofen 400mg)

54
Q

Patient presents with unilateral headache around his eye that has been occurring 5 times over the last hour. They last seconds at a time. On exam he has red watery eyes, nasal congesition and a runny nose. What is the likely diagnosis?

A

SUNCT (a type of trigeminal cephalgia)

55
Q

Male smoker presents with unilateral headache that is a 10/10 for pain, it lasts 20minutes and then relieves on its own but comes and goes 5 times a day. This has been occuring for the last 2 weeks. You send him for an MRI which comes back normal. What is the likely diagnosis

A

Cluster headache (type of trigeminal cephalgia)

MOST COMMON IN MALE SMOKERS

56
Q

Women of 40 yrs presents with severe headache on one side of her head that comes on all of a sudden. She also gets pain when looking at light and doesnt like loud noises during this time. These last up to 45 minutes and happen at least 10 times a day. What is the likely diagnosis?

A

Paroxysmal hemicrania (trigeminal cephalgia)

Common in elderly women

57
Q

Women presents with a headache when she wakes that improves with the day, and states that if she stand up suddenly everything goes black. On examination she has an enlarged blind spot and optic disc swelling, and a BMI of 30. What is the likely diagnosis?

A

Idiopathic intracranial hypertension

Common in females who are obese, treatment is to lose weight unless someone is going blind then will need a shunt

58
Q

Women 70yrs presents with severe stabbing unilateral pain that lasts no longer than a minute that happens 50times a day. She feels it can be brought on when shes doing her makeup or when its windy. Her ESR is normal and MRI is normal. What is the likely diagnosis?

A

Trigeminal neuralgia

Triggered by touch of the face by wind, chewing, swallowing, touching face. Though to be due to the trigeminal nerve touching a blood vessel

59
Q

There is a blockage of the middle cerebral artery. What is the paitent likely to present wtih?

A

Weakness in the contralateral face and arm

60
Q

What is the treatment options of an acute stroke?

A

Aspirin 300mg ASAP unless going to be thrombolysed
Thrrombolysis (TPA) given IV up to 4.5hrs after a stroke.
Thrombectomy with interventional radiology

61
Q

Who is more likely to get a subarachnoid haemorrhage?

A

Those with berry aneurysms, smokers, kidney disease, collagen gene abnormalities, hyperyension

62
Q

Man presents with weakness and tingling in his legs and hands. Feels its been getting worse. He thinks he accidentally ate some undercooked chicken. What is the likely diagnosis?

A

Guillian barre syndrome; glove and stocking distribution and can be caused by campylobacter in undercooked poultry

63
Q

Man presents with gradual hand grip weakness with him now dropping things, unable to do his laces and he has tingling in his fingers. He has a wide based gait. On exam he is hoffman’s test positive.what is the likely diagnosis?

A

Cervical myelopathy

64
Q

Man presents with his wife as continually kicking her during the night in the early hours of the morning. He is known to have parkinsons. What condition is he likely to have

A

Parasomnia (REM type)

65
Q

Man presents with his wife as she’s worried about him sleepwalking and he grinds his teeth in his sleep. This occurs during the early hours of the morning.. what is the likely diagnosis?

A

Parasomnia (Non REM)

66
Q

15 year old girl presents with daytime sleepiness that is uncontrollable during meals where she sometimes will fall into her food. And finds during a movie if she gets really scared she will pass out. What is the likely diagnosis?

A

Narcolepsy

Cataplexy is loss of muscle tone during extreme emotions (anger, laughter, sexual contact)
Daytime sleepiness

67
Q

How would you diagnose narcolepsy

A

Overnight polysomnography

Lumbar puncture for low hypocretin level

68
Q

What are some of the risk factors for developing MS?

A

Females, vitamin D deficiency, smokers, previous infectious mononucleosis (EBV)

69
Q

What are some of the conservative methods of treating hydrocephalus?

A

Keep head in midline
Loosen clothing aroundneck
Head of bed at 30-45degrees
Mannitol to lower fluid

70
Q

What is the normal score for an addenbrooke’s cognitive assessment?

A

Score out of 100 where >88

71
Q

What is the score for a mild cognitive impairment on addenbrooke’s cognitive assessment?

A

<75-90

72
Q

A subfalcine herniation is likely to cause what symptoms?

A

Loss of sensory and motor function in the leg

73
Q

A tentorial (uncal) herniation is likely to cause what symptoms?

A

CN3 impairment so have eye fixed down and out with no accomodation or pupil constriction

74
Q

A cerebellar (tonsilar) herniation would cause what symptoms?

A

Respiratory abnormalities, neck stiffness, coma,

75
Q

Ataxic gait, dementia and urinary incontinence are all signs of what condition?

A

Normal pressure hydrocephalus (hakims triad)

76
Q

Undercooked chicken, pain and tingling in arms and legs. Diagnosis

A

Guillian barre syndrome

77
Q

Man dropping things from his hands, tingling fingers, poor hand grip, loss of proprioception on exam with wide based gait. Hoffmans test positive. Diagnosis?

A

Degenerative cervical myelopathy

78
Q

How is hereditary neuropathy (charcot-marie tooth disease) inherited?

A

Dominant autosomal

Motnhs to years get high arched foot, thin lower legs, clawing of hands, freq sprained ankles

79
Q

Boxer was knocked out in a fight then woke again fine, he now presents in A/e with a headache vomiting and pupil dilation. Likely diagnosis?

A

Extradural haematoma

Loss of consciousness then lucid period then deterioration.

Due to rupture of middle meningeal artery

80
Q

Elderly man fell knocked unconscious, admitted to A/e witha. Glasgow coma score of 8. Likely diagnosis

A

Suddural hamatoma

Looks like a half crescent moon

81
Q

Oligoclonal bands in CSF and IgG antibodies. Diagnosis

A

Multiple sclerosis

82
Q

Treatment multiple sclerorsis

A

Interferon beta

Neurology Y3 JC (8 decks)

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