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conditions Flashcards

1
Q

pathophysiology behind Parkinson’s

A

loss of dopaminergic neurons in substantia nigra

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2
Q

if someone presents with Parkinson’s and autonomic dysfunction eg pissing themselves or postural hypotension what is diagnosis

A

multi system atrophy

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3
Q

is the tremor in Parkinsons symmetrical or asymmetrical

A

asymmetrical

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4
Q

how is rigidity distinguished from spascity

A

rigidity is velocity dependent

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5
Q

what test is used to identify bradykinesia in Parkinson

A

tap index finger and thumb together should have decreased amplitude

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6
Q

what scan helps to distinguish Parkinson’s from dystonia

A

DAT scan

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7
Q

what test should be done in a younger patient presenting with Parkinson’s symptoms

A

DAT, MRI , bloods as Wilsons disease can cause Parkinsonism

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8
Q

what is motor neurone disease

A

cluster of degenerative diseases assoc with selective loss of motor neurons in either motor cortex, CN nuclei and anterior horn of spinal cord

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9
Q

what kind of MND is most common

A

Amyotrophic lateral sclerosis ALS or Lou Gehrig

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10
Q

median survival after onset of MND

A

3 years

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11
Q

average age of diagnosis of MND

A

64 years

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12
Q

how is MND most likely to present

A

muscle weakness most commonly upper limb. may be bulbar onset

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13
Q

describe ALS and classic symptoms

A 
mixed upper and lower motor neurone deficit 
weak grip and arm abduction 
stumbling gait 
foot drop 
drooling and dysarthria
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14
Q

what drug can be given in MND to prolong life

A

riluzole

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15
Q

what criteria system is used in MND

A

EL ESCORIAL

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16
Q

what additional medication is commonly given in MND

A

anticholinergic for drosling and baclofen for muscle spasms and cramps

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17
Q

what kind of dementia is MND associated with

A

frontotemporal dementia

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18
Q

what would distinguish MND from myasthenia graves

A

and doesn’t affect the eyes

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19
Q

what would distinguish MS from MND

A

no sensory or sphincter involvement

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20
Q

what is syndenhams chorea

A

chorea seen In children after infection (strep throat )

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21
Q

what is a stroke defined as

A

sudden disturbance of cerebral function of vascular origin that causes death or lasts 24 hours

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22
Q

whats more likely a haemorrhage or thrombosis embolic stroke

A

thrombosis embolic

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23
Q

what artery is most commonly affected in thrombotic cerebral infarction

A

MCA

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24
Q

where is atheroma most likely to originate from in emboli cerebral infarction

A

ICA or aortic arch

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25
Q

what is charcot Marie foot also known as

A

hereditary sensory motor neuropathy

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26
Q

high arched foot, champagne bottle deformity and lower limb distal muscle weakness

A

charcot marie tooth

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27
Q

early viral exposure to what may predispose to MS

A

EBV

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28
Q

when does MS present

A

30-40s

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29
Q

F:M ratio of MS

A

3:1

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30
Q

describe progressive relapsing form of MS

A

slowly gets worse and has flair ups. After flair up is worse than prior to it

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31
Q

clinical features of MS

A

optic neuritis , pyramidal dysfunction (weakness) , sensory symptoms, lower urinary tract dysfunction, cerebella r and brain stem features, cognitive impairment

32
Q

symptoms of optic neuritis

A

painful eye movements and visual loss that resolves

33
Q

how many episodes have to have occurred for diagnosis of MS

A

minimum 2 episodes

34
Q

what is seen in CSF in MS and not in serum

A

IgG oligoclonal bands

35
Q

what test may be used to diagnose MS

A

MRI, CSF, neurophysiology and bloods - PV, FBC CRp should all be normal

36
Q

what is first line treatment for remitting relapsing MS

A

tefidera and interferons and Glitiramer Acetate

37
Q

what is second line treatment for MS

A

fingolimed/cadrabine and monoclonal antibodies

38
Q

what is seen macroscopically in the brain in MS

A

plaques of inflammation - well demaricated- ill defined if active

39
Q

a GCS of less than what on initial assessment would indicate CT within an hour

A

<13

40
Q

a CT within 1 hour of head injury would be indicated if how many episode of vomiting

A

> 1

41
Q

what traumatic haematoma would be suspected if they present with a lucid interval

A

extradural haematoma

42
Q

what neurotransmitter is released in excitotoxicity and subsequently what ion

A

glutamate and calcium

43
Q

who can certify brainstem death

A

2 doctors one must be a consultant

44
Q

what immune cells are activated in MS

A

t-cells

45
Q

are gliosis seen in MND

A

yes

46
Q

what protein does CAG code for

A

glutamine

47
Q

below what age is Alzheimers classed as early onset

A

<65

48
Q

what genes are implicated in Alzheimers

A

Amyloid precursor protein (APP)

presnilin 1 and 2

49
Q

what dementia is seen in downs syndrome

A

alzheimers

50
Q

what are neuritic plauques formed of in Alzheimers

A

A-beta amyloid core and astrocyte peripherally

51
Q

what protein is dysregulated in Alzheimers

A

tau

52
Q

what is seen microscopically in Alzheimers

A

neurofibrillary tangles and neuritic plaques

53
Q

what does amyloid precursor protein cleave ?

A

a-beta (aka b-amyloid protein)

54
Q

what chromosome is the APP gene found on

A

21

55
Q

what apoliipoportine is associated with Alzheimers

A

e4

56
Q

what area of the brain atrophies 1st in Alzheimers

A

hippocampus found in temporal lobe

57
Q

what is a Lewy body

A

intracytoplsmic eosinophilic inclusion with dense core surrounded by alpha-synuclei fibrils

58
Q

describe features of Lewy body dementia

A

progressive dementia along with hallucinations and fluctuating levels of attention and cognition

59
Q

what neurotransmitter is release at NMJ

A

ACh

60
Q

name 2 pre-synaptic disorders of the NMJ

A

botulism and Lambert eaton myasthenia syndrome

61
Q

describe pathophysiology of myasthenia gravis

A

autoimmune antibodies against post synaptic Each receptor

62
Q

conditions of what other organ are seen in myasthenia graves

A

thymus abnormalities

63
Q

describe Lambert eaton

A

antibodies to pe-synpatic calcium channel

64
Q

what carcinoma is associated with Lambert eaton syndrome

A

small cell carcinoma

65
Q

treatment of Lambert eaton

A

3,4, diaminopyridine

66
Q

treatment of myasthenia graves

A

pyridostigmine
IV Ig
thymectomy

67
Q

diagnosis of myasthenia graves

A

nerve conduction with repetitive stimulation

68
Q

what drug should be avoided in myasthenia graves

A

gentamicin

69
Q

marker of polymyositis and treatment

A

increased CK and steroids

70
Q

what drugs can cause myopathies

A

statins, amiodarone, diuretics and steroids

71
Q

what spills from muscle into plasma in rhabdomyolysis

A

potassium , PO4, myoglobin

72
Q

describe transiten global amnesia

A

abrupt onset anterograde >retrograde amnesia
repetition
transit 4-6 hours
generally a one off

73
Q

describe sporadic CJD

A

rapid onset dementia , neurological signs and myoclonus

74
Q

prognosis for sporadic CJD

A

4 months

75
Q

what atypical kind of Alzheimers did Terry prachett have

A

posterior cortical atrophy

76
Q

symptoms of posterior cortical atrophy

A

visuospatial disturbances, visual agnosia

77
Q

what type of Alzheimers results in loss of language first

A

primary progressive aphasia

neuro (13 decks)

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